Coventry Health Care, Inc.

[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: this date of payment is not in question.  I am aware that this payment was taken out of my account, as I was called and my account number was verified.  I have also cancelled my insurance effective July 31st, so no more payments will be taken out of my account.  My initial complaint is that I did not have a payment of $130.84 taken out of my account on June 2nd as I was told, even though it's "posted" to my account.  I have verified this with the bank, and made multiple phone calls to your office, and received no help at all.  I never received a phone call back from a supervisor, was never allowed to speak with a supervisor, nor was the payment ever taken care of.  I do not want this to mess up my taxes, or my bank account for that matter.  This is still not being addressed.
Regards,
[redacted]

January 31, 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 termination of his CoventryOne policy effective...

December 31, 2013 and premium refund for January 2014. The request was received by CHC Carolinas on January 30, 2014.
CHC Carolinas does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing him in this matter. CHC Carolinas will respond directly to **. [redacted].
Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted] between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.

[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 still have not gotten my refund company states they dont know how to refund my 489.00 they owe me.I also having issues with marketplace working with them to submit my refund
Regards,
[redacted]

---------- Forwarded message ----------
From: [redacted]
Date: Tue, May 6, 2014 at 10:10 AM
Subject: Complaint ID # [redacted]
To: [email protected]
I was able to get a hold of people at Coventry this morning.  [redacted] provided me...

with confirmation number for the cancellation.  They stated that they had no record of the letter sent to me on 2/13/14 in my file.  [redacted] claims that the May payment is for May 2014.  Every insurance company I have dealt with bills a month in advance.  I requested a print out of my account history be sent to me.  Ken stated that will be sent in the mail.  the confirmation numbers he gave me are:
Cancellation of Policy conf #: [redacted]
Billing History conf #: [redacted]

Dear Ms....

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 26, 2015.
During our investigation, it was determined that Mr. [redacted]’s policy was enrolled through the Health Insurance Marketplace.  His policy was passively renewed for 2015 but remained a Marketplace plan.  A notification was not received from the Marketplace advising us to terminate his policy or that he had gotten other coverage for 2015.  We have been granted the ability to terminate passively renewed policies back to December 31, 2014, in situations where the person has other coverage effective January 1, 2015.  We respectfully request that he allow 7-10 days for the termination to be processed. 
Mr. [redacted] may disregard any further premium billings from Coventry that are received as he has paid the premiums for his 2014 coverage.  Future bills will not be sent once the termination is processed.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [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]
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]@[redacted].com.
 
Regards,
Chris
B[redacted]
Complaints
and Appeals Consultant
Executive
Resolution Team

Dear [redacted],
Thank you for allowing us to...

address the concerns reported in complaint #[redacted] for [redacted]h that was received by us on November 19, 2014, regarding unauthorized premium drafts.  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 are not showing any unauthorized premium drafts.  The standard authorized monthly draft of the premium for coverage for the month of November was processed successfully on November 5, 2014.  [redacted] then called and authorized another payment on November 11, 2014.  This second payment was applied to his premium for December, so his policy is currently paid through December 31, 2014. 
If [redacted] wishes for us to review for possible reimbursement of any NSF or overdraft fees, the Premium Accounting department will require a copy of a bank statement showing the account activity and the running balance.  The bank statement must show the name and at least the last four digits of the account number.  We will not require full details of any transactions other than the Coventry payments and drafts, but we will require dates and amounts for all transactions. 
[redacted]’s concerns regarding the service issues he experienced have been reported to the appropriate department for handling and education.  Any decisions made regarding termination of employees are confidential and will be handled internally. As both payments that were made were authorized and have been applied to his policy, we are unable to identify an issue that would require software revision or replacement. 
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

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

Hello,
[redacted] I am adding the resolution for Revdex.com case #[redacted] for [redacted]. Please confirm receipt of the email.
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 view with you.
Upon receipt of the complaint we immediately reached out to Coventry's Billing department to request that they cover your overdraft fee you acquired due to two premiums being taken out of your account in one month. We were advised that it was approved and a check was mailed to the home address on file in the amount of $25.00. I sincerely apologize for difficulties you have experienced surrounding 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 you have any additional questions regarding this particular m[redacted]er, please contact the Executive Resolution Team at [redacted]
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

August 11, 2014
Dear [redacted]:This letter is in reference to the complaint [redacted] filed to the Revdex.com (Revdex.com) that we received on August 1, 2014.The [redacted] ([redacted]) is a health benefits plan established under the [redacted]...

[redacted], 5 USC sec. 8901 et seq., pursuant to a federal government procurement contract between its sponsoring employee organization and the US Office of Personnel Management (OPM). The [redacted] is underwritten and administered by Coventry Health Care, an [redacted] company on an ASO-basis. As a [redacted] ([redacted]), the [redacted] is not subject to state insurance laws or regulation in regard to the nature or extent of its coverage, its benefits, or payments with respect to benefits based on the extensive federal preemption provision contained at 5 USC sec. 8902(m)(1). That provision provides:The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any state or local law, or any regulation issued thereunder, which relates to health insurance or plans.The resolution of disputed enrollment and claims matters under [redacted] plans is governed exclusively by OPM pursuant to the implementing regulations promulgated by that agency, see 5 C.F.R. sec 890.104 (disputed enrollment issues) and 5 C.F.R. sec. 890.105 (disputed claims issues).However, the Plan responded to [redacted]’s concerns and sent her a letter dated August 11, 2014.If you have any further questions, please do not hesitate to contact me at ###-###-####.Sincerely, Britt P. [redacted] Client Advocate

September 29, 2014Dear [redacted]:Thank you for giving Coventry Health Care of Georgia, Inc. the opportunity to review your Revdex.com complaint regarding the non-coverage of [redacted] contraceptive. We appreciate your feedback in regards to our Customer Service process.[redacted] ([redacted]) is not a no cost sharing agent under your pharmacy benefit plan, unless the prior authorization requirements are met. Please have your physician contact the Pharmacy Department at ###-###-#### to initiate the prior authorization process. The prior authorization requirements include physical or mental incapacity to take oral contraceptives.If you have any questions, please contact Customer Service at ###-###-####.Sincerely,Appeals Department

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 the Coventry Billing and Premium department to verify that you were currently set up for EFT payments. They confirmed that you were set up on EFT and that it was an error inputting the member’s information in the system which caused a returned payment and the EFT to turn off. We have switched the EFT back on and show the policy paid through April 30, 2015.
We have received notice from the Marketplace that your premium will change effective May 1, 2015, to reflect $15.38 owed a month. If you have specific questions regarding this change please contact the Marketplace for the details.
To receive reimbursement for your medications that you paid out of pocket for please fill out the form from the link listed below and send to the address listed at the bottom of the second page. Please submit this form filled out with the pharmacy receipt (the page that the pharmacist staples on the front of your prescription that shows a quantity, refills left, and amount paid). If you do not have these documents anymore you can request your pharmacy reprint them for you.
http://[redacted].pdf
Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur.  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. I 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 Consultant
Executive Resolution Team

November 17, 2014
Dear Sirs:
This letter is...

in response to the aforementioned Case Number [redacted] regarding [redacted]’s premium issue. Please find below the requested information.Our records indicate that [redacted] was unable to fill her prescriptions because her policy was reflecting as past due in the Express Scripts system. Currently, [redacted] is reflecting as paid through December 31, 2014, in the Billing and Enrollment Department. The Grace Period flag was placed on [redacted]’s policy because the November premium was not received on time. On November 14, 2014, an expedited Urgent Care request was submitted to Home Office to have the flag removed and reflecting the correct paid through date in all other systems. The flag removal process can take 24-48 hours. Once the flag is removed, [redacted] will be able to fill her prescriptions.
Below is a call history in chronological order which took place between [redacted] and Coventry.Call History:
May 2, 2014: [redacted] called to make a payment. The representative assisted her through the process and provided a confirmation number.June 27, 204: [redacted] called stating that her plan was supposed to become effective May 1, 2014.July 25, 2014: [redacted] called because the effective date of her policy is reflecting as April 1, 2014, when it should be May 1, 2014. The representative conferenced the Marketplace and the Marketplace confirmed that the effective date should be May 1, 2014. The representative submitted the request for review.July 31, 2014: [redacted] called to inquire about the status of her effective date. The representative advised the request was submitted on July 25, 2014, and to allow 3-5 business days for the Reconciliation team to review.August 1, 2014: [redacted] called regarding the red flag on her policy. The representative advised the flag was placed due to a payment for April not being received. [redacted] advised that she should not have the flag placed because she changed her effective date to May 1, 2014, and should not have a past due balance. The representative submitted a request to have the flag removed from the policy.
August 4, 2014: [redacted] called regarding the red flag removal. The representative advised the flag was removed on August 4, 2014.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.
Sincerely,
Tracy T
Complaint and Appeal Analyst

March 10, 2014
Dear **. [redacted]:
Your letter of February 26, 2014 to Coventry Health and Life Insurance Company, Inc. (Coventry) was referred to my attention for review and response.
On December 6, 2013, [redacted]. [redacted] contacted Coventry’s Billing and...

Enrollment Department to discuss alternative plans. The Customer Service Representative (CSR) advised [redacted]. [redacted] to contact the agent on record.
On January 5, 2014, Coventry attempted to collect the recurring premium payment for insurance coverage via Electronic Funds Transfer (EFT) in the amount of $1,185.80. On January 9, 2014, the [redacted]’s financial institution informed Coventry that the payment could not be drafted from their account. Therefore, on January 10, 2014, Coventry issued a letter to **. [redacted] advising of the returned EFT Draft and advised a $20.00 service fee would be assessed for non-sufficient funds.
On January 22, 2014, [redacted]. [redacted] contacted Coventry’s Billing and Enrollment Department to terminate their policy coverage. The CSR advised [redacted]. [redacted] in order to cancel the policy the primary insured, which is **. [redacted], would need to call Coventry to terminate the policy. Additionally, [redacted]. [redacted] was advised that the policy would be prospectively terminated through the paid date of the current month.
On February 14, 2014, [redacted]. [redacted] contacted Coventry’s Billing and Enrollment. Department to terminate the policy. Additionally, [redacted]. [redacted] advised she contacted Coventry in December 2013 to terminate the policy. The CSR advised only one call was received in December 2013 to discuss alternative policies. The CSR advised she would submit a request for a refund for both the January and February premium and to have the policy retroactively terminated as an exception.
According to business rules only a primary member can request to terminate a policy. Coventry did not receive a written request or a phone call from **. [redacted] requesting to terminate the policy. Additionally, Coventry did not receive a phone call from [redacted]. [redacted] requesting to terminate the policy until January 22, 2014. During this call [redacted]. [redacted] was advised **. [redacted] would have to submit the request. Based on the details of this case, there was no error on Coventry’s part as the primary member never requested to terminate the policy. Therefore, Coventry will not refund the [redacted] $279.00 for the charges the bank assessed for over draft fees and stop payment fees.
If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].
Sincerely,

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

Hello,
size="3">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 your complaint we immediately reached out to Coventry to verify if you were being refunded $1600.00 as the complaint stated. We were advised that as per business rules, the employer is the only one who can request to remove the member from the premium billing. Only the member can request to terminate the entire policy and we did not receive a termination request from this member. Per the member’s contract it states that we must receive notice within 30 days from the date the termination is being requested to terminate the policy.
This policy was terminated effective December 31, 2014 per the employer request, and there is no refund due. The employer paid this member’s premium for the life of the policy and the policy was never unavailable to use for medications or doctor visits. When the member was disassociated from the employer, she was responsible for her own premium if she wished to continue the policy in 2015. Since no payments were made after the disassociation she was terminated for non-payment. The billing history is available and was not deleted, I am sorry that you were advised incorrectly. I have attached the payment history for the member’s records.
Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur.  I sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserve.  These actions are not consistent with our service standards and we appreciate you notifying us of your experience.  We have addressed your customer service concerns directly with the managers of the representatives who handled your calls.  
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

"Times New Roman";">Dear
[redacted],
Please
see our response to complaint #[redacted] for [redacted]
that was received by us on November 9, 2015.
We are
showing that [redacted] was covered by a plan named [redacted] through
Coventry Health Care of Georgia beginning on January 11, 2012.  The application for that plan was not done
through the Marketplace.  The plan was no
longer offered as of December 31, 2014, so the policy passively renewed to a
new plan named Bronze $20 Copay HMO PD effective January 1, 2015. 
A termination request was not received for that policy and the recurring
Electronic Funds Transfer (EFT) draft authorization had not been removed so the
premium was drafted for January and February. 
We regret that the renewal notice [redacted] was sent in 2014 did
not mention that a termination request would need to be sent to prevent the
passive renewal even if a new policy was applied for.
 
As [redacted] applied for a new policy through the Marketplace that became
effective January 1, 2015, we were able to have the non-Marketplace policy
terminated effective December 31, 2014. 
A refund of $419.02 was issued through the EFT process directly into the
bank account from which the payments had been collected. The approximate
posting date for the deposit was November 13, 2015.
 
At this
time, we are showing that [redacted]’s 2015 policy has a termination date
of December 31, 2015, so as long as the premium is paid for December, her
coverage will remain active through the end of the year.  Information was received from the Marketplace
to enroll her on a different policy effective January 1, 2016.  The first month’s premium payment will need
to be made for that policy to complete the activation process.
 
We were
not able to locate a call to Coventry such as the interaction [redacted]
described regarding the November 30, 2015, termination date.  All termination requests need to be requested
through the Marketplace so she may have been speaking with them.  If she wishes, we can assist in contacting
the Marketplace to report the poor service she received.
 
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] for [redacted] that was received by us on January 9, 2015.
In reviewing Ms. [redacted]’s complaint, we determined that a file had been sent from the Marketplace requesting a termination date for her policy of May 21, 2014, but the file contained errors and we were not able to process it.  We did not receive additional contact from her or the Marketplace requesting termination of her policy until this situation arose.  Due to this, her policy remained active.
We were able to terminate Ms. [redacted]’s policy effective December 31, 2014, as she had requested in the complaint.  At this time, we are showing that the premium payment she had initially made for December 2014, in the amount of $61.68, was returned to her on January 8, 2014.  We had drafted $94.17 from her account on December 31, 2014, when her policy was still active for January 2015.  This leaves a credit on the account of $32.49 which is the amount that she owes for the December 2014 premium that was returned minus the amount that she had overpaid now that her coverage is no longer active for January 2015.  We respectfully request that she allow 7-10 business days for the refund of $32.49 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 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

Complaint: [redacted]
I am rejecting this response because:
Billing or Collection Issues - The company has failed to correct billing errorsNOTE: This issue is regarding Coventry Health Care of the Carolinas (specifically NC) I have talked to countless people and spent countless hours on the phone getting lied to and redirected. The fact of the matter is they changed my health insurance policy without telling me. Also, I called in to confirm whether or not they changed my health insurance policy and they said it was the same. After the change I went to the doctors and now I am left with a 1,000.00 doctor bill. Even though I pay for high end health insurance. I was them to pay for my doctors bill. I opened up a previous case #[redacted] that was closed without my consent. Please do not close this case until there is confirmation from me. Coventry health insurance lies and they will lie to you that is why their Revdex.com is a D-. Please help me get this resolved. I do not have $1,000.00 to pay for these doctors bills and this has gone on for too long. Desired Outcome: I would like Coventry Health Insurance to pay for all of my doctors bills outside of the $30 co pay per visit I originally agreed upon. The only reason I am in this situation is because my health insurance department has lied and acted inappropriately to me as a customer. I have spent countless hours with them over the phone and they continue to lie and cheat it's too much. I need a 3rd party to please help. Please do not close this case without my consent. The last case I opened Coventry just lied about the situation and the case was closed.
Regards,
[redacted]

March 5, 2014
Dear Sir or Madam:
The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding non-credit of her payment for...

health coverage.
After extensive research into the member’s complaint, it was determined that **. [redacted] had applied three times and was given three different policy numbers. For that reason, the funds that **. [redacted] had paid were applied to the earlier applications. When this was discovered, the funds from the previous policies were applied to the third policy with an effective date of March 1, 2014. **. [redacted] should not have any further problems with her policy nor will she have had a lapse in coverage.
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,