T L C Marine Service Inc

May 19, 2016Dear [redacted]:I am writing in response to the May 2, 2016, letter to Detra D[redacted] on behalf of **. and [redacted]. Your complaint was received in our office on May 9, 2016 and concerns **. and [redacted]'s dental coverage under the BlueExtra plan.We have received the valid HIPAA authorization from **. and [redacted], which lists your office as an authorized recipient of her PHI and are able to share the details about our review.The matter at hand In the inquiry to your office, **. [redacted] expressed concerns about enrollment for him and his wife, Joan, under the BlueExtra plan, which includes supplemental coverage for dental, vision, and hearing services. **. [redacted] advised that the only reason he selected this policy was to continue dental care at his longstanding primary dental office (PDO), [redacted]. However, he was refused services because his PDO informed him that they should not be participating with his current dental insurance carrier, [redacted]). As a result, the [redacted] were not able to obtain dental care, and **. [redacted] was required to pay for services up front.Our review According to our records, **. and [redacted] were enrolled under separate policies, with the BlueExtra plan, effective November 1, 2015. Their monthly premium rate for this policy was $29. Effective March 1, 2016, **. and [redacted]'s BlueExtra policy was cancelled based on their telephone request. Each individual was enrolled under separate policies. **. [redacted]'s member identification number is [redacted], and [redacted]'s member identification number is [redacted].On March 16, 2016, the [redacted] visited their PDO, [redacted], and were informed by the office that they do not participate with their dental insurance carrier, [redacted]. As a result, **. [redacted] was required to pay $214 for the services rendered at this time. Our dental carrier-[redacted]-has been in contact with the dental office, and they were informed that [redacted]'s $214 claim was paid by Delta Dental Insurance. Subsequently, the dental office advised that they have credited **. [redacted]'s account for this amount, as she paid them directly.It was identified that [redacted]'s records show this dental office has been participating since November 1, 1998. However, they have not been accepting patients for some time. [redacted] is currently working with the dental office to ensure their records are corrected accordingly. We would like to extend our apology to both **. and [redacted] for any inconvenience they experienced as a result of this situation.In conclusion, due to the [redacted]'s customer experience and difficulty receiving care, our management team has approved **. [redacted]'s request. We are processing premium refunds to reimburse **. and [redacted] for the period of time in which they were enrolled under the Blue Extra plan; November 1, 2015, to March 1, 2016. Each payment will be for the amount of $145. These payments are being processed to refund the [redacted] all premium payments made from November 1, 2015, through March 1, 2016, totaling $145 for each member ($29 for five months).I would like to add that previous refund checks were issued to **. and [redacted] on April 6, 2016, each for $58. These refunds were the result of each policy being paid two months in advance, beyond the March 1, 2016, cancellation date.[redacted], we appreciate your bringing the [redacted]s' concerns to our attention. If you have any additional questions specific to this matter, please contact me at ###-###-####. I will be pleased to assist you.Sincerely,Diane H. Lead Client Services Representative Executive Inquiries Department

[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]

November 6,2017 Dear [redacted]:I am writing in response to the October 23,2017, letter to Detra D[redacted] on behalf of [redacted]. Thank you for providing the completed and signed Authorization form, which allows our office to provide you with [redacted]’s protected health information.The purpose of our response is to inform you that we are unable to reinstate [redacted]’s coverage.Complainant’s ConcernsSpecifically, [redacted] contacted your office regarding the cancellation of his policy due to nonpayment. He is requesting that his coverage be reinstated.Our reviewAccording to our records, [redacted] was enrolled in the Keystone Health Plan East HMO Silver Proactive Direct Pay plan through the Federally Facilitated Marketplace (FFM). This policy was effective on May 1,2017, and the total cost for the plan was $355.22. [redacted] received an Advanced Premium Tax Credit (APTC) of $292.00, which reduced his monthly premium responsibility to $63.22.Based on our review, it has been determined that [redacted]’s policy was cancelled for nonpayment on September 7,2017, with a retroactive effective date of July 1,2017, correctly. Our review concluded that the policy cancellation was due to the receipt of multiple late premium payments and subsequent account delinquency. Please allow us to explain.As you are aware, we send a monthly premium statement to our members, which provides a breakdown of past due and current balances According to our records, a billing invoice was mailed to [redacted]’s address, on file, for each month during 2017. [redacted] was also registered online through IBXpress, during the same time period, which also allowed him the option to view and/or pay his monthly premiums electronically.Based on the guidelines set forth by the Federally Facilitated Marketplace (FFM), members receiving a federal subsidy are entitled to a 90-day grace period before a cancellation of the health insurance can be processed. Members receive a delinquency letter explaining the payment requirement as a reminder that the premium payment is overdue and to avoid a policy cancellation. In this instance, [redacted] was sent delinquency notices in June 2017 and August 2017.1 have attached them for your review and records.During the 90-day grace period, the member must pay the account out of delinquency (this includes past due and current balances) to avoid a legitimate cancellation of the health insurance. In [redacted]’s case, the balance of $253.30 was due before September 1,2017. Please see the enclosed payment history outlining this information.Please note, partial payments would not prevent [redacted]’s account from becoming delinquent.In his letter [redacted] advised that he was told not to make any premium payments for a few months. However, according to our records, on April 4,2017, [redacted] called our office and was advised that because he had a credit on his account in the amount of $62.80, he would not be responsible for the entire monthly premium of $63.22, for the month of May 2017. Also, On April 10,2017, an invoice was issued to [redacted] advising that 42 cents was due before May 1,2017.1 have enclosed the May 2017 invoice for your review.Finally, [redacted] escalated this matter through the FFM. On October 6,2017, the FFM submitted a Health Insurance Casework System (HICS) complaint on his behalf. This is an escalation request administered by the FFM and submitted to the Plan (Independence) to investigate the reason for cancellation. If the result of a HICS investigation identifies a plan error, the consumer would qualify for reinstatement. However, in this instance, it was determined that there was no plan error, as [redacted]’s payments were not received timely. I have attached a copy of the HICS determination letter issued to [redacted].Note: On October 6,2017, [redacted] made a payment in the amount of $253.30 to satisfy the June 2017 through September 2017 premium balance. However, his plan was already cancelled effective July 1,2017. As such, $63.64 was applied to the June 2017 invoice and on October 30,2017, a refund in the amount of $^89.66 was issued to [redacted]’s home address on file.[redacted], we appreciate your office bringing [redacted]’s concerns to our attention. If you have any additional questions, please contact me at ###-###-####.Sincerely,Rasheeda H.SpecialistExecutive Inquiries Department

I am writing to acknowledge receipt of the March 27, 2017, correspondence you addressed to Detra D[redacted], Supervisor of the Executive Inquiries Department. This complaint was received in our office on April 4, 2017. The concerns presented by [redacted] are resolved, and the member...

has been notified. Should you require additional information, please contact me. Sincerely, Kathleen L[redacted]Lead Client Services RepresentativeExecutive Inquiries

April 22, 2015Dear [redacted]:Our Supervisor of the Executive Inquiries Department, Detra...

D[redacted], has requested that I respond to your recent correspondence regarding [redacted]. The purpose of this letter is to inform your office that we have responded directly to [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 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.As we have not received an authorization form from [redacted], naming you and your office as an authorized recipient of his PHI and to prevent any unnecessary delays, we have directed ourresponse to [redacted].[redacted], we appreciate your office bringing [redacted]'s concerns to our attention.Sincerely,Rafael ** D[redacted]Specialist Executive Inquiries Department

Dear Ms. [redacted],
I am writing in receipt of Mr. [redacted]'s complaint. In order to provide your office with a copy of our findings a completed HIPAA authorization form is required.
Please provide our office with the completed authorization form. Once received we will be able to share our findings...

with your office.
If you have any questions, please feel free to contact me at ###-###-####. I will be happy to assist you.
Sincerely,
Sylvia B[redacted], Specialist
Executive Inquiries

January 13, 2015Dear [redacted]:Thank you for your patience while we conducted a review...

of [redacted]’s concerns. We also received the completed Health Insurance Portability and Accountability Act (HIPAA) authorization form which allows us to respond to your December 30, 2014, letter. The purpose of our letter is to inform you that we corrected the premium invoice for [redacted].[redacted]'s concerns [redacted] contacted your office about possible HIPAA violation because his premium invoices have been addressed to his daughter and not to him the subscriber. He received several premium invoices showing the incorrect name. He has contacted our office about this situation to o avail.Our finding A review our records determined that we had the correct mailing for [redacted] in our member detail system; however, this information was not in our member database. We sincerely apologize for any inconvenience this situation may have caused. Because of the concerns expressed by [redacted] we notified our Privacy Office to make them aware of your concerns.Based on the information it was determined that yes the incorrect name appears on your premium invoice; however, it was to the correct mailing address. There is no indication that an unauthorized person saw the invoice or any Personal Health Information (PHI) prior to it being delivered.We have updated our records to correctly show your Ed Vesey as the subscriber on the premium invoice. His next premium invoice should reflect the change.[redacted], thank you for bringing this matter to our attention. If you have any additional questions, please contact me at ###-###-####. I will be happy to assist you.Sincerely,Sylvia BSpecialist Executive Inquiries

I am writing in response to the May 2, 2016 letter to Detra D[redacted] on behalf of Ms. [redacted]. Your complaint was received in our office on May 9, 2016 and concerns a flu shot reimbursement for Ms. [redacted].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 Ms. [redacted]'s complaint to your office. It was identified that we previously resolved this matter on March 15, 2016, and currently consider it closed.Ms. [redacted], we appreciate your bringing Ms. [redacted]'s concerns to our attention. If you have any additional questions, please contact me at ###-###-####.Sincerely,Diane H[redacted] Lead Client Services Representative Executive Inquiries Department

Good morning [redacted]:
We want you to know that we have resolved the website access issue for [redacted] and have updated his user name. He is now able to log on to our website.
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

Hi Heather,                 Please see the attached HIPAA Authorization form for [redacted].  I will be handling this inquiry. Thanks,Chris H[redacted]Executive Inquiries Analyst1901 Market Street, Philadelphia, PA 19103

Thank you for speaking with me today. As you requested, this is just a confirmation that we are currently working with the consumer and will issue our response directly to her. Your assigned ID number for this case is [redacted]. The consumer is Jessica Mosby. Please contact me if you have any...

questions.  Scott Y[redacted]SpecialistExecutive Inquiries[redacted]Philadelphia, PA [redacted]

I am writing in response to the February 13, 2017 letter to Detra D[redacted] on behalf of [redacted]. Your complaint was received in our office on February 22, 2017, and concerns [redacted]’s plan change request. 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 February 20, 2017 and currently consider it closed. In the event that you wish to receive details about it, we need the Authorization to Release form completed. I have attached it for your use. [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 [redacted] Sincerely, Rasheeda H[redacted]Lead Client Services Rep.Executive Inquiries1901 Market Street, 13th FloorPhiladelphia, PA 19103

November 3, 2015Dear [redacted]I am Writing in response to your October 2, 2015, correspondence to Detra D[redacted], Supervisor of the Executive Inquiries Department. Your inquiry was written on behalf of [redacted], who contacted your agency regarding the status of his daughter, [redacted]'s Personal Choice Level II member appeal. The purpose of this letter to is to provide you with that information.We are in receipt of the Authorization to Release Information form that accompanied your inquiry. [redacted] completed the document on August 20, 2015, designating the Revdex.com (Revdex.com) as the recipient of her protected health information. We consider the form valid and as such, are able to disclose our findings to you.Our review [redacted]'s appeal was filed by her father, [redacted], who initiated the Level II review seeking additional consideration concerning our denial of benefits on his daughter's August 4, 2014, claim for oral Surgery. The following will Summarize the outcome of [redacted]'s Level II appeal:The reviewing committee overturned our original denial. Our decision was based on provider billing errors that [redacted] reported on earlier claims. During the appeal, it was found that several claims were submitted for the services rendered on August 4, and that Several of the claims contained incorrect billing provider information.On September 9, 2015, following the conclusion of the Level II review, [redacted] was sent a letter formally notifying him of our decision. That letter also explained that one of the claims (number [redacted]) did process for payment in the amount of $455.00, payable to [redacted]. Additionally, because our records showed that the check (number [redacted]) dated February 20, 2015, was cashed on April 3, our letter asked that [redacted] return the $455.00 we paid, at which point we would reprocess [redacted]s claims correctly. I have enclosed a copy of that letter for your review and filesTo date, we have not received the $455.00, we paid. In an effort to move this situation toward its conclusion, we processed [redacted]'s August 4, service under claim number 203261 10377. This claim will remit our payment allowance – in the amount of $1,119.60- to [redacted]. Because [redacted] is a Personal Choice in-network provider, our allowance will be accepted as payment in full with no further billing to the [redacted]. It will also create a $455.00 overpayment on [redacted]’s patient account with [redacted]. The provider should refund the overpayment amount to [redacted], who can then reimburse the Overage amount to our plan. This will reconcile and resolve this matter completely.[redacted], thank you for bringing [redacted]'s concerns to our attention and for allowing us the opportunity to be of assistance. Should [redacted] have any questions about this arrangement, he may contact Ms. Melody W[redacted], the Appeals Committee Facilitator involved with his daughter's appeal. Ms. W[redacted] can be reached by calling ###-###-####, and will be happy to be of assistance.Sincerely,Yvonne P., Specialist Executive Inquiries

[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]

[redacted],
May 12, 2015Dear [redacted]:Our Supervisor of the Executive Inquiries Department, Detra D[redacted], has requested that I respond to your May 5, 2015, correspondence regarding [redacted]. The purpose of this letter is to inform your office that we have responded directly to [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 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.As we have not received an authorization form from your office with [redacted] naming you and your office as an authorized recipient of her PHI and to prevent any unnecessary delays, we have directed our response to [redacted]. In our April 29, 2015, response letter, we addressed [redacted]'s concern completely. I trust that [redacted] will find that our response sufficiently resolved her concerns.[redacted], we appreciate your office bringing [redacted]'s concerns to our attention. I kinldy ask that you share this letter with your colleague. [redacted] as we have received and responded to inquiries regarding [redacted] from [redacted] as well.
Regards,
Rafael *. D[redacted]
Executive Inquiries Department
Independence Blue Cross

I am writing in response to your May 2, 2016, correspondence, as well as to your May 18 email, to Detra D[redacted], Supervisor of the Executive Inquiries Department. Your original inquiry was received on May 10, and was written on behalf of Ms. [redacted], who contacted your office regarding the...

enrollment status of her newborn daughter, as well as a claim processing issue.   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 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. Unfortunately, we do not have a completed Authorization to Release Information form on file designating you/the Revdex.com as recipients of our member’s protected health information. As a result, we are unable to disclose any information regarding our review to you. However, you have our assurance that we have completed our review and that rather than delay our reply, we have responded directly to Ms. [redacted].     Ms. [redacted], we thank you for bringing Ms. [redacted]’s concerns to our attention, and for allowing us the opportunity to be of assistance. Sincerely,

Good Afternoon [redacted],
I am writing to acknowledge our receipt of your recent complaint on behalf of [redacted]. We are currently investigating the concerns expresssed by  [redacted].
Our records indicate that there is no authorization for youroffice to receive [redacted]...

protected health information or PHI. As a result, we cannot disclose any information regarding our member. Please complete the enclosed Authorization form . Once this information is received and processed, we will be able to release his PHI to your office.
Sincerely,
 
Sylvia B[redacted], Specialist
Executive Inquiries

[redacted],
Good morning,
I am writing to acknowledge the complaint, recognized under your identification number of [redacted], 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 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.
 
For your covenience, I have attached a HIPAA Authorization Form for [redacted]'s completion. Your office may returne the comleted form to my attention via fax at ###-###-#### or you may scan and e-mail it to me at [redacted]@ibx.com .
 
In the interim, we have commenced an investigation into the matter presented. Upon receipt of the completed and valid authorization form from [redacted] naming you and your office as an authorized recipient of her PHI, we will provide your office with our response.
 
[redacted], should you have any questions, please contact me directly at ###-###-####.
 
Thank you.
 
Sincerely,
 
Rafael *. D[redacted]
Specialist, Executive Inquiries Department
Independence Blue Cross

[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]

back on 7-22-15 @ 2:59pm I filed a complaint against this company that I would like to re open. the case number is [redacted] unfortunately I have not been able to access my email's so I was unaware that independence had responded to the Revdex.com. I do not agree with the statement that they made nor am I satisfied with the resolution of this case. they took my money and have not done anything in regards to the actual problem at hand. I am asking that the Revdex.com Metro Washington DC & Eastern Pennsylvania please reopen my case to attempt to resolve this problem diplomatically. The complaint remains the same as the case number I wrote above. their staff does not know what they are doing - I had had to increase the amount of funds on my FSA in order to make sure that I can account for all my medical bills all due to misrepresentation by independence blue cross their staff and their mngt staff as well. the additional funds are funds coming out of my paychecks which exceed that of the overall family deductible and even after the 3000.00 family deductible has been paid in full I still owe money? I'm sorry but they are ripping me off and stealing from me.Desired Outcome: Independence blue cross owes me money more than 1000.00 but I am only asking for 1000.00 the 500.00 from last yr and the 500.00 from this yr. Until they provide me with the refund rightfully owed to me I will not be satisfied with anything they have to offer.