April 20, 2011


MAXIMUS Federal Services
Managed Care & PACE Reconsideration Project
50 Square Drive, Suite 210
Victor, NY 14564

Re: Gloria E. Thompson vs. Secure Horizons
Appeal number: 1-757054111

Gentlemen
This is a follow up to the letter you sent to me dated April 4, 2010 (copy attached). Please advise the status of your efforts.
My appeal is based upon the claim by my wife’s medical provider that they have sent in multiple copies of three claims with only one having been paid. The insurer claims that the second two were duplicates, were sent to the wrong address, etc. The latter cannot be true as they received and paid the first claim which was sent to the same address. I have sent in the claim to be sure it was sent to the right address. The insurer never acknowledged receiving the claim from me and commented that they do not accept claims from policy holders! I will never understand the rationale behind this reasoning.
The provider has referred their debt to a collection agency. The collection agency has reported my wife to three credit bureaus. The collection agency now threatens to sue us for the amount due. All this has been revealed to Secure Horizons and the do not care.
What worth is an insurance policy that does not pay valid claims? In total frustration I have offered to pay the amount due with the belief that I will not be reimbursed as the insurer has already stated that they do not accept claims from policy holders. If I pay the claim, it appears that I will bear the cost in spite of having insurance that is supposed to respond.
Out of total frustration I have sought help from the Texas Dept. of Insurance which has responded that they have no jurisdiction. Where can I go for help?
My wife and I are retired and living on a fixed income. Paying this claim out of our pocket would present a financial hardship. We are also concerned that Secure Horizons will not pay future claims. If something serious happens to my wife or I, it appears unlikely that our insurer will respond based upon their actions on this claim. We are very worried. The next open enrollment period for Medicare is Oct., 2011. We are counting the days. Any insurer would be better than Secure Horizons.
I will be happy to send you copies of the multitude of documents I have sent to Secure Horizons (note: many of which have been ignored), the providers collection agency and to the provider.
Secure Horizons is incompetent and arrogant. I can’t fight them any longer. Please help!


Sincerely,


John W. Thompson
(authorized representative for Gloria E. Thompson)

Cc: Rhonda and/or Chris Mundus
Office of Dr. Kuhn
4461 Coit Rd., Ste. 309
Frisco, Tx 75035

United Healthcare-Customer Service
P.O. Box 29675
Hot Springs, AR 71903-9802

I. C. Systems, Inc.
Attn: Ms. Brown and/or Mr. Becker
444 Highway 96 East
P.O. Box 64437
St. Paul, Mn 55164-0437

AARP Secure Horizons as a medi-gap insurance is totally impossible in terms of customer service. They are cheery upon sign up, but if you ever have an issue you cannot get past person #1 who will wear you out, wear you down until you surrernder. In our case, even though they issued a new card for our move 90 miles away, with a new doctor, they canceled us saying we had "moved out of are." Well, uh, yeah, 90 miles north (in Califorina.) You gave us a new card/new primary physician, so? After literally hours on the phone, all documented - no help. Meanwhile, for 9 months no Medicare Part D, medigap and now nobody will insure us since were were canceled by another company. They should be sued!