MagnaCare

Dear [redacted] : This responds to your notice in connection with [redacted] Please be advised that MagnaCare is not [redacted] ’s health plan, IBEW Local 25; it is only a service provider to that entityNonetheless, MagnaCare has endeavored to assist [redacted] and has successfully requested his plan to reconsider its decision on the denied claim that is the subject of his complaintMagnaCare is advised by Local that the denial will be overturned and the claim paid in accordance with the plan’s terms and conditions [redacted] ***

Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: MagnaCare has allowed this Bill to go unpaid for three months, Sept to Jan 2015, when [redacted] declared Bankruptcy The date of service at the hospital was September *, We made [redacted] payments from April to September until my wife's new Health Plan started with her new employer [redacted] did not apply for bankrutcy protection until January Due to MagnaCare's Delay in paying this bill, they are trying to cover themselves under the Bankruptcy Laws This is a travessty and quite frankly I plan to contact the US Dept of Labor Helath Div to complain on how [redacted] plans are being administered MagnaCare's month delay in paying this bill has created the problem and I will see if I can get relief from the media (on your Side, WABC) or in Small Claims Court, if U can get No Justice Here! [Your Answer Here] In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]

Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: [I have read MagnaCare's Response and it seems to skirt the non payment issue with legal maneuvering to insulate itself from the responsibility of the actual payment itself I question the fact that [redacted] a company hired by MagnaCare, to collect [redacted] payments for [redacted] and is another legal layer to avoid payment responsibility, IF [redacted] is Still Collecting [redacted] payment from unsuspecting former employees of [redacted] MagnaCare may Not legally be responsible for the actual payment under current laws, But They Should Be If They represent their client They should take out Bankruptcy Protection Insurance, rather than walk away and leave an unsuspecting public holding the bag Legally there is nothing for me to do, Morally I hope it happens to their parents Your Answer Here] In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]

*** ***:This responds to the latest reply by the complainant in the above matter in which he states, in part, the following:“I have reviewed the response made by the business in reference to complaint ID# ***, and have determined that my complaint has NOT been resolved because: MagnaCare has allowed this Bill to go unpaid for three months, Sept to Jan 2015, when *** declared Bankruptcy The date of service at the hospital was September *, We made *** payments from April to September until my wife's new Health Plan started with her new employer *** did not apply for bankrutcy protection until January Due to MagnaCare's Delay in paying this bill, they are trying to cover themselves under the Bankruptcy Laws.” I am afraid that *** *** is incorrect in his assertionIn fact, MagnaCare received the subject claim on September **, and processed it on the same day MagnaCare then billed its client, *** *** ***, LLC d/b/a *** *** (“***”) on September **, but, likely as a result of its insolvency, *** never funded the claimSubsequently, *** formally declared bankruptcy resulting in an automatic stay of all of its pre-petition financial obligationsAs stated in our previous response, MagnaCare is a service provider, it is not itself a health plan and, accordingly, did not insure, underwrite, sponsor or assume financial responsibility for the health insurance benefits received by the complainantMagnaCare does not, and cannot, issue payment to any provider for any claim, including the one at issue here, for which it does not receive prior funding from its client Therefore, MagnaCare was not responsible for issuing payment to CentraState Hospital, which, on the claimant’s behalf, MagnaCare has asked to suspend collection activities. I trust that the foregoing addresses the complainant’s concerns and rectifies the mistaken impression conveyed to the Revdex.com that MagnaCare’s actions in any way caused the subject claim to be unpaid by ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# ***, and have determined that my complaint has NOT been resolved because:
[Your Answer Here]
Our contract is with Magnacare- not ***We would expect Magnacare to help resolve this issue with *** especially since the members/patients, having a Magnacare logo on their card, are expecting an in network claim processing based on our contract between *** and MagnacareAlthough *** states they have made payments of said amount in complaint response - we have not received the paymentsOur argument with *** is that they state they made the payment as shown in their records but payments were "lost" in the mailWe have multiple check tracers taking up to 6/months to resolveThis is an obvious pattern and unacceptableIts been going on for well over yearTo add to the aggravation, contacting *** is nearly impossible even for simple follow up
In order for the Revdex.com to appropriately process your response, you MUST answer the question above
Sincerely,*** ***

Dear *** ***:I response to the above complaint, please note that MagnaCare is a service provider, it is not itself a health plan and, accordingly, did not insure, underwrite, sponsor or assume financial responsibility for the health insurance benefits received by the complainantRather,
the complainant is insured under the health benefits plan sponsored by *** *** ***, LLC d/b/a *** *** (“***”)By the Notice of Chapter Bankruptcy Case, *** declared bankruptcy as of 12/**/Accordingly, *** has not funded its pre-petition (i.e., 12/**/14) financial obligations, including those related to claims for medical and hospital services received by participants in its health benefits planThis fact has been communicated to the complainantIn the absence of any legal or other right or ability for MagnaCare to facilitate ***’s funding of claims incurred prior to its bankruptcy, we have taken the liberty of contacting CentraState Medical Center, whose unpaid claim is at issue, which has agreed to put the complainant’s account on a hold and not to pursue collection activities for the time being Further communications on this matter should be referred directly to the complainant’s employer at: *** *** ***, LLC, *** *** *** *** ** *** or to its attorney, J*** ** ***, *** *** *** *** *** *** *** *** *** *** ** *** ###-###-####. Of course, please feel free to contact me if anything further is needed
*** ** *** *** *** *** * *** *** *** *** *** *** *** *** ** ***

This responds to the above complaint
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As we have previously noted, MagnaCare is not an insurance company and nor it is responsible for the funding of any claims payable to a provider, including the claims incurred by the Complainant at *** *** *** *** MagnaCare serves only as a provider network and is not the Complainant’s health plan nor responsible for the payment of her health benefit claimsThe Complainant receives her health insurance benefits from a self-insured health plan which is administered by United Health Plus, a third party administrator located at *** *** *** *** ** *** (the contact there is *** ***, ***, phone number ###-###-#### and fax number ###-###-####)In response to our inquiry into circumstances underlying the Revdex.com complaint, United Health Plus advised that payments in the amount of $130,have been made on the Complainant’s claims and that the complaint is, therefore, resolvedIn the event that the provider has any issues with its compensation, it should direct them to United Health Plus at the address set forth above as MagnaCare, acting only as a provider network, is not financially responsible for making any claim payments
Please let me know if anything further is needed

In response to the complainant’s last statement, please be advised that *** ***’s email address is ***I have already provided the *** telephone number and the provider should speak to *** at extension *** in order to more expediently speak to a *** representative In addition, a MagnaCare provider relations representative has contacted the complainant to offer further assistance
We consider the matter resolved; thank you for your assistance

Dear [redacted]:
 
This responds to your notice in connection with...

[redacted].
 
Please be advised that MagnaCare is not [redacted]’s health plan, IBEW Local 25; it is only a service provider to that entity. Nonetheless, MagnaCare has endeavored to assist [redacted] and has successfully requested his plan to reconsider its decision on the denied claim that is the subject of his complaint. MagnaCare is advised by Local 25 that the denial will be overturned and the claim paid in accordance with the plan’s terms and conditions.
 
 
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:  MagnaCare has allowed this Bill to go unpaid for three months, Sept 2014 to Jan 2015, when [redacted] declared Bankruptcy.  The date of service at the hospital was September *, 2014.  We made [redacted] payments from April 2014 to September 2014 until my wife's new Health Plan started with her new employer.  [redacted] did not apply for bankrutcy protection until January 2015.  Due to MagnaCare's Delay in paying this bill, they are trying to cover themselves under the Bankruptcy Laws.  This is a travessty and quite frankly I plan to contact the US Dept of Labor Helath Div to complain on how [redacted] plans are being administered.  MagnaCare's 3 month delay in paying this bill has created the problem and I will see if I can get relief from the media (7 on your Side, WABC) or in Small Claims Court, if U can get No Justice Here!.  

[Your Answer Here]
 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted]. Although we still have pending claims issues ( not only [redacted])   and we have not addressed future claims and processes as previously requested. We will close this case for now. Our hopes are that Magnacare will abide by the terms of our contract and insure that the locals they price for  process claims for reimbursement in accordance to that contract and/or intervene/assist when we, as a contracted provider, are experiencing such issues as untimely reimbursement.  
Sincerely, [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[I have read MagnaCare's Response and it seems to skirt the non payment issue with legal maneuvering to insulate itself from the responsibility of the actual payment itself.  I question the fact that [redacted] a company hired by MagnaCare, to collect [redacted] payments for [redacted] and is another legal layer to avoid payment responsibility, IF [redacted] is Still Collecting [redacted] payment from unsuspecting former employees of [redacted].  MagnaCare may Not legally be responsible for the actual payment under current laws, But They Should Be.  If They represent their client They should take out Bankruptcy Protection Insurance, rather than walk away and leave an unsuspecting public holding the bag.    Legally there is nothing for me to do, Morally I hope it happens to their parents.  Your Answer Here]
 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

Magna Care has an absurd policy on how they handle providers who are calling in to
check status of a patient claim. EVEN IF ONE PATIENT HAS A CLAIM SPLIT INTO 5-6
CLAIMS - THEY WILL ONLY HELP YOU WITH 3 OF THE CLAIMS. THEN TRANSFER YOU TO WAIT ANOTHER HOUR TO FINISH THE STATUS! At least help with the TOTAL patient claim! As a provider, I will say this is DISCUSTING service! All because they have others waiting? Yes - we are waiting! The same people you push back in to your queue!
HORRIBLE SERVICE - WHO IS THE BRAIN CHILD THAT PUT THIS POLICY IN PLACE?
YOU DESERVE NO RATING - I WAS FORCED TO PUT IN A STAR. YOU DO NOT DESERVE IT.

Review: Magnacare has denied my Claim #: [redacted] . They refused to accept my appeal multiple times, saying it was past the 180 day limit of time allowed to appeal a claim determination. However, I was NOT notified of denial of claim within 180 days, therefore it would have been impossible for me to appeal their denial within that time frame. I only found out about Magnacare's claim denial after the hospital sent me to a national collection agency, which was way after their 180 day limit for appeals. Magnacare is refusing to re-open this case and examine the facts, to cover the cost of the medical procedure that my insurance plan pays for them to do. This situation is unfair to me, because I was denied payment for this claim, due to circumstances that were out of my control.Desired Settlement: Magnacare to reopen this claim, examine the facts, and see that I could not have possibly appealed their denial of my claim within their time frame, and cover the cost of the medical procedure that my insurance plan pays them to do.

Business

Response:

Dear [redacted]:

This responds to your notice in connection with [redacted].

Please be advised that MagnaCare is not [redacted]’s health plan, IBEW Local 25; it is only a service provider to that entity. Nonetheless, MagnaCare has endeavored to assist [redacted] and has successfully requested his plan to reconsider its decision on the denied claim that is the subject of his complaint. MagnaCare is advised by Local 25 that the denial will be overturned and the claim paid in accordance with the plan’s terms and conditions.

Review: MagnaCare refuses to process the Outstanding Emergency Room bill from [redacted]. They acknowledge that my wife's [redacted] Policy was in effect and the Outstanding Bill has been processed iand is awaiting payment. The hospital is threatening collection and hurting our Credit Rating, which is excellant. MagnaCare now wants us to write an "Appeal Letter " in order to release the payment. [redacted] my wife's former employer declared bankruptcy in Jan 2015, I believe That is the reason MagnaCare is dragging their feet, even though we paid [redacted] from Apr 2014 thru Seot 2014 $740 per month, Magna is not releasing the payment. Why do we need to "Appeal" anything??????Desired Settlement: Pay the Outstanding Emergency Room Bills for my wife (Kathleen Amalfitano),, date of service 9/*/2014 at the [redacted] Medical Center in Freehold NJ. Wife's [redacted] Policy # [redacted] - , MagnaCare Bill Ref # [redacted] (Apr 2015) & Ref # [redacted] (Jan 2015).

Business

Response:

Dear [redacted]:I response to the above complaint, please note that MagnaCare is a service provider, it is not itself a health plan and, accordingly, did not insure, underwrite, sponsor or assume financial responsibility for the health insurance benefits received by the complainant. Rather, the complainant is insured under the health benefits plan sponsored by [redacted], LLC d/b/a [redacted] (“[redacted]”). By the Notice of Chapter 11 Bankruptcy Case, [redacted] declared bankruptcy as of 12/**/14. Accordingly, [redacted] has not funded its pre-petition (i.e., 12/**/14) financial obligations, including those related to claims for medical and hospital services received by participants in its health benefits plan. This fact has been communicated to the complainant. In the absence of any legal or other right or ability for MagnaCare to facilitate [redacted]’s funding of claims incurred prior to its bankruptcy, we have taken the liberty of contacting CentraState Medical Center, whose unpaid claim is at issue, which has agreed to put the complainant’s account on a hold and not to pursue collection activities for the time being. Further communications on this matter should be referred directly to the complainant’s employer at: [redacted], LLC, [redacted] or to its attorney, J[redacted], [redacted] ###-###-####. Of course, please feel free to contact me if anything further is needed.

Review: As a contracted provider we have been trying to resolve our issues with Magnacare directly for well over one year now. We continue to experience the same problems. Our claims are submitted within the timely filing limits per our contract agreement. Magnacare in turn takes months and many times well over 1 year to process our claims. After many battles with them I was able to get some of our 2012 claims resolved this year! Our contract is with Magnacare and any claims that go to [redacted] are processed using our Magnacare contract. [redacted] claims that every check they send to us is "lost" and requires a check tracer that takes 6 or more months to resolve. An obvious stall tactic. We have put in hours of extra and unnecessary work sending Magnacare provider reps, the ** and the [redacted] written complaints and spreadsheets of pending unpaid claims. Our contract with Magnacare clearly states clean claims will be paid within 30 days. At this time the representatives I have been reaching out to are now ignoring our complaints and have not sent us a notice of the actions taken to resolve these matters for better claim processing in the future. It seems as though this will be an on going battle with Magnacare and we will forever have to handle our claims in this time consuming fashion of e-mails, complaints and spreadsheets.Desired Settlement: We would like to see the following: 1) every claim for covered and eligible services that are pending over 30 days to be paid, 2) interest on all claims past due in accordance to regulation, 3) a notice sent clarifying what steps will be taken to correct these problems, and 3) to ensure future claims processing in a timely manner according to their statements in their website and per provider contract verbiage. Thank you in advance

Business

Response:

This responds to the above complaint.

As we have previously noted, MagnaCare is not an insurance company and nor it is responsible for the funding of any claims payable to a provider, including the claims incurred by the Complainant at [redacted] MagnaCare serves only as a provider network and is not the Complainant’s health plan nor responsible for the payment of her health benefit claims. The Complainant receives her health insurance benefits from a self-insured health plan which is administered by United Health Plus, a third party administrator located at [redacted] (the contact there is [redacted], [redacted], phone number ###-###-#### and fax number ###-###-####). In response to our inquiry into circumstances underlying the Revdex.com complaint, United Health Plus advised that payments in the amount of $130,883.80 have been made on the Complainant’s claims and that the complaint is, therefore, resolved. In the event that the provider has any issues with its compensation, it should direct them to United Health Plus at the address set forth above as MagnaCare, acting only as a provider network, is not financially responsible for making any claim payments.

Please let me know if anything further is needed.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[Your Answer Here]

Our contract is with Magnacare- not [redacted]. We would expect Magnacare to help resolve this issue with [redacted] especially since the members/patients, having a Magnacare logo on their card, are expecting an in network claim processing based on our contract between [redacted] and Magnacare. . Although [redacted] states they have made payments of said amount in complaint response - we have not received the payments. Our argument with [redacted] is that they state they made the payment as shown in their records but payments were "lost" in the mail. We have multiple check tracers taking up to 6/8 months to resolve. This is an obvious pattern and unacceptable. Its been going on for well over 1 year. To add to the aggravation, contacting [redacted] is nearly impossible even for simple follow up.

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Business

Response:

In response to the complainant’s last statement, please be advised that [redacted]’s email address is [redacted]. I have already provided the [redacted] telephone number and the provider should speak to [redacted] at extension [redacted] in order to more expediently speak to a [redacted] representative . In addition, a MagnaCare provider relations representative has contacted the complainant to offer further assistance.

We consider the matter resolved; thank you for your assistance.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted]. Although we still have pending claims issues ( not only [redacted]) and we have not addressed future claims and processes as previously requested. We will close this case for now. Our hopes are that Magnacare will abide by the terms of our contract and insure that the locals they price for process claims for reimbursement in accordance to that contract and/or intervene/assist when we, as a contracted provider, are experiencing such issues as untimely reimbursement.

Sincerely,