Independence Blue Cross

[redacted],
Good afternoon.
I am writing to acknowledge our receipt of the concerns for [redacted] under complaint # [redacted]. I will be handling the review and response to the concerns presented. In accordance with the Health Information Portability and Accountability Act (HIPAA),...

we can not release protected health information (PHI) to any recipient without the member's consent/authorization. I will fax the HIPAA Authorization Form to your attention so that [redacted] can complete and return to my attention naming you and the Revdex.com of PA/DC as authorized recipient of his PHI in this matter.
Regards,
Rafael *. D[redacted]
Specialist, Executive Inquiries Department
Independence Blue Cross
###-###-####

[redacted]
this is to acknowledge our receipt of this inquiry. It's curently under review.
As our records do not reflect receipt fo a HIPAA authorization on file, I have attached a form for you to forward to the member for his completion. Once received, we can share our findinghs...

with you. In the event that we dodn;t receive his written authroization to share his protected health information (PHI), then we willm respond directly to the member.
 
Reginald H[redacted]
Executive Inquiries Specialist
[redacted]
[redacted]
*  [redacted]  [redacted]  *   *  [redacted]

Dear [redacted]:
I have enclosed a HIPAA form to be completed ny the member so that we can correspond directly with your office. In the interim I have already begun my investigation regarding the concerns presented in your inquiry.
If you have any questions, please contact me at...

###-###-####. I will be glad to assist you.
Sincerely,
[redacted]
Executive Inquiries

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because the information is incorrect. I informed the customer service rep to keep the original address because the rep informed that I would have to change the address through the marketplace, a hassle that I decided to avoid since I still get mail at the original address. I have never on any occasions received anything but bills. I have never recieved a card in the mail and, at this point, I demand a full refund for all the premiums that I paid. This company continues not sending the insurance card and not being diligent and attentive.  
Regards,
[redacted]

I am writing in response to the May 2, 2016, letter to Detra [redacted] on behalf of Mr. [redacted]. Your complaint was received in our office on May 10, 2016 and concerns enrollment activity.As you are aware, the federal Health Insurance Portability and Accountability Act, known as...

the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing his/her protected health information or PHI. While our records indicate that there is no authorization for you to receive this member's PHI, we want you to know that we have reviewed Mr. [redacted]'s complaint to your office. It has been identified that this matter is resolved and currently consider it closed.Ms. [redacted], we appreciate your bringing Ms. [redacted]'s concerns to our attention. If you have any additional questions, please contact me at ###-###-####.Sincerely,Rafael P. D[redacted] Lead Client Services Representative Executive Inquiries Department

August 24. 2015
Dear [redacted]:Our Manager of the Executive Inquiries Department. Detra D[redacted]. has requested that respond to your August 3, 2015. correspondence regarding [redacted]. The purpose of this letter is to provide you with the details of our reviews outcome.In accordance with the federal health Insurance Portability and Accountability Act. known as the HIPAA privacy rule. it requires that we obtain an individual’s written approval before using or disclosing his her protected health information (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval called an authorization, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule. We appreciate your of lice submitting the authorization from [redacted] listing your office as an authorized recipient of her PHI.
The matter at handIn her correspondence. [redacted] shared the details of several conversations which she had with our customer service team members regarding her family deductible and how she has repeatedly received conflicting information. Additionally. [redacted] submitted her request for reimbursement of $1000 for $500 for 2015 and $500 for 2014 in additional costs she has had to render due to her perspective that our office exceeded her deductible.
Our review Upon receipt of [redacted]'s inquiry. We commenced an investigation into the concerns presented and we discovered the following:
During the May 26, 2015, call our customer service can then her incorrectly advised that two individuals had to meet $1500 towards the deductible in order for the family deductible to the net. The member has an embedded deductible which means once an individual meets their portion of the deductible: services are paid for that person without the entire family deductible being met. All other family members can contribute to the balance $1500 to meet the family deductible.

CUSTOMER NAME:                        [redacted]COMPLAINT ID:                              [redacted] Dear Ms. [redacted]:          ...

            I am writing to acknowledge receipt of the May 12, 2016, correspondence you addressed to Detra D[redacted], Supervisor of the Executive Inquiries Department. This complaint was received in our office on May 18, 2016. The concerns presented by Ms. [redacted] are being reviewed, and will be addressed upon finalization of our review. As you know, the Federal Health Insurance Portability and Accountability Act, known as HIPAA, requires that we obtain an individual’s written approval before disclosing his/her protected health information (PHI). In order for us to provide your office with a resolution, Ms. [redacted] may complete the attached HIPAA Authorization Form. Ms. [redacted], thank you for bringing this matter to our attention. Sincerely,        Diane H[redacted]Lead Client Services RepresentativeExecutive Inquiries Department [redacted]Philadelphia, PA 19103

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
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.  Providing that they actually follow through with the refund.  Time will tell.    
Regards,
Shannon Y[redacted]
Specialist Executive Inquiries

[redacted],
size="3"> 
Per our email exchange on yesterday.
 
We do not have a HIPAA authorization on file from [redacted] (file# [redacted]) to release the details to you about her concerns. However, I can tell you that my team member, [redacted], spoke with **. [redacted] on 4/11/14. **. [redacted] is in an appeal process with our organization about the service she has requested. In fact, it is at the third level appeal review with an external review organization, which should be completed around 4/23/14. **. [redacted] has advised that she does not want us to send her anything in writing until that review is completed.
 
Let me know if you have any questions.
 
[redacted]
Manager
Customer Service1901 Market Street, Mailstop: SG2Philadelphia, PA 19103P  ###-###-####  x[redacted]  |  F  ###-###-####  
[redacted]

Good Morning,...


Member's account is reinstated and he was able to obtain his prescripton drug purhase. I am waiting for information from our Billing Department to complete my response letter.
If you have any questions, please contact me at ###-###-####.
Sincereley,
 
Sylvia B[redacted], Specialist
Executive Inquiries

To:  [redacted]
Helvetica;">The Revdex.comMy complaint has been resolved.  We received the refund owed to us.  I wish the company would see my complaint and perhaps realize that returning customers call would allay frustrations.  Thank you for your help.[redacted]Sent from [redacted] Mobile App

Dear [redacted]
Thank you for contacting us. [redacted] issue has been resolved. His billing account file has been corrected to reflect the proper premium and an invoice was issued to him on March 17, 2014, as he requested.
if you have any questions, please contact me at...

[redacted]. I will be glad to assist you.
sincerely,
Scott Y[redacted] Specialist
Executive Inquiries

I am writing in response to your March 3, 2015, correspondence to Detra D[redacted], Supervisor of the Executive Inquiries Department. Your inquiry was written on behalf of [redacted]'s mother, who contacted your office regarding her daughter’s enrollment and its impact on her ability to obtain the prescription medication she requires.
Unfortunately, we have not received the completed Authorization to Release Information form that would enable us to disclose the details of our review with you. Additionally, it is important to note that our records indicate that there is no authorization on file for Ms. [redacted]’s mother to receive her protected health information either. We are therefore prohibited from disclosing any information regarding our review to you concerning this member.Rather than delay our response, please be advised that we have corresponded our findings directly to Ms. [redacted]. What we can tell you is that we provided her with a clear and favorable resolution to the concerns her mother presented.Mr. [redacted], thank you for writing. If you have any additional questions, please contact me at ###-###-####. I will be happy to assist you.
Sincerely,
 Yvonne Pilgrim, Specialist Executive Inquiries

December 9, 2014
[redacted]
Revdex.com Metro Washington, DC and Eastern Pennsylvania
1441 K St. NW, 10th Floor
Washington, DC  20005-3404
Re:      [redacted]      Complaint ID#:                       [redacted]
Dear [redacted]:
I am writing in response to your follow-up inquiry regarding [redacted]. The purpose of this letter is to inform your office that we have applied the payment in the amount of $1,132.82 to [redacted]’s account.
The matter at hand
In his original complaint to your office, [redacted] stated that, “Independence Blue Cross has failed to credit my account in the amount of $1,132.82 since July 2014.Although the company has received the above funds, they posted it to someone else’s account. I have sent them proof of payment 4 times, and it still is not being resolved. My most recent inquiry did not result in the credit being applied. I have been told a supervisor will call me…but they do not. I receive late notices and letters saying my account may be cancelled. The level of incompetence there is alarming.”
In our November 7, 2014 response, we indicated that our records did not reflect that he was entitled to a premium credit of $1,132.82.
Due to your most recent inquiry, we took a second look at [redacted]’s concern about his account and discovered that we did in fact receive his check, number 2353658685 for $1, 132.82; however, we applied it to an incorrect account. We transferred the payment from the erroneous account and applied it to [redacted]’s account on November 5, 2014. As of today, [redacted]’s balance is $1,132.82, which represents the December 2014 monthly premium.
[redacted], we appreciate the opportunity to address [redacted]’s concern. If you have additional concerns regarding this matter, please feel free to contact me via email at [redacted] .I will be pleased to assist you.
Sincerely,
Rafael *. D[redacted], Specialist
Executive Inquiries Department

Dear [redacted],
EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA">I am writing to acknowledge our receipt of your June 16, 2014, correspondence on behalf of [redacted] (file no: [redacted]). 
We appreciate your writing to alert us to your concern(s). 
 
Our records indicate that there is no authorization for office to receive [redacted]' protected health information or PHI. As a result, we cannot disclose any information regarding our member. Please complete the enclosed Authorization form and return it in the envelope provided. Once this information is received and processed, we will be able to release his PHI to your office.
                            
  Should you have any questions, please call me at ###-###-####.  I will be glad to assist you.
 
Thank you.  
 
Sincerely,
 
 
[redacted]
Specialist
Executive Inquiries

[redacted] --
This is to acknowledge reciept of your email inquiry for [redacted].
Attached is a HIPAA authorization form that needs to be completed by the member in order for us to release PHI to you. If we don;t receive it, then we will respond directly to the...

member.
[redacted]
Executive Inquiries Specialist
[redacted]P  ###-###-####  x[redacted]  |   F  ###-###-####

June 3, 2015Dear [redacted]:
Our Supervisor of the Executive Inquiries Department. Detra D[redacted], has requested that I respond to your May 20, 2015. correspondence regarding [redacted]. The purpose of this letter is to inform your office that we will once again respond directly to [redacted] specific to her additional concerns.
As we shared in our May 11, 2015, The federal Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing his/her protected health information (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.
We did receive the authorization form from your office; however the form was not completed in its entirety and did not actually name you and your office as an authorized recipient of her HIPAA So to prevent any further unnecessary delays, we will direct our response to [redacted]. we appreciate your office bringing [redacted]'s latest concerns to our attention.
Rafael D.
Specialist Executive Inquiries Department

Good afternoon.
I am writing to acknowledge the complaint under file #[redacted]. We have commenced a review into the matter presented and will present our response upon the conclusion of our review.
Regards,
Rafael *. D[redacted]
Specialist, Executive Inquiries...

Department
Independence Blue Cross

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:My complaint is regarding poor customer service. The issue is not that they denied my claims. The issue is that I am unable to talk to anyone at Independence Blue Cross to discuss my claims, get necessary authorizations, switch PCPs, etc. I tried calling again last week and waited on hold for 2 hours and 47 minutes before being disconnected. When I called the customer service number listed on my member ID card, someone answered within 20 minutes but told me that because I have a marketplace policy purchased on healthcare.gov that I needed to be transferred to another number specifically for those policies which resulted in me waiting on hold for almost 3 hours before being disconnected. It is absolutely ridiculous that their members should have to wait on hold for several hours each time they need to contact customer service for required authorizations. Their Obamacare policies with their excessive restrictions, lack of participating providers, and inability to contact customer service to get mandatory authorizations and approvals are clearly inferior to standard insurance policies and Independence Blue Cross did not make me aware of this before purchasing a plan.The response I received was a form about protected health information.  I am not interested in discussing protected health information with the Revdex.com. I am interested in getting a correct phone number listed on my member ID card and receiving prompt customer service.
Regards,
[redacted]

#1f497d;">       
               Re:    [redacted]                   
                                        ...⇄

 



 
                            
   Dear [redacted]:
 
I am writing to acknowledge our receipt of your March 5, 2014, correspondence to [redacted], Manager of the Executive Inquiries Department. We appreciate your writing to alert us to your concern(s).
 
In order to fully address the concerns you have presented, additional research is necessary. I have forwarded your correspondence to the appropriate liaison for further review. 
 
However, as you may be aware, the federal Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing his/her protected health information or PHI for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.
 
Our records indicate that there is no authorization for you to receive this member’s PHI. As a result, we cannot disclose any information regarding our member. We ask that you have [redacted] complete the attached Authorization to Release Information form. In order for the form to be considered valid, all sections of the document must be completed. Should [redacted] require assistance, instructions for the completion of the form are located on the back of the document. Please return the completed document to us via email as a PDF.
 
[redacted], should we complete our review before the completed form is received, we will be required to correspond our findings directly to [redacted].  Thank you for bringing this matter to our attention and for the opportunity to address her concerns.
 
Sincerely,    
 
 
[redacted], Specialist
Executive Inquiries
 
Attachment