Independence Blue Cross

Review: My wife and I had Independence Blue Cross Blue Shield member number [redacted]. Due to high premium we had changed from this plan to another which allowed a lesser premium. This account is closed JAN 31, 2014. I called billing and stopped automatic withdrawal also. However, on FEB 3, 2014 they withdrew 1308.08 from my checking account. I called them asking them to cancel automatic withdraw, we no longer have this plan. I confirmed several times. I was told that the amount withdrawn will be sent via check in a couple of weeks. It could not be put back into the account automatically. So I was okay with that. An error has been made and if it can be corrected, no problem. Then again, on MAR 3, 2014 ANOTHER payment of 1308.08 was withdrawn AGAIN!! I called, furious and explained the same thing. The representative said that she saw a credit of 2617.60 on my account and that it should arrive in a few weeks. She made assure that automatic withdraw be stopped. Thankfully, there have not been anymore withdrawals, but even now I am awaiting my 2617.60. I wrote to them several times inquiring about it without any luck. Can someone please help me get my refund back!!?? It is now June. Thank you.Desired Settlement: I really wish to have the amount returned. They confirmed that the member account was closed JAN 31, 2014. No money should have been withdrawn after the account was closed.

Business

Response:

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

Review: I believe an investigation of the practices Independence Blue Cross at [redacted] should be investigated. Each of the past 2 years I have been required to pay more than the plan maximum, as indicated on statements that Blue Cross sends. When contacting them about the over payment they have to investigate and call back in a couple days. They never call back. In 2013 it took 6 weeks and 4 phone calls from me to get my money back. Several co-workers had the same issue and saw the same delays. This year on July 7th I received a statement indicating an over payment of $555.70. I have called them 4 times 97/11; 7/28; 8/11; 8/14) and spent a total of one hour and 45 minutes on the phone with them and am still waiting for confirmation that they will refund the money. I was promised 2 call backs that have not occurred from one of their supervisors (Arthur Trippett). I believe this is standard protocol for them to hold people’s money and delay refunds. I continue to pay my copay even though I have met my out of pocket maximum. I will continue to pursue getting my refund but I think there is a bigger issue at Blue Cross.Desired Settlement: Investigate Blue Cross practices of delaying refund of overpayments

Business

Response:

Hi [redacted]-

This is to acknolwledge receipt of your inquiry. The concerns presented are under review.

So that we may release the member's PHI to your office, I have attached a HIPAA authorization form with a request that you forward it to the member for his completion. Once we receive it, we will be happy to release our findings to you. In the event that we should not receive it, then we will respond directly to the member.

Thanks [redacted].

Reginald H[redacted]

Executive Inquiries Specialist

Review: Ibx charged my account but has failed to provide a member id card or member number. They also do not show me as registered for August 1st as a memeber. I have called several times and just get bounced around. Very angry.Desired Settlement: Want my health insurance that I paid for!

Business

Response:

Dear [redacted]:

I am writing in response to case number [redacted], for [redacted].

We spoke with [redacted] on August 5, 2014, about her concerns. She has decided to remain in the plan she chose with us. She is aware that once her payment is applied to her account, her identification card will be issued to her.

Thank you for bring [redacted]' concern to our attention. if you have any questions, please contact me at ###-###-####. I willbe glad to assist you.

sincerely,

Scott Y[redacted]

Executive Inquiries

Review: This company keeps sending me bills for health insurance. I had looked at them on the ACA website, but cancelled my application. I have health insurance from another company and told them this, they said to fax my name and phone number to them to cancel the policy. I did this and they still are harassing me with bills. They told me they received the fax and I had to get the ACA website to deal with the cancellation. After calling ACA they said I have no enrollment with [redacted] and not to pay them a dime but there is nothing else they can do for me.Desired Settlement: Stop them from sending me bills for health insurance that I don't have or want.

Business

Response:

dear **. [redacted]:

As a result of your inquiry, we have cancelled the policy for **. [redacted] as never effective. This was completed on January 30, 2014.

We apologize for any inconvenience suffered by **. [redacted]. He can disregard the invoice that he received.

If you have any questions, please contact me at ###-###-####. Iw ill be glad to assist you.

sincerely,

[redacted], Specialist

Executive Inquiries

Review: I recently enrolled [redacted] HMO under the Affordable Care Act. They are a wholly owned sub of Independence Blue Cross. I enrolled because it seemed reasonable price and coverage. In the description of the Bronze HMO plan it says it covers generic drug prescriptions for a $10 copay with no deductible ---NOTE GENERIC ONLY. THe company is denying coverage until I meet my overall $6,000 individual deductible. This is NOT what the plan brochure states. The plan states it doesn't pay fro BRAND NAME drugs until the deductible is met. As a result I can not afford to fill my prescriptions. MY family and I are on a total of 10 regular Prescriptions. THree so far have had to be put on hold because they were almost $500.

This is a systemic problem. They are applying this error to all policyholders of the Bronze plan. The problem lies in that the brochure has 2 lines to describe RX coverage. the first line addresses BRAND NAME RX which requires the policyholder to meet the plan deductible of $6000/individual before paying. The second line describes a $10 copay with no deductible for GENERIC only scripts.Desired Settlement: I would like the company to meet it's promise and deliver the generic RX coverage at $10

Business

Response:

Dear **. [redacted]:

I am writing in response to your recent inquiry to the Manager of the Executive Inquiries Department, [redacted], on behalf of **. [redacted]. I spoke with **. [redacted] via telephone and she informed me that all of her issues have already been resolved and that she was able to switch health plans to better suit the needs of her and her family.

**. [redacted] was thankful that I contacted her and explained that she was satisfied with the outcome of her inquiry.

If you have any additional questions or concerns, please contact me at ###-###-####. I will be glad to assist you.

Sincerely,

[redacted], Specialist

Executive Inquiries

Review: I have been a) took three days to allow me to pay an invoice which delayed use of my policy because everytime I called, I was placed on hold until disconnected which was up to two hours at a time; b) once I paid the bill, I asked for my ID card information so I could start using the insurance I paid for and the lady in billing told me I wasn't privy to a BIN# - that only the pharmacy would be able to access that information and when I called the pharmacy with said information, they not only NEEDED the BIN#, but, also needed two other numbers not provided to me. So, I called personal choice back and was placed on hold for approximately two hours the first time only to have a man answer, tell me I had the wrong department and disconnect my call. I called right back and was placed on hold for 47 minutes for a lady to tell me that I had the wrong department. After I told her the last man hung up on me, she stated she'd wait on the line with me while she transferred my call and I was on the phone for 3.5 hours.Desired Settlement: Billing adjustment pro rata for the days I was unable to retain my insurance and maybe a little more for an apology.

Business

Response:

Re: [redacted]

Review: My son was diagnosed two years ago with Speech Delay/Autistic Spectrum Disorder. He has had services provided by numerous providers. Bulk of the treatment is done by [redacted] that charges [redacted]’s CHIP insurance ([redacted]). [redacted] attends private speech therapy (two providers) who bill me directly and I submit the claims to my private insurance carrier (Independence Blue Cross/Blue Shield). The speech therapists claim that process dealing with insurance is too cumbersome to deal with. Since beginning of this year all my claims are being rejected because I exceed the number of allowable visit. I turn out that speech therapist were using two codes – one for autism and one for speech delay. Independence Blue Cross consistently picked speech delay CPT instead of autism. This way they reached the decision that claim limit was reached – it is 50 visits per year. In respect to autism code they claim that it is incorrect number and they cannot process the claim. This is surprise that under the contract with [redacted] they should allow the expense to 36k per year. Independence Blue Cross is not willing to tell me what is the correct billing code (!!!!). They tried to reach providers but not to avail. Finally when providers reached them it turned out that code for at least one of them is correct. The other provider was using code without one zero though diagnosis was spelled out on the chart. However, regardless whether code is 299.00 or 299.0 they continue to deny the claims. I have bills in excess of $2000. I spend countless time talking over the phone with their representative ([redacted], [redacted], other representative over 20 times) but not to avail. I hope this is the first issue you can help me with.

Moreover, they are not willing to tell me what procedure codes are covered under the service contract. They cannot provide me with description of services that [redacted] is entitled to. [redacted] claims that releasing this information will encourage the fraud. What is really happening I have no idea what services [redacted] is entitled to. This would be second thing you could help me with.Desired Settlement: I expect company to release the information what codes of treatment are covered under the contract and reimburse me for service. I also expect a letter of apology.

Business

Response:

Review: I have been under the care of [redacted] Cancer Care Center for over 6 years with on going care. It was recommeded by my oncologist as well as radiologist and gynocologist that based on my history as well as recent finindings on my mamogram that I undergo bilateral mastectomy with breast reconstruction. I did undergo the surgery which Independence Blue Cross Blue has denied paying. My oncologist has advised that he has never never seen anything like this denial and has never had any prior problems similar to this with any insurance carrier. My gynocologist has advised that this is one of the lowest things he has ever seen an insurance carrier do. I have been dealing with health issues now recuperation and in addition to not being well I have to deal with the insurance issues.Desired Settlement: I am requesting that Independence Blue Cross Blue Shield pay for the treatment as well as surgery which I underwent.

Business

Response:

[redacted],

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.

Review: I was taken by Ambulance on Sept 1, 2013 from [redacted] in [redacted] to [redacted] Hospital in [redacted] California by the ambulance company [redacted]. I did not call the ambulance and was semi conscious at the time they picked me up. To the best of my knowledge I did not sign anything at the time of their arrival and was semi conscious. I received a bill from [redacted] for $2,146.43. The trip is less than two miles. I received a check from Independence Blue Cross in the amount of $342.99 and was told by a representative of Independence Blue Cross to either forward the check to [redacted] or write them a new check plus a $38.11 for my co-payment. I submitted a check to [redacted] for $381.10 which they have cashed. At the time of my call to the representative for Independence Blue Cross I was told the [redacted] would absorb the additional $1,765.33. They have not done that and are demanding payment.Desired Settlement: My desired settlement is for Independence Blue Cross to pay the ambulance company [redacted] the balance of $1,765.33 since they were my insurance company at the time of this incident. I say this because I was told by a representative of Indepdence Blue Cross that this matter was closed since he informed me they would aborb the loss. They are not and threatening collecting proceedings against me. Please have Independence blue cross sumbit the balance of $1,765.33 to [redacted] or send the remainder to myself and I can write them a check.

Business

Response:

Dear **. [redacted],

I am writing to respond to your October 26, 2013, correspondence (ID [redacted]), which we received on November 1 and again on November 12. The purpose of this email is to let you know that we will be closing today's email inquiry as a duplicate.

On November 1 we received the same correspondence, ID [redacted]. Our specialist, [redacted], responded to you and **. [redacted] on November 7. I have attached a copy of your letter to this email. As a result of the November 1 correspondence, the claim in question was reprocessed. We sent **. [redacted] the desired settlement amount, minus his member liability.

Again, thank you for bringing this matter to our attention and for the opportunity to be of assistance.

Sincerely,

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: They denied a claim submitted by my Dr. for services provided in Jan. After spending over 7 hours on hold trying to speak to someone I finally submitted a request via thier secure email system. They said I had a policy in 2014 but it was never activated, so I had no coverage in 2014. I provided the dates and amounts of electronic payments and asked that they pay the claim from Jan or return all of the premium payments I made in 2014 and I haven't heard from them again. I'm on hold with them again as I type this but have little hope of speaking to someone.

I also paid my premium for April, got a new job April 7th so called to cancel and ask for a refund (since I hadn't used my insurance in April). They agreed to issue a refund and I haven't gotten it.Desired Settlement: Either they refund all premium payments for 2014 or pay the claim from my Dr. from Jan, and refund my April premium since I didn't use the policy and cancelled in the first week of the month.

Consumer

Response:

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]

Business

Response:

November

17, 2014Dear

[redacted]:I

am writing in response to the recent inquiry received from the RevDex.com (Revdex.com) on your behalf. The purpose of this letter is to inform you that

we issued a refund to you for $289.15.We

apologize for any inconvenience this situation may have caused you and want you

to know that the appropriate members of our Leadership Team are aware of your

experience.On

November 10, 2014, we notified the Revdex.com that we needed a valid authorization

form signed by you, which would allow us to communicate your protected health

information to their office. Since we did not receive the form, we are

responding to you directly.After

a care review of your account, here is what we have identified:Your policy effective date was January 1, 2014, and cancel date is April 1, 2014.Total payments posted to your account# [redacted] equals $1,156.60; however, since this policy was active from January 1 through April 1, you will receive a refund in the amount of $289.15. The refund $289.15 was processed on November 17, 2014. You should receive it within 7 to ten business days.[redacted], thank you for bringing your concerns to our attention. If you have any

questions, please contact me at ###-###-####. I will be glad to assist you.Sincerely,Scott Y

Review: I prepaid for 3 months of health insurance which was to start on 4/1/14. Bank statement shows IBC took out the money.

I monitired IBXpress.com under my username and it never showed payment. I sent an email thru the ibxpress portal inquiring where did my payment go? It went unanswered.

Received cancellation letter today stating policy terminated because of non payment.

Obviously this company is not capable of handling my healthcare needs since they can not even figure out how to apply payments to the correct account.Desired Settlement: I wish to switch to a capable Health Insurance provider which can apply my payments to my account, and be confident in the services in which I pay.

I also need to have emails answered when asking critical questions such as where did my pre-paid 3 months of premium go? They surely received my money as my bank statement shows.

Business

Response:

[redacted]--

As you are aware, a HIPAA Authorization is required to release the member's Protected Health Information (PHI) to your office. If we receive from you, we will be permitted to share our findings with you. However, if we do not have the member's written authorization tol release his PHI to your offcie, we will respond to the member directly.

Reginald H[redacted]

Executive Inquiries Specialist

1901 Market Street: Mailstop SG2Philadelphia, PA 19103P ###-###-#### x23034 | F ###-###-####

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:

Review: 1. My January invoice arrived on January 15, and it said payment was due the same day (Jan 15). I called and made a payment by phone the same day. The funds cleared from my checking account on the 16th. Payment confirmation # [redacted]. On January 18, I received my February invoice which was billing me for February and a "past due balance" of $6.07. THERE IS NO PAST DUE BALANCE! My January bill WAS PAID! I called on the 18th and left a message (no one answered the phone). No reply was made as of the 22nd at 8am. On the 22nd, I made a payment online of $6.07. I will NOT pay the invoiced $12.14, as the "past due balance" was already paid. I was told that my policy would be canceled if the remaining balance was not paid. THERE IS NO REMAINING BALANCE!

2. I have no copy of my contract. I do not know what is or is not covered, and what exclusions there are. When I signed up, I was told that I had a prescription plan. When I checked my account online, it said I had no prescription coverage.

3. I can not access my list of doctors online. There is a link, but I let it load for as long as 30 minutes on several occasions and it WILL NOT LOAD.

4. The website asks for my e-mail address, but the box where I am supposed to enter it will not allow me to type in it.

5. I have called this company more times than I can count, and there is always another excuse as to why they can't help me. Today it is the weather. Other days, I have been told that no one can answer my question. On several occasions, I was disconnected due to "high call volume" after being on hold FOR AN HOUR!Desired Settlement: 1. See that my invoice is corrected. I paid $6.07 on January 15, and another $6.07 on January 22. I am now paid through the end of February, AND I HAVE NO OUTSTANDING BALANCE!

2. I would like a complete copy of my contract sent to my address on file. I will not continue to pay for a service when the terms have not been explicitly specified. Furthermore, I ask that you reinstate the prescription coverage that I was promised when I signed up.

3. I would like a list of doctors sent to my address on file, and I would like to be provided a means to select a doctor without using the NON-FUNCTIONAL website.

4. I would like to be able to add my e-mail address so that I can receive bills and other information by e-mail.

5. I would like you to fix your phone lines both technically (dropped calls) and personally (train associates to be able to properly assist customers).

Business

Response:

February 24, 2014Dear **. [redacted]:I am writing in respond to your January 23, 2014, correspondence to [redacted], Manager of the Executive Inquiries Department. Your inquiry was written on behalf of **. [redacted], who contacted your agency regarding the premium payments status of his [redacted] HMO Silver Proactive 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.On January 24, I sent you an email acknowledging our receipt of your inquiry. Since our records our records indicate that there is no authorization for you to receive this member’s protected health information or PHI, I attached a blank Authorization to Release Information form for you to have **. [redacted] complete, designating you/the Revdex.com as a recipient of his protected health information.Unfortunately, to date, we have not received the completed form. As a result, we cannot disclose any information regarding our member to you. Since we have finalized our review, rather than delay our response, please be advised that we have addressed our findings directly 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 never received any authorization form that they claim they sent. I am not filing this complaint "on behalf" of **. [redacted], I am **. [redacted]... I am the account holder. I am asking for information about my own plan.In addition, I did receive a booklet in the mail about a week ago titled "Everything you need to know about your health plan." On page 105 is a section titled "Section EX - Exclusions." It starts with "The following are excluded from your coverage:" and it proceeds with a fairly extensive list. On page 111 is number 56 on this list "Any treatment of Mental Illness, including Serious Mental Illness, or Substance Abuse;" Under the new health care law, you are not allowed to exclude coverage for any of these illnesses. I called HealthCare.gov, and they confirmed that such exclusions are a violation of federal law.Please send me a revised book that complies with the law. You can send it to my address on file, so no authorization form should be necessary.

Regards,

Business

Response:

Re: [redacted]

Review: This is the second time I have had to file a complaint against my mental health insurance company, Amerihealth. In 2013 they did not pay my psychotherapist, [redacted], for her months of service until I filed with Better Business. Once again, they have not paid for her services from September 2013 to the present. [redacted]'s rate for her psychotherapy sessions is $170.00 an hour. I pay her a $25.00 copay per session. [redacted] owes her $145 per session. The dates unpaid are: 9/10/13, 9/17/13, 10/22/13, 11/5/13, and 12/13.Desired Settlement: [redacted] will pay my therapist, [redacted] the money they owe her for her services.

Business

Response:

Re: [redacted]

Dear **. [redacted]:

Review: Company has the worst customer service I've ever experience. They first mixed up my ID cards while continuing to take my premiu** earlier this year. I was sick and couldn't see the doctor because they had someone else's name with my insurance. I spent hours on hold and never got to the right dept. They continue to keep you on hold for hours and yet never transfer you to the right person. Appalling service.Desired Settlement: I'd like the health insurance premiu** for Jan 2014 (313.57) + $200.00 for mental frustration and not being able to see a doctor.

Business

Response:

Dear **. [redacted],

Re: [redacted]

File No: [redacted]

I am writing to acknowledge our receipt of your April 28, 2014, letter to the Manager of the Executive Inquiries Department, [redacted]. We appreciate your writing to alert us to your concern(s).

We will respond to your letter shortly once we have looked into the matter you raised. Should you have any questions, please call me at ###-###-####. I will be glad to assist you.

Review: My health insurance is provided by Independence Blue Cross. I am covered for mental health services under the terms of this contract. I have an ongoing need for mental health services, and I have been filing claims for these services with Independence Blue Cross monthly for at least three years.

In March of 2014, I had two sessions with a psychotherapist. The psychotherapist used was not part of the Independence Blue Cross network of providers. Under the terms of my contract, I am entitled to a partial reimbursement for this expense. I submitted a claim with Independence Blue Cross for the partial reimbursement of the cost of using an out-of-network mental health care provider to which I am entitled. The claim was denied by Independence Blue Cross without any explanation offered as to why it was denied.

The denial of this claim is part of an ongoing problem that I have had with Independence Blue Cross for over one year. I have tried to resolve the problem in every conceivable way, including spending hours on the phone with Independence Blue Cross’ ‘customer service’ staff. I have also used my employer’s benefits management provider to advocate for me. Nothing that I have done to date has corrected the problem.Desired Settlement: I would like Independence Blue Cross to review these claims and to issue the partial reimbursement to me to which I am entitled.

I would like Independence Blue Cross to process my future claims correctly the first time that I submit them.

I would like Independence Blue Cross to process my future claims in a timely manner.

Business

Response:

Dear [redacted]:

I am writing in response to your inquiry on behalf of **. [redacted]. The purpose of this email is to inform you that on May 12, 2014, we processed the claim for **. [redacted]'s dates of service March 11 and March 24, 2014. Payment for these services were paid to **. [redacted] via check number [redacted].

We apologize for the onconvenience that **. [redacted] experienced. 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:

Review: I have repeatedly tried to contact IBX and they never answer the phone. I need to update my billing info. They never are available. They have cancelled my health insurance and this is not acceptable.Desired Settlement: Contact me and reinstate my account t with updated billing info

Business

Response:

Dear [redacted],

I am writing to acknowledge our receipt of your June 16

Review: Let me first say this issue has been unresolved for nearly a year at this point.

Back in November/December of 2012 I went to [redacted] of PA for health care. On or around December 13th I was informed that I owed that group my $500 deductible for 2012. I paid it. Throughout January to July, I saw multiple other doctors (pregnancy) for various services, and began receiving bills regarding my care. I called [redacted] and confirmed that my deductible had been met ([redacted] has 4th quarter carryover concerning deductible coverage) so customer service started digging into why I was receiving bills. It turns out [redacted] had made an error in billing with [redacted], resulting in me having to pay much more of my deductible than I should have. After repeated calls over the course of February through June, the [redacted] bills were finally straightened out. However, upon contacting that group for my refund, I was informed [redacted] Administrators would have to authorize it and dictate the amount. This never happened, so I still do not have my money. Along with this unresolved issue, [redacted] also needed to correct the billing for all services provided to me since my visits to [redacted]. This is due to the original billing errors, which then caused the rest of the bills to have incorrect amounts regarding what [redacted] will pay and what I owe. I spent hours contacting the various companies and explaining to them that I would not be paying yet and they would be receiving a corrected bill from [redacted]. I have not had any word from [redacted] since June, and I have called repeatedly and left messages for Team Lead [redacted] who was handling my complaints. Nothing has been fixed, and I have not received calls back. I am now getting collection notices from the doctor's offices and other service providers because I haven't paid. I cannot pay them if the corrected bills have not been processed! I am beyond frustrated, and now have a 2 month old baby who demands most of my daily attention. I need these bills corrected, and I need the portion of my deductible back from [redacted] of PA in order to pay the bills for 2013.Desired Settlement: All bills corrected, refund issued from first doctor, [redacted] of PA MLF Division. Immediately!!!

Business

Response:

Dear **. [redacted],

Attached please find our response letter.

Please make note that this inquiry should be redirected to [redacted] Administrators. The contact information is referenced in the letter.

Thank you.

[redacted], EI Specialist

September 5, 2013

Dear **. [redacted]:

I am writing to let you know that your September 5, 2013, correspondence was received. The purpose of our letter is to let you know that [redacted] is a member with [redacted] ([redacted]).

Although [redacted] is our subsidiary company, it operates as a separate and wholly independent organization. As such, any [redacted] complaints that you receive should be sent to:

Email: [redacted]

Tel.[redacted] Fax.###-###-####

As you are aware, the federal Health Insurance Portability and Accountability Act, known as the HIP A A 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 her PHI, please have her complete the attached Authorization to Release Information Form. To be considered valid, all required categories must be fully completed.

**. [redacted], we thank you for the opportunity to be of assistance. Please do no hesitate to contact [redacted] with any questions you may have about this matter.

Sincerely,

Review: My Insurance coverage was canceled as of 09/01/2012, due to my request. However , I was still receiving invoices on a monthly basis. Unfortunately, I was using automatic withdrawal method for monthly premium and therefore company had my bank information. Therefore, I was forced to put stop payment on the amount charged by Independence Blue Cross in my bank account in order to avoid monthly deduction. On February 28, 2013 I was deducted $156.15 from my bank account (stop payment did not work because the premium amount has been changed). I contacted customer service multiple times requesting the refund. As of March 27, 2013 I still did not received the refund.Desired Settlement: Refund

Business

Response:

Please see attached information from Independence Blue Cross.

Review: I have been calling and emailing Ind. Blue Cross since late February 2014. My insurance through the Marketplace is $44.69 each month. This month, November, my statements are still showing I owe $244.69. It was verified with the Marketplace and submitted for changes by Christina Barnes of Ind. Blue Cross on April 24, 2014. I also received a notice telling me to pay $245.00 by November 30 or my insurance as of July 30 would be cancelled, and all claims denied. Ind. Blue Cross claimed I never paid for July. I called and spoke with Namir B[redacted] of their Consumer Billing Center on Nov. 5 and he confirmed (after I read each date of withdrawal from my checking account statements, showing I paid for EVERY month, from March up to and including November). He told me to "disregard the notice. It is an internal error". He confirmed "I owe nothing". He said, "If Independence Blue Cross does cancel my health insurance, they will restart it at no charge to me because of their internal error.". He said "December's statement should reflect only $44.69", and to call back if a problem. Also, I feel it is important that the Revdex.com knows that Ind. Blue Cross sends a confirmation email once they have taken a payment over the phone. The email states you will be contacted if there is a problem with the payment. That is flat out untrue. A payment of mine did not go through, and I received absolutely no calls, mail, or emails. I found out the next month. The representation I spoke with, "Janice," told me "Independence Blue Cross does not call". That was when I questioned why I was not contacted, and cited the email I had received.Desired Settlement: I think the Revdex.com needs to know the nonsense that Independence Blue Cross has been causing this year. I want my bill adjusted, that is true. But, more importantly, I truly believe that Ind. Blue Cross WILL cancel my health insurance, despite Namir B[redacted]'s admittance that Independence Blue Cross has made yet another internal error in my account. (I want someone to be aware of the likelihood). And, I don't really believe that anyone in different departments talk to each other. Best desired outcome: bill adjustment to correct $44.69 due monthly, and a sincere apology for the headaches I've had since March 2014. (I called to pay for March, on 3/3 and 3/5. I even called back on 2/26/14. Each time I was told I would receive a phone call in the next 24-48 hours. REPEATEDLY, no one ever called. Finally paid for March in April.

Business

Response:

November 21, 2014Dear [redacted]:Our Manager of the Executive Inquiries Department, Detra D[redacted], has requested that I respond to your November 10, 2014, correspondence regarding [redacted]. The purpose of this letter is to confirm [redacted]'s account balance and also clarify her premium responsibility.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 office submitting the authorization from [redacted] listing your office as an authorized recipient of her PHI.The matter at hand In her correspondence, [redacted] shared details of her multiple interactions with our organization regarding her premium account activity. Additionally, [redacted] expressed her concerns about the delay in her experience. In conclusion of her complaint, [redacted], submitted her request to have her premium invoice adjusted as well as to receive a sincere apology from our organization.On behalf of our President and Chief Executive Officer, Mr. Daniel *. H[redacted], and our entire organization, we extend our sincere apology to [redacted] for the unacceptable level of service that she received pertaining to her experience. Please be assured that this is not indicative of the high-quality level of customer service that we strive to render to our customers. The appropriate leadership team members have been advised of [redacted]'s experience. Please be assured that we have taken the opportunity to provide additional training to the applicable customer service representatives.Our review Upon receipt of your correspondence, we conducted an investigation into the concerns which [redacted] presented. In our examination of the issues presented, we discovered various points during our review. Here they are:• During the timeframe between March 4, 2014 and October 21, 2014, there were numerous telephone interactions—including receiving several ACH payments— regarding [redacted]’s account before we were able to have her account and invoices reflect the appropriate premium responsibility.• On June 30, 2014, we received documentation from the federally-facilitated marketplace (FFM) confirming the monthly premium amount of $44.69. Subsequently, we began the process of correct [redacted]'s premium invoices from May 2014 to July 2014.• On October 22, 2014, we processed an adjustment regarding [redacted]'s subsidy in the amount of $200. At that time, [redacted]’s balance was $44.69.• We reviewed [redacted]'s claim history and recognized that the only claim that we denied for the absence of coverage, we reprocessed it to send payment to the provider prior to [redacted]'s inquiry to your office.• According to our records, [redacted]'s policy became active as of March 1, 2014 with a premium rate of $244.69; subsidy of $200 ergo, [redacted] responsibility is $44.69. • We have generated [redacted]'s December 2014 premium invoice on November 12, 2014; however, it will not reflect the payment of $44.69 which we posted to the account on November 18, 2014.• As of the date of this letter, [redacted] has a $0.00 premium balance and her account is paid to January 1, 2015.[redacted], we appreciate the opportunity to address [redacted]'s concern. If you have additional concerns regarding this matter, please feel free to contact me at [redacted]. I will be pleased to assist you.Sincerely,Rafael D. Team Member

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: IBX is the worst insurance company I've ever dealt with. They deny claims they should be paying, give confusing reasons, long delays getting Customer Service on the phone, promises to investigate an issue and get back to me and providers w/in 10 business days which NEVER happens.

Current issue is physical for my 18yo son in December2013! They won't pay it. 1st they said he'd already had a physical w/in the year which is not true. Their own CS rep. I spoke to looked in the system and confirmed they had NO RECORD of him having a previous physical. Provider called about this and they said they're resubmit the claim but then denied their own resubmission as 'duplicate claim'?!

Since then they've changed their story to something "Reimbursement included in another service" or something like that. I got a CS rep on the phone on 18-Jun-14 and she initiated a 3-way call with provider who confirmed our son hadn't been there in 2 years, the only charge they have for us is the physical, and they have received nothing. CS rep said she'd resubmit the claim and we should receive an Explanation of Benefits (EOB) within 10 business days. As of today Jul 9th it has been 17 days and still no answer.

If you look on the IBX facebook page you will find many, many others with similar issues.Desired Settlement: Pay the darn bill of $202.

Business

Response:

Complaint ID: [redacted]Complainant: [redacted]

Dear Sir/Madame,

I will be handling the review and response for the above complaint. Please be assured that our investigation is underway; however, I will not be able to respond to your office without consent from the member.

Compliance with the HIPAA Privacy Rule. 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. PHI is individually identifiable health information transmitted or maintained in any form or medium (including written, spoken, or electronic) related to: health care, health conditions, payment for care, and identity. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.

If **. [redacted] wishes to appoint yourself /Revdex.com as the recipient of his son's PHI, he must complete and return the attached Authorization form. Please complete one form, per member. You may return the form by way of this email or mail it to: Independence Blue Cross, Attention: [redacted]

Thanks so much.

Sincerely,

[redacted]Specialist, Executive InquiriesTelephone: ###-###-####

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 was a bit uncomfortable providing a HIPPA form to Revdex.com (no offense intended). What I really needed was to get the attention of someone at Independence BlueCross (IBX) who could do more than just repeat what's in their database on this matter, and cared enough to get to the root of the problem. The woman who responded from IBX is that person. She clearly knows what she needs to do to resolve this issue and has a vested interest in doing so.* She and I are in direct contact and she has now figured out what the problem was. It has been corrected and we just have to wait to confirm that IBX will now pay the bill.