Coventry Health Care, Inc.

October 17, 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 his questions on what types of services go to his deductible.
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 surgery that was scheduled for September 11 and the current deductible he has met to date. The member believes his deductible should already have been met due to doctor visits, ER visits, laboratory services, and diagnostic services to date for the calendar year.
As of September 23, the member has met $62,31 of his $1,750.00 annual, in-network deductible; however, he has already met his 2014 out of pocket maximum.
In Coventry Health Care’s response to the Missouri Department of Insurance's inquiry regarding this same member, we attached an Explanations of Benefits and spreadsheet explaining which services applied to the member deductible. We arc not including this information herewith due to HIPAA concerns.
This member’s deductible and out of pocket maximum reset each calendar year, and as such, since the member has met his out of pocket maximum for 2014, he will not experience a cost share on any service through December 31, 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 [redacted], extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]
Very truly yours,
Neil M
Regulatory Compliance Analyst

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on December 30, 2014.
[redacted]’s policy has now been terminated.  The termination date was entered as January 1, 2015.  This caused our system to consider the policy as active for January 1, 2015, and prorate her refund amount.  We collected $179.97 through the EFT draft on December 31, 2014 for her premium for January 2015.  This calculates to a premium amount per day of $5.81 for the 31 days in January.  A refund was deposited into her bank account on January 9, 2015 in the amount of $174.16.  We are still working to determine if we are able to backdate the termination to December 31, 2014, which will allow us to refund the additional $5.81 that was kept as payment for the premium for January 1, 2015.  We respectfully request that she allow 7-10 days for additional action to be taken regarding that situation.
We do apologize for the frustration [redacted] has experienced in seeking resolution for this issue.  We are unable to offer any reimbursement for her time spent.  However, if any overdraft fees or ACH return fees resulted, we can review those for possible reimbursement if a bank statement supporting the amounts is provided. 
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

Complaint: [redacted]
I am rejecting this response because: 
The first three times were unscheduled phone calls. I have set work schedule and cannot answer unscheduled phone calls. The fourth time was scheduled, but they did not honor the arrangement. The call was scheduled at 1:00 PM sharp on 6/11/2015, and I did not receive a call until 1:11 PM. I assumed that they forgot the call by by 1:11 PM and was indisposed. In 10+ years of business, I have never received a business call that was not either 5 minutes before the stated time or exactly on the time stated.Regards,
[redacted]

I have NEVER seen such a slipshod operation. Coventry Health Care offers NO real care, no response and no customer service."We've cleared the path for you to control your own healthcare" boasts the banner, on Coventry's website. They're also busy clearing the path for you to pay for and PROVIDE your own health care. Eventually, they'll send you a "DIY Surgery Kit" -- you'll do the cutting and suturing - but you'll have to pay THEM, because "hidden costs".
It has always been a painful struggle to get any response via email. They don't cover anything, and phone encounters have been a nauseating 3-ring circus of non-communicative exchanges with incompetent "customer service" representatives.
I signed with Coventry for a child's health care. "Oh, yes - children are our priority" began the mantra. They started early, giving me the one step forward, two steps back treatment. That should have been a red flag. We won't cover A, but if you go to B, they'll refer you to us to cover C, and then you can file for A. But we don't cover A, so file for A and see what happens, cause we love paperwork.
The list of "covered" providers. On a list of 20, 17 were no longer accepting Coventry as a carrier. (Golly, wonder why?) Of course Coventry reps wanted to argue with me on this, even after I'd gotten the info directly from the provider. And mysteriously, providers who did accept Coventry coverage -- Coventry didn't have listed. Right hand, left hand - who's minding the store?
Last straw. I called to transfer coverage for my move to another state. "You'll get a call back to confirm that within 2-3 days." Of course I had no call from them. After a week, I called back. No one had any record of that conversation. I was put on a 20 minute hold. I called back. This representative insisted I'd have to wait for paper mail - no one could email me any information - it just wasn't done. They email me junk 3 times a week, but this question couldn't possibly be confirmed via email. I asked to speak with a supervisor and was suddenly, magically disconnected. What a shock. The new address is in a state that Coventry supposedly covers. What, like they've been covering me? No thanks.
Coventry provides no response, no straight answers, returned phone calls or any kind of information - EVER. It's been a nightmare trying to find out what, if anything, they cover - and when claims will be processed. The answers: "nothing" and "wait and see".
Final act of bad faith: On August 23, I went into a CVS pharmacy to get a monthly prescription filled. The PHARMACIST - not a Coventry Customer Service agent - told me my insurance policy had been terminated the day before. No notice from Coventry. I paid my premium August 5. They had NO trouble taking the money. Providing consistent coverage, however, is apparently a big challenge for them. So I'm terminated... fine. Good riddance to bad rubbish.
Coventry is a bad joke.

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 17, 2015.
We are showing that [redacted] currently owes premiums for January and February 2015.  The plan that had covered his family for 2014 was no longer offered for 2015 so he was renewed automatically renewed with a similar plan.  The premium owed for the new plan after factoring in the Advanced Premium Tax Credit (APTC) was $493.57.  Coventry received an update from the Marketplace advising that [redacted]’s family was to be changed to a different plan effective February 1, 2015.  The new plan has a premium of $165.39 after the APTC. 
[redacted]’s premium payments have all been made for 2014.  While payments for some of the months were made after the due date, they were eventually received and nothing is currently owed for 2014.   The current amount owed for premiums for 2015 is $658.96.  This includes $493.57 for January and $165.39 for February.  An attempt to pay $165.39 by EFT was made on February 9, 2015, but the transaction was unable to be completed due to invalid account information according to a notice we received on February 12, 2015. 
At this time, the policy is in the three month grace period that is granted to those who are receiving APTCs.  The grace period guideline is that all premiums must be paid to current by the end of the grace period.  If the policy is still past due at the end of the grace period, it is to be terminated back to the end of the first month of the grace period. In this case, if the full amount is not paid the termination date of the policy would be January 31, 2015.
We are showing that Coventry received a file from the Marketplace on February 19, 2015, requesting to terminate [redacted]’s policy effective February 28, 2015.  In order to keep the policy active for February, we would need to receive the premium payments for January and February. 
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 to complaint #[redacted]
for [redacted]
that was received by us on November 30, 2015.
It
was found that [redacted] was not considered as an authorized representative
to act on his son’s behalf.  We were able
to reach out to his son, [redacted], to obtain the necessary authorization for this
situation and have mailed him a form that can be completed to authorize his
father to act on his behalf in the future. 
Upon
receiving the authorization from [redacted], we provided the details of the
resolution reached directly to [redacted] and he accepted our resolution.  Due to the protected health information
involved, the details are not being given in this response. 
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr. Khattak’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

February 27, 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 $1439.70
Below is a timeline of events leading up to the resolution of the member’s complaint.
December 3, 2012 11:59 AM - A new application was received.
December 7, 2012 5:26 PM - [redacted] contacted billing and enrollment to verify the draft date. She stated that she was advised by her agent that her first premium would not come out until the day the policy was effective. The member was advised that the first payment would be drafted upon the issue date.
December 16, 2012 3:50 PM - [redacted] contacted billing and enrollment and stated that she spoke with a representative named [redacted] on December 6, 2013 in regard to her renewal. The member stated that the representative had not returned her call. The member was advised that her new plan became effective January 1, 2014 and the new premium amount is $334.24.
January 15, 2014 - An EFT return letter was mailed.
February 5, 2014 11:16 AM - [redacted] contacted billing and enrollment in regards to the draft. He stated that his wife never agreed to renew the policy and applied through the MarketPlace effective January 1, 2014. The member stated that we had attempted to draft the premium in January however he placed a stop payment and the agent was supposed to have the policy terminated. He was advised that we did not have a written request on file. The member was advised to submit a written request with proof of other coverage and the policy would be retro terminated and we could request a refund. The member was provided with the correspondence address and case number.
February 10, 2014 2:58 PM - [redacted] contacted billing and enrollment he stated that he was supposed to have a supervisor contact him. The member stated he had contacted billing on February 6th and that he wanted a refund for the amount that was drafted. He stated that he placed a stop payment at his checking account because he did not want to be charged any late fees, but he was charged for not making the payment and administrative fees. The member requested to speak to a supervisor, and a request for a supervisor call back was placed.
February 14, 2014 11:23 AM - [redacted] contacted billing and enrollment to verify the status of the refund. She was advised that $688.48 returned on February 13, 2014.
February 20, 2014 - An EFT return letter was mailed.
ROOT CAUSE:
The member wanted to terminate her coverage for December 31, 2013 however we never received proof of other coverage. This information was requested, and to date we have not received the requested proof of other coverage.
RESOLUTION:
The members policy is currently active, however it is on [redacted]. The policy will eventually terminate for nonpayment. If the member wants to retro terminate for December 31, 2013, we will require a handwritten request with proof of other coverage. We do not have any calls on file that mention the termination.
If you have any questions or concerns regarding this matter I can be reached at ###-###-####.
Sincerely,

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 18, 2015.
We contacted the office manager at [redacted] Vision who stated that [redacted] came into the office with her father, [redacted] who is also a member of this plan. They both received eye exams and ordered eyeglasses.
[redacted] has a $400.00 benefit per calendar year for eyeglasses on her plan. The eyeglasses she selected were fully covered by the plan. However, she was charged $98.00 in error. The error was discovered and the $98.00 was refunded to her [redacted] on March 10, 2015.  
Her father, [redacted] has a $250.00 benefit per year for his eyeglasses. He chose a pair of glasses that was over his allowance. He was charged an additional fee of $80.00 for his frames. [redacted] also chose transition and non-glare lens. Since these are not covered by the plan, he was charged an additional $79.00 for the lens. All these fees were charged to [redacted] with her permission.
We contacted [redacted] on March 26, 2015, and she confirmed that the $98.00 overcharge was refunded to her [redacted]. She also informed us that her father, [redacted] was not satisfied with the additional fees for his eyeglasses. He returned to the provider’s office and chose a less expensive frame that did not exceed his benefit. He received an $80.00 cash refund from the doctor’s office. He did choose to keep the transition non-glare lens.
[redacted] advised she is satisfied and that the issue has been resolved. However, she was not satisfied with the service she received from the customer service representative that she spoke to after this incident. This issue has been forwarded to the representative’s supervisor for review and appropriate action will be taken.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted].  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

[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 do not accept the response made by Coventry to resolve
this issue. First of all, no one from Coventry or the Marketplace has attempted
to contact me to resolve this issue. Secondly, the Marketplace did not take my
insurance premiums in the amount of $1,744.90, Coventry did. Coventry took this
money every month as an automatic withdrawal from my bank account, not the Marketplace. I understand that
I signed up for Coventry through the Marketplace, but the Marketplace never
took any money from me. All this money was paid directly to Coventry!!
Regards,
[redacted]

--------- Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Thu, Mar 12, 2015 at...

9:14 AMSubject: Fwd: [redacted]To: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted] <[redacted]@[redacted].com>Date: Wed, Mar 11, 2015 at 11:31 PMSubject: Re: [redacted]To: [email protected]
Hello,
My complaint ID [redacted] has been resolved. Thank you very much for your assistance. I believe it was your contact that probed the action.
All best,[redacted]

Complaint: [redacted]
I am rejecting this response because:-------- Forwarded message ----------From: <[redacted]>Date: Fri, Nov 14, 2014 at 9:00 AMSubject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Penn...To: [email protected]
I sent a signed letter to the insurance company to give permission to get my medical records a few days after receiving this letter. Thank you and have a great day !
Regards,
[redacted]

I have called in asking to cancel my insurance and was told I could not. My health insurance company is lying or did not update their records when I called. The fact of the matter remains that I have spent over 18 hours calling and fixing my health insurance. I have been lied to and forced to do a lot as a customer and have not been able to use my service for months due to misinformation. I need reimbursed for both my time and my health insurance premium as I have been being lied to and do not have any more time to fix what they have broken resulting in bills adding up that I should not have to pay because I have done my due diligence and beyond. Again I no longer have the time to do their job for them. I need to start seeing a discounted monthly premium (at least half) or reimbursed for the months I have asked to cancel my insurance and me being told I could not until "enrollment periods" as I was told. 
 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]I am rejecting this response because:As noted, we received a notice that our application was being processed by Coventry.  This letter from Coventry was dated September 24, 2014 and was not received until Saturday, September 27th.  The following day, Coventry sent their first and only demand for payment on September 25th.  As noted in my complaint, this letter was not received until September 29th.  Our cancelled check from Coventry shows it was cashed and deposited by Coventry on Monday, October 6th, not October 15th as alleged by Mr. B[redacted].  Perhaps the Coventry system did not update to reflect payment was not received until October 15th, but our check clearly shows a deposit date of October 6, 2014 by Coventry.
Furthermore, a demand for payment made 5 days before threatened cancellation is exceptionally poor business practice at best.  Taking said payment, depositing the payment and then cancelling the policy without sending a refund (except on request) borders on illegality and reflects extremely poor business practices morally and ethically.
As noted previously, I request payment for the doctor's services rendered when we should have had coverage as well as punitive damages for Coventry's deceptive business practices.Regards,[redacted]

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 6, 2015.
During our investigation, we were unable to locate a call made to our Billing and Enrollment department to request termination of [redacted]’s policy.  We did note that a call was made to Coventry on December 9, 2014, but the representative reached wasn’t in the correct area for receiving or processing termination requests.  [redacted]s should have been referred to the appropriate area to request the termination at that time.  Unfortunately, we couldn’t retrieve a recording of that phone call to determine what was stated.
[redacted]s’ policy has now been terminated back to December 31, 2014.  A refund was also issued for the premium we had collected for January 2015.  The refund was in the amount of $396.46 and was deposited directly into the bank account we have on file for him.  Coventry’s part of the refund process was completed on February 10, 2015, but the actual date of the deposit may vary on [redacted]s’ bank statements depending on the processing time required by his bank. 
We were not able to refund any additional amounts to [redacted]s.  However, if there were any overdraft or NSF fees that were applied due to the premium being collected, we are able to review to determine if any reimbursement can be made for those.  In order to perform that review, we would need a copy of a bank statement showing the dates and amounts of any fees applied.
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

It appears from the Complaint that [redacted] is the mother of, not one of, our insureds.  In order to...

investigate this matter, Coventry Health Care would need the daughter’s information and a HIPAA authorization form signed by our insured. If the daughter is a minor, we would still need the daughter's information and a signed form from whomever has the authorization to do so.
 
Thank you,
 
[redacted]

--------- Forwarded message ----------
From: Revdex.com of Metro Washington DC <[email protected]>
Date: Tue, Sep 23, 2014 at 10:35 AM
Subject: Fwd: Complaint #[redacted]
To: Cynthia Cameron <[email protected]>
---------- Forwarded message ----------
From: [redacted] <[redacted].com>
Date: Mon, Sep 22, 2014 at 11:07 AM
Subject: Complaint #[redacted]
To: [email protected] attached all the proof of overdrafts. One photo includes the email I originally sent to Coventry with the overdrafts from the first 2 incorrect charges to my account.
Thank you
[redacted]
 
--

Dear [redacted],
Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on March 13, 2015.
Unfortunately, if [redacted] did not have other insurance that began January 1, 2015, Coventry will not be able to change the termination date for her policy.  As an insurance carrier offering coverage on the Health Insurance Marketplace, we are bound by their established guidelines.  At this time, the termination date for [redacted]’s policy is correctly listed as January 20, 2015.  No further premium refund is due.
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

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 21, 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 reached out to our Enrollment department for assistance during our investigation.  Our records show that [redacted] had requested termination of his policy by faxing in a request form on October 23, 2014.  Due to this request, the process was begun to terminate the policy effective October 30, 2014.  This process was completed on November 6, 2014.  We were able to locate a phone call from October 29, 2014, that [redacted] had made to stop the termination from occurring.  Unfortunately, the process had already been started and was not stopped.  Upon locating that call, we were able to reinstate the policy with no lapse in coverage, as the contact had been made in the same month we received the termination request.  The reinstatement was completed on November 21, 2014.  A premium payment was made on November 24, 2014, so the policy is paid through November 30, 2014.  The premium will need to be collected for December in order for the policy to remain active through the end of the year. 
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

April 29, 2014
Dear [redacted]:Your letter of April 25, 2014 to Coventry Health Care of Nebraska, Inc. (Coventry) was received in our office, and referred to my attention for review and response. [redacted] is covered under Coventry effective April 1, 2014.On April 28, 2014,...

Coventry confirmed [redacted]’s $21.46 initial binder payment was received. [redacted]’s policy effective date is April 1, 2014. Her next premium payment of $21.46 is due on May 1, 2014. An extension has been granted for [redacted] to mail in her May premium payment. Additionally, she may make a payment over the phone by calling ###-###-####.On April 28, 2014 and April 29, 2014, Coventry contacted [redacted] and advised of the circumstances surrounding her policy issuance. [redacted] was provided with my direct contact information in case she experienced any additional issues in the process. [redacted] was provided with her policy identification number and how to obtain member materials online prior to receipt via mail. Coventry apologized for the inconvenience this has caused [redacted].If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].Sincerely,

[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:
 
Ms. M[redacted] and I did discuss yesterday my issue and concerns regarding the way conventry has handled my wife's prescription for [redacted].   While I did agree to get information from tHe doctor that recommends [redacted] as the treatment, I did express my belief that there would not be a good resolution, but rather the same outcome.  I provided some previous documentation to Ms. M[redacted] relating to the history of all previous requests including the previous coventry supervisor who tried to have this resolved, to no avail.
Ms. M[redacted] was very professional and seems to want to help resolve this, which will be using a different approach in the appeal process.   As such I will not accept this as a resolution which may close my complaint.    If the process that Ms. M[redacted] results in a positive outcome, I will accept and close my complaint.    But until this happens I will not accept this as resolved
Regards,
[redacted]