Balloons Are Forever

This member purchased his medical insurance policy through the Federal Healthcare Exchange, also known as the Marketplace The Marketplace manages all eligibility for on-exchange policies The Marketplace notified Blue Cross and Blue Shield of Kansas City (Blue KC) electronically of this member’s enrollment Blue KC completed the enrollment process by mailing out an identification card, making a welcome call to the member and reviewing how his policy works This member was set up on autopay for his premium due monthly.Blue KC received a call from the member on December 30, 2016, to question why his premium was deducted from his account According to the member, he canceled his policy on December 27, The Blue KC representative informed this member that the Marketplace had not yet notified Blue KC of his cancelation The Blue KC representative confirmed with the Marketplace that the policy had been cancelled Blue KC has started the cancelation process and are working on the refund due to the member

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Assumed Answered] Complaint: [redacted] I am rejecting this response because: Blue Cross/Blue Shield (that is the name of the company on the front of the Insurance card) has admitted that they double billed by refunding two of the three months that we were paying both premiums On the same admitted premise, they should refund the third month that they double billed, not hide behind 'company policy' as their excuse to not return our $ We bought our health policy through Blue Cross Blue Shield and then the new employer also carried Blue Cross/ Blue Shield They don't distinguish that it is two different companies to the consumer, letting us think it is the same brand, purposefully It is not until we realized they were still taking out $from our credit card that we called, they had me flip our insurance card over to point out that what we thought was the same company (because of the name of Blue Cross/Blue Shield on the front of the card) was actually two different companies In today's world where it is becoming increasingly more difficult for the average consumer, who is trying to comply with government mandates, to navigate insurance policies and costs, insurance companies should be more transparent and forthright I maintain that Blue Cross/Blue Shield, whether the overall parent company or the smaller companies who are using its name, should be more honest with individuals On the open market of individual policies, the policies offered by all the insurance companies are about the same as far as costs, deductibles, coverages We chose Blue Cross/Blue Shield because of it's name recognition Given their deception on this matter, I would never recommend them to another Regards, [redacted] ***

I am unfamiliar with any issues this member had with Blue Cross and Blue Shield of Illinois back in Blue Cross and Blue Shield of Kansas City (Blue KC) is independently owned and operated This member obtained her health insurance policy through the Marketplace The Marketplace is responsible for handling the eligibility for all on-exchange policies The member is correct, she did pay her monthly premiums for There were claims filed to Blue KC on this member’s behalf for Blue KC allowed benefit payments on of the claims and denied three claims for lack of coverage There was a discrepancy with this members account because the Marketplace had two separate applications for two different policies on this one member The discrepancy has been resolved and the member is currently active without a lapse in coverage The three denied claims are in the process of being adjusted to allow payment I apologize for any inconvenience this has caused the member

The member is questioning why she was not notified of the cancelation or provided the option to renew her policy Please be advised, Short-Term policies are not renewable They are intended to provide coverage for a short period of time until insurance can be obtained through employment or through the Marketplace during the open-enrollment period This member was notified of the December 31st cancelation of the Short-Term policy The first notification was on the application she filled out on April 30, The following information was provided under the “Agreement” section of the application: “I understand that, if persons proposed for coverage are eligible and coverage is offered: (1) effective date of coverage will be 12:a.mon the date I requested; (2) preexisting conditionswill not be covered; (3) coverage under this Contract will terminate at 11:p.mon December 31st; ” The second notification of the cancelation date on this Short-Term policy was in the acceptance letter The following information was provided under the “Important Dates” section of the acceptance letter: Your effective date of coverage is 05/01/2016.Your short-term coverage will automatically terminate on 12/31/The third notification of the cancelation date on this Short-Term policy is in the contract language Members are responsible for being knowledgeable of the terms of their contract The following information is found in the “Terminating the Contract” section of the contract: Non-Renewability This Contract is for short term coverageThe Contract is not renewable nor is it intended to be permanent coverageHowever, if Your temporary need for this coverage continues beyond December 31st, You may apply for a new short term contractIn no event will coverage under this Contract be provided in excess of consecutive months They system did automatically cancel the policy on December 31, as stipulated in the member’s contract However, the auto-payment did not cancel correctly causing an additional draft in January and February Since the policy was canceled the money was in a suspended account until the mistake was identified Both premium payments were refunded to the member I apologize for any confusion this caused This member did elect to apply for another Short-Term policy that is scheduled to cancel on December 31,

This member went through the Marketplace to obtain medical health insurance The Marketplace is responsible for managing the eligibility of all On-Exchange policies Blue Cross and Blue Shield of Kansas City (Blue KC) may only cancel an On-Exchange policy due to non-payment of premium This member sent an e-mail request to Blue KC on September 1, 2016, to have everyone but his child canceled from the policy A Blue KC representative responded to the member via e-mail (on September 1, 2016) that he would need to contact the Marketplace to make any changes to his On-Exchange policy.This member sent another e-mail request to Blue KC on September 7, 2016, to request the policy be canceled A Blue KC representative responded to the member via e-mail (on September 7, 2016) that he would need to contact the Marketplace to cancel his On-Exchange policy This member sent another e-mail to Blue KC on September 8, 2016, to advise he spoke to the Marketplace regarding the cancelation of his policy The Marketplace informed the member the policy would be canceled in days The cancelation date is September 22, A Blue KC representative responded to the member via e-mail (on September 8, 2016) that we would cancel his policy as soon as we received the electronic notification from the Marketplace Blue KC canceled the policy on September 22, 2016, as instructed by the Marketplace We also issued a partial refund of the premium previously paid for the month of September The member’s complaint indicated Blue KC has a policy that allows for a cancelation within one week of the next scheduled payment Please be advised, this is not a Blue KC policy Blue KC directs all members enrolled in an On-Exchange policy to the Marketplace to make all eligibility changes This member has the right to address his dissatisfaction with the cancelation policy directly with the Marketplace

I understand the complainant does not agree with the response originally provided However, the Membership Department is able to provide documented proof of the card being declined along with the reason for the decline This was specific and isolated to this member’s policy I would encourage the member to follwith the Customer Service phone number on their card to review any possible discrepancies The member was directed to the Marketplace to discuss eligibility since the called made to Blue KC was after the policy had been canceled for lack of premium payment Blue KC does not have the authority to make eligibility changes to policies obtained through the MarketplaceThis member has the right to appeal the eligibility decisions directly with the Marketplace If any eligibility changes are made as a result of the appeal review, then the Marketplace will notify Blue KC directly

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Assumed Answered]
Complaint: ***
I am rejecting this response because: This is NOT AT ALL what happenedI was on the phone with them and paid my bill but they would accept my son's because they said he we had to contact the MarketplaceWhich we did and call BLUE CROSS NUMEROUS times AS THEY KNOW I am rejecting this because it's NOT TRUE and they are lying which is unaccceptable My card was alway goodAS I said and they also said, THEY are the ones who had a problem with the auto pay AND with numerous customers and had they just let me pay my son's bill this would not have been an issue He was without insurance for months due to this
Regards,
*** ***

This member enrolled in a Short-Term PPO policy that became effective on May 1, 2016. This policy was canceled on December 31, 2017. The member’s contract contains the following language regarding the Short-Term policy: “This Contract is for short term coverageThe Contract is not
renewable nor is it intended to be permanent coverageHowever, if Your temporary need for this coverage continues beyond December 31st, You may apply for a new short term contractIn no event will coverage under this Contract be provided in excess of consecutive months.” Short-Term policies are designed to provide a member with medical health insurance until they can obtain coverage through an employer or until they can sign up for coverage during the open enrollment period. This member did re-enroll in another Short-Term policy that became effective February 15, 2017. This policy has an anticipated cancelation date of December 31,

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Assumed Answered]I called numerous times before a letter was even received as I pay two premiums and neither had been paid.  I paid one and was told the other could not be paid as I explained in the first complaint.  I would gladly call and get verifications but there are no verifications. I've called my credit card company and nothing was even TRIED to process.  There was never a fraud problem.  As I said Blue Cross had a problem with their auto pay system.  They took the blame.  Now they're denying it.  Several customers were effected, they explained to me in my first conversation.  This was on 12/01/16.  I made a payment on the one account and at that same time tried to pay [redacted]'s.  So why would one payment go through just fine and not his?  I'd like to know the reasoning for that?  Which resulted in him having no insurance for the past 2 months of the year.I am not gping to continue going back and forth with this company.  I have an email document stating that on Dec 23 I was set up to pay for the last 2 months PLUS the upcoming January for his account ending in [redacted].  The next time he went on to check the payment the entire account was gone.  I also have documents.  What I don't have are ALL the times and hours spend on the phone trying to rectify the situation.  They don't care! They never called back and I'm leaving this as an unfinished business and poor customer service.  I'm sure they have all kinds of ways to cover their end.  I'm not fighting with them and I am not ending this with a "satisfaction" is received.About This MessageThis email was sent to [redacted]. You received this email to confirm the activity described above on your Blue KC account number ending in XXXX[redacted].      This email confirms that you have successfully added a funding source for your payments to your Blue KC online bill payment profile.Thank you.About This MessageThis email was sent to [redacted]. You received this email to confirm the activity described above on your Blue KC account number ending in XXXX[redacted].Account Related Questions:
Complaint: [redacted]Complaint
I am rejecting this response because:
Regards,
[redacted]

I am unfamiliar with any issues this member had with Blue Cross and Blue Shield of Illinois back in 2015.   Blue Cross and Blue Shield of Kansas City (Blue KC) is independently owned and operated.  This member obtained her health insurance policy through the Marketplace.  The...

Marketplace is responsible for handling the eligibility for all on-exchange policies.  The member is correct, she did pay her monthly premiums for 2016.  There were 27 claims filed to Blue KC on this member’s behalf for 2016.  Blue KC allowed benefit payments on 24 of the claims and denied three claims for lack of coverage.  There was a discrepancy with this members account because the Marketplace had two separate applications for two different policies on this one member.  The discrepancy has been resolved and the member is currently active without a lapse in coverage.  The three denied claims are in the process of being adjusted to allow payment.  I apologize for any inconvenience this has caused the 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 [redacted], and find that this resolution is satisfactory to me.
thank you very much.
Regards,
[redacted]

I sent this prospective member's request to the Department Vice President of Individual and Small Group Sales for review.  We will have him removed from all marketing materials and future advertisements as he requested.

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Assumed Answered]
Complaint: [redacted]
I am rejecting this response because:  Blue Cross Blue Shield did not notify me prior to the 12/31 termination of the policy nor did they provide me with renewal notification. They continued to take premium out  of my bank account in January and February as though the policy was in force.  They refunded the January and February premiums in mid February without notice. When I inquired as to the reason for the refund, that's when they notified me that they terminated the policy. This notification is after the close of the open enrollment period, preventing me and my  Family from obtaining  Health care coverage in the marketplace  and forcing us to have to enroll for another short term policy and face fines from the government. 
Regards,
[redacted]

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Assumed Answered]
Complaint: [redacted]
I am rejecting this response because: Blue Cross/Blue Shield (that is the name of the company on the front of the Insurance card) has admitted that they double billed by refunding two of the three months that we were paying both premiums.  On the same admitted premise, they should refund the third month that they double billed,  not hide behind 'company policy' as their excuse to not return our $850.  We bought our health policy through Blue Cross Blue Shield and then the new employer also carried Blue Cross/ Blue Shield.  They don't distinguish that it is two different companies to the consumer, letting us think it is the same brand, purposefully.  It is not until we realized they were still taking out $850.00 from our credit card that we called, they had me flip our insurance card over to point out that what we thought was the same company (because of the name of Blue Cross/Blue Shield on the front of the card) was actually two different companies.  In today's world where it is becoming increasingly more difficult for the average consumer, who is trying to comply with government mandates,  to navigate insurance policies and costs, insurance companies should be more transparent and forthright.  I maintain that Blue Cross/Blue Shield, whether the overall parent company or the smaller companies who are using its name, should be more honest with individuals.  On the open market of individual policies, the policies offered by all the insurance companies are about the same as far as costs, deductibles, coverages.  We chose Blue Cross/Blue Shield because of it's name recognition.  Given their deception on this matter, I would never recommend them to another. 
Regards,
[redacted]

This member purchased his medical insurance policy through the Federal Healthcare Exchange, also known as the Marketplace.  The Marketplace manages all eligibility for on-exchange policies.  The Marketplace notified Blue Cross and Blue Shield of Kansas City (Blue KC) electronically of...

this member’s enrollment.  Blue KC completed the enrollment process by mailing out an identification card, making a welcome call to the member and reviewing how his policy works.  This member was set up on autopay for his premium due monthly.Blue KC received a call from the member on December 30, 2016, to question why his premium was deducted from his account.  According to the member, he canceled his policy on December 27, 2016.  The Blue KC representative informed this member that the Marketplace had not yet notified Blue KC of his cancelation.  The Blue KC representative confirmed with the Marketplace that the policy had been cancelled.  Blue KC has started the cancelation process and are working on the refund due to the member.

The member is questioning why she was not notified of the cancelation or provided the option to renew her policy.  Please be advised, Short-Term policies are not renewable.  They are intended to provide coverage for a short period of time until insurance can be obtained through employment or through the Marketplace during the open-enrollment period.  This member was notified of the December 31st cancelation of the Short-Term policy.  The first notification was on the application she filled out on April 30, 2016.  The following information was provided under the “Agreement” section of the application: “I understand that, if persons proposed for coverage are eligible and coverage is offered: (1) effective date of coverage will be 12:01 a.m. on the date I requested; (2) preexisting conditions1 will not be covered; (3) coverage under this Contract will terminate at 11:59 p.m. on December 31st; …” The second notification of the cancelation date on this Short-Term policy was in the acceptance letter.  The following information was provided under the “Important Dates” section of the acceptance letter: Your effective date of coverage is 05/01/2016.Your short-term coverage will automatically terminate on 12/31/2016. The third notification of the cancelation date on this Short-Term policy is in the contract language.  Members are responsible for being knowledgeable of the terms of their contract.  The following information is found in the “Terminating the Contract” section of the contract: Non-Renewability This Contract is for short term coverage. The Contract is not renewable nor is it intended to be permanent coverage. However, if Your temporary need for this coverage continues beyond December 31st, You may apply for a new short term contract. In no event will coverage under this Contract be provided in excess of 12 consecutive months.  They system did automatically cancel the policy on December 31, 2016 as stipulated in the member’s contract.  However, the auto-payment did not cancel correctly causing an additional draft in January and February 2017.  Since the policy was canceled the money was in a suspended account until the mistake was identified.  Both premium payments were refunded to the member.  I apologize for any confusion this caused.  This member did elect to apply for another Short-Term policy that is scheduled to cancel on December 31, 2017.

Blue Cross and Blue Shield of Kansas City (Blue KC) did attempt to draft the monthly premium payment from this member’s account.  The draft attempt was declined with the following message:“Issuer has flagged account as suspected fraud…”Once Blue KC received the card decline notice, we mailed a...

delinquency letter to the member.  Payments are due on the 1st of every month.  If the payment is not made by the 10th of the month, then we generate a delinquency letter.  If the premium payment is not made by the 28th of the month, then the policy will automatically terminate.    This member needed to make the premium payment by the end of November to avoid cancelation.  Blue KC did not receive the premium payment; therefore the policy was canceled.  The member did call Blue KC on December 1st, but the Blue KC representative could not accept payment since the policy had already been canceled.  This policy was purchased through the Marketplace.  Once the policy terminates for non-payment of premium, Blue KC cannot reinstate it.  The member did work with the Marketplace and the policy will be effective on January 1, 2017.

This member went through the Marketplace to obtain medical health insurance.  The Marketplace is responsible for managing the eligibility of all On-Exchange policies.  Blue Cross and Blue Shield of Kansas City (Blue KC) may only cancel an On-Exchange policy due to non-payment of...

premium.  This member sent an e-mail request to Blue KC on September 1, 2016, to have everyone but his child canceled from the policy.  A Blue KC representative responded to the member via e-mail (on September 1, 2016) that he would need to contact the Marketplace to make any changes to his On-Exchange policy.This member sent another e-mail request to Blue KC on September 7, 2016, to request the policy be canceled.  A Blue KC representative responded to the member via e-mail (on September 7, 2016) that he would need to contact the Marketplace to cancel his On-Exchange policy.      This member sent another e-mail to Blue KC on September 8, 2016, to advise he spoke to the Marketplace regarding the cancelation of his policy.  The Marketplace informed the member the policy would be canceled in 14 days.  The cancelation date is September 22, 2016.  A Blue KC representative responded to the member via e-mail (on September 8, 2016) that we would cancel his policy as soon as we received the electronic notification from the Marketplace.  Blue KC canceled the policy on September 22, 2016, as instructed by the Marketplace.  We also issued a partial refund of the premium previously paid for the month of September.  The member’s complaint indicated Blue KC has a policy that allows for a cancelation within one week of the next scheduled payment.  Please be advised, this is not a Blue KC policy.  Blue KC directs all members enrolled in an On-Exchange policy to the Marketplace to make all eligibility changes.  This member has the right to address his dissatisfaction with the cancelation policy directly with the Marketplace.

I understand the complainant does not agree with the response originally provided.  However, the Membership Department is able to provide documented proof of the card being declined along with the reason for the decline.  This was specific and isolated to this member’s policy.  I would encourage the member to follow-up with the Customer Service phone number on their card to review any possible discrepancies.  The member was directed to the Marketplace to discuss eligibility since the called made to Blue KC was after the policy had been canceled for lack of premium payment.   Blue KC does not have the authority to make eligibility changes to policies obtained through the Marketplace. This member has the right to appeal the eligibility decisions directly with the Marketplace.  If any eligibility changes are made as a result of the appeal review, then the Marketplace will notify Blue KC directly.

This member elected to enroll her family in a Blue Cross and Blue Shield of Kansas City (Blue KC) policy. The effective date of this policy was November 1, 2015. At the time of enrollment, the policyholder requested the monthly premium payment be electronically drafted from her credit card. The...

monthly premium was drafted each month through February 2016.
The policyholder called Blue KC on February 11, 2016, to request the family policy be canceled retroactively. According to the policyholder, her husband started a new job on November 23, 2015. They elected to take out health insurance for the family through the new employer. The policyholder provided the identification number for the new medical insurance policy. The identification number provided was not a Blue KC policy. However, the Blue KC representative was able to determine the new policy was through Blue Cross and Blue Shield of Illinois based on the three letter alpha prefix given as part of the identification number. Blue KC is independently owned and operated; therefore we do not have access to the Illinois plan data.
Blue KC does allow verbal cancelation notice from a policyholder. The cancelation is made effective the first of the following month in which the request is made. In this case the member called on February 11, 2016; therefore the cancelation date should have been made March 1, 2016.
The policyholder requested a retroactive cancelation date that included a refund on three months of premium. This request was reviewed by Blue KC management. It was determined that Blue KC was within their rights to follow the company cancelation policy and to collect the premium through February 2016. However, management elected to retroactively cancel this policy to January 1, 2016 and refund two months of premium. The premium was refunded to the policyholder on February 19, 2016.

The policyholder’s complaint is based on their belief that Blue KC was incorrectly “double billing” them for both policies. As indicated above, Blue KC was only billing for one Direct Pay policy. The other group policy was purchased through the Blue Cross and Blue Shield of Illinois plan. Please keep in mind that it is not uncommon for a person(s) to have more than one medical insurance policy. This policyholder could keep both insurance policies if they wanted. Blue KC did refund two of the three months premium requested. This was approved by management as a courtesy and not because the months were billed incorrectly.