Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:29/12/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Ref: ********** I had a eye examination claim for $70 which is eligible under my plan. This was serviced on Aug 17, 2022. ************ took a long time to reply and I send an inquiry Oct 13, 2022 and they replied back on Oct 26, 2022 giving the below reasons for denial:"Our records indicate the claim for eye exam has declined for the services were provided by and ineligible practitioner. Please note since this profession is regulated in *******, the practitioner must be a Registered member in good standing with the **********************************, in order for services to be eligible for coverage" I called them explaining my parents used the same optometrist and were able to claim the expense as the optometrist is licensed and yet they denied. I left this aside for a while as I was pursuing my post graduate. Now that I am done, I have done some research and found through the ********************************** "*********************" my optometrist has been licensed since 2014. Hence, this claim should have been made in the first place. I'm requesting my claim of $70 (no deductible) to be fully reimbursed. As a student paying out of pocket, I believe it's a fair claim. I'm enclosing all necessary supporting documents. Thanks,

  Business Response

  Date: 05/01/2024

  When the claim was initially received, the provided receipt was unclear as to the practitioner who performed the eye exam.The name of the optician listed was processed, and the claim had rejected as an optician is not considered an eligible provider for an eye exam.  The name of the ******* ********************** did appear on the receipt, though this was not recognized as the practitioner providing the eye exam, at the time the claim was processed.
  
  We had received follow-up correspondence in May 2023 regarding the optometrist providing the service, and the member was advised at that time the plan was no longer active, with the coverage terminated on August 31, 2022.
  
  The claim for the expense incurred on August 17, 2022, is now well over 12 months old, and exceeds the plan run-off period for claim and/or supplementary documentation submissions.  As the third-party administrator for this plan, no further corrective action can be taken for this claimed expense.  The coverage provided by the plan is no longer available for consideration of reimbursement.

  Customer Answer

  Date: 07/01/2024

   
  Complaint: 21070150
  
  I am rejecting this response because:

  If you review the attached claim form I submitted it was clearly indicated the practitioner's name as *********************. It was understood that ************************* who also wrote a receipt for the service rendered which has been attached was the one who performed the service. As per my last correspondence, ************************* is an eligible optometrist since 2014. I was never given such detailed explanation as given now through BBB. The explanation - titled - REJECTED CLAIM attached was "Services have been provided by an ineligible practitioner". When I called to inquire I was never given the reason for reject except it was provided by an ineligible practitioner. It is clear that this claim was eligible in the 1st place but was not looked properly by ************. The only reason I opened this claim back was when my parents told me that ************************* is an eligible optometrist and the claim of $70.00 for services rendered should have been approved in the 1st place and never rejected. To go further, ************ took a long time to reply back to my claims, this is evident in the *** inquiry Regarding.... This in turn extended the delay in processing and hence missing my chance for claim. 

  I believe ************ should have looked into this carefully and instead of just giving a reason of "Services have been provided by an ineligible practitioner", should have explained properly. I had also included the invoice from ************************* - the optometrist. No practitioner would unnecessary issue an invoice for an amount of $70.00, this ************ should have picked up on in the 1st place. Finally, the lengthy delay whether it was deliberate or not is deceiving insured like us in forgetting or letting our claims go. I understand this has gone past the expiration but it should have been dealt properly. I humbly request ************ in honouring their responsibility and refunding the $70.00 claim I put forth. 
  
  Sincerely,
  
  *****************************

• Initial Complaint

  Date:14/11/2023

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am deeply disappointed and disturbed by the way in which my claim is being handled for an accidental injury I sustained in May 2022 during which I lost SIX of my front teeth! This company is a scam!They initially approved a quote I submitted with my surgeon and dentist, but they funded me the money instead of just approving or denying the quote. As I have required extensive reconstructive dental work due to this accident, I did not know the total cost and cost the recovery from each procedure lasted weeks if not months. I called ClaimSecure and informed them that they deposited the money to me when it was just supposed to be a quote. They took the money back and admitted to their mistake but assured me the costs would be covered once I completed all the work and submitted the final cost to them.Low and behold they are refusing to pay now that the first half of my surgeries are completed saying it took more than one year!!!!!I am thousands of dollars out of pocket with a mortgage that is about to double, a small toddler, and my wife is expecting! They are causing us pain and suffering for an accidental injury that has affected my quality of life for the past 18 months!!!! I cannot believe the way in which these people do business.I have no responses from them, they refuse to get back to me, no explanation of why this was covered then suddenly not. I have provided the letter from the doctor and the surgeon. I have it all in writing.The next step is to *** them as Ive already alerted my attorney!I require them to pay me back for the accidental injury repair that they promised to cover the costs of! I have fronted this money and shouldnt be required to suffer for something Im paying this company to be honest responsible for each month!!!

  Business Response

  Date: 16/11/2023

  The plan provider has been in contact with us regarding the claim for services relating to the accidental injury, and has approved a treatment extension beyond the plan parameters of all related services must be completed within 12 months from the date of the accident, due to the severity of the injury.  The claim is currently being reviewed and will be reimbursed accordingly.
  
  As the third-party administrator for the benefit plan provided by the employer, claims are processed based on the plan parameters set by the plan provider.  We received a call regarding the rejection of the claim, and had advised of the terms of the plan, and the appeal process.  The terms and conditions regarding accidental dental services are outlined in the employee benefit booklet, available through the employee portal.  An appeal of the claim decision was received by the employer, and was in the process of review at the time of the complaint.  The employer has now confirmed the approval of an extension.

• Initial Complaint

  Date:07/09/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Just had the worst experience with this medical provider..9/6/2023 .HIGHLY "SUGGEST" you find a better benefit provider!!Had a prescription from my knee surgeon to have "custom orthotics" made took my PRESCRIPTION to my chiro as my surgeon is over an hour away. He did the 3D fitting ordered them, I had to pay in advance then submitted my expense...INCLUDING the prescription from the Surgeon and now Claimsecure has refused to pay me because it done through the *********************** MAKES NO SENSE WHERE I GOT THEM IF I HAD A PRESCRIPTION!!!

  Business Response

  Date: 11/09/2023

  As a standard, registered podiatrists, chiropodists, pedorthists, orthotists,and certified orthopedic footwear specialists are considered eligible dispensers for orthotics, as they are specialists of the feet or specialists in orthotics/prosthetics. With benefit plans following this standard, a claim for orthotics dispensed by a chiropractor is not eligible for reimbursement.
  
  For orthotics to be eligible for coverage, they must be prescribed by a physician, chiropodist or podiatrist and dispensed by a registered podiatrist, chiropodist, pedorthist, orthotist or certified orthopedic footwear specialist. In addition to this approval criteria,the prescriber and dispenser must be two different providers unless the orthotic was sent to an offsite laboratory to be fabricated.

  It is recommended to submit an estimate prior to purchasing a high-priced item or service. The estimate is an opportunity for written confirmation of the eligibility for coverage, including plan limitations and criteria for coverage.  

  To review this specific claim in more detail, the plan members group and certificate numbers are required. 

  Customer Answer

  Date: 11/09/2023

   
  Complaint: 20569556
  
  I am rejecting this response because:
  
  Sincerely,
  
  ***********************