Health Republic Insurance of New York

Review: Worst Company Ever..!!!

company offered wellness visit at no charge in November'**, after hesitation company rep convinced me to see local doctor saying FREE and they made the appointment for visit..

me and spouse went for visit

Did some regular check up weight,height,medical history,blood pressure check up...

Started getting bill for same,

$440 for each of me & spouse

Disputed with the company for same,

paid for full charges for visit as it went to collection agency after fighting for 10 MonthsDesired Settlement: Refund

Business

Response:

September **, 2015 The Revdex.com VIA WEB: [redacted] Re: Member Complaint Revdex.com Complaint ID: [redacted] Dear Sir/Madam: Thank you for your inquiry in connection with the above referenced complaint ID. Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted], received on September **, 2015 by the Revdex.com (“Revdex.com”). Member complains of services not covered for a wellness exam for him and his spouse, however he is being subsequently billed the full amount for the services. The member was enrolled in the Essential Care Bronze Plan, an On- Exchange Individual Policy, effective 5/*/2014. Heal Republic has identified one (1) claim on file under the subscriber, dated 12/**/2014. The claim was denied on 1/*/2015, benefits not in force when services were rendered. A grievance was received on 1/**/2015m however the determination on upheld informing the member there were no benefits at the time of service. In review, the member made one (1) payment to the policy on 4/**/2014, in the amount of $466.35. No other payment had been received since the initial payment, with no attempts to make additional payments. It has been confirmed the member was billed monthly invoices reflecting owed balances. The member was sent a warning letter dated 10/**/2014 (attached), advising the grace period is over and payments are past due. If payment is not received in full by 10/**/2014 the coverage will be terminated. A payment was not received, terminating the policy effective 5/**/2014. In addition, a letter dated 11/**/2014 (attached), was sent to the member informing their coverage has ended. Health Republic apologizes to the member for the inconvenience experienced. Respectfully, Case: Revdex.com Complaint ID #[redacted] 2 [redacted] Vice President, Operational Policy Implementation Health Republic Insurance of New York [redacted] Member ID# [redacted] IMPORTANT: YOUR PREMIUM PAYMENTS ARE PAST DUE Dear [redacted]L: This is a reminder that our records indicate that we have not received several of your premium payments and you are currently past due. If you need assistance determining your current outstanding balance, please call Member Services at ###-###-#### Monday through Friday, 8 am to 5:30 pm. The grace period is over, and the balance must be paid in full by October **, 2014 in order to keep your coverage active. Failure to pay your premium balance at this time will result in termination of your plan coverage. Further, effective immediately, all claims are suspended and we will not pay for services until your balance is paid in full. If we do not receive full payment by October **, 2014, your policy will be cancelled as of the last paid date and you may be responsible for any claims we have paid after your last paid date. You have three payment options: • Pay online: You can make one-time payments from your bank account (ACH payments) or at newyork.healthrepublic.us. You can also use your bank’s online bill pay tool to set up Health Republic Insurance of New York as a payee and schedule a payment. (If your bank requests our address information, use the following: Health Republic Insurance of New York, [redacted].) • Mail a check: Mail your check or money order along with the remittance portion of your invoice to Health Republic Insurance of New York, [redacted]. If you do not have your invoice, write your Member ID# (shown above) on your check or money order. • Call us: Call Member Services at ###-###-#### Monday through Friday, 8 am to 5:30 pm, to make a one-time payment from your bank account. We want to help you in any way that we can. If you have any questions about this notice please call ###-###-#### Monday through Friday, 8 am to 5:30 pm. Please reference your Member ID Number at the top of this letter when you call. Para obtener asistencia en Español, llame al ###-###-####. Sincerely, Health Republic Insurance of New York Member Services [redacted] Health Republic Member Services Team [redacted] IMPORTANT: Your health insurance coverage has ended Dear [redacted]: We regret to inform you that your health insurance coverage with Health Republic Insurance of New York has ended as of June **, 2014 because we have not received your premium payment. We last received payment from you on April **, 2014, which was for coverage through May **, 2014. If you have a remaining balance, please be sure to remit payment as soon as possible. A Certificate of Creditable Coverage, as required by the federal Health Insurance Portability and Accountability Act (HIPAA), is enclosed for your records. If you would like to enroll in a Health Republic Insurance of New York plan in the future, you can enroll again during the next Open Enrollment period. If you experience a Qualifying Life Event, you are entitled to a Special Enrollment period. You have 60 days from the date of the Qualifying Life Event to enroll in a new health plan. Some examples of a Qualifying Life Event are: marriage, birth, adoption, or loss of other coverage. Call us. We’re here to answer your questions. If you have any questions about this notice, please contact our Member Services Team at ###-###-####. Member Services is available Monday through Friday (except holidays), 8:30 am – 5:30 pm ET. Para obtener asistencia en Español, por favor llame al ###-###-####. Sincerely, Health Republic Member Services

[redacted] November **, 2014 [redacted]

CERTIFICATE OF HEALTH PLAN COVERAGE IMPORTANT - This certificate provides evidence of your health insurance coverage with Health Republic Insurance of New York. Subscriber: [redacted] Plan Level Coverage Effective Date Coverage End Date EssentialCare Bronze Individual + Spouse 05/**/2014 05/**/2014 Covered Dependent: [redacted]

Plan Level Coverage Effective Date Coverage End Date EssentialCare Bronze Individual + Spouse 05/**/2014 05/**/2014 If you have any questions, please feel free to contact the Member Services Team at ###-###-####, Monday through Friday, (excluding holidays) 8:30 am – 5:30 pm ET. Sincerely, Health Republic Member Services [redacted] | ###-###-#### | [redacted]

Review: We were previously insured by Health Republic. In December of 2014, we terminated our health coverage with Health Republic via the NYS Online Health Plan Marketplace, and enrolled with a new provider, [redacted]s. We also contacted Health Republic to notify them that we were switching providers. Health Republic requested us to fax a request to their Billing Department requesting that all future Automatic Payment deductions be ceased, effective 12-**-2014. We faxed the requested document to them.

On 12/**/2014, Health Republic Deducted $887.88 from our Bank of America checking account, for January 2015 Health Insurance Premium, even though we are no longer enrolled with them. On 01/**/2015, they have deducted another $887.88 from our Bank of America checking account, for a grand total of $1775.76, even though we terminated our enrollment with them at the close of 2014 via the NY Healthcare Exchange.

Our prior Health Republic member ID was [redacted]. We are owed a refund from Health Republic for $1775.76, for January and February Premiums that they automatically deducted from our checking account after we cancelled coverage with them at the end of 2014.Desired Settlement: Health Republic is continuing to bill us, monthly $887.88, for insurance coverage that was terminated at the close of 2014. We would like a full refund for the January and February premiums they have deducted from our checking account, totaling $1775.76

Business

Response:

[redacted]

Dear Sir/Madam:Thank you for your inquiry in connection with the captioned complaint, Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted], which the Revdex.com (“Revdex.com”) sent to us on January **, 2015.Health Republic can confirm that the member was an active subscriber with us for plan year 2014. However, he elected to terminate his policy in favor of that offered by an alternate carrier in December, 2014. At this time however, we had already processed the Annual Enrollment transaction from the New York State of Health; accordingly, premium payments were drafted for deduction by us on December **, 2014. These payments were later voided by the member’s financial institution on January **, 2015 as ineligible for deduction. Outreach was performed to the member and it was confirmed that the funds were never received by Health Republic. The member’s coverage has been effectively terminated 12/**/14.We trust this solution satisfactorily addresses the member’s concerns. Health Republic apologizes for the inconvenience experienced by the member.Sincerely,Health Republic Insurance of New York

Review: I purchased a Platinum plan through the New York Health Exchange with premiums totaling over $1400 a month for a no deductible platinum plan . The plan started Jan *, 2014. My wife had a baby girl Feb **, 2014. Health Republic has not paid on any claims from Feb [redacted] through May * that had anything to do with the baby. Both Health Republic and the NY Health Exchange were notified of the baby's birth within 7 days. I have spent over 50 hours over the phone with them and now have close to $10,000 in hospital bills. Apparently no one I speak to in customer service has the power to change anything. They keep on giving me deadlines by which time the problem would be fixed. Each deadline passes and nothing happens. Its been months. The baby should have been covered either way under the mother's (my wife's) policy either way for 30 days according to the Affordable Care Act. My wife was included in my plan since Jan *. They are giving me a run around and are not doing anything to resolve it. I am pretty sure that the customer service centers are outsourced call centers and may not even work directly for the company which is why they don' t have the power to do anything.Desired Settlement: I would like the hospital and doctors bills to be paid immediately with confirmation that this was done and a refund of some sort of my premiums as there is no reason I should have had to go through that much harassment to get something simple done. If insurance doesnt pay for medical bills what is the point of it. I would also like to be in contact with someone from their corporate office who will take responsibility for this mess and issue an apology for the situation.

Consumer

Response:

At this time, I have been contacted directly by Health Republic Insurance of NY regarding complaint ID [redacted], however my complaint has NOT been resolved because:

They still have not paid out on all the claims. I still had to have numerous conversations with them. And I still have not gotten a call from anyone who actually has the power to fix anything.

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Business

Response:

Dear [redacted]:

Thank you for your correspondence concerning the above captioned member. Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint herein, which your Department remitted to us on July *, 2014.

COMPLAINT SUMMARY

1. According to the complaint, the member enrolled in a family plan with Health Republic for coverage starting January *, 2014 and on February **, 2014 the member’s spouse had a baby.

2. The member states that Health Republic refuses to pay claims from the baby’s date of birth, notwithstanding, the he has been paying in excess of $1,400.00 per month, for which he has yet to derive any benefits on behalf of his child;

3. According to the complaint, Health Republic is required to satisfy his child’s medical expenses which is now in excess of $10,000.00, and notwithstanding the many assurances by Health Republic, this has yet to be resolved; and

4. Based on the foregoing the member filed the captioned complaint with Revdex.com.

RESPONSE

1. On July *, 2014, 2014, following receipt of the complaint herein, Health Republic cross-referenced it’s records and found that the material elements of the complaint was already directed to the Department of Financial Services for resolution;

2. Notwithstanding the foregoing, Health Republic can confirm the following time-line of events, leading to the remediation of the complaint:

(i) On December **, 2013 Health Republic received the member’s electronic enrollment file from the Exchange, for coverage effective January *, 2014;

(ii) On December **, 2014 Health Republic received the member’s binder payment thereby effectuating his January coverage;

(iii) On March *, 2014 Health Republic received an additional file thereby adding the newborn for coverage effective March *, 2014 to the policy, changing it to an Individual + Family plan;

(iv) The member contacted both Health Republic and the Exchange to have the newborn’s coverage effective date changed to February **, 2014, the date of birth of the dependent child, so that claims submitted on the child’s behalf for nursery and well-baby visits would we paid;

(v) Health Republic advised the member that effective date changes would need to be addressed to the Exchange;

(vi) The member made several attempts to have the effective date changed through the Exchange to no avail; and on April **, 2014 a member services [redacted] conferenced the member in on a call to the Exchange’s Appeals Department. The member service [redacted] and the member were advised that the incorrect effective date for the newborn is a “defect” with the eligibility department which would be corrected. Health Republic now awaits the corrective file from the Exchange in order to make the necessary changes;

(vii) Health Republic can confirm that several of the member’s reimbursement claims have been processed and approved; and for those that were not: they did not fall within the parameters of his plan benefits;

(viii) The Complainant should have already received an Explanation of Benefits (“EOB”) and therefore ought to be aware of the reason for the denial for those claims which were denied. Further, there is an established appeals process, which Health Republic recommends the member take advantage of;

(ix) Health Republic regrets that the member felt frustration regarding his newborns coverage. We strive to provide exemplary service at every level and corrective action has been taken; and

(x) The issues within the complaint have been investigated and addressed. Health Republic herein asserts that Member’s claim has been fully resolved.

Respectfully,

HRINY Operations Team

Consumer

Response:

At this time, I have not been contacted by Health Republic Insurance of NY regarding complaint ID [redacted].

Sincerely,

Business

Response:

[redacted]

Dear [redacted]:

Thank you for your correspondence, dated, July **, 2014, in connection with the captioned complaint. According to the complainant her matter has not been fully resolved for the following reasons:

1. Health Republic denied claims from facility that is In-Network (INN):

All claims that have been submitted by the complainant will be processed within the limitations of her contract of insurance; and as at the date of this complaint and the answer concomitant therewith, there are several claims that are in the processing stream. Unfortunately, Health Republic cannot commit to a date for completion but can assure the complainant, that any and all claims that are properly within network will be covered.

Health Republic will continue to monitor this matter.

2. Health Republic is not processing claims in accordance with the PPACA:

The Patient Protection and Affordable Care Act (PPACA), provides that a new born is entitled to a 48 hour hospital stay following child birth (96 hours in the case of a caesarean birth). The PPACA, however, makes provision for a special enrollment period if the plan is advised by the primary holder within 30 days of the birth of the child. The Law then requires a retroactive effective date back to the date of birth of the child. As such, Health Republic is acting in strict accordance with the law in New York State.

As advised in our first response, Health Republic is working closely with the Exchange, and is mindful of the legal and ethical constraints; and as such the newborns coverage effective date has been modified to coincide with the date of birth, February **, 2014.

We trust the complainant will allow the implemented and established process to run its course, if however, he is dissatisfied with our determination then he is invited to appeal the decision in the manner that is contractual stipulated.

Review: I had signed up the week of Dec [redacted] 2014 for Health Insurance on the NYS Portal, with Health Republic of NY. I chose that company because my Dr. was listed with them on the portal. I made my first payment and the same day I looked into setting up my profile on their website and noticed my Dr. wasnt listed anymore. I called my Dr. and they confirmed they do not take that insurance. That same day I made the payment, I called and cancelled it. They said it was pending and couldnt cancel it, so they would issue me a check that would take 7-10 WEEKS to come back to me. I waited, and decided on Tuesday 1/**/15 to call and check on the refund. When I called they said that I still havent been issued a refund because the department that takes care of the refunds, "forgot" my case because it was pending due to the time I cancelled originally. They then said they would email the appropriate party to issue my refund. I called today 1/**/15 to check on it, and they cant find anything in the system and have had me on hold for 30 minutes. Everytime I call the billing department I am put on hold for 30 minutes, if I call sales they pick right up but then transfer me to a hold. I feel like I am being jipped. They wont give me my money back.Desired Settlement: I want a full refund IMMEDIATELY.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved.

Sincerely,

Review: I was a Health Republic (HR) member, and I never enrolled in HR’s automatic payment program (ACH). After noticing that I was enrolled in ACH in May, I called HR to request that I be un-enrolled, and was told that my request processed successfully. Funds were debited from my account anyway in June, and then I was told that I was still enrolled in ACH and that the only way to get a refund is to terminate coverage via the [redacted]. I terminated coverage that same day and advised HR the following day.

[redacted] could have mitigated the damages caused by HR’s unauthorized withdrawal by properly processing my termination request, but instead they did not and instead filed - improperly at first - an appeal with the Dept of Health to terminate my policy effective the end of June. After three months, the appeal is still pending, and the [redacted] is currently investigating whether my appeal will need to go before the [redacted] instead, bringing me back to square one.

Regardless of the [redacted]’s actions/inactions, HR is the primary wrongdoer. First, HR enrolled me in ACH without permission. Second, HR did not properly un-enroll me, despite their statement that they did, in fact, un-enroll me. Third, HR accessed my checking account after I specifically told them they did not have authorization to do so. Fourth, HR did not stand behind the information given by their representative. Fifth, HR did not refund me my payment when I requested the same. Sixth, HR’s actions in forcing me to make at least 20-30 calls and spend anywhere from 6 to 10 hours on the phone, even after it became obvious that I was and still am having difficulty resolving this, can only be described as anti-consumer.

In short, HR took money from my checking account without authorization and is placing conditions on its return that are apparently impossible to achieve despite my many efforts.Desired Settlement: Health Republic withdrew funds from my checking account without authorization - and in fact, after I specifically told them not to - and then refused to return the funds they took. For that reason, I believe I am owed a full refund of the funds that Health Republic withdrew from my account.

Business

Response:

[redacted]

Dear [redacted]:

Thank you for your inquiry in connection with the captioned complaint, Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted], received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on October **, 2014.

COMPLAINT SUMMARY

1. According to the Complainant, he subscribed through New York State of Health (the “Exchange”) with Health Republic for a policy of insurance. According to the complainant at no point did he enroll for Health Republic’s automatic recurring ACH program, by which premium payments are deducted from a participants account every month to satisfy any and all due and payable balances ;

2. The complainant states that sometime in May, 2014, became aware that unbeknownst to him, he had been registered for the recurring ACH program, at which point the complainant contacted Health Republic to confirm his ACH status, and after validating same, recanting his consent and thereafter cancelling the authority of Health Republic to deduct any further payments on his account. According to the complainant, he was assured by a representative of Health Republic that he was no longer a participant in the program;

3. Despite the foregoing, Health Republic deducted a further premium payment from the complainant’s account in June, 2014, and when the complainant called to query the deduction, he was informed that he was still enrolled in recurring ACH, and further, that the only means by which a refund could be processed was to terminate the policy through the Exchange;

4. According to the complainant he contacted the Exchange and terminated his coverage, but the Exchange failed to process his termination correctly, instead filing an appeal with the Department of Health (“DOH”) which is still pending, with no substantive steps being taken to address his overall concerns;

5. According to the complainant, though the Exchange failed in its mandate, the greater part of the blame for his present predicament lies with Health Republic, for: enrolling him in recurring ACH without his authority, failing to terminate the recurring ACH after having assured him that it was so terminated, deducting payments form his account without his consent and/or knowledge; failing to honor its word issued by an authorized representative; and for failing to issue a refund when it became clear that one was owed;

6. After attempts to resolve this matter without avail, the complainant filed this complaint with the Revdex.com (“Revdex.com”).

RESPONSE

The following is a timeline with references to supporting documentation describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof.

1. On October **, 2014 Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com;

2. On October **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”);

3. The team confirmed that, on December **, 2014, the complainant registered himself for recurring ACH via Health Republic’s website. Consequently, Health Republic had the requisite authority to deduct payments from the complainant’s account using this means;

4. On June **, 2014, the complainant called Health Republic to verify that he was enrolled for recurring ACH, the complainant was informed that he has been enrolled since, December **, 2013, at which point the complainant directed the cancellation of the program. The complainant was led to believe that no further steps were required to cancel the recurring ACH, and as such, he took no further action with respect to this matter;

5. Health Republic can advise that it’s policy for terminating recurring ACH, is to have the participant send a request in writing;

6. As the recurring ACH was not cancelled in accordance with Health Republic guidelines, the complainant’s account was deducted for a further premium payment allocated against the month of July, 2014;

7. Health Republic recognizes that the complainant expressed an interest to terminate his policy as well as to cancel recurring ACH as of July **, 2014, as such; it has coordinated with the Exchange to rectify the complainant’s enrollment record to reflect termination as of July *, 2014, thus voiding the balance outstanding for the month of July;

8. In view of the foregoing, the complainant is entitled to a refund for the month of July, which has been authorized by Health Republic.

9. Health Republic apologizes for the inconvenience caused to the complainant; and

10. Based on the contents of the foregoing, we believe the Complainant’s matter has been satisfactorily addressed.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved.

Sincerely,

Review: health republic of new york denied my health coverage for biologic infusion soon after federal government "closed" all their NYS branches. after covering 4-5 consecutive infusions of mine in recent past , they suddenly claimed I needed more paperwork to support my disease. I believe this is a stahl-tactic used by them until they become "insolvent " ( aka bankrupt ) on january [redacted], 2016.Desired Settlement: this company , part of the floundering affordable care act ( ACA ) , promised to cover patients w/pre-existing conditions , & now is re-negging after less than two years in business ...pathetic !

Business

Response:

[redacted] Dear Sir/Madam: Thank you for your inquiry in connection with the above referenced complaint ID. Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted], received on October **, 2015 by the Revdex.com (“Revdex.com”). According to the member’s complaint, attempts have been made to Health Republic, inquiring the continuation and receipt of the required infusion medication. In review, an inquiry was received for the medication Remicade, however additional information was requested. Upon receipt of the requested information, the member was approved on 10/**/2015. Six (6) visits were certified from 6/*/2015 through 12/**/2015. The approval allowed distribution of the medication to the member, however the provider has requested to purchase the medication and bill Health Republic, treating the member in the office. In addition, two claims dated 6/**/2015 and 8/*/2015 had originally denied due to the request of the additional information. These claims have since been reprocessed to pay the provider. However, as a result of the wind down of Health Republic operations, the resolution of this complaint is subject to the terms of regular claims processing time frames. Health Republic will provide updated information on claims reprocessing and/or interest payment due upon completion of those claims in queue. Health Republic apologizes for the delay and to the member for the inconvenience experienced. Respectfully, Stacey Blair-G[redacted] Vice President, Operational Policy Implementation Health Republic Insurance of New York

Review: In January, I called to do a one time deduction to pay for my insurance. I was told it was not possible to retrieve it from a saving account. Jan. [redacted], I sent a money order. It was received Jan. [redacted]. In February, I received a form letter from them. It stated I could have the amount taken out of checking or saving account. I thought they had resolved their issue, after all, it was THEIR form letter. They received it Feb. [redacted] and it would start Feb. [redacted]. Unfortunately, the issue has not been resolved and from that point on it has been an issue. March [redacted], spoke with [redacted] at 11:55. I asked to speak to a supervisor, I was on hold from 11:55 until 12:31. I then spoke with [redacted]. She said they could not take the money from a savings account and would credit me the $2.50 they charged me for something they CANNOT do. On March [redacted], I spoke with [redacted]. I asked for a letter stating info would be erased from the computer since it is something they cannot do. I never received a letter and it is still an issue. On April [redacted] a message was left on my phone by [redacted] with reference #[redacted]. I called after work, spoke with [redacted] and she said they would credit my account the $2.50 one more time. On April [redacted], I received a letter dated April [redacted] and was once again charged the $2.50. I called at 5:40 and asked for a supervisor. I was on hold for 11 minutes when I hung up. I then went up on their [redacted] page and lodged a complaint. On April [redacted] with a direct line ###-###-####, called me. I explained the problem one more time. She said she would look into it and leave a message on my phone, as I was heading into work. She left a voice mail, said the credit memo was in the mail, and the information to my saving account would be deleted from the system so this problem would not happen again. I received in the mail today, May [redacted], an invoice for $2.50.Desired Settlement: I would like my saving account information taken out of their computer. I would like a credit to my account and copy sent to me. I would like to have a separate bill sent to me so I know how much I owe and when it is due. I would like this to ACTUALLY end this problem and not just the words that "this problem is resolved, it will not happen again".

Business

Response:

May **, 2015 The Revdex.com VIA WEB: http://newyork.Revdex.com.org/respond [redacted] Re: Member Complaint Revdex.com Complaint ID: [redacted] Dear Sir/Madam: Thank you for your inquiry in connection with the above referenced complaint ID. Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted], received on May *, 2015 by the Revdex.com (“Revdex.com”). The member enrolled with Health Republic, through the [redacted] (“[redacted]”), effective, February *, 2015. She then contacted Health Republic in January 2015 to make a one-time premium payment towards her coverage. The member was then informed that Health Republic was unable to deduct a payment from her savings account. The member indicates that she was later charged a fee of $2.50. Based on further review, we have confirmed that members may utilize a savings account for ACH payments. However, the charge the member incurred was due to an invalid account number. Health Republic has cancelled the member’s most recently billed $2.50 void payment fee for June 2015; and has sent her an updated invoice with her current outstanding balance. The member has since been contacted and advised of these corrections. Health Republic apologizes to the member for the inconvenience experienced. Respectfully, [redacted] Health Republic Insurance of New York

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[Your Answer Here]

I was told my ach info was correct by [redacted]. This is an internal issue with the company. I was also told MULTIPLE times my ach info was deleted from my account, and yet, EVERY month they still send it and then charge me. I will not agree this issue is corrected until AT THE MINIMUM two months goes by without them trying to access my account and then turning around and billing me. If they truly believe, my info is wrong (which it is not) why do they keep trying to use it?

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Business

Response:

June *, 2015 The Revdex.com VIA WEB: http://newyork.Revdex.com.org/respond [redacted] Re: Member Complaint Addendum Revdex.com Complaint ID: [redacted] Dear Sir/Madam: Thank you for the follow-up inquiry in connection with the above referenced complaint ID. Health Republic Insurance of New York (“Health Republic”) hereby provides a follow-up response to the answer provided to the Revdex.com (“Revdex.com”) on May **, 2015. The member’s follow-up inquiry is specific to the $2.50 ACH rejection fees and her request to discontinue ACH payment method. Health Republic has reconciled the member’s account which includes discontinuance of ACH payment method, which will cease further rejection fees. Health Republic will continue to monitor this member’s account. The member has been in close contact with a dedicated Health Republic representative and is satisfied with this resolution. Health Republic reiterates an apology for the inconvenience experienced by the complainant. Respectfully, [redacted] Health Republic Insurance of New York

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[Your Answer Here]

I would like to keep this complaint open for the months of July and August. I have been told for 5 months this has been resolved. Yet, here I am. I have been told the issue has been solved but until 2 months pass without an issue, I am not willing to believe them. Please keep this complaint open until I receive both the July and August bills to confirm the issue is resolved. Thank you.

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Review: I moved out of New York in November of 2014 and canceled my insurance through the NY Health Exchange as of Dec **, 2014. Health Republic of New York continued to bill me until March before I noticed. They claimed to have never received my cancellation from the Health Exchange. They told me the only way they would stop auto-billing me was if I contacted the health exchange and canceled as of March **. So I did that. The Health Exchange did tell me that I had a cancellation on file as of Dec [redacted] 2014, but advised me to add a cancellation date to stop from being auto-billed. So I did that. Then they had me file an appeal to force Health Republic of New York to recognize my original cancellation date of Dec [redacted] 2014. So I did that. After filing (in May) I was told it would take a few weeks to be approved. I waited 2 weeks and called back and was told it was approved. They said it would take another few weeks before the cancellation date was updated in their system and they could issue a refund. I waited a few more weeks, called back, was told it was not updated. Repeat 2 more times before finally getting to talk to a supervisor. Then I was told that the original appeal was filed incorrectly by the representative and was therefore rejected (and that the representative was supposed to correct it and refile but never did). And that I would need a representative to refile. At this point I have spent at least 15 hours on the phone with Health Republic and the NY Health Exchange (mostly on hold), and I am convinced that no matter how many hoops I jump through, they will never refund my money. I would have given up on this long ago, if it wasn't for the fact that I knew they had taken this money from me illegally. I cancelled my insurance exactly how I was supposed to (through the health exchange), this has been confirmed by the health exchange, but it makes no difference to the insurance company. They are continuing to bill me through what they call "clerical and system errors", and even while acknowledging that, they have come no closer to issuing a refund.Desired Settlement: I want a refund of $607.12 that Health Republic of New York owes me.

Business

Response:

Dear Sir/Madam:Thank you for your inquiry in connection with the captioned complaint ID. Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted], received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to us on July **, 2015.The member enrolled with Health Republic, through the New York State of Health (“Exchange”), effective, May *, 2014. The member resided in New York State until late 2014; thereby, terminating his policy with Health Republic as of December **, 2014. However, the member indicates that he subsequently received three (3) monthly billing invoices from Health Republic during plan year 2015. Additionally, since the member was previously signed up for re-occurring ACH payments, the member states his billing invoices resulted in three monthly (3) ACH premium payments being deducted towards his plan year 2015 coverage. The member contacted Health Republic to inquire about his termination date. The member was informed due to enrollment through the Exchange, he would need to contact the Exchange directly in order to terminate his policy and to stop the re-occurring ACH payments. Upon terminating his policy, through the Exchange, to March **, 2015, the member filed an app eal to the Exchange requesting a December **, 2014 termination date. The member requests that the Exchange terminate his policy with Health Republic to December **, 2014; and process a refund of his three (3) plan year 2015 ACH premium payments. Health Republic can advise that we did not receive notification that the member was moving outside of New York prior to the beginning of plan year 2015. Accordingly, we could not terminate his policy until we received a directive doing so. With respect to our deduction of ACH premium payments, Health Republic can advise that as the member was enrolled in re-occurring ACH payments, we proceeded to deduct his monthly premium payments as they became due via automatic ACH until we received a directive to terminate the member’s policy.We have terminated the member’s policy with Health Republic, through a directive of the Exchange, effective, December **, 2014. Therefore, we have processed a refund of the three (3) premium payments deducted from his account against his plan year 2015 coverage, in the amount of $607.08. The refund will be processed within 72 hours. However, should the member fail to receive same, he is directed to contact our customer service during regular business hours.Health Republic apologizes to the member for the inconvenience experienced.

Review: I was trying to get the medical insurance from Health Republic Insurance thru my agent 4 month ago.During that time I didn't get any information, latter, phone calls. My agent e-mailed to the insurance as well. On May * I got the bill for $2,063.24 fro 4 month. I had no idea that I was enrolled, no welcome latter, nothing.I called to my agent and he told that that is common situation with that compony and he rejected to call them.I called on May ** (Call #[redacted]) to the customer service and they told that will response on that. No response.I called on May ** (Call # [redacted] ) as per representative they will try to change the enrollment day, but can't guarantee it and will get back to me.I am with medical issues and 4 month do not get any medical health.Please help me on that.Also will write the latter to the [redacted].Desired Settlement: I need to change the enrollment day, remove charge for $2000, I never used that insurance ,mail me the pcg and enroll me from June *, as per advise with the representative.

Business

Response:

[redacted]

Dear Dispute Resolution Services:

Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (the “Respondent”) hereby responds to the complaint filed by Complainant ID [redacted], (the “Complainant”), received by the Revdex.com (“Revdex.com”), and relayed to the Respondent on May **, 2014.

COMPLAINT FACTS

1. According to the Complainant, she enrolled for a policy with Health Republic some four (4) months ago, with the aid of an Insurance Agent (“Agent”);

2. It is the Complainant’s position that she received no communications from Health Republic whether written or oral to confirm her policy of insurance. As a consequence of which she reached out to her Agent, who sent Health Republic an e-mail to inquire further;

3. According to the complainant, on May *, 2014, she received a bill from Health Republic for the amount of $2,063.24, representing four (4) months outstanding premiums;

4. According to the Complainant, she had no idea that she was enrolled with Health Republic for a policy of insurance, as she had received no Welcome Package or any other indication of membership;

5. The Complainant alleges that as a result of the contents of paragraph 4 herein, she called her Agent who refused to contact Health Republic again on her behalf;

6. The Complainant thereafter made two (2) calls to Health Republic, one on May *, 2014, and the other on May **, 2014, both of which proved futile as Health Republic had yet to change her policy date as of the time this case was submitted.

7. As a result of the matters raised in paragraphs 1 through 6 hereof, the Complainant filed this complaint with the Revdex.com (“Revdex.com”).

RESPONSE

The following is a timeline with references to supporting documentation describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof.

1. On May **, 2014 Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com;

2. On May **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”), which confirmed that member enrolled in the Essential Care Platinum plan, effective February *, 2014;

3. The team confirmed the following:

a) On 2/**/2014 – A new participant binder and billing form was mailed to the Complainant at her record address, detailing the steps and payment she was required to make to effectuate her policy;

b) On 2/**/2014 – A new participant Summary of Benefits and Coverage (“SBC”) was sent to the Complainant via e-mail; and

c) Between 2/**/2014 through to 5/**/2014 – Four (4) separate Individual Billing Statement Forms were sent to the Complainant, to maintain her policy.

4. Health Republic asserts that all forms were sent to the record address of the Complainant. It therefore remains unknown how the Complainant only received the last billing statement, but not the several others which were sent to the same address;

5. Accordingly, Health republic has taken the good faith decision to change the Complainant’s effective date to June *, 2014;

6. On June [redacted], the member made the payment for the June premium and effectuated her policy;

7. Based on the contents of the foregoing, the Complainant’s matter has been satisfactorily addressed. However, should there be any other questions or concerns, these can be directed to our Customer Service Department at our toll free number [redacted]

Review: I filed an online application through the New York State of health market place in December of 2013. At that time I was told that the health plan I have selected must receive the monthly premium by December [redacted]2013, in order for the insurance for my self and two kids to become active on January *, 2014. Even though I filled out the application and selected the health plan I still was looking for a more affordable plan, so I decided not to send the payment by December **/2013, knowing that my health coverage will not start on January */2014.

On January **/2014, I called NYS of health and I told them I want to change the health plan. during that phone conversation I was told that because I did not sent the payment by Dec **/2013 my application has been cancelled and I need to start over a new application( this was another confirmation that I had no coverage on January of 2014), Then, I filled out the new application for my self and kids and sent the payment knowing that my health coverage will start on March */ 2014. A few months later, I begin getting the bill for January of 2014 in the amount of $745.18 which was the premium of my first chosen plan if my health coverage had started on January */2014, indeed this never happened because the premium never was sent. I contacted the health republic of New York regarding this bill and they told me that NYS of health market place billed you and you have to call them. I called the NYS of health and asked the health republic of NY rep to stay on the line, and while we were having a conference call they started accusing each other and asking each other to remove the charges but neither one never did it. My husband and I contacted them in a number of occasions and they admitted that when we called in January the customer service rep. never removed my name from the billing cycle. Furthermore, I continued to pay my monthly premium but I never paid the January premium because I never had coverage for the month of January. Later, On November **, 2014 I received the letter from the Health republic of New York that my health insurance for my self and two kids has been canceled on October */2014, even though the premiums for October and November,2014 already were paid. I visited the doctor in October knowing that I have health coverage, and later I had to pay the bills, even though I was paying the premium. This action of health republic of New York to leave my kids without health coverage with their error was unacceptable and beyond believe. Since then, I have spent hours and hours talking on the phone with them and asking to refund my $745.18 that they took from me. Last conversation I had with them was Monday March **/2015. Even though on the prior phone call they admitted that was their error and they are willing to refund my money, on Monday they said that they will not issue the refund because it was our mistake and not theirs. In summary, one more time I want to inform the Revdex.com that the health insuarnce plan known as Health Republic of New York grabbed my money and cancelled my health coverage - although all required premiums for the months I had coverage were paid on time. This is the worst customer service I have received for 16 years of living in the United States. Please help me get my money backDesired Settlement: Get my money back, and receive apology from them

Business

Response:

[redacted]Dear Sir/Madam:Thank you for your inquiry in connection with the captioned complaint, Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to us on March **, 2015. The member enrolled for a policy of insurance with Health Republic, through the New York State of Health (“Exchange”), effective, March *, 2014. According to the Complainant, she had a premium payment allocated towards January, 2014, although, she was previously informed that her January coverage had been cancelled, because her initial premium payment was not received prior to December **, 2013. The complainant then filed a new application with the Exchange to start her policy, effective, March *, 2014, and made the required premium payments. However, the complainant was notified on November, **, 2014, in a letter from Health Republic that her coverage was terminated as of October *, 2014 despite the fact that she had made premium payments through the end of the year. As Health Republic had partially refunded the member on February **, 2015 in the amount of $496.78, the complainant is seeking a refund for her additional payment in the amount of $745.18.Having completed our investigation, Health Republic can advise that the complainant is owed $745.18. The refund was issued on April *, 2015, and outreach has been made to the member to advise her on the status of the refund. Health Republic sincerely apologizes for any inconvenience experienced by the member. However, we trust the foregoing adequately addresses the concerns raised by the complainant. Respectfully, [redacted]

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory, however, due to the past experience with the mention business, at this time I cannot say that the matter has been resolved until I receive my funds that I have worked very hard to earn them. Yesterday, I was reached by this business and I was promised that I should expect to receive funds within 5-7 business days. Now I'm waiting for their factual response.

Sincerely,

Review: [redacted], **

Health Republic Insurance

Re: Insurance Policy #[redacted]

Dear [redacted];

My husband and I had signed up with Health Republic of New York on February [redacted], 2014, so that we would be covered starting March [redacted], 2014 for medical coverage with your Essential Care Platinum plan. The last week in February 2014, we received an introductory type package confirming the plan that we had chosen. Around February [redacted], 2014, we had wondered why we didn’t receive a bill to start our coverage so we contacted your office in which the customer service representative was unable to locate any information regarding our plan choice. Luckily we had the confirmation number from the NYS Health Website, which was [redacted]. We gave it to the customer service representative which still was unable to locate any information regarding our purchase. They had advised us that we could make a payment over the telephone to start up our insurance coverage, however, since they were able to locate our purchase we felt uncomfortable doing so.

We had contacted your office on March [redacted] and then again on March [redacted], 2014, when our bill finally arrived. Previous to our bill coming we had asked the representatives that once this payment was made would they be able to send us our insurance cards via email, and both times we were told that they could. So, we had checked our email several times to see if the cards had come, since they had informed us it would take 10 business days for them to come in the mail. By waiting for that period of time it would mean that half the month would be over before we could make any type of doctor appointments or have any prescriptions filled.

Once again on March [redacted] ref. [redacted], we had contacted your office to find out the status of our insurance cards to only be told that the file had not been sent over to the department it needed to be sent to so it could be uploaded in your computer system. At which time we were advised they needed to wait until our payment was cleared from the bank which took place on March [redacted], 2014. The Customer Service Representative told us since our payment was processed it would now take up to 72 hours before the file would be uploaded and cards would now be available.

On March **, 2014, ref. [redacted] we had contacted your office only to find out that no file had been sent over. This time we had to spend almost 1 hour on the phone, and still didn’t get anywhere. They did, however, transfer us to a [redacted] named [redacted] who informed us that she would see what she could do to escalate our cards and would contact us by 5:00 pm, on Friday, March [redacted], 2014. Needless to say she never did contact us.

So, on Monday, March [redacted], 2014, we contacted your offices once again only to get the run around, this time we had spoken with [redacted] ref.# [redacted], who attempted to have a three way conversation with [redacted] in Enrollment. He stated that the file was sent to their department, but not loaded into your system once again. We were asked for our email address again stating that they would email us our insurance cards once the file was loaded and he would have them escalate this process. Going along with your business protocol that it takes 72 hours for the file to be loaded and cards generated.

Our last telephone conversation on March **, 2014, ref. #[redacted] our phone call kept being fed back into the main line to wait for a representative to assist us, so after having this happen with 3 different representatives we ended up speaking with a Customer Service Representative named [redacted] just like all the other representatives said, that they still didn’t have the information/file, but took my email once again to have the cards emailed to me.

If this is happening to us, how many other people is this happening too. We are outraged in the service that we have received thus far. Not to mention the time that has been spent on the telephone trying to get this matter resolved. Paying for an insurance plan that you cannot even use is ridiculous. We tried to get a prescription filled, but they stated we needed the cards. Consumers need to be aware of the run around and the way this company is doing business. We are requesting that our absorbent premium of $658.19 be prorated and refunded to us. We are on the coattails of the end of this month with no insurance cards in sight. The one doctor’s appointment that we did go on would have cost us much less money by paying out of pocket, and we have to hope that there won’t be any problem with you paying the doctor for services rendered. It has made us consider finding another more reputable provider for our insurance needs.

We are requesting some type of feedback from your company regarding our request for a prorated refund within 10 days.

Sincerely,

[redacted] & [redacted]

Email Communication

Dear [redacted], ** ([redacted]),

Please find attached a letter stating the poor service we have received attempting to get insurance cards for a premium we had paid for.

[redacted] & [redacted]

Mar ** to me

[redacted],

I have received your letter and this email and will forward the request regarding a pro-rated refund to the appropriate party.

I share your concerns around the ability to obtain ID cards as they are the point of entry for health care services.

You mentioned that it would have cost less to obtain the medical services if you had paid out of pocket. Would you care to elaborate?

All the best,

[redacted], **

Mar ** (8 days ago)

to ** Dear [redacted],

This email is a follow up from our recent email/and letter that we sent to you regarding the run around we have received with Health Republic Insurance.

On March [redacted], 2014, we received a Welcome Packet in the mail. However, tomorrow will be March [redacted], 2014, and we still NO insurance cards.

Do you have any status on our request for a pro rated refund? If there is a particular person, address, email, etc that would assist us in obtaining this refund request, please email us that information.

Also, you had asked us to elaborate on our statement that it would cost less money to pay for doctor services we received out of pocket. We were UNABLE to use the insurance since doctors/pharmacy wanted the card. Therefore, we only went to ONE doctor for an initial visit. Whatever the cost of his first visit was (which I have asked the Billing Department at [redacted]'s office to provide me with the charge information) would have been less than the $667.34 premium we paid for coverage.

Sincerely,

[redacted] & [redacted]

Mar ** (8 days ago)

to me

Thanks for clarifying the point on physician payment

I will resend your note

Generally they get back to people promptly ** Sent from my iPhoneDesired Settlement: We are requesting a pro-rated refund since we never received insurance cards to utilize the service.

Consumer

Response:

At this time, I have not been contacted by Health Republic Insurance of NY regarding complaint ID [redacted].

Sincerely,

[redacted]

Business

Response:

Dear [redacted]:

Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (the “Respondent”) hereby responds to the complaint filed by [redacted], (the “Complainant”) received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on April **, 2014

COMPLAINT FACTS

1. According to the complaint, on February *, 2014, the Complainant and her Husband enrolled for insurance coverage with Health Republic for an effective date of March *, 2014;

2. On February **, 2014, having not received the first Invoice to make a payment on account, the Complainant contacted a Member Service Representative (“MSR”) of Health Republic, and was informed that the Respondent could not locate her account, but that Health Republic would look into the issue;

3. On March *, 2014, the Invoice for March, 2014, arrived in the mail, and the Complainant made a payment on account, thereby effectuating her policy;

4. On March *, 2014, the payment on account of the first month’s premium cleared Health Republic’s account, and was consequently deducted from the Complainant’s account;

5. The Complainant was informed by a MSR that ID Cards would not be issued until the payment was cleared. However, notwithstanding that the payment cleared the Complainant was still not issued ID Cards.

6. As a direct result of Health Republic’s failure to issue ID Cards, the Complainant was unable to access the full spectrum of benefits guaranteed by her coverage;

7. The Complainant has made several attempts to resolve her concerns with Respondent’s MSRs, all without avail; and

8. As a result of the matters raised in paragraphs 1 through 5 hereof, the Complainant filed this complaint with the Revdex.com (“Revdex.com”).

RESPONSE

The following is a timeline describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof.

1. On April **, 2014 Respondent received the Complaint from [redacted], Revdex.com).

2. On April **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s [redacted] team, which confirmed that member enrolled in the Essential Care Platinum plan, effective March *, 2014, through to termination on March **, 2014;

3. On April **, 2014, Health Republic’s Billing and Enrollment Team confirmed that the Complainant’s payment had been received and allocated against the Complainant’s account on March *, 2014;

4. On April **, 2014, Health Republic’s vendor-partner (POMCO), confirmed that the member’s ID Cards were mailed on March **, 2014, thereby confirming the Complainant’s allegation that she was unable to access benefits for the greater part of the month of March; and

5. On April **, 2014, Health Republic received confirmation from the Billing Department that Complainant’s full refund for the month of March was processed.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

In the response that was provided to me it is stating that the company had mailed me insurance cards on March [redacted], which we never received and I had stated that in in my original letter of contact. We received a welcome package around March [redacted] with no health cards.

Further in the correspondence it states that they issued me a full refund on April **, 2014. I have never received a check in the mail. Please provide a copy of such refund or better yet re issue me a new check. Please provide me with a contact person and phone number for your billing department.

[redacted]

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

[redacted]

Consumer

Response:

At this time, my complaint, ID [redacted] regarding Health Republic Insurance of NY has been resolved.

(By clicking "OK", your complaint will be closed as Resolved.)

Sincerely,

[redacted]

Review: I signed up for their health plan which is described exactly as follows on their web page ([redacted])

"PrimarySelect Plan: Breaks down barriers to accessing the healthcare you deserve - visits to your selected primary care physician are free and you get access to the full MagnaCare PPO network of specialty care providers without a referral."

Now they tell me I cannot have my selected primary care physician.Desired Settlement: Refund of premiums and ability to purchase from a different company. I phoned them about this - call reference number [redacted]. They did not offer any resolution but the customer rep said they would fix their website. Doing so would not help me - I'm stuck with a health plan that is not as advertised.

Business

Response:

Good Afternoon,

Health Republic Insurance of New York (HRINY) recently received the above mention case and reached out to the Complainant to gather more information in effort to come to a resolution to his satisfaction. The member notified me via email to confirm that the issue in his complaint has already been addressed and resolved by HRINY. Is it possible to have the complaint withdrawn, since the issue was resolved prior to us receiving the complaint? Please see the attached email from the Complainant confirming that the issue was resolved.

Thank You,

Health Republic Insurance of New York

Review: At the end of March I signed up for health insurance for my husband and myself under the obamacare. I signed up with the ACH (electronic debit). By April I noticed that the money was not debited from my account and called and made a payment over the phone. I faxed the ACH form on April ** and followed up with a phone call to see if they received it. Again in May no payment was deducted from my checking account and I called on May ** and [redacted] and was told the problem was being resolved. Again I doubled checked that they had my right information. June came and once again no payment was deducted from my account and I called June **, June ** and June ** and was promised the problem would be resolved. As expected my July payment was not deducted and I made calls on July **, 2014, July **, 2014, July **, 2014 and even resent a copy of my bank information via fax. I am now in August and have called August *, 2014 and August *, 2014. Today I was told that a [redacted] would get back to me when they finished a busy meeting. I now owe over $2,000 to Health Republic, which I have no problem paying. I just wish someone would sort the problem out without my numerous calls every month.Desired Settlement: To set up my ACH Account properly once and for all.

Business

Response:

Thank you for your inquiry in connection with the captioned complaint, Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted] received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on August *, 2014.

COMPLAINT SUMMARY

1. According to the Complainant, she subscribed for a policy of insurance with Health Republic and elected to make her payments via ACH;

2. Sometime on or about April **, 2014, the complainant signed all such forms which were necessary in order to ensure that all future premium payments associated with the policy would be automatically deducted using the ACH mechanism;

3. Notwithstanding the foregoing, Health Republic failed and/or neglected each month that a premium payment was due to deduct same from the complainant’s bank account in accordance with her express desires and instructions;

4. According to the complainant she called several times throughout the months of May, June and July, all without avail, after receiving assurances from Health Republic that the matter would be addressed with expediently;

5. It has been several months since this issue began and according to the complainant she has yet to receive any tangible answers from Health Republic relative to the resolution of this matter; and

6. After attempts to resolve this matter without avail, the complainant filed this complaint with the Revdex.com (“Revdex.com”).

RESPONSE

The following is a timeline with references to supporting documentation describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof.

1. On August *, 2014 Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com;

2. On August *, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”), which confirmed that member enrolled for a policy of insurance with Health Republic for coverage effective February *, 2014;

3. Health Republic can advise that there was a certain data configuration issue impacting the ability of Health Republic to utilize the ACH function selected by the complainant. This issue has since been identified and resolved, and Health Republic can now make the appropriate automatic deductions on a monthly basis;

4. Health Republic apologizes for the inconvenience occasioned to the complainant. The complainant is advised to contact Health Republic using the member services line should the problem persist, though we do not anticipate that it will; and

5. Based on the contents of the foregoing, the Complainant’s matter has been satisfactorily addressed.

Review: In late November thru nystateofhealth I enrolled and selected a Health Republic plan(maketplace ID [redacted], account ID [redacted])

On 12/**/14 I received confirmation letter from nystateofhealth showing my selected Health Republic Plan

On 12/**/14 I received an invoice for $0 from Health Republic also indicating my member ID of [redacted] asking me to pay the $0 by 12/**/14.

When I logged on Heath Republic website there is no plan or temporary ID card under my account.

at my first phone inquiry from Health Republic, I was told wait few days until the plan selection inf arrive from nystateofhealth.

at my 12/**/14 phone inquiry I was told that nystateofhealth did not send the plan selection to Health Republic and I should contact them myself

and ask them to send the ET file. I called nystateofhealth and was told the error is by Health Republic and the plan selection/confirmation data was sent

to Health Republic same time I received my confirmation letter and that is how Health Republic has my info and assigned me Health Republic member ID

My follow up phonecalls and phone messages to Health Republic remains unanswered, logging on my account at Health Republic website show no amount due, no temporary ID card nor a selected

health plan when all suppose to be in effect 1/*/15Desired Settlement: Health Republic service reps should stop harrassment by giving me a runaround and asking me to go after nystateofhealth given that I also have emailed them a copy of nystateofhealth confirmation letter

showing the plan selection or the info Health Republic claims missing.

Health Republic of NY should process my registeration as it suppose to do.

Per nystateofhealth any error regarding lack of info on selected plan is by Health Republic, Health Republic should handle the matter and stop shifting the burden on me.

This is also a contact issue that Health Republic refuses to sign me up ( most likely because of age) thru stalls and runarounds by their assortments of ignorant/incompetant phone reps.

Consumer

Response:

At this time, my complaint, ID [redacted] regarding Health Republic Insurance of New York Corp. has been resolved.

(By clicking "OK", your complaint will be closed as Resolved.)

Sincerely,[redacted]

Review: I have the essential care platinum plan with Health Republic Insurance of New York through the health care exchange. According to the summary of benefits and coverage for my plan I am supposed to have a $100 copay for emergency room visits whether it's an in or out of network provider and everything else is supposed to be covered by Health Republic of New York. It says that there are no limitations or exceptions to this coverage. However, by daughter had a visit to the emergency room in March and they are refusing to cover the bill for the doctor that saw my daughter while in the emergency room. They are treating it separate from the emergency room claim. They paid out $225.10 on a $1,608.00 bill from the doctor and now I am being balance billed for the difference by the doctor. I paid the $100 copay that I was supposed to pay the hospital. Since the summary of benefits and coverage says that my only responsibility for an emergency room visit is the $100 copay and there are no limitations or exceptions to this they should cover the full bill for the doctor that saw my daughter in the emergency room. My wife did not have a choice as to which doctor saw my daughter. I was balance billed for $1,382.90 and was able to negotiate to have to pay $691.45 to settle the bill.Desired Settlement: I wish to be refunded the $691.45 that I had to pay to the [redacted], which is the company that bills on behalf of the doctor for this claim.

Consumer

Response:

At this time, I have not been contacted by Health Republic Insurance of NY regarding complaint ID [redacted].

Sincerely,

Business

Response:

[redacted]

Dear [redacted]:

Thank you for your inquiry in connection with the captioned complaint, Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted] received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on August *, 2014.

COMPLAINT SUMMARY

1. According to the Complainant, he subscribed through New York State of Health (hereinafter the “Exchange”) with Health Republic for the policy of insurance, categorized as the Essential Care Platinum Plan, through which his daughter accesses benefits as a designated dependent;

2. Sometime in or about March, 2014, his daughter was taken to the Emergency Unit, where, unbeknownst to the complainant at the time, she was provided with care by an Out-of-Network provider;

3. Health Republic has since refused to cover the full costs of benefits provided by the provider; and the complainant is now being balanced bill for the difference between the costs of medical services provided, $1,608.00, and the amount that Health Republic has elected to cover, $**5.00;

4. According to the complainant, the summary of benefits and coverage (“SBC”) connected with his policy provides that he is responsible for a co-pay of $100.00 on emergent visit, without limitations or exceptions. Accordingly, he should not have to pay for any balance billed by the provider;

5. According to the complainant he has since been able through negotiating with the provider to reduce his balance, which is now $691.45;

6. The complainant believes Health Republic is shirking its responsibility pursuant to contract by its failure to pay the outstanding balance; and

7. After attempts to resolve this matter without avail, the complainant filed this complaint with the Revdex.com (“Revdex.com”).

RESPONSE

The following is a timeline with references to supporting documentation describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof.

1. On August **, 2014 Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com;

2. On August **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”), which confirmed that member enrolled for a policy of insurance with Health Republic for coverage effective January *, 2014;

3. The team confirmed that, on March **, 2014, the member’s daughter, presented to an in-network facility, with emergent symptoms and was seen by an out-of-network (“OON”) provider;

4. On April **, 2014, Health Republic received the claims for services rendered on the abovementioned date of service totaling $1,608.00;

5. On May **, 2014 the claim was sent for negotiations and returned denied, as the provider was unwilling to negotiate the rates.

6. On June *, 2014 Health Republic paid the claim for services rendered in the amount of $**5.00, 125% of the fee Medicare would have paid in accordance to the member’s certificate of coverage;

7. On August **, 2014, the matter was again referred to the claims department based on a complaint filed with the Department of Financial Services. The claims department confirmed:

a. The member’s claims history as illustrated in Paragraphs 3 through 6.

b. The $100 copay referenced by the complainant, pertains to the ER facility Fee and not charges associated with any physician services rendered.

Business

Response:

[redacted]

Dear [redacted]:

Thank you for your correspondence concerning the above captioned member. Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint filed by “the member” with the Revdex.com (“Revdex.com”), which Revdex.com relayed to Health Republic on September **, 2014.

COMPLAINT SUMMARY

1. According to the complaint, the member enrolled for a family insurance plan with Health Republic through the New York State of Health Exchange (“the Exchange”);

2. On March **, 2014 the member’s daughter was admitted to the Emergency Room (“ER”) with difficulty breathing and was later diagnosed with [redacted],

3. The member attests that they had no choice over which physician to see once his daughter was admitted, therefore he should only be responsible for the $100 ER copay as stated in his Summary of Coverage and Benefits (“SBC”);

4. However, the member is being balance billed by the physician’s office, the difference between the $1608 charged for services rendered and the $225.10 paid by Health Republic.

5. Based on the foregoing the member filed the captioned complaint with DFS.

RESPONSE

Health Republic can confirm that the claim has been paid and a corrected Explanation of Benefits was mailed out to the member and provider on October **, 2014, adjusting the previous claim.

We believe that this matter has been satisfactorily investigated and addressed.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved.

Sincerely,