Tokio Marine HCC Medical Insurance Services Group / HCCMIS.comall the claims and appeals, customer service

Review updated:

Claims department don't know the difference between existing conditions and what the patient condition was, when they went for service. We went for the condition which the patient never had in her history and we informed doctor about all the conditions she has which is no way related to the current condition (I think every patient should inform doctors about the medical history even though they are not related to the current condition and thats what we did).

If the patient has condition X currently and informed the doctor that she has history of Y and Z, that doesn't mean X is pre existing. They declined the claims saying that patient has pre-existing conditions while Y and Z are no way related to X. I appealed once saying that this is not a pre-existing condition and they declined without checking and the reason is the same. Don't know if they even look into the appeal or not and they just decline.

There is no direct link between us and the appeals department. The customer service don't know ABC's of claims.

The worst part is I called customer service and Ciara M is the representative who picked up the call. The rudest service I ever experienced in my life. I was talking to her and finding out ways to deal with the claim and appeal, and she just said I can't help it, thank you, bye bye.

I asked her name and she replied in very rude tone saying I can't give last name. I told to connect to manager and she declined. I told her I'll write a review and complaint about this behaviour and she said go ahead and do. She said bye and I'll be on the line for all day, you can do what you want...

I just muted the call and made her hang the call. This review is going on every board I can think of.

I hope the managers look into call records.

Jun 18, 2018
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  • Vi
      Nov 12, 2018

    I am facing the claims denied due to pre-existing conditions which is not the case. I even made an appeal and it got denied too. Has anyone ever got a claim approved with HCCMIS?

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