Connecticare Inc.

Review: [redacted] Insurance says the annual physical are completely free. So I and my wife went to see my PCP for annual physical check up. We only went for our annual check up because we were being told it is completely free. The doctor prescribed some blood and urine test at [redacted]. Before giving our blood and urine sample, we asked the [redacted] representative to make sure it is covered by my [redacted] Insurance. She told me it was covered. Now I am getting a bill of $63.37 for me and $82.54 for my wife from [redacted]. We would not have given the blood and urine samples to [redacted] if we knew in advance that it would cost us. It was not any emergency. It was just an annual physical exam.

I am unhappy with [redacted] and [redacted] for false representation.

Regards,

[redacted] Member ID# [redacted]

Date of Birth: 03/10/1978

Spouse's information

[redacted] Member ID# [redacted]

Date of Birth: 04/03/1992Desired Settlement: We want the [redacted] and [redacted] to work out an arrangement to tell the customer how much it would it cost before the service is done. We don't mind if it takes a week or month for [redacted] and [redacted] to figure out how much it would cost and let the customer know. We don't want any surprises with a bill in the mail after the fact.

We don't want to pay the bill as we were not being told in advance we would have to pay any. We were told it was covered by the insurance. If we were told, we would have to pay, we would not have done it.

Business

Response:

October 2, 2015 Ms. [redacted] Manager, Marketplace Operations Revdex.com [redacted] Re: [redacted] Revdex.com (“Revdex.com”) ID #[redacted] Dear Ms. [redacted]: This letter is in response to a letter [redacted] received, on September 23, 2015, regarding the above-referenced file. [redacted] is covered under an [redacted] HSA Plan (the”Plan”) through [redacted] The Plan is issued by [redacted] Mr. [redacted]’s complains that [redacted] denied payment for preventive laboratory services after he was told they were covered 100% under the Plan. Attached is a copy of the Preventive Services Exempt from Cost Share Grid for Mr. [redacted]’s Plan. The Plan has the following provision for preventive services: PREVENTIVE AND WELLNESS CARE Some Participating Provider preventive and wellness services, as defined by the United States Preventive Service Task Force are exempt from all Member Cost-Shares (Deductible, Copayment and Coinsurance) under the federal Patient Protection and Affordable Care Act (PPACA). These services are identified by the specific coding your provider submits to [redacted]. The service coding must match [redacted]’s coding list to be exempt from all Cost-Sharing under PPACA. On July 30, 2015, Mr. [redacted] contacted [redacted]’s Member Services Department about coverage for an annual physical. [redacted]’s Member Services Representative informed Mr. [redacted] that the annual preventive physical is covered as long as the services are done by a participating provider. Mr. [redacted] indicated that he and his wife recently received a yearly preventive physical and blood work services. [redacted]’s records reflect the following claim information for the blood work services: On August 12, 2015, [redacted] received Claim #[redacted] for date of service 08/08/15 in the total amount of $436.60 for Mr. [redacted]. [redacted] processed the Claim, as follows: CPT Code [redacted] – [redacted] Total Charge $228.61; Allowed Amount $63.37; Deductible $63.37; Payment $0 CPT Code [redacted] Total Charge $45.76; Allowed Amount $3.16; Deductible $0; Payment $3.16 CPT Code [redacted] Total Charge $141.68; Allowed Amount $18.85; Deductible $0; Payment $18.85 CPT [redacted] Total Charge $20.55; Allowed Amount $3.00; Deductible $0; Payment $3.00 On August 13, 2015, [redacted] received Claim #[redacted] for date of service 08/08/15 in the total amount of $544.76 for Mrs. [redacted]. [redacted] processed the Claim, as follows: CPT Code [redacted] – [redacted] Total Charge $228.61; Allowed Amount $63.37; Deductible $63.37; Payment $0 CPT Code [redacted] Total Charge $45.76; Allowed Amount $4.45; Deductible $0; Payment $4.45 CPT Code [redacted] Total Charge $108.16; Allowed Amount $19.17; Deductible $19.17; Payment $0 CPT Code [redacted] Total Charge $141.68; Allowed Amount $18.85; Deductible $0; Payment $18.85 CPT [redacted] Total Charge $20.55; Allowed Amount $3.00; Deductible $0; Payment $3.00 The claims were processed correctly in accordance with Mr. [redacted]’s Plan. Sincerely, COMPLAINT COORDINATOR jma Sincerely, COMPLAINT COORDINATOR Legal Department [redacted] cc: [redacted]