Tell us why here...
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
Dear Revdex.com:
Thank you for bringing this member concern to our attention. We 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 3/*/2015. He complained that he never received an ID Card and welcome packet, but received a termination of coverage letter on or about 4/**/2015. 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” payment. Failure to make the binder payment will result in coverage termination. We reviewed this complaint reinstated the Member’s coverage effective back to March 2015. Affinity Health Plan wrote off the months that the member could not access care. At the time of enrollment we were experiencing issues with our enrollment files which resulted in some delays in getting ID cards generated and mailed. We 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 network. We discussed this resolution with the member on 7/*/15 and he is in agreement.
We take our Member’s concerns seriously and continue to work diligently to permanently resolve these issues. We thanked him for his patience while we resolved his concern. He has been provided with my direct dial should he have additional concerns.
Sincerely,
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[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]
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 $9.00 to $15.00 because of a change in income in the household. This 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 received. Although 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 *, 2016 to be current. The premium payment was set to come out on the 10th. Based on the Plan’s findings, the HOH stated that she is fine with the Plan not refunding her the premium payments of $30.00 that were made on March *, 2016 and March **, 2016 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 $95.00 she paid out of pocket for her son’s doctor’s office visit. The Supervisor advised that he would call the doctor’s office and assist the HOH with her request for reimbursement. The Plan apologies to the Head of Household for any inconvenience this matter has caused.Sincerely,Reugenia S[redacted],Director of Complaints, Grievances and Appeals
Upon receipt of this complaint, a review of the member's authorization requests were reviewed and revealed that an authorization request for [redacted] was received and was denied on March *, 2016 by one of the Plan's Medical Directors because the services were deemed not medically necessary. The member's appeal request records were reviewed and revealed that to date; the member has not submitted an appeal for the same denial.The Supervisor of Member Services was contacted and asked to review the member's call history for any complaints regarding long wait times and dropped calls. The Supervisor advised that there were a number of inbound calls from the member but there was no documentation regarding long wait times or dropped calls. The member needs to provide specific dates that these incidents occurred so that we can investigate further. The Clinical Pharmacy Manager was contacted and advised that the member's records were reviewed and revealed that most of the member's claims were paid with the exception as one. The claim rejected because the member attempted to refill the medication too soon. In addition, the member's records did not show a request for reimbursement for out of pocket expenses for medications. 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 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 have determined that my complaint has NOT been resolved because:
The...
response just was 2 screenshots. The response did not state how this issue will be addressed. The screenshot regarding screening mammogram's stated one annually is allowed for women age 40 and over, and also if a 1st degree relative has a history of [redacted]. I qualify for both of these. I used a participating provider and my provider recommended I need this procedure. I did not have more than 1 mammogram annually. The screenshot states it is NOT subject to copayments, deductibles or coinsurance. So 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]
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 have determined that my complaint has NOT been resolved because:
[Your Answer Herethe business responded on 10/**/16 to the Revdex.com that they would initiate a refund within 48-72 hours. It is now more than 72 hours and I've not been refunded as of yet. Once 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]
Good Day,[redacted] complaint was reviewed and our records indicated that Tracy P[redacted] submitted a check request for the member to be reimbursed the $299.99, less shipment, of a boot. However, the associate never submitted the request for approval and as a result, the check was not sent ...
On January **, 2017, the member's request for reimbursement was approved and payment in the amount of $299.00 was issued to the member. The Plan apologizes for the inconvenience this matter may have caused. A copy of the check has been attached for your records. Please allow time for mailing.
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 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 $493.14 and that you are paid through June **, 2016. 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 recur. The 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 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 Affinity. The NY State of Health requires a new confirmation number to reinstate health plans. Since 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 me. Unless 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]
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 out. When I called them on Thursday Mach [redacted], 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 [redacted], so this is yet another fabrication. If they received the complaint on the [redacted], the check would have already been cut and sent out on the [redacted], which they obviously lied about... again.I was told that this has been given to their legal dept and that they will not speak to me regarding this issue. Sincerely,[redacted]
[redacted]
[redacted]Dear sir or madam, I am sending this email to inform that I have received a resolution from the business that I filed a complaint against on 10/**/16. I would like to close out/ end my complaint against Affinity Health Plan. Thank you, [redacted]Sent from my iPhone
Tell us why here...
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
Dear Revdex.com:
Thank you for bringing this member concern to our attention. We 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 3/*/2015. He complained that he never received an ID Card and welcome packet, but received a termination of coverage letter on or about 4/**/2015. 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” payment. Failure to make the binder payment will result in coverage termination. We reviewed this complaint reinstated the Member’s coverage effective back to March 2015. Affinity Health Plan wrote off the months that the member could not access care. At the time of enrollment we were experiencing issues with our enrollment files which resulted in some delays in getting ID cards generated and mailed. We 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 network. We discussed this resolution with the member on 7/*/15 and he is in agreement.
We take our Member’s concerns seriously and continue to work diligently to permanently resolve these issues. We thanked him for his patience while we resolved his concern. He has been provided with my direct dial should he have additional concerns.
Sincerely,
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[redacted]
[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]
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 $9.00 to $15.00 because of a change in income in the household. This 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 received. Although 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 *, 2016 to be current. The premium payment was set to come out on the 10th. Based on the Plan’s findings, the HOH stated that she is fine with the Plan not refunding her the premium payments of $30.00 that were made on March *, 2016 and March **, 2016 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 $95.00 she paid out of pocket for her son’s doctor’s office visit. The Supervisor advised that he would call the doctor’s office and assist the HOH with her request for reimbursement. The Plan apologies to the Head of Household for any inconvenience this matter has caused.Sincerely,Reugenia S[redacted],Director of Complaints, Grievances and Appeals
Upon receipt of this complaint, a review of the member's authorization requests were reviewed and revealed that an authorization request for [redacted] was received and was denied on March *, 2016 by one of the Plan's Medical Directors because the services were deemed not medically necessary. The member's appeal request records were reviewed and revealed that to date; the member has not submitted an appeal for the same denial.The Supervisor of Member Services was contacted and asked to review the member's call history for any complaints regarding long wait times and dropped calls. The Supervisor advised that there were a number of inbound calls from the member but there was no documentation regarding long wait times or dropped calls. The member needs to provide specific dates that these incidents occurred so that we can investigate further. The Clinical Pharmacy Manager was contacted and advised that the member's records were reviewed and revealed that most of the member's claims were paid with the exception as one. The claim rejected because the member attempted to refill the medication too soon. In addition, the member's records did not show a request for reimbursement for out of pocket expenses for medications. 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 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 have determined that my complaint has NOT been resolved because:
The...
response just was 2 screenshots. The response did not state how this issue will be addressed. The screenshot regarding screening mammogram's stated one annually is allowed for women age 40 and over, and also if a 1st degree relative has a history of [redacted]. I qualify for both of these. I used a participating provider and my provider recommended I need this procedure. I did not have more than 1 mammogram annually. The screenshot states it is NOT subject to copayments, deductibles or coinsurance. So 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]
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 have determined that my complaint has NOT been resolved because:
[Your Answer Herethe business responded on 10/**/16 to the Revdex.com that they would initiate a refund within 48-72 hours. It is now more than 72 hours and I've not been refunded as of yet. Once 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]
Good Day,[redacted] complaint was reviewed and our records indicated that Tracy P[redacted] submitted a check request for the member to be reimbursed the $299.99, less shipment, of a boot. However, the associate never submitted the request for approval and as a result, the check was not sent ...
On January **, 2017, the member's request for reimbursement was approved and payment in the amount of $299.00 was issued to the member. The Plan apologizes for the inconvenience this matter may have caused. A copy of the check has been attached for your records. Please allow time for mailing.
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 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 $493.14 and that you are paid through June **, 2016. 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 recur. The 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 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 Affinity. The NY State of Health requires a new confirmation number to reinstate health plans. Since 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 me. Unless 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]
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 out. When I called them on Thursday Mach [redacted], 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 [redacted], so this is yet another fabrication. If they received the complaint on the [redacted], the check would have already been cut and sent out on the [redacted], which they obviously lied about... again.I was told that this has been given to their legal dept and that they will not speak to me regarding this issue. Sincerely,[redacted]
[redacted]
[redacted]Dear sir or madam, I am sending this email to inform that I have received a resolution from the business that I filed a complaint against on 10/**/16. I would like to close out/ end my complaint against Affinity Health Plan. Thank you, [redacted]Sent from my iPhone