Robert Ritch & Associates

Revdex.com of CENTRAL INDIANA NDelaware Street, #Indianapolis, IN 46204-? RE: Revdex.com Complaint ID Number [redacted] FAX 317-488- We received your letters regarding the above-referenced complaintsMHS has also received notice of this issue through a number of avenues, including the Indiana Family and Social Services Administration (FSSA)We are happy to take this opportunity to let you know that we have contacted our member about her issuesWe made attempts to talk to her on the phone, and a letter was sent on November 10, and informed FSSA of our findingsBecause the issue is already addressed, and because of our concern not to disclose an individual member's protected health and demographic information, we are declining to publish here the details of this particular situationWe thank you for your assistance to our plan member and for your dedication to? businessaccountability.Sincerely,Scott L [redacted] Director, Compliance

Revdex.com: I have reviewed the? response made by the business in reference to complaint ID [redacted] , and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below Brittany has indeed contacted me regarding my complaints but they have not been resolvedFor instance - the echo web coordinator had sent me an e-mail stating that two types of crowns maybe coveredBrittany said only type of crown would be covered, the stainless steelHer objection to the statement made be the echo coordinator does not hold water because Brittany stated that the echo coordsaid the word 'maybe' was used and so the other crown is not part of my benefits, ? but the word 'maybe' applies to both types of crown not just the one that Brittany is objecting toBrittany also stated that it is hard to determine the coverage without an actual code to go with itMy objection, if I don't know what type of crown is covered I could potentially go to every dentist in the network and they could all use a code for a crown that is not covered and I will be wasting my time, money, and other resources and would no longer have a job since I would have to keep calling off to visit every dentist in the network until they 'hit upon the right code' to perform the workBrittany also stated that I could go to an out - of -network dentist but that would most likely not be coveredI have already tried two in-network dentist and one said the procedure is not covered, the other dentist I contacted said they didn't think it was covered but if it was it would be a stainless steel and they don't perform the workWhat good is dental coverage if the dentist in the network won't perform the work? MHS is also refusing to provide me with a summary of benefits that tells me what is covered and to what percentSeveral months ago I went to get my eyes checkedThe information provided on the MHS network stated they cover pair of glassesI did not look into it further, it didn't say there were any restrictions, etcBut MHS did not cover the full expense of the glassesWhen I complained to the Revdex.com I received a statement saying the case was dismissed because I failed to fully investigate my coverageNow I am trying and MHS is refusing to give me the informationTo Resolve just the dental issue this is what needs to happen.? The right to see my out of network dentistTo have that dentist compensated up to the amount an in-network dentist would have been compensatedThe right to choose the more expensive crown WITH NO ADDITIONAL COST TO THE INSURANCE CARRIER THAN WHAT THEY WOULD NORMALLY PAY FOR WHATEVER TYPE OF CROWN THEY DO COVERI believe this request to be fair to both parties involvedI am not expecting them to pay more than what they would normally pay, just pay that same amount to an out-of-network provider and I will pay the additional expense to have the work performed correctlyFINALLY, MY INSURANCE IS RUNNING OUT WITH THIS PROVIDER (AT THE END OF THE MONTH IS MY UNDERSTAIDING) SO IF I AM UNABLE TO GET TO A DENTIST BECAUSE OF MHS INABILITY TO FOLLOW THROUGH, THE WORK SHOULD BE PAID FOR AT THE EARLIEST OPPORTUNITY WHETHER OR NOT I AM STILL COVERED BY MHS Regards, [redacted] ***

January 6, Revdex.com of CENTRAL INDIANA NDelaware Street, #Indianapolis, IN 46204- RE: Revdex.com Complaint ID Number *** Dear Ms***: We received your letter regarding the above-referenced complaint on December 21, Once your complaint was received
we conducted a thorough investigation of this issue We have corrected the issueAmbetter from MHS has contacted our member to inform her we have corrected the issue Because the issue is already addressed, and because of our concern not to disclose an individual member’s protected health and demographic information, we are declining to publish here the details of this particular situation. We thank you for your assistance to our plan member and for your dedication to business accountability. Best Regards, Rebecca S***

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
Brittany has indeed contacted me regarding my complaints but they have not been resolvedFor instance - the echo web coordinator had sent me an e-mail stating that two types of crowns maybe coveredBrittany said only type of crown would be covered, the stainless steelHer objection to the statement made be the echo coordinator does not hold water because Brittany stated that the echo coordsaid the word 'maybe' was used and so the other crown is not part of my benefits, ? but the word 'maybe' applies to both types of crown not just the one that Brittany is objecting toBrittany also stated that it is hard to determine the coverage without an actual code to go with itMy objection, if I don't know what type of crown is covered I could potentially go to every dentist in the network and they could all use a code for a crown that is not covered and I will be wasting my time, money, and other resources and would no longer have a job since I would have to keep calling off to visit every dentist in the network until they 'hit upon the right code' to perform the workBrittany also stated that I could go to an out - of -network dentist but that would most likely not be coveredI have already tried two in-network dentist and one said the procedure is not covered, the other dentist I contacted said they didn't think it was covered but if it was it would be a stainless steel and they don't perform the workWhat good is dental coverage if the dentist in the network won't perform the work? MHS is also refusing to provide me with a summary of benefits that tells me what is covered and to what percentSeveral months ago I went to get my eyes checkedThe information provided on the MHS network stated they cover pair of glassesI did not look into it further, it didn't say there were any restrictions, etcBut MHS did not cover the full expense of the glassesWhen I complained to the Revdex.com I received a statement saying the case was dismissed because I failed to fully investigate my coverageNow I am trying and MHS is refusing to give me the informationTo Resolve just the dental issue this is what needs to happen.? The right to see my out of network dentistTo have that dentist compensated up to the amount an in-network dentist would have been compensatedThe right to choose the more expensive crown WITH NO ADDITIONAL COST TO THE INSURANCE CARRIER THAN WHAT THEY WOULD NORMALLY PAY FOR WHATEVER TYPE OF CROWN THEY DO COVERI believe this request to be fair to both parties involvedI am not expecting them to pay more than what they would normally pay, just pay that same amount to an out-of-network provider and I will pay the additional expense to have the work performed correctlyFINALLY, MY INSURANCE IS RUNNING OUT WITH THIS PROVIDER (AT THE END OF THE MONTH IS MY UNDERSTAIDING) SO IF I AM UNABLE TO GET TO A DENTIST BECAUSE OF MHS INABILITY TO FOLLOW THROUGH, THE WORK SHOULD BE PAID FOR AT THE EARLIEST OPPORTUNITY WHETHER OR NOT I AM STILL COVERED BY MHS
Regards,
*** ***

We received your letter regarding the above-referenced complaint on November 20, Thank you for the opportunity to address the concerns of our Ambetter from MHS memberThe member in this case expressed concern that his premiums were different amounts, he was not enrolled in the rewards program
for receiving preventative services and he has unpaid claims.After conducting a thorough investigation we found this member's premium has remained the same since his enrollmentAfter reviewing claims for this member we found some that denied claims because the provider is not in network with Ambetter from MHS and authorization was not obtained prior to the service the provider the provider billed with incorrect informationIn his complaint this member stated he was not enrolled in the rewards program for receiving preventative servicesAmbetter from MHS found this member has received rewards however the rewards card has not been activated.Ambetter from MHS has attempted to reach our member to address his concerns.We thank you for your assistance to our plan member and for your dedication to business accountability.Best Regards,? Scott L***Director Compliance(317) 684-

Revdex.com of CENTRAL INDIANA NDelaware Street, #Indianapolis, IN 46204-? RE: Revdex.com Complaint ID Number [redacted] FAX 317-488- We received your letters regarding the above-referenced complaintsMHS has also received notice of this issue through a number of avenues, including the
Indiana Family and Social Services Administration (FSSA)We are happy to take this opportunity to let you know that we have contacted our member about her issuesWe made attempts to talk to her on the phone, and a letter was sent on November 10, and informed FSSA of our findingsBecause the issue is already addressed, and because of our concern not to disclose an individual member's protected health and demographic information, we are declining to publish here the details of this particular situationWe thank you for your assistance to our plan member and for your dedication to? businessaccountability.Sincerely,Scott L[redacted]Director, Compliance

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
This business did not resolve this problem until January 14,It is resolved nowThank you for all your help.?
Regards,
*** ***