Caremark PHC, LLC

February 5, 2018   Revdex.com of Eastern MA, ME, RI, & VT 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA 01752-4705 Complaint ID: [redacted] / [redacted] M. [redacted]...

                                        ...⇄ To whom it may concern:   CVS Caremark® administers the prescription benefits portion of the [redacted] health plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on January 20, 2018. Thank you for the opportunity to address Ms. [redacted]’s concern as expressed in Complaint ID: [redacted].   Upon review of this inquiry and concern, we verified that Ms. [redacted]’s accumulations were satisfied in October 2017. We re-verified and confirmed that Ms. [redacted]’s deductible was completely satisfied on April 2017; then in October 2017 Ms. [redacted] satisfied her Maximum out of Pocket expense. Ms. [redacted]’s accumulations were checked multiple time to verify they were correct. We could not find any evidence of Ms. [redacted] being overcharged. At this time we conclude Ms. [redacted] is not owed any reimbursement for copayments assessed for her medications. If Ms. [redacted] can provide any documentation which reflects where she was overcharged we would be glad to further review this situation.        We value our members and we are confident that future service will better reflect our commitment to our purpose of, “helping people on their path to better health.” Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at 1-[redacted].   Sincerely,     [redacted] Member Advocate

CVS/caremark administers the proscription benefits portion of the [redacted], of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office February 29, 2016. Thank you for the opportunity to address Ms. [redacted]'s concerns as...

expressed in Complaint ID [redacted]. Upon review of this concern we confirmed there was a systematic issue that created the erroneous charge. As the order was being processed processed, [redacted] ( the assistance program), was only being 20.00 of the 30 bill which triggered the remaining balance to be charged to Ms. [redacted]. Once the matter was corrected, the charges were reversed which gave a credit balance to Ms. [redacted] and remained on file with specialty. A refund check for 10.00 has been requested and will take a approx 7 to 10 business days to generate and mail to Ms. [redacted]. Internally, calls will be reviewed and feed back and coaching will be provided to each member of the customer care team with whom Ms. [redacted] interacted. We sincerely apologize for any frustration or inconvenience that Ms. [redacted] experienced. We value Ms. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, "helping people on their path to better health". Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].

July 22, 2015 Revdex.com[redacted]
[redacted]Complaint ID: [redacted] To whom it may concern: CVS/Caremark administers the prescription benefits portion of the health plan for the [redacted] which Mrs. [redacted] is a...

member. This letter is in response to the correspondence we received from your office on June 8, 2015. Thank you for the opportunity to address Mrs. [redacted]’s concerns as expressed in Complaint ID [redacted]. Upon review of this concern, it was determined that the medication in question required a prior authorization. This information was received, processed and approved as of July 17, 2015 and is good until July 17, 2018. A letter has been sent to Mrs. [redacted] informing her of the approval and time frame. A message has also been left for Mrs. [redacted] to inform her of our findings.  We sincerely apologize for any frustration or inconvenience that Mrs. [redacted] experienced. We value Mrs. [redacted] as a member and we remain fully committed to our purpose of “helping people on their path to better health”. Should you or Mrs. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted]. Sincerely,  [redacted]Member Advocate

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
I have just been on the phone with the billing dept at CVS and was informed that most of the over charge to Humira support has been sent back to the support program however for whatever reason CVS chose to hold 400.00 dollars back why? As for the [redacted] support I was informed CVS has issued a credit through their billing Dept. only, no monies are available for me to use nor have they been returned to [redacted] support. Which they alsio with held some 400.00 in the reversal of these charges. I received exactly 1 phone call from CVS in which they did leave a message, I was compiling all the information needed to return the call. I have been informed that althought they have overcharged the [redacted] support 6,921.37 I still have a balance owing of 5.00$. They had done the same with my Husbands [redacted] supprt program and simply credited my husbands account for over 6000.00 dollars. The billing dept is telling me the over payment from [redacted] is simply in a credit position for CVS.not being sent to [redacted] Support or credited to my account.
Regards,
[redacted]

August 25, 2016               
 
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
[redacted]
 
Complaint ID: [redacted] – [redacted]...

[redacted]
 
To whom it may concern:
 
CVS Caremark administers the prescription benefits portion of the [redacted] insurance plan, of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on August 17, 2016. Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID: [redacted].
 
Upon review of Mr. [redacted]’s concerns, pursuant to the [redacted] prescription benefit, prescription mail order requests cannot be released without payment. When calling CVS Caremark for a refill, payment is required at the time the order is placed.  If there is a previous balance, the members of the customer care team will request all monies owed in order to avoid any potential delays with processing of an order. If the balance, new or aged, on the mail order profile exceeds a specific threshold the order will be held until CVS Caremark receives a secondary approval from the member.
 
In regards to the medication in question, it has been determined CVS Caremark mail order pharmacy had two prescriptions on file. On May 8, 2016 one prescription was transferred to [redacted] on [redacted]. The remaining prescription on file expired April 28, 2015. When an order is placed for an expired prescription; the system will automatically send a fax to the prescribing physician requesting an updated prescription. If there is no response from the doctor a letter is mailed and records show a letter was sent to Mr. [redacted] on August 16, 2016. Unfortunately, the fax was sent to the prescribing physician on record but Mr. [redacted] had changed doctors.
 
Upon receiving the complaint, we assisted Mr. [redacted] in obtaining the medication at the local CVS Pharmacy on August 17, 2016. The mail order pharmacy has a new prescription that will begin processing September 9, 2016. In order to ensure procedures were followed and accurate information was provided, calls will be reviewed and feedback will be given to all members of the Customer Care Team who assisting Mr. [redacted] with his concerns.
 
We sincerely apologize for any frustration or inconvenience that Mr. [redacted] experienced. We value Mr. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, "helping people on their path to better health". Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
 
Sincerely,
 
 
[redacted]
Member Advocate

[A default letter is provided here which indicates your acceptance of the business's response.  If...

you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

June 10, 2016
 
 
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
[redacted]
 
Complaint # [redacted] / [redacted]
 
CVS/caremark administers the prescription benefits portion of the **...

[redacted] health plan, of which Mrs. [redacted] is a member. Thank you for the opportunity to address Mrs. [redacted]'s concerns as expressed in Complaint # [redacted].
 
Upon review of Mrs. [redacted]'s concern with her request for paper claims reimbursement we verified the claims adjudicated when submitted by the retail pharmacy. Mrs. [redacted]'s request for paper claims reimbursement rejected due to the paid claims at the retail pharmacy. In an effort to resolve this issue in Mrs. [redacted]'s favor, we were able to reprocess the request for reimbursement. The request paid successfully on June 7, 2016. Check Number [redacted] generated on June 7, 2016 and will be sent to the address on file: [redacted].
 
We sincerely apologize for any frustration or inconvenience that Mrs. [redacted] experienced. We value Mrs. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Mrs. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
 
Sincerely,
 
 
[redacted]
Member Advocate

September 23, 2016
 
Revdex.com
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
 
Complaint ID: [redacted]
 
To whom it may concern:
 
CVS Caremark administers the prescription benefits portion of the health plan for [redacted] **., of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on September 16, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID: [redacted].
Upon further review of this concern, we verified that there was no CVS Caremark website error. When checking drug cost on the CVS Caremark website the following disclaimer is provided: “Estimated usage, costs and savings are calculated through current plan year or the end of current calendar year. Actual savings may vary depending on plan structure, deductibles, previous payments, future claims and prior authorizations. Actual and projected costs may vary.” The website indicated an estimated $0.00 copayment for the retail fill and when Ms. [redacted] filled her medication at the local retail pharmacy, her cost was $0.00. 
 
The funds used to care for the cost of the medication in question were allocated from Ms. [redacted]’s Medical Reimbursement Account provided by her employer. CVS Caremark’s website can provide benefits information but is limited due to the intricacies of each plan which is why a   disclaimer is provided. Ms. [redacted]’s concern with the CVS Caremark website has been reported to our web team as well as the JP Morgan Chase account team for research and review. An additional request for a $200.00 refund was again denied. Ms. [redacted] may check with her local pharmacy to work with them regarding their return policy.
 
We value Ms. [redacted] as a member and we remain fully committed to our purpose, “helping people on their path to better health”. Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at ###-###-####.
 
Sincerely,
 
 
[redacted]
Member Advocate

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
I want to be reimbursed the money I have paid for this medicine out of pocket.  While I understand they are now saying it is not covered I was told by several employees of Caremark that I would be reimbursed the money I paid out.  Numerous times I was told it would be approved by appeal process and my money would be reimbursed.  So that is what I want to happen.  They should not be allowed to say it will be approved by appeals and promise money only to not deliver.  Now I'm sure they will not have record of this as they have not kept accurate records since April 24th. 
Regards,
[redacted]

Dear Sir or Madam, Please review the attached response for case number [redacted]. Please feel free to contact me directly with any questions or concerns regarding this response. Sincerely,[redacted].Senior Consultant, Medicare Part D Grievances

CVS/caremark administers the prescription benefits portion of the [redacted] insurance plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on February 29, 2016. Thank you for the opportunity to address Ms. [redacted]'s concerns as...

expressed in Complaint ID [redacted]. Upon review of this concern we confirmed there was a systematic issue that created the erroneous charge. As the order was being processed, [redacted] (the assistance program), was only billed 20.00 of the 30.00 bill which triggered the remaining balance to Ms. [redacted]. Once the matter was corrected, the charges were reversed which gave a credit balance to Ms. [redacted] and remained on file with specialty. A refund check for 10.00 has been requested and will take approximately 7 to 10 business days to generate and mail to Ms. [redacted]. Internally, calls will be reviewed and feedback and coaching will be provided to each member of the customer care team with whom ms. [redacted] interacted. We sincerely apologize for any frustration or inconvenience that Ms. [redacted] experienced. We value Ms. [redacted] as a member and we are confident that Future service will consistently reflect our commitment to our purpose, "helping people on their path to better health". Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me [redacted].

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
 
Regards,
[redacted]

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

Thank you for giving us the opportunity to address your concerns regarding the SilverScript Insurance Prescription Drug Plan (PDP). This response is in reference to your correspondence dated March 13, 2015.
On April 5, 2016, I spoke with the member regarding the Revdex.com complaint. The member...

indicated this complaint is not related to SilverScript Insurance. The complaint is against his former prescription drug plan. I advised him to please resubmit his complaint to the correct company for review.
 
Please feel free to contact me with additional questions regarding this response.
Sincerely,
[redacted]
SilverScript Insurance Company
Medicare Part D Regulatory Grievances
Phone [redacted]
Fax ###-###-####

January 28, 2016
Revdex.com
[redacted]
Complaint ID: [redacted]
To whom it may concern:
CVS/caremark administers the prescription benefits portion of the health plan for [redacted], of which Mr. [redacted] is a...

member.  This letter is in response to the correspondence we received from your office on January 25, 2016.  Thank you for the opportunity to address Mr. [redacted]'s concerns as expressed in Complaint ID [redacted]. 
Upon review of Mr. [redacted]’s concern, we found that there are several issues at hand.  First, Mr. [redacted] may want to consider filling his specialty medication through other channels to optimize his plan benefits.  In the future, it would be best to contact [redacted] Specialty Pharmacy for specialty needs at [redacted].  This will allow the prescription benefit and medical benefit to work together to provide the best coverage.  Second, in response to the balance on the account for the order of [redacted], the assistance program is properly set up but continues to get a denial.  Upon contacting the assistance program to determine why the denial occurred, which has been processed several times, there is still not a clear answer.  The assistance program   has advised that the plan was back dated prior to July 24, 2014 when this medication was shipped but is still being rejected for “billed prior to enrollment”. 
For this claim on July 24, 2014, the plan benefit paid $219.76 of the total claim for $846.45.  If the assistance program paid, the maximum that would be paid would be $170.00.  This would still leave a balance for patient responsibility of $456.69 rather than $626.69.  Due to the prolonged period of time that this has been in dispute, the CVS/caremark specialty pharmacy is going to issue a one-time courtesy credit for the full $626.69, which will bring your balance down to $0.00 and stop any attempts for collections.  For any questions pertaining to coverage or plan benefit information, please call [redacted] customer care at [redacted].
We sincerely apologize for any frustration or inconvenience that Mr. [redacted] experienced.   We value Mr. [redacted] as a member and we remain fully committed to our purpose, "helping people on their path to better health".  Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate to contact me at [redacted].
Respectfully,
[redacted]
Member Advocate

November 13, 2015 Revdex.com [redacted]Complaint ID: [redacted] / [redacted]To whom it may concern:This letter is in response to the correspondence we received from your office on November 3, 2015.  CVS/caremark administers the...

prescription drug plan for the [redacted], of which Mr. [redacted] is a member.  Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID: [redacted].Upon review of Mr. [redacted]’s concern we verified that his plan only covers a limited quantity of the medication described but has a process for covering additional quantities under certain circumstances. Mr. [redacted] does not currently meet the criteria for coverage of additional quantities. Mr. [redacted] has been advised of this determination and his appeal rights. To date, Mr. [redacted] has not yet appealed this decision.  Mr. [redacted] is still able to fill his approved quantity that he has been receiving.   Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate to contact me at [redacted].  My office hours are Monday thru Friday from 9:00 a.m. until 5:30 p.m. Central Standard.Sincerely,[redacted]Member Advocate

Medicine is [redacted] 30mg

In order to properly investigate your concerns, we are in need of additional information.    Please provide us with the following information: The medication in question

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

November 30, 2016
Revdex.com
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
Complaint ID: [redacted]
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the health plan for [redacted], of which Ms. [redacted]...

[redacted] is a member. This letter is in response to the correspondence we received from your office on November 17, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID: [redacted].
Upon review of this concern we verified our customer care team placed a refill order for Ms. [redacted] without her consent. Due to this miscommunication with our customer service team, Ms. [redacted] has been credited $72.18 for the medication in question. Ms. [redacted] has also been allowed to keep the medication in question.
Additionally, upon review of Ms. [redacted]’s interactions with our customer care team we recognize that there were several opportunities for additional training and coaching for our staff.. Feedback has been provided to each member of the customer care team with whom Ms. [redacted] interacted.
We value Ms. [redacted] as a member and we remain fully committed to our purpose, “helping people on their path to better health”. Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
Sincerely,
[redacted]
Member Advocate