Coventry Health Care, Inc.

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

Hello,
Thank you for your inquiry, regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the request to cover the overdraft fee we immediately sent the bank statement to the Billing and Premium department and they advised that they would need a rolling bank statement that would show that Coventry caused the overdraft fee. I do apologize that this was not explained in detail in our previous response. Once we receive this we will be happy to review the overdraft fee again.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 9, 2015.
During our investigation, it was determined that [redacted] had two active cases for coverage that overlapped for an extended time period.  This was caused by [redacted] having an existing policy that began July 1, 2013, and then applying for a new policy with a requested start date December 15, 2013.  The application was accepted and he was enrolled on the new policy with the requested start date.  A request to terminate the existing policy was not received causing both policies to be left active.  Both policies were set up for recurring EFT drafts for the premium payments, which meant that the premiums were automatically collected each month.
Our Billing and Enrollment department was able to terminate the policy that began on July 1, 2013, retroactively to December 31, 2013.  The result of that action will be that all premiums collected for that policy for 2014 and 2015 will be refunded to the bank account from which the premiums were drafted.  The refund will include the premium draft for $620.22 that was noted in [redacted]’s complaint.  We respectfully request that he allow 7-10 business days for the refund process to be completed by Coventry.
It was also noted that the policy that began on December 15, 2013, had already been terminated effective January 31, 2015, at the time the complaint was received.  This means that [redacted] no longer has active coverage with Coventry and we will no longer be collecting premium 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 there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

In response to Coventry response. 
#1 - My name is not [redacted]
#2 - My appeal was faxed on 1/15/2015 - yet this response said it was already denied. How exactly did that happen when there was no apparent review
#3 - I nor my husband have never received a letter from Coventry regarding the appeal nor have EVER received a phone call FROM them despite REPEATED messages both via email and phone
#4 - I find the notion that the denials have been upheld ridiculous as [redacted] hospital stated we were never informed of coverage issues as we had no primary care AND how are they denied when the appeal was not reviewed. Their timeline or lack thereof shows Coventry's total disregard of their own stated process.
Regards,
[redacted]

May 30, 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 a claims payment determination for date of service February 19, 2014. The request...

was received by CHC Carolinas on May 26, 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 we 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.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,

Dear [redacted],
Please see our response below to the additional concerns reported in complaint #[redacted] for [redacted] that were received by us on January 14, 2015.
We had been informed previously by [redacted] that she had sent the gift cards and that they had been delivered and received by **. [redacted].  Upon contacting him on January 14, 2015, he stated that he had not actually received them but that he had been in contact with [redacted] and she would be resending them. 
I personally followed up with **. [redacted] on January 23, 2015, and he stated that he has now received the cards.  We do apologize for the extended length of time it took for him to receive what was promised and will be taking steps to attempt to ensure that this does not happen to others. 
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

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on May 18, 2015.
During our review, we found that this policy was created on January 14, 2015, from a file received from the Marketplace on January 13, 2015. The policy had an effective date of February 01, 2015, with a monthly premium due of $226.42 and an Advance Premium Tax Credit (APTC) of $0.00. [redacted] was sent a past due reminder letter dated March 05, 2015, and was given until April 07, 2015, to make the March’s premium payment of $226.42. The policy was terminated on April 08, 2015, with an effective date of February 28, 2015.
Due to the policy not receiving an Advance Premium Tax Credit (NON-APTC), the member has a 30 days grace period. The last payment made was the binder payment on January 14, 2015. The policy terminated correctly. Unfortunately, per business rule, the policy does not qualify to be reinstated.
I apologize for the difficulties and frustration 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] or ###-###-####.
Regards,
Julian C[redacted]
Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
I sent them info and proof that a refund has not been received is there anything legally I can do against them instead of bouncing emails bank and forth in which they just keep lying and stealing my money?
Regards,
[redacted]

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on December 5, 2014, regarding the termination of her policy.  Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you.
We were able to locate the proof of other insurance that [redacted] submitted.  It was received on November 5, 2014, and had already been processed at the time we performed our review.  [redacted]’s policy has been terminated effective October 31, 2014.  Unfortunately, the termination date for policies must be at the end of the month so it is not possible to backdate it to the October 14, 2014, effective date of her other insurance. 
A premium was collected for November due to the termination request not being received in time to prevent the draft process from occurring.  We are showing that the request for a refund was entered into the system on December 13, 2014.  The amount of the refund is $118.18 and will be deposited directly into the bank account we have on file for [redacted].  We ask that she please allow 7-10 days for the refund to be deposited.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

August 22, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to Ms. [redacted] regarding maternity coverage for her CoventryOne® policy purchased on the Federally Funded...

Marketplace for an effective date of April 1, 2014. The request was received by CHC Carolinas on August 12, 2014.CHC Carolinas does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing her in this matter, however we will contact **. [redacted] within three business days. We will inform **. [redacted] that her case is being reviewed and that 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 CComplaint and Appeal Analyst

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
I have still not received a letter that says I have a zero balance and that my account has been closed as of 3/31/15. Ironically I received my monthly bill despite Coventry claiming my policy has been canceled effective 3/31/15. When can I expect this letter?
Regards,
[redacted]

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on June 09, 2015.
Based on our records, [redacted]’s policy, case#[redacted], was created on May 07, 2015, with an effective date of June 01, 2015, per the file received from the Marketplace on May 06, 2015. The members, [redacted]. and her daughter, [redacted] are covered by the [redacted] Coventry Silver $10 Copay MIPP plan, with a monthly premium due of $98.57 and an Advance Premium Tax Credit (APTC) of $273. Per our Claims and Benefits department, the member’s ID # had processed in their system but did not feed over to the billing and enrollment systems. As a result, a manual feed request was sent and the process was completed to update in all systems. The member ID [redacted] is now reflected in all systems.
Currently, the policy is active effective June 01, 2015, and paid through June 30, 2015. On June 10, 2015, [redacted]s was contacted by one of our health concierge via phone but [redacted]s asked the representative to call her back. The representative called back several times but was not able to reach [redacted]s and left a voice mail message. On June 11, 2015, the representative sent [redacted]s an e-mail to offer assistance in selecting in-network providers and advised her to contact customer service at ###-###-#### should she need any additional assistance.
I apologize for any difficulties this situation has caused [redacted]s. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]s’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@[redacted].com.
Regards,
Julian C[redacted]
Executive Resolution Team

May 22, 2014
Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s complaint.[redacted] is currently enrolled with the Health Plan’s BRZ $10 HMO PD CARELINK, effective May 1, 2014. In order for [redacted] to change his plan he will...

need to reach out to his agent of record, **. [redacted] located at [redacted], FL [redacted]. **. [redacted]’s phone number is ###-###-####.In an effort to assist [redacted] with his complaint, the Health Plan has reached out to **. [redacted] regarding [redacted]’s complaint.• 1 st attempt - [redacted], [redacted] on 5/22/2014 at 2:26pm called **. [redacted] at ###-###-####. **. [redacted] spoke to **. [redacted]’s assistant [redacted]. **. [redacted] advised [redacted] that [redacted] contacted the Revdex.com with concerns of his current policy. [redacted] stated that she would contact **. [redacted] to contact [redacted].• 2nd attempt- [redacted] contacted **. [redacted] regarding [redacted]’s policy. **. [redacted] advised [redacted] that she would need to contact the Billing and Enrollment department for additional options for [redacted].
In regards to the wait time, with the unprecedented growth of membership with our Affordable Care Act (ACA) plans the wait time is a little bit longer than usually, but the plan is working diligently to rectify this issue.
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 directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. My fax number is ###-###-####, and my e-mail address is [redacted].Sincerely,

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on December 30, 2014, regarding termination of his policy.  Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you.
We were able to locate a policy for [redacted] and called to speak with him due to the complaint not containing enough identifying information to verify which Coventry member had filed the complaint.  We were able to reach him and verify that we were speaking with the correct person. 
After the complainant was verified, we were able to discuss the complaint with [redacted].  We explained the role the Marketplace plays in health insurance coverage and why all requests for termination need to be made with the Marketplace when a person initially applies for a policy through them. 
It was determined that the previous contacts that [redacted] had made with Coventry to attempt to terminate his policy were sent directly to Coventry using our online coordination of benefits questionnaire.  The information in those requests was reviewed to ensure we were properly coordinating the benefits between Coventry and [redacted]’s other insurance carrier.  Unfortunately, those requests did not allow us to terminate his policy. 
At this time, we are unable to refund any of the premiums paid for [redacted]’s policy.  The premiums we have collected are for the months of active coverage from June 1, 2014, through December 31, 2014.  [redacted] stated that the Marketplace is reviewing his case and he will attempt to request a backdated termination date with them.  In the event that the Marketplace allows a retroactive termination, Coventry will refund any premiums that were collected for the months of coverage after the end date for the policy, once that date is received by us. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

Hello,
Thank you...

for your inquiry, regarding complaint # [redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the complaint we immediately reached out to our Eligibility department to verify that the member’s coverage was active and we had the correct requested termination date on file. We confirmed the member’s policy is still active and paid through the end of the month. The Marketplace file we have received shows a future termination of September 30, 2015.
We confirmed with our Claims and Benefits department the member has the ability to submit his claims until September 30, 2015. Please have the member re submit any claims they may have and reach out to the Claims and Benefits department at ###-###-#### for reimbursement for any out of pocket expenses.
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.
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
We have reached back out to Coventry to verify why this member’s payment...

was lost and if we were ever able to locate the member's check. We verified that the member sent a check in for her premium payment with the member ID listed as the account number with her online bill pay system. This caused the check to go to our holding account, where checks are sent when they are unable to locate a policy to apply them to. Our system is set up to separate and apply checks using the billing case number. A policy will be flagged when a member's policy is reflecting past due amounts. The member's fund were applied in June 2014 and the flag was removed.Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at [redacted], would also like to thank you for sharing your experience with us. It is feedback like yours that helps us address issues and prevent them from reoccurring.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]'s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Thank you,
Ashley S.Complaint and Appeal ConsultantExecutive Resolution Team

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on December 15, 2014, regarding an incorrect premium being charged for her daughter’s policy.  Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you.
We are showing that an incorrect amount was being requested for the premium for the months of October, November, and December.  The amount being requested was $166.57 per month but should have been $122.88.  The system has been updated to reflect the correct premium amounts. The policy for [redacted]’s daughter is currently showing as terminated effective September 30, 2014, due to non-payment of the full premiums for October through December, but it is eligible for reinstatement. 
The premiums for the months of September through December come to a total of $491.52.  At present, we have received one payment for that period in the amount of $210.24. In order to bring the policy current, a payment needs to be made in the amount of $281.28.  This is the amount of the premiums owed for those four months of coverage minus the amount we have already received.  We will waive the $20 NSF fee that was applied when the previous premium draft for $289.45 was rejected. 
On December 22, 2014, we made an outbound call to [redacted] using the phone number we had on file to determine if she still wished to continue with the reinstatement.  Our call was not answered but a message was left with my name and contact information.  She is able to contact me directly at [redacted] with her decision.  Once a response is received, I will notify our Enrollment department to advise them on how to proceed. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

October 10, 2014Dear Sir or Madam:Thank you for allowing us the opportunity to respond in regard to the case filed by [redacted].We have been communicating with [redacted] regarding the process for policy termination. According to our records, [redacted] contacted us on 08/06/2014...

to change his plan. We then received a telephone call from [redacted] on 09/08/2014 requesting that we cancel his policy effective 08/31/2014. At that time we advised [redacted] of the termination process and the required document for him to submit in order to initiate the policy termination. On 09/22/2014 [redacted] called inquiring about the termination of his policy. Our representative explained that we had not received the required document to terminate his policy. Because we not yet received the documentation required to terminate [redacted]’s plan, the policy remained active and we attempted to draft his account for September’s premium.We have since received the required documentation to terminate [redacted]’s policy and his policy was terminated effective 08/31/2014. The September premium was never received as our draft was returned to us from [redacted]’s bank for insufficient funds. We originally charged a $20 fee for the returned draft, however, we have since waived this fee on [redacted]’s account.[redacted]’s complaint has been resolved according to the desired resolution that he requested.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 ###-###-#### and my e-mail address is [redacted].Very truly yours,Shelly UDirector, Service Operations

"Times New Roman";">Dear
[redacted],
Please
see our response to complaint #[redacted] for [redacted] that was received by us on January 8, 2016.
In
reviewing the concerns [redacted] reported, it was noted that she was required
to provide her bank account information again for her 2016 coverage due to a
new billing case being created.  The new
billing case was created based on the way the Federal Health Insurance Marketplace
sent the enrollment files to us.  We
regret any frustration this caused.  The payment
for the January premium was posted to her account on January 6, 2016.
The
last manual ID card request we found was from December 14, 2015.  At that time, [redacted] had reported that
she lost her ID card.  As the policy for
2016 was not yet active, the card mailed was for her 2015 coverage.  After receiving the payment for her 2016
coverage, a copy of her 2016 card was automatically mailed to the address we
have on file.
Finally,
we do apologize for any lengthy hold times that [redacted] has experienced
recently.   Unfortunately, due to the
increase in call volume during the open enrollment period, it can take longer
to reach a representative at times.  The
forty-five minute wait that she reported is not typical and we do strive to
answer all calls as quickly as possible. 
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],
Please see our response to complaint #[redacted] for [redacted] that was received by us on June 18, 2015.
During our review, we found the confirmation receipt from our bank, [redacted], which confirms that [redacted] was provided with his refund of $98.57 on March 18, 2015. I have attached a copy of this receipt for his records.
If [redacted] has bank statements that show this refund did not enter his account, he may e-mail it to [redacted]@healthplan.com. Once received, our Billing and Enrollment department will review and send out the refund again if necessary.
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].com.
Regards,
Julian C[redacted]
Executive Resolution Team