Coventry Health Care, Inc.

Dear...

Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 7, 2015.
During our investigation, we were informed that the free gym membership benefit that Mr. [redacted] is requesting was a Value Added Benefit in previous years.  The benefit was reduced for 2015 to a discount on gym membership fees.  The Coventry account manager for Mr. [redacted]’s plan notified his employer of the change through their Office of Personnel Management (OPM).  Unfortunately, when the OPM created the policy documents for 2015, they did not update the section which lists the free gym memberships as a benefit of selecting Coventry as their insurance carrier.  Coventry was not at fault for the error, and will not honor the free gym membership benefit at this time.  However, we will continue to monitor the situation and if we receive additional information we will communicate it directly to Mr. [redacted].
The link to the document that Mr. [redacted] included in his complaint is an Open Season Guide for Coventry’s Federal Employees plans, but it is from 2013.  The free gym membership was still offered at that time.  An Open Season Guide from Coventry for this past year was not found.    
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]+.
Regards,
Chris Binsfeld
Executive Resolution Team

September 12, 2014Dear [redacted]
Your letter of September 4, 2014 to Coventry Health Care of Virginia, Inc. ("Coventry Health Care") was referred to my attention for review and response,
[redacted] expressed concern regarding the cancellation of her policy and the...

August premium she was charged. Coventry addresses these concerns below.On July 30, 2014, [redacted] contacted Coventry's Billing and Enrollment Department to discuss adding her dependent, [redacted], to her current Coventry.One policy. The Customer Service Representative (CSR) advised she would need to submit a form to add the dependent.
On August 3, 2014, Coventry received notification from the Marketplace [redacted] and [redacted]'s new Gold policy would be effective on September 1, 2014, [redacted] received notification in writing that her new policy would be effective on September 1, 2014 once she made her initial binder payment. According to this information Coventry continued to withdraw $289.19 for the Coventy One policy's August premium from [redacted]'s bank account.
On August 4, 2014, [redacted] contacted Coventry's Billing and Enrollment Department to cancel her policy as she created a new account through the Marketplace, The CSR advised her policy would be terminated and she would need to contact the Marketplace for any additional assistance.
On September 8, 2014, [redacted] contacted Coventry's Billing and Enrollment Department requesting a refund of $289.19 as she terminated her policy as of August 4, 2014. The CSR advised [redacted] she would need to contact the Marketplace.
[redacted]'s Coventry Che policy was prospectively terminated on August 31, 2014 based on policy language and her August 4, 2014 request, 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] would need to contact the Marketplace to request her Gold policy effective date to be updated. If the Marketplace approves [redacted]'s request for an August 1, 2014 effective date then Coventry would be able to review terminating the Coventry Che policy effective July 31, 2014.
Coventry apologizes for any inconvenience this has caused [redacted], 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 have any questions, please contact the Customer Service Department at ###-###-####.
Sincerely,
Teresa E
Complaint and Appeal Program

[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
[redacted],
Please see our response below to the
additional concerns reported in complaint # [redacted]
for Terri
Spiegel that were received by us on September 21, 2015.
We did not mean to cause further aggravation
or frustration for [redacted] in denying her requested refund.  The Department of Health and Human Services
oversees the Marketplace policies and discourages premiums from being waived.  This is especially true in cases where Advanced
Premium Tax Credits are being paid, due to the impact the premiums and tax
credits have on determining a person’s income tax liability. 
Coventry did speak with the provider’s
office in question.  While we were not
able to determine what [redacted] was advised by that office, we were able to
confirm that they are still in network and that the office staff was aware.
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].com.
Sincerely,
Chris B[redacted]
Complaints and Appeals Consultant - Executive Resolution Team

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 13, 2015.
We apologize for the delay in processing [redacted]’s refund.  The error that caused the delay has been corrected.  The refund process was completed by Coventry on February 20, 2015.  The refund was sent by EFT and will be deposited directly into the bank account that we have on file for [redacted].  Depending on the processing times required by her bank, it may take an additional 1 to 5 business days for the refund to be posted to her account.  The amount of the refund is $385.51
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,
Chris B[redacted]
Executive Resolution Team

May 22, 2014
Dear [redacted]:
The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.
[redacted], (the “member”) has filed a complaint. The Member’s complaint concerns plan coverage retro...

termination effective date and refund of premium payments withdrawn by the Plan. The member is requesting a plan coverage retro termination effective date of November 1, 2013 and premium payment refunds for all months since November of 2013.Upon review, as per business rules and the member contract, term requests must be submitted prior to the requested term date. When proof of coverage is received, CHL can retro term back 60 days from receipt of the proof of coverage. This policy has been terminated per business rules for February 28, 2014. A refund has been requested for March through May of 2014 premium payments. The refund will be processed within 3-5 business days and, once processed, will appear back in the member’s account within 1- 5 business days. The total amount of the refund is $169.98.To go any further back with the termination, outside of the established business rules, would require CFO (Chief Financial Officer for the Plan) approval or member validation of prior submission.
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 CHL 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 CHL. 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.
All business rules were followed for this member. CHL received the proof of coverage May 20, 2014 (copy attached). If the member has proof that notice was submitted earlier, he must provide that proof in order for a different determination to be considered.
If you have any questions or concerns regarding this matter I can be reached at ###-###-####.
Sincerely,

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #10343009 for [redacted] that was received by us on December 12, 2014, regarding her Medicare Part B premium reduction.  Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you.
We would first like to apologize for any frustration or inconvenience [redacted] has experienced during the process of resolving her issue.  The particular problem she has reported often requires an extended length of time to correct. 
Our research has found that Coventry’s systems and the Center for Medicare and Medicaid (CMS) systems reflect the Part B premium reduction.   However, the Social Security Administration (SSA) systems do not have this information and consequently they are deducting the full Part B premium from her monthly payments. 
We were able to determine that the issue is related to a change in the last character of her HICN from a “T” to an “A” during 2014.  Beyond that we may never know what exactly caused this, as the research and resolution is handled by entities not affiliated with Coventry.  Unfortunately, this means we also do not have control over the resolution timeframes and can only give our best estimates on how long it may take to be corrected.  Coventry’s role in resolving these issues is confirming that we have correctly identified the person as being eligible for the reduction which has already been done. 
Currently, a ticket is open with CMS and they are working to resolve the issue.  Our last contact with them occurred on December 10, 2014.   Other members who have experienced the same situation as [redacted] have reported that any refunds come from SSA and will usually be noticed as an electronic deposit into a checking account prior to receiving a written notice advising that the refund is being deposited. 
We will be making regular calls to [redacted] to keep her apprised of the situation, even if we have not received any updates, in order to ensure that she knows her request has not been lost or forgotten.  We will also be requesting that outbound calls be made from CMS if the issue has not been resolved within three weeks in order to reinforce what Coventry is stating.  We can not make promises that CMS will place the calls but the request will be made.
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].
Sincerely,
Chris B[redacted]

July 25, 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 [redacted] regarding miscommunication between she and the customer service...

representative whom she reached on the telephone.We regret that [redacted] did not have a good experience when she contacted Coventry to discuss her policy. Because we realize that there could be several explanations as to why the call between [redacted] and the customer service representative was prematurely disconnected, Stephanie H[redacted] from our Local &Regional Business Operations department reached out to [redacted]. According to Ms. H[redacted]’ notes, she originally spoke to the member on July 15, 2014 in the late afternoon around 4:44pm Pacific time. At that time [redacted] asked Ms. H[redacted] to call her back in the morning because her phone was about to quit. Ms. H[redacted] called [redacted] twice on July 16, once in the morning and the other time in the afternoon, but only got a voicemail. She left a voicemail, both times, with her direct number to call her back.Ms. H[redacted] called again on July 17 around 9:47am. She called [redacted]’s home phone number and reached her husband. He asked Ms. H[redacted] to call [redacted]’s cell number, which he gave to her again. Ms. H[redacted] called the cell number and reached [redacted]’s voicemail again. She left another message with her direct phone number and that fact that she could be reached until 5pm Pacific time. Ms. H[redacted] never heard back from [redacted].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] certainly is entitled to a good experience when speaking with a Coventry customer service representative. If there is difficulty communicating with whoever answers her call and, if at any time the call is inadvertently dropped, she should call back and explain the situation to the representative.Very truly yours,Neil M, B.A.Regulatory Compliance Analyst Coventry Health Care

[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 read the review [redacted] / Coventry Health sent to you folks. Almost none of it makes sense to me. They stated that I had a call In January asking about a Copay on something. I didn't even realize that I still had an option to do this. I didn't know I was covered by these people at all.  I have no recollection of this phone call. Last time I talked to somebody in the collection department, they said that because of a particular call, I only had 60 days to receive my refund. I feel like I have been getting the run around for two months so they can avoid giving me a refund.
 The first call I made this year was to tell them that I didn't want to be charged for a policy I did not want. I asked them to stop the payment. They did not. My bank account was overdrafted, then they put the money back in. I have received no compensation for the bank fines, and I am okay with that.
The first call I made this year was to inquire about why a new policy was being started for me. The gentlemen on the phone found out that I had coverage somewhere else and HAD coverage somewhere else, while they were supposedly covering me.... He told me if I provided proper documentation of this coverage, then I was due a refund.  That at some point a mistake was made.... I provided that information. I was told I was due a refund and it would be in the mail. I assumed that it was taken care of and gave them an adequate amount of time to send the refund. I was never alerted that something went wrong or didn't go through. I made a call, they told me they had recieved the letter and the check was in the mail.  I have been lied to many times in the past few months. Lied to about who I was talking to, who I can talk to. People were supposed to call me from upper-management, it never happened.
By all means I did not accept the resolution that they gave me on the phone, I was just about to explode with anger so I politely hung up.
The June 9th part of the statement they sent you is an example of my frustration. I was never inquiring about the payment that was taken out of my bank account then put back in. It was the about the 11 months of payments taken out. 
The June 13th part of the explanation they sent you is wrong. I was calling to inquire about the refund. They ask for your address every single time you call so I may have updated my address. But that is not why I called. They also kept telling me I had more than 1 active policy when I didn't believe I had A single active policy. But it's never why I called.  I really don't know what else to do.
Please help me, and hopefully the others that this company has tormented.
Regards,
[redacted]

face="Calibri">Dear Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 13, 2015.
We have been unable to locate any calls from Ms. [redacted] attempting to set up payment for her policy in December.  The last contact we found where a payment was made was from September 19, 2014.  At that time, the payment made brought her premiums current through September 30, 2014. 
It was noted that the confirmation number she provided is not a valid payment confirmation number or call reference number.  We were also not able to locate a current or former employee of Coventry named Alison M[redacted].  If any additional information can be provided, we can certainly continue to attempt to locate the contact that she indicates took place.  Helpful information that would aid us in any future searches would be the exact time and date of her call and the telephone number that she had called.  Unfortunately, as we were not able to find an error on Coventry’s part, we can’t reinstate Ms. [redacted]’s policy. 
As stated above, the last month that we received payment for was September 2014.  She was given a 90 day grace period starting October 1, 2014, to bring her premiums current.  The process for policies that are given grace periods is to terminate coverage at the end of the first month of the grace period if the policy is still past due after the 90 days.  This means her coverage ended on 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 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

Dear [redacted],
Please see our response below to the additional concerns from [redacted] reported in complaint # [redacted] that were received by us on December 1, 2014. 
We are showing that the policy has been correctly cancelled in Coventry’s systems and are unable to explain why the Marketplace does not show corresponding information. We would like to setup a call between our Enrollment department, the Marketplace, and [redacted] to attempt to resolve this issue. 
A call was placed to her on December 1, 2014, but the call was not answered.  At that time, a detailed message was left offering the phone number and extension that she can call to reach the representative who will complete the three-way call. A response to that message has not yet been received, but [redacted] may still call in using the information provided in the message.  She may also respond to me at the e-mail address listed below with a time that is convenient for her, and I will schedule another outbound call from our Enrollment department.
If you or [redacted] have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

Complaint: [redacted]
I am rejecting this response because:
--------- Forwarded message ----------From: Revdex.com of Metro Washington DC<[email protected]>Date: Mon, May 18, 2015 at 10:17 AMSubject: Fwd: Revdex.com Complaint Case# [redacted] (Ref#[redacted])To: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------
From: [redacted] <[redacted].com>Date: Sat, May 16, 2015 at 3:21 PMSubject: Re: Revdex.com Complaint Case# [redacted] (Ref#[redacted])To: Revdex.com <[redacted].com>, [email protected], [redacted].com
Dear Revdex.com, [redacted],
First, thank you for your help.
This is regarding Complaint Case: [redacted] which was originally filed as Complaint ID [redacted] and Complaint ID [redacted]. Please transfer this to the right Revdex.com person if this is not the right Revdex.com contact. The best way to communicate with me is via my professional e-mail address at [redacted].com. 
History:
previous to 4/22/15 - Neither the Marketplace nor CoventryOne will correctly communicate with me in this previous months about the policy for member ID [redacted]. The Marketplace representative signed me up for Medicaid in February 2015, but made the error of NOT cancelling the CoventryOne policy for member ID [redacted] in February 2015.
4/22/15 - Two complaints were filed with the Revdex.com, Complaint ID [redacted], and Complaint ID [redacted] in regards to this issue.
4/22/15 - CoventryOne customer service was called and Coventry didn't wish to speak with me about the issue, promptly transferring me back to the Marketplace. 
4/22/15 - The Marketplace representative submitted an escalation case ID: [redacted] for policy of member ID [redacted], which assigns a retroactive termination date and asks for the removal of any previously assigned fees in relation to this case. In this case, the amount of fees is $406.95. They asked me to call Coventry to review the status of my escalation case in 5-7 business days at###-###-####. I am not sure if Coventry reviewed this case. The Marketplace asked me to call them back in approximately a month.
4/30/15 - Julian C[redacted] from CoventryOne/[redacted] stated, "Once we receive the termination file from the Market Place, we will be able to process [redacted]’s request."
5/16/15 - The marketplace case ID: [redacted] is checked on by calling the Marketplace. They stated my escalation case was closed because they were "unable to terminate policy due to health insurance..." for whatever reason. They will not file another escalation case for whatever reason. 
Please retroactively terminate this policy to February 2015, and cancel the $406.95 in charges. This policy for February, March, and April was never supposed to exist as I was on Medicaid at the time. It is not my fault the Marketplace representative forgot to cancel it at the same time he/she signed me up for Medicaid instead.
Thank you again,
Daniel I[redacted]

Dear [redacted],
Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on February 10, 2015.
During our review of [redacted]’s concerns, it was determined that the bill for the $225.15 that she will owe back to Coventry has not yet been sent.  We have made a request with our Billing and Enrollment department to have that process expedited.  Coventry has not made any attempt to draft the amount from [redacted]’s account and will not do so.  The bill will contain instructions on how to make the payments.
In my initial response, I had stated that it is possible for [redacted] to be reimbursed for any overdraft fees that were applied to her bank account due to this situation.  If she wishes to seek reimbursement, she will need to send in a bank statement that supports the amounts of any fees and the dates they were applied. 
While our normal process is to offer the e-mail address as a point of contact for additional concerns, if she wishes to speak with me over the phone she can call me directly at [redacted].  I will not be able to accept any payments or make the decision on reimbursement for fees, but I would be able to help explain any parts of either of my responses that need clarification.
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].
Sincerely,
Chris B[redacted]
Executive Resolution Team

October 1, 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 Whitney Michel regarding a refund for payments made after his policy...

terminated.After research into this matter, it was found that the member made five payments to the policy, each in the amount of $259.09. The effective date of the policy was January 1, 2014, and the effective termination date of the policy was March 31, 2014. Two payments of $259.09 were returned back to the member, one on June 2, 2014, and one on June 11, 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 MRegulatory Compliance Analyst

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 a refund that was requested due to a premium payment overage.  Our Executive Resolution Team researched your concerns and we 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 show that his initial call advising that a refund was due was received on August 5, 2014.  He also called on September 5, 2014 and September 26, 2014, to request the refund be sent and then called again on October 17, 2014, to request it be expedited.  We confirmed that the refund was reversed back into his account on November 10, 2014, in two separate payments.
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

December 19, 2014Dear [redacted],
Your letter of December 10, 2014 to Coventry Health and Life Insurance Company (Coventry) was received in our office, and referred to my attention for review and response.
In her objection submitted to the Revdex.com, [redacted] voiced displeasure with Coventry's response to her complaint. The Garzonis had an employer group Health Reimbursement Account (HRA) along with a Coventry medical policy. An HRA is a US Internal Revenue Service (IRS)-sanctioned employer-funded, tax-advantaged employer health benefit plans that reimburse employees for out-of-pocket medical expenses and individual health insurance premiums. Employees are reimbursed tax-free for qualified medical expenses up to a maximum dollar amount for a coverage period. HRAs reimburse only those items (co-pays, coinsurance, deductibles, and services) agreed to by the employer which are not covered by the employer's selected standard insurance plan.
At the time the claims in question were processed, neither the up front nor the deductible had been met. [redacted] had $1,010,45 left to go to meet her individual $2,500 deductible on the medical plan and $510,45 left to go to meet the family $2,000 up front with the HRA. The medical plan applied the $1,010.45 to meet the deductible and paid the remaining $455.98 of the allowed amount. That information was forwarded to the HRA. The HRA considered the $1,010,45 that medical left for the member to pay, applied $510.45 to mect the up front, and paid the remaining $500.00.
Of the total allowed amount of $1,466,43, the medical plan paid $455.98, which was the amount above the remaining deductible, and the HRA paid $500,00, which was the amount applied to the deductible that was above the remaining up front. That left [redacted] responsible for the remaining $510.45 that was applied toward and met both the deductible and the up front requirement per her HRA.
Coventry did process the claims correctly and applied the charges [redacted]’s deductible correctly, Coventry can not guarantee any charges or payments until the claim has been processed. Unfortunately, [redacted] was quoted the HRA benefits for a single member when her plan was for a family. The employer group requires $2000,00 to be paid up front before the HRA would pay on the plan. [redacted]’s appeal for this matter was reviewed by a Grievance Committee. The original processing of the claims was upheld as they processed correctly,Sincerely,Shawn M.Complaint and Appeal Analyst

I am rejecting this response because:
Nature of Complaint:
Customer Service Issues - Customer service failed to provide assistance
Problem:
I filed complaint #[redacted] previously, but the company failed to resolve the issue as promised, and has in the process created more issues that they refuse to resolve. First, calling customer services is unreliable. Representatives hang up on me when I use LucyPhone software to wait on hold for me, and this is unacceptably poor customer service. This was mentioned in the previous complaint and nothing was done to address it. The previous complaint was that my wife was not in the system, and ultimately she had no insurance card since January 1. Now (months after the previous complaint was filed, and after I have repeatedly called customer service since then) she is apparently in the system, but she has yet to receive an insurance card. Also, in the process of selecting a doctor for my wife [redacted], Coventry changed my Primary Care Provider. In setting up an online account, I noticed that they had an incorrect address for my wife [redacted]. Although we are on the same account, my address is correct but hers is not. The site said to call the Healthcare Marketplace to change it, but the Marketplace assured me that they had the correct address because it was submitted with mine. I called Coventry then, and they initially refused to change her address. Finally they promised they would, along with changing the doctor. Two weeks later I called back because neither had been changed, and it turned out they changed my doctor to the one I had requested my wife's be changed to. I again requested that the address be corrected and explained who our doctors needed to be. They changed my wife's doctor finally, to the one I requested, but they still have not changed mine back to correct their mistake, and they still have not changed her address in the system. At this point calling them again seems pointless because they agree to do what I request but fail to do it. Also, the previous complaint requested a refund for [redacted] since she was not put on the insurance as of January 1. Coventry promised that they would look into this, but I have heard nothing about it. This is a subsidized insurance plan under the ACA, but my income is going up this year and I may lose the subsidy. If that occurs, I do not wish to have to reimburse the government on my taxes for months of healthcare which my wife DID NOT RECEIVE. I expect a refund for the difference in cost between two people having insurance (what was paid to them) and one person having insurance (the service I received), from January 1 to July 1, 2014. While the account was paid by the ACA, this refund should be sent directly to me as I will have to repay it on my 2014 tax return.
Desired Outcome:
I want my doctor set to [redacted] as I had previously requested (3 times now!), and I want my wife's address set to the same as mine, [redacted] as I have requested twice now. I am also reiterating my request for the refund for [redacted]'s portion of the premium, to apply from 1/1 to 7/1/14.
Regards,
[redacted]

October 10, 2014
Dear [redacted]:
Your letter of October 1, 2014 was received in our office, and referred to my attention for review and response.In her complaint to the Revdex.com, [redacted] expressed concern that her claims for dates of service April 22, 2014 and...

April 23, 2014 processed at the out-of-network rate, even though she went to the provider listed on her insurance card. During the investigation, Coventry identified that [redacted] was assigned a Primary Care Provider (PCP) that is not a participating provider in her policy network. This incorrect assignment occurred during [redacted]’s enrollment with the Marketplace. Coventry continues to work with the Marketplace to remedy errors of this nature.Based on the circumstances of the complaint, Coventry will allow a one-time exception to process the April 22, 2014 and April 23, 2014 services at the in-network benefit level. Please allow 7-10 business days for the adjusted Explanation of Benefits (EOBs) to be issued. Coventry will provide [redacted] with the EOBs once they are available.Our goal is to provide the opportunity and resources for [redacted] to establish care with an in-network provider. [redacted] may visit the website at www.chcne.com, and choose the Carelink Powered by MIPPA link. [redacted] may also call our Customer Service Department at ###-###-####, in order to find a Participating Primary Care Provider in her Open Access Point of Service (OA POS) MIPPA network.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted]
Sincerely,
Shawn M
Complaint and Appeal Analyst

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 26, 2015.
During our investigation, it was noted that a request had already been sent to have the claim in question processed at the in network level on February 26, 2015.  The request was handled on February 27, 2015 and the claim was reprocessed.  The reprocessed claim shows [redacted] as no longer being responsible for making any payment.
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,
Chris B[redacted]
Executive Resolution Team

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 11, 2015.
During our investigation, it was determined that a renewal notice was sent to [redacted] to advise of the plan change that took place January 1, 2015.  Coventry’s system shows the letter was sent September 26, 2014.  As the proper notification was sent, we are not able to find an error on Coventry’s part and will not be able to refund any portion of the premiums we collected for his coverage for 2015.
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,
Chris B[redacted]
Executive Resolution Team