UPMC Health Plan

Re: Complaint ID [redacted] Dear Ms [redacted] :UPMC Health Plan, Inc("UPMCHP") has received and reviewed your letter dated August 9,2017, regarding Complaint ID [redacted] .As explained inUPMCHP's August 1,response, without a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaintWe have attached a copy of that form for Ms [redacted] to fill out, sign, and submit if she desires.Should you have any questions or require any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Ariell A [redacted] Staff Attorney UPMC Health Plan

Re: Complaint No [redacted] by [redacted] ***Dear Ms [redacted] :UPMC Health Plan, Inc, ("UPMCHP”) has received and reviewed your letter dated November 24, 2015, as well as the accompanying complaint submitted by [redacted] ***.Mr***’ complaint was not accompanied by a HIPAA compliant authorization to disclose PHIAs such, UPMC Health Plan has responded to Mr [redacted] directly regarding his complaint.Thank you tor bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at [redacted] .Sincerely,Laura ***M***, Esquire Associate Counsel

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 [redacted] ***November 20, 2015Revdex.com [redacted] ***Re; Complaint [redacted] Mrs [redacted] ,I got an email about a response from UPMC about my complaint and I responded rejecting their response.A little while later I received a letter from UPMC that is acceptable and I would like to now dose the complaint.Thank you.Sincerely, [redacted] ***

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below The response from UPMCHP (the health plan) does not provide an explanation of where my overpayments are They refuse to provide a record of payments and I have no way to get them to give this to me As long as they are allowed to hold my money hostage and pretend to be confused about which entity of UPMC is holding my money, they will The only way to resolve this complaint is for UPMC to provide me with a list of payments and where the payments I have made have been applied- exactly To which hosptial, which bill, which encounter, etc Otherwise, they can continue to hold my money hostage under the guise that I actually owe it to them I may have outstanding payments- but I'm really not sure I'm not paying bills that do not include histories of past payments, etcbecause they keep holding my overpayments and saying that I owed them- but won't produce records of payments, bills, etc Regards, [redacted]

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. I did not know that my Doctor did not do a prauthorization for this dose, but UPMC approved it anyway. Sorry for the inconveniance to UPMC and BBB Thank You, [redacted] ***

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] I find that their response which was sent to me directly has addressed many of my concerns Regardless of whether I find their responses satisfactory or not, it is appreciatedI am not entirely satisfied that UPMCHP will effect any real change that will avoid for other customers the issues that led to my complaint I will present any further concerns directly to the company as they have asked that I forward marketing material that I found questionable to themThe wording of said marketing material was part of my previous complaintA copy of the marketing piece has been attached and may be forwarded to UPMCHPAfter which, the Revdex.com may close this complaintRegards, [redacted] ***

RE: Complaint ID [redacted] Dear Ms [redacted] :UPMC Health Plart, Inc, ("UPMCHP") has received and reviewed your letter dated October 17, regarding Complaint ID [redacted] .The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health informationWithout a HIPAA-complaint authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaintHowever, UPMCHP will determine whether the affected individual is a UPMCHP member and, if so, will respond directly to the affected individual with a more detailed response,Thank you for bringing this matter to our attention, Should you have any questions or require any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Ariell A [redacted] Staff Attorney UPMC Health Plan

Re: Complaint ID: ***
Dear Ms*** ***:UPMC Health Plan, Inc(“UPMCHP”) has received and reviewed your letter dated May 21, 2015, as well as the accompanying
complaint filed at the above-captioned file numberIn accordance with the directions included in your leuer, this response will not personally identify the member.As we discussed on the telephone, the above-referenced letter did not include a HIPAA Authorization to disclosc protected health informationWithout a HIPAA compliant authorization, UPMCHP is unable to provide a response to the Better Business Buieau to this complaintHowever, per our discussion, UPMCHP will outreach to the complainant directly.Thank you for bringing this matter to our attentionShould you have any further questions or concerns, please do not hesitate to contact me at ###-###-####.Sincerely*** *** Esq, UPMC Health Plan

UPMC is the worst!..Filing a complaint does nothing and is more or less swept under the rug!..I have a heart problem and the last times the doctor said he wanted test done and would call me when I was to go to the hospital but both times no one from his office called me back!! I have had many problems with the Doctor's staff manager but nothing has ever been done to solve the problemIf I should die because of this just WHO is going to be held responsible?? You go to a doctor the help keep you alive NOT to help you die!!

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,
*** ***

Re: Complaint No*** by *** ***Dear Ms***:UPMC Health Plan, Inc(“UPMCHP”) has received and reviewed your letter dated November 11, 2015, as well as the accompanying complaint submitted by *** ***.As we discussed in a telephone call November 16,
2015, Mr***’s complaint was not accompanied by a HIPAA compliant authorization to disclose PHIAs suchUPMC Health Plan has responded to Mr*** directly regarding his complaint.Thank you for bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,*** *** ***, Esquire
Associate Counsel

Re: Complaint No*** by *** ***Dear Ms***:UPMC Health Plan, Inc(“UPMCHP”) has received and reviewed your letter dated November 11, 2015, as well as the accompanying complaint submitted by *** ***.As we discussed in a telephone call November 16, 2015, Mr***’s complaint
was not accompanied by a HIPAA compliant authorization to disclose PHIAs suchUPMC Health Plan has responded to Mr*** directly regarding his complaint.Thank you for bringing this matter to our attentionIf you have any further questions or need any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,*** *** ***, Esquire Associate Counsel

RE: Complaint ID ***Dear Ms*** ***:UPMC Health Plan, Inc(UPMCHP) has received and reviewed your letter dated June 3, 2016, as well as the underlying complaint filed with ID of 11470374The UPMCHP member at issue was a member of a PPO plan with separate in-network and out-of-network
benefit levelsAccording to the complaint, the member received an emergency appendectomy at *** Hospital on October 4, 2015, and UPMCHP paid the claims from that procedure at the lower, out-of-network benefit level.UPMCHP has reviewed the complaint and determined that *** Hospital incorrectly billed the procedure as an ambulatory procedure occurring at an ambulatory surgical centerAs a result, UPMCHP originally processed the claim as non-emergent and paid at the lower benefit levelAfter reviewing the file, UPMCHP has reprocessed the claims as emergency services, and UPMCHP will pay the claims at the higher, in-network benefit level, subject to the applicable in-network copayments and deductiblesThe payment should process within two business days of the date of this letter.UPMCHP apologizes for the inconvenience to this memberShould you have any questions or concerns, please do not hesitate to contact me.Sincerely,Matt S*Staff AttorneyUPMC Health Plan

Re: *** ** ***Complaint ID: ***
Dear Ms*** ***:UPMC Health Plan, Inc(“UPMCHP”) has received and reviewed your letter of February 1,2018, as well as the accompanying complaint filed by *** ** *** at the above-captioned file number.The above-referenced complaint did not
include a HIPAA authorization that would allow UPMCHP to disclose protected health informationWithout a HIPAA-complaint authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaintHowever, UPMCHP will determine whether the affected individual is a UPMCHP member and, if so, will respond directly to the affected individual with a more detailed response.Thank you for bringing this matter to our attentionShould you have any questions or require any additional information, please do not hesitate to contact me at ###-###-####.Sincerely, Lakshmi D*** Staff Attorney UPMC Health Plan

UPMC Health Plan, Inc("UPMCHP”) has received and reviewed your letter dated January 04,2017, as well as the accompanying complaint.The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health informationWithout a HIPAA-complaint
authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaintHowever, UPMCHP will determine whether the affected individual is a UPMCHP member and, if so, will respond directly to the affected individual with a more detailed response.Thank you for bringing this matter to our attentionShould you have any questions or require any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Ariell A***Staff Attorney UPMC Health Plan

Re: *** ***Complaint ID: ***Dear Ms*** ***:UPMC Health Plan, Inc(“UPMCHP'’) has received and reviewed your letter of January 14,2016, as well as the accompanying complaint tiled by *** *** at the
above-captioned file number.Mr*** complains about the denial of reimbursement for medicationMr*** has prescription drug coverage under the UPMCHP *** *** ***UPMCHP established prior authorization requirements and quantity limits on certain medications to comply with Food and Drug Administration guidelines and to encourage appropriate prescribing and use of such medicationsOur records show that Mr*** repeatedly attempted to fill a prescription for *** * ** ** on September 3, through October 19, Coverage was denied because *** requires prior authorizationOn November 2, 2015, UPMCHP received medical records demonstrating that as of October 27, 2015, Mr*** met the prescribing criteria, and the requested medication was approved indefinitelyUPMCHP attempted to contact Mr*** by telephone on November 4, 2015, to inform him that the authorization was approved effective November 2, 2015, but was unable to reach himUPMCHP backdated the authorization to October 27, (the day Mr*** was found to meet criteria for approval).On November 19, 2015, Mr*** contacted UPMCHP requesting reimbursement for out of pocket expenses incurred up to the date of approvalA UPMCHP representative provided him with instructions to file a claim.A claim for reimbursement was received on December 16, 2015, for dates of service commencing on October 5, However, because this date of service was before October 27, 2015, the request was denied.While UPMCHP is sympathetic to Mr***’s complaint, UPMCHP is unable to reimburse him for medication purchased prior to meeting the medical necessity guidelines, which in this case, include the required screening performed on October 27, 2015.Thank you for bringing this matter to our attentionShould you have any further questions or concerns, please do not hesitate to contact me at ###-###-####.Sincerely,Nancy ** F* Esq.UPMC Health Plan

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 I am a member of UPMC, to prove this, I have ID#: ***My name on my insurance card reads as *** * ***I would like this issue resolved as it is hurting my credit score
Regards,
*** ***

Dear Ms*** ***:UPMC Health Plan, Inc, (“UPMCHP”) has received and reviewed your letter of May 19, 2015, as well as the accompanying complaint filed by a UPMCHP member at the above- ’captioned file numberIn accordance with the directions included in your letter, this response will not
personally identify the member.The member's complaint concerns the fact that she was provided inaccurate information regarding whether a particular procedure was covered under her benefit planBetween July and September of 2013, the member contacted UPMCHP on several occasions to inquire as to whether a *** *** reversal was covered under her planInitially, the member received incorrect information from a Member Services representative and was told that the procedure was a covered benefitPrior to the member receiving the procedure, both she and her provider were advised that the procedure was actually excluded from coverage based on her plan benefits. UPMCHP apologizes for any confusion and inconvenience caused by the incorrect information provided and has taken appropriate steps to provide additional training to the Member Services representative involvedHowever, because the requested procedure is not a covered benefit, the member was ultimately provided with correct information about her benefits, and she did not receive the procedure in reliance on the incorrect information, we are unable to cover the service.The member also disputes her cost-sharing for other services received on August 2, and August 22, UPMCHP has reviewed the dates of service in question and has confirmed that the member was billed correctly in accordance with her coverageOn August 2, the member incurred a $copay for visiting a specialist, which is the standard copayment amount under her planShe was also charged $98.45, which applied to her deductible, for services received on August 22, Because the claims for these dates of service were processed correctly and the member received the services in question, we are unable to provide reimbursement for this cost-sharing"Thank you for bringing this matter to our attentionShould you have any further questions or concerns, please do not hesitate to contact me at ###-###-####.Sincerely*** *** Esq

RE: Complaint ID ***Dear Ms*** ***:UPMC Health Plan, Inc("UPMCHP") has received and reviewed your letter dated October 17, 2016, regarding Complaint ID ***.The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to
disclose protected health informationWithout a HJPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint.Please be advised that UPMCHP has diligently and thoroughly investigated the subject matter of this complaint, UPMCHP Member Services will be outreaching directly to the complainant today or tomorrow regarding the issues raised in the complaint.Thank you for bringing this matter to our attention.Sincerely,Matthew S*Staff AttorneyUPMC Health Plan - Legal Services Department

Re: [redacted]Complaint ID: [redacted] Dear Ms [redacted] UPMC Health Plan, Inc(“UPMCHP”) has received and reviewed your letter of January 23, 2014, as well as the accompanying complaint filed by [redacted] at the above-captioned file numberAs I indicated in my February 6, voicemail to you, the January 23, letter did not include a HIPAA Authorization to disclose protected health informationWithout a HIPAA compliant authorization, UPMCHP is unable to provide a response to the Revdex.com to this complaint
I am in receipt of your February 7, voicemail indicating that Mr [redacted] was provided with a HIPAA Authorization, but failed to return it to the Revdex.comAs per your direction, UPMCHP will review the complaint and respond directly to Mr***, as appropriate
Thank you for bringing this matter to our attentionShould you have any further questions or concerns, please do not hesitate to contact me at ###-###-####
Sincerely,
[redacted] Assistant Counsel