[redacted] Revdex.comP.OBox 1000DuPont, WA Re: [redacted] *** ID [redacted] Dear Ms [redacted] , The purpose of this letter is to respond to a complaint submitted by our member, [redacted] *** Mr [redacted] was enrolled in Ambetter from Coordinated Care from January 1st, to July 31st, Customer’s Statement of the Problem: “We have called this people several time every time they toss us to other partner they have and they don’t want to pay the hospital and clinic we went to we keep getting bills and collection tread”Desired Settlement: “Why they don’t pay the hospital and clinic we went to for service? I need to know explanation of benefit and other things”Ambetter from Coordinated Care is dedicated to providing great Customer Service to our members When we do not meet our member’s expectations we take it very seriously With the limited information provided by our member it is difficult to address a specific claim However, we did take this opportunity to review our member’s entire account and any claims that may have led to our member’s dissatisfactionWe located claims that had been suspended due to premium delinquency concerning the member’s insurance premiums Our contract with our members and the Washington State Exchange clearly states that any account days or more delinquent will result in the suspension of claims payment Ultimately, if premium delinquency is not addressed, it can result in the member being directly responsible for all costs incurred for medical services receivedWe located two claims that were suspended due to delinquency: [redacted] and [redacted] Both claims were adjudicated on July 30th, These claims were paid due to recent insurance premiums submitted to Coordinated Care by Mr*** This allowed us to update Mr***’s termination date and remove him from the delinquency grace period Please see claim adjudication overview: · [redacted] – Coordinated Care paid $40.55; Member Deductible $21.36; Member Co-Pay $30.00· [redacted] – Claim adjudicated with total billed applying to member’s deductible: $ Per our conversation with the Washington Health Benefits Exchange (WAHBE), Mr [redacted] has a July 31st, termination date Therefore any claims submitted after this date will be denied due to no coverage We appreciate Mr [redacted] patronage and wish him wellPlease let us know if you have any further questions or concernsRespectfully, Kristin R [redacted] , JDCompliance SpecialistCoordinated Care [redacted] Tacoma, WA
Good Afternoon, Thank you for responding. We are going to reach out to the customer we understand what he is asking for as a desired and will respond to him to settle. I will update the BBB during the process. Thank you, [redacted] ***
Revdex.com:
I have reviewed the
response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** *** Problem is that as of 12/16/No one has responded as per the normMy last conversation was with a *** whom is taking over for ***That was on 11/20/Again I was told it would be taken care of
I apologize for the confusion and frustration you have experienced in attempt to settle this claim. My team has reviewed your files and I am confident we have corrected the issue. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding your claims was sent directly to you at the address we have on file.
We appreciate your patronage and thank you for bringing this situation to our attention.
Respectfully,
Dean R. S[redacted]
Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted]. The company is making things clear now. It is unfortunate that it took this kind of action to get competent people to address my concern.Sincerely, [redacted]
Revdex.com:
While it is unfortunate that I had to resort to the Revdex.com, the Office of the Insurance Commisioner, and file a claim with my bank to receive a satisfactory response from Ambetter, I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me, despite an obvious injustice. If I were to steal money from someone and refuse to give it back without involvement from authorities I'd be sent to jail.
Sincerely,
[redacted]
Dear Valued Member:
I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file.
We appreciate your patronage and thank you for bringing these issues to our attention.
Respectfully,
Dean S[redacted]
Senior Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Again, I sincerely apologize for the frustration and inconvenience you have experienced during our review of this situation. We have resolved the issue and you have received your My Health Pays reward card. The response in the mailed resolution letter you received came from myself, and I am more than happy to speak with you and explain why a refund or credit of premium will not be issued. Please call our customer service at 1-877-687-1197 and ask to speak with myself. If I am unavailable please let the customer service representative know and I will return your call. We are responding in writing with resolution addressing your concerns at the address we have on file
We appreciate your patronage.
Respectfully,
Dean S[redacted]
Senior Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Dear Valued Member:
I apologize for the confusion and frustration you have experienced. An official grievance has been opened on your behalf and my team is currently reviewing your file to uncover the root cause. Rest assured we will continue to work diligently with you to resolve this matter....
However, because Ambetter from Coordinated Care is dedicated to protecting your personal health information I am unable to go into specifics about your case here. We will reach out to you via the contact information we have on file and provide you with an update on our investigation within a week.
We appreciate your patronage and thank you for bringing this situation to our attention.
Respectfully,
Dean R. S[redacted]
Director, Operations
[redacted]
Tacoma, WA 98402
Complaint: [redacted]I am rejecting this response because: I need to know exactly how this will be resolved and see that it is resolved. I've been promised more than once that this will be taken care of and it hasn't been. Sincerely,[redacted]
Complaint: [redacted]I am rejecting this response because: You say this is "resolved" just because after putting a FIRE under you through the Revdex.com you decided that four months was long enough to NOT send me out the rewards card I had earned.
I failed to mention that the card I was supposedly sent in March, 2016 that I never received, could have gained me quite a bit of rewards money. As I have a wellness check up every year, a flu shot, and have belonged to a gym all my adult life. In reality I should have more money coming that I never knew about because I didn't know about the rewards service that Ambetter had.
You explained that you can't waive a months premium. I'm not asking for that. I said in my last message I would settle for a pre-paid visa card. Any business can supply that to their customers.
I would like someone higher up in the company to review my complaint so this can be resolved.
In good faith Ambetter owes me this for making me wait so many months and gave me terrible customer service the entire time.
AGAIN, had I not taken this to the Revdex.com I would still be waiting for my rewards card. In my eyes, this wasn't "resolved", but you were forced to send me out my card.
This will be resolved with you sending me out a pre-paid visa card with the equivalent of at least a months worth of what I have paid in premiums. ($135.00).
Sincerely,[redacted]
I apologize for the delay and inconvenience you have experienced in attempt to settle this matter. My team has reviewed your files and I am confident we have corrected the issue. Ambetter from Coordinated Care is dedicated to protecting your personal health information so...
I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding cancellation of your enrollment was sent directly to you at the address we have on file.
Thank you for bringing this situation to our attention.
Respectfully,
Dean R. S[redacted]
Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Dear Valued Member: I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the email address we have on file. We appreciate your patronage and thank you for bringing these issues to our attention. Respectfully, Dean S[redacted] Senior Director, Operations 1145 Broadway Suite 300 Tacoma, WA 98402
Dear Valued Member:
I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal...
health information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file.
We appreciate your patronage and thank you for bringing these issues to our attention.
Respectfully,
Dean S[redacted]
Director, Operations
[redacted]
Tacoma, WA 98402
Good Afternoon, Thank you for responding. We are going to reach out to the customer we understand what he is asking for as a desired and will respond to him to settle. I will update the Revdex.com during the process. Thank you, [redacted]
Dear Valued Member: I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have addressed the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file. We appreciate your patronage and thank you for bringing these issues to our attention. Respectfully, Dean S[redacted] Senior Director, Operations 1145 Broadway Suite 300 Tacoma, WA 98402
Complaint: [redacted]I am rejecting this response because:Sincerely,[redacted]
I read your letter and see that you are refusing to pay for the physical therapy. I understand that it is not covered but your employee told me it was and I would have never done it had I received correct information. I think the least you could do is acknowledge your part in this and pay half. I also see that payment is still pending on my counseling appointments and have been for over a week. I would feel more comfortable accepting your response once those have gone through.
Thank you, [redacted]
Dear Valued Member:I apologize for the frustration and inconvenience you have experienced in attempt to resolve this issue. My team has reviewed your information and I am confident we have corrected the issue. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, we do show your issue was resolved on 2/4/2016. Please call our customer service at [redacted] if you have any questions.We appreciate your patronage and thank you for bringing these issues to our attention.
Dear Valued Member, We appreciate you taking the time to inform of us your less than satisfactory experience in trying to locate a suitable location to fulfill your eye care needs (lenses and frames). We have identified four Optical Centers immediately available that are located...
in your vicinity. We will be reaching out to you immediately to relay these locations and answer any questions you may have. We sincerely apologize for this inconvenience and look forward to speaking with you. Respectfully,Dean RS[redacted]Director of OperationsAmbetter from Coordinated Care
Dear Valued Member:I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file.We appreciate your patronage and thank you for bringing these issues to our attention.Respectfully,Dean S[redacted]Director, Operations[redacted]
[redacted] Revdex.comP.OBox 1000DuPont, WA Re: [redacted] *** ID [redacted] Dear Ms [redacted] , The purpose of this letter is to respond to a complaint submitted by our member, [redacted] *** Mr [redacted] was enrolled in Ambetter from Coordinated Care from January 1st, to July 31st, Customer’s Statement of the Problem: “We have called this people several time every time they toss us to other partner they have and they don’t want to pay the hospital and clinic we went to we keep getting bills and collection tread”Desired Settlement: “Why they don’t pay the hospital and clinic we went to for service? I need to know explanation of benefit and other things”Ambetter from Coordinated Care is dedicated to providing great Customer Service to our members When we do not meet our member’s expectations we take it very seriously With the limited information provided by our member it is difficult to address a specific claim However, we did take this opportunity to review our member’s entire account and any claims that may have led to our member’s dissatisfactionWe located claims that had been suspended due to premium delinquency concerning the member’s insurance premiums Our contract with our members and the Washington State Exchange clearly states that any account days or more delinquent will result in the suspension of claims payment Ultimately, if premium delinquency is not addressed, it can result in the member being directly responsible for all costs incurred for medical services receivedWe located two claims that were suspended due to delinquency: [redacted] and [redacted] Both claims were adjudicated on July 30th, These claims were paid due to recent insurance premiums submitted to Coordinated Care by Mr*** This allowed us to update Mr***’s termination date and remove him from the delinquency grace period Please see claim adjudication overview: · [redacted] – Coordinated Care paid $40.55; Member Deductible $21.36; Member Co-Pay $30.00· [redacted] – Claim adjudicated with total billed applying to member’s deductible: $ Per our conversation with the Washington Health Benefits Exchange (WAHBE), Mr [redacted] has a July 31st, termination date Therefore any claims submitted after this date will be denied due to no coverage We appreciate Mr [redacted] patronage and wish him wellPlease let us know if you have any further questions or concernsRespectfully, Kristin R [redacted] , JDCompliance SpecialistCoordinated Care [redacted] Tacoma, WA
Good Afternoon, Thank you for responding. We are going to reach out to the customer we understand what he is asking for as a desired and will respond to him to settle. I will update the BBB during the process. Thank you, [redacted] ***
Revdex.com:
I have reviewed the
response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** *** Problem is that as of 12/16/No one has responded as per the normMy last conversation was with a *** whom is taking over for ***That was on 11/20/Again I was told it would be taken care of
Dear Valued Member:
I apologize for the confusion and frustration you have experienced in attempt to settle this claim. My team has reviewed your files and I am confident we have corrected the issue. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding your claims was sent directly to you at the address we have on file.
We appreciate your patronage and thank you for bringing this situation to our attention.
Respectfully,
Dean R. S[redacted]
Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted]. The company is making things clear now. It is unfortunate that it took this kind of action to get competent people to address my concern.Sincerely, [redacted]
Revdex.com:
While it is unfortunate that I had to resort to the Revdex.com, the Office of the Insurance Commisioner, and file a claim with my bank to receive a satisfactory response from Ambetter, I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me, despite an obvious injustice. If I were to steal money from someone and refuse to give it back without involvement from authorities I'd be sent to jail.
Sincerely,
[redacted]
Dear Valued Member:
I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file.
We appreciate your patronage and thank you for bringing these issues to our attention.
Respectfully,
Dean S[redacted]
Senior Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Dear Valued Member:
Again, I sincerely apologize for the frustration and inconvenience you have experienced during our review of this situation. We have resolved the issue and you have received your My Health Pays reward card. The response in the mailed resolution letter you received came from myself, and I am more than happy to speak with you and explain why a refund or credit of premium will not be issued. Please call our customer service at 1-877-687-1197 and ask to speak with myself. If I am unavailable please let the customer service representative know and I will return your call. We are responding in writing with resolution addressing your concerns at the address we have on file
We appreciate your patronage.
Respectfully,
Dean S[redacted]
Senior Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Dear Valued Member:
I apologize for the confusion and frustration you have experienced. An official grievance has been opened on your behalf and my team is currently reviewing your file to uncover the root cause. Rest assured we will continue to work diligently with you to resolve this matter....
However, because Ambetter from Coordinated Care is dedicated to protecting your personal health information I am unable to go into specifics about your case here. We will reach out to you via the contact information we have on file and provide you with an update on our investigation within a week.
We appreciate your patronage and thank you for bringing this situation to our attention.
Respectfully,
Dean R. S[redacted]
Director, Operations
[redacted]
Tacoma, WA 98402
Complaint: [redacted]I am rejecting this response because: I need to know exactly how this will be resolved and see that it is resolved. I've been promised more than once that this will be taken care of and it hasn't been. Sincerely,[redacted]
Complaint: [redacted]I am rejecting this response because: You say this is "resolved" just because after putting a FIRE under you through the Revdex.com you decided that four months was long enough to NOT send me out the rewards card I had earned.
I failed to mention that the card I was supposedly sent in March, 2016 that I never received, could have gained me quite a bit of rewards money. As I have a wellness check up every year, a flu shot, and have belonged to a gym all my adult life. In reality I should have more money coming that I never knew about because I didn't know about the rewards service that Ambetter had.
You explained that you can't waive a months premium. I'm not asking for that. I said in my last message I would settle for a pre-paid visa card. Any business can supply that to their customers.
I would like someone higher up in the company to review my complaint so this can be resolved.
In good faith Ambetter owes me this for making me wait so many months and gave me terrible customer service the entire time.
AGAIN, had I not taken this to the Revdex.com I would still be waiting for my rewards card. In my eyes, this wasn't "resolved", but you were forced to send me out my card.
This will be resolved with you sending me out a pre-paid visa card with the equivalent of at least a months worth of what I have paid in premiums. ($135.00).
Sincerely,[redacted]
Dear Mr. [redacted]:
I apologize for the delay and inconvenience you have experienced in attempt to settle this matter. My team has reviewed your files and I am confident we have corrected the issue. Ambetter from Coordinated Care is dedicated to protecting your personal health information so...
I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding cancellation of your enrollment was sent directly to you at the address we have on file.
Thank you for bringing this situation to our attention.
Respectfully,
Dean R. S[redacted]
Director, Operations
1145 Broadway
Suite 300
Tacoma, WA 98402
Dear Valued Member: I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the email address we have on file. We appreciate your patronage and thank you for bringing these issues to our attention. Respectfully, Dean S[redacted] Senior Director, Operations 1145 Broadway Suite 300 Tacoma, WA 98402
Dear Valued Member:
I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal...
health information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file.
We appreciate your patronage and thank you for bringing these issues to our attention.
Respectfully,
Dean S[redacted]
Director, Operations
[redacted]
Tacoma, WA 98402
Good Afternoon, Thank you for responding. We are going to reach out to the customer we understand what he is asking for as a desired and will respond to him to settle. I will update the Revdex.com during the process. Thank you, [redacted]
Dear Valued Member: I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have addressed the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file. We appreciate your patronage and thank you for bringing these issues to our attention. Respectfully, Dean S[redacted] Senior Director, Operations 1145 Broadway Suite 300 Tacoma, WA 98402
Complaint: [redacted]I am rejecting this response because:Sincerely,[redacted]
I read your letter and see that you are refusing to pay for the physical therapy. I understand that it is not covered but your employee told me it was and I would have never done it had I received correct information. I think the least you could do is acknowledge your part in this and pay half. I also see that payment is still pending on my counseling appointments and have been for over a week. I would feel more comfortable accepting your response once those have gone through.
Thank you, [redacted]
Dear Valued Member:I apologize for the frustration and inconvenience you have experienced in attempt to resolve this issue. My team has reviewed your information and I am confident we have corrected the issue. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, we do show your issue was resolved on 2/4/2016. Please call our customer service at [redacted] if you have any questions.We appreciate your patronage and thank you for bringing these issues to our attention.
Dear Valued Member, We appreciate you taking the time to inform of us your less than satisfactory experience in trying to locate a suitable location to fulfill your eye care needs (lenses and frames). We have identified four Optical Centers immediately available that are located...
in your vicinity. We will be reaching out to you immediately to relay these locations and answer any questions you may have. We sincerely apologize for this inconvenience and look forward to speaking with you. Respectfully,Dean RS[redacted]Director of OperationsAmbetter from Coordinated Care
Dear Valued Member:I apologize for the frustration and inconvenience you have experienced in attempt to resolve these issues. My team has reviewed your information and I am confident we have corrected the issues. Ambetter from Coordinated Care is dedicated to protecting your personal health...
information, so I am unable to go into specifics about the resolution here. However, a comprehensive reply regarding the issues you reported was sent directly to you at the address we have on file.We appreciate your patronage and thank you for bringing these issues to our attention.Respectfully,Dean S[redacted]Director, Operations[redacted]