Reilly & Sons Tree Service

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered] Complaint: [redacted] I am rejecting this response because: It is not an offer, it is a disclosure and I am unable to send it forward due to lack of contact information,I will gladly sign and return the form but I do not see any contact for the Capital Blue Cross representative Reference is made to a phone number below, but there is none listed Regards, [redacted]

January 14, 2017Dear [redacted] ***:This letter is response to a complaint received on January 9, from the Revdex.com on your behalf concerning your current enrollment status with Capital BlueCross.Our records indicate you were enrolled with Healthy Benefits PPO 4500/0/health care coverage from December 1, through December 31, under an Individual Account policy not purchased on the Federal-facilitated Market Place (FFM).Due to a system issue, your enrollment information was not updatedWe apologize for any inconvenience this may have causedYour enrollment has been updated showing coverage effective January 1, on the Silver PPO 4500/0/plan.The invoice for the January monthly premium rate of $was created on January 12, The due date for this premium is January 26, The expected mailing date of your identification card is January 18, I have enclosed an imaged copy of the identification card (front and back) for your records in the event you need to supply this information to a provider and/or facility prior to receiving your card.Thank you for your patience while this inquiry was under reviewIf you have any questions, you may contact our Customer Service Department at [redacted] , Monday through Friday, between the hours of 8:a.mand 6:p.m.Sincerely,Jacqueline BSenior Appeals & Grievances Resolution Specialist

July 25, 2016Dear [redacted] :We received your letter dated July 13, 2016, on July 15, 2016, written on behalf of [redacted] ***In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a member's Protected Health Information (PHI) may only be released to authorized representatives.In order to release any PHI to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by [redacted] ***, which would authorize us to release information to your bureauSince we have no such authorization on file, we are unable to respond to you regarding the issue in [redacted] ***'s complaint.Please be advised that we will review your inquiry and respond directly to [redacted] regarding her concernsIf [redacted] would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health Information (PHI) directly to you and/or the Revdex.com.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at ###-###-####.Sincerely,Jenny PSenior Appeals & Grievances Resolution Specialist

------- Forwarded message ----------From: Revdex.com of Metro Washington DCDate: Thu, Feb 16, at 8:AMSubject: Fwd: d: FW: Emailing: Revdex.com Complaint Management ID # [redacted] .htmTo: [redacted] < [redacted] @myRevdex.com.org---------- Forwarded message ----------From: A [redacted] , Angela (CBC) Date: Thu, Feb 16, at 8:AMSubject: d: FW: Emailing: Revdex.com Complaint Management ID # [redacted] .htmTo: "[email protected]" Re: [redacted] Inquiry # [redacted] Complaint Id # [redacted] This e-mail is in response to the below inquiry you forwarded to Capital BlueCross on behalf of Daniel DThierryThe issue is pertaining to a premium refund, which [redacted] is trying to obtainIn accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized representativeCapital BlueCross has no authorization on file from [redacted] , which permits us to release any information directly to your office; therefore, Capital BlueCross will send a response directly to [redacted] regarding this issue once our review has been completedIf [redacted] would like Capital BlueCross to send a response directly to your office, we will need him to complete and return the attached Capital BlueCross Member Authorization Form (MAF) advising that we are permitted to release his PHI directly to your officeThank you for your patience while your inquiry was under reviewIf you have any question regarding this issue, you may contact me directly at the phone number provided belowSincerely, ANGELA A [redacted] Senior Specialist | Commercial Appeals & Grievances Resolution Dept

January 11, Dear [redacted] :I am writing in response to your e-mail, which we received on January 9, Your inquiry is written on behalf of [redacted] The issue is pertaining to the cancellation of her health care contract.In accordance with the Health insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be released to an authorized representativeCapital BlueCross has no authorization on file from [redacted] , which permits us to release any information directly to you; therefore, Capital BlueCross will send a response directly to [redacted] regarding this issue once our review has been completed.If [redacted] would like Capital BlueCross to send a response directly to you/The Revdex.com, we will need her to complete and return the enclosed Capital BlueCross Member AuthorizationForm (MAF) advising that we are permitted to release her PH directly to your office.Thank you for your patience while your inquiry was under reviewIf you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely,Angela A.Senior Appeals & Grievances Resolution Specialist

February 18, 2016Dear [redacted] :We received your letter dated February 12, 2016, written on behalf of [redacted] In accordance with the Health insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health information (PHI) may only be released to authorized... representatives.In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by [redacted] , which would authorize us to release information to your Bureau. Since we have no such authorization on file, we are unable to respond to you regarding the issue in [redacted] 's complaint.Please be advised that we will review your inquiry and respond directly to [redacted] regarding his concerns. If [redacted] would like to have Capital BlueCross send a response directly to you and/or the RevDex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health information (PHI) directly to you and/or the RevDex.com.Thank you for your patience while your inquiry was under review. If you have any questions you may contact me directly at ###-###-####.Sincerely,Jenny P.Senior Resolution Specialist Appeals and Grievances Resolution Department

February 14, 2017Dear [redacted] :This letter is in response to a recent inquiry we received on your behalf from the Revdex.com on February 1, The inquiry states you are not satisfied with the response you received from Capital BlueCross on your original case filed to the Revdex.com on January 9, pertaining to your enrollment status and unpaid claim(s).The information supplied in the original inquiry accurately represents the premium amount, billing and payment information listed in your enrollment records with Capital BlueCross for your Healthy Benefits Value HMO coverage effective January 1, through February 29, The information contained in the response letter is listed below.Coverage Period Issue Date Due Date Premium Amount Amount Received Date Received Amount Due1/1-1/31/ 12/10/ 1/1/ $ $ 1/11/ $ 11.382/1-2/29/ 1/11/ 2/1/ $ $ 2/18/ $ ($162.50+ $11.38) 3/- 3/31/ 2/10/ 3/1/ $ $ $ ($162.50+ $11.38) 4/- 4/30/ 3/10/ 4/1/ $ $ $ ($162.50+ $173.88)5/- 5/31/ 4/11/ 5/1/ $ $ 5/7/ $ ($162.50+ $336.38)In the current inquiry filed with the Revdex.com, you state that the premium payment made in February was for the March coverageThe payment made prior was for the February coverage but was applied to January 2016's coverage in error as you had other coverageOn January 4, our records indicate you made a request for a Primary Care Physician (PCP) updateAlso, calls were made on January 8, regarding your enrollment and billingCapital BlueCross has no information from you regarding other coverageAs such, the payments received were applied to your January and February premiums.Capital BlueCross has no information listed for any calls received in regards to your contract between the dates of January 9, through May 5, On May 6, a call was received in Customer Service regarding your enrollment status and the payment made in March which was applied to your outstanding premium for February 2016.Because your contract was cancelled effective February 29, any claims received with a date of service after February 29, must remain denied.Thank you for your patience while your inquiry was under reviewIf you have any questions, you may contact our Customer Service Department at [redacted] , Monday through Friday 8:a.mto 6:p.m.Sincerely,Jacqueline B.Senior Appeals & Grievances Resolution Specialist

March 21, 2016Dear [redacted] :I am writing in response to your letter dated March 8, 2016, written on behalf of [redacted] The issue is pertaining to cancelling her health care contract.In accordance with the Health insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health information (PHI) may only be released to an authorized representativeCapital BlueCross has no authorization on file from [redacted] , which permits us to release any information directly to you; therefore, Capital BlueCross will send a response directly to [redacted] regarding this issue.If [redacted] would like Capital BlueCross to send a response directly to you/The Revdex.com, we will need her to complete and return the enclosed Capital BlueCross Member Authorization Form (MAF) advising that we are permitted to release his PH directly to your office.Thank you for your patience while your inquiry was under reviewIf you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely,Angela A.Senior Resolution SpecialistAppeals & Grievances Resolution Department

I did not receive the earlier complaints. I will assign this complaint as a priority and you will receive a response within the next several days. Feel free to contact me with any additional questions and or concerns.----- Forwarded message ----------From: BBB of Metro Washington... DC<[email protected]>Date: Thu, Feb 2, 2017 at 9:09 AMSubject: Fwd: d: FW: BBB Complaint - PriorityTo: [redacted] < [redacted] @mybbb.org>---------- Forwarded message ----------From: A [redacted] Angela (CBC) < [redacted] @capbluecross.com>Date: Thu, Feb 2, 2017 at 8:05 AMSubject: d: FW: BBB Complaint - PriorityTo: "[email protected]" <[email protected]>Re: [redacted] *** Inquiry # [redacted] Complaint Id # [redacted] In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized representative. Capital BlueCross has no authorization on file from [redacted] which permits us to release any information directly to you/ The RevDex.com.A previous appeal, submitted to Capital BlueCross, by [redacted] on January 11, 2017, regarding this same issue, was reviewed and a response was sent to [redacted] advising of the outcome.You may wish to contact [redacted] for information regarding the outcome of our review. If [redacted] would like Capital BlueCross to send a formal response to your office informing you of the outcome of her appeal, we will need her to complete and return the attached Capital BlueCross Member Authorization Form (MAF) advising that we are permitted to release her Protected Health Information (PHI) directly to your office.Thank you for your patience while your inquiry was under review. If you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely, ANGELA A [redacted] Senior Specialist | Commercial Appeals & Grievances Resolution DeptCAPITAL BLUE CROSS Office: ###-###-#### | Fax: ###-###-####

July 1, 2015Dear *** ***:We received your letter dated June 23, 2015, written on behalf of *** ** ***In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI} may only be released to authorized
representatives.In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by *** ***, which would authorize us to release information to your BureauSince we have no such authorization on file, we are unable to respond to you regarding the issue in *** *** complaint.Please be advised that we will review your inquiry and respond directly to *** *** regarding his concernsIf *** *** would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health Information (PHI} directly to you and/or the Revdex.com.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at ###-###-####.Sincerely,Jenny PSenior Resolution Specialist Appeals and Grievances Resolution DepartmentAlso, please sign and return the attached HIPPA Form You can return it to us at [email protected] or fax it to ###-###-####

Re: *** ** *** Your Case #*** Dear Ms***: In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized
representativeCapital BlueCross has no authorization on file from Mr***, which permits us to release any information directly to you; therefore, Capital BlueCross will send a response directly to Mr. *** regarding this issue once our review has been completed. Thank you for your patience while your inquiry was under review. If you have any questions regarding this issue, you may contact me directly at ###-###-####. Sincerely, Angela A*** Angela A***Senior Appeals & Grievances Resolution Specialist

January 8, 2016Dear *** ***:We received your letter dated December 30, 2015, written on behalf of *** ***.In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be released to authorized
representativesIn order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by *** ***, which would authorize us to release information to your BureauSince we have no such authorization on file, We are unable to respond to you regarding the issue in *** ***’s complaint.Please be advised that we have responded to *** *** directlyIf *** *** would like to have Capital BlueCross send a response to you and/or the Revdex.com, we will need him to complete and return a MAF advising that we are allowed to release his Protected Health Information (PHI) directly to you and for the Revdex.comAn MAF is enclosed.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at ###-###-####Sincerely,Jenny P.Senior Commercial Appeals and Grievances Resolution Specialist

Dear ** ***:This in response to your email dated April 29, 2017, regarding a complaint filed by *** ***We apologize for the delay in our response to you.Because your office did not supply a signed release form from our member, we are unable to share the results of this member's
complaintWe will respond directly to our member.If you have any questions, please contact meat *** ***.Sincerely, /%; &feedMelissa S*** Operations SpecialistHealth care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, *** *** *** ***, *** *** *** *** and *** *** *** *** ***licensees of the BlueCross BlueShiefd Association.Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for aii CompaniesC-?]?2013}

January 11,2017Dear *** ***:I am writing in response to your letter dated January 9, 2017, on behalf of *** ** ***’s complaint regarding her health care enrollment with Capital BlueCross.In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a
Member’s Protected Health Information (PHI) may only be released to an authorized representativeCapital BlueCross has no authorization on file from *** *** which permits us to release any information directly to youTherefore, Capital BlueCross will send a response directly to *** *** regarding this issue.If *** *** would like Capital BlueCross to send a response directly to you at the Revdex.com, we will need her to complete and return the enclosed Capital BlueCross Member Authorization Form (MAF) advising that we are permitted to release her PHI directly to your office.Thank you for your patience while your inquiry was under reviewIf you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely,Jacqueline B.Senior Appeals & Grievances Resolution

Complaint: ***
I am rejecting this response because:To whom it may concern:Let me start off by saying that the billing issue is not being argued at this point anymore because I understand you r position but do not AGREE with itThe payment I made in February was for MarchYou put it towards the month before and that was paid that month and that payment was put towards January but I did not need coverage then because I had other coverage, But, you should all be on the same page because I am telling you I received different info multiple times or I would have been on track.No 2-do you RECORD your calls because then you would know that the gentleman I spoke to DID say I could not pay-when a few days later I received a notice saying there was a grace period and I did have TIME and if I had paid then I would NOT be in this position.Check your phone records and you will see I am telling the truthHopefully- you have themI marked it down That being said-this would have been resolved by nowI am paying the price for these issues.Your lack of customer service should not be disputed and with me and should be addressed as well as customer friendly and more clearer billing.I am certainly discourged at this point; but instead of arguing with me you should be helping me come to a resolution that we both can agree on instead of saying you are not at fault at any of itThis insurance is offered to all ages and should be more understandable for everyone
Regards,
*** ***

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

We received your letter dated February 29, 2016, written on behalf of *** *** ***In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health information (PHI) may only be released to authorized representatives.in order to release
any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by Ms*** ***, which would authorize us to release information to your BureauSince we have no such authorization on file, we are unable to respond to you regarding the issue in Ms*** ***'s complaint.Please be advised that we will review your inquiry and respond directly to Ms*** *** regarding his concernsIf Ms*** *** would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health Information (PHI) directly to you and/or the Revdex.com.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at ###-###-####.Sincerely,Jenny P*** Senior Resolution Specialist Appeals and Grievances Resolution Department

Dear *** *** *** and the Revdex.com:
I have reviewed the response from Capital Blue Cross in reference to my complaint ID #*** and accept the response and resolutionShould you or Capital Blue Cross need anything further from me regarding this complaint I can be reached at ###-###-####. I appreciate the assistance of the Revdex.com and thank you very much for your time in this matter Best Regards, *** *** *** ###-###-####
***@***.com

February 13, 2018Dear *** ***:I am writing in response to your e-mail, which we received on February 12, Your inquiry is written on behalf of *** ** ***The issue is pertaining to the deductible application.In accordance with the Health Insurance Portability and Accountability
Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized representativeCapital BlueCross has no authorization on file from *** ***, which permits us to release any information directly to you; therefore, Capital BlueCross will send a response directly to *** *** regarding this issue once our review has been completed.If *** *** would like Capital BlueCross to send a response directly to you/The Revdex.com, we will need her to complete and return the enclosed Capital BlueCross Member Authorization Form (MAF) advising that we are permitted to release her PHI directly to your office.Thank you for your patience while your inquiry was under reviewIf you have any questions regarding this issue, you may contact me directly at ***.Sincerely, Angela A***Senior Appeals & Grievances Resolution Specialist

August 1, 2016Dear *** ***:We received your letter dated July 18, 2016, on July 20, 2016, written on behalf of *** ** ***In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a member's Protected Health Information (PHI) may only be released to
authorized representatives.In order to release any PH to you directly we would need approval, in the form of a Capital BlueCross Member Authorization Form (MAF), signed by *** ***, which would authorize us to release information to your bureauSince we have no such authorization on file, we are unable to respond to you regarding the issue in *** ***'s complaint.Please be advised that we will review your inquiry and respond directly to *** *** regarding her concernsIf *** *** would like to have Capital BlueCross send a response directly to you and/or the Revdex.com, we will need her to complete and return a MAF advising that we are allowed to release her Protected Health Information (PHI) directly to you and/or the Revdex.com.Thank you for your patience while your inquiry was under reviewIf you have any questions you may contact me directly at *** ***.Sincerely,Jenny PSenior Appeals & Grievances Resolution Specialist