EL NIPLITO DEL SURESTE

July 19, 2016Revdex.comServing Metro Washington DC and Eastern Pennsylvania[redacted]Attention: [redacted]ID Number: [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] regarding prescription drug expenses that the member incurred in 2012.We have no record of the member questioning the processing of these 2012 charges until a recent contact made to Customer Service in May 2016, Because the complaint filed to your office did not include specific dates of service or amounts related to each service, the information provided in this response refers to a claim the member submitted in October 2012, A review of this claim information confirmed that the member had not previously received reimbursement for six (6) prescription drug expenses. Therefore, [redacted] recently forwarded the member two (2) checks; check number [redacted] for $8.15 was sent on July 10,2016, and check number [redacted] for $257.19 was sent on July 16,2016. I am providing a summary of the check/payment information and the prescription dates the payments are related to:  Pate Indicated on Prescription Drug Receipt Total Rx Charges Copayment Amount Amount Paid Check Number and Check Date 9-24-2012 $18,15 $10.00 $8.15 7-10-2016 9-7-20120 $14.78 S10.00 $4.78 7-16-2016 9-21-2012 $160.62 S10.00 $150.62 7-16-2016 9-21-2012 $79,08 $10,00 $69.08 7-16-2016 9-21-2012 $34.72 S10.00 $24.72 7-16-2016 9-24-2012 $17.99 $10.00 $7.99 7-16-2016  I can confirm that the prescription receipts indicating a payment was made to the pharmacy for $4.00, $6,00, $8.00 or $30.00, was equal to, or less than the amount of the prescription drug copayment that was applicable at that time under the member’s 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, or equal to, the copayment that would have applied, per the member's benefits: Date Indicated on Prescription Drug Receipt Amount Indicated as Payment Made to Pharmacy 9-7-2012 $4.00 9-7-2012 $4.00 9-7-2012 $4.00 9-7-2012 $8.00 9-7-2012 $8.00 10-2-2012 $4.00 10-3-2012 $6.00 10-3-2012 $30.00Lastly, the member included only cash register receipts for certain dates, but did not include a matching prescription drug receipt, A review of our records indicate for the dates that the member included only cash register receipts, the amounts indicated on those receipts are for copayments that would have been the member’s responsibility. I am also providing a summary of these services for your reference: Date on Cash Register Receipt Amount Indicated on Cash Register Receipt Date Rx Filled by Pharmacy Copayment Amount 7-12-2012 $4.63 7-10-2012 $4.63 7-12-2012 $4.63 7-10-2012 $4.63 7-12-2012 $10.00 7-10-2012 $10.00 7-12-2012 $10.00 7-10-2012 $10.00 7-19-2012 $4.89 7-17-2012 $4.89 7-19-2012 $10.00 7-17-2012 510.00 7-29-2012 $10.00 7-27-2012 $10.00 7-29-2012 $10.00 7-27-2012 $10.00 8-11-2012 $10.00 8-10-2012 S 10.00 8-14-2012 $4,63 8-13-2012 S4.63 8-14-2012 $4,63 8-13-2012 $4.63 8-14-2012 SI 0.00 8-14-2012 $10.00 8-21-2012 $4.89 8-19-2012 $4.89   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,Sincerely,Margie L[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 below.
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.]
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 $118.03. $118.03 check was cashed out on November, 2015, and HighMark Blue Shield still doesn’t pay for the rest of bill. Instead, I received a letter from [redacted]. saying that “We are writing in regard to an overdue balance of $551.00 for medical services provided to you at [redacted]. This is your final notice. In 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 years. Thanks.Please pay the rest of bill as soon as possible. Thanks. $551.00 - 118.05 = What HighMark Blue Shield should pay.

June 15, 2015     Revdex.com Attn: [redacted]
[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. The 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, 2015.  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 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.
I would like contact Ms. Margie directly.  The number Blue Shield was not valid.
[redacted]
[redacted]

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.
The August 7th payment was made after calling Highmark to review the reasons for the double invoice amount due.  Regardless of the August 1st payment date, I needed the time to determine the issue and resolve it.  I never received any additional notice aside from the July statement and was lead to believe making the payment in August resolved the issue.  I also paid Septembers as well without issue.  A 31 day grace period on a policy that is invoiced every 30 days seems set up to intentionally fail if there is ever a mistake.  There is not an option to automatically make payments either via the online system or the mailed invoices.  Regardless if it's a "Correct" cancellation due to non-payment, it seems rigid and intentionally unfair especially considering this affect someone's health and well being.  The careless attitude of the staff, billing department and this claim is not how I'd expect a health insurance company to act.  I've purchased new insurance starting Jan 1st with another company.  I would still like my insurance reinstated retroactively - as the non-payment was unintentional and resolved as soon as I was made aware.  
Regards,
[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 member. The bill needs to show the $119.03 as paid by the member and showing the remaining balance of $507.97 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 inquiries. I 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

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 2017 plan year she fell behind in her payments. She 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 so. The 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 premiums. According 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 cancelled. She 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 Service. The member was enrolled in the health Savings Blue KPO 6500 policy effective January 1, 2017. 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 month. The. account first fell into a delinquent status in July 2017. The July premium was due before July 1, 2017. 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 delinquencies. The 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 period. This invoice reflected the past due July premium, as well as the August premium, for a total balance due of $760.12. On July 19, 2017, the member called Highmark and made a payment of $380.06 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 payment. This 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 termination. The 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, .Highmark. invoiced for the October coverage period, including the past due amount for September, for a total balance due of $760.12. No payment was received prior to the November invoice being sent. This 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 November. On 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 premium. On 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 for. The CSA advised that they owed four months premium in order to pull out of the delinquency, and that the full amount of $1,520.20 must be received by December 7, 2017. 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 current. He also asked what would happen if he just did not make a payment on this policy, and enrolled in a new plan for 2018. 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-payment. She 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 date. The 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 CSA. She asked if payment arrangements could be made in order to pay the account current. The CSA explained to her that due to the three month grace period, payment arrangements could not be made. The 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 $380.06. This payment posted to the member's account on December 5. 2017. 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 January. Education 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 payment. The CSA advised there is a current balance of $1,140.18, and he stated he was only paying one month's premium. A payment was posted in the amount of $380.06. 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-payment. During the three month grace period, any claims incurred during the first month of the delinquency will be processed and paid as normal. Any claims received for dates of service beyond the first month will deny until the account is fully paid out of delinquency. Due 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 policy. Although 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 pay. In addition, the member had called Highmark in June 2017, to advise she had moved and needed to change her address. She 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 received. Her 2017 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: ###-###-####

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, 2015. She stated the payment was withdrawn from her bank account with no problems. On February 26, 2015, the member stated she received a letter from Highmark Blue Shield that stated her policy had been canceled for nonpayment of premium. She 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 resolved. The member stated she spoke with a CSA on March 3, 2015, and was advised that the issue was still processing. She 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 reinstated. The member stated she again contacted Highmark Blue Shield on March 12, 2015, regarding the reinstatement of her plan. She stated the CSA advised her that the policy was still under review and that an answer should be received very soon. The member stated she did not receive any notification of the reinstated via phone, mail or email. She 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 $535.48. She stated that the invoice included February’s premium, which she paid. The member stated she wrote three letters to Highmark instead of calling because her promised callbacks were not received. She 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 policy. The 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 plan. The 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 reinstatement. The CSA advised her that it can take approximately thirty days for a reinstatement request to be processed. The member advised that her daughter had a doctor’s appointment and was concerned because of the status of her account. The CSA attempted to contact the member’s physician to explain the situation with the account but was unable to talk to anyone. The CSA advised the member to keep the appointment because Highmark would reprocess the claims if necessary. Highmark 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, 2015. There was no answer but a voice mail was left for the member regarding the reinstatement. Highmark does not send letters when an account has been reinstated. The invoice the member received on May 2, 2015, had a total amount due prior to May 17, 2015, of $401.61. This amount was for the months of March, April and May.There is a claim on file that initially denied in March. That claim is being reprocessed according to the member’s benefits. A new Explanation of Benefits will be mailed to the member when the processing is finalized. Highmark 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 $133.87 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]

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, 2016 regarding complaint ID #[redacted].Ms. [redacted]...

[redacted] is filing a complaint against Freedom Blue PPO regarding her premium payments. She 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, 2015 via check # [redacted] in the amount of $279.50 that was misapplied to another member’s account. This other member did not have an active policy, and so the payment was refunded to that member in error. The amount of $279.50 in lieu of this payment has been removed from the balance of Ms. [redacted]’s account on February 25, 2016. Her account now reflects credit for this payment as well as two additional payments: one in the amount of $559.00 received February 5, 2016 and one in the amount of $279.50 received February 23, 2016. Ms. [redacted]’s account is paid through March 31, 2016 as of the writing of this response.I apologize for any confusion this issue has caused. If Ms. [redacted] has any additional questions or concerns, she may contact a Freedom Blue PPO Customer Service Representative at [redacted] Monday through Sunday 8:00 a.m. to 8:00 p.m.Sincerely,Jennifer B.CMS Complaint Specialist

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 book. He states that when he advised she had not, that the Highmark representative advised that she would print and mail it herself by June 29, 2015. 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 husband. When 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 priority. I advised him that I could see where the initial request was made for mailing on April 16, 2015 as well as the second request on May 5, 2015. The request on May 5, 2015, was canceled in error. I worked directly with our enrollment area to ensure a benefit book was printed and mailed on June 26, 2015 and sent to the member using overnight delivery. I 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 have reviewed the response made by the business in reference to complaint ID [redacted], and it still doesn't seem to be correct, but my current invoice on Highmark's website seems to be correct now, so I am dropping it strictly because I am tired of going back and forth and not really getting anywhere. The most recent letter states that my total balance due by June, 27th is $398.72. Looking on their website, my balance due is actually only $278.24, and not due until July 1st.
Regards,
[redacted]

Jennifer, Case Id #[redacted]. The $456.00 charge for [redacted] Emergency Med Associates, paid to subscriber. Issued 12/15/15, check number [redacted], cashed 12/23/15, in  the amount of $456.00. The charge for $945.00?? for [redacted] Hospital for the date of service 06/07/15,. The...

charged amount is  $1,757.50, the allowed is $483.96, we paid $445.43, the patient responsibility is just a $50.00 copayment. Thanks, Theresa Theresa G[redacted]Member Grievance and AppealsPhone#: [redacted]Fax#: [redacted]Email: [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 she was told by Highmark she would not owe anything for routine checkups. The member stated that she had blood work done at Quest...

Diagnostics, as part of her routine checkup on July 24, 2015. She then received a bill from Quest Diagnostics for $50.00. The member stated that she contacted Highmark about the services not being covered and was advised by a Customer Service Advocate (CSA) to disregard the bill because the doctor had coded the blood work wrong and her doctor would need to resubmit the claim. She stated that her doctor resubmitted the claim but she received another bill from Quest Diagnostics for $50.00. The member stated this time she contacted Quest Diagnostics and the representative from Quest Diagnostics contacted Highmark. The representative from Quest Diagnostics advised the member that everything had been taken care of and to disregard the bill. She stated a couple months later she received another bill from Quest Diagnostics. The member then stated she contacted Highmark and was advised to disregard the bill because there was a duplicate bill in their system from when the doctor resubmitted it, and the duplicate would be deleted. In March of 2016 she received another bill from Quest Diagnostics for $50.00. The member stated that she contacted Highmark again and the CSA contacted Quest Diagnostics while she was on hold. She stated that the Highmark CSA advised her that after speaking with Quest Diagnostics that everything was straightened out and that she should not receive any more bills, and to disregard the bill. In April 2016 she received another bill from Quest Diagnostics and was told by Highmark for the first time in nine months that she did owe the $50.00 because one of the tests was not considered routine.The member stated she appealed the bill because she felt like she was being misled by Highmark, who for months reassured her that she owned nothing. Her appeal was denied and she owed $50.00. She contacted Highmark for further explanation of the denial letter. She stated the Highmark CSA advised her that she owes $55.75 instead of $50.00. The member stated that Highmark is incompetent and misleading in their billing practices and cannot even decide on what amount they want to bill you.Highmark has reviewed the claim in question. The claim from July 24, 2015, has been correctly processed according to the benefits of the plan. The claim has five procedures listed on it. The procedures listed on the claim that are not covered under the preventive schedule on this claim are: [redacted] and [redacted]. The procedures that are covered under the preventive schedule are: [redacted] and [redacted]. Highmark cannot process the other procedures listed on the claim as routine because the procedures are not part of the 2015 preventive schedule. The preventive schedules are viewable online at www.highmarkbcbs.com and in the member’s benefit book. I have enclosed a copy of the 2015 preventive schedule.Highmark’s records indicate that the member contacted Highmark Customer Service four times regarding the claim for date of service July 24,2015. During the call on September 14,2015, which was prior to the resubmission of the claim, the member was advised that her responsible amount was $50.00. The claim was resubmitted by the provider and reprocessed according to the member’s benefits. Based on the revised billing codes, the claim processed with the member responsibility of $55.75. The member had a copay of $50.00 and $5.75 was applied to the member’s deductible.On behalf of Highmark, I apologize for any anxiety or inconvenience this issue may have caused. If you have additional questions, please contact me directly.Sincerely,Michelle D[redacted]Appeals CoordinatorPhone: [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 payments. The plan was cancelled effective November 1, 2015 for non-payment. The member notes that they have routinely sent in payments and Highmark WV continued to cash their checks for November 2015, December 2015, and January 2016. 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 $1,500 deductible plan with an effective date of January 1, 2015. The member’s monthly premium for 2015 was $1,303.13. For plan year 2016, the member’s monthly premium is $1,658,51. The member’s plan has been reinstated as of March 3, 2016. and all payments have been accounted for. However, 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 cancellation. February’s premium was due on or before February 1, 2016 and March’s premium was due on or before March 1, 2016. The plan has a grace period of thirty one days. To 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 Payment. amount January 2015 12/30/2014 01/05/2015 No 01/06/2015* 1303.13 • February 2015 01/08/2015 01/31/2015 No 02/09/2015* 1303.13 March 2015 02/07/2015 02/28/2015 Yes 03/10/2015* 1303.13 April 2015 03/07/2015 03/31/2015 Yes 03/30/2015 1303.13 May 2015 04/08/2015 04/30/2015 No 06/08/2015* 1303.13 June 2015 05/08/2015 05/31/2015 Yes 06/08/2015 1303.13 July 2015 07/03/2015 07/20/2015 No 07/31/2015* 1303.13 August 2015 07/10/2015 08/01/2015 Yes 09/23/2015* 1303.13 September 2015 08/08/2015 09/01/2015 Yes 09/23/2015* 1303.13 October 2015 Policy termed N/A N/A 11/23/2015* 1303.13 November 2015 10/08/2015 11/01/2015 Yes 12/15/2015* 1303.13 December 2015 11/10/2015 12/01/2015 Yes 01/04/2016* 1303.13 January 2016 12/09/2015 01/01/2016 Yes 01/26/2016* 1658.51 February 2016 01/09/2016 02/01/2016 Yes N/A N/A* denotes late payment The undersigned notes that throughout plan year 2015 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 due. The 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 satisfaction. If you have additional questions, please contact me directly.Sincerely,Courtney N, L[redacted]Associate Counsel[redacted](1)Per the member’s Certificate of Benefits booklet; "Grace Period. A grace period of thirty-one (31) days from the due date will be granted for ihe payment of each premium. During 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 B. BENEFITS AFTER TERMINATION OF COVERAGE of this Section. If 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 premium. The 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."

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, 2015. 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, 2015. The advocate left a message that she would try to call her again on Monday, Dec 21 , 2015. 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 payment. She 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 bank. She was advised of the Walk-In Center 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 terminate. The 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

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]

After talking the associate, I contacted Fisher-Titus billing center and asked them to correct the billing amount that BC/BS required. And then, I received a correct billing letter from Fisher-Titus billing center and forward to BC/BS last month. Like the BC/BS associate said, as soon as BC/BS received the correct billing letter, BC/BS will pay the bill. Yesterday, I received a letter from Fisher-Titus saying that the bill is still not paid, and will have my account placed with a collecting agency.BC/BS pays the bill as soon as possible as they promised. Fisher-Titus : [redacted] Account number: [redacted] Patient: [redacted] Amount: 432.97 ---------------------------------- Member name: [redacted] Member ID: [redacted]