Peffer Heating and Air, Inc.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, 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,
*** ***Thank you for your assistance in resolving my complaintI appreciate your help! I did not receive your email supposedly sent Febrequesting a response from meThe company did respond and reimburse me for my outstanding claim, howeverMany thanks! *** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, I agree that the company who initially sold me the insurance policies should speak to how the policies were contracted out to two different companies. I originally spoke to HealthCompare to get the policies started and have been directed to contact *** who is associated with HealthCompare. I contacted *** on December 2, and was told they would review the call between myself and their agent when the policies were sold and they would get back to me. They have not. I will wait to hear back from this company and let you know when or if the issue is resolved.
Regards,
*** ***

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.Dear Revdex.com -- I'm re-opening an existing complaint that has not been resolved by HCC Medical Insurance Services (MIS)To give you some background, below at the bottom was and still is my complaint about this companyAfter submitting the below complaint, HCC MIS advised that I resubmit all claimant statement forms again (please note, I already had submitted these forms multiple times before that they peculiarly "lost" on one occasion and "never received on many other occasions)In any event, I resubmitted the forms once again and they were successfully received electronicallyAfter that, HCCMIS sent a letter on Feb23rd, to *** *** Hospital, which is the place where I had visited for emergency room servicesThe letter stated that they need all of my medical records from 8/1/on file with the facilityThis letter was signed off by a one-named person called "***"In multiple conversations last year with customer service, I repeatedly told them that I'm not from the United States and that this was my first time in this countryThe only medical records I have are the ones from this emergency room visit and that these claims are already on file with HCCMISThere are no other medical records that can be provided since 2012, since I currently live in Lebanon and have no prior medical historyCustomer service repeatedly said this will not pose any issues and this requirement will be waived in my caseI then received an Explanation of Benefits from HCCMIS stating that "this condition is not covered due to pre-existing limitation" and am still responsible for 100% of $4,expenses incurred during my hospital visitI just wanted re-iterate my complete and utter dissatisfaction and disgust with the way this company operatesI feel they are intentionally not paying the 80% of the policy that they are obligated to pay as part of the medical plan that I purchasedIf this matter is not promptly resolved and my portion of the balance paid by July 31st, 2015, I will be hiring local legal counsel in the United States in order to take legal action against this fraudulent companyIn addition, I will continue to file this same Revdex.com complaint against HCCMIS on a monthly basis until this matter is resolved as well and will continually report this company as a scam via the Revdex.com and any other avenues as wellI sincerely hope it doesn't reach that point and this company will honor the contract of service that I purchased back in AugustPlease help in resolving this matter! I do not know what else to do besides hire an attorney in the US, especially given I am half a world away in Lebanon! Your assistance is greatly appreciatedI'd also like the name and contact information of HCCMIS's legal counsel as well, if possible"To Whom This May Concern -- I'm from Lebanon and visited the U.Sin August of While in the U.S., I purchased a travelers insurance policy on-line from HCC Medical Insurance Services for ~$USD, which provides for coverage of 80% of a patient's medical costs, while the patient is responsible for 20%Unfortunately, while I was in the U.S., I had an urgent need to visit the emergency room for sharp pains in my lower abdomen on August 5thAs a result, I was admitted to the ER and had a variety of tests performed to ensure that it was seriousAt the time, I called HCC Medical Insurance Services to notify them that I was visiting the ER and they said that is acceptable and they appreciated the notificationAfter all of the medical services were performed by the hospital, I followed the claims process as outlined by HCC and fully completed a Claimant's Statement & Authorization form as requestedThe claim numbers from the ER visit, along with the amounts that need to be paid in parentheses, are as follows: 1) *** ($3,159.50), 2) Claim # *** ($1,028.00), 3) Claim # *** ($377.00)My plan number is ***The insurance policy stated that HCC would pay 80% of these costs ($3,651.60), while I would pay 20% ($912.90)So I sent in these forms the first time in September, but HCC said they never received these forms after following up with themAfter this, I had to leave the country and return home to LebanonFrustratingly, I had a distant relative complete these forms a second time, along with an authorization from HCC that authorized this person to act on my behalfAfter following up with them in November to ensure they received it a 2nd time, they then said the form was incomplete, which was totally and an utter lie from their sideThe forms were completed 100%They asked me to resend these forms in againFrustration is really growing now at this point with their service and incompetenceThe forms were sent in again in November and were received by HCC in December, which was confirmed by a phone call to a customer service rep that the forms were received and properly completed and that she was going to place an urgent priority to get these processed by the claims department in order to start the payment process (call reference # provided by the agent was 465184)They stated it may take 30-days to process, but she would the best she could to expedite itSo then this week we followed up with HCC again, since it has been months since those forms were received by HCC as confirmed during a phone call with themWe asked where they were in the process and they stated the forms that I sent in December were done so at a time when they were implementing a new online system to submit claims, so those forms were never properly processed and I have to resubmit these forms again a 4th timeI'm beyond livid at this point with the level of service and the reality that I'm being given the "run-around" by a company that I believe is fraudulent and deceptive to its customersI need your help in resolving this case as soon as possible, so that HCC can pay 80% of the medical costs to these various providersDebt collection letters are being received now from debt collection agencies asking for their payments, due to the incompetency and fraudulent activity of HCC Medical InsurancesI feel like this company is purposely avoiding these paymentsYour assistance is greatly valued and appreciated in resolving this matter."
The claim numbers from the ER visit, along with the amounts that need to be paid in parentheses, are as follows: 1) *** ($3,159.50), 2) Claim # *** ($1,028.00), 3) Claim # *** ($377.00)My plan number is ***The insurance policy stated that HCC would pay 80% of these costs ($3,651.60), while I would pay 20% ($912.90)This is my expectation is for HCC to pay for $3,and would I like this to be promptly paidI'm not going to send in any more claims forms I've done that times alreadyThey have the forms and they know the amounts that need to be immediately paidThey need to honor the insurance policy / agreement that I purchased for $in August.Regards,*** ***

We have reviewed the issues surrounding Ms. *** claimWe have made an administrative exception and processed her claimMs. *** will receive a new Explanation of benefit statement shortlyI hope this information will allow the Bureau to conclude handling of this fileIf I can be of any further assistance, please let me know
Respectfully,
*** ** *** Esq

We apologize if Ms*** has experienced service delaysUnfortunately, her situation is quite complex since some conditions are not covered under her insuranceWe ask for her patience as medical records must be requested and received before our review can be completed
I hope this information
will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know
Respectfully,
Charles HM***, Esq

We have reviewed the claim submitted by Ms *** and have determined that the claim is eligible for payment under the policyWe apologize for the delay encountered by M.s*Ms*** will receive a check in the amount of $and an new Explanation of Benefits shortlyI hope this information
will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me knowSincerely, Jon ***HCC Medical Insurance Services

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.Customer service (not the claims department) did call us, which is a first for them calling US, but they told the same story: they need our son's medical recordsWe have sent these records both by mail and email and even received a confirmation on their receiving the email in NovemberWe have the exact dates and copies of the emails and if you need us to send those we canThe customer service lady did not want to go through all the files to find the records as we have several claims, so had us email the records again to another emailThe customer service representative acknowledged receiving the records and said she would forward them on to the claims department. In effect we are now presently at the same situation as when we filed the initial complaint. We have called HCC multiple times since and we continue to receive conflicting information from them as to their receipt of the medical records and claimant statement and authorization forms we have sentWe are in this continuous circle of constantly sending the same records to be told they don't have them and we need to send them again, etcRegards,*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below
They have rejected all doctor's appointments that I have hadHaving a breast exam that is clear does not constitute a preexisting condition My pap exam did show a preexisting condition which the insurance denied treatment forI understand thatBut, that does not justify them going back and denying all previous appointments that had nothing to do with that exam
Regards,
*** ***

I am sorry Ms*** has chosen to continue to dispute the issue this way, but unless and until an appeal is properly filed, the file will remain closedOur correspondence was mailed to the address Mr*** provided at time of purchaseIf they go to our Client Zone, the instructions and forms for an appeal are availableI hope this information will allow the Bureau to conclude handling of this fileIf I can be of any further assistance, please let me knowRespectfully, Charles ** ***, Esq

We have reviewed the issues raised in Mr*** complaintUnfortunately, these items are not a covered expense under his mother's policy, I regret our decision could not be more favorable
I hope this information will allow the Bureau to conclude handling of this fileIf I can be of any further
assistance, please let me know
Respectfully,
Charles HM***l, Esq

Dear Ms***:
I have attached our response to Ms***s follow up inquiry. Unfortunately, our response is unchanged and our decision is final
Sincerely,
*** ** ***

We apologize if Ms*** has had trouble reaching our claims departmentI have asked that one of our managers reach out to her at the number provided to see if we can resolve or expedite this matterI hope this information will allow the Bureau to conclude handling of this fileIf I can be
of any further assistance, please let me know
Respectfully,
*** * ***, Esq770-693-*** direct

Thank you for your patience as we reviewed Ms*** situationMs. *** terminated her coverage with our company and this was handled properlyIt appears her complaint is related to a different companyWe have forwarded this matter to her agent to handle with the other carrierI hope
this information will allow the Bureau to conclude handling of this fileIf I can be of any further assistance, please let me knowRespectfully,
Charles HMacPhaul, [email protected]%

The insured was covered under our Atlas America policy which is issued on a non-admitted basis to The Atlas /International Citizen Group Insurance Trust out of Hamilton, BermudaThe insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCC MIS) is the administratorWe
have reviewed the claims and medical records concerning this matterIt is clear that the insured received treatment and submitted claims for a condition that is specifically excluded under the policyConsequently, we are upholding our decision in this matterI hope this information will allow the Bureau to conclude handling of this fileIf I can be of any further assistance, please let me knowSincerely, HCC Medical Insurance Services

We apologize for the delay on this issueWe are waiting for information from one of the providers before we can release this claimI will have one of our managers reach out to her at the number provided to see if we can resolve or expedite this matterI hope this information will allow the Bureau to conclude handling of this fileIf I can be of any further assistance, please let me knowRespectfully,
*** ** *** Esq

Mr. [redacted] was covered under our StudentSecure policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda. The insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the...

administrator.
We have reviewed Mr. [redacted] complaint and medical records again. It is clear from the medical records that the condition pre-dated our policy. The medical records clearly indicate that his symptoms predate the effective date of the policy and are excluded as a pre-existing condition. Please see exclusion below.
Exclusions: Pre-existing Conditions — Charges resulting directly or indirectly from any Pre-existing Condition, as herein defined, are excluded from this insurance during the first six (6) months of coverage.
Pre-existing Conditions: Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 12 months immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 12 months immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 12 months immediately preceding the Certificate Effective Date.
I regret our decision could not be more favorable, but our decision is final.
I hope this information will allow the Bureau to conclude the handling of this file. If I can be of any further assistance, please let me know.
Sincerely,
Jon P[redacted]
HCC Medical Insurance Services

Revdex.com:
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.
Generic response.  No reason was given as to why my claim was correctly rejected, AND why that reason was selected (why it is valid).  See original details.  
Regards,
[redacted]

I am sorry Ms. [redacted] has experienced a delay in the processing of her claims. Our files indicate Ms. [redacted] was paid earlier this week and I apologize for the delay.
I hope this information will allow the Bureau to conclude handling of this file. If I can be of any further...

assistance, please let me know.
Respectfully,
 
[redacted] Esq.

As previously stated in the response letter dated 2/25/2015, Mr. [redacted] claims have been properly processed and paid under the terms and conditions of his policy. We hope this information will allow the Bureau to conclude the handling of this file. If we can be of any further assistance, please let me know. Respectfully,Brittani [redacted]770.693.6457b[redacted]@hcclife.com

Thank you for your patience as we reviewed Mr. [redacted] situation. Unfortunately, Mr. [redacted] medical condition is not covered under our policy. We have reviewed his file and we will be contacting Mr. [redacted] shortly concerning his insurance. I hope this information will allow the Bureau to...

conclude handling of this file. If I can be of any further assistance, please let me know. Respectfully, Charles [redacted], Esq. 770.693.6585 c[redacted][email protected]