ComplaintsforAdministrative Concepts, Incorporated

• Initial Complaint

  03/07/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have been paying a monthly fee of $204.95 for an health insurance policy. I had noticed on my account that the policy had been terminated in August of 2020. I contacted Administrative Concepts right away and asked them about it. They told me that as long as I paid the premium each month, my policy was active. They paid claims until August of 2021 and then stopped paying my medical claims, because the policy was shown as terminated. I have contacted Administrative Concepts many times to see if they have done anything to resolve the issue, but they tell me that the payment goes through another company. (The phone number that shows up on my bank statements is for Members Services. **************.) When I call to check on the status of their investigation into the matter, they ask me to be patient and that they are working on it. They have been doing this for over 6 months and nothing has been resolved.

  

  Business response

  03/21/2022

     ACI is the claims administrator for this account and we have nothing to do with enrollment, billing or premium collection/refunds.

    A review of the claims file on ************** shows that we initially did deny some claims as we were informed the policy had terminated, but subsequently went back and reprocessed them when eligibility records were corrected.  All claims we have been presented with have been processed.

  If ************** feels some billing adjustment is needed, she will have to continue to work that through with the agent at the 800 number in her complaint.

  Customer response

  04/15/2022

  [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,
  
  ***************************
  

• Initial Complaint

  12/29/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Hello, I'm writing to you about my short term disability claim that was filed on 11/3/2021.I'm still going round and round with them over this. I still haven't received payment. On 11/20/2021 they sent a fax to my doctors office with the wrong last name and address. My doctors office disregarded it because they can't send out my personal information with the wrong information. That person who sent the fax should have made sure my information was correct and should get spoken to about the mistake. The short term disability pay is my only income while I'm out of work due to surgery. On 12/8/2021 I spoke to someone about when I was going to get paid because I was running low on funds. I was told they need more information from my doctors office. On 12/9/2021 they received the fax from my doctors office. Up to 12/22/2021 I have been calling once or twice a week and emailed them. No one never had the correct answers. No one never told me that it would take 10-15 business days process a claim until 12/22/2021. All I want is to get paid. I'm behind in everything because of someones mistake. I'm going to lose my health insurance because of this also. I'm very upset over that. Something should be done about that also. I am broke now, since I haven't been paid. This is like some horrible dream. Please help me.

  

  Business response

  01/05/2022

    Hello In response to this inquiry, I offer the following information.

  *** ******'s claim was received on November 15, 2021. After initial review by our claims staff, it was determined that additional information was needed. On 11/22 we requested medical records from her physician and when a timely response was not received, we discovered the error in our request as mentioned by ****************.

  Once this error was discovered, to avoid additional delay we faxed a corrected letter to her physician requesting her medical records and they were received and entered into our system on 12/15.

  With the addition of the medical records, the claim was once again reviewed against the terms of the policy and it was determined that her disability was caused by a pre-existing condition. Claims resulting from pre-existing conditions are excluded from coverage.

  The attached letter was mailed to the insured explaining the outcome of our review and the pre-existing conditions policy language. Our claim examiner also attempted to call her yesterday, January 4, and when there was no answer left a message that a letter was coming with the results of our review of the claim.

  I believe this to be responsive to her complaint.

  Customer response

  01/07/2022

  [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,
  
  *************************
  

• Initial Complaint

  12/02/2021

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Very similar experience to the other reviews. I signed up August 26, 2021 through ******* ********* *********. The carrier is ***** ****** PPO. I had the Secure Plan; the highest tiered plan. Reviewed in detail critical test and exams that were needed for my Daughter prior to signing up. They confirmed that all of the in-network visits and exams would be covered immediately at 80%, out if of network at 70%. This doesn't include the 3 $70 visits per Doctor/Specialist. Please note that I called in numerous time prior to each visit to ensure that it would be covered; and they did. The providers (All in-network) also called directly to verify coverages before treatments and were told the same thing. In some instances for earlier appointments, the providers had to wait until we were past 30 days to get the pre-authorization from ***** ******. Fast forward, I start getting Explanation of Benefits statements from Administrative Concepts, Inc (ACI). The discounted amounts are basically what the provider would give you if you paid cash anyway. They are not paying 80% of anything. I've made numerous calls to ACI, about the discrepancy and they send me back to Supreme Insurance, who then consistently states that I do have coverage and that ACI is incorrect. I've gone through this for months. No Manager will call me back and there is no one to escalate this to. I've been given several numbers between Supreme Insurance, and Associated Healthcare Management (The customer service reps for the carrier). Both confirmed the coverage that I signed up for but ********** ****** sends me to ******* that signed me up, and ******* continues to state that ACI is incorrect and that I need to escalate it with them to get the claim paid out correctly. Neither party is willing to do a 3=way call. ACI will then state that they do not underwrite or sell any insurance policies as they serve only as a Third Party Administrator processing claims on behalf of the carrier

  

  Business response

  12/20/2021

  As requested by *************, we have re-reviewed all of the claims for ******* and ******. In both instances, we received bills without the necessary support to consider under the terms of the policies. I have attached copies of letters sent to ************** indicating what is needed to further consider the claims. We have sent copies to providers as well when necessary.

  ACI is the claims administrator and we do have a customer service department that should be able to answer his calls for information, or they will take his concerns, get the necessary information and call him back. I cannot speak to any information pre-sale or since given ************** by Supreme Insurance Solutions as ACI does not participate in the sale, premium collection, or information given him regarding the claims.

  If needed, our customer service department should be able to go through his questions, charge by charge, and explain what is needed and what coverage is available for each.

  I believe this answers his concerns, but please let me know if he has any additional questions.

  Thank you

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