Coventry Health Care, Inc.

Dear...

Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 8, 2015.
We have determined that Mr. [redacted]’s policy was processed as an automatic renewal for 2015.  A letter had been sent to him on September 26, 2014 explaining the automatic renewal process and advising him of his options.  At any time in between receiving the letter and the end of the year, he could have requested that we terminate his policy instead of proceeding with the automatic renewal.  Unfortunately, we did not receive a request from him until after January 5, 2015, which is the date we performed the draft from his bank for the premium. 
Mr. [redacted] is still able to submit proof of other insurance to request termination of his policy back to December 31, 2014.  We received some documentation from him on January 9, 2015, but that documentation did not include the effective date of coverage for his policy with his new insurance carrier.  If he has any additional information to provide, it can be faxed to ###-###-####.  He will also want to include the termination request form that he had sent previously to ensure timely processing.
We understand that there are drawbacks to performing the automatic renewals and policy changes for our members but there are benefits as well.  One benefit is that a person doesn’t lose their coverage entirely, which could result in large medical bills or having to pay for expensive medications out of pocket.  Obviously, one drawback is the issue that Mr. [redacted] has experienced.  Coventry feels that the benefits outweigh the drawbacks and will continue to use our current process.  The communications that we send out to our members regarding the automatic renewal explain the options they have if they do not wish to accept the offer.  
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

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on December 30, 2014.
Our investigation into the complaint determined that [redacted] had contacted eHealthInsurance to begin the process of applying for the policy but that they had submitted the request for coverage through the Marketplace.  For 2014 and 2015 he has been covered under plans that are only offered for members who apply through the Marketplace. 
We are also showing that he is receiving an Advanced Premium Tax Credit (APTC) to help pay a portion of the premium that he would otherwise need to pay in full.  The APTC is only available to policies applied for through the Marketplace.  The previous representatives were correct in advising that the requests for termination must be made with the Marketplace in these situations.  This is the standard process that all insurance carriers selling plans through the Marketplace must follow.
When [redacted] filled out the termination request for his policy it was sent to eHealthInsurance, who then forwarded it to Coventry.  Unfortunately, we were not able to process the request.  If he is unable to terminate the policy through the Marketplace himself, he may wish to contact eHealthInsurance once again and advise them to submit the request for him through the Marketplace. 
[redacted] will continue to receive notices advising him that we have not received his premium payment for now.  These notices will not affect his credit nor will we send him to collections for those amounts.  If he does not pay the premiums, his policy will eventually terminate for nonpayment, but this will not occur until March 31, 2015.  His policy end date would then be January 31, 2015, even if he never pays the premium for the month of January.  This is in accordance with the grace period policy that Coventry must follow for members receiving the APTC.
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

[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]

September 29, 2014
Dear [redacted]:
This letter is in response to the aforementioned case number [redacted] regarding [redacted]’s complaint.
[redacted] is currently enrolled with the Health Plan’s SILVER $0 HMO #1 Carelink, effective April 1, 2014. Please see the following...

correspondence timeline with [redacted]:TIMELINE: .
03/24/14 8:23am [redacted] contacted the Billing and Enrollment department to enroll her children into a policy. The representative transferred [redacted] to the Sales department for further assistance. .
04/25/14 5:58pm [redacted] contacted the Billing and Enrollment department to inform us that she received a bill for the bronze plan, but initially requested the silver plan. The representative transferred [redacted] to the Marketplace for further assistance with changing the plan. -
04/29/14 6:32pm [redacted] contacted the Billing and Enrollment department to inquire about her new silver plan. [redacted] stated that she had not received any correspondence about the new plan. The representative stated that the new silver plan could not be found in the system.
06/03/14 4:09pm [redacted] contacted the Billing and Enrollment department to inquire about the policy. The representative advised [redacted] that the policy only included her, and did not include her husband.
07/09/14 1:21pm [redacted] contacted the Billing and Enrollment department to inquire about the bill. [redacted] stated that the premium should be $0, but she was billed for the older premium. The representative advised [redacted] that the bill would be rerun to correct the balance to reflect $0 due.
In an effort to assist [redacted] with her complaint, the issue was forward to the Billing and Enrollment department for further investigation. On September 26, 2014, the Billing and Enrollment department completed their review and responded with the following information:
[redacted]’s policy was created on March 4, 2014 with an effective date of April 1, 2014 per the file received from the Marketplace on March 3, 2014. The monthly premium due was $296.36, and the initial binder premium was paid on March 11, 2014 to effectuate the policy. [redacted]’s policy also included her husband, and covered them under the Bronze $10 Copay HMO [redacted] plan. However, [redacted] submitted a request through the Marketplace to remove her husband, and switch to the SILVER $0 HMO #1 [redacted] plan.
In addition, a subsequent file was received from the Marketplace on March 24, 2014 for a [redacted] - SILVER $0 HMO #1 [redacted] plan and a $0 premium effective April 1, 2014. This change in the policy did not include [redacted]’s husband or dependents. The file was processed on April 22, 2014, [redacted] was billed for the older plan, before the new plan took effect. [redacted] was billed twice in the amount of $296.36, and paid a premium of $296.36 once. [redacted] was refunded the initial binder premium paid on August 5, 2014 in the amount of $296.36 for the Bronze $10 Copay HMO [redacted] 6K4050 plan.Therefore, [redacted] was moved from the SILVER $0 HMO #1 [redacted] plan and her husband and dependents were moved from the Bronze $10 Copay HMO [redacted] 6K4050 plan on September 22, 2014. Their new policy is the SILVER $0 HMO #1 CLK with an effective date of April 1, 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 directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. My fax number is ###-###-####, and my e-mail address is [redacted].
Sincerely,Siana L
Complaint and Appeal Analyst

[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]

May 30, 2014Dear [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 the request to terminate her policy as of February 28, 2014 and refund her...

premium payment in the amount of $398.26. The request was received by CHC Carolinas on May 15, 2014.CHC Carolinas does not have a signed authorization release form from [redacted] indicating that the Revdex.com is representing her in this matter; however we will contact [redacted] within three business days. We will inform [redacted] that if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within 30 calendar days of receipt of her request.Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,

August 28, 2014Dear [redacted]:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our office on August 27, 2014. We appreciate the opportunity to respond.
[redacted], [redacted]’s policy was originally loaded with an incorrect date of...

birth. When the date of birth was corrected, the premium changed to $174.00, Your request stated that you with the policy termed as never in force. We have put in a refund request for the premium paid on [redacted]’s policy and terminated the policy.[redacted] now has a Marketplace effective 09/01/14 under your plan. We hope you are satisfied with this outcome,We trust this information has addressed the issues raised in this complaint. If we may be of any further assistance, please contact customer service on the back of your card,Respectfully,
Brandy H
Appeals Department Coventry Health Care

Coventry Health Care
Advantra Gold Medicare Advantage Plan – Ohio
TERRIBLE CLAIM HANDLING
Even a claim that was appealed and approved did not get handled -- it's been 8 months since the procedure was done. I paid the bill to the hospital to keep it out of collection and I am out $654 at this point.
My Ophthalmologist has been fighting claim problems for months and now refuses to accept customers (old or new) with Coventry insurance. How many more providers will take that approach????
I made the mistake of renewing my coverage for 2016. That was a POOR choice on my part. This isn't "cheap" Obamacare insurance or free Medicare Advantage insurance; I pay a premium every month for Advantra Gold insurance.

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 24, 2014, regarding issues she has experienced while applying for insurance through the Health Insurance Marketplace.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Our research has determined a reason for the mismatch that displays for [redacted] when comparing the copayment summary to the Summary of Benefit Coverage (SBC) on www.Healthcare.gov.  When shopping for a plan on the Marketplace, a series of questions is asked to determine if the person searching is eligible for any type of assistance with paying for the premium or for healthcare.  If an income level is entered to the relevant question that qualifies the person for assistance, a message is displayed that provides an estimate of any premium tax credits and states, “In addition this household may also be eligible for a cost-sharing reduction on a Silver plan that reduces the out-of-pocket expenses paid for deductibles, copayments, and coinsurance.”  After continuing onto the next page, a list of all available plans is displayed, with links to additional information and a brief summary of copayments and coinsurance for each plan.  The information displayed under the copayment/coinsurance summary section automatically includes the cost-sharing reduction mentioned in the previous message. 
The Center for Medicare and Medicaid Services (CMS), which maintains the Marketplace website, has directed the insurance carriers offering plans to only submit the SBC for the standard plans that do not include the cost-sharing reduction.  Thus, the links to the SBC are only able to display the benefits that would apply for the standard plan, which do not match to the benefits that would apply for members who qualify for the assistance. 
We were unable to locate any phone calls to Coventry representatives from [redacted].  Nonetheless, all plans that are offered on the Marketplace have been fully approved by all the required organizations as well as Coventry.  The appropriate regulatory approvals are a CMS requirement for every plan that is offered.   
We do apologize for any frustration [redacted] experienced with her plan selection for 2014.  The information Coventry received from the Marketplace indicated that she had selected a High Performance Network (HPN) plan with a network type called Carelink.  It is unfortunate that her established physicians do not participate with the Carelink network.  When making her selection for 2015, [redacted] can use our provider search to find lists of all participating providers for the plan she chooses.  A link to the provider search is available through the Marketplace.  If she chooses a plan with FocusedCare or Carelink in the plan name, she would need to select the corresponding HPN option on the plan type selector before performing the search.  If FocusedCare or Carelink are not in the plan name, she would need to select the CoventryOne PPO Network. 
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

July 17, 2014
Dear **. [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to **. [redacted] regarding issues with payment and cancellation of two policies. The request was received by CHC Carolinas from this...

Revdex.com on June 26, 2014.**. [redacted] claims that Coventry accidentally signed her up for two policies by mistake. In fact, **. [redacted] enrolled in a privately off-exchange policy with CHC Carolinas which was in effect from January 1 - 31, 2014 and then terminated. The payment for this policy was automatically debited from **. [redacted]’s bank account on February 11 for the policy in effect in January.In January **. [redacted] enrolled through the Federally Funded Marketplace exchange in a policy with an effective date of February 1, 2014. **. [redacted] made her initial binder payment on January 16, 2014 for February; she made a credit card payment on February 14 for March; she made a short payment on April 14 for April. On-exchange policies require 100% premium payment by the due date which she did not do and for that reason, **. [redacted]’s policy was cancelled. There were no double payments made. The last short payment **. [redacted] made which caused the cancellation of her policy has been refunded to her.CHC Carolinas has explained in great detail all of the above information in a series of letters with the North Carolina Department of Insurance which we will not repeat here for privacy reasons.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted]. I am pleased that this matter is finally resolved. Unfortunately, it required three weeks of follow up calls to Coventry and a complaint to the Revdex.com. I appreciate your assistance as I received a satisfactory resolution within 1 day of filing the complaint. Thank you!
Regards,
[redacted]

July 17, 2014
Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the above-referenced complaint filed by [redacted] regarding insulin affordability.**. [redacted] chose an...

individual full-risk PPO Silver Plan effective May 01, 2014. **. [redacted] is currently receiving [redacted] insulin. [redacted] is on the Tier 2 prescription drug list. The pharmacy benefit for Tier 2 Preferred Brand Drugs is the preferred pharmacy deductible + $45.00. **. [redacted]’s annual deductible is $2,500.00. After her deductible is met, benefits will be paid minus the $45.00 copay. If **. [redacted] wishes to consider a different plan, plan changes must be processed by [redacted] and can only be made following timelines and guidelines set by [redacted]. It is not something over which Coventry Health Care has any control. Plan change may impact eligibility and premium, and therefore must be processed by [redacted].The only other option **. [redacted] may have is to do a web search for Manufacturer Coupons. She may need to consult with her pharmacy to determine if there are any discount programs.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 ###-###-####. My fax number is ###-###-####, and my e-mail address is [redacted].Very truly yours,

Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on July 23, 2015.
As stated in our previous response, during our review, we found that [redacted]’s policy was terminated on March 11, 2015, effective December 31, 2014, for non-payment. The member’s 90 day grace period started on December 01, 2014 and ended on February 28, 2015. [redacted] owed $451.67 for December, January, and February because the initial payment for December was used to cover the premium never collected for the month of June 2014. The member was refunded the amount of $203.69 which was the remainder of the funds after the premium of $123.99 was applied to the June 2014 premium. Based on our records, there is currently no refund due for $123.99 as the payment was posted to the December 2014 premium that was past due.
If the member feels a refund is still due to her, she can send in a copy of the bank statements from May 01, 2014 to December 31, 2014. This was previously stated to her in our phone conversation on July 02, 2015, and she understood. Upon receiving the bank statement for the month of June 2014, we can have our Premium Accounting department research that payment and verify if any additional money is owed. The bank statement that we received in this rejection did not include the month of June 2014, which is the month we are stating was never collected from the member.
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

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on December 26, 2014.
We have been able to confirm that an extra payment was taken from the bank account of [redacted] and applied to another member’s policy.  This was caused by the banking information that he had sent to set up the EFT withdrawal process for his own policy being incorrectly linked to the other member’s policy.  We do have the copies of [redacted]’s bank statements that were submitted multiple times and he will not be required to file any type of criminal complaint in order to receive his refund.
We do apologize for the extended period of time it has taken to resolve this issue.  It was through no fault of [redacted] or the other member that the issue occurred and we are diligently working to correct the problem.  Escalated requests have been sent to get the refund issued.  Currently, it is in the hands of our Enrollment department and we respectfully request 7-10 days for the refund to be sent.  We will continue to monitor the situation and will personally contact [redacted] once the process is completed.  If he wishes he may also call me directly at [redacted] to inquire on the status of the refund. 
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 me at the phone number above or the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

September 26, 2014Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]'s complaint.[redacted] is currently enrolled with the Health Plan's SILVER $10 HMO #2 CLK, effective January 1, 2014. Please see the following correspondence...

timeline with [redacted]:TIMELINE:01/24/2014 @ 9:09am [redacted] contacted the Health Plans Customer Service Department to request a list of providers in her area. The representative advised [redacted] that they would mail her a list. [redacted] was assigned to Dr.[redacted] from January 1, 2014 to April 23, 2014.
03/21/2014 @ 9:33am [redacted] contacted the Health Plans Customer Service Department stating that she needed to find a primary care provider. The representative advised [redacted] that they would email her the list of the following providers: Family Practice, Internal Medicine, Gynecologist, OB/GYN and plan information to email: [redacted].
04/24/2014 @12:25pm [redacted] contacted the Health Plan regarding PCP in her area, urgent care benefits and copayments. The Representative advised [redacted] that urgent care copayment was $75.00 and that once she selected a pcp she can call back the Health Plan.
04/24/2014 @ 2:28pm. [redacted] contacted the Health Plan to advise that she did not change her pcp to Dr. [redacted]. The representative advised [redacted] that there was a glitch in the system which changed the pc?. 
04/25/2014 @ 12:07pm [redacted] contacted the Health Plan requesting to change her pcp back to [redacted]. The representative advised [redacted] that the change would take effective on May 1, 2014.
05/05/2014 @ 5:57pm [redacted] contacted the Health Plan to change her pcp back to [redacted] office. The representative requested the pcp change.
In an effort to assist [redacted] with her complaint, the Health Plan spoke to Dr. [redacted] and [redacted] at Dr. [redacted]’ office regarding the complaint, **. [redacted] and [redacted] were advised that since they are a Participating Provider with the Health Plan, claims would need to be submitted for the services rendered. Once the claims have been submitted and processed according to [redacted]'s Schedule of Benefits, they will need to refund [redacted] the difference in what she paid out of pocket. [redacted] also confirmed that on January 24, 2014, [redacted] went to see Dr. [redacted] for a sick visit and did not present her insurance card at the time. On April 24, 2014, [redacted] had services rendered again without presenting her insurance card. [redacted] stated that the office received a copy of [redacted]’s insurance card on May 24, 2014, but a different provider was listed so they were not able to submit the information.
Pursuant to the Schedule of Benefits, Section 1, Using Your Benefits, page 9: 1.7 Payment to Providers. I 1.7.1. In Network Providers (Participating Providers): For In-Network Covered Services, the Participating Provider will bill the Health Plan directly for the services. You do not have to file any claims for these services.
You are responsible for payment of: A, The applicable In-Network Copayment, Deductible, and/or Coinsurance amounts; B, Services that require Prior Authorization, which were not Prior Authorized; C. Services that are not Medically Necessary; and D. Services that are not Covered Services.
Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. My fax number is ###-###-####, and my e-mail address is [redacted].
Sincerely,Siana L
Complaint and Appeal Analyst

Dear [redacted]...

[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 Coventry received two separate enrollment files from the Health Insurance Marketplace. The initial file was received December 19, 2013.  It specified to enroll [redacted] onto a Coventry policy effective January 1, 2014.  The second file was received January 2, 2014.  It specified to enroll [redacted] onto a Coventry policy effective February 1, 2014.  We did not receive a file advising us to terminate the initial policy that was created so both remained active. 
Our Billing and Enrollment department was able to terminate the initial policy that was created as if it was never in force.  The policy termination was processed on March 11, 2015.  The reconciliation for the Advanced Premium Tax Credits that Coventry receives based on our enrollment is processed once a month.  When the next reconciliation is sent to and received by the Marketplace, they will be responsible for sending [redacted] an updated [redacted] tax form.
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 December 30, 2014.
In review of [redacted]’s account, we have determined that she was sent a letter dated October 25, 2014, advising her that the policy would auto-renew for 2015 and providing the new premium amount for 2015.  We were not able to locate any contact from [redacted] or the Marketplace requesting termination of the policy for 2015 at an early enough date to prevent the premium draft scheduled for December 31, 2014.  The termination request for her policy was processed on January 1, 2015, and it was noted that our attempted withdrawal for the premium for January 2015 was returned to us by [redacted]’s bank. 
A refund for the ACH stop payment fee that [redacted] indicates was applied is still possible.  In order to review the request to determine if the refund can be issued, we will require a copy of a bank statement reflecting the stop payment charge being applied.  The bank statement can be faxed to our Enrollment department at ###-###-#### or e-mailed to me at [redacted].  Along with the statement, [redacted] should also include a signed and dated letter that provides her member ID number and gives a brief description of what she is requesting.
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

-------- Forwarded message ----------
From: Revdex.com of Metro Washington DC <[email protected]>
Date: Tue, Sep 23, 2014 at 10:01...

AM
Subject: Fwd: Complaint ID#: [redacted], Business Name: Coventry Health Care Inc
To: [redacted] <[redacted]>
---------- Forwarded message ----------
From: [redacted] <[redacted]>
Date: Mon, Sep 22, 2014 at 9:01 PM
Subject: Complaint ID#: [redacted], Business Name: Coventry Health Care Inc
To: [email protected]
Good evening,
Update regarding Complaint ID#: [redacted], Business Name: Coventry Health Care Inc: Coventry responded with the following message and the attached flyer (which they say was sent to all members— this is the first time I’ve ever seen such a flyer):
-------
Dear [redacted],
Thank you for your online inquiry regarding the Woman’s Preventive Care Act. I have attached the flyer that was sent to all members listing all of the contraceptives Coventry is required to cover at 100% according to the Act and it’s regulations. [redacted] is not a required preventive contraceptive and is not covered under your plan. According to the government and the Woman’s Preventive Care Act, Coventry has been compliant with the regulations. Please look over the attached list.
Thank you for choosing CHC of Georgia as your health care provider. For future inquiries, or if there is anything else we can help you with, please contact our department by e-mail via the Message Center in My Online Services or calling us ###-###-####.
Jennifer *. H[redacted]
———
Please advise.
Thank you,
[redacted]
--

May 30, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to your request received by our office on 4-15-14. This letter is in response to the consumer complaint filed by [redacted]...

[redacted] regarding the billing for his health insurance policy.Please note we received a MO Department of Insurance complaint (#[redacted]) regarding this matter on 5-15-14 and have been corresponding with Ms. Kathleen T[redacted] at that office concerning this complaint.[redacted] complains of wanting to return to his pre-2014 health insurance policy (which carried a lower premium) and of being unable to do so. Please note that on 10-1913 Coventry Health Care sent a letter to [redacted] advising him of the changes coming as of 1-1-14 and of his ability to renew his current plan early. We did not receive this back from the member suggesting he wanted to keep his old policy.Upon received of the instant complaint, a representative attempted to contact [redacted] by phone on 5-16-14, but there was no answer and no ability to leave a voice mail on that line. On 5-19-14, the same representative sent an email to [redacted] regarding the plan and premium discrepancy. She requested a working phone number to reach him as she was unable to reach him or leave a message at the number we have on file.On 5–19-14 we received a return email from [redacted] in which he listed his frustrations and refused contact that did not funnel through the Revdex.com, the Attorney General’s office, or the Missouri Department of Insurance. We contacted the MQ DOI on 5-19-14 to attempt to expedite this issue before the due date of this response. We assume the DOI has yet to hear back from the member regarding the options we provided.There are three options available to this member we are making available to remediate the situation:• If he wishes to return to his pre-ACA plan, he needs to be aware there will be an effective date change, premium change, and that his claims will have to be reprocessed to reflect the 12/l effective date.• Before we move the member back to the pre-ACA plan, we need confirmation from [redacted] of accepting the new rate of $521.44 for the plan 5000 80/50. There was an annual rate increase for this member's plan although this new rate is still less than the $869.00 quoted in his complaint. He would not be paying the $474,62 premium he previously had .• [redacted] has 3 options — (1)Agree to the effective date change and new premium, (2) Stay on the ACA plan he migrated to on 2/1, or (3) terminate his Coverage.Coventry Health Care hopes this explanation provides your office 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 [redacted], and my e-mail address is [redacted]Very truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted]and that was received by us on April 15, 2015.
We contacted our Billing and Enrollment department and they advised that [redacted] has only one policy that is active now.  The other policies were terminated as if never active.  [redacted] owes $31.08 for the month of May.  This payment is due by April 30, 2015.  Any funds that were applied to the other two policies were moved to the active policy.  An adjustment has been applied to the account in order to correct the billing from when the invalid policies were terminated as never in force.  The bill should reflect that the $31.08 for the month of May is due in 24-48 hours.
I apologize for the difficulties this situation has caused. 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