Coventry Health Care, Inc.

Review: Coventry one is taking money out of my checking acct unauthorized,also says I owe for a month I have already paid for.Coventry One

Coventry one health care is taking monies out of my acct UNATHORIZED! Due to them doing this I recevied a None Sufficecnt Funds charge on my checking account. Coventry one also charged ME 20.00 due to this NSF fee. Also they say they did not receive my payment, I have bank account statements proving they took it out of checking acct at [redacted] AND out of my checking acct at [redacted]. I paid my health care premium over the phone , through the automated system. When I did this, I heard a recording saying " your account is invalid" thinking maybe I did smohting wrong I tried again, I got the same response. So I used my other account. I got the same recording. At that point I called coventry one to discuss the situation , they assured me my payment went through , only one time and that my account was up to date. I have got two bills since this date ( aprox. 4/15/14) saying my account is over due. I called and spoke to a represenative and the PROMISED me that she would have a manager call me back, that never happened. A few days later I called coventy again and explained to the rep what happened, she asked if I would fax her a copy of my bank statement I said absolulty not due to the fact that I do not trust them and they have already went into my acct without my knowledge. SHe put me on hold, talked to her manger and told me " she will apply my NSF(32.00) to next months premium, and assured me that she would have the 20.00 that coventty charged me taken off. " I also asked for her to send me a letter promising me that they would not go into either one of my accounts, she again m assured me she would send that. I have not received a letter. Today , 5/19/14 , a month later this issue is still not resolved. Today I was told I will have to pay the 20.00 returned check fee from Coventry and that a manger would call me back. I informed her to please notate my account saying I am reporting them . She did not give me a confirmation number, MY member # for coventry is # [redacted].I would like this resolved .. I would like my 32.oo NSF fee returned to me ( or applied to my acct AS PROMISED ) , I would also like the 20.00 fee reversed on my account, I would also like the payment I made to actually be applied to my account. I call coventry one and I get absolutly NO help, its very frustrating, all they say is " A manager will call you , " and they do not.Desired Settlement: I want my 32.00 NSF fee refuned to me OR applied to my coventry one health care premium as THEY promised me . I would also like the 20.00 fee coventry one charged me for going into my account (without my permission )and taking monies out when I did not have money in there. Lastly I would like the payment I made to be applied to my account!

Business

Response:

May 29, 2014Dear [redacted]:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our office on May 20, 2014. 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 [redacted] in this matter. Therefore, Coventry is responding directly to [redacted],We trust this adequately responds to your inquiry.Sincerely,

Review: For over ten years , I have had the same health insurance and I have been seeing an Endocrinologist for years. Recently, I was not getting satisfactory results from a medicine i' ve been on for a decade so my Doctor switched me to a new product and my tests improved. I filled the original script, refilled it once, and went back for a second refill and it was denied. The insurance Comp now require a pre authorization and my Doctor did and it was denied saying "medical necessity not met" and the Health Assurance Doctor included " in this case there is no documentation from the medicine of intolerable side effects or failure to achieve satisfactory effect" from the medicine was on and that I no benefited from using.

So my doctor applied for authorization for the script I was on for ten years and authorization was denied again by " not meeting medical necessity". My Endocrinologist sent all my test results and a personal letter pleading my case and I was still denied treatment. Finally, my Doctor suggested I take a test mentioned by the insurance that would qualify me for treatment if the results came back from the lab showing I was low. I am being billed $ 500. now for a test that the results showed I now "meet the medical necessity for" but they still denied treatment still. Add the fact the new medicine is over $300 cheaper per month.Desired Settlement: I want Health Assurance to approve the new medicine ( [redacted] ) with no further issues and pay the $ 500, for the test that they won't honor that proves my "Medical Necessity".

Business

Response:

May 2, 2014**. [redacted]:The Member is participating in a non-grandfathered self-insured PPO health benefit plan through his employer, City of [redacted] and administered in part by HealthAmerica Pennsylvania, Inc.The Member’s complaint concerns the denial of medication [redacted] and the deductible applied to laboratory services rendered on February 1, 2014 with [redacted] Medical Center.Upon review, the member had laboratory services rendered on February 1, 2014 with [redacted] Medical Center. On February 14, 2014 the claim was received by the Health Plan with primary Diagnosis Code [redacted]. The claim was processed according to the member’s benefit plan applying $497.81 toward the member’s deductible. The member has a $2500 annual deductible that must be satisfied before the Health Plan begins to pay. In a request received On March 11, 2014, the member filed an internal first level appeal with his plan. The 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, 2014 with [redacted] Medical Center. I have attached the appeal denial letter that was mailed to the member on April 7, 2014.On February 10, 2014 the member’s provider requested authorization for [redacted] medication. The request was reviewed by a HealthAmerica Medical Director and denied, 3001: Medical Necessity Criteria Not Met. I have attached the denial letter sent to **. [redacted] on February 11, 2014. Please note that the member has not utilized his internal first level appeal available to him in regards to the denial of the [redacted] medication.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

Review: After browsing through the new Healthcare Marketplace, I looked at a plan offered by Coventry Health Care. I did NOT sign up for the plan at this time, I did not even finish my application, I believe I canceled the application on December 30th, 2013. My credit card was billed by Coventry for 241.07 on January 1st, which is surprising as this wasn't even the cost of the plans being offered that I had looked at. When I contacted Coventry about this they at first were not able to even find me in their system, however, after transferring me to another customer support number within Coventry they DID find me and my plan (using my SSN, DOB, full name and address), though they stated that they were unable to offer a refund or cancel the plan as it was purchased through the Healthcare Marketplace. I contacted the Healthcare Marketplace and they confirmed that I was correct, that I had never even finished my application through the Marketplace, they were showing me as still having an application in progress. I was given no policy number, no description of what kind of coverage I allegedly signed up for, just charged for $241.07 by "COVENTRY HEALTH CARE INC" and then given the run around when I contacted customer support.Desired Settlement: I need to have this matter resolved, as I simply can't afford a plan which costs $241.07 and offers I don't even know what kind of coverage. I would like to cancel whatever plan I seem to have inadvertently signed up for and need a refund of the charge against my credit card.

Business

Response:

January 7, 2014

Dear **. [redacted]:

This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to a complaint submitted by [redacted] regarding an unauthorized bank draft submitted to his account by CHC Carolinas. The request was received by CHC Carolinas on January 7, 2014.

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

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

Sincerely,

Review: Account # [redacted]To: Revdex.comFrom: [redacted]. [redacted]Subject: cancelation of policy above.As written in the letter above, I was told I could not cancel my account because I did not do it before the 8th of Dec. 2013. At that time I had no idea of the amount they intended to raise the account. I was not notified of the raise until I recieved my payment booklet on 12/23/13. Do not believe this to be a ethical or legal manuever. I am refusing to pay.Thank you, [redacted]. [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

Consumer desires to cancel insurance. "I am refusing to pay."

Business

Response:

February 20, 2014Dear [redacted]:This letter is in response to your written inquiry received February 20, 2014. In that correspondence you asked about the following:Member, [redacted], contacted the Revdex.com regarding his concern over the 2014 premium for his First Health Part D (PDP) Plan and wants to dis-enroll due to not being notified.We will contact **. [redacted] separately via a letter to address his concerns regarding the premium change.Please note the resolution that will be provided to **. [redacted] has not been included in this letter in an effort to keep our member’s personal and health information confidential.We appreciate you contacting us, and trust the additional information that we have provided satisfactorily addresses your inquiry. Your inquiry provides us with valuable insight as we continuously seek opportunities to improve our member communication materials.Should you have any further questions, please contact Customer Service at ###-###-####, 24 hours a day, seven days a week your local time. TTY/TDD users please call 711 Telecommunications Relay Services.Sincerely,

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Please see attached handwritten response.

Regards,

[redacted]. [redacted]

Review: I haven't been able to reach Coventry Health. One of their options on the automatic phone service sends me to Healthcare.org customer service. I've called 15 times and I have waited up to 2 hours.

I called last month to change my billing address, which wasn't changed. I emailed a complaint on their website and didn't get a response. I just received a notice saying I haven't paid two months' coverage, which I don't believe is true.Desired Settlement: I simply want them to change my address and explain what months I'm supposed to be paying for so far.

Business

Response:

August 20, 2014Coventry Health Care responded directly to the member on May 15, 2014, regarding the abovereferenced Complaint. To date, [redacted] has not rejected our response nor has she recontacted the Revdex.com, so we request that this matter be closed.Thank you.

Review: I signed up for healthcare through the Healthcare Marketplace before the December deadline, in time for coverage to begin in January. I was approved for subsidized coverage for me and my wife, and the application was submitted to Coventry One. I received a card from CoventryOne, but my wife did not. I called Coventry to resolve this issue in January, and they blamed the Healthcare marketplace. I called the Healthcare marketplace several times, but they assured me that the paperwork is correct on their end. When I got the bill from Coventry, I notice that the premium for my Silver Carelink plan is the total that was quoted for both my wife and I. I called Coventry again in March and was promised that someone would get back with me, but never heard back. At the beginning of April I called again and the representative said that Coventry did receive the information from the Healthcare marketplace and promised to expedite this, that her information should be in the system with her card online within 48 hours. Over 2 weeks later and still nothing online. Today I called twice. Waited on hold twice using LucyPhone for about an hour EACH TIME and Coventry hung up both times. Right now I have to call before I can even see the doctor, as Coventry has screwed up my Primary Care Provider. I'm a guy but was initially assigned to a gynecologist as my PCP. No problem, I requested it to be changed, and it was, once I figured out how. Then two weeks after I changed it they sent me a new card, changing it again to someone else whom I never requested. The physician I initially requested is still in the system. But they refuse to take my calls today to fix the PCP issue and follow up on my wife's issue. They have been overcharging for insurance for two people since January 1, and only providing insurance for one. I have not even been able to take advantage of the insurance for myself due to the constant issues with the PCP. So I might as well have no insurance.Desired Settlement: refund for service not provided since 1/1/14. Provide service for my wife as requested and paid for starting now. Fix primary care physician back to who I originally requested. Provide executive customer service support # for future issues, which I expect will be plentiful.

Business

Response:

May 2, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted] request to refund his premiums and Primary Care Physician assignment.Please be advised that after review of this grievance, we have confirmed [redacted]’ policy is effective as of January 1, 2014. [redacted]’ plan requires Primary Care Physician (PCP) assignment. He was initially assigned to Dr. [redacted]. On April 23, 2014, the Health Plan contacted [redacted] to inquire the name of his preferred PCP. [redacted] informed the Health Plan he prefers Dr. [redacted]. As of April 23, 2014, [redacted] has been reassigned. A new ID card has been requested. [redacted] should allow 7-10 business toreceive his new card.[redacted] also applied for a policy with his wife on December 20, 2013. The policy took effect January 1, 2014, but [redacted] was not added to the policy in a timely manner, [redacted]’ policy is effective as April 1, 2014. [redacted] was also automatically assigned to a PCP. If [redacted] prefers to another primary care physician; she should call our Customer Service Department and update the PCP. For PCP changes also visit our website at www.coventryone.com and Select “Find a Doctor”.In regards to [redacted]’ refund request; the request has been forwarded to our Recon Department. Based on the information that was received; the Health Plan will continue to conduct an investigation into [redacted]’ request. Our goal is to resolve your concern in a fair and timely manner, [redacted] will be notified upon completion of the investigation.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,Yanique M[redacted] Complaint and Appeal Analyst Grievance & Appeals Dept.

Consumer

Response:

I am rejecting this response because:

Nature of Review:

Customer Service Issues - Customer service failed to provide assistance

Problem:

I filed complaint #[redacted] previously, but the company failed to resolve the issue as promised, and has in the process created more issues that they refuse to resolve. First, calling customer services is unreliable. Representatives hang up on me when I use LucyPhone software to wait on hold for me, and this is unacceptably poor customer service. This was mentioned in the previous complaint and nothing was done to address it. The previous complaint was that my wife was not in the system, and ultimately she had no insurance card since January 1. Now (months after the previous complaint was filed, and after I have repeatedly called customer service since then) she is apparently in the system, but she has yet to receive an insurance card. Also, in the process of selecting a doctor for my wife [redacted], Coventry changed my Primary Care Provider. In setting up an online account, I noticed that they had an incorrect address for my wife [redacted]. Although we are on the same account, my address is correct but hers is not. The site said to call the Healthcare Marketplace to change it, but the Marketplace assured me that they had the correct address because it was submitted with mine. I called Coventry then, and they initially refused to change her address. Finally they promised they would, along with changing the doctor. Two weeks later I called back because neither had been changed, and it turned out they changed my doctor to the one I had requested my wife's be changed to. I again requested that the address be corrected and explained who our doctors needed to be. They changed my wife's doctor finally, to the one I requested, but they still have not changed mine back to correct their mistake, and they still have not changed her address in the system. At this point calling them again seems pointless because they agree to do what I request but fail to do it. Also, the previous complaint requested a refund for [redacted] since she was not put on the insurance as of January 1. Coventry promised that they would look into this, but I have heard nothing about it. This is a subsidized insurance plan under the ACA, but my income is going up this year and I may lose the subsidy. If that occurs, I do not wish to have to reimburse the government on my taxes for months of healthcare which my wife DID NOT RECEIVE. I expect a refund for the difference in cost between two people having insurance (what was paid to them) and one person having insurance (the service I received), from January 1 to July 1, 2014. While the account was paid by the ACA, this refund should be sent directly to me as I will have to repay it on my 2014 tax return.

Desired Outcome:

I want my doctor set to [redacted] as I had previously requested (3 times now!), and I want my wife's address set to the same as mine, [redacted] as I have requested twice now. I am also reiterating my request for the refund for [redacted]'s portion of the premium, to apply from 1/1 to 7/1/14.

Regards,

Consumer

Response:

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

Review: [redacted]

I am rejecting this response because:

Review: One cannot reach a customer service representative in a timely fashion - or sometimes not at all.

I have tried multiple times to reach customer service when I cannot solve my problem on the web site. Telephone customer support is virtually non-existant.Desired Settlement: Either they need to get adequate customer support or I wish to change my insurance company

Business

Response:

June 10, 2014Dear [redacted]:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted]r regarding issues with CHC Carolinas’ registration website. The request was received by CHC Carolinas on May 30, 2014.CHC Carolinas does not have a signed authorization release form from [redacted]r indicating that the Revdex.com is representing him in this matter. However, CHC Carolinas responded directly to [redacted] regarding his complaint in writing on June 10, 2014.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,

Review: Since starting with Coventry Health Care in March, Coventry has messed up EVERY SINGLE thing with my healthcare policy.

On March 18th, I applied for health insurance using the healthcare.gov website. I was told to wait about a week to call Coventry with my payment and to get any answers to questions about the policy I signed up for. I called Coventry over TEN times because they had not received any of my information. My policy was set to start May 1st. After several calls between the marketplace and Coventry, on April 24th, they FINALLY received my information. I went to make my payment and wait once again for Coventry to accept the payment and generate my account so that I could get answers about my policy I signed up for. Everything was fine after that. I went to the doctor, picked up a prescription, and everything was fine. UNTIL I went to make a payment for my July bill. I logged into my account on June 27th. My balance was TWICE what it should be. When I called Coventry to inquire as to why my account was showing a past due amount and why it said I owed TWICE what my monthly premium should be, they told me it was because they "forgot" to charge me for April. I told them that I did not have a policy with them in April. My policy start date was May 1st. The representative went on to tell me that the records show that I owe for the month of April because that is the start date they have. I continued to tell the person that I did not have a policy in April. The representative then told me he was "transferring" me to a "specialist". The representative transferred me to the marketplace. So I proceed to tell my story ALL OVER AGAIN, and the marketplace representative tells me that their records show that my policy did in fact start on MAY 1ST! So that representative "escalated" the proper information to Coventry to fix my policy start date. They said it would take 30 days. So I waited, and I waited. I called Coventry on JULY 25th to see if any progress had been made. At this point, I was trying to fill a prescription that I should not miss a single dose of. The pharmacy THAT I WORK AT, called Coventry to find out way my prescription was "rejecting" in our system. They told my pharmacist that it was because I was "past due" on my payment. I was NOT past due. I made my first payment on May 2nd for the month of may. I made my June payment on June 3rd, and I waited until July 14th to make my July payment because Coventry wanted me to pay for April even though my account was screwed up. So on July 31th (after the 30 day mark) I called Coventry to find out why my prescription still was not processing. They told me that they were processing information about the policy change and in order for me to get my prescription that day I would have to pay full cash price ($120) for the medication and they would "reimburse" me at a later date. If I had $120 to just throw around, I would have payed the extra premium and hoped to get reimbursed for that. Here it is AUGUST 1st, I have yet to get my medication I'm supposed to be taking every single day. I can not get my medication because COVENTRY ONE says I am still past due on my account. As I am writing this, I am ON HOLD with this stupid insurance trying to get any type of response from them as to why my account shows a May 1st start date now but they will not pull the past due amount off the account so I can get my prescription. I am so over all the bull crap I have had to go through with this company. I am not stupid, I know what my benefits are, I know when I make payments, and I know when a HEALTH INSURANCE COMPANY is refusing to help a PATIENT receive the services they PAY FOR. And I have yet to receive any type of resolution to my issue. I just keep getting told that I need to wait for more escalation processes to complete because that is the way Coventry does things. I am having to pay for Coventry's mistake.Desired Settlement: In all honesty, I want to move to Florida [redacted] because I believe it is unlawful to withhold any type of medical treatment INCLUDING medication due to Coventry screwing this up. Unfortunately I have been told I can not switch to [redacted] unless I have a special circumstance like marrying or divorcing. All because of the way the healthcare is set up now.

Business

Response:

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

Thank you,

Deborah F[redacted]

Business

Response:

November 17, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s premium issue. Please find below the requested information.Our records indicate that [redacted] was unable to fill her prescriptions because her policy was reflecting as past due in the Express Scripts system. Currently, [redacted] is reflecting as paid through December 31, 2014, in the Billing and Enrollment Department. The Grace Period flag was placed on [redacted]’s policy because the November premium was not received on time. On November 14, 2014, an expedited Urgent Care request was submitted to Home Office to have the flag removed and reflecting the correct paid through date in all other systems. The flag removal process can take 24-48 hours. Once the flag is removed, [redacted] will be able to fill her prescriptions.Below is a call history in chronological order which took place between [redacted] and Coventry.Call History:May 2, 2014: [redacted] called to make a payment. The representative assisted her through the process and provided a confirmation number.June 27, 204: [redacted] called stating that her plan was supposed to become effective May 1, 2014.July 25, 2014: [redacted] called because the effective date of her policy is reflecting as April 1, 2014, when it should be May 1, 2014. The representative conferenced the Marketplace and the Marketplace confirmed that the effective date should be May 1, 2014. The representative submitted the request for review. July 31, 2014: [redacted] called to inquire about the status of her effective date. The representative advised the request was submitted on July 25, 2014, and to allow 3-5 business days for the Reconciliation team to review.August 1, 2014: [redacted] called regarding the red flag on her policy. The representative advised the flag was placed due to a payment for April not being received. [redacted] advised that she should not have the flag placed because she changed her effective date to May 1, 2014, and should not have a past due balance. The representative submitted a request to have the flag removed from the policy.August 4, 2014: [redacted] called regarding the red flag removal. The representative advised the flag was removed on August 4, 2014.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.Sincerely,

Tracy TComplaint and Appeal Analyst

Review: We have SSD our current PPO company had done away with a lot of the doctors.On December 6 2013 At about 2:30Pm I called via telephone to enroll my husband and myselfin their HMO that has no premium and $5 dr Co pay $30 for specialist ect etc.Yesterday I called to checked the status of our enrollment.. I was Shocked then they said they had no record of us enrolling. [redacted].. I was on the phone to them for almost a hour on 12/6I asked how do they plan to correct this matter and she said the enrollment is closed..as of 12/7/2013. Unless you get extra help. bUT THEY WOULD TELL US HOW TO...Bottom line is they knew we had [redacted] this year.. I know that as a Cancer patient andcardiac patient I do use see a lot of doctors. My husband has problems with chronic earinfections, bad back and knee high Blood Preasure. I THINK THAT THEY CHECK WITH [redacted] AND CHOSE NOT TO HAVE US... THIS IS ILLEGEAL UNDER THENEW AFFORDABLE HEALTH LAW.. I AM READY TO GO TO THE NEWS MEDIA AND I AM SURE THIS WILL BE PICKED UP BY THE NATIONALNEWS...Desired Settlement: ENROLLMENT IN THIS PLAN BY jANUARY AND MY ID CARDS IN HAND... NOTHING LESSTHEY BROKE FEDERAL LAWS

Business

Response:

Coventry Health Care, Inc., respectively requests an extension in order to file a response to this Complaint.

Thank you,

Business

Response:

January 3, 2014

Dear **. & [redacted]. [redacted]:

Health America, Advantra has received your Health Care Complaint dated December 20, 2013.

Health America, Advantra, of Coventry Health Care, Inc. ("Coventry”), received the above captioned complaint for review and response. Health America, Advantra is a Medicare Advantage plan through a contract with the Centers for Medicare and Medicaid Services ("CMS”).

Upon review of the complaint, we completed a thorough review of our enrollment phone records and find no calls from [redacted], [redacted] or [redacted] in our records during the time period of December 4, 2013 through January 3, 2014.

As you may be aware, the open enrollment season for Medicare is between October 15, 2013 and December 7, 2013. As such, we are not permitted to enroll you into our plan at this time.

We apologize for any inconvenience this may have caused you. You are welcome to enroll during the October 15, 2014 through December 7, 2014 enrollment period to be effective January 1, 2015 unless you qualify for a special enrollment period through Medicare.

We appreciate you contacting us, and trust the additional information that we have provided satisfactorily addresses your inquiry.

Should you have any further questions please contact [redacted], Manager Appeal and Grievance Department, at ###-###-####.

Sincerely,

Review: CHC has at its discretion and without consult with my doctor, or wifes doctor denied medication that we have been successfully used for years.

I am a long term type 2 diabetic who has taken a medicine for the last 5 years for successful treatment. Coventry is now denying me the use fo the meds without consult of doctor or knowing my history. the alternative is pill which is not as effective. the medicine I take is [redacted], of which I have been taking for the last 5 years and has my diabetes under control.

they are doing the same thing with my wife, who has been taken and eye drop to lower her eye pressure. she has been taking this medicine for the last 7 years. she has had two surgeries related to her eyes,of which her specialists recommended the eye drop--[redacted]. Now coventry wants to deny the prescription and provide an alternative that has severe side effects, including loss of vision, high blood pressure and more.

this change in medication is being done without consult with doctors, or knowing the entire history of my wife or myself.

Prior to coventry, my wife and I were covered by [redacted] and did not have any issues. on April 1 of this year my company switch insurance to cofentry.

again, I have been taking [redacted] for the treatment of Diabetes for the last 5 years with much success, and my wife [redacted], has been taking [redacted] for 7 years and now Coventry is denying the use fo [redacted] and wants an alternative. the alternative for both of us is of lesser quality with side effects that can have long term severe effects. for me that could be complications from diabetes, such as stroke, heart attack or death.

For my wife, it could be blindness.

The following is my member number and group number of Coventry Health Care of Nebraska

Group # [redacted]

member number [redacted] ([redacted].

Group Name: [redacted].

customer service number ###-###-####Desired Settlement: the settlement I am seeking is for Coventry to authorize the continue use of the following two medicines. [redacted] for the treatment of my diabetes. I am bill stack.

for my wife the authorization to continue the use of [redacted], versus a lesser eye drop. my wifes name is [redacted].

Business

Response:

October 2, 2014Dear [redacted]:Your letter of September 24, 2014 to Coventry Health Care of Nebraska, Inc. (Coventry) was received in our office, and referred to my attention for review and response. **. and [redacted] are on Qualified High Deductible Health Plan Preferred Provider Organization (QHDHP PPO) policy with an April 1, 2014 effective date through [redacted]’s employer.In his complaint to the Revdex.com, [redacted] expressed concern with the request to switch his prescription medication, [redacted]. [redacted] also expressed concern that [redacted] would have to switch her prescription eye drops, [redacted].Policy LanguageSection 2: Benefit Information2.1 The following rules apply to Prescription Orders and Refills:2.7 Prior Authorization Requirements Regardless of where a Prescription Order or Refill is filled, some drugs require Prior Authorization or Step Therapy in order for them to be Covered. These include, but are not limited to, medications that require special medical tests before use, that are not recommended as a first-line treatment, or that have a potential misuse or abuse. Prescription Drugs requiring Prior Authorization are identified within the Formulary with “PA" next to the name of the drug. Prescription Drugs requiring Step Therapy are identified within the Formulary with "ST" next to the name of the drug.Section 5: Definitions5.19 Prior Authorization A process where the Health Plan or its designee determines, prior to dispensing, that a Prescription Order or Refill, otherwise Covered under this Rider, has been reviewed and, based upon information provided by the Prescribing Provider, the Prescription Order or Refill satisfies the requirements for Coverage. Please see 2.7 of the Benefit Information Section for more information.5.23 Step Therapy Step Therapy is an automated form of Prior Authorization based on previous pharmaceutical treatment where a trial of an alternative medication is required prior to Coverage. Please see 2.7 of the Benefit Information Section for more information.[redacted]’s provider submitted a pre-authorization request to Coventry for prescription medication [redacted] on July 17, 2014. Coventry approved the request effective July 17, 2014 to July 17, 2017. [redacted] and his provider were notified of the approval on July 17, 2014.**s. Stack’s pre-authorization request for [redacted] was denied due to Step Therapy requirements for the medication. Step Therapy requires [redacted] to try two therapeutically equivalent prescription eye drops, Xalatan (latanoprost) and Travatan Z (travoprost). Once complete, **s. Stack’s provider can submit to Coventry a request for prior authorization indicating [redacted] tried and failed the two therapy agents listed above. If prior authorization is not requested, but [redacted] meets the step therapy pre- requisites, the claim submission for [redacted] will process systematically and no other action will be required by [redacted] or her provider.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 understand how pre authorization works and the entire process. In this case my company had switch insurance carriers from [redacted] to coventry. I, as well as my wife, had already gone thru the entire per authorization process with the previous insurance company and have been on the medications for years prior to coventry.

Review: For two months I have been trying to resolve Coventry's mistake around my billing. I registered on the ACA online market place in December. My premium has been paid. Coventry has even verified having a record of that payment to the social services person who has bee assisting me through this nightmare. Today is March 27 and I still have no coverage. I have spent literally hours on the phone, trying multiple lines, trying to resolve this issue. Most often, I get continuously re-directed in circles in their automated answering system and ultimately get hung up on. On the rare occasion someone answers, they have no idea how to help me and end up sending me back into the automated answering loop. I did finally speak to someone over a week ago and made a complaint. I was assured my case had been expedited and that someone of some one of higher authority would call me in 24-48 hours to resolve the issue. No one ever did. I have tried multiple times to reach them again in the last week, with no success. I cannot even leave a message or send an email. Their site even has a "Contact Us" section, but no listings of who to contact, nor any email address, yet requires one be provided. Since 1/1/2014, I have been turned away from doctor for not being covered and have had to pay for my meds out of pocket.

Product_Or_Service: Coventry Gold Plan insuranceDesired Settlement: DesiredSettlementID: Refund

I want to be reimbursed for the money I've had to pay out of pocket. ($200)

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 billing issues and termination of his insurance policy.This matter has been investigated. [redacted]’s application for the policy was received from the Marketplace on December 29, 2013 with an effective date of January 1, 2014. However, his initial binder payment was received after the February 10, 2014 deadline for policies effective January 1, 2014. [redacted]’s binder payment was not received until February 25, 2014. Because the binder payment was not paid by the deadline, the policy was cancelled and was not eligible for reinstatement. However, after speaking with [redacted], his policy was reinstated by a supervisor on March 29, 2014 with the same effective date of January 1, 2014, and [redacted]’s payment posted to the policy on March 31, 2014. [redacted] paid subsequent premiums on April 4 and April 24, each in the amount of $318.90. However, no payments were received after April 24, 2014. Therefore, [redacted]’s policy terminated on July 9, 2014 with an effective termination date of May 31, 2014. The policy terminated with a reason of non-payment of the premium.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: My insurance premium went up over 33% in one year, no reason, and every month statement it will go down

This is unbelievable : as a senior citizen, I already believe we were protected with age, but this company, without reason, has raised premium from $600 to $800 a month, or over 33%, with no medical claims or reason whatsoever. My contract renewed mid this year, and previously they asked me in last December to change contract to more expensive one because of Obamacare. I wanted to stay on current plan, why should I pay more when contract still had 6 months to go ? After that period, I received NO explanation, NOTHING, but every month, a stupid letter stating that premium will be $800.81, and will be regular scheduled amount next month. And yes, the next month, same deal... This is illegal, should be stripped of their license to sell health insurance !!Desired Settlement: This is the WORST service ever !

I would not treat my dog like this, and the system allows this really ? Someone should look at this, and file complaints all over this company! Imagine what they would do if we would have health problems? Raising 330 or 3300 per cent ? They do not care, do you ?

Business

Response:

October 10, 2014Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s complaint.After review of this complaint, the Health Plan has confirmed that [redacted] is not currently enrolled with the Health Plan’s PREM 25/$7500 PPO effective June 1, 2011 to May 31, 2014. [redacted] is currently enrolled with the Health Plan’s BRONZE $10 HMO PD PLAN effective June 1, 2014.On September 11, 2013, the Health Plan sent [redacted] a letter (enclosed) advising that the Affordable Care Act (ACA) would begin in January 1, 2014. With the launch of federal and state exchanges, also known as marketplace, the Health Plan offered [redacted] the option to keep the benefits he has today. This would allow [redacted] to start a new policy, with the same benefits he currently had, which would have become effective December 1, 2013. This new policy would have replaced [redacted]’s current plan with the new Health Plan, and would remain in force until December 31, 2014. Enclosed with this letter was a “New Policy Confirmation Form” that he could sign and return. As indicated in the letter, if [redacted] had any questions about this new policy, he could have called us at ###-###-####. Our team of experts is available from 8 a.m. to 8 p.m., Eastern Time.In addition, on March 28, 2014 the Health Plan sent [redacted] a Migration letter (enclosed) advising that his plan design(s) would not change until his policy period ended on May 31, 2014. At that time he would need to have a new 2014 plan in place so he did not have a gap in health coverage. When his policy ended, he would have three (3) options. However, when the Health Plan did not receive back either form, [redacted] was auto-enrolled onto a new ACA plan, option 1. Option 1 states:OPTION 1 - Allow us to automatically move you to a plan that based on your current coverage may meet your needs, and also meets all of the ACA requirements. If we do not hear from you or you do not take any action, we will enroll you into our Bronze $10 Copay HMO PD, effective June 1, 2014.At this time no plan changes can be made without a qualifying event. The premium for this plan is $800.81 per month. Visit http://www.coventryhealthcare.com/fl72633 to view the Summary of Benefits and Coverage for this plan. You can call ###-###-#### to obtain a Certificate of Coverage and/or a Schedule of Benefits.Further, on July 8, 2014, the Health Plan received a complaint from the Department of Financial Services regarding the same issue from [redacted]. On July 10, 2014, the Health Plan addressed [redacted]’s complaint with the Department of Financial Services. We have not received any additional phone calls or request for additional information to date.Coventry Health Care hopes this explanation provides the necessary information to complete the investigation of this matter. If you have any additional questions, please contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm.Sincerely,Siana LSenior Complaint and Appeal Analyst Grievance and Appeals Department

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:It just does not respond to my complaint, and shows how little we mean for the health industry : I am now in a plan costing $ 800plus/month, or over 33% more expensive, with no knowledge WHAT the plan means ...There was NO response to the monthly letter I am receiving that 'next month your premium will go back to the normal level'This company should not even do business, if it does not explain what happens, takes $200/month, AND GETS AWAY WITH IT !!!!I have NEVER given any authorization to change plans, and no answer should NEVER be that the company can do whatever they choose to do. Where are our rights here, really ?????This is outrageous, and I will reserve the right to publish this everywhere, to show where we stand, no rights, no knowledge, just pay and stay healthy, otherwise we quadruple your premium ! And we will do so because you did not respond to our new plan : 'the top-expensive-plan-with-no-rights-just-pay-and-shut-up-plan'Great plan, great company!

Regards,

Business

Response:

October 17, 2014Dear [redacted]:The Health Plan received your request to our initial response on February 5, 2014. In response to [redacted]’s rejection:[redacted] states that he has no knowledge “WHAT” the plan means. The Health Plan has no record that [redacted] contacted us regarding these concerns. The Health Plan has enclosed a copy of [redacted]’s Summary of Benefits material that he can review for benefits information, a copy of which he has received previously.If [redacted] has questions regarding his coverage, he may contact the Customer Service Department which is available to answer any questions he may have about his coverage. [redacted] can reach them at ###-###-#### Monday through Friday, 8:00 a.m. to 6:00 p.m. EST. [redacted] may also access his benefit information 24 hours a day, seven days a week by registering and logging in at [redacted].In regard to [redacted] receiving monthly letters stating that “next month your premium will go back to normal level,” the Billing and Enrollment department has confirmed that an “Adjusted Pull” letter was sent to the member in error, for which we apologize. This letter should only be sent to those members who will be drafted an amount different from their standard premium. This was not the case for [redacted].Finally, the Health Plan does not make a change to a member’s policy without prior notice. [redacted] was given prior notice on two separate occasions regarding changes to his policy and the opportunity to either make a selection or contact Customer Service for assistance. Since the Health Plan did not receive the required documentation back from [redacted], in order to prevent a lapse of coverage or termination of the policy, the default choice was selected as was explained in the notifications.Coventry Health Care hopes this explanation provides the necessary information to complete the investigation of this matter. If you have any additional questions, please contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm.Sincerely,Siana LSenior Complaint and Appeal Analyst Grievance and Appeals Department

Review: Dear Madam or Sir,

I received a bill from the office of [redacted], P.A. dated 9/8/14. The bill is in the amount of $195.65, and stems from an office visit on 6/4/14. The doctor’s office filed a claim to Coventry Health Care, but Coventry has paid for very little of the cost of my primary care office visit. This visit was because of my high blood pressure, and the fact that the medication my doctor always prescribed me was not lowering it. I was having severe heart palpitations with my blood pressure reaching 170/110, and I was having strong heartburn episodes.

On the day of 6/4/14, I paid my $25 copay in full, then was given just a routine check up, in addition to an EKG. I am very upset that Coventry has not paid in full for this visit, because the reason I signed up with them to be my Health Insurance Provider was that I believed they covered primary physician office visits. I feel I was tricked into choosing Coventry as my provider by their online description that primary care office visits are covered by the copay.Desired Settlement: I would like Coventry Health Care to waive the bill stemming from my 6/4/14 office visit.

Business

Response:

October 10, 2014Dear [redacted]:I am writing in response to complaint ID [redacted], filed by our member, [redacted].We have thoroughly reviewed the complaint submitted by [redacted] as well as your request for information regarding his complaint.[redacted] has filed this complaint as result of the claim filed for date of service June 4, 2014 for office visit services rendered by Dr. [redacted]., MD of [redacted] PA. To summarize [redacted]’s complaint, he states that he feels that the visit should be covered with a member copay of $25on the basis that he was “given a routine check up, in addition to an EKG”.We have thoroughly reviewed [redacted]’s plan and the claim in question. [redacted] is enrolled in a full risk, individual CoventryOne Preferred Provider Organization (“PPO”) that took effect December 15, 2013 and is still active. The plan is administered by Coventry Health and Life (“CH&L”)Per the Schedule of Benefits (“SOB”) (Attachment 1) “Primary Care Services Provided in a Physician’s Office when a participating provider is used – the member pays a $25 copay and then the coverage pays 100% (the deductible does not apply).” The SOB also states “Primary Care Services Provided in a Physician’s Office when a non-participating provider is used – the member pays contract year Deductible and 40% Coinsurance of the Out-of- Network rate (Well-Child Services and Breast Cancer screenings are not subject to a deductible)”Dr. [redacted]., MD of [redacted] PA is not a participating provider with [redacted]. As such, the non participating provider benefits were applied during the processing of the claim. The explanation of benefits has been enclosed for your ease of review (Attachment 2). The deductible was applied in accordance with the benefit plan.We respectfully submit that there is no call history indicating that [redacted] contacted our customer service department prior to the office visit to confirm Dr. Johnson’s participating status. Also, review of our records indicates that [redacted] has not exhausted his appeal rights.We trust the above information is fully responsive to your request. Should you have any questions or concerns regarding this complaint, please do not hesitate to contact me.Sincerely,Candice GComplaint and Appeal Consultant

Review: I canceled my health insurance 08/12/2014 and the following month 09/09/2014 they withdrew 292.60 from my bank account. I called they said it was a mistake and would refund my money within 7 business days. I have since called three additional times with no success in retrieving my stolen money.Desired Settlement: return my stolen money to my bank account, I need it to pay my bills.

Business

Response:

October 13, 2014Dear [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual HMO ACA health benefit plan.[redacted] (the “member”) has filed a complaint. The Member states that his premium payment was drafted by the plan after the Member cancelled his coverage on 8/2/2014. The Member is requesting reimbursement of the premium payment processed on 9/9/2014 in the amount of $292.60.Upon review, the member called on 8/5/2014 to term the payment for August, however the August payment had not posted. Therefore, at that time, the member was not paid through August. He did not call back to terminate coverage until 9/11/2014, resulting in the CHL enrollment representative terming the member effective 9/30/2014. We have now termed the policy as of 08/31/2014 and a refund is in process for $292.60.We trust the above information is fully responsive to your request. Should you have any questions or concerns regarding this complaint, please do not hesitate to contact me.Sincerely,Emily MComplaint and Appeal Consultant

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: Unable to cancel policy.

I signed up for Healthcare through the Health Insurance Marketplace. Now that I am a member of Coventry, they are NO LONGER involved. ALL I want to do is cancel my policy due to terrible customer support and get my money back. They refuse to acknowledge my calls and e-mails. I've been hung up on. This is ridiculous. Coventry of Florida IS NOT a government agency. They are a Health Insurance Company and they have to cancel me if I want to be cancelled. They also have to provide a refund if they did not provide the care I need.Desired Settlement: I want a refund of the premium I paid for January.

Business

Response:

Good Afternoon [redacted],

We reviewed the complaint on behalf of [redacted] under your department file number of [redacted]. **. [redacted] contacted your office asking that we cancel her coverage and provide a premium refund.

After reviewing our records we were unable to locate an account or application for [redacted]. As you are aware, we service five counties, [redacted], [redacted], [redacted], [redacted], [redacted]. Per [redacted]'somplaint she resides in Florida. If you find that this information is incorrect, please provide the members identification number and plan coverage.

Sincerely,

[redacted], Specialist

Executive Inquiries

.

Business

Response:

September 16, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regaining **. [redacted] termination of coverage and locating a Pain Management Provider that prescribes “[redacted]”Please be advised that after review of your grievance, **. [redacted] was contacted and informed about the criteria regarding [redacted] prescriptions. **. [redacted] was advised she will need a referral from her (PCP); who will request authorization from Coventry Health Care, Inc. **. [redacted] expressed that she is not satisfied with Coventry’s process surrounding [redacted] prescriptions. **. [redacted] stated she anticipates termination and then ended the callPlease find (enclosed) Analgesics, Narcotics and Narcotic Combinations and Termination Criteria. Additionally, below is part of the criteria for; Analgesics, Narcotics and Narcotic Combinations and Termination:A documented diagnosis of moderate to severe chronic painANDFormal, pain evaluation has been documentedANDOther pain management regimens have been inadequateTermination by Subscriber:If **. [redacted], still needs to terminate her policy; she must return to the Marketplace in order to terminate her coverage. According the Certificate of Coverage (enclosed) Section 3 Termination of Coverage; A, Termination by Subscriber:The Subscriber may terminate Coverage for himself/herself and any enrolled Dependents under the Contract for any reason by providing fourteen (14) days advance written notice to the Health Insurance Marketplace. For notices received on the 1st through 15th day of the month, termination will take effect on the first day of the month in which the notice was received. For notices received on the 16th through 31st day of the month, termination will take effect on the first day of the month foll owing the month in which the notice was received, unless the Health Plan agrees to an earlier termination. The notice of termination should be sent to the Health Insurance Marketplace through which You enrolled.If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm, or you may roach me directly at ###-###-####. If you are hearing impaired please call 7-1-1 Telecommunications Relay Service.Sincerely,

Consumer

Response:

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

Review: [redacted]

I am rejecting this response because: I finally spoke with [redacted] after I called and left several messages. She is the young lady I spoke with before. I told her that she never finished helping me the last time we were in contact because we never located a covered doctor. [redacted] told me that the problem is not with my coverage, it's with a doctor that will prescribe me [redacted]. I told her she was mistaken because I am already on [redacted] and I have been asking Coventry since day one (01-01-2014) to please help me find a provider that's in network. Coventry assured they would and once I was sign up and paid, nobody helped me. My conversation with [redacted] ended with her saying there is no doctor in their network that prescribes [redacted]. I told her I am extremely upset at having been strung along for 9 1/2 months, but at least I have an answer. I need to file an official fraud complaint against Coventry because they gave me the wrong information in order to get me to sign up. It's misrepresenting the policy, it's fraud, and it's illegal.

Review: I was needing individual health insurance coverage. I contacted them the last of November 2013 to request insurance coverage. Finally received an email on December 9, 2013 that my application had been approved with an inception date of 12/1/13. My rate was to be $434.81. I was to let them know within 10 days if I wanted to be covered by CoventryOne insurance. I did call back but did not document the date. I was waiting to get more information in the mail but did not receive anything. I called back on 1/3/14 to see if they had placed anything in the mail. I was still not covered. Called back again and was told due to not sending a payment that I was not covered. Was asked to send December payment of $434.81 and also January payment of $434.81. Checks for Coventry One was deposited on 1/8/14. Called back on 1/17/14 to see if I was covered under their insurance and I was still was not covered. When I called back the lady gave me a confirmation number and said that she would send down to underwriting. I called back on 1/28/14 and I still am not covered. I began calling at 9:30 a.m. and did not get someone on the line until 10:25 a.m. I was put on hold again and lady did not come back on the line for another 30 to 40 minutes. I have requested a full refund of $869.62 and cancellation of this insurance.I have a [redacted] medication that I use at night time and I was needing to get coverage so I could get my medication.The company is Coventry Health Care of the Carolinas, Inc.

Product_Or_Service: Coventry Health Care

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

Full Refund of $869.62 so I can use it to get coverage from another insurance company.I could not recommend this company. Very dissatisfied with this company.

Business

Response:

February 4, 2014

Dear **. [redacted]:

This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to a complaint submitted by [redacted] regarding a premium refund for her CoventryOne policy effective December 1, 2013. The request was received by CHC Carolinas on February 4, 2014.

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

Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted] between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.

Consumer

Response:

I am rejecting this because the problem has not been resolved. I did not receive ID Cards/policy from Coventry Health Care in a timely manner and no longer need their services. I applied for coverage in November 2013 and requested coverage beginning on Dec. 1, 2013. I received a email from them on Dec. 9, 2013 stating that I had been accepted. I made several phone calls to Coventry Health Care and was told something different each time. Then on Jan. 28, 2014 I contacted the Revdex.com of NC and also the NC Department of Insurance. I am now covered with another insurance company and would like a full refund of $869.62. Tried to contact the person on this email letter on 02/05/14 and this is a call center. Requested her phone number ([redacted])and left a message. I have had no response from her. Also called back the NC Department of Insurance on 02/05/14 and I was told there was no mention of a refund. In a letter he received it said that a policy had been issued. I have not received anything from Coventry at this time nor do I want to. The money I am requesting to be refunded was for the Dec. 2013 & January 2014 premiums. Checks were mailed to Coventry Health Care P.O. Box [redacted] on 1/3/14 and cleared our bank on 1/8/14.

[redacted]. [redacted]

[redacted] ###-###-####

E-mail: [redacted]

02/06/14

Complaint ID [redacted]

Review: Coventry Health Care of Ga is the worst Health Care company on the market.Their customer service people are arrogant liars. They will tell you one thing and do what ever they want. I have given up being put on hold for over a hour at many times. They don't care ..and say "Oh well" . They in their "coverage policies" reject everything that doctor's suggest for treatment.These are doctors are in their network . I will be leaving soon but want others to know this company is a group of liars and have billing departments and customer service that rank at the bottom of their industry.

Product_Or_Service: health care policy

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

Customer service said the $511 family premium I already paid would be credited as I took the kids off the policy . My single premium is 267.22 .(JAN 1st 2014.)That leave a balance of $244.54 .Today... now they have told me too bad ....

Business

Response:

February 24, 2014

Dear **. [redacted]:

Thank you for giving Coventry Health Care of Georgia the opportunity to review your Revdex.com complaint. We appreciate your feedback in regards to our Customer Service process.

After a thorough review based on the information submitted, **. [redacted] submitted a request to terminate his children from his policy, effective 12/31/13 due to the children going on their mother's health plan.

Unfortunately, **. [redacted] written termination request was received on 1/13/14. The dependents were termed based on normal business rules, which indicate that we are not able to retro-terminate until the end of the month. The dependents were termed 1/31/14.

On 2/21/14, a determination has been made to retro terminate your dependents from your CoventryOne policy back to 12/31/13. All dependent term dates have been corrected and your account will be updated to reflect the changes to your policy.

If you have any questions, please contact the Customer Service Department at ###-###-####.

Sincerely,

Appeals Department

Consumer

Response:

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

Review: [redacted]

I am rejecting this response because:

Regards,

Review: September 24th, my account was debited $226.96 for payment for health insurance. Seven days later, October 1st, my account was again debited $226.96 for health insurance. I noticed immediately and called Coventry. Customer service was not sympathetic and demanded proof. I immediately printed my bank statement and faxed it to them. It was two weeks later and I had not heard back from them. I contacted customer service again. I was told my paperwork had been processed and I was due for a refund. I waited on the line for a supervisor and then I was hung up on. I called back went through the exact same process and was hung up on a second time. I called a third time and was told I could not speak to a supervisor, and that my account would not be debited for the next month's payment (November). I waited to see what would happen and again my account was in deed debited the $226.96 for November. I called customer service and requested to speak to a Supervisor. I was told a request was made a a supervisor would be contacting me within 24-48 hours. No supervisor ever contacted me. I cannot get anywhere with customer service and leave me as a very frustrated customer.Desired Settlement: I need a refund of the amount taken from my account, $226.96.

Business

Response:

Dear

Review: I Just enrolled in July and was quoted one price for medicine and changed double for 3 essential drugs at pharmacy. One drug Castor I have had to discontinue use though it is detrimental to my health. I am diabetic.Desired Settlement: I would like First Health Part D to reconsider my contract and allow these drugs at the $30 price originally quoted. I would like this NOW and not at the end on enrollment period. If not, let me out of contract immediately without financial repercussions.

Business

Response:

Coventry Health Care, Inc., respectfully requests an extension of time in order to complete our investigation of this matter.

Thank you,

Business

Response:

Attached please find Coventry Health Care's response to Complaint #[redacted] which was sent directly to the member on October 11, 2013.

Thank you,

October 11, 2013

Dear **. [redacted]:

This letter is in response to your complaint that you filed with the Revdex.com on September 19, 2013.

Based upon our review, you state you were misinformed during the enrollment process. We have listened to the recorded call and find that you were not misinformed. You state during the call that you want to enroll in the First Health Part D Value Plus plan. The agent offered to review your drugs with you and you stated “your agent already went over that”. We understand you may have had a conversation with some type of advisor, in which we are unable to verify; however this was not the Coventry Health Care (First Health) Agent enrolling you. After careful consideration the plan has reviewed your request “honor the drugs at the $30 price originally quoted” and your request to for this accommodation remains denied.

For certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these rules to help our members use drugs in the most effective ways. These special rules also help control overall drug costs, which keeps your drug coverage more affordable. You or your doctor can ask the plan to cover the medication by calling ###-###-#### or faxing the Prescription Drug Coverage Determination form to ###-###-####. Please be sure clinical information and supporting documentation is included as well. The turn around time for a standard coverage determination is 72 hours and 24 hours for expedited requests.

As an alternative, we encourage you to always provide your Formulary document to your providers when you visit them to be sure that they understand what is required for your benefit plan to cover the drugs that they are prescribing. If your provider feels it appropriate and available, they can pursue other formulary alternatives perhaps at a lower tier or cost to you.

You have also requested to disenroll from the plan. During the Annual Election Period, from October 15th through December 7th you may explore plans being offered and make changes.

During this time we will be happy to share information about plans that we may have available in your area. This would be effective January 1, 2014. In certain situations, members of First Health Part D us may be eligible for a Special Enrollment Period.

Who is eligible for a Special Enrollment Period? If any of the following situations apply to you, you may qualify for a Special Enrollment Period. These are just examples, for the full list you can contact the plan, call Medicare, or visit the Medicare website (http://www.medicare.gov):

• If you have moved out of your plan’s service area.

• If you have Medicaid.

• If you are eligible for Extra Help with paying for your Medicare prescriptions.

• If you are getting care in an institution, such as a nursing home or long-term care hospital.

Please note that you may be able to get Extra Help to pay for your prescription drug premiums and costs. Medicare provides Extra Help to pay prescription drug costs for people who have limited income and resources. To see if you qualify for Extra Help, call:

• 1-800-MEDICARE (###-###-####). TTY users should call ###-###-####, 24 hours a day, 7 days a week;

• The Social Security Office at ###-###-####, between 7 am to 7 pm, Monday through Friday. TTY users should call ###-###-####; or

• Your State Medicaid Office: Illinois Department of Health and Human Services ###-###-#### Website: https://www.illinois.gov/medical

We appreciate you contacting us and we hope that we have satisfactorily addressed your concerns.

If you have any questions, please feel free to contact Customer Services at ###-###-####, 24 hours a day, seven (7) days a week. You can request language translation services when you call. TTY/TDD users please call 711 Telecommunications Relay Services.

Once again, we apologize for any inconvenience.

Sincerely,

Review: Coventry insurance care link can not connect me to any doctors that are in my network. My primary care doctor told me I needed to have a colonoscopy. I found a doctor in [redacted] fl in May 2014 that was in my care link network. I made an appointment And went for a consultation I paid $50.00 and scheduled to have the procedure done June 24 2014 . I was informed by the doctors office on June 17 that the doctor was dropped from care link network. I called Coventry and asked them to direct me to a new doctor that would accept my Coventry care link insurance. Waited on the phone for 45 min and was told they couldn't find one . They are adding new doctors all the time but can't find me one now. I should call back in 2-3 weeks and see if they have one then. Most doctors accept Coventry insurance. But none are in the Coventry care link network.... So I have insurance, but no doctors to go to,,,, I have hospitals and doctors offices all around me but no one that is in my network.. Please advise thank you,,,Desired Settlement: DesiredSettlementID: Other (requires explanation)

If Coventry care link can't find me a doctor in the Care Link net work, some where reasonable close they should let me use doctors that are still in the Coventry network even if they are not in the Care Link network.

Business

Response:

July 3, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s request for an In-Network specialist.In an effort to assist [redacted], the Health Plan contacted him on July 2, 2014. [redacted] advised that he is satisfied with his Primary Care Physician (PCP). However, he has a referral for a colonoscopy but is unable to locate a Gastroenterologist, [redacted] also inquired about finding an Urologist in [redacted] County. [redacted] was advised that our CoventryOne Customer Service Team is working to locate and verify both requested specialist within 20miles of his zip code. The CoventryOne Customer Service Team will also confirm the selected specialists are accepting new [redacted] members. [redacted] will be contacted and provided with the contact information for the selected providers available.[redacted] was also informed many providers’ new patient panel is closed at this time in his area. This means new patients are not being accepted. In the event that a participating specialist provider cannot be located; [redacted] and his PCP must obtain a prior authorization to see a non-participating provider. -[redacted] will be eligible to enroll under a different plan if desires during the open enrollment and special enrollment periods as defined by the Health Insurance Marketplace and as set forth in 45 CFR 147.104. The annual open enrollment period will occur annually from October 15th through December 7th of each year for benefit years beginning January 1, 2015. Qualified individual currently enrolled in a Qualified Health Plan may also change plans at this time and enrollees will be notified in writing about the annual open enrollment period in September of each benefit year.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,Yanique MComplaint and Appeal Analyst Grievance & Appeals Dept.