Tokio Marine HCC Medical Insurance Services Group / HCCMIS.com
Reviews and Complaints

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.

I bought this insurance in Dec 2016. I even paid an extra $100.00 to add 6 months to the policy. I never intended on using it but under the law was required to have insurance. Failing to meet any qualification for Obama Care I purchased it. Unfortunately after having this ins. I had an emergency with an internal bleed. I was approved for hospital care in which I received 3 units of blood and 4 days hospitalization during the Christmas holidays. None of this was paid siting that I had used it before a 48hr waiting period. This would have made no difference as I stated I was literally bleeding to death.

I had some visits after the hospital which nothing was paid either siting it was pre-existing. Every bill there was always some other reason not to pay. I am left now with close to $35, 000 in bills.

I put a complaint against then a couple of years ago. Ingrid Robinson a fraud investigator just contacted me that a federal class action and federal criminal charges are being filed against HCC. Contact Ingrid Robinson [protected]
My name is Lisa Halas and HCC made my life hell when I was going through my darkest times fighting breast cancer. Not paying bills, deciding which medicine I can go without because they would not cover anything, the endless run around, send this form, we don't have it, to we do not have your medical records even though all these were sent certified mail. Today, I am in the process of bankruptcy because of non-payment from them.
Lisa Halas [protected]

08/15/2016: date of service received
03/21/2017: date of denied letter has been received.
SS0016056700

This Insurance is the worst ever. They do everything to not to pay the claims, they put my claims "In Review" for three months, but they were denied then. Those claims were about one day that I'd had a very strong pain, so I went to an Urgent Care and took an injection. After that, the UC doctor requested me to go to a specialist. So I did it. But that Insurance started to ask me about my medical records, and even I replying all of the letters that I received from them (like 6 letters), they denied my claims for "Missing Information".
I can't pay all the medical bills, I'd contracted an Insurance and I felt secure that this company could help me, but I've never regret about a decision.
I need my claims to be paid by the insurance because they're about unexpected and urgent medical condition.

Thiscompany provides a low cost high deductible insurance. That doesn't allow for pre-existing conditions.
They took 4 months to process and urgent care claim. Stating they needed records for the past 5 years. They only needed to process insurance discounts, they were not paying a penny! There is a 5000. Deductible. I have called over three times on this claim. I finally sent a letter to the provider, and they said they never got anything from them reuesting these records. They expect the insured to forward the letter I guess.

I renewed for another 6 months, now had a serios injry and srgery to knee. Awaiting now three months and the same letters keep coming.. My meddical providers do not get the forms they are claiming to want... They are scam artists

We purchased HCC as visitors insurance for my mom visiting US. We brought the best insurance possible through HCC with pre-existing coverage in case of life threatening emergency. When she was here got stomach upset and we had to go to urgent care and then ER because of ECG variation. It appears it was acid related issue due to the sudden changes in food habit as she was not used to restaurant food. HCC denied our medical claim by saying it was a preexisting condition. We tried to convince them that she never had before or after any sign of acid reflex, very healthy women with no history of blood pressure, diabetic or any heart related issues. Then they came back and said she had an Appendicitis surgery 20 years back and she had abdominal pain for two to three weeks, so its pre-existing (we were renewing policy monthly). Long story short they dont pay for the claim...yes they can find any silly loop hole to say its preexisting. When we asked on what basics and evidence you are telling it is pre-existing condition, answer really surprised me, they dont need any evidence, they just believe it is pre-existing condition and they have the every right to deny a claim if their is an uncertainty about a medical condition! No past evidence needed! I believe its an act of fraud...

I was 32 when I was hospitalized with a bacteria infection of my blood for what had gone misdiagnosed for 2 months this summer.I then needed an emergency open heart surgery to replace a valve the bacteria had eaten away at.

I had bought HCC through a broker and felt like it was a sketchy company when I purchased since I was told it was not under the Affordable Care Act. But, HCC assured the broker, and both the hospitals I was hospitalized at that I was covered. Now, over 4 months after my surgery, HCC has denied every claim. Most are denied for pre-existing.

I did not know what I had until hospitalization. I have started to work with Ingrid Robison ingrid.[protected]@yahoo.com, she can help.

I most likely will have to pay my medical bills on my own and it will affect me and my family greatly.

I suggest anyone that is confused or frustrated with HCC and feels that they have been cheated out of the coverage HCC claims to provide, to contact Ingrid, her contact is above .She can help and give you piece of mind about this fraudulent company.

I have had similar issues as the postings on this site. After seven months of weekly phone conversations and endless communications with HCC, all claims for myself and my dependents have been denied with no hope of appeal ( around 30k). It is like I did not have health insurance although I was paying a lot for it. I found the HCC representatives to be uninformed, rude, and in a few cases lied to me directly on the phone.
Ingrid Robinson at ingrid.[protected]@yahoo.com has been helping me deal with HCC. Contact her if you are at a loss of what to do as well.
Mark

HCC Medical Insurance is running what appears to be a deliberate scam on consumers.

HCC appears to do everything possible to avoid paying on claims. Below are some illustrative examples but are no means complete:

1/ Constantly claiming that information that was sent was "never received". In the case of one document, the provider sent it four (!) times and HCC kept claiming it was never received. I asked for an address that I could send it myself by fedex to ensure that it was received and was told this was impossible. I asked for a fax number so I could have confirmation and was told this was impossible. When i threatened HCC with a formal complaint followed by IMR, they miraculously "found" the documents. This has happened with every single document submitted - HCC's first response is always, invariably, they don't have it. This appears to be a deliberate fraud on consumers to make it impossible for them to file a claim.

2/ Provide inaccurate information and then do not stand behind their employees' commitments. When I signed up for the plan, I was told it was an indemnity plan and that I should pay providers for medical expenses incurred and then submit to HCC for reimbursement. Several months later, when it comes time to process claims, I was told that this is not the case and that HCC would not honor its employee's commitment. This has cost me several thousand dollars (the difference between the "negotiated rate" that HCC is willing to pay providers and what providers actually charge). This negotiated rate was never disclosed to me at any time, nor was I ever mailed a guide to the program.

3/ Delays beyond a reasonable scope. HCC claims to resolve claims within 30 days. However, none of my claims ever advanced at all without me calling to intervene and jump through several hoops. We are now in November, my claims were submitted in June, and we are no further ahead. This appears to be deliberate policy to exhaust consumers' patience so that HCC doesn't have to pay.

4/ Payout to the wrong entities. Despite the fact that HCC knew that I paid providers directly for medical work - acting on HCC's specific and clear instructions - they refuse to reimburse me but are reimbursing providers instead, knowing that it will be next to impossible for me to get providers' attention and ask them to issue checks to me commensurate with their reimbursement from HCC.

HCC is a SCAM, A fraudulent business, call the FBI to arrest these people, they are criminals.
They took your money and provide no insurance coverage, we need to lock up these criminals, put them in jail, so they can not scam on American
people any more. Make them pay for their crime.
I paid $330 per month to HCC in 2016, and I was in hospital three times, June and July 2016 with $95, 000+ hospital bills. HCC deny all claims, pay $0 bills. They said that they did not receive medical record, which they did received it. They will say anything not to pay bills. They do this to thousands customers.
Call state insurance commissioner and FBI to report HCC SCAM!

After a phone call with them (with a very very rude girl on the phone) asking them if my next doctor appointment would be fully covered by them, getting the answer (with an attitude) that it definitely would be as long as I chose a doctor from the list on their website. At the doctor and asked them again, as I wouldn't go in if it wouldn't be covered by the insurance, the doctor assistant called HCCMIS again to be sure, and they told her as well that it would be fully covered. Then, a few weeks later, after sending them my official receipts, they tell the doctor that they don't cover it anymore and I can pay for the doctor appointment and the medicines myself. WHAT? If I knew this beforehand, I would've never been going. HCCMIS are liars and don't do anything for you except giving you an attitude and stealing your money, don't go with them. I'm looking for a different insurance company right now.

I bought Atlas Insurance product from this company in effective on March 2nd 2016 for my mother. Her ear started hurting on the night of the same day. We thought it might go away so waited overnight. Unfortunately, It still hurt the next day. Given her age and her ear never hurt before, I took her to nearby Urgent Care Center for a checkup to be sure. It was a simple outer ear infection and doctor prescribed antibiotics. It was a simple 15-min office visit with prescribed antibiotics bills for 5 days. The Urgent Care Center filed claim directly to HCCMIS. Since then claims were pending for over 3 months and finally after numerous phone calls and emails, we received an EOB for claim denial. Denial reason is: pre-existing limitation. We called for further explanation and were told that it was classified as pre-existing because we went to the doctor's office the day after the effective date. How is that reasonable? So a claim is only valid if the insured doesn't fall ill after, say, a week? If that's the case, it should be clearly stated in the policy agreement/conditions about the pre-existing conditions. So people are aware of what they are getting into. Following is the definition of pre-existing condition per HCC.
"PRE-EXISTING CONDITION – Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Pre-existing Condition."

We were sold this health policy with a 2500 deductible. We paid all premiums on time. I had an emergency health issue last November. This company has denied all claims do to my medical providers not giving them requested information. For 6 months we have been calling the claims department and providing every bit of information they requested.

These people are scam artists, and should be sued for fraud. I have legitimate claims they are denying, and beginning to ruin my credit.

Is there a class action suit pending? I either want to join or start one.

Let me start that this company is absolute fraud. I purchased this expensive insurance due to coverage for "acute onset of pre-existing condition". This is biggest bogus sales pitch. If you are purchasing based on this clause then never go for it.
My father had an heart attack. He never had a medical history of high cholesterol, BP or Diabetes. He had his full physical done before travelling to US and 3 months before the incident. (We have the reports). After having a hot bath he got a severe heart attack (Called 911, electric shocks, angioplasty happened, $130k bill).
HCCMIS denied that this happened due to pre-existing condition and not considered acute onset.
I understand that this heart attack was due to unknown pre-existing condition, then what the hell is "acute onset".
They said heart attacks are never or rarely covered.
My question is why we should buy such expensive policy in the name of "acute onset" when other policies much cheaper covers accidents etc.
I wasted $25, 000 in last 3 years by buying policy from them for my friends and relatives visiting US. I should have used that money to pay hospital bills.
God curse these robbers.

this company is a scam. they are frauds. I purchased short term medical insurance from them on 05/14/2015. after seeing my primary doctor, shortly after getting insurance, I discovered I had a bleeding ulcer. iwas admitted to the hospital and received (5) pints of blood. they also did a endoscopic procedure. 3 day stay and $ 14, 000.00 later, the game of sending in claim forms began. all claims were submitted by providers and yet they tell you they haven"t received them as yet... I called and talked to the claims dept constantly, their response was always : waiting for paperwork. I checked with all providers, and they sent in all paper work. today is February 22-2016, and still no claims paid ! I am not sure how I am going to pay the bills. I am 62 and self employed as a carpenter. I need help.

I have come to United States from India on a vacation. I had severe stomach ache on Saturday 6/27/15. As it was a weekend and there were no urgent care facilities open on that day I had to be rushed to emergency room because the pain was unbearable. Also I was diabetic and this called for immediate attention. In the emergency room, I was given pain killers to control pain. After diagnosis from blood, urine samples and CT scan it was concluded that the cause of pain was kidney stones and I was prescribed medication and discharged on the same day. Total bill from Sharp was around 13K ! HCC denial payment saying that emergency care services will not be covered if the patient was not admitted directly as in patient. I had a history of kidney stones when I was in India and I had undergone surgery in India on 2007 for kidney stones (supporting documents attached in this email) For the below reasons my case should be considered as “Acute onset of pre- existing condition” • My condition of kidney stone was preexisting and it occurred suddenly without any symptom ( I have attached the documents from the treatment that was done at India) • It is not chronic or congenital • I had to be treated within 24 hrs. as my pain was unbearable From the policy description of coverage I understand that there is a $75000 life time maximum coverage for acute onset of preexisting condition. I have filed an appeal with HCC against thier decision to deny payment . It has been over 6 months since the appeal was filed and i do not have a response from them yet . What should i do now ?

HCC Medical Insurance Services, LLC PO Box 2005 Farmington Hills MI 48333 I am filing this complaint against HCC medical Insurance. It has been almost a year and the insurance company has yet to process my claim for my Mother who was visiting the US for a short period of time and for whom the insurance was purchased. I have called over 20 times and initially I was told that all medical records & lab reports were not provided from the respective hospitals. Then I was told that they did receive all the medical records and that they wanted additional information about the patient's medical history.I clarified that this checkup was related to an abnormal increase in blood pressure than there were no prior medical history related to this case. Then I was told that even after they received all the medical records that they needed the hospital to resend the medical records stating that this was the final records. In spite of them receiving the same with this statement, I have been trying to call them several times for the last few months and they ahev been unable to tell me why the claim has yet to be processed and they kept telling me that they have been making a note. Please stay away from this issurance company.

I purchased insurance in October 2014 and went for a routine mammogram and boom breast cancer. They give you the run around submit this claim again and again and again. Then it was medical records that I sent certified mail 3 times. Finally had to get a lawyer and they started paying but not like they are suppose to according to their insurance book. They are suppose to pay within 30 days and nothing was paid till my lawyer contacted them with a lawsuit in May of 2015. Another outraged customer contacted me and he has a lawyer who is going with a civil class lawsuit. If you have had enough contact me [protected]@yahoo.com Lisa Halas

I paid all of my premiums for 4 months. They are asking my doctor for 5 years of medical records for treating 1 UTI. They are also requesting 5 years of my son's medical records for falling off of his skateboard. I have filled out every single form for each claim they send and I can not get them to process anything. This is an endless cycle of paperwork and not a single payment. Its better to be uninsured. DO NOT WASTE YOUR MONEY

I bought a medical insurance from HCCMIS since May 2014. Got sick in August 2014. Was admitted to emergency room, then got transferred to ICU after a heart surgery. Since then HCCMIS has not settled the case and asked my passport photocopy, old medical records from my home country, medical records from all current providers who treated me (emergency room, hospital, cardiologist, radiologist, etc). We have submitted all the documents and still got a letter today on Jan 5, 2015 that they have not received my medical records from my home country and they have also not received medical records from providers. After I fax or mail the documents I call customer service agents to verify whether they received and their answers are always the same it will take 3-4 weeks to get in the system. After 4 weeks I call them again and they again give the same reply that they are still expecting documents. I am in process of taling to consumer department and an attorney to file a case against the company as I think they are going to do the same thing that is going to deny in the end saying that either it is pre-existing condition or too much time has passed to further process the claim. PLEASE BE AWARE OF THIS COMPANY! THEIR INSURANCE IS A SCAM AND THE COMPANY IS A FRAUD.