Clark Insurance

Dear Ms[redacted],
"Times New Roman"">Please
see our response to complaint #[redacted]
for [redacted] that was received by us on April 11, 2016.During
our investigation of Mr[redacted]'s complaint, it was identified that the trouble began
with a known issue where a system error caused premiums to be drafted
multiple times in early April. The issue was detected and corrected quickly
and the funds collected through those drafts were returned to the accounts from
whence they came automatically.
Unfortunately, it was not possible to determine the amounts of any
overdrafts that had resulted from the multiple drafts being performed. Approval
has been given to reimburse the $that Mr[redacted] is requesting. The reimbursement will be sent to him in the
form of a paper check and should be received in 7-business days from April
12, We have contacted Mr[redacted] and confirmed that he was satisfied
with that outcome and provided direct contact information to use in the event
that he experiences further difficulty in regards to this issueWe
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr[redacted]'s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at [redacted]. Regards,
Chris
B[redacted]Complaints
and Appeals Consultant
Executive
Resolution Team

Dear
[redacted],
Please
see our response to complaint #[redacted] for [redacted] and
[redacted] that was received by us on January 19, 2016.
In
reviewing the policy for **. and [redacted], it was found that it did become
effective December 1, 2015, with a premium of $939.53 owed...

for the month of
December.  The policy had been applied
for through the Federal Health Insurance Marketplace.  On December 20, 2015, an enrollment file was
received from the Marketplace with a new premium amount of $1497.42 starting
January 1, 2016.  Coventry is required to
charge the amount sent to us in the enrollment files by the Marketplace.  It is the Marketplace’s responsibility to
notify people who have applied through them of premium amount changes.  Any dispute on the amount
collected for January would need to be taken to the Marketplace.
It
was noted that we received an enrollment file from the Marketplace advising
that the policy should be terminated with the last day of coverage being
February 1, 2016.  As our system does not
have the capability of accepting only prorated amounts, we will seek to collect
the entire premium for February which was $833.42, due to separate files received
on January 5, 2016, that lowered the premium from the $1497.42 owed for January.  If the premium is paid for all of February, a
refund would then be issued for the days past February 1, 2016, for which the
policy would no longer be active. 
Otherwise, **. and [redacted] can contact the Marketplace to request
that the policy be terminated January 31, 2016, instead of February 1, 2016.
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address **. and [redacted]’s
concerns.  If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.
Regards,
Chris
B[redacted]
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 response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because:Hello , Here is the bank statements , [redacted].They will show 2 payments accepted on the [redacted] but 4 payments taken. One payment was refunded but the other was not. So the representive is wrong, they owe me a payment refunded.Thank you, [redacted]Regards,
[redacted]

Dear [redacted]:Please see our response to complaint #[redacted] for [redacted] that was received by us on February 21, 2017.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.Upon receipt of [redacted]’s...

complaint, we reviewed our Billing and Enrollment systems.  It was found that the premium she owed for each month of coverage in 2016 was $74.78.  Her coverage was active from January 1, 2016, through April 30, 2016, giving her four months of active coverage.  The total owed for this time frame then is $299.12.  The payments we received from [redacted] totaled $373.90.  She was issued a refund of $74.78 on or around July 2, 2016.  The resulting net total of payments received is $299.12.  As the amount paid is equal to the amount owed, no further refund is due. We did note in her complaint that [redacted] stated her 1095 form only showed 2 months of coverage while Coventry’s systems show her having four months of active coverage. Her policy was applied for through the Federal Health Insurance Marketplace (FHIM).  The 1095-A form is sent by the FHIM and shows the months of active coverage that the FHIM has on file.  We reported the coverage dates for [redacted] of January 1, 2016, to April 30, 2016, to the FHIM.  If there is a discrepancy with the information shown on the form, corrections would need to be made by FHIM.  A review of the form can be requested by calling the Marketplace Call Center at ###-###-####.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.Regards,Christopher B[redacted]Complaints and Appeals ConsultantExecutive Resolution Team

Dear Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] Jr. that was received by us on June 29, 2015.
During our investigation of the complaint, it was confirmed that Mr. [redacted] was given correct information on his previous contacts.  We will regrettably...

not be able to remove the $20 NSF fees that have been applied. 
The Electronic Funds Transfer process does not provide the capability of determining if a bank account is open or closed at any given time.  That information is only sent to Coventry when a transaction is attempted.  Because of this, we are unable to prevent drafts from being scheduled to be taken out of an account that has been closed.  It is very important to ensure that valid account information is given every time a payment is scheduled.
All bank account information that we have been provided is stored with our member’s cases in our Billing and Enrollment system.  The account information can be removed from a case by sending in a Change Payment Method form or by using our website.  If an account is closed, new account information can be entered and the old account information can be removed so it is no longer possible to accidentally schedule a payment from the wrong one.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
 
Regards,
Chris B[redacted]
Executive Resolution Team

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted]. I am pleased that this matter is finally resolved. Unfortunately, it required three weeks of follow up calls to Coventry and a complaint to the Revdex.com. I appreciate your assistance as I received a satisfactory resolution within 1 day of filing the complaint. Thank you!
Regards,
[redacted]

Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on July 16, 2015.
It was determined that the delay in the enrollment for [redacted]’s daughter’s policy was due to a document that had been requested that was needed in order to...

confirm her eligibility.  Upon receipt, the document was reviewed by our Underwriting department and the policy was created. 
We noted that two payments were collected from [redacted].  One was authorized through the application process and the other was scheduled on to a phone call to our Billing and Enrollment department.  The agent who she spoke with should not have scheduled the second payment and has been educated on the proper processes.  A refund check has been mailed to [redacted] for $186.16.  She will be responsible for the August premium once it becomes due if she wishes to continue the coverage.
A recording of the phone call with the supervisor that [redacted] spoke to could not be located so regrettably we are not able to determine the content of the call.  However, the person that she spoke with will be provided with coaching to ensure that high quality service is always provided. 
Finally, we were able to speak with the doctor’s office that treated [redacted]’s daughter.  We gave them the policy information and the instructions for claim submission.  The claim was received and processed on July 17, 2015.  A payment was made to the provider on July 21, 2015.  At this time, the claim is showing that the only member responsibility is a $10 copayment.  Any additional amount [redacted] paid to the doctor’s office will need to be refunded to her or issued as a credit on her account with them. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.
 
Regards,
Chris B[redacted]
Executive Resolution Team

Dear
[redacted],
Please
see our response to complaint #[redacted]
for [redacted] that was received by us on January 21, 2016.
Upon
receiving the complaint, we found that [redacted] is on a Medicare Part D
plan.  We reached out to our Medicare Grievance
team and found...

that they were already aware of the situation.  Contracted pharmacies cannot refuse to fill a
medication because they feel they are underpaid.  This issue has been escalated to our Network
Team to find a solution so that this does not happen in the future.  Until a solution can be found, should [redacted] be refused a medication, we advise that he ask the pharmacy to contact
our Customer Service department at the number located on his ID card. 
[redacted] had indicated that he paid the pharmacy out of his pocket for the medication.  We encourage him to submit a claim for
reimbursement of the amount he paid.  A
prescription claim form is attached that can be used to file for reimbursement.  Please note that a receipt from the pharmacy
is required to be sent with the claim form. The receipt must include specific
information including the patients name, the prescription number, the medicine’s
national drug code number, the date of the fill, the metric quantity, the total
charge, the number of day’s supply for the prescription, the pharmacy’s name, address,
and [redacted] Number, and the prescribing physician’s National Provider Identification
number.
 
In
reviewing the messages [redacted] had sent through our online member portal, it
was noted that attempts had been made to contact [redacted] by phone but were
not successful.  A Grievance response letter
was sent on January 15, 2016. 
 
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address [redacted]’s
concerns.  If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.
 
Regards,
Chris
B[redacted]
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 response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because: Until this amount that is being sought by the hospital is gone I will not accept that this situation has been resolved. I did speak to a rep from Coventry and he has been very helpful and seems to be getting somewhere with the hospital. However, until that amount is erased this is not resolved. 
Regards,
[redacted]

Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 28, 2016.
During our review, it was determined that our guidelines allow for retroactive terminations of policies going back 60 days from the first request. As such, we were able to grant a termination date of September 9, 2015. With the retroactive termination date we will issue a prorated refund for the month of September as well as refunds for the total amount paid for the October and November coverage. Unfortunately, we are unable to provide a refund of the entire amount. Since the premiums were drafted from a bank account through Electronic Funds Transfer, the refunds will be deposited directly into the same account using the same method.
I apologize for any difficulties or confusion this may have caused [redacted]. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.
Regards,
Julian C[redacted]
Executive Resolution Team

Dear Mr. [redacted]: Please see our response to complaint #[redacted] for [redacted] that was received by us on December 31, 2017.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you. In reviewing Mr. [redacted]’s complaint, it...

was noted that he indicated the product/service he pur[redacted]d was [redacted].  [redacted] is not directly affiliated with [redacted], Coventry Health Care, or [redacted].  Our relationship with [redacted] is only through a network rental agreement that they have with [redacted].  The agreement allows their membership to visit providers who are contracted with [redacted] and receive discounted rates for services.  As we do not have any involvement with the administration of the policy, we are unable to assist further with Mr. [redacted]’s request to terminate the policy or receive refunds of the premiums he has paid.  Our investigation indicated that [redacted] is part of [redacted].  They would need to be contacted for further review of this issue.    We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].   Regards, Chris B. Complaints and Appeals Consultant Executive Resolution Team

Dear
[redacted],
Please
see our response to complaint #[redacted] for [redacted] that was received by us on January 8, 2016.
In
reviewing the concerns [redacted] reported, it was noted that she was required
to provide her bank account information again for her 2016 coverage due...

to a
new billing case being created.  The new
billing case was created based on the way the Federal Health Insurance Marketplace
sent the enrollment files to us.  We
regret any frustration this caused.  The payment
for the January premium was posted to her account on January 6, 2016.
The
last manual ID card request we found was from December 14, 2015.  At that time, [redacted] had reported that
she lost her ID card.  As the policy for
2016 was not yet active, the card mailed was for her 2015 coverage.  After receiving the payment for her 2016
coverage, a copy of her 2016 card was automatically mailed to the address we
have on file.
Finally,
we do apologize for any lengthy hold times that [redacted] has experienced
recently.   Unfortunately, due to the
increase in call volume during the open enrollment period, it can take longer
to reach a representative at times.  The
forty-five minute wait that she reported is not typical and we do strive to
answer all calls as quickly as possible. 
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address [redacted]’s
concerns.  If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.
Regards,
Chris
B[redacted]
Complaints
and Appeals Consultant
Executive
Resolution Team