HealthSmart

Lisa W [redacted] < [redacted] >12:PM (hour ago)tomeHello Ms [redacted] :Our office is unable to identify this insured Could you please advise if you could have the insured submit a copy of the i.dcard or can we email and request?Thank you,LisaLisa W [redacted] SrClaims ExaminerHealthSmart Benefit Solutions [redacted] ** [redacted] [redacted] * [redacted] [redacted]

(Revdex.com copied from original fileSee attached document.)Dear Ms***:Our office is in receipt of the above referenced complaintsUnitedHealthcare Insurance Company is the insurance carrier for *** University's Student Health Insurance PlanHealthSmart Benefit Solutions is the Claims
Administrator for the planThis is fully insured, one-year, non-renewable term injury and sickness plane.*** University has confirmed that Ms*** has been insured with the medical plan since August 12, The claims for services rendered at the *** Student Health Center were received for the dates of service 12/16/in the amount of $which has been paid in full to the provider of service.Our office corresponded via email with Ms*** on 3/10/in which she responded that the services were rendered on 12/16/as indicated above, and that she was unfamiliar with HealthSmart Benefit Solutions role in the processing of the claims and now understands the process.Ms*** indicated in the email that she will withdraw the complaints.If you have any additional questions, please do not hesitate to contact our office.Sincerely,Lisa ** W***

(Revdex.com copied from original document.)HealthSmart Benefit Solutions, Inc("HBS") hereby submits its response to the above referenced complaintFor purposes of clarification, HBS is the Third Party Administrator for the Soprema, IncSelf-Insured Health and Welfare Plan (the "Plan"), and as such,
administers benefits based on the Plan's provisions, limitations, and exclusions in effect at the time services were processedHBS, however, does not have the responsibility to fund claims payments, and thus, is only permitted to release payments to providers after receiving funding and authorization from the Plan.The treatment received from Tacoma Treatment for services rendered to Ms*** after 12/10/have been determined to not be medically necessary.The information received from the treatment center was forwarded for a first level appeal and a second level appeal which upheld the denial stated that the maximum therapeutic benefit was reached on 12/10/15.Ms*** requested an external review of the denied services.The external review was performed by an MD who is Board Certified in *** with additional expertise in *** *** who indicated the following:"There is no objective medical evidence in the form of treatment notes or office visit notes which support the need for methadone maintenance treatmentThere is documentation in the form of letters from the attending physician and a letter from the treating *** which states that the patient has *** *** and is in treatment at a treatment programHowever, there are no medical documents in the form of office visit notes, treatment notes, physician orders, nursing notes, medication administration logs, laboratory test results, or other documents which substantiate the diagnosis, treatment plan, progress, or prognosis of the patient....."The treatment has been reviewed as a first and second level appeal and as an external review.based on the reviews the information received does not substantiate the medical necessity of the treatment.The utilization management department requested the above information previously with no responseAnother request for this information has been sent to the provider of service from our officeOnce the information is received an additional review will be completed.I hope this letter will serve to clarify this matterIf you have any additional questions, please do not hesitate to contact our officeSincerely,Lisa W***

Lisa W[redacted]<[redacted]>12:10 PM (1 hour ago)tomeHello Ms. [redacted]:Our office is unable to identify this insured.  Could you please advise if you could have the insured submit a copy of the i.d. card or can we email and request?Thank you,LisaLisa W[redacted]Sr. Claims...

ExaminerHealthSmart Benefit Solutions[redacted]

(Revdex.com Copied from original document, see attached file for full response.)
Dear Ms. [redacted]:
Our office is in receipt of the above referenced complaint. UnitedHealthcare Insurance Company is the insurance carrier for The Ohio State University's Student Health Insurance Plan. HealthSmart Benefit...

Solutions is the Claims Administrator for the Plan. This is a fully insured, on-year, non-renewable term injury and sickness plan.
the billing for services rendered by Franklin Township Fire Department in the amount of $814.37 was initially received in our office on 2/24/16. The claim was denied advising that the billing needed to be sent to the PPO Network United HealthCare for potential repricing. Please find attached the explanations of benefit issued to the provider of service and the insured.
The claim was received in our office on 6/6/16 indicationg that the provider of service was non-network with the UnitedHealthcare PPO Network. Our office contacted the Franklin Township Fire Department to negotiate a discount which was unsuccessful. The claim was processed for payment on 7/5/16. Please find attached a copy of the explanation of benefit for your records.
If you have any additional questions, please do not hesitate to contact our office.
Sincerely,
Lisa ** W[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.