The Loomis Company

I pay for Loomis to provide me with Gap coverage in the event of an accidental injury. I paid 3 years (auto pay) before I finally needed to use it. I stepped on a large rock at home and broke my ankle. I went to the ER, was xrayed, splinted, prescribed meds and referred to an orthopedic doctor. I went and was given an air cast (basically a big plastic looking boot that you use air to help stabilize the ankle) and given a follow up. At the follow up it was determined that a piece of the bone popped off when the tendon separated from the ankle so I needed the air cast for another week and given another follow up. I called Loomis and explained what happened and they sent me the paperwork to fill out and submit. Told me they only had mail, no fax number. I get everything, bills and filled out the report saying what happened. They said, after I called them since I hadn't heard anything, that they needed an itemized bill. That they didn't get the paperwork I sent in, but they got the accident report (it was WITH all the paperwork I mailed in that they said they didn't get). I requested itemized bills and submitted. They wanted codes and the hospital wouldn't give it to me. I spent an hour on the phone with my primary insurance getting NPRs, tax ids, cpt codes, dx codes, addresses and phone numbers. I submitted (finally through a fax number that magically appeared) and they wouldn't process the claim. I, again, had to call and ask what the problem was. They said one of the doctors said the break "could have happened anywhere" and that meant I needed to fill out another set of forms again describing when, where and how the accident happened. We're now almost 6 months post break and they still are giving me problems. Saying it isn't covered, even though it is, and still waiting for the accident paperwork. This company is fighting me this hard over just under $900 and I've paid them more than that since I joined. I'm considering hiring an attorney over this! Please save your money, this company is obviously out to scam people. AND, their customer service reps are rude and unhelpful!

Please do not use THE LOOMIS INSURANCE COMPANY, They will take huge monthly payments and when you go to the doctor and bill loomis for payment they will not pay your claim, I wish I had read the REVIEWS before signing on with this no good worthless company, I am utterly disgusted with loomis. How is this company even still in business? I am better off not having any insurance at all, Why would I pay loomis monthly and still pay my own doctor bills?

this company has been taking money from my bank account for nothing,was very sick after surgery and made company aware of cancelling my policy but the company kept taking money from my bank account,was very sick at of time of my calling to cancel services

8/22/2015Dear [redacted] ***, This is in response to your complaint setter dated 8/13/2015, Revdex.com ID [redacted] The [redacted] ***health care plan is an [redacted] self-funded group health plan, The Loomis Company is a third party administrator contracted to adjudicate claims in accordance with the terms of the plan.Based on a review of the: Schedule of benefits and HRA account rules the claims were originally processed according to coverage restrictionsThe determination was based on the HRA coverage summary does not cover services which are not covered under the plan , re: dependant pregnancyThe employee emailed overify her medical benefits 6/2/, we responded 6/3/to confirm her inquiry that the plan does not cover dependant pregnancyThe plan has since decided to add dependant pregnancy to their HRA covered expenses and her claims were reprocessed to pay out to the employee an additional $ out of her HRA.The opinions expressed are based solely upon a review of records and other written information submitted to The Loomis CompanyIn, the event the information provided is incomplete, inaccurate, or in the event a change of circumstances occurs subsequent to the review, a reconsideration of the review and the opinions expressed may be warrantedSincerely, Denise GThe Loomis Company Benefits Division

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and I will accept their response with following corrections: I made no less than phone calls to collect my refund between 9/10/and 10/10/I was asked for my banking information on at least four occasions I was also asked to provide my personal bank statements, which I refused to do Regards, Lila M***

worst

THE WORST HEALTH INSURANCE CO. EVER !
Last year my wife ended up in the emergency room after her doctor said she might a problem with the gallbladder, very dangerous. She ended up being admitted because they had to lots of lab tests. She stayed for 2 days, and they found out she had a virus that attacked her liver, and that's why she had very high fever. The whole bill came out to be close to $27,000. Loomis paid a little more than $8,000, leaving us with a $15,000 debt. They always had the excuse of preexisting conditions for not paying. It took a year to solve all the rejections. Hundreds of phone calls. They are very quick to take the monthly premium from our account but they do not want to pay the claims.
This system does not let me put less than 1 star otherwise I would.

DO NOT BUY FROM LOOMIS !

Reading some other reviews I see consumers had same issue as myself. Go for a routine office visit for blood pressure meds, they deny the coverage. under investigation for pre existing, want 5 yr.'s of medical history. These people are a scam, should be shut down.

I went in for my normal annual visit with my Dermatologist. He found two basically microscopic pre-cancerous spots on my face which he removed with nitrous oxide. Loomis sent me a letter stating that they believed that this was a pre-existing condition. However, they sent me a request asking for every single doctor and prescription I have had for the last five years. I believe, and my attorneys believe, that this is a part of a plan, to dissuade individuals for completing the claim. The claim has remained denied.

I would recommend to anyone considering this company to run away as fast as you can. I plan a social media blitz over the next year to educate the general public about this unscrupulous company.

The Loomis Company gave me the run around on how to cancel their insurance, which left me paying for insurance I didn't need for 6 additional months, and they refuse to reimburse. Do yourself a favor, skip the hassle, and go with a reputable company. Every place I write a review says the same thing...untrustworthy.

We are in receipt of your recent letter addressed to MrMichael M*** at The Loomis Companydated September 11, 2017, in regards to the above ?le number.You have asked for a written reply supported with relevant documentation addressing each issueraised in the complaint.We have reviewed our records
and we have determined that *** *** has a Core Accessinsurance plan, which is underwritten by *** *** *** *** ***and administered by Loomis.After further review the claim issue has been resolved and will be issued this week andreimbursed to MrBarton. ***Melissa B***Director of Outsourcing OperationsThe Loomis company*** *** * ** *
*** ** * *** ** *** *** *

Worst company. Left me with huge bills covers basically nothing.
My insurance agent calls me to recommend a new policy that I now qualify for under this administration. After a good sales pitch, I switch over.

Terrible agent, Gregory Hicks in Tampa Florida to recommend this company. Extremely poor advise. Due to switching over to Loomis, I am stuck with re-existing conditions.

Stay away from both.

Worst insurance I've ever had. Do yourself a favor and search for a decent company that actually pays the medical claims when you have to go to the hospital for an emergency. Went to the emergency room in June, spent three days in the hospital and received a $17,000 bill. Loomis applied a $2000 discount and I got stuck with the $15,000 balance. I would have been better off saving the $500 per month or putting this into an HSA and pay out of pocket for the difference. Absolute garbage company.

Worst medical insurance company ever! Do not pay for insurance with this company. To put it simply - they do not pay claims - period. They will gladly take your premium money and THEY TO DO NOT PAY YOUR CLAIMS!

We are in receipt of your recent letter addressed to MrMichael M*** at The Loomis Company dated October 23,2017, in regards to the above file number.You have asked for a written reply supported with relevant documentation addressing each issue raised in the complaint.We have reviewed our records
and we have determined that *** *** has a Core Access insurance plan, which is underwritten by *** *** *** *** (***) and administered by Loomis. After further review the member made her initial premium payment on $on 8/31/17.-She then decided to cancel the policy on 9/5/17.-We attempted to refund her premium on 9/15/17.-The member called on 9/18/regarding her refund and we told her that is was processed on 9/15/and takes approximately 7-business days to go through.-On 9/26/we were notified that the refund was returned and not accepted by her bank stating that there was no such accountWe called her the same day to get correct banking information to get the refund to her.-Member called us back on 9/28/with corrected baking infoimation for the refund to be processed.-Refund was processed again on 10/6/17.Melissa B***Director of Outsourcing Operations

8/24/2015Dear *** ***,This is in response to your complaint letter dated 8/11/for ID ***The *** *** *** health care plan is a self funded group health plan, The Loomis Company is a third party administrator contracted to adjudicate claims in accordance with the terms of
the plan.Based on a review of the:Eligibility files and claims history, it appears the three claims that were denied for after termination date were already reprocessed on 7/23/and 6/12/We show the provider called in on 7/8/on one claim and the complainant called in on 6/11/on the other two denied claims at which time they were forwarded to the claims team and on 6/12/they were immediately redoneWe did not have her birthday loaded incorrectly, the eligibility system is set up to auto deny at age due to HCR coverage limitationsThis plan allows coverage till the end of the month following the termination date therefore we had to adjust this in order to pay those claims which were still eligible.The opinions expressed are based solely upon a review of records and other written information submitted to The Loomis CompanyIn the event the information provided is incomplete, inaccurate, or in the event a change of circumstances occurs subsequent to the review, a reconsideration of the review and the opinions expressed may be warranted.Sincerely,Denise G.Benefits Division

worst company I have ever worked with! After pre-qualifying with them they started sending my doctor and I forms to fill out we filled them out sent them in now the sent us more forms for every doctors appointment since 2012 after we fill out all the forms Loomis told me they made a mistake they did not notice they canceled there contract with the hospital they sent me to so they will not pay the claim 0 stars

They do not honor their contract with accidental insurance & major medical. A scam.

8/24/2015
Dear [redacted],
This is in response to your complaint letter dated 8/11/2015 for ID [redacted]. The [redacted] health care plan is a self funded group health plan, The Loomis Company is a third party administrator contracted to adjudicate claims in accordance...

with the terms of the plan.Based on a review of the:
Eligibility files and claims history, it appears the three claims that were denied for after termination date were already reprocessed on 7/23/2014 and 6/12/2015. We show the provider called in on 7/8/2014 on one claim and the complainant called in on 6/11/2015 on the other two denied claims at which time they were forwarded to the claims team and on 6/12/2015 they were immediately redone. We did not have her birthday loaded incorrectly, the eligibility system is set up to auto deny at age 26 due to HCR coverage limitations. This plan allows coverage till the end of the month following the termination date therefore we had to adjust this in order to pay those claims which were still eligible.
The opinions expressed are based solely upon a review of records and other written information submitted to The Loomis Company. In the event the information provided is incomplete, inaccurate, or in the event a change of circumstances occurs subsequent to the review, a reconsideration of the review and the opinions expressed may be warranted.
Sincerely,Denise G.
Benefits Division

April 5, 2017Dear Dispute Resolution Consultant:In reply to the notification regarding the above-captioned complainant ID, please be advised that the Consumer has not executed a HIPAA release and authorization that names the Revdex.com as an authorized party to receive information as to...

the Complainant's insurance Coverage. Therefore, please be generally advised the Consumer's concern will be investigated and a detailed response will issue directly to the Consumer.If anything further is required, please Contact us.Sincerely,Melissa B. Director of Outsourcing Operations