Independence Blue Cross

Review: I enrolled in Amerihealth for myself and my wife on December 23, 2013, since then I have remitted two payments (for January and February) to Amerihealth by check. I have bank statements and copies of both checks being cleared as proof. It is now March 4, 2014 and we have still yet to receive our insurance ID cards, information on our insurance plan, including a list of doctors/providers.

I have now received the invoice for March and it still shows that I have two months of overdue payments (outstanding January and February payments). This was the same issue with February's invoice (which stated they had not received January payment) that also asked for an overdue payment (although I had paid). When I somehow miraculously got through to their GENERAL line after over an hour wait on the phone and being transferred twice, the representative told me that I needed to submit proof of payment, that they had not received payment. They also mentioned that my and my wife's insurance ID card was sent out and that we should receive it within 3 business days.

The ID cards never came. I sent in a copy of the cleared check and they are STILL sending me an incorrect overdue bill. I will not be submitting payment until I am able to receive a corrected bill or some sort of receipt of my previous payments that's been credited to my account.

It is IMPOSSIBLE to reach someone via phone and I have lost my patience in trying to work with their customer service. Every time I call I am placed on a wait due to "a large number of calls". When I call during business hours, their automated message says that they have extended their customer service hours to 8PM due to the high volume of calls however, when I call at 5PM the automated message says that they are closed as their normal business hours end at 5PM. Their customer support system is extremely inadequate and their service is unconscionable.

I refuse to submit the payment for March until they send me the ID cards as they claim to have sent out, a revised invoiced crediting my payments as well as all other necessary paperwork and information regarding the health insurance plan that we have purchased. It is also astonishing that I have YET to actually speak to a representative in the billing department.

If a revised bill cannot be sent IMMEDIATELY then I would like a refund for the two payments I have made and would like to cancel my account.Desired Settlement: I would like ANY of the following: billing adjustment, our id cards, a refund, a phone call, and if none of the above can be provided then a refund for all payments.

Business

Response:

Re: [redacted]

Review: Independence Blue Cross cannot confirm their contractual agreements with [redacted] and other 3rd par** vendors that may have access to my and my dependents' medical information.

Please see complaint ID [redacted] filed with Kentucky Revdex.com on 11/10/13. Another related complain was filed with Kentucky Revdex.com on 11/22/13, but a complaint ID was not provided.

I spoke with [redacted] and [redacted] at 1-800-ASK-BLUE. [redacted] filed my complaint in their system at Independence Blue Cross regarding the securi** and privacy of my and my dependents' medical records.Desired Settlement: I am requesting a letter confirming the following requests were completed by Independence Blue Cross:

1) Remove all medical information belonging to myself (as the policy holder) and my dependents from the [redacted] database.

2) Confirmation that [redacted] will no longer contact me or my dependents on file in the Independence Blue Cross database. [redacted] is not authorized to have our information.

Business

Response:

November 27, 2013

**. [redacted]

The Revdex.com

1337 N. Front Street

Harrisburg, PA 17102

Re: [redacted]

File No: [redacted]

Dear **. [redacted]:

I am writing in response to your November 25, 2013, letter to the Manager of the Executive Inquiries Department, [redacted].

Our records indicate that there is no authorization for your office to receive **. **’s protected health information or PHI. As a result, we cannot disclose any information regarding our member. Because this letter provides general information, we are able to respond to you regarding the matter in question. In the event that your office requires additional information, I have enclosed a HIPAA authorization form to be completed by **. ** to allow our office to release her personal health information (PHI).

**. **’s concerns

**. ** contacted your office about [redacted] having access to her and her family’s medical information. She feels that this is a direct violation of her family’s PHI.

Our Findings

This section will explain who why we use [redacted] and to assure **. ** that her and her families PHI is in no way being compromised.

[redacted]. [redacted] is the leading single source for claims recovery solutions in the U.S. Healthcare payors across the country recognize the value of our unique, integrated recovery services which combine a disciplined process with the use of expert staff and proprietary technology, [redacted], to deliver leading-edge solutions.

(over)

**. [redacted] Page 2 of 2

Review: Good Evening:I am writing this complaint regarding my current health insurance information. I enrolled in a health insurance plan with [redacted] of Florida through the marketplace exchange website back in November 26, 2013. I paid my plan premium in December 12,2013. I have never my insurance card and plan information. when I finally find someone to tell me what is going on with my plan. He gave me an old insurance policy information that I had through my former employer instead of the current plan I paid in full for back in December. the old plan was a regular health plan but I enrolled in an "HEALTH SAVINGS ACCOUNT" plan.Desired Settlement: DesiredSettlementID: Refund

Two weeks ago, I told one of the representative and sent an e-mail requesting a refund of my premium so that I can go to another provider to get the plan coverage that I want. I still have not heard anything from them. When I called them they place me on hold for about 30 - 40 minutes.

Business

Response:

**. [redacted],

**. [redacted] is not our member. She is a member of [redacted] of Florida. Please contact them for more details concerning this member at:

CoventryOne Direct Customer Service

Toll free: ###-###-####

TDD: 711 (for the hearing impaired)

Hours of operation: Monday through Friday between 8:00 a.m. to 6:00 p.m. EST

Sincerely,

[redacted], Team Manager

Review: Blue cross has failed to provide dental cards and coverage under my account. When I originally call on behalf of myself and wife effective date was originally promised as back dated to 7/1 - but I never received my cards.Desired Settlement: I would like my dental checkups and repairs covered for myself and my Wife and I would like a refund for the period of time that I have been unable to receive coverage beginning in July of 2014.

Business

Response:

Good afternoon [redacted]:

I am writing in response to your inquiry on behalf of [redacted]. [redacted] contacted your office requesting assistance in getting his dental checkups and repairs covered for himself and his wife. He also requested that he be refunded for the period of time that he was unable to use his dental coverage because he states that he had no ID cards to present to the dentist.

[redacted]’s coverage is through his employer group and the premiums are paid by the group; therefore, if there is a refund to be issued to him it would have to come from his group. We identified that on July 9, 2014, our customer services representative contacted the dental provider, [redacted], and requested that ID cards be issued to [redacted]. This was done again on August 7, 2014.

[redacted], thank you for bringing [redacted]’s concerns to our attention. If you have any questions please contact me at ###-###-####. I will be glad to assist you.

Sincerely,

Scott Y[redacted]

Specialist

Executive Inquiries

Review: My husband has repeatedly asked this itic company whose insurance we got through Obama care to send us the member ID card. The only thing we get is bills, but not the member ID card. This has prevented me from getting the medical assistance that I need. My husband spoke to one customer service rep today who informed him that an ID card has been sent, but when my husband told him that we won't pay this insurance anymore until we get the card, the rep said that we will not be getting a member ID card then. The behavior of the rep is disgusting and sickening . The next two reps refused to honor my husband's request to confirm the card is being sent because he wasn't verified on the account (I was not there to confirm that I wanted him to speak on my behalf) even though all he asked for was to send a member ID card (and he pays the bills on the account) to the same place this company send the bills to, and I have already verified him as my acceptable representative on the account when I signed up for this insurance via the Obama care website. Further, he was transferred to the billing department to verify that he does pay the bills on the account, but they again requested to speak to me, demonstrating how disorganized and incompetent they are.

This company should have sent the member ID card in the beginning before they sent me these bills, and they repeatedly refused to send it later on, finding all the excuses possible not to send the card.Desired Settlement: I want a refund of the all of the premiums that I paid. I want all of the money that I paid into the insurance back unless I get the member ID card sent to by express mail in the next two days. This company has exactly 48 hours to get me that card or issue a full refund of all of the premiums.

Business

Response:

Good Morning [redacted],

Thank you for providing our office with a copy of the HIPAA authorization form for [redacted]. Your department file number is [redacted]. Unfotunately, the form is invald., under Section D nothing was selected therefore, we have to enter the form in as invalid.

Please provide a copy of a complete HIPAA authorization form which will allow us to respond directly to your office.

If you have any questions, please feel free to contact me at ###-###-####.

Sincereley,

Sylvia B[redacted], Specialist

Executive Inquiries

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 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,

Business

Response:

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 BSpecialist Executive Inquiries

Consumer

Response:

[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.]

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,

Review: I had applied through Healthcare.gov for my family to get health insurance. They had told me that my son could not be on my plan because he was not a dependent, even though he was a full-time student over 18 and not working. They put him on his own policy and charged him $127 per month.I finally got them to understand that he is indeed my dependent and put him on a new plan with my husband. I was told his original account would be cancelled and the money for the original account would not be taken out of my bank account as of May 1, 2014. Unfortunately this was not done, and although I have called repeatedly, Blue Cross continues to take out money for this account AND the new one. My son's name is [redacted], Jr., birthdate 1/30/1995. Neither Blue Cross nor the Healthcare Marketplace will take responsibility; they both blame the other for missed information and we are caught in the middle. Each time I call I am either given different information, or promised it will be fixed.As of July 17, 2014 I received a letter stating that we will not be reimbursed for the 3 months when he had two separate accounts, and that the decision was final. No mention of appeals was made. I don't know what else to do. Yesterday, July 21 my husband was on the phone with several different people for 6 hours, and today (July 22) I was on the phone for 3 hours with both IBC and the Marketplace, along with a conference call between all three of us. I'm still not sure if the situation has been fixed because they both kept giving me a runaround.Desired Settlement: I would like the 3 months of charges ($127.15 per month) refunded.

Business

Response:

Dear [redacted],

I am writing to acknowledge our receipt of your July 23, 2014, letter to the Manager of the Executive Inquiries Department, [redacted]. We appreciate your writing to alert us to your concern(s).

Our record indicate that there is no authorization for your office to receive [redacted]'s protected health information our PHI. As a result, we cannot dislcose any informaton regarding our member. Please complete te enclosed authorizatio form. Once this information is received and process, we will be abloe to release [redacted]'s PHI to your office. Should you have any questions, please call me at ###-###-####. I will be glad to assist you.

Thank you.

Sincerely,

Sylvia B[redacted]

Specialist

Executive Inquiries

Consumer

Response:

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

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.

Review: Called in to cancel account and was assured of cancellation at l[redacted] twice well before the billing date in early September of this year. Debit was taken out of my bank account today October 1st.Desired Settlement: Immediate refund of the $212.09 that was debited from my account on October 1st 2013

Business

Response:

Dear **. [redacted]:

this is just an alert to inform you that I will be handling the review and response for this inquiry. if you have any questions, please contact me at ###-###-####. I will be glad to assist you.

sincerely,

[redacted], Specialist

Executive Inquiries

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:

I have received yet another email stating that I have an invoice ready for review. I cancelled this account in early September! I have not received a refund for the debited funds, even though I called in to the billing department the same day I issued this complaint and was assured that an "expedited" refund was on its way. YOUR ORGANIZATION HAS A CLEAR PROCESS ISSUE WHEN IT COMES TO CANCELLING AN ACCOUNT.

This still has not been resolved.

Regards,

Business

Response:

I have had a horrible experience with this company this year. It mirrors what others have said on Yelp: http://www.yelp.com/biz/independence-blue-cross-philadelphia
I called because they improperly sent me a refund check for two months of premium. I wanted them to void the check because it was a mistake. I paid 12 months of premium early. The first premium was paid by credit card the next 11 were paid by direct payments from my checking account. They had me on the phone for 2 hours without resolution. They wouldn't transfer me to a supervisor. There was no access to the website to resolve the issue and no available time to speak with a representative in the evening or on the weekend. I don't have 2 hours to waste on their mistake EVER nevertheless during the work week. This may be the worst customer service experience I've ever had.

Review: I was terrified by the customer service of this company.

Due to an error in the billing code, I was over-charged for the service

which should be partially covered by insurance. Therefore, my doctor

resubmitted the re[redacted] last July. But since then, I kept receiving

the billing re[redacted] from [redacted] (The biller). It turned out

[redacted] didn't get an updated information for the claim. I called IBX

two to three times, every time I was told the issue will be resolved.

From last year to 2014, [redacted] sent multiple requests to ask for the

new information, but no response from Independent Blue Cross (IBX).

On March 10, 2014, I tried to reach IBX again. As usual, I was put in the

waiting line for about 40 mins. After I gave them my ID number, a lady

told me this is the old ID card, and before I could say anything, she

transferred me into another line, again a long waiting list. I

actually logged into IBX website and found that the information I gave

them is the most recent information.

Finally I gave up. Instead of trying to reach them, I left them an

email message. But so far, I didn't receive any call or message from

them.Desired Settlement: 1. Retract the old claim to [redacted] and replace with the corrected claim.

2. Improve the quality of customer service.

Business

Response:

Re: [redacted]

Review: I have submitted reimbursement forms countless times and I am still waiting for reimbursement from over a year ago. I have not been reimbursed for emergency medical care and optical care.Desired Settlement: Total for amount paid out plus appropriate interest accrued (29.9%)for amount of time unpaid

Business

Response:

Please see attached

Review: I had a new health plan - [redacted] Health Plan East - become effective May 1, 2014. When I go to doctor's office visits, I do not appear in the [redacted] system and it displays "No Member record found" when my member id is entered. As a result, I am unable to get the necessary referrals for follow-up treatments to my visits - xrays, labwork, physical therapy. I've called Blue Cross numerous times over the past month and get the run around and that the issue will be escalated and I'll receive a callback with an update on the issue. However, I never receive a callback and end up calling Blue Cross and submitting inquiries via the member portal. This issue has been going on for a little over a month now and no one can seem to get the issue resolved. I'm paying for healthcare that I'm unable to use and it not only impacts me as my husband is covered on my plan.Desired Settlement: I want to be entered into the proper system so I can appear in [redacted] and utilize the necessary services at doctor office visits. I'd also like to speak with someone higher up than a rep.

Business

Response:

Re: [redacted]

Dear [redacted]:

I am writing to acknowledge our receipt of your June 26, 2014, correspondence to Detra D[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,

Yvonne *. P[redacted], Specialist

Executive Inquiries

Attachment

Consumer

Response:

In response to a message from [redacted]e regarding Complaint [redacted], I am attaching the requested HIPAA form.

Review: I had been going to an out-of-network mental health professional for almost a year. Independence Blue Cross is my insurance provider, and according to the plan I have with them, they are supposed to pay 80% of what they deem an appropriate charge for out-of-network providers, after the 200 dollar deductible has been met. They have not made the last eight payments. I have called them literally six times or so over the last few months, and each time the claims are sent back for reprocessing. Their customer service people are very nice, but nothing has been done about payment. The last payment from them was received almost six months ago.

[redacted] processes the in-network claims, but they do not process the out-of-network claims, so my mental health provider is correct is submitting directly to IBX.Desired Settlement: I want them to send a check for the unpaid mental health services. I believe there are eight unpaid visits.

Business

Response:

Hello [redacted],

Attached please find our letter requesting a signed authorization form from [redacted].

Thank you.

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:

There was nothing attached to the message you sent me. Can you please resend their response?

Regards,

Business

Response:

Dear [redacted],

The email serves as follow up to my voicemail I left for you today in regard to the May 24, 2013, rejection response.

Please know that we have sent our response letter to [redacted] today.

On May 20, 2013, I emailed you an authorization form to be completed by [redacted] and to be returned to us. As of today, we have not received the form. Therefore, we cannot disclose his personal health information to you at this time. Once we receive the completed authorization form from you, or [redacted], we will be glad to email you a copy of our response letter.

Be well.

[redacted], Specialist

Executive Inquiries

Review: Email edited to remove personal information as per instructions.

Originally emailed via ibx.com contact form September 7, 2014 (response included)

Resubmitted October 31, 2014 (no response as of November 6, 2014)

On April 9, 2014, I had faxed a cancellation request to the enrollment department canceling my coverage effective April 30, 2014, as I was switching to a new plan via the new health care website. My payments were set up to be automatically deducted from my bank however, and the May payment of $252.55 was deducted by Blue Cross for May coverage.

After noticing that the money had been deducted from my bank even though coverage was canceled, I called Blue Cross on May 2, 2014, and spoke with someone by the name of Al. Al told me that the May invoice had been deleted and that he was sending an email over to the billing department to inform them of the cancellation. He told me it would be about a week before the money was refunded back to my bank.

When I didn't receive the refund by mid-June, I called back and was told it would be at least a month before I saw the money in my bank account.

Still having not received the refund owed, I called back on July 25, 2014. I was then told that the $252.55 credit was transferred from my old Blue Cross account to the new one that I had set up in May under the new health care laws. I had to speak to multiple people regarding this, some who could only see my old account information, and some who could only view my new account information.

The old account representative said that the money was credited to my new account at the end of May, and the new account representative said that they were not seeing the credit on my account.

So my question is, where exactly is my refund of $252.55? It's been 5 months now, and it's getting to be a bit ridiculous. No one that I have spoken to on the phone seems to have any idea what is going on, and the last time I called I was transferred to 4 different people before being transferred back to the same woman I started the conversation with.

Basically, Blue Cross stole $252.22 from my bank account. I would like this money refunded either by check or transferred back into my bank as soon as possible.

Any help with this would be appreciated. If there are any questions I can be reached either by email at , or by phone at .

Thanks for your assistance with this matter.

Account number prior to May 1, 2014 -

Account number effective May 1, 2014 -

10/31/14 Update: This is the response I received after I initially contacted Blue Cross via the contact form. Needless to say, almost 2 months later, I still have yet to receive this refund. It has now been 6 months of this. I'm seriously contemplating charging Blue Cross for all of the hours I've had to work for this still unresolved issue. I know a colleague of mine, [redacted], is also having the same trouble getting his money back. I wonder how many other people Blue Cross has also stolen money from? I'm honestly at a loss as to what the next step can be. Social media? Is public shaming the only way to get corporations to sort their mistakes out?

09/10/14

Dear **. [redacted]:

I am responding to the below email regarding your health insurance premium payment.

I first would like to apologize for the delay in our response and any inconvenience this matter has caused you. I have forwarded a request to our escalated billing area for review and a refund. Please allow five to seven business days for the review to be completed. Once I receive notification of the outcome of the review, I will send a follow-up email to you.

If you have any additional questions, please feel free to email or call our office directly at 1-800-ASK-BLUE. A representative will be happy to assist you.

Thank you for selecting [redacted] Health Plan East as your health plan. We appreciate your business and remain committed to providing you with quality service.

Sincerely,

Correspondence Team Member/MariaDesired Settlement: Multiple employees have agreed that Blue Cross owes me this $252.55 that they debited from my bank account. All I'm looking for is the full refund, either by check or credited back to my bank account. They have told me about 10x that they'd be applying the money to my new health insurance account, and it hasn't happened yet, so I want nothing to do with that nonsense.

Business

Response:

Good Morning,

Thank you for providing our office with the completed HIPAA authorization form for [redacted]. Upon completion of our investigationa a response letter will be sent to your office.

Sincerely,

Sylvia B[redacted], Specialist

Executive Inquiries

Business

Response:

November 24, 2014Dear [redacted]:Thank you for providing our office with the completed HIPAA authorization form, which allows us to respond to your office. I am writing in response to your November 21, 2014, letter to the Manager of the Executive Inquiries, Detra D[redacted]. The purpose of our letter is to inform you that a refund of $252.55 will be issued to [redacted] shortly.The balance of our letter will summarize [redacted]’s concerns and explain the circumstances surrounding [redacted]’s account.[redacted]’s concerns [redacted] contacted the Revdex.com (Revdex.com) about the status of her premium refund. [redacted] cancelled her [redacted] coverage effective April 30, 2014, a premium payment of $252.55 was deducted from her account. She made several contacts with our office to obtain her refund but was unsuccessful.Our findings our records confirm that [redacted] contacted our office via email on September 10, 2014, about the cancellation and refund of her account. Unfortunately, due to human error, the refund request was never processed. We apologize that this occurred. As a result, our Billing Department submitted a request to refund $252.55 to [redacted]. [redacted] will receive this refund shortly.[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

Consumer

Response:

[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.]

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

Review: I am billed monthly from [redacted] health Plan east for my Independence Blue Cross coverage. I have paid it every month.I was notified in my bill for 2/15/14 to 3/14/2014 that I was past due. I called the company and found out they did not have a record of my payment even though my bank statement showed the check was cashed. The firm was unable to address the problem internally and I had to fax them a copy of my bank statement on 2/7/2014. I received a phone call that [redacted] had my fax and copy of bank statement and they were still looking into the situation and would call me back. I have never received another call back and continue to get past due notices that I am not paid up to date.Desired Settlement: I want my account corrected to reflect that it is paid current to date. Any record of my being past due is erased from my account due to the fact this is [redacted]'s internal problem.If I start to occur any over due fees they are removed from my account.And I really think I should get one month free coverage for the "headaches" they have caused me with this situation.

Business

Response:

Good morning [redacted]:

I am writing to acknowledge our receipt of the case# [redacted]. We ave resolved this case; however, there is no authorization on file allowing me to communicate our findings to your office, which involves the member's protected health information. Please advise if you would like me to respond directly to the member in this instance.

Sincerely,

[redacted], Specialist

Executive Inquiries

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:there is no information in the business response in how they plan to resolve the problem. I am fine with them contacting me directly but need to know hoe they have resolved the situation.

Regards,

Business

Response:

Dear [redacted]:

On March 14, 2014, we issued a response to the complaint directly to [redacted] and the outcome was favorable.

thank you,

[redacted], Specialist

Executive Inquiries

Consumer

Response:

[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.]

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,

Review: I have been working on an issue with IBX member services since March 18, 2014 regarding a collection on a bill that should never have occurred. In August 2013 I applied for insurance with IBX to begin in September 2013. In September before I received the card or any materials I requested they cancel my policy completely. In December I received a notice stating that they were going to add me to a new plan from January onwards at which time I called and told them I wanted any January policy also canceled. On March 17 I received a notice from a billing collections group stating that I owed IBX $1,416.56. I called IBX on March 18, 2014 to resolve the issue, and was advised to send in a fax stating that I had canceled a policy as of September 2013 and should not have been billed and providing the requested information on the call. (I have the fax transmittal and the number was ###-###-#### (the enrollment department). On March 31, 2014 I called IBX to confirm they received the fax since I had not heard anything yet. They advised me that they did not receive a fax so I transmitted a new fax including the March 18th letter - and have that transmittal form and papers with me as well.

A few days later I called to find out the status. Member Services representative [redacted] took the case and elevated it. He had them retrieve my September call and have it listened to so that enrollment had more information. The actual tape of the call was not found however there are records of me calling in September with notes. The cancellation occurred on a call. I was advised they would elevate the status of this issue and request enrollment to look into it. I have called twice a week for status updates but was unable to get one till April 16, when they told me during a call that I had initiated, that enrollment services is denying the deletion of coverage. The member services representative sent a note to [redacted] as well, and also initiated her own review with her supervisor because it didn't seem right to them. I didn't have the name of the collection agency till April 17, 2014 so on April 18,2014 I called member services and asked to speak with [redacted]. [redacted] is now reading the comments and determining an appeals process but cannot seem to find one.

During the time of supposed coverage no IBX services were provided, the card did not get activated and I received no invoices telling me I had coverage and that a bill is due. They have lost the confirming tape of the call where it was requested to be canceled. I have also been unable to directly reach an enrollment professional because there is no mechanism to do so. The call center also appears to have difficulty returning calls to customers who they have promised to keep informed - I was told by one representative that the member services representative have to wait till when they don't have any callers in order to return calls - but that can be extremely difficult to do.Desired Settlement: I am requesting the bill be deleted and coverage get canceled retroactively so that no coverage existed from Aug 31 - Dec 31.

Business

Response:

Re: [redacted]

Identification No: [redacted]

Review: About a year ago my wife needed to be sent to the hospital via an ambulance. We had at the time [redacted] health plan easy through her employer and realized that this would be covered under the insurance. However, the ambulance correctly submitted the claim to insurance about 5 times and each time we were told there was information missing from the ambulance company on the claim form. After about 7 months of this back and forth, we realized it was [redacted] health plan east that was continuously creating errors in the paper work. This January, the bill that had not been paid got submitted for collections. After I received a phone call that my credit was being effected, I paid the approx. $2200 bill out of my own pocket to the collections agency. After calling the health insurance, I was connected to a supervisor named [redacted]. She ensured me it would be taken care of and a check would be mailed out. After a week, I called [redacted] back just to find out that there were apparently more errors and I would have to wait a week. Since I have paid that $2200 I have been continually in a financial hole from that lack of the health insurance failing to pay the claim. The company continually hides from paying the services in which they are under contract for.Desired Settlement: I would like the full amount including the extra fees I had to pay the collections agency in a check as soon as

Possible.

Business

Response:

[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.

Review: I have now contacted IBX 5 times over the past three weeks because I have neither received confirmation of insurance, nor a bill for services beginning January 1, 2014. Every time I call, I have been told something different: Last week, "oh, your enrollment was just received, you'll have a confirmation Friday" - never happened. This morning, "oh someone will call you back shortly - today, I promise" - never happened. I have now spent nearly 4 hours on hold, and have had no service or response at all.Desired Settlement: Immediate confirmation of enrollment and member ID# as of 1/1/14.Waiver of first month's premium as compensation for my time and aggravation.

Business

Response:

January 17, 2014

Dear **. [redacted]:

I am writing to acknowledge and respond to your January 6, 2014, correspondence to [redacted], Manager of the Executive

Inquiries Department. Your inquiry was written on behalf of **. [redacted], who contacted your agency regarding her enrollment status with our plan. The purpose of this letter is to inform you that we have finalized our review and have responded directly to **. [redacted] with the details of our findings.

This reply will also serve to acknowledge our receipt of your January 14, letter requesting the status of our review of your January 6, inquiry.

While you have indicated that your original letter was sent on January 2, permit me to clarify: our records show that it was sent on January 6, and was assigned for review on January 7, at which time I forwarded the matter to the appropriate liaison for review.

That same day, I sent you an email acknowledging our receipt of your inquiry and a blank Authorization to Release Information form for **. [redacted]'s completion.

Unfortunately, to date, we have not received the completed authorization form. Since we have finalized our review, rather than delay our response, we have addressed our findings to **. [redacted].

[redacted], thank you for bringing this matter to our attention.

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:

I sent in a second, unrelated complaint in on 2/1/14 and it was denied as a "duplicate".

It was not a duplicate.

Regards,

Review: Dispute the validity of debt. On 2/2/2013, I turned 65 and became eligible for Medicare. In late January (2013) I received an invoice for the February premium on my IBX Personal Choice policy. I emailed IBX (TWICE) and called once (since they never responded to either email). I explained that I had become eligible for Medicare (and therefore ineligible to continue the private Personal Choice policy). I also asked why they were continuing to send me invoices since they were fully aware of my age and had been sending me information on Medigap policies. I told them that I had already purchased a Medigap policy and they should stop annoying me. They completely ignored my three requests and continued to send invoices. Then on Friday, 6/21/13, I received a call from [redacted] and I was told that the February & March invoices had been put in for collection! I explained the situation and was told they will make a note that I am disputing the charge. I then immediately called IBX and was astonished when [redacted] (the rep in billing) read one of my emails back to me (dated 2/3/13) and also said IBX had records of both emails and my phone call! So, why put it in for collection? He couldn't answer that but after him checking and me holding on for 15 minutes, he stated that because of those emails and phone call he would AS A COURTESY (???) backdate my cancellation to 1/31/13. He would also send an email to the IBX collection department but it would take 4 to 6 weeks! As of today I have received numerouse additional calls from [redacted] despite them telling me they would mark the debt "disputed". I have had numerous problems with IBX over the last 13 years I have been with them and was thrilled to finally be able to get away from them but they continue to be a problem. I think that IBX did this because I went with another insurance company form my medigap policy.Desired Settlement: Do want their rep [redacted] said and immediately notify [redacted], [redacted]. that the policy has been cancelled as of 1/31/13 and that no money is due from me whatsoever!

Business

Response:

Good afternoon **. [redacted]:

Attached is our response to the July 1, 2013, inquiry you addressed to [redacted].

As noted therein, should you have additional questions, or concerns, please contact me at ###-###-####.

Sincerely,

Specialist - Executive Inquiries

Review: January of this year my rate went from $148.70 to $156.15. Back in Feb this year 2013, Blue Crossed Special Care raised my rates again from $156.15 to $213.10 and asked me to verify how much I earned last year (2012) I sent them all my W2s and my 1099 unemployment forms. There reason for doing this is because they thought I earned more money last year. So in order for the rate not to go up I sent and mailed them these forms numerous times and every few weeks they send me a letter stating that "they cannot finish procession my claim because I have not sent them the forms." I have also faxed the forms to them too. I have called them about a dozen times and spoken to many people about what is going on and that is should be resolved soon. Everyone tells me to pay the higher rate to make sure that I have continuous health coverage. It is now May 30, 2013 and I received another letter from them stating that " they did not receive the proper form for my recertification. I feel that they are ignoring me and that they are just taking me in circles. I am a substitute teacher and I do not earn a lot of money. Last year I earned around $10,000. I have to received any unemployment since January 7, 2013. I also do not receive any unemployment in the summer because I work for a school district. Special care is for people who are unable to afford normal health insurance. I cannot afford to keep paying the higher rate and I am very frustrated that they are not helping me and I feel that I am being taking advantage of. I need you help in resolving this issues and I need my old rate to be instated and for the extra money that I have being paying since March to be applied to my bill. I amDesired Settlement: I want this issue to be resolved and for Blue Cross Special Care to stop giving me the run around! I want my rate to go back to the $156.15. I am very frustrated and I don't know what else to do. Please help me in resolving this issue! I would be so appreciative.

Business

Response:

Good morning [redacted]:

I am writing in response to the complaint filed by [redacted] (Your ID#[redacted]). We do not have authorization on file from [redacted] allowing us to release her protected health informatin (PHI) to you; however, we do not need it to inform you that the outcome of our review was favorable to [redacted], and provide you with general information about the outcome.

As a result of your inquiry, we identified that we received [redacted]'s recertification information at our officie, reviewed, and found it to be in good order. Therefore, we changed her account back to the lesser premium, as requested by [redacted], effective March 1, 2013.

[redacted], thank you for bring [redacted]'s concerns to our attention. If you have any questions, please contact me at [redacted]. I will be glad to assist you.

Sincerely,

[redacted], Specialist

Executive Inquiries