The Loomis Company

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 restrictions. The determination was based on the HRA coverage summary does not cover services which are not covered under the plan , re: dependant pregnancy. The employee emailed overify her medical benefits 6/2/2015 , we responded 6/3/2015 to confirm her inquiry that the plan does not cover dependant pregnancy. The 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 $ 3812.49 out of her HRA.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.
The 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 10 phone calls to collect my refund between 9/10/17 and 10/10/17. 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[redacted]

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 restrictions. The determination was based on the HRA coverage summary does not cover services which are not covered under the plan , re: dependant pregnancy. The employee emailed overify her medical benefits 6/2/2015 , we responded 6/3/2015 to confirm her inquiry that the plan does not cover dependant pregnancy. The 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 $ 3812.49 out of her HRA.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.The Loomis Company Benefits Division

Review: As a baseball umpire I joined an organization - [redacted] - that stands for [redacted]. I took their high option for lost game fee insurance at the cost of $75 per year. The Loomis Co. is the [redacted]'s insurance carrier. On 06/20/2012 I was hit with a foul tip and suffered injury to my upper left chest. Due to the injury I was out of work the last week in June and all of July before returning in 09/12 - we close down in Aug. due to vacations. The insurance carrier requires the the injury be reported within 90 days and this was done along with all required statements from doctors, hospitals and witness.

Now comes the 'kicker'! " Part A must be completed, dated and signed by an official or the organization." I was confused by the wording and had [redacted], my organization's commisioner sign said form. In Jan. of 2013 the Loomis Co. sent me a different form to have signed that clearly stated the form needed to be signed by [redacted]. I finally got this done and sent to the insurance co. Months went by and when I called about my claim, was told that since Part A finally signed correctly was past the 90 days requirement and all paper work that I had sent by Certified Mail had been destroyed.Desired Settlement: *With the high option I took out, it was to pay $100 per week with a max of 25 weeks. I ask that I be paid $100 per week for 5 weeks.