Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] Their rules state that I am entitled to an appeal for adverse denial of benefits even when they used a rule to deny said benefits They continue to deny my right to appealThey will not give me information on how to appealThey are not following their own ruleI want to pursue a formal appeal which I am entitled to per the same manual they have referenced in their response
[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 [redacted] , and find that this resolution is satisfactory to me Please thank them for honoring the insurance policy, and thank you for giving us a means to obtain resolution to these types of issues Regards, [redacted]
Dear Ms***:I am writing in response to your letter dated November 30, 2015, regarding the member’s right to file an appeal in the case of an adverse claim determinationPlease refer to the below section from the member’s Ohio Public Employee Retirement System (OPERS) Medical Plan Description:Introduction, which states: you must enroll in Medicare the first day you become eligibleIf you or any of your eligible dependents are eligible for Medicare but do not enroll, this Plan's coverage for covered hospital (Medicare A) and/or medical (Medicare B) expenses will be reduced by the amount Medicare would have paidThis will be done whether or not you actually enroll in the Medicare program.Helpful Notes, which states: as soon as you are eligible for any type of Medicare, you MUST sign up for it, notify OPERS of your enrollment and use itIf you don't, it will cost you a lot of your own moneyThere are some exceptions, but until you hear otherwise from OPERS, assume this rule is always true.In accordance with the plan benefits, the member does have the right to appeal an adverse claim determinationMedical Mutual is not denying the member their right to appealIf Medical Mutual had received an appeal, the denial would have been upheld based on the above requirementsIf the member would have been enrolled in Medicare Part B, as required by the Group, Medicare would have paid percent of their Allow Amount for the home visitsTherefore, no benefit would have been due under the OPERS planMedical Mutual administers the benefits onlyMedical Mutual is not permitted to change or alter any membership and/or eligibility requirements established by the GroupAttached is the Medical Plan DescriptionIf you have any questions, please don’t hesitate to contact me Sincerely, [redacted] , Sr Appeals SpecialistMember Appeals departmentAttachment
I have the right to appealI do not want the company to tell me what the possible outcome of the appeal might beI want them to give me the information on how to complete the appeal they should allow me to complete the appeal as is their stated policyI request to exercise my right to appeal no matter what they think the out come may beAs we speak my ulcers have worsened without the needed careI am looking for a compassionate look at my appealThis is very urgent now that my ulcers are worse without the need home health care servicesb
June 3, [redacted] ***Revdex.comEast 9th Street Suite 200Cleveland, Ohio 44115-1299Case ID: [redacted] Dear [redacted] ***s:I am writing in response to your letter dated May 28, 2015, regarding the member’s Market Classic Gold policyWhen members have an Exchange policy all enrollment information and changes is received from the MarketplaceWhen Medical Mutual receives a Change in Circumstances from the Marketplace an explanation as to what has changed is not providedBased on the information received, the member’s account is adjusted accordinglyThe member would need to contact the Marketplace for an explanation as to what changed.On 4/21/15, Medical Mutual responded to the member’s email regarding the increase in premiumsThe member was advised that his monthly premium was $581.78, $1,was due, and if the monthly premium is incorrect he would need to contact the Marketplace On 4/24/15, Medical Mutual received a letter from the member regarding his premiums and requesting a policy cancellationA response was issued to the member on 5/7/As previously stated in our response to the Revdex.com on 5/20/15, the member had a day grace period to pay premiums in fullThe member’s grace period started on 4/1/and ended on 5/1/15.On 5/7/15, Medical Mutual canceled the policy 3/31/15, since the grace period had ended, the premiums were not paid in full and we had received the member’s request to cancelOn 5/8/15, the Certificate of Creditable Coverage was issued to the member Attached is the letter from the member and Medical Mutual’s responseIf you have any questions regarding this issue, please don’t hesitate to contact me Sincerely, [redacted] Sr Appeals SpecialistMember Appeals departmentFax
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 Regards, [redacted] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] Their rules state that I am entitled to an appeal for adverse denial of benefits even when they used a rule to deny said benefits They continue to deny my right to appealThey will not give me information on how to appealThey are not following their own ruleI want to pursue a formal appeal which I am entitled to per the same manual they have referenced in their response
[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 [redacted] , and find that this resolution is satisfactory to me Please thank them for honoring the insurance policy, and thank you for giving us a means to obtain resolution to these types of issues Regards, [redacted]
Dear Ms***:I am writing in response to your letter dated November 30, 2015, regarding the member’s right to file an appeal in the case of an adverse claim determinationPlease refer to the below section from the member’s Ohio Public Employee Retirement System (OPERS) Medical Plan Description:Introduction, which states: you must enroll in Medicare the first day you become eligibleIf you or any of your eligible dependents are eligible for Medicare but do not enroll, this Plan's coverage for covered hospital (Medicare A) and/or medical (Medicare B) expenses will be reduced by the amount Medicare would have paidThis will be done whether or not you actually enroll in the Medicare program.Helpful Notes, which states: as soon as you are eligible for any type of Medicare, you MUST sign up for it, notify OPERS of your enrollment and use itIf you don't, it will cost you a lot of your own moneyThere are some exceptions, but until you hear otherwise from OPERS, assume this rule is always true.In accordance with the plan benefits, the member does have the right to appeal an adverse claim determinationMedical Mutual is not denying the member their right to appealIf Medical Mutual had received an appeal, the denial would have been upheld based on the above requirementsIf the member would have been enrolled in Medicare Part B, as required by the Group, Medicare would have paid percent of their Allow Amount for the home visitsTherefore, no benefit would have been due under the OPERS planMedical Mutual administers the benefits onlyMedical Mutual is not permitted to change or alter any membership and/or eligibility requirements established by the GroupAttached is the Medical Plan DescriptionIf you have any questions, please don’t hesitate to contact me Sincerely, [redacted] , Sr Appeals SpecialistMember Appeals departmentAttachment
I have the right to appealI do not want the company to tell me what the possible outcome of the appeal might beI want them to give me the information on how to complete the appeal they should allow me to complete the appeal as is their stated policyI request to exercise my right to appeal no matter what they think the out come may beAs we speak my ulcers have worsened without the needed careI am looking for a compassionate look at my appealThis is very urgent now that my ulcers are worse without the need home health care servicesb
June 3, [redacted] ***Revdex.comEast 9th Street Suite 200Cleveland, Ohio 44115-1299Case ID: [redacted] Dear [redacted] ***s:I am writing in response to your letter dated May 28, 2015, regarding the member’s Market Classic Gold policyWhen members have an Exchange policy all enrollment information and changes is received from the MarketplaceWhen Medical Mutual receives a Change in Circumstances from the Marketplace an explanation as to what has changed is not providedBased on the information received, the member’s account is adjusted accordinglyThe member would need to contact the Marketplace for an explanation as to what changed.On 4/21/15, Medical Mutual responded to the member’s email regarding the increase in premiumsThe member was advised that his monthly premium was $581.78, $1,was due, and if the monthly premium is incorrect he would need to contact the Marketplace On 4/24/15, Medical Mutual received a letter from the member regarding his premiums and requesting a policy cancellationA response was issued to the member on 5/7/As previously stated in our response to the Revdex.com on 5/20/15, the member had a day grace period to pay premiums in fullThe member’s grace period started on 4/1/and ended on 5/1/15.On 5/7/15, Medical Mutual canceled the policy 3/31/15, since the grace period had ended, the premiums were not paid in full and we had received the member’s request to cancelOn 5/8/15, the Certificate of Creditable Coverage was issued to the member Attached is the letter from the member and Medical Mutual’s responseIf you have any questions regarding this issue, please don’t hesitate to contact me Sincerely, [redacted] Sr Appeals SpecialistMember Appeals departmentFax
Please see the attached response and related documentsSincerely, [redacted]
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 Regards, [redacted] ***