Security Life Insurance Company of America

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me

August 7, 2017Dear [redacted] :Receipt of your October 25, correspondence regarding the complaint filed by [redacted] against Security Life Insurance Company of America is acknowledged.We are sorry to hear of [redacted] ’s dissatisfaction with Security Life Insurance Company of America At Security Life Insurance Company of America, we strive to provide excellent customer service to our customers.While we would very much like to respond directly with you regarding the issues within [redacted] ’s complaint, in the absence of an Authorization for Release of Protected Health Information, as required by HIPAA; we are unable to communicate with you directlyWe will review the information that your office forwarded to our office, and we will respond our member in a timely manner.Sincerely,Heather M.Quality Control Section

I am writing in response to the inquiry received regarding the above referenced ID number.Ms [redacted] submitted the same concerns to the Nebraska Department of Insurance, to which we have respondedEnclosed is a copy of our response.If you have any questions or need additional information, please contact me at ###-###-####.Sincerely,Stacy P [redacted] *Product AnalystsecurityLIFE April 17, [redacted] ***, Insurance Investigator Consumer Affairs DivisionState of Nebraska Department of Insurance [redacted] ***Lincoln, NE 68501-2089RE: Department Tracking ID: ***Insured: [redacted] Policy Number: [redacted] Security Life Insurance Company of America - Dear Mr***,I am writing in response to the above reference file numberIn her complaint, Ms [redacted] maintains that she has been unable to receive requested benefit information.Enclosed is a copy of Policy [redacted] , an Individual Dental Insurance Policy with a Vision Benefit RiderThis policy was issued to Ms [redacted] , on May 10, Our records indicate that the policy, with id cards were mailed to Ms [redacted] 's address of record, [redacted] **., North Platte, NE 69101, on May 12, The Policy provides a detailed description on the Preventive, Basic and Major services provided, along with Deductibles and percentages payable for each of the servicesAs stated on the Coverage Schedule, payments are based on the usual and customary charge for dental procedures and services after any required deductible amountPlease note that there is a Predetermination of Benefits provision within the policyThis provision states in part, "It is recommended that a treatment plan be submitted...” “We will review the treatment plan and estimate what we will pay." For the type of policy in question, Security Life does not utilize a fee schedule and therefore cannot provide an actual dollar amount of a specific procedure without receiving a pretreatment estimate or an actual claim from a providerAs is a standard in the industry, providers submit their charges for services, and we base our payment for treatment with reasonable and customary charges in the areaWhen Security Life receives the necessary documentation from the provider, a claims representative accesses a data base that provides reasonable and customary charges in an area.Pursuant to your request, enclosed is a cq which includes recorded telephone calls with Ms [redacted] Unfortunately, if calls are not initially made to a customer service line or a call is transferred out of the customer service queue, calls are not recordedAlso attached is a copy of system notes documenting Verification of Benefit (VOB) requests and customer service correspondenceOur records indicate a call history as followsDate CRR Recorded Call? Description5/5/ Michele Yes Rebecca (Agent) called, requested a fee schedule and what is UCR in the areaShe was advised that we do not have a fee schedule, but there is a website that they can access to get estimates on UCR in a specific area, www.falrhealthconsumer.org ln order to get a specific dollar amount, a claim or pretreatment estimate would have to be submitted to be reviewed by a claims examiner.5/6/ Roxanne Yes Matt (Agent} called concerning verification of benefits, advised that the provider stated they tried to call times to verify benefitsThere was no record of insured on our system, call transferred to another administrator, (**Policy was not issued until 5/10/14) 5/29/ Paula Yes Ms [redacted] called, stated that the provider had been unable to verify benefitsOur records show that we provided VOB to the provider and spoke directly to Amanda at the dental officeMs [redacted] also stated that she had not received her id cardsThe Customer Service Rep(CSR) advised that she would call the dental office again, and advised insured that if she does not receive her id cards to call her directly, as she provided her extension, and she would reissue them or email them directly to her5/30/ Dean Yes Matt (Agent} called, regarding verification of benefitsRequested the number that providers should call.7/9/ Tammy Yes Rebecca (Agent) called, on behalf of Ms [redacted] , stating she did not receive her id cardsRecords show that id cards were mailed to the address on fileID cards were reissued.7/10/(two) Roxanne Yes Ms [redacted] called, indicated that she had not received herid cardsAdvised that they were mailed 5/12/14, and a request for them to be reissued had been made and they will be mailed out 7/11/We advised that no claims had been submitted at that timeCSR provided a breakdown of deductible and benefits - preventive, basic and majorMs [redacted] requested additional sales options and was referred over to the sales department7/10/ Robert Yes Ms [redacted] called, indicating her dissatisfaction with being transferred to the sales department and receiving voice mailboxCSR determines the correct place to transfer Ms [redacted] , regarding sales and changes to her policyCSR offers to transfer the call and go through the prompts for her3/30/ Robert Yes Ms [redacted] called, requesting prices on a procedureShe was advised that we cannot provide a price over the phone, and the provider should submit a pretreatment estimate for pricingMs [redacted] stated that she had never received an id card and would like another malled to herShe repeatedly asked what her policy coveredThe CSR looked up the certificate to provide her with coverage information and benefit percentages,xrays covered at 25% for first policy yearShe was advised that we could not provide UCR and referred her to a website that could provide her with the informationMs [redacted] requested to speak with a supervisor3/30/Paula, No Ms [redacted] called using Paula's direct extension therefore this call was not recordedAs stated on the system notes, Ms [redacted] became argumentative and abusive and was transferred to Betty, Team Lead Customer Service Supervisor 3/30/(two) Michele Yes Ms [redacted] called, stated she was transferred to Betty (supervisor) voicemall and she refused to leave a messageShe stated that she wanted to talk to Betty at her convenience and stated she would be contacting the insurance commissionThe CSR ultimately terminated the call and transferred Ms [redacted] to the supervisor's voicemailCSRs are instructed to terminate conversation if a caller becomes abusive3/30/ Betty, Supervisor No As a transfer, this call was not recordedAs stated in the notes, Ms [redacted] became abusive and the call was terminated3/31/ Betty, Supervisor No As stated in the notes, Ms [redacted] continues to call in, she is offered options to help including the option to terminate the policyWhen calls are determined to be argumentative, they are terminated3/31/Manuel Yes Ms [redacted] called, requesting to speak with Dan L [redacted] –VP of operationsShe was advised that he was not available, yet she did not want to be transferred to his voicemailShe indicated that she did not want to speak with Betty, SupervisorUltimately the CSR ended the call and transferred to Dan's volcemail3/31/(two) Robert Yes Ms [redacted] called indicating that she wanted to file a complaint against the representativesNotes indicate that he isto transfer all calls to a SupervisorMs [redacted] uses foul language and becomes abusive and the CSR ultimately transfers call to the supervisor3/31/ Dan No Dan L [redacted] , VP-Operations called and spoke with Ms [redacted] He explained how usual and customary works, where we get the figures from and why we do not give them out to providersMr L [redacted] agreed to pay any valid claim at 50% rather than 25% as she was only a few days shy of the waiting period expiring and it did not appear that she was informed of that when she had her procedures done 4/1/ Michele Yes [redacted] from [redacted] called requesting id cards for Ms [redacted] She was advised that id cards were requested to be reissued two days priorAdvised that vision benefits were through [redacted] and that she would need to contact them for benefit information4/1/ Sam No Notes indicate that CSR received a transferred call therefore this was not recordedCSR with help from Betty, provided basic vision benefits to Ms [redacted] Ms [redacted] connected us to her vision provider, provider advised us that a claim had been paid by [redacted] We advised that we do not administer vision claims and referred her to [redacted] Ms [redacted] stated she did not want to talk to Eyes MedWhen CSR returned to the phone call, he did not receive any response from Ms [redacted] and disconnected the call4/1/ Michele Yes Ms [redacted] called, about previous call with Sam regarding Vision benefits(two) Michele puts call on hold, and returns to advise Ms [redacted] that she was instructed by her supervisor (Betty) that Daniof operations will call her the next day to go over her informationMs [redacted] indicates that she wants to speak with Dan todayBetty intercedes and explains that Dan is not in the office and can call her at the next dayMs [redacted] indicates that she is not available then, Betty attempts to set a time for Dan to call her backMs [redacted] indicates that she wants her vision benefits, and Betty offers to email her the informationMs [redacted] indicates that she is not clear what she should be discussing with Dan and that she does not want to speak to BettyMs [redacted] indicates that she may contact her broker to obtain different dental coverageBetty offers to terminate the policyMs [redacted] questions on what groundsBetty offers to send her a copy of her policyMs [redacted] questions why she needs a copy of the policy if we will terminate the policy prior to her contacting her brokerBetty ends the call advising that we will send her a copy of her policy and any further communication can be handled in writing4/1/ Tammy Yes Ms [redacted] called to terminate her coveragePolicy to be cancelled as of (three) 3/31/She was advised that any claims submitted when she was covered would still be processedMs [redacted] indicated that she does not want Dan or anyone else to contact her any further, and she does not want anything mailed to her4/6/ Betty No Call received from Eyesvied, advised that Ms [redacted] terminated her policy as of 3/31/ 4/7/ Michele No CSR received a call from Steve in our Sales departmentHe indicated that Ms [redacted] called inquiring about purchasing a policy, he contacted customer service because he noted that she had just terminated a policyWhen Steve returned to the call, Ms [redacted] had disconnected4/14/| Tammy Yes Ms [redacted] called to verify if her policy was still activeShe was advised that her policy had been terminatedThe CSR attempts to refer Ms [redacted] back to the DOlThe CSRs were advised that Ms [redacted] had filed a complaint with the DOI and she should be referred to themMs [redacted] states that she was not advised that if she cancelled her policy, she would lose her benefitsTammy reiterates that there is nothing else she can do, and places her on hold to get her supervisorBetty gets on the line and advises her that the situation is under investigation and refers her back to the Department of InsuranceIn your letter, you requested an explanation regarding purported poor/rude service including inability to obtain plan benefit informationA review of records shows that we provided Benefit information to the provider on numerous occasions, both electronically, which automatically creates a system generated note in our system, and verbally by customer service representativesA review of recorded telephone conversations demonstrates that our Customer Service Representative consistently conducted themselves in a professional manner in attempting to provide Ms [redacted] with informationPursuant to Ms [redacted] 's request on April 1, 2015, the policy was terminated as of March 31, Enclosed is a copy of the termination letter, dated April 2, that was sent to Ms [redacted] at her address of recordThe policy will not be reinstatedAny claims received during her period of coverage will be processed accordinglyIf you have any questions or need additional information, please contact me directly at ###-###-####Sincerely, Stacy P [redacted] Product Analyst [redacted]

I am rejecting this response because: Security life insurance is an industry of fraud, and should be shut down by the government, they have no money to pay claims and they sell fraudulent policies. ---- 99% of policy holders do not have the time... or patience to fight this company, and that's how Security life makes its profit. ---- They promise to cover 25% to 100% of dental treatment, but that never happen, not even in a million years. --- They deny claims without any valid reason, delay acknowledge of receipt of claim, and hang up when I call. ---- This company is the worst of the worst. ---- On top of it they hide their name when they sell policies, they use a fake name of "spirit dental insurance" instead of "security life insurance" so no one can research them before purchasing the policy. (and no one make research after purchase, until they already lost their premium and not getting paid for claims) ---- I had to spend 3 months in emails and calls and complaints to BBB and Department of insurance just to get a response. ---- In that response, I received email from Security life insurance, that they will pay $129 for the root canal in tooth 2 I complained about. ---- That $129 is nothing but a joke. the root canal is $1,000, and they suppose to pay 25% which is $250, not $129. ---- Security life should pay additional $121 to Doctor Stephan ***. (total $250)

Initial Business Response /* (1000, 10, 2015/05/21) */
*** Additional Response attached ***
Dear Mr***
I am writing in response to the above subject complaint filed by *** *** on May , In his complaint, Mr, *** disagrees with the requirement to show proof of credible
coverage in order to reduce the waiting period on the current policyMr*** requests a lapse of coverage to be accepted and a claim to be paid
*** *** is insured by Group Dental Policy GH-XXXX-XXXXXMr*** is a covered spouse on her coverageEnclosed is a copy of the Group Dental insurance Certificate and Coverage Schedule for your referenceAs shown on the Coverage Schedule, there is a month waiting period for Major Services,
Also, enclosed is a copy of the First Choice Product GuideThis guide is provided to a groups administratorAs stated on Page 6:
o Credit for prior coverage: if the plan is replacing an existing group dental plan (with comparable coverage), those employees (and their dependents) who were covered under the preceding plan will receive credit for the time covered towards this plans waiting periods, Credit will be calculated based on the number of months each employee was covered under the prior planNew employees (and dependents) joining the plan will be subject to the waiting periodsA copy of the groups prior plan and last billing statement showing those covered (and their prior plan effective date) must be provided with the group application to ensure proper credit is given
Unfortunately, until we receive a copy of *** *** Certificate of Credible Coverage from either the Subscriber, *** (Mr*** Spouse) group policy or *** *** group policy reflecting no lapse in coverage, we cannot reduce the month waiting periodWe requested this information from Mr*** and he emailed us the attached information from Assurant Health, which was not a Certificate of Credible Coverage from a Group Dental Plan
________________
________________
We have administered benefits in accordance with the contract provisions, and cannot accommodate Mr
*** desired resolution
Please let us know if you require additional information concerning this matter
Sincerely,
*** Manager of IT, Audits & Compliance

I have contacted Dr Robert ***, the VP of operations at Unified. I have also forwarded the complaint from Mr ***. A Unified Repwill be calling Mr *** back shortly. Unified's phone number is ###-###-####. Helene ***

This was responded to on September 14,

I am rejecting this response because: This is about my complaint with regard to epicoectomy
predetermination for tooth 29, --- Security life insurance is an industry of fraud, and should be shut down by the government, they have no money to pay claims and they sell fraudulent policies---- 99% of policy holders do not have the time or patience to fight this company, and that's how Security life makes its profit--- They promise to cover 25% to 100% of dental treatment, but that never happen, not even in a million years--- They deny claims without any valid reason, delay acknowledge of receipt of claim, and hang up when I call---- This company is the worst of the worst---- On top of it they hide their name when they sell policies, they use a fake name of "spirit dental insurance" instead of "security life insurance" so no one can research them before purchasing the policy(and no one make research after purchase, until they already lost their premium and not getting paid for coverage) ---- I had to spend months in emails and calls and complaints to Revdex.com and Department of insurance just to get a response---- in that response they issue a predetermination for $out $1,720, which is only 20% instead of 25%--- Security life insurance fraudulently advertise 25% coverage for major care, but then reduce the eligibility of the total, and what is not eligible is what I pay out of pocket, which means the 25% coverage was just a fraud to trick me to buy the policy------- and I got that response only after month of fights through Revdex.com and department of insurance----- the sales brochure from Security life insurance (AKA Spirit dental insurance) didn't require me to manage a months war just to get a response ---- security life insurance take my premiums on silver platter each and every month on due date through my credit card, so why I should not get paid the same way ? why I have to spend enormous amount of time in calls, emails, and complaints, just to get a response----- 99% of people out there do not have the time or energy to fight for months on a small claim, and that's where Security life execute and profit from its fraudSecurity life insurance should be shut down by the government

Initial Business Response /* (1000, 8, 2015/12/23) */
*** Hard copy Attached ***
Dear Mr***,
I am writing in response to the correspondence you received from *** *** regarding the benefits provided with her dental coverageIn her letter, Ms*** expressed dissatisfaction with
the benefits provided and requested a refund of premium payments
A review of our records shows the following: Effective date 10/15/On 10/23/15, we receive a claim, fora crown, date of service 10/21/The Claim was for a crownOn 11/17/15, we denied the claim, and requested an x-ray and age of previous crown and if it is a replacement crownOn 11/6/15, we received a claim for date of service 10/14/The claim was denied as it before the effective dateOn 11/25/15, we receive the x-ray for reviewBecause the crown may have been prepped prior to the effective date of coverage, we verbally requested treatment notes from the providerThe treatment notes were faxed to us on 12/10/The Claim was reviewed and processed immediatelyIt was determined that the crown was prepped on 10/21/15, so It was eligible for coverageA check in the amount of $was issued to her provider
Attached are copies of the claims and EOBs
Our telephone records indicate that Ms*** contacted our customer service department on December 9, and stated that she did not want the policy to be cancelled
We have administered benefits in accordance with the contract provisionsSince the date of issue, Ms*** has been actively covered and claims were paid, therefore no refund of premium will be granted
If you have any questions I can be reached at ***, ext***
Stacy *** Product Analyst
Initial Consumer Rebuttal /* (3000, 10, 2015/12/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Previous messageNext messageBack to messages
RE: Revdex.com Complaint Case# *** (Ref#19-9368-***-9-1100)
RE: Revdex.com Complaint Case# *** (Ref#19-9368-***-9-1100)
*** ***
11:AM
To: Revdex.com, ***@insuractive.com, ***@medicaremarketplace.com, ***@firstchoicedental.com
To Whom it May Concern, (Revdex.com in particular)
I just researched this situation and pasted in below what I foundSecurity Life is definitely using 'BAD FAITH INSURANCE TACTICS' and it appears to be a common pattern among dishonest insurance agenciesFor example they knew at the beginning of the week that I had not gotten my reimbursement check so why didn't they simply stop payment and issue me a new one and send it by some sort of priority mail...why? Because they NEVER sent one in the first place!!! According to the information I have discovered they are probably waiting for the claim time to expire and then they will refuse to re-issue a check or should I say...issue it in the first place
And why wouldn't they respond to my inquiries as to the coverage amount for cleanings and exams...and why do have to go through this much trouble to simply get the coverage they owe me??????????????
*** ***
Bad Faith Insurance Tactics
Some bad faith insurance tactics may simply seem inconvenient at first, until a pattern appearsCustomers report that insurance companies will repeatedly lose or misplace important documents, requiring them to fill out the same paperwork over and overThey may simply deny a claim at first, hoping that the customer will not appeal the denialOr they may put a limitation on the time allowed for a claim, and then delay awarding the claim until that time has passed
Among bad faith insurance tactics:
Failing to pay a claim in a timely manner;
Offering an amount below what the claimant is entitled to;
Failing to defend a policyholder against a third-party claim;
Using a policyholder's previous claims as grounds to deny a new claim;
Failing to conduct a reasonable and full investigation of the claim;
Misrepresenting important facts or insurance policy provisions as they relate to coverage;
Misuse of claimants' medical records;
Requiring excessive paperwork;
Canceling a policy after a claim is made;
Purposely targeting high-cost claims for denials; and
Ignoring expert opinion in cases where that opinion would result in a claim being paid out (such as finding that a death was suicide when a medical examiner has ruled it accidental);
Bad faith insurance means that an insurance company has illegally denied or delayed paying a valid claimDoing so can have consequences for you and your loved oneInsurers have a duty to act in good faith toward their policyholders; failure to do so can be considered bad faith insuranceIf this happens, you may be eligible to file a lawsuit against your insurance companyIn cases where the insurance company's conduct is beyond unreasonable, punitive damages may be awarded
Below is one more example of not getting the answers I requested...I have simply copied and pasted in the e-mail I sent on 12/10/15:
FW: Dental exams???
*** ***
12/10/
Keep this message at the top of your inbox
Photos
To: ***@insuractive.com
He Brian,
After I spoke with my employer on this situation he mentioned that I should be able to access the company directlyYou said you were not allowed to cancel my policy to 'protect me.' How is that protecting me? I'm supposed to be able to trust you and why on earth am I being filtered through a middle man anyway?
Now here is a good example of how Bb *** treated me like a rube and as my employer also commented it should have raised a 'red flag' with me right awayI was very concerned that the first premium would get pulled out of my account before my direct deposit pay from UW Madison would be depositedHe assured me it would take a week or twoIt's all on those tapes you claim that you listened to tooI had my assessment appointment on the 14th and he knew that tooWell, sure enough the premium got ripped out of my account on the very night of when I had agreed to take the policyWhen I wrote him a message telling him that he completely ignored what had happened....no apology or even excuse given...and what I got instead was some decorative form letter in which the message was not even typed by him) on the company's stationery congratulating me on my new policyApparently he did not hold himself in any way accountable for this situationHe didn't even take a moment to say that he had no idea they'd withdraw it so soon (although I'm sure he knew they would if he has represented them for any amount of time
Please call SL today and have these anonymous reviews to pull my claim off the bottom of the stack and quit dawdling aroundThey grabbed my premium in a heartbeat and now my claim has been sitting there since October while stall aroundFirst they claimed to not have the x-rays (a lie) then they denied it due to the dates of service even though *** knew full well that I needed to go in for that assessmentFirst Choice told me yesterday that they then asked for more information....OMG it is a crownI need to know today before they take any more of my hard earned money and then do another spin doctor number on meDo you all realize that it is nearly Christmas?
Let me know by the end of the day pleaseTHAT IS YOUR JOB
*** ***
From: ***@hotmail.com
To: ***@insuractive.com
Subject: Dental exams???
Date: Wed, Dec 16:18:-
These are legitimate questions and I shouldn't even have to be asking them in the first placeThis is not "additional information" but information that I should have been made aware of at the onset of this situation
When a person gives misleading information no matter how cordial they are it still insults a person's intelligence
I was totally given the impression that dental cleanings, exams were freeThat should be on previous taped conversations with Bb ***That is precisely why I made that appointmentFirst Choice informed me today that only 25% is coveredYou can stand by him all you want but he did not give me fair and honest information and now I am in this situation and don't know what to do
First Choice sent the x-rays and the dates of service to SL back in October just after my first visit and no further correspondence transpired to them from SL before my claim was completely deniedI had to cancel that exam that I had scheduled for a cleaning and an exam for this FridayI scheduled on faith...that it would be covered by SL
Also, now SL has asked for even more information which First Choice once again promptly sent and so my claim is allegedly under reviewIf they deny it again not only do I have no other coverage to pick up some of the bill but I will have once again lost almost dollars for a premium because I would need to cancel by Friday to have the payment stopped from being removed from my bank account
Also why are they not accredited by Revdex.com and why have others had similar situations as mine and had to struggle for refunds? Review are published for a good reason but I didn't think to read them prior to taking out this policy
From: [email protected]
To: ***@hotmail.com
Subject: Revdex.com Complaint Case# *** (Ref#19-9368-***-9-1100)
Date: Wed, Dec 16:03:-
The Revdex.com has received a formal response from Security Life Insurance Company of AmericaWe ask that you review the response and understand that the Revdex.com is here to assist both parties in reaching a fair and reasonable resolution
If the company's response resolves your issue, please use the access information below to notify the Revdex.com that you accept the response and that the issue has been resolved
If the company's response does not address all of the facts or does not fully resolve your issue, you may submit a rebuttal in writing through our website, via e-mail, or postal mailYour rebuttal only needs to address concerns not resolved by the company's initial response
If we do not hear from you by January 2, 2016, we will conclude that you are satisfied with the company's response and close the case as resolved
You may access your complaint at www.Revdex.com.org/minnesota/complaintreplyEnter your case id, *** and your password, y3nc8bPlease select 'complainant'
Thank you for using the services of the Revdex.com
Sincerely,
*** ***, Mediation Coordinator
***
***@thefirstRevdex.com.org
You can manage your email preferences and unsubscribe from email sent by Revdex.com by following the link belowUnsubscribing from email by Revdex.com may delay resolution of complaints as email is the fastest way for us to communicate with youTo
Final Consumer Response /* (2000, 19, 2016/01/08) */
I received my reimbursement today from First Choice DentalSince it was made out to THEM they had no idea it was mine but thought it was some sort of payment to my dental accountOf course you knew that would happenIf it didn't get cashed you could always use it as a write off and I would have never gotten my money or would have had to spend months trying to obtain itI am cancelling my policy with your agency tooI worked at Farmer's Insurance Agency for five years before I returned to college and so I know that any properly trained office worker would never send a reimbursement check to the health care provider unless specified by all parties concernedEither you have ies working for you or this was done out of spiteThe nonchalant way you mentioned where it was mailed to me in the e-mail below tells me it was done out of spite because you are well aware that I filed a complaint against youI have blocked any further messages from you too because I find you, *** ***, and your entire staff loathsome!
*** ***
Final Business Response /* (4000, 17, 2016/01/08) */
I am writing in response to the additional correspondence you received from *** *** regarding her dental coverage
Attached is a copy of Ms***'s dental policyWithin the dental policy, the coverage schedule explains all benefits providedIf Ms*** has any additional questions concerning coverage provided, she is advised to contact our customer service department
In her correspondence, Ms*** questioned the claim payments being Issued to her providerThe Claim was assigned to her dentistAs stated in the policy, All or any portion of any benefits provided may be paid directly to the person rendering the service, unless you direct otherwise at the time of claim
Our telephone records show that Ms*** called our customer service department on December 31, and terminated her policyHer coverage has been in force from the issue date of October 15, until January 14, Ms*** has paid months of premium equaling To date, we have only received and paid one claim while the policy was in forceOur payment was
We have administered benefits in accordance with the contract provisionsIf you have any additional questions, I can be reached at
***, ext***
Sincerely,
Stacy *** Product Analyst

October 24, 2014 Dear [redacted],I am writing in response to the correspondence you received from [redacted] and [redacted] regarding the benefits provided with their dental coverage. In their letter, Mr. and Mrs. [redacted] express dissatisfaction with the benefits provided and...

request a refund of premium payments minus any claim payments.Dental Coverage was issued to Ms. [redacted] effective February 1, 2010. **. [redacted] is listed as a dependent. Enclosed is a copy of the Dental Certificate.The contractual language that supports how the claims were processed can be found within the Coverage Schedule, page S2, which states in part,Class C. Major Services Include:12.The combined cost of surgical and non surgical dental implant procedures for endosteal implants as an alternative to the lowest cost covered traditional (non-implant) dental procedure that would provide satisfactory results. The eligible amount considered for the implant procedure will be the amount the plan would have considered as eligible for the covered traditional dental procedure. Pre-Determination is requested. All deductible, co-insurance and maximum limitations of the plan apply. The date of incurral shall be the date that the pre surgical or surgical service is performed.Coverage under this provision is not provided for:d.implants place for teeth extracted prior to the date covered under this plan.Enclosed is a copy of the Pre-Treatment Estimate, dated September 26, 2013, which was requested from [redacted]., DMD. Prior to the start of any dental procedures, it was estimated that $700 would be payable towards the procedures.On November 20, 2013, [redacted] proceeded with services of 'Surgical placement of implant body, endosteal implant' on Tooth #19 and #20. Enclosed is a copy of the Explanation of Benefits for the Dental claim we received and processed for those services.Regarding tooth #19, the policy does not pay for implants or implant crowns. The coverage provided is equal to the coverage we would provide for the alternative benefit. Therefore, the alternative benefit of a partial denture was applied. $100 was ineligible because the charge exceeded the reasonable and customary allowance under the plan. Major Services are covered at 50%, therefore a benefit of $700 (50% of $1500) was payable.Regarding Tooth #20, this tooth was extracted prior to the effective date of their coverage, therefore no benefit is payable.On June 30, 2014, [redacted], D.M.D. performed the procedures 'Implant - Porcelain Fused to Metal Crown' and ' Prefabricated Abutment' to both tooth #19 and tooth #20. [redacted] provided a copy of the dental claim form and the Explanation of Benefits associated with these procedures with his complaint.No additional benefits were payable on Tooth #19. The policy states that we give the alternative benefit for combined cost of both "surgical and non surgical dental implant procedures". The benefit for this service was included in the allowance for other related services. We already provided the benefit at the time of the surgical procedure on November 20, 2013. Again, there were no benefits payable for tooth #20 because the extraction of the tooth occurred prior to the effective date of the coverage.[redacted] stated that he contacted Security Life on September 16, 2014, to cancel the policy and to request a refund of premium for the remaining portion of the month of September. A review of our records confirms that the policy is now terminated, as requested. Termination was effective September 30, 2014, in accordance with the provision, 'YOUR INSURANCE ENDS', found on page C3 of the policy, which states in part, Insurance will end on the last day of the month for which a premium has been paid. No refund of premium is due.We have administered benefits in accordance with the contract provisions. Since the date of issue, [redacted] has been actively covered and claims were paid, therefore no refund of premium will be granted.If you have any questions or need additional information, please contact me at ###-###-####.Sincerely,
Stacy P. 
Product Analyst

I am rejecting this response because: Security life insurance is an industry of fraud, and should be shut down by the government, they have no money to pay claims and they sell fraudulent policies. ---- 99% of policy holders do not have the time...

or patience to fight this company, and that's how Security life makes its profit. ---- They promise to cover 25% to 100% of dental treatment, but that never happen, not even in a million years. --- They deny claims without any valid reason, delay acknowledge of receipt of claim, and hang up when I call. ---- This company is the worst of the worst. ---- On top of it they hide their name when they sell policies, they use a fake name of "spirit dental insurance" instead of "security life insurance" so no one can research them before purchasing the policy. (and no one make research after purchase, until they already lost their premium and not getting paid for claims) ---- I had to spend 3 months in emails and calls and complaints to Revdex.com and Department of insurance just to get  a response. ---- In that response, I received email from Security life insurance, that they will pay $129 for the root canal in tooth 2 I complained about. ---- That $129 is nothing but a joke. the root canal is $1,000, and they suppose to pay 25% which is $250, not $129. ---- Security life should pay additional $121 to Doctor Stephan [redacted]. (total $250)

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

------- Forwarded message ----------From: Stacy P[redacted] <Stacy.P[redacted]@securitylife.com>Date: Mon, Apr 13, 2015 at 12:01 PMSubject: Consumer Complaint - [redacted]To: "[email protected]"...

<[email protected]>
Good Afternoon,
 
Regarding the above referenced complaint number,  the complainant has also filed a complaint with the Department of insurance.  We are actively gathering all correspondence we have had and are preparing a response.  We will provide response as soon as possible.
 
Thank you, 
 
 
 
Stacy P[redacted]PRODUCT ANALYST
D: 717.391.5718  |  F: 717.481.8238  |  SecurityLife.com1808 Colonial Village Lane, Suite 102, Lancaster, PA  17601
Connect with Us:Facebook | LinkedIn | Google+ | YouTube

August
7, 2017Dear [redacted]:Receipt of your October
25, 2016 correspondence regarding the complaint filed by [redacted] against
Security Life Insurance Company of America is acknowledged.We are sorry to hear of [redacted]’s dissatisfaction with Security Life Insurance Company of...

America.  At Security Life Insurance Company of
America, we strive to provide excellent customer service to our customers.While we would very much
like to respond directly with you regarding the issues within [redacted]’s
complaint, in the absence of an Authorization for Release of Protected Health
Information, as required by HIPAA; we are unable to communicate with you
directly. We will review the
information that your office forwarded to our office, and we will respond our
member in a timely manner.Sincerely,Heather M.Quality Control Section

To Whom It May Concern:
Thank you for taking the time to communicate with this insurance company.  I find it very sad that they can and have the resources to quote or summarize each or almost each phone call and place blame on the consumer, never on their own reps.  If you listen to the phone calls, especially the calls involving BETTY, you will quickly see how this supervisor was very unprofessional, rude and condescending.
However, it is very apparent to me that the focus has moved from their lack of transparency towards me, my policy, my questions, and the dentist's office questions to they are totally in the right and have done everything possible to allow me and my DENTIST to fully understand my benefits.  Even the dentist billing staff cannot get clear answers from this company, therefore we still have an unresolved problem.
It is my understanding that after treatment plans are submitted, this insurance company is not transparent with their disclosure of how much they will pay on each billing code.  If the dentist office cannot get clear and concise answers, then how does this insurance company believe that a consumer will be able to understand the hidden amounts that they will or will not pay.
As a consumer who manages an office with CPT codes and visits with insurance companies on a daily basis, I can assure you that dealing with this organization has been a nightmare.  This insurance company must produce what they will pay for when I or the dentist office calls, or submits treatment plans, and they do not and are not transparent, therefore causing the consumer as well as the dentist office undue stress.
Calls become escalated for a reason and shifting the blame on the consumer is a very WEAK attempt to cover up their own problems with their staff members, especially BETTY. 
My solution would be for this organization to become transparent with their benefits and not be adversarial when a customer or a dentist office calls or treatment plans for benefits.
Respectfully,
[redacted] A. [redacted]
 Complaint: [redacted]
I am rejecting this response because:
Regards,
[redacted]

This company is absolutely the worst company I have ever tried to deal with. I have their dental insurance and simply have a very basic question about coverage. I have called their customer service line several times over the past two weeks and am on hold for over 20 minutes. No one ever comes on the line. This company should not be allowed to sell insurance.

This response was initially faxed on September 14 and then uploaded on September 19, 2016.Our response includes [redacted], [redacted], and [redacted].  Please see those file numbers as well.

In looking for dental insurance we were directed, via the WWW, to this company. They appear to be a broker and we purchased our plan through them. They said all the right words and promised all the right things until we went to actually use our insurance. Even the website for the company they referred to has the deception well hidden. What we found out is that this plan is actually a "tier plan" and those bells and whistles do not actually kick in until year 3 of the program. A little tongue and cheek. Really flat out lies to get us in then reveal the whole truth. I am grateful we only lost $350.

I am writing in response to the inquiry received regarding the above referenced ID number.Ms. [redacted] submitted the same concerns to the Nebraska Department of Insurance, to which we have responded. Enclosed is a copy of our response.If you have any questions or need additional information, please contact me at ###-###-####.Sincerely,Stacy P[redacted]
*Product AnalystsecurityLIFE
April 17, 2015
[redacted], Insurance Investigator Consumer Affairs DivisionState of Nebraska Department of Insurance [redacted] [redacted]Lincoln, NE 68501-2089RE: Department Tracking ID: [redacted]Insured: [redacted]Policy Number: [redacted] Security Life Insurance Company of America - 68721
Dear Mr. [redacted],I am writing in response to the above reference file number. In her complaint, Ms. [redacted] maintains that she has been unable to receive requested benefit information.Enclosed is a copy of Policy [redacted], an Individual Dental Insurance Policy with a Vision Benefit Rider. This policy was issued to Ms. [redacted], on May 10, 2014. Our records indicate that the policy, with id cards were mailed to Ms. [redacted]'s address of record, [redacted]., North Platte, NE 69101, on May 12, 2014.
The Policy provides a detailed description on the Preventive, Basic and Major services provided, along with Deductibles and percentages payable for each of the services. As stated on the Coverage Schedule, payments are based on the usual and customary charge for dental procedures and services after any required deductible amount. Please note that there is a Predetermination of Benefits provision within the policy. This provision states in part, "It is recommended that a treatment plan be submitted...” “We will review the treatment plan and estimate what we will pay."
For the type of policy in question, Security Life does not utilize a fee schedule and therefore cannot provide an actual dollar amount of a specific procedure without receiving a pretreatment estimate or an actual claim from a provider. As is a standard in the industry, providers submit their charges for services, and we base our payment for treatment with reasonable and customary charges in the area. When Security Life receives the necessary documentation from the provider, a claims representative accesses a data base that provides reasonable and customary charges in an area.Pursuant to your request, enclosed is a cq which includes recorded telephone calls with Ms. [redacted]. Unfortunately, if calls are not initially made to a customer service line or a call is transferred out of the customer service queue, calls are not recorded. Also attached is a copy of system notes documenting Verification of Benefit (VOB) requests and customer service correspondence. Our records indicate a call history as followsDate            CRR            Recorded Call?           Description5/5/14         Michele       Yes                             Rebecca (Agent) called, requested a fee schedule and what is UCR in the area. She was advised that we do not have a fee schedule, but there is a website that they can access to get estimates                                                                               on UCR in a specific area, www.falrhealthconsumer.org . ln order to get a specific dollar amount, a claim or pretreatment estimate would have to be submitted to be reviewed by a claims                                                                                       examiner.5/6/14        Roxanne      Yes                            Matt (Agent} called concerning verification of benefits, advised that the provider stated they tried to call 3 times to verify benefits. There was no record of insured on our system, call transferred                                                                           to another administrator, (**Policy was not issued until 5/10/14) 
5/29/14       Paula           Yes                           Ms. [redacted] called, stated that the provider had been unable to verify benefits. Our records show that we provided VOB to the provider and spoke directly to Amanda at the dental office. Ms. [redacted]                                                                         also stated that she had not received her id cards. The Customer Service Rep. (CSR) advised that she would call the dental office again, and advised insured that if she does not receive her id cards                                                               to call her directly, as she provided her extension, and she would reissue them or email them directly to her.
5/30/14       Dean           Yes                           Matt (Agent} called, regarding verification of benefits. Requested the number that providers should call.7/9/14        Tammy         Yes                           Rebecca (Agent) called, on behalf of Ms. [redacted], stating she did not receive her id cards. Records show that id cards were mailed to the address on file. ID cards were reissued.7/10/14 (two) Roxanne    Yes                       Ms. [redacted] called, indicated that she had not received herid cards. Advised that they were mailed 5/12/14, and a request for them to be reissued had been made and they will be mailed out                                                                                  7/11/14. We advised that no claims had been submitted at that time. CSR provided a breakdown of deductible and benefits - preventive, basic and major. Ms. [redacted] requested additional sales                                                                              options and was referred over to the sales department.
7/10/14    Robert            Yes                        Ms. [redacted] called, indicating her dissatisfaction with being transferred to the sales department and receiving voice mailbox. CSR determines the correct place to transfer Ms. [redacted], regarding sales                                                                          and changes to her policy. CSR offers to transfer the call and go through the prompts for her.
3/30/15     Robert            Yes                      Ms. [redacted] called, requesting prices on a procedure. She was advised that we cannot provide a price over the phone, and the provider should submit a pretreatment estimate for pricing. Ms. [redacted]                                                                       stated that she had never received an id card and would like another malled to her. She repeatedly asked what her policy covered. The CSR looked up the certificate to provide  her with coverage                                                                          information and benefit percentages,xrays covered at 25% for first policy year. She was advised that we could not provide UCR and referred her to a website that could provide her with the                                                                                  information. Ms. [redacted] requested to speak with a supervisor.
3/30/15 Paula,                 No                      Ms. [redacted] called using Paula's direct extension therefore this call was not recorded. As stated on the system notes, Ms. [redacted] became argumentative and abusive and was transferred to Betty,                                                                              Team Lead Customer Service Supervisor. 
 
3/30/15 (two) Michele    Yes                      Ms . [redacted] called, stated she was transferred to Betty (supervisor) voicemall and she refused to leave a message. She stated that she wanted to talk to Betty at her convenience and stated she would                                                                   be contacting the insurance commission. The CSR ultimately terminated the call and transferred Ms. [redacted] to the supervisor's voicemail. CSRs are instructed to terminate conversation if a caller                                                                           becomes abusive.
3/30/15  Betty, Supervisor No                   As a transfer, this call was not recorded. As stated in the notes, Ms. [redacted] became abusive and the call was terminated.
3/31/15  Betty, Supervisor No                  As stated in the notes, Ms. [redacted] continues to call in, she is offered options to help including the option to terminate the policy. When calls are determined to be argumentative, they are terminated.
3/31/15 Manuel                 Yes                  Ms. [redacted] called, requesting to speak with Dan L[redacted]–VP of operations. She was advised that he was not available, yet she did not want to be transferred to his voicemail. She indicated that she                                                                      did not want to speak with Betty, Supervisor. Ultimately the CSR ended the call and transferred to Dan's volcemail.
3/31/15 (two) Robert         Yes                 Ms. [redacted] called indicating that she wanted to file a complaint against the representatives. Notes indicate that he isto transfer all calls to a Supervisor. Ms. [redacted] uses foul language and becomes                                                                          abusive and the CSR ultimately transfers call to the supervisor.
3/31/15     Dan           No                        Dan L[redacted], VP-Operations called and spoke with Ms. [redacted]. He explained how usual and customary works, where we get the figures from and why we do not give them out to providers. Mr.                                                                             L[redacted] agreed to pay any valid claim at 50% rather than 25% as she was only a few days shy of the waiting period expiring and it did not appear that she was informed of that when she had her                                                                         procedures done. 
4/1/15      Michele      Yes            [redacted] from [redacted] called requesting id cards for Ms. [redacted]. She was advised that id cards were requested to be reissued two days prior. Advised that vision benefits were through [redacted] and that                                                             she would need to contact them for benefit information.
4/1/15      Sam            No          Notes indicate that CSR received a transferred call therefore this was not recorded. CSR with help from Betty, provided basic vision benefits to Ms. [redacted]. Ms. [redacted] connected us to her vision provider,                                                                provider advised us that a claim had been paid by [redacted]. We advised that we do not administer vision claims and referred her to [redacted]. Ms. [redacted] stated she did not want to talk to Eyes Med. When CSR                                                           returned to the phone call, he did not receive any response from Ms. [redacted] and disconnected the call.
4/1/15      Michele       Yes          Ms. [redacted] called, about previous call with Sam regarding Vision benefits. (two) Michele puts call on hold, and returns to advise Ms. [redacted] that she was instructed by her supervisor (Betty) that Daniel-VP of                                                           operations will call her the next day to go over her information. Ms. [redacted] indicates that she wants to speak with Dan today. Betty intercedes and explains that Dan is not in the office and can call her at 11                                                         the next day. Ms. [redacted] indicates that she is not available then, Betty attempts to set a time for Dan to call her back. Ms. [redacted] indicates that she wants her vision benefits, and Betty offers to email her the                                                         information. Ms. [redacted] indicates that she is not clear what she should be discussing with Dan and that she does not want to speak to Betty. Ms. [redacted] indicates that she may contact her broker to obtain                                                             different dental coverage. Betty offers to terminate the policy. Ms. [redacted] questions on what grounds. Betty offers to send her a copy of her policy. Ms. [redacted] questions why she needs a copy of the policy if                                                         we will terminate the policy prior to her contacting her broker. Betty ends the call advising that we will send her a copy of her policy and any further communication can be handled in writing.
4/1/15       Tammy         Yes         Ms. [redacted] called to terminate her coverage. Policy to be cancelled as of (three) 3/31/15. She was advised that any claims submitted when she was covered would still be processed. Ms. [redacted] indicated that                                                         she does not want Dan or anyone else to contact her any further, and she does not want anything mailed to her.
4/6/15       Betty            No                  Call received from Eyesvied, advised that Ms. [redacted] terminated her policy as of 3/31/15 
4/7/15      Michele        No                 CSR received a call from Steve in our Sales department. He indicated that Ms. [redacted] called inquiring about purchasing a policy, he contacted customer service because he noted that she had just                                                                         terminated a policy. When Steve returned to the call, Ms. [redacted] had disconnected.
4/14/15 | Tammy          Yes                 Ms. [redacted] called to verify if her policy was still active. She was advised that her policy had been terminated. The CSR attempts to refer Ms. [redacted] back to the DOl. The CSRs were advised that Ms. [redacted]                                                                had filed a complaint with the DOI and she should be referred to them. Ms. [redacted] states that she was not advised that if she cancelled her policy, she would lose her benefits. Tammy reiterates that there                                                            is nothing else she can do, and places her on hold to get her supervisor. Betty gets on the line and advises her that the situation is under investigation and refers her back to the Department of                                                                            Insurance.
In your letter, you requested an explanation regarding purported poor/rude service including inability to obtain plan benefit information. A review of records shows that we provided Benefit information to the provider on numerous occasions, both electronically, which automatically creates a system generated note in our system, and verbally by customer service representatives. A review of recorded telephone conversations demonstrates that our Customer Service Representative consistently conducted themselves in a professional manner in attempting to provide Ms. [redacted] with information.
Pursuant to Ms. [redacted]'s request on April 1, 2015, the policy was terminated as of March 31, 2015. Enclosed is a copy of the termination letter, dated April 2, 2015 that was sent to Ms. [redacted] at her address of record. The policy will not be reinstated. Any claims received during her period of coverage will be processed accordingly.
If you have any questions or need additional information, please contact me directly at ###-###-####.
Sincerely,
Stacy P[redacted]Product Analyst[redacted]

Review: Company fails to pay for correct services/product, (dental crowns, wants to say that I received a Partial).Desired Settlement: Refund of ALL premiums paid since February 1, 2010 minus amounts actually paid for dental services rendered.

Business

Response:

October 24, 2014 Dear [redacted],I am writing in response to the correspondence you received from [redacted] and [redacted] regarding the benefits provided with their dental coverage. In their letter, Mr. and Mrs. [redacted] express dissatisfaction with the benefits provided and request a refund of premium payments minus any claim payments.Dental Coverage was issued to Ms. [redacted] effective February 1, 2010. **. [redacted] is listed as a dependent. Enclosed is a copy of the Dental Certificate.The contractual language that supports how the claims were processed can be found within the Coverage Schedule, page S2, which states in part,Class C. Major Services Include:12.The combined cost of surgical and non surgical dental implant procedures for endosteal implants as an alternative to the lowest cost covered traditional (non-implant) dental procedure that would provide satisfactory results. The eligible amount considered for the implant procedure will be the amount the plan would have considered as eligible for the covered traditional dental procedure. Pre-Determination is requested. All deductible, co-insurance and maximum limitations of the plan apply. The date of incurral shall be the date that the pre surgical or surgical service is performed.Coverage under this provision is not provided for:d.implants place for teeth extracted prior to the date covered under this plan.Enclosed is a copy of the Pre-Treatment Estimate, dated September 26, 2013, which was requested from [redacted]., DMD. Prior to the start of any dental procedures, it was estimated that $700 would be payable towards the procedures.On November 20, 2013, [redacted] proceeded with services of 'Surgical placement of implant body, endosteal implant' on Tooth #19 and #20. Enclosed is a copy of the Explanation of Benefits for the Dental claim we received and processed for those services.Regarding tooth #19, the policy does not pay for implants or implant crowns. The coverage provided is equal to the coverage we would provide for the alternative benefit. Therefore, the alternative benefit of a partial denture was applied. $100 was ineligible because the charge exceeded the reasonable and customary allowance under the plan. Major Services are covered at 50%, therefore a benefit of $700 (50% of $1500) was payable.Regarding Tooth #20, this tooth was extracted prior to the effective date of their coverage, therefore no benefit is payable.On June 30, 2014, [redacted], D.M.D. performed the procedures 'Implant - Porcelain Fused to Metal Crown' and ' Prefabricated Abutment' to both tooth #19 and tooth #20. [redacted] provided a copy of the dental claim form and the Explanation of Benefits associated with these procedures with his complaint.No additional benefits were payable on Tooth #19. The policy states that we give the alternative benefit for combined cost of both "surgical and non surgical dental implant procedures". The benefit for this service was included in the allowance for other related services. We already provided the benefit at the time of the surgical procedure on November 20, 2013. Again, there were no benefits payable for tooth #20 because the extraction of the tooth occurred prior to the effective date of the coverage.[redacted] stated that he contacted Security Life on September 16, 2014, to cancel the policy and to request a refund of premium for the remaining portion of the month of September. A review of our records confirms that the policy is now terminated, as requested. Termination was effective September 30, 2014, in accordance with the provision, 'YOUR INSURANCE ENDS', found on page C3 of the policy, which states in part, Insurance will end on the last day of the month for which a premium has been paid. No refund of premium is due.We have administered benefits in accordance with the contract provisions. Since the date of issue, [redacted] has been actively covered and claims were paid, therefore no refund of premium will be granted.If you have any questions or need additional information, please contact me at ###-###-####.Sincerely,Stacy P. Product Analyst