Blue Cross Blue Shield of Arizona, Inc.

[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 would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved
Regards,
*** ***

Another representative has reached out to advise they will look into, but until something is actually resolved I do not accept their response as a resolution to my complaint. BCBS denied my mother's claim stating she had the services rendered as a "convenience". I'm not sure how receiving the proper medical attention is a convenience when they were absolutely necessary and life dependent. Without, she would have diedBCBS has paid the claims for services rendered state-side due to the health issue mentioned, so why would the treatment received at the onset of the issue be considered a convenience?

This Dr. Andrea Darby Stewart has failed me, as I am a special patient with rare congenital medical conditions, this Dr. is the typical take two aspirin, and call me in the morning type of Dr...

Poor staffing cause many problems with referrals and you spend a lot of time most of the time on the phone trying to get thru when they call you for a medical reason.

I do not mind helping people in need, though there is a line you have to stop at when it comes to helping undocumented person, this Dr. and her clinic that she works for do poor work for bonifide citizens of the united states...

Also this Dr. may have had some type of problems at Banner health, or other medical facilities, as she worked for them in the past but does not work there any longer, she is at Honor Health which ranks 16 in Arizona, in contrast to Banner Health that ranks 2 in Arizona, it is prudent to direct to your attention that the Dr. of focus in review interned at Mayo Clinic which ranks 1 in Arizona did not keep Dr. Stewart on board after her residency, as most people know if you are very good they keep you, rather than get rid of you.

This Dr. is a good person; however the review above is very accurate, and factual we medical patients, who are citizens of the United States deserve better than this.

Patient with a degree in law

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s (Revdex.com) second submission of case#[redacted] had previously expressed concern with the handling of his prescription and medical claims. Please refer to BCBSAZ’s response dated 5/19/16. I hope this information is also helpful.In his most recent comment, Mr. [redacted] requests a “30 day extension”. Additional review of BCBSAZ records shows adjustment of a claim recently questioned, contact with his provider and the issuance of a corrected Explanation of Benefits on May 28, 2016. Review also confirms Mr. [redacted]’s concerns regarding both pharmacy and medical claims have been addressed as appropriate, however, if you or Mr. [redacted] have remaining questions or concerns, you are always welcome to contact me. I will be happy to facilitate your request. SincerelyAnne K[redacted]Corporate OmbudsmanOffice of the President Blue Cross® Blue Shield® of Arizona###-###-####  fax: ###-###-####[redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to theRevdex.com’s complaint case#[redacted] filed by BCBSAZ member [redacted], concerning incorrect billing statements received for her IndividualBCBSAZ coverage plan. I hope this information is helpful.When your...

correspondence was received, we initiated a priority review of the concerns Ms. [redacted] brings to yourattention. Our records do not document our receipt of a release authorizing usto share protected information with your agency, therefore, due to privacyconsiderations, I am limited in the information I am able to share.  I can however, tell you that our review determined prior processing to this member’s BCBSAZ coverage plan had in fact, created an outof balance accounts receivable situation that affected the plan’s premiumbillings. This error has been corrected and Ms. [redacted] has been contacted withconfirmation and our apologies for any inconvenience caused. We believe thisissue is being resolved to the member’s satisfaction.  I hope this information is helpful.  We do appreciate the opportunity to reviewthis situation for our member and thank you for bringing it to ourattention.  If you have additionalquestions or information regarding this situation, please feel free to contactme.Sincerely, [redacted]Corporate OmbudsmanOffice of the PresidentBlue Cross® Blue Shieldof Arizona[redacted]  *  [redacted]

YOu have given me no indication that you have resolved the matter.. You have contacted [redacted] and let them know of the problem but that is the same thing I have been doing for 2 years so that wont fix anything.. Therefore the issue is NOT resolved.Someone from BCbS contacted me this week on the phone and I gave them Verbal AUTHORIZATION to discuss this matter with [redacted].  I am now giving you WRITTEN AUTHORIZATION thru this email to contact them and try to resolve the issue.If you need additional WRITTEN authorization to proceed, let me know the name and fax number of the person who should receive this and I will send it.You have NOT resolved this matter and it must be pursued further.

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s complaint case# [redacted], filed by [redacted]. [redacted], concerning the issuance of an Individual BCBSAZ coverage plan.  We hope this information is helpful.Our records do not indicate...

receipt of a release authorizing BCBSAZ to disclose specific information with your agency. I can tell you however, that when your correspondence was received, a priority review was initiated to assess the concerns Mr. [redacted] brings to your attention. Our review showed that both Mr. [redacted] and the broker associated with this coverage plan recently contacted BCBSAZ and review of this concern was already in process. Although review of BCBSAZ records does confirm receipt of a completed enrollment request, which was processed appropriately in accordance with BCBSAZ standard procedure, it is the contention of both Mr. [redacted] and the agent of record that there was no intention of submitting this application. Based on these findings, BCBSAZ has agreed to cancel this coverage plan as though it were never in effect and refund all premiums paid. An outreach call was made to Mr. [redacted] on July 22, 2015 to confirm this action and he indicated his approval.   Again, I hope this information is helpful.  We do appreciate the opportunity to review this situation.  If you have additional questions regarding this situation, please feel free to contact me.Sincerely,[redacted]Corporate OmbudsmanOffice of the PresidentBlue Cross® Blue Shield® of Arizona

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com case# [redacted], filed by BCBSAZ member [redacted], concerning the processing of his prescription claims. I hope this information is helpful.  Our records do not...

document a release, authorizing us to share specific protected information with your agency; however, I can tell you that when we received Mr. [redacted]’s concern, we initiated a priority review, which showed prior contact with Mr. [redacted] as well as the Arizona Department of Insurance (ADOI) on this matter. The negative deductible concern mentioned in Mr. [redacted]’s complaint was confirmed to be a result of the reversal of several prior pharmacy claims. Review also determined that due to what appeared to be a timing issue, a claim had indeed processed with an incorrect cost share. BCBSAZ acknowledged and apologized for this error and in a detailed letter to Mr. [redacted] dated 5/13/16 agreed to not request reimbursement for this misapplied claim. It was also made clear that going forward, future pharmacy claims will be appropriately applied to the plan deductible, which was not yet satisfied. This action and related information was also communicated to the ADOI on 5/17/16.   We believe this concern has been addressed appropriately and are happy to continue to communicate directly with Mr. [redacted] on any further questions he may have.  If you have additional questions, please feel free to contact me. Sincerely,   Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona ###-###-####  |  cell: ###-###-#### fax: ###-###-#### [redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com's (Revdex.com) complaint case# 12016364, filed by BCBSAZ member [redacted] on behalf of her husband, concerning his claims and the benefits provided under his Employer Group medical plan. Mrs....

[redacted]’s Revdex.com correspondence did not provide her husband’s name or identification information. We were however, able to locate Mr. [redacted]’s coverage with BCBSAZ. I hope the following information is helpful. Our records do not document receipt from the member authorizing us to disclose specific information with your agency or anyone else, which limits the information I am able to share. I can tell you however, our review documents receipt of a request made on behalf of Mr. [redacted] by his provider. A detailed response to this request, referencing established Medical Coverage Guidelines, the Provider Operating Guide and providing next steps in the review process, was mailed to the provider on 2/28/17.   On 3/2/17, BCBSAZ also responded to an email received from Mrs. [redacted] dated 3/1/17 with instructions for completion of a Confidential Information Release Form (CIRF). Completion of a CIRF by Mr. [redacted] will allow BCBSAZ to discuss and initiate any applicable review regarding his coverage with Mrs. [redacted].   We will continue to communicate directly with the [redacted]’s in response to this request. We do appreciate the opportunity to review this situation and thank you for bringing it to our attention. If you or the [redacted]’s have questions, you are welcome to contact me. Sincerely,   Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona (602) 864-4448  fax: (602) 864-4376 anne.k[redacted]@azblue.com

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the 9/25/15 Revdex.com’s case# [redacted], filed by BCBSAZ member [redacted], concerning the effective dates associated with his Individual ON Exchange Medical plan purchased through the Federally...

Facilitated Marketplace (FFM). Because our records do not indicate receipt of a release from the member authorizing BCBSAZ to disclose specific information with your agency, I am limited in the information I am able to share. I can tell you however, that when your correspondence was received, a priority review was initiated to assess the concerns Mr. [redacted] brings to your attention. I hope the following information is also helpful.   It may be helpful to note that when a medical plan is purchased ON the Federal Exchange, BCBSAZ is required to follow directive as received from the FFM. Based on contact we received direct from Mr. [redacted] and further communication with the FFM, BCBSAZ was able to confirm confusion that occurred with regard to his plan’s start date and dependent addition. We have corresponded directly with Mr. [redacted] via telephone call on 9/29/15 to apologize and confirm our resolution in completion of the effective date changes and applicable claims adjustment. We believe an agreeable resolution to this issue has been met and will continue to communicate directly with Mr. [redacted].   Again, we hope this is helpful. We do believe this to be resolved, however, if you or Mr. [redacted] have additional questions, you are welcome to contact me. Sincerely,     Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona ###-###-####  |  fax: ###-###-#### [redacted]@azblue.com

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the 5/2/15 Revdex.com’s case# [redacted], filed by BCBSAZ member [redacted], concerning premium payments he has made for his BCBSAZ coverage plan. Because our records do not indicate receipt of a release from the...

member authorizing BCBSAZ to disclose specific information with your agency, I  am limited in the information I am able to share. I can tell you however, that when your correspondence was received, a priority review was initiated to assess the concerns Mr. [redacted] brings to your attention.  I hope this information is helpful.BCBSAZ records show Mr. [redacted] was contacted on 7/28/15 by BCBSAZ enrollment management who provided him with confirmation of his premium payments, which included a credit, verification of his next payment draft and assurance that claims will be processed according to his benefit plan specifications. We believe this situation has been appropriately resolved for our member and again, hope this information is helpful. If you or Mr. [redacted] have additional questions, you are always welcome to contact me.Sincerely,[redacted]Corporate OmbudsmanOffice of the President

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s (Revdex.com) second request received on June 10, 2015 for case #[redacted], filed by Mr. [redacted].As mentioned previously, a voice message and email was sent to Mr. [redacted] on June 2, 2015 in an effort to make sure his concerns regarding his plan were answered to his satisfaction. Because we did not hear back from Mr. [redacted], it was assumed (incorrectly) that he was satisfied. In follow up to the Revdex.com's second notice and the member's comment that his concerns had not been fully addressed, on June 11, 2015, BCBSAZ conducted another outreach call to Mr. [redacted]. During this telephone contact, a detailed review of the premium payments made to BCBSAZ was completed. In addition, a hard copy of his payment history was also mailed to his attention. A BCBSAZ contact has been established for any further questions.  BCBSAZ apologizes for any confusion associated with this case and hopes this is helpful. If you or Mr. [redacted] have questions, you are also welcome to contact me.Sincerely,[redacted]Corporate OmbudsmanOffice of the PresidentBlue Cross Blue Shield of Arizona

I respectfully request a 30 day extension while BCBS and I are in the process of resolving the issues in this matter.  The additional time would ensure time to address the issue and resolve any unresolved matters.Thanks you for your consideration

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]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
I disagree with their account.
Regards,
[redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the 10/1/15 Revdex.com’s case# [redacted], filed by [redacted], concerning a request made by BCBSAZ that he return the cost of a prescription obtained after the termination date of his BCBSAZ medical plan...

purchased through the Federally Facilitated Marketplace (FFM). Because our records do not indicate receipt of a release from the member authorizing BCBSAZ to disclose specific information with your agency, I am limited in the information I am able to share. I can tell you however, that when your correspondence was received, a priority review was initiated to assess the concerns Mr. [redacted] brings to your attention. I hope this information is helpful.   Our records confirm the termination of Mr. [redacted] BCBSAZ plan effective 1/1/15, which was processed on 1/15/15. When the prescription in question was purchased on 1/7/15, the plan was still active because the termination had not yet been processed. This claim was processed appropriately based on the benefit plan’s specified 30 day premium grace period. BCBSAZ did not make an error in the initial processing of this prescription claim. We do however, acknowledge the delay in communicating the request for reimbursement to Mr. [redacted], which made it difficult to resubmit under his new medical insurance carrier. For this reason, an administrative decision has been made to discontinue the recovery process for the prescription charges in the amount of $166.89. This decision has been relayed to Mr. [redacted] via letter dated 10/5/15 and also by phone call on 10/8/15.    This administrative decision is based on the specific circumstances related to this situation only and does not in any way imply BCBSAZ has made an error in handling of the initial claim or application of contract benefits.  During discussion with Mr. [redacted] on 10/8/15, he indicated his satisfaction with this action. If you or Mr. [redacted] have additional questions, you are welcome to contact me. Sincerely,   [redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona ###-###-####  fax: ###-###-#### [redacted].[redacted]@azblue.com

Hello, I just checked what BC/BS did to FIX the problem. I received a call from them, telling me that I do not owe any money to BC/BS and they wanted to deactivate the old plan [redacted] and apply the overpayment to the active plan [redacted]. Now the plan [redacted] (ended 12/31/2015) shows an open balance of [redacted]. This plan was always paid in full, actually overpaid by $ [redacted] which should be credited to my active plan [redacted]. The 2016 plan is correct, except the credit of the [redacted]So they did not what they said they do and I still have 2 active plans in their system. It is actually an easy fix, BC/BS should really get somebody with common sense on that case and it could be resolved in minutes. Zero out plan [redacted] and deactivate it and apply the 13.58$ credit to my account[redacted]. DONE!I am really upset, because BC/BS makes it look like I did not pay, and I am very particular with my payments. My bills get normally paid about 2 weeks before they are due.  Well, I hope this helps to clean up this mess and I hope I never have a real complicated case with BC/BS Arizona. Respectfully [redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the 2/8/16 Revdex.com’s case# [redacted] filed by BCBSAZ member [redacted], concerning duplicate enrollment with BCBSAZ in an Individual ON Exchange Medical plan. Because our records do not...

indicate receipt of a release from the member authorizing BCBSAZ to disclose specific information with your agency, I am limited in the information I am able to share. I can tell you however, that when your correspondence was received, a priority review was initiated to assess the concerns Mr. [redacted] brings to your attention. It may be helpful to first note that when a medical plan is purchased ON Exchange, BCBSAZ is required to follow directive as received from the Marketplace. I hope the following information is helpful. Our records confirm Mr. [redacted]’s comments regarding confusion with regard to receipt and BCBSAZ’s handling of his 2016 BCBSAZ enrollment, which resulted in the issuance of a duplicate identification (ID) number. BCBSAZ acknowledges the confusion noted above and this will confirm that our Membership Services office contacted Mr. [redacted] directly via telephone call on 2/10/16 to apologize and confirm our resolution in his ID number assignment. This will also confirm that premiums are being credited to the appropriate benefit plan and claims for services are being adjusted accordingly. We do believe an agreeable resolution to this issue has been met and will continue to communicate directly with Mr. [redacted] to address any questions that may arise.    Again, we hope this information is helpful and sincerely apologize for any confusion or inconvenience that may have resulted. If you or Mr. [redacted] have questions, you are also always welcome to contact me. Sincerely, [redacted]
[redacted]
[redacted]
[redacted]
[redacted] 
[redacted]
[redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s (Revdex.com) second submission of case#[redacted] had expressed concern regarding claims processing delays associated with completion of coverage verification required by his employer group and has also clarified he believes it is BCBSAZ’s handling of these verifications that may have attributed to these delays. Although our documentation appears to differ, we do appreciate his concern and have shared his comments with the appropriate claims management for continued process review. We are very sorry for any delay or inconvenience he believes is associated with the handling of his coverage verification submission and communication with BCBSAZ. As always , both you and Mr. [redacted] are welcome to contact me direct should he have further questions. Sincerely, Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona ###-###-####  fax: ###-###-#### anne.k[redacted]@azblue.com

[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 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]