November 11, 2015Dear [redacted] ,This letter is in response to a complaint filed with your office by one of our Members, [redacted] [redacted] is dissatisfied that the Plan did not terminate his Plan coverage effective 1/31/15, the Plan is billing for his coverage 2/1/through 4/30/and that he was provided poor Customer service.The Health Plan initiated first level complaint/ post-service appeal on 10/12/after receiving the Member's complaint from your officeA letter of acknowledgement was Sent to the Member on 10/13/15.The Member's complaint issue was sent to the Health Plan's Enrollment and Accounts Receivable designees for their investigation and response.On 1/10/the decision was made to OVERTURN the original decision and terminate the Member's coverage effective 1/31/15, Our Customer Service Team Leaders were unable to locate any faxes or letters that the Member had submitted regarding his request to terminate his coverage effective 1/31/15.The Accounts Receivable Team Leader indicated that the Member's letter dated July 15, was received in the Accounts Receivable Department but that it did not ask for a return call from the PlanThis letter was forwarded to the Enrollment Department and because the limit for retroactive disenrollment is ninety (90) days, the Health Plan could have only have gone back to April to terminate his coverage and the group had already termed the plan effective 4/30/15.As the Member has requested, the Plan terminated his coverage retroactively effective 1/31/15, however, there are a number of claims for dates of service after 1/31/Some of them are pharmacy claims but there are two medical claims for dates of service 3/16/and 3/28/Those claims will therefore be adjusted and payment retractedThe Member can expect that the providers of these services will then submit those claims to the Member’s insurance carrier that was in effect on the dates of service.Please feel free to contact me with any additional questions you may have regarding the above informationI can be reached at ###-###-####.Sincerely,Elizabeth W., RN, CPC Manager, Appeals Department
October 16, 2015Dear [redacted] ,This letter responds to the complaint filed by the above Member regarding his dissatisfaction with his Geisinger PlanWe have reviewed the information from the Member as well as the additional information provided by the Revdex.comWe would like to provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint processThe Member will receive a response from the Health Plan within the next thirty (30) calendar days.Please feel free to contact me with any additional questions you may have regarding the above informationI can be reached at ###-###-####.Sincerely,BethAnn P.Appeals Department
Please review and get back to me I'm not sure what the complaint is regarding There is no patient information and it looks to be about health insurance enrollment If anything further is needed on our part, please adviseThanks,Diane A***
January 18, 2017Dear *** ***:This letter responds to the complaint filed by the above Member regarding her dissatisfaction with the delay in receiving her insurance ID card and benefit informationWe have reviewed the information from the Member as well as the additional information provided by
the Revdex.comWe would like to provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint (non-medical appeal) processThe Member’s complaint and all of the additional information provided is scheduled to be reviewed at the Plan’s internal appeal committee on January 24, The Member has been provided the opportunity to participate in the review via telephone or in-personOnce the Committee reviews the information, the Member will be notified of the Plan's decision via U.SMail.Please feel free to contact me with any additional questions you may have regarding the above information, I can be reached at ###-###-####.Sincerely,BethAnn P.Appeals Department
August 4, 2015Dear [redacted]:This letter is in response to a complaint filed with your office by one of our Members, [redacted].[redacted] is requested a refund of an over-charged premium in the amount of $2825.21.The Health Plan's Appeal Coordinator initiated a first level pre-service...
complaint on 7/27/2015 on behalf of the Member. The Appeal Coordinator forwarded the Member's complaint to the Plan's Accounts Receivable department for a response to be provided to the Member. The Member was sent a letter acknowledging his appeals via USPS on 7/27/2015.As you may be aware, the PA Department of Insurance mandates a 30-day timeframe for a disposition to be made and a response sent to the Member. This case's deadline date is 8/26/2015.We will continue to investigate this case and provide a response within the required timeframe.Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.Sincerely,Elizabeth W. RN, CPC Manager, Appeals Department
October 16, 2015Dear [redacted],This letter responds to the complaint filed by the above Member regarding his dissatisfaction with his Geisinger Plan. We have reviewed the information from the Member as well as the additional information provided by the Revdex.com. We would like to...
provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint process. The Member will receive a response from the Health Plan within the next thirty (30) calendar days.Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.Sincerely,BethAnn P.Appeals Department
From: [redacted] <[redacted].[redacted]@[redacted].com>Date: Tue, May 19, 2015 at 12:39 PMSubject: Fw: Fwd: InsuranceTo: "[redacted]@myRevdex.com.org" <[redacted]@myRevdex.com.org>On Wednesday, April 22, 2015 12:48 PM, [redacted] <[redacted].[redacted]@[redacted].com> wrote:On Thursday, April 2, 2015 3:50...
PM, [redacted]> wrote:---------- Forwarded message ----------From: [redacted]Date: Mon, Mar 30, 2015 at 8:21 PMSubject: InsuranceTo: [redacted]3/20/15[redacted]Peckville, PA [redacted] Dear [redacted]:Congratulations, your insurance package is complete approved for 4/1/15. For less of about the same as you had quotes from other companies you get MUCH more total health coverage, not just major medical! You may have already have received emails with links to review your coverage. If not you will be receiving information in the mail.As per our conversation today you are now properly registered on the Federal Exchange to replace your former insurance expiring for new much broader coverage. In most cases that includes at least dental, vision, life and hospital confinement direct. In most cases also in includes not only help from the federal exchange paying part of our coverage but lowering your deductibles and out of pocket maximums. I remind you also of my own story of bankruptcy when I was 38 from one medical event and my wife’s near bankruptcy but aversion of the problem because she had supplemental coverage. I must also remind you that my story is not unusual. Remember please the survey that says 63% of all bankruptcy has to do with one medical event and 87% of those people that went under had major medical. That is what supplemental coverage is for, It’s nice that [redacted] (or some other major medical carrier) that pays the doctors but who pays the grocery, electric, mortgage, car payment, dentist, eyeglasses, credit or water bill? Built into your plan could be coverage from [redacted] Life to partial solve some of those problems including dental, vision, as well as money paid directly to you for going to the doctor, hospital or ER for most accidents, cash paid directly to you for most admissions into the hospital. All of the supplemental coverage plans available from [redacted] Life include; Dental , Vision, Life, Hospital Confinement Direct, Cancer, Critical Illness, Disability, Accidental Disability, Association Membership with accident coverage.You may be contacted by the federal marketplace by mail to confirm your income. Call me if that is the case and we will go over what you need to send them. You may well be getting a phone call from [redacted] Life to confirm your plans. Please answer it and confirm your health package. Remember also if your income goes up or down substantially during the next year you should contact me or the marketplace to increase or decrease your subsidy so you will either not be forced to pay extra next year’s April 15th.Remember if your income goes up or down you will need to report it to the federal marketplace and change your subsidy and premium. If you move or have a life event like divorce, marriage, new baby, adoption, etc… you need to contact the federal marketplace either directly or through me.I have phoned your major medical carrier, Geisinger to pay your first bill. I will contact them and ask about automatic payment options and get back to you. In case we need to remind you of all the bad press when this program first started? Well it hasn’t ended, the press just got bored with the problems. Sometimes policies seem to get lost.The reason for this is simple. I know this next statement on my part sounds absurd but remember this is the government that is now running this and you have to realize things never go correctly when government is involved. But we can cut it off at the pass if we act correctly. Be that as it may, as I told you there seems to be a hole in the wire between the Federal exchange and the insurance companies that names seem to fall out of. This only happens with the major medical companies like [redacted], Geisinger, [redacted] Health, [redacted], and [redacted] (or [redacted] or [redacted] names for [redacted]). IF THAT HAPPENS there is a solution already set up by the government. We will need to phone the federal exchange and ask for an “ [redacted] Escalation” to find your lost policy. Their phone number is ###-###-####. IF THAT HAPPENS you will need to give them your name, address, social security number, phone number AND YOUR Application # listed in the first paragraph of this email.IF you have additional problems you can call me and I will attempt to get it rolling faster for you.IF THAT IS THE CASE, even though I signed you up originally the government has a system for letting me help you. You will still have to call them and tell them that you give [redacted] your agent from [redacted] the authority to speak for you about your health insurance. I will then get the “[redacted] Escalation” enacted for you. Your Federal Marketplace application # is[redacted]Your Receipt Number for payment of your [redacted] Life supplemental coverage plans is [redacted] and [redacted]Your Receipt Number for your first payment to your major medical carrier Geisinger is PA[redacted].Your Federal Supplement is for $4378.76/year and will be given directly to your insurance carrier.The total bill for insurance IF you bought it off the Marketplace would be $5514.14/year.You will have payments of $53.03/month to [redacted] Life for your supplemental coverage (plus a $20 application fee for your first month) and $34.23. $114.98 need to go to to your major medical carrier Geisinger monthly.Thank you,Grace and peace,[redacted]Licensed Insurance Agent [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] *Mountain Top, PA [redacted]P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-####[redacted]@[redacted].com ¦ www.[redacted].com/[redacted]1. Requested Effective Date: 4/1/20152. Zip Code: [redacted]3. County: Lackawanna4. State: PA5. Participants: 1[redacted] Life w/ Geisinger Marketplace Silver HMO Extra 10/50/3000Est. Monthly Premium:Est. Monthly SubsidyEst. Monthly Premium after Subsidy$452.24$250.00$202.24 Essential Health Benefits - This plan meets the minimum essential coverage requirements under the Affordable Care Act.Additional Information - The following is an overview of plan benefits. Please review the Plan Brochure for more detailed information including the plan exclusions and limitations. Benefit DetailsMedical DeductibleIndividual: $100 Family: $200 Drug DeductibleIndividual: $0 Family: $0 Medical Out of Pocket MaximumIndividual: $750 Family: $1,500 Drug Out of Pocket MaximumIndividual: Included in Medical Family: Included in Medical Office VisitPrimary Doctor$3Specialist$10Prescription DrugsPreferred Brand Drugs$7Non Preferred Brand Drugs$20Generic DrugsNo ChargeSpecialty Drugs20%Inpatient CoverageHospital ServicesNo Charge after DeductibleInpatient ServicesNo ChargeEmergency and Urgent CareEmergency Room$25MaternityDental/Vision/Life/Hospital Confinement Direct – [redacted] Life [redacted] Insurance Agency (d/b/a or assumed name of [redacted] Insurance Solutions, Inc.) isn’t able to display all required plan information about this Qualified Health Plan at this time. To get more information about this Qualified Health Plan, visit the Health Insurance Marketplace website at HealthCare.gov-- [redacted]Licensed Insurance Agent [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] ¦ <Mountain Top, PA [redacted]P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-####BParker@[redacted].com ¦ www.[redacted].com/[redacted]
Please review and get back to me. I'm not sure what the complaint is regarding. There is no patient information and it looks to be about health insurance enrollment. If anything further is needed on our part, please advise. Thanks,Diane A[redacted]
November 11, 2015Dear [redacted],This letter is in response to a complaint filed with your office by one of our Members, [redacted] is dissatisfied that the Plan did not terminate his Plan coverage effective 1/31/15, the Plan is billing for his coverage 2/1/15 through 4/30/15 and that he was provided poor Customer service.The Health Plan initiated first level complaint/ post-service appeal on 10/12/15 after receiving the Member's complaint from your office. A letter of acknowledgement was Sent to the Member on 10/13/15.The Member's complaint issue was sent to the Health Plan's Enrollment and Accounts Receivable designees for their investigation and response.On 1/10/15 the decision was made to OVERTURN the original decision and terminate the Member's coverage effective 1/31/15, Our Customer Service Team Leaders were unable to locate any faxes or letters that the Member had submitted regarding his request to terminate his coverage effective 1/31/15.The Accounts Receivable Team Leader indicated that the Member's letter dated July 15, 2015 was received in the Accounts Receivable Department but that it did not ask for a return call from the Plan. This letter was forwarded to the Enrollment Department and because the limit for retroactive disenrollment is ninety (90) days, the Health Plan could have only have gone back to April to terminate his coverage and the group had already termed the plan effective 4/30/15.As the Member has requested, the Plan terminated his coverage retroactively effective 1/31/15, however, there are a number of claims for dates of service after 1/31/15. Some of them are pharmacy claims but there are two medical claims for dates of service 3/16/15 and 3/28/15. Those claims will therefore be adjusted and payment retracted. The Member can expect that the providers of these services will then submit those claims to the Member’s insurance carrier that was in effect on the dates of service.Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.Sincerely,Elizabeth W., RN, CPC Manager, Appeals Department
November 11, 2015Dear [redacted] ,This letter is in response to a complaint filed with your office by one of our Members, [redacted] [redacted] is dissatisfied that the Plan did not terminate his Plan coverage effective 1/31/15, the Plan is billing for his coverage 2/1/through 4/30/and that he was provided poor Customer service.The Health Plan initiated first level complaint/ post-service appeal on 10/12/after receiving the Member's complaint from your officeA letter of acknowledgement was Sent to the Member on 10/13/15.The Member's complaint issue was sent to the Health Plan's Enrollment and Accounts Receivable designees for their investigation and response.On 1/10/the decision was made to OVERTURN the original decision and terminate the Member's coverage effective 1/31/15, Our Customer Service Team Leaders were unable to locate any faxes or letters that the Member had submitted regarding his request to terminate his coverage effective 1/31/15.The Accounts Receivable Team Leader indicated that the Member's letter dated July 15, was received in the Accounts Receivable Department but that it did not ask for a return call from the PlanThis letter was forwarded to the Enrollment Department and because the limit for retroactive disenrollment is ninety (90) days, the Health Plan could have only have gone back to April to terminate his coverage and the group had already termed the plan effective 4/30/15.As the Member has requested, the Plan terminated his coverage retroactively effective 1/31/15, however, there are a number of claims for dates of service after 1/31/Some of them are pharmacy claims but there are two medical claims for dates of service 3/16/and 3/28/Those claims will therefore be adjusted and payment retractedThe Member can expect that the providers of these services will then submit those claims to the Member’s insurance carrier that was in effect on the dates of service.Please feel free to contact me with any additional questions you may have regarding the above informationI can be reached at ###-###-####.Sincerely,Elizabeth W., RN, CPC Manager, Appeals Department
October 16, 2015Dear [redacted] ,This letter responds to the complaint filed by the above Member regarding his dissatisfaction with his Geisinger PlanWe have reviewed the information from the Member as well as the additional information provided by the Revdex.comWe would like to provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint processThe Member will receive a response from the Health Plan within the next thirty (30) calendar days.Please feel free to contact me with any additional questions you may have regarding the above informationI can be reached at ###-###-####.Sincerely,BethAnn P.Appeals Department
Please review and get back to me I'm not sure what the complaint is regarding There is no patient information and it looks to be about health insurance enrollment If anything further is needed on our part, please adviseThanks,Diane A***
January 18, 2017Dear *** ***:This letter responds to the complaint filed by the above Member regarding her dissatisfaction with the delay in receiving her insurance ID card and benefit informationWe have reviewed the information from the Member as well as the additional information provided by
the Revdex.comWe would like to provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint (non-medical appeal) processThe Member’s complaint and all of the additional information provided is scheduled to be reviewed at the Plan’s internal appeal committee on January 24, The Member has been provided the opportunity to participate in the review via telephone or in-personOnce the Committee reviews the information, the Member will be notified of the Plan's decision via U.SMail.Please feel free to contact me with any additional questions you may have regarding the above information, I can be reached at ###-###-####.Sincerely,BethAnn P.Appeals Department
August 4, 2015Dear [redacted]:This letter is in response to a complaint filed with your office by one of our Members, [redacted].[redacted] is requested a refund of an over-charged premium in the amount of $2825.21.The Health Plan's Appeal Coordinator initiated a first level pre-service...
complaint on 7/27/2015 on behalf of the Member. The Appeal Coordinator forwarded the Member's complaint to the Plan's Accounts Receivable department for a response to be provided to the Member. The Member was sent a letter acknowledging his appeals via USPS on 7/27/2015.As you may be aware, the PA Department of Insurance mandates a 30-day timeframe for a disposition to be made and a response sent to the Member. This case's deadline date is 8/26/2015.We will continue to investigate this case and provide a response within the required timeframe.Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.Sincerely,Elizabeth W. RN, CPC Manager, Appeals Department
October 16, 2015Dear [redacted],This letter responds to the complaint filed by the above Member regarding his dissatisfaction with his Geisinger Plan. We have reviewed the information from the Member as well as the additional information provided by the Revdex.com. We would like to...
provide to you the following response.Following our receipt of the complaint, the Member's information has been forwarded to be reviewed through the Plan's complaint process. The Member will receive a response from the Health Plan within the next thirty (30) calendar days.Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.Sincerely,BethAnn P.Appeals Department
From: [redacted] <[redacted].[redacted]@[redacted].com>Date: Tue, May 19, 2015 at 12:39 PMSubject: Fw: Fwd: InsuranceTo: "[redacted]@myRevdex.com.org" <[redacted]@myRevdex.com.org>On Wednesday, April 22, 2015 12:48 PM, [redacted] <[redacted].[redacted]@[redacted].com> wrote:On Thursday, April 2, 2015 3:50...
PM, [redacted]> wrote:---------- Forwarded message ----------From: [redacted]Date: Mon, Mar 30, 2015 at 8:21 PMSubject: InsuranceTo: [redacted]3/20/15[redacted]Peckville, PA [redacted] Dear [redacted]:Congratulations, your insurance package is complete approved for 4/1/15. For less of about the same as you had quotes from other companies you get MUCH more total health coverage, not just major medical! You may have already have received emails with links to review your coverage. If not you will be receiving information in the mail.As per our conversation today you are now properly registered on the Federal Exchange to replace your former insurance expiring for new much broader coverage. In most cases that includes at least dental, vision, life and hospital confinement direct. In most cases also in includes not only help from the federal exchange paying part of our coverage but lowering your deductibles and out of pocket maximums. I remind you also of my own story of bankruptcy when I was 38 from one medical event and my wife’s near bankruptcy but aversion of the problem because she had supplemental coverage. I must also remind you that my story is not unusual. Remember please the survey that says 63% of all bankruptcy has to do with one medical event and 87% of those people that went under had major medical. That is what supplemental coverage is for, It’s nice that [redacted] (or some other major medical carrier) that pays the doctors but who pays the grocery, electric, mortgage, car payment, dentist, eyeglasses, credit or water bill? Built into your plan could be coverage from [redacted] Life to partial solve some of those problems including dental, vision, as well as money paid directly to you for going to the doctor, hospital or ER for most accidents, cash paid directly to you for most admissions into the hospital. All of the supplemental coverage plans available from [redacted] Life include; Dental , Vision, Life, Hospital Confinement Direct, Cancer, Critical Illness, Disability, Accidental Disability, Association Membership with accident coverage.You may be contacted by the federal marketplace by mail to confirm your income. Call me if that is the case and we will go over what you need to send them. You may well be getting a phone call from [redacted] Life to confirm your plans. Please answer it and confirm your health package. Remember also if your income goes up or down substantially during the next year you should contact me or the marketplace to increase or decrease your subsidy so you will either not be forced to pay extra next year’s April 15th.Remember if your income goes up or down you will need to report it to the federal marketplace and change your subsidy and premium. If you move or have a life event like divorce, marriage, new baby, adoption, etc… you need to contact the federal marketplace either directly or through me.I have phoned your major medical carrier, Geisinger to pay your first bill. I will contact them and ask about automatic payment options and get back to you. In case we need to remind you of all the bad press when this program first started? Well it hasn’t ended, the press just got bored with the problems. Sometimes policies seem to get lost.The reason for this is simple. I know this next statement on my part sounds absurd but remember this is the government that is now running this and you have to realize things never go correctly when government is involved. But we can cut it off at the pass if we act correctly. Be that as it may, as I told you there seems to be a hole in the wire between the Federal exchange and the insurance companies that names seem to fall out of. This only happens with the major medical companies like [redacted], Geisinger, [redacted] Health, [redacted], and [redacted] (or [redacted] or [redacted] names for [redacted]). IF THAT HAPPENS there is a solution already set up by the government. We will need to phone the federal exchange and ask for an “ [redacted] Escalation” to find your lost policy. Their phone number is ###-###-####. IF THAT HAPPENS you will need to give them your name, address, social security number, phone number AND YOUR Application # listed in the first paragraph of this email.IF you have additional problems you can call me and I will attempt to get it rolling faster for you.IF THAT IS THE CASE, even though I signed you up originally the government has a system for letting me help you. You will still have to call them and tell them that you give [redacted] your agent from [redacted] the authority to speak for you about your health insurance. I will then get the “[redacted] Escalation” enacted for you. Your Federal Marketplace application # is[redacted]Your Receipt Number for payment of your [redacted] Life supplemental coverage plans is [redacted] and [redacted]Your Receipt Number for your first payment to your major medical carrier Geisinger is PA[redacted].Your Federal Supplement is for $4378.76/year and will be given directly to your insurance carrier.The total bill for insurance IF you bought it off the Marketplace would be $5514.14/year.You will have payments of $53.03/month to [redacted] Life for your supplemental coverage (plus a $20 application fee for your first month) and $34.23. $114.98 need to go to to your major medical carrier Geisinger monthly.Thank you,Grace and peace,[redacted]Licensed Insurance Agent [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] *Mountain Top, PA [redacted]P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-####[redacted]@[redacted].com ¦ www.[redacted].com/[redacted]1. Requested Effective Date: 4/1/20152. Zip Code: [redacted]3. County: Lackawanna4. State: PA5. Participants: 1[redacted] Life w/ Geisinger Marketplace Silver HMO Extra 10/50/3000Est. Monthly Premium:Est. Monthly SubsidyEst. Monthly Premium after Subsidy$452.24$250.00$202.24 Essential Health Benefits - This plan meets the minimum essential coverage requirements under the Affordable Care Act.Additional Information - The following is an overview of plan benefits. Please review the Plan Brochure for more detailed information including the plan exclusions and limitations. Benefit DetailsMedical DeductibleIndividual: $100 Family: $200 Drug DeductibleIndividual: $0 Family: $0 Medical Out of Pocket MaximumIndividual: $750 Family: $1,500 Drug Out of Pocket MaximumIndividual: Included in Medical Family: Included in Medical Office VisitPrimary Doctor$3Specialist$10Prescription DrugsPreferred Brand Drugs$7Non Preferred Brand Drugs$20Generic DrugsNo ChargeSpecialty Drugs20%Inpatient CoverageHospital ServicesNo Charge after DeductibleInpatient ServicesNo ChargeEmergency and Urgent CareEmergency Room$25MaternityDental/Vision/Life/Hospital Confinement Direct – [redacted] Life [redacted] Insurance Agency (d/b/a or assumed name of [redacted] Insurance Solutions, Inc.) isn’t able to display all required plan information about this Qualified Health Plan at this time. To get more information about this Qualified Health Plan, visit the Health Insurance Marketplace website at HealthCare.gov-- [redacted]Licensed Insurance Agent [redacted] Insurance Agency Life | Health | Medicare | Long-Term Care [redacted] ¦ <Mountain Top, PA [redacted]P ###-###-#### ¦ C ###-###-#### ¦ F ###-###-####BParker@[redacted].com ¦ www.[redacted].com/[redacted]
Please review and get back to me. I'm not sure what the complaint is regarding. There is no patient information and it looks to be about health insurance enrollment. If anything further is needed on our part, please advise. Thanks,Diane A[redacted]
November 11, 2015Dear [redacted],This letter is in response to a complaint filed with your office by one of our Members, [redacted] is dissatisfied that the Plan did not terminate his Plan coverage effective 1/31/15, the Plan is billing for his coverage 2/1/15 through 4/30/15 and that he was provided poor Customer service.The Health Plan initiated first level complaint/ post-service appeal on 10/12/15 after receiving the Member's complaint from your office. A letter of acknowledgement was Sent to the Member on 10/13/15.The Member's complaint issue was sent to the Health Plan's Enrollment and Accounts Receivable designees for their investigation and response.On 1/10/15 the decision was made to OVERTURN the original decision and terminate the Member's coverage effective 1/31/15, Our Customer Service Team Leaders were unable to locate any faxes or letters that the Member had submitted regarding his request to terminate his coverage effective 1/31/15.The Accounts Receivable Team Leader indicated that the Member's letter dated July 15, 2015 was received in the Accounts Receivable Department but that it did not ask for a return call from the Plan. This letter was forwarded to the Enrollment Department and because the limit for retroactive disenrollment is ninety (90) days, the Health Plan could have only have gone back to April to terminate his coverage and the group had already termed the plan effective 4/30/15.As the Member has requested, the Plan terminated his coverage retroactively effective 1/31/15, however, there are a number of claims for dates of service after 1/31/15. Some of them are pharmacy claims but there are two medical claims for dates of service 3/16/15 and 3/28/15. Those claims will therefore be adjusted and payment retracted. The Member can expect that the providers of these services will then submit those claims to the Member’s insurance carrier that was in effect on the dates of service.Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.Sincerely,Elizabeth W., RN, CPC Manager, Appeals Department