Clark Insurance

Dear
*** ***,
Please
see our response to complaint #***
for *** *** that was received by us on March 07,
During
our review, we reached out to our Billing and Enrollment department who
confirmed that when the member was advised previously by a representative that
the balance on the account was $0.00, this was incorrect information
Additional feedback and training has been provided to the department involved
We spoke with *** *** on March 09,
where *** *** requested the bank account information be taken off her
billing account so that the premiums would not keep drafting automatically
This update was completed per her requestWe also discussed other options for
coverageHowever, the member stated she would not want to renew with Coventry
We advised *** *** if that is what she chooses, she would need to request a
Special Enrollment Period (SEP) directly through another carrier or through the
Marketplace and advise that carrier that the qualifying circumstance for the
SEP request would be loss of eligibility for her previous coverage
I
apologize for any difficulties or confusion this may have caused *** ***We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s concerns.
If there are any additional questions regarding this particular matter, please
contact the Executive Resolution Team at ***@***.com
Regards,
Julian
C***
Executive
Resolution Team

Dear
*** ***,
"Times New Roman"">Please
see our response to complaint #*** for *** *** that was received by us on March 15,
Upon
receipt of *** ***’s complaint, we found that a file had been received from
the Federal Health Insurance Marketplace for the December 31, 2015, termination date. That file was processed on December 10, Unfortunately, the termination date was then improperly removed from our systems.
With the termination date removed, it appeared as if *** *** owed the
premiums for the continued coverage, and additional bills were generated and
sent to her.
We
have reviewed our Billing and Enrollment system and noted that the termination
of her policy has again been processed and made effective December 31,
2015. A letter was sent out stating that
the policy had been cancelled as of that date.
A copy of the letter, which is dated March 10, 2016, is attached.
Now
that the termination date has been reentered, she will not receive additional
billings. She can also disregard the
bill that she received on March 14, 2016.
The extra bills that were sent for the coverage that is no longer
active will not affect her credit rating.
We regret any frustration *** *** experienced in resolving this
issue.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

Dear Ms***,Please see our response to complaint #*** for *** *** that was received by us on March 2, 2016.In reviewing the contacts we have on record in regards to Mr***’s recent injury, it was noted that a request had been made to have a doctor that was not part of the network
for his plan covered as if the doctor was part of the network The request was not approved as there are other doctors that have the same specialty that are part of the network and are within a reasonable distance This does not mean that Mr*** is unable to see the out of network doctor or that the visits would not be covered It only means that the visits would not be covered at the higher in network benefit level Since Mr***’s policy was applied for through the Marketplace, all requests to end the policy or to change insurance carriers need to be made with the Marketplace We have found that an electronic file was received from the Marketplace which shows to end his coverage with Coventry as of March 31, The Marketplace does not provide us with information about insurance policies that are through other carriers so we will not be able to determine if he has other coverage that will become effective April 1, As the files received from the Marketplace show Mr*** as having active coverage with Coventry from January 1, 2016, through March 31, 2016, and all premiums we have collected are for that period of active coverage, a refund will not be issued at this time We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***.Regards, Chris B***Complaints and Appeals ConsultantExecutive Resolution Team

[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 made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meI would like some written confirmation that this has been done for my records
Regards,
*** ***

Dear *** ***: Please see our response to complaint #*** for *** *** that was received by us on October 21, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we
reviewed our claims system and confirmed the details as described by *** ***. The physician that performed the procedure is out-of-network for her plan that was active at the time of the service and the claim was thus handled as out-of-network. As a claim that processed as out-of-network is considered an adverse benefit determination, the next option available for reconsideration of the claim is to file an appeal. We forwarded the information in the complaint to our Coventry Appeals department and they will contact *** *** directly to continue the process. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.comRegards, Chris B*** Complaints and Appeals Consultant Executive Resolution Team

[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:A resolution was achieved Monday the 14thI attempted to find a way to cancel my complaint but could not find oneSorry for the inconvenience
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Dear
*** ***,
"Times New Roman"">Please
see our response to complaint #*** for Daniel
Grecco that was received by us on March 18,
Upon
receipt of the complaint, we reviewed the enrollment files that were sent to us
by the Federal Health Insurance Marketplace for *** ***’s policy. It was found that the final date of
eligibility they provided was March 3, 2016.
This termination date was entered into our system as a pending update,
as we are not able to fully process the termination until all premiums are paid
for any periods of active coverage. As
noted in the complaint, any proration of premiums is done on the back end as
well so this meant the premiums owed through March 31, 2016, needed to be paid
before the termination would process.
We
are showing that a payment was posted to the policy on March 24, 2016, for the
amount owed for the full February and March premiums. The pending termination is now
processing. We expect that process to
complete within 24-hours. The
prorated refund for the portion of the March premium that is no longer owed
will be issued once the termination is finalized. Refunds are issued according to the source
that the payments came from. In this
case, since the most recent payment was made using a debit or credit card, the
refund will be sent back to that same card.
We expect the refund to be made within 7-business days
Finally,
in most cases we are required to follow the effective and termination dates
provided to us by the Marketplace.
However, we have reached out to senior management to determine if an
exception can be granted to allow the February 29, 2016, termination date
requested in the complaint. The
exception is being requested based on the difficulty *** *** experienced
during his attempts to contact the Marketplace to request the termination. We have been in contact with *** *** and
will reach out to him again directly to provide the final decision on whether
or not an exception will be made
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

Hello ***,I went into complaint #*** for *** *** and I was unable to respond to her requestIt is not past the days so not sure if this did not require a response?In any case I would like to let you know the resolution to her last rejection:Hello,Thank you for your inquiry, regarding complaint #*** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.We were able to confirm that this is the correct provider and correct *** that the member is pulling up on the website referenced in the previous resolutionWe apologize for any inconveniences this has caused the member.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com.Thank you,Ashley S.Complaint and Appeal ConsultantExecutive Resolution Team

Dear
*** ***,
Please see our response to complaint
#*** for *** *** that was received by us on January 20,
In reviewing *** ***’s policy, we
found that an issue with our systems had caused the policy to be terminated as
never in force back on December
31, 2015.
While correcting that issue, her spouse was inadvertently left off of
the reactivated policy. He has been
added back to the policy effective January 1, 2016. The process of adding him to the policy and
assigning an ID number was completed on January 22, 2016.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address *** ***’s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at ***@***.com
Regards,
Chris B***
Complaints and Appeals Consultant
Executive Resolution Team

Dear *** ***: Please see our response to complaint # *** for *** *** that was received by us on October 6, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youUpon receipt of the complaint, we reached
out to our Billing and Enrollment department. It was determined that a billing error in caused *** *** to not be billed correctly for the premiums for March, April, May, and June of 2015. The billing errors were noted and corrected in January of and a letter was sent to collect the additional amount owed for those months, but a payment was not received. Because the payment was not received, the policy was terminated retroactively to September 30, 2015. Through our review of the past due letter that was sent and the date the termination of the policy was processed, it was noted that enough time was not given for the letter to be received and for the payment to be made. Due to that issue, we are allowing *** ***’s policy to be reinstated. Our Reconciliation department is currently reviewing all files received from the Federal Health Insurance Marketplace to ensure that the correct benefit plans and premium amounts are listed in our system. Once the review is completed, our Billing and Enrollment department will contact *** *** directly to collect any additional premiums owed and to ensure she is satisfied with the final outcomeWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.comRegards, Chris B*** Complaints and Appeals Consultant Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint # *** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Our records indicate that we were not able to locate a call from *** *** where he requested to cancel his policy since June 25, As previously stated termination requests can be made over the phone by calling our Billing and Enrollment department at ***I have also attached a termination form that can be filled out and emailed back to our executive team directly and we will send it for reviewThe member will not have to wait for the next enrollment period to cancel the planThe plan will terminate if premiums are not paid, but we will not send a member to collections for unpaid premiums
Please keep in mind that if you wish to cancel your policy any dates of services that occurred and were paid after the requested termination date will become the member’s responsibility and could be eligible for overpayments requests
Also as stated in the prior response a one-time exception was made during the previous complaint review to reprocess the claims that we had received for *** *** up to that point and apply the benefits for his plan from That process has been completed and he has been made aware of the new processing of the claimsI apologize for the frustrations and difficulties you encountered while attempting to resolve this issue and regret that this matter required much of your time in order to facilitate a resolutionUnfortunately, we are unable to honor your request for compensation and an exception will not be made to refund or discount the premiums that have been paid for his policy
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Dear
*** ***,
"Times New Roman"">Please
see our response to complaint #*** for *** *** that was received by us on March 11,
In
reviewing *** ***’s complaint, it was noted that Coventry had received
enrollment files from the Federal Health Insurance Marketplace on or around
September 16, 2015, that showed he and his spouse were no longer eligible for
an Advanced Premium Tax Credit (APTC) effective October 1, 2015. This meant the total premium became his
amount to pay for the coverage each month going forward. The total premium for the plan was $525.20,
and that was the amount collected each month
*** *** has stated that his wife was to be removed from the policy and his APTC
reinstated in October 2015. We did receive
files which showed his wife was no longer to be covered on the plan and that
*** *** is eligible for an APTC again effective January 1, 2016, but none have been received for the plan year.
We
will continue to work with *** *** and the Marketplace in attempting to get
the supporting documentation that will allow us to make the changes he is
requesting. Until those updates are
made, we are unable to issue a refund as the premiums collected match what the
Marketplace has advised us is owed for each month of coverage. We apologize for any frustration he has
experienced during this situation.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

[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 made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Dear *** *** ***: Please see our response to complaint #*** for *** *** that was received by us on October 31, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you Upon
receipt of the complaint we immediately reached out to the member to gather additional information to better assist in the requestWe stayed in touch with the member and were able to confirm that she no longer had an active policy with CoventryThis morning November 08, 2016, I email the member directly a letter that stated she no longer had active coverage with Coventry to provide to Medicaid and keep for her recordsShe has my direct contact information if anything further is needed to provide to Medicaid to update her files I apologize for the frustrations and difficulties she encountered while attempting to resolve this issue and regret that this matter required much of her time in order to facilitate a resolutionWe do appreciate her patience during the time involved in researching and resolving the issue We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com Sincerely, Ashley WComplaint and Appeals Consultant Executive Resolution Team

Dear
*** ***,
"Times New Roman"">Please
see our response to complaint #***
for Gloria
Karwoski that was received by us on February 1,
Upon
receipt of the complaint, we reviewed our Billing and Enrollment system. It was found that errors in the enrollment
files sent to us by Marketplace caused it to appear as if she had two active
plans with Coventry which in turn caused us to attempt to collect the premium
for both plans. That issue has been
resolved, and the account has been updated to correct the premium owed for each
month and to give *** *** proper credit for the payments she has
made.
At
this time, the amount *** *** owes for each month of coverage in is
$123.58. She has already paid
$260.16. Rather than issue a refund for
the $that would be viewed as an overpayment in bringing the policy current
through February, a credit will be given to reduce the amount that she is asked
to pay for her March coverage
A
$fee was applied to the billing account due to a stop payment that *** *** had placed with her bank when we tried to collect the increased amount
in February that our system showed as owed.
This fee is in the process of being waived. We expect the process to be completed within
1-business daysOnce the fee is
removed from the account, our system will properly reflect that she owes
$for her March coverage.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: I looked up Heather U*** on the website you provided and the only person I was able to locate was a male is this correct?I will fill out the paper work provided, I just really wish this was given to me back when I requested to have my records pulled back in December because I would have the records since the paper is stating it takes days to process the paperworkNow I will have to cancel my surgery for the 2nd time because I'm waiting on information from your company.Provider Information for *** Search Back to Results NPI View DRHEATHER U*** MD Gender: MALE NPI: *** Last Updated: 2007-10-
Regards,
*** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because:I was covered by another insurance policy at the time. Please see the attached letter. I have essentially been billed by two separate insurance companies for the same month of coverage. I have contacted the Healthcare Marketplace and have a case opened to reinvestigate what the situation is. I had initial gone through the escalation process with the Marketplace back in and thought the issue had been resolved. I question Coventry's ability to withdraw funds from a clients account from years ago with little explanationAs many consumers, I assume that you balance your accounts on an annual basis and don't leave the door open to withdraw funds at any time. If you find a discrepancy contacting that individual and having a conversation might glean some insight into what has happened. Sending out a form letter covers your butt for notification but does little to instill trust and dialogue with your clientsI also have found the way your customer service team and billing clerk handled the situation increased the level of misunderstanding and stress involved in figuring out just what was going onAgain, as stated in my previous complaint I received multiple stories as to what happened and still haven't received a callback from Gail after failed attempts Obviously this issue is one that I am following up with the Health Care Marketplace and hope to have resolved within the next days. Perhaps through the Marketplace, *** *** and Coventry can communicate with one another and figure out why both are claiming they can bill me for insurance If you have any power to provide customer service I would hope you will see there has been some misunderstanding and will actively communicate with parties involved to get this issue resolved
Regards,
*** ***

Dear Ms***,
Please see our response to complaint #*** for *** *** that was received by us on July 9,
During our review it was noted that Ms*** had called Coventry on June 5, 2015, to request a refund of the premium that had been drafted for June and to request
that she be changed to paper billing instead of a recurring Electronic Funds Transfer (EFT) draft. Regrettably, financial hardship was not considered a valid reason to issue a refund. The change to paper billing was made but Coventry does not offer paper billing for members in the state where Ms*** lives.
Once the paper billing issue was noticed, Ms*** was set back up to be on recurring EFT. When she called on July 2, 2015, the policy was cancelled back to June 30, 2015. At that time, it was too late to stop the EFT that had already been scheduled for the July premium. The EFT was processed on July 6, 2015. A return notice showing that the draft failed was processed on July 8, 2015. Since no money was taken out of the account, no refund is due for the July premium. Also, because the policy has been terminated back to June 30, 2015, an NSF fee will not be applied for the returned payment.
Ms*** should have been told initially that paper billing was not allowed and also notified that the recurring EFTs were being set back up for her policy. We have forwarded the information from this case to the appropriate department to provide education to the parties involved.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

Dear *** ***
Please see our response to complaint #*** for *** *** that was received by us on June 10,
Based on our review, the records indicate that we received a change file from the Marketplace on March 24, 2014, to add *** ***’s dependent, *** ***, to the
policy with an effective date of April 01, However, the policy requires that we add a dependent from their date of birthAs such, we have submitted a ticket to our Reconciliation department to have ***’s effective date changed to her date of birth March 21, Once the effective date has been corrected, we will have the previously denied claims reprocessed
I apologize for the difficulties this situation has caused *** ***, and regret that she encountered the customer service experience stated in her complaint*** ***’s feedback has been forwarded to the Customer Service department for improvement opportunities.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Julian C***
Executive Resolution Team

*** *** *** Please see our response to complaint *** *** *** *** that was received by us on May 4, 2017. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youIn reviewing *** *** policy, we
did note that she had contacted Coventry Health Care on August 4, 2016, to request termination of her policy retroactive to July 31, 2016. She was advised that proof of the effective date for her new coverage would need to be sent in order to process her request. She advised that she sent the information on August 9, 2016, but it was determined that it was faxed to Coventry’s Underwriting department instead of the Billing and Enrollment department. *** *** stated that she had sent it to the fax number that was provided to her. We apologize for the correct fax number not being givenDue to the information being sent to the wrong area, it was not able to be located or processedOn September 13, 2016, *** *** contacted our Billing and Enrollment department inquiring as to the status of her request for termination. She was advised that her previous fax was not found and was asked to send the information again. She was provided the correct fax number at that time. That same day she sent another fax with the cover sheet from her previous fax and a brief description of what she was requesting, but did not include the proof of her new coverage. Since proof of her new coverage was not sent, we still did not have the information needed to process her request to cancel her policy back to July 31, 2016. After the above information was found, we confirmed that *** *** new policy is with *** and were able to see that the effective date for that policy was August 1, 2016. With this discovery, we requested that our Billing and Enrollment department terminate her Coventry Health Care policy retroactively to July 31, 2016. The request was granted and a refund for the premiums she had paid to Coventry for August and September was approved. The refund will be made through electronic funds transfer back to the bank account that the initial payments were collected from. The estimated posting date for the refund is May 9, 2017. However, due to processing times the funds may not be available in her account for 3-business days. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Regards, Chris B***
*** *** *** ***
*** *** ***