Community Health Options

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] this does not resolve my complaint because I was never notified that my insurance was cancelled before this invoice was sent to meAlso even if I did not pay on time I did pay for the month of February in full so you owe me at least the month of February as payment back because I was not covered for the month according to you and I still payedIf you were a fair company you would at least refund that amount back to me or reinstate my insurance to me since it was now paid to you Regards, [redacted] ***

We have reached out to Mr [redacted] since this complaint was made We believe we have provided him with the information he was seeking but are always happy to provide additional assistance to members should they request it

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] That is a flat out lie no one has called [redacted] I dont want to have to call someone who does not know what this issue is aboutI need a supervisor to call me because I have called you multiple times with no one knowing what is going on other than insurance is canceledIf you have called this number then why don't I have a voice mail or a missed call from youIm home all night call meIm home all day tommorow call me Regards, [redacted] ***

We do apologize for the unfortunate enrollment experience this former member hadAs people may be aware, some individuals who passively enrolled through the Federally Facilitated Marketplace (FFM) fell into the category of Unaffiliated Issuer Enrollments (formerly known as “issuer orphans”) This means they appeared in Health Options’ records as being actively enrolled but did not appear this way in the FFM recordsAs such, these individuals experienced difficulty using their coverageThis may be applicable to the individual who filed this complaintWe have refunded this member's money

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]

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] I do not accept thisRevdex.com, please advise Regards, [redacted] ***

Community Health Options provides Members with monthly invoices detailing, among other things, when payment is due, how the Grace Period works for recipients of APTC and non-recipients, and what month of the Grace Period a Member is in, as applicableAlso, the Member Benefit Agreement provided to Members provides all of this information as well as information about the Binding Premium PaymentThis is the full premium payment due in order to effectuate the PlanThe Binding Premium Payment is due on or prior to the effective date of coverageNo grace periods applyFor more information about policy termination, we advise contacting our Member Service Associates at [redacted] They can speak in greater detail about the specifics of an account

We are reaching out to [redacted] to resolve this issue. We recognize people have busy schedules but do encourage our members to read all mail sent by [redacted]

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 # ***
Regards,
*** ***

We are aware of the concerns raised by the Member and have been working to resolve the issues impacting her accountWe apologize the resolution process has not yet concluded but we are implementing a strategy that we believe will correct the errorWe have dedicated resources to carefully review
this situation and expect to provide our Member with a positive update in the near future

Dear Dr***: This letter is in response to the inquiry you filed with the Revdex.com dated 4/5/regarding termination of your coverageOur records indicate that you purchased your coverage in via the Health Insurance MarketplaceWhile you advise that your address was
incorrect, any address change would be made through the Health Insurance MarketplaceThe first record we have of any conversation with you regarding an incorrect address was on November 28, 2017, when you were seeking reinstatement of your coverageAt that time, you advised us that you had moved and we advised that an address change needed to be made through the HIMI have included a copy of notes from that conversation for your convenience.[Please see attachment as image will not load in this text box]It is the responsibility of each Member to pay their invoice prior to the beginning of the month when coverage is providedI have included a copy of your payment history that indicates that no payments were received from you after August until DecemberThe December payment was applied to the past due amount; however, you remained in arrears and your account was terminatedThere is a 31-day grace period for late payment of premiumI have included a summary of your payment history from our Finance Department PeriodStart PeriodEnd TransactionDate TransactionType ChargeAmount CreditAmount Balance 8/1/8/31/8/5/Premium Due 9/1/9/30/8/8/Premium Due 8/10/Payment 10/1/10/31/9/14/Premium Due 10/1/10/31/10/9/Premium Reversal 10/1/10/1/10/9/Premium 12/5/Payment You are accurate that we do not send monthly e-mail premium remindersWe appreciate your membership in We will not be reinstating your coverage or paying a claim that was incurred after your coverage terminated in 2017. If you have any questions or require further information, please let me knowSincerely, Community Health Options

Dear Dr***,We mailed invoices to the address we have on file which you provided to the Health Insurance Marketplace (***)As we previously advised, your address should be updated with the Health Insurance MarketplaceFor additional guidance, we encourage you to visit this web page, *** *As is noted on invoices and in the Member Benefit Agreement provided to all enrollees and available on our site, premium payments are due on or before the first day of the month for which coverage is provided.Regards,Community Health Options

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 # ***
I do not accept thisYou admitted to sending the invoices to the incorrect addressYou are truly a bottom-feeding organizationYou should be ashamed of yourself and the company you representYou provide no value to the U.Shealthcare systemIn reality, you achieve the opposite effect and extract value from the systemYou are a parasiteIf your company had a shred of human decency, they would have given me the opportunity to catch up on my modest premiums and re-instated coverageImagine if I had actually had a life-threatening medical conditionIf you refuse to make this right, hopefully the Revdex.com will continue to expose what a pathetic, unscrupulous company you represent
Best Regards,
Dr*** ***

We appreciate Dr*** expressing the concerns about peer-to-peer review requirements when seeking PA that were outlined in the complaint filed with the Revdex.comWe reached out to Dr*** by phone to better understand her experience and followwith our partners who were involved in this
process to ensure continual improvementWe do appreciate that Providers in our Network have busy schedules but we do have a wide Network and scheduling calls is, in part, intended to ensure that all Providers requesting PA have the opportunity to discuss medical care pertaining to our MembersIn the course of our conversation with Dr*** it became clear that our partner’s participation in the peer-to-peer call was not punctualWe do apologize for that and the inconvenience that resulted from itWe will work toward improving our performance in this areaCommunity Health Options seeks to ensure our Members receive the appropriate care as expeditiously as possibleThe PA process allows us to verify that Members receive medically necessary care in an appropriate mannerThis prevents the company from paying for unneeded medical services that would increase the cost of insurance for all MembersThe peer-to-peer review is not intended to delay care but, rather, provide an opportunity for medical professionals to further review and discuss adverse utilization management determinationsWe do hope we are better able to accommodate the schedules of Providers requesting peer-to-peer review in the future

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 # ***Please add your rejection comments belowNobody from the business has reached out to me as they have said in their responseI have logged into my account and my telephone number and E-Mail listed are correct
Regards,
*** ***

To Whom It May Concern:Below is Community Health Options’ response to the above noted Revdex.com complaint. In response to Ms***’s complaint to the Revdex.com, Community Health Options does recognize that incorrect credit card information was applied to Ms***’s
account and Health Options apologizes for the inconvenience this has caused Upon receiving Ms***’s complaint Community Health Options took immediate action and is actively engaged in resolving her concerns We would like to reiterate that no personal or financial information was compromised As Consumer Operated and Oriented Plan (CO-OP) Health Options strives for member satisfaction and will use this situation to improve our operational processes. Sincerely, *** ***

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 # ***.
this does not resolve my complaint because I was never notified that my insurance was cancelled before this invoice was sent to meAlso even if I did not pay on time I did pay for the month of February in full so you owe me at least the month of February as payment back because I was not covered for the month according to you and I still payedIf you were a fair company you would at least refund that amount back to me or reinstate my insurance to me since it was now paid to you
Regards,
*** ***

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 # ***Please add your rejection comments below.
I was offered reinstatement of my insurance as long as I pay the back premium amounts which would be over $I find this unacceptableI've had to cancel appointments, and pay full price for my prescriptionsThis was an error on their part not mineI would be more than happy to have the insurance reinstated, but I will not pay the back premium amounts
Regards,
*** ***

We have reached out to Mr*** since this complaint was made We believe we have provided him with the information he was seeking but are always happy to provide additional assistance to members should they request it

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 # ***.
please call *** current phone to see our options regarding this matter
Regards,
*** ***