Independence Blue Cross

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
1901 Market Street: Mailstop SG2Philadelphia, PA 19103P  ###-###-####  x[redacted]  |   F  ###-###-####

On Tue, May 27, 2014 at 3:13 PM, [redacted] <[redacted]> wrote:
I have mentioned several times already that the company has to do what I noted in the original complaint. There is no updated information as nothing has been done since you closed the case.  Nothing has been done since I filed the complaint.  the company has to compensate me the amounts mentioned in the original  complaint ($513.27).  Please reopen this case and stop being redundant and wasting everybody's time.  thanks

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 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.
 
[redacted]
Specialist
Executive Inquiries

Thank you for speaking with me today. As you requested, this is just a confirmation that we are currently working with the consumer and will issue our response directly to her. Your assigned ID number for this case is [redacted]. The consumer is Jessica Mosby. Please contact me if you...

have any questions.  Scott Y[redacted]SpecialistExecutive Inquiries[redacted]Philadelphia, PA [redacted]

[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:
12/29/2015
RE: DO NOT ACCEPT RESPONSE MADE BY IBX
To Whom It May Concern:
This additional letter is in reference to the complaint I made regarding IBX handling my claims.
I am attaching a signed HIPPA Authorization Form and additional supporting documentation as part ofmy reason to continue with the complaint.
The following documents are also included:
1) [redacted].jpg - Print Screen From IBX website that Shows my provider indicated in the disputed claims    are in IBX network.2) [redacted]2.jpg - Additional print screens taken directly from the IBX website that shows Dr. Nicasia is in network.3) [redacted]3.jpg - Print Screen taken directly from the IBX website that showed my coverage at time I was enrolled   with IBX and during the time when the claims were made. 4) [redacted]4.jpg - Breakdown explanation of what is considered in-network and out of network as part of my coverage    taken directly from the IBX website. 5  [redacted]5.jpg - Additional print screens to show the breakdown explanation of what is considered in-network and out of network as part of my coverage    taken directly from the IBX website.6) [redacted]6.jpg - Additional print screen taken directly from the IBX website that explains what is considered in-network    and out-of network for outpatient mental health as part of my coverage. According to this print screen whether Dr. N[redacted]   is in-network or out-of-network my IBX coverage (and tier level) is resulting in a $50 copayment only. This print screen was taken   at 12/29/2015 at 3:30PM EST. 7) 6) [redacted]7.jpg - Final print screen tken directly from the IBX website that explains what is considered in-network    and out-of network for coverage under my tier.
Please review this as part of my complaint and please feel free to contact me with questions.
Regards,
[redacted]

I am writing in response to the May 2, 2016 letter to Detra D[redacted] on behalf of Ms. [redacted]. Your complaint was received in our office on May 9, 2016 and concerns a flu shot reimbursement for Ms. [redacted].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 PHI. While 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 Ms. [redacted]'s complaint to your office. It was identified that we previously resolved this matter on March 15, 2016, and currently consider it closed.Ms. [redacted], we appreciate your bringing Ms. [redacted]'s concerns to our attention. If you have any additional questions, please contact me at ###-###-####.Sincerely,Diane H[redacted] Lead Client Services Representative Executive Inquiries Department

Good Afternoon [redacted],
I am writing in receipt of [redacted]'s complaint to your office. We are investigating her concerns and will be in contact with your office shortly. As you are aware, a completed authorization is needed so that we can share our findings with your office....


Once this is received, a copy of our response will be sent to your office.
In the interim, if you have any questions, please contact me at ###-###-####. I will be happy to assist you.
Sincerely,
Sylvia B[redacted], Specialist
Executive Inquiries

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

I had missed ONE payment by accident. IBX never contacted me to let me know that my insurance would be terminated. When I called they could not provide an explanation as to why they wouldnt warn me that they were terminating my coverage due to nonpayment. I offered immediately to pay the missed payment and the next one as well. They said that would reinstate my coverage without a problem. It would take 3-5 days for the coverage to be reinstated from time of payment. Ten days went by and I still did not show coverage. I called in to find out that the woman who accepted my payment never sent the paperwork through to reinstate my coverage. Apparently there is nothing that they can do about that and I now have to wait another 3-5 days for my coverage to be reinstated. This is unacceptable as they already have my money. I explained I take a very time sensitive medication each month and they told me to "Go pay for it out of pocket" to have it reimbursed when my coverage is reinstated. My medication is over $5,000 and I am certainly not going to pay for it out of pocket. I am insulted and shocked at this. How can they not simply update their system???

Re:    ...

[redacted]    
 
                            
            Dear [redacted]
 
I am writing to acknowledge our receipt of your April 1, 2014,  correspondence to Detra D[redacted] Manager
of the Executive Inquiries Department. We appreciate your writing to alert us to your concern(s). In order to fully address the concerns you have presented, additional research is necessary. I have forwarded your correspondence to the appropriate liaison for further review. 
 
However, as you 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 PHI for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.
 
Our records indicate that there is no authorization for you to receive this member’s PHI. As a result, we cannot disclose any information regarding our member. We ask that you have [redacted] complete the attached Authorization to Release Information form. In order for the form to be considered valid, all sections of the document must be completed. Should [redacted] require assistance, instructions for the completion of the form are located on the back of the document. Please return the completed document to us via email as a PDF. 
 
[redacted], should we complete our review before the completed form is received, we will be required to correspond our findings directly to [redacted].   Thank you for bringing this matter to our attention and for the opportunity to address her concerns.
 
Sincerely,
 
 
Yvonne M. P[redacted], Specialist
Executive Inquiries
 
Attachment

[redacted],
Good afternoon.
I am writing to acknowledge the complaint # [redacted]. We are investigating the matter and will supply our response upon the conclusion of our review.
Thank you.
Regards,
Rafael ** D[redacted]
Specialist, Executive Inquiries...

Department
Independence Blue Cross

[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: 11089657
I am rejecting this response because:I have contacted the Marketplsce several times. Each time, their representatives assured me that IBX was placed on proper notice of January 2016 coverage. Of note, IBX continues to bill me for two January 2016 policies. As stated, I want only one policy for 2016- the PPO Gold policy in which I am currently enrolled. IBX is refusing to permit me to access my benefits until overpayment for two January policies is received. 
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

January 13, 2015
Dear [redacted]:
Thank you for your...

patience while we conducted a review of [redacted]’s concerns. We also received the completed Health Insurance Portability and Accountability Act (HIPAA) authorization form which allows us to respond to your December 30, 2014, letter. The purpose of our letter is to inform you that we corrected the premium invoice for [redacted].[redacted]'s concerns [redacted] contacted your office about possible HIPAA violation because his premium invoices have been addressed to his daughter and not to him the subscriber. He received several premium invoices showing the incorrect name. He has contacted our office about this situation to o avail.
Our finding
A review our records determined that we had the correct mailing for [redacted] in our member detail system; however, this information was not in our member database. We sincerely apologize for any inconvenience this situation may have caused. Because of the concerns expressed by [redacted] we notified our Privacy Office to make them aware of your concerns.
Based on the information it was determined that yes the incorrect name appears on your premium invoice; however, it was to the correct mailing address. There is no indication that an unauthorized person saw the invoice or any Personal Health Information (PHI) prior to it being delivered.We have updated our records to correctly show your Ed Vesey as the subscriber on the premium invoice. His next premium invoice should reflect the change.
[redacted], thank you for bringing this matter to our attention. If you have any additional questions, please contact me at ###-###-####. I will be happy to assist you.Sincerely,Sylvia B
Specialist Executive Inquiries

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

Re:   [redacted]
 
size="3">Dear Mr. [redacted]: 
I am writing to acknowledge our receipt of your March 3, 2015, correspondence to Detra D[redacted], Manager of the Executive Inquiries Department. We appreciate your writing to alert us to Ms. [redacted]'s concern(s). 
In order to fully address the concerns you have presented, additional research is necessary. I have forwarded your correspondence to the appropriate liaison for further review. However, as you may be aware, the federal Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing her/his protected health information or PHI for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule. 
Our records indicate that there is no authorization for you to receive this member’s PHI. As a result, we cannot disclose any information regarding our member. We ask that you have Ms. [redacted] complete the enclosed Authorization to Release Information form. In order for us to consider the authorization valid, all sections of the document must be completed. Should Ms. [redacted] require assistance, instructions for the completion of the form are located on the back of the document. When she has proved you with the completed the authorization form, to expedite our receipt, please forward it to me via email as a PDF.
If we have not received the completed autorization form by the time we have finalized our review, we will respond directly to Ms. [redacted]. 
Mr. [redacted], should we complete our review before the completed form is received, we will be required to correspond our findings directly to Ms. [redacted]. Thank you for bringing this matter to our attention and for the opportunity to address her concerns. 
Sincerely, 
 
Yvonne M. P[redacted], Specialist/Executive Inquiries 
Enclosure

Good Morning,
Thank you for providing our office with the completed HIPAA authorization form for [redacted]. Upon completion of our investigationa a response letter will be sent to your office.
Sincerely,
 
Sylvia B[redacted], Specialist
Executive...

Inquiries

[redacted] Philadelphia, PA 19103-1480IndependenceMarch 23, 2015Mr. [redacted]
The Revdex.com
1411 K. Street NW, 10th Floor Washington, DC 2005-3404Re: [redacted]File No: [redacted]I am writing in response to your March 20, 2015, email to the Manager of the Executive Inquiries Department, Detra D[redacted]. The purpose of our letter is to inform you that Mr. [redacted]'s concerns have been resolved.On March 20, 2015, we notified your office that in accordance with the federal Health Insurance Portability and Accountability Act requirement, authorization was needed from Mr. [redacted] to release his protected health information (PHI). As of today, we have not received the completed form.Because this letter provides general information, we are able to respond to you regarding the matter in question.Addressing his concerns Mr. [redacted] contacted your office about not receiving a refund for a previous account. He also advised that his current coverage is showing delinquent and in danger of cancellation. Mr. [redacted] asks that we correct his account and apply his premium payments accordingly.The concerns expressed by Mr. [redacted] have been addressed and the outcome is favorable to the member.(over)Mr. [redacted], if you have any additional questions, please feel free contact me at ###-###-####. I will be happy to assist you.
Sincerely,
Sylvia B[redacted], Specialist Executive Inquiries

Dear Ms. [redacted],
I am writing in receipt of Mr. [redacted]'s complaint. In order to provide your office with a copy of our findings a completed HIPAA authorization form is required.
Please provide our office with the completed authorization form. Once received we will be able to...

share our findings with your office.
If you have any questions, please feel free to contact me at ###-###-####. I will be happy to assist you.
Sincerely,
Sylvia B[redacted], Specialist
Executive Inquiries

Complaint ID: [redacted]Complainant: [redacted]
Dear Sir/Madame,
We are in receipt of your July 9, 2014, communication that includes **. [redacted]'s rejection of your response and additional comments about his past experience with us.
We acknowledge that we could have handled **. [redacted]'s past inquiries in a timelier manner and are truly sorry for the fustration we caused him. Please be assured that we have addressed his previous inquiries mentioned in his comments . As part of our investigation(s) we troubleshoot any identifiable system errors, determine the root cause and remedy it. We review the telephone calls for quality assurance and training purposes, and if warranted, we coach/educate our representatives to ensure that they are consistently providing quality customer service to our members.  Lastly, **. [redacted] can be assured that key members of our leadership team are aware of his experience with us.
Still, I am closely monitoring the progress of his initial filing and will contact him once it has been resolved.
I hope that this information helpful.
Sincerely,[redacted]SpecialistExecutive Inquiries