Coventry Health Care, Inc.

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,

[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]

Dear...

Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 23, 2015.
During our investigation, it was determined that Ms. [redacted] is not set up to have recurring EFT drafts for her premiums for 2015.  The premium collected on February 19, 2015, was a debit card transaction that had been requested through the Health Insurance Marketplace at the time of her active renewal.  The initial payment request was made in December and would have been for the premium for January 2015, but a hold was placed on it.  The hold was lifted in February causing the transaction to process.  Ms. [redacted] had already paid the premiums for January and February at the time of processing so the payment was applied to her March premium.
If a refund is issued, the amount would be removed from her March premium.  She would then owe the exact same amount of the refund back to Coventry.  Due to this, we are unable to determine a benefit to issuing a refund at this time.  However, if Ms. [redacted] was charged any overdraft or NSF fees due to the unexpected transaction, we may be able to reimburse her.  Requests for reimbursement of any fees applied would need to include bank statements that show the rolling total of her bank account as well as the dates that any fees that were applied and their amounts. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

"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

July 14, 2014
Dear **. [redacted]:The Member is participating in the Coventry Health and Life...

Insurance Comp any (“CHL”) HealthAmerica One individual HMO Health Care Reform health benefit plan.[redacted] (the “Member”) has filed a complaint. The Member’s complaint concerns poor customer service provided by CHL. The Member states that she requested and has not received an explanation as to when her automatic debit premium payment would be processed and also requested a detailed policy premium for her daughter and herself and has yet to receive anything from CHL.Below is a timeline of events leading up to the resolution of the Member’s complaint.07/02/2013- The Member called to update address.12/11 /2013- The Member called to get a breakdown of premium.05/01/2014- The Member called to see if she can get the breakdown of premium mailed to her.06/13/2014- The Member called about her recurring payment and stated her premium is incorrect. CHL representative advised renewal came and premium changed. Member wanted to speak to a supervisor.ROOT CAUSE:The Member requested a letter of premium breakdown, however it was sent to an email on file and not home address.RESOLUTION:We have provided the information being requested as well as a payment history. Member’s premium changed effective May 1, 2014 due to renewal. A migration letter was sent out advising so and the CHL has provided all documentations requested by the Member.We apologize for any inconvenience this may have caused the Member.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

Dear Ms....

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 25, 2015.
We reached out to our Billing and Enrollment department for assistance during our investigation.  They confirmed that the statement on the bills is correct and the due date for premiums is the last day of the month prior to the coverage period.  Ms. [redacted] is receiving an Advanced Premium Tax Credit which means that she is allowed a grace period for making the payments but to avoid disruptions in coverage and claim processing the payments should be made on time.  The due date statement on the bills will not be changed.
In reviewing Ms. [redacted]’s payment history, it was noted that she has not made her $11.94 premium payment for February or March.  As she is in the second month of her grace period at this time, claims for dates of service from March will be denied. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
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:
Regards,
[redacted]
Ok you probably notified my employer, but you didnt notify you personell offering. On November 2014 a representative gave us a brochure indicating a free gym membership and one of the questions asked was about the gym memebrship I asked her and she said that this service will continued as previously How can a company like yours Coventry cannot fing the 2014 brochure?  is that strange. So you dont keep records (minutes, meetings). Youre intentions were to get as many mebers as possible because coventry was being purchase by another insurance carrier. I can find the brochure for you as needed but  I will so I can display your unethical practices and the lie behind it. I will not stoped until you guys paid what I was offered.   I will look for the brochure.
 
Kind regards,  
[redacted]

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.

Complaint: [redacted]
I am rejecting this response because:
 
I had contacted Revdex.com previously because my insurance company cancelled my health insurance without notifying me. After sometime and many hour long phone calls spent mostly on hold with Coventry and after the Revdex.com contacted them they agreed they were in the wrong and said they would reinstate my policy. I informed them I no longer wanted their policy as I had by this time, obtained another one. I received a letter in the mail this saturday 12/13 that they were ach withdrawing $1,098 from my bank account for payment for 3 months of coverage. I contacted them immediately but nobody there will do anything to help and my bank is unable to stop the pending withdrawal. Below is the original complaint: Sent Via: Email (ODR) From: Revdex.com serving Metro Washington DC & Eastern Pennsylvania To: [redacted] [redacted]. Subject: Message received from the business about your complaint Date Sent: 11/21/2014 8:24:30 AM Attachments: Click here for printer friendly version [redacted] Berlin MD [redacted] Dear [redacted] : This message is in regard to your complaint submitted on 11/10/2014 10:25:18 AM against Coventry Health Care, Inc.. Your complaint was assigned ID [redacted]. The business has sent the Revdex.com a message regarding this complaint, and we are passing it on to you. The contents of this message are below or attached. Please respond to this message in written form within 10 days. The text of your complaint may be publicly posted on Revdex.coms Web site (Revdex.com reserves the right to not post in accordance with Revdex.com policy). Please do not include any personally identifiable information when you tell us about your problem or in your desired outcome. By submitting your complaint, you are representing that it is a truthful account of your experience with the business. Revdex.com may edit your complaint to protect privacy rights and to remove inappropriate language. Regards, [redacted] The Revdex.com MESSAGE FROM BUSINESS: 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
 
return my $1,098.96 immediately
Regards,
[redacted]

September 30, 2014
Dear [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual off exchange HMO health benefit plan.The Member’s complaint concerns premium payments refund due to premium payments drafted from the Member’s bank account for 11 months in error. The member is requesting a refund of premium payments.The member’s request for back premium is denied and will continue to be denied. He did not follow the terms of his contract with Coventry which state the following:The Subscriber may terminate Coverage for himself/herself and any enrolled Dependents under the Group Contract for any reason immediately (same day) upon thirty (30) days prior written notice (including facsimile or e-mail) to Us after the first 30 days of Your Contract. Such terminations will be effective at 11:59 p.m. on the termination date provided by the Subscriber in the notice to Us. Retroactive termination will be permitted up to a sixty (60) day time frame provided proof in writing is supplied that other insurance was in effect during that time frame. ([redacted]12/11)• The first documented termination notification was received on 05/05/14.• As a business rule applied to all cases, according to his contract, we will retro-terminate back 60 days.• If the member has proof, that can be validated, of a written termination notification prior to 05/05/14, we will be glad to reconsider the termination date.I have included a copy of the Member’s contract language for your review.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 at ###-###-####.Sincerely,Emily M
Complaint and Appeal Consultant

September 19, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding maternity coverage for her CoventryOne® policy purchased on the Federally Funded Marketplace for an effective date of April 1, 2014. The request was received by CHC Carolinas on August 12, 2014.CHC Carolinas responded in writing directly to [redacted] by 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 CComplaint and Appeal Analyst

[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]

July 2, 2014
Dear [redacted]:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint received by Coventry Health Care on June 24, 2014 which was filed by [redacted]...

regarding overcharges to his account.A review of our records shows **. [redacted]’s overcharges were a result of an incorrect renewal rate being entered into the system. That error was found and corrected. Thereafter, on June 6, 2014 (prior to Coventry Health Care’s receipt of the instant complaint), three EFT transfers were deposited to **. [redacted]’s account in the amounts of $395.11, $395.11 and $109.78, for a total of $900. This should resolve all of the outstanding overcharges.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 [email protected] truly yours,

July 17, 2014
Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding her request for a refund of her June 2014 premium payment in the amount of $491.00. The request was received...

by CHC Carolinas on July 16, 2014.CHC Carolinas does not have a signed authorization release form from [redacted] indicating that the Revdex.com is representing her in this matter, however will contact [redacted] within three business days. We will inform [redacted] that if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within 30 calendar days of receipt of her request.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[redacted] Complaint and Appeal Analyst Coventry Health Care of the Carolinas, Inc

[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. 
Thanks!
[redacted]

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like share the results of the review with you.
We verified that [redacted] was sent the refund for $406.17 on November 21, 2014, to...

his home address on file. I sincerely apologize about how long it took for you to receive this money back and for the administrative hassles you encountered trying to retrieve this money.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 ConsultantExecutive Resolution Team

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 26, 2015.
During our review, it was determined that [redacted]’s policy was active from May 01, 2014 to December 02, 2014 , which is a total of seven months and two days of coverage.  However, Coventry had only collected a total of six months’ worth of premiums as there was a bank rejection for the month of June’s premium.  This is why the owed premium of $172.86 was collected on December 01, 2014. This means the member is caught up and nothing is owed to the member.
In addition, [redacted] requested to terminate the policy through the Marketplace in November. The subsequent file received from the Marketplace on November 18, 2014, contained a termination date of December 02, 2014, which is why the plan was terminated December 02, 2014. Therefore, [redacted] currently owes $11.15 of premium for the two days of coverage for the month of December. If this termination date is incorrect and [redacted] does not wish to pay the $11.15, he may contact the Marketplace at [redacted] to request a termination date of November 30, 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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Julian C[redacted]
Executive Resolution Team

Dear [redacted],
Please see our response below to the additional concerns reported in complaint #[redacted] for [redacted] that were received by us on November 24, 2014. 
In our previous response, we were not stating that a qualifying event was not experienced or that one would be required to make a plan change midyear for an individual policy.  However, that was the reason provided to us by Mr. E[redacted]’s assistant, Adrianna, as to why the plan change process was never completed.  The letter that was sent as Coventry’s response to the previous Revdex.com complaint was fully reviewed prior to our initial response, so a copy is not needed. 
The adjusted pull letters are generated with predetermined text, which does not change whether the adjusted pull process is occurring due to a nonstandard draft amount or a nonstandard draft date.  We were not previously notified by our Enrollment department that an adjusted pull letter was sent in September.  It has been confirmed that one was sent on September 4, 2014, as the scheduled draft for September had been cancelled, so it had to be set up as an adjusted pull. 
We have verified that [redacted]’s policy has been fully terminated on both the enrollment and benefit sides of the system.  We will not be attempting to collect any further premiums or fees from him at this time. 
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.  Our standard process is to offer the e-mail address for the Executive Resolution Team, but if he has additional concerns regarding this matter, he may call me directly at ###-###-####.
Regards,
Chris B[redacted]
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:
The address for my wife [redacted] is still incorrect in the system. Also, to clarify, she has never received an insurance card. (Presumably these have all been sent to the incorrect address, jeopardizing our privacy by sharing this personal information with strangers.) The only reason she was able to visit the doctor now is because we signed her up for a separate online account and printed out the card, but her doctor is requesting the actual card on her next visit.
I will be keeping this open until we receive a physical card for [redacted] at the correct address.
Regards,
[redacted]

[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'm rejecting this answer because: Coventry raised their rates, being an insurance for people with very limited resources,the Withdrawn amount from my account, is the salary of a week and a half of work.I paid for the month of January according to this subject, two companies: Coventry and [redacted].I think I must have a reimburse from Coventry,since I had another insurance company  [redacted],with  rates according Obama care Policy.
Regards,
[redacted]