Initial Business Response /* (1000, 8, 2015/09/25) */
Dear Ms***
In response to this complaint filed against us, we provide the following response:
HealthComp, Incis not an insurance company and is not financially responsible for the payment of claimsRather, we are a licensed
third-party administrator for self-funded health plans governed by ERISAHealthComp's actions are restricted by the terms and conditions of the underlying Plan, over which we have no controlWe are also required to abide by multiple state and federal regulations, including regulations aimed at preventing fraud
In this instance the member provided a claimHis claim indicated he had a new address, but we are unable to accept a change of address unless it is on an official formThis is for the protection of the memberAny person could contact us, claim to be the member, and then change the address so that checks would be sent to that personAn official change of address form is required, and the member was advised of sameBecause no change of address was filed, and because we are required to administer claims within specified time periods under state and federal law, we were forced to send the claim check to the address on fileSimilarly, checks are not forwarded by the U.SPostal Service because that would be another easy avenue for fraud to occurInstead, the checks are returned to us by the U.SPostal Service
As previously noted, HealthComp is not financially responsible for claims paymentsAs such, we have no access to bank accounts or the restrictions placed by the actual plan on re-issuance of checksThe plan requires that re-issuance of checks are subject to a specified time period to ensure that the check has not been cashed, that a void-stop-payment can become effective, and a new check can only then be re-issuedThese requirements are consistent with the Plan Administrator's fiduciary obligations under ERISA and the stringent requirements applicable to such plans as imposed by the D.O.L./EBSA and the IRS
It is unfortunate that this member has had such a delay in receiving his benefit check from the Plan, but following plan requirements regarding change-of-address as he was advised would have prevented this situation from occurringBecause claims checks are not issued with our own funds, HealthComp has absolutely nothing to gain by delaying or denying claimsTo the contrary, situations such as this including the need to re-issue checks) only causes additional work for our office for which we are not compensated
The member should be receiving his replacement check soon, and is encouraged to promptly notify his employer and our office of a change in his address to prevent future delays
Sincerely,
*** Weeks Appeal DeptManager HealthComp Administrators
Initial Consumer Rebuttal /* (3000, 10, 2015/09/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I called Healthcomp again todayThey insist that they will be mailing the new check to my old addressI asked for a change of address form that *** *** claims I have been offeredI was informed that only my company can do thisI have put in a change of address for with my company timesI can't force them to move any faster and now I want to fill out the form the MrWeaks said I failed to do, but I can'tI would like the Revdex.com to call Healthcomp and ask them for the form since clearly mr Leaks lied about it being available to meI need a chick mailed to XX-XXX *** Ct coachella, CA XXXXXI was warned that this would happen by my coworkers and I thought they were exaggeratingThis is the worst customer service I have ever receivedI want the reimbursement that I am entitled to as they have collected my eye care medical payment all year!
Final Business Response /* (4000, 12, 2015/10/08) */
In response to the rebuttal, we renew our statement that HealthComp is not an insurance companyThe consumer is not in a contractual relationship with our office, and does not make premium, or any other, payment to usRegardless, it is our policy to attempt to assist consumers with their claims
As previously stated, due to fraud concerns and policies implemented by the consumer's Plan Sponsor (not HealthComp), we are unable to change addresses consumers directlyIt is required that the consumer change his address with his employer, who will then notify HealthCompIf we were to accept any change of address without knowing the person directly, it would be easy for someone to falsely claim they were the consumer in question and have payments redirected to them in a fraudulent mannerWe have no control over a change of address, and cannot release checks to an address that has not been verified by the employerIf the consumer had followed the procedures required of him and changed his address as soon as it occurred, there would have been no check sent to his old address and there would have been no delay
But I can advise that the address has now been verified by the employer, and a replacement check has been mailed to the consumer at his new addressWe hope this puts an end to this dispute
We also request that you update your system to reflect that we did provide a timely responseAccording to our telephone conversation, the response was received timely but you were out of the office and had not logged it into your system before your system automatically generated a letter stating we had not respondedSuch an assertion is simply inaccurate, and your records give the impression that we did not provide a response or ignored this situation
*** *** ext***
Legal Counsel
Initial Business Response /* (1000, 11, 2015/09/25) */
In response to this complaint filed against us, we provide the following response:
HealthComp, Inc. is not an insurance company and is not financially responsible for the payment of claims. Rather, we are a licensed third-party administrator...
for self-funded health plans governed by ERISA. HealthComp's actions are restricted by the terms and conditions of the underlying Plan, over which we have no control.
This member is enrolled on a Plan which provides no benefits regarding non-contracted providers unless the situations is considered an emergency. This claim was from a non-contracted provider and was not billed as an emergency. Accordingly, it was automatically rejected by the claims clearinghousenot HealthComp. The provider then called us about the denial, claimed it was an emergency, provided records on September 8, and we intervened and had the claim manually processed and paid.
In the future, it is requested that this member contact our office so that we can resolve any such issues, as we did in this case. The denial of this claim was done by a different party, and that only occurred because of the way the provider chose to bill the claim. Once the matter was brought to our attention, we were able to resolve it for the member prior to our receiving this complaint via the Revdex.com,
Sincerely,
[redacted] Appeal Dept. Manager HealthComp Administrators
Initial Consumer Rebuttal /* (3000, 13, 2015/09/28) */
(The consumer indicated he/she DID NOT accept the response from the business.)
According to the last statement that mention that the matter was resolved prior to the complaint as this time is not accurate I checked the account and the amount is still owed
Final Business Response /* (4000, 15, 2015/10/08) */
In response to the rebuttal, we renew our statement that HealthComp is not an insurance company. The consumer is not in a contractual relationship with our office, and does not make premium, or any other, payment to us. Regardless, it is our policy to attempt to assist consumers with their claims.
As to the issue of the claim itself, the claims are paid by NBC Anthem/Blue Cross. The claim has cleared our system for payment and has been released. Payment is remitted electronically from NBC to the provider. This process can take several days, and it may be several more days before the accounts receivables department processes the payment and then posts it to the patient's account. If the consumer will allow a few more days, he should see his account properly credited and should receive a statement from the provider indicating payment has been received.
If the consumer does not see the credit shortly, please contact us again and we can try to trace the payment to see where any delay is occurring. But the claim has been released from our office for payment.
We also request that you update your system to reflect that we did provide a timely response. According to our telephone conversation, the response was received timely but you were out of the office and had not logged it into your system before your system automatically generated a letter stating we had not responded. Such an assertion is simply inaccurate, and your records give the impression that we did not provide a response or ignored this situation.
Thank you,
[redacted]
Final Consumer Response /* (4200, 21, 2015/10/26) */
Healthcomp noted that they are making payments but provider been waiting.....
Initial Business Response /* (1000, 8, 2015/09/25) */
Dear Ms***
In response to this complaint filed against us, we provide the following response:
HealthComp, Incis not an insurance company and is not financially responsible for the payment of claimsRather, we are a licensed
third-party administrator for self-funded health plans governed by ERISAHealthComp's actions are restricted by the terms and conditions of the underlying Plan, over which we have no controlWe are also required to abide by multiple state and federal regulations, including regulations aimed at preventing fraud
In this instance the member provided a claimHis claim indicated he had a new address, but we are unable to accept a change of address unless it is on an official formThis is for the protection of the memberAny person could contact us, claim to be the member, and then change the address so that checks would be sent to that personAn official change of address form is required, and the member was advised of sameBecause no change of address was filed, and because we are required to administer claims within specified time periods under state and federal law, we were forced to send the claim check to the address on fileSimilarly, checks are not forwarded by the U.SPostal Service because that would be another easy avenue for fraud to occurInstead, the checks are returned to us by the U.SPostal Service
As previously noted, HealthComp is not financially responsible for claims paymentsAs such, we have no access to bank accounts or the restrictions placed by the actual plan on re-issuance of checksThe plan requires that re-issuance of checks are subject to a specified time period to ensure that the check has not been cashed, that a void-stop-payment can become effective, and a new check can only then be re-issuedThese requirements are consistent with the Plan Administrator's fiduciary obligations under ERISA and the stringent requirements applicable to such plans as imposed by the D.O.L./EBSA and the IRS
It is unfortunate that this member has had such a delay in receiving his benefit check from the Plan, but following plan requirements regarding change-of-address as he was advised would have prevented this situation from occurringBecause claims checks are not issued with our own funds, HealthComp has absolutely nothing to gain by delaying or denying claimsTo the contrary, situations such as this including the need to re-issue checks) only causes additional work for our office for which we are not compensated
The member should be receiving his replacement check soon, and is encouraged to promptly notify his employer and our office of a change in his address to prevent future delays
Sincerely,
*** Weeks Appeal DeptManager HealthComp Administrators
Initial Consumer Rebuttal /* (3000, 10, 2015/09/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I called Healthcomp again todayThey insist that they will be mailing the new check to my old addressI asked for a change of address form that *** *** claims I have been offeredI was informed that only my company can do thisI have put in a change of address for with my company timesI can't force them to move any faster and now I want to fill out the form the MrWeaks said I failed to do, but I can'tI would like the Revdex.com to call Healthcomp and ask them for the form since clearly mr Leaks lied about it being available to meI need a chick mailed to XX-XXX *** Ct coachella, CA XXXXXI was warned that this would happen by my coworkers and I thought they were exaggeratingThis is the worst customer service I have ever receivedI want the reimbursement that I am entitled to as they have collected my eye care medical payment all year!
Final Business Response /* (4000, 12, 2015/10/08) */
In response to the rebuttal, we renew our statement that HealthComp is not an insurance companyThe consumer is not in a contractual relationship with our office, and does not make premium, or any other, payment to usRegardless, it is our policy to attempt to assist consumers with their claims
As previously stated, due to fraud concerns and policies implemented by the consumer's Plan Sponsor (not HealthComp), we are unable to change addresses consumers directlyIt is required that the consumer change his address with his employer, who will then notify HealthCompIf we were to accept any change of address without knowing the person directly, it would be easy for someone to falsely claim they were the consumer in question and have payments redirected to them in a fraudulent mannerWe have no control over a change of address, and cannot release checks to an address that has not been verified by the employerIf the consumer had followed the procedures required of him and changed his address as soon as it occurred, there would have been no check sent to his old address and there would have been no delay
But I can advise that the address has now been verified by the employer, and a replacement check has been mailed to the consumer at his new addressWe hope this puts an end to this dispute
We also request that you update your system to reflect that we did provide a timely responseAccording to our telephone conversation, the response was received timely but you were out of the office and had not logged it into your system before your system automatically generated a letter stating we had not respondedSuch an assertion is simply inaccurate, and your records give the impression that we did not provide a response or ignored this situation
*** *** ext***
Legal Counsel
Initial Business Response /* (1000, 11, 2015/09/25) */
In response to this complaint filed against us, we provide the following response:
HealthComp, Inc. is not an insurance company and is not financially responsible for the payment of claims. Rather, we are a licensed third-party administrator...
for self-funded health plans governed by ERISA. HealthComp's actions are restricted by the terms and conditions of the underlying Plan, over which we have no control.
This member is enrolled on a Plan which provides no benefits regarding non-contracted providers unless the situations is considered an emergency. This claim was from a non-contracted provider and was not billed as an emergency. Accordingly, it was automatically rejected by the claims clearinghousenot HealthComp. The provider then called us about the denial, claimed it was an emergency, provided records on September 8, and we intervened and had the claim manually processed and paid.
In the future, it is requested that this member contact our office so that we can resolve any such issues, as we did in this case. The denial of this claim was done by a different party, and that only occurred because of the way the provider chose to bill the claim. Once the matter was brought to our attention, we were able to resolve it for the member prior to our receiving this complaint via the Revdex.com,
Sincerely,
[redacted] Appeal Dept. Manager HealthComp Administrators
Initial Consumer Rebuttal /* (3000, 13, 2015/09/28) */
(The consumer indicated he/she DID NOT accept the response from the business.)
According to the last statement that mention that the matter was resolved prior to the complaint as this time is not accurate I checked the account and the amount is still owed
Final Business Response /* (4000, 15, 2015/10/08) */
In response to the rebuttal, we renew our statement that HealthComp is not an insurance company. The consumer is not in a contractual relationship with our office, and does not make premium, or any other, payment to us. Regardless, it is our policy to attempt to assist consumers with their claims.
As to the issue of the claim itself, the claims are paid by NBC Anthem/Blue Cross. The claim has cleared our system for payment and has been released. Payment is remitted electronically from NBC to the provider. This process can take several days, and it may be several more days before the accounts receivables department processes the payment and then posts it to the patient's account. If the consumer will allow a few more days, he should see his account properly credited and should receive a statement from the provider indicating payment has been received.
If the consumer does not see the credit shortly, please contact us again and we can try to trace the payment to see where any delay is occurring. But the claim has been released from our office for payment.
We also request that you update your system to reflect that we did provide a timely response. According to our telephone conversation, the response was received timely but you were out of the office and had not logged it into your system before your system automatically generated a letter stating we had not responded. Such an assertion is simply inaccurate, and your records give the impression that we did not provide a response or ignored this situation.
Thank you,
[redacted]
Final Consumer Response /* (4200, 21, 2015/10/26) */
Healthcomp noted that they are making payments but provider been waiting.....