ComplaintsforThe Rawlings Group

• Initial Complaint

  06/12/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  If I could give them "0" stars it would be a ZERO!! This company apparently contracts to investigate insurance coverage and alerts them when clients may have duplicate coverage. Some sort of 3rd party investigation. Well let me tell you they do not investigate. Kept insisting I had active coverage with **** and notified ***** of this finding. My **** was termed on 2.29.24 and ***** started on 3.1.24. After emailing them this information they continued to insist I had coverage with **** and ***** sent us a letter they were going to deny payment unless "Rawlings" cleared it up. Well it takes one phone call by me to **** to clarify my benefits were actually termed 2.29.24. When I asked what kind of investigating they did to come to the finding the policy was still active "***" did not really have any answer and deferred that it was not her job to investigate. What ended up happening is I did the work for them and they get paid by *****. Corporate America at its finest. I have filed a complaint with them and notified *****. I deserve the fee for clarifying this not Rawlings. Stay clear from this company.

  

  Business response

  06/21/2024

  This is in response to the Complaint filed with your organization bearing #********. The Rawlings Company LLC (“Rawlings”) provides data mining and claims recovery services to health insurance companies and administrators, including the Complainant’s health insurer. As part of its work, Rawlings seeks to recover from providers payments which were made by its clients for claims that should have been paid by another carrier.
  
  In this instance, *** ****’s prior insurer had not updated the termination date of her policy at the time of Rawlings’ initial review. The termination date was later updated to state 2/29/24 with her new coverage beginning on 3/1/24. It is Rawlings’ standard procedure for coverage dates to be verified by its analysts where possible without the involvement of the member. Rawlings’ analyst did not follow these procedures in this case as she should have. (Rawlings has separately re-verified the relevant coverage dates.)
  
  The analyst has received management counseling and retraining regarding these procedures. Rawlings’ file has been closed. Rawlings apologizes for the frustration and inconvenience that this process has caused *** ****. 

  Customer response

  06/24/2024

  
  Complaint: ********
  
  I am rejecting this response because:  You did not do your due diligence. A simple phone call at anytime to **** would have prevented this occurring.  I was able to verify my term date in March of 2024 via phone and your staff should have too.  When someone does not do their job appropriately a plan of action should be presented and followed thru on.  I would like to see this plan of action for said employee *** ******.

  Thank you in advance.
  
  Sincerely,
  
  ***** ****

  

  Business response

  07/01/2024

  We understand your frustrations pertaining to this situation. Rawlings would like to re-emphasize that our employee has received management counseling and retraining on this matter. We greatly appreciate your feedback as it  helps our employees and organization improve in providing our services.  
  
  

  Customer response

  07/02/2024

  
  Complaint: ********
  
  I am rejecting this response because:  It is not a resolution to the time and effort I spent doing her job.  I expect restitution for the 2 hours time I spent which would have taken her 1 phone call.

  at 30.00 per hour as a RN you can mail a 60 dollar check to me at *** ******* ******* ***** **  *****

  
  
  Sincerely,
  
  ***** ****

• Initial Complaint

  05/02/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Received a bill stating I owe $1,219.51 for prescriptions filled after coverage ended. I used *** mail order with ***** coverage. The prescriptions were filled 7/03/23 and 7/07/23. Coverage ended 6/30/23. *** Mail Order would have had to get approval from ***** to fill PRIOR to filling the prescription. The fill dates are when the items were filled, when did *** request approval to fill these? If *** failed to get approval to fill, this is their fault not mine. *** has a duty to get insurance providers approval and pricing PRIOR to filling the prescriptions. The demand for payment sent is conveniently vague with dates and threatening in nature for a first request. I want to see verification of *** requesting approval to fill the prescriptions along with the date. Sending me a BS bill is irresponsible billing, they have a fiduciary responsibility as a debt collector to verify all information prior to demanding payment.

  

  Business response

  05/09/2024

              This letter is in response to the Complaint filed with your organization bearing #********. Rawlings Financial Services, LLC (“RFS”) provides data mining and claims recovery services to health insurance companies and administrators, including the Complainant’s prior health insurer. As part of its work, Rawlings seeks to recover payments which were made by its clients for prescriptions filled by a pharmacy after an individual’s coverage with that insurer or plan has ended.
  
              We have confirmed with the Complainant’s prior insurer that its coverage ended 6/30/23. We have also confirmed with *** that one of its retail pharmacy stores in Palm Springs filled prescriptions for the Complainant on 7/3/23 and 7/7/23. These same prescriptions were picked-up at that store on 7/8/23 at 3:03 pm.  These were not prescriptions filled using *** mail order. The prescriptions were filled after the Complainant’s coverage had terminated. Rawlings’ client was then billed by the pharmacy and paid for these prescriptions.
  
              Rawlings will submit these claims to the Complainant’s new carrier and attempt to obtain on behalf of its client the reimbursement that has been sought.
  
              We trust that this will help to resolve the Complainant’s concerns. We certainly regret any inconvenience that this process may have caused. Please do not hesitate to let us know if additional information is needed. Thank you. 

  Customer response

  05/10/2024

  
  Complaint: ********
  
  I am rejecting this response because: *** Pharmacy in Palm Springs HAD TO GET INSURANCE APPROVAL PRIOR TO FILLING PRESCRIPTION. I ASKED AND THEY DID NOT PROVIDE DATE *** REQUESTED AND RECEIVED APPROVAL TO FILL PRESCRIPTIONS, OBVIOUSLY IF THEY PERFORMED THEIR RESPONSIBILITY AS PRESCRIBED AND REQUESTED AND RECEIVED APPROVAL PRIOR TO EXPIRATION AND I POCKED UP AFTER EXPIRATION, THISIS ***’s FAULT. I AM AGAIN REQUESTING PROOF OF DATE APPROVAL FROM ***** FROM *** APPROVAL TO FILL SAID PRESCRIPTIONS, I KNOW WHEN I PICKED THEM UP.  DID *** REQUEST AND OBTAIN APPROVAL TO FILL PRIOR TO EXPIRATION OF ***** INSURANCE. SIMPLE QUESTION IF YOU CAN SAY WHAT TIME I PICKED THEM UP. I WILL NOT PAY UNTIL I RECEIVE WRITTEN PROOF, NOT JUST YOUR WORD, I WANT TO SEE PROOF, COMPUTER PRINT OUTS OF WHEN APPROVAL WAS REQUESTED AND APPROVED. 
  
  Sincerely,
  
  **** ******

  

  Business response

  05/20/2024

  To better address the Complainant's concerns, Rawlings will telephone the Complainant to discuss the refund process in these situations and to discuss the available information. 

• Initial Complaint

  04/24/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  To Whom It May Concern: Myself and family including two minors were involved in a car accident on 02/12/2023, Sunday on our way to Church worship. The accident was not our fault and we have come to a settlement offer with at fault driver's Insurance ******* for the amount of $50,000. We have learned that *****, through Rawlings company has a lien of $8430.12. I attempted to negotiate with the subrogation analyst assigned for this case which is ********* ******* and so far it is not successful. She is so adamant and shows no effort to work with me. I contacted and emailed multiple times and her answers are different each time. She stated that you got large amounts and more than the lien amount and the money The Rawling's claiming is not yours , it is ****** So I contacted ***** on 04/18/2024 and they stated that I don't have to pay for this amount. Hence they connected with Rawlings company in a three way with a different analyst and they provided a supervisor name and I emailed the supervisor Gavin on 04/18/2024 but I haven't heard back from the supervisor, but ********* called me on 04/18/2024 and stated that the supervisor answer will be same as mine and there won't be any benefit reaching out to him. I have cited to GA law - O.C.G.A. § 33-24-56.1(b)(1) but she hasn't responded for that citation. I don't have ***** health insurance anymore and we believe it is not fair to collect these amount from the offered settlement amount. Hence we do request hereby to have some one from The Rawlings company conduct a research on the subject and provide us a resolution, Sincerely **** ******** * ***** ********* ******* ******** *** ********* *********

  

  Business response

  05/03/2024

  Ladies and Gentlemen:

           This communication is in response to the Complaint bearing * ********* For over forty years, Rawlings has provided claims recovery services to health insurance companies and health plan administrators throughout the country. Rawlings seeks to recover through subrogation and/or reimbursement payments made by the health plan for medical claims which should have been paid by other parties, such as in the case of an accident caused by a third party. Rawlings is contracted to provide these recovery services on behalf of the Complainant's prior health plan. The health plan paid on behalf of the Complainant and his family members medical claims that allegedly resulted from such an accident.  The Complainant has requested that the health plan waive its claim with respect to any settlement  from the at-fault party’s insurer.  

          In April, Rawlings participated in at least 3 phone calls with the Complainant (or a family member) and exchanged an e-mail. It has been explained to the Complainant that because the health plan is a self-funded ERISA qualified plan Georgia state law is pre-empted and does not apply. Rather, federal law and the language of the health plan controls. The health plan which provided benefits specifically provides the plan with the rights of recovery being pursued. Based on upon the information gathered to date by Rawlings pertaining to the accident and the resulting claim with the insurer for the at-fault party, waiver of the health plan’s claim is not agreeable.

          A member of Rawlings’ management team, *** ***** ******* will contact the Complainant to attempt to resolve this matter. Despite statements in the Complaint to the contrary, *** ****** has not received any communications to  date from the Complainant. (*** ****** can be contacted at ************.) We look forward to working toward a resolution and certainly regret any inconvenience or concern that this process may have caused the Complainant.

• Initial Complaint

  04/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had been seeing a doctor since 2019 every month it's from my injury that I got put on disability I have a dramatic brain injury and then I had an automobile accident April 21st 2023 and I went to thieves chiropractic only and they never build nobody or nothing and you could see the disbursement check cheat that only thing chiropractic got 39.37-38 in money Rollins company said that signal paid money on my automobile accident ***** is my health insurance they did not pay a dime and I've been trying to contact them since January 2024 and they will not reply I've said five letters and I have proof that they received them I've emailed several times The specialist name in the letter that you were getting a copy of ***** ******* and she will not reply at all I spoke with left a message with her supervisor ******* **** at ************* I've called ***** insurance my health insurance spoke with ***** have a reference number of **** of my complaint and my question if they paid and he says they have never paid a dime on my automobile accident they have only paid injuries medical bills that I received from my traumatic brain injury but they will not reply and I need your help please better visit you I've read their reviews and everything and they've done this to several people and they're in Lagrange Kentucky could you please help

  

  Business response

  04/19/2024

  This is in response to the Complaint filed with your organization bearing #********. The Rawlings Company LLC (“Rawlings”) provides claims recovery services to health plans, including the Complainant’s insurer. It is our understanding that the Complainant may have been involved in an accident. In some cases, many insurance plans have a claim to be reimbursed for the benefits it paid on behalf of the member as a result. Rawlings was also informed that the Complainant was represented by counsel with respect to his accident.
  
  The Complainant’s attorney was notified of the insurer’s potential recovery claim. In response, counsel requested an itemization of claims paid on behalf of his client. Such a listing was provided, and counsel sent a check to Rawlings.
  
  Subsequently, the Complainant contacted Rawlings. After discussing the matter with the Complainant, Rawlings has agreed to refund the monies it previously received. Rawlings is processing this refund and will mail the proceeds to the Complainant.
  
  We certainly regret any inconvenience that this process may have caused.
  
  
  

  Customer response

  04/22/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  *** *****

• Initial Complaint

  03/26/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  5 months after picking up a prescription I received a demand from Rawlings Financial for an amount due. It would appear, after the expiration of my coverage with ****** *** errantly billed the old insurer. Rawlings, in the name of ***** *it appears* now is claiming I owe a balance of money resulting from coverage they provided to ***, something which occurred when I no longer was a member. Essentially the long and short is that they are saying I shouldn't be covered because I'm was no longer a covered member, but also since I once was a covered member I need to pay for their error. The real issue is that the amount being demanded is significantly more than the amount I would have paid *** cash on the day of pickup. I am more than happy to have to pay a balance to *** for the amount that should have been due and would also consider paying ***** directly with admission of error on their part and clear indication that this isn't a "settlement" and that you aren't doing me any favors - something which Rawlings seems to be implying. In a detailed call with ***** - who apparently has contracted with Rawlings, ***** was unable to see any balance due and also unable to provide any support for the amount despite 3 way calls both with my former employer who provided ***** as well as with Rawlings itself. It would appear that Rawlings, under threat of credit harm, is trying to collect on a debt which they do not own, while the owner is telling me that there is no debt at all. At this point Rawlings, using the language "settlement," offered to take 50% off the balance, which is about what we would have paid to *** had the error not occurred, however I have become extremely distrustful of what is going on and have no interest paying Rawlings, a company I have absolutely no relationship with. I have also filed notice with the Virginia Bureau of Insurance as the way this is being handled and detail (complete lack thereof) provided obviously is not in line with the laws here.

  

  Business response

  04/05/2024

  Ladies and Gentlemen:
  
              This letter is in response to the Complaint filed with your organization bearing #********* Rawlings Financial Services, LLC (“Rawlings”) provides data mining and claims recovery services to health insurance companies and administrators, including the Complainant’s prior health insurer. As part of its work, Rawlings seeks to recover payments which were made by its clients for prescriptions filled by a pharmacy after an individual’s coverage with that insurer has ended. Rawlings is contracted with the Complainant’s prior insurer to provide these services.
  
              In this instance, a prescription was filled for the Complainant after his coverage with the prior insurer had terminated. Rawlings’ client was subsequently billed by the pharmacy which filled the prescription, and it paid the pharmacy for that prescription. Rawlings correctly sought to recover the amounts paid by its client because there was no coverage in effect with the prior insurer at that time. Hence, the prior insurer paid for claims it had no obligation to cover. (The prior insurer’s system would not reflect the recovery efforts of Rawlings in this regard.)
  
              Rawlings properly mailed to the Complainant’s address letters detailing the claims paid by the prior insurer after the recorded termination date of the health policy. These letters correctly included the amount paid by the insurer and the date the prescription was filled. Rawlings has previously spoken by telephone with the Complainant.

              Rawlings will not send any additional letters to the Complainant related to this matter.  We certainly regret any inconvenience that this process may have caused. The Complainant is certainly welcome to telephone Rawlings to again discuss the details of this matter.  Please do not hesitate to let us know if additional information is needed. Thank you.

  
  

  Customer response

  04/05/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  
  I have CONFIRMED with the previous employer - who is trying to now return the premiums to me - that premiums for the period covering the prescription and November were in fact withheld from my paycheck paid! Rawlings and apparently ***** who has contracted them is welcome to confirm with ******** ****** that premiums were in fact withheld from my paycheck and thus ALL of the previous error documented above are further made moot by the fact I had paid for full coverage anyways. In a phone conversation with ***** that ultimately was expanded to include both Rawlings and the previous employer ***** confirmed they could see no balance due.
  
  I don't doubt that these issues often involve consumers upset, but also in the wrong....that is not the case here and I encourage interested readers to be aware that this company is actively attempting to demand something and causing tremendous hassles that they ultimately are not entitled to and will not get. The response above from Rawlings though typed matter of factly is both ethically and now objectively false. I will not be pay $1,000 for a $500 medicine after I already paid $600 in premiums for for coverage for the period in question and paid my appropriate share of $40 at time of pick up (Even though we never intended to pick up the medication.) It would serve Rawlings well to actually confirm the facts before attempting to bully and grab cash. The issue has been forwarded to the *** ****** of Insurance for examination on multiple accounts.  
  
  Sincerely,
  
  ***** *****

  

  Business response

  04/15/2024

  Rawlings has re-confirmed with the prior insurer that the termination date of the Complainant’s coverage was in fact 10/31/23. Hence, there was no coverage in force through the prior insurer when he filled a prescription on 11/3/23, and Rawlings correctly sought to recover the amounts paid by its client.  (As stated in the previous response, the prior insurer’s system would not reflect the recovery efforts of Rawlings.)
  The timing and manner of paycheck withholdings by the Complainant’s previous employer is likely an issue to be resolved between the prior employer and the Complainant. 

• Initial Complaint

  03/25/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Rawlings Financial services is acting as collection agency and is charging me for prescriptions bills that does not exist. I contacted pharmacy and insurance agency and they do not have record that these debt exist.

  

  Business response

  04/04/2024

  Ladies and Gentlemen:
  
              This letter is in response to the Complaint filed with your organization bearing #********. Rawlings Financial Services, LLC (“Rawlings”) provides data mining and claims recovery services to health insurance companies and administrators, including the Complainant’s prior health insurer. As part of its work, Rawlings seeks to recover payments which were made by its clients for prescriptions filled by a pharmacy after an individual’s coverage with that insurer or plan has ended.
  
              In this instance, Rawlings confirmed that a prescription was filled after the Complainant’s coverage with the his prior insurer had terminated. Rawlings’ client, however, was billed by the pharmacy, and it paid the pharmacy for that prescription even though there was no coverage.
  
              On or about 3/19/24, Rawlings mailed to the Complainant’s address a letter regarding the claims paid after the recorded termination date of the health policy. There was no response from the Complainant until this Complaint.

  
              Rawlings made a proper request regarding prescriptions filled by the Complainant. Rawlings, however, will not make any further outreach to the Complainant related to this matter and will close its file regarding this pharmacy claim.  
              We trust that this will help to resolve the Complainant’s concerns. We certainly regret any inconvenience that this process may have caused. Please do not hesitate to let us know if additional information is needed. Thank you.

  
  

• Initial Complaint

  03/25/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received a letter from this company over 6 weeks ago stating that I owed them a bill on behalf of ****** **** for a COVID-19 vaccine. At that time, I called the pharmacy that administered the shot and discovered that they had incorrectly billed my previous insurance, as I did not have insurance at the time of the shot, and that's what was still in their system. The pharmacy took the additional steps to complete a request for the billing to be reversed, since these shots are provided for free by the government. I immediately called Rawlings and told them this. I also let them know that the pharmacy said their paperwork stated it could take up to 12 weeks for this to be fully processed. on March 19, 2024 I receive yet another bill from Rawlings Financial Services stating that I owe them/their client money that I do not owe them. They have already been made aware of this situation, and that I do not owe them a single penny. Yet they will not stop harassing me for money that they are not owed. I am printing a letter right now to send them demanding that they never contact me again or I will explore my legal remedies for their harassment and the nuisance they are knowing causing over a bill they already know that I do not owe.

  

  Business response

  03/29/2024

  This message is in response to the Complaint filed with your organization bearing #********. Rawlings Financial Services, LLC (“RFS”) provides data mining and claims recovery services to health insurance companies and administrators, including the Complainant’s prior health insurer. As part of its work, Rawlings seeks to recover payments which were made by its clients for prescriptions filled or services provided by a pharmacy after an individual’s coverage with that insurer or plan has ended. As noted in the Complaint, the Complainant’s pharmacy billed his prior insurer at a time when he did not have coverage. Rawlings’ client was nonetheless billed by the pharmacy and paid for that service. Repayment of this amount was therefore sought on behalf of the prior insurer.

  RFS mailed to the Complainant’s address two (2) letters regarding one claim paid after the recorded termination date of the health policy. Each letter provided instructions on the different methods by which the matter could be resolved.
  

  Rawlings has confirmed that the claim has now been reversed by the pharmacy, and no amount is due and owing by the Complaint. Rawlings is sending a letter to the Complainant to confirm that its file on this matter is now closed.   
  
  We trust that this will help to resolve the Complainant’s concerns. We certainly regret any inconvenience that this process may have caused. Please do not hesitate to let us know if additional information is needed. Thank you. 

  Customer response

  04/01/2024

  
  Complaint: ********
  
  I am rejecting this response because I specifically stated that I want all of my information permanently deleted from this fraudulent bill collectors system, with confirmation of that deletion. Although the response admitted that I in fact own them nor their client anything, they very intentionally did not address thus demand - despite also stating that they are a data mill, and now have all of my personal contact data for no reasonable or legal purpose.
  
  Sincerely,
  
  ****** ******

  

  Business response

  04/08/2024

  Rawlings properly sought recovery for the amount paid by it’s client at a time when the Complainant had no coverage. Once confirmation was received from the pharmacy that the claim had been reversed, Rawlings mailed to the Complainant a letter stating that the audit had been closed and no refund was due. This letter was dated 3/28/24.

  Rawlings cannot to permanently delete the Complainant’s information as requested. Rawlings is required to maintain the information it has pertaining to this audit in order to meet contractual and administrative requirements. As a Business Associate to the Complainant’s prior insurer, Rawlings will securely maintain and safeguard this information, as well as limit its disclosure, as required by HIPAA.

• Initial Complaint

  03/15/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Hello I've been dealing with my insurance company ******* **** on behalf of my son ******** ******* which covers us for health insurance however I WAS assured every medical bill that was owed was paid and cleared under MY CHILDS NAME (******** ******* (dob 2/16/2013 . However THE Attorney office WHO IS OVERSEEING THE BILS is still stating that the Rawlings Company is still stated my son has a medical tax lien that has not been paid nor covered under his name it still shows a outstanding balance that has not Shows original amount of $1815.07 and says the amount I owe is $1133.22 it says the Rawlings Company from ******* **** ( ref 133353676 This should not be showing AS I CHECK AND EVERYTHING SHOWES 0 AND THE REP ALSO DOUBLE CHECK EVERYTHING. I've been dealing with ***** ******* at the executive office that their should be no outstanding bills do that everything was paid for however the Rawlings company is still showing it owe i need them to update their information and email me a 0 balance statement this is becoming to be some sort of fraud going on at this point ad i need this to be look into

  

  Business response

  03/25/2024

  Ladies and Gentlemen:
              This letter is in response to the Complaint filed with your organization bearing #********. For over forty years, Rawlings has provided claims recovery services to health insurance companies and health plan administrators throughout the country. Rawlings seeks to recover through subrogation or reimbursement payments made by the plan for medical claims which should have been paid by other parties, such as in the case of an accident caused by a third party. Rawlings is contracted to provide these recovery services on behalf of the Complainant's health plan. The health plan paid on behalf of the Complainant's child medical claims that allegedly resulted, in whole or in part, from such an accident.
              The injured party is represented by legal counsel. For the past several months, Rawlings has been working with his attorney regarding the amounts paid by the health plan and the health plan’s legal recovery rights. On March 7, 2024, Rawlings sent a letter to the attorney regarding potential settlement of the health pan’s claims.
  
              We understand that the Complainant recently spoke with a customer representative of the  health plan and may have been informed that there is no amount due. This is incorrect. We understand that the injured party’s attorney has also spoken with the health plan, and Rawlings is waiting to hear back from the attorney regarding the results of his outreach.
  
              As the representative of the health plan regarding its recovery rights, Rawlings will continue to work with the Complainant’s legal counsel to resolve the plan’s pending recovery claim. We regret any inconvenience or concern that this process may have caused the Complainant.
  

  Customer response

  03/26/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  ******* ******

• Initial Complaint

  02/27/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was charged nearly $6000 from Rawlings for medical reimbursement bills. I would like to dispute these charges. The reference numbers are attched.

  

  Business response

  03/08/2024

  Ladies and Gentlemen:
  This letter is in response to the Complaint filed with your organization bearing #********. For over forty years, Rawlings has provided claims recovery services to health insurance companies and health plan administrators throughout the country. Rawlings seeks to recover through subrogation or reimbursement payments made by the plan for medical claims which should have been paid by other parties, such as in the case of an accident caused by a third party. Rawlings provides these services on behalf of the Complainant's health plan. The health plan paid on the Complainant's behalf medical claims that may have resulted, in whole or in part, from such an accident.

  
  The Complainant is represented by legal counsel. As such, Rawlings has exchanged communications with his attorney regarding the amounts paid by the health plan and any potential recovery. This has included providing counsel with information regarding the amount paid by the health plan, an amount less than stated in the Complaint.
  
  Rawlings will continue to work with the Complainant’s legal counsel to resolve the pending claim of the health plan. We regret any inconvenience or concern that this process may
  have caused the Complainant.
  
  
  

  
  

  Customer response

  03/08/2024

  
  Complaint: ********
  
  I am rejecting this response because: as of March 01, 2024, I do not have legal counsel. All communications should be made directly with me the insured. 
  
  Sincerely,
  
  ******* *****

  

  Business response

  03/18/2024

  The Complainant’s message to your organization dated 3/13/24 was Rawlings’ first notice that he is no longer represented by legal counsel.  A Rawlings’ manager telephoned the Complainant on 3/15/24 and again on 3/18/24. In each case, Rawlings left a voice message which included the manager’s name and a phone number at which he can be reached. As of this writing, Rawlings has not received a return call from the Complainant. Rawlings wishes to speak to the Complainant to attempt to resolve the pending claim. 

• Initial Complaint

  02/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Received a phone call from my health insurance provider today, saying I needed to contact this agency and if I didn’t, I would have Medicaid sanctions. When I called, I spoke with a representative, who told me they were investigating a bill that was 2 years old. The agent said I was mailed letters and I was told to about the issue. I asked him to verify the address to where the letters were sent to, since I moved from ********** to **** and my ID was still a ********** ID. He refused. I told him, the letters were probably sent to **********, since they probably used the address on my ID. He said that that’s no way for him to know. I said he needed to do his job and figure out before threatening me with sanctions. He took a hostile tone and I reminded him of his position in customer service and it’s HIS JOB NOT MINE to verify the address of record BEFORE the company takes action against me. I even said I would send copies of my past and current ID’s to verify my addresses. I even said I would send a copy of my fiancé’s death certificate to prove when I moved to Iowa. I NEVER received a letter from this agency. I request a letter of apology and an admission of wrongdoing. Willing to speak to the media. To automatically threaten me with sanctions is irresponsible and unacceptable. They should VERIFY ANY AND ALL INFORMATION!!!

  

  Business response

  03/04/2024

  Ladies and Gentlemen:
  
              This letter is in response to the Complaint filed with your organization bearing #********. The Rawlings Company LLC (“Rawlings”) provides claim recovery services to health insurance companies and health plans throughout the country. Rawlings seeks to recover on behalf of the health plan payments made by it for medical claims which should have been paid by other parties, such as in the case of an accident caused by a third party. Once Rawlings identifies patient treatment that may be related to an accident, Rawlings mails a questionnaire to the plan member. If there is no response, a second letter is sent.

  
              On or about July 18, 2022, Rawlings mailed to the Complainant a letter with a questionnaire. Not having received a response, a second letter was sent on August  23, 2022.  These letters provided instructions on the various ways in which the requested information could be provided (including use of a toll-free number or mailing the response using a postage-paid envelope).

  
              The address used by Rawlings to mail these letters to the Complainant was provided by the health plan, and it was in Iowa. (The address Rawlings currently has on file for the Complainant matches the address we see in the Complaint.) Rawlings is required to notify the health plan when a plan member does not respond. Such was the case here. Any resulting action by the plan is not determined by Rawlings.
  
              On February 23, 2024, Rawlings received a telephone from the Complainant’s health plan with the Complainant on the line. During this call, Rawlings was able to obtain the information requested in the 2022 letters. This fact was then reported to the health plan, and Rawlings has closed its file regarding the member and the claims which caused the 2022 letters to be sent.
  
              We apologize for any inconvenience or concern that this process may have caused the Complainant.  

  
  

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