T L C Marine Service Inc

Good Morning,
Member's account is reinstated and he was able to...

obtain his prescripton drug purhase. I am waiting for information from our Billing Department to complete my response letter.
If you have any questions, please contact me at ###-###-####.
Sincereley,
 
Sylvia B[redacted], Specialist
Executive Inquiries

Good afternoon:
We will be issuing a response directly to the member in this case as there is no HIPAA authorization on file allowing us to correspond with your office. If you have any questions, please feel free to contact me at ###-###-####. I will be glad to assist you.
sincerely,
Scott...

Y[redacted]
Executive Inquiries

[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 Administratively Resolved] Complaint: [redacted]I am rejecting this response because:
It is true that the prescription plan is reinstated, but every doctor claim had been denied. Regards,[redacted]

May 11, 2016I am writing in response to the May 2, 2016, letter to Detra D[redacted] on behalf of [redacted]. Your complaint was received in our office on May 10, 2016 and concerns policy benefits.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 has been identified that this matter was resolved on March 9, 2016, and currently consider it closed.[redacted], we appreciate your bringing [redacted]'s concerns to our attention. If you have any additional questions, please do not hesitate to contact me at ###-###-####.Sincerely,Rafael .D Lead Client Services Representative Executive Inquiries Department

I have enclosed the requested form. I am still seeking a resolution for the issue on hand. I have also enclosed a copy of the check that shows payment was made. I have also spoken with IBX representative that was adamant that payment was not received until I produced a check. I have yet to receive a response regarding this check.

Complaint [redacted] has been resolved. Thank you.[redacted]General Manager

Hello [redacted], I am responding to [redacted]s latest rejection to the complaint. We are sensitive to [redacted]s situation and recognize that this is not the outcome he had expected. On November 27, 2017, [redacted] told me that he would call the performing  provider...

and conference me on the call—this did not happen. To date, [redacted] has not called me back as promised. At this time, we consider this case to be resolved as we do not have any additional or new information to give to [redacted] or the Revdex.com. Lastly, once [redacted] has appointed the Revdex.com as an authorized recipient of his personal health information, I can send you a copy of our response letter. Our response letter explains in great detail about out-of-area provider contracting and claim processing procedures. Please let me know if you require anything else. Sincerely, Tedra F[redacted] Executive Inquiries Department Executive Inquiry Specialist 1900 Market Street, 6th floor Philadelphia, PA 19103 P  ###-###-#### X[redacted]  |  F ###-###-####  NOTICE: This email message is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

I am writing to acknowledge receipt of the February 22, 2017, correspondence you addressed to Detra D[redacted], Supervisor of Executive Inquiries Department. This complaint was received in our office on March 3, 2017.  As you know, the Federal Health Insurance Portability...

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, it would be necessary for [redacted] to complete the attached HIPAA Authorization Form.  [redacted], that you for bringing this matter to our attention.  Sincerely, Chris H[redacted]Executive Inquiries Analyst1901 Market Street, Philadelphia, PA 19103

I am writing in response to your November 9, 2015 inquiry on behalf of [redacted]. The purpose of this email is to provide you with the details of our review of the concerns you presented. Per the identification number listed in your inquiry for the member, we identified that the case is for [redacted], not [redacted]. [redacted] stated that they have not received an invoice but that their check for $1621.45 was received and cashed by Independence. He stated that when they went to the pharmacy in mid-September, they were advised that their coverage was not active. We have identified that [redacted] currently owes a balance of $4812.05. The account is not cancelled, but is only paid to October 1, 2015. We experienced delays in issuing his invoices, but were able to issue his December 2015 invoice. Thank you for bringing [redacted]’s concerns to our attention. If you have any questions, please contact me at ###-###-####. I will be glad to assist you. Sincerely, Scott Y[redacted]SpecialistExecutive Inquiries[redacted]

I am writing to acknowledge receipt of the February 23, 2017, correspondence you addressed to Detra D[redacted], Supervisor of the Executive Inquiries Department. This complaint was received in our office on March 3, 2017.The concerns presented by [redacted] 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, [redacted] may complete the attached HIPAA Authorization Form.[redacted], thank you for bringing this matter to our attention.Sincerely,Diane H[redacted], Lead Client Services RepresentativeExecutive Inquiries Department

Please see attached completed HIPAA form. I have also mailed it to the Philadelphia PO Box listed at the bottom of the form.Thanks![redacted]

[redacted],
Good afternoon.
I am writing to acknowledge our receipt of the concerns for [redacted] under complaint # [redacted]. I will be handling the review and response to the concerns presented. In accordance with the Health Information Portability and Accountability Act (HIPAA), we can not...

release protected health information (PHI) to any recipient without the member's consent/authorization. I will fax the HIPAA Authorization Form to your attention so that [redacted] can complete and return to my attention naming you and the Revdex.com of PA/DC as authorized recipient of his PHI in this matter.
Regards,
Rafael *. D[redacted]
Specialist, Executive Inquiries Department
Independence Blue Cross
###-###-####

Good afternoon:
I am writing in response to complaint number [redacted], for [redacted]. The purpose of this letter is to inform you that we have issued a refund check to him in the amount of $247.09 on September 15, 2015.In addition, his policy was cancelled effective September 2, 2015. if he...

has a discrepancy with the cancellation date, he needs to contact the Federal Facilitated Market place and request a change in the date.
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

[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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
I received no information or closure in the aforementioned case.I received no reimbursement for the erroneously rejected claims.Furthermore, I disputed two more claims in the meantime  (one for our son'so rejected hearing exam, which should have been covered at 100%; the other for counseling, which was never correctly sent to or processed through [redacted]. I reject the response--there has been no response or resolution. 
Regards,
[redacted]

I am writing in response to your recent inquiry on behalf of [redacted] for Complaint # [redacted]. The purpose of this letter is to inform you that we correctly processed [redacted]’s claim for services rendered to him on June 17, 2015, at [redacted] Medical Center of the [redacted]. [redacted] contacted your office requesting assistance in getting his copayment removed for his services on June 17, 2015. He contends that according to his benefits summary booklet it states that "If you have a test," then in the subrow "Diagnostic test (x-ray, blood work)," in the column for "Your Cost If You Use" for "a [redacted] Provider" says "No Charge". However, he is being charged a copayment of $50.00. We identified that [redacted] Medical Center of the [redacted] is not a participating [redacted] provider; therefore, subjecting him to a copayment of $50.00. The following is the breakdown of his provider grid and cost sharing: In-NetworkOut-of-NetworkBenefits                                     [redacted] NetworkPersonal Choice NetworkOut-of-Network*                          OUTPATIENT DIAGNOSTIC SERVICESRoutine Radiology$15 Copayment ([redacted] facility), $20 Copayment (non-[redacted] facility)$50 Copayment then 70%, after deductible60%, after deductible [redacted], please advise if I can be of further assistance. If you have any questions, please contact me at ###-###-####. I will be glad to assist you. Sincerely,  Scott Y[redacted]

This is what I received in mail from Blue Extra & a copy of my return to them. To Whom it may concern, The complaint was for both me and my wife.  I have the brochures and copies of enrollment forms.  Please contact me at [redacted] if any questions.Sincerely,

August 23, 2016Dear [redacted]:I am writing in response to the August 17, 2016, letter to Detra D[redacted] on behalf of [redacted]. Your complaint was received in our office on August 17, 2016, and concerns [redacted]'s experience when she contacted our office for benefit information and...

a claim processing complaint.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 August 17, 2016, and currently consider it closed.[redacted], we appreciate your bringing [redacted]'s concerns to our attention. If you have any additional questions, please do not hesitate to contact me at ###-###-####.Sincerely,Tedra F. Lead Client Services Representative Executive Inquiries Department

Our Supervisor of the Executive Inquiries Department, Detra Davidson-Stewart, has requested that I respond to your January 16, 2016, correspondence regarding [redacted].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 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 office submitting the authorization from Ms. [redacted] listing your office as an authorized recipient of her PHI.The matter at hand In her inquiry to your office, Ms. [redacted] indicated that her health insurance is supposed to begin on February 1, 2016. Additionally, Ms. [redacted] mentioned that despite having cancelled her January coverage plans in December, she has since received invoices for two health care insurance plans in January 2016. In conclusion, Ms. [redacted] advised that she has no access to January 2016 coverage benefits, as they were cancelled. Ms. [redacted] shared that her desired outcome is for Independence Blue Cross (IBC) to cancel both of the plans she had previously considered for January, as IBC confirmed in December 2015.Our review We identified that Ms. [redacted] purchased her coverage plan through the Federally Facilitated Marketplace (FFM) and in accordance with the FFM guidelines. We must first receive notification from the FFM prior to making any enrollment or coverage changes. Ms. [redacted] will need to reach out to the FFM at ###-###-#### to request that it void or cancel her coverage before we can cancel her current coverage.We trust that this information will be helpful to you. Please contact me at ###-###-#### with any additional questions specific to this matter and I will be pleased to assist you.Executive Inquiries Department
Sincerely,
Rafael P. D[redacted]

[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 [redacted], and find that this resolution is satisfactory to me.  My complaint was about my check being cashed and my insurance being cancelled w/o notifying me.  It took over 100 minutes on the phone.  I reached out to IBC on Monday, I received conformation on 2/23/17. Very poorly trained customer service.  Thank you Revdex.com.
Regards,
[redacted]