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:
After numerous conversations with Coventry since Early May this is rather insulting! I received none of the paperwork mentioned, which was explained in many of the calls with Coventry.  I received no follow-up from Coventry, as requested in many of the calls.  I received none of the calls from Supervisors, as was requested in at least 2 of the calls.  Coventry failed to do their part and now I have thousands of dollars of medical bills and providers refusing to see me because of this nightmare, which effects both my health and well being as well as financially and puts me in a position to find new treatments elsewhere. All because Coventry did not withdraw the premiums from my account as was originally slated to be done when the purchase on the Marketplace was made.   I did not find out about this terminated policy until Early May.  If payment was not received, why did it take 4 months? That does not make sense. 
The new policy took 2.5 MONTHS to get straightened out and was not confirmed by Coventry until August, though the policy date was 07/01.  It took 3-4 CONFERENCE CALLS with Marketplace to finally get somewhere and yet still there are issues.  Each time, Marketplace confirming files were sent while Coventry simply kept saying to check back in a week or two.  I had to call regularly to finally get confirmation that I had insurance and request my cards be sent because I had not received them. 
Coventry has the opportunity to accept the file from Marketplace with the May changes and tax credit applied, to retroactively apply it to Feb 1- June 30. 
Regards,
[redacted]

February 24, 2014
Dear **. [redacted]:
Thank you for giving Coventry Health Care of Georgia the opportunity to review your Revdex.com complaint. We appreciate your feedback in regards to our Customer Service process.
After a thorough review based on the...

information submitted, **. [redacted] submitted a request to terminate his children from his policy, effective 12/31/13 due to the children going on their mother's health plan.
Unfortunately, **. [redacted] written termination request was received on 1/13/14. The dependents were termed based on normal business rules, which indicate that we are not able to retro-terminate until the end of the month. The dependents were termed 1/31/14.
On 2/21/14, a determination has been made to retro terminate your dependents from your CoventryOne policy back to 12/31/13. All dependent term dates have been corrected and your account will be updated to reflect the changes to your policy.
If you have any questions, please contact the Customer Service Department at ###-###-####.
Sincerely,
Appeals Department

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 6, 2015.
In reviewing [redacted]’s complaint, we have determined that a letter was sent to him on August 27, 2014.  The letter advised that his coverage would end on December 31, 2014, and could not be renewed.  Unfortunately, Coventry no longer offers individual policies in his area so we are not able to reinstate his coverage. 
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].
Sincerely,
Chris B[redacted]
Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: This is the same response I have been receiving for months.  The company will not tell me or the provider what codes are required.  The provider is using standard codes that are accepted by all other insurance companies, and has given Coventry this information repeatedly.  This seems to be just more stalling and avoidance.  I had a natural birth of a healthy child.  Conventry should need no other information to provide the payment that was promised for the services required for that event.
Regards,
[redacted]

Coventry Health Care did not receive the above-referenced Complaint until 11/6/2014 and respectfully requests an additional few days in order to complete its investigation into this matter.
Thank you,
Deborah F[redacted]

February 4, 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 a premium refund for her CoventryOne policy...

effective December 1, 2013. The request was received by CHC Carolinas on February 4, 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.

February 20, 2014
Dear [redacted]:This letter is in response to your written inquiry received February 20, 2014. In that correspondence you asked about the following:Member, [redacted], contacted the Revdex.com regarding his concern over the 2014 premium...

for his First Health Part D (PDP) Plan and wants to dis-enroll due to not being notified.We will contact **. [redacted] separately via a letter to address his concerns regarding the premium change.Please note the resolution that will be provided to **. [redacted] has not been included in this letter in an effort to keep our member’s personal and health information confidential.We appreciate you contacting us, and trust the additional information that we have provided satisfactorily addresses your inquiry. Your inquiry provides us with valuable insight as we continuously seek opportunities to improve our member communication materials.Should you have any further questions, please contact Customer Service at ###-###-####, 24 hours a day, seven days a week your local time. TTY/TDD users please call 711 Telecommunications Relay Services.Sincerely,

October 24, 2014
Dear [redacted]:
The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual HMO off exchange health benefit plan.[redacted] (the “Member”) has filed a complaint. The Member’s complaint concerns...

premium payments withdrawn from an incorrect bank account by the Plan. The Member is requesting a refund for premium payments taken out of the member’s bank account after a request for termination of coverage was made. The Member is requesting reinstatement, reimbursement for medication that was paid out of pocket, and 1 month of free insurance for the hassle.Below is a timeline of events leading up to the resolution of the Member’s complaint.November 14, 2012 – The Member contacted Billing & Enrollment to change his address. The zip code has changed, so the member was advised that he needs to send a written request.
November 27, 2012 – The Member contacted Billing & Enrollment to update his address.
December 10, 2012 – The Member contacted Billing & Enrollment to update his address. The member was advised he was now out of area.
August 5, 2013 – The Member contacted Billing & Enrollment to advise that the account that funds come out of is currently closed. The member was advised that we draft on the 5th of every month, and was advised that there is a non sufficient funds fee NSF fee if the payment returns.
August 13, 2013 – The Member contacted Billing & Enrollment because there was not enough money in his account to cover the draft, but he added the funds. The member was advised he was paid in advanced.October 9, 2013 – The Member contacted Billing & Enrollment to see if his payment posted.
December 20, 2013 – The Member contacted Billing & Enrollment because funds were not available. The member advised that he will send in a payment.
February 11, 2014 – The Member contacted Billing & Enrollment because he moved to NY. The member was advised to send in a written request, as he may be out of area.
February 11, 2014 – The Member contacted Billing & Enrollment to get a refund of overpayment.
August 7, 2014 – The Member contacted Billing & Enrollment to update his banking information. The member was sent an automated clearing house (ACH) form.
August 19, 2014 – The Member contacted Billing & Enrollment to see if we received his updated banking information. The member was advised that it was not received and was advised to fax it in.
September 4, 2014 – The Member contacted Billing & Enrollment advising that we have drafted the wrong account although he sent in new banking information.
September 4, 2014 – The Member contacted Billing & Enrollment to make a payment.
October 10, 2014 – The Member contacted Billing & Enrollment because he did not understand why his policy terminated because he made his payments.
October 10, 2014 – The Member contacted Billing & Enrollment because his policy was terminated. The member was advised that he is paid thru August 31, 2014. The member stated that he will send in bank statements of the payments he has made. The member had been paying the old premium of $541.38 but he had migrated onto a new plan with the new premium of $886.33.
October 16, 2014 – The Member contacted Billing & Enrollment about his premium. The member was advised that he will need to follow the reinstatement process.
ROOT CAUSE:The member’s premium increased upon his renewal but he did not pay the increased premium amount.
RESOLUTION:The policy has been terminated effective August 31, 2014 due to non-payment of the total amount of his new premium. The member will need to proceed with the reinstatement process, as he was sent his renewal information.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.
Sincerely,
Emily M Appeals Coordinator

October 17, 2014
Dear [redacted]:
This letter is in response to your written inquiry dated September 24, 2014. In that correspondence you asked about the following:
You expressed concern about the cost of your medications using your First Health Part D Essentials (PDP)...

Plan.Based upon a review of your benefit plan, you contacted the Revdex.com regarding your concern over the cost of medications using your First Health Part D Essentials (PDP) Plan. You shared that you have experienced difficulty affording your medications and would like assistance from your plan. We are deeply sorry to learn of your experience and frustration. We would like to provide an overview of the 2014 First Health Part D Essentials (PDP) Plan.As a reminder, the 2014 First Health Part D Essentials plan is a 3 tier plan. After you meet your deductible of $310, you will enter the Initial Coverage stage. During your Initial Coverage stage what you pay for medication will depend on what tier the medication is on and where you fill your medication. The tier of each medication can be found in your formulary. Additionally, by using our preferred pharmacies, you can lower your cost share for covered prescriptions. Our preferred pharmacies in your area include: [redacted] Pharmacy, [redacted] Pharmacy, and [redacted] Pharmacy. In addition to these major retailers, your preferred pharmacy network also includes some local pharmacies. You may refer to your pharmacy directory for local pharmacies in your area that are included in our preferred pharmacy network. For questions about a particular drug or pharmacy, please contact the number listed at the end of this letter. You remain in this stage until the total cost of your covered drugs (the amount you pay combined with the amount we pay) reaches $2,850.
After your total yearly drug costs reach $2,850, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.After your yearly out-of-pocket drug costs reach $4,550, you would enter the last stage of coverage known as the Catastrophic stage. During this stage, the plan will pay most of the cost for your covered drugs for the remainder of the calendar year. Your share of the cost for a covered drug will either be a coinsurance (percentage of the cost) or a copayment, whichever is the larger amount. You will pay either a coinsurance of 5% of the cost of the drug or either a copayment of $2.55 for a generic drug (or drug that is treated like a generic) or a copayment of $6.35 for all other drugs.
In your inquiry, you expressed a concern about your prescription copays. To address this concern, we would like to share the following information with you regarding the plan design and cost share associated with your 2014 First Health Part D Essentials (PDP) Plan. After the $310 deductible has been met, the cost share associated for a drug filled at an in-network preferred pharmacy during the initial coverage stage is as follows:
                     30 day supply       90 day supply
Tier 1 drug     $1 ?????              $3 ?????
Tier 2 drug    15% coinsurance   15% coinsurance
Tier 3 drug    44% coinsurance   44% coinsurance
The design of our plan for 2014 takes many factors into consideration including feedback received directly from our members. Copays are an effective way to help members budget for their expected drug costs. This change was made in an effort to improve our plan design for members and lower their overall out of pocket costs. If the cost of your medication is less than the co-pay assigned to your drug, you will pay the negotiated rate for the drug. We appreciate your feedback as it will help us design plans that meet our members’ needs in the future.
You commented that your plan is not providing coverage for any of your medications. Our records indicate that your enrollment in the First Health Part D Essentials (PDP) Plan ended on April 30, 2014. This termination of coverage was due to non-payment of your plan's monthly premium. The premium associated with your First Health Part D Essentials (PDP) Plan is $47.10 per month. If you do not pay the plan premiums for two (2) or more calendar months from the date on which the monthly plan premium was due, we must end your membership in the plan. This does not apply to full dual members and members receiving “Extra Help”. We must notify you in writing that you have two (2) calendar months to pay the plan premium before we end your membership. Low Income Subsidy (LIS) and dual eligible members will not be dis-enrolled for failure to pay premium.
[redacted], you shared that you are disabled and have a low monthly income. People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify won’t have a coverage gap or a late enrollment penalty. Many people qualify for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at ###-###-####. TTY users should call I-800-325-0.778, You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp.
You also shared that you do not have Prescription Drug Coverage. We encourage members to make well-informed healthcare decisions. If you would like to explore other plan options for 2015, we encourage you to contact a SHIP counselor at ###-###-####, Monday through Friday 8:00am - 5:00pm. You may make changes to your Medicare coverage during the Annual Enrollment Period (AEP) starting October 15 through December 7 to be effective January 1.[redacted], you expressed in your inquiry to the Revdex.com that your desired outcome is for First Health Part D Essentials (PDP) to provide you with coverage for your medications. We would like to offer our sincerest apologies to you, but unfortunately as indicated above, you are no longer a member of the First Health Part D Essentials (PDP) Plan as of April 30, 2014. Because you are no longer a member of a First Health Part D plan, we are unable to provide coverage for your medications. We encourage you to contact Social Security and/or a SHIP counselor to learn about any financial assistance programs that you may qualify for.
We appreciate you contacting us, and trust the additional information that we have provided satisfactorily addresses your inquiry. Your inquiry provides us with valuable insight as we continuously seek opportunities to improve our member communication materials. Thank you for allowing us to serve your prescription drug needs.
Should you have any further questions, please contact Customer Service at ###-###-####, 24 hours a day, seven days a week your local time. TTY/TDD users please call 71 | Telecommunications Relay Services.
Sincerely,
Kristy H
Medicare Appeal & Grievance Coordinator

September 9, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding billing issues for his insurance...

policy.[redacted]’s complaint states that his policy was set up so that payment was to be drafted monthly in the amount of $59.10 beginning in March 2014. According to [redacted], it wasn’t until August when he discovered a charge of $729 had been drafted out of his account that he realized that the monthly payments had not been deducted and that there was an increase in fees. [redacted] claims that he was unaware of any changes to his policy or increase in fees. Additionally, [redacted] states that he should not be responsible for payments that were not timely drafted from his account.
Coventry Health Care regrets that there apparently was a glitch in our system that prevented us from withdrawing [redacted]’s monthly payments. However, [redacted]’s insurance policy was in effect during that entire period and therefore the money was due and owing to Coventry. If at any time [redacted] had desired to use his insurance coverage, there would not have been any problems with him doing so.
After investigating [redacted]’s statement that he was unaware of a change in policy, according to our records [redacted] contacted customer service on July 23 to confirm that his plan had changed as of June 1 and that the payments should be $185.05. When [redacted] spoke with a supervisor on August 15 and requested that his policy be terminated as of August 31, 2014, the supervisor accommodated [redacted]. As of that time, [redacted]’s payments for coverage were up to date. Therefore there is no refund due.
[redacted] indicated that because of the amount of money that was withdrawn in August, he had over drafted his bank account. If he can send a copy of his bank statement to me showing the overdraft fees, I will be happy to look into the matter of reimbursement of those fees to him.
Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]
Very truly yours,Neil MRegulatory 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 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:  your bureau is not helping that all. is their abused policy against a customer they have more money thank you
Regards,
[redacted]

Good Afternoon [redacted],
We reviewed the complaint on behalf of [redacted] under your department file number of [redacted]. **. [redacted] contacted your office asking that we cancel her coverage and provide a premium refund.
After reviewing our records we were unable to locate an...

account or application for [redacted]. As you are aware, we service five counties, [redacted], [redacted], [redacted], [redacted], [redacted]. Per [redacted]'somplaint she resides in Florida. If you find that this information is incorrect, please provide the members identification number and plan coverage.
Sincerely,
[redacted], Specialist
Executive Inquiries
.

Dear...

[redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 21, 2014, regarding shopping cards that were offered through a recent television promotion.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
We were able to have the local Sales Director call and speak with **. and [redacted] today regarding this matter.  The certificates are being mailed to allow them to receive their gift cards. 
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, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding her request for a refund of her June 2014 premium payment in the amount of $491.00. The request was received by CHC Carolinas on July 16, 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 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.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,Melody *. C[redacted] Complaint and Appeal Analyst Coventry Health Care of the Carolinas, Inc.

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. It is good to know that at least one person currently working at Coventry was not lobotomized upon hire.
Regards,
[redacted]  [redacted]

Dear Ms....

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on March 9, 2015.
During our investigation, it was determined that Mr. [redacted]’s card was not accepted for several prescription claims due to ongoing updates to the coverage dates for his policy.  The updates have been completed and Mr. [redacted]’s policy is currently showing that he has active coverage and that it has been active since April 1, 2014.  At different points of time in 2015, Coventry’s systems did not accurately reflect this. 
We apologize for any inconvenience this may have caused Mr. [redacted].  We will continue to work to improve the service we 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 Ms....

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 26, 2015.
During our review, it was noted that the termination of Ms. [redacted]’s policy was processed on February 26, 2015.  That termination was retroactive to December 31, 2014.  This caused the premiums she had paid for January 2015 to show up as a credit on her account on February 27, 2015.  The previous termination was processed with an effective date of January 31, 2015.  This caused the Coventry system to not show that a refund was due prior to the update on February 26, 2015.
Ms. [redacted] will be issued the refund in the amount of $192.62 due to that credit now showing.  The refund will be sent as a direct deposit to the bank account we have on file for her.  The refund process takes 7-10 business days, which has not yet passed.  We respectfully request that Ms. [redacted] allow 2-3 additional business days for Coventry to complete the refund process.  We will continue to monitor the situation as well and will ask that the refund be expedited if any further issues are encountered.   If she has any additional questions or concerns in the meantime, she may contact me directly at ###-###-####.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

-------- Forwarded message ----------From: Revdex.com of Metro Washington DC<[email protected]>Date: Mon, Feb 22, 2016 at 8:51 AMSubject: Fwd:To: [redacted]@myRevdex.com.org
---------- Forwarded message ----------From: [redacted] <[redacted].com>Date: Sat, Feb 20, 2016 at 9:51 AMSubject: To: [email protected]
This is just a heartfelt and sincere vote of thanks for your help in solving my complaint, [redacted].
[redacted]

------ Forwarded message ----------From: Revdex.com of Metro Washington DC <[email protected]>Date: Wed, Dec 30, 2015 at 11:40 AMSubject: Fwd: Complaint # [redacted]. Resolved ThanksTo: [redacted] <[redacted]@myRevdex.com.org>---------- Forwarded message ----------From: [redacted] <[redacted]>Date: Wed, Dec 30, 2015 at 11:31 AMSubject: Complaint # [redacted]. Resolved ThanksTo: "[email protected]" <[email protected]>[redacted]