National Association of Letter Carriers

Complaint: [redacted] I am rejecting this response because: NALC knows who I am they only cancelled one person on October 15, that they NEVER provide any insurance to during I must have proof I paid for insurance for January through October because that rotten corrupt incompetent Obama and his Obamacare requires you to have insuranceI paid for insurance this is critical for tax purposes that I have proof > Regards, [redacted] **

As stated on our phone conversation today, we are unable to identify Mr [redacted] of San Francisco, CA as an NALC Health Benefit Plan Member based on the information you supplied us Feel free to contact me if you obtain any additional information from Mr**

We received the complaint on 3/21/16. We have reviewed all claims and are paying the negotiated rate of $559.67 at 100% for the breast pump rentals. An additional payment of $8.57 has been issued to the member. If the member paid more than the negotiated rate, reimbursement should... be requested from the provider of service. A letter is being sent to our member.

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***
I have not received any correspondance from them at this time

The NALC Health Benefit Plan (the Plan) is in receipt of your July 8, correspondence referencing our member, *** ***, and her issue of a prescription charge for a drug that was delivered to her address, but not received.We are sure that you are familiar with the Health insurance Portability
and Accountability Act (HIPAA) privacy laws and that this Plan cannot share specific claim information with anyone other than our member without our member's specific written consentSince we do not have *** ***' written consent, we are notifying you that we have reviewed this issue and will correspond with our member directly.Thank you for facilitating our member's request for a reviewWe will be contacting her shortly under separate cover.Sincerely,Brian H*** Director

Complaint: [redacted]
I am...

rejecting this response because: NALC knows who I am they only cancelled one person on October 15, 2016 that they NEVER provide any insurance to during 2016. I must have proof I paid for insurance for January 1 through October 15 because that rotten corrupt incompetent Obama and his Obamacare requires you to have insurance. I paid for insurance this is critical for tax purposes that I have proof
>
Regards,
[redacted]

We received the complaint on 3/21/16.  We have reviewed all claims and are paying the negotiated rate of $559.67 at 100% for the breast pump rentals.  An additional payment of $8.57 has been issued to the member.  If the member paid more than the negotiated rate, reimbursement should...

be requested from the provider of service.  A letter is being sent to our member.

As stated on our phone conversation today, we are unable to identify Mr. [redacted] of San Francisco, CA as an NALC Health Benefit Plan Member based on the information you supplied us.  Feel free to contact me if you obtain any additional information from Mr. **.

Review: NALC is my primary health insurance through my employer ([redacted]). I have a daughter with extreme medical needs. Over a period of 2011 and 2012, NALC overpaid the nursing agency that cares for my daughter ([redacted]). NALC and [redacted] have been trying to straighten out the billing problems so that the proper payments and paid and received by all parties (my daughter has a second and third insurance that would pick up all payments due). Rather than attempting to successfully resolve this issue, NALC has made allegations of deceipt against [redacted] (their own contracted provider), has demanded that I pay NALC out of my own pocket over $2800, and have threatened collections, and now is refusing to pay any of my family's medical claims.Desired Settlement: NALC needs to go after the agency they overpaid, and pay all of the claims that are now building up on my family for medical bills.

Business

Response:

November 6, 2013

Dear **. [redacted]:

We are in receipt of your recent inquiry to the NALC Health Benefit Plan (the Plan) concerning a claims payment issue brought to your attention by our member, [redacted].

The NALC Health Benefit Plan is a participant in the Federal Employees Health Benefits Program, and as such, our members have specific procedure they must follow when disputing the actions of their health plan. Ultimately, the U.S. Office of Personnel Management determines if the Plan has acted in accordance with our contract.

Please also be advised that the Health Insurance Portability and Accountability Act (Privacy Rule) prevents us from releasing any protected health information including, but not limited to treatment, payment, and individually identifiable information without signed consent from the patient or designated representative.

We have been in contact with this member and are actively working to resolve her concerns.

Sincerely

Review: I had a child on 7/25/2011 and he had a newborn hearing test on 8/5/2011. The claim was billed by hospital for 340.00 and it was denied as non covered benefit incorrectly. I called multiple times and was given different reasons for it being denied, then told they had no record of my contact and it was now past timely period for adjustment. I have wwritten letters to the Director [redacted] without appropriate response. This was not processed according to my benefit and I want it fixedDesired Settlement: I want them to process my claim according to the benefits I have been paying for

Business

Response:

November 27, 2013

Dear **. [redacted]:

The NALC Health Benefit Plan has been in contact with our member and resolved the issue associated with the Identification Number referenced above. However, due to HIPAA Guidelines, since the Revdex.com is not listed as a Personal Representative of the patient, we cannot give any specific or detailed information regarding the matter.

Sincerely,