T L C Marine Service Inc

Good mroning [redacted]:
I am writing inresponse to the above refereenced complaint for on behalf of [redacted]. The purposoe of this letter is to inform you that we originally processed his claim for date of service June 17, 2015, and no adjustment or reprocessing of the claim is...

necessary.
[redacted] contends that his claim was not properly processed correctly as a a [redacted] employee with services rendered by [redacted]. He feels he should not have been subject to the cost sharing that was assessed on his claim.
After further review it appears his claim processed correctly under tier2, taking a $50 copayment. The services were performed at [redacted] Medical Center of the [redacted] Health system which, is not a facility within the [redacted] Network. If services were perfomed by a [redacted] provider, the claim would have processed under tier1 benefit level.
Thank you for bringing [redacted]'s concerns to our attention. If you have any questions, please feel free to contact me at ###-###-####. I will be glad to assist you.
Sincerely,
Scott Y[redacted], Specialist
Executive Inquiries

I am writing in response to the May 2, 2016 letter to [redacted] on behalf of Mr. [redacted]. Your complaint was received in our office on May 9, 2016 and concerns the enrollment status of Mr. [redacted]’s vision plan. As you are aware, the federal Health Insurance Portability and...

Accountability Act, known as the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing his/her protected health information or PHI. While our records indicate that there is no authorization for you to receive this member’s PHI, we want you to know that we have reviewed [redacted]’s complaint to your office. It was identified that we previously resolved this matter on April 22, 2016 and currently consider it closed. Ms. [redacted], we appreciate your bringing Mr. [redacted]’s concerns to our attention. If you have any additional questions, please do not hesitate to contact me at ###-###-####. Sincerely, Jamela W[redacted]Customer Touch Point Analyst IIExecutive Inquiries[redacted]Philadelphia, PA 19103

RE: Member:  [redacted]
       Revdex.com ID #: [redacted] Dear [redacted], Our records indicate that there is no authorization for The Revdex.com to receive this member’s protected health information or PHI. As a result, we cannot disclose any information...

regarding our member. Please complete the enclosed Authorization form and return it in the envelope provided. Once this information is received and processed, we will be able to release your PHI to your designated recipient.

I apologize for the delay in our response regaring [redacted]'s concerns. I am waiting to obtain confirmation that the update has been made.
If you have any questions, please contact me at [redacted]

August 24. 2015Dear [redacted]:Our Manager of the Executive Inquiries Department. Detra D[redacted]. has requested that respond to your August 3, 2015. correspondence regarding [redacted]. The purpose of this letter is to provide you with the details of our reviews outcome.In accordance with the federal health Insurance Portability and Accountability Act. known as the HIPAA privacy rule. it requires that we obtain an individual’s written approval before using or disclosing his her protected health information (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval called an authorization, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule. We appreciate your of lice submitting the authorization from [redacted] listing your office as an authorized recipient of her PHI.The matter at handIn her correspondence. [redacted] shared the details of several conversations which she had with our customer service team members regarding her family deductible and how she has repeatedly received conflicting information. Additionally. [redacted] submitted her request for reimbursement of $1000 for $500 for 2015 and $500 for 2014 in additional costs she has had to render due to her perspective that our office exceeded her deductible.Our review Upon receipt of [redacted]'s inquiry. We commenced an investigation into the concerns presented and we discovered the following:During the May 26, 2015, call our customer service can then her incorrectly advised that two individuals had to meet $1500 towards the deductible in order for the family deductible to the net. The member has an embedded deductible which means once an individual meets their portion of the deductible: services are paid for that person without the entire family deductible being met. All other family members can contribute to the balance $1500 to meet the family deductible.

I am writing to acknowledge and respond to your February 16, 2016, email to Detra...

D[redacted], Supervisor of the Executive Inquiries Department.  You contacted Ms. D[redacted], on behalf of [redacted], who contacted the Revdex.com (Revdex.com) regarding a copayment amount we applied to her son’s claim. We received the Authorization to Release Information form that accompanied your inquiry. Unfortunately, upon review, we determined that the form has not been completed correctly. [redacted] signed under both the Member Signature and the Personal Representative Information fields. Since the Personal Representative Information field should only be signed when an individual has been designated by the member to be their personal representative, [redacted] only needed to sign under the Member Signature field. Having signed both fields has rendered the document invalid, and we are unable to disclose the member’s protected health information to you under the federal Health Insurance Portability and Accountability Act, known as HIPAA.        I can tell you that prior to receiving your inquiry, this matter was presented to our plan by the Pennsylvania Insurance Department, and has been reviewed and resolved. Rather than delay our reply, please be advised that we have corresponded our findings directly to [redacted]. [redacted], we thank you for bringing this matter to our attention. Sincerely, Yvonne P[redacted], Lead Client Services RepresentativeExecutive Inquiries

Re:   [redacted]
 
Dear Mr. [redacted]: 
I am writing to acknowledge our receipt of your March 3, 2015, correspondence to Detra D[redacted], Manager of the Executive Inquiries Department. We appreciate your writing to alert us to Ms....

[redacted]'s concern(s). 
In order to fully address the concerns you have presented, additional research is necessary. I have forwarded your correspondence to the appropriate liaison for further review. However, as you may be aware, the federal Health Insurance Portability and Accountability Act, known as the HIPAA Privacy rule requires that we obtain an individual’s written approval before using or disclosing her/his protected health information or PHI for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable law. The written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule. 
Our records indicate that there is no authorization for you to receive this member’s PHI. As a result, we cannot disclose any information regarding our member. We ask that you have Ms. [redacted] complete the enclosed Authorization to Release Information form. In order for us to consider the authorization valid, all sections of the document must be completed. Should Ms. [redacted] require assistance, instructions for the completion of the form are located on the back of the document. When she has proved you with the completed the authorization form, to expedite our receipt, please forward it to me via email as a PDF.
If we have not received the completed autorization form by the time we have finalized our review, we will respond directly to Ms. [redacted]. 
Mr. [redacted], should we complete our review before the completed form is received, we will be required to correspond our findings directly to Ms. [redacted]. Thank you for bringing this matter to our attention and for the opportunity to address her concerns. 
Sincerely, 
 
Yvonne M. P[redacted], Specialist/Executive Inquiries 
Enclosure