EL NIPLITO DEL SURESTE

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]

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 find that this resolution is satisfactory to me. 
Regards,
[redacted] I was able to speak with Stephanie and she was able to assist me.

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 back. Almost 4 years of waiting and Lied to is not good business. Didn't have co-pays. Amazing how they can take someones hard earned money and put them through so much then give less and call it ok. not acceptable. almost killed me!
Regards,
[redacted]

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 2017 plan period, He states that he enrolled in a policy through another...

carrier. He is concerned because he has called Highmark to cancel the policy and is still receiving invoices. He would like to ensure that his policy for 2017 is no longer active, and that this will not reflect negatively on his credit report due to the invoices that were sent.Highmark has reviewed the member’s account. The member was auto-enrolled into a policy for the 2017 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 FFM. On December 14, 2016, an enrollment file was received from the FFM, enrolling the member and his spouse into the Connect Blue EPO 2500 policy effective January 1, 2017. A cancellation file was received from the FFM on January 16, 2017, directing Highmark to cancel the policy effective January 1, 2017. However, due to a systemic error, the enrollment system did not cancel the policy.Higlimark has voided the coverage for the 2017 plan year effective January 1, 2017. 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 member. If you have additional questions, please contact me directly.Sincerely, Linda K[redacted]Executive/Legislative InquiriesPhone: [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, 2016. 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 policy. She 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 letter. She stated she called Highmark back and requested someone email her the letter of cancellation, but instead received an email stating her cancellation date. She 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 letter. She 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 cancellation. The letter was dated March 8, 2016, and the email was sent on April 27, 2016. 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 caused. If you have additional questions, please contact me directly.Sincerely,Michelle D[redacted]Appeals CoordinatorPhone: [redacted]

June 19, 2015 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 above. In the complaint, the member’s husband states that she did not receive a benefit book for her policy after enrolling in the Balance Blue PPO 1000 on April 10, 2015.  He states that they called and requested the books, and were advised she would receive them within a couple of weeks, but they were never received.  Upon review of the account, there was a request made on April 30, 2015 for the Enrollment packet.  However, this request was cancelled in error on May 5, 2015.  I placed a new request in the system today and she should receive the packet within seven to ten business days.  I will follow up with the member to confirm of receipt of the enrollment packet. If you have additional questions, please contact me directly.                                           ...⇄ Sincerely,                                             ...⇄ Linda S[redacted]                                         ...⇄ Appeals Coordinator                                         ...⇄ Phone: [redacted]

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 screenings. As 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 services. The 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 time. Unfortunately, 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 plan. Should our member have any additional questions, a Customer Advocate is available to assist them at [redacted].Sincerely, Ms. L[redacted]Appeals Analyst

Dear Ms. Gasser, 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, 2016.  Thank you.

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.  I appreciate your apology for my frustration. I also made a request on 12-28-15 when I made my first payment by phone. That is probably why in the last week or two I have receive 4 benefit books. Thank you for taking care of this. I only wish it was done in the time frame I was told it would be done. I do believe it is unfair that the whole country has to do their insurance at the same time & during the holidays at that. But then if the leadership of this country doesn't care about God or the people that do & celebrate those holidays what should we expect?Again thank you.
Regards,
[redacted]

March 24, 2016Member: [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 Security Blue HMO on March 24, 2016 regarding complaint ID...

#[redacted].The member is filing a complaint regarding the assessment of copays for an Emergency Room visit and an Inpatient Hospital Stay for the same dates of service.In review of the member's account, it was found that for dates of service January 9, 2016 -January 11, 2016 there are two separate claims with assessed copays. There is a claim for an Emergency Room Visit with a $75.00 patient responsibility, and a claim for an Inpatien Hospital Stay with a $400.00 patient responsibility.Per the member's benefits as outlined in the plan's Evidence of Coverage (EOC):“If you are admitted to the hospital within 3-days for the same condition, you pay $0 for the emergency room visit. The emergency room copayment applies if you are in the hospital for up to 48 hours for observation or rapid treatment as these are not considered hospital admissions.”The claim for the Emergency Room Visit has been adjusted to reflect a $0.00 patient responsibility. A corrected Explanation of Benefits statement (EOB) will be issued to both the member and the provider.I apologize for any inconvenience this issue has caused. If Mr. [redacted] has any additional questions or concerns, he may contact a Security Blue HMO Customer Service Representative at [redacted] Monday through Sunday 8:00 a.m. to 8:00 p.m.SincerelyJennifer BCMS Complaint Specialist