This document contains records of all confirmed and unconfirmed complaints filed against Senior Health Insurance Company of Pennsylvania between July 18, 2013 and July 18, 2018 that were received by the Texas Department of Insurance. For the confirmed complaints, the most common reasons for the complaints were delays in claims handling and denials of claims. The complaints were typically resolved through the insurance company providing additional money or information to the complainant. For the unconfirmed complaints, the most common reasons given were contract language issues, delays in underwriting or claims handling, and denials of claims. These complaints were usually closed as the insurance company position being upheld or insufficient information being provided.

1. SIRCON
ALL CONFIRMED COMPLAINTS RECEIVED AT TDI BETWEEN JUL 18, 2013 AND JUL 18, 2018 FILED AGAINST SENIOR HEALTH INSURANCE COMPANY OF PENSYLVANIA
RSN
TYPE
OWNR CMPLN# COMPANY NAME DATE RCVD CNFD? REASON CATEGORY CODE TYPE' DISPOSITION
---- ------- -------------------------------------------------- ----------- ----- -------------------- ------ ------------------------------ ----------------------------------------
CR 74414 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 08-SEP-2014 Y Claim Handling DLY Delays (Claims Handling) Additional Monies Received
83877 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 23-DEC-2014 Y Policyholder Service DLNR Delays (Policyholder Service) Additional Monies Received
DLNR Delays (Policyholder Service) Premium Refunded
93551 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 07-APR-2015 Y Claim Handling DOC Denial Of Claim Additional Monies Received
DLY Delays (Claims Handling)
USSO Unsatisfactory Settle/Offer
DLY Delays (Claims Handling) Contract Language/Legal Issue
DOC Denial Of Claim
USSO Unsatisfactory Settle/Offer
USSO Unsatisfactory Settle/Offer Information Furnished
DOC Denial Of Claim
DLY Delays (Claims Handling)
154277 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 10-NOV-2016 Y Claim Handling USSO Unsatisfactory Settle/Offer Additional Monies Received
DLY Delays (Claims Handling)
USSO Unsatisfactory Settle/Offer Information Furnished
DLY Delays (Claims Handling)
USSO Unsatisfactory Settle/Offer Stat Pen Pd-Up To 45 Dys Late
DLY Delays (Claims Handling)
161048 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 19-DEC-2016 Y Policyholder Service PMRF Refund Of Premium Information Furnished
DLNR Delays (Policyholder Service)
20 rows selected.
CNFD? Y=Confirmed/Justified
SIRCON
ALL NOT CONFIRMED COMPLAINTS RECEIVED AT TDI BETWEEN JUL 18, 2013 AND JUL 18, 2018 FILED AGAINST SENIOR HEALTH INSURANCE COMPANY OF
PENSYLVANIA
RSN
TYPE
OWNR CMPLN# COMPANY NAME DATE RCVD CNFD? REASON CATEGORY CODE TYPE' DISPOSITION
---- ------- -------------------------------------------------- ----------- ----- -------------------- ------ ------------------------------ ----------------------------------------
CR 49328 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 17-DEC-2013 N Claim Handling DLY Delays (Claims Handling) Contract Language/Legal Issue
DLY Delays (Claims Handling) Information Furnished
52569 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 27-JAN-2014 N Claim Handling DLY Delays (Claims Handling) Contract Language/Legal Issue
62771 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 01-MAY-2014 N Claim Handling DOC Denial Of Claim Additional Monies Received
DOC Denial Of Claim Contract Language/Legal Issue
70500 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 31-JUL-2014 N Miscellaneous Compla D90 Other Record Only
71187 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 04-AUG-2014 N Claim Handling DOC Denial Of Claim No Jurisdiction
72973 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 21-AUG-2014 N Policyholder Service DLNR Delays (Policyholder Service) Policy Not In Force
CV Cash Value
75308 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 17-SEP-2014 N Claim Handling DOC Denial Of Claim Additional Monies Received
D94 Customer Service
78025 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 14-OCT-2014 N Claim Handling D383 Deficient Claim Notice Information Furnished
DLY Delays (Claims Handling)
87903 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 12-JAN-2015 N Claim Handling DOC Denial Of Claim Company Position Upheld
DOC Denial Of Claim Contract Language/Legal Issue
DOC Denial Of Claim Information Furnished
Patient Protection R D77 Continuity Of Treatment Company Position Upheld
D77 Continuity Of Treatment Contract Language/Legal Issue
D77 Continuity Of Treatment Information Furnished
98904 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 09-JUN-2015 N Claim Handling DLY Delays (Claims Handling) Contract Language/Legal Issue
DLY Delays (Claims Handling) Information Furnished
111851 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 05-OCT-2015 N Claim Handling DLY Delays (Claims Handling) Additional Monies Received
DOC Denial Of Claim
D94 Customer Service
DLY Delays (Claims Handling) Information Furnished
DOC Denial Of Claim
D94 Customer Service
117084 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 23-NOV-2015 N Policyholder Service DLNR Delays (Policyholder Service) Insufficient Information
120102 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 25-JAN-2016 N Claim Handling D1049 Maximum Out of Pocket Company Position Upheld
D1049 Maximum Out of Pocket Contract Language/Legal Issue
120261 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 26-JAN-2016 N Claim Handling DOC Denial Of Claim Contract Language/Legal Issue
121248 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 04-JAN-2016 N Patient Protection R D75 Disclosure Of Benefits Contract Language/Legal Issue
D75 Disclosure Of Benefits Information Furnished
121640 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 06-JAN-2016 N Underwriting CNCL Cancellation Information Furnished

2. CNCL Cancellation Policy Issued/Restored
123979 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 05-FEB-2016 N Miscellaneous Compla D90 Other Information Furnished
131157 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 31-MAR-2016 N Claim Handling USSO Unsatisfactory Settle/Offer Company Position Upheld
USSO Unsatisfactory Settle/Offer Contract Language/Legal Issue
USSO Unsatisfactory Settle/Offer Question of Fact
Patient Protection R D77 Continuity Of Treatment Company Position Upheld
D77 Continuity Of Treatment Contract Language/Legal Issue
D77 Continuity Of Treatment Question of Fact
131325 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 28-APR-2016 N Claim Handling D94 Customer Service Company Position Upheld
DOC Denial Of Claim
COB Coordination of Benefits
DLY Delays (Claims Handling)
DLY Delays (Claims Handling) Contract Language/Legal Issue
D94 Customer Service
COB Coordination of Benefits
DOC Denial Of Claim
COB Coordination of Benefits Information Furnished
D94 Customer Service
DLY Delays (Claims Handling)
DOC Denial Of Claim
134042 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 22-APR-2016 N Claim Handling DOC Denial Of Claim Information Furnished
MDNC Medical Necessity
USSO Unsatisfactory Settle/Offer
USSO Unsatisfactory Settle/Offer No Jurisdiction
DOC Denial Of Claim
MDNC Medical Necessity
135033 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 31-MAY-2016 N Claim Handling D94 Customer Service Additional Monies Received
DLY Delays (Claims Handling)
DLY Delays (Claims Handling) Contract Language/Legal Issue
D94 Customer Service
Policyholder Service DLNR Delays (Policyholder Service) Additional Monies Received
D77A Continuity of Treatment
DLNR Delays (Policyholder Service) Contract Language/Legal Issue
D77A Continuity of Treatment
155927 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 10-NOV-2016 N Policyholder Service PMRF Refund Of Premium Information Furnished
156701 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 31-OCT-2016 N Claim Handling USSO Unsatisfactory Settle/Offer Contract Language/Legal Issue
USSO Unsatisfactory Settle/Offer Information Furnished
163152 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 06-FEB-2017 N Claim Handling USSO Unsatisfactory Settle/Offer Additional Monies Received
DOC Denial Of Claim
USSO Unsatisfactory Settle/Offer Contract Language/Legal Issue
DOC Denial Of Claim
DOC Denial Of Claim Stat Pen Pd-Up To 45 Dys Late
USSO Unsatisfactory Settle/Offer
166210 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 31-JAN-2017 N Policyholder Service ACTC Access to Care Contract Language/Legal Issue
DLNR Delays (Policyholder Service)
ACTC Access to Care Policy Issued/Restored
DLNR Delays (Policyholder Service)
Underwriting CNCL Cancellation Contract Language/Legal Issue
DLYUND Delays (Underwriting)
CNCL Cancellation Policy Issued/Restored
DLYUND Delays (Underwriting)
167435 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 15-FEB-2017 N Claim Handling DLY Delays (Claims Handling) Contract Language/Legal Issue
DOC Denial Of Claim
DOC Denial Of Claim Information Furnished
DLY Delays (Claims Handling)
169316 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 13-MAR-2017 N Marketing & Sales D27 Non-Disclosure Of Coverage Contract Language/Legal Issue
D938 Summary of Benefits
D27 Non-Disclosure Of Coverage Information Furnished
D938 Summary of Benefits
Underwriting CTBF Continuation of Benefits Contract Language/Legal Issue
PMTR Premium and Rating
CTBF Continuation of Benefits Information Furnished
PMTR Premium and Rating
179067 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 26-APR-2017 N Underwriting D07 Excessive Rates Contract Language/Legal Issue
PMTR Premium and Rating
193727 SENIOR HEALTH INSURANCE COMPANY OF PENNSYLVANIA 06-NOV-2017 N Underwriting DLYUND Delays (Underwriting) Contract Language/Legal Issue
CNCL Cancellation
CNCL Cancellation Question of Fact
DLYUND Delays (Underwriting)
103 rows selected.
CNFD? N=Not Confirmed/Unjustified