Health Republic Insurance of New York

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

[redacted] Dear [redacted] ***: Thank you for your correspondence, dated, July **, 2014, in connection with the captioned complaintAccording to the complainant her matter has not been fully resolved for the following reasons: 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 streamUnfortunately, 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 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 hour hospital stay following child birth (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 days of the birth of the childThe Law then requires a retroactive effective date back to the date of birth of the childAs 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 **, 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

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

To: The Revdex.com (Revdex.com) This is in response to the inquiry filed under complaint # [redacted] Health Republic is currently in wind down of operations and working closely with our regulators At this time, claims processing remains in a hold status during the wind down review Please continue to refer to our website for updates on payment of claims as it becomes available Thank youSincerely, [redacted] Health Republic Insurance of New York

To - Revdex.com: This is in response to the inquiry filed under complaint # [redacted] Health Republic Insurance of New York ("Health Republic") is currently in wind down of operations and working closely with our regulators At this time, claims processing remains on hold during the wind down review Please continue to refer to our website for updates on payment of claims as it becomes available Thank you Sincerely, Stacey B [redacted] Health Republic Insurance of New York Inc

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 **, COMPLAINT FACTS According to the complaint, the Complainant enrolled with Health Republic for a policy of Insurance sometime in or about the end of November, 2013; The Complainant states that she never received a welcome package, which prompted her to contact Health Republic for an explanation, at which point the Complainant was assured by Health Republic that her enrollment was active and that the Respondent’s record of her billing address mirrored her mailing address; The Complainant alleges that sometime in or about February, 2014, she discovered that Health Republic did not in fact record her address correctly; Based on the contents of paragraph hereof, the Complainant registered a complaint with Health Republic and demanded redress for the breach (described by the Complainant as a HIPAA violation), by the Respondent According to the Complainant, the Respondent answered the Respondent’s complaint by issuing her a credit for three (3) months premium; On April *, 2014, the Complainant discovered that an unauthorized policy change was made to her account, which gave rise to an account balance of $458.24; The Complainant was informed by a CSR of the Respondent that there was a glitch in the system, which caused an error in her account balance; The Complainant asserts that she has been attempting to have her billing issue resolved since April **, 2014, without success; and As a result of the matters raised in paragraphs through 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 On April **, Respondent received the Complaint from [redacted] ( [redacted] ) On April **, 2014, Respondent began its internal review and escalated this Complaint with the Enrollment Specialist team, which confirmed that member was enrolled for coverage effective, January *, 2014; On April **, 2014, Health Republic’s Billing and Enrollment Team confirmed that the history of the Complainant’s coverage revealed that, the file received from New York State of Health (NYSOH hereinafter the “Exchange”) contained both a physical address and a billing address, the billing address appeared to be a transposition of the numbers on the numerical portion of the physical address; The file that was sent by the Exchange contains information physically inputted and supplied by the Complainant at the point that she filled out the Enrollment Form on the Exchange web-siteIt is this information which was used by the Exchange to create a file which was then sent to the Respondent to initiate and complete the Complainant’s enrollment; A further investigation into the Complainant’s matter, confirmed that due to the error, ostensibly produced and/or authored by the Complainant, two (2) Invoices were sent by Health Republic to the said addressHealth Republic can confirm that in March of 2014, it adopted a new policy of manually changing addresses that were faulty, irrespective of the origin of the fault, and which could result in bills being sent to an incorrect address upon receiving authorization to correct same from its subscriberConsequently, the Complainant’s address was corrected on March *, 2014, pursuant to her direction; As of May *, 2014, the Complainant’s physical and billing addresses correspond with the information provided to the Respondent by the Complainant; On May *, 2014, the Respondent authorized its Billing and Enrollment team to process abatements for the months of: January, February and March, Accordingly, the Complainant will not be required to make any further premiums payment until sometime in or about June **, 2014, to be allocated against the month of July, 2014; Let the record reflect that the abatements were not granted to the Complainant as a result of any HIPAA violation, as Health Republic’s risk assessment revealed that there was none, but rather because a commitment was made by one of Health Republic’s CSR’s, clothed with apparent and inherent authority, though no actual authority to approve the abatementsConsequently, Health Republic was bound, both legally and ethically to honor the commitment made by its representative; and In view of the contents of paragraphs through 8, the Complainant’s concerns have been thoroughly worked and resolved in satisfaction of the complaint Thank You, [redacted] Office: ###-###-#### [redacted] This electronic message is intended to be for the use only of the named recipient, and may contain information from Health Republic Insurance of New York that may be confidential and/or privilegedIf you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of the contents of this message is strictly prohibitedIf you have received this message in error or are not the named recipient, please notify us immediately, either by contacting the sender at the electronic mail address noted above, and please delete and destroy all copies of this messageThank you

Thank you for your correspondence concerning premium payments remitted for health insurance coverageHealth Republic Insurance of New York (“Health Republic”) hereby responds to the complaint filed by the member via the Revdex.com (“Revdex.com”), which the Revdex.com relayed to Health Republic on January *, Health Republic can confirm that a refund of premium payments totaling $was issued to the member by check on January **, 2016, to the [redacted] address listed on fileIf the member fails to receive the refund check within (15) business days, she is advised to contact [redacted] referencing the captioned Revdex.com case numberRespectfully, Member Solutions Health Republic Insurance of New York

RevDex.com: 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 ***. 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 BBB to appropriately process your response, you MUST answer the question above. Sincerely, [redacted]

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

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me I will wait to see if the check arrives by mail and keep the Revdex.com updated with the situation Sincerely, [redacted]

March *, VIA WEB-SUBMISSION http://newyork.Revdex.com.org/respond The RevDex.com [redacted] Re: Response to Complaint in the following matter: Revdex.com Complaint ID: [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 February **, Health Republic can confirm that the member was an active subscriber with us effective, September *, who elected to remit premium payments via recurring ***On November **, 2014, following receipt of a [redacted] (the “Exchange”) transaction to renew the member’s policy for plan year 2015, we continued collecting premium payments via the same mechanism for the plan yearHealth Republic has since coordinated with the Exchange to rescind the member’s renewal and as such, authorized a refund of premiums paidThe premium payment deducted from the member’s account for January has been refunded; and the premium payment deducted for February 2015, was stopped by the member’s financial institution and therefore voided by usHealth Republic regrets any inconvenience experienced by the member; however, we trust this solution satisfactorily addresses the member’s concernsSincerely, Health Republic Insurance of New York

[redacted] 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 “member”) received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on June **, COMPLAINT SUMMARY According to the member, he is a subscriber holding a policy of health insurance with Health RepublicHe asserts that on an unspecified date during the current year, he made a payment against his policy using his checking account and received confirmation that the transaction was successful; The member avers that at some point his Financial Institution (“Bank”) contacted him and informed him that his Debit/Credit card (“card”)was compromised as a result of a security breach unrelated to his transaction with Health Republic, and therefore his card was deactivated by the Bank; The member asserts that as a result of the foregoing matters, Health Republic refused to accept any further payments from his checking account, though he is unclear how the foregoing detailed incident would affect his checking account status as a form of legal tender to satisfy his monthly premium obligations with Health Republic; The member thereafter contacted Health Republic and made two (2) payments against his policy by telephone, which the member was assured were allocated against his policy; According to the member, he was informed by Health Republic that there was a glitch in the system that was preventing it from accepting his checking account but that within a month, the situation would be remediedSubsequent events have proven this statement misleading and/or false, as his checking account has yet to be readmitted as an acceptable form of tender by Health Republic; Moreover, the member asserts that he checked his account status on-line only to find that his payments have hitherto failed to be applied against his policy; and As a result of the matters raised in paragraphs through hereof, the member 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 On June **, 2014, after receiving this complaint from the Revdex.com, the matter was referred for investigation with the Respondent’s Billing and Enrollment Specialist team (“team”), who confirmed that on April *, 2014, the member’s premium payment against his policy was voided with an indicator notation, “account invalid”; As a result of the foregoing, Health Republic’s system triggered an account restriction against the member’s account, thereby effectively preventing any further premium payments being deducted using the account number of record; On June **, 2014, Health Republic removed the restriction against the member’s account, and advised him to verify his account before attempting to utilize it to satisfy his premium paymentsThe member was also advised that he was at liberty to use another account to satisfy his monthly obligations with Health Republic; and Based on the contents of the foregoing, the Complainant’s matter has been satisfactorily addressedHowever, should the member have any other concerns, it is suggested that he reach out to our Customer Service Department at our toll free number [redacted] *** Respectfully, [redacted] ***

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Dear Sir/Madam: Thank you for your inquiry in connection with the above referenced complaint IDHealth Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID ***, received on October **, 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 medicationIn review, an inquiry was received for the medication Remicade, however additional information was requestedUpon receipt of the requested information, the member was approved on 10/**/Six (6) visits were certified from 6/*/through 12/**/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 officeIn addition, two claims dated 6/**/and 8/*/had originally denied due to the request of the additional informationThese claims have since been reprocessed to pay the providerHowever, 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 framesHealth Republic will provide updated information on claims reprocessing and/or interest payment due upon completion of those claims in queueHealth Republic apologizes for the delay and to the member for the inconvenience experiencedRespectfully, Stacey Blair-G*** Vice President, Operational Policy Implementation Health Republic Insurance of New York

To - Revdex.com: This is in response to the inquiry filed under complaint # *** Health Republic Insurance of New York ("Health Republic") is currently in wind down of operations and working closely with our regulators At this time, claims processing remains on
hold during the wind down review Please continue to refer to our website for updates on payment of claims as it becomes available Thank you. Sincerely,Stacey BHealth Republic Insurance of New York Inc

*** ** *** *** *** *** *** *** *** *** ** *** *** *** * *** *** *** *** * * *** *** *** *** *** *** *** ***Dear Sir/Madam:Thank you for your inquiry in connection with the above referenced complaint IDHealth Republic
Insurance of New York (“Health Republic”) hereby responds to complaint ID ***, received on July **, by the Revdex.com (“Revdex.com”).In review, the member’s claim was received by Health Republic in January for dates of service 7/*/2014-12/**/In February and March 2015, the documents were received but could not be printed due to email formatting errorsIn April the member was contacted and informed of this, in which she emailed againThe claim was processed in May 2015, and the member was informed a check has been sentHowever the information provided was incorrectDue to a processing error, the payment processed against the wrong account. In further review, the check issued was put on a stop pay, and the original claim in question dated 7/*/2014-12/**/had denied due to timely filing in errorThis claim has been sent for reprocessingThe member has been outreached and informed of this information on 8/*/Health Republic will be in contact with the member upon completion of the claimThe recently submitted medical claim with various service dates, has been received and sent for processing as of 7/**/2015. Health Republic apologizes to the member for the inconvenience experienced

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# ***, and have determined that my complaint has NOT been resolved because:
Yes but this doesn't help me in telling medical billers who are billing me for services rendered and covered by Health Republic of NY since Oct 2015-- it is now end of March I've been in contact with regulators and so far no one is giving me helpful information and now medical billers are threatening to attack my credit "Winding down operations" isn't a suitable response to leaving me with over $40,worth of medical bills for services that are covered by Health Republic of NY Why else would one pay for insurance?At the very least, you can respond to the providers when they send bills but to date, they haven't received a response Health Republic should do the right thing, as these providers aren't listening to me.
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,
*** *** ***

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 *** received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on August *,
COMPLAINT SUMMARY
According to the Complainant, she subscribed for a policy of insurance with Health Republic and elected to make her payments via ACH;
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;
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;
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;
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
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
On August *, Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com;
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;
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 complainantThis issue has since been identified and resolved, and Health Republic can now make the appropriate automatic deductions on a monthly basis;
Health Republic apologizes for the inconvenience occasioned to the complainantThe 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
Based on the contents of the foregoing, the Complainant’s matter has been satisfactorily addressed

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me and the matter has been resolved
Sincerely,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me, payment has been received, and I consider the matter has been resolved
Sincerely,
*** ***

Thank you for your correspondence concerning premium payments remitted for health insurance coverageHealth Republic Insurance of New York (“Health Republic”) hereby responds to the complaint filed by the member via the Revdex.com (“Revdex.com”), which the Revdex.com relayed to Health Republic on
January **, Health Republic can confirm that a refund of premium payments totaling $ was issued to the member by check on January **, 2016, to the *** *** address listed on fileIf the member fails to receive the refund check within (15) business days, they are advised to contact *** referencing the captioned Revdex.com case numberRespectfully, Member Solutions Health Republic Insurance of New York