Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reviewed the member’s Evidence of Coverage (EOC) and Summary of Benefits Coverage (SBC) to verify the benefitsWe confirmed that the EOC states that a deductible and coinsurance apply to tier two providers for any Preventive Care / Screening/Immunization services renderedThe SBC provided online is a short summary of the benefits that is not able to distinguish tiersThere is a disclaimer at the top of the SBC that states: “This is only a summaryIf you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://altius.coventryhealthcare.com/ or by calling ###-###-####.” We assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under your health planWe have attached the EOC for the member to review We had our Claims department review the claims and were advised they are processed correctly under the member’s tier benefits, so we will not be able to have the claim adjustedWe also reviewed the son’s claim and the services were denied correctly as not covered under benefit planThe member is of the age of and the plan does not cover routine eye exams for adults; the member only has coverage for pediatric vision less than years of ageI understand your concerns and recognize this is not the outcome you desiredOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @aetna.com Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
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 Sincerely, [redacted] ***
Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon receipt of the complaint we immediately reviewed the member’s Evidence of Coverage (EOC) and Summary of Benefits Coverage (SBC) to verify the benefitsWe confirmed that the EOC states that a deductible and coinsurance apply to tier two providers for any Preventive Care / Screening/Immunization services renderedThe SBC provided online is a short summary of the benefits that is not able to distinguish tiersThere is a disclaimer at the top of the SBC that states: “This is only a summaryIf you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://altius.coventryhealthcare.com/ or by calling ###-###-####.” We assure you that it is not our intent to mislead or misrepresent any benefit that may or may not be available under your health planWe have attached the EOC for the member to review We had our Claims department review the claims and were advised they are processed correctly under the member’s tier benefits, so we will not be able to have the claim adjustedWe also reviewed the son’s claim and the services were denied correctly as not covered under benefit planThe member is of the age of and the plan does not cover routine eye exams for adults; the member only has coverage for pediatric vision less than years of ageI understand your concerns and recognize this is not the outcome you desiredOur actions are solely guided by the plan guidelines in order to administer fairly and equitably to all participants We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @aetna.com Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team
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 Sincerely, [redacted] ***