Coventry Health Care, Inc.

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,

[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],
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

Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted]...

[redacted] that was received by us on 11/10/2014 and was regarding cancellation of her 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. Our records do not show that we received a verbal request from the member to end her coverage in September 2014. We do show that the member had called us on October 7, 2014 and was informed at that time that her request must be sent in writing. We received the member’s written request to cancel her policy effective November 4, 2014.  The request was dated October 10, 2014. Since policies are terminated at the end of the month and the member indicated that she had employer coverage effective November 1, 2014, the coverage has been terminated effective October 31, 2014.
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]@aetna.com.
 
Regards,
Chris B[redacted]
Executive Resolution Team

August 20, 2014
Dear Sir of Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding termination of her policy for non-payment.
We have...

researched [redacted]'s complaint and our records indicate that the member was set up on the “Paper billing” method. This means [redacted] would have been sent a paper bill in the mail with instructions on how to send the payment. It appears that she had not been on an automatic billing method at any point in the policy. In order to be set up on auto payment, [redacted] would have needed to sign and return an auto withdrawal form that authorized Coventry to take the payment monthly. Also, the [redacted] could have set up automatic payment online at the member website (member.cvty.com). This is why Coventry never automatically withdrew from [redacted]’s account. On January 1, 2014 [redacted] was mailed an initial payment letter indicating that her payment was due. On March 9, 2014 she was mailed a past due letter. [redacted] did not respond to either letter.[redacted] has a new policy. This policy is effective 07/01/2014 for a $0.00 premium on the Silver Integrated $10 Copay PPC plan. Due to the other policy being terminated for January 31, 2014, there will be no coverage for [redacted] from February 1st to June 30th. The older policy cannot be reinstated to cover for the lapse of coverage as it was terminated for nonpayment. After further research it was concluded there was no error on the behalf of Coventry as the proper documentation was sent to [redacted] reminding her of the payment that was due.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 ###-###-####. My fax number is [redacted], and my e-mail address is [redacted].Very truly yours,Kimberly S RN, BSN,  CPC
Health Services Manager, Appeals

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

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

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,

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,

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.

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 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

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

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

[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]

"Times New Roman";">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].com.
Regards,
Chris
B[redacted]
Complaints
and Appeals Consultant
Executive
Resolution Team

May 16, 2014Dear [redacted]:Your letter of May 15, 2014 to Coventry Health Care of Iowa, Inc. (Coventry) was received in our office, and referred to my attention for review and response. **. [redacted]’s family coverage will terminate effective May 31, 2014.In his complaint to the...

Revdex.com, **. [redacted] advised that he experienced frustration with long hold times and system problems when he contacted Coventry regarding cancelling his coverage. Coventry has experienced a high level call volume after the first of the year regarding the Marketplace Applicants. On May 13, 2014, during **. [redacted]’s initial phone call, Coventry’s system was down. The representative did not have access to his policy, therefore **. [redacted] was asked to try calling later. Coventry understands **. [redacted]’s frustration and apologizes for any inconvenience this may have caused him.On May, 16, 2014, [redacted] contacted **. [redacted] to personally apologize for the inconvenience he experienced. Coventry looks for opportunities to improve the customer experience and his concerns will be addressed.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].Sincerely,

July 3, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s request for an In-Network specialist.In an effort to assist [redacted], the Health Plan contacted him on July 2, 2014. [redacted] advised that he is satisfied...

with his Primary Care Physician (PCP). However, he has a referral for a colonoscopy but is unable to locate a Gastroenterologist, [redacted] also inquired about finding an Urologist in [redacted] County. [redacted] was advised that our CoventryOne Customer Service Team is working to locate and verify both requested specialist within 20miles of his zip code. The CoventryOne Customer Service Team will also confirm the selected specialists are accepting new [redacted] members. [redacted] will be contacted and provided with the contact information for the selected providers available.[redacted] was also informed many providers’ new patient panel is closed at this time in his area. This means new patients are not being accepted. In the event that a participating specialist provider cannot be located; [redacted] and his PCP must obtain a prior authorization to see a non-participating provider. -[redacted] will be eligible to enroll under a different plan if desires during the open enrollment and special enrollment periods as defined by the Health Insurance Marketplace and as set forth in 45 CFR 147.104. The annual open enrollment period will occur annually from October 15th through December 7th of each year for benefit years beginning January 1, 2015. Qualified individual currently enrolled in a Qualified Health Plan may also change plans at this time and enrollees will be notified in writing about the annual open enrollment period in September of each benefit year.If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm or you may reach me directly at ###-###-####. If you are hearing impaired please call 7-1-1 Telecommunications Relay Service.Sincerely,Yanique MComplaint and Appeal Analyst Grievance & Appeals Dept.

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

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