First Financial Funding Group

An authorization allowing the release of PHI, PII, and NPI has not been provided, therefore, confidentiality and privacy laws will not permit the sharing of that information with a third party. Eligibility determinations, benefit verifications, coverage decisions, and payments of benefits can
be determined and adjudicated only after Proof of Claim is submitted, an opportunity for reasonable investigation and/or review is provided, cooperation is received, and all facts and supporting information, including relevant data, information and medical records are presented in writing. Certain items must be submitted by the Insured Person to be considered a complete Proof of Claim eligible for consideration of coverage including but not limited to a completed, timely, signed Claim Form and authorization for release of information. The Insured Person has days from the date a claim is incurred to submit a complete Proof of ClaimIf the Insured Person wishes to submit Proof of Claim, the form located at www.imglobal.com/en/client-resources/claims.aspx will need to be completed and returned along with medical records related to the chargesIn the event the Company denies all or part of a claim, the Insured Person can appeal the denial under which there will be a review of the claim and the determinationInsured Persons have days from the date that the notice of denial was mailed within which to appeal the determination, and have the opportunity to submit written comments, documents, records, and other information relating to the claimThe Company’s review will take into account all comments, documents, records, and other information submitted by the Insured Person relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination

Mr***'s claims have all been adjudicated. A stop-payment was placed on previous claims payment check which was never received, and reissued. If you have any additional questions, please let me know. Yours truly, Carolyn O***Assistant to General Counsel

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
In the response, the business claimed that I am not valid insured personIn fact I amTheir delay of processing claims and multiple followup with no proper response is not acceptable business standard. Regards,
*** ***

RevDex.com:IMG only responded to my claim after my filing a formal complaint with the Revdex.comPrior to that there were numerous denials & outrightstatements regarding my claimI appreciate your intervention because without it I would have been cheated out of thousands of dollars.it is my opinion that this company has probably done this to others as wellNever even received an apologyWill certainly never use their services again
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to me.
Regards, *** ***
*** ***

Information regarding amounts paid, dates of payment, and
medical providers paid can be reviewed within Explanation of Benefit statements
communicated to the Insured Person or accessed at
https://myimg.imglobal.com In the event
the Company denies all or part of a claim, the Insured Person
has a reasonable opportunity
to appeal the denial under which there will be a review of the claim and the
determination Insured Persons shall
have days from the date the denial was mailed to the Insured Person within
which to appeal the determination, and have the opportunity to submit written
comments, documents, records, and other information relating to the claim The Company’s review will take into account
all comments, documents, records, and other information submitted by the
Insured Person relating to the claim, without regard to whether such
information was submitted or considered in the initial claim determination Upon receipt of a written appeal, the Company has
an opportunity for further reasonable investigation and will respond in writing
as soon as reasonably practicable, or within days

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I talked to the clinic I went and they said that all claim forms were sent to themThey just denied and don't want to pay bills I got from clinic.
Regards,
*** ***

An authorization allowing the release of PHI, PII, and NPI has not been provided, therefore, confidentiality and privacy laws will not permit the sharing of that information with a third party. Certain items must be submitted by the Insured Person to be considered a complete Proof of Claim eligible for consideration of coverage (“Proof of Claim”) including but not limited to a completed, signed Claim Form and authorization for release of information. The Insured Person has days from the date a claim is incurred to submit a complete Proof of Claim, and the Company at its option may pend resolution and adjudication of submitted claims and/or may deny coverage: for Proofs of Claim submitted thereafter; for incomplete Proofs of Claim; and/or for failure to submit a Proof of Claim. If the Insured Person wishes to submit Proof of Claim, the form located at www.imglobal.com/en/client-resources/claims.aspx will need to be completed and returned along with medical records related to the chargesIn the event the Company denies all or part of a claim, the Insured Person can appeal the denial under which there will be a review of the claim and the determinationInsured Persons have days from the date that the notice of denial was mailed within which to appeal, and the opportunity to submit written comments, documents, records, and other information relating to the claimThe Company’s review will take into account all comments, documents, records, and other information submitted by the Insured Person relating to the claim, without regard to whether such information was submitted or considered in the initial claim determinationUpon receipt of a written appeal, the Company shall have an opportunity for further reasonable investigation and review and will respond in writing as soon as reasonably practicable, and within days from receipt thereof

Dear Ms*** and Ms***: The file shows that IMG received two (2) pieces of correspondence the wire transfer information and the claim. The claim was received on 1/10/and the claim was processed on 2/15/2018. I am not sure what additional information that can be provided. The claim was paid in the course of business.Yours truly,Carolyn RO***Assistant to General CounselInternational Medical Group, Inc

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[I already sent written email few months back on the concern with claims rejected stating pre-existing condition even though it is not. But no action from insurance company. I was told to contact doctor office to discuss further & not with insurance company. I am getting bill dues from Doctor office as claims were rejected]
Regards,
[redacted]

The individual is not the insured.  Without an authorization from the insured, confidential and private information cannot be shared with third parties.  Another copy of the declaration of insurance, insurance contract, and Explanation of Benefit statements can be accessed via...

[redacted]  Certain items must be submitted by the Insured Person to be considered a complete Proof of Claim eligible for consideration of coverage including but not limited to a completed, timely, signed Claim Form and authorization for release of information.  The insured has 90 days from the date a claim is incurred to submit a complete Proof of Claim.  If the Insured Person wishes to submit Proof of Claim, the form located at www.imglobal.com/en/client-resources/claims.aspx will need to be completed and returned.In the event the Company denies all or part of a claim, the Insured Person can appeal the denial under which there will be a review of the claim and the determination.  Insureds have 60 days from the date the notice was mailed within which to appeal the determination, and have the opportunity to submit written comments, documents, records, and other information relating to the claim.  The review will take into account all comments, documents, records, and other information submitted by the Insured Person relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination.  Upon receipt of a written appeal from the Insured Person, the Company shall have an opportunity for further reasonable investigation and review, and will respond as soon as reasonably practicable and within 90 days.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. my ID is [redacted]
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[Provide details of why you are not satisfied with this resolution.]This response from IMG is not acceptable. Two written appeals were made by Stanford hospital to IMG (In January 2015 and March 2015) where the doctors office treating my mom at Stanford hospital has provided all the details of her case and have specifically called out in writing that her condition cannot be considered pre-existing. IMG on both times came back stating they consider my mothers condition is pre-existing. The doctors at Stanford hospital do not agree with IMG's assessment. They are unclear who has done the assessment and on what basis as all the medical records that IMG has are from Stanford and Washington hospital that the Stanford doctors have either generated or assessed. Stanford hospital has provided their full support to my mother and me to raise this situation and our concern to Revdex.com .The response from IMG is inadequate ( written appeals have been made) and they should re-assess their response to the appeals.Stanford doctors who have been treating my mother do not agree with IMG response. 
Regards,
[redacted]

The person submitting the complaint does not appear to be the insured person.  An authorization has not been provided by the insured person allowing the release of PHI or PII to third parties.  That form can be accessed via http://www.imglobal.com/pdf_forms/claimform-interactive.doc...

Information regarding any amounts paid, dates of payment, and medical providers paid can be reviewed within Explanation of Benefit statements communicated to the Insured Person or accessed at https://myimg.imglobal.com If the Insured Person disagrees with any decision(s) communicated, the Insured Person may ask the Company to reconsider that decision and supply medical records and opinions to support the appeal.  The Company will then reconsider its decision based on review of any additional documentation and facts and advise the Insured Person of its decision.

Dear Mr. [redacted]:The claims submitted are pending adjudication for receipt from you of the following:1.  Travel documents;2.  Proof of other insurance and copy of Explanation of Benefits; and3.  Proof of Residency outside of Home Country (USA) for at least the past 6 months from the...

date of application.Please submit the required documents directly to the IMG Claim Department, or you may send them directly to my attention.Yours truly, Carolyn R. O[redacted]Legal AssistantInternational Medical Group, Inc.2960 North Meridian StreetIndianapolis, IN 46208

If any insured needs another copy of their insurance information, the ability to access the insurance contract, declaration of insurance, and ID cards, submit claims, view claim status, and pre-certify treatment is available by visiting https://myimg.imglobal.com Eligibility determinations, benefit...

verifications, coverage decisions, and payment of benefits can be determined only after a complete Proof of Claim is submitted, an opportunity for reasonable investigation and/or review is provided, cooperation is received, and all facts and supporting information, including relevant data, information and medical records are presented in writing. Eligible Medical Expenses under this insurance previously paid by the insured person at the time of the Company’s favorable adjudication will be reimbursed.  Claim settlements, payments and reimbursements remain subject to the deductible, coinsurance, limits, and all other Terms of this insurance.  Information regarding amounts paid, dates of payment, and medical providers paid can be reviewed within Explanation of Benefit statements communicated to the insured person or accessed at https://myimg.imglobal.com

In review of the file for Ms. [redacted], doctor visits/claims were submitted for the period January - May 2017, with several physicians.  Medical records were requested from each physician, with not all physicians promptly providing the requested records.  The Claims Review Team pulled all the...

information together and the claims are being adjudicated in accordance with the certificate of insurance, and Explanation of Benefits should be sent within the next week.If you have any additional questions, please let me know. Yours truly,Carolyn R. O[redacted]Assistant to General CounselInternational Medical Group, Inc.

An authorization has not been provided by the insured person allowing the release of PHI or PII to third parties. That form can be accessed via http://www.imglobal.com/pdf_forms/claimforminteractive.docInformation regarding any amounts paid, dates of payment, and medical providers paid can be reviewed within Explanation of Benefit statements communicated to the Insured Person or accessed at https://myimg.imglobal.comIf the Insured Person disagrees with any decision(s) communicated, the Insured Person may ask the Company in writing to reconsider that decision and supply medical records and opinions to support the appeal. The Company will then reconsider its decision based on review of anyadditional documentation and facts and advise the Insured Person of its decision.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[Provide details of why you are not satisfied with this resolution.]Response received was generic process information and nothing specific to my issue
Regards,
[redacted]

The individual submitting the complaint is not the insured or the patient.  Neither the insured nor the patient have authorized the sharing of information protected under confidentiality and privacy laws with third parties such as your organization.In the event the Company denies all or part of...

a claim, the Insured Person has a reasonable opportunity to appeal the denial under whichthere will be a review of the claim and the determination.  Insured Persons have the opportunity to submit written comments, documents, records, and other information relating to the claim.  The Company’s review will take into account all comments, documents, records, and other information submitted by the Insured Person relating to the claim, without regard to whether such information was submitted or considered in the initial claim determination.  Upon receipt of a written appeal from the Insured Person, the Company has an opportunity for further reasonable investigation and review, and will respond in writing to the Insured Person as soon as reasonably practicable.

Dear Revdex.com and Ms. [redacted]:IMG has not received enough information to match Ms. [redacted] as an Insured.  If you can provide a Certificate number or Insured ID number, I will be happy to review your file. Yours truly, Carolyn R. O[redacted]Assistant to General CounselInternational...

Medical Group, Inc.