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: Now they say our premium rate has changed. We were never informed about this, and it is strange, that on their attempts to collect money from our old bank account, they still tried to collect the amount of 541.38 $.
We do not want any further steps done, because we are tired of it, and are already looking for other Health Care Providers.
Thank you very much,
Regards,
[redacted]

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 13, 2015.
During our investigation into the complaint, it was noted that two separate premium payments had indeed been collected in February.  Both payments show a processed date of February 26, 2015.  Our Billing and Enrollment department stated that the payments were taken by EFT and that the requests for the payments were made via Coventry’s automated phone system.  They were unable to determine why two payments were taken but suggested that either multiple phone calls were made or the button to confirm the payment at the end of the call had been pressed multiple times. 
Coventry did refund one of the payments to [redacted] by EFT.  The date of the refund shows March 11, 2015.  The actual date that the funds became available in her account may vary depending on the processing time required by her bank for the EFT notification.
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

"Times New Roman";">Dear
[redacted],
Please
see our response to complaint #[redacted]
for [redacted] that was received by us on January 21, 2016.
Upon
receiving the complaint, we found that [redacted] is on a Medicare Part D
plan.  We reached out to our Medicare Grievance
team and found that they were already aware of the situation.  Contracted pharmacies cannot refuse to fill a
medication because they feel they are underpaid.  This issue has been escalated to our Network
Team to find a solution so that this does not happen in the future.  Until a solution can be found, should [redacted] be refused a medication, we advise that he ask the pharmacy to contact
our Customer Service department at the number located on his ID card. 
[redacted] had indicated that he paid the pharmacy out of his pocket for the medication.  We encourage him to submit a claim for
reimbursement of the amount he paid.  A
prescription claim form is attached that can be used to file for reimbursement.  Please note that a receipt from the pharmacy
is required to be sent with the claim form. The receipt must include specific
information including the patients name, the prescription number, the medicine’s
national drug code number, the date of the fill, the metric quantity, the total
charge, the number of day’s supply for the prescription, the pharmacy’s name, address,
and [redacted] Number, and the prescribing physician’s National Provider Identification
number.
 
In
reviewing the messages [redacted] had sent through our online member portal, it
was noted that attempts had been made to contact [redacted] by phone but were
not successful.  A Grievance response letter
was sent on January 15, 2016. 
 
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

February 13, 2014
Dear **. [redacted]:
The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.
[redacted] has filed a complaint on behalf of her spouse,...

[redacted] (the “member”). The Member’s complaint concerns premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $737.41
Below is a timeline of events leading up to the resolution of the member’s complaint.
May 9, 2013 11:50 AM: [redacted] and [redacted] contacted billing and enrollment to update their address. The new address was provided and a request was sent to processing to have it updated.
February 10, 2014 10:17 AM: [redacted] contacted billing and enrollment in regards to the termination of the policy. She stated that she had spoken to several people that informed her that we would cancel the policy. The member was advised to submit a written request with proof of other coverage. A supervisor advised the member to submit the information to him and he would terminate the policy.
ROOT CAUSE:
The member had two policies, the other policy was sent to our department as terminated for May 15, 2012. The termination email was applied to the old policy.
Per business rules the member would need to submit a written request with a handwritten signature. The email did not include a handwritten signature.
The policy has been terminated for January 31, 2014 based on email that was received. If the member wishes to back date their termination any further, they will need to submit a written request with proof of other coverage.
A refund has been requested. Please allow 7-10 business days for processing and an additional 7-10 business days for mailing time. If the funds are reversed back into the members account it may take an additional 1-5 business days for the funds to post after the refund is processed.
If you have any questions or concerns regarding this matter I can be reached at ###-###-####.
Sincerely,

Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 28, 2016.
During our review, it was determined that 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. Unfortunately, we are unable to provide a refund of the entire amount. 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.
I apologize for any difficulties or confusion this may have 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]@[redacted].com.
Regards,
Julian C[redacted]
Executive Resolution Team

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 16, 2015.
During our investigation, we were unable to locate a phone call made to Coventry at any time in December requesting termination of the policy.  As [redacted] stated, we did receive an e-mail on February 7, 2015 that supported her family had obtained other coverage for 2015.  This allowed us to terminate the policy back to December 31, 2014.  The refund was requested multiple times but errors prevented the refund from being issued.  We apologize for any inconvenience caused by the delay in sending the refund and will seek to prevent the same issue from happening to others.
We are showing that the refund process has now been successfully completed.  Our system is showing a processed date for the refund of March 23, 2015.  The refund was done through [redacted] directly to the bank account of record that we have for the policy.  The amount of the refund was $1711.58.  The actual date the funds became available may vary depending on the time required by the receiving bank to process the transaction.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. Miller’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

July 28, 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 Crystal Rose regarding continuation of insurance. The member states that she filled...

out a form to request cancellation of her policy however, a subsequent payment deduction still occurred.Research into this matter revealed that this member has an On-Exchange policy that was purchased through the Marketplace. As a carrier, Coventry Health Care is not able to terminate coverage on this policy. The member must reach out to the Marketplace and initiate the termination record through them. The exact procedure would be for the member to log into the marketplace website that was used to enroll. According to the Healthcare.gov website there will be a red button titled “Terminate/end all coverage”. Once that is completed a file will be sent electronically from the Marketplace to the issuer (Coventry) to terminate the policy.Though it might seem to Coventry’s customers that it should be able to make changes to their coverage such as terminating coverage based on a member request without requiring direction from the Marketplace itself, Coventry is unable to make that change. The structure of the ACA forces changes like this to occur only at the federal marketplace, and not at the health carrier, level. The federal marketplace is working on their systems at this time, and they are erroneously sending customers to their carriers to make these changes. The customer must work through the federal marketplace in order to make this change on their end.The Exchange is the source of truth for enrollment and SEP determinations. Consumers must enroll through the Exchange, the Exchange sends an 834 (standard EDI transmission) to Issuers that triggers enrollment actions and Issuers send back to the Exchange a confirmation. Issuers are also notified by the Exchange of approved SEPs.Issuers may not make enrollment changes, including SEPS, outside the Exchange process.Therefore, in order for the member to cancel her policy, she must take the steps described above to do so. Once Coventry Health Care receives the Marketplaces’ data, it will terminate the member’s policy as she has requested.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 [email protected] truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

[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]

[To assist us in bringing this m[redacted]er 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 have submitted this information numerous times.  I [redacted]ached copies to my complaint with the Revdex.com. I am again [redacted]aching the same files.  I printed this my online account and it show where Coventry took the money overdrew my account, on the next page it shows where the payment was taken on 03/03/2015.  In addition, I have [redacted]ached the fax confirmation where the information was sent on the 10th of March when the issue was first created.  In addition , I am unsure of whom [redacted] tried to contact on April 2, 2015; however, I can assure you it was not me or my number.  I can pull my records from [redacted] which will show all call logs for this date and I can assure you I have came from Coventry or [redacted], nor was there a voicemail. 
I now am of the mind to be compensated for the issues this has created for me.  I would like to receive interest on this amount of money.  It only took 1 day to mess up my checking account, which is my business account, but it has taken or will take more than 30 days to have this issue resolved.  I would like an additional, 25.00 for my time and efforts to correct Coventry's mistake.
Regards,
[redacted]

October 17, 2014Dear [redacted]:
The Health Plan received your request to our initial response on February 5, 2014. In response to [redacted]’s rejection:[redacted] states that he has no knowledge “WHAT” the plan means. The Health Plan has no record that [redacted] contacted us regarding these concerns. The Health Plan has enclosed a copy of [redacted]’s Summary of Benefits material that he can review for benefits information, a copy of which he has received previously.
If [redacted] has questions regarding his coverage, he may contact the Customer Service Department which is available to answer any questions he may have about his coverage. [redacted] can reach them at ###-###-#### Monday through Friday, 8:00 a.m. to 6:00 p.m. EST. [redacted] may also access his benefit information 24 hours a day, seven days a week by registering and logging in at [redacted].
In regard to [redacted] receiving monthly letters stating that “next month your premium will go back to normal level,” the Billing and Enrollment department has confirmed that an “Adjusted Pull” letter was sent to the member in error, for which we apologize. This letter should only be sent to those members who will be drafted an amount different from their standard premium. This was not the case for [redacted].
Finally, the Health Plan does not make a change to a member’s policy without prior notice. [redacted] was given prior notice on two separate occasions regarding changes to his policy and the opportunity to either make a selection or contact Customer Service for assistance. Since the Health Plan did not receive the required documentation back from [redacted], in order to prevent a lapse of coverage or termination of the policy, the default choice was selected as was explained in the notifications.
Coventry Health Care hopes this explanation provides the necessary information to complete the investigation of this matter. If you have any additional questions, please contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm.Sincerely,Siana L
Senior Complaint and Appeal Analyst Grievance and Appeals Department

March 14, 2014Dear **. [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.[redacted], (the “member”) has filed a complaint. The Member’s complaint concerns premium payments...

deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $216.79Upon review, the member’s effective date was December 31, 2013. This effective date was offered so members could have the option of non-ACA plans. Therefore, premium payments were processed for the month of December 2013: $7.01, January 2014: $216.78 (paid), February 2014: $216.78, March 2014: $216.78. The total due was $440.57. Please be advised that this a request to collect the amount due for the time frame in which the member received coverage. The member’s coverage remains effective.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
 This was the same time frame I was given initially and it was never followed through.  I have since filed a dispute complaint with my bank regarding the amount and the bank refunded my money.  This matter has been resolved, but by other means.
Regards,
[redacted]

October 1, 2015
Although I am definitely NOT happy with the resolution, because who knows if or when this "computer glitch" issue could happen again, I have decided that it is pointless to keep going around & around.  Thank you very much for looking into this issue for me!
Sincerely,
[redacted]

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 18, 2015.
During our investigation, we found a renewal notice dated October 25, 2014, which was mailed to [redacted].  The renewal notice gave the new premium amount of $131.30 for her policy for 2015.  A draft change letter was also sent to [redacted] on December 19, 2014, to advise that $131.30 would be withdrawn from her bank account on December 31, 2014.  The policy was allowed to passively renew since Coventry didn’t receive notification to cancel it prior to the draft taking place.
A file from the Marketplace processed on January 6, 2015, gave us a termination date for the policy of January 20, 2014.  As the premium had been collected for the entire month of January, [redacted] was sent a prorated refund for the eleven days of January that her policy was no longer active.  Coventry posted the refund to her bank account in the amount of $46.59 on January 12, 2015.
It was noted that [redacted] indicated she has secured other coverage, but didn’t provide the date it became active.  We have been given the approval to terminate passively renewed policies if the person had other coverage active on January 1, 2015.  If [redacted] had other coverage starting right away in 2015, Coventry would be able to terminate our policy back to December 31, 2014, and issue a refund for the remaining premium collected for January 2015.  [redacted] may contact the Billing and Enrollment department at ###-###-#### or myself at ###-###-#### to provide the date her other insurance became active. 
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]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on June 02, 2015.
During our review, we found that [redacted]’s policy was created on March 08, 2014, per the file that was received from the Marketplace on March 07, 2014, with an effective date of April 01, 2014. The member was enrolled in a [redacted] Plan with a premium of $267.33 and an Advanced Premium Tax Credit ([redacted]) of $0.00. Starting June 01, 2014, the member was enrolled in a [redacted] Plan with a premium of $209.55 and an [redacted] of $58.00.
Starting January 01, 2015, the member was enrolled in a [redacted] Plan with a premium of $254.65 and an [redacted] of $58.00. Regarding [redacted]’s refund request, we are unable to issue the member a refund for the full month of March. We received a termination file from the Marketplace on March 04, 2015, with a termination date of March 19, 2015. We charged the member the full premium amount of March and issued a partial refund on March 20, 2015, in the amount of $98.57.
The member will need to contact the Marketplace to have the termination date changed. Once the Marketplace is able to change the termination date for the member, we can issue a refund based upon the termination date we receive. The member can contact the Marketplace at ###-###-#### for further assistance.
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 below to the additional concerns from [redacted], received by us on December 1, 2014.
We have attempted to address all of the issues [redacted] has raised in his previous messages.  We apologize if our previous responses have not resolved the matter to his satisfaction.  None of the information he has provided to date has shown proof of wrongdoing or would allow for reinstatement of his policy.  Additional investigation can be performed upon our receipt of a copy of the check that [redacted] indicates Coventry had cashed.  If [redacted] wishes, he can fax in this documentation to my attention at ###-###-####.
Coventry did process the policy as quickly as possible upon receiving the information from the Marketplace.   We had every intention of insuring [redacted].  In order for us to do so, the premium needed to be received by the due date.  A letter was sent on October 9, 2014, stating that the first month’s premium payment had not been received by the due date and advising that the policy was being cancelled.  Any changes to the requested effective date must be made through the Marketplace.  Due to this, Coventry was not able to offer an alternate start date. 
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

Coventry Health Care respectfully requests that the member wait until he receives the response mailed on this day to him directly by our Company to determine whether our actions have met his needs.
Thank you,
[redacted]

Yes, [redacted] is my father and my client and I have his permission to file this complaint on his behalf.

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 review of the complaint we reached out to Coventry to confirm that [redacted]...

received her refund of $383.17. We confirmed that a check was mailed out on June 20, 2014, but was returned to us for a bad address. We sent a check again on November 10, 2014, and our records show this was received by [redacted] and cashed on November 18, 2014.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 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 at [redacted],Thank you,Ashley S.Complaint and Appeal ConsultantExecutive 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 the company as a whole has yet to take responsibility for their employees who they train. I received my refund on Dec 16th which is actually 28 business days after I had called to terminate my policy. Your employees said nothing about writing a letter and signing that letter to terminate my policy. I called your company on November 5th, 20th, December 1st and 3rd. In all four of these phone calls was that not mentioned.  You can listen to these phone calls for proof at your leisure since your company records them. You can not expect your customers to know your policies, if your employees do not. Further more you have never discussed the "Manager Eva" who would not tell me who her supervisor was nor transfer me to any other personnel. You also never touched base on why Missy S[redacted] from your Advanced Solutions was unable to call me in 24-48 hour period as I was told. You also have not said anything about how I was treated as a customer or what your plans are to ensure this does not occur to another customer. Everything I have read says you do not take responsibility as a company for lack of training, wrong information and flat out lies. I understand that you can not refund October even when your employee said you could, which you haven't apologized for either. Americans are being told to purchase health insurance or pay a fine. I as a consumer believe that your company is taking advantage of this and not holding your employees responsible or accountable for the lack of customer service or knowledge of your company and its policies. 
Regards,
[redacted]