Lone Star Siding Solutions

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 2, 2016, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue
Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedA response will be sent directly to *** ***Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.comUnfortunately, without a signed release of information from *** ***, we are unable to provide a copy of the resolution to the Revdex.comIf *** *** has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at *** or by mail at: *** *** ***
** *** *** ** *** If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,*** ***, Executive Inquiry Coordinator

ID # ***This is concerning Blue Shield of CABlue Shield has credited my account, therefore this is resolvedThank you very much *** ***

I am rejecting this response because:Dear Revdex.com, I have in fact completed the grievance process with Blue Shield's plan and have letters from them if needed to verifyI waited the days, and was not reimbursed for the out of network claims in full.I would like to reiterate that they hid the details of the out of network services from me prior to my signing up even though requested and then had unreasonable amounts allowed per provider and annually once I had a contract with their company. We have had other insurance companies prior to and after blue shield with no issues at all with the amounts our providers are requestingFurther, there are no providers in our area that will charge the allowable fees that blue shield requiresI am continuing to request that blue shield reimburse us according to the full amount from each out of network provider. Thank you for your assistance.Sincerely,*** ***

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 22, 2015, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank
you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedA response will be sent directly to *** ***Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.comUnfortunately, without a signed release of information from *** ***, we are unable to provide a copy of the resolution to the Revdex.comIf *** *** has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at *** or by mail at: *** *** *** *** *** ** ***If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely, *** ***, Executive Inquiry Coordinator***

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on July 20,2015, concerning a Blue Shield enrollee by the name of *** ***the information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for
forwarding these concerns to Blue Shield for review and would like to inform you that *** ***, has completed our grievance process regarding this specific issueA response letter was mailed directly to the member on July 14, If the member is dissatisfied with the grievance resolution, she may contact the Department of Managed Health Care for additional assistanceThe department has a toll-free telephone number (***) for the hearing and speech impairedthe department's Internet Web site *** has complaint forms, IMR application forms and instructions online.If you have ant additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,*** *** Executive Inquiries Department

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is UNSATISFACTORY to me
I have NO OTHER CHOICE but to accept due to the fact that they business is not willing to provide a suitable ressoultion. They continue to insist that "a letter with an answer will be mailed". Defenately NOT doing business with this company againUnprofessional customer service representativesAnd NOT ONCE have they have apologized for all the mistakes they've madeI have no choice but to accept and wait for their "letter with an answer"

I would like to thank all of you for your kindness and support also I would like to close-out my complain because I just got reimbursed by Blue Shield

Member appeals and complaints are reviewed under the Blue Shield (Blue Shield of California) grievance processThe grievance process is designed to give Blue Shield an opportunity to fully review and provide a written response to the submitted member concerns and make a determination of any request if necessaryIf we are unable to comply with the member's request at the end of our review, we will provide information regarding an Independent Medical Review which may be available through the Department of Managed Health CareIf the member wishes that we discontinue the review of the concerns raised, the member may request that the grievance be withdrawn by contacting the assigned grievance coordinator as indicated on the Blue Shield acknowledgement letter

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 5, 2016, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield. We
thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedA response will be sent directly to *** ***Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.comUnfortunately, without a signed release of information from *** *** we are unable to provide a copy of the resolution to the Revdex.comIf *** *** has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at *** or by mail at: *** *** ***
** *** *** ** *** If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,*** ***, Executive Inquiry Coordinator

We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that *** ***, has completed our grievance process regarding this specific issueA response letter was mailed directly to the member on December 16, Our records do not reflect that a
signed release of information was submitted with the correspondence sent by the Revdex.comUnfortunately, without a signed release of information from *** ***, we are unable to provide a copy of the resolution to the Revdex.comIf the member is dissatisfied with our grievance resolution, she may contact the Department of Managed Health Care for additional assistanceThe department has a toll-free telephone number (***) and a TDD line (***) for the hearing and speech impairedThe department’s Internet Web site *** has complaint forms, IMR application forms and instructions online

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for reviewAs requested we will call Ms*** on Monday May 8, 2017, to discuss her grievance determination

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 5, 2016, concerning a Blue Shield enrollee by the name of *** *** ***The information provided by the Revdex.com included a consumer complaint against Blue
Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedA response will be sent directly to *** *** ***Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.comUnfortunately, without a signed release of information from *** *** ***, we are unable to provide a copy of the resolution to the Revdex.comIf *** *** ***, has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at*** or by mail at: *** *** ***
** *** *** ** ***
If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely, *** *** Executive Inquiry Coordinator

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
Please forward Release of information that I signed and faxed to Revdex.com today. Thank you*** ***

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 provide a written response to *** *** and the Revdex.com within calendar
days

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 ***
*** *** within calendar daysWe have mailed an acknowledgement letter to Mr*** ***'s mailing address with additional information regarding the grievance process as well as direct contact information for her assigned grievance coordinatorPlease note *** ** *** *** is not a listed member under this plan and therefore, all correspondence regarding this matter will be addressed to the subscriber

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 submittedThank you for providing us with a copy of the signed release of information formWe
will provide a copy of our written response to Sally Cage as well as the Revdex.com via U.SPostal Mail within calendar days

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 11, 2015, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank
you for forwarding these concerns to Blue Shield for review and would like to inform you that *** *** has completed our grievance process regarding this specific issueA response letter was mailed directly to the mamber on June 12, If the member is dissatisfied with the grievance resolution, she may contact the Department of Managed Health Care for additional assistanceThe department has a toll-free telephone number (***) and a TDD line ( ***) for the hearing and speech impairedThe department's Internet Web site *** has complaint forms, IMR application forms and instructions online.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below. Chasytie White, Executive Inquiries CoordinatorGrievance Department(916) 350-

I am rejecting this response because: I file an grievance back in March...I was assign to *** *...to help sort this out On our first call she lead to believe that she understood what was going on, she said she read the file and would work this out She advise me to contact CA coverage and *** for Families Services, which is what I have been going through since January, 2014.(see attached letter).I inform *** that I almost lost my job due to many, many hours on the phone with *** & CA coverage and that I could not do that again I stated her that Blue Shield was the one taking my money and not providing the Services that I qualify for(2) days later I called her with an update and was told she had to close the file!!!! The result of my finding those (2) days: *** did not show any coverage for my son it was me that showed the problem CA coverage sent my application (without my permission) to *** to see if I qualify, while CA Coverage had already approved for coverage I was told by the Supervisor (*** ***) that she had done everything she could do at her level and that I needed to contact MMCD by phone then email to release me from *** even though I did not qualify for *** but in there system it was showing something differentThis process took about (2-3) months During this time I still not do have coverage but when you call CA Coverage it shows that as of February I was approve for the Silver 70PPO at $per month, but when you call Blue Shield they show something totally different I have tried to still make payments to Blue Shield but the amount they have in there system shows a different amount and will not accept my payments unless I pay the monthly of $of which I cannot affordAs of today MMCD has released me from there systemBlue Shield did not honor the coverage I was approved for by CA Coverage in but took my payments every month Again I have spent hours on the phone with these people and they all say the thing, just continue to make the payment to keep the coverage, my question to them is what coverage? I did that in for a whole year and Blue Shield could not verify my coverage according to them for past due paymentsI had coverage prior to CA coverage but now due to my age and pre-condition of High Blood Pressure I cannot get coverage at a price I can affordI am asking for your help because Blue Shield took my money knowing that they would not honor coverage

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for review and would like to inform you that *** *** has completed our grievance process regarding this specific issueA response letter was mailed directly to the member on August 23, If the
member is dissatisfied with her grievance resolution, the member has the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC)The assigned grievance coordinator has been notified of the member’s request to discuss her grievance and the member will be contacted within hours

This is in response to the grievance by Blue Shield of California (Blue Shield) on April 14, 2015, regarding your health plan premium paymentYou have requested Blue Shield refund and dues on file remaining after termination of your health plan.Your request has been approvedWe have verified a refund of all health plan premium dues have been refunded to youUpon review of your health plan, we found that a refund was processed to your bank account in the amount of $We also found that a refund of $was sent to you in the form of a checkIn total, Blue Shield has refunded $1,We have included a table to explain how Blue Shield found the correct amount was refunded to you: It is important to understand that this decision has been made on an exception basis and, in making this decision, Blue Shield does not waive any of its rights to enforce the provisions of your health plan in this or any other claim. The appeal preview was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievancesIf you have questions regarding this letter, please contact me directly.Sincerely,*** **Grievance Coordinator