PacificSource Health Plans

We received your letter of September 2, 2016, referencing a complaint from [redacted] We are sympathetic to [redacted] concerns.We work diligently to maintain an up-to-date provider network directoryUnfortunately, we do not receive changes in real time and, as a result, the directory is always a step behind any changes that providers make to the addresses where they practice, their participating status, and the days on which they practice at different addressesIn this situation, the two providers practiced at addresses where they did not participate with PacificSource Health Plans' policies and other addresses where they did participate with such policiesThe status of one provider changed during this time from participating to non-participating [redacted] also received information from one provider that had not yet been communicated to PacificSource Health Plans.We understand that this can be confusing and our Customer Service Department is available to assistIn this situation, our Customer Service Department worked with the providers to ensure that we had the most up-to-date information and then worked with [redacted] to ensure access to the appropriate providers was available.If [redacted] has additional questions, we encourage her to call our Customer Service Department at [redacted]

We responded to this complaint via letter on January 13, 2017, as we received the original complaint via written notice from the Revdex.com. The "second notice" was sent via email, so we are responding again. Thank you
Dear Sir or Madam:We received your letter of January 4, 2017, indicating
that a complaint was filed about ourcompanyIn response, we offer the following in response:"We are sorry to hear of your dissatisfaction with our serviceThere appears tobe some confusion about what did or did not change with your plan; rest assuredthat we do not make any changes to your plan without notice to youIf youwould like a copy of the notice that went to you describing changes to your planfor 2017, we would be pleased to provide you with a copyUnfortunately, forprivacy reasons, state and federal law prohibit us from responding more directlywith an explanation of what occurredIf you have any further concerns orquestions, or would like a copy of the notice sent October 19th, please contact ourCustomer Service Department at 888-977-9299."Please contact me at [email protected] if you need to contact me for any reason.Sincerely,
Kristin ** K***General Counsel
*Please view attached document

We are sorry to hear of your dissatisfaction with our service. We believe that everything was resolved on January 9th, and hope that you agree. Unfortunately, for privacy reasons, state and federal law prohibit us from responding more directly with an explanation of what occurred.
If you have any further concerns or questions, please contact our Customer Service Department at 888-977-

Complaint: [redacted]I am rejecting this response because:  None of the two items I requested we provided by Pacific South, or even addressed.The resolution to my complaint was clearly expressed to Pacific South in my complaint.  They failed to address the resolutions, but rather provided vague, insignificant statements in their address.  I requested the two items be readdressed and provided by Pacific South.Sincerely,[redacted]

We received your letter of September 2, 2016, referencing a complaint from [redacted]. We are sympathetic to [redacted] concerns.We work diligently to maintain an up-to-date provider network directory. Unfortunately, we do not receive changes in real time and, as a result, the directory is...

always a step behind any changes that providers make to the addresses where they practice, their participating status, and the days on which they practice at different addresses. In this situation, the two providers practiced at addresses where they did not participate with PacificSource Health Plans' policies and other addresses where they did participate with such policies. The status of one provider changed during this time from participating to non-participating. [redacted] also received information from one provider that had not yet been communicated to PacificSource Health Plans.We understand that this can be confusing and our Customer Service Department is available to assist. In this situation, our Customer Service Department worked with the providers to ensure that we had the most up-to-date information and then worked with [redacted] to ensure access to the appropriate providers was available.If [redacted] has additional questions, we encourage her to call our Customer Service Department at [redacted].

We already responded to this complaint when it was first filed under an incorrect company name.  The individual also replied to our comment and there is no new communication in this report, so it is unclear why a response is being requested.  We also had a company representative reach out...

to this individual via telephone. 
We are copying in the relevant portion of our earlier response:
"While state and federal privacy laws prohibit us from providing specific information, we can verify that no monies were inappropriately withdrawn and this customer received the information he requested.  When people are enrolled through an exchange, we have less flexibility than when they are enrolled directly with us.  We are sorry that he is unhappy with the company and encourage him to contact our Customer Service team at 877-590-1596 if he has any further questions or concerns."

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. Sincerely, [redacted]