EL NIPLITO DEL SURESTE

Case ID: [redacted] Dear Ms [redacted] ***:This member idenilfied has a FlexibIe Spending Account (FSA} through Highmark0ur records indicate this member contacted our Customer Service Department on March 21, 2018, concerned about issues with her Flexible Spending Account,, and she was advised that a few of her transactions were not eligible per IRS guidelines.This-member had been using her FSA debit card for expenses incurred in the prior plan year and submitting balance forward bills from the prior plan yearThe card can only be used for current year expensesWe require itemized receipts or the full Explanation of Benefits statements to confirm that the expense is an eligible IRS expense.Please know our records indicate a supervisor contacted this member on March 22, 2018, per her request to the Customer Service Advocate.If’the member has any questions concerning this coverage, please have her contact our Customer Service Department at [redacted] If you have additional questions, please contact me directly.Sincerely, Marguenue M***-S [redacted] Executive Legislative Inquiries

Case ID: [redacted] Dear Ms, [redacted] :This is in response to your inquiry sent to us on behalf of the member identified by Case ID [redacted] The member is currently enrolled in a Preferred Provider Organization through an employer group with an effective date of June This fully-insured nongrandfathered group has one level of appeal to be administered by Highmark with an external review available for medical necessity' denials only.The member has already received and paid for the services in questionHe was instructed to submit a claim directly to HighmarkHowever, this member resides in California and Blue Cross Blue Shield Association guidelines require we forward the member submitted claims to the local plan to be entered and processed viathe BlueCard programThis process may take four to six weeks.The BlueCsrd program that is designed to allow Blue Cross Bine Shield plans to share the participating provider discounts and allowances with other Blue Cross Blue Shield PlansThis program is also designed, to hold members harmless for the difference between a participating provider's charge and the allowanceClaims are submitted to the provider’s local Blue Cross Blue Shield PlanThe local plan is considered the host plan and is responsible for pricing, allowances, transmitting the claim to the home plan and payment to She providerAs the home plan, Highmark verifies membership eligibility and benefits and transmits the claim back to the host plan for payment.Our records indicate that on December 2017, our advocate advised the member that he would receive a callback, but only when our advocate was alerted of the claim showing on our systemOur advocated advised he could not guarantee an exact dateOnce the claim has been entered and forwarded to Highmark, our advocate wilt contact the member.If this member has any questions concerning his coverage, please have him contact our Customer Service Department at ###-###-####If you have additional questions, please contact me directly.Sincerely,Margueritte M***-S [redacted] Executive Legislative Inquiries

Dear MsGasser, We have responded to the member in writing concerning his 1095-B form The letter explains the following: Blue Cross received your complaint through the Revdex.com regarding the processing timeframes of your health insurance tax form (1095B form)The 1095B form is a health insurance tax form which reports the following information: type of health care coverage; dependents covered under the insurance policy; the period of coverage for the prior year The form is used when filing taxes to verify that the filer and dependents had at least the minimum qualifying health insurance coverage Please be advised that the 1095B form was sent to members on Monday, March 28, 2016, which meets the timeframe required by the Federal Government of mailing the form by March 31, Thank you

April 7, 2017Revdex.comHoliday Drive, Suite 220Pittsburgh, PA 15220Attn: [redacted] Case ID: [redacted] Dear Ms [redacted] This is in response to your inquiry sent to us on behalf of the member identified by Case ID [redacted] .Although this member advised she had contacted Highmark West Virginia over times to cancel her coverage, please note our records show her first contact to Highmark West Virginia in was on March 16, Through investigation, it was determined that she had making her requests to an outside national producer not affiliated with Highmark.Our policy is to cancel coverage the first of the month following notification, which would be April 1, Currently, our records show an April 1, cancel date.While I understand she feels she had cancelled her coverage, our records show prescription benefits were utilized in January and February, However, please know that a request to allow a retro cancellation of the policy has been made, but is still pendingThe member will be advised once a decision has been made.If the member has any questions concerning this coverage, please have her contact our Customer Service Department at [redacted] If you have additional questions, please contact me directlySincerely, Margueritte M [redacted] Executive Legislative Inquiries

November 4, 2015Revdex.comAttn: [redacted] ***Case ID: [redacted] File Number: [redacted] Dear [redacted] :This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.The member stated in her complaint that she enrolled in a health care plan for an effective date of February 1, 2015, and made the initial payment on February 2, She stated the payment was withdrawn from her bank account with no problemsOn February 26, 2015, the member stated she received a letter from Highmark Blue Shield that stated her policy had been canceled for nonpayment of premiumShe stated she contacted Highmark Customer Service and the Customer Service Advocate (CSA) stated that she would send a request for a reinstatement and contact the member back when the issue was resolvedThe member stated she spoke with a CSA on March 3, 2015, and was advised that the issue was still processingShe stated she advised the CSA that she wanted to make the March premium payment, but the CSA advised that she was not able to accept a payment until the policy was reinstatedThe member stated she again contacted Highmark Blue Shield on March 12, 2015, regarding the reinstatement of her planShe stated the CSA advised her that the policy was still under review and that an answer should be received very soonThe member stated she did not receive any notification of the reinstated via phone, mail or emailShe stated she again called the beginning of April and was advised by a CSA that she would receive written notification of the reinstatement resolution.The member stated she did not receive any notification of the reinstatement but did receive an invoice in the mail on May 2, 2015, with an amount due of $She stated that the invoice included February’s premium, which she paidThe member stated she wrote three letters to Highmark instead of calling because her promised callbacks were not receivedShe stated the only reply she received from Highmark were form letters dated September 8, and September 14, 2015, advising her of the termination of her policyThe member stated that she would simply like to get a refund on the money she paid because she feels she was unable to use the plan.According to Highmark’s records the member contacting Highmark Blue Shield on February 2, 2015, and made the initial payment for her healthcare planThe member contacted Highmark on March 3, 2015, regarding the cancelation notice she had received and the CSA advised she would request the member be reinstated because the plan had been canceled in error.On March 12, 2015, the member contacted Highmark Blue Shield requesting the status of her reinstatementThe CSA advised her that it can take approximately thirty days for a reinstatement request to be processedThe member advised that her daughter had a doctor’s appointment and was concerned because of the status of her accountThe CSA attempted to contact the member’s physician to explain the situation with the account but was unable to talk to anyoneThe CSA advised the member to keep the appointment because Highmark would reprocess the claims if necessaryHighmark has no record of additional calls or letters received from the memberThe original CSA attempted to contact the member on April 28, 2015, to advise that the policy was reinstated to the original effective date of February 1, There was no answer but a voice mail was left for the member regarding the reinstatementHighmark does not send letters when an account has been reinstatedThe invoice the member received on May 2, 2015, had a total amount due prior to May 17, 2015, of $This amount was for the months of March, April and May.There is a claim on file that initially denied in MarchThat claim is being reprocessed according to the member’s benefitsA new Explanation of Benefits will be mailed to the member when the processing is finalizedHighmark cannot retroactively cancel a member to the original effective date without a directive from the Federally Facilitated Marketplace (FFM)If the member contacts the FFM and they advise Highmark to retroactively cancel the plan, a refund in the amount of $will be mailed to the member and the plan canceled effective February 1,2015.If you have additional questions, please contact me directly.Sincerely, Cassandra M.Appeals CoordinatorPhone: [redacted]

June 24, [redacted] Revdex.com [redacted] Re: ID# [redacted] Dear [redacted] : We are in receipt of the Complaint dated June 8, regarding the member’s ongoing billing and collection issues The member had previously contacted the President of Highmark Incdirectly on May 25, The member’s account was reviewed with respect to the noted issues with payments not being posted to his account and revealed that the automatic payment feature with the member’s banking institution was set up with the incorrect billing account number which caused the payments to be directed to the wrong accountOn Friday, May 29, 2015, the member’s payments were located and applied to the correct account The member’s paid to date was then advanced to July 1, The member was contacted on May 29th and advised of the status of his complaint and the correction made to his accountBy this point the new invoices for June had already been generated and mailed, which will account for why the June invoice remained incorrectHighmark set up monthly monitoring on the member’s account to ensure that payments are posted correctly Upon further review on June 12, 2015, the member’s account is still accurate and his most recent invoice was also correct Highmark will continue to monitor this accountHighmark WV understands the frustration the member has experienced trying to get the matter resolved We appreciate the opportunity to advocate education with our billing team to understand why there continued to be an issue and what we could do to correct it so that other members would not experience the same issuesIf we can be of further assistance, please contact me at the below email addressSincerely, Courtney NL***, Associate Counsel [redacted]

June 24,2016Revdex.com [redacted] ***Attention: [redacted] Dear Ms [redacted] :This is in response to your inquiry sent to us on behalf of the member identified in your inquiry by Case ID [redacted] , and their recent, additional comments related to our previous responses submitted to your office.A review of our records located recent correspondence received from the member which included a provider billing statement that provided the required information to forward additional reimbursement to the memberTherefore, an additional payment has been forwarded to the member on June 23, They should receive the updated Explanation of Benefits statement and check/payment within the next seven (7) to ten (10) days.Combining the initial payment originally paid to the member, and the recent payment that has been forwarded to them, reimbursement for the total charges related to the services in question has now been made directly to the memberTherefore, forwarding payment to the out-ofnetwork provider for the services the patient received would be considered the responsibility of the patient.If the member has any questions concerning this information, please have them contact Customer Service at [redacted] If you have additional questions, please contact me directlySincerely, Margie L [redacted] *Executive/Legislative Inquiries

Member: [redacted] Group Number: [redacted] Revdex.com of Western Pennsylvania [redacted] ***Dear Ms [redacted] :This letter is in response to your inquiry that was received at Freedom Blue PPO on February 18, regarding complaint ID # [redacted] .Ms*** [redacted] is filing a complaint against Freedom Blue PPO regarding her premium paymentsShe states she sent in a payment for January that was never applied to her account, and her invoicing indicates she is one month in arrears.I have investigated this issue and found that there was a payment received on December 11, via check # [redacted] in the amount of $that was misapplied to another member’s accountThis other member did not have an active policy, and so the payment was refunded to that member in errorThe amount of $in lieu of this payment has been removed from the balance of Ms [redacted] ’s account on February 25, Her account now reflects credit for this payment as well as two additional payments: one in the amount of $received February 5, and one in the amount of $received February 23, Ms [redacted] ’s account is paid through March 31, as of the writing of this response.I apologize for any confusion this issue has causedIf Ms [redacted] has any additional questions or concerns, she may contact a Freedom Blue PPO Customer Service Representative at [redacted] Monday through Sunday 8:a.mto 8:p.m.Sincerely,Jennifer B.CMS Complaint Specialist

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below [To assist us in bringing this matter to a close, we would like to know your view on the matter.]I received a letter asking me to forward the bill to BCBS, which I did I will be really happy to close this case as soon as know the bill is paid Regards, [redacted]

October 16, 2015Revdex.com [redacted] Case ID: [redacted] Dear [redacted] :This is in response to your follinquiry sent to us on behalf of the member identified by case ID [redacted] .Our records show this member is enrolled on a Chip Gatekeeper policy effective September 1, 2015.The September 2015, premium payment in the amount of $61.75, was cleared by the bank on September 14, The paid to date on the account was updated to October 1, 2015, and denied claim number [redacted] was adjusted for payment on September 22, The Supervisor called the mother on September 15, 2015, and provided an update on the account, and the mother was satisfied with the outcome.Premium payments are due by the 15th of the month, and are applied to the next month’s coverageThe October 2015, premium was due by September 15, 2015, and the November 2015, premium is due by October 15, 2015, making the October 2015, premium past due.The enrollee’s mother called Highmark on October 7, 2015, and requested to speak with the Supervisor, but the Supervisor was out of the office due to a serious illnessThe Supervisor has returned to work, and is in the process of placing a return phone call to address any outstanding concerns the mother may have.On behalf of Highmark, please extend my sincere apology to the enrollee’s mother for any frustration, or dissatisfaction she may have experienced in dealing with our Customer AdvocatesBe assured we strive to provide efficient, courteous, and quality service, and are concerned when these standards are not met.I trust this addresses the mother’s concernsIf she has any questions, she can contact Customer Service at [redacted] Should you have additional questions, please contact me directly.Sincerely,Janice M***Executive/Legislative Inquiries

Revdex.com: I send my deepest apologies Upon receiving BCBS' response I checked with my husband to only discover he had in fact received and cashed the check Regards, [redacted]

May 11,2016Revdex.comAttn: [redacted] ***Case ID: [redacted] File Number: [redacted] Dear Ms [redacted] :This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.In her complaint, the member stated that her policy with Highmark officially ended on January 1, She stated in order for her new insurance to work, she needs an official cancellation letter from Highmark stating she is no longer covered under the policyShe stated after an attempt to have a cancellation letter faxed to the New York State of Health, she was informed that Highmark the New York State of Health never received the fax even though Highmark said they would fax the letterShe stated she called Highmark back and requested someone email her the letter of cancellation, but instead received an email stating her cancellation dateShe stated she then called Highmark back to receive the letter and was told she would receive the email with the letter as an attachment; however, she still has not received a letterShe stated this is causing her to be unable to fill her medications and is becoming a life threatening situation.Highmark sent one letter and one email to her for proof of cancellationThe letter was dated March 8, 2016, and the email was sent on April 27, Highmark’s records indicate a letter was sent to [redacted] and an email was sent to [redacted] on April 28, 2016, Highmark contacted her to advise another letter has been prepared and securely emailed to her and faxed to the New York State of Health at [redacted] Highmark also sent a copy of the cancellation letter to her through the mail.On behalf of Highmark, I apologize for any anxiety or inconvenience this issue may have causedIf you have additional questions, please contact me directly.Sincerely,Michelle D***Appeals CoordinatorPhone: [redacted]

Revdex.com Attn: [redacted] ***Case ID: [redacted] File Number: [redacted] Dear [redacted] :This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.In his complaint, the member states that he was contacted by Highmark on June 26, 2015, to see if his wife had received her benefit bookHe states that when he advised she had not, that the Highmark representative advised that she would print and mail it herself by June 29, He further states that the previous response did not reference the fact that the benefit book was not mailed when his wife made her initial payment, nor was it mailed after the subsequent requests.I contacted the member on June 26, 2015, and spoke to her husbandWhen he advised me that his wife had only received a second member identification card, but had not received a benefit book, I apologized and advised him that I would ensure one was printed and mailed as a priorityI advised him that I could see where the initial request was made for mailing on April 16, as well as the second request on May 5, The request on May 5, 2015, was canceled in errorI worked directly with our enrollment area to ensure a benefit book was printed and mailed on June 26, and sent to the member using overnight deliveryI confirmed via the United States Postal Service website, as well as with the member’s husband via telephone on June 30, 2015, that the benefit book was received on June 27, 2015.If you have additional questions, please contact me directly.Sincerely, Linda S [redacted] Appeals CoordinatorPhone: [redacted]

Revdex.com: I was contacted today by Linda S [redacted] from Highmark to see if we had received the booklet I informed her all we had received was another ID card She stated she could see on the computer that again the booklet was not mailed and that she would print it and mail it on Monday the 29th.Also their response did not cover the fact that when my wife made the 1st payment on 04/10/the booklet was not mailed at that time and was not mailed after my 1st or 2nd request or after my wife requested it I do not know which request was cancelled by mistake or even that I believe that as an answer at this point I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] ***

December 10, 2015Revdex.com [redacted] ***Attention: [redacted] Case ID: [redacted] Dear [redacted] :This is in response to your inquiry sent to us on behalf of the member identified in your inquiry by Case ID [redacted] , and their additional concerns related to our original response submitted to your office on October 20, 2015.On October 9, 2015, a letter was sent to the member along with a copy of the cancelled check issued to the member, dated January 24, 2014, which was related to the claim in questionThis same letter also provided the member instructions on how to contact our office once the amount associated with this cancelled check was forwarded to the provider, applied to their account, and a bill for the remaining balance was received from the providerTo date, our records indicate the member has not contacted our office to provide this informationFor consideration of the remaining balance, the member should refer to the instructions provided in this letter.If the member has misplaced our letter dated October 9, 2015, or needs to receive instructions on how to forward the required information to consider their remaining balance, the member should contact our Customer Service Department at [redacted] If you have additional questions, please contact me directly.Sincerely,Margie L***Executive/Legislative Inquiries

June 12, Revdex.com Attn: [redacted] ** *** Case ID: [redacted] File Number: [redacted] Dear [redacted] : This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted aboveIn her complaint, the member states that she did not receive an invoice for the April coverage period The member states she called Highmark Customer Service on April 6, 2015, and was advised that the policy would be reinstated, and that the reinstatement would take two to three weeks On June 1, 2015, the member received an invoice in the amount of $for the April, May, and June coverage periods The member further states that she called Highmark to cancel her coverage after receiving that invoice, as she felt she should not be held responsible for premium payments for the months she felt she did not have coverage The member wants to cancel her coverage and to have an account balance of $ After reviewing the member’s account, I have determined that the policy did in fact cancel in error during the month of March This cancellation was reversed and processed on May 21, With a reinstatement, the policy would be reactivated with no lapse in the coverage, and the member would be responsible for the premiums for that time period Any medical services or prescriptions paid for by the member could still be submitted for processing according to the terms of the policy We have received a cancellation request from the Federally Facilitated Marketplace (FFM) effective June 16, However, because the member is paid to April 1, 2015, the policy will be retroactively cancelled back to the paid to date, and the member will not owe any further premiums If you have additional questions, please contact me directly Sincerely, [redacted] Appeals Coordinator Phone: [redacted]

Case ID: [redacted] Dear MsGasser:This is in response to your inquiry sent to us on behalf of the member identified by your Case ID [redacted] .The member was enrolled in a Preferred Provider Organization (PPO) plan through an employer group from July 1,to March 1,This self-insured non-grandfathered group has two levels of appeal to be administered by Highmark with an external available for medical necessity denials only.As the member indicates, she was advised a payment would be issue to her due to incorrect information being provided regarding immunizationsAccording to our records, a request was forwarded to have the claim’s payment issued to her, but it has not finalized as the initial payment was issued to the provider inadvertentlyThe payment is being retracted from the provider and will be issued to the member.While I understand that the member is requesting interest, please recognize that we are unable to reimburse a nonmedical expense.If the member has any questions concerning this coverage, please have her contact our Customer Service Department at ###-###-####If you have additional questions, please contact me directly.Sincerely, Marqueritte M***-S [redacted] Executive Legislative InquiriesEnclosures

May 18, 2016Dear Ms [redacted] ,This is the Highmark Blue Cross Blue Shield Delaware response to the customer concern under Revdex.com Case number [redacted] .The services the member and his dependent child received on October 16, 2015, were submitted by the network provider as comprehensive eye exams, with refractions, and not as routine vision screeningsAs indicated on the Summary of Benefits information the member included with his complaint, when received from a network provider, comprehensive eye exams are eligible at eighty percent (80%), after the deductible; routine vision screenings are eligible at one-hundred percent (100%), and the deductible does not apply.The member submitted an appeal related to these allowed charges being applied to his plan deductible and received notification his appeal request was denied, Based upon the procedure codes submitted by the provider, the plan deductible was appropriately applied to these servicesThe denial letter the member received advised of his Second Level Appeal rights However, we have no record of receiving his Second Level Appeal request within the allowed amount of timeUnfortunately, the member has no additional appeal levels available to him related to the processing of these services.Additionally, we are unable to change, alter or delete coding information received from a provider to satisfy individual payment According to the claim information submitted by the provider, these services processed correctly according to the terms of the member’s benefit planShould our member have any additional questions, a Customer Advocate is available to assist them at [redacted] .Sincerely, MsL***Appeals Analyst

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below I would like contact MsMargie directly The number Blue Shield was not valid [redacted]

December 20, 2016Revdex.comAttn: [redacted] Case ID: [redacted] File Number: [redacted] Dear Ms [redacted] This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.In her complaint, the member states that she and her husband enrolled in coverage through the Federally Facilitated Marketplace (FFM) in February She states that at the time of enrollment, they were advised their son was eligible for Medicaid, and could not go onto their Highmark policyShe states that Medicaid advised them that he was not eligible, and at that time they contacted the FFM to have him added to their Highmark coverageA couple of months after adding him onto their policy, they were notified that their son did qualify for Medicaid and they received his Medicaid cardThey again contacted the FFM and had him removed from their Highmark policy.The member further states in her complaint that her husband’s birthdate was initially incorrect on the FFM enrollment file, causing Highmark to invoice them the incorrect premium for several monthsShe states that after several attempts to have the billing corrected, they received an invoice which stated they owed Highmark over $to bring the account currentBecause they were advised they must pay this higher premium or lose their coverage, she states her husband was forced to go without his medications for a monthThe member is asking for someone to review the account, and ensure that there are no more issues with the billing.Highmark has reviewed the member’s accountOn February 26, 2015, Highmark received an enrollment file from the FFMThis file included the member and her husband only, effective March 1, This application had the incorrect birthdate for her husbandOn April 3, 2016, a new enrollment file was received from the FFMThis file had the correct birthdate for her husband, which resulted in adjustments to the billing to correct the previously invoiced amounts.On August 26, 2015, another file was received from the FFM, which placed the member’s son on the policy retroactive to March 1, 2015, and cancelling his coverage effective August This file however, did not include his premiumHe was added to the policy, but the billing was not updatedIt was not until August 2016, when the September invoice was generated, that the account was adjusted to reflect their son’s premiums for the six month he was on the policy in This resulted in a significant balance to the member.Upon reviewing the account and speaking to the member, Highmark has made the determination to write off the premiums they paid for their sonMedicaid had covered him from his date of birth, and the updates sent to Highmark from the FFM were not accurateThe total paid in premiums for their son was $709.42, and a refund in that amount was issued on December 16, 2016.On behalf of Highmark, I apologize for any anxiety or frustration the member experienced as a result of these mattersWe strive to provide efficient, courteous and quality serviceEven when these standards are not met, we are continually working to improve our service to meet the needs of our valued customers.If you have additional questions, please contact me directly.Sincerely,Linda K [redacted] Executive/Legislative InquiriesPhone: [redacted]