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Via Benefits Reviews (143)

We have reached out to the department responsible for processing reimbursement requests. We will follow up with the participant directly to provide resolution

Complaint: ***
I am rejecting this response because: You can not believe or trust these peopleThey are discriminating against me because I am ill and downThey now want mybank statements, Credit card statements, cancelled checks, which was never part of the initial filing requirementWe are talking about $and $and II an certain that no matter what I file it will never be enough because they have already spent MY MONEY and will never reimburse me in this life timeFrom here I will go to theCounty, the Union, Retirees Association and to the Press and Media to expose this GroupNow I'm pissed !!!
Gary J***

We recognize the customer’s frustration at the length of time it has taken to get a resolution to this matter and do apologize that this has taken so long, but we need the customer to submit the claim forms in order to proceed with a resolutionOur understanding is that the customer was given instructions on what was needed in order to fill out a claim form for reimbursementIf there are any other challenges or concerns in this process, we will be happy to assist the customer to see that they are resolved as well
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me

Complaint: ***
I am rejecting this response because:
Alfred D*** This whole charade has been caused by incompetence on OnExchanges part. When I followed their format to receive reimbursement from my health account it was rejected. Whomever reviewed my reimbursement form claim mistakenly viewed my wife's reimbursements for the months of June and July. I am the retired General Dynamics employee and my wife is my dependent, and we have identical health care, Harvard Pilgrim and drug coverage with Humana.What, weeks age should have been a simple phone call and investigation has now turned into an ordeal for reimbursement, now at approx$430., and all because of the stoic rigidity of OnExchange and PayFlex.Witness the response I have received after many calls and emails. I have complied with their request for filing their reimbursement form and had it rejected, and all because they didn't review their own data on my wife's acctand mine.We have these accts since April without a hitch, till now and the mule is certainly balking.I had mistakenly thought that when I had contacted Deanee M*** @ PayFlex this issue would have been resolved, but it drags on.The change that took place was that I have a Health Acct from two companies this year, GE and GD. Payflex obviously does not have a software provision to acctfor retirees receiving Health care accounts and would rather put the individual through the rigorsof a paper documentation system - which in my case is also deficient

Complaint: ***
I am rejecting this response because:I paid cash for my copaysWhat do you want ?
Gary J***

Complaint: ***
I am rejecting this response because: While I am pleased with the prompt response, I will not be satisfied until I have
the total amount of the past checks from October,to the present in hand and the assurance in the form of monthly forthcoming checks
*** ***

OneExchange spoke to Mr*** regarding his planThe representative explained that EmblemHealth was created in through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP)It was explained that EmblemHealth is different from HIPThe
representative offered to contact EmblemHealth to help him find a specialist in network however he had already found one

Complaint: ***
I am rejecting this response because: Although we have made some progress we still have a lot to do to catch up If the job of OneExchange at Towers Watson is to support retirees, my experience is you make a poot attempt at doing so I would like to know how many retiree members die from stroke while waiting on the phone And I would like to know what value Tower Watson earns from holding HRA funds
*** ***

On August 3, 2015, a representative from OneExchange
contacted MrJ*** to discuss his claims.
In order for his claims to be paid, we needed additional information. Our representative told him specifically what
he needed to submit (documents). We
explained why we needed the detailed documentation. Our representative also told MrJ*** we
can get his claim paid this week if he can provide the documentation that was
discussedMrJ*** feels this is an inconvenience and told our
representative he did not want to send us anything else.
We are sorry that MrJ***
feels we are trying to keep his funds.
That is not at all the case. We
feel we have done everything (and will continue to) to assist MrJ***

We will contact the customer within 1-business days to review the different requirements between our departments and we will update their file with their POA information. We believe this will resolve the issue

This issue has been escalated to a specialized team. Members of this team have been attempting to reach the participant and have left messages. We will continue to reach out to the participant directly to assist

This issue has been resolved We spoke with the participant on 5/and advised of the resolution

Complaint: ***
I am rejecting this response because:Even in this response it is stated that I was only covered until when in truth I was covered thru 2017. The answer I keep getting from Domtar Indis that One
Exchange is doing the denial even though they have never offered an insurance policy to me.Thank you for trying to help and hope you realize the problem that I am having dealing with this companyIf that is their final answer the only recourse that I know of is the Federal insurance commin Atlanta, Gaor small claims court in Sullivan County Tennessee
*** ***

We discussed the enrollment options available to Mrs
*** on 1/13/17. We assisted Mrs
*** in speaking with the insurance provider and her options with them
were discussed. If we can be of further
assistance we are happy to help
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meI want to thank yougreatly for your helpMy reimbursement has taken eight months to receive when it should have taken weeks, so I know that your help was invaluable
Gail D***
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meThis was corrected because I had to complain to and the Insurance CommissionIf I did not take the actions, I would still have an issue because they refused to correct the problem
*** ***

Via Benefits Insurance Services reached out and spoke to the participant on 4/2/2018. The issue has been resolved and the details of the complaints were discussed. We apologize for any inconvenience

We assisted the participants with requesting claim forms on January 3rd. We will reach out to the participants directly to assist with any claims questions and/or concerns

Complaint: ***
I am rejecting this response because: Not resolved! I have been at nearly this same position twice before with no positive outcome and similar situation on other occasions but no solutionRecently I filed a claim for several months in and got a letter back saying that one item of information was missing and that I should resend the claim There was no indication of what the missing item was! Your associate was only days late with promised call as he was “under the weather” or something; I have been told that I only have days to file claims for a previous year and other statements that contradict that.statement Yes, your people seem to blame Blue Shield for sending wrong info or none at all On my last call to your associate on January he connected us with Anika H*** at Blue Shield and she promised to send info via email by end of day She sent info late the next day but the info is a little questionable, looks like a typo; your associate seemed to think you could sort it out We will see! We are three years behind on claims for Blue shield insurance and this will not be resolved with words alone
*** ***

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