Capital BlueCross

July 1, Dear [redacted] : We received your letter dated June 23, 2015, written on behalf of [redacted] ***In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI} may only be released to authorized representatives.In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by [redacted] ***, which would authorize us to release information to your BureauSince we have no such authorization on file, we are unable to respond to you regarding the issue in [redacted] complaint.Please be advised that we will review your inquiry and respond directly to [redacted] regarding his concernsIf [redacted] would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health Information (PHI} directly to you and/or the Revdex.comThank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at ###-###-####Sincerely, Jenny P Senior Resolution Specialist Appeals and Grievances Resolution Department Also, please sign and return the attached HIPPA Form You can return it to us at [email protected] or fax it to ###-###-####

This company canceled my service after taking our payments from our bank account (documented in our statements with confirmation numbers) claiming they had not received paymentMy son currently has no insurance because of their inept payment processingI am expecting a full refund from these snakes and will never do business with them again

September 22, Dear ** [redacted] :This letter is in response to your inquiry dated September 11, 2014, written on behalf of [redacted] * [redacted] ** [redacted] ’s complaint is concerning the denial of his daughter, [redacted] * [redacted] ’s claim for services provided by [redacted] on February 6, [redacted] is currently enrolled for CHIP HMO - Subsidized Program effective February 1, under identification # [redacted] .The claim in question, # [redacted] , was denied because eye exams, glasses and contacts are not eligible for coverage under the medical portion of the contractUnder the terms of [redacted] ’s contract, [redacted] (***) administers the vision coverage.On behalf of ** [redacted] , we have forwarded the bill from [redacted] to [redacted] for processingPayment will be made to the provider and an Explanation of Benefits Statement will be sent to ** [redacted] once processing has been completed.Please know that it is the member’s responsibility to make sure that each provider has the current policy informationThe member should show each provider their current identification card at the time of their visit to ensure that claims will be submitted accurately and processed efficiently.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact the Analyst who researched the inquiry, [redacted] at ###-###-####.Sincerely,

[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.]Better Business Bureau:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted]

Since we have received the completed Capital BlueCross MAF authorizing us to release the members information to your office, attached is a copy of our resolution letter, regarding this matter, which was sent to *** *** on 6/11/Since we have still not received a claim from the provider, under
the patients correct la , and you have submitted a copy of the bill, we will sa claim for processing*** *** will receive a new EOB when processing is completed

July 15, Dear ***:This letter is in response to your inquiry dated July 8, 2014, written on behalf of *** ***’s complaint is concerning the denial of his daughter, *** ***’s claim for services provided by *** Opthalmology
*** on February 6, 2014.*** is currently enrolled for CHIP HMO - Subsidized Program effective February 1, under identification #*** ***.*** had enrollment for CHIP HMO - Free coverage under identification #*** *** from November 1, through October 31, According to our records, the claim in question was submitted to this identification # and therefore was denied because coverage is no longer in effect under this policy.We have submitted the bill for these services to the current identification # (*** ***) for processingPayment will be made to the provider once the claim has completed processing and *** will receive a new Explanation of Benefits Statement for this date of service.Please know that it is the member’s responsibility to make sure that each provider has the current policy informationThe member should show each provider their current identification card at the time of their visit to ensure that claims will be submitted accurately and processed efficiently.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact the Analyst who researched the inquiry, *** ***, at ###-###-####.Sincerely,

Please see attached response
Please sign the attached HIPPA form and return it to the Revdex.com within days

Complaint: ***
I am rejecting this response because:We have Capital Blue Cross CHIP health insurance for our daughterHer eye wear prescriptions are supposed to be covered by CHIPWell, CHIP is still refusing or unable to pay for the new prescription prescribed by the eye doctor which is stated under the policyThis is unacceptable! The original excuse given by CHIP was it was originally turned in under the wrong numberWell if they would look up *** *** on their computer it would show the correct group number and see that the health insurance policy is activeThis has been going on for months!! It was turned in AGAIN under the CORRECT number beginning of August yet Capital Blue Cross CHIP is still screwing around the *** *** ***!!!! I have also reported this once already a few months ago to the Revdex.com and Capital Blue Cross still has NOT paid the $owed to the *** *** *** ***This has gone on too long!!!! I will keep reporting this to the Revdex.com until CBC CHIP covers this as stated as this is a covered service!Pay the *** *** *** *** the $that was originally turned in on 2/6/2014!!! No excuses accepted!!!!!
Regards,
*** ***

February 18, Dear *** ***:We received your letter dated February 12, 2016, written on behalf of *** ** *** In accordance with the Health insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health information (PHI) may only be released to
authorized representatives.In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by *** ***, which would authorize us to release information to your BureauSince we have no such authorization on file, we are unable to respond to you regarding the issue in *** ***'s complaintPlease be advised that we will review your inquiry and respond directly to *** *** regarding his concernsIf *** *** would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health information (PHI) directly to you and/or the Revdex.comThank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at ###-###-####Sincerely,
Jenny PSenior Resolution Specialist Appeals and Grievances Resolution Department

September 22, 2014
Dear **. [redacted]:This letter is in response to your inquiry dated September 11, 2014, written on behalf of [redacted]. **. [redacted]’s complaint is concerning the denial of his daughter, [redacted]’s claim for services provided by [redacted] on February 6, 2014.[redacted] is currently enrolled for CHIP HMO - Subsidized Program 3 effective February 1, 2014 under identification #[redacted].The claim in question, #[redacted], was denied because eye exams, glasses and contacts are not eligible for coverage under the medical portion of the contract. Under the terms of [redacted]’s contract, [redacted]) administers the vision coverage.On behalf of **. [redacted], we have forwarded the bill from [redacted] to [redacted] for processing. Payment will be made to the provider and an Explanation of Benefits Statement will be sent to **. [redacted] once processing has been completed.Please know that it is the member’s responsibility to make sure that each provider has the current policy information. The member should show each provider their current identification card at the time of their visit to ensure that claims will be submitted accurately and processed efficiently.Thank you for your patience while your inquiry was under review. If you have any questions you may contact the Analyst who researched the inquiry, [redacted] at ###-###-####.Sincerely,

This company canceled my service after taking our payments from our bank account (documented in our statements with confirmation numbers) claiming they had not received payment. My son currently has no insurance because of their inept payment processing. I am expecting a full refund from these snakes and will never do business with them again.

July 1, 2015
Dear [redacted]:
We received your letter dated June 23, 2015, written on behalf of [redacted]. In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI} may only be released to...

authorized representatives.In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by [redacted], which would authorize us to release information to your Bureau. Since we have no such authorization on file, we are unable to respond to you regarding the issue in [redacted] complaint.Please be advised that we will review your inquiry and respond directly to [redacted] regarding his concerns. If [redacted] would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health Information (PHI} directly to you and/or the Revdex.com.
Thank you for your patience while your inquiry was under review. If you have any questions you may contact me directly at ###-###-####.
Sincerely,
Jenny P.
Senior Resolution Specialist Appeals and Grievances Resolution Department
Also, please sign and return the attached HIPPA Form.  You can return it to us at [email protected] or fax it to ###-###-####.

[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.]Better Business...

Bureau:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  Regards, [redacted]

January 8, 2016
Dear [redacted]  [redacted]:
We received your letter dated December 30, 2015, written on behalf of [redacted].
In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be...

released to authorized representatives. In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by [redacted], which would authorize us to release information to your Bureau. Since we have no such authorization on file, We are unable to respond to you regarding the issue in [redacted]’s complaint.Please be advised that we have responded to [redacted] directly. If [redacted] would like to have Capital BlueCross send a response  to you and/or the Revdex.com, we will need him to complete and return a MAF advising that we are allowed to release his Protected Health Information (PHI) directly to you and for the Revdex.com. An MAF is enclosed.
Thank you for your patience while your inquiry was under review. If you have any questions you may contact me directly at ###-###-####
Sincerely,
Jenny P.
Senior Commercial Appeals and Grievances Resolution Specialist

I am rejecting their response. I have e-mailed your company over a signed HIPAA. I also recently received Capital Blue Cross final denial letter and I requested in writing on 06/29/2015 an external review (someone not affiliated with their company).

Review: We have had Capital Blue Cross CHIP for our daughter for many years now. We had her to [redacted] Family Medicine in [redacted], PA in 11/27/2013 for sore throat and strep test. We had coverage at this time, and because CHIP has NOT covered the bill this is why we are reporting this. This service is SUPPOSED to be covered by CHIP Capital Blue Cross and I have been on the phone with them repeatedly, and have even turned in the appropriate information to [redacted] Family Medicine ([redacted]) in the past few months. I have talked to CHIP to verify the correct information and turned it in this spring AGAIN to [redacted] Family Medicine ([redacted]). Now the account has been turned into COLLECTIONS because of the tardiness of Capital Blue Cross CHIP to pay this bill!!!!Desired Settlement: PAY [redacted] and cover this Doctor's visit like you are supposed to!!!!!!! It has been too long this has been dragging out and I am sick of the excuses!!!! Now I have to go report [redacted] to get it out of collections because of Capital Blue Cross CHIP's incompetance!!!

Business

Response:

Since we have received the completed Capital BlueCross MAF authorizing us to release the members information to your office, attached is a copy of our resolution letter, regarding this matter, which was sent to [redacted] on 6/11/14. Since we have still not received a claim from the provider, under the patients correct la , and you have submitted a copy of the bill, we will set-up a claim for processing. [redacted] will receive a new EOB when processing is completed.

Review: I have been trying for 4 months to get a letter of explanation of benefits for a certain matter. On several occasions I was told a letter was being sent. Each time it was the wrong letter. Each time I called back and complained the wrong letter was sent again. I have finally run out of time for this certain matter and need this fixed immediately. After fighting with one of the customer service personnel I was finally told that customer service was unable to help me at all, and that I should have been referred to legal the entire time. They wasted 4 months to tell me that. I requested Legal's phone number and was denied. They told me I would have to write them a letter. Since they have wasted 4 months, I no longer have time for that. I told them so and they best they could do was submit a request to have legal call me. They were supposed to call the same day. They did not.

I called again the next day to request legal's number, again denied, again told they will submit a request for legal to call me immediately. That was hours ago and still no phone call. I told the agent to inform her manager that I will be filing a complaint. Very disappointed in this company.Desired Settlement: Either have legal call me immediately so I can get the letter I need or give me their number so that I can call them and get the letter.

Business

Response:

Please see attached response.

Please sign the attached HIPPA form and return it to the Revdex.com within 10 days.

Consumer

Response:

[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 is satisfactory to me. Regards, [redacted]

Review: I was a customer of Capital Blue Cross for the first 5 months of 2012 through my husband's employer-provided coverage. On February 17th, 2012, I had a procedure at an oral surgeon's office in [redacted], PA, which I was assured was a covered procedure. I presented my (valid) Capital Blue Cross insurance card, had the procedure done by Dr. [redacted] of [redacted] and [redacted] of the [redacted], and I assumed this provider would bill my insurance. Dr. [redacted] was in network with [redacted] Blue Cross, and was presented as an in-network provider to me via the blue cross website at that time.

However, I am now in receipt of a bill for the procedure (plus late fees and rebilling fees), since Dr. [redacted] did not successfully submit the bill to Capital Blue in a timely manner (a full year). This bill is going to be sent to collections. On the attached statement, it can be seen that Dr. [redacted] may not have even attempted to submit the claim until March of 2013, more than a year past the procedure date.

I don’t have any explanation for why Dr. [redacted] did not get this bill submitted. I don’t have any control over this provider’s operations and ask that you reconsider this claim denial. I have tried to resolve this with Capital Blue for months now, and I was assured that for the provider to bill me directly was not even allowable, since they are in-network and are governed by policies on how and when to bill. I was promised that there was a department at Capital Blue that would resolve this, and I could consider it concluded.

When it was not concluded, I tried to appeal this denied claim (ID [redacted]), and have been informed that my appeal has been denied because I did not respond to an explanation of benefits letter within 180 days. I have been separated from my husband and the address where this letter was likely sent since 2 months after the procedure, effective April 15, 2012. I have no idea when the 180 day time period started. All I am hearing is “No” at every turn.Desired Settlement: I would like for Capital One to either pay this claim, or work with [redacted] on their provider to stop billing me for a service that should have been covered by insurance had the provider submitted the claim within the first year after the procedure. I was told by Capital Blue Cross that the provider wasn't even allowed to bill me for this, yet Capital Blue Cross has done nothing to resolve the problem with [redacted] or the provider.

Business

Response:

January 23, 2014

Dear Ms tamerom

This is in response to your letter dated January 21{ 2014, regarding a complaint filed by [redacted].

Because your office did not supply a signed release form from our member we are unable to share the results of this member’s complaint. We will respond directly to our member.

If you have any questions, please contact me at ([redacted]) [redacted].

Sincerely,

Please sign and return to the Revdex.com the attached Authorization for Release of Health Information form.

Review: Dear Revdex.comYou were so helpfully on with my complaint against [redacted] Office. I need your help with Capital Blue Cross/Vision, I had filed an appeal in April 10, 2010 for eye exam that I had at [redacted] Department Store on 2/17/2012. when I received the glasses,I could not wear them with getting nauseous, so I returned them. I called Capital Blue Cross and asked them not to paid them because the prescription was so bad,that I would be going back to my doctor I had before [redacted]. Captial Blue Cross said because I returned the glasses there would be no problem using my insurance again. Well that didn't happen. I was charge$65.00 at [redacted] office for my exam, becuase they said Blue Cross told them I use my insurance already. I have called Capital Blue Cross many times, Spoke to [redacted] From NVA (9[redacted])faxed the appeal to her with proof of the [redacted] prescription and the prescription that I got from [redacted], which shown that they were so difference. I could wear the glasses I got from [redacted]. If you need a copy of the appeal letter and the prescriptions I can faxed them to you. I can be reach at [redacted]Thank You[redacted]Desired Settlement: I want to be reimsbure for $65.00 that I paid out of pocket.

Business

Response:

Please see attached response.

Consumer

Response:

[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 is satisfactory to me.

Regards,

Review: Our daughter is covered with CHIP under Capital Blue of PA. She has a LAZY eye which has required treatment for years now. Her eye glass prescriptions are supposed to be covered with CHIP. Well we received a claim rejected notice due to no coverage. THIS IS NOT TRUE!! We have coverage!! We pay $75.00 a month to Capital Blue while we are in a financial hardship!!!Desired Settlement: The prescription part for the eye glasses needs to be covered as stated within the CHIP Capital Blue coverage!!!

Business

Response:

July 15, 2014Dear **. [redacted]:This letter is in response to your inquiry dated July 8, 2014, written on behalf of [redacted]. [redacted]. **. [redacted]’s complaint is concerning the denial of his daughter, [redacted]. [redacted]’s claim for services provided by [redacted] Opthalmology [redacted] on February 6, 2014.[redacted] is currently enrolled for CHIP HMO - Subsidized Program 3 effective February 1, 2014 under identification #[redacted].[redacted] had enrollment for CHIP HMO - Free coverage under identification #[redacted] from November 1, 2012 through October 31, 2013. According to our records, the claim in question was submitted to this identification # and therefore was denied because coverage is no longer in effect under this policy.We have submitted the bill for these services to the current identification # ([redacted]) for processing. Payment will be made to the provider once the claim has completed processing and **. [redacted] will receive a new Explanation of Benefits Statement for this date of service.Please know that it is the member’s responsibility to make sure that each provider has the current policy information. The member should show each provider their current identification card at the time of their visit to ensure that claims will be submitted accurately and processed efficiently.Thank you for your patience while your inquiry was under review. If you have any questions you may contact the Analyst who researched the inquiry, [redacted], at ###-###-####.Sincerely,

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

We have Capital Blue Cross CHIP health insurance for our daughter. Her eye wear prescriptions are supposed to be covered by CHIP. Well, CHIP is still refusing or unable to pay for the new prescription prescribed by the eye doctor which is stated under the policy. This is unacceptable! The original excuse given by CHIP was it was originally turned in under the wrong number. Well if they would look up [redacted] on their computer it would show the correct group number and see that the health insurance policy is active. This has been going on for months!! It was turned in AGAIN under the CORRECT number beginning of August yet Capital Blue Cross CHIP is still screwing around the [redacted]!!!! I have also reported this once already a few months ago to the Revdex.com and Capital Blue Cross still has NOT paid the $185.00 owed to the [redacted]. This has gone on too long!!!! I will keep reporting this to the Revdex.com until CBC CHIP covers this as stated as this is a covered service!

Pay the [redacted] the $185.00 that was originally turned in on 2/6/2014!!! No excuses accepted!!!!!

Regards,

Business

Response:

September 22, 2014Dear **. [redacted]:This letter is in response to your inquiry dated September 11, 2014, written on behalf of [redacted]. [redacted]. **. [redacted]’s complaint is concerning the denial of his daughter, [redacted]. [redacted]’s claim for services provided by [redacted] on February 6, 2014.[redacted] is currently enrolled for CHIP HMO - Subsidized Program 3 effective February 1, 2014 under identification #[redacted].The claim in question, #[redacted], was denied because eye exams, glasses and contacts are not eligible for coverage under the medical portion of the contract. Under the terms of [redacted]’s contract, [redacted] ([redacted]) administers the vision coverage.On behalf of **. [redacted], we have forwarded the bill from [redacted] to [redacted] for processing. Payment will be made to the provider and an Explanation of Benefits Statement will be sent to **. [redacted] once processing has been completed.Please know that it is the member’s responsibility to make sure that each provider has the current policy information. The member should show each provider their current identification card at the time of their visit to ensure that claims will be submitted accurately and processed efficiently.Thank you for your patience while your inquiry was under review. If you have any questions you may contact the Analyst who researched the inquiry, [redacted] at ###-###-####.Sincerely,