Initial Business Response /* (1000, 5, 2015/05/13) */
May 13, 2015
Revdex.com
330 N. Wabash Avenue Suite 3120
Chicago, IL 60611-7621
Re: Your Complaint Number: XXXXXXXX
Consumer: [redacted]
Dear Ms. [redacted]:
This letter is being written in response to your inquiry of...
May 7, 2015.
The policy Ms. [redacted] discussed in her inquiry to your office was issued on November 10, 2014. As her loss occurred within the first year of the policy issue date, our Claim Department began a standard pre-existing condition investigation. Such 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 names. The requested information was received on March 30, 2015 and on April 2, 2015 letters were mailed to two of her doctors. At 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, 2015 and an additional request by fax to the same doctor on April 21, 2015, the records from that doctor were received on April 24, 2015. 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 policy. However, in reviewing the file for this response, a claim manager noted that an incorrect benefit was provided. An additional payment was issued to Ms. [redacted]. 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 policy. The additional benefit was included in the initial benefit check of May 8, 2015.)
Ms. [redacted] also indicated that she was receiving multiple emails. These emails were sent through our Vodafone system, a system that was designed to provide automatic claim updates. The 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 intentionally. Please assure her that a routine claim investigation took place because her loss happened to be within the first year of the policy's issue date. Once 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 /* (1000, 5, 2015/10/14) */
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 [redacted] information, specifically regarding...
claims, while continuing to provide high quality service to our customers.
As the disclosure of Mr.[redacted] claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that our Claim Manager has already spoken with Mr.[redacted] and Mr.[redacted] has further been contacted through the mail.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us.
Sincerely,
[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
(The consumer indicated he/she DID NOT accept the response from the business.)
No resolution was offered, and just more jargon. My response to their letter, which they alleged would satisfy the matter, did nothing more than claim they didn't have knowledge of the outstanding monies owed, and/or that the excessive information required for a standard office visit payout had not been received from the doctor (who doubtless has better things to do). Regardless....Combined Insurance continues to willfully refuse to comply with the policy language and to intentionally, and in bad faith, refuse to pay on legitimate claims. (Back [redacted])
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 claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that we have been in contact with Mrs. [redacted] by phone and we have mailed correspondence directly to her addressing the concerns expressed in her inquiry to you. She should receive our letter within the next 10-15 business days. If you have any questions, or if we may be of further assistance, 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
Initial Business Response /* (1000, 5, 2015/05/13) */
May 13, 2015
Revdex.com
330 N. Wabash Avenue Suite 3120
Chicago, IL 60611-7621
Re: Your Complaint Number: XXXXXXXX
Consumer: [redacted]
Dear Ms. [redacted]:
This letter is being written in response to your inquiry of...
May 7, 2015.
The policy Ms. [redacted] discussed in her inquiry to your office was issued on November 10, 2014. As her loss occurred within the first year of the policy issue date, our Claim Department began a standard pre-existing condition investigation. Such 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 names. The requested information was received on March 30, 2015 and on April 2, 2015 letters were mailed to two of her doctors. At 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, 2015 and an additional request by fax to the same doctor on April 21, 2015, the records from that doctor were received on April 24, 2015. 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 policy. However, in reviewing the file for this response, a claim manager noted that an incorrect benefit was provided. An additional payment was issued to Ms. [redacted]. 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 policy. The additional benefit was included in the initial benefit check of May 8, 2015.)
Ms. [redacted] also indicated that she was receiving multiple emails. These emails were sent through our Vodafone system, a system that was designed to provide automatic claim updates. The 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 intentionally. Please assure her that a routine claim investigation took place because her loss happened to be within the first year of the policy's issue date. Once 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 /* (1000, 5, 2015/10/14) */
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 [redacted] information, specifically regarding...
claims, while continuing to provide high quality service to our customers.
As the disclosure of Mr.[redacted] claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that our Claim Manager has already spoken with Mr.[redacted] and Mr.[redacted] has further been contacted through the mail.
If you have any questions, or if we may be of further assistance, please do not hesitate to contact us.
Sincerely,
[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
(The consumer indicated he/she DID NOT accept the response from the business.)
No resolution was offered, and just more jargon. My response to their letter, which they alleged would satisfy the matter, did nothing more than claim they didn't have knowledge of the outstanding monies owed, and/or that the excessive information required for a standard office visit payout had not been received from the doctor (who doubtless has better things to do). Regardless....Combined Insurance continues to willfully refuse to comply with the policy language and to intentionally, and in bad faith, refuse to pay on legitimate claims. (Back [redacted])
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 claim information is strictly prohibited, we are unable to provide any further information to you at this time. However, be assured that we have been in contact with Mrs. [redacted] by phone and we have mailed correspondence directly to her addressing the concerns expressed in her inquiry to you. She should receive our letter within the next 10-15 business days. If you have any questions, or if we may be of further assistance, 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