Initial Business Response / [redacted] (1000, 11, 2015/09/25) */ 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 control This member is enrolled on a Plan which provides no benefits regarding non-contracted providers unless the situations is considered an emergencyThis claim was from a non-contracted provider and was not billed as an emergencyAccordingly, it was automatically rejected by the claims clearinghousenot HealthCompThe 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 caseThe denial of this claim was done by a different party, and that only occurred because of the way the provider chose to bill the claimOnce 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 DeptManager HealthComp Administrators Initial Consumer Rebuttal / [redacted] (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 / [redacted] (4000, 15, 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 to the issue of the claim itself, the claims are paid by NBC Anthem/Blue CrossThe claim has cleared our system for payment and has been releasedPayment is remitted electronically from NBC to the providerThis 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 accountIf 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 occurringBut 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 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 Thank you, [redacted] Final Consumer Response / [redacted] (4200, 21, 2015/10/26) */ Healthcomp noted that they are making payments but provider been waiting
Initial Business Response / [redacted] (1000, 11, 2015/09/25) */ 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 control This member is enrolled on a Plan which provides no benefits regarding non-contracted providers unless the situations is considered an emergencyThis claim was from a non-contracted provider and was not billed as an emergencyAccordingly, it was automatically rejected by the claims clearinghousenot HealthCompThe 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 caseThe denial of this claim was done by a different party, and that only occurred because of the way the provider chose to bill the claimOnce 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 DeptManager HealthComp Administrators Initial Consumer Rebuttal / [redacted] (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 / [redacted] (4000, 15, 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 to the issue of the claim itself, the claims are paid by NBC Anthem/Blue CrossThe claim has cleared our system for payment and has been releasedPayment is remitted electronically from NBC to the providerThis 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 accountIf 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 occurringBut 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 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 Thank you, [redacted] Final Consumer Response / [redacted] (4200, 21, 2015/10/26) */ Healthcomp noted that they are making payments but provider been waiting