WPS Health Solutions

This letter is in response to your letter dated August 17, 2015, concerning the complainant named above.As indicated in our correspondence with you dated August 14, August and September 9,2015, the complainant had coverage under a Health Benefit Plan that was self-funded by Mid-StateTechnical College for its employeeshis means that Mid-State Technical College paid for all covered medical expenses under the Health Benefit Plan ("PIEln")The Plan was administered byWPS Administrative Services, a division of Wisconsin Physicians Service Insurance Corporation ('WPSU), based on an Administrative Services Agreement ("ASO") between Mid-State TechnicalCollege and WPS.The ASO agreement and the Plan terminated on' December 31, As part of the terms of the ASO agreement WPS continued to process claims for the following six months for dates of serviceincurred during the effective dates of the Plan and the ASO agreementWPS processed claims until June 30, WPS Is no longer reviewing or processing claims for Mid-State TechnicalCollege for its covered employees.We regret that our reply could not be more favorable.Sincerely, [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.As I explained before, I do not agree with the response from the WPS I was trying to resolve with the WPS since the very beginning Since the very beginning, the WPS was blaming the hospital for not writing the code for annual routine examThe WPS was the one who delayed everything and never admitted its mistakeWhy should I be responsible for my claim mishandling and delaying? It is now proved from my submitted documentation that it is a WPS mistakeEither WPS should pay this claim or the WPS should contact Mid-State Technical College to pay me this claimAs far as I am concerned, it is WPS responsibility to arrange payment of this claim.Thanks Regards, [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.As I explained before, I do not agree with the response from the WPS. I was trying to resolve with the WPS since the very beginning. Since the very beginning, the WPS was blaming the hospital for not writing the code for annual routine exam. The WPS was the one who delayed everything and never admitted its mistakeWhy should I be responsible for my claim mishandling and delaying? It is now proved from my submitted documentation that it is a WPS mistakeEither WPS should pay this claim or the WPS should contact Mid-State Technical College to pay me this claimAs far as I am concerned, it is WPS responsibility to arrange payment of this claim.Thanks
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
The insurance company always told me that it is not paying these charges because the diagnosis code is not right. The hospital always told me that the hospital sent the correct code to the insurance company. Finally I filed an appeal to the insurance companyThe appeal reply is attached ('Appeal Reply Page 1'). It clearly states that the insurance company is not paying these charges because the code is not for the annual routine exam and the hospital has not sent claim with the corrected code.Finally after a lot of frustration, I requested Attorney General Office to resolve this problemThe reply from the Sacred Heart Hospital is attached ('Info from Sacred Heart Hospital'. In this reply, the insurance company admits that the code is right but now the insurance company says that it is not paying these charges because this service is not covered under annual routine exam. The reply from the insurance company to the Revdex.com states entirely different third reason for not paying these charges. I am now retired from my employment and I want WPS to resolve this problemI am really frustrated with WPS for handling this issue
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
The insurance company always told me that it is not paying these charges because the diagnosis code is not right. The hospital always told me that the hospital sent the correct code to the insurance company. Finally I filed an appeal to the insurance companyThe appeal reply is attached ('Appeal Reply Page 1'). It clearly states that the insurance company is not paying these charges because the code is not for the annual routine exam and the hospital has not sent claim with the corrected code.Finally after a lot of frustration, I requested Attorney General Office to resolve this problemThe reply from the Sacred Heart Hospital is attached ('Info from Sacred Heart Hospital'. In this reply, the insurance company admits that the code is right but now the insurance company says that it is not paying these charges because this service is not covered under annual routine exam. The reply from the insurance company to the Revdex.com states entirely different third reason for not paying these charges. I am now retired from my employment and I want WPS to resolve this problemI am really frustrated with WPS for handling this issue
Regards,
*** ***

This letter is in response to your letter dated August 17, 2015, concerning the complainant named? above.As indicated in our correspondence with you dated August 14, August and September 9,2015,? the complainant had coverage under a Health Benefit Plan that was self-funded by Mid-StateTechnical College for its employeeshis means that Mid-State Technical College paid for all? covered medical expenses under the Health Benefit Plan ("PIEln")The Plan was administered byWPS Administrative Services, a division of Wisconsin Physicians Service Insurance Corporation? ('WPSU), based on an Administrative Services Agreement ("ASO") between Mid-State TechnicalCollege and WPS.The ASO agreement and the Plan terminated on' December 31, As part of the terms of the? ASO agreement WPS continued to process claims for the following six months for dates of serviceincurred during the effective dates of the Plan and the ASO agreementWPS processed claims? until June 30, WPS Is no longer reviewing or processing claims for Mid-State TechnicalCollege for its covered employees.We regret that our reply could not be more favorable.Sincerely,*** ***

This letter is in response to your letter dated August 17, 2015, concerning the complainant named above.As indicated in our correspondence with you dated August 14, August 27 and September 9,2015, the complainant had coverage under a Health Benefit Plan that was self-funded by Mid-StateTechnical College for its employees. 1 his means that Mid-State Technical College paid for all covered medical expenses under the Health Benefit Plan ("PIEln"). The Plan was administered byWPS Administrative Services, a division of Wisconsin Physicians Service Insurance Corporation ('WPSU), based on an Administrative Services Agreement ("ASO") between Mid-State TechnicalCollege and WPS.The ASO agreement and the Plan terminated on' December 31, 2014. As part of the terms of the ASO agreement WPS continued to process claims for the following six months for dates of serviceincurred during the effective dates of the Plan and the ASO agreement. WPS processed claims until June 30, 2015. WPS Is no longer reviewing or processing claims for Mid-State TechnicalCollege for its covered employees.We regret that our reply could not be more favorable.Sincerely,[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.As I explained before, I do not agree with the response from the WPS.  I was trying to resolve with the WPS since the very beginning.  Since the very beginning, the WPS was blaming the hospital for not writing the code for annual routine exam. The WPS was the one who delayed everything and never admitted its mistake. Why should I be responsible for my claim mishandling and delaying? It is now proved from my submitted documentation that it is a WPS mistake. Either WPS should pay this claim or the WPS should contact Mid-State Technical College to pay me this claim. As far as I am concerned, it is WPS responsibility to arrange payment of this claim.Thanks.
Regards,
[redacted]

I am writing in response to your letter, dated August 12, 2015, concerning the processing of charges for services provided to Mr. [redacted] on November 12, 2014.At the time of the claim in subject, the patient had coverage under a Health Benefit Plan that was self-insured/funded by Mid-State...

Technial College for its employees. Within a self-insured plan,the employer pays for all medical expenses that are covered under the Health Benefit Plan ("Plan") The Plan was administered by WPS Administrative Services, a division of Wisconsin PhysiciansService Insurance Corporation ("UWPS"), based on an Administrative Services Agreement ("ASO·) between Mid-State Technical College and WPS.On December 31,2014, the Plan and the ASO agreement between Mid-State Technical College and WPS terminated. As part of the ASO agreement WPS continued to process claims for thefollowing six months for dates of service incurred during the effective dates of the Plan and the ASOagreement. WPS processed claims until June 30, 2015. Under the ASO agreement, WPS processed claims and appeals for six consecutive months following the termination of the agreerrment. The exhaustion date for that portion of the ASOagreement was December 31, 2014, with an extension agreement that exhausted on June 30, 2015.Since all medical expenses covered under the Plan were paid for by Mid-State Technical College, and the Plan has terminated its ASO agreement and terminated the subsequent agreement withWPS, we will not make any adjustments to the claims regardless of the dates of service.The patient may submit the claim to the new claims administrator for consideration under the Plan.Sincerely,[redacted]