Cambia

Complaint: [redacted] I am rejecting this response because: I don't want my personal healthcare information shared, which is requested in the form sent.Sincerely, [redacted] ***

Good Morning ***, I updated our response online regarding [redacted] , however, it is not giving me the opportunity to go back in and upload the HIPAA auth form I went ahead and attached it to this email, and highlighted where Ms [redacted] will need to sign to hopefully make this easier Teresa P [redacted] Regence Legal Department Teresa.P***@regence.com PH (503) 226- FAX (888) 496-1560>>>>>>>>>>>>>>>>Please see attached HIPPA form

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me, which is the completion of the attached form

This is in response to your inquiry regarding [redacted] concerns, which Regence received on May 2, [redacted] has addressed concerns regarding a payment recovery request, as it relates to services provided to his wife, [redacted] Please note that [redacted] is on a self-funded group plan with [redacted] ***This means that while Regence does not insure [redacted] ***., we do provide administrative services to this self-funded group.According to our records, we show that the original claim for date of service, February 20, 2015, was paid to the [redacted] in the amount of $ However, Regence later identified that [redacted] had other coverage through ***, which we were not informed ofIn contacting ***, it was advised that they were Mrs [redacted] primary carrierBased on this information, it resulted in the February 20, claim being denied until a primary Explanation of Benefit (EOB) was received by ***Additionally, a payment recovery request of $was issued to the [redacted] When Regence received payment information (EOB) from Mrs [redacted] primary carrier; ***, this resulted in the claim being reprocessed, and a payment of $was created to be paid to [redacted] However, since [redacted] had not returned the previous $payment, the $was suppressed and applied to the outstanding balance of$This left a remaining balance due of $122.00.As Regence had not received any payment(s) from [redacted] for the remaining $balance, and the account was 90-days old; this was forwarded to [redacted] who works on behalf of Regence to recover fundsDuring this same time period, a corrected EOB was again received by ***This resulted in another adjustment and payment of $on March 23, This payment was also suppressed and applied to the remaining balance due of $122.00; bringing the total payment recovery down to $96.00.On April 27, 2016, [redacted] contacted Customer Service with concerns that the overpayment had been sent to [redacted] Regence advised that we would place a hold on the account, and in return, he could send the overpayment of$directly to RegencePer [redacted] ’s request, it was also asked that Regence provide him with a letter of the amount due, and explain how we arrived at the $This letter was mailed to [redacted] on April 27, 2016.Following receipt of the April 27, letter, [redacted] did not feel that this adequately explained how Regence arrived at the $96.00, which resulted in a second letter being mailed on April 28, 2016.At this time, [redacted] ’s group has agreed to reprocess Mrs [redacted] claim, leaving the member with $balance This claim was reprocessed on May 6, 2016, and a corrected EOB will be mailed to [redacted] in the next 14-business days Additionally, [redacted] is able to access the claim information online at www.regence.com.Understanding that [redacted] has been working with Regence regarding this matter, the above information was previously communicated to himWe hope this information has addressed [redacted] ’s concernsShould you have any further questions regarding this letter, please feel free to contact me

Re: Case#: [redacted] Consumer: [redacted] This is in response to your inquiry regarding [redacted] 's concerns, which Regence received onDecember 15, Ms [redacted] has addressed concerns regarding collections notices she has received.Regence BlueShield would be happy to review Ms [redacted] s concerns, however, our office does need to obtain asigned HIPAA Disclosure Authorization Form in order to release informationOnce this form has been completed,and signed by Ms [redacted] , we will review the concerns addressed in Ms [redacted] 's complaint to the Better BusinessBureauIf Ms [redacted] has any questions, she is also welcome to contact Regence's Customer Service departmentat (888) 849- Please note, all Revdex.com complaints should be submitted to the following email address: [email protected] Should you have any further questions concerning this letter, please feel free to contact me Sincerely,Teresa LP [redacted] Legal Department

Thank you for writingWe apologize for the delay in our response.Due to the unique circumstances, Regence BlueShield has written off the remaining balanceowed for the complainant's prescription claim filled on September We have alsocontacted [redacted] to request her removal from the collection process and to removethis incident from her credit history.We hope this resolves your complainant's concernsIf you need any further assistance, pleasecontact me at [redacted] Ext***.Sincerely, Nicole B***Member ServiceRegence BlueShield

Dear Ms***,This is in response to your inquiry regarding *** ***’s concerns, which Regence received onFebruary 17, Ms*** has addressed concerns regarding her medical claims
Regence BlueCross BlueShield of Oregon would be happy to review Ms***’s concerns, however, our
office doesneed to obtain a signed HIPAA Disclosure Authorization Form in order to release informationOnce this form hasbeen completed, and signed by Ms***, we will review the concerns addressed in Ms***’s complaint to theRevdex.comIf Ms*** has any questions, she is also welcome to contact Regence’s CustomerService department at (888) 675-
Should you have any further questions regarding this letter, please feel free to contact me
Sincerely,Miranda A***Legal DepartmentRegence BlueCross BlueShield of OregonMiranda.A***@

I have included attachments above which includes our response and a HIPAA authorization form
Dear Ms***,This is in response to your inquiry regarding *** ***’s concerns, which Regence received via email on December 26, 2015. In reviewing the December 26,
complaint, it states that your office submitted a previous complaint to Regence concerning Ms*** on December 15, 2015, which was not responded to. However, the only notification Regence has received was via email on December 26, 2015.Regence BlueShield would be happy to review Ms***’s concerns, however, our office does need to obtain a signed HIPAA Disclosure Authorization Form in order to release personal information. Once this form has been completed, and signed by Ms***, we will be able to address these concerns. If Ms*** has any questions, she is also welcome to contact Regence’s Customer Service department at (888) 849-3681.Enclosed, I have included a copy of our HIPAA Disclosure Authorization Form for Ms***’s convenience.Should you have any further questions concerning this letter, please feel free to contact meSincerely,Teresa LP***Legal DepartmentRegence [email protected](503) 226-8720FAX (888) 496-
***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***

Dear Ms***,
This is in response to your inquiry regarding *** ***’s concerns, which Regence received onMarch 23, Mrs*** is requesting that Regence approve her husband’s knee surgery, and that we reimbursehim for medication(s) that were previously denied
Regence
BlueShield of Idaho would be happy to review Mrs***’s concerns, however, our office does need to obtaina signed HIPAA Disclosure Authorization Form in order to release informationOnce this form has been completed,and signed by her husband, we will review and respond to the concerns addressed in the complaint filed with theRevdex.comIf the ***’s have any questions, they are also welcome to contact Regence’s CustomerService department at (888) 367-
For convenience, I have enclosed a copy of Regence’s HIPAA Disclosure Authorization FormShould you have anyfurther questions concerning this letter, please feel free to contact me
Sincerely,Teresa LP***Legal DepartmentRegence BlueShield of [email protected].(503) 226-8720FAX (888) 496-1560Enclosure: HIPAA

Thank your for bringing Ms*** ***’ complaint to our attentionEnclosed, please find our response to the issues she raises in her letter
Ms*** *** called our member services team after the complaint was filedAs our member service specialist explained to Ms***, the ** ***
termination does not affect her choice of, or cost for, health care during an emergencyEmergency care is always covered at in-network ratesWe also made her aware that she could continue to receive routine, non-emergency care at ** *** with higher out-of-network cost-sharing
Regence also offers a low-cost HMO option that includes ** *** in her areaMs*** indicated that she was not interested in selecting that option
If she has additional questions, we encourage her to call our Member Services Team
Sincerely,
Holly M***
Medicare Operations Director
In Reference to: UW Termination from Regence Medicare Advantage PPO network
We understand that our members are concerned about ** *** no longer being part of the Regence Medicare Advantage PPO networkWe regret any inconvenience to our members
The ** *** termination does not affect members’ choices in an emergencyIn an emergency we recommend that members go to the hospital or facility closest to themEmergency care is always covered at the in-network rate
In addition, members who wish to continue obtaining services from ** *** for non-emergency, routine care, still have the option to do so with higher cost-sharing at the out-of-network rate
Using an in-network provider for regular health care enables members to obtain the care they need at lower in-network ratesThe Regence Medicare Advantage PPO network includes many other excellent providers that offer our members high-quality care close to homeOur Member Services team can help members who currently obtain services from a ** *** provider or facility transition to another in-network providerThey can search for in-network providers using the “Find a Doctor” resource at Regence.com/Medicare or request a directory of in-network providers by sending an email to [email protected]
We carefully consider all factors before making the decision to terminate a providerWe have a responsibility to all our members to ensure they receive high-quality care and that their premium dollars go toward providing them the care they need and ensuring better health outcomes
We are focused on doing everything we can to control costs for our membersThat’s why we decided to terminate ** *** from our Medicare Advantage PPO network
Regence also offers a low-cost HMO plan in certain service areas with in-network coverage at ** *** providers and facilities

May 6, 2016Revdex.com Revdex.com Resolutions Consultant PO Box 1000DuPont, WA
98327Re:Case#:***Consumer:*** ***Dear Ms***This is in response to your inquiry regarding *** ***’s concerns, which Regence received on April 29, *** *** has addressed concerns regarding a payment recovery that was issued regarding a vision claim.Regence BlueShield would be happy to review *** ***’s concerns, however, our office does need to obtain a signed HIPAA Disclosure Authorization Form from, *** ***, in order to release informationBased on *** ***’s inquiry, the services in question are regarding *** ***’s vision claim Understanding that a signed HIPAA Disclosure Authorization Form was completed and submitted by *** ***, this would actually need to be completed by *** *** Once this form has been completed, and signed by *** ***, we will most certainly review and respond to the concerns addressed in the complaint to the Revdex.comIf either Arthur or *** *** have any questions, they are welcome to contact Regence’s Customer Service department at *** ***For your convenience, I have enclosed a copy of a HIPAA Disclosure Form Should you have any further questions concerning this letter, please feel free to contact me

Complaint: ***I am rejecting this response because: Regence has changed the way their networks work and even their team leads cannot adequately advise on who I can see in my network and who isn't coveredFor example, I called to find out where the nearest in network urgent care facility was and was given two addresses for different Seattle Children's Hospital locationsI am a year old woman, not a childBut this mistake was made by a team leadThe next closest urgent care was in Renton - more than miles away! So I called back and was told that I could go to UW Med in Shoreline, but that I needed to ask at the time of service who is working because not all doctors at that facility are in networkIf I'm going to urgent care it's because of a serious injury, and I don't think it's reasonable that I can be expected to navigate in network vsout of network coverage while injured or bleedingI realize now that the two doctors I saw are not in the network for me, but I have purchased many Regence plans in the past and I thought I was getting Regence plus UW Med, not just UW MedI don't think it was made clear who is in that network and their website is very confusingSincerely,*** ***

Regence's response to Ms*** concerns are in the attached letter
*** *** *** ** *** *** Milwaukie, OR Complaint #: *** ID#: *** Group#: *** Plan Type: Group- Self-Funded Plan Name: *** *** Dear Ms***, This is in response to your inquiry, which
Regence BlueCross BlueShield of Oregon (Regence) received on June 25, You raised concerns regarding a prescription refund request for a claim filled after the termination date of your plan*** *** is an employer-paid benefit plan administered by RegenceThis means that *** ***, not Regence pays for their employees covered medical services and suppliesAs the plan administrator, Regence does not assume any financial risk or obligation with respect to claimsAs a self-funded group, any decisions regarding claim exceptions are solely at the discretion of *** ***Following receipt of your complaint, Regence contacted *** *** regarding your concerns*** *** advised that they will take liability for your prescription claimRegence is contacting *** *** to remove your account from collectionsYou should not receive any further recovery notices from Regence or *** *** regarding your March 1, claimIt is important to note that Regence does not have record of receiving an appeal regarding these claims and regrets any inconvenience you experiencedShould you have any further questions regarding this letter, please feel free to contact me directlySincerely,

Complaint: [redacted]I am rejecting this response because: Regence needs to explain why they erroneously breached my contract and did not comply with a federal mandate for Preventive Care coverage. Further, they need to explain why I, the consumer, had to try to resolve this for months without their cooperation. They are illegally attempting to not pay what is covered under Preventive Care and trying to draw this process out further so I just give up. By refusing to cover Preventive Care, Regence is harming me, as well as all of the other policy-holders who were denied coverage for Preventive Care. A "coding error by the provider" does not mean that the consumer needs to spend months between the two parties to try to resolve a simple issue. Their Customer Service reps all told me different things and they have still refused to give me anything in writing, even though I requested all records pertaining to what they have attempted to do regarding this claim.Sincerely,[redacted]

[redacted]This is in response to your inquiry regarding [redacted]'s concerns, which Regence received onNovember 18, 2015. Ms. [redacted] is requesting that Regence reprocess her 2015 claims to her in-network benefits.
Ms. [redacted] completed an application requesting an effective date of July 1,...

2015, which Regence received onJune 5, 2015. The application includes a wide variety of netwrk options that our members can choose from. Priorto selecting a network, the application explains the importance of first verifYing the network status of providers and/orfacilities that will be utilized. In order to confirm network participation, the application directs members toregence.com. This website has a "Find a Doctor" function that allows members to search for a provider and/or facilityby name and location. The search results include a list of specific networks that providers and/or facilities arecontracted with.
In reviewing Ms. [redacted]'s account history, we show the netwrk selected on her application was UW Medicine. Incomparing the claims on file from the time of Ms. [redacted]'s enrollment of July 1, 2015, we show she received servicesfrom two providers. According to regence.com, we have confirmed that these providers are only contracted with ourPreferred (PPO) and Providence-Swedish Health networks. Understanding that Ms. [redacted] specifically selected theUW Medicine network on her application, and that the providers she received services from are not listed onregence.com as being contracted with the UW Medicine network, Ms. [redacted]'s claims processed appropriately to herout-of-network benefits.
Should you have any further questions regarding this letter, please feel free to contact me.
Sincerely,
Miranda A[redacted]
Legal Department

This is in response to your inquiry regarding [redacted] concerns, which Regence received on May 2, 2016.[redacted] has addressed concerns regarding a 2015 payment recovery request, as it relates to services provided to his wife, [redacted]Please note that [redacted] is on a self-funded group plan with [redacted]. This means that while Regence does not insure [redacted]., we do provide administrative services to this self-funded group.According to our records, we show that the original claim for date of service, February 20, 2015, was paid to the [redacted] in the amount of $150.00.  However, Regence later identified that [redacted] had other coverage through [redacted], which we were not informed of. In contacting [redacted], it was advised that they were Mrs. [redacted] primary carrier. Based on this information, it resulted in the February 20, 2016 claim being denied until a primary Explanation of Benefit (EOB) was received by [redacted]. Additionally, a payment recovery request of $150.00 was issued to the [redacted]When Regence received payment information (EOB) from Mrs. [redacted] primary carrier; [redacted], this resulted in the claim being reprocessed, and a payment of $28.00 was created to be paid to [redacted]. However, since [redacted] had not returned the previous $150.00 payment, the $28.00 was suppressed and applied to the outstanding balance of$150.00. This left a remaining balance due of $122.00.As Regence had not received any payment(s) from [redacted] for the remaining $96.00 balance, and the account  was 90-days old; this was forwarded to [redacted] who works on behalf of Regence to recover funds. During this same time period, a corrected EOB was again received by [redacted]. This resulted in another adjustment and payment of $26.00 on March 23, 2016. This payment was also suppressed and applied to the remaining balance due of $122.00; bringing the total payment recovery down to $96.00.On April 27, 2016, [redacted] contacted Customer Service with concerns that the overpayment had been sent to [redacted].  Regence advised that we would place a hold on the account, and in return, he could send the overpayment of$96.00 directly to Regence. Per [redacted]’s request, it was also asked that Regence provide him with a letter of the amount due, and explain how we arrived at the $96.00. This letter was mailed to [redacted] on April 27, 2016.Following receipt of the April 27, 2016 letter, [redacted] did not feel that this adequately explained how Regence arrived at the $96.00, which resulted in a second letter being mailed on April 28, 2016.At this time, [redacted]’s group has agreed to reprocess Mrs. [redacted] claim, leaving the member with $0.00 balance.  This claim was reprocessed on May 6, 2016, and a corrected EOB will be mailed to [redacted] in the next 14-business days.  Additionally, [redacted] is able to access the claim information online at www.regence.com.Understanding that [redacted] has been working with Regence regarding this matter, the above information was previously communicated to him. We hope this information has addressed [redacted]’s concerns. Should you have any further questions regarding this letter, please feel free to contact me.

Thank you for writing. We apologize for the delay in our response.Due to the unique circumstances, Regence BlueShield has written off the remaining balanceowed for the complainant's prescription claim filled on September 31 2013. We have alsocontacted [redacted] to request her removal from the...

collection process and to removethis incident from her credit history.We hope this resolves your complainant's concerns. If you need any further assistance, pleasecontact me at[redacted] Ext. [redacted].Sincerely,
Nicole B[redacted]Member ServiceRegence BlueShield

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me, which is the completion of the attached form.

Good Morning,
 
Please see our attached response concerning [redacted].  If you have any further questions, please let me know.
 
This is in response to your inquiry regarding [redacted]’ concerns, which Regence received onDecember 31, 2016. Ms. [redacted] has raised concerns...

regarding getting reimbursement claims for vision hardwareprocessed.Regence BlueShield would be happy to review Ms. [redacted]’ concerns, however, our office does need to obtain asigned HIPAA Disclosure Authorization Form in order to release information. Once this form has been completed,and signed by Ms. [redacted], we will review the concerns addressed in Ms. [redacted]’ complaint to the Better BusinessBureau. If Ms. [redacted] has any questions, she is also welcome to contact Regence’s Customer Service departmentat 1 (888) 344-6347.Should you have any further questions regarding this letter, please feel free to contact me.Sincerely,Miranda A[redacted]Legal DepartmentRegence BlueShield
 
Thank you.

Re: Case#:[redacted]Consumer: [redacted]This is in response to your inquiry regarding [redacted]'s concerns, which Regence received onDecember 15, 2015. Ms. [redacted] has addressed concerns regarding collections notices she has received.Regence BlueShield would be happy to review Ms....

[redacted]s concerns, however, our office does need to obtain asigned HIPAA Disclosure Authorization Form in order to release information. Once this form has been completed,and signed by Ms. [redacted], we will review the concerns addressed in Ms. [redacted]'s complaint to the Better BusinessBureau. If Ms. [redacted] has any questions, she is also welcome to contact Regence's Customer Service departmentat (888) 849-3681.
Please note, all Revdex.com complaints should be submitted to the following email address:
[email protected]
Should you have any further questions concerning this letter, please feel free to contact me
Sincerely,Teresa L. P[redacted]
Legal Department