IHC Specialty Benefits, Inc.

I am rejecting this response because:
I have had four people from IHC call me backI have been able to speak to one and she was inappropriate on the phoneI still have some questions about exactly which claims were received and also what receipts were received for things I've already paid forI also want to report the inappropriateness of Paige ***, as well as why they cannot all communicate with each other especially since they claim it is so difficult to return the volume of phone calls they getWhy am I hearing from four different people? Perhaps they could improve some efficiency with phone calls if they had a way of logging them in a central network so that they could see what has already been done on an account. I am continuing to try to reach Debbie HShe has tried to reach me as wellI hope to connect with her todayPage *** literally said to me on the phone "I don't want to assume anything because it makes an as out of you and me" she was having trouble understanding one of the bills which was quite obvious to meI do not think what she said was appropriateShe also became quite impatient with my questions on the phone

I am rejecting this response because:A lady did call me and acted like she had no clue I had to give her my bank information and she said she would get back to me She still has never gotton back with me

I am rejecting this response because:A lady did call me and acted like she had no clue I had to give her my bank information and she said she would get back to me She still has never gotton back with me

Calls to the provider and to the insured were made November 3, leaving messages. To date, we have claims received 10/24, 10/and 10/28, they are pending processingClaims will be processed today for benefitsThese claims are all medical- a hospital ER billing, a radiology bill,
and an ER physical bill. Upon receipt of this complaint, one of our senior customer service representatives attempted another call to both the provider and Mrs***, leaving her name and direct phone number, as well as the information that injury to sound natural teeth are covered as a medical expenseMrs*** communicated that she wasn’t available to discuss the case with us at that time, but we have since been in communication to complete the claim.

Mr*** applied for a Secure Edge month Limited Short Term plan on 04/11/Policy was issued with an effective date of 11/05/& termed months later on 05/05/Due to charges/diagnoses received shortly after the policy effective date, further review was warranted under the Pre-x
conditions Limitation in the policyMedical records were requested from source at the time of the initial reviewAt the same time, a Prior Treatment letter & signed authorization for release of medical records were requested from the insured. The required information was not received from the insured and therefore, pending claims received were placed in a ‘suspend’ statusInsured was notified of this action via correspondence & explanation of benefit forms The PTL and medical record from the source have been received, file reopened & reviewed. It has been determined that the claims received are not related to a Pre-x condition. A review of the billed diagnosis finds that numerous charges were received with mental nervous billing codesThese charges will be denied under Section 5- Exclusions And Limitations from Coverage - The policy does not provide any benefits from the following expenses: for the treatment of mental illness or nervous disorders, including, but not limited to, neurosis, psychoneurosis, psychopathy, psychosis, attention deficit disorder, autism, hyperactivity, or mental or emotional disease or disorder of any kind;…. The Claims Department has been notified to reopen & reconsider all charges previously ‘suspended’Once all charges have been processed according to the above review results, the insured & his treating providers will receive the explanations of benefits (EOB) forms advising them of our determination under separate cover

Policy Services Supervisor, Michele *** spoke with Mrs*** on Monday, January Additional information was needed to find the policy informationFound the policy was under ***'s husband, *** S*** and credit card information of charges has the policy has been found - case
***Policy Services department are looking into charges further, and will reach back out to Mrs*** for a follow up

? I am rejecting this response because:
I have had four people from IHC call me backI have been able to speak to one and she was inappropriate on the phoneI still have some questions about exactly which claims were received and also what receipts were received for things I've already paid forI also want to report the inappropriateness of Paige ***, as well as why they cannot all communicate with each other especially since they claim it is so difficult to return the volume of phone calls they getWhy am I hearing from four different people? Perhaps they could improve some efficiency with phone calls if they had a way of logging them in a central network so that they could see what has already been done on an account.? I am continuing to try to reach Debbie HShe has tried to reach me as wellI hope to connect with her todayPage *** literally said to me on the phone "I don't want to assume anything because it makes an as out of you and me" she was having trouble understanding one of the bills which was quite obvious to meI do not think what she said was appropriateShe also became quite impatient with my questions on the phone

? I am rejecting this response because: I have went through a lot of stress and I have spent a lot of my own personal time trying to get all of this fixed and I want be helped more than this from this companyThis is the most pathetic excuse of an insurance company I have ever been part off

? I am rejecting this response because:I will sign form you sent after the first of the year when I can print it.? IHC says they are going to refund me money but they have not yet

I am rejecting this response because: I have went through a lot of stress and I have spent a lot of my own personal time trying to get all of this fixed and I want be helped more than this from this company. This is the most pathetic excuse of an insurance company I have ever been part off

Calls to the provider and to the insured were made November 3, 2016 leaving messages.  To date, we have 3 claims received 10/24, 10/25 and 10/28, they are pending processing. Claims will be processed today for benefits. These claims are all medical- a hospital ER billing, a radiology bill,...

and an ER physical bill.  Upon receipt of this complaint, one of our senior customer service representatives attempted another call to both the provider and Mrs. [redacted], leaving her name and direct phone number, as well as the information that injury to sound natural teeth are covered as a medical expense. Mrs. [redacted] communicated that she wasn’t available to discuss the case with us at that time, but we have since been in communication to complete the claim.

Mr. [redacted] applied for a Secure Edge 6 month Limited Short Term plan on 04/11/15. Policy was issued with an effective date of 11/05/15 & termed 6 months later on 05/05/16. Due to charges/diagnoses received shortly after the policy effective date, further review was warranted under the Pre-x...

conditions Limitation in the policy. Medical records were requested from 1 source at the time of the initial review. At the same time, a Prior Treatment letter & signed authorization for release of medical records were requested from the insured.  The required information was not received from the insured and therefore, pending claims received were placed in a ‘suspend’ status. Insured was notified of this action via correspondence & explanation of benefit forms.   The PTL and medical record from the 1 source have been received, file reopened & reviewed.  It has been determined that the claims received are not related to a Pre-x condition.  A review of the billed diagnosis finds that numerous charges were received with mental nervous billing codes. These charges will be denied under Section 5- Exclusions And Limitations from Coverage  - The policy does not provide any benefits from the following expenses: for the treatment of mental illness or nervous disorders, including, but not limited to, neurosis, psychoneurosis, psychopathy, psychosis, attention deficit disorder, autism, hyperactivity, or mental or emotional disease or disorder of any kind;….    The Claims Department has been notified to reopen & reconsider all charges previously ‘suspended’. Once all charges have been processed according to the above review results, the insured & his treating providers will receive the explanations of benefits (EOB) forms advising them of our determination under separate cover.

Policy Services Supervisor, Michele [redacted] spoke with Mrs. [redacted] on Monday, January 16. Additional information was needed to find the policy information. Found the policy was under [redacted]'s husband, [redacted] S. [redacted] and credit card information of charges has the policy has been found - case...

[redacted]. Policy Services department are looking into charges further, and will reach back out to Mrs. [redacted] for a follow up.