Land of Lincoln Health

Revdex.com of Chicago & Northern Illinois 330 Wabash, Ste. 3120 Chicago, IL 60611 RE: Case [redacted] To Whom It May Concern: Land of Lincoln Health received case [redacted] regarding a claim appeal. We have...

verified that the appeal for services on the date of service 7/16/15 has been approved. The member will be receiving a formalized letter shortly with additional details related to this claim and payment. Best Regards, Land of Lincoln Health

Revdex.com Chicago & Northern Illinois
330 Lower...

Wabash Ave Chicago, IL 60611
 
 
 
RE: Case [redacted]
 
To Whom It May Concern:
 
Land of Lincoln Health received case [redacted] regarding the timeliness of medical claims payment.
 
Effective 1/1/2016, LLH pended all 2016 claims while we conducted an audit to ensure accurate processing. The audit was completed on 2/28/2016 and we lifted the claims hold on 2/29/2016. The member has a total of nine claims on file, five of which were successfully paid out on the 29th through checks [redacted] which have been mailed to the appropriate provider. The member’s additional claims are currently in process and will be paid shortly.
 
Best Regards,
 
Land of Lincoln Health

Complaint: [redacted]
I am rejecting this response because:
Each time I have called this business I have received a different response. Now I'm told the the specific test I originally called about is not classified as a test, but in the same category as outpatient surgery with the attendant higher costs yet to be clarified. 
Part of my complaint was that my health providers were given the wrong information by Land of Lincoln. They have now given the correct information regarding this specific matter only after several weeks and this complaint being filed. However there is no system in place to suggest that Land of Lincoln will give the correct information in a timely manner in the future.
Sincerely,
[redacted]

Revdex.com Chicago & Northern Illinois 330 Lower Wabash Ave Chicago, IL 60611       RE: Case [redacted]   To Whom It May Concern:   Land of Lincoln Health received case [redacted] regarding an eligibility...

issue.   The member has been reinstated to active coverage and all incurred claims will be paid in accordance with the member’s policy. The member’s payment has been received and posted to his account.   Best Regards,   Land of Lincoln Health

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

I have been a member since Jan 1, 2015 & had my 1st doctor visit & Rx purchase on 1/5/15. I still can't see my claims, prescriptions, or any indication of what they have or do not have submitted to them.
the website says " 2015 Claims, Explanation of Benefits (EOB's) and Accumulators are currently being processed and will be available to view soon"

I have left 5 phone messages - you are not allowed to hold, you enter your call back number & are assured just before you are disconnected that "they will call you back - you will not lose your place in line" - THEY DO NOT CALL BACK - 2 weeks since my first call & nothing - no communication. I have sent 2 emails - no reply. The only thing they have communicated is my premium invoice!

I am starting to think I made a horrible mistake choosing Land Of Lincoln Health - how do I find out what is going on with my claims if they will not communicate with me?

HORRIBLE customer service. As far as I can tell, Land of Lincoln's staff is totally incompetent, and they could not care less about resolving problems.
My daughter was born late last year. This year, Land of Lincoln cancelled her policy with no warning and refused to pay for claims. When my wife and I called Land of Lincoln, they told us, and this is a quote from the Land of Lincoln representative, "Oh, we shouldn't have cancelled that policy." They promised to get it fixed ASAP.
Six months and dozens of calls later, claims from that cancelled month remain unpaid. The doctor's office is threatening to send us to collections. Land of Lincoln alternates between refusing to pay because her policy was cancelled--even though they've admitted many times they cancelled the policy mistakenly--and promising to pay "after a review in 60 or 90 days." When we follow-up, no action is ever taken.
Absolutely horrible.

Revdex.com of Chicago & Northern Illinois [redacted]       RE: Case [redacted]   To Whom It May Concern:   Land of Lincoln Health received case [redacted] regarding a...

refund and balance inquiry.   Please reference the attached payment and invoice history provided by the LLH Finance Department detailing all transactions for this member’s account. Information is separated into two tabs, “Invoices Due” and “Payments & Tax Credits.” The member’s account has a $0 balance at this time.   Best Regards,   Land of Lincoln Health

Revdex.com of Chicago & Northern Illinois 330 Wabash, Ste. 3120 Chicago, IL 60611 RE: Case [redacted] To Whom It May Concern: Land of Lincoln Health received case [redacted] regarding a claim appeal. We have verified that the appeal for services on the date of service 7/16/15 has been approved. The...

member will be receiving a formalized letter shortly with additional details related to this claim and payment. Best Regards, Land of Lincoln Health

Initial Business Response /* (1000, 5, 2015/04/02) */
Land of Lincoln Health received case 94544135 regarding a provider relations issue with a health insurance claim from 2014.
LLH sincerely apologizes for the inconvenience this issue has caused to the member. Upon being notified of the...

complexity of this issue, the LLH Provider Relations Department began working directly with the hospital indicated in the complaint to resolve this issue and ensure claims are paid properly according to the contract with this provider as to not cause a burden to the member.
LLH unfortunately does not have a final resolution with the provider at this time but expects the issue to be resolved within the next week. Once completed, the member will be contacted by our Issue Resolution Team to advise the status. LLH will also keep the member up to date with additional information as it becomes available.

Revdex.com of Chicago & Northern Illinois 330 N Wabash, Ste. 3120 Chicago, IL 60611 RE: Case [redacted] To Whom It May Concern: Land of Lincoln Health received case [redacted] regarding a plan termination. As...

stated previously in response to this member’s complaint under a separate case number, LLH does not have the authority to cancel an insurance policy for a member who purchased their coverage through the Health Insurance Marketplace. If the member has cancelled coverage, this request has not been sent to LLH to terminate her policy. In this case, the member will need to contact them at [redacted] and request to open a [redacted] (health insurance casework system) case. We will then be notified of the termination and will reach out to confirm this. Alternatively, the member has the option of not paying her invoices and she would then be cancelled for non-payment. We would terminate the policy as of 1/1. LLH does not report to collections agency or credit bureaus and this would in no way affect the member negatively. Until the policy is cancelled either through the [redacted] process or through automatic cancellation, LLH may receive tax credits for this member. Upon termination, these will be returned on behalf of the member through our monthly reconciliation with the Marketplace. At this time, however, LLH can do nothing other than to wait for the member’s policy to terminate due to non-payment. Best Regards, Land of Lincoln Health

Horrible, horrible, horrible. I'm convinced that no actual human beings work here, other than the one who recorded their sermon about 'being committed to quality customer service.' Talk is cheap, so the saying goes. Actually, it's not: I pay over $1000 a month for a $10,000 annual deductible. I DARE YOU to try to get an actual person on the phone without dying of old age. The simplest things can't seem to be accomplished, like sending out new ID cards, after multiple requests. Their mobile app doesn't show the correct covereage...on and on. How does this place ACTUALLY STAY IN BUSINESS?

I've had my policy for a year thought the market place and I am not renewing (although getting them to acknowledge that is a whole other issue!). My Dr was in network with them but not preferred and therefore expensive to visit, but there are no preferred Drs in Hyde Park. They tried to put my premium up by $80 a month newt year which is just a joke - they're going for the get them in cheap and then hope they can't be bothered to switch approach to business. Additionally their customer service is awful - I've spent 1.5 hrs on hold trying to notify them I wish to cancel my policy (and I also contacted the market place twice) and yet they still sent me an email thanking me for renewing and an invoice for Jan '16! There is no mailing or email address for customer services and so you have no way of contacting them other than spending endless hours on hold. I can't figure out if it's incompetence or a deliberate tactic. Stay away.

Initial Business Response /* (1000, 5, 2015/01/09) */
Land of Lincoln Health (LLH) recently received case number XXXXXXXX in reference to an issue with payment and eligibility. The member enrolled in a Land of Lincoln Health insurance plan through the [redacted] which...

provides an electronic data file of enrollment information to LLH as the insurer.
LLH discovered a systemic issue with a number of [redacted] enrollments, whose information was not able to be properly loaded into our payment and eligibility system. After attempting to receive an updated file from the [redacted] to correct this issue, LLH developed a work around solution for this by performing manual data entry into our eligibility system. Unfortunately, as this was a manual process, the data entry took a significant amount of time, and needed to be quality checked to ensure no further issues were being created for the benefit of our members. Therefore, the member's enrollment information was delayed in being loaded to our system; however, his enrollment into an LLH health insurance plan was effective retroactively to a 1/1/15 effective date as requested.
LLH contacted the member by phone once this was completed to update him on the status of his enrollment, and were able to advise him of his member ID number as well as the expected delivery of his welcome kit. LLH staff also instructed the member as to how to print a temporary ID card and view other policy information through Land of Lincoln Health's member portal. Furthermore, LLH has confirmed receipt of the member's payment which was made through the Marketplace and has applied this to the member's account as of today.

Revdex.com of Chicago & Northern Illinois [redacted]RE: Case [redacted] To Whom It May Concern: Land of Lincoln Health received case [redacted] regarding a precertification for a medical procedure. The member’s...

procedure was reviewed for medical necessity and was approved on 4/8/16 under authorization number [redacted]2. A copy of the authorization letter has been sent to the member and provider. Best Regards, Land of Lincoln Health

Revdex.com of Chicago & Northern Illinois [redacted]
[redacted]
* RE: Case [redacted] To Whom It May Concern: Land of Lincoln Health received a rebuttal to case [redacted] regarding a precertification for a medical procedure. We apologize for the delay with the precertification process. On 3/1/2016, Land of Lincoln Health changed medical management vendors, which resulted in a delay in processing requests for some of our members. The situation has now been rectified and requests are now being processed within 5-10 business days. The member should no longer have such a delay going forward if another precertification is needed. Best Regards, Land of Lincoln Health

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

Revdex.com Chicago & Northern Illinois
330 Lower Wabash...

Ave Chicago, IL 60611
 



RE: Case [redacted]
 

To Whom It May Concern:

Land of Lincoln Health received case [redacted] regarding a plan termination.

LLH receives enrollment information from the Health Insurance Marketplace, and in this particular case we received an automatic re-enrollment for her for 2016. The Marketplace is the “source of truth” for eligibility and we cannot override their enrollment data. Therefore, the member will need to contact them at [redacted] and request to open a HICS (health insurance casework system) case. We will then be notified of the termination and will reach out to confirm this.

Alternatively, the member has the option of not paying her invoices and she would then be cancelled for non-payment. We would terminate the policy as of 1/1. LLH does not report to collections agency or credit bureaus and this would in no way affect the member negatively.

Best Regards,

Land of Lincoln Health

Initial Business Response /* (1000, 5, 2015/02/20) */
Land of Lincoln Health received case XXXXXXXX regarding a member who experienced difficulty with obtaining prescription drugs and using her benefits for a doctor's visit.
Our records indicate that the member enrolled with Land of...

Lincoln Health for the 2014 calendar year, and re-enrolled in an LLH plan for the 2015 year through the Marketplace. LLH received the member's 2015 enrollment selection and loaded her new plan into our eligibility system on January 3, 2015.
Upon enrollment, LLH generated an invoice for her January premium payment, which was subsequently mailed to the member. This invoice was due by the end of January for that month's health insurance coverage. To date, we have not received payment for this invoice.
On January 14th, a February invoice was also generated for both the January and February premium payments due. This invoice is also outstanding, and no payment for 2015 has been received.
While we regret not being able to cover services for this member, we are unable to do so because of non-payment.
Initial Consumer Rebuttal /* (3000, 7, 2015/02/23) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have paid my premium and am disturbed that Land of Lincoln doesn't seem to know that.
In addition, my main complaint was not that my services weren't covered, but that it was virtually impossible to talk to someone to find out why my claims were being denied. When I finally did manage to speak to someone (this was after three days of leaving unanswered messages and waiting for more than an hour on hold), I finally got a human being who told me that the problem, at least with one of my claims, was actually that LOL had changed billing service providers, and they would call my doctor to tell him that.
Like the unpaid premium, that information didn't turn out to be accurate, either.
I found out the real reason my claims were being denied only by accident. It turned out that LOL had issued me a new member ID number. Once I gave that number to my pharmacy, both my prescriptions and my doctor's claims.
It is extremely disturbing to me that: 1) It took me three days and constant attempts to find a human being to talk to; 2) Land of Lincoln did not give me the correct information about why my claims were being denied (and apparently still does not have the correct information); 3) Land of Lincoln still, in this response, does not know that I paid my outstanding balance almost two weeks ago.
Moreover, I tried to sign up for autopay on the phone and was told I would have to call back, which is completely impossible when no one returns the messages you are forced to leave (Land of Lincoln rarely gives you the option even to wait on hold). Out of desperation, I made a comment on LOL's Facebook page in response to someone who had had a similar problem reaching someone. The Facebook administrator immediately responded and said someone would call me about the Autopay issue. That was on February 10, almost 2 weeks ago, and I have still heard nothing.
I have been very happy with Land of Lincoln's coverage thus far and respect its nonprofit business model. However, if customer service doesn't improve soon, I will have to go elsewhere. It is simply too difficult to talk to a person and accurate information is just too difficult to obtain. I hope these issues can be resolved so I can stay with this company, but since I still have not heard from a human being despite repeated attempts over a range of channels, I cannot resolve this claim.
[redacted]
Final Business Response /* (4000, 11, 2015/03/09) */
Since inception of this case and the request for further information, Land of Lincoln Health has been in communication with the member and has reinstated the member's account effective January 1, 2015. We are also happy to assist the member in submitting a request for reimbursement of claims, as needed.

Revdex.com Chicago & Northern Illinois
330 Lower Wabash Ave
Chicago, IL 60611
RE: Case [redacted]
To Whom It May Concern:
Land of Lincoln Health received Revdex.com case [redacted] regarding claim and pharmacy issues.
We are able to provide the...

following update on the claims in question:
2[redacted] - claim has been reprocessed with $0 patient responsibility
[redacted] - an appeal for this claim has been received and is currently in process, denied because the provider did not pre-certify this procedure
2[redacted] - claim has been reprocessed with $0 patient responsibility
[redacted] - claim has been reprocessed with $0 patient responsibility
[redacted] - claim has been reprocessed with a $20 copayment
The member also mentioned issues receiving her prescription. We have verified that the pharmacy filling her medication incorrectly submitted this claim to our pharmacy benefit manager, Catamaran. The inhaler is for a 30 day supply of medication, but the pharmacy submitted this for a 29 day supply, which caused the rejection. Ensuring that the pharmacy submits claims correctly will ensure that the member does not have any issues moving forward.
Best Regards,
Land of Lincoln Health
(Revdex.com Wurster Response.docx)