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Blue Cross of Idaho Health Service, Inc.

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Reviews Blue Cross of Idaho Health Service, Inc.

Blue Cross of Idaho Health Service, Inc. Reviews (10)

l am writing in response to your letter dated September 22, Within your letter was a complaint submittedby our member expressing concerns of potential mishandling of her son's new policy by the SalesRepresentative that set up the policyIn addition, she expressed concerns that incorrect
information was givento her by that Sales Representative, resulting in an adverse benefit determinationAs palt of our internal review,we have forwarded these concerns to the Manager of Direct Sales for any necessary follow up training andcoaching opportunities to prevent any such occurrence in the future
Our records indicate that our member has been working with one of the Senior Customer Service Advocatesregarding the benefit information that was provided, and the subsequent claim determinationAfter a fullreview of the circumstances, we have been able to verify that incorrect information was indeed given to thememberAs a result, the affected claims are currently being reprocessedOnce completed, a new Explanationof Benefit (EOB) for the claims will be mailed to the members address on file, within the next 5-businessdays
We are unable to refund a month's premium back to the member as she has requested, but hope that she willaccept our sincerest apologies for any inconvenience this issue may have caused herWe do take all complaintsseriously and take appropriate action when necessary
Thank you for allowing us the opportunity to resolve this matterShould you have any questions or requireadditional information, please do not hesitate to contact me at (208) 345-4550, extension
Sincerely,
Sherren C***
Complaint Resolution Specialist

[redacted]DOCUMENT ATTACHED[redacted]May 2, 2017 [redacted]Revdex.com PO Box 1000DuPont, WA  98327 sent via e-mail to [redacted]@theRevdex.com.org Complaint Number:  [redacted] [redacted]Dear  Ms.  [redacted],I am writing in response to your letter dated April 19, 2017, but received on...

May 1 , 2017. Attached to your letter was an e-mail submitted complaint completed by our member, regarding her concerns about the way a claim processed  for what she states were preventive services.Our records indicate that the claim  for this member was received on October 24, 2016, but not all of the claim lines were coded as preventive services.  Applicable deductible and coinsurance for the plan was applied as necessary due to non-preventive coding, leaving an amount of $389.3 1 due to the provider.  When the member contacted the Blue Cross of Idaho customer service department and made us aware that the claims may havebilled with the wrong codes, we contacted the provider and confirmed the incorrect coding.  The provider stated that they would send an updated claim with the corrected coding.I show that on April 24, 2017, this claim was reprocessed and benefit s were applied at 100% of the maximum allowance as preventive services. The member owes $0.00 after this adjustment.  We apologize for any inconvenience the coding and reprocessing of the claim may have caused.Thank you for allowing us the opportunity to resolve this matter.  Should you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550 , extension [redacted].

Complaint Number:  [redacted]
 
I am writing in response to your letter dated January 20, 2017.  Attached to your letter was an e-mail submitted com plaint completed by our member, regarding her concerns about the termination of her policy.We have completed a full review of all...

documentation and correspondence regarding this complaint, as well as all applicable recorded phone calls. Our records indicate that this member called in to the Customer Serice Department on October I 7, 2016, and spoke with a Blue Cross of Idaho (BCI) Customer Advocate (CA) regarding the termination of her health insurance policy. Her current policy was no longer available for the 201 7 plan year, and she was auto enrolled onto the plan available for 201 7 which most closely resembled her 2016 policy.  She requested that her policy be terminated at the end of 2016, and the CA advised that she would send the request to the Enrollment & Billing Services (EBS) to process her request.EBS reviewed the request, and then contacted the CA, explaining that because the member was set up for  monthly payments processing automatically through her checking account, teminating the policy at that time would cause the automatic payments to terminate, resulting in the member having to pay November and December 20 16 premiums manually.  The CA then called the member back on October 19, 2016, to verify whether she'd prefer to proceed with manual payments, or preferred to delay cancellation of her automatic payments at the end of the benefit year. The member d id not answer, and at that time the CA left a message requesting a cal l back. The CA attempted two subsequent calls, on October 20, 20 16, requesting a return call, and finally on October 2 1 , 2016, leaving a message that the member must call back at the end of December, 20 1 6, if she wishes to cancel her 20 17 pol icy.On January 13, 20 I 7, the member called in again requesting termination stating that she understood that this was to be taken care of in October. The request was again sent to EBS, who responded that because the previous CA called and left numerous messages for the member requesting callback, and because no return calls from the member were received , a written request from the member would be required to consider for retroactivetermination of the 2017. When the CA cal led back the member and advised her about the written requirement, the member stated that she would not do that and she ended the call.Originally, the member 's policy would have shown a termination date of January 3 1, 2017; however, we are accepting this complaint as her written request for retro-termination to December 31 , 20 16. Please note, there will be no refund of the January 20 17 premium, as the original payment was returned due to Non-Sufficient  Funds (NSF).  In addition , our Director of Enrollment and Billing Services contacted her by phone on January 31 , 2017, to ensure we had proper understanding of her request, to advise her of the ending of open enrollment, and to ensure she had the opportunity to select coverage if she wished to do so.Thank you for allowing us the opportunity to resolve this matter.  Should you have any questions or require additional information, please do not hesitate to contact me at ([redacted], extension [redacted].

Complaint Number: [redacted] Dear Ms. [redacted], I am writing in response to your letter dated April 6, 2016. Attached to your letter was an e-mail submitted complaint completed by our member, regarding the fact that her daughter was covered by two policies for the 2015 plan year, and she has been...

unable to get reimbursed for her payments on one of them. Our records indicate that there were two active policies for the member's daughter in 2015; however, we have not identified any error on the part of Blue Cross of Idaho that will allow us to issue any reimbursement. The member states that she was unaware of one of the policies until the end of 2015, but there were several notifications sent to the family by mail. On December 18, 2014, the member was sent a welcome letter detailing the new pol cy number and the monthly premium amount, and on December 12, 2014, another letter was sent detailing the premium amount, due date, and specification as to which members were included on the policy. The member was sent a billing statement for March 2015, and then a subsequent notice of non-payment on March 25, 2015. That payment was received, and the April 2015 billing statement was sent to the member. Subsequently, we received a request for automatic payment from the member that was in effect from February 1, 2015, through December 31 , 2015. This policy showed the member as an insured on the policy; however her spouse was the enrollee. On the policy that she claims knowledge of, she is the enrollee, and her spouse is not on the policy at all. For these reasons, we feel that the member was informed adequately about the policy she is disputing, and because of the differing names on each of the policies, there should have been no confusion. I  have enclosed copies of the correspondence we've had with the member for your review. Thank you for allowing us the opportunity to resolve this matter. Should you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension [redacted].
[redacted]SUPPORTING DOCUMENTS REDACTED BY Revdex.com[redacted]

Complaint: [redacted]
I am rejecting this response because:When I originally signed up for coverage in 2015 I had specifically asked both the HR department and the Blue Cross representative who attended the benefits meeting about the drug program that I had been using.  I was assured there was no issue with the program with the health plan I was looking at.  I then asked again in 2016 and was assured there were no changes and no problems again.  To say that I misunderstood my plan is inaccurate as I reviewed all materials available to me and asked questions specific to this use of this program with this plan.  I even called Blue Cross and tried to ask questions and was told that because it was not an active plan they could not provide me any information until I'd signed up and the plan became active, at which point I would be locked in and unable to make changes should I decide the features and limitations of the plan were not what I needed. I have spoken to a Blue Cross employee and there have not been audits done like this in the past, this is not a routine procedure.  During an internal audit for an unrelated problem Blue Cross became aware in late 2015 and just started receiving revised information from the pharmacies to identify how the deductible payment was made.  Previously the pharmacy just reported the deductible was paid without specifics of how it was paid.  Blue Cross had discussions internally about the gross unfairness of going back on their customers and making them pay for something that they've never enforced previously (if this rule in paragraph "X" did in fact exist in prior contracts), nor did they notify their customers in advance that they would have a problem or potential liability. They have since decided they do not care how their customers are affected, they just want to save money at their own bottom line.Had I paid this amount to the pharmacy in early 2016 Blue Cross would in fact be liable for the claims which they are now rejecting.  If the payment is a problem Blue Cross should have the pharmacy claim revisited and the "un-allowed" funds returned so I can pay for my prescription, Blue Cross would then still have to pay for all the same claims which they've now reduced their payments.  The way Blue Cross is going about this gives the undeniable appearance that they are trying to get out of paying claims and reducing their expenditures at the expense of the customers, who in my case, did everything possible to ensure I was using programs within their limits.  I am now being blindsided by something related to a plan year which is closed and past and which leaves me zero ability to budget appropriately for such a large expenditure, and also has me now locked into the same plan facing another $4000 in costs which I did not expect on top of what they're now saying I owe for the last plan year.    Sincerely,
[redacted]

Complaint Number: [redacted]We are writing in response to your letter dated December 16,2017. Attached to your letter was a complaintcompleted by our member, regarding her concerns about the adjustments to some of her claims payments basedon her use of a manufacturer's co-pay assistance card for...

prescription drugs, and her notification of changes onher contract.The member states that when she asked if there would be any changes to her policy during 2016 openenrollment for her employer group, she was told that there were no changes to her policy. The information shewas given is correct, as there has been no change to this part of the contract. The information below is part ofthe original employer group contract, and has not changed:x. Prescription Drugs Exclusions and LimitationsIf an Insured receives a discount or other cost reduction, in any form, including but not limitedto a coupon or discount card from a pharmaceutical manufacturer, pharmacy, or other healthcare Provider, or cost-sharing from a prohibited third party organization, the cost reduction oramount discounted toward the purchase of the Prescription Drug will not be applied to theInsured's applicable Deductible amounts, and will not be applied to the Insured's Out ofPocket Limit for this Policy. (Emphasis added.)To monitor this type of benefit, Blue Cross of Idaho periodically audits enrollee accounts to determine if a co-pay assistance card has been used, and if they find that it has, any affected claims will be corrected to reflect themember's contract. We do not disallow the use of a manufacturer's co-pay assistance card; however, per thecontract, amounts discounted would not be applied toward the insured's deductible or out of pocket liability.We apologize if the member was unaware of this portion of her contract.Thank you for allowing us the opportunity to resolve this matter. Should you have any questions or requireadditional information, please do not hesitate to contact me at (208) 345-4550, extension [redacted].

[redacted]DOCUMENT ATTACHED[redacted]I am writing in response to your letter dated August 28, 20 17. Attached to your letter was an e-mail submitted complaint completed by our member , regarding issues he has been having when trying to use the member website to print his ID cards.We sincerely apologize for the...

issues that he has been having while trying to use the member portal , and would like to thank him for bringing his concerns to our attention.  His concerns regarding the websi te have been passed on to our technical team for review, and we will be having one of our Customer Advocates contact hjm at his phone num ber on file, and walk him through the process of printing  his ID cards.Thank you for allowing us the opportunity to resolve thi s matter.  Should you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension [redacted].

I am writing in response to your letter dated March 6, 2016. Attached to your letter was an e-mail submitted complaint completed by our member, regarding issues she has been having when trying to look at her policy on line, make payments, or when her providers try to look up benefits for her on...

line. Our records indicate that the member currently has one active policy. I have verified that the correct policy has been marked as the default policy on the member's online account so that when she logs in, it will reflect information for her current, active policy. I have also verified that when she calls into our automated line it will direct her to her active policy. If her providers use the correct enrollee ID number, they should be able to review the m embers' benefits
online for the correct policy. We do apologize for any inconvenience during the policy transition while she added her husband. This policy in an "On-Exchange" policy through Your  Health Idaho (YHI), and Blue Cross of Idaho (BCL) must fulfill any policy changes requested by YHI. When the member added her husband, YHI sent a request to us on October 28, 2015, for a new policy showing him as the subscriber, and requested that we terminate the policy that reflected her as the sole enrollee. The new policy request that we received on October 30, 2015, reflected her husband as the subscriber, but showed no Advanced Premium Tax Credit (APTC). We then received another request from YHI on February 7, 2016, for another new policy, effective February 1, 2016, that did include the members' APTC; this is the member's current, active policy. Thank you for allowing us the opportunity to resolve this matter. Should you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension [redacted].

Dear Ms. [redacted],This is in response to your letter dated February 9, 2018.
Attached to your letter was an e-mail submitted complaint completed by our
member, regarding concerns he has with the pricing of his insulin.Our records
indicate that this member's employer group plan renewed December l,...

2017. At
this time, the prescription plan deductible changed from a no deductible
prescription plan, to a onethousand dollar ($1 ,000.00) prescription
deductible. His prescription was refilled on December 29, 2017, and the amount charged was
applied to the newly added 2017 deductible. On January I, 2018, his plan
benefits were reset for the 2018 plan year, which is why the one-thousand
dollar ($ ,000.00) prescription deductible was now owed. In February, the
member was shipped a 90 day supply of his insulin. One-thousand dollars
($1,000.00) applied to his 2018 prescription deductible, and he was charged a ninety dollar ($90.00)
co-payment (3 months x $30.00). He was also shipped a fifty (50) day supply of
test strips, and paid a sixty dollar ($60.00) co-payment (2 months x $30.00)
for them.We offer our apologies for any confusion or frustration that
this may have caused. The deductible changes noted in the complaint were
changes made by the member's employer group upon renewal, and were facilitated by Blue Cross
of Idaho based on the group's request.Thank you for allowing us the
opportunity to resolve this matter. Should you have any questions or require
additional information, please do not hesitate to contact me at (208) 345-4550,
extension [redacted].

Complaint: [redacted]I am rejecting this response because:
I have received the amount in question through my own efforts by returning the ACH through my bank. It is wrong that I had to initiate that approach, and this response from Blue Cross indicates that was the only way I could get what was owed me.
As I understand it,the Revdex.com is here to ensure fair treatment for all consumers.  Therefore, this can only be resolved for others in this exact same situation if there is assurance of the following:
If it is OK for an insurance company to automatically re-enroll in January for a new plan without approval from the insured, then there has to be an easy way for the insured and the service department to take a request to reject the new plan in October ( when the letter was sent).  The response to my complaint indicates there was no way for that to take place.  This lack of process is the reason I was billed in error.  This gap is the problem that Blue Cross of Idaho needs to publicly respond to as fixed going forward before this can truly be resolved.

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