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 case# [redacted] received on 9/9/15, filed by BCBSAZ member [redacted],...

concerning her purchase and handling of her BCBSAZ’s Individual Off 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 Ms. [redacted] brings to your attention. I hope this information is helpful. It may first be helpful to note that premium rates associated with Individual plans are determined based upon certain factors, including geographic location and age.

Ms. [redacted] Individual Blue Portfolio Off Exchange medical plan for herself only became effective March 1, 2015.  The original application processed with the address location within zip code 85140, in Pinal County, AZ. On February 25, 2015, Ms. [redacted] contacted BCBSAZ to update her address to a P.O. Box located in zip code 85142. This mailing address is in Maricopa County, which triggered a rating area change. 

During a routine audit of files, it was determined that Ms. [redacted] was in the wrong rating area for her corrected address.  This was the reason for the initial premium increase, which she mistakenly believed was due to “renewal”. Premium rates are is also based on the age at the time of the application and do not increase until the plan renewal even if the individual has a birthday in the meantime.  Unfortunately, the letter BCBSAZ sent Ms. [redacted] informing her of the audit, misquoted Ms. [redacted] premium, and included an increase for the next age band for a female living in Maricopa County. As we now understand it, Ms. [redacted] lives in Pinal County but uses a post office box address in Maricopa County.   

On September 16, 2015, BCBSAZ Membership Services contacted Ms. [redacted] to apologize for any confusion and inform her that her 2015 premiums will be recalculated using the initial Pinal County and age at point of application premium rate, with any overpayment refunded to her.  Ms. [redacted] has advised us that she has obtained coverage through the Federal Marketplace. At her request her Blue Portfolio policy has been terminated effective October 1, 2015. 

We apologize for any inconvenience this confusion may have caused Ms. [redacted] and appreciate the opportunity to address her concerns.  If you or Ms. [redacted] have questions, you are welcome to contact me.
Sincerely,

[redacted]
Corporate Ombudsman
Office 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 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

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 theRevdex.com’s complaint case# [redacted], filed by [redacted]

[redacted], concerning a change made to his BCBSAZ coverage plan and subsequentclaims that have been processed. This will confirm that [redacted]...

[redacted] has alsocontacted the Federal Facilitated Marketplace and BCBSAZ has been in directcontact with him regarding this concern. It may be helpful to first clarify that BCBSAZ must follow certain direction providedby the Marketplace when a consumer purchases coverage On the Exchange. This will also confirm that BCBSAZ received notice from the Marketplace on November10, 2014 authorizing BCBSAZ to correct a coverage plan change inadvertently madeby the Marketplace when [redacted] communicated a change in his plan’s dependentstatus earlier this year. BCBSAZ has been in contact with [redacted] and hisproviders to confirm the necessary corrections are in process. All affected claimsfor services will be adjusted to process according to the corrected benefitplan’s specifications. We will continue to communicate directly with [redacted]

[redacted] on this process. We do appreciate the opportunity to review and resolve this situation with ourmember and thank you for bringing it to our attention.  If you have additional questions, please feelfree to call me.Sincerely,[redacted]

Corporate OmbudsmanOffice of the PresidentBlue Cross® Blue Shield®of Arizona[redacted]  *  [redacted]

 (please note - my email has changed)

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]

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]. [redacted] had previously expressed concern with the handling of a duplicate enrollment situation that occurred with his Individual ON Exchange medical plan through the Federal Marketplace. Please refer to BCBSAZ’s response dated 2/11/16 to the initial Revdex.com case #[redacted] with acknowledgement and apology for the initial confusion related to Mr. [redacted]’s concern. I hope this information is helpful.
BCBSAZ had initially contacted Mr. [redacted] on 2/10/16 to acknowledge our awareness of this situation regarding the duplicate enrollment situation and to advise of the initiation of correction efforts. Upon receipt of the second Revdex.com notice, additional member outreach was conducted. 

On 2/16/16, Mr. [redacted] was contacted again by phone to apologize for remaining confusion and to explain that full resolution of this situation, which impacted his premium and claims requires a multi-day correction process. Additional communication on the status of this effort was provided on 2/18/16. We are very sorry for the delay associated with this correction process and will remain in direct contact with Mr. [redacted] to ensure all questions are addressed and final resolution of this matter.
Sincerely,

[redacted]

Blue Cross® Blue Shield® of Arizona
(602) 864-4448  |  cell: (602) 320-7229
fax: (602) 864-4376
[email protected]

[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.]

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 for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

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]. [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 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’s 1/26/15 complaint case# [redacted],  filed by BCBSAZ member [redacted], regarding his...

concerns related to contacting BCBSAZ. I hope this information is helpful.When your correspondence was received, we initiated a priority review of the concerns [redacted] brings to your attention. [redacted] also contacted BCBSAZ via email.  Although attempts to reach him by phone were unsuccessful, our records confirm we have been communicating with [redacted] via email to address his questions, including confirming his address to ensure receipt of his identification cards and plan information as well as those related to the benefits provided under his BCBSAZ plan.  Our records reflect email communication on 1/24/15, 1/26/15 and 1/28/15. We will continue to correspond directly with [redacted] to address any questions he may have. I hope this information is helpful.  We do appreciate the opportunity to review this situation for our member and thank you for bringing it to our attention.  If you or [redacted] have additional questions, you are also welcome to contact me.Sincerely, [redacted]Corporate OmbudsmanOffice of the President Blue Cross® Blue Shield® of Arizona[redacted]  *  [redacted]  *  [redacted]

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]  [redacted]

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]   

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]@azblue.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,

BCBS of AZ is one of the worst companies I have ever dealt with. Their customer service is very poor and they hang up on you whenever they feel like it. None of my questions were answered

I do apologize for the delay in response. Although several attempts to reach [redacted] by phone were unsuccessful, I hope the following documentation of our email communication with [redacted] is helpful. In each response, the BCBSAZ representative provided her name, phone number, fax and email. ·         Saturday 1/24/15, 10:44 AM – Received [redacted]’s initial email stating he was ill and unable to reach anyone via phone or email. ·         Saturday 1/24/15, 11:30 AM – (Same day) BCBSAZ responded via email to [redacted]’s initial email of 1/24/15, providing a list of Urgent Care, Hospital and Family providers and basic instructions to access this information on our website at azblue.com·         Saturday 1/24/15, 8:23 PM – Email from [redacted] questioning specific plan and benefit information.·         Monday 1/26/15, 3:10 PM – BCBSAZ responded via email with benefit information.·         Monday 1/26/15, 8:17 PM – [redacted] emailed us asking benefit information related to a specific service .·         Wednesday 1/28/15, 10:46 AM – BCBSAZ responded with specific benefit information and also asked for an address update for our records because he had mentioned he had not received his ID card. ·         Wednesday 1/28/15, 7:12 PM – [redacted] responded via email with an updated address only.·         Friday 2/6/15, 3:53 PM – BCBSAZ sent an email to [redacted] following up to ensure his questions were addressed and asking if he needed any additional assistance. In this email, it was also offered to arrange to call him at his convenience. We have not heard further. BCBSAZ sincerely appreciates [redacted] as our customer and will continue to make every effort to respond to his inquiries on a timely basis. I am unaware of any immediate plans to change our customer service business hours and in [redacted]’s case, we understand his work schedule may pose some difficulty with his communication times. Because of this, as stated in our most recent email, we are also more than happy to arrange phone contact at his convenience, outside of our established customer service business hours. If you or [redacted] have questions, you are also always welcome to contact me.Sincerely,   [redacted]Corporate OmbudsmanOffice 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 3/13/14 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. As a result, the necessary precertification was obtained, the claim was resubmitted and reimbursement will be made for any direct RX purchases obtained during this process. BCBSAZ also acknowledges the confusion Mr. [redacted] noted and has corresponded directly with Mr. [redacted] via telephone call, email and a follow up written response from our Vice President of Pharmacy Management on 3/13/14 to apologize for any confusion and confirm our resolution to this matter. We believe resolution to this issue has been achieved with our member and will continue to communicate directly with him to address further questions he may have.    If you have additional questions, please feel free to contact me. Please note that my new email is:  [redacted].com Sincerely, [redacted]Corporate OmbudsmanOffice of the PresidentBlue Cross® Blue Shield® of Arizona

The issue is not the employer requiring verification every month.  The issue is that every time BCBS-AZ has sent the verification letter, we fill it out properly and send it back in and then it gets "lost".  And the even bigger issue is that we are given no notification of this, the first we hear of this is when BCBS-AZ denies claims with our medical providers.  I was advised on the phone that every time the 6 month re-validation comes up I should call BCBS-AZ (and of course go through numerous robo-prompts and spend a considerable amount of time on hold) and provide this information to someone on the phone.  BCBS-AZ needs to fix the issues with their internal re-validation process and stop putting the burden of proof onto the customer when it is your processing error that is causing the problem.  It is not the customer's job to track down your clerical error and then take a large amount of my time and effort to correct it for you.  Not to mention I then have to get back in contact with any/all health care providers who have our outstanding claims and ask them to re-run the claim to BCBS-AZ.

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,
 
 

Corporate Ombudsman
Office of the President
 
Blue Cross® Blue Shield® of Arizona
[redacted]  *