UPMC Health Plan

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.
Regards,
[redacted]

RE: Complaint ID [redacted]Dear Ms. [redacted]UPMC Health Plan, inc. ("UPMCHP") has received and reviewed your letter dated April 4, 2017, regarding; Complaint ID [redacted].The above-ieferenc'ed complaint did. not include a HIPA A authorization that would allow UPMCHP to disclose protected health...

information. Without a HIPAA-complaint authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint. However, 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,John S[redacted] Staff Attorney UPMC Health Plan

RE: Complaint ID [redacted]Dear Ms. [redacted]:UPMC Health Plan, Inc. ("UPMCHP") has received and reviewed your letter dated; November 22, 2017 regarding additional concerns in connection with Complaint ID [redacted]. ’As explained in UPMCHP's initial response dated November 3, 2017, without a HIPAA compliant- authorization form UPMCHP is unable provide a response to the Revdex.com regarding this complaint. We have attached a copy of that form for Ms. Battaglia 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 [redacted]Sincerely,Ariell A[redacted]Staff Attorney UPMC Health Plan

UPMC Health Plan, Inc. (“UPMCHP”) has received and reviewed your complaint filed with the Revdex.com on September 23, 2014 (Complaint ID: [redacted]). The Revdex.com indicates that you were provided with a HIPAA compliant authorization to disclose protected health...

information, but that you did not complete and return the authorization to it. As such, the Revdex.com has directed UPMCHP to reach out to you directly regarding your complaint.
Your Revdex.com complaint is in regard to an Explanation of Benefits from UPMCHP and subsequent bill from your provider, Dr. [redacted], in the amount of $406.00. The claim in dispute was initially denied because the primary diagnosis listed by your provider was not a covered diagnosis. UPMCHP has received three additional primary diagnoses for this claim and for which you received treatment, all of which are valid and payable diagnoses. Accordingly, this claim will be reprocessed and paid in accordance with your benefit plan, subject to any applicable copayments or coinsurance.
Our records also indicate that you did not file any complaints or grievances with UPMCHP related to this matter. Your Certificate of Coverage outlines the processes for resolving disputes with UPMCHP. Following these processes may result in a more expeditious resolution of any concerns or issues you may have. A copy of your Certificate of Coverage is available online. If you need additional assistance regarding your Certificate of Coverage, please call the Member Service Department at ###-###-####.
UPMC Health Plan considers your input a valuable source of information, and we believe member communication helps us improve our services. If you have any other questions, please call the Member Service Department at ###-###-####.
Thank you for alerting us to your concern.
Sincerely,
UPMC Health Plan

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.  I've attached the HIPPA authorization.
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 Revdex.com
Thank You,
 
[redacted]

I received a letter in the mail in January from UPMC offering me a $25 gift card for going online and taking the healthcare assessment and choosing a PCP. I did this, but I never received my gift card. I sent a message online to complain, and I received a response saying I never chose my PCP. I responded and said I did and could see the PCP name on my homepage, but I gave it to them again anyways. I asked if I was still receiving the gift card and was told to contact [redacted]. I sent another email complaining about not receiving the gift card I was promised, and this time I was told I was not eligible because I have Medicaire UPMC and the gift card was only eligible for regular plan members. Why did they send me the offer in the first place if I was not eligible? And why did the other rep not tell me this? I feel like they just wanted an excuse to not pay me the gift card. I'm disappointed in the customer service.

RE: Complaint ID [redacted]
Dear Ms. [redacted]:UPMC Health Plan, Inc. ("UPMCHP") has received and reviewed your letter dated October 12,2017 regarding Complaint ID [redacted].The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health...

information. Without a HIPAA-complaint authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint. However, 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 nothesitate to contact me at [redacted]Sincerely,Ariell A[redacted] Staff Attorney UPMC Health Plan

RE: Complaint ID #[redacted] Dear Ms, [redacted]:UPMC Health Plan, Inc, ("UPMCHP") has received and reviewed your letter dated January 4,2018, as well as the accompanying complaint.The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health...

information. Without a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint, However, 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 further questions or require additional information, please do not hesitate to contact me at ###-###-####.Respectfully Submitted,Chad *. G[redacted] UPMC Health Plan

Re: Complaint No. [redacted] by [redacted]Dear Ms. [redacted]:UPMC Health Plan, Inc. (“UPMCHP”) has received and reviewed the letter submitted by David [redacted] on November 20,2015.UPMC Health Plan's response to the Revdex.com was on behalf of its UPMC for Life Medicare Advantage products. As you know, UPMC Health Plan was unable to offer a detailed response to Mr. [redacted]’s complaint in the absence of a HIPAA compliant authorization. As such, a letter was sent to Mr. [redacted] that addressed his concerns. Once received, we believe Mr. [redacted] should be satisfied with the outcome. We are happy to share a copy of the letter sent to Mr. [redacted] with the Revdex.com should Mr. [redacted] sign a HIPAA compliant authorization to do so.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,Laura N.K. Miller Associate Counsel

Re: Complaint No. [redacted] by David [redacted]Dear Ms. [redacted]:UPMC Health Plan, tnc, ("UPMCHP") has received and reviewed your letter dated August 31, 2015, as well as the accompanying complaint submitted by [redacted].Mr. [redacted]'s complaint was not accompanied by a HIPAA compliant authorization to...

disclose PHI. As such, UPMC Health Plan has responded to Mr. [redacted] directly regarding his complaint.Thank you for bringing this matter to our attention. If you have any further questions or need any additional information, please do not hesitate to contact me at ###-###-####.Sincerely,Nancy ** F[redacted], Esquire UPMC- Health Plan — Legal

Dear Ms. [redacted]: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 number. In 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 plan. Between July and September of 2013, the member contacted UPMCHP on several occasions to inquire as to whether a [redacted] reversal was covered under her plan. Initially, the member received incorrect information from a Member Services representative and was told that the procedure was a covered benefit. Prior 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 involved. However, 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, 2013 and August 22, 2013. UPMCHP has reviewed the dates of service in question and has confirmed that the member was billed correctly in accordance with her coverage. On August 2, the member incurred a $40 copay for visiting a specialist, which is the standard copayment amount under her plan. She was also charged $98.45, which applied to her deductible, for services received on August 22, 2013. 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 attention. Should you have any further questions or concerns, please do not hesitate to contact me at ###-###-####.Sincerely. [redacted] Esq.

Re: Complaint ID: [redacted]Dear Ms. [redacted]: UPMC Health Plan, Inc. (“UPMCHP”) has received and reviewed the abovecaptioned complaint...

dated October 13, 2015. Pursuant to the directions included in the letter, this response will not personally identify the member.The complaint sets forth lhat the complainant, received diabetic education services on July 8, 2015, and is upsett that these services were not covered by UPMCHP. In this instance, the services were not covered based on the nature of the claims submitted by the complainant’s provider. However, UPMCHP is working with the provider on getting a proper claim submitted, and will contact the complainant directly regarding the outcome.UPMCHP values the satisfaction of its membership, and we thank you for bringing this matter to our attention. If you have any further questions or need additional information, please contact me at ###-###-####.Sincerely,[redacted] Esq.
UPMC Health Plan

RE: Complaint ID [redacted]Dear Ms. [redacted]:UPMC Health Plan, Inc. ("UPMCHP") has received and reviewed your letter dated October 27,2017 regarding Complaint ID [redacted].The above-referenced complaint did not. include a HIPAA authorization that would allow UPMCHP to disclose protected health...

information. Without a HIPAA-complaint authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint. However, 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 Antonio Staff Attorney UPMC Health Plan

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]

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 1,2017 response, without a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint. We 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 ID [redacted]Dear Ms. [redacted]:UPMC Health Plan, Inc* ("UPMCHP") has received and reviewed your letter dated December 1,2017 regarding Complaint ID [redacted]The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health...

information, Without a HIPAA-complaint authorization, UPMCHP is unable to provide a response to the Revdex.com regarding this complaint, However, 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 AttorneyUPMC Health Plan

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.
Regards,
Megan Walker

Re: Complaint ID: [redacted]Dear Ms. [redacted]: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 number. In 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 information. Without a HIPAA compliant authorization, UPMCHP is unable to provide a response to the Better Business Buieau to this complaint. However, per our discussion, UPMCHP will outreach to the complainant directly.Thank you for bringing this matter to our attention. Should you have any further questions or concerns, please do not hesitate to contact me at ###-###-####.Sincerely[redacted] Esq, UPMC Health Plan

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.
Hello, In accordance with the letter received I am updating you on recent contact with UPMC Health plan.On 12/21, I received a call from their “800” number.I was told that because of a “glitch” in the system and failure to notify me.That I did not have insurance, that it had been cancelled, I would be reinstated.My reference number for this was [redacted]In order for the reinstatement to be completed I would need to make December paymentWhich I did, $275.58, confirmation number for that [redacted]I held on the line while I was reinstated, or thought. Today, 12/28, I went to the pharmacy.No insurance.Please call UPMC, which I did and was told I was never reinstatedAnd it was denied.(the reinstatement)So, now I am out two payments of $275.58 And have yet to be formally notified that I do not have coverage. Is this for real? Sincerely,[redacted]