Tokio Marine HCC MIS Group

9-14-21
To: Brown County Rural
Water Association.
3818 US 52
Ripley, Ohio 45167
Dan You are required by law to give me the Insurance Info! Info
like name of company policy number and agent, the way the law reads
the Insurance company is does not have to make the first call to me.
(This is the same as being in a car reck and how info is exchanged).
For over 3 years I work as a Independent Insurance Adjuster helping
people get paid from what there insurance company denied there claim
for the largest firm in the US.

I only got paid after they got there money
and made good money doing so.
Dan the insurance company has not contacted me, I now require
the Bond info that Brown County Rural Water Association carriers. I
also need the three people names and address that did the work and
caused the accidented.
To Dan Sarbach General Manager I understand this has been turn
over to you and is this going to be taker of. I want know or I will Have
my attorney fille the law suit.
Mr. Bobby Bischoff This happened on 9-2-21 at about 7 pm When
I went to cut grass the Bobcat Zero turn mower hit a piece of rebar in
the grass witch it was sticking up less than 4.5 Right at the property
line where your worker installed a new water line.

I have been cutting
both Properties for nine years. Where the water line was installed no
one ever took care of it and Pike township threatened me with fines, so
it was easier cut and maintain it.
On 8-16-21 your work crew installed the new line. They also either
left a piece of rebar in the ground or the excavator kick up the property
marker up in the air from the cleats on the track for the excavator
which can be seen by the pictures. This almost cost me my life!

When
the zero-turn mower hit that piece of rebar it launches the mower
straight in the air about two to three feet and parts came out and hit
me in my back and rib cage I am still hurt, and it will take time for me to
get better. The mower has only 928.9 hours on it and now needs about
$2000 to $2,500 of repairs to it from what Doctor Mills shop quoted me
that does not include getting it there. I also got a quote of what it will
cost to get my yard cut by a lawn service, they want $850 a cut.
So, your crew left a job site in a state that Should not have been
left in! I almost lost my life from this.

There is proof where the
Excavator was is where the rebar was, and cleat marks can be seen. The
ground has bare spots where the excavator was. There is no way for me
to tell if was from the Excavator or where it was driven in the ground by
your crew and left. Well, the bottom line the job site was not property
clean up and checked, and no supervisor checked the site for things like
this.

I could not see the rebar before cutting the grass I did walk over
there to check because of the dirt pile.
I will be sending Pictures with this letter. It will take over two
months to get fixed by a shop. It will take over two weeks to get the
parts in. the mower needs a new set of blades and new hardware and
three cones and new pump and pully on the left side the shaft is bent
and leaking now.

The baffle will need replaced on the mower deck.
I have bever been this shaken up by what happened. Bobby did
you call OSHA, or do I need to? I do want to make sure that something
like this will never happen again! To anyone.
I am open to getting the mower replaced it mite be cheaper than
getting the lawn 6 to 8 times at $850 cut.

The doctor office did a video
and is playing wait and see because of Covid19.
From: Ken Klosterman 1431Maple Grove Rd. Williamsburg, Ohio.45176 klostermanken@***.com

Tokio Marine Hcc is trying to rip you off. first of all; if you want to call them you have to know what combination of "menu of option numbers" you have to dial.

Second don't bother yourself to call them because customer service basically don't do anything about your issues. they only tell you to email them your concerns. And nobody does anything even if you email them. I'm trying to cancel my policy and still waiting for the email response, what a lovely customer care.

I cannot access my online account because they entered my date of birth wrong. Plus that's the only information you need in order to access to your account besides the certificate number. And there's no indication that your member id number is the same as certificate number.

Ugh that's a big mess. Don't waste your time with these scammers.

My father who was visiting USA had the Atlas America insurance. He had a cardiac emergency and had to be hospitalized and undergo a bypass surgery.

The insurance did not cover a penny and chased us away to be on our own. They manipulate the "Acute onset of a pre-existing illness" clause in a way that benefits them.

They use it to sell the insurance but when the time comes for a claim they do not accept it. They did not accept that my father's condition was an acute onset despite the doctors providing the certificate that it was an acute onset.

Sadly this is so common with this company and their group of policies. I worked for a call center that took on the HCC account and it was a nightmare! Let me tell you a few things about that experience. I’ll have to be somewhat vague as I do not want the backlash that would follow for disclosing the behind the scenes that goes on there.

1.) The websites are a joke. They are difficult to navigate and so poorly coded that if you do not follow the sign up procedures to the letter you cannot access the site. Even then the web portals crash and are down so often that it almost doesn’t matter if can get in in the first place. Claims, policy review, procedures and more are all accessible through the websites for the company but the only one that ever seems to work correctly is the landing page for signing up for insurance. Case in point; I had to walk a person working at Microsoft in Redmond Washington through it one night because even though he was a web developer it was still too complicated to use. This I might add is a problem because there are at least two websites you need to get into, one for claims and claim related issues and one for account review and management. No one on the phone can access these or even see what the pages look like so we can’t really help you with them other than to follow a script and flow chart the company provides. We cannot reset a password or update information over the phone, not at all, not one little bit. It really makes you question how they can call it customer service.

2.) The reason that it takes so long for documents to be processed is because like the main customer service lines it has been outsourced. So when they do receive your records from a doctor or any paperwork in the mail it is sent to China to be scanned into the already broken software system they use called Javalina. Even after it is scanned in and uploaded to the offsite third party servers that are linked to Javalina it is often not labeled in such a way as to be useful or searchable. Instead of something professional like "Dr. Chen DOS 12-12-12" it is often a completely unrelated and random string of numbers like "294757****84757.pdf". So when you call in we have no way to figure out if your documents are on file other than to put you on hold (but not for longer than 2 minutes before checking in with you) and open everything we have and go through them one by one, page by page to confirm it’s what you needed. But even then we’re not claims adjusters so we really can’t say if what came in matters in the least to what you would need to get a claim moving. All we can do is hope the claims people left detailed notes in the system about what they needed and from who so we can match it to a document on file. On top of even that though the received dates for the files very wildly from reality since it goes through so many hands.

3.) I believe that HCC has an in-house callcenter but the majority of the work is farmed out to Global Response based out of Margate Florida. As a “Brand Care Specialist” we were trained to work in HCC’s systems and handle their calls but there was almost no support from the company HCC or Global. Not only did we take the most heart breaking calls from customers but also from hospitals and debit collectors looking to get information on claims to pursue the customer. We had to provide up to three claims per call so you’d get the same handful of debit collectors with a different name each time and a thick accent “Hello this is Tom from provider’s office”. Additionally and perhaps most tragically if we wanted to help someone out the only real options were to post to an internal Microsoft SharePoint website and hope that someone took it to HCC or to pass it to another team member acting as manager to have an email sent to the same place that yours would go. The only way anything went somewhere was if the caller mentioned a lawsuit and at that point it was passed to the HCC legal team and we were instructed to end the call. I want to emphasize here that we had no way to contact HCC directly, or to interact with them (I’m guessing by design) so we had no way to ever get your issues addressed beyond what you could find out for yourself.

Before training was even over we lost a number of good people brought over from other accounts that just could not handle the stress of being this kind of unprofessional, impotent person. After training we lost even more people and the turn over is really high on this account. The only people that can take it are the ones that can just parrot out the party line “Did you read your policy?” , “Did you check the website?”, “Did you send in the forms?” and basically convince themselves that it’s always the customers fault. That’s right it’s your fault for not taking a day or so and doing a through investigation on the company, you had/have no expectation of not being screwed.

In the end even though we complained about it and asked for transfers the internal politics of Call Centers meant we had to stay until we burned out or quit, which means no unemployment. The whole account was unprofessional and I had serious moral and ethical issues representing the company. Just because something is legal it does not make it right.

Even trying to help out a customer by using non-legal terms or walking them through the disheartening process of claims was cause for a “Coaching”, that is management talk for a dressing down but not on the record. So even the ability to explain things to you in terms you’d understand was tightly controlled.

It basically comes down to this; When you call in the people that are on the other line have no power, ZERO authority or means to help you out beyond what you can do for yourself on the websites. In my bosses words “We’re just telling them what is on the website and what they can find out for themselves”.

The last straw for me was when an elderly man called in because he had terminal cancer and none of his bills were being paid. He slowly went from angry to weeping as I did my best to make sure that the call was documented but knowing it wouldn’t go anywhere, it was preexisting. In the end he stated he was going to just kill himself with a shotgun because he could not afford to leave his family with that kind of debit, it was already in the tens of thousands and this was not a one time case, this was a daily occurrence. I began drinking and falling into a deep depression after that and was let go a month later, I’m still unemployed and struggling with depression. For emphasis here I’ll repeat that “Just because it’s legal doesn’t make it morally or ethically right”.

4.) Even internally it was obvious that the name of the game is runaround. It starts with the need for a separate Claimants Statement and Authorization Form for every claim submitted; only that story changes over time and depending on who you ask to “for every claim on a different day” to even “Every claim based on injury”. So even internally there was never any clarity as to what we were supposed to do to help people navigate the bureaucracy. It really felt like everything was designed to be so cumbersome that the customer would either get frustrated and give up or they could stall long enough to not have to pay out on the claim. I even think the idea was to get us so frustrated that we’d blow the customers off or just tell them we had received documents just to get them to go away. The whole idea here is that we’re a legal buffer between HCC and you as was made crystal clear in training when they said outright that we’d be thrown under the bus if we ever deviated from the script; that HCC and Global Response would not protect us if legal action was directed at the company. Basically we’d be the bumper.

5.) The number of people that didn’t get a copy of their policy until the review period was up hit about 70/30 odds against the customer depending on type of policy. This was always loopholed by the fact that it was available online so it was the customers fault if they didn’t go online as soon as they got home and reviewed the coverage. The problem is that since anyone can sell these policies From Atlas, HII Quote, HCCMIS (The umbrella company), Student Secure etc, the people that were selling them often but not always seemed to leave that information out in favor of a commission. So by the time anyone could review and realize the coverage was garbage it was too late to get their money back. This also applied to other mailings such as requests for information, it was always the customers fault for not giving us a correct address; the problem being that in the sign up stage people are often mislead to give an address that does not apply to them, such as with travelers or students with the home address. It too can be changed online but you better have patience and a degree in computer sciences to figure out how, but cannot be changed by calling in.

6.) The company doesn’t even have it’s own software which it could afford as well as the data center to house it. Instead like so many companies in the insurance racket they lease their software programs and so have no direct control over it’s operation or stability, which is in part why it’s always crashing and down. Companies do this to limit their liability for any data breaches or failures at the cost of efficiency and customer service. This also means that to do something as simple as change the way a file is presented graphically on screen requires a committee and all the parties that lease the software need to agree to it… designed by committee to fail by being as cheap as you can get.

7.) Almost every policy they sell is non-ACA compliant. This means that Routine Exams and anything billed that has the word “Routine” in it is denied. This doesn’t include State Mandated coverage so it varies by state if it’s covered or not. They do not cover pre-existing. So in the case of the old man with cancer he obviously had cancer even if it wasn’t diagnosed when he bought the policy so there is no legal grounds to cover the claims. I believed him when he told me the agent that sold the policy to him said it’d be covered but that is part and parcel when it comes to agents out there. Get them in, get the commission and after that it really doesn’t matter because they’ll have to talk to the insurer anyway. This also means that if the shifty claims people at the company find in your records that you had a twisted ankle in the past any ankle related injuries are going to be denied, yes I saw exactly this happen. They will go out of their way to pour over your medical records, of which they’ll request so so many, to find even a hint that you had something wrong that can be linked to the claim today no matter how obscure. Their job is not to process claims quickly and efficiently it’s to use the law and general medical knowledge to find a way not to pay a claim, that is what they get paid to do.

8.) The Better Business Bureau ranks them high because they look at “GOOD FAITH” efforts to resolve issues. Well this too is legally accurate but not exactly true. This company does give a variety of ways to be ignored; this includes email to multiple addresses based on policy type, so if you send it to the wrong one out of eight or so addresses they have every legal right to ignore it, toll free numbers to people that don’t have the authority or access to transfer you to anyone at HCC proper, the broken hard to use websites for self help and regular mail that can take months before it is scanned, uploaded and reviewed and that’s if it can even be found within the tight timeframe allowed for processing.

While we’re on the topic yes it is a highly rated company. They make a lot of money, LOTS OF MONEY! This means that they are beholden to the share holders to keep making massive profits every quarter and you don’t do that by spending money on infrastructure or paying claims. Now this is true for pretty much all large companies full stop, but when it comes to health and wellness some compassion should matter much more than the almighty dollar.

9.) Finally while this isn’t everything I wanted to share I need to wrap this up so I’ll end with the Media/Online team they actually do invest resources in. These are people that scour the internet from Facebook and Youtube to Twitter and Tumblr looking for anyone saying anything bad about the company and posting their “Deepest regrets about your experience” and promising to “Contact you privately to resolve this issue” so that they can maintain the image of actually trying in good faith to help people.

Yes folks they even have people to post reviews and rate reviews of the company to help their image, not unheard of or even uncommon but I thought you’d like to know. So if you really are angry get out there and post, post, post and be sure to make your voice heard. Always read your policy BEFORE you sign anything period. Remember that insurance agents are a lot like used car salesmen and they use a whole host of psychological manipulation to get you sign so they can get that commission; because once you’re out the door you’re someone else’s problem.

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, a financial fraud investigator. ingrid.robinson2@***.com. She is working on a larger lawsuit against HCC.

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. She can help and give you piece of mind about this fraudulent company.