Blue Cross Blue Shield of Arizona, Inc.

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]. [redacted] had expressed concern with her receipt of BCBSAZ Explanation of Benefit (EOB) notices for claims processed under her terminated BCBSAZ policy. I again hope this information is helpful. As explained in our response of 7/14/17, a review of our records also shows the claims Ms. [redacted] refers to, which were submitted to BCBSAZ by APIPA and generated the EOB notices advising of her BCBSAZ plan’s termination. BCBSAZ contacted AHCCCS in an effort to assist with relaying confirmation of her BCBSAZ plan termination, however, it appears this information is required directly from Ms. [redacted]. In addition, BCBSAZ has taken steps to suppress the mailing of these EOB notices. We are very sorry that Ms. [redacted] remains unhappy with this situation but the fact remains BCBSAZ has made every effort to assist with notification to her new carrier. We are happy to discuss further with Ms. [redacted] if she has additional questions.  Sincerely,   Anne K[redacted] Corporate Ombudsman Blue Cross® Blue Shield® of Arizona [redacted] 
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On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s complaint case# 10538151, filed by [redacted] concerning the processing of her BCBSAZ Individual coverage plan. I hope this information is helpful. Because our records do not...

document receipt of a release from the member, authorizing us to share specific protected information with your agency, I am limited in the detail I am able to share. I can however, confirm to you that BCBSAZ’s review of our records shows that Ms. [redacted] purchased a Portfolio Alliance 6300 OFF Exchange plan effective 2/1/15. BCBSAZ also recognizes that confusion may have existed within the application and the verification processes confirming the contracting status of her providers in this case. Because of this, administrative approval has been made to allow Ms. [redacted] to change her plan from the Portfolio Alliance 6300 to the Portfolio Select 6300 plan as of her original effective date of 2/1/15. Any affected claims will be adjusted to process in accordance with the Select plan and premium will be applied accordingly.  Our attempts to reach Ms. [redacted] by phone to confirm have been unsuccessful, so written confirmation of this action is also being mailed. We do appreciate the opportunity to review and resolve this situation and thank you for bringing it to our attention.  If you or Ms. [redacted] have additional questions, please feel free to contact me. Sincerely,  Anne KennedyCorporate OmbudsmanOffice of the President Blue Cross® Blue Shield® of Arizona[redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the 5/28/15 Revdex.com’s case# [redacted], filed by BCBSAZ member [redacted], concerning his [redacted] Medical plan and the associated subsidy amount assigned to his plan by the Federally...

Facilitated Marketplace (MP). 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 MP. I hope the following information is also helpful.Our review of this case shows that in late December 2014, BCBSAZ followed specific direction from the MP in changing Mr. [redacted]’s BCBSAZ medical plan. In April 2015, updated information was received from the MP authorizing us to re-adjust the subsidy and his plan choice retroactive to January 2015. Review of recent billings statements mailed to Mr. [redacted] confirms these adjustments. Additionally, documentation of recent telephone discussions with BCBSAZ indicate Mr. [redacted]’s satisfaction with the action taken. As a courtesy, on 6/2/15 BCBSAZ followed up with a voice message and email to Mr. [redacted] to make sure his concerns have been addressed.Again, we hope this is helpful. We believe this to be resolved, however, if you or Mr. [redacted] have additional questions, you are 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 Revdex.com’s case #[redacted] dated 7/9/17, filed by [redacted] regarding her receipt of Explanation of Benefit (EOB) notices for claims submitted under her terminated BCBSAZ plan. Because our records do...

not indicate receipt of a release authorizing BCBSAZ to disclose specific information with your agency, I may be 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 Ms. [redacted] brings to your attention.  I hope this information is helpful.  Our review of this matter confirms Ms. [redacted]’ comments related to claims submitted to BCBSAZ by APIPA, which in turn generate the EOB’s she has received. BCBSAZ recognizes this may be frustrating and in an effort to assist, has contacted [redacted] to ensure the appropriate office is aware of the end date of her BCBSAZ plan. [redacted] has advised that due to privacy concerns, they are unable to accept this information directly from BCBSAZ. On 7/11/17 BCBSAZ contacted Ms. [redacted] by phone to relay this information.  BCBSAZ has also taken additional steps to document this matter, which we believe will assist with eliminating the mailing of any future EOB notification to Ms. [redacted]. Again, we hope this is helpful. Sincerely,Anne K[redacted]Corporate OmbudsmanOffice of the President [redacted]
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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.This response is entirely inaccurate.   I have called five more times since April since the promised change never occured, until after this complaint was lodged, June 2015.  I am still waiting on a call.
Regards,
[redacted]

I have sent the required documents three times and been promised a check was being issued twice prior to this contact.  Until the check is received I am not in agreement onclosing this complaint.

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.
  [redacted],I have been a Blue Cross Blue Shield customer for many years now. Every month, I faithfully pay my premium, without having been late on a payment once, NOT ONCE. I make sure of this by having them automatically take my premium from my account every month on the same day of the month. I have faithfully made sure that every month on that day, the funds are in the account whether I have had a good month, financially, or not. I have continued being a customer with them through the years despite the annual premium increases. I have never made a medical claim since being a customer, and the one time ...the one time in all these years I have been ill, after having been a faithful paying customer, I can't reach anybody....NOBODY. The number to call for assistance is only available from 8 to 4 Monday through Friday, so any normal gainfully employed person will have a hard time reaching them. I called them the Friday before I entered the Revdex.com complaint and was put on a hold and had to almost go without lunch that day because it's only time I had to make a call at work. On Saturday, the next day, I went to their site and the only.....ONLY....phone number where you could reach anyone was to the sales department. So on a Saturday, I can be sick and dying without any hope of reaching anybody for help with my policy but I can sure as hell buy a new policy if I wanted to. [redacted], I feel robbed. I feel like all my years of paying premiums were for naught. After making an emailed complaint to Blue Cross Blue Shield on that very same Saturday I did receive an email response the next day. Fortunately my sickness didn't put me in the hospital where a day might have been a day too late, but I still feel robbed. If Blue Cross Blue Shield operated with any good faith towards their customers they would at the very least have their customer service department operate with the same hours of operation as their sales department does. It's really a damned shame that the Affordable Car Act has now made us hostages to the whims of these greedy [redacted] insurance companies.[redacted]

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s complaint case# [redacted], filed by previous BCBSAZ Federal Employee Program (FEP) member [redacted] expresses concern regarding the request for the return of reimbursement...

made for prescriptions obtained after her BCBSAZ coverage termination date. We hope this information is helpful. It is very important to understand that the Federal Employee Program eligibility requirements are established by the Office of Personnel Management (OPM.) BCBSAZ is limited in the action we are able to take in this type of situation. When this notice was received from the Revdex.com, BCBSAZ contacted OPM and have been advised that they did not receive the standard documentation from [redacted] HR department, therefor the member is responsible for any claims submitted to BCBSAZ after the termination date of the plan.   It may also help to understand that BCBSAZ is unable to provide benefits for services obtained after the termination date of coverage. There are no benefits available on and after the date coverage ends. Additionally, based on this review, we are unable to discontinue the collection process. If the member disagrees, they may wish to directly contact the OPM to discuss further. BCBSAZ also reached out to [redacted] on January 22, 2015 to explain this.   I realize that this is not the answer [redacted] was hoping for, but hope that it is beneficial in providing an additional understanding of the basis for this request. Sincerely,   [redacted]Corporate OmbudsmanOffice of the President Blue Cross® Blue Shield® of Arizona[redacted]  * 
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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 his purchase of an Individual Off Exchange Medical plan and benefits provided for services obtained at...

an out of network provider. 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 review determined several documented discussions with Mr. [redacted] in which out of network benefits, specifically referencing the contracting status of [redacted] were discussed. This included an initial discussion during his plan purchase on 10/6/14, as well as several subsequent conversations. Although there is no evidence of inaccuracy or miscommunication noted in these conversations, BCBSAZ recognizes that there may have been confusion and because of this, although under no obligation to do so, BCBSAZ contacted Mr. [redacted] on 5/11/15 in an effort to review additional OFF Exchange plan options. During this call, Mr. [redacted] chose a plan that he believes better met his current needs.  It is important to note that this plan change will not affect provider contracting status or the plan’s out of network benefits.   This decision is based on the specific circumstances related to this situation only.  It reflects our desire to make every attempt to work with our customers and does not in any way imply BCBSAZ has made an error in this case. If you or Mr. [redacted] have additional questions, you are always welcome to contact me. Sincerely,    Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona [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], acting as personal representative for her deceased brother [redacted], had expressed concern regarding the reissuance of a stale dated reimbursement check and advised she would not consider the case closed until the check in question is received. As explained in our response of March 30, 2017, BCBSAZ confirmed receipt of the documentation and completion of the process necessary to reissue the check to the appropriate estate. BCBSAZ has attempted to reach Ms. [redacted] by phone and will continue outreach attempts to confirm her receipt of the check in question. We are very sorry for any delay or inconvenience she believes is associated with the handling of this verification process and communication with BCBSAZ. As always, both you and Ms. [redacted] are welcome to contact me direct should there be further questions. Sincerely, Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona [redacted] 
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On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s complaint case# [redacted], filed by [redacted], concerning the processing of claims and premiums applied to his BCBSAZ Individual coverage plan. I apologize for the delay in...

this response and hope this information is helpful.Because our records do not document receipt of a release from the member, authorizing us to share specific protected information with your agency, I am limited in the detail I am able to share. I can however, confirm to you that our records show that changes [redacted] have requested on their BCBSAZ On Exchange benefit plans have been completed based on the direction received through the Federal Marketplace. Direction was received authorizing the termination of [redacted] BCBSAZ coverage, which included [redacted] as a dependent, effective 4/1/14 due to [redacted] eligibility. An On Exchange enrollment for [redacted] was also received from the Marketplace authorizing a separate coverage plan that was issued to her effective 4/1/14 under a different identification number. This new plan, issued to [redacted] effective 4/1/14, is now also showing terminated effective 10/1/14 based on further direction due to her own [redacted] status. Our review shows that excess premium under the initial plan was transferred to [redacted]'s new plan and a refund of the overage issued. We also determined the receipt of certain claims for [redacted] that may have initially processed under their joint plan that terminated 4/1/14. We believe this may have caused some confusion. The affected claims have now been adjusted to process correctly and in accordance with the coverage plan in place at the time of service. We have contacted [redacted] direct to confirm. We do appreciate the opportunity to review and resolve this situation and thank you for bringing it to our attention.  If you have additional questions, please feel free to call me. Sincerely[redacted]Corporate OmbudsmanOffice of the PresidentBlue Cross® Blue Shield®of Arizona[redacted]   
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On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s case# [redacted], filed by BCBSAZ member [redacted], concerning her family’s 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 this correspondence was received, a priority review was initiated to assess the concerns Ms. [redacted] brings to your attention. I hope the following information is 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 review, BCBSAZ was able to confirm possible confusion resulting from the receipt of multiple marketplace plan actions related to Ms. [redacted]’s plan and recent dependent addition. We corresponded directly with Ms. [redacted] via telephone call on 7/19/16 to confirm plan reinstatement and return of the premium refund. Systems were also updated to allow medical services.   Again, we hope this is helpful. We do believe this to be resolved, however, if you or Ms. [redacted] have questions, you are welcome to contact us. 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 Revdex.com’s (Revdex.com) second submission of case#1080346, dated 10/27/15. [redacted] had previously expressed concern with the handling of premium rates and purchase of an Individual Off Exchange medical plan. Please refer to BCBSAZ’s response dated 9/18/15 to the initial Revdex.com case #1080346 with acknowledgement and apology for the initial confusion related to Ms. [redacted] residential address which directly affected the rates. I again hope this information is helpful. BCBSAZ had also contacted Ms. [redacted] on 9/16/15 to also acknowledge and apologize for the confusion regarding her address on file and confirmed that her 2015 premiums were being recalculated using her address in Pinal County and her age at point of application for premium rate calculation. It was during this conversation, she advised us of her decision to purchase other coverage. We received no further contact from Ms. [redacted], however, upon receipt of the second Revdex.com notice, additional outreach was conducted to determine and address any possible remaining issues. On 11/3/15, Ms. [redacted] was contacted by phone and confirmed her continued dissatisfaction with the premium rates associated with BCBSAZ benefit plans. She indicated her belief that additional negotiation on the rates associated with her specific plan could have been provided. During this telephone discussion, Ms. [redacted] also made very clear that it is her right to share her on-going dissatisfaction with the Revdex.com. We are very sorry that Ms. [redacted] remains unhappy with BCBSAZ premium rates, however, it may also help to note that we are required to administer all aspects of our benefit plans, including those related to the cost for medical insurance plans, in a consistent manner for all BCBSAZ members. Because of this, we are unable to “negotiate” premium rates. If you or Ms. [redacted] have additional questions, or would like to discuss further, you are always welcome to contact me. Sincerely, [redacted] Corporate Ombudsman Office of the President Blue Cross® Blue Shield® of Arizona [redacted] 
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The response form BCBSAZ is inadequate and boarders in ridiculous. It is 2/6/17 and BSBSAz haas still not found an PCP for my daughter. I have personally called 25 Dr.'s #'s given directly from BCBS and NONE of them accept our plan. I received an email from BCBS stating that they had yet again reassigned her to a new Dr. and that they had "personally called and verified". When I attempted to set up and appointment with this provider the provider said that they have NEVER been contracted with this plan and had not received any calls from BCBSAZ.  The response from BCBSAz is a bold faced lie.

On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s case# [redacted], filed by BCBSAZ member Liana Chiarenza, concerning her purchase of an Individual Off Exchange Medical plan and benefits provided for services obtained at an out of...

network provider. 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 Ms. [redacted] brings to your attention. I hope this information is helpful. Our review determined several documented discussions with Ms. [redacted] including initial plan purchase and subsequent conversations regarding her choice of plan. It is recognized that confusion regarding her plan choice may have existed both during the application process and during those subsequent communications. Because of this, BCBSAZ has been in direct telephone contact with Ms. [redacted] and will continue to communicate directly with her in an effort to achieve resolution.   Our action reflects our desire to make every attempt to work with our customers. If you or Ms. [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 Revdex.com’s complaint case# [redacted], filed by BCBSAZ member John Haeuptle, concerning the processing of his claims under his BCBSAZ employer group benefit plan. We have been working directly with our...

member to address this matter and hope this information is helpful.   Our records do not document our receipt of a Confidential Information Release Form from the member, authorizing us to disclose specific information with your agency, which may limit the information that I am able to share. I can tell you however, that we initiated a priority review of the concerns Mr. Haeuptle expressed. Our records determined that confusion did in fact exist regarding the claims submitted and two similar benefits applied under his group contract.    BCBSAZ acknowledges the confusion noted above and initial error made in the processing of Mr. Haeuptle’s claims and has corresponded directly with our member via telephone call on 8/16/16 to confirm our resolution to this matter. We believe an agreeable resolution to this issue has been made and will continue to communicate directly with Mr. Haeuptle to address any questions associated with his claims for services associated with this benefit.   Again, we hope this information is helpful. If you or Mr. Haeuptle have additional questions, you are also 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 Revdex.com’s (Revdex.com) second submission of case#[redacted]. [redacted] had expressed concern with the process of assigning a Primary Care Physician (PCP) to her daughter’s Individual BCBSAZ medical plan. Please refer to BCBSAZ’s response dated 2/1/17 to the initial Revdex.com case #[redacted]. I hope this information is helpful. As previously explained, our records showed several documented discussions with Ms. [redacted], in an effort to assist her in locating a PCP who met her needs. Current review confirms her comments regarding additional questions and also documents BCBSAZ’s communications with both Ms. [redacted] and medical providers to assist with scheduling appointments and obtain referrals. As is our process, BCBSAZ will remain available to continue this line of communication with Ms. [redacted], to address any questions related to the medical plan purchased.  If you or Ms. [redacted] have questions, you are also welcome to contact me. Sincerely, Anne K[redacted] Corporate Ombudsman Office of the President   Blue Cross® Blue Shield® of Arizona [redacted]  
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On behalf of Blue Cross Blue Shield of Arizona (BCBSAZ), I am responding to the Revdex.com’s complaint case# [redacted], filed by BCBSAZ member [redacted], concerning the processing of claims under her BCBSAZ employer group plan. I hope this information is helpful.Our records do not...

document our receipt of a Confidential Information Release Form from the member, authorizing us to disclose specific information with your agency, which limits the information that I am able to share. I can tell you however, that when Ms. [redacted] contacted BCBSAZ with her concerns, we initiated a priority review. Our records determined that confusion did in fact exist with regard to the required update of her plan’s information related to verification of the existence of other insurance coverage.  It may also be important to note that Ms. [redacted]’s employer plan requires this informational update in 6 month increments. BCBSAZ acknowledges the confusion noted above which caused the delay in claims processing and corresponded directly with Ms. [redacted] via telephone call on 8/6/15 to apologize and confirm our resolution in completion of updates and claims adjustment on 8/4/15. We believe an agreeable resolution to this issue has been met and will continue to communicate directly with Ms. [redacted] as needed to assist with future plan updates to her file.   Again, we hope this information is helpful. If you have additional questions, please feel free to contact me.[redacted]Office of the PresidentBlue Cross® Blue Shield® of Arizona

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 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]

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