Blue Cross and Blue Shield of Kansas City

This is in response to your continued concerns regarding the termination policy Please keep in mind, the two week termination policy is not a requirement established by Blue Cross and Blue Shield of Kansas City (Blue KC) The termination policy is set by the Federal Healthcare Exchange Blue KC referred you to the Federal Healthcare Exchange when you called on June 2, at 10:35am, to cancel your policy The Blue KC representative canceled your automatic premium payment effective July 1, You were told that if the Federal Healthcare Exchange cancels your policy back to June 1, 2014, then Blue KC will refund your premium If the Federal Healthcare Exchange does not retro-actively cancel your policy, then the cancelation date would be July 1, You called Blue KC again on June 2, at 11:04am, regarding your eligibility You informed the Blue KC representative that the Federal Healthcare Exchange said there would be a two week termination timeframe I listened to both call recordings at your request I found the Blue KC representative fully explained the process of canceling your policy that is managed through the Federal Healthcare Exchange You asked the Blue KC representative what would happen if you just did not pay your premium The Blue KC representative advised the policy would eventually be canceled after a day grace period I did not find documentation that supports you were told the policy would be canceled back to June 1, 2014, if you did not make your payment You were advised it was up to the Federal Healthcare Exchange to notify Blue KC what your termination date should be Currently you have the right to contact the Federal Healthcare Exchange to express your dissatisfaction with their termination policy You also have the right to appeal for a retro-active cancelation date directly with the Federal Healthcare Exchange Blue KC cannot take any further action until we are directed to do so by the Federal Healthcare Exchange

[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 Administratively Resolved] Complaint: [redacted] I am rejecting this response because:Again, I was NEVER notified of a termination policy It is unethical to hold people accountable for money due when they were never notify of the appropriate policies It is BCBS that is billing me If I received information prior to June 1, telling me of a week termination policy, please send it to mePer your e-mail I believe you are informing me that you have a contract between the government and BCBS that states there must be a two week termination policy I was never notified of this condition but furthermore I don't know how BCBS can hold a customer (a third party ) accountable the terms and conditions of an agreement in which they never agreed that was between BCBS and the government I found your account of the conversations held with BCBS representatives to not be the complete story and hence not an accurate portrayal of the entire conversation My understanding of the conversation was that the BCBS agent was trying to help me find a way to terminate my policy immeditaly In this conversation, I was informed that if BCBS does not receive payment then my policy is terminated which is why I requested my funds be returned I would have never done this if the BCBS representative did not inform me of this possibility Furthermore why would BCBS return my funds if this was not the case Regards, [redacted]

[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 Administratively Resolved]
Complaint: ***
I am rejecting this response because:Again, I was never notified of the termination policy. How can you hold someone accountable for funds due on policies in which they were never notified of all pertinent information (i.etermination clauses) This is unethical in every way. I have asked representatives continuous if they ever notified me of a week notification policy. Representatives said that they did not believe soThe first representative I spoke with informed me that the policy was not terminated immediately because they had received my automatic payment and that if I could obtain my funds back (which per the bank only happens if BCBS gives permission which they did) then my policy would have been automatically terminated effective June 1st 2014. Please go back and listen to the tapes as I was informed that our conversation was recordedI was informed that the only way to immediate terminated coverage per my initial conversation which is outlined in point 2. Per your last e-mail I am for the first time being notified of how I could have helped make this processes easier on everyone involved. An avenue that I would have pursued. I have not wasted countless number of hours trying to resolve this issue through miscommunication and employees refusing to return calls. If you are not prepared do work with the federal government then you should not be offering a service. I should not be made to paid for lack of notification of policies, misinformation, and inept of customer service
Regards,
*** ***

This is in response to your continued concerns regarding the termination policy.  Please keep in mind, the two week termination policy is not a requirement established by Blue Cross and Blue Shield of Kansas City (Blue KC).  The termination policy is set by the Federal Healthcare Exchange.  Blue KC referred you to the Federal Healthcare Exchange when you called on June 2, 2014 at 10:35am, to cancel your policy.  The Blue KC representative canceled your automatic premium payment effective July 1, 2014.  You were told that if the Federal Healthcare Exchange cancels your policy back to June 1, 2014, then Blue KC will refund your premium.  If the Federal Healthcare Exchange does not retro-actively cancel your policy, then the cancelation date would be July 1, 2014.
You called Blue KC again on June 2, 2014 at 11:04am, regarding your eligibility.  You informed the Blue KC representative that the Federal Healthcare Exchange said there would be a two week termination timeframe.  I listened to both call recordings at your request.  I found the Blue KC representative fully explained the process of canceling your policy that is managed through the Federal Healthcare Exchange.  You asked the Blue KC representative what would happen if you just did not pay your premium.  The Blue KC representative advised the policy would eventually be canceled after a 90 day grace period.  I did not find documentation that supports you were told the policy would be canceled back to June 1, 2014, if you did not make your payment.  You were advised it was up to the Federal Healthcare Exchange to notify Blue KC what your termination date should be. 
Currently you have the right to contact the Federal Healthcare Exchange to express your dissatisfaction with their termination policy.  You also have the right to appeal for a retro-active cancelation date directly with the Federal Healthcare Exchange.  Blue KC cannot take any further action until we are directed to do so by the Federal Healthcare Exchange.

[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 Administratively Resolved]
Complaint: [redacted]
I am rejecting this response because:1. Again, I was NEVER notified of a termination policy.  It is unethical to hold people accountable for money due when they were never notify of the appropriate policies.  It is BCBS that is billing me.  If I received information prior to June 1, 2014 telling me of a 2 week termination policy, please send it to me.2. Per your e-mail I believe you are informing me that you have a contract between the government and BCBS that states there must be a two week termination policy.  I was never notified of this condition but furthermore I don't know how BCBS can hold a customer (a third party ) accountable  the terms and conditions of an agreement in which they never agreed that was between BCBS and the government.  3. I found your account of the conversations held with BCBS representatives to not be the complete story and hence not an accurate portrayal of the entire conversation.  My understanding of the conversation was that the BCBS agent was trying to help me find a way to terminate my policy immeditaly.  In this conversation, I was informed that if BCBS does not receive payment then my policy is terminated which is why I requested my funds be returned.  I would have never done this if the BCBS representative did not inform me of this possibility.  Furthermore why would BCBS return my funds if this was not the case.
Regards,
[redacted]

The member went through the Federal Healthcare Exchange to enroll in a Blue Cross and Blue Shield of Kansas City (Blue KC) policy.  Blue KC was notified electronically by the Federal Healthcare Exchange of the member’s enrollment.  The notification included the member’s identifying...

information, the policy selected, the premium amount and the effective date of the policy.
The member called Blue KC on June 2, 2014, to advise that she needed to cancel the policy.  The Blue KC representative informed the member that the Federal Healthcare Exchange manages the eligibility of her policy.  The member was informed to contact the Federal Healthcare Exchange at ###-###-#### to request her policy be canceled.  The member requested that Blue KC cancel the automatic deduction of the monthly premium payment.  The Blue KC representative did have the automatic deduction canceled effective July 1, 2014.  The Blue KC representative informed the member that if the Federal Healthcare Exchange cancels her policy back to June 1, 2014, then Blue KC will refund her payment. 
The member called Blue KC again on June 2, 2014.  She advised the Federal Healthcare Exchange informed her they require a two week termination timeframe.  The Blue KC representative informed the member that we cannot cancel her policy until we receive notification from the Federal Healthcare Exchange.  The member was further advised the automatic deduction of her monthly premium was stopped as she previously requested.  However, the June payment had already been deducted.  The member advised they needed their payment back because they now have insurance through her husband’s employer.  The Blue KC representative informed the member that she can contact her bank to see if they will not honor the deduction of the June payment. 
The June payment was reversed due to the member contacting her bank.  Although the June payment was reversed by the bank, the member’s policy was still active.  As of today, Blue KC has not received notification to retroactively cancel this member’s policy back to June 1, 2014.  The cancelation date is July 1, 2014.  Blue KC continued to send the member billing statements for the June premium.  On October 28, 2014, Blue KC sent the member a premium pursuit letter. 
The member called Blue KC on November 3, 2014, to question why she received a premium pursuit letter.  The Blue KC representative informed the member that her policy was still active through June based on the information provided bythe Federal Healthcare Exchange.  The member requested a member of management reviewed this issue.  The Blue KC representative agreed and informed the member they would call back with the result of managments review.  Management confirmed that Blue KC correctly notified the member on June 2, 2014, to contact the Federal Healthcare Exchange to request her policy be canceled.  The member was informed by the Federal Healthcare Exchange that they require a two week timeframe to cancel the policy.  The member was aware her policy would not be canceled on June 1, 2014.  The Blue KC representative called the member back on November 12, 2014, to give the results of the managements review. 
As previously mentioned, Blue KC does not control the eligibility for on-exchange policies.  Currently the member has the right to send an appeal to the Federal Healthcare Exchange to request her policy be retroactively canceled back to June 1, 2014.  The member will need to list the reason for the retroactive cancelation date.  If the Federal Healthcare Exchange approves the retroactive cancelation date, they will send Blue KC notification.  Blue KC will then update the approved cancelation date and the member would not owe the June premium.