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: [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 completed. The 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 matter. This
company has continuously lied and "deleted" information
involving my wife's claims in a purpose to better serve them. I 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]
[redacted]
###-###-####

In response to a message from [redacted]e regarding Complaint [redacted], I am attaching the requested HIPAA form.
I can be reached via [redacted] (c) for any further questions.

Re:   [redacted]
 
Dear Ms....

[redacted]: 
I am writing to acknowledge our receipt of your February 28, 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 [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]. 
Ms. [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 afternoon. I am writing to acknowledge the complaint regarding [redacted]. Previously, we received Ms. [redacted]’ concern specific to receiving benefit booklet by way of an February 2016 governmental inquiry.  We immediately confirmed her residential...

address and reissued the booklet to Ms. [redacted] overnight. We confirmed that we had previously fulfilled three prior requests but could not verify if there was an issue with the postal service. We were informed that the legislator’s office confirmed with Ms. [redacted] that she did receive the 168-page booklet and that she was satisfied. Please advise if you require additional information pertaining to this matter. Regards,Rafael P. D[redacted]Lead Client Services RepresentativeExecutive Inquiries Department [redacted] Philadelphia, PA 19103

To Revdex.com of Metro Washington DC & Eastern Pennsylvania -
We have received the complaint under complaint number [redacted]. We will commence an investigation and will provide your office with our response upon the conclusion of our review.
Regards,
Rafael *....

D[redacted]
Executive Inquiry Specialist
Independence Blue Cross

Revdex.com of Metro Washington DC & Eastern Pennsylviana,

class="MsoNormal">
We acknowledged the receipt of inquiry. It will be assigned to a specialist for review and response.
Chris R[redacted] Jr.Business Specialist
Customer Service 1901 Market Street, SG2Philadelphia, PA 19103P  ###-###-####  x[redacted]

January 18, 2016Dear [redacted]:
Our Supervisor of the Executive Inquiries Department, Detra D[redacted], has requested that respond to your December 21, 2015, correspondence regarding [redacted]. The purpose of this letter is to inform your office that we have responded directly to [redacted].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 law. The 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 a valid authorization form from your office with [redacted] naming you and your office as an authorized recipient of her PHI and to prevent any unnecessary delays, we have directed our response to [redacted].[redacted], we appreciate your office bringing [redacted]'s concerns to our attention.
Sincerely,
Rafael D.
Specialist Executive Inquiries Department

[redacted],
Good morning,
I am writing to acknowledge the complaint, recognized under your identification number of [redacted], regarding [redacted]....


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 law. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.
 
For your covenience, I have attached a HIPAA Authorization Form for [redacted]'s completion. Your office may returne the comleted form to my attention via fax at ###-###-#### or you may scan and e-mail it to me at [redacted]@ibx.com .
 
In the interim, we have commenced an investigation into the matter presented. Upon receipt of the completed and valid authorization form from [redacted] naming you and your office as an authorized recipient of her PHI, we will provide your office with our response.
 
[redacted], should you have any questions, please contact me directly at ###-###-####.
 
Thank you.
 
Sincerely,
 
Rafael *. D[redacted]
Specialist, Executive Inquiries Department
Independence Blue Cross

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

New Roman','serif'; FONT-SIZE: 12pt; mso-fareast-font-family: 'Times New Roman'">Dear [redacted]:
 
I am writing to acknowledge our receipt of your September 18, 2015, correspondence to Detra D[redacted], Supervisor of the Executive Inquiries Department. We 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 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 on file for us to disclose information to you concerning this member. In order to provide you with the requested information, please have [redacted] complete the attached Authorization to Release Information form. To be considered valid, all areas of the document must be completed. Instructions are listed on the back of the form should assistance be required. Once 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

[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  ###-###-####

Thank you for your response, enclosed is an attachment with the completed HIPPA form. Please let me know if there is anything else you need to resolve this issue. Thanks. 
Best Regards, [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: 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 (Revdex.com) 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 Revdex.com receive my insurance ID number from me or from IBX?  I cannot remember if I actually provided it to you. 
Regards,
[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: [redacted] - can you please put this on hold until such time as we hear back from IBX.  The last response from Ms. Baker indicated that we are waiting for the Enrollment Department to respond. 
Regards,
[redacted]

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[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:
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]

[redacted]--
As previously indicated to your office, we need to have the meber's written consent to release his PHI. As our records do no reflect that we have received it neither from you nor the member, we will response directly to the member. In the event that we should receive this information, then  we will share our findings with you.
If you have any questions, you may call me at ###-###-####.
Reginald Hall-Gregory
Executive Inquiries Specialist
[redacted]Philadelphia, PA 19103P  ###-###-####  x[redacted]  |   F  ###-###-####

Re: 
#1f497d;">[redacted]              
                                  
            Dear [redacted]:
I am writing to acknowledge our receipt of your March 13, 2014, correspondence to [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 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 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 his concerns.
Sincerely,
[redacted], Specialist
Executive Inquiries
Attachment

Good Afternoon [redacted],
I am writing to acknowledge our receipt of your recent complaint on behalf of [redacted]. We are currently investigating the concerns expresssed by  [redacted].
Roman">Our records indicate that there is no authorization for youroffice to receive [redacted] protected health information or PHI. As a result, we cannot disclose any information regarding our member. Please complete the enclosed Authorization form . Once this information is received and processed, we will be able to release his PHI to your office.
Sincerely,
 
Sylvia B[redacted], Specialist
Executive Inquiries