Highmark Blue Cross Blue Shield

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted] After filing a compliant via Revdex.com, I received a phone and letter saying that HighMark Blue Shield will take care of the rest of bill, $ 551.00, from [redacted] for [redacted], account number: [redacted], as soon as I pay $118.03. $118.03 check was cashed out on November, 2015, and HighMark Blue Shield still doesn’t pay for the rest of bill. Instead, I received a letter from [redacted]. saying that “We are writing in regard to an overdue balance of $551.00 for medical services provided to you at [redacted]. This is your final notice. In order to avoid having your account placed with a collection agency, please remit balance in full today or call our patient service center at [redacted].” I don’t know how long take HighMark Blue Shield to pay what they should pay, but it’s been years. Thanks.Please pay the rest of bill as soon as possible. Thanks. $551.00 - 118.05 = What HighMark Blue Shield should pay.

Dear Ms. [redacted]:This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.In her complaint, the member stated that she was told by Highmark she would not owe anything for routine checkups. The member stated that she had blood work done at Quest...

Diagnostics, as part of her routine checkup on July 24, 2015. She then received a bill from Quest Diagnostics for $50.00. The member stated that she contacted Highmark about the services not being covered and was advised by a Customer Service Advocate (CSA) to disregard the bill because the doctor had coded the blood work wrong and her doctor would need to resubmit the claim. She stated that her doctor resubmitted the claim but she received another bill from Quest Diagnostics for $50.00. The member stated this time she contacted Quest Diagnostics and the representative from Quest Diagnostics contacted Highmark. The representative from Quest Diagnostics advised the member that everything had been taken care of and to disregard the bill. She stated a couple months later she received another bill from Quest Diagnostics. The member then stated she contacted Highmark and was advised to disregard the bill because there was a duplicate bill in their system from when the doctor resubmitted it, and the duplicate would be deleted. In March of 2016 she received another bill from Quest Diagnostics for $50.00. The member stated that she contacted Highmark again and the CSA contacted Quest Diagnostics while she was on hold. She stated that the Highmark CSA advised her that after speaking with Quest Diagnostics that everything was straightened out and that she should not receive any more bills, and to disregard the bill. In April 2016 she received another bill from Quest Diagnostics and was told by Highmark for the first time in nine months that she did owe the $50.00 because one of the tests was not considered routine.The member stated she appealed the bill because she felt like she was being misled by Highmark, who for months reassured her that she owned nothing. Her appeal was denied and she owed $50.00. She contacted Highmark for further explanation of the denial letter. She stated the Highmark CSA advised her that she owes $55.75 instead of $50.00. The member stated that Highmark is incompetent and misleading in their billing practices and cannot even decide on what amount they want to bill you.Highmark has reviewed the claim in question. The claim from July 24, 2015, has been correctly processed according to the benefits of the plan. The claim has five procedures listed on it. The procedures listed on the claim that are not covered under the preventive schedule on this claim are: [redacted], [redacted] and [redacted]. The procedures that are covered under the preventive schedule are: [redacted] and [redacted]. Highmark cannot process the other procedures listed on the claim as routine because the procedures are not part of the 2015 preventive schedule. The preventive schedules are viewable online at www.highmarkbcbs.com and in the member’s benefit book. I have enclosed a copy of the 2015 preventive schedule.Highmark’s records indicate that the member contacted Highmark Customer Service four times regarding the claim for date of service July 24,2015. During the call on September 14,2015, which was prior to the resubmission of the claim, the member was advised that her responsible amount was $50.00. The claim was resubmitted by the provider and reprocessed according to the member’s benefits. Based on the revised billing codes, the claim processed with the member responsibility of $55.75. The member had a copay of $50.00 and $5.75 was applied to the member’s deductible.On behalf of Highmark, I apologize for any anxiety or inconvenience this issue may have caused. If you have additional questions, please contact me directly.Sincerely,Michelle D[redacted]Appeals CoordinatorPhone: [redacted]

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 IF the invoices are generated correctly and at the correct amount as noted on my healthcare.gov agreement.Thanks to [redacted] in W VA for sleuthing out the problem and to all who have addressed it for a resolution.  
Regards,
[redacted]

June 24, 2015 [redacted] Revdex.com [redacted] Re: ID# [redacted] Dear [redacted]: We are in receipt of the Complaint dated June 8, 2015 regarding the member’s ongoing billing and collection issues.  The member had previously contacted...

the President of Highmark Inc. directly on May 25, 2015. The member’s account was reviewed with respect to the noted issues with payments not being posted to his account and revealed that the automatic payment feature with the member’s banking institution was set up with the incorrect billing account number which caused the payments to be directed to the wrong account. On Friday, May 29, 2015, the member’s payments were located and applied to the correct account.  The member’s paid to date was then advanced to July 1, 2015.  The member was contacted on May 29th and advised of the status of his complaint and the correction made to his account. By this point the new invoices for June had already been generated and mailed, which will account for why the June invoice remained incorrect. Highmark set up monthly monitoring on the member’s account to ensure that payments are posted correctly.  Upon further review on June 12, 2015, the member’s account is still accurate and his most recent invoice was also correct.  Highmark will continue to monitor this account. Highmark WV understands the frustration the member has experienced trying to get the matter resolved.  We appreciate the opportunity to advocate education with our billing team to understand why there continued to be an issue and what we could do to correct it so that other members would not experience the same issues. If we can be of further assistance, please contact me at the below email address. Sincerely, Courtney N. L[redacted], Associate Counsel [redacted]

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. I just received another statement showing an outstanding amount of $139.40.  I spoke with Harold at BCBS on 6/02/2015 regarding my office visit dated of 04/21/2015 (Procedure Code [redacted]).  He said BCBS had to re file  the claim. This is to show you that I continue to have on going problems.    [redacted], attached is the paper work from [redacted] showing Highmark BCBS not covering my [redacted]!  Highmark say's I'm cover for the vaccination but they won't pay any of it and you can see were [redacted] is charging me $ 214.55.  Can you help me resolve this matter? Thank you,[redacted]
Regards,
[redacted]

This is in response to your inquiry sent to us on behalf of member identified by the Case IDnumber noted above.The customer states that they made the first premium payment and after the policy was cancelled requested thepayment be refunded.Unfortunately, the application received from the PPM...

contained the incorrect address for theconsumer. A reftuid of the consumer’s premium wits mailed to the member and returned toHighmark as undeliverable, A new refund check has been reissued to the consumer at the addressprovided in the complaint. The refund was issued on January 21, 2015.On behalf of Highmark, I apologize for any inconvenience or anxiety the consumer experiencedin relation to this matter.If you have additional questions, please contact me directly.Sincerely,[redacted]

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. my payments were taken each month, leaving me with the impression I was insured. if the company did not intend to insure me. they should not have collected my payments or waited until december to inform me that I was not insured.  i am rather disgusted with highmark and request my money back for the entire year. dr [redacted] should be paid what he is owed and my irs penalty should be taken care of. this does not even take into account all the hours of my time that was wasted on the phone being transferring from one 'csa' to the nxet
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me, although I actually DID contact the [redacted] as per instructions.When I called the [redacted] a second time, I verified that they did log my first cancellation request. Thank you for all your help.   
Regards,
[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's spouse states in her complaint that she contacted a Highmark customer service supervisor and the [redacted] ([redacted]) and was advised...

that her husband's plan and her son's plan  would cancel December 31, 2014 for both members. The member’s spouse did contact Highmark on December 17 2014 and a conference call was done with all three parties, the member’s spouse, Highmark and the [redacted]. The [redacted] representative advised that the plans for 2014 would end December 31, 2014 with no additional enrollment information on file for 2015. Highmark did not receive a termination file from the [redacted], and per the guidelines from the [redacted], the member was automatically enrolled into the same plan for the 2015 benefit year. Those plans have subsequently been cancelled effective January 1, 2015, when the member contacted Highmark Customer Service and advised they did not want to be enrolled for 2015. The member may disregard any invoices pertaining to the 2015 policy. On behalf of Highmark, I apologize for any inconvenience or concerns the member may have experienced due to this matter. If you have any additional questions, please contact me directly. Sincerely, [redacted] Executive Legislative Inquiries Highmark Inc.

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.
Regards,
Amy KohrAttention [redacted]Complaint #[redacted]I have attached two documents  The first, Claim 1 shows how my original claim processed to show I owe nothing.  Which is why for 9 months I was told I owe nothing.  The second document, Claim 2 shows that on some unknown date they adjusted my original claim and charged me $55.75  You don’t after 9 months decide to adjust a claim for no apparent reason.  I can’t tell you the numerous people I spoke to at Highmark over that nine month period who assured me I owe nothing and to disregard the bill.  I can’t believe there are that many incompetent people working there.  The reason they told me I owe nothing is because it was showing them, on their end, I owe nothing. Or are they going to try to say, yes these people could see I owe the $55.75 but they all decided to tell me for nine months I didn’t.  I don’t think so. This is why I am still disputing this charge

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted] I was able to speak with Stephanie and she was able to assist me.

December 10, 2015Revdex.com[redacted]Attention: [redacted]Case ID: [redacted]Dear [redacted]:This is in response to your inquiry sent to us on behalf of the member identified in your inquiry by Case ID [redacted], and their additional concerns related to our original response submitted to your office on October 20, 2015.On October 9, 2015, a letter was sent to the member along with a copy of the cancelled check issued to the member, dated January 24, 2014, which was related to the claim in question. This same letter also provided the member instructions on how to contact our office once the amount associated with this cancelled check was forwarded to the provider, applied to their account, and a bill for the remaining balance was received from the provider. To date, our records indicate the member has not contacted our office to provide this information. For consideration of the remaining balance, the member should refer to the instructions provided in this letter.If the member has misplaced our letter dated October 9, 2015, or needs to receive instructions on how to forward the required information to consider their remaining balance, the member should contact our Customer Service Department at [redacted]. If you have additional questions, please contact me directly.Sincerely,Margie L[redacted]Executive/Legislative Inquiries

This is in response to your inquiry sent to us regarding the member identified by your case ID[redacted]The member received an Explanation of Benefits (EOB) statement, for a claim that showed twoseparate services each with different charge amounts, but listed as the same type of service. Thisclaim...

processed one charge as an eligible service, but denied the other charge. The membercontacted our Customer Service Department for an explanation was advised that although theservices were both listed on the statement as the same type of service on the statement, therewere different procedure codes attached to each service on the claim.While our EOB statements for professional claims list specific procedure codes for servicesrendered, facility claims, such as the one in question, show revenue codes on our statements.These revenue codes are categorized by general service; however, a more specific procedurecode may be required for processing to determine benefits and pricing. The revenue andprocedure code is submitted by the facility to Highmark, and is present on our processingsystem, but both codes aren’t shown on our statements. However, Customer Service and/or thebilling facility may provide this information to the member.The denial of the service found in this facility claim was determined to be experimental andinvestigational, according to our Medical Policy, thus rendering the service ineligible forcoverage. This specific policy bulletin was recently provided to this member, along with aresponse to his letter received in our Law Department.Customer Service is the most appropriate source of information pertaining to claims and benefits.We respectfully request that this member continue to utilize this service for questions.

Revdex.com:
I send my deepest apologies.  Upon receiving BCBS' response I checked with my husband to only discover he had in fact received and cashed the check.
Regards,
[redacted]

May 11,2016Revdex.comAttn: [redacted]Case ID: [redacted]File Number: [redacted]Dear Ms. [redacted]:This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above.In her complaint, the member...

stated that her policy with Highmark officially ended on January 1, 2016. She stated in order for her new insurance to work, she needs an official cancellation letter from Highmark stating she is no longer covered under the policy. She stated after an attempt to have a cancellation letter faxed to the New York State of Health, she was informed that Highmark the New York State of Health never received the fax even though Highmark said they would fax the letter. She stated she called Highmark back and requested someone email her the letter of cancellation, but instead received an email stating her cancellation date. She stated she then called Highmark back to receive the letter and was told she would receive the email with the letter as an attachment; however, she still has not received a letter. She stated this is causing her to be unable to fill her medications and is becoming a life threatening situation.Highmark sent one letter and one email to her for proof of cancellation. The letter was dated March 8, 2016, and the email was sent on April 27, 2016. Highmark’s records indicate a letter was sent to [redacted] and an email was sent to [redacted] on April 28, 2016, Highmark contacted her to advise another letter has been prepared and securely emailed to her and faxed to the New York State of Health at [redacted]. Highmark also sent a copy of the cancellation letter to her through the mail.On behalf of Highmark, I apologize for any anxiety or inconvenience this issue may have caused. If you have additional questions, please contact me directly.Sincerely,Michelle D[redacted]Appeals CoordinatorPhone: [redacted]

May 29, 2015 Revdex.com Attn: [redacted]  [redacted]                                                                                       Case ID: [redacted]                                         ...⇄ File Number: [redacted] Dear [redacted]: This is in response to your inquiry sent to us on behalf of member identified by the Case ID number noted above. The member stated in the complaint that they went to fill a prescription and received a rejection.  The member states that all premium payments have been made on time, and also states that their PCP says there is still a balance due because of denied medical claims.  This complaint is a follow up to the complaint that was filed on March 19, 2015 which was due to errors in the billing which resulted in claim denials.  I have reviewed the account thoroughly, and have verified that all of the issues have been resolved. The issues within the account actually finalized on May 8, 2015 when the prescription system updated with the correct paid to date information. All medical claims and prescription claims submitted have also been reviewed, and all have processed and paid according to the terms of the contract. The last medical claims finalized on May 7, 2015. The member should be receiving updated Explanations of Benefits for these claims. 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,                                             ...⇄ Linda S[redacted]                                         ...⇄ Appeals Coordinator                                         ...⇄ Phone: [redacted]

December 31, 2015Revdex.com[redacted]Pittsburgh, PA 15220Attn: [redacted]Case ID: [redacted]Dear [redacted]:This is in response to your inquiry sent to us on behalf of the member identified in your inquiry by Case ID [redacted].Our records indicate that a letter was issued to the member on December 14, 2015, advising that a copy of a balance bill from the provider was required from the member. The bill needs to show the $119.03 as paid by the member and showing the remaining balance of $507.97 as being billed to the member.While the member has requested a call back from the previous Executive Legislative Analyst, please recognize that the member has a dedicated service department for telephone inquiries. I confirmed that the telephone number listed at the closing of this letter is correct.If the member has any questions concerning this coverage, please have the member contact our Customer Service Department at [redacted]. If you have additional questions, please contact me directly.Sincerely, Margueritte M[redacted]Executive/Legislative Inquiries

Dear Ms. [redacted]:This is in response to your inquiry sent to us on behalf of the member identified by the Case ID number noted above.In his complaint, the member states that he did not enroll in coverage through Highmark for the 2017 plan period, He states that he enrolled in a policy through another...

carrier. He is concerned because he has called Highmark to cancel the policy and is still receiving invoices. He would like to ensure that his policy for 2017 is no longer active, and that this will not reflect negatively on his credit report due to the invoices that were sent.Highmark has reviewed the member’s account. The member was auto-enrolled into a policy for the 2017 plan period by the Federally Facilitated Marketplace (FFM). Per the guidelines set by the FFM, health insurers are not permitted to cancel a member’s coverage without the direction of the FFM. On December 14, 2016, an enrollment file was received from the FFM, enrolling the member and his spouse into the Connect Blue EPO 2500 policy effective January 1, 2017. A cancellation file was received from the FFM on January 16, 2017, directing Highmark to cancel the policy effective January 1, 2017. However, due to a systemic error, the enrollment system did not cancel the policy.Higlimark has voided the coverage for the 2017 plan year effective January 1, 2017. Highmark does not report to any outside credit agencies if an invoice is unpaid, and also because the policy was voided, there will not be any impact to the member’s credit report.On behalf of Highmark, I apologize for the confusion and frustration felt by the member. If you have additional questions, please contact me directly.Sincerely, Linda K[redacted]Executive/Legislative InquiriesPhone: [redacted]

Dear Ms. Gasser, We have responded to the member in writing concerning  his 1095-B form.  The letter explains the following: Blue Cross received your complaint through the Revdex.com regarding the processing timeframes of your health insurance tax form (1095B...

form). The 1095B form is a health insurance tax form which reports the following information: type of health care coverage; dependents covered under the insurance policy; the period of coverage for the prior year.  The form is used when filing taxes to verify that the filer and dependents had at least the minimum qualifying health insurance coverage Please be advised that the 1095B form was sent to members on Monday, March 28, 2016, which meets the timeframe required by the Federal Government of mailing the form by March 31, 2016.  Thank you.

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