Complaint: [redacted] I am rejecting this response because: We have filed a complaint with YHI to cover our claims or provide proof they sent over our second policy ( [redacted] ) before 4/20/If they have proof, we will send that to you in a new message Sincerely, [redacted]
Unfortunately the member's issues can not be resolved by MHC but must be handled by Your Health Idaho which is where and how the member enrolled in their policy Following is information associated with the ***'s account and policy:
POLICY
***
10/29/2015 MHC received an auto renew file from YHI for member and husband *** with a premium of $effective 1/1/
12/30/ MHC received a termination file from YHI with an end date of 1/31/
12/30/ MHC received an add file for husband and spouse with a premium of $
effective 2/1/
2/9/2016 MHC termed this policy as of 12/31/for non-payment of premium
PHONE LOGS ON ***
05/02/2016 Member insists that her policy began on 4/1/not 2/1/2016. Member refuses to contact YHI to see what her effective date is. Member said she spoke with someone, a lady, who told her that her eff was 4/1/because we sent back her February premium
DOCUMENTS SENT ON POLICY ***
1. Change Letter dated 01/01/
2. Past Due letter dated 01/08/
3. Cancellation letter 02/09/
POLICY ***
4/8/ MHC received a file from YHI with an effective date of 1/1/The member and Spouse were covered by the Link Silver Plan, and the monthly premium due was $
05/20/2016 YHI is confirming that the member has 2/1/effective date
8/17/2016 MHC received a cancel file from YHI for the effective date of the 2/1/file update
8/17/2016 MHC received an add file for the member and spouse enrolling them into the Link Bronze plus Plan with a premium of $effective 2/1/
PHONE LOGS ON ***
04/28/2016 *** *** called regarding their latest billing statement. She paid $on 4/8/which she believed to be her April premium. The member said she also received ID cards that show her enrolled in a Silver plan and she is certain she is enrolled in a Bronze plan
05/20/2016 YHI has confirmed that the member has 2/1/effective date
DOCUMENTS SENT ON POLICY ***
1. Past Due letter dated 07/07/
2. Cancellation letter dated 07/12/
At this time, the member’s policy has been correctly terminated for 5/31/due to non-payment of premiumsThe member is not due a refund and will owe for any outstanding claimsThe member will need to reach out to the YHI for further assistance in resolving this matter
Dear *** *** Please accept this as our response to complaint ID *** received by MHC on August 3, This inquiry or complaint is associated with the member’s plan selection and tax credit through the federal marketplacePlease find the following information regarding this complaint:
? Mr*** contacted customer service on two separate occasions inquiring about sleep study benefits and a participating providerNeither MHC or our Third Party Administrator has any record of Mr*** or his partner contacting us in regards to a plan change or billing issuesThe July invoice was billed at $because it included a past due amountPaper invoices are mailed to the address on file every month? Mr*** states that he worked with an agent when signing up for his policy, however, there is no agent of record for his policyAs his plan is subsidized, he would have signed up through the Federally Funded Marketplace which indicates he spoke to an “agent” at the Marketplace call centerWe cannot be responsible for a person selecting a product based upon a recommendation by an agent at the Marketplace? The member did file a HICS case (Health Insurance Casework System) *** with the Marketplace exchange on 07/027/2016, regarding the premium amount he was being billedMr*** believes his premium amount should be $each monthMHC responded with a letter dated 08/08/2016, explaining that the member is being billed $each month with an APTC amount of The member is on the Connected Care Bronze? Mr*** may change his plan during the open enrollment period beginning on November 1, We will send Mr*** hard copy documents of his policy and summary of benefits and coverageWe also encourage Mr*** to contact our customer service directly at (855) 447-and a representative can assist him with his billing questionsPlease contact me directly if you have any questions or require additional information regarding this caseSincerely,
Complaint: [redacted]I am rejecting this response because:
We were told not to pay the January premium of $425.78.
We then paid our new premium for February of $363.34.
This payment was refunded to our account and MHC said our plan had been terminated.
We did not have health insurance for February and March while we worked with MHC and YHI to resolve the issue.
We finally got a new effective date of 4/1/2016 and paid that premium.
Why do we have to pay premiums for February and March when our February premium was refunded after paying and our plan was cancelled?
Why did your employees not apply our February premium to the right policy?
If our policy was cancelled on 4/30/2016, why did our May, June, and July payment not get refunded to us?
If you used all of our payments (4 premiums) for the effective date you say, 2/1/2016 - 4/30/2016 (3 months of premiums), we should have 1 payment refunded to us at least.
It is also very frustrating that you cannot work with YHI directly and always need us as the middle man.
We are not going to pay for February and March when your employees said our plan was cancelled so we did not use our health insurance at all.
We are going to continue to work with MHC and YHI to resolve this issue.
Sincerely,[redacted]
Revdex.com, The member complaining has submitted their appeal to YHI according to their response, which is what our initial recommendation was. We can not make the change without YHI's approving. There is nothing MHC can do until this happens.
Complaint: [redacted]I am rejecting this response because:
We have filed a complaint with YHI to cover our claims or provide proof they sent over our second policy ([redacted]) before 4/20/2016. If they have proof, we will send that to you in a new message.
Sincerely,[redacted]
Complaint: [redacted] I am rejecting this response because: We have filed a complaint with YHI to cover our claims or provide proof they sent over our second policy ( [redacted] ) before 4/20/If they have proof, we will send that to you in a new message Sincerely, [redacted]
Unfortunately the member's issues can not be resolved by MHC but must be handled by Your Health Idaho which is where and how the member enrolled in their policy Following is information associated with the ***'s account and policy:
POLICY
***
10/29/2015 MHC received an auto renew file from YHI for member and husband *** with a premium of $effective 1/1/
12/30/ MHC received a termination file from YHI with an end date of 1/31/
12/30/ MHC received an add file for husband and spouse with a premium of $
effective 2/1/
2/9/2016 MHC termed this policy as of 12/31/for non-payment of premium
PHONE LOGS ON ***
05/02/2016 Member insists that her policy began on 4/1/not 2/1/2016. Member refuses to contact YHI to see what her effective date is. Member said she spoke with someone, a lady, who told her that her eff was 4/1/because we sent back her February premium
DOCUMENTS SENT ON POLICY ***
1. Change Letter dated 01/01/
2. Past Due letter dated 01/08/
3. Cancellation letter 02/09/
POLICY ***
4/8/ MHC received a file from YHI with an effective date of 1/1/The member and Spouse were covered by the Link Silver Plan, and the monthly premium due was $
05/20/2016 YHI is confirming that the member has 2/1/effective date
8/17/2016 MHC received a cancel file from YHI for the effective date of the 2/1/file update
8/17/2016 MHC received an add file for the member and spouse enrolling them into the Link Bronze plus Plan with a premium of $effective 2/1/
PHONE LOGS ON ***
04/28/2016 *** *** called regarding their latest billing statement. She paid $on 4/8/which she believed to be her April premium. The member said she also received ID cards that show her enrolled in a Silver plan and she is certain she is enrolled in a Bronze plan
05/20/2016 YHI has confirmed that the member has 2/1/effective date
DOCUMENTS SENT ON POLICY ***
1. Past Due letter dated 07/07/
2. Cancellation letter dated 07/12/
At this time, the member’s policy has been correctly terminated for 5/31/due to non-payment of premiumsThe member is not due a refund and will owe for any outstanding claimsThe member will need to reach out to the YHI for further assistance in resolving this matter
Dear *** *** Please accept this as our response to complaint ID *** received by MHC on August 3, This inquiry or complaint is associated with the member’s plan selection and tax credit through the federal marketplacePlease find the following information regarding this complaint:
? Mr*** contacted customer service on two separate occasions inquiring about sleep study benefits and a participating providerNeither MHC or our Third Party Administrator has any record of Mr*** or his partner contacting us in regards to a plan change or billing issuesThe July invoice was billed at $because it included a past due amountPaper invoices are mailed to the address on file every month? Mr*** states that he worked with an agent when signing up for his policy, however, there is no agent of record for his policyAs his plan is subsidized, he would have signed up through the Federally Funded Marketplace which indicates he spoke to an “agent” at the Marketplace call centerWe cannot be responsible for a person selecting a product based upon a recommendation by an agent at the Marketplace? The member did file a HICS case (Health Insurance Casework System) *** with the Marketplace exchange on 07/027/2016, regarding the premium amount he was being billedMr*** believes his premium amount should be $each monthMHC responded with a letter dated 08/08/2016, explaining that the member is being billed $each month with an APTC amount of The member is on the Connected Care Bronze? Mr*** may change his plan during the open enrollment period beginning on November 1, We will send Mr*** hard copy documents of his policy and summary of benefits and coverageWe also encourage Mr*** to contact our customer service directly at (855) 447-and a representative can assist him with his billing questionsPlease contact me directly if you have any questions or require additional information regarding this caseSincerely,
Complaint: [redacted]I am rejecting this response because:
We were told not to pay the January premium of $425.78.
We then paid our new premium for February of $363.34.
This payment was refunded to our account and MHC said our plan had been terminated.
We did not have health insurance for February and March while we worked with MHC and YHI to resolve the issue.
We finally got a new effective date of 4/1/2016 and paid that premium.
Why do we have to pay premiums for February and March when our February premium was refunded after paying and our plan was cancelled?
Why did your employees not apply our February premium to the right policy?
If our policy was cancelled on 4/30/2016, why did our May, June, and July payment not get refunded to us?
If you used all of our payments (4 premiums) for the effective date you say, 2/1/2016 - 4/30/2016 (3 months of premiums), we should have 1 payment refunded to us at least.
It is also very frustrating that you cannot work with YHI directly and always need us as the middle man.
We are not going to pay for February and March when your employees said our plan was cancelled so we did not use our health insurance at all.
We are going to continue to work with MHC and YHI to resolve this issue.
Sincerely,[redacted]
Revdex.com, The member complaining has submitted their appeal to YHI according to their response, which is what our initial recommendation was. We can not make the change without YHI's approving. There is nothing MHC can do until this happens.
Complaint: [redacted]I am rejecting this response because:
We have filed a complaint with YHI to cover our claims or provide proof they sent over our second policy ([redacted]) before 4/20/2016. If they have proof, we will send that to you in a new message.
Sincerely,[redacted]