Coventry Health Care, Inc.

Review: Countless times when I've called agencies and not been able to understand the person on the other end due to their poor English, I deal with it. Today I called my health insurance company, Coventry One of Illinois, to inquire about a few issues. Again, I was unable to understand the female representative and asked her if I could please speak to a CSR that spoke English clearly, as I couldn't understand her. She hung up on me!Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like to have clarification if it's my right to request and English-speaking person when I call a company/any company in the U.S.A.? If not, please explain. This is in no way a prejudice complaint because I'm not that type of person... I truly just want to know what my rights are. Thank you in advance for your response. [redacted]

Business

Response:

July 25, 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 miscommunication between she and the customer service representative whom she reached on the telephone.We regret that [redacted] did not have a good experience when she contacted Coventry to discuss her policy. Because we realize that there could be several explanations as to why the call between [redacted] and the customer service representative was prematurely disconnected, Stephanie H[redacted] from our Local &Regional Business Operations department reached out to [redacted]. According to Ms. H[redacted]’ notes, she originally spoke to the member on July 15, 2014 in the late afternoon around 4:44pm Pacific time. At that time [redacted] asked Ms. H[redacted] to call her back in the morning because her phone was about to quit. Ms. H[redacted] called [redacted] twice on July 16, once in the morning and the other time in the afternoon, but only got a voicemail. She left a voicemail, both times, with her direct number to call her back.Ms. H[redacted] called again on July 17 around 9:47am. She called [redacted]’s home phone number and reached her husband. He asked Ms. H[redacted] to call [redacted]’s cell number, which he gave to her again. Ms. H[redacted] called the cell number and reached [redacted]’s voicemail again. She left another message with her direct phone number and that fact that she could be reached until 5pm Pacific time. Ms. H[redacted] never heard back from [redacted].Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted] certainly is entitled to a good experience when speaking with a Coventry customer service representative. If there is difficulty communicating with whoever answers her call and, if at any time the call is inadvertently dropped, she should call back and explain the situation to the representative.Very truly yours,Neil M, B.A.Regulatory Compliance Analyst Coventry Health Care

Review: Horrible customer service. REPEAT: HORRIBLE CUSTOMER SERVICE!!!!!!!!!

Contacted customer service this morning (spoke with [redacted] from [redacted]) as my normally scheduled payment due monthly on the 5th hasn't been debited from my checking account and it is now the 13th. Concerned, I thought it best to make sure there wasn't any error on my end. Also, last month I received a letter that I was holding in my hands during the conversation that stated that my premium had increased for the month of May, and would returm to normal next month (june). So, I asked [redacted] if she had and idea what the delay was on the automatic debit, or when it will be occuring. "Sometime next week" was the answer I received from [redacted]. Okay, also I have this letter, and I read it to her. Asking of her to please tell me the amount my premium would be returning to. She told me she "had no idea why that letter was sent to me and I should look at paperwork from MARCH to answer my questions

Why would your company bother sending me this paper if it doesn't mean anything? To which I once again got, "I have no idea ma'am" I requested a manager or supervisor get on the the phone ,"none are available ma'am" I then asked for a phonenumber to contact one directly, "I don't have one ma'am" to which I hung up completely frustrated with NONE of my questions answered, and wondering how [redacted] cashes her paychecks without the feeling of guilt. Also, on three different occasions now I have contacted customer service requesting a mailed detailed copy of my policy premiums for my daughter and myself as they are court ordered to my ex-husband as he is responsible for paying a portion of my daughters healthcare costs. Three times now I have been told a manager must approve such request and it will be mailed to me within 7-10 days. The most recent request I made via customer service was well over a month ago and prior to that my first request was mad 6 months ago. I am by no means a hound and am VERY patient. This is getting out of hand, I have a judge telling me I need to provide information and my health insurance provider that I pay for cant provide me with any information I request!!!!!Desired Settlement: I would like a supervisor to please contact me via mail with answers and the information I have requested so many times.

Business

Response:

Coventry Health Care, Inc. respectfully requests an extension of time in order to further its investigation of the above-referenced Complaint.

Thank you,

Business

Response:

July 14, 2014Dear **. [redacted]:The Member is participating in the Coventry Health and Life Insurance Comp any (“CHL”) HealthAmerica One individual HMO Health Care Reform health benefit plan.[redacted] (the “Member”) has filed a complaint. The Member’s complaint concerns poor customer service provided by CHL. The Member states that she requested and has not received an explanation as to when her automatic debit premium payment would be processed and also requested a detailed policy premium for her daughter and herself and has yet to receive anything from CHL.Below is a timeline of events leading up to the resolution of the Member’s complaint.07/02/2013- The Member called to update address.12/11 /2013- The Member called to get a breakdown of premium.05/01/2014- The Member called to see if she can get the breakdown of premium mailed to her.06/13/2014- The Member called about her recurring payment and stated her premium is incorrect. CHL representative advised renewal came and premium changed. Member wanted to speak to a supervisor.ROOT CAUSE:The Member requested a letter of premium breakdown, however it was sent to an email on file and not home address.RESOLUTION:We have provided the information being requested as well as a payment history. Member’s premium changed effective May 1, 2014 due to renewal. A migration letter was sent out advising so and the CHL has provided all documentations requested by the Member.We apologize for any inconvenience this may have caused the Member.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

Review: I have been trying to cancel this Health Inurance coverage for over 8 weeks: phone calls, emails, faxes. Several Managers assuring me that they would help - yet they continue to direct debit my checking account. No one has ever called back or emailed. I had to go to my bank and pay an additional $40 to have them reject any attempt from Health America to take more money from my account. They still owe me for the January payment, but every time I get someone on the phone it's as if they've never heard anything about it.Desired Settlement: They owe me my January payment and also the money my bank charged me to stop the payments.

Business

Response:

February 13, 2014

Dear **. [redacted]:

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

[redacted] has filed a complaint on behalf of her spouse, [redacted] (the “member”). The Member’s complaint concerns premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $737.41

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

May 9, 2013 11:50 AM: [redacted] and [redacted] contacted billing and enrollment to update their address. The new address was provided and a request was sent to processing to have it updated.

February 10, 2014 10:17 AM: [redacted] contacted billing and enrollment in regards to the termination of the policy. She stated that she had spoken to several people that informed her that we would cancel the policy. The member was advised to submit a written request with proof of other coverage. A supervisor advised the member to submit the information to him and he would terminate the policy.

ROOT CAUSE:

The member had two policies, the other policy was sent to our department as terminated for May 15, 2012. The termination email was applied to the old policy.

Per business rules the member would need to submit a written request with a handwritten signature. The email did not include a handwritten signature.

The policy has been terminated for January 31, 2014 based on email that was received. If the member wishes to back date their termination any further, they will need to submit a written request with proof of other coverage.

A refund has been requested. Please allow 7-10 business days for processing and an additional 7-10 business days for mailing time. If the funds are reversed back into the members account it may take an additional 1-5 business days for the funds to post after the refund is processed.

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

Sincerely,

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:

They have NEVER contacted me regarding anything - but I see you received a prompt reply!!! I had been attempting to cancel this policy since the Middle of December - not just the February date. We require a refund from January 1st, not the 31st. I had MANY conversations with them, and they never requested any additional information from us. This is absolutely shameless customer service. I went to my bank and they are crediting my account as they are still attempting to take funds from us.

Regards,

Business

Response:

February 27, 2014

Dear **. [redacted]:

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

[redacted] has filed a complaint on behalf of her spouse, [redacted] (the “member”). The Member’s complaint concerns premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $737.41

Upon further review, the member’s contract will terminate effective December 31, 2013. The payments have been “ returned” by the bank to the member’s bank account. Also, a request to refund the $40 in bank fees that may have occurred during the process has been submitted.

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

Sincerely,

Review: Since May 2014, my wife and I had been enrolled to medical insurance service at Coventry One through the health market (healthcare.gov). When I submitted my application to healthcare.gov in April 2014, a health market officer told me I need to pay just initial payment of $325.60 by credit card and till the end of the year my wife and I would be insured and the US Government will assist us with premiums payment. The Coventry One company broke our agreements and the Federal low several times. First, according the IRS Notice of Proposed Rulemaking Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit, premium payment cannot exceed up to 9% of total household income (in our case it was 7%). We should pay just $61.60 with Premium tax credit $264 per month, but Coventry One charged me twice in full (totally $651.20). I deleted my bank account info at Coventry One web site and send them a check with $61.60 for September 2014 period, but Coventry One returned the check with $61.60 and they terminated our insurance plan without any notice. Later I found that termination plan was made because of non-payment. Second, I did not authorize Coventry One use my bank account and charge my account without my permission. I did not sign any form or document providing such permission, but Coventry Ones web site created in a very tricky way and it forces applicants provide their credit card and debit card accounts. Therefore, I state that Coventry One deceived me obtaining my personal data and charged me illegally. At the same time Coventry One did nothing for me and my wife.

Product_Or_Service: Bronze Plan Deductable [redacted] Order_Number: ID#: [redacted] Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I suggest two options to solve this issue:-Coventry One returns us all taken money ($651.20). Then Coventry One must delete all our personal data from its files and databases. Therefore, we bring our relationship terms as they were in April 2014.-Coventry One restore our insurance plan (the old terminated or creating a new one) and we continue pay premiums according the US Government standards with the Government support. In this case I apprecia

Business

Response:

October 28, 2014Dear [redacted]:Your letter of October 20, 2014 to Coventry Health Care of Iowa, Inc. (Coventry) was received in our office, and referred to my attention for review and response. [redacted] was on a CoventryOne policy with a May 1, 2014 effective date. [redacted] enrolled for coverage through the Health Insurance Exchange (Marketplace).In his complaint to the Revdex.com, [redacted] expressed that he believed he was overcharged on his monthly premium. [redacted] also advised that his policy was terminated without notice.On April 15, 2014, [redacted] applied for health coverage through the Marketplace for an effective date of May 1, 2014. The monthly premium payment for the policy was $325.60. On April 29, 2014, Coventry issued an Electronic Funds Transfer letter to [redacted] confirming his enrollment in having his monthly premium payments automatically withdrawn from his bank account.On July 26, 2014, Coventry was notified by the Marketplace that [redacted]’s premium would be $61.60 effective September 1, 2014. Because [redacted] was enrolled in an Electronic Funds Transfer program with Coventry, Coventry automatically withdrew monthly premium payments in the amount of $325.60 for June and July as the premium reduction was not in effect until September 1, 2014.On July 28, 2014, [redacted] contacted Coventry to confirm that his new premium of $61.60 would begin in September. The Customer Service Representative confirmed this, but advised [redacted] that he still needed to pay $325.60 for August in order to avoid his policy termination. [redacted] asked if he could terminate his policy and re-enroll for September. [redacted] was referred to the Marketplace to request a policy change.On July 29, 2014, Coventry issued a Policy Change letter to [redacted] confirming the policy changes he requested. On August 7, 2014, Coventry issued a Payment Due letter to [redacted] advising that his monthly premium payment of $325.60 for August was not received. This was due to the fact that [redacted] had deleted his automatic payment information.On August 2, 2014, [redacted] contacted Coventry to request a premium change due to his income. [redacted] was referred to the Marketplace. Though it might seem to our customers that we as carriers should be able to make changes to health insurance policies ourselves, certain changes (such as changes in effective and termination dates) must be done through the federal Marketplace. The structure of the Affordable Care Act requires that these types of changes occur only through the federal level.On September 10, 2014, Coventry issued a Policy Termination letter to [redacted] because his premium for August was not received. On September 10, 2014, Coventry retroactively terminated [redacted]’s policy effective July 31, 2014 for non-payment of premium. Coventry did not terminate [redacted]’s policy in error or without notice. Coventry did not receive the full payment due for August. [redacted] is not eligible for a refund for the months of June and July, as he received health insurance coverage during that time. On September 25, 2014, Coventry mailed a premium refund of $61.60 to [redacted] for the payment received on August 25, 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

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved] Review: [redacted]I am rejecting this

response because:I feel that the Coventry

One company did not provide me any kind of service and they just

stole $651.20 from me. I tried to obey the federal law and tried to avoid the

fee that will be imposed by government to uninsured people. Otherwise, I would

never have a deal with such dishonest company like Coventry One which dares to deceive

and rob the poorest people.

Coventry One is a monopoly health insurance company in Iowa that represent Federal

Healthmarket and you have no choice just

deal with them if you buy a Health Insurance via Government Market Place.

According the Law and Affordable Care Act it is mandatory for anyone living in

the US to have a medical insurance and I applied for the insurance for my wife

and myself via www.healthcare.gov in March 2014. At that time my income was

unstable and it was near $1800. The healthcare.gov officer assured me I have to

pay just initial payment $325.60 and the next premiums will be paid by

Government till my financial situation would be improved. Also I was assured

that my wife and I will be covered till the end of the year 2014. I believed

them and applied for the Bronze plan as they advised. Again, at that period of

time we rented an apartment which cost us $1025/month and it would be a suicide

action for me to have in addition such unbearable burden like $325.60/month of

premium for the med. insurance. First couple months my account was not charged

by Coventry and everything worked as I was promised. Unexpectedly, in June 30,

without my authorization Coventry One charged my account for $325.60 which was

also against the federal low that states that premiums cannot exceed the up to

9% of total household income. I found the way to delete my bank account

information from Coventry One. I submitted several complains to Coventry and

Helthmarket about the situation. For me it is unclear why the rules were changed

and why Coventry One started to charge me $325.60 each month. Anyway, the

Healthmarket representatives suggested me to continue have deal with Coventry

One and take a tax credit of $264.00 as a financial support from the Government.

Therefore, our monthly premiums should be $61.60 per month, which was fair and

reasonable for Bronze plan.

Unfortunately, Coventry

One demanded to pay $387.20 which I cannot give them since it was not

affordable for me. Therefore, I sent them $61.60 for Septmeber 2014 and via

phone conversation to Coventry One representative I requested to cancel service

for the August. By the way, I don't understand how could Coventry one charge

people in full if it is against the law? Why the Coventry One agreed to become

a Government Healthmarket provider and not follow the Affordable Care act

rules?

I think that Coventry

One just takes money and do nothing for people. They tell you that you are

insured, but we have to pay $12000 for med. service ourselves during a year (in addition to monthly

premiums $325.60), before the Coventry One will start to provide their real insurance

service. If you call them or send them letters they just redirect you to

healthmarket. In my opinion the Coventry One company just uses the "great opportunity" to rob poor

people and grab easy money almost for nothing. I don’t believe them anymore and just want my money

back.

Respectfully yours,

Review: I had a routine Dr. visit ON 9-4-13, to review recent bloodwork. I paid my $15.00 co-pay at the visit. On 9-24-13 I received a bill for $15.95 for smoking cessation! I called the billing office and was told that my insurance requires my DR. to advise me it's bad to smoke and must show that billing code or when audited they could lose the insurance carrier. I called customer service and got the run around. customer service basically said she wasn't at the visit and I should take it up with my DR. I AM BEING PENALIZED BECAUSE I AM A SMOKER! I don't consider being asked if I still smoke a smoking cessation program or visit. I want the charge removed from my account!!!!Desired Settlement: Billing adjustment

Business

Response:

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

Thank you,

October 12, 2013

Dear Provider:

We received your request for an appeal regarding charge for smoking cessation rendered on September 4, 2013 for [redacted], on October 11, 2013. The calculation of the appeal time period begins when the appeal is received by HealthAmerica,

You can expect a response to your appeal on or before November 9, 2013.

At any time during the appeal process, you may appoint an authorized representative to act on your behalf by contacting the Member Services Department. You or your authorized representative may request a copy of the HealthAmerica information related to your complaint and you may submit additional information to be considered in the appeal review.

You or your authorized representative may request, at no cost to you, the aid of a Plan Customer Service Representative, with no previous involvement in your appeal issue, in preparing and presenting your first level complaint. You may request such aid by contacting the Member Services Department.

If you have any questions regarding your appeal, please contact the Member Services Department at ###-###-#### in central and eastern Pennsylvania, ###-###-#### in northwestern Pennsylvania, or ###-###-#### in western Pennsylvania and Ohio.

Sincerely,

Review: I RECEIVED A LETTER FROM COVENTRY INSURANCE P.O. BOX [redacted], FLORIDA [redacted], STATING THAT I NEEDED TO PAY MY BILL ON SEPTEMBER 30, 2014. SO WHEN I GOT PAID I PAID $416.00 ON THAT DAY IN TWO INSTALLMENTS. HOWEVER NO ONE INFORMED ME THROUGH A LETTER OR PHONE CALL THAT MY ACCOUNT HAD A RED FLAG ON IT. MEANING I CAN NOT GET MY MEDICINE UNTIL IT HAD BEEN LIFTED. I WENT TO GET MY MEDICINE AND IT WAS OVER $150.00. HOWEVER I COULD NOT AFFORD IT. I CALLED COVENTRY AND THEY INFORMED MY I HAD A RED FLAG ON MY ACCOUNT AND IT TAKES FIVE TO SEVEN DAYS TO LIFT IT. SO I SPOKE WITH MICHAEL A SUPERVISOR. HE SAID HE WOULD SEND AN EMAIL, BECAUSE THEY HAD NO TELEPHONE NUMBERS AT THE FACILITY WHERE THEY PUT FLAGS ON YOUR ACCOUNT. THIS WAS ON 9/30/14. I HAD SPOKEN WITH SEVERAL PEOPLE ON THIS DAY BUT NO ONE KNEW ANYTHING. WELL I CALLED BACK ON YESTERDAY (10/3/14) TIA I BELIEVE IS HER NAME SENT AN URGENT EMAIL STATING I NEEDED MY MEDICINE TO SURVIVE. YOU CAN NOT STOP TAKING HIGH BLOOD MEDS IT WILL CAUSE A STROKE OR HEART ATTACK. SO I AM CONTACTING MY LAWYER JUST IN CASE. THE POINT I AM TRYING TO MAKE IS AS SOON AS THEY SAW MY ACCOUNT WAS PAID, THE RED FLAG WHICH I KNEW NOTHING ABOUT SHOULD HAVE BEEN LIFTED. I BELIEVE THIS IS JUST ANOTHER AWFUL PRACTICE TO MAKE PRESIDENT OBAMA LOOK BAD IN TRYING TO GET HEALTHCARE FOR ALL AMERICANS. I ALSO WANT THE COMPANY TO SEND OUT LETTERS AND INFORM THE PUBLIC OF ITS MALICIOUS PRACTICE OF PUNISHING CONSUMERS WHEN THEY GET THEIR BILLS IN ON THE LAST DAY. THEY HAVE HIJACKED MY MEDICINE AND TAKEN MY MONEY AND WILL NOT LIFT THE RED FLAG. I HAVE PAID THEM OVER $2050.00 AND I ALSO BELIEVE THEY ARE NOT PAYING MY DOCTORS BILL, BECAUSE I KEEP GETTING THEM IN THE MAIL. I AM PAYING MY PREMIUMS, I AM ALSO PAID UP FOR OCTOBER.

Product_Or_Service: INSURANCE

Account_Number: ID # [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I WANT THEM TO BAN THE RED FLAG, BECAUSE THE ELDERLY MIGHT BE GOING THROUGH THIS AND THEY WILL HAVE NO CLUE AS TO WHAT IS GOING ON. THIS REMINDS ME OF THE POOR VETERANS HAVING TO WAIT THREE OR MORE MONTHS TO GET CARE AND SOME OF THEM DIED IN THE MEANTIME. WHAT IS THE DIFFERENCE, PEOPLE WILL DIE IF THEY HAVE TO WAIT FIVE TO TEN DAYS WITHOUT THEIR MEDICINE. I THINK THIS IS AN UNFAIR, PREJUDICIAL, TOTALLY DETRIMENTAL PRACTICE TO PUNISH THE CITIZENS

Business

Response:

October 17, 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 which have led to her account being flagged.A review of [redacted]’s account shows a series of late payments and reminder letters. Currently, [redacted] is paid through 10/31/2014 and there is not a payment flag on the policy to prevent her from obtaining medications. Unfortunately, due to the Healthcare Marketplace guidelines, the payment flag process cannot be banned as [redacted] has requested. Once a member falls into their grace period, the flag will be placed and will not be removed until the policy is paid through. At that point, once the policy is paid up to date, it can take 5-7 business days once the request has been made to get the flag removed. In order to prevent the payment flag, [redacted] must make a payment by the deadline.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil MRegulatory Compliance Analyst

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: I did not receive a notice telling me, once I paid my account current, mymedication would not be available to me. If I had known, I would have paid my payments in advance. Furthermore, they need to send out notifications to all clients apprising this of the situation of a "RED FLAG" I personally have never heard of it. Thank God my Pharmacist had a benevolent spirit, otherwise there is no telling what might have happened. So the resolution is to make all of their clients aware that if they are late making a payment, a "RED FLAG" will be placed on their accounts,which in turn will delay for up to a week their ability to receive critical care or critical medication.Or is this done to only a select few?

Sincerely,

Business

Response:

October 31, 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 rejection filed by [redacted] regarding payment issues for her policy which have led to her account being flagged.[redacted] claims in her rejection that she had never heard of a “red flag” and that she should have been notified of such. According to her Plan documents that she received (a copy of which is attached hereto),1.8 Premium Payment and Grace Period. The monthly Premium is due on the first (1st) day of each month. There is a one month grace period for Premium payments. In other words, if the required Premium payment is not paid on or before the first (1st) day of the month (i.e., the due date), it may be paid during the grace period. This Contract will Stay in force during the grace period. If the Premium payment is not received by the end of the grace period, Your Coverage under the Contract will be terminated as of the last date for which the Premium was paid in full. If Your Coverage is terminated, You will be responsible for the cost of any health care services You receive after the last date for which the Premium was paid in full.IF THE HEALTH INSURANCE MARKETPLACE HAS DETERMINED THAT YOU ARE A PERSON ELIGIBLE TO RECEIVE ADVANCE PAYMENT OF THE PREMIUM TAX CREDIT THE FOLLOWING APPLIES TO YOUR COVERAGE RATHER THAN THE ABOVE SECTION 1.8. Premium Payment and Grace Period for Persons Receiving Advance Payment of the Premium Tax Credit. The monthly Premium is due on the first (1st) day of each month. There is a three (3) month grace period for Premium payments. If the required Premium payment is not paid on or before the first (1st) day of the month (i.e., the due date), it may be paid during the grace period. During the first month of the grace period, We will continue to pay claims for Covered Services During the second and third months of the grace period, We will suspend payment of any claims until We receive the past due Premiums. If Premium payment is not received by the end of the grace period, Your Coverage under the Contract will be terminated effective at 11:59 p.m. on the last day of the first month of the grace period. You will be responsible for the cost of any health care services You receive after the last day of the first month.In other words, it is not that [redacted] had to pay her premiums in advance. It was that she paid very late. If she had paid during the first month of the grace period, there would have been no noticeable different in her coverage. If she did so during the next two months of her grace period, although she would not have had her coverage terminated, she would have had it suspended until payment was made and processed. That is what happened in the instant matter. [redacted] made payment at the very end of the three-month grace period; the “red flag” (or suspension as explained in the Plan documents) can only be removed after payment is made and processed. But because she did make payment before the end of the grace period, according to Section 1.8 above, her coverage was only suspended, not terminated.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil MRegulatory Compliance Analyst

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: They are still skirting around the issue of notifying clients that there will be a Red Flag placed on the account, thereby no medications will be available for them,for a week or longer, if they miss payments. Once they put this in place, then the clients will remember to pay their bills on time. And for your information Mr. Neil, I paid my payments on time, I had until the end of the month, which is when I paid them, I also doubled up and paid more than was necessary and it is Mrs.[redacted], not Ms. However there is no need to have a response from them at this time, unless they inform me that they have a notification of sending clients info about a "Red Flag"

Regards,

Review: I called Coventry at the end of October to tell them I wanted to cancel my health insurance policy with them effective Nov. 14. I was to start a new health insurance policy with another company Nov. 15. Since I prepaid for the whole month of November I asked about a refund for half the month. The rep gave me a verbal commitment that if I called before the day I wanted to cancel, any date was fine, that they could cancel my policy mid month and give me a refund for half of the amount of the premium I paid for the whole month. I paid $178.18 for the whole month.

I then bought and paid for a new health insurance policy with another company that started Nov. 15. A few days before Nov. 15 I called Coventry to cancel and get refund and the rep this time said they can not cancel my policy mid month or issue refund. I spoke with a supervisor, [redacted] in Tampa office, who said there was nothing he could do for me, I was given wrong information. He gave me an address and told me to write a letter.

I called corporate office and filed a complaint and was told they would get back to me immediately. This was last week. I can not get in touch with anybody from corporate.

I want my Coventry policy cancelled IMMEDIATELY. I also want a refund of at least half the monthly premium I paid them.Desired Settlement: I want my Coventry policy cancelled IMMEDIATELY. I also want a refund of at least half the monthly premium I paid them.

Business

Response:

November 25, 2013

Dear **. [redacted]:

This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to a complaint submitted by [redacted] Barry [redacted] regarding a request termination of his policy with an effective date of November 15, 2013. This is a North Carolina Plan. This request was received by CHC Carolinas on November 20, 2013.

CHC Carolinas does not have a signed authorization release form from the member indicating that the Revdex.com is representing **. [redacted] in this matter. CHC Carolinas is responding directly to **.[redacted].

Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted], Monday through Friday from 8a.m. until 5 p.m.

Sincerely,

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Review: I am trying to get a refill on my [redacted] birth control, and Coventry is refusing to cover the cost of the prescription, stating that only oral contraceptives are covered. Under the Affordable Care Act, all FDA-approved contraceptives are supposed to be covered under all healthcare plans, without co-pay, co-insurance, or a deductible. After approximately 20 minutes of arguing with a prescriptive services representative and a claims and benefits representative for Coventry via telephone, I still have no coverage for my [redacted], which costs $105.00 per month without coverage. The man informed me that, if I took a pill, I would be covered; however, I have previously tried being on several different brands of "the pill" and became very ill. I am on birth control for medical reasons and experience severe menstrual cramps, nausea, weight loss, and spotting when I am not on the [redacted]. I need this to be covered, and it supposed to be under the new healthcare law. Coventry is breaking the law by refusing to provide adequate coverage to its insured.

Product_Or_Service: Health Insurance

Account_Number: Member No. [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I want my [redacted] covered, and not just for me. Coventry is failing to provide adequate coverage under the law for its insured members by denying them full access to birth control, as required under the ACA.

Consumer

Response:

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

From: Revdex.com of Metro Washington DC <[email protected]>

Date: Tue, Sep 23, 2014 at 10:01 AM

Subject: Fwd: Complaint ID#: [redacted], Business Name: Coventry Health Care Inc

To: [redacted] <[redacted]>

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

From: [redacted] <[redacted]>

Date: Mon, Sep 22, 2014 at 9:01 PM

Subject: Complaint ID#: [redacted], Business Name: Coventry Health Care Inc

To: [email protected]

Good evening,

Review: This company refuses to give me the insurance information for the insurance I am paying for. I ask to speak to supervisors and they are all "too busy" I was told it would be 24 hours till I get my member number. I wait the 24 hours and I get told it will be 24-48 more hours. My effective date was the 1st. They should have a system set up that if they are billing someone they should actually be able to deliver the product paid for.Desired Settlement: I need my member number NOW!

Business

Response:

Dear [redacted]:

Please see the attached letter requesting an extension in this matter.

Thank you,

Business

Response:

Attached please find Coventry Health Care's response to the above-referencec Complaint.

Thank you,

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. I was abr r le to get my member number. After being promised that once I recieved my member number I would be able to review my ID card I came to find that again was not the case. The ID card was not yet available. I suggest they provide all the proper information so people can use their insurance they are paying for. The issue is now resolved though and there is no point arguing over it now.

Regards,

Review: My policy with Coventry One was set up to auto-drafted out of my account once a month at a rate of $59/Month from the months of February to June. I logged on to my bank account last night and noticed a $729 charge coming from Coventry One Health Care that over-drafted my bank account. This charge was unauthorized and unexpected. I called into customer service to see what the issue was and to see if it was possible to have the charge at least partially reversed. They informed me that the reason I was charged so much was because from the months of February to July I was not charged because of a "glitch" in their system. So the system apparently caught up with itself come August and then proceeded to charge me for those months in which my account was not being charged. My policy apparently "renewed itself" in June, (which in their terms means they get to charge me more) to a premium of $184.05. Mind you, when I called last month to check on getting a new plan I was told that my policy had not changed at all. When I asked about changing my policy so that I would not be charged that much money I was treated rudely and told that I could not do so over the phone. Which was extremely inconvenient to someone who does not have the time nor desire to sit down with an agent to discuss health insurance options. Especially when I can pick a short term plan online. So, in summation Coventry One decided to charge me for 6 months of health insurance in one month because of their system error. This is not in my opinion a way in which you do business with someone. I can't even imagine what could have happened had I needed to use such insurance during that time.Desired Settlement: I would really like it if the company would give me at least refund me part of the funds. It does not seem fair that because of their error that I am the one who has to pay for it.

Business

Response:

September 9, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding billing issues for his insurance policy.[redacted]’s complaint states that his policy was set up so that payment was to be drafted monthly in the amount of $59.10 beginning in March 2014. According to [redacted], it wasn’t until August when he discovered a charge of $729 had been drafted out of his account that he realized that the monthly payments had not been deducted and that there was an increase in fees. [redacted] claims that he was unaware of any changes to his policy or increase in fees. Additionally, [redacted] states that he should not be responsible for payments that were not timely drafted from his account.Coventry Health Care regrets that there apparently was a glitch in our system that prevented us from withdrawing [redacted]’s monthly payments. However, [redacted]’s insurance policy was in effect during that entire period and therefore the money was due and owing to Coventry. If at any time [redacted] had desired to use his insurance coverage, there would not have been any problems with him doing so.After investigating [redacted]’s statement that he was unaware of a change in policy, according to our records [redacted] contacted customer service on July 23 to confirm that his plan had changed as of June 1 and that the payments should be $185.05. When [redacted] spoke with a supervisor on August 15 and requested that his policy be terminated as of August 31, 2014, the supervisor accommodated [redacted]. As of that time, [redacted]’s payments for coverage were up to date. Therefore there is no refund due.[redacted] indicated that because of the amount of money that was withdrawn in August, he had over drafted his bank account. If he can send a copy of his bank statement to me showing the overdraft fees, I will be happy to look into the matter of reimbursement of those fees to him.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil MRegulatory Compliance Analyst Coventry Health Care

Review: The company took an extra month's premium out of my account. After 2 months and multiple attempts I have not been refunded yet.

First of all, just getting to talk to a person is a stretch when trying to contact the company. There are many days that I call, wait on hold, and have to disconnect before I even speak to a live person.

I have called at least 10 times in the past 2 months. I applied for a policy for my husband and kids back in November. I thought that the policy was going to begin on December 1st. After waiting the entire month for our insurance cards, I called on Dec. 31 to find out that apparently there was something missing on my application form and so our policy had never been processed. So the employee said she took care of the problem and changed the effective date to Jan. 1 instead of Dec. 1st because I had not been covered throughout December. Then in March, the company took out 3 months of pay with no explanation. When I called and finally got to speak to someone, she explained that they had taken out payment for Dec, Jan, and March. I explained the situation to her and she looked through the notes and realized that I had not had coverage throughout the month of Dec. and that she would put in a request to get that changed. She assured me that I would be issued a refund for the Dec payment. Since then, I have called back 8 times to check on the status of my refund and each time I have spoken to a different representative and have had to start my story from the beginning. Each time they agree that they also see the problem and that the start date is still in the process of being changed. They advised me to continue to call back each week to check on the status. I called this morning and explained the situation to the employee who then put me on hold to review my file (standard procedure.) She then told me that basically they were not going to change the effective date and were also not going to issue me a refund. I asked to speak to someone who could help me take care of this problem...a supervisor. She put me on hold and then said that there were no supervisors available but she could forward my file to a supervisor and they would contact me later. I knew that this would never happen and I was not going to hang up without a solution, so I told her that I needed her to connect me with someone who could help me. She put me on hold, then transferred me to some other department, and of course I got disconnected.Desired Settlement: I would like my payment of $297.01 refunded (Dec. payment.)

Business

Response:

June 11, 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 Katie Boyer regarding a question of the effective date of her policy and the subsequent charge for the month of December.After a review of the situation, we requested approval to update the effective date to December 31, 2014. Once approval was received, the effective date of the policy was updated and a credit of $287.43 (30 days of premium for the pro rate) has been applied.The bill should now show correctly on the member portal.[redacted] cannot have a plan with an effective date of January 1, 2014 because that would require her to be on a new ACA (Affordable Care Act/Obama Care) plan. [redacted]’s current plan is only available to those with an effective date prior to January 1, 2014. To satisfy [redacted]’s needs and also following business rules, we were able to make the member effective December 31, 2013 and issue a refund for 30 days of December instead of a full month (31 days).Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,

Review: 11/11/2013

To Whom It May Concern,

I feel I was wrongfully terminated from Coventry One Health Insurance. I feel the way they went about it was wrong. I am neither solely responsible nor liable for any of the things they implied I did.

In November 20111 talk to agents named [redacted] & [redacted]. All conversations were over the phone (###-###-####) or thru email ([redacted]). They showed me plans thru emails & the agent had Coventry herself and highly recommended them. I told her I had currently had [redacted] yet my husband had just cancelled it in November due we were going to separate and possibly have to do a bankruptcy. I had a HIPAA certificate to provide & prove that I had had coverage. Also stated that I was in a car accident back in 7/2010 and had a case thru a lawyer and the car insurance at the time. So I told her I was worried about that due to no paperwork or medical records as of then yet explained all the issues I have from it and all the treatments and meds I was doing and to let me know if or about pre-existing but wanted to be up front with it all due to getting new insurance & not sure about my case at the time. I never saw any paperwork nor did I get any copies at any time, it was all over the phone. Then a year later when Coventry sent the first letter of dispute I saw my application and medical paperwork for the first time. Not at any time did anyone call to verify, question, or send paperwork to me nor did I ever sign anything!

Well on December 8th I got a letter of acceptance, I called the agent to confirm I had no pre-existing and they stated "NO". When I got the insurance card and letter I called to let Coventry know they misspelled my name and forgot the second * in my last name. So they said no problem and corrected it and sent me a new card with correct spelling. I asked to provide me with copy of my policy and they stated to go to the website and log on and I could get it there, However it was just the basic one never got a personalized one to or for me.

So I still was under the car accident and going to the pain mgmt. and getting my medication most of that year. Well then in June of 2012 had to go to a walk-in clinic for a cold. Then looked up doctors online to see who to go to thru Coventry. I scheduled appointments to get routine physicals done. The primary doctor was to have a 1st time consultation and physical with blood work, Pap smear, etc. Then referred me for a colonoscopy for the 1st time due to my age. Then went to a pain mgmt. to have a consultation. My car accident case would have had to go to trail and I was separated and filing for bankruptcy so I did file the medical bills from the car accident on my bankruptcy and the court trustee took over the case. Coventry denied payments on the visits and appointments I had for some reason or another, I called them to question the reasons for the denied payments and got no real answers. The reasons were unexplained. They stated if I would have had a pre-existing I would have received a letter stating that and for what.

Then on November 21st got a letter from Coventry that plans were changing and to request to keep current plan or pick to an alternate plan option. I kept my current plan with a slight increase for the newDesired Settlement: Unspecified

Business

Response:

December 6, 2013

Dear **. [redacted]:

Please be advised that Coventry Health & Life Insurance Company has received your written correspondence which was received on November 15, 2013.

After looking at your grievance, it was determined that your policy was terminated in accordance with the “Termination of Coverage” section of your Certificate of Coverage. This decision was base on the following events:

According to the letter (enclosed) dated December 17, 2012, a review of the application submitted on December 6, 2011 revealed your medical records contradicted the responses provided at the time the application was completed; therefore Coventry Health & Life Insurance Company intended to rescind your coverage. Before this action was final; the Health Plan granted (31) days from receipt of the notice to accept the rescission of coverage or dispute the findings.

On February 6, 2013, a letter from [redacted], P.A. (designated representative) was received in dispute. In the dispute letter, it was alleged that the agent falsified your enrollment application; in any event of suspected misrepresentation and/or fraud applications are forwarded to our Individual Fraud and Misrepresentation Committee (“IFMC”). The IMFC investigates and evaluates how the applicant would have been underwritten had the medical history been fully disclosed on the application at the time of submission.

After the review by the IFMC, a rerate letter (enclosed) was sent dated February 28, 2013. According to the rerate letter; The Application Review Committee decided to reconsider their decision to rescind your coverage and offered you an opportunity to maintain your policy by accepting the increase in premium retroactive to your effective date, January 1, 2012. Before this action was final; the Health Plan granted (31) days to accept that you failed to disclose material information and agree to the required premium to maintain coverage, which would have required completion of the ACH authorization form or provide us with written notification to terminate your coverage.

In addition, on April 30, 2013 your policy was finally terminated as in accordance with the “Termination of Coverage” section of your Certificate of Coverage (enclosed). Per the termination letter (enclosed) dated May 15, 2013, you would still be responsible for payment of the additional back premium attribute to the months that your CoventryOne agreement was in effect.

If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm or you may reach me directly at ###-###-####. If you are hearing impaired please call 7-1-1 Telecommunications Relay Service.

Sincerely,

Review: This is the second complaint I have had against Coventry One in the past year since I have had them as my provider. I am scheduled for surgery on September 11 for a torn meniscus. I received a letter from [redacted] who is preforming the surgery stating that they are not going to pay for any of the surgery because I haven't met my deductible of $1750.00 for this year. I called Coventry and explained that I disagree with this because I have had several doctors visits some of which are specialist, x-rays, MRIs, ER visits and several medications filled (one of which is over $2000.00 a month) etc.. They then told me that this deductible does not cover ER visits, MRIs, x-rays, prescriptions, preventative care, urgent care etc.. I asked them what the deductible actually does cover then since that doesn't leave much and they could not tell me. They did however, tell me that I have put $62 toward the $1750.00 deductible because of an appointment I had in August with my primary care doctor for my knee. I asked them why this counted towards my deductible and the others didn't and again they could not answer me.Desired Settlement: DesiredSettlementID: Other (requires explanation)

I want my insurance to cover this surgery like they should.

Business

Response:

Coventry Health Care requests an extension of time as we are simultaneously working with the DOI, and a response will be sent to both institutions upon completion of the investigation.

Thank you,

Deborah F[redacted]

Business

Response:

October 17, 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 his questions on what types of services go to his deductible.This member is currently enrolled in a fully insured, non-grandfathered, PPO, individual health insurance plan with Coventry Health Care as of January 1, 2014 through the on-exchange Marketplace.The member's instant complaint is regarding a surgery that was scheduled for September 11 and the current deductible he has met to date. The member believes his deductible should already have been met due to doctor visits, ER visits, laboratory services, and diagnostic services to date for the calendar year.As of September 23, the member has met $62,31 of his $1,750.00 annual, in-network deductible; however, he has already met his 2014 out of pocket maximum.In Coventry Health Care’s response to the Missouri Department of Insurance's inquiry regarding this same member, we attached an Explanations of Benefits and spreadsheet explaining which services applied to the member deductible. We arc not including this information herewith due to HIPAA concerns.This member’s deductible and out of pocket maximum reset each calendar year, and as such, since the member has met his out of pocket maximum for 2014, he will not experience a cost share on any service through December 31, 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 at [redacted], extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil MRegulatory Compliance Analyst

Review: I have made repeated attempts to get a refund of April's premium for a policy that I cancelled in late February. I cannot get the issue resolved!

I contacted the marketplace area of Coventry Health Insurance Company (phone ####-###-####) in order to cancel my policy in late Febuary. At that time I was assured that the cancellation would be processed. I was for premium of $260 for the month of April, even though the company no longer shows me as having coverage. When I contact the "main line" for Coventry (phone ####-###-####) they continue to say that they have not received notice from the marketplace area regarding my cancellation. I have spent more than 4 hours on hold waiting for help and have been transferred over ten times with no resolution. Today I tried to call and after sitting on hold more than an hour I briefly spoke with someone who hung up in an attempt to transfer me to the billing department. I need resolution to this matter and do not feel that Coventry is willing to assist me in my efforts. They just continue to point fingers at the other department in their own company and my request for policy cancellation and refund has still not been fully processed.

My policy number is [redacted].Desired Settlement: I need a refund for the draft that was taken from my checking account for April's premium ($260.00). The policy is no longer active and I should not have been charged.

Business

Response:

October 1, 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 Whitney Michel regarding a refund for payments made after his policy terminated.After research into this matter, it was found that the member made five payments to the policy, each in the amount of $259.09. The effective date of the policy was January 1, 2014, and the effective termination date of the policy was March 31, 2014. Two payments of $259.09 were returned back to the member, one on June 2, 2014, and one on June 11, 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 at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil MRegulatory Compliance Analyst

Review: I received a letter of termination of my health care even though I paid and the checks were cashed. When I called to asked about what's going on the customer service reps act like I'm interrupting their day , I'm placed on hold and then disconnected. I've had to call back several times to talk to someone who won't disconnect me after putting me on hold. Then after I discuss what's going on the response is " I don't know". I've asked to speak to a supervisor and I'm put on hold and disconnected. I call back the supervisor cannot come to the phone so I leave a message and I don't get a call back. This has been going on for 3 weeks now, while I don't have health care. I do finally talk to someone who tells me there's been a mistake made on their part, but they don't know how long it will take to clear it up. I called today, went through being put on hold and spoke to a supervisor who didn't have a clue or care. I cannot get any resolve.Desired Settlement: They need to have customer service training, mangers and reps. It's the worst customer service I think I've ever encountered.

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 [redacted] regarding the termination of her CoventryOne® policy purchased on the Federally Funded Marketplace for an effective date of March 1, 2014 because of non-payment of premiums. 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 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 [redacted], 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:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Review: I purchased a policy for my infant, [redacted], a few months ago. The monthly premium was supposed to be approximately $115.00. I got a letter 2 months into the policy being active that stated his premium was going up to almost $400.00 a month. When I called my agent, [redacted] agency out of [redacted], MO, the agent, [redacted], stated that Coventry "accidently" issued the policy under my social security number instead of [redacted]'s. I asked her to please fix it so I could make sure his policy stayed active. I have had to contact ANOTHER agent now to help me with the issue, and Coventry still has yet to fix his policy and is now saying he can't be added. I am furious that because of Coventry's mistake, my son's policy is going to be getting cancelled. Open enrollment is important, and now we are months outside of open enrollment and my son is going to be without coverage.Desired Settlement: I want all billing to be wiped clean, as result of all the phone calls, e-mails, and missed work I have experienced, and all social security numbers be corrected. I want him to be added to my policy, through the market place, and I want him to have an active insurance policy. He is a child, meaning he goes to the doctor a lot. He can not be without health coverage.

Business

Response:

August 28, 2014Dear [redacted]:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our office on August 27, 2014. We appreciate the opportunity to respond.[redacted], [redacted]’s policy was originally loaded with an incorrect date of birth. When the date of birth was corrected, the premium changed to $174.00, Your request stated that you with the policy termed as never in force. We have put in a refund request for the premium paid on [redacted]’s policy and terminated the policy.[redacted] now has a Marketplace effective 09/01/14 under your plan. We hope you are satisfied with this outcome,We trust this information has addressed the issues raised in this complaint. If we may be of any further assistance, please contact customer service on the back of your card,Respectfully,Brandy HAppeals Department Coventry Health Care

Review: I cancelled insurance in December. They keep trying to take money out of my account causing stop payment fees and overdrafts.

On november 26th we received a letter from CoventryOne that our insurance was going to go from $520 to $1185.85 starting in January and if we did not want it we were to call and cancell. We called 3 times in December and in the first part of January they tried taking $1185.85 out of my checking account. I seen it before the bank approved and told them to not let it go. I had to pay overdrafts of $33 and stop payment of $60. I called them and told them to stop it and cancel that insurance as I told them that in December 2013. The beginning of February my bank called and told me that my account was over by 2200 and some dollars. I asked why and they said that CoventryOne was trying to take out the payment which must have been for January and February. I told them to not let it go through. More fees. Today February 14, 2014 I looked at my bank account and there it was again, trying to go through only this time it was $2300. I called them again and they told me I couldn't cancel it because my husband had to tell them that I could talk to them. I told them that I wanted my $160 back for all the fees that the bank has charged. The lady was rude and she said she would put in a request but could not talk to be because I was talking loud. Never cussed or swore at her at all. I sure could have.Desired Settlement: I expect the fees of $279 refunded for the charges the bank charged me. I told them $160 but figured wrong. Over draft fees of $33 times 3 and stop payment fees of $60 times 3.

Business

Response:

March 10, 2014

Dear **. [redacted]:

Your letter of February 26, 2014 to Coventry Health and Life Insurance Company, Inc. (Coventry) was referred to my attention for review and response.

On December 6, 2013, [redacted]. [redacted] contacted Coventry’s Billing and Enrollment Department to discuss alternative plans. The Customer Service Representative (CSR) advised [redacted]. [redacted] to contact the agent on record.

On January 5, 2014, Coventry attempted to collect the recurring premium payment for insurance coverage via Electronic Funds Transfer (EFT) in the amount of $1,185.80. On January 9, 2014, the [redacted]’s financial institution informed Coventry that the payment could not be drafted from their account. Therefore, on January 10, 2014, Coventry issued a letter to **. [redacted] advising of the returned EFT Draft and advised a $20.00 service fee would be assessed for non-sufficient funds.

On January 22, 2014, [redacted]. [redacted] contacted Coventry’s Billing and Enrollment Department to terminate their policy coverage. The CSR advised [redacted]. [redacted] in order to cancel the policy the primary insured, which is **. [redacted], would need to call Coventry to terminate the policy. Additionally, [redacted]. [redacted] was advised that the policy would be prospectively terminated through the paid date of the current month.

On February 14, 2014, [redacted]. [redacted] contacted Coventry’s Billing and Enrollment. Department to terminate the policy. Additionally, [redacted]. [redacted] advised she contacted Coventry in December 2013 to terminate the policy. The CSR advised only one call was received in December 2013 to discuss alternative policies. The CSR advised she would submit a request for a refund for both the January and February premium and to have the policy retroactively terminated as an exception.

According to business rules only a primary member can request to terminate a policy. Coventry did not receive a written request or a phone call from **. [redacted] requesting to terminate the policy. Additionally, Coventry did not receive a phone call from [redacted]. [redacted] requesting to terminate the policy until January 22, 2014. During this call [redacted]. [redacted] was advised **. [redacted] would have to submit the request. Based on the details of this case, there was no error on Coventry’s part as the primary member never requested to terminate the policy. Therefore, Coventry will not refund the [redacted] $279.00 for the charges the bank assessed for over draft fees and stop payment fees.

If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].

Sincerely,

Review: I've called several times to cancel my policy. Each time I'm told its done, but they never actually cancel my policy.

On Nov.5th 2014 I called to cancel my policy. I was told to fax a copy of my other insurance to them. I was told I would be pro-rated for October and reimbursed for Nov. The transaction would take 7-10 business days. Those days pass I called twice on Nov 20th. The first call I was told that they cannot locate my account using my member id. I called back later I was told my policy was still active and had not been canceled. I was told they were having technical problems and could not view the fax I sent in. I was told my policy was again canceled and I would see my refund in 7-10 business days. I asked for a confirmation email which I have still not received. I called back Dec 1st. my account still has not been canceled and no refund has been issued. Missy S[redacted] from advanced solutions dept. was suppose to contact me within 24-48 hours. The last call I placed was on Dec 3rd after I did not receive a call, but I received an email that stated I needed to send in a request in writing. This time I spoke with a supervisor Named Eva H. she then cancels my policy and tells me my refund will be in 7-10 business days. She also informed me that I will not be reimbursed for October and she doesn't know who told me that. I told Eva It was on Nov 5th the first time I called. Those calls are recorded. Therefore they can bring up that conversation. I told Eva the problems I have encountered with their company. Eva began to short and brief with me explaining to me her company isn't at fault for anything and that I will see my Nov refund in 7-10 business days. When I asked for her supervisor or manager she told me that she could not provide me with that information nor could she transfer me to them. When asked for a direct number or email, she said that she could also not provide that information either. All of this is being recorded mind you.Tomorrow will be a full month since I have started contacting this company and was promised a refund which I still have yet to receive.Desired Settlement: I would like an apology from this company for the incompetence of its employees and for the time that I have spent on the phone with them. I would like to get what I was promised from the call that took place on Nov 5th at 1:36 pm. I now believe that I should be reimbursed for the full month of Oct and Nov due to lack of customer service this company provided me with. Something that was suppose to take 7-10 business days has taken over 21 business days to complete, due to their employees.

Business

Response:

Dear

Review: On 12/9/13, I faxed Coventry One's official policy cancellation form to their billing department as I have obtained health insurance elsewhere from 1/1/14. I also sent an email through my Coventry member portal on 12/20/13 attaching the completed and signed cancellation form and asking them to confirm receipt. I heard nothing and now on 1/9/14, Coventry One has debited my account for 2 months premium totaling $1,169.82. I have tried calling them on numerous occasions only to be kept on hold for hours. As I write this, I am on hold and have been for 30.15 minutes! It is impossible to reach anyone to get my money back. This company is being very unethical.Desired Settlement: I simply want my money back for services I do not want and which I canceled in a timely fashion, and I would like a letter from Coventry apologizing for the financial mess this has caused me and confirming that they have removed my bank details from their system. Thank you.

Business

Response:

January 24, 2014

Dear **. [redacted]:

This letter is in response to your request for Coventry Health and Life Insurance Company to respond to a complaint submitted by [redacted] regarding his policy termination and premiums. This is a West Virginia Plan.

We do not have a signed authorization release form from the member indicating that the Revdex.com is representing **. [redacted] in this matter. We will be responding directly to **. [redacted].

Sincerely,

Review: Coventry One has overcharged me since 12/13 and despite 14 phone calls and 3 e-mails from me over the past 6 months, failed to correct the issue.

In a letter dated October 24, 2013, I received a renewal notice via US Postal Service Mail from Coventry One stating that, effect December 1, 2013, the premium for my health insurance policy would change. In that letter, I was made aware of two key pieces of information:

1. the total monthly premium for my current plan would be $245.11, and

2. no further action was needed if I wanted to retain my current plan

I agreed to the premium reflected in that document and so took no action. On December 6, 2013 (and each subsequent month until present), $395.11 - or, $150 more than the premium stated in their written letter from October 24, 2013 - was deducted from my bank account by Coventry One. I first contacted Coventry One by phone on December 6th regarding the issue (Case # [redacted] regarding overcharges to be credited to my bank account and adjustment of my monthly premium). In total, I have contacted this company 14 times by phone and 3 times by e-mail. My most recent email message was in response to a message from [redacted], Account Resolution Specialist, which stated that, despite assurances (during a phone conversation on the morning of May 16, 2014) from Customer Service Representative [redacted] ''[redacted]'' [redacted] that the issue would be resolved in its entirety no later than May 27, 2014, she had to send yet another request to the correct department requesting the premium change, that it would take ''several days'' to correct, and that she would keep me updated.

My response to **. [redacted], dated May 21, 2014, stated that:

1. I had received her message

2. I expected this issue would be resolved in its entirety by May 28, 2014 and,

3. I would file a formal complaint with the Revdex.com and Missouri Department of Insurance if it was not resolved in its entirety

As of May 6, 2014, I have been overcharged $900.00 by Coventry One. Despite the approximately 8 hours that I have spent on hold/on the phone with multiple Customer Service Representatives and my three e-mails since December 2013, this issue has not been resolved. As of today's date, May 29, 2014, I have not heard from **. [redacted] or any Customer Service Representative following my message from May 21, 2014.Desired Settlement: I am filing this formal complaint in order to request that the Revdex.com assist me (since my individual efforts have been unsuccessful) in having Coventry One refund the amount due to me by check or direct deposit immediately.

Business

Response:

July 2, 2014Dear [redacted]:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint received by Coventry Health Care on June 24, 2014 which was filed by [redacted] regarding overcharges to his account.A review of our records shows **. [redacted]’s overcharges were a result of an incorrect renewal rate being entered into the system. That error was found and corrected. Thereafter, on June 6, 2014 (prior to Coventry Health Care’s receipt of the instant complaint), three EFT transfers were deposited to **. [redacted]’s account in the amounts of $395.11, $395.11 and $109.78, for a total of $900. This should resolve all of the outstanding overcharges.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [email protected] truly yours,