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 1/27/2017. Please call our customer service at 1-877-687-1197 if you have any questions. We appreciate your patronage and thank you for bringing these issues to our attention. Respectfully, Dean 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], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]
[redacted]Revdex.comP.O. Box 1000DuPont, WA 98327 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, 2015 to July 31st, 2015. 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 dissatisfaction. We 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 30 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 received. We located two claims that were suspended due to delinquency: [redacted] and [redacted]. Both claims were adjudicated on July 30th, 2015. These claims were paid due to recent insurance premiums submitted to Coordinated Care by Mr. [redacted]. This allowed us to update Mr. [redacted]’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: $ 110.06 Per our conversation with the Washington Health Benefits Exchange (WAHBE), Mr. [redacted] has a July 31st, 2015 termination date. Therefore any claims submitted after this date will be denied due to no coverage. We appreciate Mr. [redacted] patronage and wish him well. Please let us know if you have any further questions or concerns. Respectfully, Kristin R[redacted], JDCompliance SpecialistCoordinated Care[redacted] Tacoma, WA 98402
This letter is in response to a complaint you received from [redacted],[redacted], Fort Wayne, IN 46808. Ms. [redacted] requested a refundfor certain months premiums paid during which she claims she was not insured.In the interest of maintaining protection of Ms. [redacted] health...
information,great detail is not being provided in this communication. However, I will confirmthat Ms. [redacted] was advised she would be receiving a refund. The check wasmailed on 3/18/16 and she was told to allow seven to ten days for receipt. Wediscussed this with Ms. [redacted], and she stated that she will cash the checkand consider this matter closed.If you have additional information, please feel free to contact me at the numberbelow.
Sincerely,
Scott L[redacted]Director of Compliance & Counsel
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and will await postal mail they state includes the resolution.Sincerely, [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.
Dear Valued Member:
I appreciate you taking my call last week and allowing me the opportunity to better understand your concerns I sincerely appreciated our candid conversation concerning your experience and thank you for your feedback. You have my direct number and email. Please contact me if you should ever have any additional feedback or comments. Ambetter from Coordinated Care is dedicated to protecting your personal health information, so I am unable to go into specifics concerning our conversation.
Thank you for bringing these issues to our attention, we appreciate your patronage.
Respectfully,
Dean S[redacted]
Senior Director, Operations
[redacted]
Dear Mr. [redacted]: Again, I sincerely apologize for the frustration and inconvenience you have experienced. We have resolved the issue. Coordinated Care is dedicated to protecting your personal health information, so I am unable to go into specifics about the resolution here. We are responding in writing with further 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
Subject: Re: Revdex.com COMPLAINT #[redacted] VS AMBETTER FROM COORDINATED CAREYes, those issues were resolved, eventually, after about one month and multiple calls.I've since switched insurance companies due to their completely inept customer service and incompetent claims processing...
Complaint: [redacted]I am rejecting this response because:until i'm sure that I won't be charged for the month of january or have this go on my credit report then and only then will I be satisfied,i'm not out to bad mouth this company if they resolve this as mentioned, my policy was canceled in december of 2015 and (again) in january of 2016 because no one canceled it when I asked them to cancel in december.Sincerely,[redacted]
Dear Valued Member,I sincerely apologize for the confusion and frustration you have experienced in attempting to settle this claim issue. My team has been reviewing this incident and we are confident we have corrected the issue. We will be reprocessing the claim to adjudicate...
correctly.One of my team members will be contacting you next week after the claim has adjudicated to ensure you are properly informed of the situation and to answer any additional questions you may have.We appreciate your patronage and thank you for bringing this situation to our attention.Respectfully,Dean * S[redacted]Director, Operations[redacted] Tacoma, WA 98402[redacted]@coordinatedcarehealth.com | CoordinatedCareHealth.com
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.
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,
On behalf of Ambetter from Coordinated Care, I sincerely apologize for the obvious frustration you have experienced. The erroneous invoice you received came as a result of the transition of [redacted] taking over premium invoicing from the [redacted]...
[redacted] ([redacted]). There was a long delay in the receipt of your termination record from the [redacted] and once Ambetter from Coordinated Care began the invoicing process our billing system calculated the back dated invoice.
Please discard the invoice. I have confirmed with our Enrollment Department that you enrollment record reflects the correct termination date. In regards to one of our staff members hanging up on you during an inquiry into this issue, I was unable to locate this incident in our call system. I can assure that this type of behavior is not condoned and will not be tolerated. I will speak with the Customer Service agent you spoke with and ensure that he/she clearly understands our policy on providing outstanding Customer Service.
I appreciate you bringing your situation to my attention.
Respectfully,Dean R S[redacted]Director of OperationsAmbetter from Coordinated Care
Complaint: [redacted]I am rejecting this response because: "I am confident the issues have been resolved." We'll that's the 14th time we've heard that. They managed to pay 2 out of the 3 bills they are responsible to pay for. I have emailed them copies of the bills. The medical provider still owed called them directly on July 14th. This shouldn't be difficult. EVERYONE agrees they need to be paid by Ambetter and not by us, including Ambetter. If the Director of Operations (not sure of what operations) can't fix it, communication is broken. And what ever happened with my grievance complaints I filed with Ambetter. They call us valued customers, boy is their value system low. All they value is that you keep sending them money.Sincerely,[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 1/27/2017. Please call our customer service at 1-877-687-1197 if you have any questions. We appreciate your patronage and thank you for bringing these issues to our attention. Respectfully, Dean 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], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]
[redacted]Revdex.comP.O. Box 1000DuPont, WA 98327 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, 2015 to July 31st, 2015. 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 dissatisfaction. We 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 30 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 received. We located two claims that were suspended due to delinquency: [redacted] and [redacted]. Both claims were adjudicated on July 30th, 2015. These claims were paid due to recent insurance premiums submitted to Coordinated Care by Mr. [redacted]. This allowed us to update Mr. [redacted]’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: $ 110.06 Per our conversation with the Washington Health Benefits Exchange (WAHBE), Mr. [redacted] has a July 31st, 2015 termination date. Therefore any claims submitted after this date will be denied due to no coverage. We appreciate Mr. [redacted] patronage and wish him well. Please let us know if you have any further questions or concerns. Respectfully, Kristin R[redacted], JDCompliance SpecialistCoordinated Care[redacted] Tacoma, WA 98402
This letter is in response to a complaint you received from [redacted],[redacted], Fort Wayne, IN 46808. Ms. [redacted] requested a refundfor certain months premiums paid during which she claims she was not insured.In the interest of maintaining protection of Ms. [redacted] health...
information,great detail is not being provided in this communication. However, I will confirmthat Ms. [redacted] was advised she would be receiving a refund. The check wasmailed on 3/18/16 and she was told to allow seven to ten days for receipt. Wediscussed this with Ms. [redacted], and she stated that she will cash the checkand consider this matter closed.If you have additional information, please feel free to contact me at the numberbelow.
Sincerely,
Scott L[redacted]Director of Compliance & Counsel
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and will await postal mail they state includes the resolution.Sincerely, [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.
Dear Valued Member:
I appreciate you taking my call last week and allowing me the opportunity to better understand your concerns I sincerely appreciated our candid conversation concerning your experience and thank you for your feedback. You have my direct number and email. Please contact me if you should ever have any additional feedback or comments. Ambetter from Coordinated Care is dedicated to protecting your personal health information, so I am unable to go into specifics concerning our conversation.
Thank you for bringing these issues to our attention, we appreciate your patronage.
Respectfully,
Dean S[redacted]
Senior Director, Operations
[redacted]
Dear Mr. [redacted]: Again, I sincerely apologize for the frustration and inconvenience you have experienced. We have resolved the issue. Coordinated Care is dedicated to protecting your personal health information, so I am unable to go into specifics about the resolution here. We are responding in writing with further 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
Subject: Re: Revdex.com COMPLAINT #[redacted] VS AMBETTER FROM COORDINATED CAREYes, those issues were resolved, eventually, after about one month and multiple calls.I've since switched insurance companies due to their completely inept customer service and incompetent claims processing...
procedures.[redacted]
Complaint: [redacted]I am rejecting this response because:until i'm sure that I won't be charged for the month of january or have this go on my credit report then and only then will I be satisfied,i'm not out to bad mouth this company if they resolve this as mentioned, my policy was canceled in december of 2015 and (again) in january of 2016 because no one canceled it when I asked them to cancel in december.Sincerely,[redacted]
Dear Valued Member,I sincerely apologize for the confusion and frustration you have experienced in attempting to settle this claim issue. My team has been reviewing this incident and we are confident we have corrected the issue. We will be reprocessing the claim to adjudicate...
correctly.One of my team members will be contacting you next week after the claim has adjudicated to ensure you are properly informed of the situation and to answer any additional questions you may have.We appreciate your patronage and thank you for bringing this situation to our attention.Respectfully,Dean * S[redacted]Director, Operations[redacted] Tacoma, WA 98402[redacted]@coordinatedcarehealth.com | CoordinatedCareHealth.com
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.
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,
On behalf of Ambetter from Coordinated Care, I sincerely apologize for the obvious frustration you have experienced. The erroneous invoice you received came as a result of the transition of [redacted] taking over premium invoicing from the [redacted]...
[redacted] ([redacted]). There was a long delay in the receipt of your termination record from the [redacted] and once Ambetter from Coordinated Care began the invoicing process our billing system calculated the back dated invoice.
Please discard the invoice. I have confirmed with our Enrollment Department that you enrollment record reflects the correct termination date. In regards to one of our staff members hanging up on you during an inquiry into this issue, I was unable to locate this incident in our call system. I can assure that this type of behavior is not condoned and will not be tolerated. I will speak with the Customer Service agent you spoke with and ensure that he/she clearly understands our policy on providing outstanding Customer Service.
I appreciate you bringing your situation to my attention.
Respectfully,Dean R S[redacted]Director of OperationsAmbetter from Coordinated Care
Complaint: [redacted]I am rejecting this response because: "I am confident the issues have been resolved." We'll that's the 14th time we've heard that. They managed to pay 2 out of the 3 bills they are responsible to pay for. I have emailed them copies of the bills. The medical provider still owed called them directly on July 14th. This shouldn't be difficult. EVERYONE agrees they need to be paid by Ambetter and not by us, including Ambetter. If the Director of Operations (not sure of what operations) can't fix it, communication is broken. And what ever happened with my grievance complaints I filed with Ambetter. They call us valued customers, boy is their value system low. All they value is that you keep sending them money.Sincerely,[redacted]