Thank you for your request for information On January 5, 2016, the Plan received the notice from the Federal Exchange to term the member's coverage effective January 20, this was completed and her automatic payment was terminated We welcome her calls for any questions The member may also submit an email to our Customer Service Email for assistance Ronni
Thank you for contacting us I have thoroughly reviewed the complaint I do see that the coverage is still in placeThe payment line is very busy and we are trying to answer those calls as soon as possible Adding additional staff causes increases in premiums and possible changes to benefits We want to help keep costs down and still be able to have enough staff to address our member's calls We are very sorry that you have had to wait so long without getting assistance I will ask to have a representative call today for that payment the ID number provided is valid, so I'm unsure why the automated update could not have been completed I will ask the representative to confirm that information I cannot give out a direct number for a manager They are frequently away from their desks and cannot manage several calls This would cause additional delays to any needed help Ronni N
To whom it may concern,
I hare researched Ms***s concerns and found a claim submitted by St Patrick Hospital for the date of service December 8, (not 2016) and the $4,989.24, (not the $2,000+). This claim was denied because the services provided require an authorization.
The facility has submitted their request for further review. Ms*** does have the right to appeal the denial as described in the denial sent on January 5, 2016.
Thank you,
Ronni N
Providence Health Plan
Thank you for your inquiry. Ms*** did contact the Plan to file a complaint about her coverage for services with the providers she mentioned. The Federal site does not allow the Plans to fully list benefits and providers associated. We do direct the prospective member to our
site where the plans are fully described and we have out provider directories. They are specific to each plan.
In our reply to Ms***, sent on February 5, 2016, we did direct her back to the Federal Market Place to file a request to change her coverage. We encourage her to complete this request if she is still wanting to receive services with the doctors that are not currently listed as participating.
Thank you,
Ronni
Appeals & Grievances Supervisor
Providence Health Plan
Thank you for your request for information. On January 5, 2016, the Plan received the notice from the Federal Exchange to term the member's coverage effective January 20, 2016. this was completed and her automatic payment was terminated.
We welcome her calls for any questions....
The member may also submit an email to our Customer Service Email for assistance.
Ronni
Thank you for contacting us. I have thoroughly reviewed the complaint. I do see that the coverage is still in place. The payment line is very busy and we are trying to answer those calls as soon as possible. Adding additional staff causes increases in premiums and possible changes...
to benefits. We want to help keep costs down and still be able to have enough staff to address our member's calls. We are very sorry that you have had to wait so long without getting assistance. I will ask to have a representative call today for that payment. the ID number provided is valid, so I'm unsure why the automated update could not have been completed. I will ask the representative to confirm that information. I cannot give out a direct number for a manager. They are frequently away from their desks and cannot manage several calls. This would cause additional delays to any needed help.
Ronni N.
Thank you for this inquiry. I reviewed Ms. [redacted]’s comments; however, without having specifics to the claims in question it is difficult to ensure that I address her concerns. I did review her family’s coverage through both employer groups. I also briefly reviewed their...
claims. I did see that the claims are processed correctly according to the benefits. The secondary coverage provided Silverton Health includes a deductible. Claims are correctly being applied to the deductible. I encourage Ms. [redacted] to contact the Customer Service Team for any specific questions and they will be able to answer her questions and provide education on how the claims are processing. The contact information is listed on her Identification Card. She may also use our confidential email that can be found on WWW.Providence.Org and select Health Plan.
I was on vacation and was unable to respond quickly enough before the response period closed for my complaint.
As to the descriptive conclusion now placed on my closed complaint:
"Answered - the business addressed the issues within the complaint, but the consumer remains dissatisfied."
I would say that the business did NOT address "the issues within the complaint." This is still very much unresolved and unaddressed—that a health care company could lure customers based on false representation of which doctors' services would be covered. The only reason I chose this company for health care is that they covered our family's doctors. Now, to learn that these doctors' services suddenly are not covered in no way "address[es] the issues within the complaint."
Thank you for your request for information On January 5, 2016, the Plan received the notice from the Federal Exchange to term the member's coverage effective January 20, this was completed and her automatic payment was terminated We welcome her calls for any questions The member may also submit an email to our Customer Service Email for assistance Ronni
Thank you for contacting us I have thoroughly reviewed the complaint I do see that the coverage is still in placeThe payment line is very busy and we are trying to answer those calls as soon as possible Adding additional staff causes increases in premiums and possible changes to benefits We want to help keep costs down and still be able to have enough staff to address our member's calls We are very sorry that you have had to wait so long without getting assistance I will ask to have a representative call today for that payment the ID number provided is valid, so I'm unsure why the automated update could not have been completed I will ask the representative to confirm that information I cannot give out a direct number for a manager They are frequently away from their desks and cannot manage several calls This would cause additional delays to any needed help Ronni N
To whom it may concern,
I hare researched Ms***s concerns and found a claim submitted by St Patrick Hospital for the date of service December 8, (not 2016) and the $4,989.24, (not the $2,000+). This claim was denied because the services provided require an authorization.
The facility has submitted their request for further review. Ms*** does have the right to appeal the denial as described in the denial sent on January 5, 2016.
Thank you,
Ronni N
Providence Health Plan
Thank you for your inquiry. Ms*** did contact the Plan to file a complaint about her coverage for services with the providers she mentioned. The Federal site does not allow the Plans to fully list benefits and providers associated. We do direct the prospective member to our
site where the plans are fully described and we have out provider directories. They are specific to each plan.
In our reply to Ms***, sent on February 5, 2016, we did direct her back to the Federal Market Place to file a request to change her coverage. We encourage her to complete this request if she is still wanting to receive services with the doctors that are not currently listed as participating.
Thank you,
Ronni
Appeals & Grievances Supervisor
Providence Health Plan
Thank you for your request for information. On January 5, 2016, the Plan received the notice from the Federal Exchange to term the member's coverage effective January 20, 2016. this was completed and her automatic payment was terminated.
We welcome her calls for any questions....
The member may also submit an email to our Customer Service Email for assistance.
Ronni
Thank you for contacting us. I have thoroughly reviewed the complaint. I do see that the coverage is still in place. The payment line is very busy and we are trying to answer those calls as soon as possible. Adding additional staff causes increases in premiums and possible changes...
to benefits. We want to help keep costs down and still be able to have enough staff to address our member's calls. We are very sorry that you have had to wait so long without getting assistance. I will ask to have a representative call today for that payment. the ID number provided is valid, so I'm unsure why the automated update could not have been completed. I will ask the representative to confirm that information. I cannot give out a direct number for a manager. They are frequently away from their desks and cannot manage several calls. This would cause additional delays to any needed help.
Ronni N.
Thank you for this inquiry. I reviewed Ms. [redacted]’s comments; however, without having specifics to the claims in question it is difficult to ensure that I address her concerns. I did review her family’s coverage through both employer groups. I also briefly reviewed their...
claims. I did see that the claims are processed correctly according to the benefits. The secondary coverage provided Silverton Health includes a deductible. Claims are correctly being applied to the deductible. I encourage Ms. [redacted] to contact the Customer Service Team for any specific questions and they will be able to answer her questions and provide education on how the claims are processing. The contact information is listed on her Identification Card. She may also use our confidential email that can be found on WWW.Providence.Org and select Health Plan.
Thank you again,
Ronni N.
I was on vacation and was unable to respond quickly enough before the response period closed for my complaint.
As to the descriptive conclusion now placed on my closed complaint:
"Answered - the business addressed the issues within the complaint, but the consumer remains dissatisfied."
I would say that the business did NOT address "the issues within the complaint." This is still very much unresolved and unaddressed—that a health care company could lure customers based on false representation of which doctors' services would be covered. The only reason I chose this company for health care is that they covered our family's doctors. Now, to learn that these doctors' services suddenly are not covered in no way "address[es] the issues within the complaint."
Please, keep the inquiry going or send it higher.
Thank you, [redacted]
--
[redacted]