Highmark Blue Cross Blue Shield Delaware

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.

Thank you for your response in reference to complaint ID [redacted]. However, cannot accept the response. We believe that the reason given by BlueCross Blue Shield Delaware as to why they have not dealt with our claim yet after more than an entire year is very far-fetched and does not make much sense. We hope that the company should carefully consider the following questions in order to improve their services in the future. 1. The company acknowledged that they first received our Claim on 8/18/2014. To date, this has been more than one year, and the problem still has no clear answer or resolution. Is this entirely the customer’s responsibility? 2. A few years ago, we made a similar claim to the same company, and the claim was successfully resolved at the time, with no problems and troubles, so we are very clear that this claim has specific procedures and steps to be followed and that our claim meets all the criteria to be processed in a reasonable and timely manner. Unfortunately, it did not happen again this time. 3. As was required by the company, we first sent all the required documents to the BlueCross Worldwide Service Center in August 2014, and we have a post office receipt as evidence, indicating we have followed the company’s procedure without sending the document evidence to BlueCross Blue Shield Delaware directly. 4. After we filed the Claim for the first time, there were long periods of time in which we received absolutely no response at all. Therefore, over the past year, we have had to call the company over 10 times in total to ask them about the status of our claim, each time followed by no response. The most recent call we made was in May 2015. Surely the company must have records of the phone calls we made? If not, then the company clearly did not care about our problem or did not bother to make a record of the fact that we made an inquiry. If it was recorded that we made those phone calls, then why was nobody willing to take responsibility for our claim? Every time I have to call or otherwise nobody from the company to contact me if they have any questions on the claim. Is it the right way to do business? 5. From the whole process during the past year, I felt that the officers in your company does not care about the customer’s inquire and also less professional skills to solve the problems. One time, when I called the company, one person in your company received my call and told me that the problem has to be solved with my Family Doctor, so I asked my family doctor’s helps to talk with your officer, but the end is that the doctor does not need to be involved in this process. The doctor got mad to me and your company for such waste time requirement. I could provide my family doctor’s information if you need. To mention the recently call in May 2015, a gentle man who received my call was better than others because he did plan to help me to solve the problem. He promised me that if I resent all the documents which he sent back to me to him again and he could definitely solve the problem. I followed his instruction carefully and sent the all the documents again to him via email. He emailed me back to let me know that he received that and put that in process (I have all the email communication evidence and can provide when needed). Unfortunately, after then I still did not receive any feedback and result. Recently about two weeks back, I email him again to follow up the status but no any response. I do not know what to do next, I felt hopeless. I had tried anything I can during a whole year, the only purpose is to solve this simple claim problem, but I failed, look like nobody from the company could really help me. I do even know what’s really wrong with that. 6. For the whole year, I was forced to talk with your company’s officers who belong to different departments, I felt that the two departments (BlueCross Worldwide Service Center and BlueCross Blue Shield Delaware) in your company does not communicate and work together smoothly. Every time I call, I have to call these two departments because they emphasized that the other department should take care of my claim. I am finally sacrificed by this inner problem in your company. 7. I have recently received the copies of our claim documents sent back to me last weekend, I should mention that the original copies are still with the company. I will follow the instructions as soon as possible and re-submit all again, but I still have no confidence. We ask that once a person is assigned to our claim, it would be better if you could please provide us with the name and contact information so that we may follow up as appropriate. I will keep the Revdex.com Delaware in the loop through the whole process.

Please find the response to Complaint #[redacted] attached.

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,

Thank you for your patience in receive our response to Complaint [redacted].  You will find our reply and resolution to this issue attached.

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...

16.  Thank you for your consideration and again our apologies.

Please find our response in the attached document entitled "Revdex.com case [redacted] response.pdf"

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 "90 days too late" bases. Having complied with everything they repeatedly asked for during the first 90 days, a simple form letter advising (reminding) me that I need to process 2013 expenses otherwise during those 90 days would have been extremely beneficial to us all.
Again I thank you.
Regards,

Please find Highmark Blue Cross Blue Shield Delaware's response attached.

Revdex.com:
Verdana;">
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.

Thank you for your response in reference to complaint ID [redacted]. However, cannot accept the response. We believe that the reason given by BlueCross Blue Shield Delaware as to why they have not dealt with our claim yet after more than an entire year is very far-fetched and does not make much sense. We hope that the company should carefully consider the following questions in order to improve their services in the future. 1. The company acknowledged that they first received our Claim on 8/18/2014. To date, this has been more than one year, and the problem still has no clear answer or resolution. Is this entirely the customer’s responsibility? 2. A few years ago, we made a similar claim to the same company, and the claim was successfully resolved at the time, with no problems and troubles, so we are very clear that this claim has specific procedures and steps to be followed and that our claim meets all the criteria to be processed in a reasonable and timely manner. Unfortunately, it did not happen again this time. 3. As was required by the company, we first sent all the required documents to the BlueCross Worldwide Service Center in August 2014, and we have a post office receipt as evidence, indicating we have followed the company’s procedure without sending the document evidence to BlueCross Blue Shield Delaware directly. 4. After we filed the Claim for the first time, there were long periods of time in which we received absolutely no response at all. Therefore, over the past year, we have had to call the company over 10 times in total to ask them about the status of our claim, each time followed by no response. The most recent call we made was in May 2015. Surely the company must have records of the phone calls we made? If not, then the company clearly did not care about our problem or did not bother to make a record of the fact that we made an inquiry. If it was recorded that we made those phone calls, then why was nobody willing to take responsibility for our claim? Every time I have to call or otherwise nobody from the company to contact me if they have any questions on the claim. Is it the right way to do business? 5. From the whole process during the past year, I felt that the officers in your company does not care about the customer’s inquire and also less professional skills to solve the problems. One time, when I called the company, one person in your company received my call and told me that the problem has to be solved with my Family Doctor, so I asked my family doctor’s helps to talk with your officer, but the end is that the doctor does not need to be involved in this process. The doctor got mad to me and your company for such waste time requirement. I could provide my family doctor’s information if you need. To mention the recently call in May 2015, a gentle man who received my call was better than others because he did plan to help me to solve the problem. He promised me that if I resent all the documents which he sent back to me to him again and he could definitely solve the problem. I followed his instruction carefully and sent the all the documents again to him via email. He emailed me back to let me know that he received that and put that in process (I have all the email communication evidence and can provide when needed). Unfortunately, after then I still did not receive any feedback and result. Recently about two weeks back, I email him again to follow up the status but no any response. I do not know what to do next, I felt hopeless. I had tried anything I can during a whole year, the only purpose is to solve this simple claim problem, but I failed, look like nobody from the company could really help me. I do even know what’s really wrong with that. 6. For the whole year, I was forced to talk with your company’s officers who belong to different departments, I felt that the two departments (BlueCross Worldwide Service Center and BlueCross Blue Shield Delaware) in your company does not communicate and work together smoothly. Every time I call, I have to call these two departments because they emphasized that the other department should take care of my claim. I am finally sacrificed by this inner problem in your company. 7. I have recently received the copies of our claim documents sent back to me last weekend, I should mention that the original copies are still with the company. I will follow the instructions as soon as possible and re-submit all again, but I still have no confidence. We ask that once a person is assigned to our claim, it would be better if you could please provide us with the name and contact information so that we may follow up as appropriate. I will keep the Revdex.com Delaware in the loop through the whole process.

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,

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

Please find our response attached.

Case #[redacted]:  Our Member Services Appeals Coordinator ([redacted]) has written a follow-up letter for you to forward to the complaintant.  We apologize for the delay in getting our response to you.  I was on vacation last week and noticed that it came in Friday afternoon (10/20).  Thank you.

The response to Case [redacted] is uploaded and 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 charge. Under 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 $300.00 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/ 14. An administrative check in the amount of$63.99 will be issued to [redacted].  [redacted] should receive the check within 7-10 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.

Attached is the response for [redacted]

Please find Highmark Blue Cross Blue Shield Delaware's response to Case #[redacted]

Review: We filed an insurance claim to this company, Highmark BlueCross BlueShield, in August 2014. We used trackable mail to ensure that the claim arrived at the right location and on time. Up to today, more than one full year later, we have not received any decision on this claim. After filing this claim, we have called the company over ten times over the course of the past year to ask about the claim, and every time we have called, no one would take responsibility for the claim and would make a different excuse and would then just pass me off to another office. In addition, the information we have received about the claim has been different each time. We have no idea what to do anymore to get a response on this claim. On top of all this, when I called the insurance company in June 2015, the person answering my call actually told me they had lost the file and that it had "disappeared." I was told to refile the claim, which I did in a very timely manner, and still have not received any new information or a resolution to it. We just really wish to resolve this claim and move on. It has already been more than one year.Desired Settlement: The desired outcome is for Highmark to resolve the insurance claim that we filed more than one year ago.

Business

Response:

The response to Case [redacted] is uploaded and attached.

Consumer

Response:

Review: Highmark Delaware has unjustifiably cancelled my heath care coverage due to numerous errors in their database. I continue to have problems receiving medical care and Rx due to their incorrect data in their system. The problems gets resolved after my many attempts to speak with customer service. They admit that the invoice and statements were incorrect and they fix the database so I can received benefits only to have the same problem weeks later. Due to their errors I have had to pay full price for 3 of my wife's 8 different Rx and then wait over 45 days to get a refundDesired Settlement: I would like a refund of my May 2015 tax credit of $1,500 and an apology for the numerous mistakes with their cancellations of paid insurance.

Business

Response:

Attached is Highmark Blue Cross Blue Shield Delaware's response to Complaint [redacted]

Review: I got surgery on 3/26/2015 to have a cyst removed. I called Highmark on 3/25/15 to confirm that I would not have to pay out of pocket for this surgery. I was told by the Rep that I would NOT have to pay anything for this surgery, and that everything would be covered 100%. I have since received multiple bills. Right now, I owe [redacted] Services LLC $534, [redacted] Anesthesia $233, and [redacted] Pathology $15. I also already paid [redacted] Services $170. That is a total of $952 that I didn't expect to pay.

Since my surgery, I had to call Highmark 5 times regarding this issue, and I keep getting the run around. On 5/18, I spoke with Samantha. She was supposed to look into it, and reach back out to me. She called me back a day or two later, and left me a broken up message that didn't make any sense to me. The return phone number she left me was the 1 800 number. I was back to square 1. I called them again on 5/20 and spoke to [redacted]. I explained the situation, and let her know about my experience with Samantha. [redacted] guaranteed me that she would h=get to the bottom of it and call me back in a way that would not leave me hanging. I never heard back from her. I called again on 8/12 and explained my situation to the lady. She said that it looks like the last person I spoke with mailed me a letter. I asked for her name, and she said, "My name is [redacted] also." I said, "are you the same [redacted] I spoke with last time?" She giggled and said "Yes." I thought that was very odd, and did not feel comfortable about the situation. Once again, I never heard back. I called today, 9/15/15, and [redacted] answered again. She said that she sent me another letter. I think they are sending me letters to my parents house.

This is getting out of control. I feel like Highmark is just messing with me at this point. When I called today, I asked [redacted] to speak with a manager, and how I could write a letter to corporate. She said, let me grab my manager, and they can tell you how to write a letter to corporate. Some one came on the phone and said, "HI this is [redacted] S, How can I help you?" I asked, "are you a manager?" She said "No." I can't continue to call this company and get nowhere. [redacted] Anesthesia sent my debt to collections, and this is starting to affect my credit. After my call on 8/12, I was very stressed out and started feeling severe stomach pain. At the time I chalked it up to stress and a stomach ache. The pain returned this past week. I went to my doctor yesterday, and he said I have a hernia. I'm not sure if this is directly related to this incident, but i'm sure it's not helping.Desired Settlement: I expect to be reimbursed the $170 that I paid to the [redacted] Services. I would like the remaining $782 in bills to be paid. I would like a correction on my credit. And I am going to speak with my doctor to see if my hernia could be related to this incident.

Business

Response:

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 16. Thank you for your consideration and again our apologies.

Consumer

Response: