ComplaintsforNAHGA Claim Services

• Initial Complaint

  06/21/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My daughter was badly injured while at daycare on 5/16/2023. The injury required an immediate visit to the children's ER Hospital. The Daycare is insured with NAHGA. NAHGA was supposed to handle the bills associated with the hospital visit and they have not. I called several times and emailed several times after this incident occurred and got no where. I spoke with the Daycare and they also advised they called them and were told it was being worked. Fast forward to today 6/21/24, I receive an invoice for an outstanding balance with the hospital. I immediately called NAHGA and spoke with ***** around 2pm ET. She was not helpful. I then called the hospital billing department and they advised that they billed NAHGA numerous times and they never received a reply or payment so now the balance is being pushed onto the consumer (me) and since it has been x amount of days, it is going to collections which is going to affect my credit. I called back to NAHGA and spoke with *****. She said that she would get a message to the adjuster ***** to work this. She would not give me a direct # or contact for the adjuster *****. When I asked why the ball was dropped on this for over a year now, she said something about they use a company called Occunet and they assumed this was taken care of and nothing was owed. This is not acceptable good faith claims handling practices. NAHGA needs to pay the outstanding balance to the hospital IMMEDIATELY.

  Business response

  06/28/2024

  June 28, 2024
  
  Better Business Bureau of **********, **, ** and **
  5 Mt. ********************
  ***********, *******; 01752-4705
  
  Re: Complaint #******** ***************************/on behalf of *************************
  
  Dear ********** ********** are in receipt of your June 21,2024 complaint from ***************************, on behalf of minor member *************************, regarding an ********************* of ********* claim. NAHGA Claim Services (hereafter NAHGA) is the Third-Party Claims Administrator for this Blanket Accident-Only policy issued to ********************* of *********, on behalf of the insurance carrier, ***************************************** ************************* is covered under the Blanket Accident-Only policy issued to ********************* of *********. This is not a self-funded plan and does not meet the criteria for *************** Act coverage. In addition, the Policy issued provides coverage on a primary basis.
  
  To date NAHGA is in receipt of the one claim on file and this was originally processed on 09/01/2023 directly to the member.  This was processed using a discounted rate through a third-party negotiator, Zelis.  The provider is balance billing the member and did not follow the appeal guidelines on the explanation of benefits.  NAHGA was made aware of the balance billing on 06/21/2024 by *************************** and has followed up with the provider and ***** regarding the balance being billed to the member.
  
  In order to resolve this matter NAHGA processed a supplemental payment on 06/26/2024 with reimbursement to *************************** and balance paid to **************************
  
  I trust this resolves the complaint; please feel free, however, to contact me should you require any additional information or have further questions.
  
  Thank you.
  
  Sincerely,
  April K, *****************
  NAHGA Claim Services
  Cc: ******************************** Company      

• Initial Complaint

  11/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On April 14, 2023 my son was injured while playing in a county sponsored youth baseball game. The injury required a visit to the local emergency room. During that visit I paid for for the medical charges and subsequently was instructed that the league had an insurance provider that would handle the expenses. Attempts to file the claim for reimbursement with the provider have been going on for over six months no with no resolution in site. Back and forth emails and calls with NAHGA and the local rep (actual provider with the county, ************* Agency **** ******** **) have yielded no results. The provider requires an itemized bill from the healthcare provider, VCU. *** Health has been contacted several times to provide the information and claims to have sent it yet NAHGA continues to deny the claim stating the same itemized bill is necessary.

  Business response

  11/29/2023

  November 28, 2023
  
  Better Business Bureau of *************************
  5 *************, Suite 100
  ***********, **  01752-4705
  
  Re: Complaint #********-***************************/on behalf of ****** Loving
  
  Dear ********** ********** are in receipt of your November 21, 2023 letter and complaint from ***************************, on behalf of minor member *******************, regarding a ******** ***************** Baseball claim. NAHGA Claim Services (hereafter NAHGA) is the Third-Party Claims Administrator for this Blanket Accident-Only policy issued to ******** ***************** Baseball,on behalf of the insurance carrier, ***************************************** ****** loving is covered under the Blanket Accident-Only policy issued to ******** ***************** Baseball.  This is not a self-funded plan, and does not meet the criteria for *************** Act coverage. In addition, the Policy issued provides coverage on an excess basis and pays eligible benefits in excess of any other primary insurance the covered person may have in effect.
  
  All medical claims on file have been processed and considered for payment on 11/28/2023 with reimbursement paid directly to ****************************
  
  I trust this resolves the complaint; please feel free, however, to contact me should you require any additional information or have further questions.
  
  Thank you.
  
  Sincerely,
  
  April K, *****************
  NAHGA Claim Services
  Cc: ******************************** Company
  

• Initial Complaint

  10/31/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I competed in a professional mixed martial arts bout on 5.13.23 and dislocated my thumb during the fight. The *** ligament had popped. I required surgery to repair this injurty. NAHGA is the fight promotions insurance agency and they are supposed to cover any amount not covered by my personal insurance. The bills came to ~ $1300 after my insurance paid. NAHGA **** out the processing of my bills for several months (5 months), continually requesting additional documents. One month after receiving the final documents they requested, they denied the claim. They denied the claim because "THE **** POLICY DOES NOT COVER INJURIES WHICH RESULT OVER A PERIOD OF TIME,AND WHICH ARE A NORMAL, FORESEEABLE RESULT OF THE SPORT."This is not an injury that is normal or resulted over a period of time. It was an acute injury that happened during the fight. The doctor that looked at my hand after the fight, did not have an X-ray or MRI machine to use. He spoke with me and thought the damage was to my already damaged wrist. The surgeon and urgent care both acknowledged that this was an acute injury, as listed in the attached documents. The remaining portion of the bills is their responsibility and I would like it paid in a timely fashion. The bills are going to go to collections, so I will now have to pay out of pocket, to avoid having the bills sent to collections. This is for each claim listed under Case #******

  Business response

  11/10/2023

  
  
  
  November 10, 2023
  
  Better Business Bureau of *************************
  5 *************, Suite 100
  ***********, **  01752-4705
  
  Re: Complaint #********-*********************
  
  Dear ********** ********** are in receipt of your October 31, 2023 letter and complaint from ********************* regarding a North American Boxing claim. NAHGA Claim Services (hereafter NAHGA) is the Third-Party Claims Administrator for this Blanket Accident-Only policy issued to North American Boxing, on behalf of the insurance carrier, United ****************************** ************** is covered under the Blanket Accident-Only policy issued to North American Boxing.  This is not a self-funded plan, and does not meet the criteria for *************** Act coverage. In addition, the Policy issued provides coverage on an excess basis and pays eligible benefits in excess of any other primary insurance the covered person may have in effect.
  
  All medical claims have been processed and considered for payment after the $500 deductible which the member will be responsible.
  
  I trust this resolves the complaint; please feel free, however, to contact me should you require any additional information or have further questions.
  
  Thank you.
  
  Sincerely,
  
  April K, *****************
  NAHGA Claim Services
  Cc: United *****************************

• Initial Complaint

  08/04/2023

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  This company has continued to drag out my claim. I had surgery in November and this third party insurance is supposed to cover the claim. Every time I call or email (now over 50 contacts) they keep changing their requirements, asking for documents that I have already sent, said they need more documents, tell me they have everything they need and the claim is processing, but then claiming they need more documents next time I call. They are not communicating through their portal and are absolutely dragging this out. They have paid me part of the claim, but are silent on the rest until I call again. It is now August and I was told in JANUARY that this would take **************************************************************************************** they are "escalating" my claim and an adjuster will be in touch...but no one ever is.

  Business response

  08/14/2023

  August 9, 2023
  
  
  BBB of Eastern MA, ME, RI &VT
  5 *************, Suite 100
  ***********, ** 01752
  
  Dept. File #: 20424423
  Complainant:  ***********************
  
  NAIC: 18058
  
  To Whom it May ****************** are in receipt of your August 4, 2023 complaint from ***********************. NAHGA Claim Services (hereafter NAHGA) is the Third-Party Claims Administrator for this Blanket Accident-Only policy on behalf of *****************************************
  
  In order to consider charges for payment we must secure the insurance itemized billing forms (HCFA1500/UB40),primary insurance explanation of benefits and proof of payment from the member,if applicable. This information was requested from both *********************** and the medical provider on 02/09/2023, 03/10/2023, 04/11/2023 and 05/9/2023. As the information was not sent in properly, we were unable to issue payment for the claims.
  
  The adjuster was able to connect with the providers to collect missing information for processing of the claims.  At this time all claims have been resolved with payments to the claimant and/or provider. 
  
  The supervisor spoke to the claimant on 07/26/2023 to provide confirmation that we had processed all claims on file and any reimbursements were being sent out to her.  Supervisor advised the claimant to reach out directly if additional questions or concerns did arise.
  
  I trust this resolves the complaint; please feel free, however, to contact me should you require any additional information or have further questions.
  
  Thank you.
  
  Sincerely,
  
  *************************
  NAHGA Claim Services

• Initial Complaint

  03/25/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My husband had an accident insurance policy with the boxing promotion company he was contracted with. He was injured during an event on October 29, 2022 and incurred $950 in out of pocket expenses related to an urgent care visit and hand specialist visits. He had a $500 deductible which was met and they paid out $75 for the charges connected with one visit my husband had. We submitted an updated itemized and a secondary itemized for the dates of service: 11/03 and 12/02. Per the insureds policy covers the expenses at 100% after the deductible is met up until the limit maximum. He is due $375 and the adjuster now has ceased all forms of communication prompting us to file a complaint with the BBB. We have sent numerous e-mails with no response. Our last attempt was on 03/18/23 communicating our intention to file a complaint and their last e-mail to us was on 02/28/23. We have now spent a considerable amount of time trying to get the athlete reimbursed for his covered injuries. We are seeking the full reimbursement for the amount owed plus interest, before pursuing legal action. To be clear: there is a provision in the ***** Protection of Policyholders Regulations 2017 (earlier since ****), that insurers shall be liable to pay interest for delay beyond a period as stated in the regulations. Sec. 15, Sub-section 8 provides that after receipt of the final survey report or the additional survey report, and on receipt of all required information/documents that are relevant and necessary for the claim, an insurer shall, with in a period of 30 days offer a settlement of the claim to the insured/claimant. Subsection 10 states: In the event the claim is not settled within 30 days as stipulated above, the insurer shall be liable to pay interest at a rate, which is 2% above the bank rate from the date of receipt of last relevant and necessary document from the insured/claimant by insurer till the date of actual payment. They received all required documents by 2/10.

  Business response

  04/06/2023

  March 31, 2023
  
  Better Business Bureau of *************************
  5 *************, Suite 100
  ***********, **  01752-4705
  
  Re: Complaint #********, insured member
  
  Dear Sir/Madam,

  All medical claims have been processed and considered for payment after the $500 deductible which the member will be responsible. The last payment for the case was issued on 3/17/2023 in the amount of $375. The claimant should have all monies for reimbursement collected at this time.
  
  I trust this resolves the complaint; please feel free, however, to contact us should you require any additional information or have further questions.
  
  Thank you.
  
  Sincerely,

  NAHGA Claim Services

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩