Guarantee Trust Life Insurance Company

From: John [redacted] [mailto [redacted] ] Sent: Tuesday, September 12, 4:PM To: Customer Relations < [redacted] > Cc: Terri Tyc < [redacted] > Subject: RE: Unresolved Consumer Complaints Dear Revdex.com: Our decision to void the coverage and deny the claim in question was based on review of medical records dated 11/20/from DrJesus A [redacted] and medical records dated 11/14/2016, 11/15/2016, and 11/21/from DrScott [redacted] These medical records show the consumer was treated on those dates for an excluded respiratory condition This treatment was prior to the 11/23/application for insurance and was not disclosed to us on the application Had our Underwriters known of this medical information when the application was submitted, the policy would not have been issued We therefore voided the policy from the date of issue and denied the claim for benefits For privacy concerns we cannot provide copies of the aforementioned medical records We suggest the consumer consult with her doctors for an explanation regarding the nature of her treatment on the referenced dates We issued the consumer a check dated 8/21/in the amount of $for the premium that was paid for the policy The consumer should contact our Customer Service Department if she has not yet received the refund check Please contact me if you still require any additional information on this case Sincerely, John J [redacted] Product Approval and Compliance Regulatory and Consumer Affairs Analyst e-mail: [redacted] P: [redacted] F: [redacted] [redacted] ***, Glenview, IL Facebook | Twitter | LinkedIn | gtlic.com

Revdex.com:This has been going on since my hospitalization on 5/27-6/5/and 6/22-25/15? I sent them an itemized bill (as per their request) and they did not respond to that for months?! I called Alexian Brothers many times to see if they received any requests from them for medical records, and they told me "NO"?! They just recently sent me the form from Parameds and I just mailed it to them The whole point of this insurance plan was to help people out while they are in the hospital, and not getting their regular salary, and how is that supposed to help us if it takes this long to get anywhere with them?? I have bills from the ambulance company (which are now in collections because part of this plan is to pay ambulance transports per year? They are supposed to pay $per transport and I haven't received anything from them on these bills either?I wish I would have done more research on this company before I signed up for it? Because there are a lot of complaints on your website about this company?! I feel they are just giving me "the run around" and don't expect any money from them I quit paying my premiums, as I told them I would, until I get any payments from them Aetna referred me to them, so I think I need to call them and let them know what is going on? They shouldn't refer customers to companies that have such bad outcomes? Bonnie Liltz

Dear Revdex.com, This is our Company’s response to the referenced complaint number The consumer was issued a Limited Benefit Hospital Confinement Policy effective 12/01/ The policy was issued on the basis of answers given to qualifying medical questions asked on the application The policy includes a ‘Time Limit On Certain Defenses’ that states “After years from The Effective Date, no misstatements, except fraudulent misstatements, made by You in the application for such coverage shall be used to void the Policy or to deny a claim for loss incurred commencing after the expiration of such year period.” The claim we received was for loss incurred within the policy’s two year contestability period The Company has a right to investigate contestable claims before it will approve payment of benefits for such claimsWe therefore requested medical records from the claimant’s attending physicians to determine what, if any, benefits would be payable Based on the medical information we received, it appears one of the qualifying application medical questions was not accurately answered If our Underwriters had known of the omitted medical information when the application was submitted, the policy would not have been issued Therefore, the policy has been voided from the date of issue and the claim denied All premiums paid for the policy have been refunded to the applicant John J [redacted] Product Approval and ComplianceRegulatory and Consumer Affairs Analyste-mail: [redacted] P: [redacted] F: [redacted] Milwaukee Ave, Glenview, IL 60025Facebook | Twitter | LinkedIn | gtlic.com

Initial Business Response / [redacted] (1000, 5, 2015/07/29) */ The claim documents we received on 6/01/do not show the diagnosis for this claim nor the exact number of days the patient was charged for room and boardWe must have this information to complete our servicing of the claimTo be of as much service as possible, we called the hospital on 6/15/15, 6/23/15, and again on 6/24/and left voicemail messages asking that they send this information to usWe also faxed a separate request for this information to the hospital on 6/16/Since we did not get a response from the hospital we sent a request for this information directly to our insuredOn 7/01/we again received a duplicate copy of the hospital statement that was previously submitted which does not provide the number of days charged for room and board nor the diagnosisOn 7/14/we sent a second request for the itemized hospital bill and diagnosis directly to our insuredAs of 7/27/we still have not received the requested necessary information we need to close our servicing of the claim, so on 7/27/we sent our insured another request for this informationWe have not denied the claim, we will gladly re-open the claim and provide any benefits due under the policy just as soon as we receive the itemized hospital bill showing the number of days charged for room and board along with the diagnosis

This policy was issued effective 5/08/The indicated diagnosis for the filed claims may be a condition that is specifically excluded by the 'GENERAL EXCLUSIONS' section of the policy However, in order to confirm the exact nature of the condition treated, we have requested medical records from Alexian Brothers Medical Center via our medical records retrieval service, ParaMeds.com The latest update from Alexian Brothers dated 11/23/on the status of the medical records request is that they have the medical records request in their queue to be processed We expressed the urgency of our request and asked Alexian Brothers to expedite our request, but they said that they process these requests in the order received We are sorry, but we are unable to complete our processing of the pending claim until we receive the requested medical records The insured terminated the policy effective 10/08/ We cannot refund the premiums paid for the policy from its effective date to the termination date Those premiums are considered "earned" having paid for protection against covered loss that may have occurred during this period, such as the pending claim which may still become payable A full premium refund would only be made in the event of proven material misrepresentation that results in the policy being voided from its issue dateI have asked our Claims Department to update me on the status of the pending claim and when a final decision is made I will then follwith the Revdex.com on the final decision

Initial Business Response / [redacted] (1000, 6, 2015/09/03) */ We did a thorough check of e-mail complaint notifications previously received from the Revdex.com, but find no record of this complaint having been transmitted to us on 8/13/We first received notice of this complaint on 8/28/The complaint is in regards to non-payment of benefits claimed for reimbursement of mileage for transportation to a treatment facility, and for radiation/chemotherapy treatmentsIn order to determine what benefits are payable for the radiation/chemotherapy treatments we must receive complete proof loss for the treatmentsFrom the medical records submitted to us we are not able to determine when our insured actually received any radiation/chemotherapy treatmentsThe medical records show the order for the treatments but not when the patient actually received the treatmentsTherefore, in order to provide benefits, we need a statement form the provider(s) of the treatments showing the actual dates the treatments were provided, we do not need itemized bills for the treatments but we would also accept an itemized billing for the treatmentsAs regards the claim for reimbursement of transportation mileage, we need proof of services rendered to the insured on the dates the mileage reimbursement is being claimed forWe must have a statement from the provider that provided treatment that day showing the provider's name and address and type of service providedWe must know the provider's address in order to compute the mileage distance from the insured's residence to the provider If the Complainant will send us the aforementioned proof of loss we will gladly complete our servicing of the claim and provide any benefits due under he terms of the policy

Initial Business Response /* (1000, 6, 2015/09/15) */
Contact Name and Title: Jane *** FLMI, AIRC
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@gtlic.com
RE: Ms*** ***
Revdex.com Case # (Ref#XX-XX-XXXXXXXX-X-XXX)
Policy Number: GTAXXXXXXX
Policy Number: GTAXXXXXXX
Dear
Madam or Sir:
Thank you for your inquiryUnfortunately, we do not have a record of receiving your initial email of August 25,
Ms***'s complaint said she had neither contacted nor contracted with Guarantee Trust *** Insurance Company
However, the Company records indicate that we received an application for two insurance policies - a daily hospital indemnity policy and a lump sum cancer policy - in the same applicationThe application appears to have been signed by Ms*** and dated 6/4/The policies were to become effective on 7/1/
At the time of application, Ms*** requested a monthly PAC (Pre-Authorized Check) mode of premium, which allows the bank to automatically deduct and send premiums to an insurer on a monthly basisMs*** would have had to provide a voided check along with the application to authorize premium deductions from her account
We show that Ms*** called on 6/16/15, requesting that the Pre-Authorized Check not be used for the two policiesWhile we don't show a specific request for cancellation of the policies, we do show that they were converted to a direct bill mode of premiumThis would automatically generate premium due notices by mail for each policyPremium due reminders were generated on 6/16/15, 7/21/15, 7/31/and a final lapse notice was sent on 8/14/This process is intended to be a service to the insured and give them the opportunity to keep their insurance
The above two policies never became effective because the initial premium was not paid
While most people appreciate receiving these reminders, we regret that Ms*** felt them to be bothersome
Because the application for insurance contains protected personal information that only a person applying for insurance would know, such as a Social Security number and bank account information, we are not including it with this letterHowever, if Ms*** desires a copy of the application she signed for her records, we will gladly provide it to her
We regret that Ms*** was not happy with her insurance or the premium billing processIf she has further inquiries, or desires a copy of her signed application, she may contact Guarantee Trust *** Insurance Company at our toll-free number, X-XXX-XXX-XXXX
If you require additional information, you may contact our Regulatory and Consumer Affairs Analyst, *** ***, at X-XXX-XXX-XXXX, extension 5309, or at the fax number below
Sincerely,
MJane ***
SrCompliance Analyst
Regulatory Compliance
Guarantee Trust Life Insurance Company
Phone: XXX-XXX-XXXX
Fax: XXX-XXX-XXXX

Complaint:
I am rejecting this response because: Prior to my policy being accepted, I had not been diagnosed with any health issues that were against their questions that were asked In March or April of was when I was starting to have difficulties and got into a specialist to find out that there were some health issues I had no idea about these health issues and was not diagnosed with anything All the doctors that were contacted, including my primary care doctor, were physicians that I did not meet until March of Also, I have not received any of my refund, as they have stated As of my contact a couple weeks ago, they were waiting for documentation from my primary care doctor, who I had not started seeing until approximately April I have been in contact with all my physicians and verified with them on what they sent in and nothing was advised to them that I was diagnosed with this illness prior to January 1st They have not provided anything in writing of their findings and refund As mentioned as of two weeks ago, they were still investigating. I want verification of what they found that is stating that I was diagnosed with my cause for being hospitalized prior to January In my original complaint I advised that I did cancel my request for my policy to be terminated but I still am getting notices advising me to pay my August premium to re-activate the policy.
Sincerely,
Elaine ***

The claim and itemized bill was received on 9/01/2015. After review by the Claim Adjuster it was determined that it was necessary to obtain additional medical records from Dr. Julia A. [redacted]l.  These records were requested on 9/25/2015 through our medical records retrieval service, ParaMeds.com.  Dr. [redacted] medical records were received on 10/26/2015, but did not include a medical report for the recent claimed Alexian Brothers Hospital emergency room visit.  We need the emergency room report to support the completion of the claim.  The hospital emergency room report was requested via ParaMeds.com on 10/26/2015.  Since that time, ParaMeds.com has been in constant communication with Alexian Brothers Medical Records Department trying to get the requested medical records from them.  Although ParaMeds expressed their urgency and asked the Hospital to expedite the case, they were advised by Scott at the hospital's Medical Records Department that they process the medical record requests in the order received.  The latest communication ParaMeds received from Scott at Alexian Brothers Medical Records Department is that they have the medical records request but will not accept the Authorization to release medical records form that was submitted with the request. Rather, the Hospital requires the patient to sign and date the Hospital's special Authorization form before they will release the medical records.  ParaMeds mailed the special Authorization form on 12/01/2015 to the patient and asked her to sign and date it and return it to ParaMeds.  As of this date the form has not been received by ParaMeds.  ParaMeds placed follow-up telephone calls to the patient on 12/08, 12/09, 12/10, and 12/11/2015 on this matter, but has only been able to reach her voicemail and left a message for a return call.  If the patient would sign, date and return the Authorization form to ParaMeds they will in turn get the signed form back to the hospital so that the hospital will release the requested medical records to ParaMeds.  We are sorry, but we cannot complete our servicing of the claim until we receive the requested Alexian Brothers Hospital medical records.

From: John [redacted] [mailto[redacted]] Sent: Tuesday, September 12, 2017 4:31 PM To: Customer Relations <[redacted]> Cc: Terri Tyc <[redacted]> Subject: RE: Unresolved Consumer Complaints   Dear Revdex.com:   Our decision to void the coverage and deny the claim in question was based on review of medical records dated 11/20/2016 from Dr. Jesus A. [redacted] and medical records dated 11/14/2016, 11/15/2016, and 11/21/2016 from Dr. Scott [redacted].  These medical records show the consumer was treated on those dates for an excluded respiratory condition.  This treatment was prior to the 11/23/2016 application for insurance and was not disclosed to us on the application.  Had our Underwriters known of this medical information when the application was submitted, the policy would not have been issued.  We therefore voided the policy from the date of issue and denied the claim for benefits.  For privacy concerns we cannot provide copies of the aforementioned medical records.  We suggest the consumer consult with her doctors for an explanation regarding the nature of her treatment on the referenced dates.   We issued the consumer a check dated 8/21/2017 in the amount of $240.40 for the premium that was paid for the policy.  The consumer should contact our Customer Service Department if she has not yet received the refund check.  Please contact me if you still require any additional information on this case.   Sincerely,   John J. [redacted] Product Approval and Compliance Regulatory and Consumer Affairs Analyst e-mail:   [redacted] P: [redacted] F: [redacted]     [redacted], Glenview, IL 60025 Facebook | Twitter | LinkedIn  | gtlic.com

Initial Business Response /* (1000, 6, 2015/09/03) */
We did a thorough check of e-mail complaint notifications previously received from the Revdex.com, but find no record of this complaint having been transmitted to us on 8/13/2015. We first received notice of this complaint on 8/28/2015. The complaint...

is in regards to non-payment of benefits claimed for reimbursement of mileage for transportation to a treatment facility, and for radiation/chemotherapy treatments. In order to determine what benefits are payable for the radiation/chemotherapy treatments we must receive complete proof loss for the treatments. From the medical records submitted to us we are not able to determine when our insured actually received any radiation/chemotherapy treatments. The medical records show the order for the treatments but not when the patient actually received the treatments. Therefore, in order to provide benefits, we need a statement form the provider(s) of the treatments showing the actual dates the treatments were provided, we do not need itemized bills for the treatments but we would also accept an itemized billing for the treatments. As regards the claim for reimbursement of transportation mileage, we need proof of services rendered to the insured on the dates the mileage reimbursement is being claimed for. We must have a statement from the provider that provided treatment that day showing the provider's name and address and type of service provided. We must know the provider's address in order to compute the mileage distance from the insured's residence to the provider.
If the Complainant will send us the aforementioned proof of loss we will gladly complete our servicing of the claim and provide any benefits due under he terms of the policy.

This policy was issued effective 5/08/2015. The indicated diagnosis for the filed claims may be a condition that is specifically excluded by the 'GENERAL EXCLUSIONS' section of the policy.  However, in order to confirm the exact nature of the condition treated, we have requested medical records...

from Alexian Brothers Medical Center via our medical records retrieval service, ParaMeds.com.  The latest update from Alexian Brothers dated 11/23/2015 on the status of the medical records request is that they have the medical records request in their queue to be processed.  We expressed the urgency of our request and asked Alexian Brothers to expedite our request, but they said that they process these requests in the order received.  We are sorry, but we are unable to complete our processing of the pending claim until we receive the requested medical records.  The insured terminated the policy effective 10/08/2015.  We cannot refund the premiums paid for the policy from its effective date to the termination date.  Those premiums are considered "earned" having paid for protection against covered loss that may have occurred during this period, such as the pending claim which may still become payable.  A full premium refund would only be made in the event of proven material misrepresentation that results in the policy being voided from its issue date. I have asked our Claims Department to update me on the status of the pending claim and when a final decision is made.  I will then follow-up with the Revdex.com on the final decision.

Revdex.com:This has been going on since my hospitalization on 5/27-6/5/15 and 6/22-25/15?  I sent them an itemized bill (as per their request) and they did not respond to that for months?!  I called Alexian Brothers many times to see if they received any requests from them for medical records, and they told me "NO"?!  They just recently sent me the form from Parameds and I just mailed it to them.  The whole point of this insurance plan was to help people out while they are in the hospital, and not getting their regular salary, and how is that supposed to help us if it takes this long to get anywhere with them??  I have 2 bills from the ambulance company (which are now in collections because part of this plan is to pay 2 ambulance transports per year?  They are supposed to pay $200.00 per transport and I haven't received anything from them on these 2 bills either?I wish I would have done more research on this company before I signed up for it?  Because there are a lot of complaints on your website about this company?!  I feel they are just giving me "the run around" and don't expect any money from them.  I quit paying my premiums, as I told them I would, until I get any payments from them.  Aetna referred me to them, so I think I need to call them and let them know what is going on?  They shouldn't refer customers to companies that have such bad outcomes?
Bonnie Liltz

Dear Revdex.com, This is our Company’s response to the referenced complaint number 12317645. The consumer was issued a Limited Benefit Hospital Confinement Policy effective 12/01/2016.  The policy was issued on the basis of answers given to qualifying medical questions asked on the...

application.  The policy includes a ‘Time Limit On Certain Defenses’ that states “After 2 years from The Effective Date, no misstatements, except fraudulent misstatements, made by You in the application for such coverage shall be used to void the Policy or to deny a claim for loss incurred commencing after the expiration of such 2 year period.”  The claim we received was for loss incurred within the policy’s two year contestability period.  The Company has a right to investigate contestable claims before it will approve payment of benefits for such claims. We therefore requested medical records from the claimant’s attending physicians to determine what, if any, benefits would be payable.  Based on the medical information we received, it appears one of the qualifying application medical questions was not accurately answered.  If our Underwriters had known of the omitted medical information when the application was submitted, the policy would not have been issued.  Therefore, the policy has been voided from the date of issue and the claim denied.  All premiums paid for the policy have been refunded to the applicant.     John J. [redacted]Product Approval and ComplianceRegulatory and Consumer Affairs Analyste-mail:   [redacted]P: [redacted]F: [redacted]  1275 Milwaukee Ave, Glenview, IL 60025Facebook | Twitter | LinkedIn  | gtlic.com

Initial Business Response /* (1000, 5, 2015/07/29) */
The claim documents we received on 6/01/15 do not show the diagnosis for this claim nor the exact number of days the patient was charged for room and board. We must have this information to complete our servicing of the claim. To be of as much...

service as possible, we called the hospital on 6/15/15, 6/23/15, and again on 6/24/15 and left voicemail messages asking that they send this information to us. We also faxed a separate request for this information to the hospital on 6/16/15. Since we did not get a response from the hospital we sent a request for this information directly to our insured. On 7/01/15 we again received a duplicate copy of the hospital statement that was previously submitted which does not provide the number of days charged for room and board nor the diagnosis. On 7/14/15 we sent a second request for the itemized hospital bill and diagnosis directly to our insured. As of 7/27/15 we still have not received the requested necessary information we need to close our servicing of the claim, so on 7/27/15 we sent our insured another request for this information. We have not denied the claim, we will gladly re-open the claim and provide any benefits due under the policy just as soon as we receive the itemized hospital bill showing the number of days charged for room and board along with the diagnosis.