Independence Blue Cross

November 7, 2014Dear *** ***:
Our Manager of the Executive Inquiries Department, Detra D***, has requested that I respond to your recent correspondences regarding *** ***The purpose of this letter is to inform your office that *** *** 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 lawThe written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy ruleWe appreciate your office submitting the authorization from *** *** listing your office as an authorized recipient of his PHIThe matter at hand In his complaint to your office, *** *** stated that, “Independence Blue Cross has failed to credit my account in the amount of $1,since July Although the company has received the above funds, they posted it to someone else’s accountI have sent them proof of payment times, and it still is not being resolvedMy most recent inquiry did not result in the credit being appliedI have been told a supervisor will call me...but they do notI receive late notices and letters saying my account may be cancelledThe level of incompetence there is alarming.”
Our review Upon receipt of *** ***’s concerns, we commenced an investigation and our examination revealed that effective January 1, 2014, his premium responsibility is $1,with no subsidyWe discovered that we erroneously applied a premium payment in the amount of $to *** ***'s premium account on October 1, 2014; however, on October 21, 2014, we removed the $amount from his policy and applied it to the correct member's policyAs of the date of our response, *** ***’s account is paid to September 30, and his current balance is $for the months of October and November Our records do not reflect that he is entitled to a premium refund.*** *** we appreciate the opportunity to address *** ***’s concernIf you have additional concerns regarding this matter, please feel free to contact me via email at*** *** I will be pleased to assist you.Sincerely,Rafael DSpecialist, Executive Inquiries Department

February 24, 2014Dear ***:I am writing in respond to your January 23, 2014, correspondence to *** ***, Manager of the Executive Inquiries DepartmentYour inquiry was written on behalf of ***, who contacted your agency regarding the premium payments status of his
*** HMO Silver Proactive planThe purpose of this letter is to inform you that we have finalized our review and have responded directly to *** with the details of our findings.On January 24, I sent you an email acknowledging our receipt of your inquirySince 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 *** complete, designating you/the Revdex.com as a recipient of his protected health information.Unfortunately, to date, we have not received the completed formAs a result, we cannot disclose any information regarding our member to youSince we have finalized our review, rather than delay our response, please be advised that we have addressed our findings directly to ***.***, thank you for bringing this matter to our attention.Sincerely,

July 31,
">Revdex.com Metro Washington, DC and Eastern Pennsylvania
K StNW, 10th Floor
Washington, DC 20005-
Re: *** *** Complaint ID#: ***
Dear *** ***:
Our Supervisor of the Executive Inquiries Department, Detra D***, has requested that I respond to your July 22, 2015, correspondence regarding *** ** ***.
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 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
As we have not received an authorization form from your office with *** *** naming you and your office as an authorized recipient of her PHI and to prevent any unnecessary delays, we have directed a general response
We have located a policy for *** ***; however, with an address adifferent than presented in the complaintAdditionally, our records indicated that we received a call on July 21, and transferred a call from *** *** to *** *** at ###-###-#### to update her Primary Dental Office
We trust that this information will be helpful to youPlease contact me at ###-###-#### with any additional questions specific to this matter and I will be pleased to assist you
Regards,
Rafael *D***
Specialist, Executive Inquiries Department
Independence Blue Cross

I am writing in response to the May 2, 2016, letter to the Supervisor of the Executive Inquiries Department, Detra D***-S***, on behalf of Ms*** ***Your complaint was received in our office on May 10, and concerns enrollment and billing
activity.We have received the valid HIPAA authorization from Ms***, which lists your office as an authorized recipient of her PHI and are able to share the details about our reviewThe matter at hand In her correspondence, Ms*** expressed her position regarding enrollment and billing activity which has occurred on her accountAs a result of the activity, improper application of premium payments and incorrect identification cards were generatedOn behalf of our President and Chief Executive Officer, MrDaniel JH***, and our entire organization, we extend our sincere apology to Ms*** for the unacceptable level of service that she received pertaining to her experiencePlease be assured that this is not indicative of the high-quality level of customer service that we strive to render to our customers and that we have taken the opportunity to provide additional training to the applicable client service team membersOur review Upon receipt of the correspondence, we reviewed all the activity on Ms***'s policy and determined that the primary cause of the inaccuracies was an enrollment errorAs a result of this error, we mistakenly applied premium payments for January, February, and March to an incorrect Preferred Provider Organization (PPO) account, as opposed to the correct Health Maintenance Organization (HMO) account for Ms***Subsequent to the realization of the errors, we have corrected Ms***'s enrollment records and transferred the appropriate monies to her HMO account under the proper Bill Account number ***The most recent premium payment for $was applied to Ms***'s policy on April 27, As such, Ms***'s account currently has a credit balance of $We are generating Ms***'s June premium invoice today, and the credit balance with will be applied to the June premiumIn addition, we have cancelled both the incorrect PPO policy and Billing Account number *** *** in accordance with our revision of the issueMs***, we appreciate your bringing Ms***'s concerns to our attentionIf you have any additional questions regarding this matter, please do not hesitate to contact me at ###-###-####Sincerely,
Rafael PD***
Lead Client Services Representative Executive Inquiries Department

I am writing to acknowledge our receipt of the March 4, 2016, email you addressed to Detra D***-S***,Supervisor of the Executive
Inquiries Department. In order to fully address the concerns you have presented, additional research is necessary I have forwarded your correspondence to the appropriate liaison(s) for further review. I have reviewed the Authorization to Release Information form that accompanied your inquiry.Unfortunately, the document cannot be considered valid for two reasons: 1) the Health Plan, and 2)Member Signature sections of the form are not completed correctlyThe Health field should list thecoverage plan in question and the member written signature is required. Please have Ms*** complete another authorization formOnce the document has been completedplease forward it to my attentionShould we finalize our review before the completed form is received,we will respond directly to Ms***. Ms***, thank you for your patience while we resolve this matter.You may expect our response shortly. Sincerely, Yvonne MP***, Specialist Executive Inquiries

November 9, 2015Dear *** ***
Our Supervisor of the Executive Inquiries Department, Detra D***, has requested that I acknowledge your recent correspondence regarding *** ***The purpose of this letter is to provide your office with an authorization
form.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 (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 ruleAs such, We have enclosed an authorization form so that *** *** could complete the form naming you and your office as an authorized recipient of his PHI so that we can provide your office with our response upon the conclusion of our investigation*** ***, should you have any additional questions, regarding this matter, please contact me at ###-###-#### and I will be glad to assist you.SincerelyRafael D., SpecialistExecutive Inquiries Department

***--
Attached is an authorization for you to provide to the member so that we can share our findings with your offcieIf we don not receive it, we will respond directly to the member
">*** ***
Executive Inquiries Specialist
*** *** *** *** ***Philadelphia, PA 19103P ###-###-#### x*** | F ###-###-####

[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:
Regards,
*** ***

Dear *** ***
I am writing to acknowlegde our receipt of your March 17, 2014, correspondence to Detra D*** Manager of the Executive Inquiries Department
Please be advised that the Revdex.com sent
this case to our plan earlier this month for review
That inquiry - which references the same file number - was assigned to my counterpart, Scott Y***Since this is the same case issue and Scott has already initiated the review proscess, rather than duplicate effort, I am closing out my involvement. However, I will ensure that the correspondence I received today is put together with Scott's paperwork/casefile
*** ***, thank you for the opportunity to be of assistance. You may direct any questions concerning this case to Scott, at ***
Sincerely,
Yvonne P*** 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: ***
I am rejecting this response because:
Hello Reginald,
*** has attached the following information for your review
Regards,
*** ***

Dear *** ***:
I am writing in response to your inquiry on behalf of *** ***We apologze for any inconvenience he experienced as a result of our original denial of his claim for date of service January 7, After a review of his claim, we identified that our claims specialist committed a processing error, which resulted in the original denial of ***'s claim
As a result of your inquiry, we were able to correct the error and reprocess his claimPayment was issued to *** *** (subscriber) on March 31,
We are monitoring the processing of **, ***'s claims to ensure that we are processing his claims correctly when we initially receive them
*** ***, thank you for bringing ***'s concerns to our attentionIf you have any questions, please contact me at ###-###-####I will be glad to assist you
Sincerely,
*** ***, Specialist
Executive Inquiries

***--
Attached is a HIPAA authorization for this case that we received on 7/2/it's still currently under reviewIf we receive the completed HIPAA auth to release the member's protected health information (PHI) to your organization, we will do soOtherwise, we will respond directly to the member
Reginald H***
Executive Inquiries Specialist
Market Street: Mailstop SG2Philadelphia, PA 19103P ###-###-#### x | F ###-###-####

[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]
1/ THE HIPAA CREDENTIAL WAS ESTABLISHED YEARS AGO2/ THE COMPANY CONTINUES TO BE IRRESPONSIBLETHE MATTER IS FAR FROM SETTLEDSUPERVISORS ARE NOT FOLLOWING THROUGHNO ONE IS REPLYING TO ME PER PROMISED PHONE CALLSTHE ACCOUNT REMAINS WRONGI AM NEVER LATE ON MY BILLS
Complaint: ***
I am rejecting this response because:
Regards,
*** ***

Complaint: ***
I am rejecting this response because:
Regards,
*** ***
MESSAGE:
Dear ***,
I have read the response from Independence Blue Cross. It states "*** *** gave permission for the *** *** to complete her Council for Affoirdable Quality Healthcare (CAQH) information and supply additional information as needed. THIS IS THE PROBLEM!!!!!
I NEVER GAVE PERMISSION FOR THIS!!!!! I have NO IDEA how this information was changed in the CAQH website!
Also, in December of Independence Blue Cross faxed a form to update our contact information. The form was filled out immediately and faxed back the same day to the number provided. *** *** Hospital's information was NOWHERE on that form!
My credentialing contact information in CAQH has since been corrected, however, this error has wreaked havoc for my practice and my Independence Blue Cross patientsSincerely,
*** ** ***, CNM
*** *** * *** ***###-###-####

[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:
I will not accept this response, as you have provided no information. I don't know who "***" is, but I am not filling out any authorization form, because I do not want you to send the information to "***," I want you to send it to me, *** ***. You have my mailing address on-file. As I said in my last message, I am the account holder, so I do not see any reason why I should need to authorize you to send me information on my own insurance plan.I called you at ###-###-#### on March 13, and was instructed to leave a message, which I did. I still have not heard back. I need an updated book with the details of my insurance coverage, as the one I have now is in violation of federal law. You can not exclude coverage for mental health or substance abuse
Regards,
*** ***

Our Supervisor of the Executive Inquiries Department, Detra ***, has requested that I acknowledge your recent correspondence regarding Mr***The purpose of this letter is to provide your office with an authorization formThe 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 (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.As such, we have enclosed an authorization form so that Mr*** can complete the form naming you and your office as an authorized recipient of his PHI so that we can provide your office with our response upon the conclusion of our investigationMs***, should you have any additional questions, regarding this matter, please contact me at ###-###-#### and I will be glad to assist youSincerely,
Tedra F* Lead Client Services Representative Executive Inquiries Department

Good afternoon *** ***:
" margin: 0px">I am writing in response to your inquiry on behalf of *** *** *** contacted your office requesting assistance in getting his dental checkups and repairs covered for himself and his wifeHe 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
*** ***’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 groupWe identified that on July 9, 2014, our customer services representative contacted the dental provider, *** ***, and requested that ID cards be issued to *** ***This was done again on August 7,
*** ***, thank you for bringing *** ***’s concerns to our attentionIf you have any questions please contact me at ###-###-####I will be glad to assist you
Sincerely,
Scott Y***
Specialist
Executive Inquiries

Dear *** ***,
I am writing in response to your June 9, 2015, letter to office on behalf *** *** *** contacted your office about the denial of payment for
shingles vaccination she received on June 6,
Our records indicate that there is no authorization for your office to receive *** ***'s protected health information or PHIAs a result, we cannot disclose any information regarding our memberPlease have *** *** complete the HIPAA authorization formOnce this information is received and processed, we will be able to release her PHI to your office
Because this letter provides general information, we are able to respond to you regarding the matter in questionOur records show that the claim for services rendered processed; however, line item denied due to age invalid for serviceAn exception has been submitted on the member's behave to process the claimSince the provider is a participating provider the member should not be held accountable for the claim
Sincerely,
Sylvia B***, Specialist
Executive Inquiries

Re: ***
***
Dear ***:
I am writing to acknowledge our receipt of your January 14, 2014, correspondence to *** ***-***, Manager of the Executive Inquiries DepartmentWe appreciate your writing to alert us to your concern(s)In order to fully address the concerns you have presented, additional research is necessaryI 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 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 for you to receive this member’s PHIAs a result, we cannot disclose any information regarding our memberWe ask that you have *** complete the attached Authorization to Release Information formIn order for the form to be considered valid, all sections of the document must be completedShould *** require assistance, instructions for the completion of the form are located on the back of the documentPlease return the completed document to us via email as a PDF
***, should we complete our review before the completed form is received, we will be required to correspond our findings directly to ***. Thank you for bringing this matter to our attention and for the opportunity to address his concerns
Sincerely,
*** ** ***, 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: ***
I am rejecting this response because: I have called Blue Cross on a regular basis since the end of May or early June and am always told that someone will folland it does not happen I have been paying for health insurance, but unable to fully utilize it and get necessary medical tests done due to the glitch
Regards,
*** ***