Highmark Blue Cross Blue Shield Delaware

I pay over $1500 per month for my wife and I and I’m told That’s not my prescriptions. In 2021 this price included prescriptions. I am now paying out of pocket for my meds. I’m going to go broke. Blue Cross needs to be sued

This is a response to the inquiry submitted to your office by [redacted] regarding a claim for hearing aid services rendered by A.IDuPont Children's Hospital, on date of service 1/14/for his daughter Highmark Delaware administers the benefits for the FEP plan The member's benefit plan states benefits are available for hearing aid services as follows : Covered Hearing Aid Revenue Codes The Hearing A id Revenue Codes listed in Chart B will process as covered DME services subject to appropriate hearing aid benefit maximum per ear per time periodChart B - Hearing Aid Revenue Codes Code Narrative General Diagnostic Treatment Other Audiology The Member does have benefits for hearing aid services when billed by the above referenced facility with the revenue codes aboveThe provider of services has billed with Revenue Code 292, which is not listed as a covered service under the benefit planHighmark Del aware h as contacted the provider's billing office on behalf of the member on 4/ 17/ and advised the provider that a corrected claim is needed Should you h ave any additional questions or concerns, please do not hesitate to contact me

We are very sorry for uploading the incorrect response for this complaint, your case # [redacted] We originally misplaced this complaint and are diligently working to provide a response Our Member Service management has promised a thorough investigation and response on Friday, October Thank you for your consideration and again our apologies

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

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 First they sent me another patients confidential information Now they are finally admitting to incorrectly advising me, but they are saying it was "after services were rendered." This is incorrect Now these bills have been sent to collections on me, and my credit is getting affected by this Regards,

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution plan sounds satisfactory to me However please note- the issue has still not been completely finalized and I am still awaiting the documents I requested The company has reached out to me and explained what their plan is to resolve the issue, but it is still in progress Regards,

Please find the response to Case # [redacted] fro Highmark Blue Cross Blue Shield Delaware

Pleae find attached Highmark Blue Cross Blue Shield Delaware's rebuttal response to Case Number: [redacted]

There are two attachments which should resolve the member's concerns

Please find attached Highmark Delaware's response to the Rebuttal regarding this case # [redacted]

RE: Final Response to Case # [redacted] Please find attached our final response for this case We had initially answered this complaint in your system advising that we needed more time to investigate Our investigation is complete and our final response is attached

This is a response #1a1a1a;">to the inquiry submitted to your office by [redacted] regarding the processing of a member submitted claim In accordance with the member's benefit booklet , all claim payments are based on Highmark Delaware's allowable chargeUnder the member's group PPO plan, immunizations billed for by an out-of-network provider are covered up to 80% of the allowable charge after a $plan year out-of-network deductible Based on a review of the member's complaint, Highmark Delaware management has determined that an exception will be made to reimburse [redacted] for her full cost of the immunization she received on date of service 4118/ An administrative check in the amount of$will be issued to [redacted] [redacted] should receive the check within 7-business days We apologize for the difficulties our member has experienced and we are committed to providing the highest level of service at all times Should you have any additional questions or concerns, please do not hesitate to contact me

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 am GREATFUL for your interaction after having spent hours filing an appeal only to be denied on the same "days too late" basesHaving complied with everything they repeatedly asked for during the first days, a simple form letter advising (reminding) me that I need to process expenses otherwise during those days would have been extremely beneficial to us allAgain I thank you Regards,

This is a response to the inquiry submitted to your office by *** *** regarding claims over-applying to her plan year deductible
*** *** has an EPO policy with Highmark Delaware that runs on a June - May 31st plan yearThe indiidual deductible for plan year 6/1113-05/
was $1,The member 's benefits correctly reflected the $1,individual plan year deductible; however, beginning in January , claims began to apply to the deductible in en-orThe issue was submitted for investigation and it was determined that the system accumulators were incorrectly reset to a calendar year benefit period in errorOur Customer Service Representatives reached out to *** *** 's billing providers and requested the patient's accounts be placed on hold while we resolved the system issueWe have fixed the system coding to correctly reflect the 06/-05/plan year in the accumulators At this time, we are expediting the adjustments to the claims that over-applied to the deductible*** *** should receive the adjusted claim Explanation of Benefits (EOBs) within to business days
We apologize for the difficulties our member has experienced and we are committed to providing the highest level of service at all timesShould you have any additional questions or concerns, please do not hesitate to contact me
Sincerely,

This is in response to your inquiry sent to us on behalf of member identified by the Case ID number you provided
The member states intheir complaint that they compared prescription medication pricing prior to obtaining coverage through the *** *** ***
*** but does not state which medications and dosages they inquired about
Highmark has researched the member's prescription claims, and have determined all claims have processed correctly in accordance with the member's benefits The member should work with their ordering physician and pharmacist to verify the pricing of his medications, as different forms of the same medication may be classified differently
If the member wishes to inquire about changing plans, they should contact the *** at **
***

Please find Highmark Blue Cross Blue Shield Delaware's response to Complaint # *** attached

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. However this should not have taken months to solve

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 12370190, and have determined that this does not resolve my complaint. For your reference,
details of the offer I reviewed appear below
*** *** ** ** *** *** *** ** * *** ** *** *** ** *** *** *** ** *** ***
***
*** ***
Hello, My basic question is I have paid more than 5000(out of pocket maximum) per year and they are still generating billsIf they process my bills next year and bills then that is not my problem. I have paid by signing up in installment plan as well- not sure why insurance is billing again.thanks***

Please find the response from Highmark Pennsylvania attached

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