ComplaintsforBenefit & Risk Management Services, Inc.

• Initial Complaint

  12/19/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I want to cancel this health insurance plan. I never signed up to it, it was provided my my job site. I contacted them, and so has my employer to try and cancel the health insurance and every time we either never hear back or they hang up. This is very unprofessional and Ive tried every route to cancel this insurance. I already have a fantastic primary healthcare plan that covers my medication, I DO NOT NEED this insurance. I would never recommend this company to anyone ever.

  Business response

  01/02/2024

  Hello,

  We were closed over the Holidays and do apologize for the delay in responding. Please see our rebuttal below.

  BRMS has been retained by All **** Home Health Services LLC and Elite HHC LLC as the active Third-Party Administrator of their self-funded medical plans. This member has been employed by both.
  
  This member is classified as an active home health care aide who is employed by these employer groups. They are subject to be compliant to Section-****-c of the ************** Public Health Law, or the Home **** Worker Wage Parity Law, which outlines that home care aides who perform *********reimbursed work within ************* and the counties of ******,Suffolk, and Westchester may be paid both a base wage and a supplemental benefit to satisfy a minimum rate of total compensation.
  
  This member had medical coverage under the active self-funded plan of All **** Home Health Services LLC, from 2/1/2019-2/28/2019 then was enrolled in the active self-funded plan under employer, Elite HHC LLC, from 3/1/2019 through current.
  
  The employers mentioned above are responsible for reporting employees hours worked to the broker of the self-funded medical plan which for both employers All **** Home Health Services LLC and Elite HHC LLC is ********************** (***). A monthly hours file is sent to the *** team that contains all of the Wage Parity hours that the employee worked each month to determine the members eligibility each month.
  *** then creates an hours-based eligibility file which is then sent to BRMS.
  
  has no authority to terminate an employee of these Groups. *** keeps sending BRMS a report showing her employed by Elite HHC LLC because they are receiving information from Elite HHC LLC that she is still active.  Again, it is the employers that is responsible to report the Wage Parity eligible hours each month to the team at *** to determine each employees appropriate coverages. Once the Wage Parity eligible hours are reported to the team at ***, the eligibility is sent to BRMS to then load the coverages into our MyHealthBenefits platform.
  
  Note: BRMS has no authority to terminate an employee of these Groups. We must receive the correct information from ***, and it has been determined that they do not have accurate reporting from the employer. 
  
  Please note that BRMS is not the *** of record for these groups as of 12/31/2023 but we are happy to work with you to assist the consumer wherever we can.  Please have her contact her former employer to ensure *** is receiving accurate information who will in turn report to BRMS. 
  
  We are sincerely sorry that the consumer is experiencing such difficulties, and we will assist where we can. However, we must follow the guidelines of the contract given to us and therefore must receive any termination instructions in the correct order.
  
  Thank you,
  BRMS
  ************************************************************

• Initial Complaint

  09/23/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  BRMS has taken months to pay a claim, to the point thats lab bill might go to collections. They have ignored my multiple requests to have in writing that my claim is pending and not denied. I have informed them their system is incorrect and showing my claim as denied on the entity who requires payments end and they have not remediated it. So, I keep getting notices I will go to collections. This is ridiculous if I go to collections. The claim has been pending SINCE JUNE.

  Business response

  10/16/2023

  RE: Complaint ID ********

   

  Claim ID# ******** for this member was received on 6/29/2023.  The normal process for any claims for this ************** is to electronically send them out for repricing against their network/*** vendor.  There were issues with this claim as the provider of service is no longer contracted.  Therefore, the claim had to route to the *** vendor for pricing which did take an extenuated amount of time to get back.

   

  On September 26th, 9:55am, the provider of services LabCorp was contacted on behalf of the patient to advise of the delay in pricing due to their network termination.  *****, from LabCorp ***************), advised our BRMS representative **** that the member has not been sent to collections and that the account has been placed on hold for 30 days pending receipt of payment.

   

  The claim was received back with pricing on September 19, 2023, and was included in the **************s next check run on September 26, 2023.  ****************** funded the claim on October 4, 2023 at which time the check was mailed to the provider.  An additional follow up call to ***** at LabCorp was made on 10/4/2023 to provide her with the check number ***** and amount paid which was $63.08, leaving a patient liability of $20 which is her copayment.

   

  Please let me know if there are any additional questions or issues that need to be addressed.

   

  Thank you

   

  ***************************
  V.P. of Client Services

• Initial Complaint

  03/22/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  BRMS is contracted to provide a third-party service through my employer. I submitted a claim on 12/14/21 for a covered service (vision exam 10/13/21 and glasses 10/13/21). I received notice via email from BRMS on 1/6/22 that the claim had been received and would take ***** days, but have received no communication since. I have emailed and called multiple times. In 2019 I had the same issue with this company which took many months and hours upon hours of my time to resolve the claim. The 2019 claim was finally paid but it took nearly a year to resolve. I want other customers to beware of this business that operates as though customers do not matter.I seek the full payment of my claim as the resolution.

  Business response

  04/04/2022

  Dear Sirs,

   

  We spoken to the member who filed the complaint and I believe we have handled the issue to her satisfaction.  This issue was originally caused by a provider who misguided her and this is not the first time we have had an issue with this same provider.

  However, one of our senior Client Managers spoke with ***************** ******** and resolved the problem.  I have attached documentation showing the claim was processed on March 23 and a check mailed to ****************** ******** in the amount of $368.98.  

  ****************** was also given a direct phone number to our senior Client Manager, *********************** and seemed happy that she has a person to contact here if she ever runs into future problems like this.

  Please close this matter.

  Kind regards,

   

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

   

   

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