ComplaintsforIndependence Blue Cross

• 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,
  
  ***************************
  

• Initial Complaint

  07/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I've submitted several claims from my therapist for reimbursement that were entered correctly on my end, but IBX has not processed my claims correctly. My therapist bills me monthly, and on my end I input multiple $200 sessions in the IBX claim portal, each of which qualify for partial reimbursement. These claims processed as if they were each for one session for $400 - $600, meaning that the reimbursement amount is half or 2/3 of what it should be. I have reached out to IBX multiple times (6+) and have altogether spent at least 12 hours trying to deal with this. Each time I get close to getting someone who understands the issue, they either need to contact their manager who will 'call me back' - but this has never actually happened - or they say the issue will be resolved within 2 - 3 weeks and my claims will be updated, but this has not happened either. The last time I spoke with someone, they would not transfer me to a manager and let me know they would only be 'allowed' to call me back if 'call volumes permitted' and I never received a call back. There is no email contact for customer service listed on the IBX site. Each time I try to deal with this issue via phone I have to re-explain the issue and start back at square one. It seems the only way I might be able to resolve this is if I took a day off work to sit on hold with IBX. My therapist has billed me the exact same way for nearly 2 years and my prior insurance never had this issue with her invoices. I think at this point IBX is purposefully making this issue very difficult to resolve so they don't have to pay my benefit. This is truly the worst customer service I have ever had from an insurance provider, and it is shameful. I see my therapist for generalized anxiety disorder, and this issue is genuinely making my anxiety worse. All I want is to receive the benefit I have paid for.

  Business response

  07/11/2023

  Good afternoon **************,

  Our review is underway, thank you.

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

  Thank you for bringing this matter to our attention.

• Initial Complaint

  07/06/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  They continue to contact me with letters regarding a procedure that I don't know about, about an overpayment that I am not aware of. I've spoken to them and they still continue. I do not want to contact them again about this and do not want to continue receiving the letters.

  Business response

  07/11/2023

  Good Afternoon,

  i will be looking into this case and report my findings.

  Thank you,

  ***********;

  Business response

  07/24/2023

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

  I apologize for the delay in acknowledging receipt of July 11,2023 correspondence you addressed to ****************************************** of the Executive Inquiries Department. the complaint was received in our office on July 11, 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 to provide your office with a resolution, **************** may complete the attached HIPAA authorization form. Once we receive the completed form, and it is deemed valid, we will be able to provide you with the outcome of our investigation.

  Sincererly,

  *********************************

  Executive Inquiries Specialist

• Initial Complaint

  06/21/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I was able to receive my ******* in April and May. I was finally getting used to the medicine and seeing some results. I went to pick up my prescription for June and it was denied. I am now left with no medication and going through a withdrawal situation. You could at least give me a month or two to get situated with another medication. *****

  Business response

  06/22/2023

  Dear **************:

  I am writing to acknowledge the June 22.2023 correspondence you addressed to ******************************************, Manager of the Executive Inquiry Department.  The complaint was received in our office today June 22, 2023. 

  As you know, the Federal Health Insurance Portability and Accountability Act, known as HPPA, requires that we obtain an individual's written approval before disclosing his/her protected health information.  In order for us to provider your office with a resolution, ************** must complete the attached HIPAA authorization form.

  Thank you for bringing this matter to our attention.

  Sincerely,

  ***********************

  Executive Inquiry Specialist

  Independence 

  ************

  Business response

  06/28/2023

  I spoke with ************** and advised that Independence Blue Cross (IBC) is not her pharmacy benefit manger (PBM). 
  
  The members employer, ****************** of ************ (****), chose to have their pharmacy benefit administered by *** ********, and that is who she needs to contact regarding any prescription issues.
  
  ****************** (****) chose only to have their medical benefits administered by Independence Blue Cross (IBC).
  
  The member stated she will withdraw her complaint against IBC and refile with your agency, a complaint against *** ********.
  
  Best Regards,
  
  ******

• Initial Complaint

  06/15/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Dear BBB,I was taken in an ambulance to ********* Hospital on December 4, 2021 by **************** Rescue Squad in ************, PA for a mental health emergency. The ambulance company sent the bill of $1,949 for the ambulance ride to Independence Administrators (under Independence Blue Cross, which was my insurance company at the time) and it was denied by the insurance company on June 22, 2022 (over sixth months after the service took place). The ambulance company then sent the bill to me, which I paid out of pocket to avoid going to collections. I then contacted Independence Administrators and asked why this was not covered by my insurance plan. I spoke to a woman by the name of ************************************** (at Independence Administrators) and she said this was a mistake and she would be sending out the reimbursement check in the mail with the next 5-10 business days. It is now June 15, 2023, and I have not received anything from Independence Blue Cross and now they are telling me that it is too late to reimburse me. As a resident of the *********************, I fall under the The No Surprises Act (www.insurance.**.gov/nosurprises).The No Surprises Act states the following: If a health plan covers any benefits for emergency services, including air ambulance, the No Surprises Act requires emergency services to be covered:? Without any prior authorization.? Regardless of whether a provider or facility is in-network. As clearly stated above, Independence Blue Cross has violated the No Surprises Act as a ************ resident as well as failing to reimburse me $1,949, claiming that too much time has passed, even though they waited over six months to deny the ambulance bill, which should have never happened. For additional information, my membership number with Independence Blue Cross was #********** and the claim number for this issue is #*************.Please help to resolve this issue of non-payment at your earliest convenience. Thanks,*****************************

  Business response

  06/22/2023

  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 the complainant to complete and return in order for us to release their PHI to the BBB. If a completed form is not received, we will respond directly to the complainant.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩