Matrix Absence Management

April 1, 2016[redacted]Revdex.comPhoenix, ArizonaRE: Complaint ID#[redacted] ("Complaint") Dear Ms. [redacted]: [redacted]Phoenix, Arizona 85029 4940Phone:...

###-###-####Fax: ###-###-#### This letter  shall serve as a response on behalf of Matrix  Absence Management, Inc. ("Matrix")to the above-referenced Complaint filed by [redacted].Matrix  is the third-party administrator for the short-term and long-term  disability benefits plans offered  to employees of Medstar  Health, Inc. This means that Matrix  is charged with handling requests  for  benefits  under  those  plans, including  ensuring  that  employee/claimants submit required  medical and other support for their initial, and continued, eligibility for benefits.Ms. [redacted]  was an employee  of Medstar  and according to  our records, received  payments under those plans from  2012 until January 21, 2016, when she was notified  by Matrix  that  she no longer  met the  eligibility  criteria  for continued, benefits  under  the terms  of the  Medstar plan.Because Matrix  takes great care to safeguard the information with  which we are entrusted, we are unable to provide  a detailed explanation of the medical information supporting our decision and are unwilling to disclose such information in a public forum,like the Revdex.com website. However, please know  that  Ms. [redacted]  has been provided with  information in the  January 21, 2016 letter  advising her of her right to appeal, and the method to do so, should she disagree with the decision to discontinue benefits.We trust that this information resolves this Complaint as to Matrix.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

Thank you for contacting Matrix regarding this matter.  While we are never pleased to see that a claimant is unhappy with our services, we do greatly appreciate a chance to clarify this matter for our claimants.
Ms. [redacted] originally filed a claim for leave of absence for the...

period of 02/19/14-04/01/14.  As part of this claim she was required to provide Matrix with the necessary paperwork for her claim to be approved.  This paperwork was received on 03/13/2014 and her FMLA claim was approved the very same day. 
In addition to filing an FMLA claim, Ms. [redacted] is also eligible to apply for short-term disability benefits.  These benefits would begin after she has been out of work for 30 continuous days.  In order to receive short-term disability benefits, the claimant must provide the necessary medical documentation to support their claim for benefits.  In this case, the medical certification form which was provided was not sufficient to approve her claim for benefits.  A letter informing Ms. [redacted] of the need for more medical information was mailed to her on 03/20/2014.   We have also been in repeated contact with her physician's office in an attempt to clarify her physical restrictions as well as medical findings to support her claim for benefits.  
Please note that we are working diligently to resolve this claim and once the medical information is received from the provider's office we will be reviewing the claim in an expeditious manner to make a decision on this claim.  We encourage Ms. [redacted] to continue to work with her provider's office to ensure that her most updated medical information is sent to our attention.  
Sincerely, 
[redacted]
Senior Director Of Operations
Matrix Absence Management 
###-###-####

Thank you for bringing this matter to our attention and we would like to acknowledge that we do take these complaints very seriously.  With regard to the specific experience of Ms. [redacted], we feel that we have been very forthcoming with information to allow Mr. [redacted] to have a solid...

understanding of her requirements as part of receiving monies under her disability policy.  In this particular case we have approved a Short-Term Disability claim for Ms. [redacted] and on 01/23/2014 we mailed her an approval letter which clearly informed her that her claim was approved from 01/23/2014 to 03/20/2014.  The letter also clearly outlined:"In regards to future benefits, we require additional documentation to support ongoing disability. Please submit medical records and fully complete the enclosed supplementary statement. Once we have received and reviewed the documentation requested, a decision as to whether or not you are entitled to additional benefits will be made in a timely fashion. While we will take reasonable steps to try to obtain this documentation on your behalf, ultimately you are responsible for providing proof to us of your ongoing disability."Additional medical information was received and as a result, Matrix extended these disability payments for the period of 03/21/14-04/07/2014.  An extension letter was mailed to Ms. [redacted] on 03/18/2014 which clearly outlined as well as the fact that additional payments would not be issued without additional medical information.  The letter outlined:"In regards to future benefits, we require additional documentation to support ongoing disability. Please submit medical records and fully complete the enclosed supplementary statement. Once we have received and reviewed the documentation requested, a decision as to whether or not you are entitled to additional benefits will be made in a timely fashion. While we will take reasonable steps to try to obtain this documentation on your behalf, ultimately you are responsible for providing proof to us of your ongoing disability."Additional medical information has been received and at this time the claim has been approved through 05/01/2014.  Please note that to receive benefits beyond 05/01/2014 Ms. [redacted] will again have to provide additional medical information.  If this medical information is not received or sufficient to support benefits beyond 05/01/2014, there may be delays in the processing of her claim payments.  We did speak with Ms. [redacted] and she is concerned about the fact that her checks have not arrived to her in a timely manner. Please note that we show checks were issued on:  02/6/14, 2/13/14, 2/20/14, 2/27/14, 3/6/14, 3/13/14, 3/20/14, 3/21/14, 3/28/14, and 4/2/14.  Any delays in the processing of these checks were due to the fact that additional medical information was not received to make a timely decision on her claim.  Ms. [redacted] also cited that it was her expectation that her checks would come to her on a weekly basis, regardless of when or if additional medical information was received.  Please note that it is a requirement of her disability policy that she is medically disabled in order to receive benefits under the terms of her policy and that her benefits are not guaranteed without proper medical documentation to support her time off work.  We do regret Ms. [redacted] being dissatisfied with her experience to date and we will attempt continue to partner with her to make sure that her experience is as pleasant as it can be when dealing with Matrix Absence Management.Sincerely, [redacted] Matrix Absence Management

On September 15, 2014 we responded to a Revdex.com complaint, however on October 10,
2014 we received a follow up request which indicated [redacted] was not satisfied
with resolution response to her initial complaint. [redacted] maintains that Matrix’
response which states we attempted to contact her on multiple occasions unsuccessfully
is untrue and that her claim was rejected.
 
The file documentation shows that [redacted] called in a claim
on August 12, 2014 with a *ate of *isability of August 6, 2014 *ue to a motor
vehicle accident.  A medical request for information was sent to [redacted]’s physician [redacted] on August 13, 2014.  [redacted]'s medical certification was received
on August 19, 2014 from [redacted] and indicated that [redacted] would be released to return to work as of August 28, 2014. 
An email was sent to [redacted] on August 19, 2014 by the claims examiner indicating that Matrix had received the medical certification but
it was insufficient and we needed additional medical documentation to support her claim for disability.  At that time we also sent a request to [redacted]’s physician [redacted] requesting medical
records containing treatment and treatment plan notes.
 
In follow up, the examiner emailed [redacted] on August 25, 2014 and informed her that a medical request was sent to [redacted] on August
19, 2014 but we had not received a response from her physician.  On August 27, 2014 a second request was sent to [redacted] as well as an email to [redacted] informing her of the second request
that was sent to her physician [redacted] for medical records. 
On September 2, 2014 we received a phone call from [redacted] indicating that she was returning to work on September 2, 2014.  We sent her an email in response, confirming we
received her voicemail regarding her return to work and we also informed her that we were still waiting for records from her physician.
On September 5, 2015, [redacted] provided the medical records that were requested and the file was sent to our medical staff to be reviewed.  The medical review concluded
that the claim was medically supported from August 6, 2014 through August 29, 2014, the *ate [redacted] stated she could return to work.
The policy of [redacted]'s employer states: 
?WEEKLY INCOME BENEFIT
DAY BENEFITS BEGIN:  Benefits, for one period of disability, will be paid as follows:
INJURY AND SICKNESS:  We will pay benefits from the greater of: (1) the thirty-first consecutive day of disability; or (2) the day immediately following
exhaustion of the Insured’s EIB (Extended Illness Bank) hours available on the date disability occurs.
We sent an email to [redacted] on September 10, 2014 indicating that the medical review had been completed.  We advised her that since she had not been
out of work for more than 30 *ays, per the policy provision above, no benefits would be payable and her claim would be *enied.  We finalized the
determination on September 15, 2014 and mailed [redacted] denial letter on September 25, 2014.
While there was a delay in sending out the denial letter, we provided [redacted] with our determination via email on September 10, 2014.

I think owners should know how there clients are being treated. This is my 3rd medical claim with this company. the intake representative are great but the claims adjusters are horrible they lie to me and don't calls back. This last claim took a whole month and I sti have not been paid. [redacted] sent my check to a wrong address he wasn't sympathics I asked to speak with his manager he transferred me to another agents name issue. She said she would overnight the check to me on Friday. I called back and spoke with [redacted] she was helpful but she could not give me a tracking number She states she had to email the audit dept and she would call me back. Then I call back and was transferred to [redacted] who said she was the operation manager and she would get a tracking number an call me back. No one called me back and I st don't have a check. I would like my check a nd would like upper management to review all calls concerning my issue. My sickness was in January and I still don't have a check. I don't appreciate the run around. This is ridiculous and this is poor business practice. I asked to speak with upper management but no one would transfer me or call me back

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
  The first check that was sent on May 7, 2014 has been received, but have to wait 7 more days before I can use any thing from it for the bank has put a hold on it and will be usable on May 19,2014.I will be waiting for the 2nd check after May 22, 2014 before I am satisfied with the actions.
Regards,
[redacted]

April15, 2016UPLOADED TO Revdex.com.org website Revdex.com Phoenix, ArizonaRE: Complaint ID#[redacted] ("Complaint") To Whom It May Concern:This letter  shall serve as a response on behalf of Matrix...

 Absence Management, Inc. ("Matrix")to the above-referenced  Complaint filed by [redacted]'.Matrix  is the  third-party administrator for  the  short-term disability  benefits  plan  offered  to employees  of [redacted] (the  "[redacted]  STD Plan" or the  "Plan").   This means that  Matrix  is charged with  handling requests for benefits under the plans, including ensuring that employee/claimants submit  required  medical and other  support  for  their  initial  eligibility  for benefits.Our records show that on or about October 7, 2015, Ms. [redacted] filed a claim to extend the benefits  she was receiving since May 2015 under the [redacted] STD Plan.   Shortly, and on many occasions, thereafter, representatives of Matrix  informed Ms. [redacted]   that,  in order  to evaluate her claim for continued  benefits  under the Plan, we would need to receive supporting medical documentation and that, while Matrix  would endeavor to request those records on her behalf, it was ultimately her responsibility as the claimant  to provide  the necessary support. Our  records  show  Matrix  also made  three  separate  attempts  to  contact  the  physician  we understood to be her treating physician to obtain  the  required  medical certification, without success.After  not  receiving  the  required  supporting objective  medical certification to  justify  benefits under the Plan beyond October 6, 2015, Matrix  denied Ms. [redacted]'s claim and sent her a letter  dated November 12, 2015, explaining the bases for the denial decision in great detail and providing her with notice of her appeal rights under the Plan. This is the avenue for a claimant under the Plan to request reconsideration of a decision.  As of this date, she has not done so.We trust that this information resolves this Complaint as to Matrix.

As previously stated in our response filed April 1, 2016, Ms. [redacted] has been advised of her right to appeal and, to date, has yet to exercise this right. Absent an appeal, Matrix cannot take any further action .

We are in receipt of the consumer complaint submitted thru the Arizona Revdex.com (ID # [redacted]).

size="3"> Matrix Absence Management is a third party administrator of benefits offered by employers and/or insurance companies, and as such is bound to policy limits, documentation, and conditions dictated by our clients.  What’s more, we are unable to disclose confidential information relating to any claimant’s health condition, employment or coverage. We have completed our review of this particular case and can only offer assurances that it was thoroughly and promptly processed in compliance with the appropriate policy concerns.  Under no circumstances does Matrix deliberately delay or impede benefits, and makes every effort to expedite required documentation and available benefits. While we recognize all claimants – especially those facing severe health issues  - are anxious to have benefits approved promptly, we are equally determined to ensure such benefits are administered accurately, fully, and in accordance with the underlying policies.
Matrix Absence Management

I think owners should know how there clients are being treated. This is my 3rd medical claim with this company. the intake representative are great but the claims adjusters are horrible they lie to me and don't calls back. This last claim took a whole month and I sti have not been paid. [redacted] sent my check to a wrong address he wasn't sympathics I asked to speak with his manager he transferred me to another agents name issue. She said she would overnight the check to me on Friday. I called back and spoke with [redacted] she was helpful but she could not give me a tracking number She states she had to email the audit dept and she would call me back. Then I call back and was transferred to [redacted] who said she was the operation manager and she would get a tracking number an call me back. No one called me back and I st don't have a check. I would like my check a nd would like upper management to review all calls concerning my issue. My sickness was in January and I still don't have a check. I don't appreciate the run around. This is ridiculous and this is poor business practice. I asked to speak with upper management but no one would transfer me or call me back

I have reviewed the response made by the business in reference to complaint ID [redacted], and have Determined that this proposed action would not resolve my complaint.  For your reference, Details of the offer I reviewed appear below.

The assertions made by Matrix contain both misleading statements and outright falsehoods.  The assertion that Matrix attempted to contact me repeatedly and unsuccessfully are untrue.  I called the agents daily and repeatedly.  These calls went unanswered.  I eventually received a few emails containing very little information and *id not answer the questions I asked.  In fact, I was told that the clinic was not sending information (an allegation Matrix see** to be back tracking upon).  It is true that they rejected my claim, but they could have been honest and forthright (eg, professional).  

Regards,

The Claimant has recieved payment per the terms of his employer's policy.  His perception of delays were the result of standard elimination periods and payment of benefits in arrears.  Responses to the Claimant's phone inquiries were made promptly, but were directed to his voice message...

service.Payments to the Claimant are continuing on schedule, per his employer policy.

After reviewing the response submitted by Ms. [redacted], it is unclear what additional response she or the Revdex.com is seeking.  While the parties appear to continue to disagree about how and whether the records Matrix received were timely submitted or received to support her claim (please see initial response submitted by Matrix for more details on our position), she indicates she is "happy" because she received the STD benefits she was seeking and is back at work, so we see no further need to respond or any additional complaint lodged that requires us to do so.
Sincerely, Gail C[redacted], Director of Employment Law & Compliance

Good afternoon, My name is [redacted] and I am the Senior Director of Operations for Matrix Absence Management.  First and foremost, we want to apologize to Mr. [redacted] for his experience to date and we hope that we can rectify this situation so that he can focus on his health, and not...

worry about his insurance benefits from Matrix Absence Management.  I have reviewed his concerns and as of yesterday, his claim has been approved and a check has been sent to his attention.   A check in the amount of $5,933.17 has been sent to his attention for the period of 2/7/14-05/01/2014.  A second check will be released on 05/22/2014 for the period of 05/02/14-06/01/14 in the amount of $2166.78.  We did call and speak with Mr. [redacted]’s wife on 05/06/2014 and explained that this claim has been approved and we have drafted an approval letter to that effect as well.  We do hope that this rectifies this situation for Mr. [redacted] and moving forward, should he experience any delays in the processing of his claim, we encourage him to communicate with his claims examiner and escalate any issues if he is not seeing a response time within 24 hours of his initial inquiry.  Again, we apologize for his experience to date and we will take every measure to ensure that his experience is much more meaningful as we continue our partnership with Mr. [redacted]. ?Sincerely, [redacted]

Thank you for contacting Matrix regarding this matter.  While we are never pleased to see that a claimant is unhappy with our services, we do greatly appreciate a chance to clarify this matter for our claimants.

Ms. [redacted] originally filed a claim for leave of absence for the...

period of 02/19/14-04/01/14.  As part of this claim she was required to provide Matrix with the necessary paperwork for her claim to be approved.  This paperwork was received on 03/13/2014 and her FMLA claim was approved the very same day. 

In addition to filing an FMLA claim, Ms. [redacted] is also eligible to apply for short-term disability benefits.  These benefits would begin after she has been out of work for 30 continuous days.  In order to receive short-term disability benefits, the claimant must provide the necessary medical documentation to support their claim for benefits.  In this case, the medical certification form which was provided was not sufficient to approve her claim for benefits.  A letter informing Ms. [redacted] of the need for more medical information was mailed to her on 03/20/2014.   We have also been in repeated contact with her physician's office in an attempt to clarify her physical restrictions as well as medical findings to support her claim for benefits.  

Please note that we are working diligently to resolve this claim and once the medical information is received from the provider's office we will be reviewing the claim in an expeditious manner to make a decision on this claim.  We encourage Ms. [redacted] to continue to work with her provider's office to ensure that her most updated medical information is sent to our attention.  

Sincerely, 

Senior Director Of Operations

Matrix Absence Management 

###-###-####

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
  The first check that was sent on May 7, 2014 has been received, but have to wait 7 more days before I can use any thing from it for the bank has put a hold on it and will be usable on May 19,2014.I will be waiting for the 2nd check after May 22, 2014 before I am satisfied with the actions.

Regards,

The paperwork was faxed multiple times from the HR office. Said paperwork was not found until this complaint was filed. Now that it is found I'm happy, I can return to work. This isn't the first time this is been a issue, the fax machine only seems to work when I bring in a third party. Also I asked times before I had to go out for the last surgery for the paperwork to be faxed to my doctor and to give me an update. Nether was done. So I'm back in work again, that will do.

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Arizona

Revdex.com:We are

in receipt today of the consumer complaint processed thru the Arizona Revdex.com (ID #

[redacted]Matrix

Absence Management is a third party administrator of benefits offered by

employers and/or insurance companies, and as such is bound to policy limits,...

documentation,

and conditions dictated by our clients.  What’s more, we are unable to

disclose confidential information relating to any claimant’s health condition,

employment or coverage. We are

completing our review of this particular case and can only offer assurances

that it is being thoroughly and promptly processed in compliance with the

appropriate policy terms.  Under no circumstances does Matrix deliberately

delay or impede benefits, and makes every effort to expedite required

documentation and available benefits.While

we recognize all claimants – especially those facing severe health issues

 - are anxious to have benefits approved promptly, we are equally

determined to ensure such benefits are administered accurately, fully, and in

accordance with the underlying policies.