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: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]

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 and the matter has been resolved.
Sincerely,
[redacted]

[redacted]:
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. All refunds were granted.
Sincerely,
[redacted]

March*, 2015VIA WEB-SUBMISSION http://newyork.Revdex.com.org/respondThe Revdex.com [redacted] [redacted] [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”), relayed to us on March *, 2015.Health Republic can confirm that the member was an active subscriber with us for plan year 2014. The member elected not to renew her membership for plan year 2015. Upon this notification Health Republic coordinated with the Exchange to terminate the member, effective, January *, 2015. During this time a premium payment had been inadvertently deducted from the member’s account. However, we can confirm a refund in the amount of $407.92 payable to the member was processed on March *, 2015 via [redacted]. Health Republic sincerely regrets any inconvenience experienced; however, we trust that the resolution meets the member’s satisfaction.Sincerely,Health Republic Insurance of New York

[redacted] 
[redacted] 
Dear [redacted]...

[redacted]:
Thank you for your correspondence concerning the above captioned member. Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted], which Revdex.com relayed to Health Republic on October **, 2014. 
COMPLAINT SUMMARY
1. According to the complaint, while on vacation the member was admitted to the Emergency Room (“ER”) with [redacted].
2. The member states that the claims for services rendered have since been denied by Health Republic as the provider of service is out-of-network (“OON”).
3. The member has been balanced billed in the amount of $816.41, which Health Republic refuses to pay.
4. Based on the foregoing the member filed the captioned complaint with DFS.
RESPONSE
1. On October **, 2014 Health Republic received the complaint from the Revdex.com.
2. On the foregoing date the complaint was forwarded to the claims department for further investigation. The claims department later confirmed that the claim in question was correctly paid in accordance to the member’s certificate of coverage.
3. As the provider is not participating with Health Republic’s MagnaCare Extra network it is within their purview to balance bill the member. As a consumer oriented and operated plan, Health Republic strives to provide quality service that serves our members best interests. As such Health Republic is committed to working with the provider’s office to learn if any further assistance is available for the member. We believe that this issue has been satisfactorily investigated and addressed.
6.3.3 Payments Relating to Emergency Services Rendered
The amount We pay a Non-Participating Provider for Emergency Services will be the greater of: (1) the amount We have negotiated with Participating Providers for the Emergency Service received (and if more than one amount is negotiated, the median of the amounts); (2) 100% of the Allowed Amount for Services provided by a Non-Participating Provider (i.e., the amount We would pay in the absence of any Cost-Sharing that would otherwise apply for services of Non-Participating Providers); or (3) the amount that would be paid under Medicare. The amounts described above exclude any Copayment or Coinsurance that applies to Emergency Services provided by a Participating Provider.
You are responsible for any Deductible, Coinsurance, or Copayment.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted].
After additional intervention on my end, my problem has been satisfactorily resolved by the company. Thanks for your assistance.
/>
Sincerely,
[redacted]

Unicode', sans-serif; color: #333333;">[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.
[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]...

[redacted]

[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[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 **, 2014.
COMPLAINT SUMMARY
1. According to the member, his account was charged a total of eight (8) times under and pursuant to his policy of insurance with Health Republic. That notwithstanding, the Complainant has yet to receive health coverage;
2. The member claims that he has called Health Republic on several occasions and has been provided with varying responses on each occasion; and
3. As a result of the matters raised in paragraphs 1 through 2 hereof, the member 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 June **, 2014 Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com;
2. On June **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”), which confirmed that member enrolled for coverage effective, January *, 2014;
3. The Complainant has since made his binder cover payment, and two (2) premiums payments to maintain his policy, for an aggregate of three (3) payments;
4. Contrary to what has been asserted by the member to date, he has accessed care under and pursuant to his policy of insurance with Health Republic a total of five (5) times, the first occurring on January **, 2014, and the last on February **, 2014;
5. On June **, 2014, The Respondent received confirmation from New York State of Health (NYSOH hereinafter the “Exchange) that the member called on several occasions complaining that he was deprived of the benefits of his policy, notwithstanding that he had made his premium payments timely. The Exchange assured the member that he presented as enrolled on the Exchanges database;
6. The Respondent has confirmed that after several attempts to regularize his account status with Health Republic the member simply opted not to use the policy of insurance in order to avoid being held responsible for an amount in excess of his commitments under his policy;
7. In view of the foregoing, the Respondent has terminated the member’s policy effective February **, 2014; and has re-enrolled the member for coverage effective July *, 2014; and
8. Based on the contents of the foregoing, the member’s matter has been satisfactorily addressed. However, 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]

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:

 
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 2016. 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 $40,000 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,
[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”) on January **, 2015. Health Republic received a transaction from the New York State of Health (“NYSOH”) enrolling the member for coverage effective, April *, 2014. Health Republic has since coordinated with NYSOH to cancel the member’s policy, effective September **, 2014 as per his request. The billing associated with his account shows a zero balance. On February *, 2015, we contacted the member and advised him of the current status of his account to which he expressed satisfaction with steps taken to resolve the matter. Health Republic apologizes for the inconvenience experienced by the member and we trust this solution satisfactorily addresses the member’s concerns. Sincerely, Health Republic Insurance of New York

Revdex.com:At this time, my complaint, ID [redacted] regarding Health Republic Insurance of New York has been resolved.
(By clicking "OK", your complaint will be closed as Resolved.)
Sincerely,[redacted]

July **, 2015The 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 July *, 2015 by the Revdex.com (“Revdex.com”).On January **, 2015 the member states she received a test in which she was advised by a Health Republic customer service representative, would be covered as routine. Thereafter, the member was informed she had a balance owed from her visit. Per our review, the claim was originally processed in error on 3/**/2015, leaving the member a balance. The claim has since been reprocessed and paid in full on 7/*/2015, with no balance owed by the member. Health Republic apologizes to the member for the inconvenience experienced. Respectfully, Stacey B[redacted] Vice President, Operational Policy ImplementationHealth 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:

There is no way to log into an account on the website to see the update of my claims. There is no phone number to call, and no correspondence with the company. The claims that have not been paid are going to collections soon if they do not pay. They should not be on hold, as they have been processing for NINE MONTHS.
 In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

[redacted]
[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

[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.

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 June *, 2015 by the Revdex.com (“Revdex.com”). The member enrolled with Health...

Republic, effective January *, 2014. The member states, in December 2014 she requested to terminate coverage effective January 2015 and continues to receive premium invoices. The member’s complaint includes reference of Health Republic requesting coverage terminations be submitted via fax and she believes Health Republic needs to consider more progressive ways to terminate coverage. Health Republic immediately terminated the member’s coverage retroactive to January 2015 and reconciled the account balance to zero, upon receipt of this written complaint. Since Health Republic continues to be dedicated to the mission of providing affordable healthcare to all New Yorkers we appreciate the suggestion of considering other methods to terminate coverage. Health Republic apologizes to the member for the inconvenience experienced. Respectfully, [redacted], [redacted], [redacted]Health Republic Insurance of New York

Thank you for your correspondence concerning premium payments remitted for health insurance coverage. Health 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 *, 2016. Health Republic can confirm that a refund of premium payments totaling $319.78 was issued to the member by check on January **, 2016, to the [redacted] address listed on file. If the member fails to receive the refund check within (15) business days, she is advised to contact [redacted] referencing the captioned Revdex.com case number. Respectfully, 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 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]