Thank you for your correspondence from [redacted] , on behalf of [redacted] , regarding Mr [redacted] 's policy with Senior Health Insurance Company of Pennsylvania (SHIP).Once a claim has been initiated, a policyholder is notified regarding additional information to submitFor a facility claim, the needed documentation is likely to include the facility's license, itemized bill, and any nursing assessmentsThe preferred type of nursing assessment, if available, is the M.D.S(Minimum Data Set).According to our records, a benefit determination began June 13, 2016, upon receipt of a claim submissionMr [redacted] and his facility, [redacted] ***, were sent letters on June 20, advising that the initial M.D.Sor similar nursing assessment, and medication administration records were needed in order to complete a benefit determinationFollletters were sent June 30, and July 14, 2016.All requested information was received by August 16, Therefore, on that same date, Mr [redacted] was sent a letter and plan of care advising that his benefits were approvedPlease note that the requested initial M.D.Swas received for the first time on August 16, Several M.D.Sdocuments of later dates (not the initial one) were received several times prior to August 16, 2016.We are unable to process benefit payments until we receive all of the required information for each month for which benefits are requestedFor facility care, we require itemized bills indicating the month on which care was provided and the charge for room and boardItemized bills were received for the first time on August 19, Please allow appropriate handling time for the processing of these bills.We regret Mr [redacted] 's unsatisfactory experience with our telephone representativesFeedback from our callers is always appreciated, as it helps in our ongoing efforts to improve serviceIf at any time during a call he feels that he is not receiving good service, he may ask to speak with a supervisor.Enclosed are the aforementioned lettersIf you have any questions regarding this case, please contact Ketrina D***, Supervisor, at (317) 566-or fax (317) 566-7588.Sincerely, Jaime A***Consumer Support SpecialistSenior Health Insurance Company of Pennsylvania
February 22, Revdex.com ATTN: Debbie [redacted] North Delaware St., #Indianapolis, IN 46204- FAX: (317) 488- RE: Senior Health Insurance Company of Pennsylvania (SHIP) Insured: [redacted] Policy Number: [redacted] Type oflnsurance: Self-Paid Home Health Care Policy (form HHC-1) Situs of Contract: Florida Case I.DNumber: [redacted] Inquiry Dated: February 13, Request Received: February 16, Dear Ms***: Thank you for your correspondence on behalf of [redacted] regarding [redacted] ' s Home Health Care policyMs [redacted] ' concerns have been reviewed Ms [redacted] 's policy provides reimbursement of the cost of ehgible Home Health Care services provided by an approved practitioner, up to a daily maximumOn September 13, 2016, Ms [redacted] 's eligibility was approved for services she was receiving at [redacted] of [redacted] Benefits were paid during September and October for dates of service through October 31, The topic of Ms [redacted] ' communication to the Revdex.com concerns benefits for dates after October 31, Since the policy is designed for reimbursement, we must received invoices in order to issue benefit paymentsAfter paying benefits through October 2016, we received no further invoices until December 14, We received an invoice on that date from [redacted] of [redacted] However, it did not show any covered charges for dates after October 31, and had a credit balanceNo additional benefits could be paid on the basis of that invoice, as there were no new charges to reimburse On December 27, we were made aware that Ms [redacted] had actually moved out of [redacted] of [redacted] and was receiving care at [redacted] of [redacted] ***This is a distinct facility operating under a different license numberTherefore it was necessary to conduct another review to determine the eligibility of the services provided thereInsured: [redacted] Policy Number: [redacted] Case I.DNumber: [redacted] February 22, We acquired invoices and a copy of the facility's credentialsThe final piece ofinformation needed to complete the eligibility review was a telephone assessment, which we obtained on January 23, Eligibility was then approved for Ms [redacted] 's care at the new facilityBenefits were paid on February 16, for the dates of service November 30, through January 31, The amount of the benefit payment issued on February 16, was $3,Ms [redacted] indicated in her letter to you that she expected a higher amountWe will be happy to explainThe policy has a Daily Maximum Benefit of $per dayThe policy states: The benefit will be the lesser of 1) the Daily Maximum Benefit set forth in the Policy Schedule or 2) the Reasonable Charge for services provided While Ms [redacted] was receiving care at [redacted] of [redacted] , her costs for covered services exceeded $per dayBenefits were paid at the maximum rate of $per dayNow that she is residing at [redacted] of [redacted] ***, her daily costs for covered care are less than the $daily maximumTherefore the payable benefit equals only the amount of the actual chargesSince this is a Home Health Care policy, it only covers services definable as Home Health CareThe policy does not cover expenses such as room and board, cable television, or guest meals We sincerely regret Ms [redacted] ' unsatisfactory experience with our telephone representativesFeedback from our callers is always welcomeWe particularly appreciate being told about the occasions on which she did not receive promised callbacks, as this information enables to take steps to help prevent future such occurrences If at any time during a call the caller feels that he or she is not receiving good service, the assistance of a supervisor may be requested Ifyou or Ms [redacted] should have any questions, please write to us at P.OBox 64913, StPaul, MN 55164, or call one of our Customer Service representatives at (877) 450-They are available Monday through Friday from 8:a.mto 6:p.mEastern time Sincerely, Senior Consumer Support Specialist SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA
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
[Provide details of why you are not satisfied with this resolution.]WNIC is using these matters as a delay in paying benefits requested and documentedAdmittedly, A-Victorian Place was lax in some paperwork, but I am being care for by A-Vict because I have lost several ADL functions and I was told by sales people I wound receive benefits without delayWNIC is still drafting a monthly premium, even though they have not helped with benefits I expected
Regards,
*** ***
February 22, 2017 Revdex.com ATTN: Debbie [redacted] 151 North Delaware St., #2020 Indianapolis, IN 46204-2599 FAX: (317) 488-2224 RE: Senior Health Insurance Company of Pennsylvania (SHIP) Insured: [redacted] Policy Number:...
[redacted] Type oflnsurance: Self-Paid Home Health Care Policy (form HHC-1) Situs of Contract: Florida Case I.D. Number: [redacted] Inquiry Dated: February 13, 2017 Request Received: February 16, 2017 Dear Ms. [redacted]: Thank you for your correspondence on behalf of [redacted] regarding [redacted]' s Home Health Care policy. Ms. [redacted]' concerns have been reviewed. Ms. [redacted]'s policy provides reimbursement of the cost of ehgible Home Health Care services provided by an approved practitioner, up to a daily maximum. On September 13, 2016, Ms. [redacted]'s eligibility was approved for services she was receiving at [redacted] of [redacted]. Benefits were paid during September 2016 and October 2016 for dates of service through October 31, 2016. The topic of Ms. [redacted]' communication to the Revdex.com concerns benefits for dates after October 31, 2016. Since the policy is designed for reimbursement, we must received invoices in order to issue benefit payments. After paying benefits through October 2016, we received no further invoices until December 14, 2016. We received an invoice on that date from [redacted] of [redacted]. However, it did not show any covered charges for dates after October 31, 2016 and had a credit balance. No additional benefits could be paid on the basis of that invoice, as there were no new charges to reimburse. On December 27, 2016 we were made aware that Ms. [redacted] had actually moved out of [redacted] of [redacted] and was receiving care at [redacted] of [redacted]. This is a distinct facility operating under a different license number. Therefore it was necessary to conduct another review to determine the eligibility of the services provided there. Insured: [redacted] Policy Number: [redacted] Case I.D. Number: [redacted] February 22, 2017 We acquired invoices and a copy of the facility's credentials. The final piece ofinformation needed to complete the eligibility review was a telephone assessment, which we obtained on January 23, 2017. Eligibility was then approved for Ms. [redacted]'s care at the new facility. Benefits were paid on February 16, 2017 for the dates of service November 30, 2016 through January 31, 2017. The amount of the benefit payment issued on February 16, 2017 was $3,663.00. Ms. [redacted] indicated in her letter to you that she expected a higher amount. We will be happy to explain. The policy has a Daily Maximum Benefit of $100.00 per day. The policy states: The benefit will be the lesser of 1) the Daily Maximum Benefit set forth in the Policy Schedule or 2) the Reasonable Charge for services provided. While Ms. [redacted] was receiving care at [redacted] of [redacted], her costs for covered services exceeded $100.00 per day. Benefits were paid at the maximum rate of $100.00 per day. Now that she is residing at [redacted] of [redacted], her daily costs for covered care are less than the $100.00 daily maximum. Therefore the payable benefit equals only the amount of the actual charges. Since this is a Home Health Care policy, it only covers services definable as Home Health Care. The policy does not cover expenses such as room and board, cable television, or guest meals. We sincerely regret Ms. [redacted]' unsatisfactory experience with our telephone representatives. Feedback from our callers is always welcome. We particularly appreciate being told about the occasions on which she did not receive promised callbacks, as this information enables to take steps to help prevent future such occurrences. If at any time during a call the caller feels that he or she is not receiving good service, the assistance of a supervisor may be requested. Ifyou or Ms. [redacted] should have any questions, please write to us at P.O. Box 64913, St. Paul, MN 55164, or call one of our Customer Service representatives at (877) 450-5824. They are available Monday through Friday from 8:00 a.m. to 6:00 p.m. Eastern time. Sincerely, Senior Consumer Support Specialist SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA
In order to make a benefit determination for confinement into a facility, a complete proof of loss must be received. This complete proof of loss consists of, but is not limited to, a completed Patient Claim Form; itemized bills;Minimum Data Set (MDS), if available; or an initial admission...
assessment, is MDS is not available; and the facility license. Please be advised our Claims Department may request additional information in order to make a benefit determination. Ms. [redacted] is not being singled out as this same information is required for all insureds filing for facility benefits.According to our records, a benefit determination began May 13, 2016, upon receipt of a claim submission. On May 22, 2016, Ms. [redacted] and her facility, A Victorians Place, were sent letters advising an initial and most recent plan of care, service agreement, or similar nursing assessment that documents her functional and cognitive status, and medication administration records were needed in order to complete a benefit determination. On June 2, 2016 and June 14, 2016, they were sent follow-up letters advising the medication administration records were still needed.On June 9, 2016, Ms. [redacted] was sent a letter advising an in-person assessment was needed.Furthermore, on June 21, 2016, they were sent letters advising the facility's published rate schedule, itemized invoices since admission, proof of loss since admission, and a copy of the facility's ledger indicating charges billed and amounts received as payment were needed in order to complete the determination.As of today's date, we are still in need of the medication administration records, the facility's published rate schedule, itemized invoices since administration, proof of loss since admission, and a copy of the facility's ledger indicating charges billed and amounts received as payment. The requested information may be mailed to P.O. Box 64739, St. Paul, MN 55164 or faxed to (952) 983-5207. Once received, a benefit determination can be completed.Enclosed is the aforementioned correspondence and a copy of the policy. If you ahve any questions regarding this matter, please contact Ketrina D[redacted], Supervisor, at (317) 566-7494 or fax them to (317) 566-7588.Sincerely, Jaime A[redacted]Consumer Support SpecialistWASHINGTON NATIONAL INSURANCE COMPANY
Thank you for your correspondence from [redacted], on behalf of [redacted], regarding Mr. [redacted]'s policy with Senior Health Insurance Company of Pennsylvania (SHIP).Once a claim has been initiated, a policyholder is notified regarding additional information to submit. For a facility claim, the...
needed documentation is likely to include the facility's license, itemized bill, and any nursing assessments. The preferred type of nursing assessment, if available, is the M.D.S. (Minimum Data Set).According to our records, a benefit determination began June 13, 2016, upon receipt of a claim submission. Mr. [redacted] and his facility, [redacted], were sent letters on June 20, 2016 advising that the initial M.D.S. or similar nursing assessment, and medication administration records were needed in order to complete a benefit determination. Follow-up letters were sent June 30, 2016 and July 14, 2016.All requested information was received by August 16, 2016. Therefore, on that same date, Mr. [redacted] was sent a letter and plan of care advising that his benefits were approved. Please note that the requested initial M.D.S. was received for the first time on August 16, 2016. Several M.D.S. documents of later dates (not the initial one) were received several times prior to August 16, 2016.We are unable to process benefit payments until we receive all of the required information for each month for which benefits are requested. For facility care, we require itemized bills indicating the month on which care was provided and the charge for room and board. Itemized bills were received for the first time on August 19, 2016. Please allow appropriate handling time for the processing of these bills.We regret Mr. [redacted]'s unsatisfactory experience with our telephone representatives. Feedback from our callers is always appreciated, as it helps in our ongoing efforts to improve service. If at any time during a call he feels that he is not receiving good service, he may ask to speak with a supervisor.Enclosed are the aforementioned letters. If you have any questions regarding this case, please contact Ketrina D[redacted], Supervisor, at (317) 566-7494 or fax (317) 566-7588.Sincerely, Jaime A[redacted]Consumer Support SpecialistSenior Health Insurance Company of Pennsylvania
Thank you for your correspondence from [redacted] , on behalf of [redacted] , regarding Mr [redacted] 's policy with Senior Health Insurance Company of Pennsylvania (SHIP).Once a claim has been initiated, a policyholder is notified regarding additional information to submitFor a facility claim, the needed documentation is likely to include the facility's license, itemized bill, and any nursing assessmentsThe preferred type of nursing assessment, if available, is the M.D.S(Minimum Data Set).According to our records, a benefit determination began June 13, 2016, upon receipt of a claim submissionMr [redacted] and his facility, [redacted] ***, were sent letters on June 20, advising that the initial M.D.Sor similar nursing assessment, and medication administration records were needed in order to complete a benefit determinationFollletters were sent June 30, and July 14, 2016.All requested information was received by August 16, Therefore, on that same date, Mr [redacted] was sent a letter and plan of care advising that his benefits were approvedPlease note that the requested initial M.D.Swas received for the first time on August 16, Several M.D.Sdocuments of later dates (not the initial one) were received several times prior to August 16, 2016.We are unable to process benefit payments until we receive all of the required information for each month for which benefits are requestedFor facility care, we require itemized bills indicating the month on which care was provided and the charge for room and boardItemized bills were received for the first time on August 19, Please allow appropriate handling time for the processing of these bills.We regret Mr [redacted] 's unsatisfactory experience with our telephone representativesFeedback from our callers is always appreciated, as it helps in our ongoing efforts to improve serviceIf at any time during a call he feels that he is not receiving good service, he may ask to speak with a supervisor.Enclosed are the aforementioned lettersIf you have any questions regarding this case, please contact Ketrina D***, Supervisor, at (317) 566-or fax (317) 566-7588.Sincerely, Jaime A***Consumer Support SpecialistSenior Health Insurance Company of Pennsylvania
February 22, Revdex.com ATTN: Debbie [redacted] North Delaware St., #Indianapolis, IN 46204- FAX: (317) 488- RE: Senior Health Insurance Company of Pennsylvania (SHIP) Insured: [redacted] Policy Number: [redacted] Type oflnsurance: Self-Paid Home Health Care Policy (form HHC-1) Situs of Contract: Florida Case I.DNumber: [redacted] Inquiry Dated: February 13, Request Received: February 16, Dear Ms***: Thank you for your correspondence on behalf of [redacted] regarding [redacted] ' s Home Health Care policyMs [redacted] ' concerns have been reviewed Ms [redacted] 's policy provides reimbursement of the cost of ehgible Home Health Care services provided by an approved practitioner, up to a daily maximumOn September 13, 2016, Ms [redacted] 's eligibility was approved for services she was receiving at [redacted] of [redacted] Benefits were paid during September and October for dates of service through October 31, The topic of Ms [redacted] ' communication to the Revdex.com concerns benefits for dates after October 31, Since the policy is designed for reimbursement, we must received invoices in order to issue benefit paymentsAfter paying benefits through October 2016, we received no further invoices until December 14, We received an invoice on that date from [redacted] of [redacted] However, it did not show any covered charges for dates after October 31, and had a credit balanceNo additional benefits could be paid on the basis of that invoice, as there were no new charges to reimburse On December 27, we were made aware that Ms [redacted] had actually moved out of [redacted] of [redacted] and was receiving care at [redacted] of [redacted] ***This is a distinct facility operating under a different license numberTherefore it was necessary to conduct another review to determine the eligibility of the services provided thereInsured: [redacted] Policy Number: [redacted] Case I.DNumber: [redacted] February 22, We acquired invoices and a copy of the facility's credentialsThe final piece ofinformation needed to complete the eligibility review was a telephone assessment, which we obtained on January 23, Eligibility was then approved for Ms [redacted] 's care at the new facilityBenefits were paid on February 16, for the dates of service November 30, through January 31, The amount of the benefit payment issued on February 16, was $3,Ms [redacted] indicated in her letter to you that she expected a higher amountWe will be happy to explainThe policy has a Daily Maximum Benefit of $per dayThe policy states: The benefit will be the lesser of 1) the Daily Maximum Benefit set forth in the Policy Schedule or 2) the Reasonable Charge for services provided While Ms [redacted] was receiving care at [redacted] of [redacted] , her costs for covered services exceeded $per dayBenefits were paid at the maximum rate of $per dayNow that she is residing at [redacted] of [redacted] ***, her daily costs for covered care are less than the $daily maximumTherefore the payable benefit equals only the amount of the actual chargesSince this is a Home Health Care policy, it only covers services definable as Home Health CareThe policy does not cover expenses such as room and board, cable television, or guest meals We sincerely regret Ms [redacted] ' unsatisfactory experience with our telephone representativesFeedback from our callers is always welcomeWe particularly appreciate being told about the occasions on which she did not receive promised callbacks, as this information enables to take steps to help prevent future such occurrences If at any time during a call the caller feels that he or she is not receiving good service, the assistance of a supervisor may be requested Ifyou or Ms [redacted] should have any questions, please write to us at P.OBox 64913, StPaul, MN 55164, or call one of our Customer Service representatives at (877) 450-They are available Monday through Friday from 8:a.mto 6:p.mEastern time Sincerely, Senior Consumer Support Specialist SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA
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
[Provide details of why you are not satisfied with this resolution.]WNIC is using these matters as a delay in paying benefits requested and documentedAdmittedly, A-Victorian Place was lax in some paperwork, but I am being care for by A-Vict because I have lost several ADL functions and I was told by sales people I wound receive benefits without delayWNIC is still drafting a monthly premium, even though they have not helped with benefits I expected
Regards,
*** ***
Please see attached.
February 22, 2017 Revdex.com ATTN: Debbie [redacted] 151 North Delaware St., #2020 Indianapolis, IN 46204-2599 FAX: (317) 488-2224 RE: Senior Health Insurance Company of Pennsylvania (SHIP) Insured: [redacted] Policy Number:...
[redacted] Type oflnsurance: Self-Paid Home Health Care Policy (form HHC-1) Situs of Contract: Florida Case I.D. Number: [redacted] Inquiry Dated: February 13, 2017 Request Received: February 16, 2017 Dear Ms. [redacted]: Thank you for your correspondence on behalf of [redacted] regarding [redacted]' s Home Health Care policy. Ms. [redacted]' concerns have been reviewed. Ms. [redacted]'s policy provides reimbursement of the cost of ehgible Home Health Care services provided by an approved practitioner, up to a daily maximum. On September 13, 2016, Ms. [redacted]'s eligibility was approved for services she was receiving at [redacted] of [redacted]. Benefits were paid during September 2016 and October 2016 for dates of service through October 31, 2016. The topic of Ms. [redacted]' communication to the Revdex.com concerns benefits for dates after October 31, 2016. Since the policy is designed for reimbursement, we must received invoices in order to issue benefit payments. After paying benefits through October 2016, we received no further invoices until December 14, 2016. We received an invoice on that date from [redacted] of [redacted]. However, it did not show any covered charges for dates after October 31, 2016 and had a credit balance. No additional benefits could be paid on the basis of that invoice, as there were no new charges to reimburse. On December 27, 2016 we were made aware that Ms. [redacted] had actually moved out of [redacted] of [redacted] and was receiving care at [redacted] of [redacted]. This is a distinct facility operating under a different license number. Therefore it was necessary to conduct another review to determine the eligibility of the services provided there. Insured: [redacted] Policy Number: [redacted] Case I.D. Number: [redacted] February 22, 2017 We acquired invoices and a copy of the facility's credentials. The final piece ofinformation needed to complete the eligibility review was a telephone assessment, which we obtained on January 23, 2017. Eligibility was then approved for Ms. [redacted]'s care at the new facility. Benefits were paid on February 16, 2017 for the dates of service November 30, 2016 through January 31, 2017. The amount of the benefit payment issued on February 16, 2017 was $3,663.00. Ms. [redacted] indicated in her letter to you that she expected a higher amount. We will be happy to explain. The policy has a Daily Maximum Benefit of $100.00 per day. The policy states: The benefit will be the lesser of 1) the Daily Maximum Benefit set forth in the Policy Schedule or 2) the Reasonable Charge for services provided. While Ms. [redacted] was receiving care at [redacted] of [redacted], her costs for covered services exceeded $100.00 per day. Benefits were paid at the maximum rate of $100.00 per day. Now that she is residing at [redacted] of [redacted], her daily costs for covered care are less than the $100.00 daily maximum. Therefore the payable benefit equals only the amount of the actual charges. Since this is a Home Health Care policy, it only covers services definable as Home Health Care. The policy does not cover expenses such as room and board, cable television, or guest meals. We sincerely regret Ms. [redacted]' unsatisfactory experience with our telephone representatives. Feedback from our callers is always welcome. We particularly appreciate being told about the occasions on which she did not receive promised callbacks, as this information enables to take steps to help prevent future such occurrences. If at any time during a call the caller feels that he or she is not receiving good service, the assistance of a supervisor may be requested. Ifyou or Ms. [redacted] should have any questions, please write to us at P.O. Box 64913, St. Paul, MN 55164, or call one of our Customer Service representatives at (877) 450-5824. They are available Monday through Friday from 8:00 a.m. to 6:00 p.m. Eastern time. Sincerely, Senior Consumer Support Specialist SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA
In order to make a benefit determination for confinement into a facility, a complete proof of loss must be received. This complete proof of loss consists of, but is not limited to, a completed Patient Claim Form; itemized bills;Minimum Data Set (MDS), if available; or an initial admission...
assessment, is MDS is not available; and the facility license. Please be advised our Claims Department may request additional information in order to make a benefit determination. Ms. [redacted] is not being singled out as this same information is required for all insureds filing for facility benefits.According to our records, a benefit determination began May 13, 2016, upon receipt of a claim submission. On May 22, 2016, Ms. [redacted] and her facility, A Victorians Place, were sent letters advising an initial and most recent plan of care, service agreement, or similar nursing assessment that documents her functional and cognitive status, and medication administration records were needed in order to complete a benefit determination. On June 2, 2016 and June 14, 2016, they were sent follow-up letters advising the medication administration records were still needed.On June 9, 2016, Ms. [redacted] was sent a letter advising an in-person assessment was needed.Furthermore, on June 21, 2016, they were sent letters advising the facility's published rate schedule, itemized invoices since admission, proof of loss since admission, and a copy of the facility's ledger indicating charges billed and amounts received as payment were needed in order to complete the determination.As of today's date, we are still in need of the medication administration records, the facility's published rate schedule, itemized invoices since administration, proof of loss since admission, and a copy of the facility's ledger indicating charges billed and amounts received as payment. The requested information may be mailed to P.O. Box 64739, St. Paul, MN 55164 or faxed to (952) 983-5207. Once received, a benefit determination can be completed.Enclosed is the aforementioned correspondence and a copy of the policy. If you ahve any questions regarding this matter, please contact Ketrina D[redacted], Supervisor, at (317) 566-7494 or fax them to (317) 566-7588.Sincerely, Jaime A[redacted]Consumer Support SpecialistWASHINGTON NATIONAL INSURANCE COMPANY
Thank you for your correspondence from [redacted], on behalf of [redacted], regarding Mr. [redacted]'s policy with Senior Health Insurance Company of Pennsylvania (SHIP).Once a claim has been initiated, a policyholder is notified regarding additional information to submit. For a facility claim, the...
needed documentation is likely to include the facility's license, itemized bill, and any nursing assessments. The preferred type of nursing assessment, if available, is the M.D.S. (Minimum Data Set).According to our records, a benefit determination began June 13, 2016, upon receipt of a claim submission. Mr. [redacted] and his facility, [redacted], were sent letters on June 20, 2016 advising that the initial M.D.S. or similar nursing assessment, and medication administration records were needed in order to complete a benefit determination. Follow-up letters were sent June 30, 2016 and July 14, 2016.All requested information was received by August 16, 2016. Therefore, on that same date, Mr. [redacted] was sent a letter and plan of care advising that his benefits were approved. Please note that the requested initial M.D.S. was received for the first time on August 16, 2016. Several M.D.S. documents of later dates (not the initial one) were received several times prior to August 16, 2016.We are unable to process benefit payments until we receive all of the required information for each month for which benefits are requested. For facility care, we require itemized bills indicating the month on which care was provided and the charge for room and board. Itemized bills were received for the first time on August 19, 2016. Please allow appropriate handling time for the processing of these bills.We regret Mr. [redacted]'s unsatisfactory experience with our telephone representatives. Feedback from our callers is always appreciated, as it helps in our ongoing efforts to improve service. If at any time during a call he feels that he is not receiving good service, he may ask to speak with a supervisor.Enclosed are the aforementioned letters. If you have any questions regarding this case, please contact Ketrina D[redacted], Supervisor, at (317) 566-7494 or fax (317) 566-7588.Sincerely, Jaime A[redacted]Consumer Support SpecialistSenior Health Insurance Company of Pennsylvania