Independence Blue Cross

Review: I signed up for medical insurance with Independence Blue Cross (at their site). My application was accepted on December 11th and payment was withdrawn from my account on December 12th. My policy was set to begin on January 1st, 2014. It is now January 13th, and I have received no ID card or policy number. I have no way of using the policy. I need a policy number to even print a temporary card. I have been calling the company constantly since January 1st. I have spent countless hours on hold. When I do get to talk to someone, they tell me I should receive my card any day or that someone will get back to me (neither is true). I can't see any doctors or get my prescriptions (which I really need). I haven't had my prescriptions since the end of last year. It is not a pleasant thought not having insurance. What will happen if I get hurt? I don't like to file a complaint in this manner, but I am getting nowhere with this company. I just want what I payed for from a company that should have been more honest with me. Time is critical.Desired Settlement: I need the policy I payed for as soon as possible. I need to be reimbursed for the time my policy was unusable. An apology might be nice, but I don't know what that would be worth from a company that wasn't honest with me from the beginning.

Business

Response:

Re: [redacted]

Dear **. [redacted]:

I am writing to acknowledge and respond to the January 14, and 27, 2014, inquiries you addressed to [redacted], Manager of the Executive Inquiries Department. Your inquiries were written on behalf of **. [redacted], who contacted your agency regarding his enrollment status with our plan.

As my January 16, acknowledgement email advised, under the Privacy rule, we are required to obtain an individual’s written approval before can disclose his/her protected health information. Unfortunately, we have not received the completed Authorization to Release Information form that accompanied that email. Therefore, I am unable to provide you with our findings.

Since we have finalized our review, rather than delay our response, we have addressed our findings directly to **. [redacted].

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

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:

As of 2/6/2014, I still have not received any ID Cards. This person has not contacted me. And I have no idea where to "sign off" on my "privacy" so they can properly address this problem. This generic response is unacceptable.

Regards,

Business

Response:

February 4, 2014

Dear **. [redacted]:

I am writing to acknowledge and respond to the January 14, and 27, 2014, inquiries you addressed to [redacted], Manager of the Executive Inquiries Department. Your inquiries were written on behalf of **. [redacted], who contacted your agency regarding his enrollment status with our plan.

As my January 16, acknowledgement email advised, under the Privacy rule, we are required to obtain an individual’s written approval before can disclose his/her protected health information.

Unfortunately, we have not received the completed Authorization to Release Information form that accompanied that email. Therefore, I am

unable to provide you with our findings.

Since we have finalized our review, rather than delay our response, we have addressed our findings to [redacted].

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

Sincerely,

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.

Review: I was incorrectly charged for a month of insurance coverage, after having canceled my policy and received notice that the cancellation had gone through. I have called the business three times to try to rectify the situation, each time I have been put on hold for over an hour and the situation has not been resolved. The last time I tried to call, the representative on the phone told me they would call me back within 24 hours, which they did not do.Desired Settlement: I would like to get a $97 refund check for their billing error. I would also like them to strongly consider addressing their human resources, as my experience on the phone was extremely frustrating and unhelpful.

Business

Response:

Dear **. [redacted],

I am acknowledging receipt of your correspondence dated May 1, 2014, addressed to the manager of the Executive Inquiries Department, [redacted].

Member/complainant: [redacted] Revdex.com Case file: [redacted].

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] would like to appoint you or the Revdex.com as the recipient of her PHI, she must complete and return the attached Authorization form to us.

If we do not receive the signed Authorization form within 10 business days from today, we will respond to **. [redacted] directly.

Thank you for bringing this matter to our attention. We will begin our investigation and respond accordingly.

Specialist

Executive Inquiries

Review: I am currently on hold waiting to talk to customer service for the 4th time and once again the wait time is extensive. I have been on hold on the phone for 55 min now for an issue that should take only 5 minutes. I'm ver dissatisfied with the custore service by independence blue cross.Desired Settlement: I was charged more than my max deductible for my insurance plan. I would like them to answer the phone first, and then figure out why I was charged more than the deductible and fix it. First and formost, at least answer the phone during their business hours. 55 min on hold is unacceptable.

Business

Response:

Good afternoon [redacted]:

this is just an alert to inform you that I will be handling the review and response for this case file [redacted]. Please have the member complete the attached HIPAA form so that we may correspond with your office.

thank you,

[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:

Regards,

IBC didn't respond with a resolution, rather a request for more info. Where is the HIPPA form they are requesting to fill out? There was no attachment.

Business

Response:

attached is the HIPAA Authorization form to be completed by the member. Please return it to my attention.

Thank you,

Executive Inquiries

Review: Independence Blue cross has failed to credit my account in the amount of $1,132.82 since July 2014.

Although the company has received the above funds, they posted it to someone elses account.

I have sent them proof of payment 4 times,and it still is not being resolved.

My most recent inquiry did not result in the credit being applied.

I have been told a supervisor will call me... but they do not.

I receive late notices and letters saying my account may be cancelled.

The level of incompetence there is alarming.Desired Settlement: Credit my account for the amount I have paid 4 months ago.

Additionally I have spent countless hours on hold and sending them information.

I would like to be compensated for my time in the form of an account credit.

Business

Response:

November 7, 2014Dear [redacted]:Our Manager of the Executive Inquiries Department, Detra D[redacted], has requested that I respond to your recent correspondences regarding [redacted]. The purpose of this letter is to inform your office that [redacted] is not entitled to a refund at this time.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 his PHI.The matter at hand In his complaint to your office, [redacted] stated that, “Independence Blue Cross has failed to credit my account in the amount of $1,132.82 since July 2014. Although the company has received the above funds, they posted it to someone else’s account. I have sent them proof of payment 4 times, and it still is not being resolved. My most recent inquiry did not result in the credit being applied. I have been told a supervisor will call me...but they do not. I receive late notices and letters saying my account may be cancelled. The level of incompetence there is alarming.”Our review Upon receipt of [redacted]’s concerns, we commenced an investigation and our examination revealed that effective January 1, 2014, his premium responsibility is $1,132.82 with no subsidy.We discovered that we erroneously applied a premium payment in the amount of $329.71 to [redacted]'s premium account on October 1, 2014; however, on October 21, 2014, we removed the $329.71 amount from his policy and applied it to the correct member's policy.As of the date of our response, [redacted]’s account is paid to September 30, 2014 and his current balance is $2265.64 for the months of October and November 2014. Our records do not reflect that he is entitled to a premium refund.[redacted] we appreciate the opportunity to address [redacted]’s concern. If you have additional concerns regarding this matter, please feel free to contact me via email at[redacted] I will be pleased to assist you.Sincerely,Rafael D.Specialist, Executive Inquiries Department

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:

Regards,

Business

Response:

December 9, 2014

Review: Due to multiple billing issues (one month my prepayment would be showing the next month I was two months behind and threatened with cancellation) with my account at the beginning of the year, I prepaid for a vision/dental plan for the entire year, I cancelled my plan as was my right effective June 30th 2014. Since then I have been fighting via phone to get a refund of my prepaid premium which still has not been issued. My last phone call today I was told I was not entitled to any refund, which I have been told repeatedly I have been. Today's interaction with IBX I was told that confirmation number ID[redacted] was assigned to my account. I have waiting several months, and have been unable to purchase replacement coverage due to my funds not being released.Desired Settlement: A refund in the amount of $174.00 AT A MINIMAL as that is what I am due for 6 months of prepaid premium at the rate of $29.00 a month.

Consumer

Response:

Hello, Please be advised that I just faxed this completed form to IBX as well..[redacted]

Review: I have had horrible experiences every time I call them for service. Usually the people are rude, uninformative and provide no real solutions. I've called before to inquire about my id cards, they couldn't tell me if they were sent out. I called about my welcome packet , they didn't know what I was talking about and provided me with no real solution. I was given the wrong benefit information several times, given the wrong information on whether or not my mental health provider was in or out of network. I called today because my medication was denied at the pharmacy. I have been on this medication which is [redacted] for almost a year. I was told that I needed prior authorization for the drug when I called Member services and spoke to [redacted]. I explained to [redacted] that I needed this because I am [redacted] and it is a life threatening medication. He said he would call [redacted] to try to get a solution. He called, to no avail they stated that I had to get prior authorization or try another drug????? How can I do that on a Friday at 7:30pm? I asked [redacted] about filing a grievance with the company. He put me on hold again, came back to the line and stated he could basically file a grievance but he didn't know where it would go because I had only been with the plan for a short period of time!! What? I then decided to ask for a Supervisor, he said he would get one and put me on hold. While waiting on hold. The music stopped and low and behold the call was "dropped". I called back and spoke to another rep and demanded to speak with a supervisor. The rep transferred me to [redacted], who was VERY rude to me. Basically told me that [redacted] did not hang up on me the call dropped which was a bunch of [redacted]. I complained to her about my experience and she told me she would file my complaint about service but refused to give me the corporate number.She stated I had to file my pharmacy complaint with [redacted] I called them, they refuse to help me and said I had to file a complaint with [redacted]Desired Settlement: I would like a letter of apology and some type of reimbursement, a member packet mailed to me as well.

Business

Response:

January 23,2014

I am writing in response 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 seeking assistance in resolving her enrollment status with our plan.

As my January 7, 2014. acknowledgement advised, our records indicate that there is no authorization on file for you to receive **. [redacted]'s protected health information. Although that email provided you with a blank Authorization to Release Information form for **. [redacted]'s completion, to date, we have not received the completed document. We are therefore prohibited from disclosing any information regarding **. [redacted]'s protected health information regarding our review to you.

Please be advised that we have responded directly to **. [redacted] with the results of our review, and that we have provided her with a clear and favorable resolution to her enrollment concerns.

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

Sincerely,

[redacted], Specialist

Executive Inquiries

Review: October 23, 2013, I sent a letter of disenrollment for myself and my wife to Blue Cross Medicare Rx. In November my wife, [redacted], received a letter stating that they accepted her disenrollment. However, there was no letter of acceptance sent to me. They will not accept my disenrollment. They keep sending me a bill. I have spent HOURS on the phone with them. They will not admit that they lost my letter.Desired Settlement: We want a post dated disenrollment letter send to [redacted]. Dated 11-09-2013 The same date of my wife's disenrollment letter.

Business

Response:

Dear **. [redacted],

Thank you for contacting our office on behalf of **. [redacted]. We checked our records and we were unable to identify him as one of our members. Please contact **. [redacted] to verify his coverage. It is possible that he is enrolled in another plan. If you find that this information is incorrect please provide his member identification number. Once received we can investigate his concerns.

Thank you for contacting our office

Sincerey,

[redacted], Specialist

Executive Inquiries

Review: I cancelled my policy on or about the 15th of March 2014 and I was informed at that time that I would be receiving a refund as my employer policy had begun on Jan. 1st 2014. While being refunded for this amount was above what I expected my bank account was charged again on or about April 1st 2014 for the cancelled plan. I spoke again to the company on April 15th 2014 and they told me that I would have to wait until the next round of refunds that would be processed on May 14th 2014. I spoke with the company again today May 30th 2014 and they had no record of the refund needing to be processed. I informed them that the taking of my funds from my account after the policy had been cancelled amounted to theft. They told me that my refund check will be mailed in 3-5 days. At this time I have no faith that the check will actually be mailed and they did not offer to put the money back in my account the same way that I made payment.Desired Settlement: At this point they should just refund the money onto the bank card from which payment was made.

Business

Response:

Dear [redacted]:

I have enclosed a HIPAA form to be completed ny the member so that we can correspond directly with your office. In the interim I have already begun my investigation regarding the concerns presented in your inquiry.

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

Sincerely,

Executive Inquiries

Review: My name is [redacted]. I am a recent college graduate with a responsible job living on my own in [redacted] Pennsylvania. I take pride in paying my bills on time each month. I am a member of [redacted] Health Plan [redacted] under my mother’s insurance. Premium payments to my insurance plan are regularly made so I am able to receive a physician’s care to maintain my health. On Wednesday, August 14, 2013, I made an appointment with the physician [redacted] at [redacted] of [redacted] for an annual physical. My insurance card was asked for and a co-pay of $40.00 was paid the day of the visit. On Monday, August 19th, I saw the physician [redacted] due to a urinary tract infection at [redacted] of [redacted]. On Tuesday, November 5th, I asked my Primary Care Physician, [redacted], for a referral to an Ear Nose and Throat doctor. A registered nurse named [redacted] responded to my request and informed me that my insurance did not require a referral. Wednesday, November 6th, after a request for a referral from my primary care physician, [redacted] to The [redacted], I saw a physician’s assistant named [redacted] due to a possible ear infection, which caused temporary hearing loss. [redacted] directed me to audiologist to perform a hearing test. A co-pay was paid after being shown my insurance card for $45.00 for this day’s visit. Later that week I scheduled an appointment with the dermatologist, [redacted], for treatment for acne (I did not get a referral for this visit because when I requested a referral for the Ear Nose and Throat doctor a few days prior, [redacted] informed me that my insurance did not require a referral). On December 24th I received a bill from these visits notifying me that the insurance clai** were denied. After calling the [redacted] Health Plan [redacted] customer service center, a man named [redacted] told me I was denied because these doctors were out of the [redacted] PA network and if I had been a part of the Guest Membership program I would not have been denied. As a [redacted] Health Plan [redacted] member, I do not think it is just that I have to pay out of pocket for these doctors visits when I was so misguided. When I went to these specialists, they viewed my insurance card and saw me without a referral but still collected a co-pay. There was never any discussion about being out of network by either specialist office, which could have been remedied by a quick phone call to [redacted]. I have received misguided information on more than one occasion and these health care balances will be financially devastating.

As a responsible consumer who is covered under an active and current insurance plan I should not be responsible for these bills.

Division of [redacted], [redacted]

[redacted], PA [redacted]

###-###-####

[redacted] ([redacted]) [redacted]

[redacted], PA [redacted] — [redacted]

[redacted], PA [redacted]- [redacted]

[redacted], PA [redacted]Desired Settlement: I would like my insurance to cover these charges made by my physicians.

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]. **. [redacted] indicated her concerns regarding the processing of claims for services that were rendered to her.

Unfortunately, we were unable to identify **. [redacted] in our database as a member of our organization. While we contacted **. [redacted] to request identifying information to initiate our review, we did not receive her response.

In the event that either **. [redacted] or your office can provide identifying information, such as her plan identification number, social security number and date of birth, we will be happy to evaluate the concerns she presented to your office.

**. [redacted], thank you for bringing your concerns to our attention. If you have any questions, you may contact me at ###-###-####. I will be happy 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 am covered under my mother's plan.

My member ID number is [redacted] and my date of birth is [redacted]

Regards,