Complaints

• Initial Complaint

  10/24/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 10/10/2023, I called Blue Cross Blue Shields 1-800-ask-blue to request a lose of insurance coverage letter listing my (2) children names in order to add them to my insurance, since my husband is no longer with the employer. Blue Cross Blue shields explained it will take 3-5 business days to have this letter sent via email and mail. I called on 10/18/2023 because i didnt received any letter yet, they told me it will be in by Friday 10/20/23. I never received anything at this point and I need this letter by 10/30/2023 in order to add my kids to my insurance. I m calling Blue Cross and Blue shields 10/24/2023-today to follow up on this letter and they advised that the letter was sent on 10/10/2023(same day of my request). I never received anything so at this point they told me they need to make a new request. I just find this issue unacceptable and very unprofessional. My kids will be without insurance if i dont submit this letter by 10/30/2023. Please i need some assistance and have someone reliable to assist me with a simple letter that states my kids are no longer under my husband insurance.

  Business response

  11/13/2023

  I have reviewed the complaint and will respond in a timely matter. Thank you for bringing this mater to our attention. 

• Initial Complaint

  10/18/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I filed an appeal regarding a $500 medical bill for two routine medical tests performed simultaneously. I received a response to my appeal stating that this letter would only address one of the claims and the other would be addressed as a separate appeal. After not hearing anything for a few weeks, I called to see when I could expect the second letter. No one knew what I was talking about. I spoke to countless agents who promised to look into it and call me back, but never did. I called several times and was never able to connect to someone in the appeals department who could actually see the letter to know what I was talking about. After almost two months, being redirected countless times, and repeatedly asking to speak to a manager and never being able to connect with one, I was told a new letter would be sent on September 26 and I would receive it in 7-10 business days. I did not receive anything. I called back and spoke to an agent who told me that he could see the request for the letter to be sent, but the department that handles mail never actually sent it. The agent then said he spoke to a manager who would be emailing the letter to me and I would absolutely for sure be receiving it that day. I never received any email. Finally, after another hour long phone call because no manager was available, I was able to connect to a supervisor who said he would call me back in one hour after researching. I have not heard from him. I have a legal right to an appeal and thus have a right to get a response. The fact that half of the people I spoke to couldn't even see the second appeal and the other half won't speak to me directly, can't read this alleged letter to me, nor call me back leads me to believe I am being intentionally deceived. How hard is it to provide me with information you said you would send two months ago?? It shouldn't take months of waiting, hours of phone calls, dodging managerial assistance, and lies about returning my call.

  Business response

  10/26/2023

  Hello **************,

  Attached is our acknowledgement letter and HIPAA consent form that needs to be completed by the complainant.

  Once we receive a valid HIPAA consent form, we will release our findings to your office.

  Thanks so much!

  TF

• Initial Complaint

  09/22/2023

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  I am a disabled veteran and live alone with my GSD service dog. My doctor wrote me a prescription for ***** for sleep. Due to severe pain i have not slept in 3 nights. *** pharmacy located on ************* in Philadelphia would not fill the prescription thru my ******** blue cross insurance or let me pay cash. *** and ******** blue cross insurance refused to prescribe my needed medication. My doctor faxed the required prior authorization form 3 days prior. I have not taken this medication in 2 years. 6 days later ******** blue cross blocked *** pharmacy from filling my medication after several calls from myself and my physician. ******** blue cross could care less about disabled veterans and senior citizens. As of today s date i still have not been prescribed my needed medication and have not slept..

  Business response

  10/04/2023

  Due to HIPAA privacy laws, we are unable to release the complainant's protected health information (PHI) without a completed HIPAA authorization form. A blank form is attached. If a completed form is not received, we will reply directly to the complainant.

• Initial Complaint

  09/21/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My husband receives infusions for Crohn's disease. His gastro doctor orders lab work to be performed for drug monitoring with each infusion every 3 months to ensure that my husband is receiving the proper dosage to best manage his condition. Since my husband returned to in person infusions in 2021, our insurance company has been randomly denying this lab work citing it as experimental/not medically necessary. We have had to appeal each lab work claim every 3 months since 2021 because they are not approving it. As of 2023, they are now picking and choosing which instance of this lab work they approve or deny with no rhyme or reason. I have escalated 2 service dates as high as I can and even contacted Pennsylvania Insurance Department for help. I was contacted by an agent named *********************** on behalf of Independence who first assured me that something would be added to the account to ensure this lab work would be blanket approved going forward and then told me on 8/14 that they would not be approving it going forward or approving previous dates I had appealed. Since 8/14 I have contacted her 6 times asking for the names and medical credentials of every person who has accessed our appeal which they are required by law to provide. She has been unresponsive. We also received and sent them a letter from my husband's doctor citing the necessary medical need for this lab work along with references showing it's necessity. I am not being unreasonable. I want Independence to approve any previous service dates for this lab work and continue to approve them without an appeal process going forward. I also want to work with another agent who will actually be responsive.

  Business response

  10/12/2023

  Dear **************:
  
  I am writing to acknowledge receipt of the October 4, 2023 correspondence you addressed to ******************************************, Manager of the Executive Inquiries Department. The complaint was received in our office on October 4, 2023.
  
  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, ******************** may complete the attached HIPAA Authorization form.
  **************, thank you for bringing this matter to our attention.
  
  Sincerely,
  
  *************************
  Executive Inquiries Specialist
  1900 Market Street, 6th floor
  Philadelphia, PA 19103
  P  ************  x*****

• Initial Complaint

  08/07/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I applied to be paneled for Independance Blue Cross on June 15, 2023. I got an automatic reply acknowledging my application on that same day. About a month later, I found out through **** ******* a large national wide provider that my paneling was denied because I have the wrong type of insurance. They explained that I would need to cancel my application as an individual provider and get a new insurance policy showing that I am covered as an individual provider. I reached out to my insurance company ******** ************ ******* which assures me that I am personally covered as well as my LLC. They also provided me with several documents to provide to IBX. I then sent those to **** *******. I got an email from them stating these documents will not suffice. I also emailed IBX to Credinquiries@ibx.com on 7/24 asking for further explanation so that I can move forward. As of today, I have not gotten an email back. I also called several times but was told me that IBX credentialing does not have a customer service line for the credentialing department. It is uncontianable to me that such a large company does not have a way that a provider can speak to a live person or receive an email response explaining the problem for paneling. Finally, I am both insured by IBX and am trying to become a provider. It's unconscionable for me that such a large insurance company can chose not have a customer service line to their credentialing department. We have a mental health crisis in this country, and I am having to fight IBX to get panelled to provide a service that their customers need. In addition, I am a bilingual therapist English/Spanish so there is a large need for my services. I have several clients waiting to for my approval to see me. ******************* NPI **********

  Business response

  08/31/2023

  I am writing to acknowledge receipt of August 16, 2023, correspondence addressed to ******************************************, Manager of the Executive Inquires Department. The complaint was received in our office on August 16, 2023.
  
  As you know, the Federal Health Insurance Portability and Accountability Act, known as HIPPA,  requires that we obtain an individuals written approval before disclosing his/her protected health information (PHI).
  
  For us to provide your office with a resolution, ************ needs to complete the attached HIPAA Authorization form.
  
  **************, thank you for bringing this matter to our attention.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  08/03/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  ON JUNE 15, 2023, I SENT PAPERWORK IN TO INDEPENDENCE BC ABOUT TRAVEL REIMBUSEMENT. ON JUNE 20, 2023, I RECIVED CONFIRMATION THAT THE PAPERWORK WAS DELIVERED. I'VE CALLED INDEPENDENCE TIME AFTER TIME ABOUT THE STATUS OF THE CLAIM AND STILL ALMOST 2 MONTHS IN AND NO ONE IS GIGIVING ME CONFIRMATION OF THE STATUS. EVERY PERSON THAT IVE TALKED TO ON THE PHONE AND THROUGH THE MOBILE APP DOESNT KNOW ANYTHING ABOUT THE PAPERWORK OR WHERE IT IS. HOW AM I GOING TO GET REIMBUSEMENT ON MY TRAVEL IF I CAN'T GET ANYONE TO ACKNOWLEDGE THAT THE PAPERWORK WAS RECIVED AND HOWS THE PROCESS GOING.I WANT MY MONEY ON MY TRAVEL EXPENSE. YOU CAN'T EVER GET SOMEONE ON THE PHONE TO DO ANYTHING YOU NEED HELP ON ITS IMPOSSIBLE. I CALLED TO MAKE A GRIEVANCE COMPLAINT AND THIS IS THE NUMBER THAT I WAS GIVEN *********** AND THATS THE LINE TO *******.

  Business response

  08/09/2023

  I am writing to acknowledge receipt of August 4, 2023, correspondence addressed to ******************************************, Manager of the Executive Inquires Department. The complaint was received in our office on August 4, 2023.
  
  As you know, the Federal Health Insurance Portability and Accountability Act, known as HIPPA,  requires that we obtain an individuals written approval before disclosing his/her protected health information (PHI).
  
  For us to provide your office with a resolution, ****************** needs to complete the attached HIPAA Authorization form.
  
   
  **************, thank you for bringing this matter to our attention.
   
  Sincerely,
  
  ***********************
  Specialist
  Executive Inquiries
  Independence Blue Cross

• Initial Complaint

  08/03/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Although I am capitated to ******** Hospital for MRI imaging, they refuse to allow me to do MRI's there. I have been waiting since Jan 2023 for an MRI and just found out that the MRI I had scheduled for months was just cancelled. I am so angry that I have insurance that I cannot use and I have a serious medical issue that has gone untreated since Jan because I am unable to get an MRI although I pay for insurance.

  Business response

  08/29/2023

  I am writing to acknowledge receipt of August 14, 2023, correspondence addressed to ******************************************, Manager of the Executive Inquires Department. The complaint was received in our office on August 14, 2023.
   
  As you know, the Federal Health Insurance Portability and Accountability Act, known as HIPPA,  requires that we obtain an individuals written approval before disclosing his/her protected health information (PHI).
  
  For us to provide your office with a resolution, ************ needs to complete the attached HIPAA Authorization form.
  
  **************, thank you for bringing this matter to our attention. 
  
  Sincerely,
  
  ***********************
  
  Specialist
  
  Executive Inquiries
  
  Independence Blue Cross

• Initial Complaint

  08/01/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Went to couples therapy/counseling with *************************** at *********** Willow Grove from February 2020 to late September of 2020. Out of network provider, so was covered/reimbursed 70% of cost after processed by insurance. Multiple counseling services were approved and we were reimbursed for 70% of the counseling fee ($75) - we were booked up front each time. Claims show as "approved" and "adjusted" for claims in March and April of 2020, but then started coming back as "denied". I have spoken with Blue Cross more times than I can count, and time after time been told the claims would be reprocessed. They never were, so we are out hundreds of dollars due to Blue Cross. Spoke to a representative 3/25/22 inquiry # I-*********. Claims to be reprocessed were 4/16/20, 4/23/20, 4/30/20, 5/14/20, 5/21/20, and 5/28/20. I have not heard back from Blue Cross since then, even though I've called multiple times! Claims need to be processed correctly and we need to receive our 70% reimbursement from Blue Cross.

  Business response

  08/02/2023

  Dear **************,

  Our review is underway, thank you.

  In the interim, please have the complainant complete the attached HIPAA consent form. Once it is returned to our office and approved, we will provide our findings to your office.

  Thank you for bringing this matter to our attention.

  **

• Initial Complaint

  07/29/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  IBX will not reimburse me for a portable oxygen concentrator which I need to function in society. After a three week stay in the hospital last year, my doctor put me on oxygen 24/7. After finishing rehab, I was told to continue the rehab at a gym. I need the oxygen concentrator to go to doctor appointments, I do grocery shopping and to continue rehab at a gym. The end of last year, I called ******** on a different issue and spoke to a well-spoken knowledgeable lady who asked had I put in for reimbursment of the concentrator. I said no. She said if I were you, I would because ******** would pay for it and whatever ******** would pay for Blue Cross should pay. In 1/23, I submitted a claim. It is now 7/29/23 and I have not received a full reimbursement for the claim. The concentrator cost me $3,740.00, which included 2 batteries, a lifetime warranty, and shipping. Since I purchased this out of network, I excepted to reimbursed at 80%. I received a reimbursement of approximately $27. Yesterday I received word that according to their policy, you cannot purchase the equipment, you must rent. Apparently, IBX sees the $27. reimbusement equal to a months rental fee. It is obvious their reimbursement clerks cannot handle a reimbursement different from the typical claims. I have been told they don't cover batteries, which you need to operate a portable concentrator, and that the concentrator was purchased out of network approved vendors. It dawned on me that the clerks were applying reimbursement rules for a stationary in-home concentrator versus a portable concentrator. It seems to me that IBX needs to update their policy to include the portable concentrators. I have been put through hell seeking reimbursement and it is so unnecessary. It has caused additional stress and anxiety, which has not helped my medical condition.

  Business response

  08/02/2023

  Due to HIPAA privacy laws, we are unable to disclose the complainant's protected health information (PHI) without their written consent. Attached is a HIPAA authorization form for completion. If no form is returned, we will reply directly to the complainant.

• Initial Complaint

  07/13/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I received medical care at ********************* ******* Hospital in Somerset, NJ from February 2023 to the present. The hospital required my driver's license as a form of ID and entered me into their system as ***************************. This is my maiden name. My insurance ID, however, has my married name on it: ************************This created a conflict I have spent FIVE MONTHS trying to resolve. At first, I attempted to change my name with the hospital to match the insurance name (from ******** to ******). This was an absolute failure and I got nowhere. After 3 months of trying I gave up.I decided instead to change my name with the insurance company - Independence Blue Cross, aka IBX - from ****** to ********. After more back and forth and conflicting information from ******** ******, it appeared we finally solved the problem by having the Benefits Dept at my husband's place of employment make the change with IBX. I have contacted Included Health and the *** billing department MULTIPLE TIMES to ask for all my claims for all services to be resubmitted. *** continually rejects the claims as "duplicate claims." The rep at ******** Health will not escalate this matter, and continues to kick the can down the road for two weeks here, one week here, a month here... The billing department at *** refuses to let me speak to their internal ins dept. IBX will not speak to me, as their customer, or to ******** ********* , as their outsourced cust svc department.In the meantime, I am receiving statements from the hospital totaling over 90 THOUSAND DOLLARS for services that are covered at 100% by IBX. Despite my desperation to avoid these charges going to collections, I can't speak to a human being at IBX, much less get any action from anyone there. I want IBX to process all claims for all dates of service at the 100% coverage outlined in my ins plan. I want to speak to a human being at IBX.Thank you.

  Business response

  07/17/2023

  Dear **************:
  
  I am writing to acknowledge receipt of the July 14, 2023 correspondence you addressed to ******************************************, Manager of the Executive Inquiries Department. The complaint was received in our office on July 14, 2023.
  
  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, ******************** may complete the attached HIPAA Authorization form.

  **************, thank you for bringing this matter to our attention.
  
  Sincerely,
  
  *************************
  Executive Inquiries Specialist
  ***********************************************************************************
  P  ************  ******

  Customer response

  07/28/2023

  [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 as Answered]
  
   Complaint: ********
  
  I am rejecting this response because: IBX requested a HIPAA form to proceed with my complaint; however, there are no instructions detailing how to get these forms to IBX once filled out. No email address, no online portal, nothing. I have made two phone calls to the IBX rep listed on that request to ask where I should send these forms. He has not returned either call. This is not satisfactory. 
  
  Regards,
  
  ***************************
  

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