Lone Star Siding Solutions

Revdex.com: I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me

Thank you for providing this additional information regarding the member's concernsWe will include the additional information in our review

I am rejecting this response because: I am assuming Blue Shield/Cross of California gave their response based on the Authorization for Release of Health Information to the Revdex.com I signed the form and faxed it to the Revdex.com of Northeast California in West Sacramento, Fax: [redacted]

Dear Ms [redacted] , This is in response to the grievance we received on February 2, 2016, regarding services provided for yourself and your family, by non-participating providers throughout your enrollment with Blue Shield of California (Blue Shield)You are requesting that Blue Shield reprocess your claims to allow a greater amount, rather than applying the allowable amounts to non-participating providers claimsYour request has been denied for the following reasons:During the course of our review it was noted that you were enrolled in the Silver PPO plan, with an original effective date of May 1, 2015, and which coverage had ended on June 30, An Evidence of Coverage (EOC) containing the terms and conditions of your plan was sent to you once after enrollment, and is sent again upon each renewalIt is your responsibility as a member to read all of the Blue Shield plan materials immediately after you are enrolled so you understand how to use your benefits and how to minimize your out of pocket costsParticipating providers agree to accept Blue Shield’s payment, plus the member’s payment of any applicable deductibles, copayments, and coinsurance as a payment-in-full for covered servicesThis is not true of non-participating providersCharges for services received by a non-participating provider in excess of Blue Shield’s allowance amount are the responsibility of the memberIf a member receives care from a non-participating provider, Blue Shield’s payment for that service may be substantially less than the amount billedThe subscriber is responsible for the difference between the amount Blue Shield pays and the amount billed by the non-participating providerWe have reviewed your appeal, and examined your agreement with Blue ShieldNon-participating providers do not accept the same usual and customary rates that our preferred providers in your area do, and because we have processed your claims according to these rates for your area, your request to have your out-of-network claims reprocessed in a way that increases the allowable amount has been deniedYour request was reviewed by a grievance coordinator who is knowledgeable about your plan’s benefits and coverageWe have enclosed copies of the appropriate pages of the Evidence of Coverage (EOC) for your health planIn addition, we have underlined the language that supports our decisionYou have the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC)If your appeal meets the criteria as determined by the DMHC, and independent review organization as selected by the DMHC will review the pertinent issues(s) and/or medical documentationWe have enclosed an IMR Application Form and addressed envelope for your convenienceIf you choose to pursue an IMR, please forward your request to the DMHC directlyYou are entitled to, upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim for benefitsDiagnosis and treatment codes related to your grievance, and their meanings, can be requested by contacting your grievance coordinatorIf you have questions about this letter, please contact me directlySincerely, [redacted]

Dear Mr [redacted] This is in response to the grievance Blue Shield of California Life & Health Insurance Company (Blue Shield Life) on November 2, 2015, regarding an erroneous debit on your financial account ending in “0050”You have requested that Blue Shield Life return the payment to you as soon as possibleYour request has been approvedAfter reviewing your account with the Billing Department, it was determined that an incorrect debit was deducted from your accountAn overdraft for the amount of $11,was returned to your account on November 23, The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievanceIf you have questions regarding this letter, please contact me directlySincerely, [redacted]

Blue Shield of California (Blue Shield)'s grievance review timeframe is up to calendar days as indicated in the member's Evidence of Coverage (EOC) bookletOur records indicate we received [redacted] grievance on August 29, We have no control over the timeframe in which the Revdex.com complaint stays open

We responded to the Revdex.com on August 26, 2016, regarding this member's complaint and an acknowledgement letter was mailed directly to the member on August 26, 2016, advising we would initiate a grievance review to address his concernsA final resolution letter was mailed to the member on September 15,

I am rejecting this response because: I was told in writing and on the phone, many times, that I would be receiving the full refund amount of $1119.12-back in November of 2014, and consistently since thenPlease see all letters and records of calls, confirmation numbers, names, and dates for this informationI received $(for no apparent reason was this amount sent to me) in January of I then recevied a letter on 1/27/15, after I filed a greivance, that said 'We have confirmed that the delayis due to needng additional information regarding your premium." Nowhere do they ask for the actual information, nowhere do they tell me who I can call to provide said informationAlong with the check for $I received on April 16, 2015, (again, for no apparent reason was this amount sent to me) they don't even mention needing information in order to send me the full refund! I demand the full refund of the additional $that I was promised, or at least the $that would also fulfill their promise of a fully refunded amount

I am rejecting this response because: I don't need a grievance counselorBlue Shield already came up with a resolution to the matter that was documented in their Case # [redacted] by their representative [redacted] *The resolution to the problem is for Blue Shield to re-bill me for $and to amend my 1095A back to the 4/28/revisionA grievance counselor would only prolong the matterWhy can they not follow through on the solution they already proposed and conclude this matter?I'm happy to write a check for $as long as they amend my 1095A back to the 4/28/revision that I submitted with my taxes.Regards, [redacted]

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedWe will respond directly to Ms [redacted] as we have not received a signed release of information formWe will contact the member shortly

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield)We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submittedWe will provide a written response to [redacted] within calendar daysWe have mailed an acknowledgement letter Ms [redacted] mailing address with additional information regarding the grievance process as well as direct contact information for her assigned grievance coordinatorThank you

Dear Revdex.com:This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 5, 2016, concerning a Blue Shield enrollee by the name of [redacted] The information provided by the Revdex.com included a consumer complaint against Blue ShieldWe thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted] , has not completed the grievance process with the planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances are resolved within days of the receipt dateA response to the review will be sent directly to [redacted] , and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.comIf you have additional questions regarding this matter, please contact me directly at the telephone number listed belowSincerely, [redacted]

I am rejecting this response because: we are in need of inmeidate medical treatment and your office is providing the wron verificationI cannot wait on a grievanceA call was placed to blue shield on January 4th and the reference number is [redacted] A call went to covered California on 1/9/case delete number [redacted] Case number [redacted] and red number [redacted] A call to blue shield on 1/23/case # [redacted] 12/30/blue shield case number [redacted] and reference number [redacted] You need to place me on the silver along with my son [redacted] Effective 1/1/ [redacted] has had orders for physical therapy since 1-4-and cannot obtain services because we cannot afford to pay the co-pay of the gold planOn 1-4- [redacted] N from Blue Shield verified Silver PPO plan effective 1-1-but blue shield keeps verifying to the medical offices that we are on the gold planThe inquiry number for that call is [redacted] We are paying for a plan but we can't get services because you are verifying the wrong coverageIt is not my responsibility to file a grievanceYou MUST fix this immediately as we are in need of medical treatmentMy blue shield ID number is [redacted] Please call me and fix this immediatelyMy number is [redacted] Thank you, [redacted]

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield)Our records indicate the member’s initial grievance review was completed on August 23, If the member has additional questions or concerns they may wish to contact the assigned grievance coordinator as listed in our response letter for assistance

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedOur response will be sent directly to [redacted] within calendar days

Revdex.com: I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory, on the condition that Blue Shield actually sends the promised refund check to meHaving been repeatedly verbally promised resolution before (including one statement that it would be resolved in my favor "in to hours" (BS ref# [redacted] )), I would prefer to keep this complaint open until it is actually satisfied as stated in BS's letter of June 12, 2015.They have given themselves days to send me the check for $1,I should receive this check by July 11, 2015.Sincerely, [redacted]

Revdex.com: I have reviewed the response made by the business in reference to my concern, and although I believe it is ridiculous to have to wait days just to get resolution, I find that this resolution is satisfactory to me

Dear Ms [redacted] ,This is in response to the grievance received by Blue Shield of California (Blue Shield) on April 5, 2016, regarding the premium dues on your health planYou have requested Blue Shield to process the refund for the overpaid premium dues debited from your banking account on January 4, 2016.Your request has been approvedBlue Shield processed a non-refundable credit to your health plan for the next billing period for a total a $198.45.The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievance.If you have questions regarding this letter, please contact me directly.Sincerely, [redacted] [redacted]

I am rejecting this response because:When selecting Blue Shield as our insurance company, we specifically chose the Silver PPO plan with out of network providers in mindIn making our decision we even told the Blue Shield representative our situation and intention of using primarily out of network providers who told us nothing about reduced coverage amounts for out of network providersThe plan stated after the deductible they would reimburse at 50%There was no way for me to be aware of the fact that the 50% reimbursement would be off of a significantly negligible allowable amount compared to what the providers requireI feel that it's deceiving of Blue Shield to hide this information from customers until after they are already in contractFor instance, I saw a provider 5/18, 6/10, 6/which totaled $for all three visits However, Blue Shield's allowed amount was $for those visitsI was therefore reimbursed $as opposed to the $I expected I would like to be reimbursed for the differenceI have yet to have an explanation as to why this information is hidden from their customers and why they chose to reimburse at such a lower amount as their acceptable amountI feel this is very deceiving to customersThank you for your assistance in this matter

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for review and would like to inform you that the parent(s) of [redacted] ***, have not completed the grievance process with the planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances are resolved within days of the receipt dateWe will provide a copy of our written response to the parent(s) of [redacted] as well as the Revdex.com via U.SPostal Mail