Coventry Health Care, Inc.

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 10, 2014, regarding the termination of his policy.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
We reached out to our Enrollment department for assistance during our investigation. We confirmed that [redacted]’s policy has been reinstated.  [redacted] will still need to pay premiums for each month of coverage, but he will otherwise be able to remain covered on his current policy until December 31, 2014.  [redacted] can contact the Enrollment department at ###-###-#### to make the payments or to cancel prior to December 31, if he does not wish to continue coverage for that long. 
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

August 21, 2014
Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter as its response to the consumer complaint filed by [redacted] regarding billing issues for her insurance policy.Our...

investigation into this matter shows that [redacted]’s application for a policy was received by the Marketplace on April 22, 2014 with an effective date of April 1, 2014. Because the member made an initial payment of $130,28 to an older policy ([redacted]) instead of the new policy ([redacted]) with a monthly premium of $162.69, the new policy was terminated for non-payment of the premium by the Marketplace on May 24, 2014 with an effective termination date of March 31, 2014 (as if never in force). As part of the investigation, the premium payment of $130.28 was moved from the older policy ([redacted]) to the new policy ([redacted]). Then on May 24, 2014, the member made a payment for the difference due of $32.41. Once the payment of $130.28 posted to the policy, the premiums due generated for May and June. Therefore, on June 4, 2014, **. [redacted]'s policy was reinstated with an effective date back to April 1, 2014.Coventry Health Carc hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,

October 31, 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 rejection filed by [redacted] regarding payment issues for her policy which have led to her account being flagged.
[redacted] claims in her rejection that she had never heard of a “red flag” and that she should have been notified of such. According to her Plan documents that she received (a copy of which is attached hereto),
1.8 Premium Payment and Grace Period. The monthly Premium is due on the first (1st) day of each month. There is a one month grace period for Premium payments. In other words, if the required Premium payment is not paid on or before the first (1st) day of the month (i.e., the due date), it may be paid during the grace period. This Contract will Stay in force during the grace period. If the Premium payment is not received by the end of the grace period, Your Coverage under the Contract will be terminated as of the last date for which the Premium was paid in full. If Your Coverage is terminated, You will be responsible for the cost of any health care services You receive after the last date for which the Premium was paid in full.
IF THE HEALTH INSURANCE MARKETPLACE HAS DETERMINED THAT YOU ARE A PERSON ELIGIBLE TO RECEIVE ADVANCE PAYMENT OF THE PREMIUM TAX CREDIT THE FOLLOWING APPLIES TO YOUR COVERAGE RATHER THAN THE ABOVE SECTION 1.8. Premium Payment and Grace Period for Persons Receiving Advance Payment of the Premium Tax Credit. The monthly Premium is due on the first (1st) day of each month. There is a three (3) month grace period for Premium payments. If the required Premium payment is not paid on or before the first (1st) day of the month (i.e., the due date), it may be paid during the grace period. During the first month of the grace period, We will continue to pay claims for Covered Services During the second and third months of the grace period, We will suspend payment of any claims until We receive the past due Premiums. If Premium payment is not received by the end of the grace period, Your Coverage under the Contract will be terminated effective at 11:59 p.m. on the last day of the first month of the grace period. You will be responsible for the cost of any health care services You receive after the last day of the first month.
In other words, it is not that [redacted] had to pay her premiums in advance. It was that she paid very late. If she had paid during the first month of the grace period, there would have been no noticeable different in her coverage. If she did so during the next two months of her grace period, although she would not have had her coverage terminated, she would have had it suspended until payment was made and processed. That is what happened in the instant matter. [redacted] made payment at the very end of the three-month grace period; the “red flag” (or suspension as explained in the Plan documents) can only be removed after payment is made and processed. But because she did make payment before the end of the grace period, according to Section 1.8 above, her coverage was only suspended, not terminated.
Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil MRegulatory Compliance Analyst

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. 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 called the facility were the services were rendered and requested to speak with a billing specialist. We spoke with Brandy in billing who asked us to send a corrected explanation of benefits (EOB) to show that the member does not owe any money for the February 4, 2015, services that were rendered. We faxed a copy of the provider EOB to [redacted]’s attention and she advised that she has adjusted the member’s account to reflect zero owed for that date of service.
Our records indicate that we received the claim for the March date of service on April 15, 2015. Our records indicate that the member is responsible for $341.97 that applied to his deductible. The member should contact the hospital about obtaining the bill as they will not provide us with that information.
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
 
Thank you,
Ashley S.
Complaint and Appeal 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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: I finally spoke with [redacted] after I called and left several messages. She is the young lady I spoke with before. I told her that she never finished helping me the last time we were in contact because we never located a covered doctor. [redacted] told me that the problem is not with my coverage, it's with a doctor that will prescribe me [redacted]. I told her she was mistaken because I am already on [redacted] and I have been asking Coventry since day one (01-01-2014) to please help me find a provider that's in network. Coventry assured they would and once I was sign up and paid, nobody helped me. 
My conversation with [redacted] ended with her saying there is no doctor in their network that prescribes [redacted]. I told her I am extremely upset at having been strung along for 9 1/2 months, but at least I have an answer. I need to file an official fraud complaint against Coventry because they gave me the wrong information in order to get me to sign up. It's misrepresenting the policy, it's fraud, and it's illegal. 
I'm requesting the Revdex.com refer me to an agency where I can file a formal complaint against the insurance company for wasting my time and costing me hundreds of dollars in uncovered healthcare charges due to them not being up front and honest with me. I'm EXTREMELY upset. There really are no words. This has been a 9 1/2 month battle with them for nothing. I was assured when signing up that my current medicine could be switched to one of their doctors.
Regards,
[redacted]

Dear [redacted]...

[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].com.
 
Regards,
Chris B[redacted]
Executive Resolution Team

October 13, 2014
Dear [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual HMO ACA health benefit plan.[redacted] (the “member”) has filed a complaint. The Member states that his premium payment was...

drafted by the plan after the Member cancelled his coverage on 8/2/2014. The Member is requesting reimbursement of the premium payment processed on 9/9/2014 in the amount of $292.60.Upon review, the member called on 8/5/2014 to term the payment for August, however the August payment had not posted. Therefore, at that time, the member was not paid through August. He did not call back to terminate coverage until 9/11/2014, resulting in the CHL enrollment representative terming the member effective 9/30/2014. We have now termed the policy as of 08/31/2014 and a refund is in process for $292.60.We trust the above information is fully responsive to your request. Should you have any questions or concerns regarding this complaint, please do not hesitate to contact me.Sincerely,Emily M
Complaint and Appeal Consultant

May 23, 2014
Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s Primacy Care Provider (PCP) and service issues. Below please find the information requested.**. [redacted] became effective on April 1, 2014, under...

the Gold HMO Carelink Plan. Our records indicate that **. [redacted] was assigned to Dr. [redacted] at [redacted], FL [redacted]. Dr. [redacted] is approximately 0.9 miles from **. [redacted]’s zip code.On May 13, 2014, **. [redacted] contacted the plan in an effort to change his PCP. **. [redacted]’s PCP was changed to Dr. [redacted] at [redacted] FL, [redacted]. Dr. [redacted] is approximately 3 miles from **. [redacted]’s zip code. **. [redacted] was also contacted on May 22, 2014. According to **. [redacted], he received the Identification (ID) card showing Dr. [redacted] as his PCP. **. [redacted] expressed his satisfaction with his new ID card and PCP.Additionally, because of the unprecedented growth of membership with our ACA plans, the call volume is higher than usually. The plan is working diligently to rectify this issue. **. [redacted] has been provided with my direct contact number in the event he has any further issues and cannot reach the appropriate department.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.Sincerely,

March 19, 2014
Dear **. [redacted]:
Re the enclosed response from [redacted], Appeals Coordinator
I contacted Coventry Health America One's customer service department several times in late in 2014 and throughout February 2014 for my insurance member id and welcome package so that I could create my new profile athttps://member.cvty.com/memberPortalWeb/appmanager/memberPortai/menriber, but more importantly, provide my new insurance information to my doctor.Every time I called, Coventry Health America One's customer service informed me no member id had yet been established for me. I was NOT able to set up any medical appointments nor procure medical services of any kind because the company failed to create a member id for me. My many follow-up calls in February 2014 to Coventry Health America One went unresolved. To add insult to injury, the company did not send me any acknowledgment regarding my calls or an ETA for when I would receive a member id and welcome package. When I still had not received a member id and welcome package by February 28, 2614,I selected and signed up with another insurance company on March 3, 2014. (I intend to stay with this alternate insurance company!)Coventry Health America One finally sent me a member id card In the mail on March 10,2014 and a welcome package the following day. However, it was too late; I had already signed up with another insurance company as stated above.I have NOT used the Coventry Health America One member id and the welcome package remains unopened. I sent a letter, dated March 12, 2014 (enclosed) to the company asking if and where I could mail back the member id card and welcome package, I also stated I wanted my reimbursement and to terminate the contract. As of March 19, 2014,I still have not received a response from the company. Also enclosed for your reference is a short letter from Coventry Health America One, which prompted my questioning of their billing practices. As you can see, there is NO reference as to a $7.01 December 2013 charge (How was this charge calculated?), nor a specific premium breakdown of $216.78 for February 2014 and March $215,78, When I called Coventry Health America at ###-###-#### on February 22 about the contents of this brief letter, I was told "computer systems are down; we cannot answer any billing inquiries at this time,"Had the February 22, 2014 letter from Coventry Health America One been more detailed oriented, I wouldn't have assumed a mathematical error on the part of the company. The so-called "premium payment" of $7.01 for December 2013 mentioned in **. [redacted]'s letter doesn't make sense, as I registered for this insurance via [redacted]com on December 26, 2013. Her response letter to the Revdex.com is the first time I've even seen a charge of $7.01 referenced for December 2013. In summary, I don't have faith in this company to cover me for any medical services, after what I've had to deal with during mid-January 2014 to late February 2014. I just want a reimbursement for the January 2014 premium ($216.73) and an official letter from the company terminating the contract.Please advise me.
Thank you.

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
The services rendered for [redacted] were upheld under a level one appeal reviewed by Coventry. The member’s next option would have been to file the second level appeal with the member's employer within 60 days of the level one appeal completion. [redacted] was notified of the uphold decision by the previous consultant handling the original Revdex.com complaint, as well as a letter being mailed to her home address detailing the reasons that the appeal was upheld.
I was able to have the ambulance bill reviewed and was advised that it was paid in full to the provider, with no member responsibility. The provider’s check was mailed on March 24, 2015 in the amount of $505.00.
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

September 19, 2014To whom it may concern:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding his premium payments not being applied to his CoventryOne® policy purchased on the...

Federally Funded Marketplace for an effective date of May 1, 2014. The request was received by CHC Carolinas on August 14, 2014.CHC Carolinas responded in writing directly to [redacted] in a letter dated today.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.
Sincerely,Melody C 
Complaint and Appeal Analyst

October 1, 2014
Dear 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 transferred from the Missouri Revdex.com and filed by Seth Cobb regarding...

payment issues for his policy. This matter was also brought to the attention of the Missouri Department of Insurance.After research, the problem with the member’s payments was discovered and, by working with the member, the matter was resolved. A letter to this effect was forwarded to the Missouri Department of Insurance on August 4, 2014.
Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]
Very truly yours,
Neil M
Regulatory Compliance Analyst

October 10, 2014Dear Sir or Madam:This letter is written in response to the consumer complaint filed with the Revdex.com by [redacted] regarding a refund of her CoventryOne policy which was terminated by her on August 31, 2014.
[redacted] received her refund on...

October 2, 2014. It was credited back to her card in the amount of $411.39. Regarding the $35 NSF, if [redacted] would submit a rolling bank statement to reflect her balance before and after the transaction that resulted in the $35 NSF, we would be happy to handle that for her.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.
Sincerely,
Melody C
Complaint and Appeal Analyst

April 21, 2014
Dear **. [redacted]:This letter is in response to your request for Coventry Health Care of Virginia, Inc. to respond to a complaint submitted by [redacted] [redacted] regarding his medication [redacted]. The member would like to be able to refill his prescription at the local...

pharmacy instead of doing a mail order.Coventry Health Care of Virginia, Inc. does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing him in this matter. We will respond directly to **. [redacted].Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted] between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.Sincerely,

April 17, 2014
Dear **. [redacted]:
Coventry Health Care of Kansas, Inc. (Coventry) received the above referenced consumer complaint in our office on April 7, 2014. We appreciate the opportunity to respond.We regret to inform you that we are unable to release information...

regarding this case without the consumers written authorization. Please be assured that this complaint is being investigated and further response will be sent to the consumer directly.we may be of any further assistance, please feel free to contact me by telephone at ###-###-#### or [redacted] ext. [redacted] or email at [redacted].Respectfully,

[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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
They have NEVER contacted me regarding anything - but I see you received a prompt reply!!!  I had been attempting to cancel this policy since the Middle of December - not just the February date.  We require a refund from January 1st, not the 31st.  I had MANY conversations with them, and they never requested any additional information from us.  This is absolutely shameless customer service.  I went to my bank and they are crediting my account as they are still attempting to take funds from us.
Regards,
[redacted]

October 27, 2014
Dear [redacted]:
I am writing in response to the additional concerns expressed by the Consumer, [redacted], regarding his Revdex.com case, Specifically, [redacted] indicated he rejected Coventry Health Care's original response because: 1) no one from either Coventry or the Marketplace had contacted him to resolve his issue; and 2) Coventry, not the Marketplace, had Collected his premium payments. He understands that he had enrolled in his coverage through the Marketplace, but states he had paid his premiums to Coventry.
At noon on October 17th, we coordinated a three-way conference call with the Marketplace, [redacted] and us. The parties spoke to Marketplace representative, Shanna P[redacted], to discuss a retro-termination of [redacted] 's Coventry policy as never-in-force during 2014, Ms. P[redacted] took the retro-termination request; she informed the parties that she would send the request over to the Marketplace's Escalation Department. The Marketplace would then contact [redacted] with a decision on his request within approximately 30 days from the date of the three-way conference call.
Though it might seem to our customers that we as Carriers should be able to make changes to health insurance policies ourselves, certain changes (such as changes in effective and termination dates) must be done through the federal Marketplace. The structure of the Affordable Care Act requires that these types of changes occur only through the federal level. [redacted] should hopefully hear from the Marketplace on his request by some time mid-November. However, should you require additional information or have any questions, please contact our Customer Service Department for more information.Sincerely,Linda LRegional Director Regulatory Compliance

August 21, 2014Dear [redacted];The Appeals Department of Coventry Health Care of Virginia, Inc. ("Coventry Health Care") writes this letter in response to your request dated August 8, 2014 and received at our office on that day, This letter is in response to the consumer complaint...

filed by [redacted] regarding termination of her 09/01/2014 policy and refund of her premium.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, [redacted] has requested these changes through the Marketplace. On 08/06/2014, [redacted] contacted the Marketplace to discuss her case. It was escalated to a dedicated Caseworker and a Case ID Was generated.
On 08/27/2014 the Health Insurance Marketplace Caseworker informed Coventry of the pending retro-termination date request, which is still in process and advised that the policy slated to begin on 09/01/2014 is now cancelled. No further action is required from Coventry.
If you have any questions, please contact the Customer Service Department at ###-###-####.
Sincerely,Appeals Department

I received a letter from Coventry Health Care stating that I had verbally authorized Coventry to debit my bank account on Jan 10-2016 AM.
In the letter they list the following items:
Payment date - Oct 31 1926 , which happens to be my birthday
Payment Amount-$74.50
Bank Routing No.- [redacted]4366, this has some no's that are the same but not in that order.
Bank Routing Number- **SSN**, Not Even Close
Payment Reference **SSN**, don't know what that is.
The letter further states that if any of the information is incorrect, I should contact them and correct it.
I have never had any conversations with Coventry, in fact i've never heard of them. I will contact my Bank, my Senator, and my State Attorney General. To report this incident!.
EMPTOR CAVETE

November 24, 2014Dear [redacted]:
Your letter of November 14, 2014 to Coventry Health Care of Virginia, Inc. (“Coventry Health Care”) was referred to my attention for review and response.
[redacted] expressed concern that her policy terminated due to being reported as...

deceased on her enrollment file. Coventry addresses this concern below.[redacted] was enrolled in Electronic Funds Transfer (EFT) for her monthly premium payment of $127.19. On May 5, 2014, the last monthly premium payment via EFT was processed to [redacted]’s account form May 2014 coverage. On May 9, 2014, Coventry issued a letter to [redacted] advising her policy would terminate oil May 31, 2014 because the coverage was not going to be available for her geographical area effective June 1, 2014. The letter also advised she was eligible to enroll in a different plan that would be offered in her area during her renewal period,
On October 21, 2014, [redacted] contacted the Billing and Enrollment Department to inquire about her policy termination. [redacted]'s policy did not terminate due to a false reporting of her death, The Customer Service Representative (CSR) misinformed [redacted] about the termination remarks on her account. The Health Plan Home Office utilizes multiple termination remarks codes to signify the discontinuation of a policy. The termination remarks on [redacted]’s account indicated that she lived outside of the coverage area, [redacted]’s policy is not eligible for reinstatement because the policy that she had is discontinued for her area. [redacted] is eligible to apply for new coverage.
Coventry apologizes for the incorrect termination information [redacted] received from the CSR. Education has been provided to CSR to prevent this error from reoccurring,
If you have any questions, please contact the Customer Service Department at ###-###-####.
Sincerely,
Shawn M. 
Complaint and Appeal Analyst