Mayo Health Plan

See Attached

The following is a history of the State Farm Insurance Claim at the above mentioned address dated November , 2014.Hector received the assignment from State Farm and he set up an appointment to estimate the damage, take measurements, send samples of the existing floor and send information to State FarmApproximately one month later Hector had to return and make an estimate for a x bathroom areaHis estimate to repair the bathroom was for the insurance.The customer then picked all her materials which were upgraded to wood and laminateHector showed her the samples and they matched the materials we had in stockShe signed the contract and we ordered the materialWe always order materials as soon as we have the approval from the insurance company and a signed contract from the insuredThe insurance companys like to resolve these claims as quickly as possibleFor us to provide good service to the company it is very important that we have the materials and avoid any delays-She came in around the first week of March and told our estimator, M [redacted] , that she wanted to change her order from laminate to woodM [redacted] told her the material she had contracted for in January was ordered in January as a special order for her job and that the stairnose was custom made for her house and could not be sent backThe laminate could be returned but she would have to pay a restocking fee and freight both ways.The customer called State Farm and said that she was going to cancel the entire order with us and go elsewhereWe have billed her for the custom order and restocking fee and freightTo date she does not return phone calls.In regards to the wood not matching the existing width of her existing floorHector took the sample that matched what we have for her jobShe approved the sample and order at the time she signed the COntract.I had a conversation with the State Farm Adjuster on April regarding the cancellation of this claim and she told me she had discussed the cancellation with the customer and informed her that there would be restocking fees etcif she canceledThe damage was done to the house and replacement was necessary so the cancellation did not make any sense to the adjuster, These facts can be confirmed by H [redacted] , ###-###-### extension And E***, State Farm Adjuster at ###-###-####Refer to State Farm Claim [redacted] .We are filing a small claims case to recover our losses and will advise on the results when they are availableWe are enclosing a copy of the contract that she signedIt is self exp***tory.Sincerely,R [redacted]

I am rejecting this response because: Please be informed,although the business mentioned in their letter that the estimation of benefits was done by mistake and will be corrected for that particular claim,the business kept doing the same behavior for all the subsequent claims as most of the claims were either unapproved,uncovered or unacceptable.the situation ended by almost charging all the costs of the health services including the preventive services to me.so althiugh I pay the health insurance company dollars a month.I being charged most of the health care services exactly as if I was not insured.I render the health insurance company responsible in covering all the health related cahrges and the preventive one should be covered at 100%

Claim date of service 05/11/17, Total charge from provider office, $1298.00, amount owed $ Claim correctly processed and Hany owes 0.00.Claim date of service 03/25/17, Total charge from provider office, $35.99, amount owed $ Claim correctly processed and Hany owes 0.00.Claim date of service 01/20/17, Total Charge from provider office $284.00, amount owed, $53.96, Claim correctly, amount due is related to coinsurance which is paid by Hany The provisions of the plan were applied correctly.Claim date of service 01/04/2017, Total charge from provider office $39.99, amount owed $ Claim correctly processed and Hany owes 0.00.Claim date of service 01/04/17, Total charge from provider office $497, amount owed, $334, Claim correctly processed, amount due is related to annual deductible and coinsurance.Upon review of claims, all are processing correctly Preventive services are processed and paid 100% in accordance to plan design Deductible and coinsurance are applied to other services in accordance of plan design

Complaint:
I am rejecting this response because: Carpet One was invited to give an estimate/proposal concerning materials and cost of those materials that could replace the damaged carpet on January My existing hardwood floor is Red Oak 1/2" X 5" and as discussed with representatives from Carpet One, the stairs needed to match the existing floorInstead of calling to inform me that the color I liked (Sahara Sand) was only available in 3" planks and that the matching stair noses for this product was no longer available from the Armstrong Company, they placed the orderThere was no need to custom order stair noses when Armstrong had a comparable 5" plank product (Oak-Gunstock/Turlington 5" Collection with matching stair noses I never received any communication concerning the proposal or materials until I visited the Carpet One store in March (1/months later)At that time, I wanted to discuss the cost of hardwood in the upstairs bedroomI did not go in to the store to change my order.....I did not know they had ordered! Since I was unaware that the order was placed or received, I was also not able to "return" it since it is still at the Carpet One storeAs far as I know, it is unused, undamaged and unopened merchandise which could have been returned within '48' hours, if they would have informed meThis is a company that does not appear to be honest or professional in their dealings with customersPlease note that I did not discuss this matter with the State Farm Adjuster as indicated by Carpet One
Regards,
C*** ***

See Attached.

Claim date of service 05/11/17, Total charge from provider office, $1298.00, amount owed $0.00.  Claim correctly processed and Hany owes 0.00.Claim date of service 03/25/17, Total charge from provider office, $35.99, amount owed $0.00.  Claim correctly processed and Hany owes 0.00.Claim date of service 01/20/17, Total Charge from provider office $284.00, amount owed, $53.96, Claim correctly, amount due is related to coinsurance which is paid by Hany.  The provisions of the plan were applied correctly.Claim date of service 01/04/2017, Total charge from provider office $39.99, amount owed $0.00.  Claim correctly processed and Hany owes 0.00.Claim date of service 01/04/17, Total charge from provider office $497, amount owed, $334,43.  Claim correctly processed, amount due is related to annual deductible and coinsurance.Upon review of claims, all are processing correctly.  Preventive services are processed and paid 100% in accordance  to plan design.  Deductible and coinsurance are applied to other services in accordance of plan design.

I am rejecting this response because:
Please be informed,although the business mentioned in their letter that the estimation of benefits was done by mistake and will be corrected for that particular claim,the business kept doing the same behavior for all the subsequent claims as...

most of the claims were either unapproved,uncovered  or unacceptable.the situation ended by almost charging all the costs of the health services including the preventive services to me.so althiugh I pay the health insurance company 1770 dollars a month.I being charged most of the health care services exactly as if I was not insured.I render the health insurance company responsible in covering all the health related cahrges and the preventive one should be covered at 100%.

We have a small claims action set for friday july 31st 2015 to resolve this matter we will inform you of the outcome when it is finshed.  R[redacted]

The following is a history of the State Farm Insurance Claim at the above mentioned address dated November , 2014.Hector received the assignment from State Farm and he set up an appointment to estimate the damage, take measurements, send samples of the existing floor and send information to State...

Farm. Approximately one month later Hector had to return and make an estimate for a 3 x 5 bathroom area. His estimate to repair the bathroom was 294.73 for the insurance.The customer then picked all her materials which were upgraded to wood and laminate. Hector showed her the samples and they matched the materials we had in stock. She signed the contract and we ordered the material. We always order materials as soon as we have the approval from the insurance company and a signed contract from the insured. The insurance companys like to resolve these claims as quickly as possible. For us to provide good service to the company it is very important that we have the materials and avoid any delays. -She came in around the first week of March and told our estimator, M[redacted], that she wanted to change her order from laminate to wood. M[redacted] told her the material she had contracted for in January was ordered in January as a special order for her job and that the stairnose was custom made for her house and could not be sent back. The laminate could be returned but she would have to pay a restocking fee and freight both ways.The customer called State Farm and said that she was going to cancel the entire order with us and go elsewhere. We have billed her for the custom order and restocking fee and freight. To date she does not return phone calls.In regards to the wood not matching the existing width of her existing floor. Hector took the sample that matched what we have for her job. She approved the sample and order at the time she signed the COntract.I had a conversation with the State Farm Adjuster on April 30 regarding the cancellation of this claim and she told me she had discussed the cancellation with the customer and informed her that there would be restocking fees etc. if she canceled. The damage was done to the house and replacement was necessary so the cancellation did not make any sense to the adjuster, These facts can be confirmed by H[redacted], ###-###-### extension 103. And E[redacted], State Farm Adjuster at ###-###-####. Refer to State Farm Claim 5[redacted].We are filing a small claims case to recover our losses and will advise on the results when they are available. We are enclosing a copy of the contract that she signed. It is self exp[redacted]tory.Sincerely,R[redacted]