Upon receipt of this complaint, the Director of the Appeals and Grievances Department reached out to an Enrollment Resolution Specialist who advised that this member was indeed MEDICAID active with during the Qualified Health Plan (***) date of service 10/*/ Member’s *** enrollment has cancelled and a refund will be issued to the member's VISA in the amount of $ The member’s refund should be issued within 2-business days
Upon receipt of this complaint, the Directory of the Appeals and Grievances Department reached out to an Enrollment Specialist and the Manager of the Claims Department for assistance The Enrollment Specialist advised that the claims were denied because they were processed under the child’s account before the effective date of service The claims were to have been processed under the parent as they were within a few days of the child’s birth this did not occur The Manager of the claims department confirmed that the denied claims were reprocessed on Tuesday, October **, [redacted] , Director, Appeals and Grievances
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: The response just was screenshotsThe response did not state how this issue will be addressedThe screenshot regarding screening mammogram's stated one annually is allowed for women age and over, and also if a 1st degree relative has a history of [redacted] I qualify for both of theseI used a participating provider and my provider recommended I need this procedureI did not have more than mammogram annuallyThe screenshot states it is NOT subject to copayments, deductibles or coinsuranceSo why is Affinity refusing to pay this claim? In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]
Upon receipt of your concern, the Plan’s Enrollment Department was contacted and a representative from that department advised that due to an internal error that occurred with the Plan’s Enrollment vendor, invoices were generated with the incorrect premium amount The representative further confirmed that the error has been corrected and the correct premium amount is $and that you are paid through June **, Leadership from the same department further advised that going forward; the Enrollment team will perform a quality check on invoices before they are sent so that this does not recurThe Plan apologizes for any inconvenience this matter may have caused you Reugenia S [redacted] Director Appeals and Grievances
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 and the matter has been resolved Sincerely, [redacted] I no longer wish to further my complaint
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 and the matter has been resolved 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 and the matter has been resolved Sincerely, [redacted] ***
Tell us why here [redacted] Dear Revdex.com: Thank you for bringing this member concern to our attentionWe welcome the opportunity to respond to the issue raised The Member stated that he enrolled with Affinity Health Plan via the New York State of Health website in order to be active for The member wants to have his coverage reinstated with a write off for the months that he did not have coverage This Member’s coverage was terminated because we did not receive his initial “binder” paymentFailure to make the binder payment will result in coverage terminationWe reviewed this complaint reinstated the Member’s coverage effective back to March Affinity Health Plan wrote off the months that the member could not access careAt the time of enrollment we were experiencing issues with our enrollment files which resulted in some delays in getting ID cards generated and mailedWe ordered a new temporary ID card for this Member and will send a permanent card when he has selected a primary Care Provider from our networkWe discussed this resolution with the member on 7/*/and he is in agreement We take our Member’s concerns seriously and continue to work diligently to permanently resolve these issuesWe thanked him for his patience while we resolved his concernHe has been provided with my direct dial should he have additional concerns Sincerely, [redacted] ***
Upon receipt of this complaint, the Supervisor of Affinity’s Membership Accounting department was contacted regarding the HOH’s concerns and advised the premium for the member’s increased from $to $because of a change in income in the householdThis information was provided to the Plan from an Eligibility File (834) that is sent by the Exchange If the member’s premium rate changes, the member’s enrollment is pended until the payment is receivedAlthough the HOH was not behind with the premium payment and the funds were directly deducted from her account, the correct premium payment needed to be received before March *, to be currentThe premium payment was set to come out on the 10thBased on the Plan’s findings, the HOH stated that she is fine with the Plan not refunding her the premium payments of $that were made on March *, and March **, because the payments will be applied to the upcoming premium payment due The Supervisor contacted the HOH to explain what occurred and she acknowledged that she understood The Supervisor stated that the HOH is still seeking the refund for the $she paid out of pocket for her son’s doctor’s office visitThe Supervisor advised that he would call the doctor’s office and assist the HOH with her request for reimbursementThe Plan apologies to the Head of Household for any inconvenience this matter has caused.Sincerely,Reugenia S [redacted] ,Director of Complaints, Grievances and Appeals
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: Can you tell me the claims you are reprocessing? What is the claim number? What is the amount? You cannot just say you will reprocess the claim without any backups In order for the Revdex.com to appropriately process your response, you MUST answer the question above 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 and the matter has been resolved Sincerely, [redacted]
Revdex.com:At this time, I have not been contacted by Affinity Health Plan regarding complaint ID [redacted] I did however contact them on Thursday March [redacted] to follow up on their promise to have sent out my refund check as they said they would I was promised that the check would be cut on THursday March [redacted] and sent outWhen I called them on Thursday Mach ***, I was told that they could no longer speak to me regarding this matter because they received a complaint from the Revdex.com and that is why the check was not sent out They told me that the Revdex.com complaint was received on Wednesday the ***, so this is yet another fabrication If they received the complaint on the ***, the check would have already been cut and sent out on the ***, which they obviously lied aboutagain.I was told that this has been given to their legal dept and that they will not speak to me regarding this issueSincerely, [redacted]
the following claim numbers were paid the claim # [redacted] - Pays in full # [redacted] - Pays in full # [redacted] - Pays in full # [redacted] - Duplicate to the cl # [redacted] # [redacted] - Duplicate to the cl # [redacted] # [redacted] - Pays in full
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: [Your Answer Herethe business responded on to the Revdex.com that they would initiate a refund within 48-hoursIt is now more than hours and I've not been refunded as of yetOnce I receive the refund into my account I will re-evualate my response and accept to close this out In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted] ***
Upon receipt of this complaint, the Plan’s Enrollment/Billing Department and vendor liaison were notified of the member’s request for her [redacted] form It was discovered that due to an internal processing error, the vendor did not generate a [redacted] form for this member On March ** , 2016, an urgent request was submitted to the vendor who was able to generate the [redacted] form for the member The Director Complaints, Grievances and Appeals obtained a copy of the [redacted] form and emailed a copy via secure email to the member Before emailing the form to MsBell, the Director contacted the member to confirm her email address asked her to confirm when the form was received The Director also apologized for the delay and inconvenience this matter may have caused On March **, the Director called the member to confirm if the [redacted] form had been received As the member was not available, a message was left A copy of the requested [redacted] form has also been attached to this responseSincerely, Reugenia S [redacted] Reugenia S [redacted] Director, Complaints Grievances and AppealsComplaint, Grievance and Appeal Unit
In order for the Plan to thoroughly investigate the allegations, the name of the insured child and member ID number is required Please provide the requested information Reugenia S [redacted] Director Appeals and Grievances
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because:Affinity Health Plan cancelled my insurance through the NY State of Health There is no record of me having gotten my Affinity Plan through the Marketplace (even though it was purchased there) because of the initial cancellation of my plan by AffinityThe NY State of Health requires a new confirmation number to reinstate health plansSince Affinity reinstated me directly and not through the Marketplace, Affinity is responsible for the delivery of my tax forms I have been in contact with the NY State of Health several times and asked them for tax forms They have no record of my insurance through Affinity and therefore have no forms for meUnless Affinity directly contacts the NY State of Health and updates my information on this issue, my tax forms need to come from Affinity In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted] ***
Affinity Health Plan (AHP) is in receipt of a complaint that was submitted on behalf of Donna Deming by the Revdex.com and was received on March **, The member states in her complaint that she and her spouse have been unable to access the dental benefit since enrolling in the Plan effective January *, Upon receipt of this complaint, the Director of the Plan’s Enrollment/Billing Department and vendor liaison were notified of the member’s inability to access their Dental Benefit It was discovered that due to an internal processing error, the information required to add the member to the dental vendor’s eligibility file was not forwarded As a result, the members did not appear as active in the DentaQuest system On March **, 2016, an urgent request was submitted to DentaQuest to add the members to their system On March **, 2016, DentaQuest confirmed that the required information was received and both members reflected as active in their system The Plan extends an apology to the member for the inconvenience that this matter has caused
The Plan's response has not changed. the denied service was approved and reprocessed under claim # [redacted] and the allowed payment will be $122.25 with no member liability.
Upon receipt of this complaint, the Director of the Appeals and Grievances Department reached out to an Enrollment Resolution Specialist who advised that this member was indeed MEDICAID active with during the Qualified Health Plan (***) date of service 10/*/ Member’s *** enrollment has cancelled and a refund will be issued to the member's VISA in the amount of $ The member’s refund should be issued within 2-business days
Upon receipt of this complaint, the Directory of the Appeals and Grievances Department reached out to an Enrollment Specialist and the Manager of the Claims Department for assistance The Enrollment Specialist advised that the claims were denied because they were processed under the child’s account before the effective date of service The claims were to have been processed under the parent as they were within a few days of the child’s birth this did not occur The Manager of the claims department confirmed that the denied claims were reprocessed on Tuesday, October **, [redacted] , Director, Appeals and Grievances
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: The response just was screenshotsThe response did not state how this issue will be addressedThe screenshot regarding screening mammogram's stated one annually is allowed for women age and over, and also if a 1st degree relative has a history of [redacted] I qualify for both of theseI used a participating provider and my provider recommended I need this procedureI did not have more than mammogram annuallyThe screenshot states it is NOT subject to copayments, deductibles or coinsuranceSo why is Affinity refusing to pay this claim? In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]
Upon receipt of your concern, the Plan’s Enrollment Department was contacted and a representative from that department advised that due to an internal error that occurred with the Plan’s Enrollment vendor, invoices were generated with the incorrect premium amount The representative further confirmed that the error has been corrected and the correct premium amount is $and that you are paid through June **, Leadership from the same department further advised that going forward; the Enrollment team will perform a quality check on invoices before they are sent so that this does not recurThe Plan apologizes for any inconvenience this matter may have caused you Reugenia S [redacted] Director Appeals and Grievances
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 and the matter has been resolved Sincerely, [redacted] I no longer wish to further my complaint
The provider will need to submit a claim to the Plan and refund the member less the applicable co-payment the refund will not come from the 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 and the matter has been resolved 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 and the matter has been resolved Sincerely, [redacted] ***
Tell us why here [redacted] Dear Revdex.com: Thank you for bringing this member concern to our attentionWe welcome the opportunity to respond to the issue raised The Member stated that he enrolled with Affinity Health Plan via the New York State of Health website in order to be active for The member wants to have his coverage reinstated with a write off for the months that he did not have coverage This Member’s coverage was terminated because we did not receive his initial “binder” paymentFailure to make the binder payment will result in coverage terminationWe reviewed this complaint reinstated the Member’s coverage effective back to March Affinity Health Plan wrote off the months that the member could not access careAt the time of enrollment we were experiencing issues with our enrollment files which resulted in some delays in getting ID cards generated and mailedWe ordered a new temporary ID card for this Member and will send a permanent card when he has selected a primary Care Provider from our networkWe discussed this resolution with the member on 7/*/and he is in agreement We take our Member’s concerns seriously and continue to work diligently to permanently resolve these issuesWe thanked him for his patience while we resolved his concernHe has been provided with my direct dial should he have additional concerns Sincerely, [redacted] ***
Upon receipt of this complaint, the Supervisor of Affinity’s Membership Accounting department was contacted regarding the HOH’s concerns and advised the premium for the member’s increased from $to $because of a change in income in the householdThis information was provided to the Plan from an Eligibility File (834) that is sent by the Exchange If the member’s premium rate changes, the member’s enrollment is pended until the payment is receivedAlthough the HOH was not behind with the premium payment and the funds were directly deducted from her account, the correct premium payment needed to be received before March *, to be currentThe premium payment was set to come out on the 10thBased on the Plan’s findings, the HOH stated that she is fine with the Plan not refunding her the premium payments of $that were made on March *, and March **, because the payments will be applied to the upcoming premium payment due The Supervisor contacted the HOH to explain what occurred and she acknowledged that she understood The Supervisor stated that the HOH is still seeking the refund for the $she paid out of pocket for her son’s doctor’s office visitThe Supervisor advised that he would call the doctor’s office and assist the HOH with her request for reimbursementThe Plan apologies to the Head of Household for any inconvenience this matter has caused.Sincerely,Reugenia S [redacted] ,Director of Complaints, Grievances and Appeals
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: Can you tell me the claims you are reprocessing? What is the claim number? What is the amount? You cannot just say you will reprocess the claim without any backups In order for the Revdex.com to appropriately process your response, you MUST answer the question above 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 and the matter has been resolved Sincerely, [redacted]
Revdex.com:At this time, I have not been contacted by Affinity Health Plan regarding complaint ID [redacted] I did however contact them on Thursday March [redacted] to follow up on their promise to have sent out my refund check as they said they would I was promised that the check would be cut on THursday March [redacted] and sent outWhen I called them on Thursday Mach ***, I was told that they could no longer speak to me regarding this matter because they received a complaint from the Revdex.com and that is why the check was not sent out They told me that the Revdex.com complaint was received on Wednesday the ***, so this is yet another fabrication If they received the complaint on the ***, the check would have already been cut and sent out on the ***, which they obviously lied aboutagain.I was told that this has been given to their legal dept and that they will not speak to me regarding this issueSincerely, [redacted]
the following claim numbers were paid the claim # [redacted] - Pays in full # [redacted] - Pays in full # [redacted] - Pays in full # [redacted] - Duplicate to the cl # [redacted] # [redacted] - Duplicate to the cl # [redacted] # [redacted] - Pays in full
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: [Your Answer Herethe business responded on to the Revdex.com that they would initiate a refund within 48-hoursIt is now more than hours and I've not been refunded as of yetOnce I receive the refund into my account I will re-evualate my response and accept to close this out In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted] ***
Upon receipt of this complaint, the Plan’s Enrollment/Billing Department and vendor liaison were notified of the member’s request for her [redacted] form It was discovered that due to an internal processing error, the vendor did not generate a [redacted] form for this member On March ** , 2016, an urgent request was submitted to the vendor who was able to generate the [redacted] form for the member The Director Complaints, Grievances and Appeals obtained a copy of the [redacted] form and emailed a copy via secure email to the member Before emailing the form to MsBell, the Director contacted the member to confirm her email address asked her to confirm when the form was received The Director also apologized for the delay and inconvenience this matter may have caused On March **, the Director called the member to confirm if the [redacted] form had been received As the member was not available, a message was left A copy of the requested [redacted] form has also been attached to this responseSincerely, Reugenia S [redacted] Reugenia S [redacted] Director, Complaints Grievances and AppealsComplaint, Grievance and Appeal Unit
In order for the Plan to thoroughly investigate the allegations, the name of the insured child and member ID number is required Please provide the requested information Reugenia S [redacted] Director Appeals and Grievances
Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because:Affinity Health Plan cancelled my insurance through the NY State of Health There is no record of me having gotten my Affinity Plan through the Marketplace (even though it was purchased there) because of the initial cancellation of my plan by AffinityThe NY State of Health requires a new confirmation number to reinstate health plansSince Affinity reinstated me directly and not through the Marketplace, Affinity is responsible for the delivery of my tax forms I have been in contact with the NY State of Health several times and asked them for tax forms They have no record of my insurance through Affinity and therefore have no forms for meUnless Affinity directly contacts the NY State of Health and updates my information on this issue, my tax forms need to come from Affinity In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted] ***
Affinity Health Plan (AHP) is in receipt of a complaint that was submitted on behalf of Donna Deming by the Revdex.com and was received on March **, The member states in her complaint that she and her spouse have been unable to access the dental benefit since enrolling in the Plan effective January *, Upon receipt of this complaint, the Director of the Plan’s Enrollment/Billing Department and vendor liaison were notified of the member’s inability to access their Dental Benefit It was discovered that due to an internal processing error, the information required to add the member to the dental vendor’s eligibility file was not forwarded As a result, the members did not appear as active in the DentaQuest system On March **, 2016, an urgent request was submitted to DentaQuest to add the members to their system On March **, 2016, DentaQuest confirmed that the required information was received and both members reflected as active in their system The Plan extends an apology to the member for the inconvenience that this matter has caused
The Plan's response has not changed. the denied service was approved and reprocessed under claim # [redacted] and the allowed payment will be $122.25 with no member liability.