Coventry Health Care, Inc.

Dear *** ***,
Please see our response below to the additional concerns reported in complaint #*** for *** *** that were received by us on December 16,
We do apologize as we had misstated the remaining timeframe that would be required for the deposit after it was entered on December 13, 2014. Rather than the 7-days we had asked to allow, the refunds take 1-days from the entry step to deposit into the account we have on file. When refunds are requested, they are sent for approval and then entered into the system once the approval is granted. A refund of $was deposited into *** ***’s bank account on December 16, 2014, which was nine business days from the request being made on December 3, 2014, and two business days from the entry of the refund after it was approved.
We were not able to process the termination of *** ***’s policy in November as the only document received was her proof of other insurance. In order to allow backdated terminations, our business rules state that we need a signed request. A signed request was not received. It was not until *** ***’s call on December 3, that we allowed her request regardless and processed the termination of her policy back to the end of October.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

We apologize for our initial response; we did go back to our Billing department and they have indicated that they have credited the member’s account with an additional $which was applied toward *** *** December premium payment.
If *** *** has any additional questions regarding this particular matter, she may also contact the Executive Resolution Team at ***@aetna.com.
Regards,
Carli M***
Executive Resolution Team

February 18,
Dear ***:
The Health Plan received your request to our initial response on February 5, In response to your rejection:
*** is currently enrolled with the Health Plan’s Individual GLD $HMO CARELINK policy# *** effective January 1, On January 15, 2014, *** policy was loaded into the systemUnfortunately, the Health Plan is limited to what is fed to us by the exchange in a timely mannerMaking 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 ***:
• January 22, - *** was contacted by the Health Plan’s Customer Service Department to advise that his policy was effectiveThere was no answer and Customer Service Representative left a message
• January 23, - *** filed a complaint with the Revdex.com regarding not received member ID cards and policy material
• January 24, 2014- *** contacted the Health Plan’s Customer Service Department and was given his member ID number
• January 29, 2014- *** contacted the Health Plan’s Customer Service Department regarding his Revdex.com complaint and the status for premium payment for February 1,
• On February 6, at 10:14am- *** called regarding a payment voucher for January premium and the status of his member ID card
• On February 6, at 11:10am- *** sent a secure email requesting information on how to print out his member ID cards online*** was advised he must register all the members of your policy to print out their member ID cards
• On February 6, at 11:19am- *** contacted Customer Service and he was advised that all cards were originally sent out on January 15, and a second request was submitted on February 5, 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 matterIf you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:am until 5:pmMy fax number is ###-###-####, and my e-mail address is [email protected]
Sincerely

June 3, Dear *** ***:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our office on June 4, We appreciate the opportunity to respond.Coventry does not have a signed authorization release form from the member indicating
that the Revdex.com is representing *** *** in this matterTherefore, Coventry is responding directly to *** ***.We trust this adequately responds to your inquiry.Sincerely,

Dear
Ms***,
class="MsoNormal" "background: white;">Please
see our response to complaint #***
for ***
*** that was received by us on April 4,
Upon
receipt of the complaint, our review showed that Mr*** had two active
policies with Coventry. This occurred
due to a policy applied for through the Federal Health Insurance Marketplace
for being automatically renewed for and a separate enrollment notice
being received from the Marketplace for coverage in 2015. Both policies were set up to have the
premiums collected automatically through recurring Electronic Funds Transfers
(EFT). As we did not receive a
termination notice for either policy and payments were being received for each,
both polices remained active, both were renewed for 2016, and an EFT was
performed for both policies for each month of coverage going back to January
We
were able to have the policy that had been automatically renewed for
terminated back to December 31, 2014.
This allowed us to move all payments received for that policy for
and to the other policy that remains active and issue a refund for a
portion of the payments we had received.
A refund in the amount of $was deposited directly into his bank
account on or around April 8, 2016. The
bank account information has now been removed from both policies which will
prevent any future payments from being collected unless the bank account
information is provided by Mr*** again.
Mr
*** had also said that he wishes to cancel all coverage with Coventry as of
March 31, 2016, due to obtaining other coverage. We have reviewed all information received
from the Marketplace and have determined that we have not received the proper
notification from the Marketplace that would allow us to grant that termination
date. We called Mr*** in an attempt
to perform a conference call with him and the Marketplace to advise them of
what is needed, but Mr*** refused.
As the Marketplace will not speak with us without authorization from the
applicant, we are unable to assist further on that part of his request at this
time. If Mr*** would like help with
the termination in the future, he may call me directly at ###-###-#### and the
conference call can be performed
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address Mr***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

October 22, Dear *** ***:
Your letter of October 16, to Coventry Health Care of Iowa, Inc(Coventry) was received in our office, and referred to my attention for review and response*** *** was on a CoventryOne Individual policy with a February 1, effective
dateThe policy terminated on September 30, 2014.In his complaint to the Revdex.com, *** *** advised his policy was terminated without notification due to a lack of proof of citizenship*** *** would like his policy reinstatedThe *** issued a letter to *** *** that advised proof of citizenship needed to be submitted to them in order for *** *** to continue his health insurance coverageSince the *** did not receive proof of citizenship from *** ***, the *** sent a policy termination file to Coventry on September 16, The file instructed Coventry to terminate *** ***’s policy effective September 30, The request for proof of citizen is solely handled by the ***Coventry does not have a copy of the notification letter sent to *** ***Coventry is unable to reinstate a policy that was initiated through the *** per the Exchange rules and regulations that we, as an insurance company, must follow*** *** needs to contact the *** directly to inquire about his policy terminationThe *** phone number is ###-###-####If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext***Sincerely,Shawn M.
Complaint and Appeal Analyst

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
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, months later, a hold has been put on the coverage for my prescriptions, which now has been in place for daysIn 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 to working days for the hold to liftOn the 8th of July, my coverage was still not active, I called again just to be told that it would probably take another additional hours for the hold to be liftedI am still waiting for it

September 30, 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 *** *** regarding withdrawal of funds the month following
termination.Our research into this matter revealed that the policy was not termed timely due to a processing error so the policy was corrected and termed for July 31, A refund was requested for the amount of $on September 23, Once the refund is processed it can take 3-business days depending on the bank*** *** should receive the refund this weekAdditionally, *** *** indicated that because of the money that was withdrawn in August, she had over drafted her bank accountIf she can send me a copy of her bank statement (with a running balance) showing the Coventry draft and subsequent fees, I will be happy to look into the matter of reimbursement of those fees to her.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is ***Very truly yours,Neil M
Regulatory Compliance Analyst

Dear
*** ***,
Please see our response to complaint #*** for *** *** that was received by us on January 6,
We were able to terminate the policy for *** ***’s family effective December 31, 2014. A refund was deposited directly into their bank account for $on January 13, 2015. This was the amount of the premium we had collected for their coverage for January
We were not able to issue a refund for any premiums from January 2014, as the coverage for *** ***’s daughter does show active for that month. Initially, her daughter’s coverage had been set up to have an effective date of February 1, 2014, which would have caused any claims received for earlier dates of service to deny. This was corrected on October 16, 2014.
It is still possible to file claims from January 2014. *** *** would need to contact the providers who performed the services to request that they file the claims to Coventry. Once processed, the accounts can be reviewed to determine if those providers owe any refunds to *** *** for amounts that she had previously paid out of pocketSeveral claims for that time period that we had already received and denied have been reviewed and sent for adjustment to be processed according to the benefit plan.
We do apologize for any frustration *** *** has experienced while attempting to resolve her issues. Coventry is constantly reviewing our processes for opportunities to improve our customer service and will continue to do so in order to prevent extended issues such as this one from occurring.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

Dear Ms
***,
Please see our response to complaint #*** for *** *** that was received by us on July 9,
During our review it was noted that Ms*** had called Coventry on June 5, 2015, to request a refund of the premium that had been drafted for June and to request that she be changed to paper billing instead of a recurring Electronic Funds Transfer (EFT) draft. Regrettably, financial hardship was not considered a valid reason to issue a refund. The change to paper billing was made but Coventry does not offer paper billing for members in the state where Ms*** lives.
Once the paper billing issue was noticed, Ms*** was set back up to be on recurring EFT. When she called on July 2, 2015, the policy was cancelled back to June 30, 2015. At that time, it was too late to stop the EFT that had already been scheduled for the July premium. The EFT was processed on July 6, 2015. A return notice showing that the draft failed was processed on July 8, 2015. Since no money was taken out of the account, no refund is due for the July premium. Also, because the policy has been terminated back to June 30, 2015, an NSF fee will not be applied for the returned payment.
Ms*** should have been told initially that paper billing was not allowed and also notified that the recurring EFTs were being set back up for her policy. We have forwarded the information from this case to the appropriate department to provide education to the parties involved.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

May 2, ***:The Member is participating in a non-grandfathered self-insured PPO health benefit plan through his employer, City of *** *** *** and administered in part by HealthAmerica Pennsylvania, Inc.The Member’s complaint concerns the denial of
medication *** and the deductible applied to laboratory services rendered on February 1, with *** Medical Center.Upon review, the member had laboratory services rendered on February 1, with *** Medical CenterOn February 14, the claim was received by the Health Plan with primary Diagnosis Code *** *** *** ***The claim was processed according to the member’s benefit plan applying $toward the member’s deductibleThe member has a $annual deductible that must be satisfied before the Health Plan begins to payIn a request received On March 11, 2014, the member filed an internal first level appeal with his planThe appeal was reviewed by a Plan committee member who is a Supervisor of Complex Case Management PA state Registered Nurse and denied the request to waive the deductible applied to laboratory services rendered on February 1, with *** Medical CenterI have attached the appeal denial letter that was mailed to the member on April 7, 2014.On February 10, the member’s provider requested authorization for *** medicationThe request was reviewed by a HealthAmerica Medical Director and denied, 3001: Medical Necessity Criteria Not MetI have attached the denial letter sent to *** on February 11, Please note that the member has not utilized his internal first level appeal available to him in regards to the denial of the *** medication.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

Dear Ms***,
Please see our response below to the additional concerns reported in complaint #*** for *** *** that were received by us on January 30,
Ms*** may disregard the bill that she received. During our review, it was determined that the file that was sent in order to have that bill mailed was created on January 11, 2015. That date was prior to the action being taken to cancel her policy and refund the overpayment. At the time of the final review prior to sending the file, the numbers would have accurately reflected what the system showed she owed at the time but those figures have since changed.
The Coventry billing system is showing the current amount owed as $0, so we do not anticipate Ms*** receiving another bill. In the event that she does receive any other notices from Coventry regarding billing, please have her contact me directly at ###-###-####
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Sincerely,
Chris B***
Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
The Business claims that I (the member) did not experience a qualifying event that would allow a plan change in the middle of the year & that No Record was found of a change request being made after that dateHowever on a letter dated May 22, 2014, Coventry Health Care wrote to Revdex.com, and I later received a copy of the moves in place for the plan changeThe letter was followed by a phone call from Mr.E***'s office talking about the plan change, a conversation with Adriana (his assistant) that lasted about minutes, and resulted in a policy change for meThe letter was in response to my previous complaint with Revdex.com about Coventry Health Care to get this solved earlierI can provide a copy of this letter upon request, however, for some reason I am unable to attach it to this message service of Revdex.com.
Secondly, the letters coming every SINGLE month from Coventry were very clear in that they said my "regularly scheduled premium will change in (said date/month)"The letters were NOT only in June, July, August, they extended until September as well, which still makes NO sense had they been about the draft date as *** claims.
To make this easiest for the three parties involved I would like to make clear the following #1, as of right now I have NO health coverage, I have yet to be notified of this, and I do believe it is for "lack of payment" however, this would be because my bank is now rejecting any EFT from my account from Coventry greater than $per month #2, the fact that my policy may have been cancelled is actually OK with me, my bank has refunded me my money and I am fine with thisI however do expect that coventry will not seek collections on anything they believe would require so#as a final attempt some time about weeks ago I want to make very clear that I called Coventry and they told me on one side of their system I was cancelled and on another I was not, of course they would place me on a hold and hang up and not call me backThis ALWAYS is happening with my situation, I guess no one wants to deal with it, and it works for them.
In the long tern I need confirmation that my policy is actually cancelled, I can easily get another provider.
Any issues ANYONE receiving this message can call me at any time directly at ###-###-####A short message to Coventry:
If my plan is cancelled, so be it, but please formally confirm this with me and do not seek collection on what you guys believe is dueAlso, as a suggestion in this modern world when handling a situation as mine, I suggest you guys be more transparent, versus providing an email, maybe a phone number would be more helpful, and at that not just a line that departments will go through and get you know where, such as *** *** did on her response.
Regards,
*** ***

Dear
*** ***,
Please see our response to complaint #*** for *** *** that was received by us on February 6,
In order to attempt to expedite the refund for the premiums collected from *** *** on February 5, 2015, we reached out to our Billing and Enrollment department. While we couldn’t shorten the standard 7-business day timeframe for refunds, we have verified that the refund in the amount of $was scheduled for February 14. Depending on the processing times required by his bank, the refund should be posted to the bank account we have on file for him within 1-business days.
If *** *** will provide a bank statement that shows the dates and amounts of any overdraft or NSF fees applied due to this situation, it can be reviewed to determine if we are able to provide additional reimbursement. It was noted that we haven’t yet received any bank statements from him
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

May 30, 2014Dear *** ***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 *** *** regarding the request to terminate her policy purchased on the Federally Funded
Marketplace exchange for an effective date of April 1, and refund her premium payment in the amount of $The request was received by CHC Carolinas on May 15, 2014.CHC Carolinas does not have a signed authorization release form from *** *** *** indicating that the Revdex.com is representing her in this matter; however we will contact *** *** *** within three business daysWe will inform *** *** *** that if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within calendar days of receipt of her request.Please contact me if you have any further questions involving this issueI can be reached at ###-###-####, extension ***, Monday through Friday from 8:a.muntil 5:p.m.Sincerely,

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
As of today April 10th I have not received the deposit back into my account
Regards,
*** ***

Dear Ms***,
Please see our response below to the additional concerns reported in complaint #*** for *** *** that were received by us on January 20,
Coventry did notify Mr***’s employer that the free gym club membership would no longer be offered as part of the benefit package beginning in 2015. We are unsure why their benefit book was not updated to show that change. Our intent was never to misrepresent the coverage in order to gain additional membership.
We have not been able to locate a open season pamphlet. However, letters are being sent out to the members of the Federal Employees Health Benefit Plan to confirm that the benefit has changed. A flyer containing the details of the gym membership discount program was sent along with that letter and is available on Coventry’s website.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected]
Sincerely,
Chris Binsfeld
Executive Resolution Team

August 14, Dear Sirs:This letter is in response to the aforementioned Case Number *** regarding *** *** *** request to update the physical address.Please be advised that after review of this grievance, *** *** wife’s address has been updated*** *** previously verified the correct address as *** ** *** *** *** *** ** ***An additional card has been requestedPlease find a temporary ID card included.If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:am until 5:pm or you may reach me directly at ###-###-####If you are hearing impaired please call 7-1-Telecommunications Relay Service.Sincerely,Yanique M*** Complaint and Appeal Analyst Grievance & Appeals Dept

June 30,2014Dear *** ***:The Appeals Department of Coventry Health Care of Georgia, Inc("Coventry Health Care") writes this letter in response to your request dated March 12,and received at our office on that dayThis letter is in response to the consumer complaint filed
by *** ** *** regarding what she considered to be an unauthorized payment from her account.Coventry's records show that the payment that was received on 02/27/went towards March's premium paymentT he member did not draft for the month of March, but her draft continued in AprilTherefore the member is neither ahead nor behind in payments.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,Appeals Department

face="Calibri">Dear Ms***,
Please see our response to complaint # *** for *** *** that was received by us on April 14,
During our review, it was determined that the member’s old plan should have been terminated effective January 01, 2015. We contacted our Billing and Enrollment department and they have terminated the policy effective January 31, 2015, as the member requestedThe policy now reflects as terminatedWe have submitted an expedited request to rush the final bill so the refund of $will occur within 3-business daysFunds will be reversed back to the drafted account
I apologize for any difficulties or confusion this may have caused *** ***We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** * concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Julian C***
Executive Resolution Team