Integrated Equity Management Inc

RE: Complaint ID ***Dear Ms***OnApril 18, UPMC Health Plan, Inc, ("UPMCHP") responded to an initial complaint filed by Mr*** ***That complaint did not include a HIPAA authorization that would have allowed UPMCHP to disclose protected health information, Without a HIPAA-compIaint authorization, UPMCHP advised that it was unable to provide a response to the Revdex.com regarding the complaint.On April 21, 2017, UPMC Health Plan, Inc("UPMCHP") received a fax sent by Mr*** *** concerning UPMCHP's responseAlthough Mr*** provided an authorization form with his April fax, he did not provide UPMCHFs required authorization and release formIn an April 24-letter, UPMCHP attached a copy of the proper form for Mr*** to fill out, sign, and submit if he desired, UPMCHP did not receive a completed copy of the correct form.UPMCHP has received your letter dated May regarding Mr***, Again,UPMCHP does not have a proper HIPAA authorization that would allow UPMCHP todisclose protected health information, Without a HIPAA-compIaint authorization,UPMCHP is unable to provide a response to the Revdex.com regarding the complaint.Should you have any questions or require any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,John S*** Staff Attorney UPMC Health Plan

UPMC Health Plan, Inc("UPMCHP”) has received and reviewed your letter dated January 04,2017, as well as the accompanying complaint.The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health informationWithout a HIPAA-complaint
authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaintHowever, UPMCHP will determine whether the affected individual is a UPMCHP member and, if so, will respond directly to the affected individual with a more detailed response.Thank you for bringing this matter to our attentionShould you have any questions or require any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Ariell A***Staff Attorney UPMC Health Plan

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint.? For your reference, details of the offer I reviewed appear below
11/8/2017? I received a response dated November 6, from UPMC attorney Ariell A***, stating that their UPMC member services placed me on the do not call list on October 26.? ? This was per my repeated requests which was not made clear in the letter.? This does not address the problem.? I was called, at the end on a daily basis, ? from Maxim health which is affiliated with UPMC.? I repeatedly told them I do not need their services.? The calls only increased to an automated system.? I requested UPMC to stop calling me.? That did not work until October 26th.? When I called UPMC again to stop the calls.? So the issue is Maxim Health Care and UPMC giving my information.? And Maxim having an aggressive sales campaign that I could not stop without much effort on my partMy effort should not have been needed.? The calls border on harassment and need to be addressed with Maxim Health Care.? And, this was not addressed in the letter.? In fact it was stated that now that I was on the DO NOT Call list the problem was solved.? *** ***

RE; Complaint ID #***? Dear Ms***:UPMC Health Plan, Etc("UPMCHP") has received and reviewed your letter dated June 6,2018, as well as the accompanying complaint.The above-referenced complaint did not include a HIPAA-compliant authorization that would allow UPMCHP to disclose
protected health informationWithout a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaintHowever, UPMCHP will determine whether the affected individual is a UPMCHP member and, if .so, will respond directly to the affected individual with a more detailed response.Thank you for bringing this matter to our attentionShould you have any further questions or require additional information, please do not hesitate to contact me at ###-###-####.Respectfully Submitted,? Chad **? G***Staff AttorneyUPMC Health PlanLegal Services DepartmentU.SSteel Tower*** *** *** *** *** ** ***T ###-###-####F ###-###-####?

RE: Complaint ID ***Dear Ms*** ***:UPMC Health Plan, Inc(UPMCHP) has received and reviewed your letter dated June 3, 2016, as well as the underlying complaint filed with ID of 11470374The UPMCHP member at issue was a member of a PPO plan with separate in-network and out-of-network
benefit levelsAccording to the complaint, the member received an emergency appendectomy at *** Hospital on October 4, 2015, and UPMCHP paid the claims from that procedure at the lower, out-of-network benefit level.UPMCHP has reviewed the complaint and determined that *** Hospital incorrectly billed the procedure as an ambulatory procedure occurring at an ambulatory surgical centerAs a result, UPMCHP originally processed the claim as non-emergent and paid at the lower benefit levelAfter reviewing the file, UPMCHP has reprocessed the claims as emergency services, and UPMCHP will pay the claims at the higher, in-network benefit level, subject to the applicable in-network copayments and deductiblesThe payment should process within two business days of the date of this letter.UPMCHP apologizes for the inconvenience to this memberShould you have any questions or concerns, please do not hesitate to contact me.Sincerely,Matt S*Staff AttorneyUPMC Health Plan

Re: Complaint No*** by *** ***Dear Ms***:UPMC Health Plan, Inc, ("UPMCHP”) has received and reviewed your letter dated November 24, 2015, as well as the accompanying complaint submitted by *** ***.Mr***’ complaint was not accompanied by a HIPAA compliant authorization to
disclose PHIAs such, UPMC Health Plan has responded to Mr*** directly regarding his complaint.Thank you tor bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at *** ***.Sincerely,Laura ***M***, Esquire Associate Counsel

Re: Complaint No***Dear Ms***:UPMC Health Plan, Inc, (“UPMCHP”) has received and reviewed your letter dated December 29, 2016, regarding the member’s additional concerns in connection with the referenced complaintPlease accept the following as UPMCHP’s response to those concerns.In her initial letter, the member sought reinstatement of her federally facilitated (FFM) UPMC EPO Silver plan which she complained had been terminated without noticeIn UPMCHP’s December 22, response, we explained that the members coverage was terminated due to a series of unpaid balances dating back to September 2016, and following an October written notice and a reminder call on November 15, Upon investigating the member’s complaint, however, UPMCHP determined that due to an error with the member enrollment system, the member was not sent a termination warning letter in November As a result this error UPMCHP offered to reinstate the member if she satisfied her account balance in full.The member confirms in her follletter that UPMCHP contacted her regarding the offer of reinstatement and states that she paid her account balanceThe member complains, however, that as of December 28, her coverage had not been reinstatedUpon investigation, the member’s coverage was reinstated as of December 28, following her call to UPMCHP, and her pharmacy was able to submit her claim.In addition, on December 29, 2016, a UPMCHP representative called the member and advised that her plan was due to terminate on December 31, and that she was not automatically enrolled for coverage because her plan was inactive at the timeUPMCHP advised member that if she wished her coverage to continue, she would need to contact the FFM to enroll and request a January 1, start date.Thank you for bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at ###-###-####.? Sincerely,Stacey ** J*** EsqUPMC Health Plan Legal Services Department

Re: Complaint No*** by *** ** ***Dear Ms***UPMC Health Plan, Inc(‘'UPMCHP”) has received and reviewed your letter dated November 21,2016, as well as the accompanying complaint submitted by *** ** ***.The above-referenced complaint did mot include a HIPAA authorization that would
allow UPMCHP to disclose protected health informationWithout a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint.Please be advised that UPMCHP has diligently and thoroughly investigated the subject matter of this complaintOn December 2, 2016, UPMCHP Member Services sent a letter directly to Mr*** regarding the issues raised in his complaint.Thank you for bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Stacey ** J*** UPMC Health Plan Legal Services Department

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint.? For your reference, details of the offer I reviewed appear below
The response from UPMCHP (the health plan) does not provide an explanation of where my overpayments are.? They refuse to provide a record of payments and I have no way to get them to give this to me.? As long as they are allowed to hold my money hostage and pretend to be confused about which entity of UPMC is holding my money, they will.? The only way to resolve this complaint is for UPMC to provide me with a list of payments and where the payments I have made have been applied- exactly.? To which hosptial, which bill, which encounter, etc.? Otherwise, they can continue to hold my money hostage under the guise that I actually owe it to them.? I may have outstanding payments- but I'm really not sure.? I'm? not paying bills that do not include histories of past payments, etcbecause they keep holding my overpayments and saying that I owed them- but won't produce records of payments, bills, etc
Regards,
*** ***

RE: Complaint ID ***Dear Ms*** ***:UPMC Health Plan, Inc("UPMCHP") has received and reviewed your letter dated October 17, 2016, regarding Complaint ID ***.The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health
informationWithout a HJPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint.Please be advised that UPMCHP has diligently and thoroughly investigated the subject matter of this complaint, UPMCHP Member Services will be outreaching directly to the complainant today or tomorrow regarding the issues raised in the complaint.Thank you for bringing this matter to our attention.Sincerely,Matthew S*Staff AttorneyUPMC Health Plan - Legal Services Department

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 12797231, and have determined that this does not resolve my complaint.? For your reference, details of the offer I reviewed appear below
I clicked the HIPAA box when submitting this.? If another form is required, UPMC should provide it
Regards,
Serdar Bankaci

Re: Complaint No*** by David ***Dear Ms***:UPMC Health Plan, tnc, ("UPMCHP") has received and reviewed your letter dated August 31, 2015, as well as the accompanying complaint submitted by *** ***.Mr***'s complaint was not accompanied by a HIPAA compliant authorization to
disclose PHIAs such, UPMC Health Plan has responded to Mr*** directly regarding his complaint.Thank you for bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Nancy ** F*, Esquire UPMC- Health Plan ??" Legal

Re: Complaint ID: ***Dear Ms*** ***: UPMC Health Plan, Inc(“UPMCHP”) has received and reviewed the abovecaptioned complaint dated October 13, Pursuant to the directions included in the letter, this response will not personally identify the member.The complaint sets forth lhat
the complainant, received diabetic education services on July 8, 2015, and is upsett that these services were not covered by UPMCHPIn this instance, the services were not covered based on the nature of the claims submitted by? the complainant’s providerHowever, UPMCHP is working with the provider on getting a proper claim submitted, and will contact the complainant directly regarding the outcome.UPMCHP values the satisfaction of its membership, and we thank you for bringing this matter to our attentionIf you have any further questions or need additional information, please contact me at ###-###-####.Sincerely,*** *** EsqUPMC Health Plan