Business ProfileforHealth Special Risk, Inc.

Health Special Risk, Inc. (HSRI) provides secondary insurance for K-12 scholastic and sporting programs for my School district. In October 2023, my son dislocated and fractured his ankle during a school football game. We went directly to the hospital via ambulance where my son spent four days in surgery and recovery. Subsequently he required 2 months in physical therapy. My primary insurance carrier (Aetna) has covered the majority of expenses but the $260 copays for physical therapy were my responsibility. All relevant forms have have been supplied to HSRI, i.e., Explanation of Benefits (EOB), Loss Report, Receipts and Proof of payment. To my astonishment, HSRI has not honored their responsibility. They have intentionally acted in bad faith to not reimburse me for the copay expenses I have advised HSRI that their reluctance to honor my valid request would subject me to file a complaint with the Better Business Bureau. They did not care. 1.HSRI, without any evidence, alleged that my son's physical therapy visits were not related to his ankle injury. I was both shocked and puzzled, as I provided all the documentation of his physical therapy treatments. HSRI then changed their position only after a direct three-way call (initiated by me) with the Physical Therapist.2.HSRI claimed that there was no copay obligation for my medical plan, and would not reimburse me. Oddly enough, HSRI did not have access to my medical plan terms and conditions to make that determination nor did they ask for them.3. HSRI said my Physical Therapist would refund me the total amount? As a courtesy, I shared with HSRI my Aetna plan's coverage which clearly indicate that is it my copay obligation. It is clear that HSRI is taking every opportunity to intentionally not reimburse me and without reason. They have refused to formally deny my claim so that I have proof of their position. Thank you for your support, ***************************