Geisinger Health System

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: I dont feel this claim by geisinger was correct, the next thing I plan on doing is typing a new complaint letter that will be sent to both you and the geisinger boardI have records and names of all the people I spoke with when I talked to geisinger customer service, geisinger complaint board and my insurance carrier, I will cover all tracks of what transpired and why I dont feel obligated to pay for blood work that was presented to me in a fashion that was like it was forced on meThat day of the apptDrT [redacted] expressed it to me saying she had noticed that I lost weight recently and she strongly recommended that I should perform blood testing, so I said yes due to the fact thinking that because of the medicine im on that it would be routine to have this type of blood testing and they would cover it since DrT [redacted] was concerned about the effects of the medicine, that she really just rushed me into it and insisted that I complete this work, I had no problem getting the work done but I feel that it was wrong of them to not inform me that it most likely would not be covered due to it being considered an unroutine/extra serviceHowever I will go more into that in my letter that you will see from me soon Regards, Bradley Matto

August 14, 2014Dear MSDondero.This letter is in response to the complaint filed by the above Member, [redacted] [redacted] is enrolled in the Geisinger Choice PPO with No Deductible Health Plan which, as he indicated in his letter, has a maximum in-network deductible of $and a maximum out-ofpocket limit of $4000.On 7/22/the Geisinger Choice PPO Appeal Department received a fax regarding the Member's dissatisfaction with Geisinger's processing of his claims and a post-service nonmedical appeal was immediately initiated on the Member's behalf.On 7/28/an Acknowledgement letter with Authorized Representative was mailed to the Member scheduling his appeal review for the morning of 8/12/at approximately 10:AM in [redacted] .On 7/28/the Appeal Coordinator contacted the GHP Enrollment representative to review and respond to the Member's issues and received the following response from the Enrollment Coordinator:We have seen this same situation with this particular plan and would like to provide the following explanationWhen Members get Prescriptive and Mental health services, we a told that it takes weeks for those "counters" to cross over within the systemAdjustments are made to claims when overages are foundThis Member's account was thoroughly reviewed from 2/1/to present and we show that the Member has met his $family deductible- no overagesThis groups plan runs from 2/1-1/The Enrollment Coordinator also checked last year's benefits and family was over by $58.96, on their OOP Max which we will need to make adjustment on a medical claim to correctThis will be sent to claims to relieveOnce the claim has been adjusted Enrollment will reach out to the Member-The issue over to Claims who will make the adjustment off of the Member's contractWhen the adjustment is made to the medical claims, the reimbursement will come from the provider that the adjustment was done on.Going forward, this will be a "manual fix" each time for these High Deductible plansThe following Member duestions were answered by Enrollment/Claims:• If there were no mental health claims, only prescriptive would this still happen?Yes, but pharmacy has something in place to catch these, Linda W [redacted] in Med Ops put a restriction in place for all family members until 1/31/15,• Why was the Member advised by Medical Management that he overpaid $Is this not correct? Who in Medical Management did he speak to?There is no record of who he would have spoken with, and they may not be able toread the benefit screens correctly, and should not have done soThe Health Plan apologizes for this error,• Is there anything that can be done specifically for this Member to make sure thisdoesn't continue to happen?Yes, we can put his family on review and will do so immediately.Please note that this Member's case went to the GHP Member Satisfaction Committee Meeting on 8/12/The Member has received notification of the Committee's decision and further appeals rights at this time.We do work hard to deliver high quality, affordable healthcare for all of our Members and I believe that the Health Plan has responded to this Member's complaint in a timely and accurate manner, in compliance with all regulatory standards and mandates.Please let me know if additional information is needed.Sincerely,Elizabeth *W [redacted] , RN, CPC Manager, Appeals Department Geisinger Health Plan

From: [redacted] < [redacted] .***@***.com>Date: Tue, May 19, at 12:PMSubject: Fw: Fwd: InsuranceTo: " [redacted] @myRevdex.com.org" < [redacted] @myRevdex.com.org>On Wednesday, April 22, 12:PM, [redacted] < [redacted] .***@***.com> wrote:On Thursday, April 2, 3:PM, [redacted] > wrote:---------- Forwarded message ----------From: [redacted] Date: Mon, Mar 30, at 8:PMSubject: InsuranceTo: [redacted] 3/20/[redacted] ***Peckville, PA *** Dear ***:Congratulations, your insurance package is complete approved for 4/1/For less of about the same as you had quotes from other companies you get MUCH more total health coverage, not just major medical! You may have already have received emails with links to review your coverage If not you will be receiving information in the mail.As per our conversation today you are now properly registered on the Federal Exchange to replace your former insurance expiring for new much broader coverage In most cases that includes at least dental, vision, life and hospital confinement direct In most cases also in includes not only help from the federal exchange paying part of our coverage but lowering your deductibles and out of pocket maximums I remind you also of my own story of bankruptcy when I was from one medical event and my wife’s near bankruptcy but aversion of the problem because she had supplemental coverage I must also remind you that my story is not unusualRemember please the survey that says 63% of all bankruptcy has to do with one medical event and 87% of those people that went under had major medical That is what supplemental coverage is for, It’s nice that [redacted] (or some other major medical carrier) that pays the doctors but who pays the grocery, electric, mortgage, car payment, dentist, eyeglasses, credit or water bill? Built into your plan could be coverage from [redacted] Life to partial solve some of those problems including dental, vision, as well as money paid directly to you for going to the doctor, hospital or ER for most accidents, cash paid directly to you for most admissions into the hospital All of the supplemental coverage plans available from [redacted] Life include; Dental , Vision, Life, Hospital Confinement Direct, Cancer, Critical Illness, Disability, Accidental Disability, Association Membership with accident coverage.You may be contacted by the federal marketplace by mail to confirm your income Call me if that is the case and we will go over what you need to send them You may well be getting a phone call from [redacted] Life to confirm your plansPlease answer it and confirm your health package Remember also if your income goes up or down substantially during the next year you should contact me or the marketplace to increase or decrease your subsidy so you will either not be forced to pay extra next year’s April 15th.Remember if your income goes up or down you will need to report it to the federal marketplace and change your subsidy and premium If you move or have a life event like divorce, marriage, new baby, adoption, etc you need to contact the federal marketplace either directly or through me.I have phoned your major medical carrier, Geisinger to pay your first bill I will contact them and ask about automatic payment options and get back to youIn case we need to remind you of all the bad press when this program first started? Well it hasn’t ended, the press just got bored with the problems Sometimes policies seem to get lost.The reason for this is simple I know this next statement on my part sounds absurd but remember this is the government that is now running this and you have to realize things never go correctly when government is involvedBut we can cut it off at the pass if we act correctly Be that as it may, as I told you there seems to be a hole in the wire between the Federal exchange and the insurance companies that names seem to fall out of This only happens with the major medical companies like [redacted] ***, [redacted] , Geisinger, [redacted] Health, [redacted] , and [redacted] (or [redacted] or [redacted] names for ***)IF THAT HAPPENS there is a solution already set up by the government We will need to phone the federal exchange and ask for an “ [redacted] Escalation” to find your lost policy Their phone number is ###-###-####IF THAT HAPPENS you will need to give them your name, address, social security number, phone number AND YOUR Application # listed in the first paragraph of this email.IF you have additional problems you can call me and I will attempt to get it rolling faster for you.IF THAT IS THE CASE, even though I signed you up originally the government has a system for letting me help you You will still have to call them and tell them that you give [redacted] your agent from [redacted] the authority to speak for you about your health insurance I will then get the “ [redacted] Escalation” enacted for you Your Federal Marketplace application # is [redacted] Your Receipt Number for payment of your [redacted] Life supplemental coverage plans is [redacted] and [redacted] Your Receipt Number for your first payment to your major medical carrier Geisinger is PA [redacted] .Your Federal Supplement is for $4378.76/year and will be given directly to your insurance carrier.The total bill for insurance IF you bought it off the Marketplace would be $5514.14/year.You will have payments of $53.03/month to [redacted] Life for your supplemental coverage (plus a $application fee for your first month) and $$need to go to to your major medical carrier Geisinger monthly.Thank you,Grace and peace, [redacted] Licensed Insurance Agent [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] *Mountain Top, PA ***P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-#### [redacted] @ [redacted] .com ¦ www[redacted] .com/ [redacted] Requested Effective Date: 4/1/ Zip Code: *** County: Lackawanna State: PA Participants: [redacted] Life w/ Geisinger Marketplace Silver HMO Extra 10/50/3000EstMonthly Premium:EstMonthly SubsidyEstMonthly Premium after Subsidy$452.24$250.00$Essential Health Benefits - This plan meets the minimum essential coverage requirements under the Affordable Care Act.Additional Information - The following is an overview of plan benefitsPlease review the Plan Brochure for more detailed information including the plan exclusions and limitationsBenefit DetailsMedical DeductibleIndividual: $Family: $ Drug DeductibleIndividual: $Family: $ Medical Out of Pocket MaximumIndividual: $Family: $1, Drug Out of Pocket MaximumIndividual: Included in Medical Family: Included in Medical Office VisitPrimary Doctor$3Specialist$10Prescription DrugsPreferred Brand Drugs$7Non Preferred Brand Drugs$20Generic DrugsNo ChargeSpecialty Drugs20%Inpatient CoverageHospital ServicesNo Charge after DeductibleInpatient ServicesNo ChargeEmergency and Urgent CareEmergency Room$25MaternityDental/Vision/Life/Hospital Confinement Direct – [redacted] Life [redacted] Insurance Agency (d/b/a or assumed name of [redacted] Insurance Solutions, Inc.) isn’t able to display all required plan information about this Qualified Health Plan at this timeTo get more information about this Qualified Health Plan, visit the Health Insurance Marketplace website at HealthCare.gov-- [redacted] Licensed Insurance Agent [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] ¦

Worst experience everThey made me see a PA before a doctor due to my blood pressureBridget H [redacted] the PA wanted me to have blood testI told her I have a severe phobia with needles and I would like to get lidocaine scriptShe looked at me like I had two faces, she told me to just close my eyes and do itShe then started to read all the negative side effects about the lidocaineMy blood pressure was going up and she made me feel so uncomfortableHow can she tell a patient to just do it!!??? She clearly does not understand everyone is different and she doesn't care about how patients feelI had lidocaine before and nothing happen to me!!! It's not like I put it on everyday and plus that's the only way for me to get needles on my armHow can she give me more fear???!! What she did was unprofessionalExample it's like telling someone that's in pain not to have pain!!! Every medication have side effects!!! lidocaine was the only thing I was depending on but when she started to say all the bad things that freaked me out even moreThis is definitely malpractice she cannot tell patient to just do it and get it over with and they have phobiaWhen I finally got my blood test they made a big mistake!!! They forget test that was listed !!!! What is wrong with geisinger in Mount Pocono or all geisinger!!!!! How I can I trust them??!!!and the worst part was they never called me and apologized!!! My specialist called me and told me that no result she orders came through!!! Unbelievable!!!! Someone need to reinforce the people that work in geisinger!!! And they need more training ASAP!!!

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because:I find this claim to be dishonest, I feel that all they are doing in this entire case is trying to use there manipulative power and continue to lie about what transpired that dayPlease ask yourself this question and lets be logical why would patient even want to have bloodwork for an unnecessary reason, the reason I committed and accepted the bloodwork to be performed is that day at the office DrT [redacted] put it to me as if was neccessary because of the medication that I am on, I am not a professional doctor or pharmicist sir I dont know deep info about medications, side effects or if your supposed to have routine bloodwork or not, in reality that is the whole reason why I visit a professional doctor, I make doctors visit because they are supposed to be expertsSo with that being said I hope you can understand my point when I mentioned about being manipulativeI feel that I am being taken advantage of with this case, I will admit I know nothing in deep about pharmaceutical medication, and what I think went down on that day was they took me and realized that I was an easygoing patient (because that's what I am) that shows no in deep knowledge of medication and were gonna tell him that he needs bloodwork and we will put it to him as if it is routine, but in the long run were gonna process it to his insurance carrier as unroutine and we can stick him with a bill so we can make extra moneyI think they are continuing to be dishonest with you guys because they are trying to cover there own backs and taking advantage of me in the meantime, I reported this matter to geisinger a couple times before I opened a case with you guys, and they always chose to not respond and completely blew me off everytime, I really don't want this bill to damage my credit history also sir, especially if it was an unnecessary charge in the first place! Regards, [redacted] ***

Please review and get back to me I'm not sure what the complaint is regarding There is no patient information and it looks to be about health insurance enrollment If anything further is needed on our part, please advise Thanks, Diane A***

October 16, Dear [redacted] , This letter responds to the complaint filed by the above Member regarding his dissatisfaction with his Geisinger PlanWe have reviewed the information from the Member as well as the additional information provided by the Revdex.com We would like to provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint processThe Member will receive a response from the Health Plan within the next thirty (30) calendar daysPlease feel free to contact me with any additional questions you may have regarding the above informationI can be reached at ###-###-####Sincerely,BethAnn PAppeals Department

We have received and reviewed the attached letter and customer experience formAmember of our billing team has reviewed the charges in question and is reaching outto the patient to discuss this matterOur records cun’ently show thc patient owes asignificantly lower out-of-pocket amount than the disputed amount listed on theattached complaintThis may have been an issue of health insurance payment timing,but our billing team representative will clarify the issue with the patient when contactis made.Thank you for bringing this mater to our attention, and we are happy to be able topromptly resolve this issue.Sincerely, [redacted] ***Operations Manager—Primary Care

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: ***I am rejecting this response because: There is no reason in the world that I should be billed for a month of coverage that I did not use, or need. I CLEARLY am stating that my employer provided and I enrolled in a Health care plan beginning 10/26/15. Let's look at some facts:
When I enrolled on the health exchange, I selected Geisinger because I THOUGHT they were the very best provider in the area. Sadly, this appears to be far from the truth
When I enrolled on the health care exchange, nowhere did I see any reference that any cancellations had to be done by the 15th
I tried to cancel on the site, it would not let me put in a date of 10/or even 10/
A representative on the phone from the health care exchange told me she did not understand why we were having this problem...said we can cancel ANYTIME
I did not know that I could put a future date of cancellation into the site, which is why I waited till near the end of what I wanted to be a day plan
There was NO PLACE on the exchange that I could indicate that I only wanted days of coverage, yet COBRA notices tell you that you can use the health care exchange
We called the Health care exchange, they referred us back to Geisinger
The bills are coming from GEISINGER, NOT from the helath care exchange
We keep getting passed back and forthyou call the Health Care Exchange, they refer us back to GEISINGER. We call Geisinger, we get no help (as evidenced in their reply)
This issue is preventing me from completing my tax return, because I need a corrected 1095-A form
We called the health care exchange over 1/weeks ago, escalated our complaint to a supervisor, was told they would take care of it, and to date nothing has been done
I cannot afford to pay, out of pocket, $for ILLEGAL DOULBE COVERAGE of my primary health care for the month of November 2014. It is not ethical, not fair, and makes no sense. I will not do it, even if I have to take this to the highest legal authority in the land.
I am convinced that someone from Geisinger has the authority to stop this incorrect bill, and is not willing to help us. Again, the bills are coming from GEISINGER.
I cannot be the only person to be a victim of this unscrupulous business practice. What if someone is unemployed, using the health exchange for coverage during the unemployment period, and immediately gets a job that DOES NOT have a waiting period for benefits. Does Geisinger and the health exchange tell the person...too bad, you have to pay double because we have to have a cancellation date before the 15th of the month? How is this just or fair? Remember, I was told by the health exchange representative that I could cancel at ANYTIME.
I need this resolved quickly so that I can get my tax return completed, and I do not want any adverse action taken on my Credit history.
I will continue to escalate this as high as I have to. If necessary, I will take this to the media, social media, and any other public source so that others do not have to face this horrific experience. Geisinger executives should consider if $900.95 is worth the negative publicity that this could bring to them.
Also be advised that I have filed complaints with both the Pennsylvania State Attorney General's Office (File ***) and the United States OESS HIPAA
I will await a further reply.Regards,*** ***

Worst hospital experience ever! I was transported to Geisinger by ambulance from another small hospitalI had double and blurred visionDoctors were concerned on a brain aneurysmI was looked at by different doctors/ suddents because they all thought my case was fastinatingIt took them hours until they ever got me in for a MRI and read my test resultsAfter my results showed no aneurysm, they sent me home and told me that I could have early signs of MS but I should be fine in to weeksThey never called me up for a follow up appointmentWhat doctor sends a patient home who has sudden blurred vision and tells them they have no idea what was wrong but they should be okay in to weeks?
Also while I was there, they "forgot" to have me sign a medical release formSo when I went home and went to a real doctor, they could not get my medical recordsGeisinger refused to release my medical records to my doctor! Since they did this, I was sent for farther unnessasary testing because they refused to send my MRI resultsI had a team of doctors look at me and not one of them had a clue of my symptomsI go to an eye doctor and she discovers what I haveVery unprofessional staff and doctorsWhen I finally called and complained to Geisinger, they sent me a letter saying they would reduce my bill only a fraction of the costI would not recommend this hospital to anyone

October 13, 2014Dear ** *** ***,
We reviewed your compliant (ID: ***) from *** *** *** related to dental billings provided by GMC Pediatric Dentistry.*** *** was contacted by phone on October 7, by our business office to review outstanding
changesIt was determined an administrative adjustment would be applied*** *** agreed with adjustment(s) and appeared satisfied with resolutionPlease consider the matter closed,Sincerely,
Brian W
Operations Director Dental Medicine

November 11, 2015Dear *** ***,
This letter is in response to a complaint filed with your office by one of our Members, *** *** *** is dissatisfied that the Plan did not terminate his Plan coverage effective 1/31/15, the Plan is billing for his coverage 2/1/through 4/30/and that he was provided poor Customer serviceThe Health Plan initiated first level complaint/ post-service appeal on 10/12/after receiving the Member's complaint from your officeA letter of acknowledgement was Sent to the Member on 10/13/The Member's complaint issue was sent to the Health Plan's Enrollment and Accounts Receivable designees for their investigation and response.On 1/10/the decision was made to OVERTURN the original decision and terminate the Member's coverage effective 1/31/15, Our Customer Service Team Leaders were unable to locate any faxes or letters that the Member had submitted regarding his request to terminate his coverage effective 1/31/The Accounts Receivable Team Leader indicated that the Member's letter dated July 15, was received in the Accounts Receivable Department but that it did not ask for a return call from the PlanThis letter was forwarded to the Enrollment Department and because the limit for retroactive disenrollment is ninety (90) days, the Health Plan could have only have gone back to April to terminate his coverage and the group had already termed the plan effective 4/30/15.As the Member has requested, the Plan terminated his coverage retroactively effective 1/31/15, however, there are a number of claims for dates of service after 1/31/Some of them are pharmacy claims but there are two medical claims for dates of service 3/16/and 3/28/Those claims will therefore be adjusted and payment retractedThe Member can expect that the providers of these services will then submit those claims to the Member’s insurance carrier that was in effect on the dates of servicePlease feel free to contact me with any additional questions you may have regarding the above informationI can be reached at ###-###-####Sincerely,
Elizabeth W., RN,
CPC Manager, Appeals Department

Dr. Matthew johnson evan shouldn't even practicing. He is the most ignorant dr. I have ever had. Hes at the geisinger dalles pa. He thinks he is god, the way he treats his patients. He treated me very poorly. He took over for dr. Cook. He has no bed side manor.

I would like to share a negative experience with Geisinger Health Plan and how they do not care about their subscribers. A family member was very ill with complications from diabetes. He was moved from the hospital to Golden Living Rehab Center to recover. While at Golden Living, my loved one contracted C-Def and was almost released knowing his is still very ill and contagious. With only a 2 day notice, he was going to be released. I fought very hard to keep him in a doctors care. I won that appeal. My loved one started to get better and improve to only contract the C-Def again and with only a 2 day notice, the insurance company decided they were not going to cover his care at Golden Living. The rehab center was very happy to continue his care for over $8,000 a month. Unfortunately that was not possible. So my loved one was released with still having C-Def and the doctor wrote a script for medication that cost over $1,000. Why is this IMPORTANT medicated not covered? Who has this kind of money! Needless to say, my loved one has be readmitted to the hospital. BEWARE families who have this coverage. How can a family prepare to take care of a loved ones with a TWO day notice. Unbelievable!!!

Geisinger Health System

I receive financial help with my outstanding medical bills that my insurance doesn't cover every year with Geisingers assistance service. Last year I filled out the normal paper work (that I have been doing for many years) that took several months to approve because they were backed up as they said or not enough employees to review the paper work. My application finally got approved (as it always was). Now because of that delay on their part I have been receiving collection calls and notices for some medical services. I called Geisinger and they said too bad I have to pay the bill. This is ridiculous!

Worst experience ever. They made me see a PA before a doctor due to my blood pressure. Bridget H[redacted] the PA wanted me to have blood test. I told her I have a severe phobia with needles and I would like to get lidocaine script. She looked at me like I had two faces, she told me to just close my eyes and do it. She then started to read all the negative side effects about the lidocaine. My blood pressure was going up and she made me feel so uncomfortable. How can she tell a patient to just do it!!??? She clearly does not understand everyone is different and she doesn't care about how patients feel. I had lidocaine before and nothing happen to me!!! It's not like I put it on everyday and plus that's the only way for me to get needles on my arm. How can she give me more fear???!! What she did was unprofessional. Example it's like telling someone that's in pain not to have pain!!! Every medication have side effects!!! lidocaine was the only thing I was depending on but when she started to say all the bad things that freaked me out even more. This is definitely malpractice she cannot tell patient to just do it and get it over with and they have phobia.
When I finally got my blood test they made a big mistake!!! They forget 8 test that was listed !!!! What is wrong with geisinger in Mount Pocono or all geisinger!!!!! How I can I trust them??!!!and the worst part was they never called me and apologized!!! My specialist called me and told me that no result she orders came through!!! Unbelievable!!!! Someone need to reinforce the people that work in geisinger!!! And they need more training ASAP!!!

From: [redacted] <[redacted].[redacted]@[redacted].com>Date: Tue, May 19, 2015 at 12:39 PMSubject: Fw: Fwd: InsuranceTo: "[redacted]@myRevdex.com.org" <[redacted]@myRevdex.com.org>On Wednesday, April 22, 2015 12:48 PM, [redacted] <[redacted].[redacted]@[redacted].com>...

wrote:On Thursday, April 2, 2015 3:50 PM, [redacted]> wrote:---------- Forwarded message ----------From: [redacted]Date: Mon, Mar 30, 2015 at 8:21 PMSubject: InsuranceTo: [redacted]3/20/15[redacted]Peckville, PA [redacted] Dear [redacted]:Congratulations, your insurance package is complete approved for 4/1/15. For less of about the same as you had quotes from other companies you get MUCH more total health coverage, not just major medical! You may have already have received emails with links to review your coverage.   If not you will be receiving information in the mail.As per our conversation today you are now properly registered on the Federal Exchange to replace your former insurance expiring for new much broader coverage.  In most cases that includes at least dental, vision, life and hospital confinement direct.  In most cases also in includes not only help from the federal exchange paying part of our coverage but lowering your deductibles and out of pocket maximums.  I remind you also of my own story of bankruptcy when I was 38 from one medical event and my wife’s near bankruptcy but aversion of the problem because she had supplemental coverage.   I must also remind you that my story is not unusual. Remember please the survey that says 63% of all bankruptcy has to do with one medical event and 87% of those people that went under had major medical.  That is what supplemental coverage is for,  It’s nice that [redacted] (or some other major medical carrier) that pays the doctors but who pays the grocery, electric, mortgage, car payment, dentist, eyeglasses, credit or water bill? Built into your plan could be coverage from [redacted] Life to partial solve some of those problems including dental, vision, as well as money paid directly to you for going to the doctor, hospital or ER for most accidents, cash paid directly to you for most admissions into the hospital.  All of the supplemental coverage plans available from [redacted] Life include; Dental , Vision, Life,  Hospital Confinement Direct, Cancer,  Critical Illness, Disability, Accidental Disability, Association Membership with accident coverage.You may be contacted by the federal marketplace by mail to confirm your income.  Call me if that is the case and we will go over what you need to send them.  You may well be getting a phone call from [redacted] Life to confirm your plans. Please answer it and confirm your health package.  Remember also if your income goes up or down substantially during the next year you should contact me or the marketplace to increase or decrease your subsidy so you will either not be forced to pay extra next year’s April 15th.Remember if your income goes up or down you will need to report it to the federal marketplace and change your subsidy and premium.  If you move or have a life event like divorce, marriage, new baby, adoption, etc… you need to contact the federal marketplace either directly or through me.I have phoned your major medical carrier, Geisinger to pay your first bill.  I will contact them and ask about automatic payment options and get back to you. In case we need to remind you of all the bad press when this program first started?  Well it hasn’t ended, the press just got bored with the problems.  Sometimes policies seem to get lost.The reason for this is simple.  I know this next statement on my part sounds absurd but remember this is the government that is now running this and you have to realize things never go correctly when government is involved. But we can cut it off at the pass if we act correctly.  Be that as it may, as I told you there seems to be a hole in the wire between the Federal exchange and the insurance companies that names seem to fall out of.  This only happens with the major medical companies like [redacted], Geisinger, [redacted] Health, [redacted], and [redacted] (or [redacted] or [redacted] names for [redacted]). IF THAT HAPPENS there is a solution already set up by  the government.  We will need to phone the federal exchange and ask for an “ [redacted] Escalation” to find your lost policy.  Their phone number is ###-###-####. IF THAT HAPPENS you will need to give them your name, address, social security number, phone number AND YOUR Application # listed in the first paragraph of this email.IF you have additional problems you can call me and I will attempt to get it rolling faster for you.IF THAT IS THE CASE,  even though I signed you up originally the government has a system for letting me help you.  You will still have to call them and tell them that you give [redacted] your agent from [redacted] the authority to speak for you about your health insurance.  I will then get the “[redacted] Escalation” enacted for you.  Your Federal  Marketplace application # is[redacted]Your Receipt Number for payment of your [redacted] Life supplemental coverage plans is [redacted] and [redacted]Your Receipt Number for your first payment to your major medical carrier Geisinger is PA[redacted].Your Federal Supplement is for $4378.76/year and will be given directly to your insurance carrier.The total bill for insurance IF you bought it off the Marketplace would be $5514.14/year.You will have payments of $53.03/month to [redacted] Life for your supplemental coverage (plus a $20 application fee for your first month) and $34.23. $114.98 need to go to to your major medical carrier Geisinger monthly.Thank you,Grace and peace,[redacted]Licensed Insurance Agent  [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] *Mountain Top, PA [redacted]P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-####[redacted]@[redacted].com ¦ www.[redacted].com/[redacted]1.       Requested Effective Date: 4/1/20152.       Zip Code: [redacted]3.       County: Lackawanna4.       State: PA5.       Participants: 1[redacted] Life w/ Geisinger Marketplace Silver HMO Extra 10/50/3000Est. Monthly Premium:Est. Monthly SubsidyEst. Monthly Premium after Subsidy$452.24$250.00$202.24 Essential Health Benefits - This plan meets the minimum essential coverage requirements under the Affordable Care Act.Additional Information - The following is an overview of plan benefits. Please review the Plan Brochure for more detailed information including the plan exclusions and limitations. Benefit DetailsMedical DeductibleIndividual: $100 Family: $200  Drug DeductibleIndividual: $0 Family: $0  Medical Out of Pocket MaximumIndividual: $750 Family: $1,500  Drug Out of Pocket MaximumIndividual: Included in Medical Family: Included in Medical   Office VisitPrimary Doctor$3Specialist$10Prescription DrugsPreferred Brand Drugs$7Non Preferred Brand Drugs$20Generic DrugsNo ChargeSpecialty Drugs20%Inpatient CoverageHospital ServicesNo Charge after DeductibleInpatient ServicesNo ChargeEmergency and Urgent CareEmergency Room$25MaternityDental/Vision/Life/Hospital Confinement Direct – [redacted] Life  [redacted] Insurance Agency (d/b/a or assumed name of [redacted] Insurance Solutions, Inc.) isn’t able to display all required plan information about this Qualified Health Plan at this time. To get more information about this Qualified Health Plan, visit the Health Insurance Marketplace website at HealthCare.gov-- [redacted]Licensed Insurance Agent  [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] ¦ <Mountain Top, PA [redacted]P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-####BParker@[redacted].com ¦ www.[redacted].com/[redacted]

October 16, 2015
Dear [redacted],
This letter responds to the complaint filed by the above Member regarding his dissatisfaction with his Geisinger Plan. We have reviewed the information from the Member as well as the additional information provided by the Revdex.com....

We would like to provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint process. The Member will receive a response from the Health Plan within the next thirty (30) calendar days.
Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.
Sincerely,BethAnn P.
Appeals Department

February 13, 2015Dear [redacted];
This letter is in response to the complaint filed by the above former Member, [redacted]. Prior to November, 2014, [redacted] was enrolled in the Marketplace Solutions 1 plan, through the Federal Marketplace.
[redacted] has expressed...

his dissatisfaction with his inability to dis-enroll from this plan in October 2014 and with being charged a premium for the month of November, 2014.Here is the sequence of events as they occurred between [redacted] and Geisinger Health Plan:
The Member's wife contacted the Health Plan on 11/03/2014 04:34:00 PM stating that she called the [redacted] to terminate her husband's coverage and the [redacted] advised her to "contact GHP and she is not sure what is going on”.
The Health Plan's Enrollment staff member contacted Nadine C[redacted] with [redacted] and conferenced the Member into the call. After speaking with both the Member and [redacted] they had term date of 11/30/2014 and it should be 10/31/2014. According to [redacted] the Member cannot do a retro termination, it had to be done by 10/15/2014 and this was explained to the Member. The Member stated that she is not paying for November and she will not be using this insurance past 10/31/2014. The Member was advised that GHP cannot terminate coverage unless [redacted] advises the Health Plan to do so,
On 01/06/2015 03:50:32 PM the Member again contacted the Health Plan's Customer Service Department stating that she is not paying the November premium. At 03:59:17 PM the Member was transferred to the Enrollment Team Leader and was advised that it is her option not to pay the November premium, however, Geisinger Health Plan cannot independently change the end date to  10/31/14 without direction from the [redacted].
On 01/07/2015 10:12:55 AM the Health Plan enrollment staff member again contacted the [redacted] on behalf of the Member. The [redacted] again confirmed the termination date of 11/30/14. The [redacted] again stated that the Member will need to contact the [redacted] at [redacted] and file a HICS through [redacted] to have any correction made,
The enrollment staff member attempted to call the Member to give her this information, however her phone number ###-###-#### will not accept calls from "blocked number". Despite attempts to unblock our number, we were unable to do so.Customer Service was advised that should the member call back to please give her the above information as this is the only way this will be resolved.
On 01/07/2015 03:38.43 PM the Health Plan's Enrollment Team Leader again attempted to call to the member and received same "blocked" message.
On 02/02/2015 04:49:58 PM, at the request of the Member, the Customer Service representative verified the Member's Benefit Span(s) were 8/4/2014 to 11/30/2014. Member attempted to make termination date 10/31/14 however the only date that it allowed him to put in was October 31, 2014. The earliest date that the Member could terminate would be 11/30/2014, and there would need to be an amended date on the [redacted]'s 1035 form.
The Member stated that she is very upset and she has written to the Attorney General and the Department of Human Services because nobody has told them about this. The Member stated that they were unable to put the correct date in under the termination date online and that it is not their fault and refuse to pay the November premiums. The Member was advised that she will Continue to receive the bills until this issue is resolved with the [redacted] Who Will then direct the Health Plan accordingly. The Member was advised that this is the only way to resolve this.
The Health Plan's Customer Service representative advised the Member that the Health Plan attempted numerous times to contact her however her phone will not except blocked calls. The Member stated she took the blocks off. The Member advised that there is an alternate number for cell phone and the Customer Service representative noted that a message should be left when contacting the Member going forward.
We do work hard to deliver high quality, affordable healthcare for all of our Members and I believe that the Health Plan has attempted to advise the Member how to resolve this issue in a timely and accurate manner, in compliance with all regulatory standards and mandates.
Please let me know if additional information is needed,
Sincerely,Elizabeth W, RN, CPC
Manager, Appeals Department

August 14, 2014Dear MS. Dondero.This letter is in response to the complaint filed by the above Member, [redacted] is enrolled in the Geisinger Choice PPO with No Deductible Health Plan which, as he indicated in his letter, has a maximum in-network deductible of...

$3000 and a maximum out-ofpocket limit of $4000.On 7/22/14 the Geisinger Choice PPO Appeal Department received a fax regarding the Member's dissatisfaction with Geisinger's processing of his claims and a post-service nonmedical appeal was immediately initiated on the Member's behalf.On 7/28/14 an Acknowledgement letter with Authorized Representative was mailed to the Member scheduling his appeal review for the morning of 8/12/14 at approximately 10:30 AM in [redacted].On 7/28/14 the Appeal Coordinator contacted the GHP Enrollment representative to review and respond to the Member's issues and received the following response from the Enrollment Coordinator:We have seen this same situation with this particular plan and would like to provide the following explanation. When Members get Prescriptive and Mental health services, we a told that it takes 2 weeks for those "counters" to cross over within the system. Adjustments are made to claims when overages are found. This Member's account was thoroughly reviewed from 2/1/14 to present and we show that the Member has met his $3000 family deductible- no overages. This groups plan runs from 2/1-1/31. The Enrollment Coordinator also checked last year's benefits and family was over by $58.96, on their OOP Max which we will need to make adjustment on a medical claim to correct. This will be sent to claims to relieve. Once the claim has been adjusted Enrollment will reach out to the Member. -The issue over to Claims who will make the adjustment off of the Member's contract. When the adjustment is made to the medical claims, the reimbursement will come from the provider that the adjustment was done on.Going forward, this will be a "manual fix" each time for these High Deductible plans. The following Member duestions were answered by Enrollment/Claims:• If there were no mental health claims, only prescriptive would this still happen?Yes, but pharmacy has something in place to catch these, Linda W[redacted] in Med Ops put a restriction in place for all family members until 1/31/15,• Why was the Member advised by Medical Management that he overpaid $225.67. Is this not correct? Who in Medical Management did he speak to?There is no record of who he would have spoken with, and they may not be able toread the benefit screens correctly, and should not have done so. The Health Plan apologizes for this error,• Is there anything that can be done specifically for this Member to make sure thisdoesn't continue to happen?Yes, we can put his family on review and will do so immediately.Please note that this Member's case went to the GHP Member Satisfaction Committee Meeting on 8/12/14. The Member has received notification of the Committee's decision and further appeals rights at this time.We do work hard to deliver high quality, affordable healthcare for all of our Members and I believe that the Health Plan has responded to this Member's complaint in a timely and accurate manner, in compliance with all regulatory standards and mandates.Please let me know if additional information is needed.Sincerely,Elizabeth *. W[redacted], RN, CPC Manager, Appeals Department Geisinger Health Plan