Health Republic Insurance of New York

To: The Revdex.com (Revdex.com) -
 
This is in response to the inquiry filed under complaint #[redacted].  Health Republic Insurance of New York ("Health Republic") has conducted a review of the member's account status and confirmed her coverage during 2015.  The...

member's account eligibility has been updated and communicated to the New York State of Health (NYSOH).  NYSOH has confirmed that a corrected [redacted] was sent to the member on April **, 2016.  We trust this matter has now been resolved and apologize for any inconvenience to the member.  Thank you.
 
Sincerely,
[redacted]
Health Republic Insurance of New York

I purchased health insurance from this company for my Dad in November 2014. By Dec 2014, he was informed that he got qualified for a Government subsided health insurance plan due to his most recent financial status. I contacted Health Republic around December **'s, 2014 every day via their online "Contact Us" service to cancel his account, but nobody got back to me. I finally spoke to a representative on Dec ** who told me to fax in a cancellation letter for my Dad and they would take care of it. I faxed them this letter that was confirmed on their end. I still received a bill for him on January 2015. Called them (waited at least half an hour) and was promised that they would take care and cancel his account. Got another bill in February. Called them again. Got a profuse apology and was promised that this problem would be take care immediately. Now, I got the March bill. Called them, but the waiting time was so long so I gave up. I have made at least 5 calls to their company and multiple emails to their Customer Service online but nothing has happened. I am extremely furious and tired about them. My Dad does not have this extra amount of money to spend every month. This was exactly what happened to me with [redacted] mobile service that I must called them every month for 6 months in a row but nothing fixed and I had to go to a [redacted] store and terminate my cell phone service with them immediately. Now, this company is illegally charging my Dad $405 every month, which I don't know when it will end.

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]

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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, from the Revdex.com (“Revdex.com”). The member enrolled with Health Republic, through the New York State of Health (“Exchange”), effective, January *, 2014. The member states she requested termination of the policy in January 2014 due to relocation of the complainant’s residence from Buffalo, New York to New Jersey. Since enrollment and enrollment changes are done directly with New York State of Health we included review of their call history in our investigation. Neither Health Republic nor New York State of Health have record of phone calls from the member. However, Health Republic confirms that the complainant’s policy has been terminated retroactively to January **, 2014 and any outstanding balances have been removed from the policy. Health Republic apologizes to the member for the inconvenience experienced. Respectfully, [redacted]
[redacted] Health Republic Insurance of New York

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, the Complainant enrolled with Health Republic for a policy of Insurance sometime in or about the end of November, 2013;
2.       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;
3.       The Complainant alleges that sometime in or about February, 2014, she discovered that Health Republic did not in fact record her address correctly;
4.       Based on the contents of paragraph 3 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.
5.       According to the Complainant, the Respondent answered the Respondent’s complaint by issuing her a credit for three (3) months premium;
6.       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;
7.       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;
8.       The Complainant asserts that she has been attempting to have her billing issue resolved since April **, 2014, without success; and
9.       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 with references to supporting documentation 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] ([redacted]).
2.       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;
3.       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;
4.       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-site. It 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;
5.       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 address. Health 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 subscriber. Consequently, the Complainant’s address was corrected on March *, 2014, pursuant to her direction;
6.       As of May *, 2014, the Complainant’s physical and billing addresses correspond with the information provided to the Respondent by the Complainant;
7.       On May *, 2014, the Respondent authorized its Billing and Enrollment team to process abatements for the months of: January, February and March, 2014. 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;
8.       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 abatements. Consequently, Health Republic was bound, both legally and ethically to honor the commitment made by its representative; and
9.       In view of the contents of paragraphs 3 through 8, the Complainant’s concerns have been thoroughly worked and resolved in satisfaction of the complaint.
 
Thank You,
 
[redacted]
[redacted]
Office: ###-###-####
 
[redacted]
[redacted]
[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 privileged. If 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 prohibited. If 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 message. Thank you.

This is in response to the member complaint filed under ID# [redacted] regarding status of claims for services received in November 2015.  Health Republic Insurance of New York ceased operations on November **, 2015.  The organization is currently in wind down of its operations with the...

full cooperation and involvement of its regulators.  At this time, claim payment processing is on hold as we coordinate with our regulators during this wind down phase.  We expect additional guidance to be made available in the near future regarding payment status of outstanding claims.  Sincerely,
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 [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,
[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:
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]

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 (the “Exchange”), effective, May *, 2014. According to the member he has been experiencing significant customer service issues with Health Republic, more specifically, he enrolled for a policy under which his two (2) daughters would be able to access benefits; however, although the member is current with his premium payments; Health Republic has been unable to establish current active status of his daughters under his policy to access benefits. Accordingly, the member would like a valid confirmation from Health Republic that his policy is currently covering both of his children and that member identification cards have been issued to them. Having completed our investigation, Health Republic can advise that one of the complainant’s children is currently a covered as a dependent under his family policy with Health Republic; while the other child is enrolled as a subscriber in a separate policy with Health Republic, through the Exchange effective January *, 2015. Health Republic can confirm that member ID cards were generated and mailed to the member, for his family policy on March **, 2015; additionally, ID cards were generated for the second child with respect to their separate policy on February **, 2015. Health Republic sincerely apologizes for any inconvenience experienced by the member in his attempts to confirm coverage of his dependents. However, we trust this response satisfactorily addresses the concerns raised by the member.

Revdex.com:After calling them more than 10 times. I finally got my refund. I am not happy with the way they deal with the issue. Very unprofessional? The customer reps are not well-trained. They don't even have the proper knowledge to help the customers which casued...

major delay for my refund. 
Sincerely, [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:
 
[Your Answer Here] I want to make it clear that this response is in reference to the following message from Health Repulic . Let it be known that I did not aurhorize my documention or any infomation of mine to be sent to an address other than the one I have been living for the past 9 years.   By the way I didn't fill anything out on the website. I dont use the computer for personal info.  I pyscially had spkoken to a person in Nov. 2013 to enroll in the health care act. Lets not turn the story around and make it my error. I don't appreciate that at all.  Health Repulic chose to be apart of the exchange. Therefore they need to be held responsible for the incompentacey of anyone who had signed up individuals to take part in their health care package. Health Repulic is fully aware that others would be working for  them. It is not my problem that incompentant indivduals chose to change my address making one up that led to this whole mess in the first place. For months I had been told my address was correct and it was not. Now that I have said that,  I'm greatful that Health Repulic has aknowleged the credit due to me and I will not have any premiuns due Until the month of July 2014.  Thank you
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-site. It 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;
5.       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 address. Health 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 subscriber. Consequently, the Complainant’s address was corrected on March *, 2014, pursuant to her direction; 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

To - The 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.  Sincerely,
[redacted]
Health Republic Insurance of New York

March *, 2015 VIA WEB-SUBMISSION http://newyork.Revdex.com.org/respond The Better Business...

Bureau [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 **, 2015. Health Republic can confirm that the member was an active subscriber with us effective, September *, 2014 who elected to remit premium payments via recurring [redacted]. 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 2015 plan year. Health Republic has since coordinated with the Exchange to rescind the member’s 2015 renewal and as such, authorized a refund of premiums paid. The premium payment deducted from the member’s account for January 2015 has been refunded; and the premium payment deducted for February 2015, was stopped by the member’s financial institution and therefore voided by us. Health Republic regrets any inconvenience experienced by the member; however, we trust this solution satisfactorily addresses the member’s concerns. Sincerely, Health Republic Insurance of New York

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

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

July **, 2015The Revdex.com VIA WEB: http://newyork.Revdex.com.org/respond 'Lucida Sans Unicode', sans-serif;">[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:
At this time, I have not been contacted by Health Republic Insurance of NY regarding complaint ID [redacted].
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]

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