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Coventry Health Care, Inc.

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Coventry Health Care, Inc. Reviews (639)

September 8, Dear *** ***:
I am writing in follow up to complaint ID ***, filed by our member, *** **Our records reflect that based on the member’s statement that the first refund had not been received, the member was re-issued a refund on August 29, in the amount of $to the mailing address provided by the member of *** *** *** *** *** ** ***We trust the above information is fully responsive to your requestShould you have any questions or concerns regarding this matter, please do not hesitate to contact meSincerely,Candice G
Appeal/Regulatory Complaint Coordinator Coventry Health Care

Hello,
Thank you
for your inquiry, regarding complaint #*** for *** ***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 Claims department to find out why the member’s claim has not been paid out to the provider yetWe were advised that we are the secondary insurance and the member had other coverage at the time of service that was primaryThe explanation of benefits (EOB) that we received stated that the primary insurance denied because the claim benefits have already been considered and that the max benefit was reachedCoventry did process the denial correctly as we would need the primary insurance's original EOB that shows either a payment was made or has different denial reason then a duplicate claimIf the member is able to provide this documentation from the primary insurance we will be able to review to see if the claim is able to be reconsidered for additional payments
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

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 *** *** regarding payment issues for her policy which have led to
her account being flagged.A review of *** ***’s account shows a series of late payments and reminder lettersCurrently, *** *** is paid through 10/31/and there is not a payment flag on the policy to prevent her from obtaining medicationsUnfortunately, due to the Healthcare Marketplace guidelines, the payment flag process cannot be banned as *** *** has requestedOnce a member falls into their grace period, the flag will be placed and will not be removed until the policy is paid throughAt that point, once the policy is paid up to date, it can take 5-business days once the request has been made to get the flag removedIn order to prevent the payment flag, *** *** must make a payment by the deadline.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is ***Very truly yours,
Neil M
Regulatory Compliance Analyst

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: I do receive the tax credit
Regards,
*** ***

September 18, 2014Dear *** ***:
The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual HMO ACA health benefit plan*** *** (the “member”) has filed a complaintThe Member’s complaint concerns termination
of his old PlanThe Member was placed on a new Plan and $premium payment was deducted electronically from his bank accountThe Member is requesting reimbursement in the amount of $506.Upon review, the member received his migration letter advising him of his new monthly premiumA letter dated October 10, was sent to the member by HealthAmerica informing the member that his insurance health plan will be affected and the member’s policy will terminate effective December 31, due to the ACA (copy of letter attached)Further, HealthAmerica is required to switch all members as of their renewal dates to an ACA compliant plan as of January 1, per the Affordable Care ActPlease note that if the member did not enroll in one of the available plans described in the letter dated June 27, (copy attached), the member would automatically be enrolled into the HMO ACA plan listed as Option One in the letter dated June 27, 2014.(copy attached)Also, you will see in the attached call log the member advised the representative that he understood that he would be unable to change his plan until open enrollmentI have attached a copy of the call logs between the Member and the Plan.We trust the above information is fully responsive to your requestShould you have any questions or concerns regarding this complaint, please do not hesitate to contact meSincerely,Emily M
Complaint and Appeal Consultant

Dear Ms***: Please see our response to complaint #
"Times New Roman";">*** for *** *** that was received by us on November 11, 2016. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with youIn reviewing Coventry Health Care’s systems, we found that Mrs*** had a policy with us effective January 1, 2016. The policy had been applied for through the Federal Health Insurance Marketplace (FHIM). At the time we received the complaint, it was noted that the policy was active but had previously been terminated effective August 31, 2016, due to non-payment of the premium for September. In regards to the statement that the policy was terminated and reinstatement was not allowed because of Mrsand Mr***’s health conditions, we wish to assure you that we do not use health conditions in making decisions regarding terminations and reinstatement. The policy had been terminated in accordance with the FHIM’s premium payment guidelines. Premium payments are due the last day of the month prior to the month of coverage being paid for, but the FHIM allows a day grace period to make the payment before the policy can be terminated Coventry’s policy follows that guideline and allows the payments to be made up to days from the date we send our past due notices. The past due notice for September was sent September 8, 2016, so the due date was set as October 7, Other month’s premium payments for Mrs***’s policy had been made past the date the premium became due but were always within the day grace period Mrs*** had been advised in error on October 25, 2016, that reinstatement could be granted if she made payment in full. Unfortunately, the FHIM guidelines do not allow for reinstatement of policies that have been terminated due to non-payment, even with the misinformation she was given A check was received for the amount owed, but as the policy was still showing as terminated at that time the check was returned to her on November 8, A reinstatement was granted due to a disaster declaration being issued for the county where Mrs*** lives. Upon her county being added to the disaster declaration, the North Carolina Department of Insurance sent a bulletin to all insurance companies advising that standard premium due date policies and termination should be suspended. The bulletin was dated November 3, 2016, and the policy was reinstated November 10, 2016. The reinstatement is still in place and will be honored as long as the past due amount is paid. If no additional payment is received, the policy will again be terminated back to August 31, AT present the amount owed to pay through the end of November is $We apologize for and regret any frustration or inconvenience Mrs*** has experienced during this issue. We have contacted the appropriate area to provide feedback to the representative that advised her on October 25, 2016, that the policy could be reinstated if she paid the premiums in full. Reinstatement was not something we were able to grant prior to the disaster declaration for her areaWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mrs***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** Regards, Chris B*** Complaints and Appeals Consultant Executive Resolution Team

November 3, Dear Sirs:This letter is in response to the aforementioned Case Number *** regarding *** ***’s request for a premium refundThank you for your patience throughout this processOur goal is to resolve your concern in a fair and timely mannerPlease be
advised that after review of your grievance, we confirmed *** *** moved from FL to TX and terminated her coverage due to being outside of network*** *** was due a refund but it was mailed to her FL address and *** *** has been trying to have the refund reissued to her current address.Currently, ***’s policy is reflecting as terminated effective June 17, per the file received from the Healthcare MarketplaceA pro-rated refund in the amount of $was issued to *** *** on August 11, 2014; however, the refund was mailed to the Florida address listed on fileCoventry cannot change a member’s address without a file from the Healthcare Marketplace requesting that changeAn expedited request has been submitted to the Premium Accounting team to have a refund re-issued to *** ***’s to her Texas addressPlease allow up to days for processing and mailingIf you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:am until 5:pm or you may reach me directly at ###-###-####If you are hearing impaired please call 7-1-Telecommunications Relay Service.Sincerely,
Yanique M
Complaint and Appeal Analyst Grievance & Appeals Dept

Dear ***,I found the paper I was looking forIt is a copy and top and bottom of letter is blacked out because of HIPPA they tell me at the doctors officeI am going to fax it today 01/04/and as always thank you for your help

Dear ***
***,
Please see our response to complaint #*** for *** *** that was received by us on March 26,
During our review, it was determined that the member’s newborn dependent *** *** was added to the policy with an effective date of March 08, The process of adding the newborn was completed on March 16,
Our call records also show that on March 30, 2015, *** *** contacted our Billing and Enrollment department and requested to terminate his plan effective March, 31, At this time, because we show a past due amount on the policy the termination process cannot be completed
We are currently researching with our Billing and Enrollment department to determine the amount of premiums owed for the policy and how much has been collectedUpon verification of the amount we will be able to determine if any correction is neededI will contact *** *** directly with my findingsIf he has any questions or concerns in the meantime, he may contact me using the information below
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *** or ###-###-####
Regards,
Julian C***
Executive Resolution Team

Dear
*** ***,
Thank you for allowing us to address the concerns reported in complaint #*** for *** *** that was received by us on December 18, 2014, regarding changes he wished to make to his policy. Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you
We determined the issue that generated the complaint was a phone call they had made to a person named Brianna in November, in an attempt to cancel *** ***’s policy and have him added to his wife ***’s policy. We contacted *** *** and his spouse in order to request additional information so that we could speak with Brianna to determine what caused them to believe that the changes were requested and were being processed. Unfortunately, we were not able to get enough detail to locate Brianna or any calls made to Coventry during the reported time period.
We were able to assist **and *** *** with the changes they wished to make to their coverage by providing the necessary forms that need to be completed to request the changes. We will also continue to monitor the situation to ensure the changes are made properly and assist them with any difficulties they may have throughout the process.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Hello,
Thank you
for your inquiry, regarding complaint #*** for *** ***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 Customer Service department to have the calls pulled that took place prior to the procedure being rendered to verify what information was provided to the memberThere were two calls on file that we had reviewed and the member was advised that the procedure would be covered at 100% with no copay if the procedure was billed as a routine/preventative service but if the service was billed as a medical/diagnostic reason then it applies towards the member’s deductible of $5,The representative on the last call verified where the procedure was being done and verified they were in network with her plan
We also reached out to our Claims department to verify how the procedure was billed by the facilityWe verified the claim was submitted with medical diagnosis codes and not preventative codes which caused the claim to apply to the member’s deductibleAt this time the claim is processed correctly under the plan since it was billed with a medical/diagnostic reason and not as preventative
We attempted to call the provider to verify if these services were billed correctly but they would not speak to us about the member’s diagnosisPlease contact your provider and discuss how they billed this claim and if it was billed incorrectly the provider may resubmit a corrected claim for reconsideration
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Dear Ms***,
class="MsoNormal" "background: white;">Please
see our response to complaint #***
for ***
*** that was received by us on April 11, 2016.During
our investigation of Mr***’s complaint, it was identified that the trouble began
with a known issue where a system error caused premiums to be drafted
multiple times in early April. The issue was detected and corrected quickly
and the funds collected through those drafts were returned to the accounts from
whence they came automatically.
Unfortunately, it was not possible to determine the amounts of any
overdrafts that had resulted from the multiple drafts being performed.
Approval
has been given to reimburse the $that Mr*** is requesting. The reimbursement will be sent to him in the
form of a paper check and should be received in 7-business days from April
12, We have contacted Mr*** and confirmed that he was satisfied
with that outcome and provided direct contact information to use in the event
that he experiences further difficulty in regards to this issue
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

To Whom this may concern:
At the beginning of the year, I signed a binding contract with Coventry HealthcareI adhered to all of the stipulations within my contract by paying my premiums on time and by making payments towards any applicable co-insuranceHowever, I have not been able to benefit fully from my insurance because Coventry has failed to apply the payments I made to a chiropractor (Country Club Chiropractic) for services renderedYou see, I paid out-of-pocket until I met my $deductibleEvery time I contact Coventry, I am told that the claims for chiropractor services are initially sent to a third party before being processed by themIt has been more than days, and I still have several other healthcare appointments I need to makeI am concerned that payment for these services will be applied toward my deductible, which actually has been met but not recorded in Coventry's systemTherefore, I would be responsible for the full payment of these services instead of 10% co-insuranceThe terms of my contract with Coventry are about to end, and I would like you to investigate this matter to ensure that Coventry they fulfill their end of our binding contractI appreciate any assistance you can provideRespectfully,
Cc: The Office of Senator Bill N***

face="Calibri">Dear *** ***
Please see our response to complaint #*** for *** *** that was received by us on June 10,
Based on our review, the records indicate that we received a change file from the Marketplace on March 24, 2014, to add *** ***’s dependent, *** ***, to the policy with an effective date of April 01, However, the policy requires that we add a dependent from their date of birthAs such, we have submitted a ticket to our Reconciliation department to have ***’s effective date changed to her date of birth March 21, Once the effective date has been corrected, we will have the previously denied claims reprocessed
I apologize for the difficulties this situation has caused *** ***, and regret that she encountered the customer service experience stated in her complaint*** ***’s feedback has been forwarded to the Customer Service department for improvement opportunities.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Julian C***
Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
Dear Cynthia Cameron;
Regarding the status of my payments to Coventry One for health insurance, I am sending proofs that I made all the payments -since May till December 2014, from our TD bank shared (with my husband *** ***) checking account, and for the months of January and February from our Chase shared checking accountFor the year 2014, all premium payments due were $x -May to December,= $In addition, $X 2= $for January, and February Besides, I have send hundreds bank statements concerning the December 8th, paymentDuring all this time, our bank account never had insufficient funds nor return paymentsA ** bank official spoke to Coventry on my behalf several times regarding this matterDuring the first days of March I received from Coventry a single check of $with no explanationsOn March the third arrived a Policy Termination number *** explaining that I didn't paid December 2014, although I made the payment on December 08, and also for the months of January, and February on February 09, 2015; Please consider that under my policy its states that "All payment due must be paid in full by the end of the three months grace period..."
In the last letter from Coventry, on 6/5/2015, HIX number *** it states that "Coventry is unable to grant your request for reinstatement." when in fact I did not, and I will not request reinstatement ever! Just consider the implications of not having health insurance for this year as well as Coventry not having resolved my payments issuesDuring this ordeal, my calls were transferred from agent to agent who were mostly uncooperativeFinally there was and is and emotional and physical toll I am suffering do to the lack of a good customer service management
Regards,
*** ***

May 29, 2014Dear *** ***:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our office on May 20, We appreciate the opportunity to respond.Coventry does not have a signed authorization release form from the member indicating
that the Revdex.com is representing *** *** in this matterTherefore, Coventry is responding directly to *** ***,We trust this adequately responds to your inquiry.Sincerely,

Dear
*** ***,
Please see our response to complaint #*** for *** *** that was received by us on February 12,
During our investigation, it was noted that *** ***’s policy was applied for through the Health Insurance Marketplace. Terminations for this type of policy must come to Coventry through the Marketplace. One exception to this requirement that we have been granted by the Centers for Medicare and Medicaid Services is for people whose policy with Coventry had passively renewed for but who also actively applied for a different policy. In those cases we are able to backdate our policy termination date to December 31, 2014. *** ***’s policy with Coventry was passively renewed for but no indication has been received that he had gotten other coverage
If *** *** does not have other insurance coverage that became effective January 1, 2015, the termination request will need to be made with the Marketplace who will then send it to Coventry. The Marketplace website, www.healthcare.gov, gives two methods for submitting termination requests. If an account has been created for the site, the account can be used to submit the request. A request can also be made over the phone by calling ###-###-####.
Unfortunately, we can’t control the wait times required to reach a representative with the Marketplace by phone. However, it can be expected that those times will improve now that the end of the open enrollment season for the Marketplace has passed. A call we placed to them on February 18, 2015, was given an estimated wait time of minutes.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. ------ Forwarded message ----------From: *** *** *** Date: Tue, Sep 30, at 3:PMSubject: Case #***To: ***
Hello ***,
I am writing to let you know that my husband, *** ***'s case (Case # ***) against Coventry Health Care of the Carolinas has been resolvedI am attaching a letter from Coventry stating that they have located the payment and credited the account
Thanks,
*** *** ***, *** ***
*** ***
*** *** *** *** ***
*** ** ***
***
***
Regards,
*** ***

Dear ***
***,
Please see our response to complaint #*** for Deborah L White that was received by us on March 27,
During our review, it was determined that in order to assist in refunding *** *** overdraft fee of $25.00, we would need to receive a copy of the bank statement showing the overdraftAfter researching our records, we have not yet received the copy of the faxed bank statement *** *** states was sent to us on March 10, I ***empted to contact *** *** on April 02, 2015, at ###-###-#### and was unable to reach herI left a voicemail with details on where the bank statement can be sent in order to process *** *** request
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concerns. If there are any additional questions regarding this particular m***er, please contact the Executive Resolution Team at ***
Regards,
Julian C***
Executive Resolution Team

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Description: Insurance Companies, Insurance - Dental, Health & Medical - General, Hospitalization, Medical & Surgical Plans

Address: 6705 Rockledge Drive, Suite 900, Bethesda, Maryland, United States, 20817

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