Seven Corners, Inc.

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
[I filed claims of dollars for physical therapy received by my mother and I already paid the money to service providersThere is dollar deductible on policy I bought for my mother so after that deduction is made I should be reimbursed for what I already paidThanks]
Regards,
*** ***

Revdex.com:
I have reviewed the? response made by the business in reference to complaint ID ***, and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.Please re-open? complaint ID *** as the company did not refund the amount based on the agreement? I have called them and no one seems to know what I am talking about.? I? don't? think they? deserve? a A+ rating.? Thanks? ***

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.I have already explained several times to several different employees of Seven Corners, when I initially purchased the travel insurance I was told that my TRIP would be covered only to find out when I filed the claim that the woman did not inform me that I had to make separate purchases to cover my tripNot only that but the amount of my trips equaled $302.90, which I was issued a check for $I am still owed $for the other portion of my tripThis company has scammed my husband and I out of over $and I have been fighting for it sinceI purchased the insurance on the 10th with the knowledge from the employee I purchased it through that my trip was coveredI then had to spend another $for more coverage which is why the day of he appointment is the day before coverageWe are being scammed out of our money by this companyI am fighting for my money back from this company.?
Regards,
*** ***

Revdex.com:
I just received a response back from Seven CornersWill review and respond as neededThank you for expediting the response
Regards,
*** ***

Revdex.com:
I have reviewed the? response made by the business in reference to complaint ID ***, and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below
? Please review the section I attached(Section IV trip cancellation/interruption (a))Also, there was no response to my complaint that I personally spoke to a representative from the company to assure me of my coverage prior to going on this trip (5/4) and well within the cancellation periodPlease have the company review the phone records of there employee to validate my claimI had, nor have I ever had a reason to purchase a claim such as this other that a potential medical emergency in which I was assured of the coverage forAgain, please address the employees assurances on 5/from a Mabel Harrera, as well as the email from a company representative that I have snipped inFurthermore, on 8/25/I received an email from Janet G***(Claims Manager) indicating "I apologize for the delay in a responseI do have the outcome of your claim and I don't agree with itI will be speaking with the account manager to see if there is anything to dispute this." This is an example of two individuals who assured me of my coverageI will be happy to send this email to anyone that would like to review it.?
Regards,
*** ***

April 15, *** *** Revdex.com N Delaware Street #Indianapolis IN? 46204- RE:? ? ? Complaint ID ??" *** ? ? ? ? ? ? ? ? ? Complainant:? *** ***
? ? ? ? ? ? ? ? Our Certificate Number *** Dear Ms***, Seven Corners, Incis in receipt of Complaint ID Number:? *** and sent to the attention of Dennis *** on April 11, 2016.? The complainant, *** ***, has expressed concerns with the handling of his recent travel medical insurance claim.? This office has reviewed the file and the claims in question.? Based on a thorough review of the file, it has been determined that the denial of the claims under the policy was incorrect as all information needed to process the claims was in our office.? ? ? The denial at this time is being overturned and the claims processed for payment in accordance with the policy benefits? ? We are also including interest payments totaling $in accordance with Massachusetts prompt payment laws.? We also find that inquiries and appeals by Mr*** were not responded to in accordance with our established customer service procedures.? We apologize for this and have addressed this issue with the appropriate personnel.? Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this office.? Sincerely, Seven Corners, Inc

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.The condition was acute exacerbation of chronic condition and would meet the criteria for treatment and coverageThis was indicated by my provider that I spoken to
Regards,
*** ***

Revdex.com:
?
I have reviewed the? response made by the business in reference to complaint ID ***, and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.I am not satisfied by the company's or Wesley's response because they are lies? Wesley told me numerous times he would help me get a better copy of the bill, he did not stop correspondence once I told him I was filing a Revdex.com complaint, he did that much earlier? The company only needs to look at his emails to confirm this? Below is one I sent on February 1st, months before the Revdex.com complaint:"Can you please let me know what's going on?Thanks"I later sent another one to Wesley S*** on february 12th: ? it is below and I'm sure the company can go through his emails to confirm this:? "Wesley,? I just can't understand why it is so hard ? to work with you.? Do you check your email?? Its 2016.? I have emailed you numerous times and and you simply ignore them.? I am calling again today to speak with your supervisor, though I doubt this will helpI will also be reaching out to the CEO personally.? I believe how customer are treated at Seven Corners should be brought to their attention."? ? Also, the above response from the company says they just recieved a claim from me in May, when in fact this was a forwarded email containing the claim that I first sent in July ? They can easily see this though its funny they don't mention it here? Given they are a large company, I'm sure they record their calls? Why else would I keep checking back with Wesley for a legible bill if he did not agree to help me procure one?When I called the hospital myself with a translator from my work to get one myself, they told me they could not send me one because the bill had been paid by Seven Corners and so the file was closed or something like that? They did pay the hospital bills, but before I had already paid the ones mentioned above out of pocket? I believe it was Wesley S***'s or Seven Corners intention to not get me a copy, knowing I couldn't get on myself and submit to my insurance first, thereby preventing them from every reimbursing me? These bills would have never been reimbursed had I not filed a report with the Revdex.com? I can't believe he would say he never said he would help me? We discussed it at lenght over the phone? I am assuming they are assuming I didn't record these calls and there is not record of it in the email, just of me asking him to do it? He is a liar, he knows it and I suspect the company knows it? They could easily listen to our phone calls and see that he surely committed to helping me get a legible copy.? Even though it took a full year to finally get reimbursed for the claim I submitted for out of pocket expennses, I am glad there are actually? responsiblepeople working at Seven Corners to offset such unprofessional, immature, dishonest pawns like Wesley S***? I understand that insurance companies need people of such low caliber to keep their profits by not keeping their promises.? I was honestly expecting to be thanking Seven Corners in this response and selecting that I was satisfied given they have finally reimbursed me for out of pocket expenses, even though it took a year after submitting the claim? I just can't believe they used this opputunity to call me a liar? I truly? believe? that all current and prospective clients should see what I have gone through and I hope the Revdex.com leaves this post up? ? ? ? ? ? ? ? ? ? ?
Regards,
*** ***

December
17, 2015***
***Revdex.com
of Central Indiana
NDelaware StreetSuite
# 2020Indianapolis,
IN? 46204-2599RE:? Complaint Number:? ***Complainant:
*** *** Our
Insured’s Name:? ? *** ** Certificate
Number: ***Policy:
Liaison
ContinentUnderwriter:? Certain Underwriters at Lloyd's, LondonDear
Ms***:We
are in receipt of your correspondence regarding the above referenced
complaint.? The complaint was received by
Seven Corners on December 17, 2015.? Seven Corners, Inc.; is an administrator for Certain Underwriters at
Lloyd's, London (Underwriters)This response is on behalf of Seven Corner’s,
Incand Certain Underwriters at Lloyd's, London (Underwriters) subscribing to
the above referenced policy.Our
records show that the effective dates of the above captioned policy were from October
9, to December 9, The
insured submitted a Proof of Loss Form stating she suffered from a skin rash
with itching since arriving in the United States on August 27, ? Based upon the Policy’s Coverage Benefits, the
coverage was not in effect until October 9, 2015.? Therefore, no coverage is afforded for the
claim submitted because the condition existed prior to the effective date of
the policyThe
policy language that is pertinent to this matter:DESCRIPTION
OF BENEFITSMedical
Expenses: Only such expenses, incurred as the result of and within one hundred
and eighty days (180) days from a Disablement, which are specifically
enumerated in the following list of charges, and which are not excluded in
EXCLUSIONS AND LIMITATIONS, shall be considered as Covered Expenses:EXCLUSIONS
AND LIMITATIONSFor
Medical benefits, this Insurance does not cover:
Pre-existing Conditions which are excluded under this policyThis means that
any claims for Pre-existing Conditions will not be covered for the duration of
this policy.a)
If You are a United States resident under age 70, this exclusion is waived for
the first $25,in eligible medical expenses incurred outside the United
States and Canada (for persons age and over, the amount is $5,000), minus
Your Deductible and selected Coinsurance option (Plan E or F)This waiver does
not include coverage for known, scheduled, required, or expected medical care,
drugs, or treatments existent or necessary prior to the effective date of this
program.b)
If you are a non-U.Sresident under age 70, this exclusion is waived for
eligible medical expenses for an Acute Onset of a Pre-existing Condition(s) (as
defined herein) up to $45,(Ages 65-limited to $2,000) for eligible
medical expenses incurred in the United States, minus Your Deductible and
selected Coinsurance option (Plan A or B)For persons age and over, there
is no benefitThis benefit does not include coverage for known, scheduled,
required, or expected medical care, drugs, or treatments existent or necessary
prior to arrival in the United States and prior to the effective date of this
program..PLAN
DEFINITIONSPre-existing
Condition(s) shall mean any medical condition, sickness, Injury, Illness,
disease, Mental Illness or Mental Nervous Disorder, regardless of the cause
including any congenital, chronic, subsequent, or recurring complications or
consequences related thereto or resulting therefrom that with reasonable
medical certainty existed at the time of application or any time during the 36*
months prior to the effective date of coverage under this policy, whether or
not previously manifested, symptomatic, known, diagnosed, treated or disclosed
This specifically includes but is not limited to any medical condition,
sickness, Injury , Illness, disease, Mental Illness or Mental Nervous Disorder,
for which medical advice, diagnosis, care or treatment was recommended or
received or for which a reasonably prudent person would have sought treatment
during the month period immediately preceding the effective date of coverage
under this policy*For Insured Persons traveling outside the United States and
Canada, the period is months instead of months.The
reasons for this denial of coverage are not limited to those stated in this
letter, and Underwriters reserve the right to supplement this letter with
further legal and factual reasons as to why there is no coverage.? Underwriters do not waive any rights under
the Policy or under applicable law.? This
response is based upon the information you provided to Underwriters and
information Underwriters have obtained during their investigation and review of
your claim.We
hope this answers any outstanding questions in relation to *** **’s claim.If
you should have any further questions or need further clarification of the
above, please do not hesitate to contact us.Sincerely,Claims
DepartmentSeven
Corners, Inc

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.]I missed two days travelling to get to my final destination for vacationAlso I was taking my mother back home who is a senior
Regards,
*** ***

Revdex.com:
I have reviewed the? response made by the business in reference to complaint ID ***, and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below
Dr*** *** is part of Seven Corners' networkI do not think I am responsible for mediating the payment process between Seven Corners and the doctors office as I made sure I go to a doctor who is part of the insurance network prior to going to the doctors' officeThe failure to communicate with the doctor should not make me a victim for? harassing letters from *** lab and their collection office and ruining my credit scoreI hope Seven Corners finds a better way for reaching the doctors' office
Regards,
*** ** ***

Revdex.com:
Please find attached the release per seven corner's request.? Please ensure that it is received by the appropriate party as? Ihave not had much luck with the inquires I have sent them.I have reviewed the? response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.? ? Thank you for your assistance in this matter
Regards,
*** ***

Revdex.com:
I have reviewed the? response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.?
Regards,
*** ***

February 14, ? *** *** Revdex.com N Delaware Street #Indianapolis IN? 46204-RE:? Complaint ID *** ? ? ? ? ? ? ? Customer:? *** *** ? ? ? ? ? ? ? Certificate ***
? ? ? ? ? ? ? Insured:? *** *** ? ? ? ? ? ? ? Policy Name:? *** *** ? ? ? ? ? ? ? Dear Ms***: Seven Corners, Incis in receipt of Complaint ID Number *** and sent to the attention of Chelsi T*** on February 1, 2017.? The complainant, *** ***, has expressed concerns with the handling of his wife’s travel medical insurance claims under the certificate # referenced aboveThis office has reviewed the file and the claim in question.? The claims were denied under the exclusion in the policy for pre-existing conditions.? This decision was made after medical review of the medical records received in connection with *** ***’s illness.? We regret that Mr*** is not happy with our customer service or claim handling.? However, our records reflect extensive communications between our company and Mr*** in efforts to explain our denial and assist him with his concerns.? Please be advised that in response to this complaint, as well as a formal complaint that has been filed by Mr*** with the California Department of Insurance, we will be undertaking a complete review of this file.? Complete, detailed response to Mr***’s complaint with documentation will be sent to the California Department of Insurance by their deadline of March 1, 2016.? Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.? ? ? ? ?

February 12, ? *** *** Revdex.com N Delaware Street #Indianapolis, IN? 46204-? RE:? Complaint ID ??" *** ? ? ? ? ? ? ? Complainant:? *** *** ? ? Dear Ms***: ? Seven Corners, Inc
is in receipt of Complaint ID Number *** and sent to the attention of Dennis W*** on January 6, 2016.? The complainant, *** ***, has expressed concerns with the handling of his father’s recent travel medical insurance claim? This office has reviewed the file and the claims in question and find that the denial of the claims under the policy exclusion for pre-existing conditions was correct based on the medical information we received.? We also find that we did receive several inquiries from Mr*** requesting more specific medical information on the determination that was made.? It appears that our responses to these inquiries did not provide the detailed information that was requested in order for Mr*** to understand our determination.? ? By separate letter directly to Mr***, we will respond with the medical details he has requested.? ? Thank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this office.? ? Sincerely, ? Seven Corners, Inc.?

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.I was contacted by the insurance company on 11/29/two times to discuss my claimThey clearly have a disconnect amongst there organizationI would request that at this time my complaint be posted for those who may be shopping/investigating travel protection have an accurate picture of my experiencePlease respond if you would like copies of the emails for times when I had correspondence with the insurer
Regards,
*** ***

Revdex.com:
I have reviewed the? response made by the business in reference to complaint ID ***, and have determined that the response? would not resolve my complaint.? For your reference, details of the offer I reviewed appear below.It is my understanding that, should you client seek treatment at your hospital, we would be better of collecting money up front as a self-pay patient and let your client handle insurance
Regards,
*** ***

March 20, ? *** *** Revdex.com N Delaware Street #Indianapolis IN? 46204-RE:? Complaint ID *** ? ? ? ? ? ? ? Customer:? *** *** ? ? ? ? ? ? ? Certificate *** ? ? ? ? ? ? ? Insured:? *** *** ? ? ? ? ? ? ? Policy Name:? *** *** ? ? ? ? ? ? ? Dear Ms***: Seven Corners, Incis in receipt of the rebuttal to Complaint ID Number *** and sent to the attention of Chelsi T*** on March 17, 2017.? The complainant, *** ***, has expressed additional concerns with the handling of his wife’s travel medical insurance claims under the certificate # referenced aboveAs advised in our response of February 14, a complete review of the file was undertaken in response to the formal complaint filed with the California Department of Insurance.? A complete, detailed response was sent to the Department of Insurance.? A detailed response was also sent to Mr*** via email on March 3, and also mailed to him via U.SMail.? This detailed response does address the questions that Mr*** has expressed in his rebuttal.? A copy of this response is attachedThank you for your time and attention to this matter and should you have questions involving this claim matter, please contact this officeSincerely, Seven Corners, Inc.? ? ? ?

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
*** ***/Revdex.com team, ? ? Thank you for getting a reply from Jennifer/ Seven CornersJennifer/Seven Corners,We can confirm that we got Jennifer's letter in reply to the Complaint that we had to file with the CA? CommissionerAnd thank you for finally replying to our Revdex.com reply from Feb Seems like a very very long? time to wait for a reply from you guys.? Unfortunately? you still have not answered the questions.In our Revdex.com Message from Feb 2017, we asked you very specific questionsWe were hoping that you would? have answered them in this new message from you that we got on March You state below that your letter? replying to our CA? Commissioner? Complaint addresses the questionsThat is not trueYour letter did not address? or answer the questions.We got your March letter replying to the CA? Commissioner? investigation.Thanks for apologizing for not? replying to the many many questions that we asked Kathy H*** over the past monthsI guess you are also? apologizing for you and Chelsi T*** not answering our questions to you directly to you, via the Revdex.com Complaint,? and via the CA Insurance CommissionerThe irony is that even though you are apologizing for not answering the? questions, it seems like you are still not answering the questions.Lets just focus on just one or two questions:First Question:The biggest question you still have not answered is, what is the "pre-existing condition"? Can you reply to this?? What is this "pre-existing condition" that apparently *** has? And also what medical certainty do you have? that she had this "pre-existing condition" during the look-back period? This look-back period seems pretty? important, as it basically means that if someone once upon a time had some "pre-existing condition" but was? stable (meaning: had no new medical condition and no prescription medication changes) during the look-back? period, then a denial based on a "pre-existing condition" can't be usedIn this new reply letter from March 2017,? you say "...***'s illnesses were pre-existing" Can you please tell us what these "illnesses" are? Since you are? telling us that with "medical certainty" they are "pre-existing," you should be able to tell us what they areAlso? please can you provide the evidence you are using to determine that the "illnesses" are "pre-existing"That would? be quite helpfulFor instance, what information, facts, or evidence are you using to determine that ***'s? ovarian cyst was "pre-existing." ?? Second Question:Also can you confirm that you got the Clarification Letters that we sent you directly in December Did you? read them? We also attached them to the Revdex.com reply on Feb 2017.If you read Tina B***'s original office visit report and her Clarification Letter you asked for, Tina B*** clearly? states that:"Her non-chronic more recent change in abdominal pain and menses required further evaluation to address her? complaint." and "The more acute problem including diagnosis or irregular menstrual cycle (N92.6,) female pelvic? pain (N94.9) required further evaluation and was not chronic in nature."? If you read Rahul C***'s Clarification letter he clearly states:"...acute onset abdominal pain and heartburnThis was the first time she had experienced such pain and? heartburn and so came to see me for consultation." he continues "While her bloating was a pre-existing? condition, her abdominal pain and heartburn were new medical problems that led to her seek Gl consultationIn? my professional opinion, her abdominal pain and heartburn were not pre-existing conditions and not related to her? prior history of bloating..."? Lets start with that, and hopefully a reply from you will come faster than the days we have waited patiently for? basically a non replyHopefully Chelsi or Jennifer and the Seven Corners people decide to stop denying the? claims, and reimburse *** for the bills she has already had to pay to stop them from going to collections, as? well as pay the current claims.Regards,*** *** ? *** *** ***
Regards,
*** ***

Seven Corners is in receipt of complaint # ***, and sent to the attention of Dennis ***? The complaint was filed by *** *** who objects to the handling of his claimWe appreciate the opportunity to address the concerns of the complainant.Mr*** purchased a Liaison Continent travel
policy on January 8, During his trip, Mr*** sought out medical care related to diabetes and hypertension at the Ella Family PracticeThe medical visit occurred on February 9, The insured party then submitted a medical expense claim to Seven Corners.On March 9, 2015, *** *** sent an email to Seven Corners requesting to cancel the purchased Liaison Continent policy and refund him the premiumLater that same day, Mr*** was sent notification via email that this office could not refund his premium because he filed a claim on policy number ***The following policy language was included in the communication to the consumer (emphasis added):Part I - INDIVIDUAL INSURANCE PROVISIONSRefund of Premium/Cancellation"REFUND OF PREMIUM - Refund of total plan cost will only be considered if written request is received by Seven Corners prior to the Effective Date of CoverageIf written request is received after the Effective Date of coverage, the unused portion of the plan cost may be refunded minus a cancellation fee, provided no claim has been submitted to Seven Corners for reimbursement."? This policy language is accessible by insured party prior to and at the time of purchase.? In order for this office to appropriately evaluate *** ***'s medical expense claim, Seven Corners proceeded to request medical records from Ella Family PracticeUpon our review of the medical documentation, it was determined the medical visit resulted from Mr***'s pre-existing medical conditionsHis presented claim was therefore ineligible for claim payment? On April 9, 2015, notification of claim denial was mailed to Mr***.When we received Mr***'s Revdex.com complaint, we reevaluated his claimBased upon the presented documentation, we must affirm the previous claim denial and reiterate that the premium paid by Mr*** is ineligible for reimbursement since a medical expense claim was presented for payment consideration.Policy Language which is pertinent to the denial of Mr***'s claim:PART IV - EXCLUSIONSMEDICAL BENEFIT EXCLUSIONSFor Medical benefits, this Insurance does not cover:Pre-existing Conditions which are excluded under this policyThis means that any claims for Pre-existing Conditions will not be covered for the duration of this policy.a) If You are a United States citizen, this exclusion is waived for the first $25,in eligible medical expenses incurred outside the United States and Canada (for persons age and over, the amount is $5,000), minus Your Deductible and selected Coinsurance option (Plan E or F)This waiver does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to the effective date of this programAny exclusion specifically listed in Medical Benefits exclusions, through 40, will not receive benefits from this waiver.b) If you are a non-U.Scitizen under age 70, this exclusion is waived for eligible medical expenses for an Acute Onset of a Pre-existing Condition(s) (as defined herein) up to the limit as provided in the Acute Onset of a Pre-existing Condition(s) section of the Schedule of Benefits for eligible medical expenses incurred in the United States, minus Your Deductible and selected Coinsurance option (Plan A or B)For persons age and over, there is no benefitThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs, or treatments existent or necessary prior to arrival in the United States and prior to the effective date of this programAny exclusion specifically listed in Medical Benefits exclusions, through 40, will not receive benefits from this waiver.PART III - DEFINITIONSThe term "Pre-existing Condition(s)" shall mean any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, regardless of the cause including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time during the 36* months prior to the effective date of coverage under this policy, whether or not previously manifested, symptomatic, known, diagnosed, treated or disclosedThis specifically includes but is not limited to any medical condition, sickness, Injury , Illness, disease, Mental Illness or Mental Nervous Disorder, for which medical advice, diagnosis, care or treatment was recommended or received or for which a reasonably prudent person would have sought treatment during the month period immediately preceding the effective date of coverage under this policy*For Insured Persons traveling outside the United States and Canada, the period is months instead of months.The term "Acute Onset of a Pre-Existing Condition(s)" shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute OnsetThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to arrival in the United States and prior to the Effective Date of coverage.We hope this answers *** ***'s concerns regarding his premium reimbursementShould you have further questions or need further clarification of the above, please do not hesitate to contact us