Coventry Health Care, Inc.

Review: I received a letter that my account was passed due and I needed to settle up my charge of $142.00 by 12/31 or have my health insurance cancelled. I called Coventry to set an automatic draft for the full amount to be drafted on 12/30. I spoke to Alison M[redacted] (x5583) and received the confirmation number [redacted]. I was leaving the country on 12/15 until after the new year. When I returned, I noticed the money had not been drafted. I called Coventry on 1/9 and spoke to a Jasmine. I was told my insurance had been cancelled and initially was refused the opportunity to speak with a supervisor. After insisting, I was put on on hold for 60 minutes, I spoke to Clay S[redacted] (x3892) who promised to pull and review my call with Alison and return my call at 11 am the next day 1/10. I never heard from Clay S[redacted]. I called back on Monday 1/12, and requested to speak to him (which he told me was possible). After being disconnected three times and returned back to he main menu three more times, I finally spoke to a woman who refused to give me her name and was again refused the chance to speak with a supervisor, but I was told that they contacted Clay S[redacted] who would definitely be returning my call by the end of the day. I did not have my call returned and it is now a week later.

My member number is [redacted]Desired Settlement: I want my insurance reinstated and the ability to pay the amount I owe.

Business

Response:

Dear

Review: Coventry debited my checking account twice within 2 weeks time. They are only authorized to debit once per month.

Coventry is authorized to debit my account once per month around the 5th of each month for my insurance, in the amount of $408.28. The payment did not go through on the 5th & on the 11th I called the company & authorized them to then debit my account & I received a confirmation number [redacted].On 11/13/14 the said amount cleared my account.On 11/18/14 I noticed Coventry attempted to debit my account again & this caused insufficient funds in my account. My bank then charged me an NSF fee of $35. I called Coventry & s/w numerous people & Susan was the last person I s/w & she was in the billing dept.She said she would have to let her supervisor handle this.I gave her my email address & said she could email me what would happen. No email sent. I also told Susan that I would call back the next morning after work. The next day, 11/19/14, I called billing back & s/w Shadae. Of course they all refuse to provide last names.I asked her to pull up my account & read what took place on 11/18/14. She did & then placed me on hold.After a couple of minutes she came back & said she would have to let her sup. handle this & placed me on hold. After a few minutes she came back said her sup. messaged her that it would be 7-10 days before I could receive the payment back & that by then my December payment would be do. I told her that Coventry illegally took 2 payments from me & said that I told Susan the day before that I expected Coventry to pay me back immediately including $35 for the NSF charge. I said that I wanted to s/w her sup. She put me back on hold for a few minutes & returned & said her sup. messaged her saying that I would be paid back within 5 business days. I asked her how that was going to happen. She said the accounting dept. would be handling it now. I questioned why she did not have her sup. s/w me on the phone & she said that her sup. was messaging her & that she was busy. I told her that if her sup. has the time to read these messages & answer you back then she has the time to s/w a customer, & I demanded to s/w her. I was placed on hold again for a couple minutes & then was told that my account would be credited back & the sup. could not s/w me. I told her you mean would not. I then said, is the accounting dept. going to pay me back for the NSF charge? She said she did not know. I asked her how am I to be paid back for this unauthorized debit? She said I would have show proof from my account of the charge & that I could fax it in to the processing dept. & was given the fax number.Desired Settlement: To be paid back through my account, as it was taken, immediately including the NSF charge. I expect Coventry to fire the supervisor who refused to s/w me on the phone. I also expect better customer service that doesn't not take up nearly an hour of my time to resolve an issue. I expect the software that allowed my account to be debited illegally twice in one month to be revised or replaced to prevent this from ever happening again.

Business

Response:

Dear [redacted],

Review: Coventry One changed my address without my approval 3 times resulting in all of my information such as billing and loss of coverage being sent to the wrong addresses. Because of this I was locked out of my account and could not access anything online or by phone. Customer service did nothing to help me. Customer service did not honor my signed consent form to allow my wife to speak on my behalf. Customer service added late charges and refused to help me take care of them after they sent my bills to the wrong address. Customer service refused to allow me to speak with anyone higher than them and hung up on my wife and I when we asked to leave feedback. Customer service was not helpful, courteous, or knowledgeable and I was never able to even speak to someone regarding my bill when I wanted to pay it.Desired Settlement: I want other customers to know how horrendous Coventry Healthcare is and how horrible they treat their paying customers. I want someone with authority to call and take care of my situation regarding my address, billing, and additional charges. I want to warn others before going into business with Coventry Healthcare.

Business

Response:

--------- Forwarded message ----------

From: F[redacted], Deborah <[redacted]>

Date: Fri, Aug 15, 2014 at 8:49 AM

Subject: Complaint #[redacted]

To: "[redacted]>

Dear [redacted]:

Coventry Health Care respectfully requests that the attached response be entered into the record regarding the Complaint filed by [redacted] in order to accurately reflect the current status of this matter.

If you have any questions, please do not hesitate to contact me.

Thank you,

Debbie

Deborah [redacted] F[redacted]

Paralegal

Aetna – Law and Regulatory Affairs

Review: Dropped Health Coverage and Gave no Notice then failed to fix the error.

In October 2014, I discovered that I no longer had health coverage (my premiums are set up for auto pay from a savings account, so I was under the assumption that all was fine; money was in the account and no draft was ever returned). When I called Coventry One during the first week of October, I found out that I had been dropped in June 2014 because they had accidentally filed me as "dead." No notice was ever mailed to my home. I am not dead. After verifying and proving that I was not dead, the operator told me that this was their error, and assured me that my coverage was fully reinstated at that point and I did not have to do anything else. I also received an apology for their error. They also stated that auto drafts would begin again. So, I did not seek out new coverage. Today, October 30, I received a letter stating that after "careful" review they are not reinstating my coverage because I waited too long to notify them of the error. I didn't know they had made the error because they never sent me any verification or documentation. They made the error, they caused the problem, and now they are compounding the problem by stating that I was covered and then going back on that agreement.Desired Settlement: An apology, a notice on their record that they do not follow fair practices, and a change in policy so that this does not happen to another person. I would also like my health insurance back to be reinstated, especially if I am unable to find new, affordable health insurance.

Business

Response:

November 24, 2014Dear [redacted]:Your letter of November 14, 2014 to Coventry Health Care of Virginia, Inc. (“Coventry Health Care”) was referred to my attention for review and response.[redacted] expressed concern that her policy terminated due to being reported as deceased on her enrollment file. Coventry addresses this concern below.[redacted] was enrolled in Electronic Funds Transfer (EFT) for her monthly premium payment of $127.19. On May 5, 2014, the last monthly premium payment via EFT was processed to [redacted]’s account form May 2014 coverage. On May 9, 2014, Coventry issued a letter to [redacted] advising her policy would terminate oil May 31, 2014 because the coverage was not going to be available for her geographical area effective June 1, 2014. The letter also advised she was eligible to enroll in a different plan that would be offered in her area during her renewal period,On October 21, 2014, [redacted] contacted the Billing and Enrollment Department to inquire about her policy termination. [redacted]'s policy did not terminate due to a false reporting of her death, The Customer Service Representative (CSR) misinformed [redacted] about the termination remarks on her account. The Health Plan Home Office utilizes multiple termination remarks codes to signify the discontinuation of a policy. The termination remarks on [redacted]’s account indicated that she lived outside of the coverage area, [redacted]’s policy is not eligible for reinstatement because the policy that she had is discontinued for her area. [redacted] is eligible to apply for new coverage.Coventry apologizes for the incorrect termination information [redacted] received from the CSR. Education has been provided to CSR to prevent this error from reoccurring,If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,Shawn M. Complaint and Appeal Analyst

Review: When I initially got the insurance the company kept sending me the a card with the wrong PCP providers name on it. The request for a new card was made numerous times. In the mean time while waiting to receive the correct card I needed to see my PCP provider but ,had to pay out of pocket twice the full amount for his services. I contacted Coventry Health about this problem and was told to submit the invoices from my PCP showing I paid for the services. Each time that I called Coventry Health I was told to submit the information all to different addresses. This was done three times and they are still saying they have not received my information. The company owes me a reimbursement of $150.Desired Settlement: Reimbursement of money paid

Business

Response:

September 26, 2014Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]'s complaint.[redacted] is currently enrolled with the Health Plan's SILVER $10 HMO #2 CLK, effective January 1, 2014. Please see the following correspondence timeline with [redacted]:TIMELINE:01/24/2014 @ 9:09am [redacted] contacted the Health Plans Customer Service Department to request a list of providers in her area. The representative advised [redacted] that they would mail her a list. [redacted] was assigned to Dr.[redacted] from January 1, 2014 to April 23, 2014.03/21/2014 @ 9:33am [redacted] contacted the Health Plans Customer Service Department stating that she needed to find a primary care provider. The representative advised [redacted] that they would email her the list of the following providers: Family Practice, Internal Medicine, Gynecologist, OB/GYN and plan information to email: [redacted].04/24/2014 @12:25pm [redacted] contacted the Health Plan regarding PCP in her area, urgent care benefits and copayments. The Representative advised [redacted] that urgent care copayment was $75.00 and that once she selected a pcp she can call back the Health Plan.04/24/2014 @ 2:28pm. [redacted] contacted the Health Plan to advise that she did not change her pcp to Dr. [redacted]. The representative advised [redacted] that there was a glitch in the system which changed the pc?. 04/25/2014 @ 12:07pm [redacted] contacted the Health Plan requesting to change her pcp back to [redacted]. The representative advised [redacted] that the change would take effective on May 1, 2014.05/05/2014 @ 5:57pm [redacted] contacted the Health Plan to change her pcp back to [redacted] office. The representative requested the pcp change.In an effort to assist [redacted] with her complaint, the Health Plan spoke to Dr. [redacted] and [redacted] at Dr. [redacted]’ office regarding the complaint, **. [redacted] and [redacted] were advised that since they are a Participating Provider with the Health Plan, claims would need to be submitted for the services rendered. Once the claims have been submitted and processed according to [redacted]'s Schedule of Benefits, they will need to refund [redacted] the difference in what she paid out of pocket. [redacted] also confirmed that on January 24, 2014, [redacted] went to see Dr. [redacted] for a sick visit and did not present her insurance card at the time. On April 24, 2014, [redacted] had services rendered again without presenting her insurance card. [redacted] stated that the office received a copy of [redacted]’s insurance card on May 24, 2014, but a different provider was listed so they were not able to submit the information.Pursuant to the Schedule of Benefits, Section 1, Using Your Benefits, page 9: 1.7 Payment to Providers. I 1.7.1. In Network Providers (Participating Providers): For In-Network Covered Services, the Participating Provider will bill the Health Plan directly for the services. You do not have to file any claims for these services.You are responsible for payment of: A, The applicable In-Network Copayment, Deductible, and/or Coinsurance amounts; B, Services that require Prior Authorization, which were not Prior Authorized; C. Services that are not Medically Necessary; and D. Services that are not Covered Services.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. My fax number is ###-###-####, and my e-mail address is [redacted].Sincerely,Siana LComplaint and Appeal Analyst

Review: I have bought insurance from Coventry One over the phone. During phone converstation my husband and me specifiaclly asked about the coverage for pregnant women. The representitative told us that everything is covered for normal pregnancy. We also looked at the Coventry One Summary of Benefits and Coverage for Coventry Health Care of the Carolinas, Inc. Bronze 100% HMO [redacted] Medicine. It specifically says "If you are pregnant" for "Prenatal and postnatal care" for "In-network Provider" there is NO CHARGE. No deductible, no co-payments, etc. I went to the OBGYN doctor at [redacted] Medical Center (in-network provider), did standard tests, ulstrasound, etc. However, Coventry One refused to cover my bills in full and now [redacted] charges me more than $1,500.During my last visit to [redacted] I have asked the [redacted]. staff to call the insurance and clarify the issue with them as they refused to cover some bills by that time. The [redacted] representitative called the insurance severeal times (insurance called them back and said that everything should be covered) so, we were told by the lady at [redacted] that the insurance supposed to cover everything except some tests which were considered non-standard. That is why we did the second trimester ultrasound and other standard tests. However, the insurance refused to cover the bills.My husband and me called them several times and we started receiving contradictory answers. Sometimes the representitative told us that everything would be covered in full, sometimes they were telling us that everything will be covered only after we pay out-of-pocket annual limit (which is $6,500).At least that tells that the representatives are not professional and knowledgeble. But the written contract states NO CHARGE for "Prenatal and postnatal care".It states that for "Delivery and all inpatient services" there is co-insurance, which I understand. If I knew in advance of such practicies and no-payments I would buy a different insuranceDesired Settlement: I would like the company to pay the contractual obligations, such as all my prenatal bills, in full amount. The written contract states "no charge" for prenatal services.

Business

Response:

August 22, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to Ms. [redacted] regarding maternity coverage for her CoventryOne® policy purchased on the Federally Funded Marketplace for an effective date of April 1, 2014. The request was received by CHC Carolinas on August 12, 2014.CHC Carolinas does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing her in this matter, however we will contact **. [redacted] within three business days. We will inform **. [redacted] that her case is being reviewed and that CHC Carolinas will respond to the complaint in writing within 30 calendar days of receipt of her request.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,Melody CComplaint and Appeal Analyst

Consumer

Response:

Review: 10170235

I am rejecting this response because:

-------- Forwarded message ----------

From: Lin Cosh <[email protected]>

Date: Wed, Aug 27, 2014 at 6:48 PM

Subject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #10170235.

To: [email protected]

Dear Ms. Cynthia Cameron,

Please find attached my signed HIPAA form.

Please confirm you have received it and can open it.

If you have any questions or need additional documents or explanations, please let me know.

Thank you very much,

Business

Response:

September 19, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding maternity coverage for her CoventryOne® policy purchased on the Federally Funded Marketplace for an effective date of April 1, 2014. The request was received by CHC Carolinas on August 12, 2014.CHC Carolinas responded in writing directly to [redacted] by letter dated today.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,Melody CComplaint and Appeal Analyst

Review: Insurer is claiming non-payment and dropped coverage when payments have been made. Insurer has been unresponsive in resolving issue.

Health insurer dropped coverage claiming non-payment. All payments have been made. All payments have been mailed to insurer from January(begging of policy) to June. Insurer cashed all payments mailed except June payment. They have been unresponsive so far in resolving this matter. I have been informed multiple times that some would call back to discuss and resolve issue. No one has ever called. Every time I have attempted to call back to resolve this issue I have been given the run around. They have claimed missed payment since the plan started, and were unresponsive in resolving the issue then. They continued to send notices of claimed non-payment. Insurer sent a letter dated July 1st informing me that coverage was dropped April 30th. As of July 15th they still have been unresponsive in resolving this issue. I am 30 weeks pregnant and have on going medical expenses. I now have to pay in full out of pocket, and now have unexpected bills from June, because of insurer failure to resolve issue.Desired Settlement: I have lived up to my end of the arrangement. I would like it if Coventry would now do their part and provide the coverage I have paid for. If Coventry cannot contact me and resolve this issue once and for all. I will be seeking legal council in this matter.

Business

Response:

July 28, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding payment issues for her policy.Research into this matter revealed that payments were received by the company from this member; however, the payments were not being posted to her account. Instead, the payments were going to the company’s Escrow (or holding) account. Generally this can happen for a number of reasons. For example, if the member does not put a billing case number on the bottom left hand corner of the check and does not send the check with the remittance slip attached to the bill, the payment will go to the Escrow account to be manually researched and applied to the proper policy which can take an extended amount of time. With online bill pay (which apparently this member is using) this happens frequently because the member fills out the payee information online, and then the bank actually cuts a physical check and sends it to the desired destination. If the member does not put the “Account Number” online as their billing case number, the bank will not send the check with the case number on it, which is crucial. Even if the member does fill in the billing case number for the account number on the online bill pay, the bank (depending on how they operate) may print the check without the account number, or they may print it in another place that our computer systems do not detect. This is most often the cause of the delay in posting the payments. After reviewing the copy of a check that the member sent in, the member ID number was being used for the Account Number and that will send the check to the Escrow account.In this case, we have made an exception to reinstate the case as if the checks were posting timely by not going to escrow, so that the member would have never been terminated. We have four payments that have now posted to the policy, and one that we received after the policy had terminated so it has not posted yet. We have sent a request to have that payment posted as soon as possible so there will be a total of five checks on file. This will pay the member through June. If there is any more payments that the member feels should have posted to the account, if she will send the front and back copy of the check in question, we can post the funds. The member needs to keep in mind that the August payment is due on July 31, 2014. Loni Campbell from our customer service department has attempted to contact the member to review the above and to ensure that the member stays current with the upcoming payment. Ms. Campbell left a detailed message for the member who is urged to return Ms. Campbell’s call if she has not already done so.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

Review: My healthcare coverage has been paid for January 1st 2014- January 31st 2014. I am unable to go to the Doctor because Coventry refuses to give me a member ID number.

I called on January 9th to ask where my membership information was, and after waiting on hold for 1 hour of my time, I was told that someone would get back with me within 24- 48 hours.

I called again on January 13th and this time spent 2 hours trying to reach someone at Coventry who could help me. I asked to speak to a supervisor, none was available I was literally PROMISED that since I had been on hold for 1 hour a supervisor would call me back that evening, and that within 24-48 hour someone would call me with my member ID number so I can go see a doctor.

January 17th- I still have yet to receive a single phone call from Coventry from a supervisor or representative .

You do not get to use my voucher for health care only to not give me access to my healthcare. My bill says I owe $0 for January so if you have been paid for a service but refuse to let me utilize it that is called theft & it's a scam.Desired Settlement: Have a supervisor call me back with my member ID number immediately.

Business

Response:

January 23, 2014

Dear **. [redacted]:

The Department of Coventry Health Care Exchange Customer Service (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding lack of member identification number or identification cards for her and for her husband.

I spoke with [redacted]. [redacted] this morning, January 23, 2014. I provided the ID information for her and her husband over the phone. I also e-mailed copies of both ID cards in case services would be needed and advised her ID cards should arrive in the mail within ten business days. I explained to [redacted]. [redacted] about our member website My Online Services and our Coventry mobile app in which members can view policy information. She did not have any other questions at this time. I provided [redacted]. [redacted] with my direct phone number should any other issues arise.

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 ###-###-####.

Very truly yours,

Review: We changed Bank Accounts in July 2014. My wife informed Health America ( HA ) about the changes at the end of July since the monthly payment is done automatically. On due date HA tried to get the money from our old Bank Account even so they were informed about the changes. Obviously we did not have enough funding in the old Account and we were charged an overdraft fee. Thereafter my wife called HA and told them about what had occurred. She was told that it was now changed in their Computer System. Then HA tried again! AND AGAIN FROM THE OLD ACCOUNT !!! We were charged overdraft again. My wife called again to inform HA. She was told by the Lady on the phone that she can see the changes in her computer. My wife went ahead and made a payment over the phone for the two month that HA now claimed we were behind. Not only did my wife call them but she also wrote a total of three letters to HA with new info as well as an explanation of what had happened .We then had to show proof for the overdraft fees which we did and my wife send a check for the next payment minus the overdraft fees. We were current on payments and two days ago my wife went to the Pharmacy to pick up a description for our daughter. She had to pay out of pocket even so it was always covered before. She asked the pharmacist for the reason why and she got told that the coverage was canceled ( absolute embarrassing ). So I called HA again today and got told that it is cancelled due to lack of payment. My question to that Company is that how come that the payment over the phone as well as the payment by check is taking out of our account and was paid to HA but they have the " right " to just go ahead and cancel the service even so it is clearly their fault due to being not competent !!!! It is ridiculous that they are more then willing to take the money but don't hold up their end of the bargain by having my family covered !!!Best regards,Dirk DohreDesired Settlement: We want to be reinstated into our plan immediately and also want to be paid back the out of pocket expense that we had for our daughters prescription. As a matter of fact they could throw in a month of free coverage for all the time that was invested by my wife as well as the embarrassment at the Pharmacy !

Business

Response:

October 24, 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] (the “Member”) has filed a complaint. The Member’s complaint concerns premium payments withdrawn from an incorrect bank account by the Plan. The Member is requesting a refund for premium payments taken out of the member’s bank account after a request for termination of coverage was made. The Member is requesting reinstatement, reimbursement for medication that was paid out of pocket, and 1 month of free insurance for the hassle.Below is a timeline of events leading up to the resolution of the Member’s complaint.November 14, 2012 – The Member contacted Billing & Enrollment to change his address. The zip code has changed, so the member was advised that he needs to send a written request.November 27, 2012 – The Member contacted Billing & Enrollment to update his address.December 10, 2012 – The Member contacted Billing & Enrollment to update his address. The member was advised he was now out of area.August 5, 2013 – The Member contacted Billing & Enrollment to advise that the account that funds come out of is currently closed. The member was advised that we draft on the 5th of every month, and was advised that there is a non sufficient funds fee NSF fee if the payment returns.August 13, 2013 – The Member contacted Billing & Enrollment because there was not enough money in his account to cover the draft, but he added the funds. The member was advised he was paid in advanced.October 9, 2013 – The Member contacted Billing & Enrollment to see if his payment posted.December 20, 2013 – The Member contacted Billing & Enrollment because funds were not available. The member advised that he will send in a payment.February 11, 2014 – The Member contacted Billing & Enrollment because he moved to NY. The member was advised to send in a written request, as he may be out of area.February 11, 2014 – The Member contacted Billing & Enrollment to get a refund of overpayment.August 7, 2014 – The Member contacted Billing & Enrollment to update his banking information. The member was sent an automated clearing house (ACH) form.August 19, 2014 – The Member contacted Billing & Enrollment to see if we received his updated banking information. The member was advised that it was not received and was advised to fax it in.September 4, 2014 – The Member contacted Billing & Enrollment advising that we have drafted the wrong account although he sent in new banking information.September 4, 2014 – The Member contacted Billing & Enrollment to make a payment.October 10, 2014 – The Member contacted Billing & Enrollment because he did not understand why his policy terminated because he made his payments.October 10, 2014 – The Member contacted Billing & Enrollment because his policy was terminated. The member was advised that he is paid thru August 31, 2014. The member stated that he will send in bank statements of the payments he has made. The member had been paying the old premium of $541.38 but he had migrated onto a new plan with the new premium of $886.33.October 16, 2014 – The Member contacted Billing & Enrollment about his premium. The member was advised that he will need to follow the reinstatement process.ROOT CAUSE:The member’s premium increased upon his renewal but he did not pay the increased premium amount.RESOLUTION:The policy has been terminated effective August 31, 2014 due to non-payment of the total amount of his new premium. The member will need to proceed with the reinstatement process, as he was sent his renewal information.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,Emily M Appeals Coordinator

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

Business

Response:

October 31, 2014Dear [redacted]:Your letter of October 29, 2014 to Coventry Health and Life Insurance Company (CHL) HealthAmerica was received in our office, and referred to my attention for review and response.In his objection submitted to the Revdex.com, [redacted] questioned the monthly premium rate assigned to his policy. Additionally, [redacted] advised that he does not want any further investigation into his policy. [redacted]’s policy terminated with CHL on August 31, 2014.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted]Sincerely,Shawn M. Complaint and Appeal Analyst

Review: Coventry took money from my account after cancellation notice sent, now they want to say it is not complete. But it is,I have the notice that was sent

My son came to work for me and my husband and needed insurance. I purchased the quickest insurance so no break in coverage. Found cheaper insurance, called canceled, and sent notice. Said is not complete and they need proof of coverage. We name the other insurance, but they do not need any other information about that as it is not their business. They took money from my account even after I paid for a stop pay, because the guy told me a different amount when I requested info about the draft amount. I never gave a authorization for this draft once the policy was requested to be terminated. Policy has never been used, have only used [redacted].Desired Settlement: I want my money back within 14 days. I feel that their practice of prorating this insurance, is not a good policy and when someone calls to cancel insurance and send in a cancellation form it should be done. Now they want to say other information is needed and the form was sent and faxed more than once. They are just dragging their heels to get more money from me. I will have to close my account to keep them from drafting anything else from my account. And I have told them that they do not have

Business

Response:

Dear [redacted]:

Regarding the above-referenced Complaint, because the Complainant was not the policy holder, we have no way to identify this member. We will need information such as an ID number or the policy holder's name, date of birth and at least the last four digits of his Social Security number. Additionally, since the Complainant is not the policy holder, she has no standing to discuss this matter with Coventry. I have attached a consent form which can be completed and returned to Coventry so that we can discuss the matter with [redacted].

Thank you for your assistance in this matter.

Sincerely,

Consumer

Response:

---------- Forwarded message ----------

From: [redacted]

Date: Thu, Mar 28, 2013 at 7:29 PM

Subject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted]

To: [redacted]

Review: It takes 45 minutes to 150 minutes to reach a customer service representative every time I call. Every time.

I have been a member of Coventry One in Florida since 4/1/14. Coventry assigned a primary care physician that is more than 30 minutes away from my home. PCP selection was never discussed with me. I have called 3 times to request a change in PCP and it has not been granted. I have received 4 insurance cards all with the incorrect PCP. It is unbelievable to me that it takes 45 minutes to an hour and a half to simply speak to someone. I have asked why hold times are so insanely long and I am always told "we are experiencing higher than normal call volume". The poor customer service of this insurance company needs to be addressed. It's very frustrating to have to hold for that length of time to only be answered by an employee that cannot complete the requested task. I have paid two months worth of premiums ($360) and I have not been able to use my insurance.Desired Settlement: I would like for Coventry One to address its exceedingly poor customer service. There is no excuse for the total lack of care that is expressed by this insurance company. It is painfully clear that all they are concerned with is collecting insurance premiums.

Business

Response:

May 23, 2014Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s Primacy Care Provider (PCP) and service issues. Below please find the information requested.**. [redacted] became effective on April 1, 2014, under the Gold HMO Carelink Plan. Our records indicate that **. [redacted] was assigned to Dr. [redacted] at [redacted], FL [redacted]. Dr. [redacted] is approximately 0.9 miles from **. [redacted]’s zip code.On May 13, 2014, **. [redacted] contacted the plan in an effort to change his PCP. **. [redacted]’s PCP was changed to Dr. [redacted] at [redacted] FL, [redacted]. Dr. [redacted] is approximately 3 miles from **. [redacted]’s zip code. **. [redacted] was also contacted on May 22, 2014. According to **. [redacted], he received the Identification (ID) card showing Dr. [redacted] as his PCP. **. [redacted] expressed his satisfaction with his new ID card and PCP.Additionally, because of the unprecedented growth of membership with our ACA plans, the call volume is higher than usually. The plan is working diligently to rectify this issue. **. [redacted] has been provided with my direct contact number in the event he has any further issues and cannot reach the appropriate department.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.Sincerely,

Review: I am sick and tired of calling Coventry Healthcare phone numbers trying unsuccessfully to read a customer service representative to help me out. I sent out requests via email, but no one responded to them. Their phone system kept running me around a circle for hours and hours at many occasions. When I finally got to talk to a representative by the name of [redacted], who was very rude and disrespectful, she hung up the phone on me. This is unbelievable!! This is the worse company that I have ever done business with. This company treats people like a piece of crap; all they care about is collecting their monthly premiums and generating their huge margin profits. I have been paying my premiums, but I cannot get customer service?? This is really unacceptable for any company to treat their customer in such manner!! If you refuse to take care of your customers, you don't deserve to be in business.Desired Settlement: The failure to respond to phone calls or written requests for assistance or support.

Business

Response:

May 1, 2014Dear **. [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s complaint.**. [redacted] is currently enrolled with the Health Plan’s SILVER $10 HMO #2 CLK, effective March 1, 2014. Please be advised of the following call history for **. [redacted]:TIME LINE:• 3/10/2014 @ 1:23pm **. [redacted] contacted the Health Plan regarding changing his address and requested to speak with a Supervisor.• 3/21/2014 @ 8:37am **. [redacted] contacted the Health Plan regarding how to create an online account with the Health Plan.• 4/8/2014 @ 1:51pm **. [redacted] contacted the Health Plan to change his mailing address and to find a PCP in zip code [redacted] who has over 10 years experience.• 4/14/2014 @ 9:07am **. [redacted] emailed the Health Plan to request his PCP be changed to a provider in zip code [redacted] or [redacted].• 4/22/2014 @ 9:47am The Health Plan received **. [redacted]’s complaint that was filed on April 18, 2014 at 1:29pm with Revdex.com.• 4/29/2014 @ 11:01am **. [redacted] emailed the Health Plan with a complaint of dissatisfaction.In an effort to assist **. [redacted] with his complaint, the Health Plan has made several attempts to reach **. [redacted] for clarification/additional information on this correspondence. We attempted to reach **. [redacted] on the following dates and times:• 1st attempt - [redacted], [redacted] on 4/22/2014 at 11:34am called **. [redacted] via phone ###-###-#### and left a voicemail message with call back name and contact number ###-###-####.• 2nd attempt- [redacted], [redacted] on 4/24/2014 at 12:35pm called **. [redacted] via phone ###-###-#### and left a voicemail message with call back name and contact number ###-###-####.• 3rd attempt- [redacted], [redacted] on 4/30/2014 at 2:21pm called **. [redacted] via phone ###-###-#### and left a voicemail message with call back name and contact number ###-###-####.At this time, we will await **. [redacted]’s return telephone call in order to be able to assist him as he has requested.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me 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 called Coventry in May to inform them as of June 1st, 2013 I will be under a new health insurance and would like them to cancel my insurance but to leave my husband on his own account. They told me this would be taken care of as of June 1st. They continued to take money from my bank account for the full amount of both health coverages, so I called them again in September 2013 and was informed that I needed to fill out paperwork to cancel and make a change, and since they had record of me calling in May they would back date my refund to 6/30/13. I sent in the paperwork by email, I have called many times, faxed and emailed to try to get this taken care of with no resolve. A manager at one time promised me everything was taken care of and he would return my call by 5pm that day to let me know when to expect my refund check and never received a call. I called 4 times in the month of December and every time the phone system says they are having technical difficulties try back later. As of 1-2-14 I waited on hold for 41 min for someone to answer and say their system is down and they cannot make outgoing calls so we would have to wait and call back later. It is not 1/3/14 and have not had any customer service rep or supervisor help with my issue. I would like my account fixed and my refund check for the last 6 months.

Product_Or_Service: Coventryone Health Insurnace

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

A refund for the last 6 months for only my portion of the insurance. I would like to keep my husband on this account. I have the documentation showing I sent in the paperwork.

Business

Response:

January 22, 2014

Dear **. [redacted]:

This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s request for termination of her Individual PPO policy.

After further review of this issue, on January 14, 2014, the Health Plan approved **. [redacted]’s request to have her policy terminated on June 30, 2013 and roll over **. [redacted] (spouse) onto his own policy. On October 12, 2013, the Health Plan received **. [redacted]’s request for termination but was missing the requested Payroll Deduction Program (PDP) form for the banking. On November 12, 2013, **. [redacted] contacted the Health Plan to check the status of her request and was advised that the PDP form was missing. On November 18, 2013, an additional outbound call was made to **. [redacted] requesting the required form.

In addition, as of January 22, 2014, the Health Plan has not received the requested PDP form but **. [redacted]’s request was completed and all extra funds were moved to **. [redacted]’s policy rather than a refund being issued. **. [redacted] may contact the Health Plan’s Customer Service Department regarding his new policy information.

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 [redacted] Relay.

Sincerely

Review: Our Employer has purchased our group Insurance through Coventry Health Care of Missouri, There was an accounting issue back in July 2013, Coventry stated we had a very large over payment to our account and did we want a refund or just use the credit for upcoming premiums? We used the credits for upcoming premiums due, We started payments again in October 2013 and continued monthly, we then receive a certified letter the week of Thanksgiving 2013, saying our group plan has been termed for non payment, Coventry was then contacted to find out what was going on, they said that it was a mistake and we didn't have a credit on our account, and they asked for a huge amount of money to reinstate the group policy, we then asked for proof of this mistake and could not be given one, now all of the employees that have this coverage do not have any insurance, this was not found out until one of the employees went to get scripts filled at the pharmacy on 11-26-13, which she had just had refills 2 weeks prior to this, which would have been the 12th of November, the pharmacy told the employee that her insurance termed on 8-31-13, which just wasn't true. to get to the point, I have been paying this insurance every month since may 2013, we have tried to get info from them , they continue to tell us, that it will be updated in 24/48 hours, that didn't happen, it has now been 8 days, and we still have no answers and no one to talk to, we have called customer service, enrollment and the pharmacy departments and nothing has been noted on account and they continue to tell us something different every time we call for updates, today we were told again we don't have anyone for you to talk to, they will call you when everything has been updated, we need answers, the employees have children on these policies and cant use it, and are paying premiums out of every check, please help!!!!!!

Product_Or_Service: Insurance

Account_Number: [redacted] Group NumDesired Settlement: DesiredSettlementID: No settlement requested - for

We want our Insurance reinstated Immediately.

Business

Response:

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

Thank you,

December 17, 2013

Dear Sir or Madam:

The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to your request dated 12-1013 and received at our office on 12-12-13. This letter is in response to the consumer complaint filed by [redacted] regarding the status of her employer group’s eligibility.

This member complains her employer lost eligibility with Coventry Health Care which resulted in claims being denied at a pharmacy on 11-26-13. After receiving this complaint, we verified with our collections department that this group has been reinstated as of 12-10-13 with no lapse in coverage.

The investigation of the issue brought to light an issue ongoing since June of this year. Billing issues regarding [redacted] Health Care’s account caused an invalid credit to be applied which was later corrected. On 12-10-13 [redacted], the Benefit Administrator for the group, paid the full outstanding balance bringing the group up to date in premium. He also registered for Online Account Management system which should help alleviate additional issues like this in the future.

Please also note the following:

• No appeal was filed by the provider or member on this matter.

• No medical records were obtained or utilized.

• There was no U&C determination.

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,

Review: Failure of Coventry Health Care to adequately communicate about my request to cancel health insurance policy

In September 2014 I contacted Coventry Health Care to cancel my individual health insurance policy as (1) I had relocated from [redacted] MO [redacted] to [redacted] CA (2) Coventry Health Care did not have a California product (3) I was enrolling in an employer sponsored plan. I was informed to put the request in writing to Coventry Health Care, PO Box [redacted] FL [redacted], Ref Case # [redacted] which I did. I am awaiting a response. On Monday 11/3/14 I spent over 2 hours on the phone attempting to get a response from Coventry Health Care concerning the cancellation of my insurance, to no avail. In this time, I dialed or was transferred to 5 different phone #, spoke with numerous persons, none of whom could handle/discuss policy cancellations.Desired Settlement: Confirmation from Coventry Health Care that my health insurance is cancelled.

Business

Response:

Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on 11/10/2014 and was regarding cancellation of her policy. Our Executive Resolution Team researched your concerns and I would like to share the results of the review with you.

Review: My health insurance was cancelled as of 5/31/14, yet Coventry withdrew an additional insurance premium from my bank account on 6/3/14 for an non-existent June premium.

06/20/14 - request refund, given confirmation number and told 7-10 days to process, expect 7/1/14.

07/04/14 - 1st rep. told me check sent to wrong address, I informed that Coverage Certificate rec'd at correct address and check not appropriate , withdrawal from my account requires deposit to the same; transferred to Billing.

07/07/14 - 2nd rep. told me check story and I responded with Coverage Certificate received at correct address and funds should be deposited to my account not sent via check, rep. hung up phone.

07/07/14 - 3rd rep. told me that refund was not processed and would expedited refund and expect funds in my account in 3-5 days.

07/10/14 - rep told me expedited refund request was not given to a supervisor and would give expedited refund request to supervisor and expect funds in my account 3-5 days.

Refund not received 35 days after informing company that funds were withdrawn in error.Desired Settlement: Funds should be returned via deposit immediately.

Business

Response:

July 17, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding her request for a refund of her June 2014 premium payment in the amount of $491.00. The request was received by CHC Carolinas on July 16, 2014.CHC Carolinas does not have a signed authorization release form from [redacted] indicating that the Revdex.com is representing her in this matter, however will contact [redacted] within three business days. We will inform [redacted] that if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within 30 calendar days of receipt of her request.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,Melody *. C[redacted] Complaint and Appeal Analyst Coventry Health Care of the Carolinas, Inc

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]

Company has sent check dated 7/17/14 in the amount of $491.00. However, it is worth noting:My first refund request of 6/20/14, where upon I was given a refund deposit date of 7/1/14 was assigned confirmation number [redacted].During my second refund request of 7/4/14, when I attempted to give the rep both my cancellation confirmation number [redacted] and the aforementioned refund request confirmation number, I was told that neither number would help the rep in resolving my issues or look up the history of my file.Therefore, it seems to me that confirmation numbers are given as a smoke screen if Coventry now takes the position that they have no record of my request for a refund prior to July 16th.I did not contact Coventry on July 16th, my last contact with Coventry was July 10th.I would like to know what records does Coventry possess of a phantom phone call, and the purpose of assigning confirmation numbers?

Regards,

Business

Response:

July 17, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding her request for a refund of her June 2014 premium payment in the amount of $491.00. The request was received by CHC Carolinas on July 16, 2014.CHC Carolinas does not have a signed authorization release form from [redacted] indicating that the Revdex.com is representing her in this matter, however will contact [redacted] within three business days. We will inform [redacted] that if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within 30 calendar days of receipt of her request.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,Melody *. C[redacted] Complaint and Appeal Analyst Coventry Health Care of the Carolinas, Inc.

Review: On March 17, 2014, I called and spoke to a girl named [redacted] to terminate my policy. She assured me that I had done that and told me when to expect my refund for my next months premium since it had already been submitted and could not be stopped. At that time, I signed up for my new policy. However, I have not received my refund and they have continued to take out another month's premium (nearly $500 for 2 months). Today, after 3 phone calls and 2 transfers, they admitted that it was their fault and that [redacted] had entered things incorrectly on her end. Despite that, I have to wait 10-15 days for a supervisor to even review the claim and then approve the refund of my money. Meanwhile, I am stuck calling other companies who I rightfully owe money to, like my mortgage provider, to ask for an extension and pay possible late fees. This is so incredibly frustrating. I explained all of this to each person I spoke to on the phone and they offered no ideas to pay me back MY money which they willingly admit they only have because they made a mistake. This is not my first issue with them. Their representatives have also failed to successfully update my address on multiple occasions. (This became an issue again today when trying to verify my account.)Desired Settlement: DesiredSettlementID: Refund

I want my money back ASAP. I don't think I should have to pay for their mistakes. I already lost an hour of work today just being passed around and trying to resolve this on the phone.

Business

Response:

May 23, 2014Dear [redacted]:The Appeals Department of Coventry Health Care of Georgia, Inc. (“Coventry Health Care”) writes this letter in response to your request dated May 15, 2014 and received at our office on that day. This letter is in response to the consumer complaint filed by [redacted] regarding termination of her policy and refund of her premium.Coventry’s records show that on March 17, 2014, the member called to terminate coverage as of April 1, 2014 and to change the address of record to [redacted], GA [redacted]. On May 12, 2014, the member called in to advise that her account had been drafted when the policy should have been terminated. A review of Coventry’s records found that the termination was not processed in enough time to avoid the draft.On May 15, 2014, the policy was terminated as of March 31, 2014 as requested and a refund issued on May 19, 2014. The amount deposited back to the drafted account is $474.44 which is two premiums of $237.22 (for April and for May). Depending on the members banking institution, funds will appear within 1-5 days from May 19, 2014.If you have any questions, please contact the Customer Service Department at [redacted].Sincerely,

Review: Coventry cancelled health insurance on my family and denied my wife her prescriptions while she had a migraine. They couldn't get the billing correct.

I applied for health insurance with Coventry Healthcare on December 16, 2012 and they drafted my checking account for $571.42 on January 23, 2013. First problem, they did not issue me a policy number for my family until January 29 at 2:22 pm only because I called them and demanded a policy number so that my children could go to the doctor, if need be. I was told they would not pro-rate the month of January so I requested that the effective date be changed to February 1, 2013 which raised my premium $6.32/ month. I was OK with that but this triggered a whole chain of events. So, they decide to draft my account for $1,142.84 on March 5 when I only owed for March due to the fact that the effective date was changed to February 1, 2013 and they took payment for $571.42 in January. However, I was advised by Coventry that they could not change this in the computer and to do a stop payment at my bank. So, I did since I did not owe that amount to them. They drafted $38.96 and $577.42 on April 5, 2013 and $20.32 on May 10. So, I informed them of what was going on and I made a manual payment of $577.74 on May 15 but they did not receive it until May 24. Then on June 5 Coventry wanted to draft my account for $1,720.58 when I only owed $1,122.84 because they couldn't draft correctly. So, on May 28, I had to put a stop payment on my bank account to prevent over payment. I inquired about making a manual payment to bring account current and was advised by Coventry NOT too. They told me they would draft my account again on June 20, 2013 for the correct amount of $1,122.84 but my bank did not remove the stop payment in time to allow the draft to go through. On June 12, Coventry denied my wife getting her prescription filled at CVS for her migraine headaches. They said her D.O.B. was incorrect and so they denied her prescriptions. I have two documents proving her D.O.B was correct. On June 18 we still could not get prescriptions. They informed me our rates were going up due to incorrect D.O.B. even though I have proof it was correct. I received a letter on July 15 (dated July 3) stating the policy cancelled backdating to April 30. Meanwhile, I sent a cashier's check on July 11 for $1,720.26 to Coventry to bring the account current and they cashed it on July 15. They claim they have NOT received payment as of July 17, 2013. I have proof of that as well.Desired Settlement: I want my healthcare policy back at the rate of $577.42/ month as we agreed upon. They recorded my wife's D.O.B. incorrectly and want to increase my rates and cancelled my policy on me. This is by far the worst company I have ever dealt with. I have proof and documentation of everything.

Business

Response:

Attached please find a copy of the letter that Coventry Health Care sent to Complainant on August 8, 2013 in response to his complaint.

Thank you,

Dear **. [redacted]:

Coventry Health and Life Insurance Company (Coventry) received your response to the letter sent to you on August 8th, 2013. We appreciate the opportunity to respond.

You were originally effective 01/01/2013. Once this was changed to February, per your request, a premium increase was assessed as you had a birthday in January and this put you into a different age bracket.

In regards to the documents submitted regarding the date of birth for your wife, [redacted], the letter with premium choices was prepared by an independent broker at the [redacted]. Coventry did not have your personal information at that time. As for the application for health coverage, a faxed copy was received and the birthday appeared to be 1985. A correction was made and put your wife into a different age bracket.

Had all this information be correct prior to coverage, the premium of $593.21 would have been given.

We trust this information has addressed the issues raised in this complaint. If we may be of any further assistance, please feel free to contact me at ###-###-####.

Respectfully,

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: Coventry One has failed to refund and continues to charge me for a plan that was canceled before it started.

I signed up for Coventry One through the ACA in March. I was originally told that I was not eligible for a subsidy. I chose a plan and immediately paid the first month ($296.32). Within a few days I was advised that there had been an error in the computer system and in fact I was eligible for a subsidy that covered the cost of health care for myself and my family. The ACA staff helped cancel the original plan and enrolled us in a new one. I called to request a refund of the first month (this was all before the plan was scheduled to start). I was told that I would receive a refund when the processing of the plan change was complete. The next month, I received another bill for the full cost of the plan. I called and was told that there was an error on the ACA end that showed me having both plans at once. The ACA denied this. They had documented that the first one was canceled and the second was in effect. Coventry finally agreed that the first plan is not correct, but still won't issue a refund and sent another bill for the same amount. They claim I owe them for another month of a plan I am not enrolled in. After complaining, yet again, I received notice two days ago that my daughters' insurance has been termed. Is this a punishment? I called and was told that I am the secondary person on the plan and they cannot speak to me. My husband called this morning and asked for a translator, only to be hung up on. We are exhausted and incredibly frustrated. Worst of all, we cannot get in touch with anyone.Desired Settlement: I want a refund for the amount paid for a plan that was cancelled before it went into effect and to clear the record that I do not owe them more money.

Business

Response:

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

Review: My policy was cancelled in January before any money was drafted from my account. In Febuary $248.92 was drafted out of my account, which is more than the payment amount would have been. My wife cancelled her policy in the same email mine was cancelled, they had drafted her payment already, but refunded her money promptly. I assumed since no monies had been taken from my account, none would be since the policy was cancelled. When I called to find out why they took money out in Febuary after the policy was cancelled, they said they messed up and didn't cancel my policy when my wife's was cancelled. Now due to their mistake they tell me I have to wait 30 days to get refund??? I don't have an extra $250 for them to hold for 30 days.Desired Settlement: REFUND BEFORE 30 DAYS!!!!

Consumer

Response: