Coventry Health Care, Inc.

Hello,
Thank you for your inquiry, regarding complaint #*** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you,
We reviewed the complaint sent in by *** *** and verified that any
claims that were processed incorrectly have since been correctedThe system was also updated and in our records indicate that all claims have been processed correctly,Please accept my apology for the delay in processing your claims correctly, and that it required multiple attempts on your part to resolve your issueUnfortunately, in some instances, procedural errors do occurWhen they do, we take them very seriously and do our best to understand how and why the errors occurred and determine what we can do to prevent a recurrence,Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur, I sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserveThese actions are not consistent with our service standards and we appreciate you notifying us of your experience.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***'s concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***Thank you,
Ashley S.Complaint and Appeal Consultant

October 7, 2014Dear *** ***;This letter is a follow up to the letter filed with your office on October 6, regarding the above-referenced member, *** *** had requested a refund in the amount of $for the overdraft fees she incurredIn order to refund the money, we will need proof from *** *** that she was assessed overdraft feesThe bank statement can be faxed to Member Services at ###-###-#### with Case #* *** notated on itOnce that has been received and approved, we will be able to issue a refund.If I may be of any further assistance, please feel free to contact me at *** or toll-free at ***, ext, ***.Sincerely,Shawn MComplaint and Appeal Analyst

face="Calibri">Dear *** ***,
Please see our response to complaint #*** for *** *** that was received by us on May 21,
During our review, it was determined that *** *** had two separate cases with our Billing and Enrollment department, *** and ***Her initial case was ***. It had an effective date of February 1, 2014, and a termination date of August 31, 2014. The new case, ***, was set to have an effective date of February 1, 2015. However, when Coventry received the payment of $107.50, the payment was instead applied to the initial case, ***. Because a premium payment was never applied to case ***, the enrollment was cancelled
We were able to work with our Billing and Enrollment department to have case *** reactivated and get the payment transferred over to that case. Since the premium listed for that policy is $107.57, the payment was still not enough to complete the enrollment and have an ID card sent to *** ***.
Case *** is still active at presentIf *** *** pays the remaining $currently owed, we will be able to complete the enrollment. Additional files were also received from the *** that will change the effective date, plan, and premium listed for that case. Once the payment is received, those files can be processed to make the appropriate updates to the case. She can contact the Billing and Enrollment department at ###-###-#### to make the payment
We would like to advise *** *** that since she is on a Health Insurance Exchange policy and is receiving an Advanced Premium Tax Credit, we will not be able to waive any of the premiums for any months of coverage for which the policy is showing as effective. We are also not able to change the effective dates for the policy without receiving files from the ***. This means that any premiums that become due upon activation of the policy will need to be paid in order for it to remain active
I apologize for any difficulties this situation has caused *** ***We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Julian C***
Executive Resolution Team

"Times New Roman";">Dear
*** ***,
Please
see our response to complaint #***
for *** *** that was received by us on January 25,
After
reviewing the complaint and *** ***’s claim history, we did locate two claims
that had been denied by Coventry that fit the situation he described. The claims were both for the same diagnostic
test but were from different providers.
One provider was billing for the technical component of the test and the
other was billing for the professional component. Both claims were initially denied as our
out-of-network fee schedules had not been set up allow them. The processing guidelines have since been
updated so we were able to have them reprocessed to overturn the denials
While
the claims were adjusted and allowed, *** *** is responsible for the entire
billed amount as everything was either applied towards his out-of-network
deductible or was above the amount we recognize as an eligible medical expense
for the services performed. If he
wishes, *** *** is able to appeal the out-of-network determination by sending
a written appeal request to *** Health Plans, Appeals Department, *** *** *** *** *** *** South Jordan, Utah, ***-***. Appeal requests can also be e-mailed to ***@cvty.com. Explanations of Benefits for each claim will
be mailed out to *** *** that give the specific processing details as well as
the information about submitting appeals
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

Dear ***
***,
Please see our response to complaint #*** for *** *** that was received by us on May 29,
During our review, we found that *** *** called our Billing and Enrollment department on March 26, 2015, to terminate her policyHowever, the representative transferred the call to the Market Place in error and the policy was never terminatedThe member submitted proof of new coverage but the ID cards were missing the effective date and the request was denied
Additional feedback has been provided to our Billing and Enrollment department to ensure accurate service is providedBased on the call *** *** made on March 26, 2015, her policy has been terminated effective March 31, Please allow 7- business days to process the refund
I apologize for any difficulties this situation has caused *** ***We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Julian C***
Executive Resolution Team

October 6, 2014Dear *** ***:Your letter of September 24, to Coventry Health Care of Iowa, Inc(Coventry) was received in our office, and referred to my attention for review and response*** *** is on a CoventryOne Individual Silver $Copay Point of Service (POS)
UnityPoint Health-*** policy, with a January 1, effective date*** *** enrolled for coverage through the Health Insurance Exchange (Marketplace).In her complaint to the Revdex.com, *** *** advised that the incorrect monthly premium amount was withdrawn from her bank account on July 1, *** *** requested a refund of $408.70; $for the amount over her monthly premium payment and $for the bank overdraft fees she incurred because of the error.On December 14, 2014, *** *** applied for health coverage through the Marketplace for an effective date of January 1, The monthly premium payment for the policy was $On May 22, 2014, Coventry received an updated enrollment file for *** *** from the Marketplace reporting a decrease in premium payment to $effective July 1, However, *** ***’ bank account was drafted the premium of $for July because the enrollment update was not processed in Coventry’s system until July 11, This caused a credit in the amount of $on *** ***’ account.*** ***’ premium payment for August was due on July 31, in the amount of $This amount was satisfied by the credit balance of $on *** ***’ accountOn August 7, 2014, Coventry issued a refund to *** *** in the amount of $for the remaining credit via Electronic Funds Transfer (EFT)*** ***’ policy is current and paid through October 31, 2014.*** ***’ request for a refund in the amount of $for the overdraft fees she incurred is currently under reviewCoventry will contact *** *** with the determination concerning an additional refund within 5-business days.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext***.Sincerely,Shawn MComplaint and Appeal Analyst

May 27, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc("Coventry Health Care”) writes this letter in response to your request dated 04/7/and received at our office on 04/7/This letter is in response to the consumer complaint filed by *** *** *** regarding payments being drafted out of an incorrect account which caused overdraft fees.However, upon receiving her request back from accounting, the member asked for a letter in writing from us to provide to her bankAt the beginning of May we sent her an email to give to her bank to waive the fees as requestedWe have advised if the bank will not accept the letter to contact us for expedited handlingAs we have not heard back from *** ***, we will consider this matter closed.The member didn’t provide a statement that o the amount of the fees.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension My fax number is ###-###-####, and my e-mail address is namillerlocyty.comVery truly yours,Very truly yours,Neil M., B.ARegulatory Compliance Analyst

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
However, I will be waiting for my daughter to be added to the policy, if this problem is not fix in - days business days as they promised I will notify you immediately.
Thanks
Regards,
*** ***

September 9, 2014Dear *** ***:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our officeWe appreciate the opportunity to respondA refund in the amount of $was returned to your account on September 4, We apologize
for an inconvenience this has caused.We trust this information has addressed the issues raised in this complaintIf we may be of any further assistance, please feel free to contact me at ###-###-####Respectfully,Brandy H
Appeals Department Coventry HealthCare

Hello,Thank you for your inquiry, regarding complaint #*** for *** ***, Our Executive Resolution Team researched your concerns, and would like to share the results of the review with you.We reviewed the complaint and confirmed that we electronically refunded *** *** on
October 14, 2014, sincerely apologize for how long it took for you to receive your refund, Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur, I apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserveThese actions are not consistent with our service standards and we appreciate you notifying us of your experienceWe have addressed your customer service concerns directly with the representatives who handled your calls,We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***'s concerns, if you have any additional questions regardingthis particular matter, please contact the Executive Resolution Team at ***.Thank you,Ashley S,Complaint and Appeal ConsultantExecutive Resolution Team

Dear
*** ***,
Please see our response to complaint #*** for *** *** that was received by us on December 29,
We would like to begin by apologizing for the difficulty *** *** experienced while attempting to update his address. Any changes made to the policy do have to come to Coventry through the Marketplace and we did not receive any updated information from them prior to *** ***’s call to us on December 26, 2014. The representative he spoke to with Coventry at that time did manually update the address in the Coventry Enrollment system. Upon receiving the complaint, we began the process of manually updating the address in the remaining areas of our systems. The process was completed on December 30, 2014.
Unfortunately, we are not able to issue a refund for any of the months that *** *** has had coverage with Coventry. He would have been able to use the coverage if needed, as having an incorrect address on file would not cause Coventry to deny claims.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

August 21, 2014Dear *** ***:The Regulatory Compliance Department of Coventry Health Care of West Virginia, Inc(“Coventry Health Care”) writes this letter in response to the consumer complaint filed by *** *** regarding his policy.*** *** complains that he never
received his identification card and that he never had a member numberAn investigation into this matter shows that *** *** did, in fact, have a member number and an active account*** *** was mailed identification cards on April 7, and August 6, *** ***’s policy was active May 1, through July 31, A customer service representative attempted to contact *** *** to confirm that the address we have on file is correct and to assist him in accessing the online services available to himAs of this date, *** *** has not responded to the voice message left for him at the telephone number he supplied on his complaint*** *** is requested to return the telephone call from the customer service representative so that he can be assisted in accessing his account.Regarding *** ***’s request for a refund of premium based on not receiving his member identification cards he will need to contact the MarketplaceCoventry is unable to process any changes to a policy that was initiated through the Marketplace per the Exchange rules and regulations that we as an insurance company must follow*** *** must request to have his policy never in force through the MarketplaceIf the Marketplace grants *** ***’s request Coventry will be notified of any policy update.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####My fax number is ###-###-####, and my e-mail address is ***.Sincerely,Teresa E
Manager, Complaint and Appeal Program Coventry Health Care

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
They have known about my request for a weekI don't feel I should have to give them an indefinite time to work on a responseThe paper work stands for its selfI will allow them one week - no more
Complaint: ***
I am rejecting this response because:
Regards,
*** ***

Hello,
size="3">Thank you for your inquiry, regarding complaint #*** for *** ***Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you
Upon receipt of the complaint we immediately reached out to Premium and Billing department for Coventry to verify that the member was paid to date for his policyWe were advised that *** *** is paid through March 31, There was a double payment in January 2015, but the member requested a refund which we show was approved and sent to the member on February 10, The member would need to make a payment of $for the April’s premium to avoid terminationWe will not be able to refund the member the premium amount he is requesting
Please be advised that we received on April 08, updates from the Marketplace that state the policy monthly premium amount as of May 01, 2015, will be increased to $The Marketplace advised that the APTC (advance premium tax credit) will no longer apply after this datePlease contact the Marketplace directly to discuss why this is occurring
We have requested that all claims reflect correctly on this policy to show the deductible amounts that have been accumulated for
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** *** concernsIf you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Thank you,
Ashley S
Complaint and Appeal Consultant
Executive Resolution Team

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Dear ***
***,
Please see our response to complaint #*** for *** *** that was received by us on July 6,
During our review we were not able to locate a call from *** *** where he requested to cancel his policy. Termination requests can be made over the phone by calling our Billing and Enrollment department at ***. I have also attached a termination form that can be filled out and faxed or mailed back to us. The form lists the fax number and address for where to send it once completedThe plan will also terminate if premiums are not paid but we will not send a member to collections for unpaid premiums.
We found that *** *** had previously filed complaint *** with the Revdex.com and was provided with a copy of the letter we sent in that advised of the plan change for 2015. That letter contains a web address for the plan documentation. We have attached a copy of the plan documentation and the renewal notice to this response as well. He may also contact the Customer Service department at ###-###-#### if he has questions about benefits for specific services.
A one-time exception was made during the previous complaint review to reprocess the claims that we had received for *** *** up to that point and apply the benefits for his plan from 2014. That process has been completed and he has been made aware of the new processing of the claims. An exception will not be made to refund the premiums that have been paid for his policy.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris B***
Executive Resolution Team

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

June 30, 2014Dear ***:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc(“Coventry Health Care”) writes this letter in response to the above-referenced complaint filed by *** *** regarding payment issues.***’s policy has
been reinstated with an effective date of January 1, Due to the error inputting ***’s birthdate, we have chosen to leave the January and February premiums as isTherefore, *** is responsible for $each for January and February and $each for March, April, May, and JuneThe total premium charged being $669.26.*** was refunded for her February 7, payment of $on May 30, She was also refunded the March 6, withdrawal of $on March, 11, Her April 2, payment of $cleared and is reflected on her account.Based on the foregoing, ***’s outstanding balance is $This amount does not include July’s premiumA representative will contact *** to assist her with remitting payment.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####My fax number is ###-###-####, and my e-mail address is ***.Very truly yours,

"Times New Roman";">Dear
*** ***,
Please
see our response to complaint #*** for *** *** that was received by us on January 4,
In
reviewing the prescription claim in question, it was found that *** ***’s
pharmacy had submitted the claim with a discontinued National Drug Code (NDC). Without having a valid NDC we are unable to
allow the claim. The denial reason code
sent back to the pharmacy specifically states that was the reason for the denial
We
did also review *** ***’s prescription benefits and found that the
medication is a tier or non-preferred medication. When using an in network provider, tier
medications apply towards the $deductible until it is met. A
Summary of Benefits and Coverage is attached for his plan which supports
that statement, as is the prescription formulary which lists the medication
as tier
It
was noted that *** ***’s still has an active policy with Coventry for
as well. All terminations must be
submitted through the Federal Health Insurance Marketplace. If he wishes to cancel his policy he may
contact the Marketplace at ###-###-####
We
take customer complaints very seriously and appreciate you taking the time to
contact us and giving us the opportunity to address *** ***’s
concerns. If there are any additional questions regarding this particular
matter, please contact the Executive Resolution Team at ***@***.com
Regards,
Chris
B***
Complaints
and Appeals Consultant
Executive
Resolution Team

September 12, 2014Dear *** ***:
Your letter of September 4, to Coventry Health Care of Virginia, Inc("Coventry Health Care") was referred to my attention for review and response*** *** expressed concern with the $3,700.00, October 29, claim denial for The
*** ***Coventry addresses this concern below.On May 6, 2014, Coventry received a claim submission for the October 29, services, The $3,charge was denied due to an incorrect diagnosis codeOn June 19, 2014, Coventry received a corrected claim with a corrected diagnosis and procedure codeThe claim was denied due to an invalid procedure codeProviders are required to adhere to submitting claims correctly based on the Services renderedHowever, *** *** has been responsible for submitting a Superbill to Coventry on behalf of The *** ***, Coventry understands *** *** is caught in the middle of this billing issueAs a one time exception, the $3,October 29, charge will be processed, *** *** should receive an Explanation of Benefits within 7-businessIf you have any questions, please contact the Customer Service Department at ###-###-####,Teresa *E*** Manager, Complaint and Appeal Program