Coventry Health Care, Inc.

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],
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

Member monthly billing statements are generated between the 8-13th of every month; premium payments are due by the 30th of the prior month. Unfortunately, a refund will not be issued to the member since the...

policy is currently active. Our records show [redacted] obtained her coverage through the Marketplace; therefore a request for termination must also be done through the Marketplace. Once the policy has been terminated, then the member will receive a refund for any additional premiums paid after her termination date.
If [redacted] has any further questions she may contact our Executive Resolution team directly at [redacted]@aetna.com.
Thank you.

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

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]

[redacted]...

[redacted]
The issue has been resolved at this point.  I just hope we don't have additional issues with dealing with them in the future.  thanks for your prompt response on this.Sent from my [redacted]

February 7, 2014
Dear **. [redacted]:
The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.
The Member’s complaint concerns premium payments deducted from...

the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $1438.00
Upon review, the member’s policy is still active and the member was drafted on February 5, 2014 for the premium owed for January and February plus a $20 service charge for the January premium that was unpaid by the bank because the member stopped payment on that draft. If the member wants the policy terminated, the member would need to send a signed termination form to enrollment. (attached) If the member wanted her policy termed as of December 31, 2013 we need the signed term form requesting a December 31, 2013 term date, and proof of new coverage in effect as of January 1, 2014. Without the proof of new coverage, we would process the member’s term request now for a February 28, 2014 date.
If you have any questions or concerns regarding this matter I can be reached at ###-###-####.
Sincerely,

February 26, 2014
Dear [redacted]This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to a complaint submitted by [redacted] regarding an his CoventryOne policy purchased on the Marketplace exchange effective January...

1, 2014. The request was received by CHC Carolinas on February 26, 2014.CHC Carolinas does not have a signed authorization release form from [redacted] indicating that the Revdex.com is representing him in this matter. CHC Carolinas will respond directly to [redacted].Please contact me if you have any further questions involving this issue. I can be reached at ###-###-#### between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.Sincerely,Stephanie * H[redacted], LPN Manager, Complaint and Appeal Programs 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 gave you a copy of my house loan bank statement showing that I had to pay an extra $63.66 because my payment was late.  The reason my house payment was late was because I was double charged by Coventry for the month of April automatically taken out.  I then called Coventry 3 different times, talked to 3 different people, who all assured me I'd have a refund of over $500 in 3-5 business days.  So I waited and waited to get my refund so I could make my house payment and not bounce.  After none of those employees came through with what they told me they'd do, I had to wait until I got paid again from work to make the payment, 2 days late, thus having to pay an extra $63.66.  If I would have made the payment before my promised refund hit the bank, taking their word (glad I didn't), I would have had an additional $30 fee from my bank plus a daily fee for being negative until money was put in there. 
 It is completely ridiculous that you won't agree to just pay this fee.  Broken promises from 3 separate employees, hours on the phone trying to get this figured out, and having to reply to these emails is exhausting.  You will be losing  my business and $2160 next year if this doesn't get resolved to my satisfaction versus $63.66 if you just pay the late fee.   Obviously customer satisfaction is not important to Coventry-this experience has been very unpleasant.
Regards,
[redacted]

June 11, 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 Katie Boyer regarding a question of the effective date of her policy and the...

subsequent charge for the month of December.After a review of the situation, we requested approval to update the effective date to December 31, 2014. Once approval was received, the effective date of the policy was updated and a credit of $287.43 (30 days of premium for the pro rate) has been applied.The bill should now show correctly on the member portal.[redacted] cannot have a plan with an effective date of January 1, 2014 because that would require her to be on a new ACA (Affordable Care Act/Obama Care) plan. [redacted]’s current plan is only available to those with an effective date prior to January 1, 2014. To satisfy [redacted]’s needs and also following business rules, we were able to make the member effective December 31, 2013 and issue a refund for 30 days of December instead of a full month (31 days).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,

I have called Coventry, the [redacted], I was thinking calling the White House!!! they are a disaster and they are stealing from people, we already arranged insurance outside of their program. Never received ID cards, they are not even available online, customer service is a joke. They should return the charged premium they charged for January.
Attached you can see that even last invoice received on 1/24 does not have an ID number. letter with ID # got to us on 1/27. Why do we have to pay for a month if there was no coverage?
Rgds,
[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]

[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]Company has sent check dated 7/17/14 in the amount of $491.00.  However, it is worth noting:
My first refund request of 6/20/14, where upon I was given a refund deposit date of 7/1/14 was assigned confirmation number [redacted].
During my second refund request of 7/4/14, when I attempted to give the rep both my cancellation confirmation number [redacted] and the aforementioned refund request confirmation number,  I was told that neither number would help the rep in resolving my issues or look up the history of my file.
Therefore, it seems to me that confirmation numbers are given as a smoke screen if Coventry now takes the position that they have no record of my request for a refund prior to July 16th.
I did not contact Coventry on July 16th, my last contact with Coventry was July 10th.
I would like to know what records does Coventry possess of a phantom phone call, and the purpose of assigning confirmation numbers?
Regards,
[redacted]

Thank you for the attempted phone call.  I am out of the country and unable to take phone calls at this time.  However, I have resolved the issue myself by signing up for another health insurance program, [redacted].
Regards,
[redacted]

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on May 29, 2015.
During our review, it was determined that starting January 01, 2015, the member was enrolled in a ([redacted]) Coventry Plan with a premium of $194.59 and an Advance Premium Tax Credit (APTC) of $434.00. Regarding [redacted]’s complaint, we are unable to reinstate the policy. The January payment that was returned on January 08, 2015, was for a payment that was never received for the month of June in the amount of $198.82. Our systems did not charge the member in June and our systems did not recognize the problem until January 08, 2015.
As of today, the policy is showing a termination date of January 31, 2015, with a paid through date of January 31, 2015. The payment that the member made in January went towards the June coverage. Therefore, the payment made in February went towards the January coverage. Because the member only had a three month grace period, the member would have had to make the February and March premium payment by March 31, 2015, to avoid termination.
On April 01, 2015, [redacted]’s policy terminated effective January 31, 2015. The member was refunded $195.77 on April 10, 2015. In order to request a reinstatement; the member will need to send in a copy of her bank statement for June showing there was a draft. If no draft occurred for June, we cannot reinstate the policy.
I apologize for any difficulties this situation has caused [redacted]. 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 to complaint #[redacted] for [redacted] that was received by us on January 8, 2015.
During our research, we determined that [redacted] has been receiving an Advanced Premium Tax Credit (APTC) through the Marketplace since beginning her coverage with Coventry on April 1, 2014.  A letter was sent to her on October 25, 2014 advising her that her premium would increase and telling her to update her information with the Marketplace to make sure that she received the full amount of the APTC to which she was entitled.  The letter explained that the deadline for making any updates that would take effect January 1, 2015, was December 15, 2014. 
Coventry did receive notification from the Marketplace that the APTC amount has been increased beginning February 1, 2015.  Unfortunately, Coventry is not able to backdate the APTC or reduce her premium prior to that date as we are required to adhere to the information we receive from the Marketplace.  The premium owed for January 2015 is $53.15.  Effective February 1, 2015, her premium will be lowered to $26.15.  At this time, [redacted] still owes an additional $36.83 for her premium for January 2015.  In order to maintain her coverage with Coventry, she must pay that amount and her premiums for February and March by March 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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

April 18, 2014Dear **. [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 premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $216.79. Upon review, the member’s policy has been terminated as never in force and a refund for the amount of $216.79 has been expedited.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 March 5, 2015.
During our investigation, it was determined that the information Ms. [redacted] had been seeking from Coventry was the Usual and Customary (U&C) rate for a procedure that was going to be performed by a surgeon that was stating they were out of network.  The U&C rate is important because the benefits for the procedure are only applied on the amount up to that rate.  Any billed amount for a procedure that is above the U&C rate would need to be paid by the patient if the provider of services chooses to bill for it. 
We noted that the doctor, [redacted], is listed as an in network provider.  This means they have a contracted rate for the services they provide and the U&C rate does not apply.  We contacted the Provider Relations representative with Coventry for Dr. [redacted], Joyce W[redacted].  Ms. W[redacted] was not aware of any contact from the doctor’s office requesting to terminate their contract or any reports of any problems they experienced. 
We were able to speak with Molly with Dr. [redacted]’s office on March 13, 2015.  She indicated that Ms. [redacted] is no longer going to have the procedure performed with Dr. [redacted].  We advised Molly that if Dr. [redacted] wants to become out of network, their best avenue would be to contact Joyce W[redacted] to begin the process.  We also informed her that they are still considered in network at this time and any claims received will be processed according to their contracted rates.
We were able to locate additional information on the process for obtaining a U&C rate, in case it is needed by Ms. [redacted] in the future.  All requests must be sent in writing and should include the procedure code for the service that will be performed, the zip code where the procedure will be performed, and the amount that will be billed by the provider of services.  The address for sending requests for U&C rates is: Coventry Health Care, [redacted], London, KY 40742-7121.
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

September 18, 2014Dear [redacted]:I am writing in response to the Revdex.com complaint filed by [redacted] regarding his individual health insurance coverage with Coventry Health Care. In his complaint, [redacted] states he signed up for health insurance coverage...

with Coventry through the Marketplace in December of 2013. He received notification of his coverage and premium amounts; then, on May 28, 2014, he received a letter from Coventry stating that the coverage he had selected was not available in his area. However, Coventry continued to take premium out for coverage at the end of May and June, and he had to put a stop payment on his account to prevent further withdrawals. He is asking for a full refund of the premiums he has paid for the past seven months, since he was not eligible to have coverage through Coventry during this time period. He has been trying to get this issue resolved through Coventry and the Marketplace without success. He has filed the instant complaint in order to try and achieve resolution of this matter.Our records reflect that [redacted] did enroll in individual health insurance coverage with Coventry through the Marketplace effective January 1, 2014, with a monthly premium payment of $257.58. However, in May, the Marketplace notified Coventry of an issue with healthcare.gov that allowed a limited number of consumers to enroll in plans outside of their service area. The Marketplace identified the impacted states, legal entities and issuers, and then the issuers, such as Coventry, were to identify those members who were allowed to enroll (in error) in a plan outside their service area during a specified time frame. The Marketplace then required issuers such as Coventry to send out letters to members impacted by the healthcare.gov system error. That letter mailed on May 28, 2014, to [redacted], and he has included a copy of that letter with his complaint. We also did subsequently send a termination letter to [redacted] terminating his coverage effective as of July 24, 2014.[redacted] received a partial premium refund in the amount of $58.16 for the July premium paid on June 30, 2014. In order to receive a refund for the premiums paid in the amount of $1,744.90 and request to have the policy terminated as “never-in-force,” the member will need to contact the Marketplace. Coventry will have a representative contact [redacted] and the Marketplace to request this change.I hope this addresses your concerns in this matter. Should you require additional information or have any questions, please contact our Customer Service Department for more information.
Sincerely,
Linda L.
Regional Director Regulatory Compliance

September 23, 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 your request received by our office on July 18, 2014. This letter is in response to the...

consumer complaint filed by [redacted] regarding a needed correction in the subsidy on her policy.This member is currently enrolled in a fully insured, non-grandfathered, PPO, individual health insurance plan with Coventry Health Care as of January 1, 2014 through the on-exchange Marketplace. The member's instant complaint is regarding a change in premium and subsidy she believes should have been effective since May, Coventry Health Care received a file from the Marketplace on May 17 to change the member’s premium amount to $60,52. Unfortunately, this file contained an error which did not allow it to process the change automatically in our system as intended. We identified the issue on July 7, and manually adjusted the member's premium to $60.52 effective as of July 1 as listed in the Marketplace file. The member's billing was adjusted to correctly Show the amount due in response to this change in premium, and a payment history is attached. The member's premium is now current through September 30.
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

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 9, 2015.
During our investigation, it was noted that [redacted] policy for 2014 was terminated due to nonpayment of premiums.  The last payment received was for September 2014.  The policy was applied for through the Health insurance Marketplace and [redacted] family was eligible for an Advanced Premium Tax Credit.  This meant that they were given a grace period to allow them an extended period of time to pay the premiums prior to our termination of the policy.
The policy entered the grace period beginning October 1, 2014, as we did not receive a payment for that month.  In order to keep the policy active, Coventry would have needed to receive payments that brought the amount owed for premiums back to $0 by December 31, 2014.  The amount owed for October through December 2014 would have been $276.03 or $92.01 per month.  Since no payment was made by the end of the grace period, the policy was terminated back to the end of the first month of the grace period.  The exact termination date is October 31, 2014.
An error did occur that left her policy active past the October in our claims processing system.  This error has been corrected and any claims that were allowed past October 31, 2014 will be reprocessed and denied.  We are not able to reinstate the policy.
We were only able to locate one call to our billing and enrollment department during the grace period.  It occurred on December 15, 2014.  The amount that was quoted as owed at that time was $396.76.  This included the $276.03 that was owed for October through December 2014, and also $120.73 that would have been owed for January 2015 if the policy had remained active.  Letters were sent on October 7, 2014, November 18, 2014, and December 6, 2014, advising of the amount owed to bring the policy back to current and the consequences of those payments not being made.
A full review of the claims for [redacted] family was also done to determine if any deductible had been applied on claims from March to June.  We found that no deductible had been applied as all services had been billed by in network providers and the policy did not have a deductible for in network services. The first claims we received that had deductible applied were for services rendered beginning in August.  Those services were performed by an out of network provider.  The total amount of deductible applied on the out of network claims for the family for 2014 was $3142.04.  This total amount applied for the whole family would not have been enough to satisfy even one person’s individual out of network deductible for either of the plans that covered them in 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,
Chris B[redacted]
Executive Resolution Team