Independence Blue Cross

Dear [redacted]:
 
I am writing to acknowledge and respond to the most recent inquiry you addressed to Detra D[redacted], Manager of the Executive Inquiries Department. Your inquiry is dated August 19, 2014, and asks that we respond to your earlier inquiries dated July 28, July 11, and June 26.
 
On July 15, I acknowledged receipt of your July 11, inquiry via email. That communication, in part, apologized for the misdirection of my original acknowledgement, dated June 26, which I addressed to your counterpart, [redacted]. It also reiterated our need to receive a completed Authorization to Release Information form from [redacted], designating you/the Revdex.com as the recipient of her protected health information before we could disclose the details of our review to you. Receiving this document was important as it represents our compliance with the federal Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule.
 
Initially, we did not have authorization to disclose our findings to you. Rather than delay our response, we addressed our findings directly to [redacted] via correspondence dated July 2, 2014. I have attached a copy of that letter for your review and files. Having received the completed authorization form on August 8, we are now able to provide you with a direct response.   
 
Our review
In your most recent inquiry, [redacted] expressed her continued frustration concerning her inability to access medical services, because her enrollment information did not appear in [redacted], the healthcare communications network used by providers to confirm enrollment, eligibility, and to perform functions like creating referrals and seeking medical authorizations.
 
We are aware of the impact this has had on [redacted]’s ability to schedule appointments for medical services. The circumstances surrounding this case are most regrettable and we have extended our sincere apologies to [redacted] for this and for the inconvenience that she has experienced as a result of it.   
 
The first indication concerning this situation was the result of a provider call we received on June 13, 2014. The call was in connection to a June 16 specialist visit that [redacted] was scheduled for, but for which her Primary Care Physician, [redacted] Primary Care, was unable to issue the required referral. Each of the representatives with whom this issue was presented took the necessary action to have [redacted]’s enrollment loaded into the [redacted] system. On June 25, we confirmed that her enrollment information was available in [redacted].
 
However, we found that subsequent to the initial activity regarding provider access to [redacted]’s coverage information via [redacted], she encountered the situation again. We determined that the reason [redacted] was not showing in the system was because of a  routing issue that has since been corrected.
 
[redacted]
 
[redacted], thank you for bringing this matter to our attention, for the patience both you and [redacted] have demonstrated, and for allowing us the opportunity to be of assistance. We hope the information provided alleviates any apprehension [redacted] had about her ability to schedule her medical appointments. Should she have additional questions, we invite her to contact us by calling 1-800-ASK-BLUE.
 
Sincerely,
 
 
 
Yvonne P[redacted], Specialist
Executive Inquiries

November 17, 2014Dear [redacted]:
I am writing in response to your February 14, 2044, letter to the Manager of the Executive Inquiries Department. The purpose of our letter is to inform you that [redacted] is not entitled to a full refund.
The balance of our letter will summarize her concerns and explain why we are unable to honor her request.[redacted]’s concerns [redacted] questioned the information provided in our response. She advised that she is able to receive mailing at her previous mailing address. [redacted] feels that we have not been diligent and attentive in providing her with a copy of her member identification card. As a result, she is asking that we provide a full refund of her premiums paid.
Our findings We regret that [redacted] feels that we have not been helpful and providing her with a copy of her member identification card. Our records confirm that several requests have been submitted and we are not sure why she is not receiving them. In regards a full premium refund, unfortunately, we are unable to honor her request because the member has paid claims on file from October 24, to October 29, 2014.
Coverage cancellation. If [redacted] wishes to cancel her coverage she can call the FFM ###-###-#### to make the request. Members who enroll through the FFM must contact them to cancel or make any changes to his/her plan.[redacted], thank you for bringing this matter to our attention. If you have any additional questions, please contact me at ###-###-####. I will be happy to assist you.Sincerely,Sylvia B
Specialist 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:
I am not accepting anything at this time until IBC actually contacts me and makes this issue correct. To date, I have 4 emails I have sent with no response from IBC and 3 phone calls they have not yet returned. Their track record for following up with emails / phone calls to answer important questions with me is ZERO thus far.
Once they contact me and make things right, I will revise my complaint to reflect such
Regards,
[redacted]

Continuous issues w/BC since 2011 across 4 different policies (Special Care, Obamacare Gold, Obamacare Silver, Medicare). If your PCP is no longer accepting new patients & you keep the same PCP, beware BC has a bug in their enrollment software that will result in them sending you an ID card with your Dr.'s name missing. You have to wait for them to send you the defective card, then call them & hassle over the phone for them to send you a corrected card. This happened 4 separate times, each time I changed policies but kept the same PCP. Voicemail left with BC's director of IT describing the problem was ignored. In 2013, BC Billing Dept. robbed my bank acct of $300. Their response was dismissive, treated me like dirt. Took 17 days to acknowledge Certified Mail when I'm only 20 miles away. Reported them to East Whiteland Police for Theft By Computer. Also filed complaint w/PA Insurance Commission. After 3 months of daily combat I got my money back. No explanation WHO did it, WHY it was done, or if anyone was disciplined. Customer reps for all 4 policies are inept, poorly trained, unprofessional, sometimes seem to just make up stuff to get rid of you. After only 6 months in Obamacare Gold, they raised my premium 121%, using a notice deceptive in its wording. I quickly downgraded to Silver. So many people did this that their billing system crashed in Jan. 2015 & stayed dead for 2 weeks. Many bills then got mailed too late, causing a big billing mess. After devoting 3 mos. reviewing >150 different plans, decided to with BC Keystone-65 Rx HMO for Medicare Part C. They lost my application form, which I sent to them in their own postage-paid envelope. Had to re-enroll by phone all over again 2 weeks later. Enrollment agent was incompetent, failed to ask me about my list of Rx's. HUGE problems getting Rx's filled under Part D coverage. Filed 36 pages of Rx preauthorizations, only to discover the FAX number on BC's own form was incorrect & everything had to be sent all over again. When I filed for an expensive Rx to be lowered to a cheaper tier, they lost the FAX twice, then demanded my Dr. experiment on me with a Rx already known to aggravate my migraines & possibly cause me to pass out (like, while driving!). Some Rx preauthorizations had to be re-submitted because their medical personnel failed to pay attention to details; they demand huge amounts of detailed info then don't read it. Within 1st month of Medicare, had to file 2 Grievances. Both were handled incompetently. Now devoting an average of 25-30 hrs/week on phone trying to resolve issues, mostly going in circles. Long waits on hold, 45% of total phone time spent waiting. Unable to resolve complex Rx issues due to blockage of direct contact with BC's pharmacy benefit mgr. (which is either FutureScripts Secure or Catamaran, depending who you talk to). Catamaran presently under legal indictment for lowballing drug prices (class-action lawsuit filed 2/13/2015 by 55 pharmacies in Harrisburg PA). WORST decision I ever made! Now desperately trying to escape from these bunglers. HUGE details they don't tell you about until after you commit yourself. BEWARE of this company! Marketing Director Paula S[redacted] (that really is her name) is notorious for distributing misinformation, if you receive anything from her THROW IT AWAY! YOU ARE WARNED! These people will WRECK YOUR LIFE.

Hi,
Attached please find the scanned copy of the completed form.  Please let me know if you need additional information.  Thanks for your help.
[redacted]

Good mroning [redacted]:
I am writing inresponse to the above refereenced complaint for on behalf of [redacted]. The purposoe of this letter is to inform you that we originally processed his claim for...

date of service June 17, 2015, and no adjustment or reprocessing of the claim is necessary.
[redacted] contends that his claim was not properly processed correctly as a a [redacted] employee with services rendered by [redacted]. He feels he should not have been subject to the cost sharing that was assessed on his claim.
After further review it appears his claim processed correctly under tier2, taking a $50 copayment. The services were performed at [redacted] Medical Center of the [redacted] Health system which, is not a facility within the [redacted] Network. If services were perfomed by a [redacted] provider, the claim would have processed under tier1 benefit level.
Thank you for bringing [redacted]'s concerns to our attention. If you have any questions, please feel free to contact me at ###-###-####. I will be glad to assist you.
Sincerely,
Scott Y[redacted], Specialist
Executive Inquiries

Dear [redacted]:
We are acknowledging receipt of your inquiry submitted on behalf of [redacted], file# [redacted].
Please find attached the HIPAA authorization form that requires completion by [redacted] before we can release his protected health information to you....


If you have any questions, please do not hesitate to contact me at ###-###-####.
Sincerely,
[redacted], Specialist
Executive Inquiries

Re:    [redacted] 
 
Dear [redacted]
I am writing...

to acknowledge our receipt of your March 17, 2014, correpondence to Detra D[redacted] Manager of the Executive Inquiries Department. 
As you are aware, as part of our acknowledgement process, we normally provide your office with a blank Authorization to Release Information form for the member's completion. This enables us to remain compliant with the federal government's Health Insurance Portability and Accountibility Act, known as the HIPAA Privacy Rule, and to disclose our findings to you. However, we are not attaching a blank authorization form because we were able to review and resolve [redacted] concerns today. Rather than delay our reply, we have responded directly to her with our findings. 
[redacted], we thank you for bringing this matter to our attention. 
Sincerely,
 
Yvonne P[redacted], Specialist
Executive Inquiries

I am writing to acknowledge receipt of the November 28, 2016 correspondence you addressed to Detra D[redacted], Supervisor of the Executive Inquiries Department. This complaint was received in our office on December 5, 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. I have also faxed the HIPAA form to your attention at ###-###-####. Ms. Ortiz, thank you for bringing this matter to our attention. Sincerely, Kathleen L[redacted]Lead Client Services RepresentativeExecutive Inquiries[redacted], 13th floorPhiladelphia, PA 19103

[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:
What does the Hippa law have anything to do with IBC taking my money and then fraudulently canceling my health insurance even tho it was pre-paid for a 3 month period? We are not asking them to share my personal medical history with anyone. This is a straight forward issue:
Money paid on 3/20 for health insurance commencing on 4/1/14 for a 3 month period
IBC charged my credit card on 3/20/14 for 3 months of premium.
Money cleared my bank same day. 3/20/14
IBC cancelled my health insurance on 5/15/14 for what they claim as non payment. My bank statement clearly shows otherwise
Should IBC wish to contact me directly, my cell is ###-###-####. I will wait for them to reach out and contact me and admit their incompetence.
My complaint stands as previously written.
Regards,
[redacted]

January 13, 2015
Dear [redacted]:
I am writing in response to your November 22, 2014, inquiry to our organization on behalf of [redacted]. Please pardon the delay in responding to this inquiry. . The purpose of this letter is to inform you that we issued a refund check in the...

amount of $438.08 to [redacted] on December 16, 2014. This check was cashed on December 24, 2014.Before providing you with our findings, we want to thank you for providing the completed Authorization to Release Information form, as this enables us to release [redacted]’s Protected Health Information (PHI) to your office, as required under the Federal Health Insurance Portability and Accountability Act (HIPAA).
The balance of this letter will provide a summary of [redacted]’s concerns and explain our rationale.
A summary of the member's concerns [redacted] stated AmeriHealth erroneously billed his account $916.26 for October and November 2014—instead of $697.22, as his dependent son, [redacted], was removed from his policy effective October 1, 2014. [redacted] requested a refund of $219.04 overpayment for October 2014 and reconciliation of his account for these months and going forward.
Our determination AmeriHealth reviewed [redacted]’s account and confirmed his son, [redacted] was not enrolled on his contract effective October 1, 2014, resulting in a reduction of his monthly premium from $916.26 to $697.22. [redacted] overpaid his October and November premiums by $219.04 during those months.
[redacted], we appreciate the opportunity to review [redacted]’s concerns and the patience you have demonstrated in awaiting our reply. If you should have any questions regarding this matter, you may contact me at ###-###-#### and I will be happy to assist you.
Sincerely,Reginald HExecutive Inquires Specialist Office of Consumer Advocacy

I am writing in response to the May 2, 2016, letter to Detra D[redacted] on behalf of Mr. [redacted]. Your complaint was received in our office on May 9, 2016 and concerns a denial for medication.
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 was identified that we previously resolved this matter on March 11, 2016, and currently consider it closed.Ms. [redacted], we appreciate your bringing Mr. [redacted]'s concerns to our attention. If you have any additional questions, please do not hesitate to contact me at ###-###-####.
Sincerely,
Rafael P. D[redacted]
Lead Client Services Representative
Executive Inquiries Department

I am writing in response to the May 2, 2016, letter to Detra D[redacted]-S[redacted] on behalf of Ms. [redacted]. Your complaint was received in our office on May 9, 2016 and concerns Ms. [redacted]'s billing account activity.We have received the valid HIPAA authorization from Ms. [redacted],...

which lists your office as an authorized recipient of her PHI and are able to share the details about our review.The matter at hand In her inquiry to your office, Ms, [redacted] expressed concerns about her billing account activity and the denial of services, as a result.
Our review Our records indicate that Ms. [redacted]'s monthly premium payments of $1,106.10 were applied to her account each month. However, it was identified that an enrollment file was received from the Federally Facilitated Marketplace (FFM), which resulted in the creation of two billing accounts. As a result, Ms. [redacted]'s payments were being applied to the wrong billing account.
Independence Blue Cross offers products directly, through its subsidiaries [redacted] Health Plan East and [redacted] Insurance Company, and with [redacted] Blue Shield. Independent Licensees of the Blue Cross and Blue Shield Association.It was identified that we previously resolved this matter on April 18, 2016, and currently consider it closed. Ms. [redacted]'s billing account was corrected and her impacted claims were reprocessed.Ms. [redacted], we appreciate your bringing Ms. [redacted]'s concerns to our attention. If you have any additional questions specific to this matter, please contact me at ###-###-####. I will be pleased to assist you.Sincerely,Diane H[redacted]
Lead Client Services Representative
Executive Inquiries Department

Review: I've been insured with Independence Blue Cross for over 2 years through my employer. I have been receiving services (outpatient counseling) that are covered at 80% after a $100 deductible by my insurance policy. I pay for the services up front with my money and submit claims in order to receive my coverage amount back. For my claims in 2014 so far, the insurance company took the deductible, took out the 20% for my copay and mailed me a check for the correct amount, they then followed up with a bill to me stating that I owed them money back, both for the deductible and for the co-pay (which they had already kept money for). The bill was very misleading about how much was owed, in one area it indicated I owed the copay plus deductible amount ($199), in another area it listed the amount owed as the 80% that they are responsible for ($396). I called them on 11/12/14 and they apologize for their mistake. However, they have done this once previously in the 2 years that I've had the insurance. In addition, they have consistently mailed my refund check to a wrong address. When this first happened 2 years ago I called several times to have my address changed, several staff members including a supervisor promised me that address was corrected. However, again the recent refund check for 2014 was sent to an incorrect address. I have spend hours on the phone, and missed work time due to trying to get this issue resolved. Despite the fact that they cannot mail my refund check to the right address they are able to send bills and general correspondence to the right address. Lastly, the refund check that I did not receive had claims from January through August, when I spoke to the rep, they said they could only seen claims through June. When pressed they said they did see July and August claims and they must have been overlooked. I believe that they are being negligent to the point where they are making it excessively difficult & long for me to get the money I am owed.Desired Settlement: I would like my address to be fixed EVERYWHERE in their system including the office that mails refund checks. I would like for my claims to be handled correctly and for them to cease sending me bills for money that I paid myself out of pocket already. I would like for them to handle ALL of the claims that I sent, instead missing some, or advise on how to send them in a better way.

If there is any building documentation that they have been making it excessively difficult for customers to receive owed money I would like this complaint to be added to any documentation of negligent business practices.

Review: Company continues to ignore crediting payments made in January 2014 and April 2014, even after proof of payment was faxed from my bank with confirmation that fax was transmitted and complete. I have been paying in advance since inception of account and balance shows past due every month. All calls have been in vain. Supervisors will not call back. I have been hung up on and 20-30 minute wait time for rep is standard here. Company is receiving Govt. funds from healthcare marketplace and not bookkeeping properly. Patient was turned away from doctor's appt

after trip made to office and 21. incurred for parking cost for below poverty level customer. Account is paid up to date, would like invoice to reflect all payments. Would be willing to set up for auto payments if company could be trusted to credit properly. Abysmal customer service. Changes to payment options, and providers change on almost monthly basis.Desired Settlement: Request payments made and verified be credited to account, reimbursement for parking cost( for office visit to doctor not provided. due to incorrect records). Humiliation and frustration no charge.,

Business

Response:

Review: I have contacted this company SIX times regarding a claim that was denied. The claim was for a visit that I made on 07/12/13 to a health care provider for treatment of poison sumac that escalated while I was out of town and unable to see my primary care physician. Prior to receiving treatment at the facility that I visited, I showed my health insurance card and asked if it was accepted there. I was told that it was, but that I needed to contact my regular doctor to ask for a referral. I did so the very same day. I also requested such TWICE in person when I saw my primary care physician the very next week. I was told by my primary care physician that they could not provide a referral because "it would be like referring us to ourselves." Even though I requested a referral by phone a FOURTH time back in September, it has not been provided. This has left me in a "Catch-22" situation that is out of my control--the insurance company is requiring a referral that my primary care physician either is unable or unwilling to provide. I have explained this OVER AND OVER to the MANY insurance company customer service representatives with whom I have spoken for a total of SEVERAL HOURS over the last few months. With little exception, NONE of the customer service representatives has bothered to follow through with what was promised to me:

09/19/13--[redacted]--Was sending a request to someone he referred to as a "network coordinator." Said he would call me when he received a response from that person. I never heard from him.

10/15/13--[redacted]--I asked to speak to a supervisor, but instead of properly transferring me to one, she disconnected me.

10/15/13--[redacted]--Told that the claim would be resubmitted for review, but when she phoned the facility that I visited, she gave the billing agent there a different story.

10/22/13--[redacted]--I asked to speak to a supervisor or manager. After waiting on hold for at least 15 minutes, was transferred to [redacted].

10/22/13--[redacted]--Identified herself as the customer service manager. Told me that a "1 time exception" would be made and that the claim would be paid. Assured me that she would be seeing that this issue would be completely resolved and that I would not have to call and speak to anyone else. Told me that it would take 7--10 business days for the claim to be reprocessed and paid. I asked her to call me back when this has been completed. Never heard from her again, and claim still not paid.

11/5/13--[redacted]--Said that she would contact her supervisor to contact [redacted] to let her know that she still needed to take care of resolving this issue. I provided [redacted] with my e-mail address and phone number and asked that the supervisor that reaches out to [redacted] please contact me, as well, so that I can see that this person is doing their job. I asked to be contacted every step of the way.

Haven't heard from anyone since. In the meantime, I continued to receive from the health care facility that I visited bills showing not just the regular charges but also finance charges and late fees, since the amount remained unpaid. This has threatened to damage the excellent credit rating that I have worked so hard to maintain for many years. As a result, I have now charged the outstanding balance to my credit card, which I the last thing I wanted to have to do.

During the many hours that I have spent on the phone with customer service for this issue, I have had the opportunity to listen to lots of recorded advertisements and messages while waiting on hold. One of them says, "...making medicine personal again; we're changing the game..." The company should probably remove this particular recorded message; it could be viewed as false advertising. I certainly don't feel like I have received ANY personal attention in this matter. In fact, I am TOTALLY DISSATISIFED with the EXTREMELY POOR customer service that I have received from the insurance company. NO ONE ever follows through with anything.

I am not willing to call anymore and waste further hours of my time.Desired Settlement: The insurance company must:

1. Immediately reimburse ME for the full amount of the charges ($238) for this medical visit.

2. Pay any additional finance charges and/or late fees incurred by me for this particular visit.

Business

Response:

Greetings **. [redacted],

Attached please find our response letter for the case number [redacted].

Since we do not have an authorization on file for you to receive **. [redacted]'s personal health information (PHI), we provided minimum necessary information in our response letter.

If **. [redacted] is not satisfied with the information in the letter and he has follow up questions, please ensure that he completes the Authorization to Release Information Form and encloses it with his follow up inquiry.

Thank you.

Specialist

Executive Inquiries

December 5, 2013

Dear **. [redacted]:

I am writing to respond to your recent letter to the Manager of the Executive Inquiries Department, [redacted]. The purpose of our letter is to inform you that we correctly processed the claim in question.

First, please extend our sincerest apologies to **. [redacted] for the frustration and inconvenience that we caused him. We reviewed our interactions with him and identified multiple service errors that included no follow up activity, we regret that this occurred. Please be assured that the appropriate members of our Leadership Team are aware of his experience.

HI PA A Privacy Act

Next, 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 for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law.

Should **. [redacted] wish to designate you/the Revdex.com to be the recipient of his PHI, please have him complete the attached Authorization to Release Information Form. To be considered valid, all required categories must be fully completed. The instructions are located on the back of the document. Please return the completed form to: Independence Blue Cross, Executive Inquiries Department - Tedra Fortune, 1901 Market Street, SG/2, Philadelphia, PA 19101.

Our review

While our records indicate that there is no authorization for you to receive **. [redacted]’s PHI, because the nature of the claim inquiry is such a simple one we will simply respond with minimum necessary information. September 19, 2013, is the date that we were first contacted by **. [redacted] about said claim; additionally, he did not contact us prior to having the services. On September 20, we reached out to his primary care physician (PCP) and spoke to [redacted]. [redacted] advised us that instead of **. [redacted] keeping his July 15 appointment with them, he instead sought medical treatment by another physician on July 12. Please know that our [redacted] Health Plan East PCPs will not refer their patient to another PCP or an Internist for treatment. Therefore, **. [redacted]’s PCP was correct in telling him that they cannot/or will not put a referral in place.

Finally, **. [redacted] signed a Member Financial Responsibility Acknowledgment Form, obligating hi**elf to be financially liable for and to pay the expenses that were incurred; therefore, we are in no position to instruct the group practice to cease collection activity.

Appeal Option.

**. [redacted] has the right to file an appeal within 180 days of receiving the explanation of benefits that was dated August 23, 2013. This means that he has until February 23, 2014, to file his appeal. He may send the appeal in writing to: KHPE Appeals Unit, P.O. 41820, Philadelphia,

PA, 19101-1820.

**. [redacted], thank you for writing. If you have any additional questions, please contact me at ###-###-####.1 will be happy to assist you.

Sincerely,

?

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

1. The response does not indicate that the "1 time exception" will be made and that the claim will be paid, both of which were already promised to me by customer service manager [redacted] when I spoke with her on October 22, 2013. It is absolutely imperative that the business follow through with everything that [redacted] had indicated would be done and see that all of these thins are indeed fully completed. Since, to avoid further late fees, finance charges, and potential damage to my credit record, I have since paid the bill in full, when the claim is paid, the payment in the amount of $238 should be sent to me.

2. The response includes false accusations, which I find infinitely offensive. I DID NOT cancel a July 15 appointment with my PCP and choose to instead go somewhere else on July 12. In fact, I NEVER EVEN HAD a July 15 appointment with my PCP, and I have NEVER cancelled any appointment with my PCP in the now near 17 years that I have been going to him. As I have explained VERY MANY times, I was OUT OF TOWN when the poison sumac escalated out of control on Friday, July 12. Once back home, I saw my PCP the following week--on Thursday, July 18--to have him check on the progress of the poison as well as to address other ongoing health-related issues completely unrelated to this complaint. The appointment for this visit to my PCP was made on the same day as the visit itself--Thursday, July 18.

Regards,

Business

Response:

Dear **. [redacted],

This email serves as follow up to my December 5 letter to you and **. [redacted]'s rejection response to our letter.

Since we have not received, from you, a signed Authorization to Release Information of **. [redacted]'s personal health information, we will respond to him directly.

Thank you for contacting us. If you have additional questions or concerns, please feel free to contact me at ###-###-####.

Sincerely,

Specialist

Executive Inquiries

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

1. This business has a history of NOT responding to me and of NOT following through with its promised actions--the very proble** which led to the original complaint--so I have no reason to trust that it will respond now. Therefore it is ABSOLUTELY IMPERATIVE that all responses from the business go to the Revdex.com too and NOT ONLY to me.

2. The business' reason for not responding to the Revdex.com is unacceptable, for several reasons. First of all, since my complaint has very little, if anything at all, to do with my protected health information, and EVERYTHING to do with the business' extremely poor customer service, lack of response, and lack of follow through with promised actions, an authorization to release my personal health information shouldn't even be needed because it should not be necessary to release any such detailed information. Nonetheless, secondly, I ALREADY had ACCEPTED the HIPAA release way back on 11/19/13 when it was presented to me in the process of filing the complaint online, and this is clearly indicated on the page showing the complaint. And finally, third, the impression is that the business is attempting to use this non-issue of a HIPAA release (which again, I had already ACCEPTED) to further stall the process of resolving this matter or to avoid the real issues of poor customer service, lack or response, and lack of follow through with promised actions that I had raised in my complaint, and this I find to be highly unprofessional.

Regards,

Review: Amerihealth is my mental health Insurance. I have been seeing my therapist, [redacted], [redacted], since March, 2013 and Amerihealth did not pay for any of her session dates until recently although the claims have been submitted countless times. There was no valid reason for the delay. Amerihealth still owes **. [redacted] for the following dates of service: 3/28/13, 4/2/13, 4/3/13, 4/9/13, 4/16/13, 4/23/13, 4/30/13, 5/14/13, 5/21/13, 6/4/13, 6/18/13,7/9/13. There may be other unpaid dates as well.Desired Settlement: Amerihealth needs to provide me with my insurance benefit. Amerihealth needs to pay **. [redacted] for her services as my and my wife's psychotherapist. Each session has been billed for $225.00.

Business

Response:

Wednesday, September 11, 2013

Dear **. [redacted]:

I am writing to acknowledge our receipt of your August 28, 2013, letter addressed to our plan. Your inquiry was received in the

Executive Inquiries Department on September 10, for review and response.

As you are aware, the Federal Health Insurance Portability and Accountability Act (HIPAA), known as the HIPAA Privacy Rule,

requires that we obtain an individual's written approval before using or disclosing their protected health information (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. Our records indicate that there is no authorization on file for you to receive **. [redacted]'s PHI.

In order to provide you with the information you've requested, please have **. [redacted] complete the attached Authorization to Release Information form. To be considered valid, all areas of the document must be completed. Instructions are listed on the back of the form should assistance be required. Please use the postage paid, self-addressed return envelope to return the form to our office.

**. [redacted], in the interim, we have initiated a review of the issues you presented. However, if we do not receive the completed authorization form by the time we have completed our review, we will correspond our findings directly to **. [redacted]. Thank you.

Sincerely,

Review: I am a terminally ill patient and I am in need of dental surgery I went to my dentist to see why was I having intensive pain daily and these 2 holes in my front teeth keeps getting bigger and bigger. They finally told me that I was in need of root canals on teeth 7,8,9, and crowns then the dentist informed me that the health plan does not cover such surgery anymore. I called into the health plan and they advised me that if I had a medical neccessity I can have my dentist fill out a BLE form which will explain why I needed the surgery they also told me to have my medical doctor fax in a letter stating that without the surgery it can harm my health. So my dentist and medical doctor sent in all the requested information and I received a denial letter in the mail when I called into [redacted] to file a complaint they said they did not see the medical need so the claim was denied. My illness helps rott out my teeth and if a medical doctor advised them it was crucial to my health how can they deny me when everything was done that they asked of me.

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like for the health plan to take into consideration my doctors letter and the dentist form and see that this is a medical need and the longer it is put off I am in pain daily taking pain pills when this can turn into and infection in my entire mouth then I will have no teeth at all. I would like for them to approve the surgery

Business

Response:

From: [redacted]

Sent: Thursday, April 18, 2013 11:52 AM

To: [redacted]

Subject: ID#[redacted] Good Morning [redacted]- I left you two detailed voice mail messages regarding ID#[redacted]. After reaching out to [redacted], she has confirmed that her coverage is with [redacted]. Please advise if you have a contact person @ [redacted] to redirect the inquiry to. Thanks in advance for your assistance. [redacted]

Technical Advisor

1[redacted]

[redacted]

Review: My problem does NOT involve any health or medical issues or other protected health information. My complaint is primarily about poor customer service (being unable to reach customer service by phone, very long hold times, voicemails not being returned, website not working).

I purchased a health insurance policy effective 1/1/14. The plan was an HMO that required selecting a primary care physician (PCP) and getting all health care authorized by the PCP. I selected a PCP on their website in January to be effective 2/1/14. In February, I was able to print a temporary ID card on the website with my PCP's office listed on it so I saw the PCP thinking I would be covered. I got a notice later saying my claim had been denied because the office visit wasn't provided by my PCP. I called customer service and was told their website was not working so my request to select a PCP was not processed. I was told they would change my PCP and make it effective 2/1/14. A week later further claims were denied and the reason listed was not authorized by PCP. They still had not changed my PCP. I called to appeal that denial and request my PCP be changed. They were busy so they took a message and said they'd contact me within 24 hours. That was a week ago. I tried to call again today but I was put on hold, transferred numerous times, and the call was disconnected before I was able to discuss my issue with anyone.Desired Settlement: I want them to adjust their records to make my current PCP request effective 2/1/14 instead of 3/1/14 as it is now so my claims will be paid.

All of my problems with this company were the result of an inadequate number of employees working in customer service. They knew they'd have additional customers as a result of Obamacare but three months into the year they still haven't hired enough staff to answer calls and resolve issues quickly. I want them to stop putting profits ahead of their members by hiring more employees and better organize their customer service so no one else has to waste their time on hold, deal with being transferred multiple times to the wrong people in one phone call, or delay medical care because they are unsure whether their claim will be paid.

Business

Response:

[redacted]--

Attached is an authorization for you to provide to the member so that we can share our findings with your offcie. If we don not receive it, we will respond directly to the member.

Review: about four months ago I set up online bill pay through my bank to [redacted] health plan, my ins. carrier. I was guided through by a rep at [redacted].I began paying this way and received invoices that were messed up. Here, my premium payment was supposed to go to one account and my dental extra plan to another so the way the rep had me set it up, everything went to the extra plan and none to the premium. I have tried at least ten lengthy times to have the problem corrected and was told that I'd be contacted or that the problem was fixed and neither ever happened. For the last time I went through this, now I'm asking for your help.Desired Settlement: I would like my billing to reflect properly.

Business

Response:

Good afternoon **. [redacted]: Thank you for returning my call and for allowing me to get our reply to you outside the normal means. Attached is our response: As I advised, in the absence of a HIPAA authorization form, we have responded directly to [redacted]. Thanking you again. Have a good one. [redacted], Specialist Executive Inquiries 1901 Market Street, SG - 2Philadelphia, Pa 19103

P ###-###-#### Ext [redacted] | F ###-###-####

?

Consumer

Response:

Review: [redacted]

I am rejecting this response because:This message is in regard to complaint numbered [redacted] that I lodged against Independence Blue Cross. They have alleged to you and I both that the problem has been resolved, this problem has not been resolved. They have been telling me that for six months. Now what they have done is basically zero-ed out my blue extra over payment of about $340 instead of applying it to the blue cross premium. This problem is not resolved

Regards,