Coventry Health Care, Inc.

11/21/2014Dear [redacted]:This letter is in response to your grievance (complaint) that you filed with us on 11/19/2014.Based upon our review, we received your written grievance expressing your dissatisfaction with the customer service...

you received. Please accept our apologies about the service you received. Coventry expects that our members are given accurate information in a professional, friendly and timely manner. Please be assured that feedback and coaching have been provided and leadership has been made aware of this incident.On 11/03/2014 you paid $33 for [redacted] 10mg because the preferred pharmacies in your area did not have your medication in stock. You may go to any of our network pharmacies. However, your cost may be less for your covered drugs if you use a preferred network pharmacy. When requesting an adjustment you can send us your request for payment along with your bill and documentation of any payment you have made. It is a good idea to make a copy of your bill and receipts for your records. To make sure you are giving us all the information we need to make a decision, you can fill out our claim form.We are including a claim form with this letter. You do not have to use the form, but it will help us process the information faster. Keep in mind that you must submit your claim to us within 36 months of the date you received the service, item, or drug.We apologize for any inconvenience that you have experienced. Please be assured that this was filed as a grievance and all grievances are reviewed by upper management for future plan process improvements.If you have any questions, please feel free to contact Customer Service at ###-###-####, 24 hours a day, seven (7) days a week. You can request language translation services when you call. TTY/TDD users please call 711 Telecommunications Relay Services.Once again, we apologize for any inconvenience.Sincerely, Advantra Silver (HMO)

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on July 27, 2015.
We show that [redacted] and his spouse were enrolled on the Gold $10 Copay plan with Coventry Health Care of Missouri through the Federal Marketplace effective January 1, 2015, to April 30, 2015.  The initial enrollment file we received from the Marketplace on December 4, 2014, set the Advanced Premium Tax Credit (APTC) for the policy at $1158.   This left the remainder of the premium, $834.50, as the portion for [redacted] to pay.  All premiums were paid for January through April.
On April 9, 2015, a new file was received from the Marketplace that removed the APTC from the policy effective May 1, 2015.  This meant that the entire premium, $1992.50, needed to be paid by [redacted] by May 31, 2015, to keep the coverage active.  A payment was received for a portion of the May premium, $834.50, on April 24, 2015.  Since that was not enough to cover the entire premium, the policy was terminated back to April 30, 2015.  The payment that was received for the May premium was refunded to [redacted] on a paper check on June 19, 2015. 
[redacted] may contact the Marketplace appeals department at ###-###-#### to have them review the APTC. The Marketplace would need to submit a new file to update or correct the APTC if an error is found.
On all the enrollment files Coventry received from the Marketplace, we were given [redacted]’s physical address.  The Past Due and Cancellation letters were sent to that address.  Coventry is required to use only the address provided by the Marketplace for the plans applied for through them.  A previous application for a non-Marketplace policy that we had received for [redacted] had a P.O. Box address but that policy was never instated. 
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]
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 May 21, 2015.
During our review, it was determined that [redacted] had two cases with our Billing and Enrollment department, [redacted] and [redacted]. The initial case [redacted] had an effective date of January 01, 2015, and a termination date of January 31, 2015. The new case, [redacted], was set to have an effective date of February 01, 2015. However, a premium payment for the first month was not received causing the enrollment to be cancelled. The member was making payments to case [redacted] and should have been making the payments to case [redacted].
We were able to work with our Billing and Enrollment department to have case [redacted] reactivated. This will allow [redacted] to make a payment for the owed premium to activate the policy, the payment required to activate the policy is $272.40. He can contact the Billing and Enrollment department at ###-###-#### to make the payment.
We would like to advise [redacted] that since he is on a Health Insurance Exchange policy and is receiving an Advanced Premium Tax Credit, we will not be able to waive any of the premiums for any months of coverage for which the policy is showing as effective.  We are also not able to change the effective dates for the policy without receiving 834 files from the Marketplace.  This means that any premiums that become due upon activation of the policy will need to be paid in order for it to remain active.
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] 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

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.

July 9, 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 the addition of her newborn dependent, [redacted] to her CoventryOne® policy purchased on the...

Federally Funded Marketplace for an effective date of April 28, 2014. The request was received by CHC Carolinas on July 7, 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. An [redacted] Company

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

[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]

[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]

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,

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]

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]

[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]

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,

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

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 February 3, 2015.
We were able to have Coventry’s system updated to show active coverage for Ms. [redacted] and her daughter for 2015.  The update was completed the evening of February 11, 2015.  Please allow 24-48 hours for the policy information to be transferred over to the system that allows pharmacy claims to be processed. 
We apologize for the delay in making the correction. We did note that Ms. [redacted] made multiple contacts with our Enrollment department to have them address the error.  The Enrollment department in turn made multiple requests to have the system updated but they were not handled in a timely fashion.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’ 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 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

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