Senior Health Insurance Company of Pennsylvania

I share your strugglesMy Mom died in SeptMom had faithfully paid her premiums for yearsS.H.I.Pmade us jump through several hoops like we were trained zoo animals And, just when we thought we had all the "correct" documentation for her $28,out-of-pocket home health care, they found other issues ONE day out of the clear blue we received a check for % We are reporting this company to the Insurance Commissioner and the Revdex.comI'm planning my assault on this company They shouldn't be allowed to rob from the elderly And, they are guilty of FRAUD If you have Facebook warn people about this companyContact you local mediaTell everyone you know SHIP ripped off my Mom and I will not stand for their abuse and thievery

In order to make a benefit determination for confinement into a facility, a complete proof of loss must be receivedThis 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 licensePlease be advised our Claims Department may request additional information in order to make a benefit determinationMs [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 submissionOn 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 determinationOn June 2, and June 14, 2016, they were sent follletters advising the medication administration records were still neededOn 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 determinationAs 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 paymentThe requested information may be mailed to P.OBox 64739, StPaul, MN or faxed to (952) 983-Once received, a benefit determination can be completedEnclosed is the aforementioned correspondence and a copy of the policyIf you ahve any questions regarding this matter, please contact Ketrina D***, Supervisor, at (317) 566-or fax them to (317) 566-Sincerely, Jaime A [redacted] Consumer Support Specialist WASHINGTON NATIONAL INSURANCE COMPANY

I have been since feb. trying to get moms care paid for! Keep getting excuses. They tell me they changed there policy and to read. what they tell us to do1! We we did we got NOWHERE!@! turned it over to the. state insurance. commissioner done this before and to my problem solved! Tired of getting reamed baby layers!

Thank you for your correspondence from *** ***, on behalf of *** ** ***, regarding Mr***'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*** and his facility, *** *** ** *** ***, 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, All requested information was received by August 16, Therefore, on that same date, Mr*** 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***'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 supervisorEnclosed are the aforementioned lettersIf you have any questions regarding this case, please contact Ketrina D***, Supervisor, at (317) 566-or fax (317) 566-Sincerely,
Jaime A***
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,
*** ***

Thank you for your correspondence on behalf of *** ** ***, regarding her policy with *** *** *** ***
12pt;">Please be advised that Senior Health Insurance Company of Pennsylvania (SHIP) services Mrs*** policy on behalf of *** *** *** *** (***)On or about September 1, 2014, *** policies were converted to SHIP's computer systemMrs*** claims will continue to be serviced through our Claims Department according to the policy language outlined within her policy provisionsMrs*** may continue to submit the itemized bills to our Claims Department at fax number (952) 983-or by mail to P.OBox 64739, StPaul, MN According to the General Provisions of Mrs*** policy, under Time of Payment of Claims, it states benefits payable under this Policy for any Loss, other than Loss for which periodic payment is provided, will be paid immediately upon receipt of written proof of LossLoss is defined as financial loss incurred as a result of expenses incurred by the Covered PersonPlease note that in order to substantiate Loss, itemized bills indicating room and board charges are requiredThe State of Texas requires insurance companies to process claims within days after all of the required information has been received, although *** typically pays benefits faster than the state requiresPlease note that after a review of Mrs*** claim file, our records indicate that dates of service ranging from July 1, through July 31, were paid prior to conversionFurthermore, the August through January claims have been processed within the allowable state guidelinesWe regret Mrs*** unsatisfactory experience with Customer ServiceHer feedback helps us in our ongoing efforts to improve serviceThe representatives assisting her have the most accurate information available and are evaluated based on the quality of service they provide to herIf, however, they are unable to address her concerns, she may ask to speak with a supervisor.
A copy of Mrs*** policy, the call records, a spreadsheet documenting claims for months of service August and their corresponding Explanations of Benefits are enclosedWe want to assure you of our continued commitment to provide the best possible customer serviceIf you should have any further questions, please feel free to contact Ketrina D*** Supervisor, at (317) 566-***, or fax them to (317) 566-Sincerely,
Jamie ***
Consumer Support Specialist
*** *** *** ***

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 Specialist
WASHINGTON NATIONAL INSURANCE COMPANY

I share your struggles. My Mom died in Sept. 2014. Mom had faithfully paid her premiums for years. S.H.I.P. made us jump through several hoops like we were trained zoo animals.

And, just when we thought we had all the "correct" documentation for her $28,000 out-of-pocket home health care, they found other issues.

ONE day out of the clear blue we received a check for %175.00.

We are reporting this company to the Insurance Commissioner and the Revdex.com. I'm planning my assault on this company. They shouldn't be allowed to rob from the elderly. And, they are guilty of FRAUD.

If you have Facebook warn people about this company. Contact you local media. Tell everyone you know.

SHIP ripped off my Mom and I will not stand for their abuse and thievery.