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. I just contacted them again today to see where we stand and their protocol has not changed. They continue to provide information that does not match their previous claims and I still have not received my payment. The claim/complaint has been forwarded to several supervisors/superiors to no avail. I have been told the check was in the mail three times, that a "check trace" would have to be done twice, that there was an an issue with my address/mailbox once, and many other stories. Please let me know how many complaints have been filed against [redacted]. Thank you.
[redacted]
Thank you for your request received October 14, 2016. Your feedback is always important, and we've looked into the members follow up to have the claim processed for reimbursement. Here's what we've determined:Case Details[redacted]
[redacted] inquiry Request: Member is requesting reimbursement for services received with an out of network provider.Findings: Since the resolution issued on October 4, 2016, it appears that I provided the incorrect reason for the denial of the claim. The members claim denied due to missing itemized receipt for the purchase. Upon further review the members receipt was included with the claim. We apologize for this error and misinformation included in the initial response. At this time the member's claim will be forwarded for processing towards the available benefits for the date of service. it should be advised that the member will be reimbursed $83.56 as the benefit applies to contact lens materials and not shipping or processing applied by the provider. Payment 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 883,338,5514.if you have any questions, call us at [redacted] (or TDD) at [redacted]), or visit:[redacted].Sincerely,[redacted] Quality Assurance Specialist
See attached document[redacted]3130 BROADWAY - KANSAS CITY, MO 64111 (800) 648.8624 Mailing Address: P.O. BOX 418131 - KANSAS CITY, MO 64141-8131November 9, 2015[redacted]Marketplace Resource ConsultantThe Revdex.com of Cincinnati1 E. 4th Street,...
Suite 600Cincinnati, OH 45202 Via Facslmille: 513.621.0907Re: ID: [redacted]Dear [redacted]:Your October 22, 2015 setter to EyeMed Vision Care, LLC was forwarded to me for review and response on November 4, 2015. 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, LLC. The insured's eye care plan is employer-sponsored vision coverage. This policy is underwritten by [redacted] ("[redacted]") and certain administrative services are provided by Eyes/led Vision Care, LLC ("EyeMed").[redacted] asserts the contact lenses she ordered on September 22, 2015 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 her. The insured subsequently contacted Eye/Med's customer service on October 20, 2015 to follow up on the $18.98 copayment refund and the $130.00 policy benefit credit. Both 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 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.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 [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.] I am sending a fax with my detailed response later today.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have found that their response was not for my complain. My complain was for my wife's refund of $35, however, their response was referenced to my refund of $26, which I received in February. Apparently the person who responded this complain didn't read the complain carefully, and responded incorrectly. You can see the poor quality of the services from EyeMed.On another hand, I did call the Complaining Department and spoke to Edna later last month, and she was able to help to get the claim re-processed, I did receive the refund check last week.Before you close this complain, please let the business know their careless and poor quality services including their response to this complain.Thank you.
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.I find it absolutely ridiculous that they would say that my plan was not active on that date. My plan allows for an eye exam and the purchase of contact lenses. My eye exam was aid for just days before, and all of a sudden I am no longer an active client? I should no longer have an EyeMed deduction on my paycheck if I am not active. Further more, they have provided ZERO direct correspondence to me in any manner. No phone calls, no emails, no direct mail contact attempts to explain any eligible lapse of coverage. I have called their customer service numerous times and have receive a different excuse each time. This is the first time I'm hearing about being covered, and it's a complete lie. I just wonder if they even bother looking at the claim, or come up with a different excuse each time to avoid paying out of network claims.This company owes me a reimbursement for my contact lens. I expect EyeMed to reimburse me. They have the proper paper work. I have proof of the admission of the paper work, I have proof of the multiple contacts. These lies from this company are just pathetic.
Regards,
[redacted]
The members complaint never once mentioned his wife, so we processed the complaint regarding the person who signed it, which was Ying Jiang, as there was no way to determine the complaint was regarding his wife. I have enclosed a copy of the complaint we received. In addition, both members have been reimbursed.
[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] Message from Revdex.com: Consumer contacted the Revdex.com and indicated that this complaint has been closed.
Thank you for sharing your concerns with us on May 31, 2016. Your
feedback is always important, and we've looked into your concerns regarding
your request to reinstate your material benefit. Here's what we've determined;Case DetailsMember Name: [redacted] Plan Name: [redacted]...
[redacted]Provider: [redacted]Date(s) of Service: 4/26/2016Complaint Request: Member requested material
benefit be reinstated due to the lab breaking the member's frame.Findings: In certain situations, remakes are
done by the lab at no charge to you or your provider. We reached out to your
provider regarding your request to reinstate your material benefits. Your
provider stated your frame was purchased from an online provider and you were
informed their location is not responsible for any damages that may occur with
your lab order. After reviewing all submitted documentation we've determined
your provider is not at fault and your request to reinstate your material
benefit is denied. Materials broken or damaged are not valid remake situations.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.[redacted]Appeal: If you disagree with the determination, you may file a
complaint appeal by submitting a written request that includes all additional
information for consideration within 30 days of this notice to:EyeMed Vision Care, L.L.C. Attn: Quality Assurance Dept. 4000 Luxottica
Place Mason, Ohio 45040Fax: 513.492.3259[redacted]If you have any questions, call us at 866.[redacted] (or TDD at
866.[redacted]), or visit [redacted].Sincerely,[redacted]Quality Assurance Specialist
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03/07/2017 12 : 09 : 08 PM - 05:00 PAE 2EyeMedVision Quality Assurance4000 Luxottica PLaceMason, OH 45040Fax [email protected] Resolution[redacted] MARKETPLACE RESOURCE CONSULTANTRE: [redacted]1 E. 4TH ST. CINCINNATI, OH 45202March 7, 2017 Reference ID: [redacted]Thank you for your request received March 7, 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: STATE VISION PLAN Claim Number: [redacted] Date(s) of Service. 2/4/2017Findings: 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 members for authorized services according to their plan design. The member's vision plan offers a $130 in network declining balance allowance for contact lenses purchased from an in-network provider. There is a $104 out of network declining balance for contact lenses purchased from an out of network provider. After reviewing all submitted documentation we've confirmed the member's out of network claim processed correctly according to his plan design. The 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 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 866.3085375), or visit www.eyemed.com.03/07/2017 12:09 PM -0500 PAGE 3 OF 3Sincerely,[redacted]Quality Assurance Specialist
Hi [redacted], Both claims were paid and checks sent. Please see below disbursements....Claim # [redacted] Member DisbursementsClaim Amount$35.99Disbursement ID[redacted]$35.99Check Date01/04/2017Void ReasonPayee[redacted]Disbursement Address[redacted]...
[redacted] Claim # [redacted] Member DisbursementsClaim Amount$25.02Disbursement ID[redacted]Check Amount$25.02Check Date03/21/2017Void ReasonPayee[redacted]Disbursement Address[redacted] In addition, I have asked our payment team to issue a check trace and submit proof if cashed and if not, to void and reissue.
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. I just contacted them again today to see where we stand and their protocol has not changed. They continue to provide information that does not match their previous claims and I still have not received my payment. The claim/complaint has been forwarded to several supervisors/superiors to no avail. I have been told the check was in the mail three times, that a "check trace" would have to be done twice, that there was an an issue with my address/mailbox once, and many other stories. Please let me know how many complaints have been filed against [redacted]. Thank you.
[redacted]
Thank you for your request received October 14, 2016. Your feedback is always important, and we've looked into the members follow up to have the claim processed for reimbursement. Here's what we've determined:Case Details[redacted]
[redacted] inquiry Request: Member is requesting reimbursement for services received with an out of network provider.Findings: Since the resolution issued on October 4, 2016, it appears that I provided the incorrect reason for the denial of the claim. The members claim denied due to missing itemized receipt for the purchase. Upon further review the members receipt was included with the claim. We apologize for this error and misinformation included in the initial response. At this time the member's claim will be forwarded for processing towards the available benefits for the date of service. it should be advised that the member will be reimbursed $83.56 as the benefit applies to contact lens materials and not shipping or processing applied by the provider. Payment 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 883,338,5514.if you have any questions, call us at [redacted] (or TDD) at [redacted]), or visit:[redacted].Sincerely,[redacted] Quality Assurance Specialist
See attached document[redacted]3130 BROADWAY - KANSAS CITY, MO 64111 (800) 648.8624 Mailing Address: P.O. BOX 418131 - KANSAS CITY, MO 64141-8131November 9, 2015[redacted]Marketplace Resource ConsultantThe Revdex.com of Cincinnati1 E. 4th Street,...
Suite 600Cincinnati, OH 45202 Via Facslmille: 513.621.0907Re: ID: [redacted]Dear [redacted]:Your October 22, 2015 setter to EyeMed Vision Care, LLC was forwarded to me for review and response on November 4, 2015. 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, LLC. The insured's eye care plan is employer-sponsored vision coverage. This policy is underwritten by [redacted] ("[redacted]") and certain administrative services are provided by Eyes/led Vision Care, LLC ("EyeMed").[redacted] asserts the contact lenses she ordered on September 22, 2015 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 her. The insured subsequently contacted Eye/Med's customer service on October 20, 2015 to follow up on the $18.98 copayment refund and the $130.00 policy benefit credit. Both 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 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.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 [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.] I am sending a fax with my detailed response later today.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have found that their response was not for my complain. My complain was for my wife's refund of $35, however, their response was referenced to my refund of $26, which I received in February. Apparently the person who responded this complain didn't read the complain carefully, and responded incorrectly. You can see the poor quality of the services from EyeMed.On another hand, I did call the Complaining Department and spoke to Edna later last month, and she was able to help to get the claim re-processed, I did receive the refund check last week.Before you close this complain, please let the business know their careless and poor quality services including their response to this complain.Thank you.
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.I find it absolutely ridiculous that they would say that my plan was not active on that date. My plan allows for an eye exam and the purchase of contact lenses. My eye exam was aid for just days before, and all of a sudden I am no longer an active client? I should no longer have an EyeMed deduction on my paycheck if I am not active. Further more, they have provided ZERO direct correspondence to me in any manner. No phone calls, no emails, no direct mail contact attempts to explain any eligible lapse of coverage. I have called their customer service numerous times and have receive a different excuse each time. This is the first time I'm hearing about being covered, and it's a complete lie. I just wonder if they even bother looking at the claim, or come up with a different excuse each time to avoid paying out of network claims.This company owes me a reimbursement for my contact lens. I expect EyeMed to reimburse me. They have the proper paper work. I have proof of the admission of the paper work, I have proof of the multiple contacts. These lies from this company are just pathetic.
Regards,
[redacted]
The members complaint never once mentioned his wife, so we processed the complaint regarding the person who signed it, which was Ying Jiang, as there was no way to determine the complaint was regarding his wife. I have enclosed a copy of the complaint we received. In addition, both members have been reimbursed.
[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] Message from Revdex.com: Consumer contacted the Revdex.com and indicated that this complaint has been closed.
Thank you for sharing your concerns with us on May 31, 2016. Your
feedback is always important, and we've looked into your concerns regarding
your request to reinstate your material benefit. Here's what we've determined;Case DetailsMember Name: [redacted] Plan Name: [redacted]...
[redacted]Provider: [redacted]Date(s) of Service: 4/26/2016Complaint Request: Member requested material
benefit be reinstated due to the lab breaking the member's frame.Findings: In certain situations, remakes are
done by the lab at no charge to you or your provider. We reached out to your
provider regarding your request to reinstate your material benefits. Your
provider stated your frame was purchased from an online provider and you were
informed their location is not responsible for any damages that may occur with
your lab order. After reviewing all submitted documentation we've determined
your provider is not at fault and your request to reinstate your material
benefit is denied. Materials broken or damaged are not valid remake situations.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.[redacted]Appeal: If you disagree with the determination, you may file a
complaint appeal by submitting a written request that includes all additional
information for consideration within 30 days of this notice to:EyeMed Vision Care, L.L.C. Attn: Quality Assurance Dept. 4000 Luxottica
Place Mason, Ohio 45040Fax: 513.492.3259[redacted]If you have any questions, call us at 866.[redacted] (or TDD at
866.[redacted]), or visit [redacted].Sincerely,[redacted]Quality Assurance Specialist
03/07/2017 12 : 09 : 08 PM - 05:00 PAGE 1. OF 3ATTN : [redacted]FROM : [redacted]DATE : March 0 7, 2017SUBJECT: REF [redacted] CASE ID [redacted]JOB: [redacted]ATTACH: "Letters 1. docx."This Fax originated From a Biscom 'Fax.com' MEMO: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03/07/2017 12 : 09 : 08 PM - 05:00 PAE 2EyeMedVision Quality Assurance4000 Luxottica PLaceMason, OH 45040Fax [email protected] Resolution[redacted] MARKETPLACE RESOURCE CONSULTANTRE: [redacted]1 E. 4TH ST. CINCINNATI, OH 45202March 7, 2017 Reference ID: [redacted]Thank you for your request received March 7, 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: STATE VISION PLAN Claim Number: [redacted] Date(s) of Service. 2/4/2017Findings: 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 members for authorized services according to their plan design. The member's vision plan offers a $130 in network declining balance allowance for contact lenses purchased from an in-network provider. There is a $104 out of network declining balance for contact lenses purchased from an out of network provider. After reviewing all submitted documentation we've confirmed the member's out of network claim processed correctly according to his plan design. The 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 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 866.3085375), or visit www.eyemed.com.03/07/2017 12:09 PM -0500 PAGE 3 OF 3Sincerely,[redacted]Quality Assurance Specialist
Hi [redacted], Both claims were paid and checks sent. Please see below disbursements....Claim # [redacted] Member DisbursementsClaim Amount$35.99Disbursement ID[redacted]$35.99Check Date01/04/2017Void ReasonPayee[redacted]Disbursement Address[redacted]...
[redacted] Claim # [redacted] Member DisbursementsClaim Amount$25.02Disbursement ID[redacted]Check Amount$25.02Check Date03/21/2017Void ReasonPayee[redacted]Disbursement Address[redacted] In addition, I have asked our payment team to issue a check trace and submit proof if cashed and if not, to void and reissue.