Initial Business Response / [redacted] (1000, 5, 2015/05/13) */ May 13, Revdex.com NWabash Avenue Suite Chicago, IL 60611- Re: Your Complaint Number: XXXXXXXX Consumer: [redacted] Dear Ms [redacted] : This letter is being written in response to your inquiry of May 7, The policy Ms [redacted] discussed in her inquiry to your office was issued on November 10, As her loss occurred within the first year of the policy issue date, our Claim Department began a standard pre-existing condition investigationSuch investigations begin by writing to the insured for a signed and dated authorization and often include a request for a list of physician's names After her claim was initially received in our mail room on March 3, 2015, the adjustor wrote to Ms [redacted] and asked her for a signed authorization and a list of physician's namesThe requested information was received on March 30, and on April 2, letters were mailed to two of her doctorsAt that time, a courtesy letter was mailed to Ms [redacted] regarding the claim status After sending a second request letter to one of her doctors on April 20, and an additional request by fax to the same doctor on April 21, 2015, the records from that doctor were received on April 24, On May 1, 2015, the claim file was sent to our Medical Director for review On May 8, 2015, a claim benefit check was issued under the new policyHowever, in reviewing the file for this response, a claim manager noted that an incorrect benefit was providedAn additional payment was issued to Ms***The combined total of the initial (incorrect) payment and the additional payment served to provide the maximum benefit payable for her loss under her new policy(It is also important to note that an additional benefit was provided under another policyThe additional benefit was included in the initial benefit check of May 8, 2015.) Ms [redacted] also indicated that she was receiving multiple emailsThese emails were sent through our Vodafone system, a system that was designed to provide automatic claim updatesThe Vodafone case was closed on May 13, 2015, so Ms [redacted] will not be receiving any more emails regarding her claim We regret that Ms [redacted] believed that her claim was being delayed intentionallyPlease assure her that a routine claim investigation took place because her loss happened to be within the first year of the policy's issue dateOnce the response was received from her doctor, the records were forwarded to our Medical Director for review and her claim was paid While we trust that this letter satisfactorily responds to her inquiry, if you have any questions, or if I can be of further assistance, please let me know Sincerely, [redacted] Binder, Senior Coordinator Combined Life Insurance Company of New York Consumer Service Investigations Direct: (XXX) XXX-XXXX Toll Free: (XXX) XXX-XXXX / Ext XXXXX FAX: (XXX) XXX-XXXX Case #XXXXXXX
Initial Business Response / [redacted] (1000, 5, 2015/01/30) */ January 30, 2015 [redacted] RevDex.com 330 Lower Wabash Avenue Chicago, IL 60611 Re: Your Case #XXXXXXXX Dear Ms. [redacted] This letter is being written in response to your letter of January 26, 2015. In her... statement to your office, Ms. [redacted] indicated that she made several attempts to cancel a policy with a monthly premium amount of $117.83, but that the advice she was given by our call center was to contact her bank to prevent the $117.83 payment from being collected. She then said that we split the payment and collected a partial payment of $75.83. We investigated this matter and learned the following. On January 9, 2015, Ms. [redacted] met with two of our agents. She applied for a SickPay Plus Policy with a monthly premium of $117.83 through agent [redacted] and an Accident and Sickness Protector Policy with a monthly premium of $75.83 through agent [redacted] Both agents met with her at the same time. The majority of our applications are now completed electronically through iPads. When an application is completed, the agent simply uploads the application to our home office for immediate processing. However, technical difficulties prevented Mr. [redacted] from submitting the application for the SickPay Plus Policy. The software in his computer ultimately had to be reloaded. When the application software was reloaded, all of the data for the SickPay Plus Policy application was lost. As a result, no premium payment was ever collected for this policy. Mr. [redacted] told our office that when he went back to meet with Ms. [redacted] in order to complete a new application, she said that she had already cancelled the coverage and went with another company. For the record, Ms. [redacted] was able to successfully upload the application for the Accident and Sickness Protector Policy. In view of the above, we did not split a premium payment and/or collect a partial payment. Instead, the $75.83 collection was the total premium amount for one of the two policies she applied for on January 9, 2015. The main challenge associated with this situation is that we had no record of the SickPay Plus Policy. While Ms. [redacted] had paperwork associated with the policy in her possession, we had no official record of it on this end when she called to cancel it because the application was never submitted to our company (for the reason discussed above.) In the absence of documentation on our end, our call center recommended that she order a stop payment through her bank. We note that a refund of the initial premium payment of $75.83 for her Accident and Sickness Protector Policy was processed and mailed to her on January 24, 2015. However, several days later, we note that we also mailed a letter to her to let her know that her bank did not honor our initial premium collection attempt. Based on this, it appears that the refund check was mailed to Ms. ***, in error. Kindly ask her to mail the check back to our company at: Combined Insurance Company PO Box 6703 Scranton, PA 18505-0703 Ms. [redacted] mentioned that we mailed her a premium notice where we requested $455.00. When the premium draft process is discontinued in the absence of a written request to cancel the process, a premium notice requesting a semi-annual payment is automatically generated and mailed. It was for this reason such a notice was mailed to her. She may simply disregard the notice at this point as the policy is no longer in force. While we trust that the above explanation successfully addresses her inquiry, please ask Ms. [redacted] to accept our apologies for any concern or inconvenience she may have experienced as a result of the challenges she encountered when she attempted to cancel her coverage. If you have any questions, please let me know. Sincerely, [redacted] Senior Coordinator Combined Insurance Company of America Consumer Service Investigations Direct: (XXX) XXX-XXXX Toll Free: (XXX) XXX-XXXX / Ext XXXXX FAX: (XXX) XXX-XXXX Case #XXXXXXX
Initial Business Response / [redacted] (1000, 5, 2015/04/06) */ Dear Ms [redacted] Thank you for your correspondence regarding your Office's case #:XXXXXXXX Please be advised that due to HIPAA protected information, our Claims department responded directly to the consumer's concerns, as expressed in his complaint, on April 2, If we can be of further assistance to you, please let us know Sincerely, [redacted] Combined Insurance Company of America Consumer Service Investigations (XXX)XXX-XXXX Direct (XXX)XXX-XXXX Ext XXXXX Toll Free (XXX)XXX-XXXX FAX Case #XXXXXXX
Initial Business Response /* (1000, 5, 2015/03/03) */
To: *** *** Dispute Resolution Specialist
RE: Your Complaint #: XXXXXXXX
Consumer: *** ***
Dear Ms***
In accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to
protect all confidential policyholder health information, specifically regarding claims, while continuing to provide high quality service to our customersAs the disclosure of Ms***' claim information is strictly prohibited, we are unable to provide any further information to you at this timeHowever, be assured that we will respond directly to Ms***, under separate cover, addressing her concerns
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us
Sincerely,
*** L***
Senior Coordinator
Combined Life Insurance Company of New York
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX ExtXXXXX
(fax) X-XXX-XXX-XXXX
Initial Business Response /* (1000, 5, 2015/04/20) */
To: *** *** Dispute Resolution Specialist
RE: Your Complaint #: XXXXXXXX
Consumer: *** ***
Dear Ms***
In accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to
protect all confidential policyholder health information, specifically regarding claims, while continuing to provide high quality service to our customers
As the disclosure of Mr***'s claim information is strictly prohibited, we are unable to provide any further information to you at this timeHowever, be assured that our Claim Department has contacted Mr*** directly to discuss his claim and we have honored his request for cancellation of his policies
If you have any questions, please do not hesitate to contact us
Sincerely,
*** L***
Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX ExtXXXXX
(fax) X-XXX-XXX-XXXX
Initial Business Response /* (1000, 5, 2015/01/05) */
January 5, 2015
[redacted]
Revdex.com
330 Lower Wabash Avenue
Chicago, IL 60611
Re: Your Case #XXXXXXXX
Dear Ms. [redacted]
This letter is being written in response to your inquiry, which we received on December 29,...
2014.
In cases where a policy is in danger of lapsing, outgoing calls are made to a customer in order to discuss possible payment options, which may simply include collecting a payment over the telephone or securing a correct credit card or bank account number for automatic draft purposes. The telephone number of the outgoing unit responsible for making such calls is the toll-free number Ms. [redacted] referenced in her inquiry to your office.
In cases where a policy appears to be nearing a state of lapse, our call center will make outgoing calls on 10 business days in the period of one month, with up to three calls on each of the 10 days. However, they are also required to leave voicemail messages. That being said, Ms. [redacted]' statement to your office regarding the lack of voicemail messages and the frequency of calls concerned us. Let me assure you, we forwarded a formal report to call center management regarding this matter and we have asked them to take any necessary corrective action.
According to our records, Ms. [redacted]' telephone number was added to our internal "Do Not Call" list in response to her December 17, 2014 call to our call center. Ms. [redacted] mentioned that she received another call the very next day, December 18, 2014. While it can take up to 48 hours before a number is removed from our system, according to our records, no further calls were made after December 18, 2014, so it appears that her number was successfully added to our "Do Not Call" list.
While we regret any concern or inconvenience that Ms. [redacted] may have experienced as a result of this situation, we are thankful that she brought this matter to our attention as inquiries of this nature enable us to identify areas in need of improvement.
We trust that this letter satisfactorily responds to your inquiry. If you have any questions, or if I can be of further assistance, please let me know.
Sincerely,
[redacted] Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
Direct: (XXX) XXX-XXXX
Toll Free: (XXX) XXX-XXXX / Ext XXXXX
FAX: (XXX) XXX-XXXX
Case #XXXXXXX
October 20, 2015
Revdex.com
330 N. Wabash Avenue, Suite 3120
Chicago, IL 60611-7621
Complaint ID#: [redacted]
Dear Revdex.com:
This letter is being written in response to your email of October 13, 2015.
While our policies have been traditionally sold in person...
by way of door-to-door sales, our home office is also reaching out to customers as well. In brief, we contact current and past customers in order to discuss new policies. However, it is not our intention to overwhelm or alienate a customer.
Based on Ms. [redacted]' report, it appears that we were rather aggressive in our approach. Please ask Ms. [redacted] to accept our apologies for any concern or inconvenience she may have experienced as a result of this situation.
In accordance with Ms. [redacted]' request, we have taken steps to discontinue all future contact with her. Specifically, we have informed sales management that all field agent contact is to be stopped and we have also flagged her former policy record to prevent telephone and mail contact with her.
While we trust that this letter satisfactorily responds to your inquiry, if you have any questions, or if I can be of further assistance, please let me know.
Sincerely,
[redacted], Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
Direct: ([redacted]
Toll Free: ([redacted]
FAX: ([redacted]
Case #[redacted]
October 27, 2015
Revdex.com Serving Chicago & Northern Illinois
330 N Wabash Ave Suite 3120
Chicago IL 60611-7621
[redacted]
[redacted]
To whom it may concern:
Thank you for contacting us regarding the additional correspondence you received from the consumer, in reference to your Complaint Case [redacted] listed above.
We understand that the consumer indicated that she did not accept the response from the business and there was no response received. Our Claims department confirmed that the letter was mailed to [redacted] on October 16, 2015, and we regret to hear that it was not received. Today, another letter was mailed to [redacted] explaining what information is needed in order for us to review her claim for benefits. Due to HIPAA, we are unable to forward copies of these letters to your office without a HIPAA authorization from the insured.
Should you have any questions, or if we may be of further assistance, please let us know.
Sincerely,
Initial Business Response /* (1000, 5, 2015/04/06) */
Dear Ms. [redacted]
Thank you for your correspondence regarding your Office's case #:XXXXXXXX.
Please be advised that due to HIPAA protected information, our Claims department responded directly to the consumer's concerns, as expressed in his...
complaint, on April 2, 2015.
If we can be of further assistance to you, please let us know.
Sincerely,
[redacted]
Combined Insurance Company of America
Consumer Service Investigations
(XXX)XXX-XXXX Direct
(XXX)XXX-XXXX Ext XXXXX Toll Free
(XXX)XXX-XXXX FAX
Case #XXXXXXX
Initial Business Response /* (1000, 5, 2015/01/30) */
January 30, 2015
[redacted]
Revdex.com
330 Lower Wabash Avenue
Chicago, IL 60611
Re: Your Case #XXXXXXXX
Dear Ms. [redacted]
This letter is being written in response to your letter of January 26, 2015.
In her...
statement to your office, Ms. [redacted] indicated that she made several attempts to cancel a policy with a monthly premium amount of $117.83, but that the advice she was given by our call center was to contact her bank to prevent the $117.83 payment from being collected. She then said that we split the payment and collected a partial payment of $75.83.
We investigated this matter and learned the following.
On January 9, 2015, Ms. [redacted] met with two of our agents. She applied for a SickPay Plus Policy with a monthly premium of $117.83 through agent [redacted] and an Accident and Sickness Protector Policy with a monthly premium of $75.83 through agent [redacted] Both agents met with her at the same time.
The majority of our applications are now completed electronically through iPads. When an application is completed, the agent simply uploads the application to our home office for immediate processing. However, technical difficulties prevented Mr. [redacted] from submitting the application for the SickPay Plus Policy. The software in his computer ultimately had to be reloaded. When the application software was reloaded, all of the data for the SickPay Plus Policy application was lost. As a result, no premium payment was ever collected for this policy. Mr. [redacted] told our office that when he went back to meet with Ms. [redacted] in order to complete a new application, she said that she had already cancelled the coverage and went with another company. For the record, Ms. [redacted] was able to successfully upload the application for the Accident and Sickness Protector Policy.
In view of the above, we did not split a premium payment and/or collect a partial payment. Instead, the $75.83 collection was the total premium amount for one of the two policies she applied for on January 9, 2015.
The main challenge associated with this situation is that we had no record of the SickPay Plus Policy. While Ms. [redacted] had paperwork associated with the policy in her possession, we had no official record of it on this end when she called to cancel it because the application was never submitted to our company (for the reason discussed above.) In the absence of documentation on our end, our call center recommended that she order a stop payment through her bank.
We note that a refund of the initial premium payment of $75.83 for her Accident and Sickness Protector Policy was processed and mailed to her on January 24, 2015. However, several days later, we note that we also mailed a letter to her to let her know that her bank did not honor our initial premium collection attempt. Based on this, it appears that the refund check was mailed to Ms. [redacted], in error. Kindly ask her to mail the check back to our company at:
Combined Insurance Company
PO Box 6703
Scranton, PA 18505-0703
Ms. [redacted] mentioned that we mailed her a premium notice where we requested $455.00. When the premium draft process is discontinued in the absence of a written request to cancel the process, a premium notice requesting a semi-annual payment is automatically generated and mailed. It was for this reason such a notice was mailed to her. She may simply disregard the notice at this point as the policy is no longer in force.
While we trust that the above explanation successfully addresses her inquiry, please ask Ms. [redacted] to accept our apologies for any concern or inconvenience she may have experienced as a result of the challenges she encountered when she attempted to cancel her coverage.
If you have any questions, please let me know.
Sincerely,
[redacted] Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
Direct: (XXX) XXX-XXXX
Toll Free: (XXX) XXX-XXXX / Ext XXXXX
FAX: (XXX) XXX-XXXX
Case #XXXXXXX
Initial Business Response /* (1000, 7, 2015/04/06) */
Our previous response included a "typo" in the first paragraph which listed an incorrect policyholder name. Below is our corrected response.
To: [redacted], Dispute Resolution Specialist
RE: Your Complaint #: XXXXXXXX
Consumer: [redacted]...
[redacted]
Dear Ms. [redacted]
In accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all confidential policyholder health information, specifically regarding claims, while continuing to provide high quality service to our customers. As the disclosure of Mr. [redacted]'s claim information is strictly prohibited, we are unable to provide any further information to you at this time.
However, be assured that we have mailed correspondence directly to Mr. [redacted], addressing the concerns expressed in his inquiry to you. He should receive our letter within the next 5-10 business days.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us.
Sincerely,
[redacted] L. [redacted]
Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX Ext. XXXXX
(fax) X-XXX-XXX-XXXX
Complaint: [redacted]
I am rejecting this response because: Their response did not solve the issue. I am withholding acceptance until I get the letter from Combined Insurance. If this correspondence is any thing like other correspondence I will either not receive a letter or it will take a month to get it.
Sincerely,
[redacted]
Our records indicate that a voicemail message was left with the customer this afternoon.If there are further questions, please let us know.Thanks,COMBINED INSURANCE COMPANY OF AMERICA
Dear Customer:Thank you for your recent inquiry. You should be hearing from our Claims department shortly regarding your concern.If you should have any questions in the meantime, please contact us at 1-800-[redacted] for further assistance. Combined Insurance
Initial Business Response /* (1000, 5, 2015/06/26) */
RE: Your Complaint # XXXXXXXX:
Consumer: [redacted] L [redacted]
To Whom It May Concern:
In accordance with our Privacy Pledge as well as HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all...
confidential policyholder information, specifically regarding claims, while continuing to provide high quality service to our customers.
As the disclosure of Ms. [redacted]'s claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that we have mailed correspondence directly to Ms. [redacted] addressing the concerns expressed in her inquiry to you. She should receive our letter within the next 10 business days.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us.
Sincerely,
[redacted] L. [redacted]
Senior Coordinator
[redacted] Insurance Company of America
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX Ext. XXXXX
(fax) X-XXX-XXX-XXXX
Initial Consumer Rebuttal /* (3000, 7, 2015/07/08) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I am still disappointed that they did not honor what the salesman promised. I understand I will not receive the monetary amount. I want it on record though that the salesperson lied and everyone must read every single word on the contract right away to find what was lied about and what is true.
Complaint: 11615606
I am rejecting this response because: They still refuse to accept responsibility for there agents mistake. Shouldn't the agents E and O insurance cover her mistake? Isn't they why they carry it, for this exact reason?
Sincerely,
Devin [redacted]
Initial Business Response /* (1000, 5, 2015/08/21) */
August 21, 2015
Revdex.com
330 N WABASH AVE STE 3120
CHICAGO IL XXXXX-XXXX
RE: YOUR CASE #: [redacted]
CONSUMER: [redacted]
Dear Sir/Madam:
Thank you for your correspondence, referenced above.
Please...
be advised that we have contacted Ms. [redacted] directly and provided a written response, addressing the concerns expressed in her inquiry to your office. Due to HIPAA (Health Insurance Portability and Accountability Act), it is our goal to protect all confidential [redacted] health information, specifically regarding claims. As such, we are unable to provide additional information to you at this time.
Should you have any questions, or if we may be of further assistance, please let us know.
Sincerely,
[redacted]
[redacted] Insurance Company of America
Consumer Service Investigations
Direct:(XXX)XXX-XXXX
Toll Free:XXX)XXX-XXXX/Ext XXXXX
FAX:(XXX)XXX-XXXX
Case #XXXXXXX
Initial Consumer Rebuttal /* (3000, 7, 2015/08/21) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Not all of it has been paid out yet. As soon as Revdex.com report then they started process of claims not all claims have been paid out and then we have a disagreement that my claims have to do with a elective surgery that does not pay which is correct but I then followed up with a sickness and they are stating they don't need to pay this as it was from a elective my sickness is stated from doctor as doctors note show this is still a sickness and it needs to be paid out on policy since I carry a sickness policy I understand they will not pay for the elective surgery but that has no effect on the after effects. They paid on some of them as if they were paying out on a policy that should not be paid out on but they were doing it on there kindness, that does not work in the real world. also there is a dispute on the amount that needs to be paid . They paid out on a minor then a major my procedure was a major not a minor it was done in a ambulatory settings you don't do a procedure like I had in a doctors office where there is Novocain and a surgical needle injected in body to drain fluid. so we still have the difference on this situation and I also don't feel I'm being treated as any other customer as They state I need to be with certain people as I'm a employee of theirs which 2 years that was not the issue at all I was able to call speak with call center and get info on claim now I'm not allowed As employee of company I have to have it handled different if this was the case why was this not in my employee contract and why 2 years go by and its now different this is discrimination and I pay for my policies as any other client. I want fairness and claims be paid out as policy shows
Final Business Response /* (4000, 9, 2015/08/28) */
August 28, 2015
Revdex.com
330 N WABASH AVE STE 3120
CHICAGO IL XXXXX-XXXX
RE: YOUR CASE #: XXXXXXXX
CONSUMER: [redacted]
Dear Sir/Madam:
Thank you for your follow up correspondence regarding the additional information you received from Ms. [redacted] on August 21, 2015.
Our Claims department has further reviewed Ms. [redacted]'s additional inquiry and concerns, and mailed an explanation letter today. We have asked Ms. [redacted] to contact the adjustor directly if she should have any further questions.
If we may be of further assistance, please let us know.
Sincerely,
[redacted] Insurance Company of America
Consumer Service Investigations
Direct: (XXX)XXX-XXXX
Toll Free: XXX XXX-XXXX/Ext XXXXX
FAX: (XXX) XXX-XXXX
Case#XXXXXXX/XXXXXXX
In accordance with our Privacy Pledge as well as HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all confidential policyholder information, specifically regarding claims, while continuing to provide high quality service to our customers. As...
the disclosure of Mr. [redacted]’s policy benefits and claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that wehave mailed correspondence directly to Mr. [redacted], addressing the concerns expressed in his inquiry to you. He should receive our letter within the next 10-15 business days. If you have any questions, please do not hesitate to contact us. Sincerely, Tamara *. [redacted], Senior Coordinator Combined Insurance Company of America Consumer Service Investigations (toll free) 1-800-225-4500 (fax) 1-312-351-6910
Initial Business Response /* (1000, 5, 2015/08/28) */
August 28, 2015
Revdex.com
330 N. Wabash Avenue, Suite 3120
Chicago, IL XXXXX-XXXX
Re: Complaint ID #: XXXXXXXX
Consumer: [redacted]
Dear Revdex.com Customer Relations Advocate:
This letter is being provided in...
response to Ms. [redacted]'s August 19, 2015 inquiry to your office.
Prompted by your inquiry to us, we reviewed our records and learned the following.
Ms. [redacted] applied for a policy through an agent of our company on August 13, 2015. On August 19, 2015, she faxed a signed policy cancellation/refund request letter to our company. On August 25, 2015, we mailed her a full premium refund check. On that same day, we also mailed a letter to her in a separate envelope in order to acknowledge that her policy was cancelled and that a full premium refund had been processed.
Her policy is now being considered null and void from the beginning.
While we trust that this letter satisfactorily responds to your inquiry, if you have any questions, or if I can be of further assistance, please let me know.
Sincerely,
[redacted], Senior Coordinator
[redacted] Insurance Company of America
Consumer Service Investigations
Direct: (XXX) XXX-XXXX
Toll Free: (XXX) XXX-XXXX / Ext XXXXX
FAX: (XXX) XXX-XXXX
Case #XXXXXXX
Initial Business Response / [redacted] (1000, 5, 2015/05/13) */ May 13, Revdex.com NWabash Avenue Suite Chicago, IL 60611- Re: Your Complaint Number: XXXXXXXX Consumer: [redacted] Dear Ms [redacted] : This letter is being written in response to your inquiry of May 7, The policy Ms [redacted] discussed in her inquiry to your office was issued on November 10, As her loss occurred within the first year of the policy issue date, our Claim Department began a standard pre-existing condition investigationSuch investigations begin by writing to the insured for a signed and dated authorization and often include a request for a list of physician's names After her claim was initially received in our mail room on March 3, 2015, the adjustor wrote to Ms [redacted] and asked her for a signed authorization and a list of physician's namesThe requested information was received on March 30, and on April 2, letters were mailed to two of her doctorsAt that time, a courtesy letter was mailed to Ms [redacted] regarding the claim status After sending a second request letter to one of her doctors on April 20, and an additional request by fax to the same doctor on April 21, 2015, the records from that doctor were received on April 24, On May 1, 2015, the claim file was sent to our Medical Director for review On May 8, 2015, a claim benefit check was issued under the new policyHowever, in reviewing the file for this response, a claim manager noted that an incorrect benefit was providedAn additional payment was issued to Ms***The combined total of the initial (incorrect) payment and the additional payment served to provide the maximum benefit payable for her loss under her new policy(It is also important to note that an additional benefit was provided under another policyThe additional benefit was included in the initial benefit check of May 8, 2015.) Ms [redacted] also indicated that she was receiving multiple emailsThese emails were sent through our Vodafone system, a system that was designed to provide automatic claim updatesThe Vodafone case was closed on May 13, 2015, so Ms [redacted] will not be receiving any more emails regarding her claim We regret that Ms [redacted] believed that her claim was being delayed intentionallyPlease assure her that a routine claim investigation took place because her loss happened to be within the first year of the policy's issue dateOnce the response was received from her doctor, the records were forwarded to our Medical Director for review and her claim was paid While we trust that this letter satisfactorily responds to her inquiry, if you have any questions, or if I can be of further assistance, please let me know Sincerely, [redacted] Binder, Senior Coordinator Combined Life Insurance Company of New York Consumer Service Investigations Direct: (XXX) XXX-XXXX Toll Free: (XXX) XXX-XXXX / Ext XXXXX FAX: (XXX) XXX-XXXX Case #XXXXXXX
Initial Business Response / [redacted] (1000, 5, 2015/01/30) */ January 30, 2015 [redacted] RevDex.com 330 Lower Wabash Avenue Chicago, IL 60611 Re: Your Case #XXXXXXXX Dear Ms. [redacted] This letter is being written in response to your letter of January 26, 2015. In her... statement to your office, Ms. [redacted] indicated that she made several attempts to cancel a policy with a monthly premium amount of $117.83, but that the advice she was given by our call center was to contact her bank to prevent the $117.83 payment from being collected. She then said that we split the payment and collected a partial payment of $75.83. We investigated this matter and learned the following. On January 9, 2015, Ms. [redacted] met with two of our agents. She applied for a SickPay Plus Policy with a monthly premium of $117.83 through agent [redacted] and an Accident and Sickness Protector Policy with a monthly premium of $75.83 through agent [redacted] Both agents met with her at the same time. The majority of our applications are now completed electronically through iPads. When an application is completed, the agent simply uploads the application to our home office for immediate processing. However, technical difficulties prevented Mr. [redacted] from submitting the application for the SickPay Plus Policy. The software in his computer ultimately had to be reloaded. When the application software was reloaded, all of the data for the SickPay Plus Policy application was lost. As a result, no premium payment was ever collected for this policy. Mr. [redacted] told our office that when he went back to meet with Ms. [redacted] in order to complete a new application, she said that she had already cancelled the coverage and went with another company. For the record, Ms. [redacted] was able to successfully upload the application for the Accident and Sickness Protector Policy. In view of the above, we did not split a premium payment and/or collect a partial payment. Instead, the $75.83 collection was the total premium amount for one of the two policies she applied for on January 9, 2015. The main challenge associated with this situation is that we had no record of the SickPay Plus Policy. While Ms. [redacted] had paperwork associated with the policy in her possession, we had no official record of it on this end when she called to cancel it because the application was never submitted to our company (for the reason discussed above.) In the absence of documentation on our end, our call center recommended that she order a stop payment through her bank. We note that a refund of the initial premium payment of $75.83 for her Accident and Sickness Protector Policy was processed and mailed to her on January 24, 2015. However, several days later, we note that we also mailed a letter to her to let her know that her bank did not honor our initial premium collection attempt. Based on this, it appears that the refund check was mailed to Ms. ***, in error. Kindly ask her to mail the check back to our company at: Combined Insurance Company PO Box 6703 Scranton, PA 18505-0703 Ms. [redacted] mentioned that we mailed her a premium notice where we requested $455.00. When the premium draft process is discontinued in the absence of a written request to cancel the process, a premium notice requesting a semi-annual payment is automatically generated and mailed. It was for this reason such a notice was mailed to her. She may simply disregard the notice at this point as the policy is no longer in force. While we trust that the above explanation successfully addresses her inquiry, please ask Ms. [redacted] to accept our apologies for any concern or inconvenience she may have experienced as a result of the challenges she encountered when she attempted to cancel her coverage. If you have any questions, please let me know. Sincerely, [redacted] Senior Coordinator Combined Insurance Company of America Consumer Service Investigations Direct: (XXX) XXX-XXXX Toll Free: (XXX) XXX-XXXX / Ext XXXXX FAX: (XXX) XXX-XXXX Case #XXXXXXX
Initial Business Response / [redacted] (1000, 5, 2015/04/06) */ Dear Ms [redacted] Thank you for your correspondence regarding your Office's case #:XXXXXXXX Please be advised that due to HIPAA protected information, our Claims department responded directly to the consumer's concerns, as expressed in his complaint, on April 2, If we can be of further assistance to you, please let us know Sincerely, [redacted] Combined Insurance Company of America Consumer Service Investigations (XXX)XXX-XXXX Direct (XXX)XXX-XXXX Ext XXXXX Toll Free (XXX)XXX-XXXX FAX Case #XXXXXXX
Initial Business Response /* (1000, 5, 2015/03/03) */
To: *** *** Dispute Resolution Specialist
RE: Your Complaint #: XXXXXXXX
Consumer: *** ***
Dear Ms***
In accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to
protect all confidential policyholder health information, specifically regarding claims, while continuing to provide high quality service to our customersAs the disclosure of Ms***' claim information is strictly prohibited, we are unable to provide any further information to you at this timeHowever, be assured that we will respond directly to Ms***, under separate cover, addressing her concerns
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us
Sincerely,
*** L***
Senior Coordinator
Combined Life Insurance Company of New York
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX ExtXXXXX
(fax) X-XXX-XXX-XXXX
Initial Business Response /* (1000, 5, 2015/04/20) */
To: *** *** Dispute Resolution Specialist
RE: Your Complaint #: XXXXXXXX
Consumer: *** ***
Dear Ms***
In accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to
protect all confidential policyholder health information, specifically regarding claims, while continuing to provide high quality service to our customers
As the disclosure of Mr***'s claim information is strictly prohibited, we are unable to provide any further information to you at this timeHowever, be assured that our Claim Department has contacted Mr*** directly to discuss his claim and we have honored his request for cancellation of his policies
If you have any questions, please do not hesitate to contact us
Sincerely,
*** L***
Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX ExtXXXXX
(fax) X-XXX-XXX-XXXX
Initial Business Response /* (1000, 5, 2015/01/05) */
January 5, 2015
[redacted]
Revdex.com
330 Lower Wabash Avenue
Chicago, IL 60611
Re: Your Case #XXXXXXXX
Dear Ms. [redacted]
This letter is being written in response to your inquiry, which we received on December 29,...
2014.
In cases where a policy is in danger of lapsing, outgoing calls are made to a customer in order to discuss possible payment options, which may simply include collecting a payment over the telephone or securing a correct credit card or bank account number for automatic draft purposes. The telephone number of the outgoing unit responsible for making such calls is the toll-free number Ms. [redacted] referenced in her inquiry to your office.
In cases where a policy appears to be nearing a state of lapse, our call center will make outgoing calls on 10 business days in the period of one month, with up to three calls on each of the 10 days. However, they are also required to leave voicemail messages. That being said, Ms. [redacted]' statement to your office regarding the lack of voicemail messages and the frequency of calls concerned us. Let me assure you, we forwarded a formal report to call center management regarding this matter and we have asked them to take any necessary corrective action.
According to our records, Ms. [redacted]' telephone number was added to our internal "Do Not Call" list in response to her December 17, 2014 call to our call center. Ms. [redacted] mentioned that she received another call the very next day, December 18, 2014. While it can take up to 48 hours before a number is removed from our system, according to our records, no further calls were made after December 18, 2014, so it appears that her number was successfully added to our "Do Not Call" list.
While we regret any concern or inconvenience that Ms. [redacted] may have experienced as a result of this situation, we are thankful that she brought this matter to our attention as inquiries of this nature enable us to identify areas in need of improvement.
We trust that this letter satisfactorily responds to your inquiry. If you have any questions, or if I can be of further assistance, please let me know.
Sincerely,
[redacted] Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
Direct: (XXX) XXX-XXXX
Toll Free: (XXX) XXX-XXXX / Ext XXXXX
FAX: (XXX) XXX-XXXX
Case #XXXXXXX
October 20, 2015
Revdex.com
330 N. Wabash Avenue, Suite 3120
Chicago, IL 60611-7621
Complaint ID#: [redacted]
Dear Revdex.com:
This letter is being written in response to your email of October 13, 2015.
While our policies have been traditionally sold in person...
by way of door-to-door sales, our home office is also reaching out to customers as well. In brief, we contact current and past customers in order to discuss new policies. However, it is not our intention to overwhelm or alienate a customer.
Based on Ms. [redacted]' report, it appears that we were rather aggressive in our approach. Please ask Ms. [redacted] to accept our apologies for any concern or inconvenience she may have experienced as a result of this situation.
In accordance with Ms. [redacted]' request, we have taken steps to discontinue all future contact with her. Specifically, we have informed sales management that all field agent contact is to be stopped and we have also flagged her former policy record to prevent telephone and mail contact with her.
While we trust that this letter satisfactorily responds to your inquiry, if you have any questions, or if I can be of further assistance, please let me know.
Sincerely,
[redacted], Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
Direct: ([redacted]
Toll Free: ([redacted]
FAX: ([redacted]
Case #[redacted]
October 27, 2015
Revdex.com Serving Chicago & Northern Illinois
330 N Wabash Ave Suite 3120
Chicago IL 60611-7621
[redacted]
[redacted]
To whom it may concern:
Thank you for contacting us regarding the additional correspondence you received from the consumer, in reference to your Complaint Case [redacted] listed above.
We understand that the consumer indicated that she did not accept the response from the business and there was no response received. Our Claims department confirmed that the letter was mailed to [redacted] on October 16, 2015, and we regret to hear that it was not received. Today, another letter was mailed to [redacted] explaining what information is needed in order for us to review her claim for benefits. Due to HIPAA, we are unable to forward copies of these letters to your office without a HIPAA authorization from the insured.
Should you have any questions, or if we may be of further assistance, please let us know.
Sincerely,
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
Initial Business Response /* (1000, 5, 2015/04/06) */
Dear Ms. [redacted]
Thank you for your correspondence regarding your Office's case #:XXXXXXXX.
Please be advised that due to HIPAA protected information, our Claims department responded directly to the consumer's concerns, as expressed in his...
complaint, on April 2, 2015.
If we can be of further assistance to you, please let us know.
Sincerely,
[redacted]
Combined Insurance Company of America
Consumer Service Investigations
(XXX)XXX-XXXX Direct
(XXX)XXX-XXXX Ext XXXXX Toll Free
(XXX)XXX-XXXX FAX
Case #XXXXXXX
Initial Business Response /* (1000, 5, 2015/01/30) */
January 30, 2015
[redacted]
Revdex.com
330 Lower Wabash Avenue
Chicago, IL 60611
Re: Your Case #XXXXXXXX
Dear Ms. [redacted]
This letter is being written in response to your letter of January 26, 2015.
In her...
statement to your office, Ms. [redacted] indicated that she made several attempts to cancel a policy with a monthly premium amount of $117.83, but that the advice she was given by our call center was to contact her bank to prevent the $117.83 payment from being collected. She then said that we split the payment and collected a partial payment of $75.83.
We investigated this matter and learned the following.
On January 9, 2015, Ms. [redacted] met with two of our agents. She applied for a SickPay Plus Policy with a monthly premium of $117.83 through agent [redacted] and an Accident and Sickness Protector Policy with a monthly premium of $75.83 through agent [redacted] Both agents met with her at the same time.
The majority of our applications are now completed electronically through iPads. When an application is completed, the agent simply uploads the application to our home office for immediate processing. However, technical difficulties prevented Mr. [redacted] from submitting the application for the SickPay Plus Policy. The software in his computer ultimately had to be reloaded. When the application software was reloaded, all of the data for the SickPay Plus Policy application was lost. As a result, no premium payment was ever collected for this policy. Mr. [redacted] told our office that when he went back to meet with Ms. [redacted] in order to complete a new application, she said that she had already cancelled the coverage and went with another company. For the record, Ms. [redacted] was able to successfully upload the application for the Accident and Sickness Protector Policy.
In view of the above, we did not split a premium payment and/or collect a partial payment. Instead, the $75.83 collection was the total premium amount for one of the two policies she applied for on January 9, 2015.
The main challenge associated with this situation is that we had no record of the SickPay Plus Policy. While Ms. [redacted] had paperwork associated with the policy in her possession, we had no official record of it on this end when she called to cancel it because the application was never submitted to our company (for the reason discussed above.) In the absence of documentation on our end, our call center recommended that she order a stop payment through her bank.
We note that a refund of the initial premium payment of $75.83 for her Accident and Sickness Protector Policy was processed and mailed to her on January 24, 2015. However, several days later, we note that we also mailed a letter to her to let her know that her bank did not honor our initial premium collection attempt. Based on this, it appears that the refund check was mailed to Ms. [redacted], in error. Kindly ask her to mail the check back to our company at:
Combined Insurance Company
PO Box 6703
Scranton, PA 18505-0703
Ms. [redacted] mentioned that we mailed her a premium notice where we requested $455.00. When the premium draft process is discontinued in the absence of a written request to cancel the process, a premium notice requesting a semi-annual payment is automatically generated and mailed. It was for this reason such a notice was mailed to her. She may simply disregard the notice at this point as the policy is no longer in force.
While we trust that the above explanation successfully addresses her inquiry, please ask Ms. [redacted] to accept our apologies for any concern or inconvenience she may have experienced as a result of the challenges she encountered when she attempted to cancel her coverage.
If you have any questions, please let me know.
Sincerely,
[redacted] Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
Direct: (XXX) XXX-XXXX
Toll Free: (XXX) XXX-XXXX / Ext XXXXX
FAX: (XXX) XXX-XXXX
Case #XXXXXXX
Please see attached document for our response.
Initial Business Response /* (1000, 7, 2015/04/06) */
Our previous response included a "typo" in the first paragraph which listed an incorrect policyholder name. Below is our corrected response.
To: [redacted], Dispute Resolution Specialist
RE: Your Complaint #: XXXXXXXX
Consumer: [redacted]...
[redacted]
Dear Ms. [redacted]
In accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all confidential policyholder health information, specifically regarding claims, while continuing to provide high quality service to our customers. As the disclosure of Mr. [redacted]'s claim information is strictly prohibited, we are unable to provide any further information to you at this time.
However, be assured that we have mailed correspondence directly to Mr. [redacted], addressing the concerns expressed in his inquiry to you. He should receive our letter within the next 5-10 business days.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us.
Sincerely,
[redacted] L. [redacted]
Senior Coordinator
Combined Insurance Company of America
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX Ext. XXXXX
(fax) X-XXX-XXX-XXXX
Complaint: [redacted]
I am rejecting this response because: Their response did not solve the issue. I am withholding acceptance until I get the letter from Combined Insurance. If this correspondence is any thing like other correspondence I will either not receive a letter or it will take a month to get it.
Sincerely,
[redacted]
Our records indicate that a voicemail message was left with the customer this afternoon.If there are further questions, please let us know.Thanks,COMBINED INSURANCE COMPANY OF AMERICA
Dear Customer:Thank you for your recent inquiry. You should be hearing from our Claims department shortly regarding your concern.If you should have any questions in the meantime, please contact us at 1-800-[redacted] for further assistance. Combined Insurance
Initial Business Response /* (1000, 5, 2015/06/26) */
RE: Your Complaint # XXXXXXXX:
Consumer: [redacted] L [redacted]
To Whom It May Concern:
In accordance with our Privacy Pledge as well as HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all...
confidential policyholder information, specifically regarding claims, while continuing to provide high quality service to our customers.
As the disclosure of Ms. [redacted]'s claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that we have mailed correspondence directly to Ms. [redacted] addressing the concerns expressed in her inquiry to you. She should receive our letter within the next 10 business days.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us.
Sincerely,
[redacted] L. [redacted]
Senior Coordinator
[redacted] Insurance Company of America
Consumer Service Investigations
(direct line) X-XXX-XXX-XXXX
(toll free) X-XXX-XXX-XXXX Ext. XXXXX
(fax) X-XXX-XXX-XXXX
Initial Consumer Rebuttal /* (3000, 7, 2015/07/08) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I am still disappointed that they did not honor what the salesman promised. I understand I will not receive the monetary amount. I want it on record though that the salesperson lied and everyone must read every single word on the contract right away to find what was lied about and what is true.
Complaint: 11615606
I am rejecting this response because: They still refuse to accept responsibility for there agents mistake. Shouldn't the agents E and O insurance cover her mistake? Isn't they why they carry it, for this exact reason?
Sincerely,
Devin [redacted]
Initial Business Response /* (1000, 5, 2015/08/21) */
August 21, 2015
Revdex.com
330 N WABASH AVE STE 3120
CHICAGO IL XXXXX-XXXX
RE: YOUR CASE #: [redacted]
CONSUMER: [redacted]
Dear Sir/Madam:
Thank you for your correspondence, referenced above.
Please...
be advised that we have contacted Ms. [redacted] directly and provided a written response, addressing the concerns expressed in her inquiry to your office. Due to HIPAA (Health Insurance Portability and Accountability Act), it is our goal to protect all confidential [redacted] health information, specifically regarding claims. As such, we are unable to provide additional information to you at this time.
Should you have any questions, or if we may be of further assistance, please let us know.
Sincerely,
[redacted]
[redacted] Insurance Company of America
Consumer Service Investigations
Direct:(XXX)XXX-XXXX
Toll Free:XXX)XXX-XXXX/Ext XXXXX
FAX:(XXX)XXX-XXXX
Case #XXXXXXX
Initial Consumer Rebuttal /* (3000, 7, 2015/08/21) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Not all of it has been paid out yet. As soon as Revdex.com report then they started process of claims not all claims have been paid out and then we have a disagreement that my claims have to do with a elective surgery that does not pay which is correct but I then followed up with a sickness and they are stating they don't need to pay this as it was from a elective my sickness is stated from doctor as doctors note show this is still a sickness and it needs to be paid out on policy since I carry a sickness policy I understand they will not pay for the elective surgery but that has no effect on the after effects. They paid on some of them as if they were paying out on a policy that should not be paid out on but they were doing it on there kindness, that does not work in the real world. also there is a dispute on the amount that needs to be paid . They paid out on a minor then a major my procedure was a major not a minor it was done in a ambulatory settings you don't do a procedure like I had in a doctors office where there is Novocain and a surgical needle injected in body to drain fluid. so we still have the difference on this situation and I also don't feel I'm being treated as any other customer as They state I need to be with certain people as I'm a employee of theirs which 2 years that was not the issue at all I was able to call speak with call center and get info on claim now I'm not allowed As employee of company I have to have it handled different if this was the case why was this not in my employee contract and why 2 years go by and its now different this is discrimination and I pay for my policies as any other client. I want fairness and claims be paid out as policy shows
Final Business Response /* (4000, 9, 2015/08/28) */
August 28, 2015
Revdex.com
330 N WABASH AVE STE 3120
CHICAGO IL XXXXX-XXXX
RE: YOUR CASE #: XXXXXXXX
CONSUMER: [redacted]
Dear Sir/Madam:
Thank you for your follow up correspondence regarding the additional information you received from Ms. [redacted] on August 21, 2015.
Our Claims department has further reviewed Ms. [redacted]'s additional inquiry and concerns, and mailed an explanation letter today. We have asked Ms. [redacted] to contact the adjustor directly if she should have any further questions.
If we may be of further assistance, please let us know.
Sincerely,
[redacted] Insurance Company of America
Consumer Service Investigations
Direct: (XXX)XXX-XXXX
Toll Free: XXX XXX-XXXX/Ext XXXXX
FAX: (XXX) XXX-XXXX
Case#XXXXXXX/XXXXXXX
In accordance with our Privacy Pledge as well as HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all confidential policyholder information, specifically regarding claims, while continuing to provide high quality service to our customers. As...
the disclosure of Mr. [redacted]’s policy benefits and claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that wehave mailed correspondence directly to Mr. [redacted], addressing the concerns expressed in his inquiry to you. He should receive our letter within the next 10-15 business days. If you have any questions, please do not hesitate to contact us. Sincerely, Tamara *. [redacted], Senior Coordinator Combined Insurance Company of America Consumer Service Investigations (toll free) 1-800-225-4500 (fax) 1-312-351-6910
Initial Business Response /* (1000, 5, 2015/08/28) */
August 28, 2015
Revdex.com
330 N. Wabash Avenue, Suite 3120
Chicago, IL XXXXX-XXXX
Re: Complaint ID #: XXXXXXXX
Consumer: [redacted]
Dear Revdex.com Customer Relations Advocate:
This letter is being provided in...
response to Ms. [redacted]'s August 19, 2015 inquiry to your office.
Prompted by your inquiry to us, we reviewed our records and learned the following.
Ms. [redacted] applied for a policy through an agent of our company on August 13, 2015. On August 19, 2015, she faxed a signed policy cancellation/refund request letter to our company. On August 25, 2015, we mailed her a full premium refund check. On that same day, we also mailed a letter to her in a separate envelope in order to acknowledge that her policy was cancelled and that a full premium refund had been processed.
Her policy is now being considered null and void from the beginning.
While we trust that this letter satisfactorily responds to your inquiry, if you have any questions, or if I can be of further assistance, please let me know.
Sincerely,
[redacted], Senior Coordinator
[redacted] Insurance Company of America
Consumer Service Investigations
Direct: (XXX) XXX-XXXX
Toll Free: (XXX) XXX-XXXX / Ext XXXXX
FAX: (XXX) XXX-XXXX
Case #XXXXXXX