Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I think MDWise has mixed this complaint up with someone else. "I spoke with Ms*** today, 9/1/15, to explain that her claims have been re-processed and that I would be emailing details about each claim to her today to ***" I am not *** and cannot be reached at that email address. My problem has been partially fixed, thanks to a customer service rep who was still in training who finally was able to fix my problem with receiving coverage. However, I am still in need of reimbursement for services that should have been covered had the insurance been processing correctly. I also continue to receive calls and letters from medical providers seeking payment
Regards,
*** ***
We have updated the accounts of Mrand Mrs*** to reflect Dr*** *** as their PMPWe apologize for the delay in making this changeShould the ***’s have any questions, they may contact me at mg***@mdwise.org or 317-822-
9/6/at 6:PM, had a lengthy conversation with the mbrAttempted to explain to her that the state has made the ruling not to waived or credit the payment of $on her accountThe mbr insisted that this has been going on for over a year and she still wants the $be remove from her
account and this is someone else mistake and she does not wish to hear anything elseI advised the mbr, I will again look into account and will call her back 9/7/at 5:PM, outreached to the member, informed her again of the denied requestAdvised for her to file an appeal with DFR to have her request be heard, the member agreed. The member than again stated that her request is now over a year old and due to someone else mistake the $should be removed from her account per her requestI attempted to explain again that her request is beyond what MDwise is able to do, the member than disconnect the call
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. Although, I am not happy with the result. The result is that I don't have a choice but to pay the remaining account balance. If I don't pay it, I will not be given health insurance. I would think that a company would be willing to erase a small amount in good faith. The amount owed is not really the issue, but the principle that I was never informed or billed for the amount until two months later and that was only because I reenrolled for insurance with company
Regards,
*** ***
Good afternoon, Ms*** is not fully eligible yet. MDwise has already sent a trigger file to the state noting member has made a payment so that her eligibility can be “triggered”. Her issue is on a list which is worked by folks from the state (FSSA).
MDwise sent another trigger last night and Ms*** is still not eligible. There is a chance she will be tomorrow. Again, MDwise does not have any control over how long it takes the state to process. The issue is communication to and from HP. FSSA fixes a member’s record, but it is not communicated to HP.Thank you,Allison
We spoke with Mr*** about his concernsWhile MDwise Marketplace paid the claims for this out of network provider at an in network rate due to their emergent nature, the provider is balance billing Mr *** for hte remainder of the feesWe are working with the provider to ensure that Mr
*** is not balanced billedWe will continue to keep Mr*** informed as we address his concernsShould Mr*** have any questions, he may contact Morgan G*** at mg***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me Assuming that this is really resolved If it is not, then I will continue this complaint
Regards,
*** ***
The member paid on 7/21. MDwise runs invoices for the following month on approximately the 10th of the month. While the member’s effective date is 7/1, it did not take effect until 7/22, which was after billing for August ran. When the September bill ran (8/10), it included
both the member’s September amount due as well as the balance from the August bill. We understand that this absolutely is confusing but it isan unfortunate reality of the retroactivity of the HIP billing process
Mrs***'s claims were, in fact, processed incorrectlyThe CPT codes billed do not require an authorization and as such have been sent for reprocessingOnce theses claims have been reprocessed, Mrs*** will receive an explanation of benefits that will breakdown how these claims were paidWe
apologize for the inconvenienceShould Mrs*** have any further questions or concerns, she may contact Morgan G*** at mg***@mdwise.org or 317-822-
We are in receipt of your letter dated August 14, notifying us of Problem Report #*** from Ms*** ***In her correspondence, Ms*** explained that several claims in May had not been paid. A MDwise Marketplace Bronze Plan was issued to Ms. *** on 1/1/
The MDwise Marketplace Claims Team researched this issue and discovered that the Center for Medicaid and Medicare Services (CMS) erroneously sent a 4/30/term record for Ms***. The next record we received was for an enrollment span of 5/1/to 5/1/15, which essentially cancelled her coverage again. CMS then sent a correct enrollment record. As a result of incorrect records from CMS, Ms***’s claims initially denied. Her claims have been re-processed, and the details are below *** *** *** is a contracted provider and is prohibited from balance billing Ms*** Claim Number Date of Service Provider Billed Amount Allowed Amount Paid Amount Check Number Date Paid Member Responsibility *** *** *** *** (withheld for provider incentive program) *** *** *** *** (withheld for provider incentive program) *** *** *** *** na na for deductible *** *** *** *** (withheld for provider incentive program) *** *** *** *** na na for deductible *** *** *** *** (withheld for provider incentive program) Our Compliance Team spoke with Ms*** on 9/1/to update her on her accountThe NAIC number for MDwise Marketplace is ***. Please let us know if we can be of further assistance Sincerely, Patty H*** MDwise Marketplace General Counsel
We looked into Ms***’s concerns and found that there where claims that were denied as member not enrolledMs*** was enrolled at the date of serviceThe denied claims will be reprocessedWe will continue to update Ms*** on these claims as they are paidShould Ms*** have
any questions, she may contact Morgan *** at 317-822-or m***@mdwise.org
This claim is being reprocessed and paid as emergent. The payment should be made on the next MDwise Connect (Marketplace) check run which is Tuesday 1/24/Member Services outreached Ms*** today and advised of the result
I spoke with Mrs*** and she informed us that she has her medication and claims are being paidI will continue to monitor Mrs***'s account to ensure that claims are processing correctlyShould Mrs*** have any questions or concerns, she may contact me at mg***@mdwise.org or
317-822-
Mrs*** is enrolled in a MDwise Marketplace Silver planWe have updated Mrs***’s patient portal to reflect a paid through date of January 31, Additionally, all claims will be reprocessed to pay, as appropriateWe apologize for the inconvenienceShould Mrs*** have any
questions or concerns, she may contact Morgan G*** at mg***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** ***
Mdwise Marketplacet sincerely apologies for the delay in sending the ***'s ID cardsOfficial ID cards were resent to the ***s on March 15, In the meantime, MDwise mailed temporary ID cards to the ***'s that should arrive in the mail on or before Monday, March 27, Should
the ***'s need to access services prior to that time, they may print their ID cards from the MyMDwise portalAgain, we apologize for any inconvenience this delay has causedShould the ***'s have any questions or concerns, they may contact me at 317-822-or mg***@mdwise.org
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me.
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
I think MDWise has mixed this complaint up with someone else. "I spoke with Ms*** today, 9/1/15, to explain that her claims have been re-processed and that I would be emailing details about each claim to her today to ***" I am not *** and cannot be reached at that email address. My problem has been partially fixed, thanks to a customer service rep who was still in training who finally was able to fix my problem with receiving coverage. However, I am still in need of reimbursement for services that should have been covered had the insurance been processing correctly. I also continue to receive calls and letters from medical providers seeking payment
Regards,
*** ***
We have updated the accounts of Mrand Mrs*** to reflect Dr*** *** as their PMPWe apologize for the delay in making this changeShould the ***’s have any questions, they may contact me at mg***@mdwise.org or 317-822-
9/6/at 6:PM, had a lengthy conversation with the mbrAttempted to explain to her that the state has made the ruling not to waived or credit the payment of $on her accountThe mbr insisted that this has been going on for over a year and she still wants the $be remove from her
account and this is someone else mistake and she does not wish to hear anything elseI advised the mbr, I will again look into account and will call her back 9/7/at 5:PM, outreached to the member, informed her again of the denied requestAdvised for her to file an appeal with DFR to have her request be heard, the member agreed. The member than again stated that her request is now over a year old and due to someone else mistake the $should be removed from her account per her requestI attempted to explain again that her request is beyond what MDwise is able to do, the member than disconnect the call
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. Although, I am not happy with the result. The result is that I don't have a choice but to pay the remaining account balance. If I don't pay it, I will not be given health insurance. I would think that a company would be willing to erase a small amount in good faith. The amount owed is not really the issue, but the principle that I was never informed or billed for the amount until two months later and that was only because I reenrolled for insurance with company
Regards,
*** ***
Good afternoon, Ms*** is not fully eligible yet. MDwise has already sent a trigger file to the state noting member has made a payment so that her eligibility can be “triggered”. Her issue is on a list which is worked by folks from the state (FSSA).
MDwise sent another trigger last night and Ms*** is still not eligible. There is a chance she will be tomorrow. Again, MDwise does not have any control over how long it takes the state to process. The issue is communication to and from HP. FSSA fixes a member’s record, but it is not communicated to HP.Thank you,Allison
We spoke with Mr*** about his concernsWhile MDwise Marketplace paid the claims for this out of network provider at an in network rate due to their emergent nature, the provider is balance billing Mr *** for hte remainder of the feesWe are working with the provider to ensure that Mr
*** is not balanced billedWe will continue to keep Mr*** informed as we address his concernsShould Mr*** have any questions, he may contact Morgan G*** at mg***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me Assuming that this is really resolved If it is not, then I will continue this complaint
Regards,
*** ***
The member paid on 7/21. MDwise runs invoices for the following month on approximately the 10th of the month. While the member’s effective date is 7/1, it did not take effect until 7/22, which was after billing for August ran. When the September bill ran (8/10), it included
both the member’s September amount due as well as the balance from the August bill. We understand that this absolutely is confusing but it isan unfortunate reality of the retroactivity of the HIP billing process
Mrs***'s claims were, in fact, processed incorrectlyThe CPT codes billed do not require an authorization and as such have been sent for reprocessingOnce theses claims have been reprocessed, Mrs*** will receive an explanation of benefits that will breakdown how these claims were paidWe
apologize for the inconvenienceShould Mrs*** have any further questions or concerns, she may contact Morgan G*** at mg***@mdwise.org or 317-822-
We are in receipt of your letter dated August 14, notifying us of Problem Report #*** from Ms*** ***In her correspondence, Ms*** explained that several claims in May had not been paid. A MDwise Marketplace Bronze Plan was issued to Ms. *** on 1/1/
The MDwise Marketplace Claims Team researched this issue and discovered that the Center for Medicaid and Medicare Services (CMS) erroneously sent a 4/30/term record for Ms***. The next record we received was for an enrollment span of 5/1/to 5/1/15, which essentially cancelled her coverage again. CMS then sent a correct enrollment record. As a result of incorrect records from CMS, Ms***’s claims initially denied. Her claims have been re-processed, and the details are below *** *** *** is a contracted provider and is prohibited from balance billing Ms*** Claim Number Date of Service Provider Billed Amount Allowed Amount Paid Amount Check Number Date Paid Member Responsibility *** *** *** *** (withheld for provider incentive program) *** *** *** *** (withheld for provider incentive program) *** *** *** *** na na for deductible *** *** *** *** (withheld for provider incentive program) *** *** *** *** na na for deductible *** *** *** *** (withheld for provider incentive program) Our Compliance Team spoke with Ms*** on 9/1/to update her on her accountThe NAIC number for MDwise Marketplace is ***. Please let us know if we can be of further assistance Sincerely, Patty H*** MDwise Marketplace General Counsel
We looked into Ms***’s concerns and found that there where claims that were denied as member not enrolledMs*** was enrolled at the date of serviceThe denied claims will be reprocessedWe will continue to update Ms*** on these claims as they are paidShould Ms*** have
any questions, she may contact Morgan *** at 317-822-or m***@mdwise.org
This claim is being reprocessed and paid as emergent. The payment should be made on the next MDwise Connect (Marketplace) check run which is Tuesday 1/24/Member Services outreached Ms*** today and advised of the result
I spoke with Mrs*** and she informed us that she has her medication and claims are being paidI will continue to monitor Mrs***'s account to ensure that claims are processing correctlyShould Mrs*** have any questions or concerns, she may contact me at mg***@mdwise.org or
317-822-
Mrs*** is enrolled in a MDwise Marketplace Silver planWe have updated Mrs***’s patient portal to reflect a paid through date of January 31, Additionally, all claims will be reprocessed to pay, as appropriateWe apologize for the inconvenienceShould Mrs*** have any
questions or concerns, she may contact Morgan G*** at mg***@mdwise.org or 317-822-
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** ***
Mdwise Marketplacet sincerely apologies for the delay in sending the ***'s ID cardsOfficial ID cards were resent to the ***s on March 15, In the meantime, MDwise mailed temporary ID cards to the ***'s that should arrive in the mail on or before Monday, March 27, Should
the ***'s need to access services prior to that time, they may print their ID cards from the MyMDwise portalAgain, we apologize for any inconvenience this delay has causedShould the ***'s have any questions or concerns, they may contact me at 317-822-or mg***@mdwise.org