Coventry Health Care, Inc.

Dear [redacted],
Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on February 23, 2015.
The documentation for the phone call we received from [redacted] on December 15, 2014, specifically states that the amount of premiums quoted as owed at that time was $396.76.  We were also unable to locate any changes made to the terminated policy with Coventry by the Marketplace in 2015.  Unfortunately, this means we are still unable to reinstate the policy.
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 Ms....

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 10, 2015.
During our investigation, it was determined that Ms. [redacted] had not contacted Coventry’s Billing and Enrollment department to request the termination of her policy prior to it becoming active.  This meant the policy remained active for January and we were not previously able to refund the premium we had collected for that month of coverage.
Ms. [redacted]’s policy was an individual policy that was not applied for through the Health Insurance Marketplace.  In order to backdate the terminations for these policies, Coventry must receive proof of other coverage that was active during the same period as the policy through us. 
We are showing that Ms. [redacted] submitted proof of her other coverage to our Billing and Enrollment department on March 16, 2015.  The documentation was reviewed and we were able to terminate the policy as if it was never in force.  The termination process was completed on March 17, 2015.  A refund will be sent for the premium payment she had made in the amount of $889.78.  We respectfully request that she allow 7-10 business days for the refund process to be completed. 
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 26, 2014
Dear Sirs:
This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s request to remove her daughter from the policy, Thank you for your patience throughout this process. Our goal is to resolve your concern in a fair and timely...

manner.Please be advised that after review of this grievance, we have confirmed the following: We received a request to remove the dependent as of September 24, 2014. Please allow 7–10 business days from that date for processing. Additionally, there is a current balance due of $1,288.48. We have not received payment since July, [redacted] is on paper billing, and it is the member’s responsibility to make payments timely. [redacted] must make a payment before the end of the month in order to avoid termination. Please find (enclosed) the termination process from the Certificate of Coverage.
If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm or you may reach me directly at ###-###-####. If you are hearing impaired please call [redacted] Telecommunications Relay Service.Sincerely,Yanique M
Complaint and Appeal Analyst Grievance & Appeals Dept

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on June 08, 2015.
During our review, it was determined that [redacted]’s banking information was entered on the incorrect policy. We had our Premium and Enrollment department immediately remove the banking information from the incorrect policy. We confirmed that the member’s refund has now been processed. An agent from our Premium and Enrollment department attempted to contact [redacted] but was unsuccessful and left a message advising that her refund had been processed.
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

[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:It just does not respond to my complaint, and shows how little we mean for the health industry : I am now in a plan costing $ 800plus/month, or over 33% more expensive, with no knowledge WHAT the plan means ...There was NO response to the monthly letter I am receiving that 'next month your premium will go back to the normal level'This company should not even do business, if it does not explain what happens, takes $200/month, AND GETS AWAY WITH IT !!!!I have NEVER given any authorization to change plans, and no answer should NEVER be that the company can do whatever they choose to do.  Where are our rights here, really ?????This is outrageous, and I will reserve the right to publish this everywhere, to show where we stand, no rights, no knowledge, just pay and stay healthy, otherwise we quadruple your premium !   And we will do so because you did not respond to our new plan : 'the top-expensive-plan-with-no-rights-just-pay-and-shut-up-plan'Great plan, great company!
Regards,
[redacted]

June 17, 2014Dear [redacted]:Thank you for giving Coventry Health Care of Georgia the opportunity to review your Revdex.com complaint regarding the termination for coverage and the refund of premium payments deducted from your bank account....

We appreciate your feedback in regards to our Customer Service process.After a thorough review, our records show that your coverage was termed on 9/30/13. Coventry collected premiums for $2331.29 for the month of October 2013 through April 2014 in error. The premium rate for each month has been corrected. The total premium amount for your spouse from October through June 2014 should be $1,637.02. The adjustment was made and you will be refunded $694.27 within 3-5 business days. (See Attachment A)We apologize for any inconvenience this may have caused.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,

Dear Ms....

Cameron,
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 6, 2015.
During our investigation, it was determined that the claim for propranolol ER from February 5, 2015, applied the $5 copay in error.  Propranolol ER is considered a non-preferred generic medication.  Claims for non-preferred generic medications will have the same benefit applied as non-preferred brand name medications.  For a 31 day supply of a non-preferred generic or brand name medication filled at a preferred pharmacy, up to a $55 copayment will be applied. 
There is a statement on the Summary of Benefits and Coverage (SBC) for Ms. [redacted]’s plan, advising that the non-preferred generic medications will apply the same benefit as non-preferred brand name medications.  We have included a copy of the SBC and the prescription formulary that provides the level of coverage for medications.  When reviewing the formulary, tier 1 is the level for preferred generic medications, tier 2 is for preferred brand name medications, and tier 3 is for non-preferred generic and brand name medications.
While the claim for February 5, 2015, was not processed at the correct level, it will not be reprocessed for correction at this time.  The claims for dates of service after February 5, 2015 have been processed correctly.
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

"Times New Roman";">Dear
[redacted],
Please
see our response to complaint #[redacted] from [redacted] for [redacted] that was received by us on January 19, 2016.
We
reviewed the renewal notice that was sent for [redacted]’s
policy in September 2014, which was for the plan year beginning January 1,
2015.  It was found the letter stated
that the plan from 2014 would no longer be offered, but did also state that [redacted] would be automatically enrolled onto a different plan with Coventry. 
The
first request for termination of the policy that we located was from November
9, 2015.  Our guidelines allow for
retroactive terminations of policies going back 60 days from the first request.  As such, we were able to grant a termination
date of September 9, 2015.  With the
retroactive termination date we will issue a prorated refund for the month of
September as well as refunds for the total amount paid for the October and
November coverage.  Since the premiums
were drafted from a bank account through Electronic Funds Transfer, the refunds
will be deposited directly into the same account using the same method.  The standard timeframe for refunds to be
deposited is 7 to 10 business days. 
We
did have a request reviewed to determine if we could go back farther than 60
days, but as there was no indication that Coventry had been contacted to cancel
the policy before November 9, 2015, the request was denied.  Also, Coventry does not provide reimbursement
to individuals for the time they spend on the phone with our
representatives. 
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 Ms....

[redacted],
Please see our response to complaint #[redacted] that was submitted by [redacted] on behalf of her son [redacted] and was received by us on March 13, 2015.
During our investigation, it was determined that Mr. [redacted]’s policy has been terminated as of March 31, 2015.  All premiums have been paid for the months of active coverage.  Coventry will not attempt to perform further premium withdrawals from Ms. [redacted]’s bank account.
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

--------- Forwarded message ----------
sans-serif;">From: Revdex.com of Metro Washington DC<[redacted]>Date: Wed, Apr 29, 2015 at 12:15 PMSubject: Fwd: complaint 10601120To: [redacted] <[redacted]>
---------- Forwarded message ----------From: [redacted] <[redacted]>Date: Wed, Apr 29, 2015 at 11:07 AMSubject: complaint 10601120To: "[redacted]" <[redacted]>I received an e-mail from Coventry stating that the claim has been paid.  Thank You.

February 5, 2014
Dear **. [redacted]:
This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s request for new...

member material and/or member ID number and refund of January 2014 premiums.
After review of this grievance, the Health Plan has confirmed, **. [redacted] paid for premiums on December 15, 2014 for a policy effective date January 1, 2014, Making a payment prior to issuance is part of the requirements for polices offered on the exchange. There is no consideration for partial month; that is not an option the Health Plan can offer, according to Federal Guidelines. As this is an on exchange plan and the binder payment is a requirement to hold the policy, we could not make an exception to refund. **. [redacted] would have to call the exchange for this or see if they were willing to move his effective date due to the circumstances. Either way the Health Plan is limited to what is fed to us by the exchange.
In addition, new member material can take up to 7-14 business days to be received. As of January 15, 2014, a request was made to have **. [redacted]’s cards mailed. Please find (enclosed) **. [redacted]’s Schedule of Benefits and Schedule of Covered Services. On January 24, 2014, the Health Plan has contacted **. [redacted] and informed that his policy is currently active.
If you have any additional questions, please contact me toll free at ###-###-####, extension [redacted] or directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. If you are hearing impaired please call TTY 7-1-1 Relay.
Sincerely

October 28, 2014Dear [redacted]:
Your letter of October 20, 2014 to Coventry Health Care of Iowa, Inc. (Coventry) was received in our office, and referred to my attention for review and response. [redacted] was on a CoventryOne policy with a May 1, 2014 effective date. [redacted]...

enrolled for coverage through the Health Insurance Exchange (Marketplace).In his complaint to the Revdex.com, [redacted] expressed that he believed he was overcharged on his monthly premium. [redacted] also advised that his policy was terminated without notice.
On April 15, 2014, [redacted] applied for health coverage through the Marketplace for an effective date of May 1, 2014. The monthly premium payment for the policy was $325.60. On April 29, 2014, Coventry issued an Electronic Funds Transfer letter to [redacted] confirming his enrollment in having his monthly premium payments automatically withdrawn from his bank account.On July 26, 2014, Coventry was notified by the Marketplace that [redacted]’s premium would be $61.60 effective September 1, 2014. Because [redacted] was enrolled in an Electronic Funds Transfer program with Coventry, Coventry automatically withdrew monthly premium payments in the amount of $325.60 for June and July as the premium reduction was not in effect until September 1, 2014.On July 28, 2014, [redacted] contacted Coventry to confirm that his new premium of $61.60 would begin in September. The Customer Service Representative confirmed this, but advised [redacted] that he still needed to pay $325.60 for August in order to avoid his policy termination. [redacted] asked if he could terminate his policy and re-enroll for September. [redacted] was referred to the Marketplace to request a policy change.
On July 29, 2014, Coventry issued a Policy Change letter to [redacted] confirming the policy changes he requested. On August 7, 2014, Coventry issued a Payment Due letter to [redacted] advising that his monthly premium payment of $325.60 for August was not received. This was due to the fact that [redacted] had deleted his automatic payment information.On August 2, 2014, [redacted] contacted Coventry to request a premium change due to his income. [redacted] was referred to the Marketplace. Though it might seem to our customers that we as carriers should be able to make changes to health insurance policies ourselves, certain changes (such as changes in effective and termination dates) must be done through the federal Marketplace. The structure of the Affordable Care Act requires that these types of changes occur only through the federal level.On September 10, 2014, Coventry issued a Policy Termination letter to [redacted] because his premium for August was not received. On September 10, 2014, Coventry retroactively terminated [redacted]’s policy effective July 31, 2014 for non-payment of premium. Coventry did not terminate [redacted]’s policy in error or without notice. Coventry did not receive the full payment due for August. [redacted] is not eligible for a refund for the months of June and July, as he received health insurance coverage during that time. On September 25, 2014, Coventry mailed a premium refund of $61.60 to [redacted] for the payment received on August 25, 2014.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

Coventry Healthcare has been a nightmare to deal with. I called them BEFORE I scheduled a doctor's appointment to confirm my costs and what they would cover. After receiving additional bills from the doctor's office, I called Coventry customer service and was told that they would cover $0.
I informed them that I had already spoke with a representative before I went to the doctor and they said they had NO record of my call. Sorry!
This is in the least, negligence but it seems from reading other complaints that this is a common practice.

Calibri; mso-bidi-font-family: 'Times New Roman'">Dear [redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted]d that was received by us on November 26, 2014, regarding coverage for [redacted].  Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you.
I would first like to provide the question and answer from the FAQ that [redacted] is referencing from the Department of Labor website at www.d[redacted].
Q14: The HRSA Guidelines include a recommendation for all Food and Drug Administration (FDA) approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity, as prescribed by a health care provider. May a plan or issuer cover only oral contraceptives?
No. The HRSA Guidelines ensure women's access to the full range of FDA-approved contraceptive methods including, but not limited to, barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider. Consistent with PHS Act section 2713 and its implementing regulations, plans and issuers may use reasonable medical management techniques to control costs and promote efficient delivery of care. For example, plans may cover a generic drug without cost-sharing and impose cost-sharing for equivalent branded drugs. However, in these instances, a plan or issuer must accommodate any individual for whom the generic drug (or a brand name drug) would be medically inappropriate, as determined by the individual's health care provider, by having a mechanism for waiving the otherwise applicable cost-sharing for the branded or non-preferred brand version. This generic substitution approach is permissible for other pharmacy products, as long as the accommodation described above exists. If, however, a generic version is not available, or would not be medically appropriate for the patient as a prescribed brand name contraceptive method (as determined by the attending provider, in consultation with the patient), then a plan or issuer must provide coverage for the brand name drug in accordance with the requirements of the interim final regulations (that is, without cost-sharing, subject to reasonable medical management).
This FAQ and the FDA publication titled “Birth Control: Medicines To Help You” list each of the different birth control methods.  We are following this guidance in ensuring that we have coverage options available under each of those listed methods.  The guidance does not require us to cover all unique forms of delivery under a given method.  Nuvaring is considered as a hormonal method, per the FDA publication.  While [redacted] is the only ring contraceptive available, there are other hormonal methods that are available at no cost share through our coverage of certain oral contraceptive pills and injectable contraceptives. 
Consistent with the previously stated guidance, we allow exceptions for situations where a member’s physician has determined that the other methods for contraception available without cost share are medically inappropriate. In those cases, we would cover a drug or device that is standardly not covered, such as a brand name hormonal contraceptive, without cost share as well. 
 
If [redacted]’s physician has determined that [redacted] is a medical necessity, they can contact us to request an authorization.  At that time, we would review the request and make a decision on whether or not an exception can be made to cover [redacted] with no cost share. 
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

Dear [redacted]...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 10, 2014, regarding her premium payment not being received before the due date.  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 we did not receive her premium payment until October 10, 2014.  The premium payment needed to be received by the end of the month prior to the effective date, so the due date was September 30, 2014.  Since the premium was not received by that date, her enrollment was cancelled.  The payment we did receive was returned to the member on November 4, 2014. Unfortunately, her policy is not eligible for reinstatement.
Only one letter was sent out requesting the premium payment and was dated September 18, 2014.  The discrepancy between the number of attempts to reach her stated in the Enrollment Cancellation letter and the actual number made has been reported to the appropriate department. 
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 1, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding billing issues for her policy.After investigation, a...

review of our records shows that the member made four payments to the policy. A payment of $66.44 posted to the policy on January 23, a payment of $128 posted to the policy on March 7, a payment of $66.44 posted to the policy on May 12, and a payment of $66.44 posted to the policy on June 13. The problem with this account appears to be the inconsistency and lateness of payments as well as the outstanding balance. The most recent payment to the policy was refunded on July 22 because the policy was considered to be terminated. However, after consideration, the decision was made to reinstate the policy. One of Coventry’s managers, Jason R[redacted], called the member to review the above and to procure payment. He was not able to reach the member, however he did leave a detailed message to give him a call back including his extension. Mr. R[redacted] advised the member that her policy is reopened but she still owes $4.88 (the difference she paid in March). He additionally advised her that she will owe for July and August ($132.88) once the bill has been adjusted. It is strongly suggested that the member contact Mr. R[redacted] as soon as possible and that she make arrangements to ensure that this (and future) payments are made on a timely basis.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 MB.A. Regulatory Compliance Analyst Coventry Health Care

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on May 07, 2015.
During our review, it was determined that the member’s policy was created on December 22, 2014, with an effective date of January 01, 2015. Per [redacted]’s request, we have terminated the policy for her and her family effective March 05, 2015. We have also updated the billing information for [redacted]’s policy. We received the prorated premium amount of $19.38 for the month of March and the policy now shows $0.00 amount due.
I apologize for the difficulties and frustration [redacted] has encountered while attempting to resolve this issue. 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

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 9, 2015.
The review of the request for the enrollment for [redacted]’ newborn back to her date of birth had already been started at the time we received the complaint.  On January 16, 2015, approval was granted to add her newborn to her policy back to the day she was born.  A letter dated the same day was sent to [redacted] advising her of this decision. We respectfully request that she allow 7-10 days for the completion of the enrollment processes.  We will contact her directly with additional information once everything has been finished.
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,
Chris B[redacted]
Executive Resolution Team

Dear...

[redacted],
Please see our response to complaint #[redacted] for Bart D[redacted] that was received by us on January 8, 2014.
Our research confirmed that Mr. D[redacted] is owed an additional $577.92 from the overpayment that was collected for his premiums on August 5, 2014.  We have requested an expedited refund for that amount.  At this time we respectfully request that he allow an additional 7-10 business days for the completion of the refund process.  Once the process is completed I will personally contact Mr. D[redacted].  If he has additional questions or concerns regarding this issue in the meantime, he may contact me directly at [redacted]. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. D[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

Coventry Health Care...

respectfully requests an extension of time as we work directly with the member to secure the proper authorizations.
Thank you,
Deborah Finch