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Wisconsin

This Business is not BBB accredited

SASid, Inc.

Additional Locations

Phone: (608) 756-2290 Fax: (253) 595-6901 View Additional Phone Numbers 462 Midland Rd Ste 100, Janesville, WI 53546 View Additional Email Addresses http://www.insurancetpa.com View Additional Web Addresses

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Description

This company designs, markets, sells and administrates health and dental products.

BBB Accreditation

This business is not BBB accredited.

Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation.

To be accredited by BBB, a business must apply for accreditation and BBB must determine that the business meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses must pay a fee for accreditation review/monitoring and for support of BBB services to the public.

Reason for Rating

BBB rating is based on 16 factors. Get the details about the factors considered.

Factors that lowered the rating for SASid, Inc. include:

  • 20 complaints filed against business

Factors that raised the rating for SASid, Inc. include:

  • Length of time business has been operating.
  • Response to 20 complaint(s) filed against business.
  • Resolution of complaint(s) filed against business.
  • BBB has sufficient background information on this business.


Customer Complaints Summary Read complaint details

20 complaints closed with BBB in last 3 years | 2 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 6
Billing/Collection Issues 5
Delivery Issues 0
Guarantee/Warranty Issues 0
Problems with Product/Service 9
Total Closed Complaints 20

Customer Reviews Summary Read customer reviews

5 Customer Reviews on SASid, Inc.
Customer Experience Total Customer Reviews
Positive Experience 1
Neutral Experience 0
Negative Experience 4
Total Customer Reviews 5

Additional Information

top
BBB file opened: October 16, 2002 Business started: 11/10/1999 in WI Business started locally: 11/10/1999 Business incorporated: 11/10/1999 in WI
Licensing, Bonding or Registration

This business is in an industry that may require professional licensing, bonding or registration. BBB encourages you to check with the appropriate agency to be certain any requirements are currently being met.

These agencies may include:

Commissioner of Insurance
125 South Webster Street, Madison WI 53703
http://oci.wi.gov/oci_home.htm
Phone Number: 6082663585 8002368517
Fax Number: (608) 266-9935

Wisconsin State Office of the Commissioner of Insurance
P.O. Box 7873, Madison WI 53707-7873
http://oci.wi.gov/oci_home.htm
Phone Number: 608-266-3585 state wide 800-236-8517
Fax Number: 608-266-9935 for general office

Type of Entity

Corporation

Business Management
Ms. Sharon A. Abney III, Operations Manager Mr. Shannon Kennedy, President Mr. D. Shawn Kennedy, Vice President
Contact Information
Principal: Ms. Sharon A. Abney III, Operations Manager
Principal: Mr. Shannon Kennedy, President
Business Category

Insurance Claim Processing Services Insurance Services Insurance - Employee Benefits Insurance - Accident & Health Insurance - Health Insurance - Life Insurance - Dental All Other Insurance Related Activities (NAICS: 524298)

Products & Services

SASid, Inc. sells the following brand(s): Core Health Insurance

SASid, Inc. offers the following product(s): Dental, Limited Medical Indemnity, Major Medical

Method(s) of Payment
Visa, MC, EFT, Check
Alternate Business Names
InsuranceTPA.com SAS Insurance Technology
Industry Tips
Discount Medical Plans

Additional Locations

  • THIS LOCATION IS NOT BBB ACCREDITED

    462 Midland Rd Ste 100

    Janesville, WI 53546 (608) 756-2290 (608) 314-2108 (855) 377-9700

  • THIS LOCATION IS NOT BBB ACCREDITED

    PO Box 998

    Janesville, WI 53547

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Professional AffiliationsX
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Types of Complaints Handled by BBB

BBB handles the following types of complaints between businesses and their customers so long as they are not, or have not been, litigated:

  • Advertising or Sales
  • Billing or Collection
  • Problems with Products or Services
  • Delivery
  • Guarantee or Warranty

We do not handle workplace disputes, discrimination claims or claims about the quality of health or legal services.

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BBB Complaint Process

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Additional Phone Numbers

  • (608) 314-2108(Phone)
  • (855) 377-9700(Phone)
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Additional Web Addresses

  • http://secure.sas-it.com/beta/customers/coreplus/launch.aspx?refnumber=000000051-090-001&cid=0&roi
  • http://www.sasid.com
  • www.asentrahealth.com
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Additional Email Addresses

  • - Customer Service
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Complaint Detail(s)

11/25/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I believe it was 10-17-2014 this company i am writing to you about withdrew $35.90 out of my checking. I immediately called them and told them you took this money out of my account without my say so! I think it was the next day i noticed they credited my account with $29.95. I called them on 10-20-2014 and complained, saying that they still owe me $5.95. They told me it was for some application fee which i did not fill out! If i did not fill any application out, why would they give me back $29.95?

Desired Settlement: $5.95 deposited in my checking account or send me a check for the amount.

Business Response:

Dear ***** *****,

Congratulations for enrolling in the Asentra Health Instant MD Plan. Your Member ID number is**********. You now have 24/7/365 access to Board Certified primary care doctors, pediatricians and registered nurses by secure internet connection on your smart phone, computer, tablet, phone or email.

You and your family have unlimited consultations with doctors, pediatricians and registered nurses for only $49.40* per month as a Preferred member. That is a savings of over 50% off our regular rate. Asentra Health works along with your primary health insurance to save you hundreds of dollars a year in medical costs. Now you can sleep easy with our services at your fingertips.


Description: MD Live
Included in your enrollment:

  • Unlimited doctor consultations via MD LIVE with no co-pay or deductible
  • Unlimited access to Ask Mayo Clinic registered nurse line
  • Online Ask Mayo Clinic self diagnostic tool
  • One million dollar medical identity theft insurance policy
  • Total medical identity restoration program by AEGIS Identity Group
  • A savings up to 65% at the pharmacy with your WellDyne well card
  • Savings at 45,000 participating medical professionals located in your local communities
  • Concierge medical program where we schedule appointments for you
  • Medical billing advocate service that will review any of your medical bills for errors and find you savings
  • $100 Reward Certificate from Name My Reward, yours to keep even if you cancel

 







Video Consultation

Phone Consultation

Secure Email Advice

See a Doctor using your computer or tablet over the internet, via your Smartphone computer or tablet.

No Webcam? No problem! You can call from your regular phone

Ask questions and get advice from our secure email system

 


 

How to Access the Instant MD Program


Step 1: Visit********************and set up your online account (required).

Step 2: Click on "Log In"

Step 3: Enter your email address (************************) and password. Enter the following for your password:

  • First three letters of your last name. The first letter onlymustbe capitalized. The rest is lower case.
  • Your 5 digit zip code.
  • %

Example - **** ***** in area code ****** ****** password will be *********

Step 4: Once logged in, you will have access to all your Benefits including MD Live for doctor consultations, Ask Mayo Clinic nurse line, WellDyne** prescription discount program and AEGIS Identity Group for identity restoration.




Whether you are at home, in the office, traveling or simply want the most convenient way to reach a doctor or nurse in your state. Instant MD is easy to use and available on your schedule anytime, anywhere. Our service is secure, confidential and compliant with all medical privacy regulations.

IMPORTANT INFORMATION:You recently selected Asentra Health’s Instant MD to be your remote health provider. As an active enrollee, you have been charged a $5.95 enrollment fee and a $29.95 prorated network access fee. After your 7 day risk free trial expires, your service will automatically continue and your first monthly payment of $49.40*, a savings of approximately 50%, will be charged to the billing information that you provided us.

If you have any questions or wish to change your plan, please call customer care at 1-808-247-CARE. This service is NOT insurance, and there is NO additional charge to members for consultations. Instant MD…Fast, Affordable Healthcare and Peace of Mind for you and your family.

To get started visit********************
and make your appointment today! If you have any customer service questions or changes to your billing information, please call our Customer Service team at ************** or email**********************************

Sincerely,

The Team from Asentra Health PPN

 



This is not insurance and does not replace your primary care physician. It does not replace COBRA or any other medical insurance program nor is it a Part D prescription drug plan. It is a discount program.

This plan is ongoing and payments will continue to post until we receive a signed notification of your request to cancel. To cancel, the member must send us a signed notification no less than 5 days prior to the established billing date. This will ensure the discontinuation of future charges to your account. Any notification after that will lead to another month of coverage.


Asentra Health makes no warranty as to the content of any treatment response. You and your physician are solely responsible for all information and/or communication sent during a consultation. All services are HIPPA compliant

Asentra’s physicians do not prescribe DEA-controlled medications or lifestyle drugs. If you have an emergency medical condition, please dial 911.

Consumer Response:

Better Business Bureau:

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.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

***** *****

I do not accept this response from the company, soley because i did not enroll in this BS! I accepted a $100.00 gift card for 5.95 i believe. Which i have received from the company. Also, i cancelled my "so called" membership right away. At the time i sent them the money for the gift card, i told them specifically, i did not want this crap about getting ahold of Dr's or nurses anytime i wanted to ask questions! Besides, i have my own private insurance with Blue Cross Blue Shield of Minnesota! Which i am perfectly satisfied with. Therefore, this crap about me signing or filling out a membership agreement is just a ploy for them to automatically take out funds from my checking account every month! If i see at any time funds from my account withdrawn from this company thy will be in DEEP DOO DOO!!!! Besides i have allready cancelled this so called membership right away at the beginning! As soon as i seen funds taken out from my account!!

 

 

Business Response:

Member: ***** *****

Certificate #: **********

Effective Date: 10/16/14

Termination Date: 10/16/14

Plan Type: Asentra Health Instant MD

File#:  ********

 

Dear Better Business Bureau,

 

This is the second correspondence is in regards to the complaint submitted to InsuranceTPA.com on complaint ID# ********. InsuranceTPA.com is the Third Party Administrator for Asentra Health Instant MD.

 

 We appreciate the opportunity to respond a second time to this inquiry. This response is on behalf of InsuranceTPA.com and Asentra Health Instant MD.

 

The complaint indicates the following:

Mr. ***** does not agree to the response of the initial complaint regarding his Asentra Health Instant MD plan.

Response to the customer complaint:

The recorded verification was provided at the time of this response indicating his approval of enrollment.

 

We are not disputing Mr. ******* request for a refund of the $5.95 application fee as stated in the original response. The application fee of $5.95 was refunded on 11/07/14 at 9:22 am CST.

 

 

 

Thank you.

InsuranceTPA.com, Inc.

PO Box 998

Janesville, WI 53547


Dear Better Business Bureau,

 

This correspondence is in regards to the complaint submitted to InsuranceTPA.com. InsuranceTPA.com is the Third Party Administrator for Asentra Health Instant MD.

 

 We appreciate the opportunity to respond to this inquiry. This response is on behalf of InsuranceTPA.com and Asentra Health Instant MD.

 

The complaint indicates the following:

Mr. ***** states in this complaint that money was withdrawn from his account for Asentra Health Instant MD without his approval.  His account was then credited the first month premium in the amount of $29.95 but the “application fee” of $5.95 was not refunded and this amount is still owed to him as he did not fill out an “application”.

 

Response to the customer complaint:

Asentra Health Instant MD is a non-insurance product that is sold telephonically to members.

There is no paper application process.  The enrollment information is taken over the phone and then preceded by a recorded enrollment verification that identifies the components of the non-insurance program along with current and reoccurring monthly costs.  In the recorded verification it indicates that the $5.95 is a processing fee for the enrollment in the Asentra Health Instant MD plan.

 

The recorded enrollment verification with Mr *****’s approval is enclosed with this response. It does state Mr. ***** clearly agrees to the costs associated with this enrollment.

 

With that said, Mr. ***** has been refunded the $5.95 processing fee and will be deposited into his financial institution within the next 5-7 business days.

 

Enclosed:

·         Enrollment Verification

·         ID Card

·         Welcome Letter

 

Thank you.

InsuranceTPA.com, Inc.

PO Box 998

Janesville, WI 53547


2/21/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I believe this company is a scam! We have paid a total of $879 and some odd cents to this company and I do not believe that it is real insurance. I went through this website to select insurance with AUIC.org and it was so easy to sign up. However, it is a much different story when you need help or are wanting to cancel. On their site, it says if you want to cancel they must receive written notice 5 days before the date your payment is to be made; however, it does not provide a link to the form or an email address to send or a number that will allow you to speak to an actual person. Other than the initial phone call I made to sign up, I only talked to a person one time and that was after leaving a couple of hysterical, angry messages because I am pretty sure I was paying for something I wasn't actually getting! Also, in one of my moments of panic, I sent a reply email to the only email address I could find which was one in my old mailbox folder from when I signed up and it told me it was not a valid email address. I thought the card I received was a little shady when we first got it because it had no BIN# or anything. Just an ID and a Group# but I didn't really start getting worried until January of 2014. I originally took the plan out on November 19, 2013 because I was anticipating losing insurance with my employer because my husband and I had both recently swapped jobs and would have to wait 90 days to get new employer insurance. I mainly got this plan to cover my then 8 month old daughter and I do not believe it is valid insurance. I took the card to my daughters pediatrician and she didn't even try it because the card barely had any information on it. She ran the visit on my old insurance which turns out had a 30 days grace period that I really wish I would have known about! Every time you try to call these people you get an answering service that ultimately leads you to an answering machine or you get a message saying that they are dealing with large call volumes and to leave a message. Now, on January 25, 2014 my daughter is not feeling well and I am hesitant to take her to her doctor because I don't believe the visit will be paid for. I tried to log in to my account today to see if her doctor was listed under "covered doctors" and surprise surprise, I got a "service error, this page is unavailable" for both the AUIC.org member login and the SASid.com login screen. However, every other tab works, how convenient. I want a refund of the total paid $879 because I do not believe this is a legitimate business! I was trying to obtain insurance with COBRA and I feel that I was redirected to this page by accident or something because I definitely do not think it functions like a real business should. It's shady people and shady "coincidences". I would like to point out that I finally did talk to someone a few days ago and she did send me the request to cancel my insurance after telling me that it was too late to stop the payment for that month (which is stupid because they are paid up a month in advance, so now I am stuck with fake insurance for another month) so I filled it out and I am so glad I asked for the fax number and the email because I tried sending the fax 3 times using the area code and trying it with the "1" in front another time and it would never send. It always said "busy or no response". It's just so strange that they are always available to take your bank information but not to answer your calls or help you with cancellation. I want my money back! We cannot afford to be out almost $900 for something that isn't even functional.

Desired Settlement: I would like a refund of $879 but would settle for $850. I DO NOT believe this company is legitimate or offers real insurance and I want to be reimbursed what I feel was stolen from me under false pretenses.

Consumer Response:

Better Business Bureau:

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.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

******* ********

 

I understand that all of the numbers and contact info is on my card. Obviously, that would be the first place I looked. However, at least 2 of those numbers always took me to the same recording and I was never able to talk to a person after my initial sign up except when I contacted someone from the Core Health Insurance website. It is a little confusing on knowing who to call when you have four different websites to choose from: insurancetpa.com, auic.org, sasid.org, corehealthinsurance.com. Also, I said I tried to log in to 2 different websites as a member and both servers were down; a little strange. When I finally got in touch with someone from core health insurance I asked for the fax number and the email to send my cancellation to and it was a good thing because I tried the fax number 3 times and there was always a "busy/no response" result. Eventually I ended up emailing it. And I've always had both of my cards with me. Anyway, I took my child to the doctor on 28th of January so we will see how it goes from there. As long as they pay for her visit I will drop the complaint but I still say that this company is too difficult to get in touch with when you have questions for them. I call insurances companies almost every other day for my job and it is never this hard to get a call back.  

Business Response:

This correspondence is in regards to the complaint submitted to InsuranceTPA.com.

InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, **** * ****** for the referenced plan.  We appreciate the opportunity to respond to your inquiry. This response is on behalf of InsuranceTPA.com and United States Fire Insurance Company.

2nd Response –February 10, 2014

·         The ID card has two toll free numbers listed: (there are not more than 2 phone numbers)

                                        Contact a participating provider **************

                                        InsuranceTPA.com **************

·         The ID card has one website listed:

                                ********************

·         The fax number is an e-fax number and is not a telephone type fax set up.  The fax number is listed on the Welcome Letter which is attached to the ID cards. This fax number does not have the opportunity for “busy/no response”.

·         The claim for the date of service of 01/28/14 for **** ******** was processed on February 10, 2014 and a benefit of $65.00 was paid to the provider of service.  A PPO discount in the amount of $22.00 was applied.  The total charge of $125 leaves a member responsibility of $38.00 after discount and applied benefit.

Thank you,

InsuranceTPA.com

----------------------------------------------------------------------------------------------------------------------------------------------

The complaint received indicates the following

  • On 11/19/2013 10:38:44 AM, ***** ******** entered the following (Invisible to Subject):
    Called in looking for options.  Has prex.  Discussed the benefits, waiting periods, ppo.  Emailed quotes.
  • On 11/19/2013 10:41:22 AM, ***** ******** entered the following (Invisible to Subject):
    Mallory will complete the application online thru the link.  She is looking to be covered for 90 days.  She is mainly concerned with the wellness benefit.  I also suggested STM.
  • On 11/19/2013 11:05:03 AM system changed Auto Pay from No to Yes.
  • On 11/19/2013 11:43:44 AM **** ******** changed Selling Partner from 51 to 5664.
  • On 11/19/2013 12:01:00 PM, ***** ******** entered the following (Invisible to Subject):
    Quote was linked to me, app link was showing ask.  I had **** look into it.
  • On 11/20/2013 2:38:09 PM **** ******* changed Internal Status from 0 to 2.
  • On 11/20/2013 2:38:09 PM, **** ******* entered the following (Visible to Subject):
    Fulfillment Kit Mailed
  • On 1/20/2014 3:21:37 PM, **** ******** entered the following (Invisible to Subject):
    Member left vm with sales earlier today to cxl.  I called her and she was upset that payment was already deducted for February benefit period.  I explained that we wouldn't be able to refund that payment and her benefits are in effect until 3/1/14.  I explained cxl proc and confirmed email.
  • On 1/20/2014 3:22:59 PM system changed Status from Approved to Cancellation Requested.
  • On 1/20/2014 3:23:00 PM, **** ******** entered the following (Visible to Subject):

Policy ID/Certificate Number: *********

Next Scheduled Draft/ Premium Due Date: 2/19/2014

Effective Date: 12/2/2013

Dear ******* ********,

You are receiving this letter because you have requested to terminate your AUIC Core Health Insurance benefits. We are confident that this limited indemnity plan is the best plan available of its kind. We care about you and your health and it is our job to make sure that your have health insurance that will fit your needs.  If you have not obtained other insurance or have questions

  • If you are sure that this limited indemnity plan is not going to give you the benefits that you need or can afford, you can terminate this plan at the end of the currently paid benefit period.  You are not locked into a commitment with this plan and are making your insurance premium payments on a month to month basis. In order to avoid future payments being drafted from your account and the continuation of your benefits we require a cancellation request with a hand written signature at least five days prior to your next premium due date.  

If you are requesting to cancel and are within your 30 day right to review period, your signed cancellation request is required within 30 days of the effective date of your insurance plan. If the required request is received by our office within the first 30 days the insurance is in effect, a refund of your premium(s) paid minus enrollment fees will be issued to the account from which it was drafted. Please note that if a claim has been submitted to us and benefits have been paid you may not be eligible for a refund.

Please check the appropriate statement, provide signature, and return to InsuranceTPA. 

____ I have thought about it and decided to keep my insurance active. Please contact me. 

____ I would like information about changing my plan to lower my monthly premium cost. Please contact me. 

____ Thank you, but I still wish to discontinue my benefits.

Primary Insured signature: ____________________________________________Date _____________________

Reason for Cancellation:______________________________________________________________________

When we receive your signed request to cancel it will be processed in the order in which it was received and within 5 business days of receipt.  We will send you a cancellation confirmation email and a formal letter in the mail. Please keep DATED proof of your sent, signed cancellation request until you have received cancellation confirmation from our office. It is the insured party's responsibility to contact our office if cancellation confirmation is not received.  No refunds are issued after premium payments have been drafted and benefits have taken effect for the next benefit period.

Please Print cancellation request with signature and send to:

Email:  ***************       
         -or-

Fax:  ************
         -or-
Mailing Address: ******************  ** *** ***  *********** **  *****

Best Regards,
InsuranceTPA/SASid

  • On 1/22/2014 3:41:06 PM ******** ****** changed Status from Cancellation Requested to Cancelled - Client being covered on employer plan.
  • On 1/22/2014 3:41:06 PM ******** ****** changed Auto Pay from On to Off.
  • On 1/22/2014 3:41:06 PM, ******** ****** entered the following (Invisible to Subject):
    Date RCVD cancellation signature:1-22-14

    Reason:other coverage through employer
  • On 1/22/2014 3:41:58 PM, ******** ****** entered the following (Visible to Subject):

Policy/Certificate *********

Dear ******* ********,

Please be advised that your Core Health Insurance Plan ********* underwritten by United States Fire Insurance Company has or will be terminated as of 3/1/2014. No further payments will be required and if any refund is due to you it will be returned to your current payment method on file.

Please contact our Customer Service Department at ************** or email us at *************** to find out if your plan has a reinstatement provision or if we can be of further assistance. If you wish to reapply at a later date, please contact your licensed agent below.

Shannon Kennedy / PA
************ **************

Additionally, any willful misuse of previously issued insurance information (i.e. Policy Application, Certificate, ID Cards, etc.) is considered fraud. Any claims submitted with a date of service after the termination date will not be payable. United States Fire Insurance Company and InsuranceTPA.com are committed to providing quality, affordable plans of insurance backed by the highest level of service.

Sincerely,

InsuranceTPA.com
Billing & Customer Service
************** ***************

4/21/2013 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: I signed up for an insurance policy with them in late July 2012. They took $143.95 out of my bank account on 7/26/12. That was authorized. Then I found out the insurance was not going to cover the things I was told it would. In August I called to cancel. I was told to FAX my request to a person and number I no longer have a record of. I was also told it would be too late to stop the August payment. I thought it was handled, but on 9/26/12 another $93.95 was taken out of my bank account. I repeated the above procedure to get them to stop. Then I went into a major depression and did not look at my bank account or balance my checkbook again until today. Today I see that this company has taken $93.95 out of my account on the 26th of each month starting 8/26/12, and their last debit from my account was 3/26/13. At this point I want ALL of my money back from these people.

Desired Settlement: $895.55 back in my checking account.

Business Response:

Thank you.

InsuranceTPA.com

###-###-####

Business Response:

 

BBB of Wisconsin                                                                                             April 2, 2013

10101 W. Greenfield Ave. Ste.125

Milwaukee, WI 53214                                                                                        

 

 

Member: ****** *****

Certificate #: *********

Effective Date: July 26, 2012

Termination Date: Active

Plan Type: Association of United Internet Consumers Core Health Physician Plan

File#:  *******

 

 

Dear Better Business Bureau,

 

This correspondence is in regards to the complaint submitted to InsuranceTPA.com.

InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. This response is on behalf of InsuranceTPA.com and United States Fire Insurance Company.

 

The complaint received indicates the following:

  • Insurance plan does not cover the things Ms. ***** was told would be covered
  • She contacted someone at InsuranceTPA.com to cancel the plan in August of 2012 and thought that the cancellation was handled at that time
  • The premium ($93.95) continued to be debited.The member “repeated” the cancellation procedure to stop premium amount again in September of 2012
  • The member went 6 months without reviewing her bank account and noticed that the premium had continued to be debited

 

Upon review of all documentation listed is the response:

  • Ms. ***** completed enrollment verification at the time the plan was purchased.This process outlines the plan benefit provisions.No claims have been received from any provider or facility and therefore nothing has been denied as a non-covered expense.
  • InsuranceTPA.com only has record of contact with Ms. ***** on 09/26/12.There is a voice recording of that conversation.There are no other voice recordings or voice mail messages from Ms. ***** which reflects no record of contact with InsuranceTPA.com other than 09/26/12.All calls are recorded and documented.See information below.In addition, we have contacted the selling agent to verify if there he was contacted separately and there is no record of any conversation with the selling agent.
  • There is only one record of contact for cancellation which is 09/26/12.The member was sent a cancellation request paper work to be signed and there is no record that the signed cancellation was received and therefore premium continued to be debited from Ms. *****’s financial institution.
  • It is unfortunate that Ms. ***** had a medical condition that prevented her from reviewing her banking information, however, InsuranceTPA.com has specific cancellation guidelines in place that are followed by any Member who wishes to cancel their plan.No record of contact by Ms. ***** was received before or after 09/26/12.

System Documentation

  • On 7/25/2012 11:23:55 AM system changed Auto Pay from No to Yes.
  • On 7/26/2012 7:29:43 AM, **** ******* entered the following (Visible to Subject):
    Fulfillment Kit Mailed
  • On 9/26/2012 10:32:44 AM system changed Status from Approved to Cancellation Requested.
  • On 9/26/2012 10:32:45 AM, ***** ******* entered the following (Visible to Subject):

Plan number: *********

Plan Type: Physician 

Primary Insured: ****** *****

Next scheduled premium draft date: 10/25/2012

Effective date of plan:  7/26/2012

 Dear ******,

 You are receiving this email because you have notified us of your request to terminate your insurance benefits with AUIC Core Health Insurance. We are confident that this limited indemnity plan is the best plan available of its kind. We do care about you and your health and it is our job to make sure that your have secured health insurance that will benefit your health needs.  If you have not obtained other insurance and have questions about this plan and the benefits it can provide for you and your family, please contact our customer service department at ###-###-####.

 If you are confident that this Limited Indemnity plan is not going to give you the benefits you need or can afford, or you have obtained other insurance coverage, you can terminate this plan.  You are not locked into a commitment with this insurance and are making your insurance premium payments on a month to month basis. In order to avoid any future payment to be drafted from your account we do require a hand written signature no later than five days before the next scheduled draft date.  

 If you are requesting to cancel your plan and are within your 10 day right to review period, your hand written request is required within ten days from the effective date requested on your application. If required information is received, a refund of your premiums paid minus enrollment fees will be issued to the account on file.

 Please check the appropriate statement, provide signature and return to our office.

 ____ I have thought about it, and have decided to keep my insurance active. Please contact me.

 ____ I would like more information about possibly downgrading my plan to lower my monthly premium cost.                       Please contact me.

 ___ Thank you, but I still wish to discontinue my benefits. I understand that by discontinuing my benefits, I forfeit the time periods already met under the Pre-Existing Condition clause.

 Primary Insured signature: __________________________________________           Date____________________

 FLM181230

Please Print,  Scan and Email request with signature to: *******************           Fax # :  ###-###-####

 Mail request to:

InsuranceTPA.com/SASid

** *** ***

********** ** *****

 Best Regards,

InsuranceTPA.com

 

When we have received your signature and request to cancel your plan, it will be processed in the order it was received and no later than 5 business days.  You will be receiving a confirmation email and a formal letter in the mail. Please keep your proof of sent request until the confirmation has been sent.   (This information was never received)

 

 

 

In closing, all documentation and recordings indicate that Ms. ***** did not follow procedure for cancellation and therefore InsuranceTPA.com continued drafting monthly premiums from her financial institution.  If Ms. ***** has dated information that reflects otherwise we will be happy to review that information to determine necessary action steps. 

  • Ms. ***** may contact our Billing department again to request cancellation of her AUIC Core Health Plan if she does not have the cancellation document that was emailed to her on 09/26/12.
  • If Ms. ***** has the paperwork that was emailed to her, she may fill out the form and fax it back to InsuranceTPA.com and we will terminate her policy immediately upon receipt.She can scan and email to the form to ******************* or fax it ###-###-####.

 

Enclosed:

  • Enrollment Verification Recording
  • Cancellation Request Recording

 

 

 

Thank you.

 

 

InsuranceTPA.com, Inc.

** *** ***

**********, ** *****

 

 

 

*InsuranceTPA.com, Inc.  Is a Third Party Administrator for United States Fire Insurance Company

InsuranceTPA.com, Inc. ** *** *** ********** ** *****

Phone: ###-###-####

Fax: ###-###-####

***********************

Any and all information will be kept in compliance with privacy statutes and be used for the sole purpose of benefits determination per the guidelines of this insurance plan.

All services are subject to plan provisions at the time services are rendered; Benefits and Eligibility are not a guarantee of payment.

4/4/2013 Advertising/Sales Issues | Read Complaint Details
X

Additional Notes

Complaint: I found this Insurance Co on line in serching for medical insurance I was contacted by a respresentative ***** **** (###-###-####)bbhe stated she had two plans that she could offer me. After speaking with her she signed me up with a plan, I specifically asked how does the plan work, she stated that because we are part of a group, like a big corporation, all I have to do is pay a monthly premium. I asked if I would be required to pay a deductible or a cost when I visited the doctor. She told me no, I was covered, all I needed to do was visit the doctor and I was covered. She also told me this WAS NOT a limited medical plan. Well, I went to the doctor, I had to have xrays, then I was sent to a specialist. I have received a bill from all three medical establishments, totalling well over $1,000! The specialist is the one who pointed out to me that the plan I have is a LIMITED MEDICAL, and is a plan that they do not except. I HAVE CALLED THEIR CUSTOMER SERVICE # ###-###-####, ext *** (****** *******) and ext *** (***** ****) and left messages. It appears that every time I call, no one is available to answer the phone, or responsible to return phone calls. To date, I have not received a return phone call from anyone at this company, however they continue to deduct a premium amount from my bank every month.

Desired Settlement: Due to the inadequate information provided at sign up, my desired income is that Insurance TPA ( AUIC.org) pay in full the existing bills that I have received and reimburse me for the premium that I have paid.

Business Response: BBB of Wisconsin                                                                                             March 19, 2013

10101 W. Greenfield Ave. Ste.125
Milwaukee, WI 53214                                                                                        

Member: ***** *******

Certificate #: *********

Effective Date: December 21, 2012

Termination Date: Active

File#:  9464418

 Dear Better Business Bureau,

This correspondence is in regards to the complaint submitted to InsuranceTPA.com.

InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC
# 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. This response is on
behalf of InsuranceTPA.com and United States Fire Insurance Company.

The complaint received indicates the following:

- Plan that was quoted was stated as NOT being a limited medical

- Services not covered under the plan ($1000)

- Insurance not accepted by Provider

- Customer Service calls not returned by the selling agent

InsuranceTPA.com Response:

- A recorded enrollment verification is performed at the time of each sale and it specifically states during the recording,
and acknowledged by Ms. *******, that the **** **** ****** plan is not a major medical plan, but it is a Limited Medical Indemnity plan.

- Services due to illness or sickness are not covered under the plan for the first 30 days from the date the plan became effective. 
This information is also stated in the recorded enrollment verification, and acknowledged by Ms. *******. 
Services performed by a Provider related to injury are covered immediately.  Based on how the claims
were submitted from all 3 Providers, the services rendered were due to illness, not injury.

- We cannot control a Provider in accepting any insurance plan. If a Provider does not accept the insurance, the
Member has the opportunity to submit a claim for reimbursement.  Our website, ******************** has a claim form and instructions on
how to submit a claim for reimbursement. They are given log-in information in their email confirmation received at the time of sale.

-The Member spoke with InsuranceTPA.com customer service team on the following dates. (Screen print provided)

-The selling agent has also been in contact with Ms. ******* to address her concerns.

In closing, all plan detail was provided at the time sale and can ben identified in the recorded enrollment
verification.  Ms. ******* also had access to her Certificate of Insurance which outlines her plan benefits,
waiting periods, limitations and exclusions accordingly.  The plan also has a 10 Day Right to Review
(DRTR)to receive the first month premium refund.  The 10 Day Right to Review is also identified
in the recorded enrollment verification enclosed.  With that, InsuranceTPA.com has taken measure
to educate the Member on the benefits of the plan design and therefore will not
be refunding the premiums paid as she is beyond the 10 DRTR.  The claims have been paid in accordance with
the plan benefits based on how they were submitted by the Provider and will not
be reprocessed to allow benefits.


Enclosed:
Recorded Enrollment Verification

Email from selling agent confirming conversation with Venia *******


Thank you.

InsuranceTPA.com,Inc.

** *** ***

**********, WI *****


Consumer Response:

Better Business Bureau:

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.

In reference to the "recording phone call" submitted, I was told if I did not agree to the compliance, I would not be able to receive the plan.  This company submits this portion of the call to justify their deception.  But they did not submit the initial call in which I was told I had to comply with the questions asked.  I have been in contact with these people and the on company  (****** *******) tells me I am covered immediately, whereas the other portion of the company tells me I'm not covered for the first 30 days. 

 

Regards,

***** *******  

 

Business Response:

 

 

BBB of Wisconsin                                                                                             March 19, 2013

10101 W. Greenfield Ave. Ste.125

Milwaukee, WI 53214                                                                                        

 

 

Member: Venia Royston

Certificate #: *********

Effective Date: December 21, 2012

Termination Date: Active

File#:  *******

 

 

Dear Better Business Bureau,

 

This correspondence is in regards to the second complaint submitted to InsuranceTPA.com.

InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. This response is on behalf of InsuranceTPA.com and United States Fire Insurance Company.

 

The second complaint received indicates the following:

  • That the member was told that if she did not agree to the compliance, then she would not be able to receive the plan
  • That the member was told that she was covered immediately the agent and had a 30 day wait by InsuranceTPA.com

 

 

InsuranceTPA.com Response:

  • Recorded enrollment verification is the last step to the purchase of any plan. Each member must complete this process to insure that they know and understand the terms of the plan prior to purchase. It is a safeguard that has been put in place to educate the member on the terms and conditions of the plan.
  • The member has immediate coverage for accident, injury and wellness visits. The 30 day wait applies to illness or sickness related services.

 

 

Both of these items are addressed in the recorded enrollment verification.

 

In closing, the Billing Department has been notified to reimburse Ms. ******* four premiums totaling $378.50 which is 4x the monthly premium of $ 93.95. The $50.00 enrollment fee is non-refundable and this is also stated in the recorded enrollment verification.  It will be refunded to her financial institution within 7-10 business days from March 26, 2013.

 

This closes this matter related to ***** *******.

 

 

 

Thank you.

 

 

InsuranceTPA.com, Inc.

** *** ***

**********, WI *****

 

 

 

*InsuranceTPA.com, Inc.  Is a Third Party Administrator for United States Fire Insurance Company

InsuranceTPA.com, Inc. ** *** *** ********** ** *****

Phone: ###-###-####

Fax: ###-###-####

claims@insurancetpa.com

Any and all information will be kept in compliance with privacy statutes and be used for the sole purpose of benefits determination per the guidelines of this insurance plan.

All services are subject to plan provisions at the time services are rendered; Benefits and Eligibility are not a guarantee of payment.

Consumer Response:

Better Business Bureau:

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.

This busness stated  "In closing, the Billing Department has been notified to reimburse Ms. ******* four premiums totaling $378.50 which is 4x the monthly premium of $ 93.95."  Again they have misstated the facts.  A refund of 93.95*4 = $375.80 not $378.50.   I have also asked that the Insurance Co. pay the bills incurred  to me due to being misinformed at sign up of this program.  When I told the representative I need to go to the doctor now, she should have explained to me of a 30 day waiting period vs the "double talk" I received and telling me if I didn't agree to the "compliance" I would be ineligible for the program.   Adequate information is vital when making decisions.  Was I given adequate information ~ certainly not!  If so, I would have never signed up for this program, thus I would not have incurred $947.22 in medical bills.

Regards,

***** *******

 

 

3/18/2013 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: AUIC refunded a cancelled insurance policy. My bank cancelled payment and AUIC refunded the $299. The bank acknowledge the double refund and sent a letter to me stating they had with drawn $299 from my credit card account because of this. AUIC says they never received the funds back from bank and are threatening collection. We do not have the withdrawn funds and do not know what the bank did with the $299 they took from are card. We received 1 refund. I sent a copy of the banks letter to them but they insist I owe them. The policy for my wife, ******* was cancelled within 10 days so a refund was in order. Now AUIC wants us to pay $299 for services we never received and cancelled.

Desired Settlement: We request that AUIC stop bothering us and seek the funds from the bank or reexamine their own accounting of what happened to the funds as we had them taken back from our account, we do not have the $299.

Business Response:

BBB of Wisconsin                                                                                             March 6, 2013

10101 W. Greenfield Ave. Ste.125

Milwaukee, WI 53214                                                                                        

 

Member: ******* *******

Certificate #: *********

Effective Date: 09/27/12

Termination Date: 09/27/12

File#:  *******

 

Dear Better Business Bureau

This correspondence is in regards to the correspondence forwarded to InsuranceTPA.com. InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. This response is on behalf of InsuranceTPA.com and United States Fire Insurance Company.

 On September 27,2012 ******* ******* purchased an *********** ** ****** ******** ********* ******* ******* ********* ****.  This plan has a 10 Day Right to Review.  If a member is dissatisfied with their plan within the first 10 days of their effective date, they may cancel and receive full premium back minus the enrollment fee.  That is the course of action that has taken place with ******* *******.

 

  • On 10/02/2012 InsuranceTPA.com was notified that the Member wished to cancel.
  • On 10/04/2012 a refund in the amount of $299.09 was credited to the Member’s account
  • On 12/26/2012 Member’s financial institution contacted InsuranceTPA.com and had initiated a “Charge Back” which means a stop pay had been performed on the original premium payment made. Of which we had already refunded to the Member on 10/04/12.
  • On 12/26/12 InsuranceTPA.com disputed the “charge back” with ***** ***** stating that we had already refunded the money and by doing a “charge back” that we were giving the money back to the member two times. We disputed the “charge back” and were denied.
  • On 01/05/13 InsuranceTPA.com disputed the charge back and was denied.
  • On 01/07/13 InsuranceTPA.com disputed the charge back and was denied.

 

Since we refunded the Member the $299.09 and the bank stopped payment in the amount of $299.09, InsuranceTPA.com is in deficit of $299.09 between the refund and the stop payment of funds made by ***** *****. As of today’s date, we have not been notified by ***** ***** that the refund amount made by InsuranceTPA.com, or a reversal of the stop payment, has been credited to our account.

 

All documentation pertinent to the disputed $299.09 is enclosed:

  • Bank statement
  • Letters to insured
  • Letter from ***** ***** regarding the “stop payment”
  • Letters to ***** ***** for Charge Back attempts
  • System documentation
In closing, thank you for allowing InsuranceTPA.com the opportunity to respond to this inquiry. We hope this additional information clarifies the outstanding questions relating to this matter. Thank you for your time and consideration.

 

 

Sincerely,

 InsuranceTPA.com, Inc.

PO Box 998

**********, WI *****

 

 

 

*InsuranceTPA.com, Inc.  Is a Third Party Administrator for United States Fire Insurance Company

InsuranceTPA.com, Inc. ** *** *** ********** WI *****

Phone: ###-###-####

Fax: ###-###-####

***********************

Any and all information will be kept in compliance with privacy statutes and be used for the sole purpose of benefits determination per the guidelines of this insurance plan.

All services are subject to plan provisions at the time services are rendered; Benefits and Eligibility are not a guarantee of payment.

Consumer Response:

Better Business Bureau:

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.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]So we do not owe this company anything; the bank does. We did not get the money as the letter stated.

Regards,

****** *******

 

 

Business Response:

BBB of Wisconsin                                                                                             March 13, 2013

10101 W. Greenfield Ave. Ste.125

Milwaukee, WI 53214                                                                                        

Member: ******* *******

Certificate #: *********

Effective Date: 09/27/12

Termination Date: 09/27/12

File#:  *******

Dear Better Business Bureau

This correspondence is in regards to the  second correspondence forwarded to InsuranceTPA.com. InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. This response is on behalf of InsuranceTPA.com and United States Fire Insurance Company.

InsuranceTPA.com has reviewed the second request for review of the status of the original complaint.

Due to the circumstances involved with the investigation of the non-returned funds, the written correspondence accordingly, and the time involved to respond to the complaint received, InsuranceTPA.com will forfeit the continued request for the deficit of funds owed to InsuranceTPA.com.

We will consider this matter closed.

Sincerely,

InsuranceTPA.com, Inc.

** *** ***

**********, WI *****

*InsuranceTPA.com, Inc.  Is a Third Party Administrator for United States Fire Insurance Company

InsuranceTPA.com, Inc. ** *** *** ********** WI *****

Phone: ###-###-####

Fax: ###-###-####

***********************

Any and all information will be kept in compliance with privacy statutes and be used for the sole purpose of benefits determination per the guidelines of this insurance plan.

All services are subject to plan provisions at the time services are rendered; Benefits and Eligibility are not a guarantee of payment.

Consumer 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.]

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID *******, and find that this resolution is satisfactory to me. 

Regards,

 

****** *******

 

 

 

2/11/2013 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: The company trying to.sell insurance services and charging my debit card without my permission.. They do not understand that it will not be accepted and police report will be filed. I refuse to accept anything from them on services etc. I have insurance already through somewhere else. They will not resolve the issue with me.

Desired Settlement: I want this company quit contacting me by phone email etc. They no right to charge me for.any services through there company that I never authorized and I am requesting a refund back from rhis company right away.

Business Response:

Please see the attached response to this filed complaint.  First attachment is a formal response and the 2nd attachment is a mp3 file of a recorded conversation.

 

Thank you.

****** *****


Re: ***** ***********
Policy #: *********

Effective date: 01/26/13

Term date: 01/26/13

ID# *******

Dear BBB of Wisconsin,


We are in receipt of a complaint filed by Ms. *********** to the Better Business Bureau of Wisconsin.

The complaint states that Ms. *********** that the insurance services is charging her debit card without her permission and that it will not be accepted and a police report will be filed.  She refuses to accept anyting from the services and that she has insurance already though somewhere else.

On January 25 Ms. *********** was in contact with an insurance agent and purchased an *********** ** ****** ******** ******** (****) **** ****** ********** plan with a reoccurring monthly premium of $93.95 and a onetime enrollment fee of $75.00.  The effective date designated by Ms. *********** was January 26, 2013.

Attached to this response is a recorded **** **** ****** plan enrollment verification.  In this recording, Ms. *********** understands and agrees to the purchase of the **** ****** plan along with the authorization to deduct the premium and enrollment fee from her
********** account ending in ****.  I have provided the enrollment verification for your records.

There were 3 attempts made to draft her account for the purchase of this insurance plan.  However, all 3 attempts were declined and no monies were deducted from her account.  See a screen shot of her billing information below.

The red “X” on the left signifies that the draft failed and no monies were withdrawn.  Ms. *********** can also confirm this information with her financial institution. 

Due to the lack of funds to purchase this account the plan is not active and Ms. *********** is not eligible for health benefits under the **** **** ****** plan.

The “Desired Settlement” reads “ I want this company to quit contacting her by phone and email.  They have no right to charge me for any services through their company that I never authorized and I am requesting a refund back from this company right away”

 As identified in this response, the Company was authorized by Ms. *********** to draft her ********** account, however, due to lack of available funds, the plan was never in effect and no monies were paid to provide a refund to Ms. ***********.

Therefore we will consider this matter closed and no resolution is required as no transaction occurred

Respectifully,

SASid, Inc.

*** ******* **** ***** ***
**********, WI *****
 

12/23/2012 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: For the past two weeks I have been attempting to contact this company to cancel an insurance policy because I have become eligible for benefits through my employer. When I called them their phone system sent me to a voice mail after a couple of rings and told me I could leave a message but I would get faster service by contacting them via e-mail. Over the past two weeks I have sent them no less than three e-mails and have yet to receive any acknowledgement from them that any contact has been made.

Desired Settlement: At this time I would like to have the remaining portion of the insurance policy that I have with them (I beleive it is dental only at this point) canceled. I would also like a refund of the premium I paid on or about November 15 refunded since I had previously contacted the customer service for the health insurance that I acquired through this company. In making that contact I believed that I had cancelled the policy that I was billed for.

Business Response:

December 12, 2012

BBB of Wisconsin

10101 W. Greenfield Ave., Ste. 125

Milwaukee, WI 53214

Fax:  ###-###-####

Email:  *****************************

 

Policyholder and Claimant:  ****** *******

Re:  ID #*******

 

Dear ******* **********,

 

Thank you for providing us the information needed to resolve and or to dispute a customer complaint sent to our business on 12/4/2012 regarding member ****** *******.

Below is a timeline of events regarding ****** *******’s cancellation:

  • 11/15/12 2:58pm:  We received a phone call from Mr. ******* in which he stated he wanted to cancel his health insurance plan *********.  This call was answered and the cancellation process was explained to him in addition to verifying his email.
  • 11/15/12 2:59pm:  Cancellation form was emailed to Mr. *******.
  • 11/15/12 4:53pm:  Signed cancellation form was returned by Mr. *******.
  • 11/15/12 4:54pm:  Status of plan ********* was changed to “Cancelled”
  • 11/15/12 4:54pm:  Cancellation Confirmation email and letter sent to Mr. *******

On 11/15/2012 4:54:31 PM, entered the following :

Policy/Certificate *********

Dear ****** *******,

Please be advised that your **** ****** ********* **** ********* underwritten by United States Fire Insurance Company has or will be terminated as of 11/16/2012. No further payments will be required and if any refund is due to you it will be returned to your current payment method on file.

Please contact our Customer Service Department at ###-###-#### or email us at *************** to find out if your plan has a reinstatement provision or if we can be of further assistance. If you wish to reapply at a later date, please contact your licensed agent below.

***** **********
###-###-####
*****************************

Additionally, any willful misuse of previously issued insurance information (i.e. Policy Application, Certificate, ID Cards, etc.) is considered fraud. Any claims submitted with a date of service after the termination date will not be payable. United States Fire Insurance Company and InsuranceTPA.com are committed to providing quality, affordable plans of insurance backed by the highest level of service.

Sincerely,

InsuranceTPA.com
Billing & Customer Service
###-###-####
***************

 

  • 11/20/12 5:00pm:  Email received from Mr. ******* asking to cancel his policy as he is being charged $9.87 to his account.  He requests an explanation of this charge.

Sparky Post reply

Nov 20

I appreciate your assistance in canceling this policy. However, there has been an additional charge to my account in the amount of $9.87. Can someone please explain the reason for this charge and how soon I should expect to have this credited back to my account?

****** *******


  • 11/21/12 8:58am:  His email was replied to, letting him know that InsuranceTPA.com was not billing him the additional $9.87.  It was recommended that he contact his agent to see if he might have signed up for something else.  The agent information was included.

On 11/21/2012 8:58:11 AM, entered the following (Visible to Subject):
******,

That charge for $9.87 isn't something that InsuranceTPA is billing you for. I would recommend contact your agent to see if they possibly signed you up for something else as well. I have enclosed the contact information to your agent: 
***** **********
US Health Solutions, Inc
Phone: ###-###-####
Email: ***************************

Thank you,

InsuranceTPA-Billing

 

In conclusion our records indicate 1 phone call and 2 emails from Mr. *******, which were all responded to in a timely manner.  The last health insurance (*********) premium Mr. ******* was billed for was on 10/16/12 in the amount of $134.38.  Mr. *******’s Complaint Backround, Product/Service, states Dental Insurance purchased on 4/16/12.  This ********* plan is exclusively health (no dental) and Mr. *******’s application e-sign date for this health insurance was 5/16/12.

 

We continue to recommend that Mr. ******* contact his agent to cancel said Dental Insurance, as this was not purchased through InsuranceTPA.com. 

***** **********
US Health Solutions, Inc
Phone: ###-###-####
Email: ***************************


Again, thank you for contacting us about this complaint. We strive to serve our customers and to supply them with an insurance plan that will benefit their needs. 

 

Sincerely,

********* *** *******

**** ****** ********* *** ***************** ***.*

** *** ***

**********, WI *****

 

 

****************** ****  ** * ***** ***** ************* *** ****** ****** **** ********* *******

InsuranceTPA.com, Inc. ** *** *** ********** ** *****

Phone: ###-###-####

Fax: ###-###-####

***********************

Any and all information will be kept in compliance with privacy statutes and be used for the sole purpose of benefits determination per the guidelines of this insurance plan.

All services are subject to plan provisions at the time services are rendered, Benefits and Eligibility are not a guarantee of payment.

 

 

12/17/2012 Advertising/Sales Issues | Complaint Details Unavailable
12/7/2012 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: they charged me for insurance that I did not authorize them to charge for. they have told me to cancel this insurance that I did not order that I have to call a different number and contact this other subsiderary. I tried to call the number and all it does it ring. I called insurancetpa.com back and the customer service agent(i use the term loosely) hung up on me when I told him he wasnt nor had helped me and that he was only making the problem worse by misdirecting me instead of handling the problem. Oh, and also they said I would see an email outlining my coverage once I was charged, no such email to verify my insurance coverage has been received. they only took my money w/out my authoization, now are giving me the run around about getting a refund. I cant even get a hold of anyone to talk to about getting a refund. this company sucks and it doopping people outta their hard earned money without their authorization and then not even following up w/ the insurance they are supposedly paying for without their consent.

Desired Settlement: A refurnd and for **************** to have the rating re evaluated. all the contacts on your website have been complaints. there is not one good word said about this company because they are a fraudelent business.

Business Response:

                 

 

 

BBB of Wisconsin                                                                                             November 21, 2012

10101 W. Greenfield Ave. Ste.125

Milwaukee, WI 53214

 

Re: ****** ***** *****

**** ** ********* ********* ***** ******** **** ***** ******** ********* *** *******

 

Dear Better Business Bureau,

This correspondence is in regards to the Better Business Bureau complaint received relevant to the Core Health Insurance plan administered by InuranceTPA.com.  InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # *****, for the referenced plan.  We appreciate the opportunity to respond to this inquiry.

This correspondence is in regards to the Better Business Bureau complaint submitted by ****** *****. The basis of the complaint indicates that the Member was charged for insurance that she did not authorize to do so and that a confirmation email was not received upon authorization of the Core Health product.

Firstly, please see the email confirmation that was sent to the Ms. ***** on November 16th, 2012:

Sent: 11/16/2012 9:26:23 AM
From: ***********************************
To: ********************
CC: ***********************************
BCC:
Subject: Your AUIC Core Health Insurance Application [*********]
Status: Read
From Product: AUIC Core Health Insurance
Customer Name: ****** *****
Partner Name:

Dear ****** *****,

We are pleased to inform you that your AUIC Core Health Insurance application has been received, and your insurance ID number is *********.

We will be mailing your Identification cards via USPS within 1-3 business days. Your coverage is subject to all policy provisions, conditions, limitations and exclusions. If you have questions regarding your coverage for specific services, please review your certificate of insurance. This policy number does not guarantee that all services will be covered.

This policy is ongoing and payments will continue to post until we receive written notification of your request to cancel.

If any information you provided is incorrect or incomplete, please immediately notify us by replying to this e-mail or calling the Customer Service Department toll-free at ###-###-#### (Mon-Fri 8:30 a.m. to 5:00 p.m. CST).

You can access your policy and other information anytime by logging in to www.CoreHealthInsurance.com.
Click here if you received this in error or if you wish to be removed from future offers or mailings. You are receiving this e-mail because you bought or requested a quote on an insurance policy or product. During the removal period, you may receive some offers that were already in process when your request was received.

Please Note:
The information in this e-mail message is legally privileged and confidential information intended only for the use of the individual(s) named above. If you, the reader of this message, are not the intended recipient, you are hereby notified that you should not further disseminate, distribute, or forward this e-mail message. If you have received this e-mail in error, please notify the sender. Thank you.

Email Confirmation

Confirmations are sent to the purchaser the day the application is complete.  An email sent may go into a Spam or Junk folder upon receipt by the purchaser and therefore it may appear that it was not received.

 

Ms. ***** contacted her agent and InsuranceTPA.com Billing Customer Service Department on 11/19/2012 and 11/20/2012 to request cancellation.  A full refund, including the Non-Refundable application fee, was refunded on 11/20/2012 to Ms. ***** to her financial institution in the amount of $265.82 which is the full amount paid by Ms. *****.  A refund may take up to 10 business day to be reflected.

 

See notes below:

On 11/19/2012 12:23:22 PM, ***** ********** entered the following ********** ** *********

A Request Ticket was just submitted for you. Please see below for more information.

Submitted Date/Time 11/19/2012 10:32:05 AM (CST)
Requested By Partner
Requested By Name ***** ***
Requested By Email ***************
Policy ID *********
Description Customer Service - Cancellation Request
Instructions Can you please see that this member is contacted regarding cancellation? Agent has requested that FULL refund of application fee is issued, if needed. Thanks! *****.

This resolves the Desired Settlement requested by Ms. ***** and we will consider this matter closed.

 

Please note that the limited medical indemnity plan provides much value for those that are uninsured or under insured and we exercise many avenues in order to educate our Members on the Core Health insurance products.

Best Regards,

****** ***** ********** ******* ****************

11/17/2012 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: on Sunday Aug 5 I was bite by a cat. Monday the wound started getting infected so I went to the doctors and got treated. The doctors office was not familiar with the insurance so I paid out of pocket to get treated. When I tried to contract the company about the situation I was just passed from person to person. Never getting a straight answer. The back of my insurance card said to ******************** . all this website did was verified that I was up to date on payments. No way to submit a claim or ask a question. what I need to know is if my insurance will cover the cost of being treated for a cat bite or not. I would also like to understand the policy better so that when I need care, I can get it without lots of hassles. Member id *********

Desired Settlement: Provide an answer on if the insurance will cover the cost of being treated for a cat bite. If claim is denied , an explanation is desired Ability to get a straight answer with out multiple phone calls. Enough information to make a decision on if **** ****** is legitimate or just some type of scam

Business Response:

Hello ********,

Attached is the response for this complaint received.  In addition to the response are supporting recorded phone conversations with this Member.

 

Thank you.

 

 

****** *****

********** *******

SASid, Inc./InsuranceTPA.com.

*** ******* ****

**********, WI *****

Ph# ###-###-####

Consumer Response:

Better Business Bureau:

Please send the attachment that was sent in the previous message.

Regards,

***** ****

 

Business Response:

Hello,

Attached is the request from ***** **** to send the attachment that was sent in the previous message.

The response email is attached including all pertinent documentation previously provided to the BBB.

 

Thank you.

Consumer Response:

Better Business Bureau:

I have not been able reviewed the response made by the business in reference to complaint ID *******, due to the fact that the attachments were sent as msg files which required MS Visual C++ 6.0 to read.   I am no longer a programmer nor do  wish to be one.    Please send the attachments in a normal end user program such as pdf, text, word, ...

Regards,

***** ****

 

Business Response:

Attached are the pertinent documents along with the official response for complaint ID#*******.

 

****** *****

InsuranceTPA.com

Consumer Response:

Better Business Bureau:

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.

  I do acknowledge that ************ has great customer service once you reach someone.  They were able to assist me in filing an insurance claim and explaining the policy.

  However, to date I have not received a response to the self file claim.   The last time I check this claim was pending.  

  I have been unable to check on the claim due to the fact that the web site (********************) which was working is now giving me an message saying that the site can not be trusted.

  I do take responsibility for not calling customer service as I don't really want to spend another hour on the phone waiting for someone. 

  Folks,  I am tired of this.   The facts are I was bitten by a cat, I went to an urgent care clinic (yes, I admitted that I did not spend time searching for 'correct' clinic to go to),  If you don't want to pay the claim than just reject it.   It's time to quit this he said / she said finger pointing.   It would also be great if you got the web site up and running again.

 

to the BBB -- No attachments were sent in this email and  previous attachments were unreadable

Regards,

***** ****

 

Consumer Response:

Better Business Bureau:

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 information sent was for ***** ****** not ***** ****.  Come on folks,  start paying attention to details.   Currently, you are in violation of the HIPPA laws.  

Regards,  

***** ****

 

Consumer Response:

Better Business Bureau:

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.

My name is NOT *****.   Quick sending me *****'s information.

Regards,

***** ****

 

11/5/2012 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: june 8th 2012 there was a charge put on my credit card for health ins. that was not suppose to be put on until july 1 st. 2012. so i had time to receive the information on the policy. the same day i called my credit card company june 8 2012(by chance) and it was already on my card. so i closed that credit card and asked them not to pay it amount of 613.25. they said it has been posted and they could not stop payment but they could hold it and it could be disputed. i also called the people who i talked to about the health ins. and said iwas canceling the poicy, they said ok and took my name. and i told him why. the company that called us lied to me and said it was the same coverage we have now and that health have to do this because of ***** **** (next level health group) red bank n.j. phone # ###-###-#### and said it would not be on my charge card until july 1st. 2012. then i receive a letter from **** **** saying i lost the dispute because i did not responed to a letter they sent out in aug. (I DID NOT RECEIVE THIS LETTER) and that i did not cancel the policy in writing. It started with a phone call why should it be cancel in writing.

Desired Settlement: A full credit of 613.25 to the credit card that was used.

Business Response:

The BBB complaint received indicated a name of ****** ******* in the “Customer Information”.  However, we do not have a ****** ******* on file.  This Member is listed in our system as ***** ******* that matches the address and account information.  This correspondence will refer to ***** ******* with complaint IF# *******.
This correspondence is in regards to the cancellation of **** ****** ********* plan of which ***** ******* purchased with an effective date of 06.01.12.
The complaint indicates that his credit card should not have been debited until July 1, 2012 until he had time to review the plan information.  Upon investigation it was determined that his complaint is valid and that the enrollment was done in error with the incorrect effective date of coverage.
With that, his plan has been termed back to 06.01.12 and a premium of $613.25 has been credited to his account per his “Desired Settlement”.
We apologize for this inconvenience.

Best Regards,


 

Thank you.

****** *****
********** *******

****************

Consumer 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.]

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID *******, and find that this resolution is satisfactory to me. 

Regards,

***** *******

 

9/16/2012 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: I had a procedure that was supposed to be covered for approx $200. Insurance denied all/any payment. when tried to call customer service to find out more detail so that i could call the right facility to get the records they needed to fix this problem, no one returned call and its been 4 days and no one ever answers the phone period. I do not call this service. I work in the healthcare profession as a professional myself and this would never be accepted as service. All I want to do is get the coverage that was told to me and pay my bills without going to collection agency. All I need to do is get few questions answered so can get things taken care of. Also, they don't even have and email site to forward questions to.

Desired Settlement: phone call and apology as well as payment for procedure

Business Response: ********,Attached is the response to the BBB complaint received for this ID# along with all supporting documentation.Please let me know if you need additional information.Thank you.  Sharon AbneyOperations ManagerSASid, Inc./InsuranceTPA.com.462 Midland RoadJanesville, WI 53547Ph# 608-314-2106 CONFIDENTIALITY NOTICE:  This electronic transmission (including any files attached hereto) contains information that is legally privileged, confidential, and exempt from disclosure.  It is intended for use only by the individual or entity named above.  If you are not the intended recipient or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any disclosure, dissemination, copying, distribution, or the taking of any action in reliance on the contents of this confidential information is strictly prohibited.  If you have received this communication in error, please destroy it, remove it from your computer and/or network and immediately notify me by email.  Thank you. 

Consumer Response: Better Business Bureau: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.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

****** *******

 

 

Consumer Response: because i never received the attachment of the company's response to even look at to be able to agree or disagree

Consumer Response: Better Business Bureau: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.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

 

Agree to attachment except for I had left 2 more messages that were never addressed/acknowledged in the 10days prior to my contact to the BBB. So far, Wes has been working with me via email on this claim. In my defense, I cant obtain records if I don’t know which of my phycisians was at fault.  That is why I attempted to call ins co twice before contacting BBB, so that I could expedite this matter on my part. I wont be totally satisfied until this matter is completely taken care of. Still, I would not recommend this company to others. Thanks again****** *******

 

Regards,

****** *******

 

 

Consumer Response:

From: ****** [mailto:************************]
Sent: Saturday, September 08, 2012 3:49 PM
To: Info
Subject:

 

My name is ****** ******* and have more to report about the sasid /core health insurance company.  I currently had filed a complaint that this outfit doesn’t return or answer any calls.  The are at it again.  I now have a claim outstanding with my pulmonologist from july because the address on the insurance card is invalid and the claim keeps getting returned and, you guessed it, the company doesn’t even return the calls from the billing department either.  I would just like my claims paid without conflict as I pay a monthly fee for a service …..not a runaround.

Business Response: Hello Cristela,Attached is the second response for the additional concerns received for file #*******. (due 09/09/12)Please confirm receipt of this information. Thank you.****** *****
CONFIDENTIALITY NOTICE:  This electronic transmission (including any files attached hereto) contains information that is legally privileged, confidential, and exempt from disclosure.  It is intended for use only by the individual or entity named above.  If you are not the intended recipient or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any disclosure, dissemination, copying, distribution, or the taking of any action in reliance on the contents of this confidential information is strictly prohibited.  If you have received this communication in error, please destroy it, remove it from your computer and/or network and immediately notify me by email.  Thank you.

Consumer Response: Better Business Bureau:

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.  I am very happy to have that particular claim paid and have welcomed the contact person for that .  i am currently waiting another claim to be rectified for an md visit before i will be satisfied.  the md billing office has had no returned phone calls either and mailed claims have been returned to the md office billing dept as incorrect address.... to which i confirmed on my card.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

****** *******

 

 

Business Response:

This is the 3rd correspondence in regards to this complaint received.

 

Thank you.

Consumer 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.]

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID *******, and find that this resolution is satisfactory to me.  Even though all my claims are not complete, i do believe they have been working diligently to expedite this process.  No one should have to go through this extreme just to be able to have claims paid or to get a returned call.

Regards,

 

****** *******

 

 

 

6/30/2012 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: I specifically asked, prior to obtaining my policy if they could paper bill me monthly, they assured me that they would do so. I verbally allowed a one time charge to my bank account to open the account, and clearly stated to the sales person that this was a one time authorization and also stated that on the recording during the interview. They preceded to bill my bank account directly, even after I called twice to make sure that this would not happen.

Desired Settlement: I would like my account with them closed, and the two payments they have charged for me returned in full. Payment One: April 23rd, 2012 - $193.95 Payment Two: May 23rd, 2012 - $ 93.95 Total: $287.90

Business Response: ********,This is my 5th attempt to send you the response.I had a recorded enrollment verification that I removed from the attachments with the thought that maybe it was hitting against something on your end.  ****** *****Operations ManagerSASid, Inc./InsuranceTPA.com.*** ******* *********
****** ** *****Ph# ************  From: ****** ***** [mailto:****************]
Sent: Tuesday, June 05, 2012 9:01 AM
To: ********* *********

Subject: BBB Complaint-
************ ******* ***** ******
 
*********
Here is the formal response for this BBB complaint, along with all supporting documentation. Thank you.  ****** *****Operations ManagerSASid, Inc./InsuranceTPA.com.462 Midland RoadJanesville, WI 53547Ph# 608-314-2106  
CONFIDENTIALITY NOTICE:  This electronic transmission (including any files attached hereto) contains information that is legally privileged, confidential, and exempt from disclosure.  It is intended for use only by the individual or entity named above.  If you are not the intended recipient or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any disclosure, dissemination, copying, distribution, or the taking of any action in reliance on the contents of this confidential information is strictly prohibited.  If you have received this communication in error, please destroy it, remove it from your computer and/or network and immediately notify me by email.  Thank you.

 

BBB of Wisconsin10101 W. Greenfield Ave. Ste.125Milwaukee, WI 53214 Re: **** ******* ***** ******
Policy: *********
Effective date: 04.24.12Term date: Currently Active Complaint ID# ******* 
Dear ******** ********,This correspondence is in regards to the complaint received by InsuranceTPA.com relevant to the plan certificate for **** ******* ***** ******.  InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, **** * *****, for the referenced plan.  We appreciate the opportunity to respond to your inquiry.**** ******* ***** ****** purchased a Physician level Core Health Insurance Limited Medical Indemnity plan with an effective date of April 24, 2012.  A Limited Medical Indemnity plan provides valuable limited benefits for an affordable premium for those individuals that are uninsured, uninsurable or underinsured.  The complaint received indicates that Ms. ****** specifically requested that she receive a monthly paper billing once the initial enrollment premium was charged to her bank account. 
According to system notes, her application was submitted on 4/23/12 for next day coverage of 4/24/12.  When the application was submitted the billing was set as auto draft.  The enrolling agent is Marc Zimmerman.   Ms. ****** had phoned and left a message on Thursday 5/24 at 6:12 pm CTS, which is after hours. This is the only voice mail message within the Billing department.  InsuranceTPA.com did speak with her the following day, the 25th of May after her payment auto drafted from the account on file 5/23/12.  This May 25th is the first discussion that InsuranceTPA.com has had with member. In addition, the Core Health Insurance plan has a 10 Day Right to Review provision in place.  A Member can review their plan and cancel within 10 days of their effective date and receive full premium refund, minus the enrollment fee.  Once the 10 days has passed, a Member has to follow the protocol for a cancellation.  This information, regarding the 10 Day Right to Review, is provided at the time of enrollment and also confirmed in the recorded enrollment verification.   The cancellation process can be identified in the email confirmation that a Member receives upon enrollment into the Core Health plan.  Ms. ****** did not contact InsuranceTPA.com within the 10 Day Right to Review and refused to follow the cancellation process.   However, with that said, InsuranceTPA.com will refund, $93.95, the 2nd monthly premium that was deducted from her financial institution and terminate her plan effective 05/25/12. The initial premium and enrollment fee will not be refunded to Ms. ****** due to the fact that she agreed to those terms at the time of enrollment.   System Notes:5/25/2012 2:42:45 PM, ***** entered the following:
Ph called and was very upset that we had posted a pymt on her plan when she had specifically requested to have bills sent to her instead of auto draft. I apologized for the misunderstanding and let her know that I would turn the billing off so that she would not be auto drafted again. She stated that she had already made a complaint with the BBB and that she would sue us if we posted another pymt. I explained that I had turned her billing off so nothing else would be taken. She wanted to cancel and never wanted to hear from us again. I apologized and explained the cancellation process. She said she wasn't going to send anything and that she would wait until the plan termed from non pymt.

Enclosed

Consumer Response: Better Business Bureau: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.I see no answer in their response, only an excuse as to why they did not contact you in response

Regards,

**** ******* ***** ******

 

 

Consumer Response: Better Business Bureau: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.

First off, I did not receive any documents from the company until after the 10 day grace period had expired.

Secondly, when I finally reached a live person from the Company they said they would turn off the auto Billing immediately, but then I got billed electronically a Month after that.  In the recording the Company said it was making I clearly Stated that I must be paper billed. 

Lastly, when they billed me at that time I spent three days trying to get a live person, during that time I filed the report with the BBB, then I finally received a call back.  I asked the Representative how to cancel and she said she would note the account and I needed to write to them, which I did refuse to do. She then Stated that paper bills would be mailed to me and I could just ignore them and the Insurance would lapse.  Yes, during this same call I did mention that I had contacted the BBB. 


I still want the refund of the money the stole electronically from my account that should have been paper billed.


Regards,

 **** ******* ***** ******

 

 

Business Response: ********,
Attached is the second response made by **** ******** ***** ******, file#*******.Response was due by 06.21.12. 

Thank  you. 
****** *****
InsuranceTPA.com
*** ******* ****
*********** **
*****
###-###-####

5/19/2012 Advertising/Sales Issues | Read Complaint Details
X

Additional Notes

Complaint: I currently have a pre existing condition( a herniated disk in my back) which makes it quite difficult to obtain health insurance. I did some resaerch on the internet and submistted an online inquiry to core health insurance dba insurancetpa, which is the company in question. I was very upfront and honest with rep and told him that I have this condition and would be needing treatment.He told me that the only treatment that would not be covered would be back surgery. This has not been the case at all.This company's claims department does not answer the phone and in the very rare occasion that you are able to reach the voicemail, calls are not returned. I was also promised that I could receive discounts on services that are not on the plan if I use a network provider,but that was false as well. When my dr recommended physical therapy, I was not able to get any type of coverage from **** health insurance and instead went through a local hospital's charity program. Clearly I did not qualify for covergae under this insurance and should have been denied, but they accepted me because they wanted my money, but did not live up to their promises. As a result, this has seriously jeopardized my relations with numerous providers and left me with large medical bills.This necessited my cancelling the policy and enrolling in the **** insurance program for the state of **********.

Desired Settlement: I believe that they should be required to refund me for all monies I paid for monthlty premium payments and should have to pay any existing claims in full.

Business Response: Lisa,Attached is the official response for Lisa Capri’s BBB complaint.  It includes all supporting documentation. Thank you.  Sharon AbneyOperations ManagerSASid, Inc./InsuranceTPA.com.462 Midland RoadJanesville, WI 53547Ph# 608-314-2106   

 

 

                 

January 11, 2011BBB of Wisconsin10101 W. Greenfield Ave. Ste.125Milwaukee, WI 53214 Re: Lisa CapriPolicy: FLM014007Effective date: 05/17/11Term date: 02/01/12 Complaint ID# 9013497 Dear Cristela Nicksion,This correspondence is in regards to the complaint received by InsuranceTPA.com relevant to the plan certificate for Lisa Capri.  InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. Lisa Capri purchased a Physician level Core Health Insurance Limited Medical Indemnity plan with an effective date of December 22, 2011  A Limited Medical Indemnity plan provides valuable limited benefits for an affordable premium for those individuals that are uninsured, uninsurable or underinsured.  The complaint received indicates the following:1.       That the Pre-existing limitation clause to the plan is relevant only to surgery2.       That voice mail messages are not returned3.       That discounts would apply for services that are not covered under the plan if an in-network provider was used.4.       That coverage was not  provided for Physical TherapyInsuranceTPA.com response:1.       Enclosed with this response is a recorded enrollment verification that outlines the followinga.       The pre-existing limitation applies to hospital confinement, surgery and anesthesiab.       The enroller advised Lisa to review her Fulfillment packet and applicable benefits. The Welcome Letter in the Fulfillment packet outlines the process in which to review benefits (Certificate of Insurance). The certificate states the Pre-existing clause and clearly reads the following:“PRE-EXISTING CONDITIONS LIMITATION”Benefits are not provided for any loss caused by, or resulting from, a Pre-existing Condition, as defined, unless the loss is incurred at least 12-months after the Effective Date of coverage for a Covered Person. Benefits are not provided for any loss caused by, or resulting from, a Pre-existing Condition, as defined. This provision does not apply to newborn or newly adopted children.  This provision only applies to Hospital Room & Board, Hospital ICU/CCU, Surgery and Anesthesia benefits as outlined in the Schedule of Benefits. 2.       Enclosed within this response are 5 voice recordings with our customer service team addressing the concerns of Lisa Capri.3.       Discounts are applied for non-covered services if Members seek treatment from an in-network participating provider (PPO). Beechstreet is the current PPO network.  The Beechstreet system was verified for Buena Vista Anesthesia Medical Group and determined that this provider of service is not part of the PPO network and therefore discounts for non-covered services were not eligible.4.       Physical therapy is not a covered benefit under the plan. Limitation and Exclusion #12 in the Certificate of Insurance reads the following: “Spinal manipulations and manual manipulative treatment or therapy;” Lastly, per the Explanation of Benefits enclosed, there were many claims that were processed as a covered benefit and PPO discounts applied as well as the Core Health Physician plan provisions were applied based on the Schedule of Benefits enclosed in the Certificate of Insurance.  Therefore this plan had provided value to the Member on other services outside of those claims that were denied due to the Pre-existing Limitation clause Lisa Capri has paid a total of $826.02 in premiums.  InsuranceTPA.com has paid a total of $1067.59 in health claims including the PPO discounts that apply.  If premiums were refunded, claims cannot be paid under the plan provisions and Lisa would be responsible for all provider charges excluding the PPO discounts.  A Member is not eligible for discounts if not enrolled in any health insurance plan. Refunding the premiums would result in a higher out of pocket expense for Lisa Capri as she would be financially responsible for paying all the health insurance claims filed in their entirety. The $50.00 enrollment fee into the Core Health insurance plan is non-refundable. System Documentation   

**** ***** *****                        DOB: 02-14-1968    REL: 1    CLM: ******

================================================================================ 1.   PREX DENIAL LETTER SENT TO INSURED ... 04-25-12 LD2 IFL.CLM              ------------------------------------------------------------------------------- 2.   DENY ALL LOW BACK SURG AS THIS IS PREX ... 04-24-12 SB2 IFL.CLM          ------------------------------------------------------------------------------- 3.   ****** ** ******* ***** MED REC RECD ... 04-18-12 BE IFL.CLM              3.1  * APPENDED *  THIS IS FOR DISC SPORT AND SPINE CENTER                           ... 04-19-12 WN2 IFL.CLM                                                 3.2  * APPENDED *  DATES PRIOR TO LOOKBACK FOR HER LBP, THEN DUP OF OTHER           RECS IN THE BELOW NOTES FROM OTHER PROVIDERS ... 04-24-12 SB2 IFL.CLM    ------------------------------------------------------------------------------- 4.   ****** ****** CLOSED FOR INFON OT RCVD FROM PROV PREX AFTER                    SEVERAL ATTEMPTS TO OBTAIN MED RECS PREX ... 01-27-12 JP4 IFL.CLM        ------------------------------------------------------------------------------- 5.   LEFT VOICEMAIL FOR 2ND REQ DISC & SPORTS CNTR ************                      ... 11-15-11 JP4 IFL.CLM                                                ------------------------------------------------------------------------------- 6.   PROVIDENCE SAINT JOSEPH MEDICAL CENTER...MED REC RECD                           ... 10-25-11 CB4 IFL.CLM        6.1  * APPENDED *  4/1/11 & 4/2/11 LBP AND SCIATICA                                  ... 04-24-12 SB2 IFL.CLM                                                ------------------------------------------------------------------------------- 7.   PD INVOICE FOR MED RECS FROM ********** ** ****** *** ***
INVOICE #********** - $69.70 ... 10-25-11 TR2 IFL.CLM                    ------------------------------------------------------------------------------- 8.   MED RECS RCVD FROM AVORS 10/20/11 ... 10-20-11 JP4 IFL.CLM                8.1  * APPENDED *  5/13/11 LBP THAT RADIATES DOWN LEFT LEG.  4/19/11  MRI           OF LOW BACK  ... 04-24-12 SB2 IFL.CLM                                    ------------------------------------------------------------------------------- 9.   ********** ** ****** ******* ** ***** *************                           *** * ***** ***** **                                                           **** ***** *** ***** ****** ***** ******* *** ****** ****** ** ***** ************      
***** ******* ****** ******* ** * *** **** *** ******* ** *****               ************ ... 10-07-11 JP4 IFL.CLM                                     9.1  * APPENDED *  PREX FORM IS HAR D TO READ SEE NOTES IN CLAIM SCANS               ... 10-07-11 JP4 IFL.CLM      ================================================================================-------------------------------------------------------------------------------10.   PREX TO INSURED ... 09-06-11 JP4 IFL.CLM                                 -------------------------------------------------------------------------------11.   ****** PREX FOR OUTPT SURG FOR                                                 ***** DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL                                          DISC                                                                   **** THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS                                UNSPECIFIED ... 09-02-11 SB2 IFL.CLM              -------------------------------------------------------------------------------                                     Payment History   Enclosed:·         Welcome Letter·         Certificate of Insurance·         Enrollment Verification·         Email Communication·         InsuranceTPA.com Voice Recordings·         Explanation of Benefits & Claim Forms·         Beechstreet PPO Provider Look UP Screen Prints Best Regards, ****** ***** Operations ManagerInsuranceTPA.com*** ******* ****
*********** ** *****

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Response:

                 

January 11, 2011BBB of Wisconsin10101 W. Greenfield Ave. Ste.125Milwaukee, WI 53214 Re: Lisa CapriPolicy: FLM014007Effective date: 05/17/11Term date: 02/01/12 Complaint ID# 9013497 Dear Cristela Nicksion,This correspondence is in regards to the complaint received by InsuranceTPA.com relevant to the plan certificate for Lisa Capri.  InsuranceTPA.com is the Third Party Administrator for United States Fire Insurance Company, NAIC # 21113, for the referenced plan.  We appreciate the opportunity to respond to your inquiry. Lisa Capri purchased a Physician level Core Health Insurance Limited Medical Indemnity plan with an effective date of December 22, 2011  A Limited Medical Indemnity plan provides valuable limited benefits for an affordable premium for those individuals that are uninsured, uninsurable or underinsured.  The complaint received indicates the following:1.       That the Pre-existing limitation clause to the plan is relevant only to surgery2.       That voice mail messages are not returned3.       That discounts would apply for services that are not covered under the plan if an in-network provider was used.4.       That coverage was not  provided for Physical TherapyInsuranceTPA.com response:1.       Enclosed with this response is a recorded enrollment verification that outlines the followinga.       The pre-existing limitation applies to hospital confinement, surgery and anesthesiab.       The enroller advised Lisa to review her Fulfillment packet and applicable benefits. The Welcome Letter in the Fulfillment packet outlines the process in which to review benefits (Certificate of Insurance). The certificate states the Pre-existing clause and clearly reads the following:“PRE-EXISTING CONDITIONS LIMITATION”Benefits are not provided for any loss caused by, or resulting from, a Pre-existing Condition, as defined, unless the loss is incurred at least 12-months after the Effective Date of coverage for a Covered Person. Benefits are not provided for any loss caused by, or resulting from, a Pre-existing Condition, as defined. This provision does not apply to newborn or newly adopted children.  This provision only applies to Hospital Room & Board, Hospital ICU/CCU, Surgery and Anesthesia benefits as outlined in the Schedule of Benefits. 2.       Enclosed within this response are 5 voice recordings with our customer service team addressing the concerns of Lisa Capri.3.       Discounts are applied for non-covered services if Members seek treatment from an in-network participating provider (PPO). Beechstreet is the current PPO network.  The Beechstreet system was verified for Buena Vista Anesthesia Medical Group and determined that this provider of service is not part of the PPO network and therefore discounts for non-covered services were not eligible.4.       Physical therapy is not a covered benefit under the plan. Limitation and Exclusion #12 in the Certificate of Insurance reads the following: “Spinal manipulations and manual manipulative treatment or therapy;” Lastly, per the Explanation of Benefits enclosed, there were many claims that were processed as a covered benefit and PPO discounts applied as well as the Core Health Physician plan provisions were applied based on the Schedule of Benefits enclosed in the Certificate of Insurance.  Therefore this plan had provided value to the Member on other services outside of those claims that were denied due to the Pre-existing Limitation clause Lisa Capri has paid a total of $826.02 in premiums.  InsuranceTPA.com has paid a total of $1067.59 in health claims including the PPO discounts that apply.  If premiums were refunded, claims cannot be paid under the plan provisions and Lisa would be responsible for all provider charges excluding the PPO discounts.  A Member is not eligible for discounts if not enrolled in any health insurance plan. Refunding the premiums would result in a higher out of pocket expense for Lisa Capri as she would be financially responsible for paying all the health insurance claims filed in their entirety. The $50.00 enrollment fee into the Core Health insurance plan is non-refundable. System Documentation   

DEP: ***** *****                        DOB: 02-14-1968    REL: 1    CLM: ******

================================================================================ 1.   PREX DENIAL LETTER SENT TO INSURED ... 04-25-12 *** ****CLM              ------------------------------------------------------------------------------- 2.   DENY ALL LOW BACK SURG AS THIS IS PREX ... 04-24-12*** ***.CLM          ------------------------------------------------------------------------------- 3.   ****** ** ******* ***** MED REC RECD ... 04-18-12 BE IFL.CLM              3.1  * APPENDED *  THIS IS FOR DISC SPORT AND SPINE CENTER                           ... 04-19-12 *** *******                                                 3.2  * APPENDED *  DATES PRIOR TO LOOKBACK FOR HER LBP, THEN DUP OF OTHER           RECS IN THE BELOW NOTES FROM OTHER PROVIDERS ... 04-24-12 *** ***.CLM    ------------------------------------------------------------------------------- 4.   ****** ****** CLOSED FOR INFON OT RCVD FROM PROV PREX AFTER                    SEVERAL ATTEMPTS TO OBTAIN MED RECS PREX ... 01-27-12 *** ***.CLM        ------------------------------------------------------------------------------- 5.   LEFT VOICEMAIL FOR 2ND REQ DISC & SPORTS CNTR ************                      ... 11-15-11 *** ***.CLM                                                ------------------------------------------------------------------------------- 6.   PROVIDENCE SAINT JOSEPH MEDICAL CENTER...MED REC RECD                           ... 10-25-11 *** IFL.CLM        6.1  * APPENDED *  4/1/11 & 4/2/11 LBP AND SCIATICA                                  ... 04-24-12 *** IFL.CLM                                                ------------------------------------------------------------------------------- 7.   PD INVOICE FOR MED RECS FROM PROVIDENCE ST JOSEPH MED CTR                      INVOICE #********** - $69.70 ... 10-25-11 TR2 IFL.CLM                    ------------------------------------------------------------------------------- 8.   MED RECS RCVD FROM AVORS 10/20/11 ... 10-20-11 *** IFL.CLM                8.1  * APPENDED *  5/13/11 LBP THAT RADIATES DOWN LEFT LEG.  4/19/11  MRI           OF LOW BACK  ... 04-24-12 *** IFL.CLM                                    ------------------------------------------------------------------------------- 9.   ********** ** ****** ******* ** ***** ************* *** * ***** ***** **                                                           **** ***** *** ***** ****** ***** ******* *** ****** ****** ** ***** ************                                                                   ***** ******* ** **** ******* ** * *** **** *** ******* ** ***** ************ *** ******** *** IFL.CLM                                     9.1  * APPENDED *  PREX FORM IS HAR D TO READ SEE NOTES IN CLAIM SCANS               ... 10-07-11 JP4 IFL.CLM      ================================================================================-------------------------------------------------------------------------------10.   PREX TO INSURED ... 09-06-11 JP4 IFL.CLM                                 -------------------------------------------------------------------------------11.   ****** PREX FOR OUTPT SURG FOR                                                 ***** DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL                                          DISC                                                                   **** THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS                                UNSPECIFIED ... 09-02-11 *** IFL.CLM              -------------------------------------------------------------------------------                                     Payment History   Enclosed:·         Welcome Letter·         Certificate of Insurance·         Enrollment Verification·         Email Communication·         InsuranceTPA.com Voice Recordings·         Explanation of Benefits & Claim Forms·         Beechstreet PPO Provider Look UP Screen Prints Best Regards, ****** *****Operations ManagerInsuranceTPA.com*** ******* ********
******* ** *****

 

3/28/2012 Advertising/Sales Issues | Read Complaint Details
X

Additional Notes

Complaint: I purchased individual health insurance from this company. I have a pre-existing condition, and I was told that this insurance would cover doctor visits to a psychiatrist. The entire phone call was recorded, and I asked several times about the psychiatrist being covered. I was told that it was definitely covered. I went to the doctor today and was told by them the insurance company does not cover mental health benefits. When I called them, they told me the same. I just want my money back. I never used the insurance at all. I would not have purchased it if it didn't cover the psychiatrist. They owe me $863.28.

Desired Settlement: I would like a full refund of all insurance premiums paid. I paid them $863.28, plus a $50 application fee. I never used the insurance at all.

Business Response: ********, Attached is the response and all applicable documentation supporting this response for #*******. 

Thank you.  

****** *****
Operations Manager
SASid, Inc./InsuranceTPA.com.
Ph# ###-###-####
Fax# ###-###-####
#**** ** **** ********

BBB of Wisconsin                                                                                              March 8, 2012
10101 W. Greenfield Ave. Ste.125
Milwaukee, WI 53214 
Re: ***** *********

Policy #: *********
Effective date: 11.12.11Term date: 3.11.12 Complaint ID# *******

Dear ******** ********,

This correspondence is in regards to the Better Business Bureau complaint submitted by ***** ******* *********. The basis of the complaint indicates that the Member was told by the enrolling agent that doctor office visits would be covered by psychiatrist. Services for this diagnosis related treatment was denied as it is an stated exclusion under the plan.  In addition, there is a 12 month waiting period for hospital and surgical benefits related to a pre-existing condition. The Member purchased a Gold level **** ****** ********* plan which is a  Limited Medical Indemnity plan administered by **************** with an effective date of November 12, 2012 Upon research of this complaint I have reviewed all the notes and have contacted the enrolling agent to obtain documentation and the recorded Enrollment Verification that is completed for each new Member at the time of enrollment into any **** ****** ********* plans. Please review all findings below. 1.       Any plan purchased has a 10 Day Right to Review which allows any Member to review their plan and if dissatisfied with the purchase of the plan may receive a full refund of premium paid, minus the non-refundable enrollment fee. (Page 1 of enclosed Certificate of Coverage)2.       The member’s effective date was 11.12.11 and the first call received regarding the Member’s dissatisfaction was on 03.05.12.  At that time the Member requested a full refund, which was not provided due to the time period that had passed.3.       There is a 30 Day Waiting Period for any illness/sickness related services.  (Next day coverage is provided for wellness related office visits) (Page 5 of enclosed Certificate of Coverage4.       Mental Nervous is clearly stated as exclusion under the plan. (Page 24, exclusion #15 of the Limitations and Exclusions enclosed in the Certificate of Coverage)5.       The recorded Enrollment Verification clearly states the 10 Day Right to Review, outline of benefits, and the Pre-Existing Limitation clause under the plan. (Attached)6.       Per email from the enrolling agent, Mental Nervous was discussed as a covered benefit as it is a standard exclusion with Limited Medical Indemnity plans.7.       Per the voice recording, which ***** ********* also addresses in her complaint, there is no recording confirmation that mental nervous conditions were discussed as a covered expense under the plan.  Enclosed:·         Recorded Enrollment Verification·         Certificate of Coverage·         Email from enrolling agent that outlines non-recorded conversations with ***** *********·         System administration notes reflecting all InsuranceTPA.com conversations with ***** *********  Based on these findings, ***** ********* is not due any refund and no miscommunication was given regarding Mental Nervous benefits under the purchased limited medical indemnity product.-----------------------------------------------------------------------------------------------------------------------------------------------App Status Cancelled - Client needed coverage for a pre-existing condition Plan Details Gold Plan Product AUIC **** ****** Insurance Effective Date 11/12/2011 App Date/Time 11/11/2011 10:02:22 AM Policy ID ********* Term Date 3/11/2012 11/14/2011 10:42:00 AM (Visible to Subject):
Fulfillment Kit Mailed On
11/29/2011 10:46:00 PM 1/31/2012 8:03:36 AM, a contact us inquiry was submitted.
From Email:**************************
Customer Name: ***** *********
Comments: I work for a small employer (it's just the two of us). He has offered to pay for a portion of this plan. Can I get something in writing that shows (or is it already available to me) what I am paying you each month?3/5/2012 12:11:42 PM ****** **** changed Status from In Force to Cancelled - Client needed coverage for a non-covered benefit.****** **** entered the following (Visible to Subject):
3/5/2012 - Policy/Certificate *********

Dear ***** *********,Please be advised that your **** ****** ********* **** ********* underwritten by United States Fire ********* Company has or will be terminated as of 3/11/2012. No further payments will be required and any refunds due to you will be issued as a credit to your account on file.Please contact our Customer Service Department at ###-###-#### or email us at admin@sasid.com to find out if your plan has a reinstatement provision or if we can be of further assistance. If you wish to reapply at a later date, please contact

.***** *****

**********

***************************
Additionally, any willful misuse of previously issued insurance information (i.e. Policy Application, Certificate, ID Cards, etc.) is considered fraud. Any claims submitted with a date of service after the termination date will not be payable. United States Fire ********* Company and InsuranceTPA.com are committed to providing quality, affordable plans of insurance backed by the highest level of service.

Sincerely,
****************
Billing & Customer Service
###-###-####
***************3/5/2012 12:14:04 PM, ****** **** entered the following (Invisible to Subject):
Feedback form and signed request to cancel received on:  03/05/2012 *Signed request saved in Scan/share (Admin)

Reason for cancellation:   No mental health coverage.

Canceled  On
3/5/2012 12:29:23 PM, ****** **** entered the following (Invisible to Subject):
Called ***** letting her know we canceled her plan as she asked.  Discussed that there would not be a refund.  She wanted a full refund of all payments made.  Explained that mental health services were not covered and she had 10-days to review her plan to determine it was not for her.  She stated that it does not state that anywhere in the certificate.  I explained that it was in the limitations and exclusions #24.  She said she was lied to by the agent and she asked why would he send her out to check for providers if there was not coverage.  I explained the benefit of possible re-pricing depending on how the provider and/or facility is contracted with ***********.  She wants a full refund by 4:00 pm today or she will sue us and go to the FTC.  She wanted to speak with my supervisor and I transferred her to Jenny.  She also stated that she had recorded the conversation between her and the agent.  I let Jenny know, so we could possibly get that recording and look into it.

On
3/5/2012 12:41:10 PM, ***** **** entered the following (Invisible to Subject):
***** called to cancel the plan and get a refund of all premiums paid as she felt she was misled. She had apt for a condition that was an exclusion and was told it was covered. I let her know that she had ten day right to review all information that send to her to review. She then demanded a refund by 5:00pm today or she will contact BBB and insurance commissioner. I am going to request voice recording to see if any mental health was discussed as a benefit.
On
3/5/2012 12:56:59 PM, ***** ********** entered the following (Invisible to Subject):


From: ***** *********
Date: Mon, 5 Mar 2012 13:23:08 -0500
Local: Mon, Mar 5 2012 12:23 pm
Subject: Re: **** ****** ********* Cancellation Confirmation

I am expecting a full refund of all monies paid to you because your insurance agent committed fraud. I specifically asked him if I would be able to see a psychiatrist with this insurance and he assured me that yes I
would, several times. I rWfer you to the recorded phone conversation I had with him prior to accepting this insurance.

Anything less than a full refund will result in my contacting the BBB, the FTC, the news station and any one else that I can get to listen. I'm sure that it's not worth the bad publicity for $860.----------------------------------------------------------------------------------------------------------------------------------------------------------Please note that the limited medical indemnity plan provides much value for those that are uninsured or under insured and we exercise many avenues in order to educate our Members on the **** ****** insurance products.

 Best Regards, 

****** *****
Operations Manager
****************    

Consumer Response: Better Business Bureau: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.

There's nothing here...no attachment or offer or letter, just a note saying that there is something attached.

Regards,

***** *********

 

 

Consumer Response: Better Business Bureau:

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.

Since you are again lying, and have only provided voice verification of what supports your viewpoint, I am still not happy. YOU owe me $860.  I will accept nothing less.  I have contacted the attorney general as well as the FTC concerning fraud.  I would NEVER have taken this policy if I was not TOLD that it would cover my psychatrist visits. 

 

A refund is expected.

 

Regards,

***** *********

 

 

Consumer Response: You did not give me a way to reply to this request on the website. There is no explanation of benefits because the DOCTOR would not even see me. I am still expecting a full refund and have contacted the FTC and the Attorney General concerning the fraud. ***** ** *********###-###-####

Business Response:

********,

I sent an email to you on March 22 responding to this complaint.  Please advise receipt of my response from the 03/22/12 email.

I have attached the email sent to you along with the 2nd response to this individual.

****** *****

Operations Manager

****************

###-###-####

Consumer 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.]

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID *******, and find that this resolution is satisfactory to me.  Regards,

 

***** *********

 

 

 

3/23/2012 Advertising/Sales Issues | Read Complaint Details
X

Additional Notes

Complaint: - Select Language -ArabicBulgarianCatalanChinese (Simplified)Chinese (Traditional)CroatianCzechDanishDutchFilipinoFinnishFrenchGermanGreekHebrewHindiIndonesianItalianJapaneseKoreanLatvianLithuanianNorwegianPolishPortugueseRomanianRussianSerbianSlovakSlovenianSpanishSwedishUkrainianVietnamese BBB Complaint Form Step 1: Tell Us About Yourself & the Business Step 2: Tell Us About Your Complaint Step 3: Additional Complaint Details Step 4: Review and Submit Your Complaint Primary Nature of your Complaint: select * Tell Us About Your Problem: Desired Settlement: select * Desired Outcome: Privacy Policy Trademarks I feel i was scamed because when you talk with they "agent" he tells you everthing you want to hear you ask over and over the same questions to make sure everthing is kosher and you even explain that you have check up coming up and he assures you that you can print your card and go to the doctor and it will pay for a check up. You call a few weeks later to the company which is who you thought you were talking to from the start and the tell you it takes 30 days the very same day i got a statement for insurance company they paid nothing call back which has taken many hour to talk to some one even left messages and call back numbers. only to find out that they don't pay for doctor in 24 hour and they won't refund my money they said i had 10 days to review my insurance i try to explain my problem with the insurance company they just keep repeating their policies i try to tell them what i heard before i paid my money she said how would an agent know about my doctor appointment and when my polies begans one i told him straight out the gate i had a doctor appointment in a couple days for a check up he said it will pay and second the insurance company hires their agents so i would think that they are knowledgeable of the polies and third i didn't know i was talking to an agent i just thought it was a sells person for the insurance company that was in the insurance company building. I try to explain they don't want to satisfiy me they talk down to customers i have not had the insurance for a month yet an cancelledit today i want a refund i fell like the misrepresented them selves i believed i had get insurance an d i was taken for 143.00 and some change premium and now i have a 120 doctor bill i have to pay and an up coming appointment that will be out of pocket because i believed i had insurances coverage after 24HOURS and thats just not so. I need to pay my doctor who reindeered services and they need to return my 143.00 because they have not reindeered any services. And because i thought i had coverage i have an other appointment i'm out of pocket on. I hope by doing this i get my money refunded because thats stealing to say one thing take money for a service and not provide. I also hope they improve the communication with other customers so no one else has to go through all this upset and grief.

Desired Settlement: I want my 143.00 dollars refunded and for them to have better communication with future and current costumers so they don't feel taken (scamed) they need to have stern full disclosure for the negitive and positive.

Business Response: ********, Here is the response and all applicable attachments.  Let me know if you need anything else. 

Thank you.  
****** *****
Operations Manager
SASid, Inc./InsuranceTPA.com.
Ph# ###-###-####
Fax# ###-###-####
#4511 on 2011 INC.5000 

3/5/2012 Advertising/Sales Issues | Read Complaint Details
X

Additional Notes

Complaint: ******** ****** ****** had contacted me about getting an insurance plan with **********. They claimed that I would be covered for doctor's visits of my current physicians 7 days after my payment was made. This was not the case. I tried to use the insurance with my therapist that was claimed by the rep was in network and covered. When my therapist contacted me they told me that there was no coverage. I immediately then contacted ********** whom told me that my coverage would not start for 30 days. I then contacted ******** ****** again and said I want to cancel the coverage, which was within the 10 days I could, but they claimed that as long as my doctors are in *********** PPO network, I would get the discount even though it had not been 30 days. I proceeded to take their word for it and went to my doctor's appointment and gave them the card that was sent to me. Then when I had an appointment 2 weeks later, I came to find out that there was no discount at all. I then immediately called ******** ****** to cancel once again and get a refund. They directed me to contact ********** directly to get the cancellation and refund. I contacted them and told the agent what had been transpiring and wanted to cancel and get a refund. She had me sign a cancellation form to email to get it cancelled. I did that the same day. I then received a call the following day that I was not eligible for a refund. I called the agent and left a message proclaiming that that was not acceptable. I was then contacted by a manager whom stated that I was past the 10 days, so she couldn't give the refund to me. I then argued the fact that I was mislead by ******** ****** and that pushed me past the 10 day mark when I tried to cancel in the 10 day period. They still would not refund my money. After arguing some more, I asked to speak to a supervisor that was higher than her only to be hung up on.

Desired Settlement: I would like a full refund for a service that was never received.

Business Response:

BBB of Wisconsin

10101

 

W. Greenfield Ave., Ste. 125

 

Milwaukee, WI 53214

Fax:

 

*********

Email: ****************************

POlicyholder and Claimant: ******* ***********

Re: 10 #*******

 

Dear ******** ********,

From: SASid and insurance1pa.com

 

 

- lin,u'4nc.e- de",elopment

 

Thank you for providing us the information needed to resolve and or to dispute a

customer compla int sent to our business on

 

21612012 regarding member *******

 

***********.

Here are the system notes as to what has occ urred.

On Friday, Jan 13th 2012 the member had applied for the **** ****** Limited Medical

Indemnity insurance plan with agency ********* ****** Health Group. The application

was submitted by that agency that same day and the first premium was drafted for a

requested effective date of

 

112012012. When the application is submitted, an email is

 

generated and sent to the member to confirm completion and to give plan certificate

number along with member log in access. Within the member log in, there is access to

view all plan benefits, copy of certificate and copy of

 

10 cards to print and use until the

 

fulfillment packet is sent in the mail. Our fulfillment department had mailed plastic

 

10

 

cards, copy of application and welcome letter along with plan benefits on the 16th of

January, which is a Monday. The certificate states that the member is allowed a ten-day

right to review all ofthe plan benefits and if they are not satisfied, they can return

 

~ with

 

refund of the premiums paid. Below is the portion of certificate that has the 1 D-day right

to return language (1

 

sl page of the certificate) that he had been given access to, and was

 

to review in addition to the entire **** ******

 

Um~ed Medical Indemnity Certificate:

 

10 DAY RIGHT TO RETURN THIS CERTIFICA TE

/ffor any reason you are not satisfied with this Certificate, You may retum it to

 

us

 

within 10-days after you receive

 

it Upon receipt, we

will refund any premium

 

paid and the Certificate will be deemed void, just

 

 

 

 

as though it had never been

 

issued.

THIS CERTIFICA TE PROVIDES UMITED BENEFITS. PLEASE READ IT

CAREFULLY.

BENEFITS ARE UMITED AND ARE NOT INTENDED TO COVER ALL

MEDICAL EXPENSES. THIS COVERAGE SHOULD NOTBE CONSIDERED

AS COMPREHENSIVE HEAL TH INSURANCE COVERAGE.

 

THIS COVERAGE PROVIDES

 

UMlTED INDEMNITY BENEFITS TO

 

REIMBURSE YOU FOR PAID EXPENSES COVERED UNDER YOUR

CERnFICA TE.

The member had been j:liven ten days from his effective date of

 

1120/12, which would

 

have been no later than 1130/12 to return his certificate by notifying us in writing.

According to system notes, we (**************** had received a call from the

member on

 

1/18/12 requesting information about the benefits of his plan. He was

 

advised at that time that his condition was not a benefit of the plan and was also

transferred directly to the claims department to give more specific information about his

benefits.

On

 

1124/12 our claims department had entered system notes saying that the provider

 

called in to get plan benefits.

 

M. that time it was explained to them that "his condition"

 

was not a covered benefit. HO'Never, if the provider was a member of the ***** ******

network, the services are eligible for discounts, even ifthe condition is an exclusion of

the certificate.

Our next conversation 'Mth the member at InsuranceTPAcom was on

 

212112. He had

 

requested to cancel the plan as he was not satisfied with the benefits of the plan.

 

M. that

 

time he was told that he was past his ten day right to review for refund of premiums, but

could terminate the plan so he was not billed again for another month of coverage. He

was not happy that a refund could not be issued and asked to speak to the supervisor of

that department.

The member was contacted the next day, 2/3/12, by a supervisor to see how we could

help him. Upon review of dates of conversationswithcustomerservice, claims

department and the agent, it was determined that still NO refund was due. During the

conversation, the member was yelling and using inappropriate language. He was politely

wamed that if he continued to yell and use inappropriate language the call would be

disconnected. He did not cease this behavior and therefore the call was disconnected.

According to the member's complaint indicates that he was told he had coverage 7 days

after making a premium payment, he signed up and paid on

 

1/13/12. The member's plan

 

was effective

 

112012012. However his certificate has a 3O-day waiting period for

 

sickness related visits (there is no waiting period forwellnessandoraccidents). We

have a recoreded confirmation with ********* ****** Health Group ensuring that they

informed the member rej:lardinj:l the 3O-dav sickness waitinj:l period. ********* ******

Health Group confirmed that the 3O-day sickness waiting period was explained to the

member verbally multiple times. The agent also informed the member that if a provider is

participating

 

with ***** ****** then the service would be eligible for a discount even if

 

the service is not covered by the certificate.

The member's complaint also stated that he was told he would get a discount for his 2

appointments, and did not. We have received only one daim for him on

 

1130/12. The

 

claim

 

is for date of service 112412012. This claim was processed with a


***** ******discount of$114.89.

 

Also. note that once a claim has been sent to us for processing within the firstten days

of the plan, we are not able to terminate the coverage as

 

he has already taken

 

advantage of his insurance.

We are in possession of the member's written request to terminate the plan on

214/2012

 

and the plan has been terminated with one month of insurance coverage.

 

No further payments will be drafted. No refund will be issued.

Again, thank you for contacting us about this customer's concern. We strive to serve our

customers and to supply them

 

with an insurance plan that will benefit their needs.

 

Sincerely.

Grievance and Appeals

Core Health Insurance c/o InsuranceTPAcom, Inc.*

** ***************** **** *****

"

Consumer Response: Better Business Bureau: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.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

******* ***********


Dear BBB:

I do not accept the response from ********** due to being mislead numerous times during the so called 10 day period by ******** ******, whom stated that I was covered while ********** said there was a 30 day wait period. I tried to cancel right after the 1st try of using the coverage as well as when I was told by ********** the there was a 30 day waiting period for coverage. I was not granted that and only mislead further with them claiming I was covered when I was clearly not. Not by beech street, **********, or anybody else. My money was taken for a service that I never received. 

In regards to the phone call I received from **********, I had explained to the lady what had transpired and how ******** ****** mislead me on their behalf past the supposed 10 day period. She would not take in what I had explained numerous times and the conversation got loud. When she warned me about it, I had stopped and then asked to speak to her supervisor. Then and only then was I hung up on. And, I even called her back to which she would not answer numerous times, and asked her to have her supervisor contact me on her voicemail to which I never received a call to allow me to explain and justify my end with someone higher up that may be able to help me since she was not willing to. 

Thank you for looking for continuing to look further into this issue for me. 

Sincerely,

******* ***********

 

 

Business Response: ********,

To expedite our response to *******’s rebuttal to our original response to his complaint, I am emailing you directly in order to place closure on this outstanding issue.Attached is our official documented response along with two voice recordings, which are identified the response. Please let me know if you have questions.Thank you for allowing us to provide you a formal response to the issue brought forth by this individual.  

****** *****
Operations Manager
SASid, Inc./InsuranceTPA.com,
###-###-#### ***
******* *************** ** *****
Office: ###-###-####
Fax# ###-###-####
#**** ** **** ********

Consumer Response: Better Business Bureau:

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 response I was sent from them claimed to have had an attachment of some sorts and their explanation, but there was no such attachment. I am still against them not refunding my money since services were never rendered. I was mislead by both them and America's Choice into keeping the coverage past a ten day period which neither verbally warned me about when I was in contact with both about the service not covering anything. Please let me know what to do further in this matter to get my refund. 

Thank you. 

Regards,

******* ***********

 

 

Business Response: ********, Here is a response to this individual’s 3rd complaint regarding the same situation. Thank you.  

****** *****

Operations ManagerSASid, Inc./InsuranceTPA.com,
###-###-####
*** ******* ****

*********** ** *****
Office: ###-###-####
Fax# ###-###-####
#**** ** **** ********    

Consumer Response: Better Business Bureau: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 recordings proved that I tried to cancel, but ******** ****** talked me out of it. Also, the ******** ****** agent, Dan, claimed that I did get a discount with my mental health professional, which is false. That is why I had to call back andy try to cancel once again and again and again. It was a vicious circle. This all proves that the services were never rendered and I was mislead to believe that I did have coverage with my mental health when I didn't. I still want my refund in full and the main proof is that Dan from ******** ****** claimed that I did indeed get coverage, when I have my Dr.'s office to prove that there was no discount or coverage of any kind. If you need their information, I am more than happy to get it to you. 


Regards,

******* ***********

 

 

Business Response: ********,Thank you for your time to discuss that matter of ******* ***********’s. As previously communicated, InsuranceTPA.com has thoroughly investigated the complaint issues by this individual.  The findings is that no one was mislead and no information was misrepresented regarding the plan provisions of this Core Health plan.However, with that said, we have refunded Mr. ***********’s insurance premium in total, $143.95 on Monday, March 5, 2012. Please be advised that there is a health claim on file for date of service 01/24/12 for services provided by ***** Diabetes and Endocrinology where a participating provider discount of $125.11 was applied.  This discount is only applicable to Members who are enrolled in this plan.  Since Mr. *********** has been refunded his entire premium he is termed back to his effective date which makes him ineligible for the discount on the claim that was submitted by this provider. The explanation for this service was provided with a previous BBB response to his complaint.  With that, we will be contacting the provider to inform him that the participating provider discount applied to this claim needs to be balance billed to Mr. *********** in the amount of $125.11 as the Member’s plan has termed and he is no longer eligible for this applied discount. Thank you for your time and please feel free to contact me if you have any questions or concerns regarding this resolution. 

Healthy regards, 

****** *****
Operations Manager
SASid, Inc./InsuranceTPA.com,
###-###-####

*** ******* ****
*********** ** *****
Office: ###-###-####
Fax# ###-###-####
#**** ** **** ********    

2/18/2012 Problems with Product/Service | Complaint Details Unavailable
1/30/2012 Problems with Product/Service | Complaint Details Unavailable
1/1/2012 Problems with Product/Service | Complaint Details Unavailable