Coventry Health Care, Inc.

Review: I have a health insurance with Coventry that started on January 2014. Because of one late payment (a few days) at the end of February I now keep getting bills asking for payment and threats to end my coverage (3 letters this month and one message on the phone, as of yesterday 6/24/214) despite my continuous calls to the company to get this cleared up. I have been calling them at least once a month to make sure that the payments have been received. For the same I called again on the 6/20, was told that the system is not updating with my payments. Despite my call and being assured that my payments had been received (it also shows on my bank statements that the checks are all on time and cleared), as of yesterday 6/24 a hold is on my coverage and I cannot get my prescriptions filled (to pay upfront it would be too expensive). I talked to a representative yesterday for 1 and a half hours again for this problem and was told that the hold would be cleared immediately. As of today the hold has not been taken off and I talked again to a representative just to be told that it will take up to 5-7 days for the hold to be cleared. Also, every time I call one person contradicts what the person I talked to in my previous said. It always take a very long time holding on the phone to get my current bill payment status; as of today 6/25, AGAIN I was told that my last payment was made at the end of May (while I payed for June and July) and I have to hold for a long time before getting the correct current status. It is clear that they are not updating it, despite all my calls every month and that very probably this will keep happening. In the mean time, for their repeated mistakes I cannot have my prescriptions filled.Desired Settlement: Refund of my past payments and the future ones, until the end of the year 2014.

Business

Response:

July 8, 2014Dear [redacted]:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to your request dated June 25, 2014 and received at our office on June 26, 2014. This letter is in response to the consumer complaint filed by [redacted] regarding payment issues on her account.[redacted] complains that although she has made payments, she has received non-payment letters and her account has been put on hold. She states that she checked with her bank and the bank shows that the checks have cleared. After research, we were able to ascertain that [redacted] was not providing the appropriate identifier on her payments which prevented the payment from posting correctly. Due to the payments posting late, the red flag was issued onto the policy. [redacted] is currently paid through 7/31 and the flag has been removed. In order to prevent these issues from occurring in the future, [redacted] must provide her billing ID on all her payments. [redacted]’s billing ID is [redacted].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 1917. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

Regards,

It might be that one of the payments, probably for February 2014, did not provide the appropriate identifier on my payment, but in the subsequent months until now, after contacting Coventry every month and speaking with representatives on the phone, I am sure that my payments were correctly identified; if not, why was I not informed about it when calling, which I did EVERY month, even more than once a month to ascertain that my payments were received? Yet, in July, 5 months later, a hold has been put on the coverage for my prescriptions, which now has been in place for 13 days. In addition to all this, when my pharmacy contacted me about it on the 27th of June for the first time, after contacting Coventry about it, I was told that it was a mistake and that it would take between 5 to 7 working days for the hold to lift. On the 8th of July, my coverage was still not active, I called again just to be told that it would probably take another additional 72 hours for the hold to be lifted. I am still waiting for it.

Review: We applied for health insurance for our family after having a life changing event in September, 2014. On September 24, 2014 Coventry sent a letter which we received on September 27, 2014. This letter from September 24 from Coventry Health indicated our application had been received and was being processed. The following day, September 25, 2015, Coventry sent a second letter which we received on September 29, 2014. According to this letter, Coventry health indicated they had not yet received our payment. They indicated a payment

premium of $487.90 was due. Coventry also indicated that they nedded to receive the payment by the end of the month or our insurance would be cancelled. A check was immediately issued but of course, did not go out until September 30, a tuesday. Our check was cashed and deposited into Coventry's account on October 6th. We then waited to receive our insurance cards. Having dealt with insurance

before, we knew it could take several weeks to receive our insurance cards. On November 5, 2014, we contacted Coventry health to inquire about the status of our insurance cards which had not yet been received. According to Coventry health, since they did not receive payment before October 1, our policy was canceled! After arguing with several current customer service representatives as well as two supervisors Coventry health indicated there is simply nothing they could do and we would have to wait until the next reenrollment period. We did not understand how on earth we could have made payment by month's end when Coventry's letter regarding our premium was not sent until September 25 and not received until September 29.Desired Settlement: We seek not only a refund of the $487.90 paid to Coventry but also a refund for $100 of health expenses incurred on November 6, 2014 for a physician's visit. We held up our end of paying Coventry and they completely failed to provide not only service, but due notification of our policy cancellation. We believe their acceptance of our payment was done fraudlently as there was no coverage provided. In addition to the requested poliy refund and physician expense refund, we seek an additional $10,000 fine for deceptive business practices and failure to provide a service which was contractually agreed to and paid for. We also seek an apology letter from Coventry. We do NOT seek further insurance coverage with Coventry.

Business

Response:

Dear [redacted],

Review: I cannot change my policy as I have tried for too long and keep paying my high premium. This is my 2nd Revdex.com Complaint

Back in March 2014, I called Coventry for 3days straight to try and change my policy per the new ACA regulations. Each day I waited on the phone for 1+ hours and gave up each day until the 3rd day where I decided to contact Revdex.com for the first time and filed a complaint. About a week or two later Coventry responded to my Revdex.com complaint, and assigned me an agent to resolve my issue. I received emails from Revdex.com and Coventry stating that the Agent would call me to find the correct plan and make the change, indeed the Agents assistant called me and told me the change was made and my new premium was now $104 instead of $168. Well the next month I received a notice from Coventry by Mail stating that the changes to my policy would take place the next month, and that this current month they had to charge me the old premium, I was fine with this at the time. Except only issue was that I received the same exact notice for 7 months total saying the same exact thing, except with new dates. So two months ago I called Coventry and explained my entire situation to a supervisor, they told me it was handled after that call and that if I ended up getting charged the full amount, I would also see a refund for the difference on my account. Well as it became no surprise, this too did not happen. So I decided my next option after making more than a normal amount of attempts by this point, was to get their attention by filing disputes with my bank for all these charges, of which the bank filed the dispute and refunded me 2 months worth of premium, I was happy as I thought this meant Coventry approved the change and refunded me my money. Well yet again, I was wrong, I just now received a notice in the mail stating that they cannot process my EFT payment of $168.74 because the bank rejected the charge, and that they would now have to charge me a $20 fee because of this, so my Past Due balance is now $188.74. I immediately called them about 30 minutes ago where surprisingly they had no long wait times and someone actually answered the phone after following the prompts on their customer service line, about 2 minutes into my explanation of this entire circumstance the call "dropped" so I called back since the wait was not too long it was not an inconvenience, on this call, someone answers the phone and is talking in the background and hangs up, this happened 2 more times just now until I received and automated prompt stating that all the representatives were busy, was on hold for 5 minutes and decided to hang up and file this complaint, as this was the only way I actually got their attention.

Case Number (Per coventry):[redacted]

Agent Name:Fernando E[redacted] My name: [redacted]

DOB: 04/06/1990

Member #:[redacted]Desired Settlement: I am seeking a refund for the difference for my premium from $168 to $104 for 3 months. I already received a refund from my Bank for 2 other months.

I am also seeking a refund for the $20 fee charged to my account.

And am finally seeking either a change in my policy as promised months ago and if this cannot be a done then a cancellation from Coventry.

At this point I prefer to pay this amount of money for a company who can at least provide me with somewhat mediocre customer service, ra

Business

Response:

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]

Business

Response:

Dear [redacted],

Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 10, 2014, regarding the amount of his monthly premium. 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 show that $168.74 was the correct premium amount for the plan [redacted] was enrolled on beginning in May. The premium increased from $116.20 on May 1, 2014, due to being moved to a different plan, because his previous plan was not compliant with the Affordable Care Act. No record was found of a plan change request being made after that date. We also spoke with Adrianna, the assistant for the member’s broker, Frederick E[redacted]. She stated that they never requested a plan change for the member because he did not experience a qualifying event that would allow a plan change in the middle of the year.

Letters were sent out June 11, 2014, July 10, 2014, and August 6, 2014, but were sent due to the draft date not being on the usual date of the 5th of each month and were not related to a changing premium amount.

The NSF fee that was applied was due to a failed premium withdrawal attempted by Coventry on September 9, 2014. The last premium we were able to successfully collect was drafted on August 19, 2014, and was for coverage for the month of August 2014. A premium was not collected for September, so his policy was terminated effective August 31, 2014. No refund is due as the NSF fee was legitimately applied, and the premiums collected were only for his months of active 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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].com.

Regards,

Chris B[redacted]

Executive Resolution Team

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

Review: [redacted] and I have went to a broker and purchased health insurance. The policy was instated as of 3/1/13. I called to make a doctors appt. and was told that my policy has cancelled. Called coventry and got everything taken care of. I went to my doctor appt but later received a bill, as if I never had insurance. [redacted] proceded to calcoventry to cancel the policy due to my doctors bill and he was advised that he policy has cancelled even though the monies for the policy was automaticaly drafted. We called ur agent and told them we were done payin for services that we never had. THey faxed us a cancellation form and we faxed it back to coventry immediately. and now on July 8,2013 they took monies out of the account again when we have no health insurance. We would like to have a refund for the 5 months we paid for health insurance we never had.Desired Settlement: $1,008.35. All of the monies that was taken from our account in which we couldn't use the health insurance due to constant cancellation

Business

Response:

Coventry Health Care, Inc. respectfully requests an extension of time in which to respond to Complaint #[redacted].

Thank you,

Business

Response:

Attached please find Coventry Health Care's response to Complaint #[redacted].

Thank you,

Review: In April 2014, I had my annual physical exam. However, Coventry is refusing to cover my bills due to the doctor supposingly not being in network. They failed to notify me of any changes, and he is listed as my primary care provider. I am totally dissatisfied and I look forward to canceling this insurance and advising others to not use them.Desired Settlement: I cannot cover this bill, I only went to this doctor because he was listed as PCP, primary care provider.

Business

Response:

October 10, 2014Dear [redacted]:Your letter of October 1, 2014 was received in our office, and referred to my attention for review and response.In her complaint to the Revdex.com, [redacted] expressed concern that her claims for dates of service April 22, 2014 and April 23, 2014 processed at the out-of-network rate, even though she went to the provider listed on her insurance card. During the investigation, Coventry identified that [redacted] was assigned a Primary Care Provider (PCP) that is not a participating provider in her policy network. This incorrect assignment occurred during [redacted]’s enrollment with the Marketplace. Coventry continues to work with the Marketplace to remedy errors of this nature.Based on the circumstances of the complaint, Coventry will allow a one-time exception to process the April 22, 2014 and April 23, 2014 services at the in-network benefit level. Please allow 7-10 business days for the adjusted Explanation of Benefits (EOBs) to be issued. Coventry will provide [redacted] with the EOBs once they are available.Our goal is to provide the opportunity and resources for [redacted] to establish care with an in-network provider. [redacted] may visit the website at www.chcne.com, and choose the Carelink Powered by MIPPA link. [redacted] may also call our Customer Service Department at ###-###-####, in order to find a Participating Primary Care Provider in her Open Access Point of Service (OA POS) MIPPA network.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted]Sincerely,Shawn MComplaint and Appeal Analyst

Review: On 8/4/14 I cancelled my insurance policy and was told I would not be charged for another month premium. On 8/27/14, I saw on my bank statement that Coventry did in fact debit my account for another month premium on 8/5/14. I called the customer service number and spoke to Maria. She informed me that due to my cancelling the policy in the middle of the month, I was responsible for total premium. I tried to explain that I called before my next premium was due, not in the middle of the month, and was assured no other premiums would be debited. Maria just continued to tell me I did not cancel in time and I would not receive a refund. I was assured I wouldnt have to pay another premium when called to cancel so I did not allow for this extra charge in my finances. If I hadn't taken the time to review my bank statement I would now have bounced checks and overdraft fees. I have a case number confirming my cancellation on the exact date of 8/4/14. If that was not possible, why didn't someone call me back, e-mail me, or at least send a letter to let me know I owed another month. I feel that my cancelling on 8/4/14 was my way of saying I don't want the service any longer and don't debit my account again. I have been all month assuming I didn't have insurance, I have not used it and I want my premium refunded. They were not authorized to charge me for this last monthDesired Settlement: I want a refund of the $289.19 premium that they debited without my authorization.

Business

Response:

September 12, 2014Dear [redacted]Your letter of September 4, 2014 to Coventry Health Care of Virginia, Inc. ("Coventry Health Care") was referred to my attention for review and response,[redacted] expressed concern regarding the cancellation of her policy and the August premium she was charged. Coventry addresses these concerns below.On July 30, 2014, [redacted] contacted Coventry's Billing and Enrollment Department to discuss adding her dependent, [redacted], to her current Coventry.One policy. The Customer Service Representative (CSR) advised she would need to submit a form to add the dependent.On August 3, 2014, Coventry received notification from the Marketplace [redacted] and [redacted]'s new Gold policy would be effective on September 1, 2014, [redacted] received notification in writing that her new policy would be effective on September 1, 2014 once she made her initial binder payment. According to this information Coventry continued to withdraw $289.19 for the Coventy One policy's August premium from [redacted]'s bank account.On August 4, 2014, [redacted] contacted Coventry's Billing and Enrollment Department to cancel her policy as she created a new account through the Marketplace, The CSR advised her policy would be terminated and she would need to contact the Marketplace for any additional assistance.On September 8, 2014, [redacted] contacted Coventry's Billing and Enrollment Department requesting a refund of $289.19 as she terminated her policy as of August 4, 2014. The CSR advised [redacted] she would need to contact the Marketplace.[redacted]'s Coventry Che policy was prospectively terminated on August 31, 2014 based on policy language and her August 4, 2014 request, Coventry is unable to process any changes to a policy that was initiated through the Marketplace per the Exchange rules and regulations that we as an insurance company must follow, [redacted] would need to contact the Marketplace to request her Gold policy effective date to be updated. If the Marketplace approves [redacted]'s request for an August 1, 2014 effective date then Coventry would be able to review terminating the Coventry Che policy effective July 31, 2014.Coventry apologizes for any inconvenience this has caused [redacted], However, as stated above the change must come through the Marketplace as Coventry is unable to change the effective date based on the Exchange rules and regulations.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,Teresa EComplaint and Appeal Program

Consumer

Response:

[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]They have known about my request for a week. I don't feel I should have to give them an indefinite time to work on a response. The paper work stands for its self. I will allow them one week - no more.

Review: [redacted]

I am rejecting this response because:

Regards,

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

All I got from the letter forwarded from Coventry is a lot of double talk. No where in her explanation does she say why I received a letter stating my cancellation date was August 4, 2014, or where my billing history shows coverage discontinued for period 8/1/2014 and this was printed on 8/27/2014. I do not think I should have to go to the Marketplace for this problem since the Marketplace is not the one that was debiting my bank account. You can spout your policies all you want, the fact remains I have paperwork showing you cancelled my policy August 4, 2014. You sent these papers to me and I went the whole month thinking I didn't have this insurance. That was your companies doing! When you saw that your "policy" would not allow this cancellation date, then someone should have sent me another letter letting me know or an e-mail. If I was one of the millions of people that don't balance their checkbook, I would never have known that an unexpected $289.19 was gone from my account until I ended up with a returned check. This is not right and I should not have to pay for poor management on Coventry's part! It's not right that an American citizen can so blatantly be robbed by an insurance company! This is fraud on the part of the insurance company and I guarantee I am not the only one that you have done this to. I am just the only one who didn't think it was useless to fight it.I still stand with what I have stated: Coventry owes me my $ 289.19 refund and that is the only thing I will settle for!

Regards,

Cristy Henderson

Attached you will find copies of paperwork proving my account was cancelled as stated

Business

Response:

September 26, 2014Dear [redacted]:Your letter of September 18, 2014 to Coventry Health Care of Virginia, Inc. ("Coventry Health Care") was referred to my attention for review and response.[redacted] objected to Coventry's original response regarding the cancellation of her policy and the August premium she was charged, Coventry addresses these concerns below.It was identified Coventry issued an incorrect date on [redacted]'s Certificate of Creditable Coverage (CoCC). However, Coventry will honor the incorrect date and [redacted] will be issued a pro-rated refund of the August 2014 premium.Based on the additional documentation Coventry has retroactively terminated [redacted]'s policy effective August 4, 2014. Please be advised [redacted] will be without medical insurance August 5, 2014 through August 31, 2014.Coventry apologizes for any inconvenience this has caused [redacted].If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,Teresa EComplaint and Appeal Program

Review: I signed up for Coventry Health Insurance through the Marketplace back in Dec 2013 for coverage that was to start Jan 1, 2014. I made my payment and set it up to automatically withdraw from my bank account. My coverage was terminated effective Jan 31, 2014 due to non-payment in which Coventry did not withdraw funds from my account each month as was initially set up. I have been attempting since the first week of May to find out why Coventry failed to do so, why they did not notify me in any way of the problem and how I could get my policy reinstated. I have spoken with their customer service and billing departments a dozen times since then, spoken to Marketplace and even had a new policy put into place effective July 1st which is still not showing as active. I also had 2 phone calls with Coventry and Marketplace on conference in which Marketplace told Coventry that all information had been submitted but yet Coventry kept claiming it was not received. During this disaster of an insurance mess, I went without medication for my MS and ADHD health issues for 2 months and continue to be without some for my ADHD. I also have a hand injury that I cannot get care for because of this and will now more than likely have to get even more care because of the lack of it to begin with. I requested on a majority of my phone conversations with Coventry's customer service to have a supervisor call me to discuss, as well as in 3 emails. No one has called, written or even attempted to contact me.Desired Settlement: I ask that my policy be reinstated for the entire year of 2014 with the Tax Credit in place as of 2/1/14 as well as my policy effective 7/1/14 be active ASAP. All Claims be paid ASAP as well as any out of pocket expenses I have had to incur because of this be also paid ASAP.

Business

Response:

August 20, 2014Dear Sir of Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding termination of her policy for non-payment.We have researched [redacted]'s complaint and our records indicate that the member was set up on the “Paper billing” method. This means [redacted] would have been sent a paper bill in the mail with instructions on how to send the payment. It appears that she had not been on an automatic billing method at any point in the policy. In order to be set up on auto payment, [redacted] would have needed to sign and return an auto withdrawal form that authorized Coventry to take the payment monthly. Also, the [redacted] could have set up automatic payment online at the member website (member.cvty.com). This is why Coventry never automatically withdrew from [redacted]’s account. On January 1, 2014 [redacted] was mailed an initial payment letter indicating that her payment was due. On March 9, 2014 she was mailed a past due letter. [redacted] did not respond to either letter.[redacted] has a new policy. This policy is effective 07/01/2014 for a $0.00 premium on the Silver Integrated $10 Copay PPC plan. Due to the other policy being terminated for January 31, 2014, there will be no coverage for [redacted] from February 1st to June 30th. The older policy cannot be reinstated to cover for the lapse of coverage as it was terminated for nonpayment. After further research it was concluded there was no error on the behalf of Coventry as the proper documentation was sent to [redacted] reminding her of the payment that was due.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 [redacted], and my e-mail address is [redacted].Very truly yours,Kimberly S RN, BSN, CPC Health Services Manager, Appeals

Consumer

Response:

[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]

Review: [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,

Business

Response:

August 29, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the consumer rejection complaint filed by [redacted] regarding termination of her policy for non-payment,We have researched [redacted]'s complaint and our initial response remains the same. We have confirmed that the address on file with the Market Place matches what we have in our system: [redacted], KS [redacted]. We cannot explain why the member did not receive our correspondence.Our system reflects this member was set up on the “Paper billing” method. This means [redacted] would have been sent a paper bill to the address indicated above, with instructions on how to make her payment. On January 1, 2014 [redacted] was mailed an initial payment letter indicating that her payment was due. We have a record of [redacted] calling our Enrollment and Billing Department on January 10, 2014 to check the status of her binder payment. The representative explained it had not posted. However, the initial payment posted on January 13, 2014.On March 9, 2014 she was mailed a past due letter and a cancellation letter on April 17, 2014, We did not receive any payments after the initial binder payment. Due to the other policy being terminated for January 31, 2014, there will be no coverage for [redacted] from February 1st to June 30th. The older policy cannot be reinstated to cover for the lapse of coverage as it was terminated for nonpayment.[redacted] has a new policy. This policy is effective 07/01/2014 for a $0.00 premium on the Silver Integrated $10 Copay PPO plan, [redacted] has concerns regarding the delay in receiving information on her new policy. Unfortunately, regardless of what may have been indicated to [redacted] by the Market Place, we did not receive the file from the Market Place timely. The system currently shows [redacted] effective July 1, 2014 on a fully subsidized plan, 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,Kimberly S RN, BSN, CPCHealth Services Manager, Appeals

Consumer

Response:

The original setup of the automatic billing process was done through the Marketplace at the time the insurance process was started, so unfortunately I have nothing to provide since it was all done online. Please let me know what else I can provide to you. Thanks, [redacted]

Review: 1.Coventry Health makes it very difficult to discontinue service. They want you to prove to them that you are insured by another agency before they will let you go. They are not a government agency and have no right to request this info.

2. I tried to discontinue service by cancelling the debit card that they hit each month but they found a way to hit the new card.

3. Lastly, they sent a new, more expensive policy to an address that no longer exists for me that was 5 times the amount of the previous policy. Since I never replied to the proposal they automatically enrolled me and unlawfully and without permission processed and e check from the info on a check given to them a year ago as a down payment when I was living in the state.Desired Settlement: It is my son who was insured in Pennsylvania. We have tried to cancel since last May, we don't live in PA and could not benefit from the insurance. I would like all the money they have stolen from me since May returned.

Business

Response:

Coventry Health Care respectfully requests an extension of time as we work directly with the member to secure the proper authorizations.

Thank you,

Deborah Finch

Business

Response:

September 15, 2014Dear [redacted]:The member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual HMO off exchange health benefit plan.[redacted] has filed a complaint with written consent on behalf of his son, [redacted] (the “member”). The member’s complaint concerns premium refunds. The member’s father 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’s father is requesting a refund for $362.00.Below is a timeline of events leading up to the resolution of the member’s complaint.June 5, 2014- [redacted] called stating that their son has been living in the state of Florida since April and is requesting a refund because his account was drafted in April through June. The member’s father requested a refund for May and June premium payments. The representative advised him to send in proof of coverage.August 19, 2014- [redacted] called stating that he has been trying to term this policy and we are still drafting from the account. The CHL representative advised that the primary member must call in and request the termination. Tyler came on the phone and requested to term the policy.ROOT CAUSE: The policy continued to draft from the account since the primary member never called or submitted a termination request.RESOLUTION: The policy is showing termed as of 08/31/2014 since primary member ([redacted]) called on 08/19/2014 and requested to term policy. Per business rules we termed the policy for the end of the month when the member sent in the request to term. The CHL representative advised if the member would like to retro terminate to receive a refund the member would need to submit proof of other coverage with effective date showing. At this time no refund is due.Further, in Section 3- Termination of Coverage of the Coventry Health and Life Insurance Company Non-Employer Group Certificate of Insurance which states the following:3.1 Termination: A. Termination by Subscriber. The Subscriber may terminate Coverage for himself/herself and any enrolled Dependents under the Contract for any reason by providing thirty-one (31) days advance written notice to Us. Termination will take effect on the first day of the month following the request notification period. The notice of termination should be sent to:HealthAmericaOne 3721 TecPort Drive PO Box 67103 Harrisburg. PA 17106In the case of a termination in accordance with above paragraph of this section, the last day of coverage is:-The termination date specified by the Subscriber, if the Subscriber provides fourteen (14) days notice;-Fourteen days after the termination is requested by the Subscriber, if the Subscriber provides less than fourteen (14) days notice; or-On a date determined by the Subscriber’s QHP issuer, if the Subscriber’s QHP issuer is able to effectuate termination in fewer than fourteen (14) days and the enrollee requests an earlier termination effective date.-If the enrollee is newly eligible for Medicaid or MCHIP, the last day of coverage is the day before Medicaid or MCHIP coverage begins.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,Emily MAppeals Coordinator

Review: In early December, 2013, we applied for Health Care Coverage with Coventry One. The initial binder payment of $909.26 was provided via ACH on 12/03/2013. Membership cards never arrived and we do not yet have a membership number to file claims against.

We never received an e-mail confirmation or instructions from you on how to file a claim and thought we were not insured.

We have tried to contact customer service department, but this is only a potentially viable option at (or slightly before) 8:00ET, when customer service becomes available. Even then, lengthy wait times are often required. We were able to get through on two (2) occasions. On both of these calls, we were told that no membership number had been assigned and none was available. When We pressed for a time frame, we were told that "no date was available."

We believe this practice unconscionable and have since switched to a competitor.Desired Settlement: We would like a refund of our initial binder payment of $909.26. We feel the services under the contract were never provided.

Business

Response:

February 26, 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 an his CoventryOne policy purchased on the Marketplace exchange effective January 1, 2014. The request was received by CHC Carolinas on February 26, 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 ###-###-#### between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.Sincerely,Stephanie * H[redacted], LPN Manager, Complaint and Appeal Programs Coventry Health Care

Business

Response:

February 26, 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 an his CoventryOne policy purchased on the Marketplace exchange effective January 1, 2014. The request was received by CHC Carolinas on February 26, 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 ###-###-#### between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.Sincerely,Stephanie * H[redacted], LPN Manager, Complaint and Appeal Programs Coventry Health Care

Consumer

Response:

Problem:

ACH Debit for Initial Health Care policy premium was on 12/3/2013. Did not hear anything from Coventry One (no e-mail, regular mail, phone call) until 1/23/2014. Thinking I did not have a policy, I bought a policy with one of their competitors. Eventually given the phone number for the Manager of Claims and Appeals. Called 7 times between 3/17 and 3/24 during working hours - sent to voice mail every time. Left detailed messages. No call-backs. No acknowledgment. I have sent a total of 3 letters respectfully requesting a refund with no resolution. This policy was never in force and the Health Marketplace has it terminated and marked as such.

Desired Settlement / Outcome

Desired Settlement:

select

Desired Outcome:

I would like a refund of my $909.26 premium payment since the policy was never in force.

Consumer

Response:

Problem:

ACH Debit for Initial Health Care policy premium was on 12/3/2013. Did not hear anything from Coventry One (no e-mail, regular mail, phone call) until 1/23/2014. Thinking I did not have a policy, I bought a policy with one of their competitors. Eventually given the phone number for the Manager of Claims and Appeals. Called 7 times between 3/17 and 3/24 during working hours - sent to voice mail every time. Left detailed messages. No call-backs. No acknowledgment. I have sent a total of 3 letters respectfully requesting a refund with no resolution. This policy was never in force and the Health Marketplace has it terminated and marked as such.

Desired Settlement / Outcome

Desired Settlement:

select

Desired Outcome:

I would like a refund of my $909.26 premium payment since the policy was never in force.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

The business has not resolved this issue. There are many more families impacted by this issue I am sure. This company did not contact me to confirm or acknowledge coverage for 8 weeks after they took my Premium payment of over $900. With no acknowledgement, we were left to conclude that we weren't covered by the policy we paid for, and I changed companies. This is unconscionable, and the company should refund our premium payment immediately. There was no policy in force. This company does not "answer" the phone (even their "claims and appeals department" is silent and does not return any calls - ever). There is no excuse for this. In this economy, to transact business like this is beyond belief. To resolve this issue, please refund my premium payment of $900 immediately.

Perhaps what we need is more publicity to reach out to other affected parties.

Regards,

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

The business has not resolved this issue. There are many more families impacted by this issue I am sure. This company did not contact me to confirm or acknowledge coverage for 8 weeks after they took my Premium payment of over $900. With no acknowledgement, we were left to conclude that we weren't covered by the policy we paid for, and I changed companies. This is unconscionable, and the company should refund our premium payment immediately. There was no policy in force. This company does not "answer" the phone (even their "claims and appeals department" is silent and does not return any calls - ever). There is no excuse for this. In this economy, to transact business like this is beyond belief. To resolve this issue, please refund my premium payment of $900 immediately.

Perhaps what we need is more publicity to reach out to other affected parties.

Regards,

Business

Response:

April 18, 2014Dear Sir or Madam:This letter is written in response to the consumer rejection of Coventry Health Care of the Carolinas, Inc.’s response to the Revdex.com filed by [redacted] regarding termination of his CoventryOne policy purchased on the Marketplace. In his latest rejection, [redacted] has again requested refund of his premium payment.As I explained in my previous response, and reiterate here, [redacted] signed up through a government site—the Marketplace Exchange—and it is the Markctplace that controls the termination date. Because it was the Marketplace that accepted his application and determined the effective date, only it can make the change to terminate as never in force. If the Marketplace grants [redacted]’s request to terminate the policy as never in force, CHC Carolinas will be notified electronically, and we will be able to take the necessary steps to refund [redacted]'s premium. However, it is [redacted] who must request that action from the Marketplace Exchange; it is not something CHC of the Carolinas is able to do. I once again request that [redacted] take the next step that is required for resolution—contact the Marketplace Exchange at [redacted] for an exception to the termination date as never in force through the Marketplace.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.Melody *. CComplaint and Appeal Analyst Coventry Health Care

Business

Response:

April 18, 2014Dear Sir or Madam:This letter is written in response to the consumer rejection of Coventry Health Care of the Carolinas, Inc.’s response to the Revdex.com filed by [redacted] regarding termination of his CoventryOne policy purchased on the Marketplace. In his latest rejection, [redacted] has again requested refund of his premium payment.As I explained in my previous response, and reiterate here, [redacted] signed up through a government site—the Marketplace Exchange—and it is the Markctplace that controls the termination date. Because it was the Marketplace that accepted his application and determined the effective date, only it can make the change to terminate as never in force. If the Marketplace grants [redacted]’s request to terminate the policy as never in force, CHC Carolinas will be notified electronically, and we will be able to take the necessary steps to refund [redacted]'s premium. However, it is [redacted] who must request that action from the Marketplace Exchange; it is not something CHC of the Carolinas is able to do. I once again request that [redacted] take the next step that is required for resolution—contact the Marketplace Exchange at [redacted] for an exception to the termination date as never in force through the Marketplace.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.Melody *. CComplaint and Appeal Analyst Coventry Health Care

Review: Day 3 of waiting for Coventry to answer the phone. Day 1 -Waited 1 hour and 45 minutes, Day 2- 1 Hour and 24 Minutes, Day 3- Today waiting 30 Minutes.

I am trying to change my insurance premium, which at this point I want to cancel because no one obviously cares. I have emailed them, left voicemails after hours and called them for now 3 days straight and waited ridiculous amounts of times until I am really bothered and hang up the phone. My member ID is [redacted], and all I am trying to do is reduce my plan because my premium went up $60 in the last month. The easiest department to get to is the regular customer service department which takes about 40 minutes to get to but they cannot help me with a policy change, its their other department for marketing that can help me, and they are the ones taking over 1 hour every time on the phone. At this point I know their entire holding music by memory, and am bored of their jingle. This is not customer service! If they don't answer soon I am going to file dispute charges from my bank. Maybe if I take away the money they are taking from me I will get their attention and they will call me. One can only hope!Desired Settlement: Refund for my monies paid, or simply the ability to change my policy is all I want!

Business

Response:

May 22, 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 BRZ $10 HMO PD CARELINK, effective May 1, 2014. In order for [redacted] to change his plan he will need to reach out to his agent of record, **. [redacted] located at [redacted], FL [redacted]. **. [redacted]’s phone number is ###-###-####.In an effort to assist [redacted] with his complaint, the Health Plan has reached out to **. [redacted] regarding [redacted]’s complaint.• 1 st attempt - [redacted], [redacted] on 5/22/2014 at 2:26pm called **. [redacted] at ###-###-####. **. [redacted] spoke to **. [redacted]’s assistant [redacted]. **. [redacted] advised [redacted] that [redacted] contacted the Revdex.com with concerns of his current policy. [redacted] stated that she would contact **. [redacted] to contact [redacted].• 2nd attempt- [redacted] contacted **. [redacted] regarding [redacted]’s policy. **. [redacted] advised [redacted] that she would need to contact the Billing and Enrollment department for additional options for [redacted].In regards to the wait time, with the unprecedented growth of membership with our Affordable Care Act (ACA) plans the wait time is a little bit longer than usually, but the plan is working diligently to rectify this issue.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,

Review: I paid my insurance premium and my check was cashed on December 10th and I continue to receive non payment notices. Now my policy has been cancelled.

I have faxed Coventry at their request, a copy of the cashed check and policy and premium amount in hope of connecting my payment to the policy. Now they tell me they never received my fax, and that I can't expect a refund without proving to them that cashed my check. So they took my payment but never provided a policy.Desired Settlement: Replacement and $95 dollars for the penalty I will have to pay for not having health insurance by March of 2014.

Business

Response:

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,

Review: I had Coventry healthcare, and was told that my coverage had to be terminated, and I had to pick a new plan. I called and the sales rep. and I decided on coverage for myself and my husband for $298.00 per month, that would be deducted from my checking account. I subsequently called numerous times and left voice mails to the sales rep. [redacted], to confirm my coverage and never got a reply. I spoke to a customer service rep. and was told that $298. would be taken out on January 5th. On January 6th, $700. was taken from my account! I stopped payment on this amount. We called and spoke to two different people there to tell them to cancel that policy as we NEVER agreed to that amount! I subsequently applied for coverage through the government website. My coverage with them begins on March1st. At no time did I ever receive correspondence from them stating the larger price. On February 5th. I was shocked to discover that over $1438.00 was deducted from my checking account without my permission. I thought I was done dealing with Coventry! My husband has called numerous time to speak to a supervisor to get this resolved to no satisfaction! I am still out all of my money, and don't know if I will get it back! How can a company get away with this? I really can not afford to lose this kind of money, and most definitely would not agree to coverage that is more than twice the amount that I have ever paid!Desired Settlement: I would like the entire amount to be refunded to me as soon as possible!

Business

Response:

February 7, 2014

Dear **. [redacted]:

The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.

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 $1438.00

Upon review, the member’s policy is still active and the member was drafted on February 5, 2014 for the premium owed for January and February plus a $20 service charge for the January premium that was unpaid by the bank because the member stopped payment on that draft. If the member wants the policy terminated, the member would need to send a signed termination form to enrollment. (attached) If the member wanted her policy termed as of December 31, 2013 we need the signed term form requesting a December 31, 2013 term date, and proof of new coverage in effect as of January 1, 2014. Without the proof of new coverage, we would process the member’s term request now for a February 28, 2014 date.

If you have any questions or concerns regarding this matter I can be reached at ###-###-####.

Sincerely,

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: I received a letter from Coventry, that THEY were terminating my coverage as of December 2013. I was working with one of their sales reps. who was to enroll me in a plan for $298. per month for my husband and myself, to begin in January. They then tried to deduct $700. per month from my checking, which is what I stopped payment on.I NEVER agreed to this amount!! I spoke to SEVERAL people at Coventry, who were to cancel my coverage completely. Why would you then in February deduct two months of $700. plus late fees that for a policy that is canceled!! Your company dropped the ball several times, and will not admit it!! I have enrolled with another provider! Do you continue to try to collect premiu** for someone who obviously does not want your coverage!! This is THIEVERY!! I still have not gotten any call-backs from any supervisor! Great customer service!

Regards,

Business

Response:

February 27, 2014

Dear **. [redacted]:

The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.

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 $1439.70

Below is a timeline of events leading up to the resolution of the member’s complaint.

December 3, 2012 11:59 AM - A new application was received.

December 7, 2012 5:26 PM - [redacted] contacted billing and enrollment to verify the draft date. She stated that she was advised by her agent that her first premium would not come out until the day the policy was effective. The member was advised that the first payment would be drafted upon the issue date.

December 16, 2012 3:50 PM - [redacted] contacted billing and enrollment and stated that she spoke with a representative named [redacted] on December 6, 2013 in regard to her renewal. The member stated that the representative had not returned her call. The member was advised that her new plan became effective January 1, 2014 and the new premium amount is $334.24.

January 15, 2014 - An EFT return letter was mailed.

February 5, 2014 11:16 AM - [redacted] contacted billing and enrollment in regards to the draft. He stated that his wife never agreed to renew the policy and applied through the MarketPlace effective January 1, 2014. The member stated that we had attempted to draft the premium in January however he placed a stop payment and the agent was supposed to have the policy terminated. He was advised that we did not have a written request on file. The member was advised to submit a written request with proof of other coverage and the policy would be retro terminated and we could request a refund. The member was provided with the correspondence address and case number.

February 10, 2014 2:58 PM - [redacted] contacted billing and enrollment he stated that he was supposed to have a supervisor contact him. The member stated he had contacted billing on February 6th and that he wanted a refund for the amount that was drafted. He stated that he placed a stop payment at his checking account because he did not want to be charged any late fees, but he was charged for not making the payment and administrative fees. The member requested to speak to a supervisor, and a request for a supervisor call back was placed.

February 14, 2014 11:23 AM - [redacted] contacted billing and enrollment to verify the status of the refund. She was advised that $688.48 returned on February 13, 2014.

February 20, 2014 - An EFT return letter was mailed.

ROOT CAUSE:

The member wanted to terminate her coverage for December 31, 2013 however we never received proof of other coverage. This information was requested, and to date we have not received the requested proof of other coverage.

RESOLUTION:

The members policy is currently active, however it is on [redacted]. The policy will eventually terminate for nonpayment. If the member wants to retro terminate for December 31, 2013, we will require a handwritten request with proof of other coverage. We do not have any calls on file that mention the termination.

If you have any questions or concerns regarding this matter I can be reached at ###-###-####.

Sincerely,

Review: We bought coverage of family health coverage under the new requirements. Policy was paid since Dec 15, 2013 and we have not received ID cards.

We have not received the ID cards and are not able to obtain medical services under the Coventry policy. My kid school is asking proof of coverage as required by the new goverment policy and we are not able to comply. We checked with the [redacted] and everything is OK, we called three times in the last 3 weeks to Coventry and they say it will be fixed , it was just a problem in their system.Desired Settlement: provide the required ID cards immediately and provide a full credit for the month of JAN 2014 due to the lack of coverage.

Business

Response:

Coventry Health Care respectfully requests an extension of time in which to complete its investigation into this Complaint.

Business

Response:

February 5, 2014

Dear **. [redacted]:

This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s request for new member material and/or member ID number and refund of January 2014 premiums.

After review of this grievance, the Health Plan has confirmed, **. [redacted] paid for premiums on December 15, 2014 for a policy effective date January 1, 2014, Making a payment prior to issuance is part of the requirements for polices offered on the exchange. There is no consideration for partial month; that is not an option the Health Plan can offer, according to Federal Guidelines. As this is an on exchange plan and the binder payment is a requirement to hold the policy, we could not make an exception to refund. **. [redacted] would have to call the exchange for this or see if they were willing to move his effective date due to the circumstances. Either way the Health Plan is limited to what is fed to us by the exchange.

In addition, new member material can take up to 7-14 business days to be received. As of January 15, 2014, a request was made to have **. [redacted]’s cards mailed. Please find (enclosed) **. [redacted]’s Schedule of Benefits and Schedule of Covered Services. On January 24, 2014, the Health Plan has contacted **. [redacted] and informed that his policy is currently active.

If you have any additional questions, please contact me toll free at ###-###-####, extension [redacted] or directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. If you are hearing impaired please call TTY 7-1-1 Relay.

Sincerely

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

As today ( Wednesday February 5th, 2014) we have not received the insurance package or ID cards. We received an statement date January 21st, 2014 and the statement does not contain an ID number. We received a letter last week with the ID # for the policy but without the proper ID cards we have not been able to use the coverage. Prescriptions for my wife and regular visit for my son has been denied.

Why should we pay coverage for January if we were not covered? payment should be applied for February, but only if we receive the required docs and cards and we can have coverage for February 2014. Right now we are still the same a Jan 2014, no coverage, no ID cards.

Regards,

Business

Response:

February 6, 2014

Dear **. [redacted]:

The Health Plan received your request to our initial response on February 5, 2014. In response to your rejection:

**. [redacted] would have to call the exchange for this or see if they were willing to move his effective date due to the circumstances. As this is an on exchange plan and the binder payment is a requirement to hold the policy, we could not make an exception to refund. Either way the Health Plan is limited to what is fed to us by the exchange. Making a payment prior to issuance is part of the requirements for polices offered on the exchange. There is no consideration for partial month; that is not an option the Health Plan can offer, according to Federal Guidelines.

In addition, on February 5, 2014, a replacement request was made to have **. [redacted]’s cards mailed. **. [redacted] can go to our website, www.chcflorida.coventryhealthcare.com to download a temporary member ID card to fill prescriptions and schedule appointments. **. [redacted] can contact our Customer Service Department to verify his policy and coverage.

If you have any additional questions, please contact me toll free at ###-###-####, extension [redacted] or directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. If you are hearing impaired please call TTY 7-1-1 Relay.

Sincerely,

Consumer

Response:

I have called Coventry, the [redacted], I was thinking calling the White House!!! they are a disaster and they are stealing from people, we already arranged insurance outside of their program. Never received ID cards, they are not even available online, customer service is a joke. They should return the charged premium they charged for January.

Attached you can see that even last invoice received on 1/24 does not have an ID number. letter with ID # got to us on 1/27. Why do we have to pay for a month if there was no coverage?

Rgds,

[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]

Review: [redacted]

I am rejecting this response because:

Regards,

Business

Response:

February 18, 2014

Dear **. [redacted]:

The Health Plan received your request to our initial response on February 5, 2014. In response to your rejection:

**. [redacted] is currently enrolled with the Health Plan’s Individual GLD $5 HMO CARELINK policy# [redacted] effective January 1, 2014. On January 15, 2014, **. [redacted] policy was loaded into the system. Unfortunately, the Health Plan is limited to what is fed to us by the exchange in a timely manner. Making a payment prior to issuance is part of the requirements for polices offered on the exchange.

Please be advised of the following events after issuance of new member material and/or member ID numbers; The Health Plan has a total of nine logs on file for **. [redacted]:

• January 22, 2014 - **. [redacted] was contacted by the Health Plan’s Customer Service Department to advise that his policy was effective. There was no answer and Customer Service Representative left a message.

• January 23, 2014 - **. [redacted] filed a complaint with the Revdex.com regarding not received member ID cards and policy material.

• January 24, 2014- **. [redacted] contacted the Health Plan’s Customer Service Department and was given his member ID number.

• January 29, 2014- **. [redacted] contacted the Health Plan’s Customer Service Department regarding his Revdex.com complaint and the status for premium payment for February 1, 2014.

• On February 6, 2014 at 10:14am- **. [redacted] called regarding a payment voucher for January premium and the status of his member ID card.

• On February 6, 2014 at 11:10am- **. [redacted] sent a secure email requesting information on how to print out his member ID cards online. **. [redacted] was advised he must register all the members of your policy to print out their member ID cards.

• On February 6, 2014 at 11:19am- **. [redacted] contacted Customer Service and he was advised that all cards were originally sent out on January 15, 2014 and a second request was submitted on February 5, 2014 to have cards mailed out.

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 [email protected].

Sincerely

Review: Coventry one refused to cancel my policy & continued to charge my bank account after I canceled my policy in November 2013.

I have spent over 10 hours on the phone trying to fix this issue. they have agreed to cancel my policy as of December 31 2013, & refund the January 2014 draft that they took without authorization. I have not received my refund even tho they have told me it was refunded to my account. I have contacted my bank , & no refund has been attempted by Coventry one. they keep making excuses & hanging up on me when I call.

please let me know why the insurance company is taking advantage of having my banking information. They should not have the right to charge my bank account when I have taken all the necessary steps to cancel my policy as requested by Coventry one.Desired Settlement: I would like Wellpath, or Coventry one to refund the payment of $194.31 that was not authorized .

Business

Response:

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]. [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.

Review: Coventry one sent me a bill for a policy that I didn't have. I called and put a stop payment on the bill in question because I was no longer a member. The Payment was taken anyway, my bank account was over drawn and I had those fees against me. I called the office, found out that for almost a year, they have been taking money out of my account while I was no longer under their coverage, and had switched to [redacted]. I was told that I was due a refund if I could provide proof of insurance. They returned the money that was taken out of my bank account, but not the overdraft fees.I provided a copy of the last year of insurance information. Called a few days later. I was promised that it was enough and that I should get a refund in 7-10 business days. I called over two weeks later, nobody filed the claim. Was told that it was taken care of, I would receive a check in 7-10 business days. Waited, no check, called back and asked to talk to a supervisor. Was put on the phone with one named "Kenneth". He assured me that he took care of it, and to wait 7-10 business days. Same story. Talked to another supervisor named Carmellia? She told me Kenneth wasn't a supervisor and that there was nothing she could do. Nor could she put me in touch with anybody in charge of anything. I have been promised call backs, multiple times to no avail. Hours of time on hold. I have been denied talking to anybody with authority every time that I have called. The home office, is the same number as customer service, all they do is bounce you back and forth between that number and enrollment and tell you to wait. I believe this company to be a scam.Desired Settlement: I was told that I am owed $961.00 for 11 months of healthcare that I didn't want. I just want that money. I would like for this company to have a better customer service system. They literally make it impossible to track your claim or to speak to a person in charge. That should change.

Business

Response:

July 28, 2014Dear [redacted]The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual off exchange HMO health benefit plan.The Member’s complaint concerns overdraft fees applied due to premium payments drafted from the Member’s bank account for 11 months in error. The member is requesting a refund of her overdraft fees in the amount of $961.Below is a timeline of events leading up to the resolution of the member’s complaint.January 13, 2013 – The Member contacted Billing & Enrollment department in regards to his copay. He was transferred to the Claims & Benefits department.May 5, 2014 – The Member contacted Billing & Enrollment department to terminate his coverage because he has had another policy for a year. The member was advised to send in proof of other coverage to seek approval for a retro-termination.May 21, 2014 –The Member contacted Billing & Enrollment department to check the status of his policy. He was advised that his policy was terminated effective May 31, 2014. The member states that he is seeking a termination date of April 30, 2013.June 9, 2014 –The Member contacted Billing & Enrollment department to inquire on the status of his policy. The call was lost.June 9, 2014 –The Member contacted Billing & Enrollment to check the status of his refund. There is no refund due because the member’s payment returned.June 13, 2014 –The Member contacted Billing & Enrollment department to request a change of address.June 25, 2014 –The Member contacted Billing & Enrollment department to request a refund for the past year of coverage. The member was advised that the refund was not approved.July 18, 2014 – The Member contacted Billing & Enrollment department to check the status of his termination and refund.July 23, 2014 – The Member contacted Billing & Enrollment department to check the status of his refund. The member was advised that at this time no refund was due.On July 24, 2014 – The Member spoke to a CHL representative. The representative read the notes left by the resolutions team and went over the billing with the member. The representative who took the call stated the member understood the breakdown of the billing and now understands why there is no refund due.ROOT CAUSE:The member had coverage through another carrier effective May 1, 2013, but did not terminate his plan with Coventry.RESOLUTION:A request has been sent to the home office for a retro-termination.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,Emily MAppeals Coordinator

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: I read the review [redacted] / Coventry Health sent to you folks. Almost none of it makes sense to me. They stated that I had a call In January asking about a Copay on something. I didn't even realize that I still had an option to do this. I didn't know I was covered by these people at all. I have no recollection of this phone call. Last time I talked to somebody in the collection department, they said that because of a particular call, I only had 60 days to receive my refund. I feel like I have been getting the run around for two months so they can avoid giving me a refund. The first call I made this year was to tell them that I didn't want to be charged for a policy I did not want. I asked them to stop the payment. They did not. My bank account was overdrafted, then they put the money back in. I have received no compensation for the bank fines, and I am okay with that.The first call I made this year was to inquire about why a new policy was being started for me. The gentlemen on the phone found out that I had coverage somewhere else and HAD coverage somewhere else, while they were supposedly covering me.... He told me if I provided proper documentation of this coverage, then I was due a refund. That at some point a mistake was made.... I provided that information. I was told I was due a refund and it would be in the mail. I assumed that it was taken care of and gave them an adequate amount of time to send the refund. I was never alerted that something went wrong or didn't go through. I made a call, they told me they had recieved the letter and the check was in the mail. I have been lied to many times in the past few months. Lied to about who I was talking to, who I can talk to. People were supposed to call me from upper-management, it never happened.By all means I did not accept the resolution that they gave me on the phone, I was just about to explode with anger so I politely hung up.The June 9th part of the statement they sent you is an example of my frustration. I was never inquiring about the payment that was taken out of my bank account then put back in. It was the about the 11 months of payments taken out. The June 13th part of the explanation they sent you is wrong. I was calling to inquire about the refund. They ask for your address every single time you call so I may have updated my address. But that is not why I called. They also kept telling me I had more than 1 active policy when I didn't believe I had A single active policy. But it's never why I called. I really don't know what else to do.Please help me, and hopefully the others that this company has tormented.

Regards,

Business

Response:

September 30, 2014Dear [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual off exchange HMO health benefit plan.The Member’s complaint concerns premium payments refund due to premium payments drafted from the Member’s bank account for 11 months in error. The member is requesting a refund of premium payments.The member’s request for back premium is denied and will continue to be denied. He did not follow the terms of his contract with Coventry which state the following:The Subscriber may terminate Coverage for himself/herself and any enrolled Dependents under the Group Contract for any reason immediately (same day) upon thirty (30) days prior written notice (including facsimile or e-mail) to Us after the first 30 days of Your Contract. Such terminations will be effective at 11:59 p.m. on the termination date provided by the Subscriber in the notice to Us. Retroactive termination will be permitted up to a sixty (60) day time frame provided proof in writing is supplied that other insurance was in effect during that time frame. ([redacted]12/11)• The first documented termination notification was received on 05/05/14.• As a business rule applied to all cases, according to his contract, we will retro-terminate back 60 days.• If the member has proof, that can be validated, of a written termination notification prior to 05/05/14, we will be glad to reconsider the termination date.I have included a copy of the Member’s contract language for your review.We trust the above information is fully responsive to your request. Should you have any questions or concerns regarding this complaint, please do not hesitate to contact me at ###-###-####.Sincerely,Emily MComplaint and Appeal Consultant

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: I was told by Coventry people on their customer service number provided by the company, that I was entitled a refund. I was told that it had been sent and would be received in the mail twice. I was lied to 3 times then? Is is okay? Coventry, [redacted], [redacted]? I am not even sure who I am fighting anymore. Bottom line is that they hurt people. If I can get anything out of this at all, I would like an explanation from the company on why this happened to me and why it's okay? Why was I told that I was owed a refund. Why is it okay that I was told that it was sent, and why was it okay that they had never sent it.

Regards,

Review: In February 2014, I received a letter stating that my health insurance plan will no longer be available in the state of Maryland and that my plan will be cancelled effective 5/31/14 at 11:59pm. Since health insurance payments are made a month in advance, the last payment to Coventry should have been on April 5,2014 for the month of May 2014. On May 5, 2014, Coventry proceeded to deduct the payment for June 2014 from my bank account. I have spent over 2 hours on hold with the company and no on ever answers the phone. I have exhausted all my efforts to get a hold of anyone in this company who can assist me. Supervisors are useless as they just want to transfer you into the cue so you have to sit on hold for a long period of time. Coventry has not supplied me with confirmation that they will no longer be deducting money from my account.Desired Settlement: I would like all people to be aware of this company and their practices. Coventry needs to be put on notice that their practices are not appropriate or ethical.

Consumer

Response:

---------- 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]

Business

Response:

May 8, 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 a billing issue and question of refund.[redacted]’s policy was effective 6/1/13 and has been terminated per her request as of 5/31/14.Initial payments are drafted upon case issuance. In this instance, **. [redacted] paid her initial payment for the month of June 2013 when underwriting issued the policy. The payment was drafted on 5/9/13 for June 2013 premium. **. [redacted] is paid through her termination date. Each month’s billing was as follows:06/01/2013 - $197.94 07/01/2013 - $197.94 08/01/2013 - $197.94 09/01/2013 - $197.94 10/01/2013 - $197.94 11/01/2013 - $197.94 12/01/2013 - $197.94 01/01/2014 - $197.9402/01/2014 - $197.94 03/01/2014 - $197.94 04/01/2014 - $197.94 05/01/2014 - $197.94TOTAL BILLED TO MEMBER = $2,375.2805/09/2013 - $197.94 07/05/2013 - $197.94 08/05/2013 - $197.94 09/05/2013 - $197.94 10/07/2013 - $197.94 11/05/2013 - $197.94 12/05/2013 - $197.94 01/06/2014 - $197.94 02/04/2014 - $197.94 03/05/2014 - $197.94 04/07/2014 - $197.94 05/05/2014 - $197.94TOTAL PAID BY MEMBER = $2,375.28Please note that the first month’s payment was paid on May 9, 2013. The next payment was not made until July 5, 2013 – no money was paid in June 2013. In other words, the payment at the beginning of each month was made for the instant month, not the upcoming month. Therefore, there is no refund due. Once a policy is terminated, the home office sends a certificate of credible coverage. This is generated once the termination date passes. The member’s account will not be drafting any further payments as the policy has been terminated per her request.The calls that are on file are as follows:6/12/13 – Member called to update her address on file.6/18/13 – Member called to confirm address because she received an email for returned mail. The representative confirmed the address of record was correct.6/28/13 – Member called to get information about her plan and seeing a physician the previous day. The representative transferred the member to claims and benefits.5/6/14 – Member called to advise that she received a letter that her policy would be terminated in February and she noticed the May draft. The representative searched the system and did not locate this letter and advised the member she can terminate for the end of May. The member wanted the termination processed for 5/31/2014 and the representative did so during the call.5/6/14 – Member called back to advise that she is due a refund. The representative explained that the member was terminated for her paid-through date and there was no refund due. The member advised she will contact the Revdex.com.That was the last call on file.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,

Review: Long story short, the first month of having my new insurance(March 2013) I went to get a prescription filled - Coventry was denied but my old insurance went through and I got my medication. I called Coventry a couple weeks later and found out they had my date of birth wrong in the system (off by one digit). This was corrected. A month later, I went to get my prescriptions filled and I was told I needed to get my doctor to submit a pre-authorization to receive the medicine. I did and was able to get my medicine.

July 2013 I get a bill from my old insurance company asking for reimbursement from the March prescriptions they paid for. I submit the proper paperwork with Coventry and file the claim. At the end of July I got a letter saying my claim was pending and I needed to contact them to see what steps I needed to take. I called Coventry and was told that my pre-authorization was filed in April and I needed my doctor to submit a pre-authorization for March so it could be retro dated.

August 28, 2013, I find out my claim is denied because the insurance company does not allow back-dated pre-authorizations. I was told since my authorization was submitted in April, they could not retro-date it to March, despite the fact I did not know I needed a preauthorization until April.Desired Settlement: I would like my full refund that is owed to me (with interest), an apology, and I would like them to change their policy/practices to prevent other people from having to go through this unethical and emotionally draining experience.

Business

Response:

Attached please find the response that was sent to the member regarding the above-referenced complaint.

Thank you,

September 4, 2013

Dear **. [redacted]:

I have reviewed your request for reconsideration of the above referenced service. Your request for [redacted] XR is approved at the in-network level of benefits. Upon submission of this claim for date of service March 1, 2013 you will be reimbursed for this medication less any applicable copayment, coinsurance, or deductible in accordance with your Schedule of Benefits.

If you would like to receive free copies of any or all the documents related to your reconsideration including a copy of the actual benefit provision, guideline, protocol or other similar criteria on which the reconsideration decision was based, send a written request to the address provided below.

Coventry Health Care of Virginia, Inc.

Attn: Appeals Department

9881 Mayland Drive

Richmond, VA 23233

For diagnosis and treatment codes, the meanings of such codes, and questions regarding this notice, please call the number listed

on your member ID card.

If you have any questions, please call Customer Service at ###-###-#### Monday through Friday, 8:30 a.m. to 5:00. p.m. If you are hearing or speech impaired and need TDD/TTY services, you may dial the TTY number at ###-###-#### or [redacted] for assistance in contacting customer service.

Sincerely,

Review: I enrolled in CoventryOne through the Healthcare Marketplace and sent my first check in the mail, as soon as I received my bill. CoventryOne apparently did not receive the check in time, and canceled my enrollment WITHOUT ANY PHONE CALL, EMAIL, OR MAIL notifying me of the lost check. Upon my attempt to call and rectify the matter by paying over the phone by credit card, I was told to call the Healthcare Marketplace, which I did. The Marketplace shows me as still enrolled, which contradicts what Coventry One is saying.

I have since received a letter from Coventry One stating that they have made multiple attempts to contact me for payment - this is not true and accurate information - and that my "reinstatement request was not received in an acceptable time frame from when the draft/payment was returned" and thus my health care coverage has been terminated.Desired Settlement: I want to have my healthcare insurance coverage reinstated. I also would like for Coventry One to accurately represent themselves in their letters when they make statements such as "we have made multiple attempts to contact you." My first contact with them was a letter stating that I had been terminated.

Business

Response:

Dear [redacted],

Review: Unfortunately I'm having to file another complaint against Coventry in an attempt to resolve a customer-no-service issue. I've attempted over the last two weeks to get a prior authorization to have an MRI scan done to rule out a possible growth on my pituitary. My attempts have failed, and I've received a message from my primary care physician this morning stating that Coventry is arguing back and forth with them on the clinical results from my blood work indicating little to no fsh and lh levels. My doctor and all of my research has found that these results should prompt an MRI scan followed up with a referral to an endocrinologist to determine treatment. I've rescheduled the MRI twice now, and even went so far as to not go to the referring MRI center due to the higher cost, and found a provider through Coventry's website that is a third of the cost. I was told the contract price with the insurance company with this provider is less than 1000.00 with me covering half of that as it applies to my deductible. I have a genuine medical issue going on that is affecting my quality of life, and the prior authorization department is questioning my blood work results and primary care physician's call for further tests to determine the problem, all over a few hundred dollars. This is causing a lot of undue stress and anxiety for me and my family getting to the date of the scheduled MRI and getting the call that they are sorry, but my insurance company is not cooperating so I have to reschedule. As I said, this complaint is a last result as I've tried on more than a dozen occasions, to call and resolve it, but I get the run around and someone pushing the blame on another department. I would elect the self pay option, but it would be nice for my payment to apply to my deductible in the event additional testing or services are needed to correct the issue.Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like for someone at an executive level at Coventry to address this issue of customer-no-service. I understand there are more cases than not with any insurance company getting requests for claims that are questionable, but when you have a patient that requires a service that is supported by both clinical and physical evidence, there is no excuse to tie this up in a back and forth with the ordering physician.

Business

Response:

May 23, 2014Dear **. [redacted]:Thank you for giving Coventry Health Care of Georgia, Inc. (Coventry) the opportunity to review your Revdex.com complaint regarding your request for a Magnetic Resonance Imaging (MRI) of the brain. We appreciate your feedback in regards to our Customer Service process.[redacted], Inc. ([redacted]) reviews certain radiology requests on behalf of Coventry. Our records indicate, on 5/8/14, [redacted] received a prior authorization request for an MRI of the brain. Based on the clinical information provided, [redacted] issued a medical necessity denial on 5/14/14. On 5/20/14, Dr. [redacted]'s office provided additional clinical information and the MRI of the brain was approved. Please see the attached approval letter.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,

Consumer

Response:

[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.]

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,

Review: My premium is sppsd to be taken out of my acct on the 30th of each month,this isn't been done,but still a pymnt is postd to my accnt,cnt get answrs

I made my first payment by EFT of $130.84. I signed papers to have my premium automatically taken out of my account monthly. I received a letter dated April 25th, 2014 stating the effective date of my coverage is May 1, 2014. The next payment would occur on 5/31/2014, the payment would automatically be withdrawn on the last day of the month, if the day of the month falls on a wknd or holiday, the payment would be withdrawn on the next business day. My next payment was posted to my account on June 2nd, HOWEVER, the payment was never taken out of my checkings account, as was supposed to be done. I have called MULTIPLE times trying to solve the issue, and I keep getting told there's a payment posted and there's nothing they could do. I was also told there was no logical explanation for the error, and to continue checking back periodically to check for payment issues. I have asked on 3 different occasions to speak with a supervisor, and I have been denied time and time again, however, on 2 occasions I was told a supervisor would get back with me by the end of the business day, on the other occasion I was told that a supervisor would get back to me by the end of the business week. I started calling on June 4th, and have called at least twice a week since then, if not more. I have even called my bank, to see if there was an issue there, as CoventryOne suggested may be the case. The bank is not responsible, they have checked 3 times. They said unless an ACH is issued by CoventryOne, there is nothing that they can do, and they have never received an ACH. I have never once received a call back, and today I was told that there was nothing they could do, except give me the option to make another payment. Why would I do this, when they show I have zero dollars being owed with a zero payment history? M;y next payment should be coming out of my account on June 30th, and there still is nothing being done, nothing has been done, and I can't get any answers.Desired Settlement: I want my insurance for June and July totally written off and not taken out of my account period, as I have had coverage, but I have tried on at least 8 different occasions to solve the problem, and absolutely no one will work with me. This is our government at it's finest. I would also like this issue looked into immediately.

Business

Response:

July 14, 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 payment issues for her policy.As [redacted] was concerned about payment drafting, a representative contacted her on July 2 and verified that the bank account information is correct in our system. [redacted] has a policy for which the member’s portion is $130.84 and APTC pays $270.00 or $400.84 for the total monthly premium. She paid $130.84 on June 30 which has her paid through July 31, 2014. [redacted]’s next premium payment of $130.84 is due on July 31 for the month of August.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 1917. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

Consumer

Response:

[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]

Review: [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,