First Financial Funding Group

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.
[All reviews of this company on Revdex.com website are 1 star only along with a lot of complaints. As a customer, I believe there is a reason for that. For my case, since this company is selling their plan on the website with explanations and etc., there is no doubt their plan should at least be able to cover something. Same as what they have mentioned in their response email, my mom has visited doctors multiple times with different symptoms, if none of them is covered, I would really like to know what they cover, if they can give us some examples! Also, if this plan is such terrible that not cover anything or only cover limited things, why they are still selling it and customers are buying it? Please don't take customers as stupid people, I believe the only reason that they sell this kind of insurance plan with all those "attractive" conditions and price is trying to fraud/trick their clients; they are expecting us not to visit a doctor, and even we did, they will not cover with "proper" reasons/explanations always! Since they will not cover anything, all I want is to at least get my $700+ insurance fee returned. What they have mentioned those questioned statements are simply ALL the doctor visits my mom did during her stay in the US.]
Regards,
[redacted]

Dear Revdex.com: The claims of Mr. [redacted] have been adjudicated in accordance with the insurance certificate. Yours truly, Carolyn R. O[redacted]Assistant to General Counsel

Dear Revdex.com:I have reviewed the file for Ms. [redacted].  The Insured is a citizen and resident of China who purchased an international plan for coverage while she was traveling outside of her home country of China.  The international plan in question contains a number of conditions...

and exclusions to coverage, and is neither a comprehensive health insurance contract nor a general health plan.The Insured purchased the international coverage effective October 31, 2016, and immediately sought medical care beginning November 1, 2016.  Regrettably, based on our medical staff's review of the clinical records, IMG concluded that the insurance did not cover this care, because (1) it was the result of a pre-existing condition and (2) it appears that the insured purchased with intent to claim immediately.The complaint was reviewed as an appeal of the denial, and the claims were adjudicated in accordance with the plan.  Yours truly, Carolyn O[redacted]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 the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I sent two claims. The first on the third for the wire transfer and the tenth for my eye appoint. A total of over the amount that I would most likely receive back. For it to just not be processed because I have contacted them relentlessly and filed a claim, is unacceptable. 
Regards,
[redacted]

Certain items must be submitted by or on behalf of the Insured Person to be considered a complete Proof of Claim eligible forconsideration of coverage (“Proof of Claim”) including but not limited to a duly completed, timely submitted, and signed Claim Form and authorization for release of...

information. The Insured Person has ninety (90) 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.  The Insured Person has not submitted a duly completed, timely submitted, signed Claim Form or authorization for release of information which is located at http://www.imglobal.com/en/client-resources/claims.aspxActual eligibility determinations, benefit verifications, final coverage decisions and claim adjudications, and final payments and/orreimbursements of benefits or claims can be determined and adjudicated only after or at the time a proper and 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 when deemed necessary or appropriate by the Company, are presented in writing.  If a definite answer to a specific benefits or coverage question is required for any reason, the Insured Person may submit a written request to the Company, including all pertinent medical information and records, and a written reply will be sent by the Company.If the Insured Person disagrees with a decision of the Company, the Insured Person may in writing ask the Company to reconsiderthe decision and supply additional documentation to support the appeal.  The Company will reconsider its decision based on review of the additional documentation and facts, if any.  The Company will advise the Insured Person of its decision within a reasonable time framefollowing receipt of additional documentation and facts.

In review of the file, the request for cancellation was made after the month of coverage had started.  The request for cancellation was denied correctly, in accordance with the insurance plan, only full unused months of coverage are refunded, and must be requested prior to the...

coverage period.  The cancellation request was made on January 31, 2017, and for coverage refund it would have to have been received prior to January 27, 2017.  Yours truly, Carolyn R. O[redacted]Assistant to General CounselInternational Medical Group, Inc.

Dear Revdex.com:I am sorry Ms. [redacted] is unsatisfied with my response.  As stated previously, the numerous providers did not promptly reply to the records requests, which delayed the claims reviews.  I just spoke with the Benefit Review team and all claims have been adjudicated. Yours truly,Carolyn R. O[redacted]Assistant to General CounselInternational Medical Group, Inc.

An authorization allowing the release of information protected under confidentiality and privacy laws has not been supplied.  If an answer to a specific benefits or coverage question is required for any reason, the Insured Person may submit a written request to the Company, including all pertinent medical information and opinions, and a written reply will be sent by the Company.

Dear Revdex.com and Ms. [redacted]: IMG received the claim on 1/10/2018, and the claim was processed on 2/15/2018.  Yours truly,Carolyn R. O[redacted]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 find that this response/resolution is satisfactory to me. Although there is still one account still awaiting a response.  I would rather have had an apology in addition to the resolution but I am very grateful that at last the issues are being settled.  
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.
My original complaint was lodged as a representative from the Insurance company already categorically stated that my claim was not valid for the reasons stated in my original claim.  The company is now changing its stance and stating that a claim form must be submitted.  If this is the case, why was it not communicated earlier.I shall submit a claim as required but I still require clarification on how the insurance company can sell travel insurance and expect the person to be insured for 90 days before a claim could be submitted.  If I resided in the USA for 90 days then I would NOT require travel insurance.
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.
I am the person who bought the insurance for my mother. All the expenses are paid by me. I have submitted claim forms along with a letter which says expenses will be reimbursed on my name in return. All the necessary documentation was sent to IMG. I called many times (even they can check the history as well). I have not got proper response from customer agent. Customer agent says - whole organization wide claims are running behind the schedule and none of the claims they are able to process it. If this is the situation, why are they selling the insurance to the innocent customers. I want my money back which I paid for the insurance or reimburse the expenses incurred. I have attached the emails proofs.
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.
I have attached the forms related to four claims. In all of them, the response is the same, a full denial, even though the services should be covered by IMG.The response obviously uses a generic customer service language, something companies often do in order not to address what the customer is saying.Besides that, there are obviously claims, and I have also submitted an appeal to the denial of coverage on claim [redacted]. I submitted it on August 24, 2016, and I've got an automated message stating "of receipt of your e-mail by IMG and to assure you that we will handle your correspondence in a timely manner". Guess what? We are starting the month of October, and I never received a response to that. IMG never got in touch with me.This is the worst customer experience I´ve have in my 38 years of life. It´s unbelievable.
Regards,
[redacted]

If the Insured Person disagrees with a decision of the Company, the Insured Person may in writing ask the Company to reconsider the decision and supply medical records and additional documentation to support the appeal. The Company will reconsider its decision based on review of any additional documentation and facts.  The Company will then advise the Insured Person of its decision within a reasonable time frame following receipt of any additional documentation and facts.

An authorization allowing the release of information protected under privacy and confidentiality laws has not been received from the insured/patient.  It appears a relative of the insured/patient has communicated with your organization.Eligibility determinations, benefit verifications, final...

coverage decisions and claim adjudications, and final payments and/orreimbursements of benefits or claims are determined and adjudicated only after or at the time a proper and 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 when deemed necessary or appropriate by the Company, are presented in writing.  If a definite answer to a specific benefits or coverage question is required for any reason, the Insured Person may submit a written request to the Company, including all pertinent medical records, and a written reply will be sent by the Company to the Insured Person.  Information regarding benefit decisions, 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

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] In the event all or part of a...

claim is denied, the insured 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 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, there is an opportunity for further reasonable investigation and review, and the response will be made as soon as reasonably practicable and within 90 days.

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.  Another copy of Explanation of Benefit statements, declarations of insurance, and insurance...

contracts can be reviewed at 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. Certain items must be submitted by the Insured Person to be considered a PROOF OF CLAIM eligible for consideration including but not limited to a completed, timely, signed claim form.  The Insured Person 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 along with medical records related to the charges.  A review of the medical records, any additional documentation, and the facts will be undertaken and the Insured Person will then be advised that 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.I have not received any apology from IMG for the time and stress that has occured while I am awaiting settlement of the claims.  I have received no explanation as to why Mr G[redacted] did not return my calls.  I have had to settle a bill myself with one of the providers, which is related to the new onset of hypertension and therefore is not a 'pre-existing' condition.  I have another account which requires settlement by July 29th and although I have been told that I will have receive answers from IMG within a week - I still have no answer.  
Regards,
[redacted]