Highmark Blue Cross Blue Shield

Review: I purchased insurance via the Marketplace during the last enrollment period. Which means my insurance was active starting Jan 1, 2015 with Highmark Insurance. I've been paying my premiums and in July I realized my premium was double. I had accidentally missed the previous month's payment. I called Highmark and clarified the issue, then made a double payment as soon as it was sorted (which was early August). My billing notices sent via mail always came later than the online bill, and the dates were not consistent between the two. I thought payments were just due at the start of the next month.

I continued paying on time then on Sept 8th they mailed a letter to me that said my insurance was canceled effective July 1st. I never received any notice about cancellation (aside from a note on my July insurance about paying in time, which I called about). I had called multiple times - for unrelated matters - after July and was never told my insurance was not active. I called after receiving the notice and was told they would initiate a reinstatement and that it was just a billing mistake. After 3-4 weeks they still hadn't called to let me know the result, so I called them and found out it was canceled, it wouldn't be re-instated and they are going to refund me for 3 months of payments.

This means I will be without insurance for 6 months this year (leading to a fine on my taxes), when I thought everything was ok. They had even sent me letters notifying me that I would be receiving a Multi-State ID card, a reimbursement form for an out of the country medical expense and multiple invoices with no indication that something was wrong. When I asked them what happened they gave me a bunch of reasons about processing billing on weekends, and that if I hadn't specifically asked the status of my insurance then no one would have told me. They said they sent me a notice on June 7th but I have all the mail they ever sent me and I don't have any additional notice. It doesn't make any sense and I did everything I could and was lead to believe my insurance was active for months. They told me I couldn't appeal through them and had to do it through the marketplace directly to reinstate my insurance since that's where I purchased it.

During the appeal process I still hadn't received my money back. Which I had to call about again. It turns out they just never sent it out. So finally at the end of November I finally received the premium payments back. Meaning my insurance was cancelled July 1st and it took them 5 months to reimburse me. They invoice every 30 days, and told me the grace period is 30 days. Meaning I have 0 days to notice if a payment is late. Previously they told me it was 32, and if I had bought it direct (and not through the Market place) that it would have been 36 days.

I appealed through the Market place and after they reviewed it, they told me that I they didn't have the authority to handle the appeal, and that it had to be done via the insurance company. So I called Highmark again, and they said I could send a letter to their appeal department via mail. There's no form, and no availability of how long it might take to process the appeal. Based on my interactions with them so far I'm assuming it will take months to determine and that they will not reverse the decision.

When it's all said and done, I made a mistake in payment in June and it's cost me 6 months of insurance, multiple days worth of calls, complaint filings, mis-leading advice which has been leading to loss of access to medical care and unnecessary financial cost. The open enrollment for insurance is only once a year, so my new coverage can't start until Jan 1st 2016.

Every rep I've talked to seems unsympathetic and just has new versions of the same excuse. It was a mistake I corrected in a timely manner (due to their non-notification prior to the next billing cycle) which will lead to a fine and loss of access to medical care, along with months of aggravation.Desired Settlement: I would like my health insurance re-instated starting July 1st - Dec 31st (I have a new company for Jan 1st), along with reimbursement for medical expenses incurred during the time of non-coverage.

Business

Response:

December 17, 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.In her complaint the member states that she purchased a policy through the Federally Facilitated Marketplace (FFM) to be effective January 1, 2015. She states that when she received her invoice in July, she realized that she had missed the previous month’s premium payment. She further states that she contacted Highmark Customer Service to verify that a payment was missed, and that she made a double payment in early August. The member states that she continued making payments and received a letter dated September 8, 2015 which stated that her policy had been cancelled for non-payment.She also states in her complaint that she called Highmark after she received the cancellation notice and was advised the cancellation was an error and that her policy would be reinstated. She states that three to four weeks later she contacted Highmark again and was advised that the policy could not be reinstated and she would need to file an appeal with the FFM. She states that she received the refund of her premiums in November.The member further states that she was advised of the thirty-one day grace period for her premium payments, which she believes gives zero days to notice if a payment was late. She states that she appealed through the FFM and was advised they cannot reinstate her coverage and she needs to appeal through Highmark.Upon review of the member's account, her policy cancelled correctly for nonpayment. There were no errors in the invoicing. The payment she made on May 18, 2015, was the premium for the June coverage period, and gave her a paid to date of July 1, 2015. The July invoice was mailed on June 8, 2015, reflecting a due date of June 30, 2015. On July 7, 2015, the August coverage period was invoiced with a total balance due of $527.48, which included the past due balance for July. This invoice also stated that in order to avoid cancellation of coverage, the total balance due must be received no later than August 1, 2015.The payment of $527.48 was received on August 7, 2015, but was after the end of the thirty-one day grace period. The invoice generated on July 7, 2015 gave a pay by date of August 1, 2015 in order to make the payment within the grace period and avoid disenrollment.Due to the guidelines set by the FFM, we are unable to reinstate a policy if the coverage was cancelled correctly for non-payment. The member will need to contact the FFM in order to enroll in coverage for 2016.If you have additional questions, please contact me directly.Sincerely,Linda ShepardAppeals CoordinatorPhone: 304-917-7187

Review: HAVE CONTACTED HIGHMARK INSURANCE CO 3 TIMES REQUESTING THE 2015 MEDICARE ADVANTAGE PLANS OFFERED BY HIGHMARK AS I HAVE DONE IN PREVIOUS YEARS W/OUT ANY PROBLEMS NOWEVER THIS YEAR I FEEL LIKE I AM GETTING THE RUN AROUND BY NOT RECEIVING THE PLAN DETAILS AND A LIST OF PROVIDERS, I HAVE HAD TO FILE A CLAIM 9/14 AND WONDERING IF THIS IS THE REASON FOR THEIR NON COMPLIANCE FOR NOT FORWARDING INFORMATION FOR THE 2015 PLANSDesired Settlement: FOR HIGHMARK TO BE COMPLIANT WITH WHAT I WAS TOLD 3 TIMES, EVEN TOLD THE ONE TIME IT WOULD BE DELIVERED BY FED EX--NEVER HAPPENED---STOP WITH THE LIES

Business

Response:

Dear Mr. [redacted]:This letter is in response to your inquiry that was received at Freedom Blue PPO onNovember 12, 2014 regarding complaint ID #[redacted].Ms. [redacted] is filing a complaint against Freedom Blue PPO regarding her request toreceive the 2015 Freedom Blue PPO plan materials. Ms. [redacted] states that she hascontacted the plan numerous times to request the information but has yet to receive it.I have investigated this issue and the plan materials were sent to Ms. [redacted] via overnightcarrier on November 10, 2014. I placed a call to Ms. [redacted] on November 21, 2014. Sheconfirmed that she received the requested information the previous week, and did notneed anything further regarding this issue.I apologize for any confusion this issue has caused. If Ms. [redacted] has any additionalquestions or concerns, she may contact a Freedom Blue PPO Customer ServiceRepresentative at ###-###-#### Monday through Sunday 8:00 a.m. to 8:00 p.m.Sincerely,[redacted]CMS Complaint Specialistghrnark

Review: I have the Health Savings Account with Highmark BCBS. I opted to have them pay a bill for me. They sent it to the wrong provider, in turn having my bill sent over to collections with the company they were supposed to pay. I did not find out until it was already in collections. Once I contacted Highmark, they couldn't exactly tell me what happened but that the money was sent to the wrong provider. They first said they would send me a check so that didn't happen a second time. I waited a few weeks for the check; and in the mean time, paid the bill from my checking account to get the report off my credit, but the check never came. I called Highmark back and they told me instead of sending me the check; they had spoke with the provider I owed and they come to an "agreement" and that I should have a posting to my account with the provider. She explained that there was another patient, not on my account, that had owed so they "called it even." She told me to wait a few weeks for it to post to my account with the provider. I did this and called the provider. They state that there is no agreement, and that's against their policies. I've paid this bill twice essentially. When I asked Highmark about where the money was- that if they paid the wrong provider, then why did that provider keep the money? The only thing they could tell me was that it "really wasn't like that, and it's hard to explain." What's hard to understand is why I haven't received my money back and have had to pay this bill twice. I would like for Highmark to reimburse me the amount they owe me.Desired Settlement: I have paid $54.10 to a provider from my HSA, and from my personal checking account. I want $54.10 reimbursed to me, or back into my HSA since I've paid it twice.

Business

Response:

August 12, 2014

Review: Even though I made all required payment, my insurnace card won't work! I called Highmark and spoke with Allison H. who told me to send a fax with proof of my payment which I did. When I went to get my medication the card wouldn't work and there was a note from Highmark that I was not eligible due to nonpayment of premiums. I had to pay for my medication out of pocket. Called Highmark again, was told no one had ever heard of Allison H. and the fax phone number was not known. I called and spoke with Rick C. and Teresa who had me fax another proof of payment to a different fax number. The card still doesn't work and can't get anyone to solve my problemDesired Settlement: Would like my Highmark Insurance card to work.

Business

Response:

Revdex.comAttn: [redacted]Pittsburgh, PA 15220 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 his complaint regarding his Comprehensive Care Blue PPO 1500 health plan that he has made all of the required premium payments but has no coverage. He stated he has sent in proof of payment and is unable to use his prescription coverage.The member made his initial payment via telephone on December 29, 2014. Unfortunately, when the payment was made, it applied to the billing account of a terminated policy. The payment is currently being moved to the correct billing account. A protective hold has been put on his account to prevent it from terminating while the payment is being moved. The member’s prescription coverage is active. If the member paid out of pocket for any prescriptions, prescription claim forms can be sent to the member and he can submit them with the paid receipts for reimbursement. I have provided the forms for the member’s convenience.On behalf of Highmark, I apologize for any inconvenience or frustration experienced as a result of this matter. We strive to provide efficient, courteous and quality service. Even when these standards are not met, we are continually working to improve our service to meet the needs of our valued customers.If you have additional questions, please contact me directly. Sincerely, Cassandra M[redacted] Appeals Coordinator Phone: [redacted]Cc: [redacted]

Consumer

Response:

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 received the attached bill from my doctor office and it was declined for payment by Highmark. I called the doctor office today and they wanted to put me on a payment plan. I then spoke with Highmark and they said it would be reprocessed but it would take 5 to 6 weeks. I have a doctor today and hope this situation is solved.Regards,[redacted] this is a bill for my eye examination from [redacted]. Highmark insisted I use them if I wanted to be reimbursed by them. Now they are denying the charge. Can you help methis?TThank you,[redacted]

Business

Response:

Revdex.com,Attn: [redacted]Case ID: [redacted] File Number: [redacted]Dear [redacted]: ;This is in response to your follow up inquiry sent to us on behalf of member identified by the Case ID number noted above. .The member stated in is complaint that Highmark Blue Cross Blue Shield insisted that he use [redacted] for an eye exam due to their level of participation. He stated the claim was denied payment.The claim in question originally denied because of the issues involving the member’s billing account. The billing issues have been corrected and the paid to date has been updated. This claim has been submitted for reconsideration per the benefits of the member’s plan. It takes approximately three to four weeks for a claim to process and the member will receive a new Explanation of Benefits when the claim has finalized.If you have additional questions, please contact me directly.Sincerely,Cassandra M.Appeals Coordinator Phone:[redacted]

Review: My insurance was canceled for late payment of 2:50 cents. Just as I am being transferred to the federal PCIP PLAN. THEREFORE MAKING ME AND MY SPOUSE INELIGIBLE FOR THAT PROGRAM. ....? Just received a letter from PCIP informing me that I could not join the program because I had no insurance in July. Called Hallmark and they say they canceled our policies for non payment. I did make payments, but was 2 dollars short, Because of bank error issues going back several months. Help please.Desired Settlement: We are with out any insurance at the moment. Of course I am willing to I pay the 2:60 cent discrepancies, and be either reinstated and continue coverage with Hallmark or be able to tell PCIP that I did have coverage and continue to itheir program. Thank you.

Review: Since February I am due back a refund of over $220 in a premium fee billed for a cancelled policy.After 3 phone calls was told a refund check would be received in 2-3 weeks and still did not receive any refund.Desired Settlement: Refund check

Business

Response:

Review: On Dec 16th 2013, I signed on for health insurance with Highmark via the "healthcare.gov" Internet site. Since that time--over three months--I have received no insurance cards, no insurance information, nothing at all to prove that Highmark even knows I exist. I've made numerous calls to their customer service department, and all I get told is that I have "several open inquiries," that I'm "not the only person experiencing this," and so on. It effects my ability to get prescription medications (leading to MORE phone calls and ridiculously long hold times), and they just keep saying that they "can't process my application." I supposedly do have insurance--they've given me numbers over the phone, and I've sent them $1200 over the last three months--but to have this drag on for this long is inexcusable. If their computers can't process my application, isn't it time to hire some new programmers to write some new code so that they CAN process it?I'm honestly just wishing I'd never signed up with Highmark, at this point. Any help would be greatly appreciated.Desired Settlement: All I want is to have my application PROCESSED, for my family and I to receive our insurance cards, and to be able to get my prescriptions from CVS without having to spend an hour on the phone with Highmark while they "Call MEDCO" to have me reinstated for coverage.

Business

Response:

Review: I filled out app for highmark through the marketplace, received a bill that said my payment was due 1/05/14-1/15/14. I went online set up automatic withdrawl from Highmark Blue Cross Blue Shield from our checking account to pull the payment of 587.67 on 1/05/2014. The payment had not pulled as of 8am on 1/15/2014. I called Highmark talked to several different people who said I would get charged on 1/28/2014 for a double bill. Logged on to bank account later to find out they had taken the 587.67. I called back they told me there was no way they could stop the double payment on 1/28 but would refund me the initial payment in form of a check. I never received check in mail and they took out double payment. I have now over drafted my checking from the 3 payments. I have talked to several people from highmark and basically they are telling me there is nothing they can do.They have double dipped payments I have now paid for January, February and March in one month.Desired Settlement: I would like my refund for March at the very least of 587.67

Business

Response:

This is in response to your inquiry sent to us on behalf of the member identified by Case ID

Review: On November 11, 2013, I received surgery on my left shoulder to repair a significant tear in my labrum. My doctor has told me that I will need many MONTHS of physical therapy to regain full use of my left arm. To date, my physical therapists have had to constantly battle my insurance company for me to receive the care that I need. The insurance company was only approving 6 physical therapy sessions before an "evaluation" from my physical therapists was required to approve another 6 sessions. Well On 12/19/13, I was notified by my physical therapists at [redacted] that my insurance company only approved 4 visist this time around. At 1435 hours, on 12/19/13, I spoke with Customer Service representative [redacted]. She told me she could give me no explanation because they outsource to a company called Healthways and she had no contact information to give me for that company. This is what's called "the runaround". Highmark Blue Cross Blue Shield is hindering my efforts at full recovery. If this blatant strategy to impede my recovery results in a loss of function of my left arm, I will be pursuing other legal options.Desired Settlement: To stop interfering with my schedule of care as required by my doctor and physical therapists.

Business

Response:

Review: We have been trying to get out health insurance squared away with Highmark since January. It start out by us never receiving the first bill, which naturally caused the first payment to be late, HighMark has been a nightmare to deal with ever since. Every time we call for an update we are always told it will be resolved in 2 days. 2 days has turned into 4 months. In that time, we payed our premiums on time, though our insurance plan has been canceled again and again, it seems as though every time we go to use our insurance, there is an issue. I am beyond frustrated when calling customer service, being told it is being taken care of, calling a few days later and being told the previous representative didn't do anything to resolve the issue. I honestly don't even remember all of the other issues that arose during this ordeal, All we want is to simply have the health insurance we are paying for. Not to mention all of the claims that are still declined, going back to December, that we were told time and time again were going to be resolved. We still have not received claim forms in the mail that we requested several times now. The complete and total lack of care by Highmark is horrible, and they should be ashamed of themselves for treating their customers this way.Desired Settlement: I just want our insurance square away and not have anymore problems for the rest of year when we will be switching companies. We shouldn't have to be babysitting our insurance company before we go to a doctor appointment. I'd like a sincere apology, since every time we called, the representative has admitted that the company mad a mistake. I know this may be stretching it, but future premium credits would be nice, since we have paid 4 months of premiums and have barely been able to use it.

Business

Response:

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.The member stated in his complaint he did not receive his initial premium invoice which caused his initial premium to be late. He stated that his premiums are paid on time but his insurance plan was cancelled. He stated his claims have been denied and he has not received claim reimbursement forms that were requested.According to Highmark’s records, the enrollment files received from the Federally Facilitated Marketplace (FFM) had errors which prevented them from being systematically uploaded. The application was manually unloaded and the initial invoice was mailed on January 14, 2015, The initial invoice was for January and February, 2015. When the initial payment was made it was for January only. Because this was not the total amount due on the invoice the system automatically cancelled the plan.A file was systematically uploaded from the FFM with a March 1,2015, effective date. The new file received from the FFM contained incorrect rates for the member. The incorrect rates caused billing errors which stopped the invoices from being generated and the paid to date from updating properly.The rates have been updated and the Total Responsible Amount, effective March 1, 2015, is $304.35. The billing is being corrected. Once corrected invoices will generate and the paid to date will update. This will allow claims to process according to the benefits of the plan. The current paid to date is June 1,2015. I have mailed medical and prescription reimbursement forms to the member on May 11,2015.On behalf of Highmark, I apologize for any anxiety or frustration experienced as a result of these matters. We strive to provide efficient, courteous and quality service. Even when these standards are not met, we are continually working to improve our service to meet the needs of our valued customers.If you have additional questions, please contact me directly.Sincerely,[redacted]. Appeals Coordinator Phone: [redacted]

Review: Had Highmark thru Obama Care for 14-15 term. ON 1/1/15 they sent letter advising new payment, I called and advised that my salary would be different 15/16 term. Said I had to reapply thru [redacted] which I did. They sent letter advising of new payment. Since that time I have not been able to get an invoice and so insurance would not cancel 1/1/15 and was told I had to make a phone payment, which I did & was told I would get an invoice which I never got. Now payment for February & still no invoice. I called again (this was my 6th call) & was told again they would request invoice be sent, again no invoice called yesterday & was told again, they would get invoice but I had better pay for Feb or be cancelled. How long does it take to issue invoice??? I keep getting the excuse will be taken care of but no luck, now telling me I will be cancelled if I again don't make a phone payment??? I want an invoice and also was just advised that I have the wrong ID card, group # is wrong, so cannot make appt to see Dr, with wrong card, (knowing my luck, I would use and they would deny claim. I don't think I asking for too much to get invoices. My employer does not offer health care plan, but does give me money to help defray costs. They however require I provide an invoice, so here I am 2 months into the policy with no invoices/money out of my pocket which cannot be reimbursed without an invoice or somthing in writing that I paid. They don't seem to have any problem strong arming me to make payment with no proof of coverage or invoice, they keep giving me excuse after excuse (my favorite is it must have gone to the wrong department) Billing is Billing, so why would it end up in another department. HELP!!!!!Desired Settlement: Want invoices for January & February 2015 term and also correct insurance card showing correct plan etc.

Business

Response:

February 9, 2015 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. Highmark received a passive enrollment file from the [redacted] on December 5, 2014, that reenrolled the consumer’s 2014 insurance policy for the 2015 benefit year. On December 10, 2014, Highmark received an enrollment file in relation to the consumer choosing a new insurance policy for 2015. Unfortunately, the [redacted] did not send a cancellation file for the consumer’s 2014 policy that was passively reenrolled by the [redacted]. This resulted in the consumer being enrolled in two policies. This caused their billing account to be in error, which prevented their invoices from being processed and mailed to them. Highmark has cancelled the 2014 policy and the consumer is only showing active in their [redacted] effective January 1, 2015. ID cards were mailed to the consumer on February 4, 2015. The consumer’s account has been put on a billing hold due to the billing error. She may contact Highmark Customer Service to make a premium payment or wait for a corrected invoice If you have additional questions, please contact me directly. Sincerely, [redacted] Executive/Legislative Inquiries

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Review: Some time ago I started getting mail from Highmark(sometimes the return address said Highmark Medicare Solutions) with an address for both as Fifth Avenue Place 120 Fifth Avenue Pittsburgh PA 15222. The initial mailings were for someone who does not nor has ever lived at my address. I called Highmark on the phone about it and the mailings stopped for a while. Then they stated coming again for the same person, then for another person that does not nor ever has lived here. Then mailings started coming in my name. I sent Highmark two letters regarding this issue. One was sent on September 28, 2013 to have my name and address removed from their mailing list. Then in October 2013 I get two more mailings again under the other two names, so I mailed Highmark another letter requesting the other two names under my address be removed from their mailing list. Today, December 4, 2013 I get another mailing under my name.Desired Settlement: Please remove my name and address from Highmark's mailing list as well as the other two names under my address which are Irene Reese and Robert Reese Sr.

Business

Response:

See attached file

Review: My family and I were enrolled in Blue Cross Blue Shield First Priority Health insurance for 2014-2015 year. We signed up via the marketplace. I was later informed that Highmark Blue Cross Blue Shield was transitioning as the provider for 2016 in a guide labeled "changes effective upon your 2016 renewal". I then received a form letter from Highmark dated 12/10/2015 stating a policy effective date for 01/012016 with a total monthly premium of $221.99 with the content of the letter stating " This is to inform you that you and your dependents have been enrolled in the individual Comprehensive major Medical non-Gatekeeper Preferred provider agreement........" I made my decision to pass on group coverage through work based on this information. Upon receiving my first bill I was charged $664.56. I called customer service to report the discrepancy on 1/11/2016 after receiving my credit card statement. I was referred by Highmark back to Blue Cross Blue Shield with a complaint number for the NEPA Legacy team. I was unable to reach them after three phone calls due to prolonged wait or no eventing hours. I received another letter from Highmark on 1/19/2016 stating that the enclose enrollment confirmation letter replaces any previous letters and that my total monthly premium was now $664.56. At this point, I am no longer eligible for group coverage thru my employer because open enrollment has passed. I called HighMark to request a supervisor. She acknowledged the letter incorrectly quoted me for individual coverage and not family coverage as it had stated. I told her my decision to choose high mark was based on the original family quote and that when It was switched without my consent, It changed my family budget for a 12 month period. She stated that she could not change the premium and that I needed to call the marketplace. The marketplace representative told me that this was high marks negligence and that they could not change premiums. She suggested filing a complaint about the unfair bait and switch practice that I had described to her on 1/20/2016.Desired Settlement: honor the original quoted agreement of $221.99 monthly for my family. Refund my credit card the charges that were not agreed upon that were unjustly charged for January 2016

Business

Response:

February 3, 2016Revdex.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.In his complaint, the member states that after enrolling in coverage for the 2016 coverage period he received a letter dated December 10, 2015, which acknowledged an effective date of coverage of January 1, 2016, with a total premium of $221.99. He further states that his bank account was charged $664.56 for the premium, and not the $221.99 that he was quoted on the acknowledgement letter. The member states that he called Highmark Customer Service on January 11, 2016, to question the charge. He states that he was referred to a complaint phone number for Blue Cross of Northwestern Pennsylvania (NEPA) Legacy Team, but was unable to reach anyone at that number.The member states that he received another letter dated January 19, 2016, which stated it was to replace any previous letters. This new letter advised that the total premium for the policy is $664.56. He states that upon receiving this letter he called Highmark and requested to speak to a supervisor. He states that the supervisor acknowledged the first enrollment letter was incorrect, and advised him to contact the Federally Facilitated Marketplace (FFM) because Highmark cannot change the premium.Upon review of the account, it was determined that there was an error in the premium quoted to the member in the initial letter. The stated amount of $221.99, is the individual premium for him. The correct premium per month for the member and his dependents is $664.56.Because of this discrepancy, Highmark has written off $442.57 from the January premium. That amount will be credited toward the February coverage period, leaving the member a balance of $221.99 for February. He will be responsible for the full $664.56 each month beginning with the March payment. Highmark contacted the member on January 29, 2016, and explained this to him. He was also advised that he can contact the FFM to look into other coverage options for a lower premium.If you have additional questions, please contact me directly.Sincerely,Linda S[redacted]Executive/Legislative InquiriesPhone:[redacted]

Review: Highmark Blue Shield, [redacted], was my health insurance company up until 9/01/15. I paid my premiums up until this date. Later in the year I was informed that my policy was terminated 6/01/15 for non-payment of premiums. I tried to resolve this matter with the insurance company several times over the phone to no avail. Since we have not been able to solve this issue I am asking for the Revdex.com to step in and help me to get the problem taken care of. It's been a long drawn out process and I must admit that patience has ran thin dealing with Highmark.Desired Settlement: For Highmark to correct the problem and pay my claims from June to Sept. 2015 for I can get out of collections.

Business

Response:

December 11, 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 states in his complaint that he had insurance with Highmark, Inc. until September 1, 2015. The member states that he made his premium payments up until then and was paid current. He later states that he was informed that his policy was cancelled effective June 1, 2015, for nonpayment, which he believes to be incorrect.The member’s policy was incorrectly cancelled effective June 1, 2015, due to the balance on the account being incorrect. The member continued to contact Highmark due to his invoices reflecting the incorrect amount and denied claims, but the billing issues were not corrected properly. The member is paid to September 1, 2015, and the policy has been reinstated until that date. Any outstanding claims that were rejected due to no active coverage are being adjusted according to the member's benefits and can take approximately two to three weeks to be completed. The member will receive an updated Explanation of Benefits once the claims are adjusted.If you have additional questions, please contact me directly.Britany H.Executive/Legislative InquiriesPhone:[redacted]

Review: The insurance policy I was sold clearly states it covers diagnostics 100%. I'm being billed for diagnostic procedures. When asked to correct the problem the insurance company claims they only cover diagnostics when there is no complaint. If there is no complaint/no symptoms then there is nothing to diagnose. Furthermore the policy does not state it only covers diagnostics in certain situations.

di·ag·nos·tic (di-ag-nos'tik)

1. Relating to or aiding in diagnosis.

2. Establishing or confirming a diagnosis.

This leaves me thinking I was sold a service that is not being honored.Desired Settlement: I want to be fully reimbursed all moneys I have payed out for services that were supposed to be covered and for Highmark to honor the policy they sold me.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10138381, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

The response is talking about preventive care schedules. I'm talking about diagnostics. Specifically the fact that the paperwork I have says diagnostics are covered 100%. It does not say preventive care, it says diagnostics are covered 100%. When I called about this problem initially the representative of Highmark tried to claim only diagnostics that are preformed when there is no complaint of symptoms are covered. Now the response is preventive care is covered. I want to know why my paperwork says diagnostics are covered 100% and when diagnostic procedures are done I get billed for the service and the run around.

The dates of the services in question are April 2, 2014 ($76.91) and April 25, 2014 ($30).

Regards,

Business

Response:

This is in response to your inquiry dated August 13, 2014.