Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear belowThank you for the copy of the recent letter you received concerning my dealings with Anthem Blue Cross/Blue Shield referencing the unpaid balances and or the lack of refund of my December payment,
Anthem neglected to reflect that I did not receive a letter from them telling me of their November termination of my coverage, but did relay that to me in a further telephone call (many numerous calls) over the past few months
Per a 3:pm call ( on July 8th 2015) to my primary physician, I asked their billing department if the December bills had been paid ( which Anthem Cobra stated had been reprocessed for payment between December and June18,2015.) The bookkeeper replied that the bills had been paid (by Anthem) and then in May of Anthem retracted their payment from the Doctor's officeNo further payment has been received from Anthem up to the date of this writingThere was no mention of that in the response they sent to you dated 6/26/
In the coming next day or so I will be contacting Anthem (again) and will reference their short-comingsI am also in close contact with the Deptof Labor since Cobra programs are governed by the U.SGovernmentThey, too are asking questions of Anthem as to why only certain elements of this case are being released to entities such as the Revdex.com, EBSA, etc
Respectfully,
*** *** (Jr.)
I contacted Mr*** to obtain additional information about the situation. Mr*** provided details concerning the automated system calling his phone number. I am attempting to put a stop to the calls. Mr*** and I had a very pleasant conversation. I
did tell Mr*** I would make every effort to stop the calls
*** ***Lead Analyst, Grievances and Appeals
Anthem BCBS
Thank you for the opportunity to review Mr*** *** complaint that was filed with the Revdex.comYour office assigned an Identification number of *** to the complaintWe have reviewed Mr***
concerns about his refund request of $and we respond as follows
Our records reflect that Mr*** had COBRA coverage with *** *** *** Incfrom August 1, to December 31, 2014, which was administered by Anthem
Please be advised that COBRA premiums are due on the first of the month with a 30-day grace periodThis information is included in the COBRA election notice and monthly premium notices issued to Mr***The invoices state, "It is very important that your payment is on time and is postmarked no later than the end of the grace period shown on the invoicePayments postmarked after the grace period end date will automatically terminate your coverage, and it cannot be reinstated." Anthem's records show that we did not receive Mr*** payment for December by the December 31, grace period end dateAs a result, his COBRA was initially canceled for nonpayment of premiums effective November 30, 2014, and a cancel notice dated January 7, was sent to inform him of thisAnthem then received his payment in January with the postmark date of December 31, Since his payment was postmarked on the last day of the grace period, the payment was accepted and applied to his December coverage periodAnthem later received notice that his employer, *** *** *** Inccanceled their COBRA administration services with AnthemTherefore, Mr*** COBRA coverage ended on December 31, The Changes in Coverage: Termination, Continuation & Conversion section of Mr*** Anthem health benefit plan (page M-66) in part states, "If you elect coverage under another carrier's health benefit plan or under any other non-Anthem plan which is offered by, through, or in connection with the Employer as an option instead of this Plan, then coverage for you and your Dependent(s) will generally terminate at the end of the billing period for which Fees have been paid."
Based on Mr*** employer group cancelling their COBRA administration plan with Anthem and the aforementioned plan language, his COBRA coverage termed correctly as of December 31, The refund request of his December premium is denied
In regards to Mr*** December claims, please note that Anthem has several claims on fileOur records show that each claim was reprocessed and paid in accordance with Mr*** benefit plan language between December 23, and June 18,
Ms***, we appreciate your efforts on behalf of Mr*** and we hope this information is helpfulIf Mr*** has additional questions or concerns he may contact us by calling the telephone number on his Identification card
Sincerely,
Donna W***
Grievances and Appeals Analyst SrGrievances and Appeals Department
Thank you for forwarding Ms***' complaint to our officeDue to the sensitive nature involved, and privacy laws, we are able to offer the following limited information in response to Ms***' concerns regarding *** ***Our records reflect that Anthem's appeals
department spoke with the member's mother, *** ***, on November 2, 2015, ans advised of the appeal options for ***'s caseOur appeals department called the facility on November 4, 2015, and spoke with *** in the facility's utilization review department and provided the facility with the right to appealThe facility declined to verbally initiate an appeal. Ms***, if you have any questions, please contact our officeOur reference number I ***Sincerely,
Kathy H***
We are in receipt of your letter dated May 9, 2016 regarding Complaint ID [redacted]. In his letter, the complainant indicated he had made a payment on February 18, 2016 but that his account was not yet showing as active. We have identified an issue with this member’s...
account and are in the process of correcting the issue. Our Customer Service Team spoke with the complainant on May 16, 2016 to let him know that we are updating his account to show that his payment has been applied. Please let me know if you have questions or need anything else. Best regards, Elizabeth E[redacted]
Thank you for bringing this matter to our attention. Please note that due to the nature of this complaint and that it would require disclosing [redacted]'s Personal Health Information (PHI) we are unable to directly respond to your office as we would be in violation of the Health Information...
Portability and Accountability Act (HIPPA). This matter will be thoroughly investigated by our Grievances and Appeals Department and a response will be issued directly to Ms. [redacted].Sincerely,
Anthem Blue Cross Blue Shield
Grievances and Appeals Department
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]
Thank you for forwarding Ms. [redacted] complaint to our office, which is concerning the recent cyber attack that was made on Anthem, Inc.
12pt;">We understand and share Ms. [redacted] concerns. Anthem Information Security has worked around the clock to reduce the risk of any further vulnerability and continues working to secure the Company's data against these types of attacks. At the same time, Anthem continues to work with law enforcement on their ongoing investigation. When a member lets us know he or she has a concern or request such as this, we will: · Investigate the concerns; · Do everything we can to correct the situation; and · Keep track of all service concerns in a database (collection of data or information). This lets us look at ways to improve quality of service when possible.
Based on the analysis to date, we've determined that Anthem was the target of an external cyber attack that gained unauthorized access to personal information relating to members who were or are currently covered by Anthem or other independent Blue Cross and Blue Shield plans whose members received services in Anthem states. Our investigation indicates that this access took place beginning in early December, 2014.
We've determined that the member data accessed included names, member ID numbers, dates of birth, Social Security numbers, addresses, phone numbers, email addresses and employment information. Our investigation has uncovered no evidence that provider data was accessed or that any diagnosis or treatment data was exposed. Further, banking and credit card information wasn't within the data that we've determined was accessed.
Starting February 13, 2015, we started offering free identity protection services to all impacted individuals provided by our vendor AllClear - a leading and trusted identity protection provider. Those impacted individuals can access these services prior to receiving a mailed notification from Anthem and can receive these services at any point during the 24 month coverage period. Please visit AnthemFacts.com to learn more. Impacted individuals may access identity repair services by calling 877-263-7995. Phone lines will be open from Monday through Saturday from 8:00 a.m. to 8:00 p.m. Central Time (Closed on Sundays).
For additional protection, and at no cost, individuals may also enroll in the Al1Clear PRO service at any time during the 24 month coverage period. This service includes credit monitoring and an identity theft insurance policy. Individuals can enroll at https://anthem.allclearid.com/. Those without Internet access can call 877-263-7995. For more information please visit https://anthem.allclearid.com/faqs.
If Ms. [redacted] has any questions about this information, she may call customer service at the phone number on the member ID card. In addition, Ms. [redacted] can visit our website, www.AnthemFacts.com, to learn more. This website will continue to be updated as the investigation continues.
Ms. [redacted], Anthem appreciates the opportunity to respond to this matter. If you have any questions, please contact our office.
Sincerely,
Dorotko [redacted]
Dorothy [redacted]
Grievances and Appeals Analyst Grievances and Appeals
Thank you for the opportunity to review Mr. [redacted] complaint that was filed with the Revdex.com. Your office assigned an Identification number of [redacted] to the complaint. We have reviewed Mr. [redacted] concerns about his COBRA...
premium refund request totaling $439.39 (Account# [redacted]) and we respond as follows. Our records reflect that Anthem administers Mr. [redacted] COBRA plan, which is offered through his [redacted] COBRA employer group, which was active from October 3, 2014 through April 30, 2015. Mr. [redacted] COBRA plan is showing termed effective May 1, 2015. Please be advised that when COBRA payments are sent to and received by Anthem, we forward the payments on to the group. The premium Mr. [redacted] sent in was forwarded back to his employer group plan. On June 2, 2015, Anthem’s COBRA administration department sent an email to the employer group, asking them to return the payment so Anthem can refund the member. We have to await a reply from the employer group before Anthem can process and issue Mr. [redacted] COBRA refund. At this time, Anthem has not received any monies back from the group to process his refund. As such, Mr. [redacted] can contact his employer and request the refund. Should Mr. [redacted] employer group issue a refund directly to him, Anthem’s COBRA administration records will still reflect he is owed a refund, unless the employer returns the money to Anthem for refund processing. Anthem generally requests that the employer refund us, and then we issue a refund to Mr. [redacted] so to track the refund in our systems.
Ms. [redacted], we appreciate your efforts on behalf of Mr. [redacted] and we hope this information is helpful. If Mr. [redacted] has additional questions or concerns he may contact us by calling the telephone number on his Identification card.
Sincerely,
Donna W[redacted]
Grievances and Appeals Analyst Sr.
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear belowThank you for the copy of the recent letter you received concerning my dealings with Anthem Blue Cross/Blue Shield referencing the unpaid balances and or the lack of refund of my December payment,
Anthem neglected to reflect that I did not receive a letter from them telling me of their November termination of my coverage, but did relay that to me in a further telephone call (many numerous calls) over the past few months
Per a 3:pm call ( on July 8th 2015) to my primary physician, I asked their billing department if the December bills had been paid ( which Anthem Cobra stated had been reprocessed for payment between December and June18,2015.) The bookkeeper replied that the bills had been paid (by Anthem) and then in May of Anthem retracted their payment from the Doctor's officeNo further payment has been received from Anthem up to the date of this writingThere was no mention of that in the response they sent to you dated 6/26/
In the coming next day or so I will be contacting Anthem (again) and will reference their short-comingsI am also in close contact with the Deptof Labor since Cobra programs are governed by the U.SGovernmentThey, too are asking questions of Anthem as to why only certain elements of this case are being released to entities such as the Revdex.com, EBSA, etc
Respectfully,
*** *** (Jr.)
I contacted Mr*** to obtain additional information about the situation. Mr*** provided details concerning the automated system calling his phone number. I am attempting to put a stop to the calls. Mr*** and I had a very pleasant conversation. I
did tell Mr*** I would make every effort to stop the calls
*** ***Lead Analyst, Grievances and Appeals
Anthem BCBS
Thank you for the opportunity to review Mr*** *** complaint that was filed with the Revdex.comYour office assigned an Identification number of *** to the complaintWe have reviewed Mr***
concerns about his refund request of $and we respond as follows
Our records reflect that Mr*** had COBRA coverage with *** *** *** Incfrom August 1, to December 31, 2014, which was administered by Anthem
Please be advised that COBRA premiums are due on the first of the month with a 30-day grace periodThis information is included in the COBRA election notice and monthly premium notices issued to Mr***The invoices state, "It is very important that your payment is on time and is postmarked no later than the end of the grace period shown on the invoicePayments postmarked after the grace period end date will automatically terminate your coverage, and it cannot be reinstated." Anthem's records show that we did not receive Mr*** payment for December by the December 31, grace period end dateAs a result, his COBRA was initially canceled for nonpayment of premiums effective November 30, 2014, and a cancel notice dated January 7, was sent to inform him of thisAnthem then received his payment in January with the postmark date of December 31, Since his payment was postmarked on the last day of the grace period, the payment was accepted and applied to his December coverage periodAnthem later received notice that his employer, *** *** *** Inccanceled their COBRA administration services with AnthemTherefore, Mr*** COBRA coverage ended on December 31, The Changes in Coverage: Termination, Continuation & Conversion section of Mr*** Anthem health benefit plan (page M-66) in part states, "If you elect coverage under another carrier's health benefit plan or under any other non-Anthem plan which is offered by, through, or in connection with the Employer as an option instead of this Plan, then coverage for you and your Dependent(s) will generally terminate at the end of the billing period for which Fees have been paid."
Based on Mr*** employer group cancelling their COBRA administration plan with Anthem and the aforementioned plan language, his COBRA coverage termed correctly as of December 31, The refund request of his December premium is denied
In regards to Mr*** December claims, please note that Anthem has several claims on fileOur records show that each claim was reprocessed and paid in accordance with Mr*** benefit plan language between December 23, and June 18,
Ms***, we appreciate your efforts on behalf of Mr*** and we hope this information is helpfulIf Mr*** has additional questions or concerns he may contact us by calling the telephone number on his Identification card
Sincerely,
Donna W***
Grievances and Appeals Analyst SrGrievances and Appeals Department
Thank you for forwarding Ms***' complaint to our officeDue to the sensitive nature involved, and privacy laws, we are able to offer the following limited information in response to Ms***' concerns regarding *** ***Our records reflect that Anthem's appeals
department spoke with the member's mother, *** ***, on November 2, 2015, ans advised of the appeal options for ***'s caseOur appeals department called the facility on November 4, 2015, and spoke with *** in the facility's utilization review department and provided the facility with the right to appealThe facility declined to verbally initiate an appeal. Ms***, if you have any questions, please contact our officeOur reference number I ***Sincerely,
Kathy H***
We are in receipt of your letter dated May 9, 2016 regarding Complaint ID [redacted]. In his letter, the complainant indicated he had made a payment on February 18, 2016 but that his account was not yet showing as active. We have identified an issue with this member’s...
account and are in the process of correcting the issue. Our Customer Service Team spoke with the complainant on May 16, 2016 to let him know that we are updating his account to show that his payment has been applied. Please let me know if you have questions or need anything else. Best regards, Elizabeth E[redacted]
Thank you for bringing this matter to our attention. Please note that due to the nature of this complaint and that it would require disclosing [redacted]'s Personal Health Information (PHI) we are unable to directly respond to your office as we would be in violation of the Health Information...
Portability and Accountability Act (HIPPA). This matter will be thoroughly investigated by our Grievances and Appeals Department and a response will be issued directly to Ms. [redacted].Sincerely,
Anthem Blue Cross Blue Shield
Grievances and Appeals Department
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]
Thank you for forwarding Ms. [redacted] complaint to our office, which is concerning the recent cyber attack that was made on Anthem, Inc.
12pt;">We understand and share Ms. [redacted] concerns. Anthem Information Security has worked around the clock to reduce the risk of any further vulnerability and continues working to secure the Company's data against these types of attacks. At the same time, Anthem continues to work with law enforcement on their ongoing investigation. When a member lets us know he or she has a concern or request such as this, we will: · Investigate the concerns; · Do everything we can to correct the situation; and · Keep track of all service concerns in a database (collection of data or information). This lets us look at ways to improve quality of service when possible.
Based on the analysis to date, we've determined that Anthem was the target of an external cyber attack that gained unauthorized access to personal information relating to members who were or are currently covered by Anthem or other independent Blue Cross and Blue Shield plans whose members received services in Anthem states. Our investigation indicates that this access took place beginning in early December, 2014.
We've determined that the member data accessed included names, member ID numbers, dates of birth, Social Security numbers, addresses, phone numbers, email addresses and employment information. Our investigation has uncovered no evidence that provider data was accessed or that any diagnosis or treatment data was exposed. Further, banking and credit card information wasn't within the data that we've determined was accessed.
Starting February 13, 2015, we started offering free identity protection services to all impacted individuals provided by our vendor AllClear - a leading and trusted identity protection provider. Those impacted individuals can access these services prior to receiving a mailed notification from Anthem and can receive these services at any point during the 24 month coverage period. Please visit AnthemFacts.com to learn more. Impacted individuals may access identity repair services by calling 877-263-7995. Phone lines will be open from Monday through Saturday from 8:00 a.m. to 8:00 p.m. Central Time (Closed on Sundays).
For additional protection, and at no cost, individuals may also enroll in the Al1Clear PRO service at any time during the 24 month coverage period. This service includes credit monitoring and an identity theft insurance policy. Individuals can enroll at https://anthem.allclearid.com/. Those without Internet access can call 877-263-7995. For more information please visit https://anthem.allclearid.com/faqs.
If Ms. [redacted] has any questions about this information, she may call customer service at the phone number on the member ID card. In addition, Ms. [redacted] can visit our website, www.AnthemFacts.com, to learn more. This website will continue to be updated as the investigation continues.
Ms. [redacted], Anthem appreciates the opportunity to respond to this matter. If you have any questions, please contact our office.
Sincerely,
Dorotko [redacted]
Dorothy [redacted]
Grievances and Appeals Analyst Grievances and Appeals
Thank you for the opportunity to review Mr. [redacted] complaint that was filed with the Revdex.com. Your office assigned an Identification number of [redacted] to the complaint. We have reviewed Mr. [redacted] concerns about his COBRA...
premium refund request totaling $439.39 (Account# [redacted]) and we respond as follows. Our records reflect that Anthem administers Mr. [redacted] COBRA plan, which is offered through his [redacted] COBRA employer group, which was active from October 3, 2014 through April 30, 2015. Mr. [redacted] COBRA plan is showing termed effective May 1, 2015. Please be advised that when COBRA payments are sent to and received by Anthem, we forward the payments on to the group. The premium Mr. [redacted] sent in was forwarded back to his employer group plan. On June 2, 2015, Anthem’s COBRA administration department sent an email to the employer group, asking them to return the payment so Anthem can refund the member. We have to await a reply from the employer group before Anthem can process and issue Mr. [redacted] COBRA refund. At this time, Anthem has not received any monies back from the group to process his refund. As such, Mr. [redacted] can contact his employer and request the refund. Should Mr. [redacted] employer group issue a refund directly to him, Anthem’s COBRA administration records will still reflect he is owed a refund, unless the employer returns the money to Anthem for refund processing. Anthem generally requests that the employer refund us, and then we issue a refund to Mr. [redacted] so to track the refund in our systems.
Ms. [redacted], we appreciate your efforts on behalf of Mr. [redacted] and we hope this information is helpful. If Mr. [redacted] has additional questions or concerns he may contact us by calling the telephone number on his Identification card.
Sincerely,
Donna W[redacted]
Grievances and Appeals Analyst Sr.
Anthem Case Reference Number: [redacted]