Anybody here who has Total Plan Concepts in Brooklyn NY as the third party administrator for their employee sponsored health insurance?
I had a paragliding accident on October 28, 2023, plunged 30 feet from the air, crashed into the ground and broke the bones on my back, was hospitalized for 4 days, and Total Plan Concepts denied coverage of my hospital bills. When I asked them for the Summary Plan Description in 2023 that defines the complete terms of my coverage, they instead sent me a 1 page list of exclusions that says that treatment for my injury is excluded because it was the result of a “hazardous activity.”. This 1 page exclusion list was written an hour and 20 minutes after I made that phone call requesting for the SPD (I have digital forensic evidence of the file creation date for the file they sent me). I have asked the Department of Labor for assistance to secure a legitimate SPD from Total Plan Concepts, but it has been more than a month and a half and the company has not responded at all to the federal agency. I have been asking the company everyday to give me a copy of the SPD for 2023, but 84 days now since my request and the company still hasn’t given me the requested document. Anybody here has any advice on what I should do next?
