Findings: The original claim form received from Dr. [redacted] office denied
due to missing/incomplete/invalid HCPCs/CPTs. Only routine vision services are
covered under the members plan. The denial was issued on July 27, 2015 and sent
to the member's address on file as well as the provider's...
location. Our
providers have 180 days from the service date to submit a claim or file
corrected claims. Some plans have shorter filing periods. We recommend our
provider's check the plan's claim filing period when they confirm benefits and
eligibility. All member requests for review must be submitted within 180 days
of the date of the explanation of benefits. Our records show our EyeMed
customer service time forwarded the members claim for processing beyond timely
filing limits as a one-time exception. The claim is now processed and payment
was issued to the member's provider on April 25, 2016. The member was advised
of the resolution via email on April 22, 2016.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].If you have any questions, call us at [redacted]Sincerely,[redacted]Quality Assurance Specialist
Your April 11, 2016 letter to EyeMed Vision Care, LLC was
forwarded to me on April 26, 2016 for review and response. [redacted]
submitted a complaint associated with his vision insurance benefits through
EyeMed Vision Care, LLC. 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).Mr. [redacted] purchased prescription eyeglasses on January 9, 2016
for his son, [redacted], and submitted a claim to EyeMed Vision Services. He
asserts that the claim was incorrectly processed. An annual out-of-network
$28.00 polycarbonate lens benefit is available for insureds under age 19.
EyeMed Vision Care, LLC indicates they were unable to fully process the lens
portion of the claim because the lens charges were not itemized by the
provider. However, EyeMed Vision Care, LLC obtained clarification from the
provider and, upon review, [redacted] instructed EyeMed Vision Care, LLC to issue the
remaining balance of the annual $28.00 lens benefit at this time. Therefore,
Mr. [redacted] will receive an updated Explanation of Benefits shortly, thereby
fully settling this matter.This letter and the accompanying documents may contain information which
is confidential and/or legally privileged. The information is intended only for
the use of the individual or entity named on this letter. Any disclosure, copying,
distribution or the taking of any action
regarding the contents of this information is strictly prohibited.[redacted]Senior Technical AnalystTechnical Claims Unit
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.
It is the same thing I have been saying all along and is 100% supported by my notes and faxes, along with my supporting documents. THIER rep is the one that promised to adjust the appeal window, since I never received the rejection letter. She reiterated this promise multiple times, noted in the timeline. I would not have wasted MONTHS worth of my time, if not directed by Joni W[redacted], from EYEMED. I am so over this nightmare!!!! It is clear that EYEMED has no intentions of doing what they said they would do. I request that my complaint remain unresolved, as they have stated they consider my case closed, even though though they did not follow-through with their promise. It is clear why on [redacted] and [redacted], they have horrendous customer service reviews. They make it impossible to speak to an agent and when they do respond, it is via a scripted letter, that has little to nothing to do with the situation at hand. I do appreciate your efforts and I have always had success with Revdex.com assistance in the past. I am forwarding my case to the Ohio Department of Insurance. This is no longer even about the $142.00 I feel entitled to. It is ALL about this company having ZERO accountability!!!! They need to revamp their customer service department. As it stands today there is NO customer service available. I couldn't even get them to respond to me most of the time. Many times the person answering the phone had no idea who Joni W[redacted] even was. It is crazy to me that they get away with their tactics.
Regards,
[redacted]
The member's appeal will be forwarded to the EyeMed Legal Department for review with the plan uderwriter. The resolution will be issued from either the Legal Department or the plan underwriter. Thank youEyeMed Quality AssuranceF: [email protected]
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and I will accept the business response after I receive the $130.00 difference.
Regards,
[redacted]
O3/06 2017 8: 42 : 52 AM - O500 PAGE 1. OF 3ATTN : [redacted]FROM : [redacted]DATE : March 06, 2017 SUBJECT :REF# ID [redacted]JOB: [redacted] ATTACH: “Letter S 1 ( 4 ) .docx.” This Fax originated From a Bis com o...
Fax.com" . MEMO: .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O3/062017 8: 42 : 52 AM - O500 PAGE OF 2 OF 3EyeMedVision eyeQuality Assurance Med4000 Luxottica PlaceMason, OH 45040Fax513.492.3259Email [email protected] Resolution[redacted] MARKETPLACE RESOURCE CONSULTANT RE: [redacted]1 E.4TH, SUITE 600CINCINNATI, OH 452O2March 6, 2017 Reference ID: [redacted]Thank you for your request received February 28, 2017. Your feedback is always important, and we've looked into your request regarding the member complaint you received. Here's what we've determined:Case DetailsMember Name: [redacted] Plan Name: SRS VISION PLAN Date(s) of Service: 9/30/2016Findings: When visiting an out-of-network provider members are responsible for payment of services and/or materials at the time of service, EyeMed will reimburse the member for authorized services according to their plan design. EyeMed will only accept itemized paid receipts that indicate the services provided and the amount charged for each service. The services must be paid in full in order to receive benefits. Handwritten receipts must be on the provider's letterhead. The EyeMed frame and lens benefit cannot be used for non-prescription sunglasses. Members cannot apply their frame benefit toward the purchase of a non-rx sunglass frame. After reviewing all submitted documentation including the member's out of network claim we've determined the member did not receive reimbursement for the original claim submitted because the frame purchase per the receipt submitted appears to have been sun wear with non-rxlenses which is not covered under the member's plan. The member has resubmitted another claim for progressive lenses since the original claim denial. The member will be reimbursed for progressive lenses due to the member providing a receipt for progressive prescription lenses however the denial still stands for the frame since the receipt indicates the member purchased sun wear with non-rx lenses.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 888.338.5514.If you have any questions, call us at 866.939.3633 (or TDD at 866.308.5375), or visit www.eyemed.com. O3/06/2017 8: 42 : 52 AM - 0500 PAGE 3 OF 3Sincerely,[redacted] Quality Assurance Specialist
[redacted] We have received the attached member complaint. Claim # [redacted] was received on 1/24/2017 and processed on 1/25/2017 and paid. A check was issued yesterday, 1/25/16, member should receive within 10-15 business days. Member DisbursementsClaim...
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.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]
See attached documentEyeMed Vision CareQuality Assurance4000 Luxiottica PlaceMason, OH 45040Fax [email protected] Resolution[redacted]March 28, 2016 Reference ID: [redacted]Thank you for your...
request received March 28, 2016. Your feedback is always important, and we’ve looked into the member’s request for reimbursement of the out of network contact lens services. Here’s what we’ve determined:Case DetailsMember Name: [redacted]Plan Name: [redacted]Provider: [redacted]Inquiry Request: Member is requesting reimbursement for out of network contact lens services.Findings: According to the member’s benefits, the member is eligible to receive up to $105 for contact lenses purchase with an out of network provider. The $105 is a declining balance does not have to be used at one time but exhausted prior to the end of the calendar year in order for the member to not lose their allowance. The allowance is reinstated on the first of January every year.The claim submitted for the December 27, 2015 service date was initially processed to reimburse the member $42.55 due to a system issue. The claim has since reprocessed reimbursing the member an additional $62.45 on March 17, 2016 maximizing the members out of network contact lens allowance of $105.The claim for the January 20, 105 service date was submitted with a retail amount of $104.90. Due to a processing error both receipts were not applied and the member was reimbursed $62.45. The member’s claim will be forwarded for reprocessing to reimbruse the member an additional $45.45. The payment for the reprocessed claim can be expected in 10-15 business days.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 888.338.5514. If you have any questions, call us at 866.939.3633 (or TDD at 866.308.5375), or visit www.eyemed.com.Sincerely,Nakia D[redacted]Quality Assurance Specialist
[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.
Regards,
[redacted]
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.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this service provider tries to find any excuse, and does not recognize their mishandling the complaint. My complaint even didn't mention my wife, however, the reference number I provided does link to my wife's purchase.We did receive both reimbursements of myself and my wife's, because I called their complaint department. Regards,
[redacted]
[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 acco
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. They have finally remedied the situation after numerous phone calls and time spent. They still have poor customer service and I won't renew this insurance again.
Regards,
[redacted]
Good morning [redacted]. EyeMed has listened to the call that [redacted] states she was told she by the call center that she would be allowed a new appeal window and that is not the case. The member is not entitled to any further review. The appeal process allows 30 days from the date of EyeMed’s determination if a member disagrees. [redacted] 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[redacted] | Corporate Legal |Eye Care and Regulatory Affairs |Senior Paralegal
EyeMed Vision CareQuality Assurance4000 Luxottica PlaceMason, OH 45040Fax [email protected] Revdex.com ATTN: [redacted] 1 E 4TH SUITE 600 CINCINNATI OH 45202RE: ID [redacted]Date of Notice: January 5, 2018...
Reference ID: [redacted]Thanks for forwarding [redacted]’s complaint which we received December 27, 2017. [redacted] asked us to reconsider additional payment toward her claim for date of service May 25, 2017. Unfortunately we have decided to uphold our original decision.Case DetailsMember Name: [redacted] Plan Name: [redacted] Claim Number: [redacted]Provider: OUT-OF-NETWORK [redacted] Date s of Service: 5/25/2017 Type of Service: FRAME, LENS Complaint Request: Member requesting additional reimbursement of $142.00Findings: 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.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 866.939.3633.If you have any questions, call us at 866.939.3633 or TDD at 866.308.5375 , or visit www.eyemed.com.Sincerely, Felicia B[redacted] Quality Assurance Specialist
See attached documenteyeMed[redacted] direct dial 513-492-6326 facsimile a[redacted]@luxotticaretail.com January 31, 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: 1/10/18 Complaint...
Request: Member requesting reimbursement of $100.00 Revdex.com ID: [redacted]Dear [redacted]:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated January 24, 2018 regarding the above- referenced matter.In review of [redacted]’s account, EyeMed shows having received two email inquiries from [redacted] regarding claim status. A response to both inquiries was sent within less than 48 business hours to [redacted]. If he is not seeing those responses, he should check his junk and/or spam folders.EyeMed does not show having previously received a claim submission on [redacted]’s account in the last 6 months. However EyeMed is now in receipt of a claim submission sent directly to our Quality Assurance department received 01/29/2018 via email. As a one-time courtesy we have forwarded that claim documentation on his behalf to our Claims Department for processing. Please allow up to 30 days to process your claim entirely once received. Your claim will be processed in the order it is received. A check and/or explanation of benefits will be mailed within 7 calendar days of the date your claim is processed.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy E. S[redacted] Senior Paralegal Corporate Legal Department4000 Luxottica Place, Mason, OH 45040
Hi [redacted], We received the attached Revdex.com complaint.We have issued a check trace to determine if the check has been cashed, if it has I will send proof, if it has not, we will void and reissue the check to the below address… [redacted] I will forward you the...
results as soon as I have them, and I have asked for this to be expedited.Hi [redacted], The reissued check [redacted] has been cashed. I have attached a copy of the cashed check.
Findings: The original claim form received from Dr. [redacted] office denied
due to missing/incomplete/invalid HCPCs/CPTs. Only routine vision services are
covered under the members plan. The denial was issued on July 27, 2015 and sent
to the member's address on file as well as the provider's...
location. Our
providers have 180 days from the service date to submit a claim or file
corrected claims. Some plans have shorter filing periods. We recommend our
provider's check the plan's claim filing period when they confirm benefits and
eligibility. All member requests for review must be submitted within 180 days
of the date of the explanation of benefits. Our records show our EyeMed
customer service time forwarded the members claim for processing beyond timely
filing limits as a one-time exception. The claim is now processed and payment
was issued to the member's provider on April 25, 2016. The member was advised
of the resolution via email on April 22, 2016.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].If you have any questions, call us at [redacted]Sincerely,[redacted]Quality Assurance Specialist
Your April 11, 2016 letter to EyeMed Vision Care, LLC was
forwarded to me on April 26, 2016 for review and response. [redacted]
submitted a complaint associated with his vision insurance benefits through
EyeMed Vision Care, LLC. 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).Mr. [redacted] purchased prescription eyeglasses on January 9, 2016
for his son, [redacted], and submitted a claim to EyeMed Vision Services. He
asserts that the claim was incorrectly processed. An annual out-of-network
$28.00 polycarbonate lens benefit is available for insureds under age 19.
EyeMed Vision Care, LLC indicates they were unable to fully process the lens
portion of the claim because the lens charges were not itemized by the
provider. However, EyeMed Vision Care, LLC obtained clarification from the
provider and, upon review, [redacted] instructed EyeMed Vision Care, LLC to issue the
remaining balance of the annual $28.00 lens benefit at this time. Therefore,
Mr. [redacted] will receive an updated Explanation of Benefits shortly, thereby
fully settling this matter.This letter and the accompanying documents may contain information which
is confidential and/or legally privileged. The information is intended only for
the use of the individual or entity named on this letter. Any disclosure, copying,
distribution or the taking of any action
regarding the contents of this information is strictly prohibited.[redacted]Senior Technical AnalystTechnical Claims Unit
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.
It is the same thing I have been saying all along and is 100% supported by my notes and faxes, along with my supporting documents. THIER rep is the one that promised to adjust the appeal window, since I never received the rejection letter. She reiterated this promise multiple times, noted in the timeline. I would not have wasted MONTHS worth of my time, if not directed by Joni W[redacted], from EYEMED. I am so over this nightmare!!!! It is clear that EYEMED has no intentions of doing what they said they would do. I request that my complaint remain unresolved, as they have stated they consider my case closed, even though though they did not follow-through with their promise. It is clear why on [redacted] and [redacted], they have horrendous customer service reviews. They make it impossible to speak to an agent and when they do respond, it is via a scripted letter, that has little to nothing to do with the situation at hand. I do appreciate your efforts and I have always had success with Revdex.com assistance in the past. I am forwarding my case to the Ohio Department of Insurance. This is no longer even about the $142.00 I feel entitled to. It is ALL about this company having ZERO accountability!!!! They need to revamp their customer service department. As it stands today there is NO customer service available. I couldn't even get them to respond to me most of the time. Many times the person answering the phone had no idea who Joni W[redacted] even was. It is crazy to me that they get away with their tactics.
Regards,
[redacted]
The member's appeal will be forwarded to the EyeMed Legal Department for review with the plan uderwriter. The resolution will be issued from either the Legal Department or the plan underwriter. Thank youEyeMed Quality AssuranceF: [email protected]
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.
Regards,
[redacted]
We have received your complaint and have forwarded to [redacted] and they will respond.Thank you.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and I will accept the business response after I receive the $130.00 difference.
Regards,
[redacted]
O3/06 2017 8: 42 : 52 AM - O500 PAGE 1. OF 3ATTN : [redacted]FROM : [redacted]DATE : March 06, 2017 SUBJECT :REF# ID [redacted]JOB: [redacted] ATTACH: “Letter S 1 ( 4 ) .docx.” This Fax originated From a Bis com o...
Fax.com" . MEMO: .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O3/062017 8: 42 : 52 AM - O500 PAGE OF 2 OF 3EyeMedVision eyeQuality Assurance Med4000 Luxottica PlaceMason, OH 45040Fax513.492.3259Email [email protected] Resolution[redacted] MARKETPLACE RESOURCE CONSULTANT RE: [redacted]1 E.4TH, SUITE 600CINCINNATI, OH 452O2March 6, 2017 Reference ID: [redacted]Thank you for your request received February 28, 2017. Your feedback is always important, and we've looked into your request regarding the member complaint you received. Here's what we've determined:Case DetailsMember Name: [redacted] Plan Name: SRS VISION PLAN Date(s) of Service: 9/30/2016Findings: When visiting an out-of-network provider members are responsible for payment of services and/or materials at the time of service, EyeMed will reimburse the member for authorized services according to their plan design. EyeMed will only accept itemized paid receipts that indicate the services provided and the amount charged for each service. The services must be paid in full in order to receive benefits. Handwritten receipts must be on the provider's letterhead. The EyeMed frame and lens benefit cannot be used for non-prescription sunglasses. Members cannot apply their frame benefit toward the purchase of a non-rx sunglass frame. After reviewing all submitted documentation including the member's out of network claim we've determined the member did not receive reimbursement for the original claim submitted because the frame purchase per the receipt submitted appears to have been sun wear with non-rxlenses which is not covered under the member's plan. The member has resubmitted another claim for progressive lenses since the original claim denial. The member will be reimbursed for progressive lenses due to the member providing a receipt for progressive prescription lenses however the denial still stands for the frame since the receipt indicates the member purchased sun wear with non-rx lenses.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 888.338.5514.If you have any questions, call us at 866.939.3633 (or TDD at 866.308.5375), or visit www.eyemed.com. O3/06/2017 8: 42 : 52 AM - 0500 PAGE 3 OF 3Sincerely,[redacted] Quality Assurance Specialist
[redacted] We have received the attached member complaint. Claim # [redacted] was received on 1/24/2017 and processed on 1/25/2017 and paid. A check was issued yesterday, 1/25/16, member should receive within 10-15 business days. Member DisbursementsClaim...
Amount$200.00Disbursement ID[redacted]Check Amount$200.00Check Date01/25/2017Void ReasonPayee[redacted]Disbursement Address[redacted]
**
[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.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]
See attached documentEyeMed Vision CareQuality Assurance4000 Luxiottica PlaceMason, OH 45040Fax [email protected] Resolution[redacted]March 28, 2016 Reference ID: [redacted]Thank you for your...
request received March 28, 2016. Your feedback is always important, and we’ve looked into the member’s request for reimbursement of the out of network contact lens services. Here’s what we’ve determined:Case DetailsMember Name: [redacted]Plan Name: [redacted]Provider: [redacted]Inquiry Request: Member is requesting reimbursement for out of network contact lens services.Findings: According to the member’s benefits, the member is eligible to receive up to $105 for contact lenses purchase with an out of network provider. The $105 is a declining balance does not have to be used at one time but exhausted prior to the end of the calendar year in order for the member to not lose their allowance. The allowance is reinstated on the first of January every year.The claim submitted for the December 27, 2015 service date was initially processed to reimburse the member $42.55 due to a system issue. The claim has since reprocessed reimbursing the member an additional $62.45 on March 17, 2016 maximizing the members out of network contact lens allowance of $105.The claim for the January 20, 105 service date was submitted with a retail amount of $104.90. Due to a processing error both receipts were not applied and the member was reimbursed $62.45. The member’s claim will be forwarded for reprocessing to reimbruse the member an additional $45.45. The payment for the reprocessed claim can be expected in 10-15 business days.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 888.338.5514. If you have any questions, call us at 866.939.3633 (or TDD at 866.308.5375), or visit www.eyemed.com.Sincerely,Nakia D[redacted]Quality Assurance Specialist
We have recieved the members complaint and have forwarded onto [redacted], you will receive a response from [redacted].
[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.
Regards,
[redacted]
[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.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this service provider tries to find any excuse, and does not recognize their mishandling the complaint. My complaint even didn't mention my wife, however, the reference number I provided does link to my wife's purchase.We did receive both reimbursements of myself and my wife's, because I called their complaint department. Regards,
[redacted]
[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 acco
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. They have finally remedied the situation after numerous phone calls and time spent. They still have poor customer service and I won't renew this insurance again.
Regards,
[redacted]
Good morning [redacted]. EyeMed has listened to the call that [redacted] states she was told she by the call center that she would be allowed a new appeal window and that is not the case. The member is not entitled to any further review. The appeal process allows 30 days from the date of EyeMed’s determination if a member disagrees. [redacted] 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[redacted] | Corporate Legal |Eye Care and Regulatory Affairs |Senior Paralegal
EyeMed Vision CareQuality Assurance4000 Luxottica PlaceMason, OH 45040Fax [email protected] Revdex.com ATTN: [redacted] 1 E 4TH SUITE 600 CINCINNATI OH 45202RE: ID [redacted]Date of Notice: January 5, 2018...
Reference ID: [redacted]Thanks for forwarding [redacted]’s complaint which we received December 27, 2017. [redacted] asked us to reconsider additional payment toward her claim for date of service May 25, 2017. Unfortunately we have decided to uphold our original decision.Case DetailsMember Name: [redacted] Plan Name: [redacted] Claim Number: [redacted]Provider: OUT-OF-NETWORK [redacted] Date s of Service: 5/25/2017 Type of Service: FRAME, LENS Complaint Request: Member requesting additional reimbursement of $142.00Findings: 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.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 866.939.3633.If you have any questions, call us at 866.939.3633 or TDD at 866.308.5375 , or visit www.eyemed.com.Sincerely, Felicia B[redacted] Quality Assurance Specialist
See attached documenteyeMed[redacted] direct dial 513-492-6326 facsimile a[redacted]@luxotticaretail.com January 31, 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: 1/10/18 Complaint...
Request: Member requesting reimbursement of $100.00 Revdex.com ID: [redacted]Dear [redacted]:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated January 24, 2018 regarding the above- referenced matter.In review of [redacted]’s account, EyeMed shows having received two email inquiries from [redacted] regarding claim status. A response to both inquiries was sent within less than 48 business hours to [redacted]. If he is not seeing those responses, he should check his junk and/or spam folders.EyeMed does not show having previously received a claim submission on [redacted]’s account in the last 6 months. However EyeMed is now in receipt of a claim submission sent directly to our Quality Assurance department received 01/29/2018 via email. As a one-time courtesy we have forwarded that claim documentation on his behalf to our Claims Department for processing. Please allow up to 30 days to process your claim entirely once received. Your claim will be processed in the order it is received. A check and/or explanation of benefits will be mailed within 7 calendar days of the date your claim is processed.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy E. S[redacted] Senior Paralegal Corporate Legal Department4000 Luxottica Place, Mason, OH 45040
Hi [redacted], We received the attached Revdex.com complaint.We have issued a check trace to determine if the check has been cashed, if it has I will send proof, if it has not, we will void and reissue the check to the below address… [redacted] I will forward you the...
results as soon as I have them, and I have asked for this to be expedited.Hi [redacted], The reissued check [redacted] has been cashed. I have attached a copy of the cashed check.