ComplaintsforNexclaim Recoveries, LLC

• Initial Complaint

  01/24/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  This company sent a letter demanding medical information while claiming to work for my employer who advised me that this was not legitimate. This is a scam to illegally acquire medical information.

  Business response

  02/21/2024

  NexClaim has been retained by the employer of the person complaining to provide a service.  The person who filed the complaint indicating that our organization illegally demanded medical information and that NexClaim did not work with their employer which both are completely incorrect.  NexClaim has been retained by the employer of the person who filed the complaint and this employer offers a self-funded medical plan to its employees.  Most if not all medical plans offered by employers have a program or a vendor that reviews the medical claims that they are about to pay or have paid to verify that those claims are not the responsibility of another party. For example, if a covered plan member was involved in an automobile accident where they were not at fault for that accident, the auto insurance carrier of the person that hit them, may be responsible for medical bills that the covered plan member's employer funded.  NexClaim is retained to identify certain paid medical claims and reach out to plan members to verify if there may have been an accident, the services received were due to a workplace injury or those paid medical claims should have been paid by another entity.  NexClaim is not a debt collector or trying to find out which medical providers were seen. NexClaim already receives all of the paid medical claim data and our only reason for contacting plan members is to verify the cause of the injury.  If the plan member that filed this complaint would have contacted the phone numbers located on the letter that we provided, someone at NexClaim could have explained this process and provided a contact within his employer that could have verified the process for him.  This is an employer with over 4,000 employees so who they contacted internally may not be aware of every health plan service and vendor that has been contracted to provide a function on behalf of their self-funded employee health plan.

  Customer response

  02/22/2024

  Upon receiving the letter, I, as the employee, searched my company's internal benefits website for a process that involved NexClaim.  I searched the benefits documents provided by the company and I did not find NexClaim mentioned anywhere.  I contacted my Human Resources department who also had no knowledge of the company.   At that point, I filed the complaint.  On 2/22/24, I received an email from a different representative of company's HR group that indicated this was in fact legitimate.  While the company was acting legally, as an agent of my company . . .  the process by which they are operating is greatly lacking.

  Customer response

  02/22/2024

  
  Better Business Bureau:
  

  Upon receiving the letter, I, as the employee, searched my company's internal benefits website for a process that involved NexClaim.  I searched the benefits documents provided by the company and I did not find NexClaim mentioned anywhere.  I contacted my Human Resources department who also had no knowledge of the company.   At that point, I filed the complaint.  On 2/22/24, I received an email from a different representative of my company's HR group that indicated this was in fact legitimate.  While the company was acting within their rights, as an agent of my company . . .  the process by which they are operating is greatly lacking.

  In conclusion, I have reviewed and verified the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

  Sincerely,
  
  **** ******

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