EL NIPLITO DEL SURESTE

June 15, Revdex.com Attn: [redacted] ** [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 aboveThe member states in their complaint that medical claims have been denying due to an incorrect paid to date in Highmark’s system The member states that Highmark has acknowledged this is an error within the internal systems and that they have contacted Highmark several times to have the issue resolved, but that claims are still denying for this reason The error within the billing system has been identified and the member’s account has been corrected The member is currently paid to July 1, Billing is being systematically updated to reflect the January through June transactions Once the invoice for July generates and the member’s paid to date is correctly advanced, the denied claims can be adjusted Once the claims finalize, the member will receive new Explanations of Benefits If you have additional questions, please contact me directly Sincerely, [redacted] Appeals Coordinator Phone: [redacted]

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.] Regards, [redacted] After filing a compliant via Revdex.com, I received a phone and letter saying that HighMark Blue Shield will take care of the rest of bill, $ 551.00, from [redacted] for [redacted] , account number: [redacted] , as soon as I pay $$check was cashed out on November, 2015, and HighMark Blue Shield still doesn’t pay for the rest of billInstead, I received a letter from [redacted] ***saying that “We are writing in regard to an overdue balance of $for medical services provided to you at [redacted] This is your final noticeIn order to avoid having your account placed with a collection agency, please remit balance in full today or call our patient service center at [redacted] .” I don’t know how long take HighMark Blue Shield to pay what they should pay, but it’s been yearsThanks.Please pay the rest of bill as soon as possibleThanks$- = What HighMark Blue Shield should pay

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 Regards, [redacted]

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.]The amounts are all paid out of pocket which I should be refunded backAlmost years of waiting and Lied to is not good businessDidn't have co-paysAmazing how they can take someones hard earned money and put them through so much then give less and call it oknot acceptablealmost killed me! Regards, [redacted] ***

RevDex.comServing Metro Washington DC and Eastern Pennsylvania [redacted] Attention: [redacted] ***ID Number: [redacted] Dear Ms. ***:This is in response to your inquiry sent to us on behalf of the member identified in your inquiry by Case ID [redacted] ... regarding prescription drug expenses that the member incurred in September and October 2012.We have no record of the member questioning the processing of these 2012 charges until a recent contact was made to Customer Service on May 31, 2016, Because the member is questioning charges that were to have been reimbursed almost four (4) years ago, I have requested the claim information related to that time period. However, this information has been purged and will take approximately an additional seven (7) to ten (10) days to be retrieved. Once this information has been received, I will provide you with an updated response with additional information.I can, however, confirm that the prescription receipts that the member submitted indicating a payment was made to the pharmacy for $4.00, $6.00 or $8.00, was less than the amount of the prescription drug copayment that was applicable at that time under his benefit plan. In 2012, for up to a 31-day supply, the member’s benefit plan applied a $10.00 copayment for generic prescription drugs and a $30.00 copayment for brand prescription drugs, Therefore, our records indicate for the following dates of service, no reimbursement would have been due to the member because the cost paid to the pharmacy was less than the copayment that would have applied, per the member's benefits:Date indicated on prescription drug receipt Amount indicated as payment made to pharmacy9-7-2012 $4.009-7-2012 $4,009-7-2012 $4.009-7-2012 $8.009-7-2012 $8,0010-2-2012 $4.0010-3-2012 $6.00 Additionally, the prescription drug receipt dated October 3, 2012, indicating a patient payment of $30.00, was the correct brand prescription drug copayment that would have been the member’s responsibility. Therefore, no reimbursement would have been due for this charge,The member also submitted only cash register receipts for the following dates; July 12, 2012, July 19, 2012, July 29, 212, August 10, 2012, August 14, 2012, and August 21, 2012. These cash register receipts did not include a matching prescription drug receipt from the merchant’s pharmacy department, but the amounts indicated on these receipts indicate the costs associated with the member’s prescriptions were either less than the plan’s applicable copayment ($4.63 and $4.89), or the total amount of the generic drug copayment, $10.00, Therefore, there would be no additional reimbursement due for these charges. If the member has any questions concerning this information, please have them contact our Customer Service Department at [redacted] . If you have additional questions, please contact me directly.Margie L***Executive/Legislative Inquiries

January 21, 2016Revdex.comAttn: [redacted] [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 his wife’s health insurer is not allowing her to pick up her prescription He states that she is out of medication, and needs the prescription badly He states that his wife has been on this medication for several years and wants the prescription filled nowUpon review of the member’s account, the Highmark policy ended effective January 1, Highmark contacted the member via telephone on January 8, 2016, and the member stated she enrolled in coverage through [redacted] Health plan for the benefit period Member was advised that if she is having difficulty filling her prescription at this time, they will need to contact the new health insurer The member and her husband explained that they had filed the complaint due to the difficulty in filling her medication during the month of December The medication that the member was prescribed, required a prior authorization She attempted to fill the medication on December 22, 2015, at which time she was advised the physician would need to submit a request for authorization The request was received on December 23, On December 28, 2015, a call was placed to the physician to obtain additional information pertaining to the request Once this was received, the authorization was approved on December 30, The member received her medication, delivered via FedEx on December 31, If you have additional questions, please contact me directlySincerely, Linda S [redacted] Executive/Legislative Inquiries Phone: [redacted]

December 31, 2015Revdex.com [redacted] ***Pittsburgh, PA 15220Attn: [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] .Our records indicate that a letter was issued to the member on December 14, 2015, advising that a copy of a balance bill from the provider was required from the memberThe bill needs to show the $as paid by the member and showing the remaining balance of $as being billed to the member.While the member has requested a call back from the previous Executive Legislative Analyst, please recognize that the member has a dedicated service department for telephone inquiriesI confirmed that the telephone number listed at the closing of this letter is correct.If the member has any questions concerning this coverage, please have the member contact our Customer Service Department at [redacted] If you have additional questions, please contact me directly.Sincerely, Margueritte M [redacted] Executive/Legislative Inquiries

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 belowmy payments were taken each month, leaving me with the impression I was insuredif the company did not intend to insure methey should not have collected my payments or waited until december to inform me that I was not insured I am rather disgusted with highmark and request my money back for the entire yeardr [redacted] should be paid what he is owed and my irs penalty should be taken care ofthis does not even take into account all the hours of my time that was wasted on the phone being transferring from one 'csa' to the nxet Regards, [redacted]

December 31,2015Revdex.com [redacted] ***Attn: [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] .Our records show a call was place by the member’s mother, (herein referred to as the member) on December 16, Our advocate advised she would have the dedicated advocate assigned to this member return her callThe dedicate advocate was not in the office con December 16, 2015, but attempted to call the member back on December 17, The advocate left a message that she would try to call her again on Monday, Dec , During the call between the member and the advocate, it was determined that the member’s check had not cleared her bank, and she was concerned about sending another paymentShe wanted the advocated to investigate where the missing payment was, but the member was advised we were unable to investigate the missing check since it had not cleared her bankShe was advised of the WaCenter in her area should she decide to make the payment.Please note that the member’s account was place on a hold so it would not terminateThe member is currently paid to December 1,2015; however, once she makes a payment in the amount of $209.00, the account will be paid to March 1, 2016.If the member has any questions concerning this coverage, please have the member contact our Customer Service Department at [redacted] If you have additional questions, please contact me directly.Sincerely, Margueritte M [redacted] Executive/Legislative Inquiries

Dear Ms [redacted] :This is in response to your inquiry sent to us on behalf of the member identified by the Case ID number noted above.In his complaint, the member states that he did not enroll in coverage through Highmark for the plan period, He states that he enrolled in a policy through another carrierHe is concerned because he has called Highmark to cancel the policy and is still receiving invoicesHe would like to ensure that his policy for is no longer active, and that this will not reflect negatively on his credit report due to the invoices that were sent.Highmark has reviewed the member’s accountThe member was auto-enrolled into a policy for the plan period by the Federally Facilitated Marketplace (FFM)Per the guidelines set by the FFM, health insurers are not permitted to cancel a member’s coverage without the direction of the FFMOn December 14, 2016, an enrollment file was received from the FFM, enrolling the member and his spouse into the Connect Blue EPO policy effective January 1, A cancellation file was received from the FFM on January 16, 2017, directing Highmark to cancel the policy effective January 1, However, due to a systemic error, the enrollment system did not cancel the policy.Higlimark has voided the coverage for the plan year effective January 1, Highmark does not report to any outside credit agencies if an invoice is unpaid, and also because the policy was voided, there will not be any impact to the member’s credit report.On behalf of Highmark, I apologize for the confusion and frustration felt by the memberIf you have additional questions, please contact me directly.Sincerely, Linda K [redacted] Executive/Legislative InquiriesPhone: [redacted]

Case ID: [redacted] File Number: [redacted] Dear Ms, [redacted] This is in response to your inquiiy sent to us on behalf of member identified by the Case ID number noted above.In her complaint, die member stated that during the plan year she fell behind in her paymentsShe stated that she spoke to Highmark Customer Service and was advised by the Customer Service Advocates (CSA) that if she paid on the past due amount that she would be caught up, so she agreed to do soThe member farther stated that when she began receiving bills for unpaid medical claims that she called Highmark again and was advised their policy had been cancelled for non-payment of the premiumsAccording to the member she did not receive any notification that the policy would be cancelled, and she made payments on the account that were never refunded after the policy cancelledShe is requesting that the unpaid hospital claims be; paid and that she receive a refund for the premiums paid.Highmark has reviewed the member’s account, including the enrollment information, invoice and payment histories, the delinquency notices sent, and the phone calls to Customer ServiceThe member was enrolled in the health Savings Blue KPO policy effective January 1, The policy had a Total Premium of $841.06, an Advance Premium Tax Credit (APTC) of $461.00, and a Total Responsible Amount of $380.06, The premium payments are due the first of the current monthTheaccount first fell into a delinquent status in July The July premium was due before July 1, A delinquency letter was sent on July 10, 2017, which explained that the policy has a three-month grace period in which to pay all premium delinquenciesThe letter advised that the member had until October 8, 2017, for all past due and current premiums to be paid in order to avoid termination of the policy.On July 12, 2017, the invoice was generated for the August coverage periodThis invoice reflected the past due July premium, as well as the August premium, for a total balance due of $On July 19, 2017, the member called Highmark and made a payment of $which posted to the account on July 21, 2017, and paid for the July premium, bringing the account out of delinquency.On August 8, 2017, another delinquency letter was mailed for the August premium paymentThis letter again, explained the three-month grace period, and advised that the premiums were to be paid by November 6, 2017, in order to avoid terminationThe member’s spouse called Highmark on September 8,2017, arid made a payment of $380.06, which posted to the account on September 12,2017, and paid for the August premium.On September 12, 2017, .Highmarkinvoiced for the October coverage period, including the past due amount for September, for a total balance due of $No payment was received prior to the November invoice being sentThis invoice: reflected a total balance due of $1,140,18, which included the past due premiums for September and October, as well as the current premium for NovemberOn November 8,2017, the invoice was mailed for the December coverage period, which reflected a total balance due of $1,520.24, including the three months previous balance, and the current December premiumOn November 9, 2017, a delinquency letter was mailed advising that ail past due and currents must be paid by December 7, 2017, to avoid termination of coverage.The member’s spouse called Highmark on December 1, 2017, to make a premium payment, and on this call he stated that he did not know what months they still owed forThe CSA advised that they owed four months premium in order to pull out of the delinquency, and that the full amount of $1,must be received by December 7, He asked if payment arrangements could be made, and the CSA explained that Highmark does not offer payment arrangements due to the three month grace period that is given to bring the accounts currentHe also asked what would happen if he just did not make a payment on this policy, and enrolled in a new plan for The CSA explained that they would have to submit a new application, because any automatic, or passive, enrollment would be cancelled if the current plan cancelled for non-paymentShe further explained that the Open Enrollment Period ended on December 15, 2017, so if that was what they chose to do, they needed to do so prior to that dateThe spouse stated he would call back if they chose to make the current premium payments.On the same day, the policy holder called Highmark, and spoke to another CSAShe asked if payment arrangements could be made in order to pay the account currentThe CSA explained to her that due to the three month grace period, payment arrangements could not be madeThe CSA advised that the total balance due was $1,520.24, and the member asked to pay just one month's premium at that time, The CSA processed a payment for $This payment posted to the member's account on December This CSA did not accurately explain the grace period, and incorrectly advised the member that this payment would keep them in their three month grace period, and that the policy would not cancel until JanuaryEducation has been provided to this CSA as this information led the member to incorrectly believe they had additional time to bring the account current.On December 5, 2017, the spouse called to make another premium paymentThe CSA advised there is a current balance of $1,140.18, and he stated he was only paying one month's premiumA payment was posted in the amount of $The CSA should have reviewed the grace period again with the caller, as there were only two days remaining to make the remaining payments; however, she did not, and education has been provided to prevent this oversight in the future.Because the full payments to bring the account out of delinquency were not received prior to December 1,2017, the policy did cancel correctly for non-paymentDuring the three month grace period, any claims incurred during the first month of the delinquency will be processed and paid as normalAny claims received for dates of service beyond the first month will deny until the account is fully paid out of delinquencyDue to this grace period, the payment that was received on December 1, 2017, was applied to the September coverage period as there were claims received and paid during this time.After reviewing the calls, and the information provided to the member, Highmark has made the determination to reinstate the policyAlthough correct information was given in the form of invoices, delinquency notices, and a telephone discussion, the CSA who spoke to her spouse bn December 1, 2017, led the member to believe that they had additional time to payIn addition, the member had called Highmark in June 2017, to advise she had moved and needed to change her addressShe was referred to the FFM for the address change, as Highmark is unable to change an address without a file from the FFM directing the change, but no new file was receivedHer invoices and delinquency letters continued to be mailed to her previous address, and were not forwarded.If you have additional questions, please contact me directly.Sincerely, Linda K, Executive/Legislative Inquiries Phone: ###-###-####

March 17, 2017Revdex.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.The member stated in her complaint that in December 2016, she contacted Highmark to find out if a Magnetic Resonance Imaging (MRI) of the [redacted] would be coveredShe spoke to two different Customer Service Advocates (CSA) on two different daysBoth of the CSAs told her that if she went to [redacted] Hospital to have the MRI done she would not have to pay anythingOn December 27, 2016, she had the MRI done at [redacted] Hospital, and afterwards she received a bill for the MRI in the amount of $3,She contacted Highmark, arid the CSA advised her that she would listen to her calls from December, and if she was told that the MRI would be covered at percent, Highmark would reprocess the claimThe member stated that now every time she calls Highmark they advise that they are still waiting on the proper department to listen to the callThis has been going on for over a month now, and she is worried that her bill will soon be overdueThe member would like for Highmark to pay for the MRI that Was performed at [redacted] Hospital in the amount of $3,848.90, because she was misinformed by a Highmark CSA.Highmark thoroughly reviewed the calls made by the member to Highmark Customer Service in December On December 6,2016, the member called Highmark Customer Service and asked the CSA if a routine mammogram and MRI of the [redacted] would be coveredThe CSA advised that as long as the mammogram is routine it would be covered at percent and the MRI would apply towards her deductibleThe CSA also advised her to get the procedure and diagnosis codes, and call back to verify it would be coveredOn December 13, 2016, she called with procedure code [redacted] and diagnosis code [redacted] to verify if the MRI would be coveredThe CSA advised that was a covered code and would be covered per her benefits.On December 21, 2016, the member called again to verify if there would be a copay for the MRI of her [redacted] The CSA advised that it would be covered with no copay and she would not have to pay anything because it was fully coveredThis information was not correct and staff education will be provided to the CSA who misadvised the memberHighmark has reprocessed the member’s claim for the MRI of the [redacted] showing no member responsibilityShe will receive a new Explanation of Benefits (EOB) once the claim has been finalized.On behalf of Highmark, I apologize for any anxiety or inconvenience this issue may have caused the memberIf you have additional questions, please contact me directly.Sincerely,Michelle D***Executive/Legislative InquiriesPhone: [redacted]

March 3,2016Revdex.com of Western Pennsylvania, Inc.Attn: [redacted] ***Member ID: [redacted] FileNumber: [redacted] Dear Ms, [redacted] :Please allow this letter to serve as a response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.The member stated in the complaint that their plan was cancelled despite having made regular premium paymentsThe plan was cancelled effective November 1, for non-paymentThe member notes that they have routinely sent in payments and Highmark WV continued to cash their checks for November 2015, December 2015, and January The member also notes that they did not receive notification that they were at risk to cancel.The member is enrolled in a Highmark WV Shared Cost Blue PPO $1,deductible plan with an effective date of January 1, The member’s monthly premium for was $1,For plan year 2016, the member’s monthly premium is $1,658,The member’s plan has been reinstated as of March 3, and all payments have been accounted forHowever, the member is currently paid to only February 1, 2016, and thus would need to make premium payments for February and March’s coverage periods immediately to avoid cancellationFebruary’s premium was due on or before February 1, and March’s premium was due on or before March 1, The plan has a grace period of thirty one daysTo be paid to April 1,2016, the member will need to pay a total of $3,317.02The member’s payment history is as follows: Invoice History Payment History Coverage period Invoice Date Due Date Past due balance on invoice Payment date Paymentamount January 12/30/01/05/No 01/06/[redacted] • February 01/08/01/31/No 02/09/[redacted] March 02/07/02/28/Yes 03/10/[redacted] April 03/07/03/31/Yes 03/30/May 04/08/04/30/No 06/08/[redacted] June 05/08/05/31/Yes 06/08/July 07/03/07/20/No 07/31/[redacted] August 07/10/08/01/Yes 09/23/[redacted] September 08/08/09/01/Yes 09/23/[redacted] October Policy termed N/A N/A 11/23/[redacted] November 10/08/11/01/Yes 12/15/[redacted] December 11/10/12/01/Yes 01/04/[redacted] January 12/09/01/01/Yes 01/26/[redacted] February 01/09/02/01/Yes N/A N/A* denotes late payment The undersigned notes that throughout plan year and into 2016, the member has consistently made payments late or after the grace period of thirty-one (31) days had passed (1)Upon cancellation, Highmark WV was prepared to refund the member’s payments made for November, December, and January in the amount of $4,264.77, however, because an Affordable Care Act (“ACA”) compliant plan is eligible for one reinstatement in a twelve month period and a maximum of two reinstatements for the lifetime of the policy, Highmark WV will reinstatement the plan for a second and final time (2)As noted above, the member has not made their February or March premium payments, which are now both past dueThe member is encouraged to contact Highmark WV and arrange for payment of at least February’s payment as soon as possible to avoid cancellation.Finally, if the member has incurred any out of pocket costs above their member responsibility per the applicable Certificate of Benefits, they are encouraged to contact Highmark WV Customer Service to obtain reimbursement claim forms.Highmark WV appreciates the opportunity to research and respond to this member’s complaint and is hopeful that the matter has been resolved to the member’s satisfactionIf you have additional questions, please contact me directly.Sincerely,Courtney N, L***Associate Counsel [redacted] (1)Per the member’s Certificate of Benefits booklet; "Grace PeriodA grace period of thirty-one (31) days from the due date will be granted for ihe payment of each premiumDuring the grace period, the Agreement will stay in force; however, no benefits will be paid for services Incurred subsequent to the Agreement's then current paid date, subject to Subsection BBENEFITS AFTER TERMINATION OF COVERAGE of this SectionIf appropriate payment is not received at the end of thirty-one (31) days, this Agreement automatically terminates as of the then current paid date without written notification to the Member.”(2)Per the member’s Certificate of Benefits booklet: “Reinstatement, If this Agreement is terminated due solely to nonpayment of the premium, coverage will be reinstated if the Subscriber, within thirty-six (36) days from the end of the Grace Period, tenders and the Plan receives payment of the premium required for reinstatement The Member(s) and the Plan have the same rights under the reinstated Agreement as they had under the Agreement immediately before the due date of the defaulted premiumThe right of the Subscriber to have this Agreement reinstated is limited to one (1) reinstatement during any twelve (12)-month period and to two (2) reinstatements during the Subscriber’s lifetime."

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Here is more correspondence from *** ***was told all was denied but received check today.They tell me I should have used my medical cardI did but was told it wasn't covered by my insuranceThis is why I paid out of pocketI also see they haven't paid me what I paid out.as far as deductible capI had been reached it while in the hospitalEverything should have been coveredAnother way to get out of paying consumers back

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Dear Ms***: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 for nine months, Highmark assured her that she did not owe anything for her blood work because it was for a wellness checkup from date of service July 24, She stated that each time she called, Highmark told her the claim was either coded wrong or it was a duplicate claim, and this was the reason she was being billedThe member stated for this reason, she does not accept Highmark’s response from her previous complaint.Highmark’s records indicate that the member contacted Highmark Customer Service four times regarding the claim for date of service July 24,During the call on September 14, 2015, the member was advised that she was her responsible for $This was prior to the resubmission of the claim, and at that time this information was correctWhen the claim was resubmitted it denied as a duplicateThe member was advised that the claim was a duplicate and because of that she did not owe anythingOn March 10, 2016, the provider contacted Highmark to have the original claim voided, and the corrected claim that had denied as a duplicate reprocessedThe corrected claim denied originally as a duplicate because the primary diagnosis code remained the sameHighmark processes claims based on the primary diagnosis codeThe diagnosis code used was a routine diagnosis code, but the procedure codes are not part of the routine preventive scheduleEnclosed with this response is a copy of the preventive scheduleOn April 22, 2016, the member called Highmark and was advised the claim had been reprocessed correctlyShe was advised that she was responsible for $The member had a copay of $and $was applied to the member’s deductible. Highmark has reviewed the claim in question per the member’s request numerous timesShe has been advised the claim processed correctlyWe understand the member’s confusion, and understand this is not the resolution desired and regret that we are unable to come to a mutually agreeable outcome regarding this issue.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: ***Enclosure: Routine Preventive Schedule

December 11, 2015Revdex.comAttn: *** *** *** *** *** *** ** ***Case ID: ***File Number: ***Dear *** ***:This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.The member states in
his complaint that he had insurance with Highmark, Incuntil September 1, The member states that he made his premium payments up until then and was paid currentHe later states that he was informed that his policy was cancelled effective June 1, 2015, for nonpayment, which he believes to be incorrect.The member’s policy was incorrectly cancelled effective June 1, 2015, due to the balance on the account being incorrectThe member continued to contact Highmark due to his invoices reflecting the incorrect amount and denied claims, but the billing issues were not corrected properlyThe member is paid to September 1, 2015, and the policy has been reinstated until that dateAny outstanding claims that were rejected due to no active coverage are being adjusted according to the member's benefits and can take approximately two to three weeks to be completedThe member will receive an updated Explanation of Benefits once the claims are adjusted.If you have additional questions, please contact me directly.Britany H.Executive/Legislative InquiriesPhone:***

March 10,2017Revdex.comAttn; *** *** *** *** *** ***
*** ** ***Case ID:***File Number: ***Dear Ms***:This is in response to your inquiry sent to us on behalf of the member identified by the Case ID number noted above.The member stated in
her complaint that she enrolled in a Highmark policy through the Federally Facilitated Marketplace (FFM)She stated that she has had nothing but problems since she enrolledInitially, she was unable to access her account to pay the January premiumAs a result, the January coverage was cancelled and she was reenrolled for FebruaryThe member stated she paid her February premium and the money was taken out of her bank accountWhen she contacted Highmark, she was advised by the Customer Service Advocate (CSA) that her policy had been cancelledShe stated that the FFM has her listed as enrolledThe member stated that she just wants her heathcare policy, and would like an explanation of what happened.Highmark has thoroughly reviewed the member’s enrollment and customer service recordsHer original enrollment was for coverage beginning January 1, 2017, but this was cancelled for failure to pay premiumsOn January 10, 2017, the member contacted Highmark for the first time regarding her January coverageShe could not access her account at this time to make her January payment, because this was after the due date of January 1, There is no grace period for initial payments, Highmark then received an enrollment for coverage beginning February 1,The policy was cancelled due to a Highmark error on January 17, Qn February 23, 2017, the member contacted Highmark Customer Service, and the CSA sent a request to have her policy reinstatedHighmark reinstated the member’s policy with an effective date of February 1, She was notified of the reinstatement on February 28, 2017.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***Executive/Legislative InquiriesPhone:***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
My view on the matter is for months Highmark assured me that I did not owe anything because the blood work was for a wellness checkup and each time I was billed they said it was either coded wrong or a duplicate and that was the reason I was mistakenly being billed. How could, in months, not one employee at Highmark see it was a so called copay as they are now stating it is. For this reason I do not accept their explanation
Regards,
*** ***