Independence Blue Cross

Good afternoon: We will be issuing a response directly to the member in this case as there is no HIPAA authorization on file allowing us to correspond with your officeIf you have any questions, please feel free to contact me at ###-###-####I will be glad to assist you sincerely, Scott Y [redacted] Executive Inquiries

New Roman','serif Dear [redacted] ***: I am writing to acknowledge our receipt of your September 18, 2015, correspondence to Detra D [redacted] , Supervisor of the Executive Inquiries DepartmentWe appreciate your writing to alert us to your concern(s) As you may be aware, under the federal government’s Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule we are required to 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 lawThe 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 on file for us to disclose information to you concerning this memberIn order to provide you with the requested information, please have [redacted] complete the attached Authorization to Release Information formTo be considered valid, all areas of the document must be completedInstructions are listed on the back of the form should assistance be requiredOnce you have received the completed docment, please return it to us for processing Should we finalize our review before the completed form is received, we will be required to correspond our findings directly to [redacted] In the interim, please be advised that I have forwarded your inquiry to the appropriate liaison(s) for further review Sincerely, Yvonne *P [redacted] , Specialist Executive Inquiries Attachment

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 months of premium early The first premium was paid by credit card the next were paid by direct payments from my checking account They had me on the phone for 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 hours to waste on their mistake EVER nevertheless during the work week This may be the worst customer service experience I've ever had

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

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: This issue has nothing to do with anything medically related information that would require this form to be completedThe issue I am having is purely the in-ability of [redacted] Health Plan [redacted] to honor their policy holders and make payments in a timely matterThis company has continuously lied and "deleted" information involving my wife's claims in a purpose to better serve themI am and have been working with [redacted] ***, phone number ###-###-####She has been involved in this issue for approximately two months and like the rest of the members employed by [redacted] Health Plan East has caused a hassle and is continuously disrupting payment be the company in order to ressolve this issue Regards, [redacted] ###-###-####

Dear ** [redacted] , I am acknowledging receipt of your correspondence dated May 1, 2014, addressed to the manager of the Executive Inquiries Department, [redacted] face="Times New Roman">Member/complainant: [redacted] Revdex.com Case file: [redacted] Compliance with the HIPAA Privacy RuleThe 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 lawPHI 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 identityThe written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy ruleIf ** [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 business days from today, we will respond to ** [redacted] directly Thank you for bringing this matter to our attentionWe will begin our investigation and respond accordingly [redacted] Specialist Executive Inquiries

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: 1) I have not received an explanation about why the claim was rejected in the first place, if the claim was legitimate and was eventually paid It has the appearance that I am being punished for using an out-of-network provider If this is not true, then why was the claim initially rejected? 2) I have not been informed of the actions that Independence Blue Cross will be taking to prevent this situation from repeating itself I just received an explanation-of-benefits notice from Independence Blue Cross that an identical claim for the month of April was rejected, again without explanation What does Independence Blue Cross plan to do to prevent this situation from recurring over and over? Regards, [redacted]

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

Good mroning [redacted] ***: I am writing inresponse to the above refereenced complaint for on behalf of [redacted] The purposoe of this letter is to inform you that we originally processed his claim for date of service June 17, 2015, and no adjustment or reprocessing of the claim is necessary [redacted] contends that his claim was not properly processed correctly as a a [redacted] employee with services rendered by [redacted] He feels he should not have been subject to the cost sharing that was assessed on his claim After further review it appears his claim processed correctly under tier2, taking a $copaymentThe services were performed at [redacted] Medical Center of the [redacted] Health system which, is not a facility within the [redacted] NetworkIf services were perfomed by a [redacted] provider, the claim would have processed under tierbenefit level Thank you for bringing [redacted] 's concerns to our attentionIf you have any questions, please feel free to contact me at ###-###-####I will be glad to assist you Sincerely, Scott Y***, Specialist Executive Inquiries

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

January 13, Dear [redacted] : I am writing in response to your November 22, 2014, inquiry to our organization on behalf of [redacted] Please pardon the delay in responding to this inquiryThe purpose of this letter is to inform you that we issued a refund check in the amount of $to [redacted] on December 16, This check was cashed on December 24, 2014.Before providing you with our findings, we want to thank you for providing the completed Authorization to Release Information form, as this enables us to release [redacted] ’s Protected Health Information (PHI) to your office, as required under the Federal Health Insurance Portability and Accountability Act (HIPAA)The balance of this letter will provide a summary of [redacted] ’s concerns and explain our rationaleA summary of the member's concerns [redacted] stated AmeriHealth erroneously billed his account $for October and November 2014—instead of $697.22, as his dependent son, [redacted] , was removed from his policy effective October 1, [redacted] requested a refund of $overpayment for October and reconciliation of his account for these months and going forwardOur determination AmeriHealth reviewed [redacted] ’s account and confirmed his son, [redacted] was not enrolled on his contract effective October 1, 2014, resulting in a reduction of his monthly premium from $to $ [redacted] overpaid his October and November premiums by $during those months [redacted] , we appreciate the opportunity to review [redacted] ’s concerns and the patience you have demonstrated in awaiting our replyIf you should have any questions regarding this matter, you may contact me at ###-###-#### and I will be happy to assist youSincerely,Reginald HExecutive Inquires Specialist Office of Consumer Advocacy

Hi [redacted] - This is to acknolwledge receipt of your inquiryThe 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 completionOnce we receive it, we will be happy to release our findings to youIn the event that we should not receive it, then we will respond directly to the member Thanks [redacted] Reginald H [redacted] Executive Inquiries Specialist Market Street: Mailstop SG2Philadelphia, PA 19103P ###-###-#### x [redacted] | F ###-###-####

I am writing in response to the May 2, 2016, letter to Detra [redacted] on behalf of Mr [redacted] Your complaint was received in our office on May 10, and concerns enrollment activity.As you are aware, the federal Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing his/her protected health information or PHIWhile our records indicate that there is no authorization for you to receive this member's PHI, we want you to know that we have reviewed Mr [redacted] 's complaint to your officeIt has been identified that this matter is resolved and currently consider it closed.Ms***, we appreciate your bringing Ms [redacted] 's concerns to our attentionIf you have any additional questions, please contact me at ###-###-####.Sincerely,Rafael PD [redacted] Lead Client Services Representative Executive Inquiries Department

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: I did not receive the required form through this system in order for you to have access to the information you need. I have called your office (BBB) requesting the form. Could you please send me the form so I can submit it to IBX so that they can send you the required information. Also, did the BBB receive my insurance ID number from me or from IBX? I cannot remember if I actually provided it to you. Regards, [redacted]

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

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: [redacted] - can you please put this on hold until such time as we hear back from IBX The last response from MsBaker indicated that we are waiting for the Enrollment Department to respond Regards, [redacted]

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

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

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
After contacting, the business, this issue is still not resolved
Collection notices are continuing to recur and now a hospital procedure that had been scheduled must be canceled because of this ongoing error and the incompetency of the business to appropriately handle and resolve this requestDoes the Revdex.com offer any insights into legal action?
Regards,
*** ***