See attached document [redacted] BROADWAY - KANSAS CITY, MO (800) Mailing Address: P.OBOX - KANSAS CITY, MO 64141-8131November 9, [redacted] ***Marketplace Resource ConsultantThe Revdex.com of CincinnatiE4th Street, Suite 600Cincinnati, OH Via Facslmille: 513.621.0907Re: ID: [redacted] Dear [redacted] ***:Your October 22, setter to EyeMed Vision Care, LLC was forwarded to me for review and response on November 4, Thank you for allowing additional time to respond to the complaint [redacted] submitted a complaint associated with her vision insurance benefits through EyeMed Vision Care, LLCThe insured's eye care plan is employer-sponsored vision coverageThis policy is underwritten by [redacted] ("***") and certain administrative services are provided by Eyes/led Vision Care, LLC ("EyeMed")[redacted] asserts the contact lenses she ordered on September 22, were incorrectly filled and they had to be exchanged for the correct prescription [redacted] asserts she was unable to reorder the correct lenses using her vision benefits under this Policy, because a representative of EyeMed informed her she had already used the contact lens benefit for the benefit period.According to the information provided by EyeMed, the insured received the incorrect disposable contact lenses and, after two phone calls With EyeMed's customer service on October 2, 2015, a return mail label was created and sent to herThe insured subsequently contacted Eye/Med's customer service on October 20, to follow up on the $copayment refund and the $policy benefit creditBoth the refund and credit were completed on October 21, 2015, and [redacted] is able to reorder the correct contact lenses utilizing her full contact lens benefit as outlined in the schedule.The information contained in this letter may contain information that is confidential and/or legally privilegedThe information is intended only for the use of the individual or entity named on this letterAny disclosure, copying, distribution or the taking of any action regarding the contents of this information is strictly prohibited.We trust this satisfactorily addresses the issues presented by [redacted] If you have other concerns or questions, please feel free to contact our office.Paul Mandry Senior Technical Analyst Technical Claims UnitCc: EyeMed [redacted] ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Nothing they said is trueI never received a response from them and I always check my junk mail. This complaint needs to stay in their file so others can see how unorganized and deceitful this company is
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me Because I received the checks on May 8th 2017, and one was issued on April and the other on April 28.Thank you so much for the help
Regards,
*** **
Good morning *** ***. EyeMed has listened to the call that *** *** states she was told she by the call center that she would be allowed a new appeal window and that is not the caseThe member is not entitled to any further review. The appeal process allows days from the date of EyeMed’s determination if a member disagrees. *** *** did not appeal within that time frame and is not entitled to an extended appeal period. We consider the case closed. Thank you! Amy *S*** | Corporate Legal |Eye Care and Regulatory Affairs |Senior Paralegal
Hello Per our contractual obligations, the members complaint will be forwarded for to the insurance underwriter for resolution, The member resolution will come from ***. Thank you Nakia D***Quality Assurance Specialist***[email protected]
See attached document03/17/::PM - PAGE OF 3 ATTN : FROM : *** ***DATE : March 7, 2017SUBJECT: FW: REF *** CASE ID ***JOB: 7319ATTACH: "Letters 1.docx." This Fax originated From a Biscom 'Fax.com'MEMO: . From: *** ***Sent: Tuesday, March 07, 12:PMTo: *** *** (Business Fax) _'Subject: REF# *** CASE ID ***03/17/1:11:26PM - PAGE OF 3EyeMedVisionQuality AssuranceLuxottica PLaceMason, OH [email protected] Resolution*** ***MARKETPLACE RESOURCE CONSULTANTRE: *** ***E4TH ST.CINCINNATI, OH 45202March 17, Reference ID: ***Thank you for your request received March 7, Your feedback is always important, and we've looked into your request regarding the member complaint you receivedHere's what we've determined:Case DetailsMember Name*** ***Plan Name: STATE VISION PLANClaim Number: ***Date(s) of Service2/4/2017Findings: When visiting an out-of-network provider, members are responsible for payment of services and/or materials at the time of serviceEyeMed will reimburse members for authorized services according to their plan designThe member's vision plan offers a $in network declining balance allowance for contact lenses purchased from an in-network providerThere is a $out of network declining balance for contact lenses purchased from an out of network providerAfter reviewing all submitted documentation we've confirmed the member's out of network claim processed correctly according to his plan designThe member can contact EyeMed customer service if they have further questions regarding their benefit coverage.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at 888.338.5514.If you have any questions, call us at (or TDD at 866.3085375), or visit www.eyemed.com.03/17/ 1:11:PM-PM PAGE OF 3Sincerely,*** ***Quality Assurance Specialist
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
*** *** See attached document.*** *** with the Revdex.comE.4th St, Suite 600Cincinnati, OH 45202 *** *** * *** ** ***
*** *** ** ***
***
1-10-18 Dear *** ***,Thank you for your reply regarding my complaintThere are many inaccuracies in the response fromEYEMEDI can prove my position with my notes, fax'sE-mails, etcI am providing my paper trail whichshows how this company has basically tried to ignore me, hoping that I will give up and go away. I am including an Index/Summary page that corresponds to the collateral I am faxing youI havespent months being blown off by EYEMEDJoni W*** is the ONLY one who has even tried to help me.Most of the time when I called to speak to Joni, I was told they did not know who she wasAlthoughJoni has at least tried, she has also fallen short of any resolution. I appreciate your assistance with this matterI fee at least that I am being heard nowUp until now I have just been spinning my wheels, as they continue to pass the buck and ignore me. I feel like I have been BEYOND diligent, trying to get to a resolutionOn the other hand I feel likeEYEMED could care lessthey don't even bother to respond to my letters, calls and faxesI have never seen anything like it. I have jumped through every hoop Joni W*** asked me to and nothing has been accomplishedThe time and energy I have spent, far exceeds the $value at this pointI just can't stand it when bigcorporations have such disregard for their clients. Please reply via e-mail- *** I look forward to your reply. Thanks again you for your time and consideration. Sincerely,*** ***
We apologize for the inconvenience of your issue. We are currently working on your issue and will respond to you. Thank you.09/22/*** *** ** *** *** ***
*** *** *** *** ***
*** *** * *** *** ** *** * *** *** *** *** *** *** *** *** *** ** ***September 22, 2015*** *** Marketplace Resource Consultant The Revdex.com of CincinnatiWest 7th Street, #Cincinnati, OH Via Facsimile: 513.621.0907Re: ID: ***Dear *** ***:Your recent letter to Eyes/sed Vision Care, LLC was forwarded to me for review and response, *** *** submitted a complaint associated with her vision insurance benefits through EyeMed Vision Care, LLCThe insured's eye care plan is employer-sponsored vision coverageThis policy is underwritten by *** *** *** *** *** (***) and certain administrative services are provided by Eyes Med Vision Care, LLC (EyeMed).The following Policy provision and Limitation apply through August 31, 2015:BENEFITS Vision MaterialsIf a Vision Examination results in an Insured Person needing Corrective Vision Materials for the Insure Parson's visual health and welfare, those Vision Materials prescribed by the Provider will be supplied, subject to certain limitations and exclusions of the Policy, as follows:Lenses provided one time in each Benefit Frequency.Frames provided one time in each Benefit FrequencyContact Lenses provided one time in each Benefit Frequency in lieu of lenses.(emphasis added)L?????????S (In part) Benefit allowances provide no remaining balance for future use Within the same Benefit Frequency.*** *** asserts she is eligible for a "total allowance of $150.00" which an insured is not required to use at one timeAs outlined in the above limitation, this was incorrect at the time of *** ***'s June 13, contact lens purchase and the June 17, eyeglass lens purchaseIf an insured does not use the entire benefit at one point of service, no remaining balance is available during the same benefit periodHowever, for purchases on or after September 1, 2015, *** ***'s plan does allow an insured to apportion the $benefit.*** *** states she mailed a claim for her June 13, contact lenses purchase for processing, which was received on June 25, On June 17, 2015, *** *** subsequently purchased one replacement eyeglass lensBecause *** *** purchased the replacement eyeglass lens through an in-network provider, the billing was electronically submitted and it was received by EyeMed prior to receiving the paper claim for the contact lensesAs noted above, contact senses are provided in lieu of eyeglass lenses during a benefit periodConsequently, the eyeglass lens claim was processed and the contactlens claim was denied due to the above benefit restriction.In light of the dates of service on which the respective lenses were purchased, *** has instructed EyeMed Vision Care, LLC to reprocess the claims and approve the contact lens claim but deny the replacement eyeglass lens claimAs a result, *** *** will receive the $difference between the two benefits, which when combined with the $20,benefit she has already received, will total the $annual maximum benefit for contact lensesAn Explanation of Benefits (ECB) will be sentunder separate cover.If you have other concerns or questions, please feel free to contact our office.*** *** Senior Technical Analyst Technical Claims Unitcc: EyeMed
You will be receiveing a response from [redacted] if you haven't already.The insured's eye care plan is employer-sponsored vision coverage.
This policy is underwritten by [redacted]
and certain administrative services are provided by EyeMed Vision Care,...
LLC
(EyeMed).[redacted] asserts he paid [redacted], the provider, $85.00 for an
anti-reflective coating for eyeglass lenses, and the coating was not applied.
Vision care benefits are limited to the Schedule of Benefits, Subject to the
terms and conditions of the policy, Anti-reflective coatings are not covered
under [redacted]'s vision care plan. The issue regarding anti-reflective
coating options and the associated charges appears to involve the provider,
[redacted] and the insured.It is our understanding that, EyesMed Vision Care, LLC has
attempted to contact the provider for an explanation. To date, [redacted] has not
responded.In Summary, [redacted]'s assertion that he paid for an
anti-reflective coating for his senses, but did not receive it, should be
directed to [redacted].He can contact EyeMed to receive [redacted]'s contact
information, or the contact information should be on his receipt. EyeMed will
not be able to help with this since they contacted [redacted] and [redacted] has not
responded.
eye Med 513-765-6326 direct dial 513-492-6326 facsimile al[redacted]@luxotticaretail.com January 11, 2018VIA E-MAIL [redacted]@cincinnati.Revdex.com.org Revdex.com Attn: [redacted] 1 E. 4th, Suite 600 Cincinnati, OH 45202RE: Member: [redacted] Date(s) of Service: 5/25/2017 Complaint Request: Member requesting additional reimbursement of $142.00 Revdex.com ID: [redacted]Dear [redacted]:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated December 27, 2017 regarding the above- referenced matter.Our records indicate we responded to the member’s request on July 27, 2017 and informed that her claim paid correctly according to her vision plans out-of-network reimbursement schedule. [redacted]’s call was reviewed and no misinformation was provided. The member inquired if out-of-network benefits were available and she was informed they were. There were no questions regarding reimbursement amounts. Per the resolution letter, the member had 30 days to appeal the determination. We received the member’s appeal on October 10, 2017 which was after the appeal period. No further review was provided. The member’s claim paid correctly according to the plan benefit. I am enclosing a copy of the plan benefit for her records. No additional reimbursement is available.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy *. S[redacted] Senior Paralegal Corporate Legal DepartmentEnclosure 4000 Luxottica Place, Mason, OH 45040
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it. If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply. Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
However, the check was never sent the first time and then returned because Eye Med had no record of where the check went all 5 times they were contacted by me. I was told they had to run 2 check traces to find out if the check had been cashed by someone else. If the check had been returned to them unable to be delivered they would have been able to see that in their records. At least we finally received our check. Thank you for your time.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
The response is not a resolution, merely an agreement to submit yet another claim in an attempt to correctly reimburse me for charges that the letter itself admits were valid. The response will be acceptable to me once they have issued and mailed me a check with the correct amount, not merely a promise to restart a claim process that may or may not lead to such a check.
Regards,
[redacted]
Hello This member is contracted under a plan with [redacted]. Per the contractual agreement the member's complaint has been forwarding for processing. A response does not come from EyeMed. As with the complaint received on September 8, 2015, this information will be forwarded to [redacted] for member review and resolution. Thank you Nakia D[redacted]EyeMed Quality Assurance Specialist
October 4, 2016 Reference [redacted]Thank you for your request received October 4, 2016. We've looked into the member's request for coverage of the contact lenses purchased with an out of network provider. Here's what we've determined:Case Details[redacted]...
[redacted]
[redacted] Inquiry Request: Member is requesting reimbursement for the services received with an out of network provider.Findings: According to our records, the members plan was not active on the date the services were received rendering the member ineligible for reimbursement for the services received on July 14, 2016. If the member feels that coverage should be available for the date of service the member will need to speak with the Benefits Administrator through the employer. Once the eligibility has been received from the Benefits Administrator, the member can resubmit the out of network claim and itemized receipt for processing.You may receive, upon request, access to and copies of documents, records and other information relevant to your Complaint.Language Services: We provide no-cost language services, such as an interpreter. Or you can have documents read to you and some sent to you in your language. For help, call us at [redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the company has not resolved the issue. I'm waiting for follow up, per their message.
Regards,
[redacted]
HelloPer EyeMed's contract with [redacted], the members complaint has been forwarded for resolution. Thank you Nakia BlairEyeMed Quality Assurance Specialist
See attached document EYE MED [redacted] direct dial 513-492-6326 facsimile a[redacted]@luxotticaretail.comJanuary 11, 2018VIA E-MAIL...
[redacted]@cincinnati.Revdex.com.orgRevdex.com Attn: [redacted] 1 E. 4th, Suite 600 Cincinnati, OH 45202RE: Member: [redacted] Date(s) of Service: 7/31/2017 Complaint Request: Member requesting payment for claim services Revdex.com ID: [redacted]Dear [redacted]:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated December 20, 2017 regarding the above- referenced matter. We apologize for the delay in responding to the complaint.Our records indicate Disbursement ID [redacted] for $160.00 posted on September 1, 2017. Payment was mailed to [redacted]. Payment was returned to our office although the address has been confirmed as correct. We sent payment via [redacted] 2 day mail with tracking to confirm receipt. The check was received by the member and cashed on January 8, 2018. Therefore, this matter appears to be settled.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy ** S[redacted] Senior Paralegal Corporate Legal Department 4000 Luxottica Place, Mason, OH 45040
See attached document [redacted] BROADWAY - KANSAS CITY, MO (800) Mailing Address: P.OBOX - KANSAS CITY, MO 64141-8131November 9, [redacted] ***Marketplace Resource ConsultantThe Revdex.com of CincinnatiE4th Street, Suite 600Cincinnati, OH Via Facslmille: 513.621.0907Re: ID: [redacted] Dear [redacted] ***:Your October 22, setter to EyeMed Vision Care, LLC was forwarded to me for review and response on November 4, Thank you for allowing additional time to respond to the complaint [redacted] submitted a complaint associated with her vision insurance benefits through EyeMed Vision Care, LLCThe insured's eye care plan is employer-sponsored vision coverageThis policy is underwritten by [redacted] ("***") and certain administrative services are provided by Eyes/led Vision Care, LLC ("EyeMed")[redacted] asserts the contact lenses she ordered on September 22, were incorrectly filled and they had to be exchanged for the correct prescription [redacted] asserts she was unable to reorder the correct lenses using her vision benefits under this Policy, because a representative of EyeMed informed her she had already used the contact lens benefit for the benefit period.According to the information provided by EyeMed, the insured received the incorrect disposable contact lenses and, after two phone calls With EyeMed's customer service on October 2, 2015, a return mail label was created and sent to herThe insured subsequently contacted Eye/Med's customer service on October 20, to follow up on the $copayment refund and the $policy benefit creditBoth the refund and credit were completed on October 21, 2015, and [redacted] is able to reorder the correct contact lenses utilizing her full contact lens benefit as outlined in the schedule.The information contained in this letter may contain information that is confidential and/or legally privilegedThe information is intended only for the use of the individual or entity named on this letterAny disclosure, copying, distribution or the taking of any action regarding the contents of this information is strictly prohibited.We trust this satisfactorily addresses the issues presented by [redacted] If you have other concerns or questions, please feel free to contact our office.Paul Mandry Senior Technical Analyst Technical Claims UnitCc: EyeMed [redacted] ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Nothing they said is trueI never received a response from them and I always check my junk mail. This complaint needs to stay in their file so others can see how unorganized and deceitful this company is
Regards,
*** ***
Hi ***, The claim was reprocessed under claim # ***. Claim paid member and additional $25, please see disbursement below… Member DisbursementsClaim Amount$26.00Disbursement ID***Check Account***Check Date02/10/2017Service UPN Disbursement Amount$26.00Void ReasonPayee***
***Disbursement Address*** *** ***
***
**
***Disbursed ServicesService IDSubmitted AmountDisbursed Amount*** *$0.00$
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me Because I received the checks on May 8th 2017, and one was issued on April and the other on April 28.Thank you so much for the help
Regards,
*** **
Good morning *** ***. EyeMed has listened to the call that *** *** states she was told she by the call center that she would be allowed a new appeal window and that is not the caseThe member is not entitled to any further review. The appeal process allows days from the date of EyeMed’s determination if a member disagrees. *** *** did not appeal within that time frame and is not entitled to an extended appeal period. We consider the case closed. Thank you! Amy *S*** | Corporate Legal |Eye Care and Regulatory Affairs |Senior Paralegal
The member is in our system with an active plan
Hello Per our contractual obligations, the members complaint will be forwarded for to the insurance underwriter for resolution, The member resolution will come from ***. Thank you Nakia D***Quality Assurance Specialist***[email protected]
See attached document03/17/::PM - PAGE OF 3 ATTN : FROM : *** ***DATE : March 7, 2017SUBJECT: FW: REF *** CASE ID ***JOB: 7319ATTACH: "Letters 1.docx." This Fax originated From a Biscom 'Fax.com'MEMO: . From: *** ***Sent: Tuesday, March 07, 12:PMTo: *** *** (Business Fax) _'Subject: REF# *** CASE ID ***03/17/1:11:26PM - PAGE OF 3EyeMedVisionQuality AssuranceLuxottica PLaceMason, OH [email protected] Resolution*** ***MARKETPLACE RESOURCE CONSULTANTRE: *** ***E4TH ST.CINCINNATI, OH 45202March 17, Reference ID: ***Thank you for your request received March 7, Your feedback is always important, and we've looked into your request regarding the member complaint you receivedHere's what we've determined:Case DetailsMember Name*** ***Plan Name: STATE VISION PLANClaim Number: ***Date(s) of Service2/4/2017Findings: When visiting an out-of-network provider, members are responsible for payment of services and/or materials at the time of serviceEyeMed will reimburse members for authorized services according to their plan designThe member's vision plan offers a $in network declining balance allowance for contact lenses purchased from an in-network providerThere is a $out of network declining balance for contact lenses purchased from an out of network providerAfter reviewing all submitted documentation we've confirmed the member's out of network claim processed correctly according to his plan designThe member can contact EyeMed customer service if they have further questions regarding their benefit coverage.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at 888.338.5514.If you have any questions, call us at (or TDD at 866.3085375), or visit www.eyemed.com.03/17/ 1:11:PM-PM PAGE OF 3Sincerely,*** ***Quality Assurance Specialist
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
*** *** See attached document.*** *** with the Revdex.comE.4th St, Suite 600Cincinnati, OH 45202 *** *** * *** ** ***
*** *** ** ***
***
1-10-18 Dear *** ***,Thank you for your reply regarding my complaintThere are many inaccuracies in the response fromEYEMEDI can prove my position with my notes, fax'sE-mails, etcI am providing my paper trail whichshows how this company has basically tried to ignore me, hoping that I will give up and go away. I am including an Index/Summary page that corresponds to the collateral I am faxing youI havespent months being blown off by EYEMEDJoni W*** is the ONLY one who has even tried to help me.Most of the time when I called to speak to Joni, I was told they did not know who she wasAlthoughJoni has at least tried, she has also fallen short of any resolution. I appreciate your assistance with this matterI fee at least that I am being heard nowUp until now I have just been spinning my wheels, as they continue to pass the buck and ignore me. I feel like I have been BEYOND diligent, trying to get to a resolutionOn the other hand I feel likeEYEMED could care lessthey don't even bother to respond to my letters, calls and faxesI have never seen anything like it. I have jumped through every hoop Joni W*** asked me to and nothing has been accomplishedThe time and energy I have spent, far exceeds the $value at this pointI just can't stand it when bigcorporations have such disregard for their clients. Please reply via e-mail- *** I look forward to your reply. Thanks again you for your time and consideration. Sincerely,*** ***
We apologize for the inconvenience of your issue. We are currently working on your issue and will respond to you. Thank you.09/22/*** *** ** *** *** ***
*** *** *** *** ***
*** *** * *** *** ** *** * *** *** *** *** *** *** *** *** *** ** ***September 22, 2015*** *** Marketplace Resource Consultant The Revdex.com of CincinnatiWest 7th Street, #Cincinnati, OH Via Facsimile: 513.621.0907Re: ID: ***Dear *** ***:Your recent letter to Eyes/sed Vision Care, LLC was forwarded to me for review and response, *** *** submitted a complaint associated with her vision insurance benefits through EyeMed Vision Care, LLCThe insured's eye care plan is employer-sponsored vision coverageThis policy is underwritten by *** *** *** *** *** (***) and certain administrative services are provided by Eyes Med Vision Care, LLC (EyeMed).The following Policy provision and Limitation apply through August 31, 2015:BENEFITS Vision MaterialsIf a Vision Examination results in an Insured Person needing Corrective Vision Materials for the Insure Parson's visual health and welfare, those Vision Materials prescribed by the Provider will be supplied, subject to certain limitations and exclusions of the Policy, as follows:Lenses provided one time in each Benefit Frequency.Frames provided one time in each Benefit FrequencyContact Lenses provided one time in each Benefit Frequency in lieu of lenses.(emphasis added)L?????????S (In part) Benefit allowances provide no remaining balance for future use Within the same Benefit Frequency.*** *** asserts she is eligible for a "total allowance of $150.00" which an insured is not required to use at one timeAs outlined in the above limitation, this was incorrect at the time of *** ***'s June 13, contact lens purchase and the June 17, eyeglass lens purchaseIf an insured does not use the entire benefit at one point of service, no remaining balance is available during the same benefit periodHowever, for purchases on or after September 1, 2015, *** ***'s plan does allow an insured to apportion the $benefit.*** *** states she mailed a claim for her June 13, contact lenses purchase for processing, which was received on June 25, On June 17, 2015, *** *** subsequently purchased one replacement eyeglass lensBecause *** *** purchased the replacement eyeglass lens through an in-network provider, the billing was electronically submitted and it was received by EyeMed prior to receiving the paper claim for the contact lensesAs noted above, contact senses are provided in lieu of eyeglass lenses during a benefit periodConsequently, the eyeglass lens claim was processed and the contactlens claim was denied due to the above benefit restriction.In light of the dates of service on which the respective lenses were purchased, *** has instructed EyeMed Vision Care, LLC to reprocess the claims and approve the contact lens claim but deny the replacement eyeglass lens claimAs a result, *** *** will receive the $difference between the two benefits, which when combined with the $20,benefit she has already received, will total the $annual maximum benefit for contact lensesAn Explanation of Benefits (ECB) will be sentunder separate cover.If you have other concerns or questions, please feel free to contact our office.*** *** Senior Technical Analyst Technical Claims Unitcc: EyeMed
I have voiced.my concern with eye med only having one in network contact provider.
You will be receiveing a response from [redacted] if you haven't already.The insured's eye care plan is employer-sponsored vision coverage.
This policy is underwritten by [redacted]
and certain administrative services are provided by EyeMed Vision Care,...
LLC
(EyeMed).[redacted] asserts he paid [redacted], the provider, $85.00 for an
anti-reflective coating for eyeglass lenses, and the coating was not applied.
Vision care benefits are limited to the Schedule of Benefits, Subject to the
terms and conditions of the policy, Anti-reflective coatings are not covered
under [redacted]'s vision care plan. The issue regarding anti-reflective
coating options and the associated charges appears to involve the provider,
[redacted] and the insured.It is our understanding that, EyesMed Vision Care, LLC has
attempted to contact the provider for an explanation. To date, [redacted] has not
responded.In Summary, [redacted]'s assertion that he paid for an
anti-reflective coating for his senses, but did not receive it, should be
directed to [redacted].He can contact EyeMed to receive [redacted]'s contact
information, or the contact information should be on his receipt. EyeMed will
not be able to help with this since they contacted [redacted] and [redacted] has not
responded.
eye Med 513-765-6326 direct dial 513-492-6326 facsimile al[redacted]@luxotticaretail.com January 11, 2018VIA E-MAIL [redacted]@cincinnati.Revdex.com.org Revdex.com Attn: [redacted] 1 E. 4th, Suite 600 Cincinnati, OH 45202RE: Member: [redacted] Date(s) of Service: 5/25/2017 Complaint Request: Member requesting additional reimbursement of $142.00 Revdex.com ID: [redacted]Dear [redacted]:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated December 27, 2017 regarding the above- referenced matter.Our records indicate we responded to the member’s request on July 27, 2017 and informed that her claim paid correctly according to her vision plans out-of-network reimbursement schedule. [redacted]’s call was reviewed and no misinformation was provided. The member inquired if out-of-network benefits were available and she was informed they were. There were no questions regarding reimbursement amounts. Per the resolution letter, the member had 30 days to appeal the determination. We received the member’s appeal on October 10, 2017 which was after the appeal period. No further review was provided. The member’s claim paid correctly according to the plan benefit. I am enclosing a copy of the plan benefit for her records. No additional reimbursement is available.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy *. S[redacted] Senior Paralegal Corporate Legal DepartmentEnclosure 4000 Luxottica Place, Mason, OH 45040
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it. If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply. Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
However, the check was never sent the first time and then returned because Eye Med had no record of where the check went all 5 times they were contacted by me. I was told they had to run 2 check traces to find out if the check had been cashed by someone else. If the check had been returned to them unable to be delivered they would have been able to see that in their records. At least we finally received our check. Thank you for your time.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
The response is not a resolution, merely an agreement to submit yet another claim in an attempt to correctly reimburse me for charges that the letter itself admits were valid. The response will be acceptable to me once they have issued and mailed me a check with the correct amount, not merely a promise to restart a claim process that may or may not lead to such a check.
Regards,
[redacted]
Hello This member is contracted under a plan with [redacted]. Per the contractual agreement the member's complaint has been forwarding for processing. A response does not come from EyeMed. As with the complaint received on September 8, 2015, this information will be forwarded to [redacted] for member review and resolution. Thank you Nakia D[redacted]EyeMed Quality Assurance Specialist
October 4, 2016 Reference [redacted]Thank you for your request received October 4, 2016. We've looked into the member's request for coverage of the contact lenses purchased with an out of network provider. Here's what we've determined:Case Details[redacted]...
[redacted]
[redacted] Inquiry Request: Member is requesting reimbursement for the services received with an out of network provider.Findings: According to our records, the members plan was not active on the date the services were received rendering the member ineligible for reimbursement for the services received on July 14, 2016. If the member feels that coverage should be available for the date of service the member will need to speak with the Benefits Administrator through the employer. Once the eligibility has been received from the Benefits Administrator, the member can resubmit the out of network claim and itemized receipt for processing.You may receive, upon request, access to and copies of documents, records and other information relevant to your Complaint.Language Services: We provide no-cost language services, such as an interpreter. Or you can have documents read to you and some sent to you in your language. For help, call us at [redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the company has not resolved the issue. I'm waiting for follow up, per their message.
Regards,
[redacted]
HelloPer EyeMed's contract with [redacted], the members complaint has been forwarded for resolution. Thank you Nakia BlairEyeMed Quality Assurance Specialist
See attached document EYE MED [redacted] direct dial 513-492-6326 facsimile a[redacted]@luxotticaretail.comJanuary 11, 2018VIA E-MAIL...
[redacted]@cincinnati.Revdex.com.orgRevdex.com Attn: [redacted] 1 E. 4th, Suite 600 Cincinnati, OH 45202RE: Member: [redacted] Date(s) of Service: 7/31/2017 Complaint Request: Member requesting payment for claim services Revdex.com ID: [redacted]Dear [redacted]:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated December 20, 2017 regarding the above- referenced matter. We apologize for the delay in responding to the complaint.Our records indicate Disbursement ID [redacted] for $160.00 posted on September 1, 2017. Payment was mailed to [redacted]. Payment was returned to our office although the address has been confirmed as correct. We sent payment via [redacted] 2 day mail with tracking to confirm receipt. The check was received by the member and cashed on January 8, 2018. Therefore, this matter appears to be settled.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy ** S[redacted] Senior Paralegal Corporate Legal Department 4000 Luxottica Place, Mason, OH 45040