***DOCUMENT ATTACHED***May 2, [redacted] Revdex.com PO Box 1000DuPont, WA sent via e-mail to [redacted] @theRevdex.com.org Complaint Number: [redacted] ***Dear Ms [redacted] ,I am writing in response to your letter dated April 19, 2017, but received on May , 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 $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 servicesThe member owes $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-, extension ***
Complaint: [redacted] I am rejecting this response because:When I originally signed up for coverage in 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 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 neededI 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 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 liabilityThey 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 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 $in costs which I did not expect on top of what they're now saying I owe for the last plan year Sincerely, [redacted]
***DOCUMENT ATTACHED***I am writing in response to your letter dated August 28, 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 ***
Complaint Number: [redacted] I am writing in response to your letter dated January 20, 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 callsOur 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 policyHer current policy was no longer available for the plan year, and she was auto enrolled onto the plan available for which most closely resembled her 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 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 yearThe member d id not answer, and at that time the CA left a message requesting a cal l backThe CA attempted two subsequent calls, on October 20, 16, requesting a return call, and finally on October , 2016, leaving a message that the member must call back at the end of December, 6, if she wishes to cancel her pol icy.On January 13, I 7, the member called in again requesting termination stating that she understood that this was to be taken care of in OctoberThe 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 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 1, 2017; however, we are accepting this complaint as her written request for retro-termination to December , Please note, there will be no refund of the January 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 , 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 ***
Complaint Number: [redacted] Dear Ms [redacted] , I am writing in response to your letter dated April 6, 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 plan year, and she has been unable to get reimbursed for her payments on one of themOur 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 reimbursementThe 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 mailOn 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 policyThe member was sent a billing statement for March 2015, and then a subsequent notice of non-payment on March 25, That payment was received, and the April billing statement was sent to the memberSubsequently, we received a request for automatic payment from the member that was in effect from February 1, 2015, through December , This policy showed the member as an insured on the policy; however her spouse was the enrolleeOn the policy that she claims knowledge of, she is the enrollee, and her spouse is not on the policy at allFor 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 confusionI have enclosed copies of the correspondence we've had with the member for your reviewThank you for allowing us the opportunity to resolve this matterShould you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension *** ***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***
Dear Ms [redacted] ,This is in response to your letter dated February 9, 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, At this time, the prescription plan deductible changed from a no deductible prescription plan, to a onethousand dollar ($,000.00) prescription deductibleHis prescription was refilled on December 29, 2017, and the amount charged was applied to the newly added deductibleOn January I, 2018, his plan benefits were reset for the plan year, which is why the one-thousand dollar ($ ,000.00) prescription deductible was now owedIn February, the member was shipped a day supply of his insulinOne-thousand dollars ($1,000.00) applied to his prescription deductible, and he was charged a ninety dollar ($90.00) co-payment (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 (months x $30.00) for them.We offer our apologies for any confusion or frustration that this may have causedThe 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 matterShould you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension ***
I am writing in response to your letter dated March 6, 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 lineOur records indicate that the member currently has one active policyI 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 policyI have also verified that when she calls into our automated line it will direct her to her active policyIf her providers use the correct enrollee ID number, they should be able to review the m embers' benefits online for the correct policyWe do apologize for any inconvenience during the policy transition while she added her husbandThis policy in an "On-Exchange" policy through Your Health Idaho (YHI), and Blue Cross of Idaho (BCL) must fulfill any policy changes requested by YHIWhen 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 enrolleeThe 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 policyThank you for allowing us the opportunity to resolve this matterShould you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension ***
***DOCUMENT ATTACHED***May 2, [redacted] Revdex.com PO Box 1000DuPont, WA sent via e-mail to [redacted] @theRevdex.com.org Complaint Number: [redacted] ***Dear Ms [redacted] ,I am writing in response to your letter dated April 19, 2017, but received on May , 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 $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 servicesThe member owes $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-, extension ***
Complaint: [redacted] I am rejecting this response because:When I originally signed up for coverage in 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 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 neededI 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 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 liabilityThey 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 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 $in costs which I did not expect on top of what they're now saying I owe for the last plan year Sincerely, [redacted]
***DOCUMENT ATTACHED***I am writing in response to your letter dated August 28, 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 ***
Complaint Number: [redacted] I am writing in response to your letter dated January 20, 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 callsOur 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 policyHer current policy was no longer available for the plan year, and she was auto enrolled onto the plan available for which most closely resembled her 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 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 yearThe member d id not answer, and at that time the CA left a message requesting a cal l backThe CA attempted two subsequent calls, on October 20, 16, requesting a return call, and finally on October , 2016, leaving a message that the member must call back at the end of December, 6, if she wishes to cancel her pol icy.On January 13, I 7, the member called in again requesting termination stating that she understood that this was to be taken care of in OctoberThe 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 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 1, 2017; however, we are accepting this complaint as her written request for retro-termination to December , Please note, there will be no refund of the January 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 , 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 ***
Complaint Number: [redacted] Dear Ms [redacted] , I am writing in response to your letter dated April 6, 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 plan year, and she has been unable to get reimbursed for her payments on one of themOur 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 reimbursementThe 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 mailOn 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 policyThe member was sent a billing statement for March 2015, and then a subsequent notice of non-payment on March 25, That payment was received, and the April billing statement was sent to the memberSubsequently, we received a request for automatic payment from the member that was in effect from February 1, 2015, through December , This policy showed the member as an insured on the policy; however her spouse was the enrolleeOn the policy that she claims knowledge of, she is the enrollee, and her spouse is not on the policy at allFor 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 confusionI have enclosed copies of the correspondence we've had with the member for your reviewThank you for allowing us the opportunity to resolve this matterShould you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension *** ***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***
Dear Ms [redacted] ,This is in response to your letter dated February 9, 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, At this time, the prescription plan deductible changed from a no deductible prescription plan, to a onethousand dollar ($,000.00) prescription deductibleHis prescription was refilled on December 29, 2017, and the amount charged was applied to the newly added deductibleOn January I, 2018, his plan benefits were reset for the plan year, which is why the one-thousand dollar ($ ,000.00) prescription deductible was now owedIn February, the member was shipped a day supply of his insulinOne-thousand dollars ($1,000.00) applied to his prescription deductible, and he was charged a ninety dollar ($90.00) co-payment (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 (months x $30.00) for them.We offer our apologies for any confusion or frustration that this may have causedThe 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 matterShould you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension ***
I am writing in response to your letter dated March 6, 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 lineOur records indicate that the member currently has one active policyI 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 policyI have also verified that when she calls into our automated line it will direct her to her active policyIf her providers use the correct enrollee ID number, they should be able to review the m embers' benefits online for the correct policyWe do apologize for any inconvenience during the policy transition while she added her husbandThis policy in an "On-Exchange" policy through Your Health Idaho (YHI), and Blue Cross of Idaho (BCL) must fulfill any policy changes requested by YHIWhen 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 enrolleeThe 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 policyThank you for allowing us the opportunity to resolve this matterShould you have any questions or require additional information, please do not hesitate to contact me at (208) 345-4550, extension ***