Coventry Health Care, Inc.

[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:The business has not resolved this issue There are many more families impacted by this issue I am sure This company did not contact me to confirm or acknowledge coverage for weeks after they took my Premium payment of over $ With no acknowledgement, we were left to conclude that we weren't covered by the policy we paid for, and I changed companies This is unconscionable, and the company should refund our premium payment immediately There was no policy in force This company does not "answer" the phone (even their "claims and appeals department" is silent and does not return any calls - ever) There is no excuse for this In this economy, to transact business like this is beyond belief To resolve this issue, please refund my premium payment of $immediately. Perhaps what we need is more publicity to reach out to other affected parties
Regards,
*** ***

Dear
*** ***,
Thank you for allowing us to address the concerns reported in complaint #*** for *** *** that was received by us on December 11, 2014, regarding the termination of his policy. Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you
We determined that the proof of other coverage that *** *** submitted was received on November 13, 2014. The proof that was sent was not initially viewed as valid due to it being in a non-standard form. Rather than an ID card or other document coming directly from the other insurance carrier and showing the effective date of coverage, *** *** submitted a letter from *** Insurance indicating his approval for the policy through *** Life Insurance Company beginning August 24, 2014. This prevented the policy termination from being processed until further review confirmed that we would accept the document
Our business rules allow us to backdate a policy termination up to days from the receipt of proof of other coverage. The rules also state that the end dates for coverage must be the last day of the given month. Calculating days prior to the receipt of the proof of other coverage gives us a date of September 15, 2014. We were unable to go back to August 31, 2014, due to that date being more than days prior to receiving the proof of other coverage. We were able to grant a termination date of September 30, 2014.
*** *** is eligible for a refund of the premiums we had collected for the months of October and November. The amount of the refund will be $233.02. We request that he allow 7-days for processing of the refund. As he was setup for EFT payments for his premiums, we have his banking information on file and the refund will be deposited directly into his account
We have also reported to the appropriate department the issues *** *** had in getting disconnected from representatives when he was transferred. That department will continue to monitor for possible service issues to prevent the same thing from happening in the future.
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
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 March 18, 2014,During our review, it was determined that the member submitted an application on November 13, for an effective date of December 01, On November
13, a letter was sant to the member advising that she needed to contact the underwriting department for a telephone interviewA second letter was sent to the member advising that if she did not complete the phone interview by December 13, the application would be withdrawn.However on February 07, our underwriting department contacted the member to complete the phone interview and issue the policy with an effective date of December 01, In base of the second letter that was sent to the member we have terminated the policy effective November 30, Please allow to day to process refundIn order to review for overdraft fee reimbursement the member will have to provide a bank statement showing the running balance before and after our draftI apologize for any difficulties this situation has caused *** ***We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***'s concernsIf there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Julian CExecutive 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: ***
Dear *** ***,
Dear *** ***,
I would like to thank you for your efforts to assist me to
solve my problem with Coventry One CompanyAs I see the Coventry One
representatives reinforce an industry friendly, customer-hostile point of view,
where rules are not there to ensure good service but to protect their company’s
revenuesThey are sayings that sounds right, but on reflection are wrong on
almost every level
My wife and I were enrolled to Bronze plan and I don’t know
how Silver plan should workAgain, in Spring I was told by Market place
officer to pay just initial payment and till the end of the we would be
insured and supported by government When
Coventry One started charging us in full, I contacted Market Place and they told
me they going to terminate previous Bronze Plan and starting September I
will be covered on the same Bronze Plan, but will have to pay just $each
month and the rest will be paid by Government
The Coventry One just took the money and they did not
provide any service to me and to my wifeWhen I call them they all time redirect
me to the Market Place
Anyway, I am done with this caseI feel I lost my money and
I lost Obamacare, but I obtained a great experience about Coventry One Company
and I just hope no one else will suffer from Coventry One
I appreciate very much help, support and the time that
Revdex.com provided me in the caseI think we should close the
case and let all people know the details of the case and the way that Coventry
One treats their customers
Respectfully yours
*** ***

Dear Ms
***,
Please see our response to complaint #*** for *** *** Jrthat was received by us on June 29,
During our investigation of the complaint, it was confirmed that Mr*** was given correct information on his previous contacts. We will regrettably not be able to remove the $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***’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

Complaint: ***
I am rejecting this response because:
Conventry has yet to initiate any contact with me. I have since contacted them again and
they did not file some paperwork correctly and promised the money would be refunded in 2-business days. I have yet to see any action from them. I also called the number on the letter and eventually spoke with someone that said that was not the correct number. They routed me to *** *** voice mail. Please send me a "signed authorization form" that they claim they do not have. I am about a week away from contacting a lawyer to file suit against them. I recorded the phone calls I have made with them. They admitted they messed this up. I am fed up with their stupidity
Regards,
*** ***

face="Calibri">Dear *** ***,
Please see our response to complaint #*** for *** *** that was received by us on August 21,
We regret any frustration that *** *** experienced while attempting to locate providers. We strive to keep our provider directories as up to date as possible. It was determined that *** *** had contacted the *** * *** *** of Palm Beach, as she had found them through our provider search. She stated that they had told her that they were not participating with Coventry. We contacted their office and they did confirm that they are still in the network for *** ***’s plan and were not able to offer a specific reason why she would have been told differently. If she has additional providers that are stating they are out of network but show up on our directory, we ask that she call our Customer Service department at ###-###-#### so we may investigate further.
In regards to the second part of *** ***’s complaint, it was found that a system issue did cause her payment for the August premium to be scheduled for a penny less than the amount owed. As the payment was already past the due date, this caused the policy to enter into a grace period. While claims would have still been processed as during the first month of the grace period, a message is displayed on our website that providers use to review eligibility which led to them seeing the “hold” on the accountTechnicians are working to correct the problem so that the same issue does not happen in the future when using our automated phone system for payments
*** *** is on a policy applied for through the Federal Marketplace and is receiving an Advanced Premium Tax Credit. Unfortunately, we are unable to waive the premiums for these policies. While we do not wish to lose *** ***’s business, we can’t refund the past premiums she has paid or discount her future premiums. The policy is currently paid through the end of September and the October premium is due on September 30,
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***
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: while I have received the $536, I have not received the refund for the overdraft feesIn addition, the amount (as provided by the attached support is $208)If this company would have refunded me in a more timely manner, maybe they could have only incurred $They seem to be more concerned about "company policy" than to serve their customerThis has been nothing but a huge source of frustrationRegards,*** ***

Dear *** ***,
Please see our response to complaint #*** for *** *** that was received by us on January 13,
Upon receipt of the Designated Representative form on January 16, 2015, we researched the issue that caused the complaint. We were able to determine that an overpayment did occur for the premium for *** ***’s policy for December 2014. The overpayment was caused by a manual payment in the form of a check being posted to the account on December 4, 2015. An EFT payment was also collected on December 5, 2015, because there was not enough time after we posted the manual payment to cancel the EFT draft that had already been scheduled.
The payment history linked to *** ***’s policy is showing that the overpayment was returned on December 8, 2014. This refund would have been deposited directly into *** ***’s bank account that we had on file for performing the EFT drafts. It often takes 1-business days for the banks to post the payments to the individual account after our return date, but that process should be completed by now. We respectfully request that the bank statements be reviewed to determine whether or not the refund was actually deposited. If no record of a deposit can be found in the amount of $176.89, and a bank statement supporting this can be provided, we can send the issue for further review
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 ***
Regards,
Chris B***
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:Coventry and I must simply agree to disagree. I see no point in furthering discussion between our two parties. The fundamental issues Coventry fails to address is their extremely poor customer service, lack of resolution, failure to provide the service paid for and failure to provide an acceptable alternative. In addition, none of Coventry's correspondence to us was completed in a timely manner. In fact, Coventry never bothered to inform us our policy was cancelled until we took the initiative to contact Coventry to find out when our insurance cards would be issued. Having cashed our check and deposited our money, we assumed we were covered. When we initially approached Coventry with our concerns, we were told we were out of luck with no recourse. Rather than taking the initiative to help solve our problem, Coventry simply chose not to assist This is not surprising given their large market presence and the fact we represent a very tiny piece of their business
For any reader of my complaints, see the initial complaint filed with the Revdex.com. Regards,*** ***

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

February 24,
Dear ***:
This letter is in response to your request for Coventry Health Care of the Carolinas, Inc(“CHC Carolinas”) to respond to a complaint submitted by *** *** regarding an increase in monthly premiums for his CoventryOne policy effective February 1, The request was received by CHC Carolinas on February 12,
CHC Carolinas does not have a signed authorization release form from *** indicating that the Revdex.com is representing him in this matterCHC Carolinas will respond directly to ***
Please contact me if you have any further questions involving this issueI can be reached at ###-###-####-*** between the hours of 8:a.mand 5:p.mMonday through Friday
Sincerely,

Dear **
***,
Please see our response to complaint #*** for *** *** that was received by us on April 20,
During our review, we found that the laboratory claims received for date of service December 12, 2014, were submitted by the provider with a medical diagnosisThese claims would have been covered at percent had the services been submitted as routine, but they were not*** ***’s policy had a deductible at that time, which was applied to both claims
*** ***’s responsibility for the laboratory claims for December 12, 2014, are as follows: $out of a total billed of $for the first bill submitted and $out of a total billed of $for the second bill submitted
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 ***
Regards,
Julian C***
Executive Resolution Team

Dear ***
***,
Please see our response to complaint #*** for *** *** that was received by us on June 15,
During our review, it was determined that the member’s initial binder payment was made May 30, This posted to the policy on June 01, I confirmed with our Billing and Enrollment department that the member’s ID card was sent on June 02,
When a binder payment is posted it can take about 7-business days for member’s to receive their ID cards in the mailAn update from the Marketplace was received on June 10, 2015, terminating the member’s coverage effective June 25, The member’s final bill and a refund for the remaining days of the month will be refunded within 7-business days
I apologize for any difficulties this situation has 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 ***@aetna.com
Regards,
Julian C***
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 was told by Coventry people on their customer service number provided by the company, that I was entitled a refundI was told that it had been sent and would be received in the mail twiceI was lied to times then? Is is okay? Coventry, ***, *** *** ***? I am not even sure who I am fighting anymoreBottom line is that they hurt peopleIf I can get anything out of this at all, I would like an explanation from the company on why this happened to me and why it's okay? Why was I told that I was owed a refundWhy is it okay that I was told that it was sent, and why was it okay that they had never sent it
Regards,
*** ***

May 29, 2014Dear *** ***:Your letter of May 19, to Coventry Health Care of Iowa, Inc(Coventry) was received in our office, and referred to my attention for review and response*** *** was covered under Coventry effective April 1, through the Health Insurance
Exchange (Marketplace)*** ***’s policy terminated effective May 28, 2014.On March 31, 2014, *** *** enrolled for coverage through the marketplace with an anticipated effective date of May 1, The Marketplace notified Coventry that *** ***’s policy effective date is April 1, 2014.Individuals who enroll for coverage on the Marketplace after the 15th day of the month are prospectively effective the first of the following monthExamples are provided below:• An individual applying for coverage on the Marketplace on March 14, 2014, the effective date of the policy would be April 1, 2014.• An individual applying for coverage on the Marketplace on March 28, 2014, the effective date of the policy would be May 1, 2014.However, the Marketplace was not enrolling members based on the example above or as listed on the www.healthcare.gov websiteBelow is an example of how the Marketplace was enrolling members:• An individual applying for coverage on the Marketplace on April 14, 2014, the effective date of the policy would be April 1, 2014.• An individual applying for coverage on the Marketplace on April 28, 2014, the effective date of the policy would be May 1, 2014.On May 5, 2014, *** ***’s $made her initial binder payment and her policy was reinstatedCoventry attempted to draft $in premium from *** ***’s bank account to bring her current*** *** was under the impression she did not have to pay for April’s premium and she contacted her bank and issued a stop payment of $On May 15, 2014, Coventry was notified by the Marketplace that *** *** terminated her policy.Resolution Coventry is unable to process any changes to a policy that was initiated through the Marketplace per the Exchange rules and regulations that we as an insurance company must follow*** *** advised she contacted the Marketplace to cancel her coverage*** ***’s policy terminated effective May 28, On May 29, 2014, *** *** was contacted and asked to submit a copy of her bank statement reflecting the stop payment fee of $Once the requested information is received a refund request will be initiated.Coventry apologizes for any inconvenience this has caused *** ***However, as stated above, the change must come through the Marketplace as Coventry is unable to change the effective date based on the Exchange rules and regulations.If you require additional information, please feel free to contact me at ###-###-####.Sincerely,

Dear Ms***, Please see our response to complaint #*** for *** *** that was
received by us on May 12, Upon receipt of the complaint, we immediately reached out to our Billing and Enrollment department. It was found that Ms***’s policy was affected by a known issue where bank drafts were attempted to collect premiums multiple times in early April. The issue was corrected quickly and the multiple drafts were reversed. However, it seems that Ms*** was given misinformation by her bank in that they stated we had only reversed seven of the eight drafts attempted instead of reversing all of them A Billing and Enrollment representative was able to perform a conference call with Ms*** and her bank and it was found that we had indeed reversed all of the attempted transactions. At that time a payment was also scheduled which brought the policy current through its period of active coverage which ends May 10, 2016. The May 10, 2016, end date for the policy was the date sent to us by the Federal Health Insurance Marketplace after Ms*** contacted them on April 26, We apologize for and regret any frustration Ms*** experienced in her contacts with our Customer Service department during her attempts to resolve her issue. All complaints are documented and reviewed by leadership as part of our ongoing efforts to determine any areas where improvements are needed in regards to the service we provideWe 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 Consultant Executive Resolution Team

November 12, 2014Dear *** ***:
This letter is in response to the aforementioned Case Number *** regarding a complaint filed by *** ***, apparently submitted to the Revdex.com on August 16, but not received by Coventry Health Care until November 10,
*** ***’s complaint states that the Health Plan denied his prescription medicine ***.*** *** was enrolled with the Health Plan’s Medicaid HMO plan effective July 1, to August 31, On July 28, 2014, the Health Plan received a prior authorization request from DrJorge *** on *** ***’s behalf for *** 100mg Intravenous SolutionThe request and medical records submitted were reviewed by a Medical Director and denied on August 11, 2014.Per the Health Plan denial, the prescriber must submit information to meet the criteria used for medical necessityIn this case the Medical Director could not determine this request to be medically necessary based on the information received, and it was denied because the Health Plan did not receive the following: Approval for *** (to treat ***’s disease) in adults (older than years) is granted only after trial and failure of *** and ***The Health Plan did not receive any information that trial and failure of *** and *** was doneOn August 11, 2014, the Health Plan sent a denial letter to *** *** in which he was advised of his appeal rightsThe Health Plan also sent Dr*** a denial letter advising that upon his receipt of this letter, he was to notify the member of the decision to ensure that he/she was aware of this adverse benefit determinationAdditionally, Dr***’s letter included the information that if he is the treating provider and would like to discuss this case with a physician reviewer, to please call ###-###-####If he has substantive information that was not available at the time of the decision, the Health Plan would be pleased to reconsider this decisionAt this time, as the member is no longer effective with the Health Plan, and has not been since August 31, 2014, there is no leave of appeal right available to *** *** or Dr***Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:am until 5:pmMy fax number is ###-###-####, and my e-mail address is ***Sincerely,Siana L
Complaint and Appeal Analyst

October 17, 2014Dear Sir or Madam:
The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter in response to the consumer complaint filed by *** *** regarding billing issues and termination of his insurance
policy.This matter has been investigated*** ***’s application for the policy was received from the Marketplace on December 29, with an effective date of January 1, However, his initial binder payment was received after the February 10, deadline for policies effective January 1, *** ***’s binder payment was not received until February 25, Because the binder payment was not paid by the deadline, the policy was cancelled and was not eligible for reinstatementHowever, after speaking with *** ***, his policy was reinstated by a supervisor on March 29, with the same effective date of January 1, 2014, and *** ***’s payment posted to the policy on March 31, *** *** paid subsequent premiums on April and April 24, each in the amount of $However, no payments were received after April 24, Therefore, *** ***’s policy terminated on July 9, with an effective termination date of May 31, The policy terminated with a reason of non-payment of the premium.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is ***
Very truly yours,Neil M
Regulatory Compliance Analyst