Reilly & Sons Tree Service

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 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 her 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 Appeals & Grievances Resolution Specialist

Signed HIPPA Form

January 14, 2017Dear [redacted]:This letter is response to a complaint received on January 9, 2017 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 4500/0/10 health care coverage from December 1, 2016 through December 31, 2016 under an Individual Account policy not purchased on the Federal-facilitated Market Place (FFM).Due to a system issue, your 2017 enrollment information was not updated. We apologize for any inconvenience this may have caused. Your enrollment has been updated showing coverage effective January 1, 2017 on the Silver PPO 4500/0/10 plan.The invoice for the January 2017 monthly premium rate of $444.07 was created on January 12, 2017. The due date for this premium is January 26, 2017. The expected mailing date of your identification card is January 18, 2017. 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 review. If you have any questions, you may contact our Customer Service Department at [redacted], Monday through Friday, between the hours of 8:00 a.m. and 6:00 p.m.Sincerely,Jacqueline BSenior Appeals & Grievances Resolution Specialist

Date Sent: 9/22/2017 7:32:45 AMThis issue has been resolved as of 09/22/17.  I received full reimbursement.

I am rejecting their response. I have e-mailed your company over a signed HIPAA. I also recently received Capital Blue Cross final denial letter and I requested in writing on 06/29/2015 an external review (someone not affiliated with their company).

March 14, 2016Dear [redacted]:I am writing in response to your letter dated March 1, 2016, written on behalf of [redacted]. The issue is pertaining to a premium rate increase for 2016, which was applied to [redacted]'s health insurance 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 representative. Capital 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 him to complete and return the enclosed Capital BlueCross Member Authorization Form (MAF) advising that we are permitted to release his 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 Resolution SpecialistAppeals & Grievances Resolution Department

January 11, 2017 Dear [redacted]:I am writing in response to your e-mail, which we received on January 9, 2017. 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 representative. Capital 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 review. If you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely,Angela A.Senior Appeals & Grievances Resolution Specialist

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, 2017. 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, 2017 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 4500.0 coverage effective January 1, 2016 through February 29, 2016. The information contained in the response letter is listed below.Coverage Period   Issue Date   Due Date   Premium Amount     Amount Received    Date Received     Amount Due1/1-1/31/2016   12/10/2015    1/1/2016           $162.50                    $151.12              1/11/2016             $ 11.382/1-2/29/2016    1/11/2016     2/1/2016           $173.88                    $162.50              2/18/2016             $ 11.38                                                                   ($162.50+ $11.38)       3/1 - 3/31/2016  2/10/2016     3/1/2016           $173.88                      $ 0.00                                            $173.88                                                                   ($162.50+ $11.38)  4/1 - 4/30/2016  3/10/2016    4/1/2016            $336.38                      $ 0.00                                            $336.38                                                                               ($162.50+ $173.88)5/1 - 5/31/2016  4/11/2016    5/1/2016          $498.88                       $ 11.38               5/7/2016              $487.50                                                                             ($162.50+ $336.38)In the current inquiry filed with the Revdex.com, you state that the premium payment made in February 2016 was for the March 2016 coverage. The payment made prior was for the February 2016 coverage but was applied to January 2016's coverage in error as you had other coverage. On January 4, 2016 our records indicate you made a request for a Primary Care Physician (PCP) update. Also, calls were made on January 8, 2016 regarding your enrollment and billing. Capital BlueCross has no information from you regarding other coverage. As such, the payments received were applied to your January 2016 and February 2016 premiums.Capital BlueCross has no information listed for any calls received in regards to your contract between the dates of January 9, 2016 through May 5, 2016. On May 6, 2016 a call was received in Customer Service regarding your enrollment status and the payment made in March 2016 which was applied to your outstanding premium for February 2016.Because your contract was cancelled effective February 29, 2016 any claims received with a date of service after February 29, 2016 must remain denied.Thank you for your patience while your inquiry was under review. If you have any questions, you may contact our Customer Service Department at [redacted], Monday through Friday 8:00 a.m. to 6:00 p.m.Sincerely,Jacqueline B.Senior Appeals & Grievances Resolution Specialist

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If 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]

March 14, 2016Dear [redacted]:I am writing in response to your letter dated March 1, 2016, written on behalf of [redacted]. The issue is pertaining to the cancellation of [redacted]'s health insurance 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 representative. Capital 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 him 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 review. If you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely,Angela A. Senior Resolution Specialist Appeals & Grievances Resolution Department

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 representative. Capital 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 review. If you have any questions regarding this issue, you may contact me directly at ###-###-####.Sincerely,Angela A.Senior Resolution SpecialistAppeals & Grievances Resolution Department

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

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: Revdex.com of Metro Washington...

DC<[email protected]>Date: Thu, Feb 2, 2017 at 9:09 AMSubject: Fwd: d: FW: Revdex.com Complaint - PriorityTo: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: A[redacted] Angela (CBC) <[redacted]@capbluecross.com>Date: Thu, Feb 2, 2017 at 8:05 AMSubject: d: FW: Revdex.com 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: ###-###-####

------- Forwarded message ----------From: Revdex.com of Metro Washington DC<[email protected]>Date: Thu, Feb 16, 2017 at 8:49 AMSubject: Fwd: d: FW: Emailing: Revdex.com Complaint Management ID #[redacted].htmTo: [redacted] <[redacted]@myRevdex.com.org---------- Forwarded message...

----------From: A[redacted], Angela (CBC) <Angela.A[redacted]@capbluecross.com>Date: Thu, Feb 16, 2017 at 8:46 AMSubject: d: FW: Emailing: Revdex.com Complaint Management ID #[redacted].htmTo: "[email protected]" <[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 D. Thierry. The issue is pertaining to a premium refund, which [redacted] is trying to obtain. 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 your office; 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 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 office. Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at the phone number provided below. Sincerely, ANGELA A[redacted]  Senior Specialist | Commercial Appeals & Grievances Resolution Dept