T L C Marine Service Inc

[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 Administratively Resolved]
Complaint: ***
I am rejecting this response because:12/29/2015RE: DO NOT ACCEPT RESPONSE MADE BY IBXTo Whom It May Concern:This additional letter is in reference to the complaint I made regarding IBX handling my claimsI am attaching a signed HIPPA Authorization Form and additional supporting documentation as part ofmy reason to continue with the complaintThe following documents are also included:1) ***.jpg - Print Screen From IBX website that Shows my provider indicated in the disputed claims are in IBX network.2) ***2.jpg - Additional print screens taken directly from the IBX website that shows DrNicasia is in network.3) ***3.jpg - Print Screen taken directly from the IBX website that showed my coverage at time I was enrolled with IBX and during the time when the claims were made4) ***4.jpg - Breakdown explanation of what is considered in-network and out of network as part of my coverage taken directly from the IBX website5 ***5.jpg - Additional print screens to show the breakdown explanation of what is considered in-network and out of network as part of my coverage taken directly from the IBX website.6) ***6.jpg - Additional print screen taken directly from the IBX website that explains what is considered in-network and onetwork for outpatient mental health as part of my coverageAccording to this print screen whether DrN*** is in-network or out-of-network my IBX coverage (and tier level) is resulting in a $copayment onlyThis print screen was taken at 12/29/at 3:30PM EST7) 6) ***7.jpg - Final print screen tken directly from the IBX website that explains what is considered in-network and onetwork for coverage under my tierPlease review this as part of my complaint and please feel free to contact me with questions
Regards,
*** ***

Dear *** ***:I am writing to acknowledge and respond to your October 5, correspondence to Detra D***, Supervisor of the Executive Inquiries Department.During my preliminary review, I was unable to locate any membership information concerning *** ***Based on the information
you provided, I contacted and confirmed that *** *** is insured by *** AdministratorsAs such, I have forwarded your inquiry to that plan's Account Benefit Specialist, Maureen R***, for review and response.*** ***, thank you for bringing this matter to our attention and for the opportunity to be of assistanceIn the interim, should you have any questions, you can reach MsR*** at ###-###-####.Sincerely,Kathleen L***Executive Inquiries SpecialistExecutive InquiriesMarket Street, 13th floorPhiladelphia, PA 19103PH: ###-###-####

Dear *** ***,
Thank you for following up and advocating for *** ***There seems to be a gap in communications; therefore, I have copied *** *** on this email so that everyone has the same understanding
Myself and *** *** have been in talks about the claim reportThere are no errors with how the claims were processed*** ***'s questions are surrounded around the accuracy in which we applied the member cost-sharing and the date the out-of-pocket (OOP) maximum was metI explained to *** *** that the original date in which the (OOP) was met has changed because we had to adjust several claims to correct the OOP overageAs a result of the corrections, *** *** is entitled to a refund in the amount of $4,from the medical professionals
Our December 3, 2015, conversation ended with me having two claims reviewedI left a voicemail for *** *** to call meShortly after, I emailed our findings to her on December 9, I have confirmation that she has read today's emailI will wait to hear from on separate cover
I hope that this timeline of events is helpful
Sincerely,
Tedra F*
Specialist, Executive Inquiries
###-###-####

I am writing in response to your November 12, 2015, inquiry on behalf of *** ***The purpose of this response is to inform you that *** *** has a current balance owed of $and his account is paid to October 1, Her coverage was effective from September 1, 2015, to October
7, 2015, then reinstated on October 8, 2015. Due to the lack of HIPAA authorization allowing me to disclose the member’s protected health information, I am contacting the member directly as well to provide clarification of her accountif you have any questions, please contact me and I will be glad to assist you. Sincerely, Scott Y***SpecialistExecutive Inquiries*** *** *** ***Philadelphia, PA ***

[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 Administratively Resolved] Complaint: ***I am rejecting this response because: I have been told and promised for almost three months that everything would be straightened out and someone would call me backStill have never heard from Blue Cross, and my online account billing is still showing that I owe a balance of $I also am in the predicament of trying to get this plan renewed for I have not received any bills or indication that the plan will be renewed and in effect starting January 1, 2015.Regards,*** ***

Thank you for returning the attached authorization formHowever, it is deemed invalid because the Recipient information is missing*** *** has been notified that she will need to complete this section before we can disclose her Personal Health Information to you. In the interim, we have responded to *** *** and consider this case closed with an amicable outcome. Please let me know if you need anything else. Sincerely, Tedra F*Executive InquiriesLead Client Services RepresentativeMarket Street, 13th floorPhiladelphia, PA

August 5, 2015Our Supervisor of the Executive Inquiries Department, Detra D***, has requested that respond to your July 19, 2015, correspondence regarding *** ***The purpose of this letter is to inform your office that we have responded directly to ***.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 (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable lawThe written approval, called an “authorization”, must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.As we have not received an authorization form from your office with *** *** naming you and your office as an authorized recipient of his PHl and to prevent any unnecessary delays, we have directed our response to *** ***.*** ***, we appreciate your office bringing *** ***'s concerns to our attention.Sincerely,Rafael *D***Specialist, Executive Inquiries Department

I am writing to acknowledge receipt of the December 9, 2016, correspondence you addressed to Detra D***, Supervisor of the Executive Inquiries DepartmentThis complaint was received in our office on December 14, 2016.The concerns presented by *** *** are being reviewed, and will be
addressed upon finalization of our review. As you know, the Federal Health Insurance Portability and Accountability Act, known as HIPAA, requires that we obtain an individual’s written approval before disclosing his/her protected health information (PHI)In order for us to provide your office with a resolution, is would be necessary for *** *** to complete the attached HIPAA Authorization Form.*** ***, thank you for bringing this matter to our attention.Sincerely, Rasheeda H***Lead Client Services Rep.Executive Inquiries

RE: Member: *** *** Revdex.com ID #: *** Dear *** ***, Our records indicate that there is no authorization for The Revdex.com to receive this member’s protected health information or PHIAs a result, we cannot disclose any information
regarding our memberPlease complete the enclosed Authorization form and return it in the envelope providedOnce this information is received and processed, we will be able to release your PHI to your designated recipient. Jamela W***Customer Touch Point Analyst IIExecutive InquiriesMarket St., 13th FloorPhiladelphia, PA

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
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,
*** ***

Thank you for your response, enclosed is an attachment with the completed HIPPA formPlease let me know if there is anything else you need to resolve this issueThanks. Best Regards, *** ** ***

Re: *** ***
Dear Ms***:
I am writing to acknowledge our receipt of your July 9, 2015, correspondence to *** ***-***, Supervisor of the Executive Inquiries Department. We appreciate your writing to
alert us to your concern(s)
As you are aware, the Federal Health Insurance Portability and Accountability Act (HIPAA), known as the HIPAA Privacy Rule, requires that we obtain an individual’s written approval before using or disclosing their protected health information (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable lawOur records indicate that there is no authorization on file for you to receive Mr***'s PHI
In order to provide you with the information you’ve requested, please have Mr*** complete the attached Authorization to Release Information formTo be considered valid, all areas of the document must be completedInstructions are listed on the back of the form should assistance be requiredPlease return envelope to return the form to my attention.
In the interim, we have initiated a review of the issues you presentedHowever, if we do not receive the completed authorization form by the time we have completed our review, we will correspond our findings directly to Mr***Thank you.
Sincerely,
Yvonne MP***, Specialist
Executive Inquiries
Attachment

I will be coordinating the review and response for the following complaint: Member: *** *** *** Complaint ID # :
*** However, we require a HIPAA Authorization Form regarding this caseI kindly ask that your office request that *** *** complete the attached form naming you/your office as an authorized recipient of her PHIWe look forward to receiving as soon as possible. Thank you. Regards,Rafael *D***Lead Client Services Representative***Please fill out attached form

[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: ***
I am rejecting this response because:All I want is my insurance company to tell me how much this ph probe costsThey have prevented themselves from giving me this informationI attempted to call *** and they did not answer the phoneI would also like to file a complaint against them but could not find them in the Revdex.com search.
Regards,
*** ***

As we discussed on 12/29/and this morning, because our records do not reflect receipt of a HIPAA authorization to issue the member’s Protected Health Information (PHI) to your office, we will respond directly to the member with our findings. Thanks Reginald H***Lead Client
Service RepresenativeOffice of Consumer Advocacy *** *** *** *** **Philadelphia, PA ***P ###-###-#### x*** |

May 10, 2016Dear *** ***:I am writing in response to the May 2, 2016, letter to Detra D*** on behalf of *** *** ***, Your complaint was received in our office on May 9, and concerns his dental coverage.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 (PHI) for any purpose not permitted or required by the HIPAA Privacy Rule or other applicable lawThe written approval, called an "authorization', must contain certain required elements for us to consider it valid under the HIPAA Privacy rule.As we have not received a valid authorization form from your office with *** *** naming you and your office as an authorized recipient of his PHI, and to prevent any unnecessary delays, we will be directing our response to *** ***.*** ***, we appreciate your office bringing *** ***'s concerns to our attentionIf you have any additional questions, please contact me at ###-###-####.Sincerely,Diane H.Lead Client Services Representative Executive Inquiries Department

[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 Administratively Resolved]
Complaint: ***
I am rejecting this response because the concerns were not all addressed and the problems were not rectified as statedI received your letter and spoke to one of your representatives todayLike I already stated, as a result of this error or not updating your system with my payment, many insurance claims for the month of april were denied when they were not supposed to beThe reason for the denial stated that I was not an active member, when in fact I was because I paid the entire bronze invoice (the payment that was not applied to the silver invoice)You once again hide behind HIPPA regulations and avoid addressing this very serious problem that has resulted in other issuesLike I said, I have already made the Revdex.com an authorized intermediary in a prior complaint and in this oneIt seems that instead of your company using its time wisely and resolving this mistake and its ramifications, you ignored them, causing me the burden of having to continue calling your incompetent customer service reps every single day, who continue to assure me that everything will be ok and continue "resubmitting" these claims that continue coming up as denied in the IBX systemYour company has done nothing to resolve this problem except send an apology letterIn fact, the IBX system still does not reflect the payment that I made, but it certainly makes clear that your company rejected every major claim that was made in the month of aprilYour response has made me ill and I will have file a lawsuit against your company for breach of contract if this major issue is not remedied immediately.
Regards,
*** ***

See Attachment

I am writing in response to the May 2, 2016, letter to Detra *** on behalf of Mr*** ***Your complaint was received in our office on May 10, and concerns enrollment activity.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 PHIWhile 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 Mr***'s complaint to your officeIt has been identified that this matter is resolved and currently consider it closed.Ms***, we appreciate your bringing Ms***'s concerns to our attentionIf you have any additional questions, please contact me at ###-###-####.Sincerely,Rafael PD*** Lead Client Services Representative Executive Inquiries Department

I am contacting you regarding complaint ID # ***I have spoken to *** *** *** today and confirmed his complaint/concerns should be directed to the *** *** *** and not Independence Blue CrossHe understood and thanked me for my assistance. Please contact me at
###-###-#### if you have any questions. Thanks, Chris H***Executive Inquiries AnalystMarket Street, Philadelphia, PA