Lifeshield National Insurance

Complaint: ***
I am rejecting this response because: I completely understand the policy, my claims were months agoThe EOB I received was sent June 01, the date of my Doctors visit was December 14, The EOB also listed that my claim was rejected for my policy being terminatedIn the comments it also stated that they were waiting for information from my providerIf my claim was invalid due to termination of policy why would they also be waiting for information from the provider? I believe that this company intentionally used these codes to avoid making paymentsMy doctors office also was lead to believe that I was no longer covered and their need to submit the requested documentation was muteI will not resolve my complaint until they pay what is due.
Sincerely,
*** ***

Please be advised that the policies Mr. and Mrs. [redacted] purchased is a short-term, limited benefit policies.  To date, they have purchased 4 policies underwritten by LifeShield National Insurance Co, Administered by Health Insurance Innovations, with Claims Adjudication performed by...

InsuranceTPA. These policies are 3 months in duration, have a 5 day waiting period for sickness benefits, a 30 day waiting period for [redacted] and include a Pre-Existing Condition exclusion wherein charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice within the 12 month period immediately preceding such person's Certificate Effective Date.  Due to this exclusion, all claims received go through a rigorous Pre-Ex Certification Process.  Additionally, these policies are not major-medical policies and are not ACA Compliant.   At the time of purchase, the [redacted]'s signed an Echo Sign document wherein by allowing their electronic signature to be attached to the document, they certified that they understood all of the limits and exclusions of the policy, including the Pre-Existing Condition Exclusion. When claims were received for these policies, due to the diagnoses, a pre-ex investigation began.  Information was requested from the [redacted]s, along with a HIPPA Release form. This information was received, and then the Providers listed were contacted and further information was requested.  2nd requests have been sent to the Providers, however, to date, the Claims Administrator is still waiting for medical records from 3 Providers in order to complete the pre-ex certification.  This investigation process is in no way a way to avoid paying claims.  These are the terms of the contracts the customers agreed to.  We apologize that Mr. [redacted] has experienced issues getting in touch with the Claims Administrator, as they do experience high call volumes.  We must close these claims if the information requested is not received within the time frame allowed, however, please be advised that if the requested information is received, the claims will be re-opened and adjudicated according to the terms of the policy.  If the customer would like more specific information related to this issue, please feel free to contact me, [redacted], at [redacted] or via email at [redacted]. Thank you for allowing us the opportunity to respond to this issue.  Sincerely, [redacted]