Coventry Health Care, Inc.

Complaint:
I am rejecting this response because:-------- Forwarded message ----------From: Lin Cosh Date: Wed, Aug 27, at 6:PMSubject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #10170235.To: [email protected] MsCynthia Cameron,Please find attached my signed HIPAA form.Please confirm you have received it and can open it.If you have any questions or need additional documents or explanations, please let me know.Thank you very much,***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: I have reached out to your company at least ten times, which clearly did not work out at allI would like someone to call me, or at least be provided with a direct contact number, rather than an email address. Again, this is the worst customer service you could provide. Your company REALLY needs to re-evaluate a few things when it comes to the customer experience. Also, I have yet to receive a bill from your company regarding the amount I owe. If I owe it, send me a bill. Don't keep trying to take it from an account, causing overdraft fees. All of this is completely your company's fault, NOT mine. As I mentioned before I transfer money to that account as I have bills due. The fees keep piling up, and I plan to recover those one way or another from your company. My next action will be to file a complaint with Consumer Affairs if this cannot be taken care of in this format
Regards,
*** ***

Dear
*** ***,
Please see our response to complaint #*** for *** *** that was received by us on January 9,
We have been unable to locate a communication sent to *** *** indicating that her pharmacy would continue to be in network for 2015. If she is able to provide a copy of the letter, we can forward it for additional review.
The list of in network pharmacies in her area was reviewed and the one she has been using is no longer in network as of January 1, 2015. If she wishes, our Customer Service department can make outbound calls to the in network pharmacies in her area to determine if any others offer home delivery.
Our upper management is also reviewing the situation to determine if any exceptions can be granted. I will personally contact her with their decision once one is reached. If she has any additional questions or concerns in the meantime, she may contact me directly at ###-###-####.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ***’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

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
How can I have the contact informtion (Company name, address, email) from the MarketplaceI just tried again, and the estimated waiting time is minutesIf the phone doesn't work property, I need other form of contact beside phone call
Regards,
*** ***

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

[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.
Regards,
*** ***

September 12, 2014Dear *** ***:Your letter of September 9, to Coventry Health Care of Iowa, Inc(Coventry) was received in our office, and referred to my attention for review and response*** *** is on Qualified High Deductible Health Plan Open Access Health Maintenance
(QHDHP OA HMO) policy with a February 1, effective date through his spouse’s employer.In his complaint to the Revdex.com, *** *** advised that one of the billing associates with Hansen Family Clinic stated he would receive the same copay/member responsibility as other hospitals that are within the Coventry network*** *** is on a QHDHP policy and his annual family deductible is $5,*** *** does not have a copayment associated with his policyTherefore all services would be subject to his $5,annual family deductibleCoventry processed several claim submissions for *** ***The claims processed at the negotiated contract allowance with the providers*** *** would be responsible for the amount subject to his deductibleThere was no payment issued to the providers of serviceIf the providers notify Coventry that the claims should not have been submitted, the deductible amounts will be removed from *** ***’s policyAt this time, Coventry has not received any corrected claims from the provider of serviceIf I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext***.Sincerely,Teresa E
Manager, Complaint and Appeal Program

February 4,
Dear ***:
The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter in response to your request dated 2/3/and received at our office on that dayThis letter is in
reply to the above-referenced consumer complaint filed by *** *** *** regarding a prescription coverage
Both the member and his provider were notified of the appeal decision to approve the requested prescription the morning of 1/31/2014, prior to Coventry Health Care’s receipt of this Revdex.com complaint
Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is ***
Very truly yours,

July 3, 2014Dear *** ***:
I am writing in response to complaint ID ***, filed by our member, *** **.We have thoroughly reviewed the complaint submitted by *** ** as well as your request for information regarding her complaint*** ** has filed this complaint
as result of the policy termination subsequent to premium payment.Our records reflect that the appropriate identifying information was missing on the check submitted as paymentAs a result, the member’s payment was held in an escrow account until the correct policy was locatedAs a courtesy we have reinstated the member’s policyHowever, premium payment is currently due for the months of May through JulyThe member may call our customer service department prioir to July 15, to make payment to avoid terminationThe phone number for our customer service unit is ***Of note, please be advised that all future premium payments should include the member’s case number on payments made by check to avoid payments going to escrowWe trust the above information is fully responsive to your requestShould you have any questions or concerns regarding this matter, please do not hesitate to contact meSincerely,Candice G
Appeal/Regulatory Complaint Coordinator Coventry Health Care

Dear
*** ***,
Thank you for allowing us to address the concerns that were reported in complaint #*** for *** Terrel that was received by us on December 17, 2014, regarding an extra premium being drafted that caused overdraft fees to be applied by her bank. Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you
Our investigation determined that the issue was already being reviewed at the time we received the Revdex.com complaint. The expedited refund process had been started for the extra premium that was drafted and the overdraft fees that were subsequently applied. The refund for the premium draft of $was approved by our Accounting department and entered into the system on December 19, 2014. Once entered into the system, the turnaround time for a refund to be deposited into the bank account on file is 1-business days.
Approval was also given by the Enrollment department to reimburse for $in overdraft fees, which was the amount showing on the previous bank statements that were provided to us. The request for reimbursement of that amount was also sent to our Accounting department but requires additional levels of approval within that department and can therefore take slightly longer. We expect for the process to be completed by the end of the day on December 23, 2014, at which time the deposit of that refund will again take 1-business days.
It was noted that the amount of the overdraft fees requested in the complaint message does not match to the amount that has been approved. At present, the reimbursement is for the six overdraft fees that were reflected on the bank statement that we had received. If more fees have been assessed, we will need an updated bank statement that shows the total number and amount applied. Once received, those statements can be sent for review to determine if additional amounts can be paid.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsTerrel’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
THE REQUESTED FORM HAS BEEN EXECUTED BY CLIENT, *** ***, AND HAS BEEN ATTACHED HERETO FOR COVENTRY'S FILE.
Regards,
*** ***

[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.
Regards,
*** ***

[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 want them and you to understand that I had tried to resolve this multiple times by phone and email and no one ever told me I needed to sign anything or give me specific instructions as to how to take care of this I was transferred to multiple other departments and people without success and they had no clue how to help me Interesting how it was resolved only after the Revdex.com got involved
Regards,
*** *** ***

Complaint: ***
I am rejecting this response because:
I have fled an official grievance against Coventry One operating as Coventry of the Carolinas in my stateThey have failed to respond to this grievance despite their own policy that states they will respondMy original complaint was made when they failed to pay medical bills for my son despite having coverageI have evidence of questionable business practices (I have the ambulance company also to back me up since they were never paid either) and shoddy record keepingI am filing an official complaint with the state as well.I would like a response from anybody and a refund of my out pf pocket expenses which will total over thousand dollars
Regards,
*** ***

September 15, Dear *** ***:The Appeals Department of Coventry Health Care of Virginia, Inc(“Coventry Health Care”) writes this letter in response to the rejection of Coventry Health Care’s initial response of the complaint filed by *** *** regarding termination of her 09/01/policy and refund of her premium*** *** rejected the initial response because she has not received her refund of $from Coventry Health Care and that she is having difficulty working with the Marketplace to secure her refundThe policy slated to begin on 09/01/was successfully terminatedAs stated in the previous letter, Coventry 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 followOn 09/12/2014, a regional Health Insurance Marketplace Caseworker informed Coventry of the following:Regional offices [CMS] nor Issuers [Coventry Health Care] are involved in the appeals processOnce the consumer files an appeal with the Marketplace, the Marketplace will respond within days with next stepsThe appeals process and appeals determination is solely between the consumer and the MarketplaceThe determination on whether *** *** will receive a refund is processed through the MarketplaceThe Marketplace Appeals process is still ongoing in this caseNo further action is required or allowed by CoventryIf you have any questions, please contact the Customer Service Department at ***.Sincerely,Appeals Department

face="Calibri">Dear
*** ***,
Please
see our response to complaint #*** for *** ***
that was received by us on January 15,
In
researching *** ***’s complaint, it was noted that the application we had
received for her policy did request a November 1, 2015, effective date. When the application was first received and
reviewed, it was determined that additional supporting documentation needed to
be provided to activate the policy. The
supporting documentation needed was proof of a qualifying event that would
allow for a midyear effective date.
Proof of termination of other insurance coverage was received in
December and the policy was activated at that time, retroactive to November 1,
2015. When the policy was activated, the
November premium was drafted.
We made a request with our Underwriting department to change the effective date of the policy to December 1, 2015. The request was granted. This allows the premium that she paid for the month of November to be credited back to her. Rather than issue a refund, we will apply the credit towards her February premium which will reduce the amount she has to pay for that month
Ms
Erb’s premium increased as of January 1, 2016, since all individual policies
are subject to be re-rated the first of every year. A notice was sent to *** *** regarding the
increase but due to the short turnaround time in between the activation of the
policy and the end of the year, she may not have received the notice in time to
read it and become aware of the change.
A letter was also sent advising her that the next premium withdrawal
would be for an increased amount in order to collect the premium for December
and the higher amount for January.
Again, with the shortened timeframes, she most likely would not have
received the adjusted premium withdrawal notice in time to deposit the required
funds into her account or cancel the scheduled withdrawal
Finally,
in order to determine if we will issue reimbursement of any overdraft fees,
Coventry requires bank statements supporting the amount of the fees. We spoke with *** *** over the phone and
requested those bank statements. They
have been received and will be forwarded to the appropriate area for
review. We will notify her directly of
the outcome of that review.
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 ***@***.comRegards,
Chris
B***
Complaints
and Appeals Consultant

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: Insurance cancellation for the end of October However, the business is still billing me for a November premium, and is trying to get late charges as I wouldn't pay a premium on a canceled policyTherefore, the business needs to accept that the policy has been canceled.
Regards,
*** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
This company has not reinstated my policy and if they did , I would only owe JulyAt this point I am requesting my payment of $be refundedI'm no longer interested in being serviced by Coventry
Regards,
*** **

Dear *** ***,
Please see our response to complaint #*** for *** *** that was received by us on June 11,
During our review, it was determined that in order for *** ***’s policy to be terminated, we would need to receive a termination file from the MarketplaceA complaint would need to be filed to the Marketplace in order for the policy to be retroactively terminatedThe member’s billing cannot be adjusted until the termination file is received from the Marketplace
We contacted *** *** in order to have a conference call with the Marketplace to request a retroactive termination on April 28, In the conference call, the Marketplace representative stated there was an escalated complaint already submitted for this member on April 22, However, there was currently no identification number assigned to the complaint as of yet
The Marketplace representative advised *** *** that it may take up to days to process this termination request and that he could follow up with the Marketplace to verify the statusI have attempted to contact *** *** several times to set up a conference call with him and the Marketplace to follow up on the status of his complaint but have been unsuccessfulI would like to advise that we are unable to speak to the Marketplace on his behalf, as we are not authorized to do so*** *** can contact the Marketplace himself at ###-###-#### to follow up on the status of his complaintOnce we receive the termination file from the Marketplace, we will be able to process *** ***’s request
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 ***@***.com
Regards,
Julian C***
Executive Resolution Team

Dear
Ms***,
Please see our response to complaint #*** for *** *** that was received by us on January 13,
During our review, we did find that the pre-existing condition exclusion was explained to Ms*** during a phone call she had placed to Coventry on January 21, 2014. We also noted that the certificate of coverage for Ms***’s policy outlines the pre-existing condition exclusion on page 10. I have included the relevant section below and have also attached the entire document to this response
There is no coverage for Covered Services to treat a Pre-existing Condition or Medical Conditions arising from a Pre-existing Condition until twelve (12) months has lapsed from the Member’s Enrollment DateThis Pre-existing Condition exclusionary period shall be reduced by the number of months for which you present proof of Creditable CoverageThis Pre-Existing Condition exclusionary period begins on the first day of the Waiting Period for Initial Enrollees or the Member’s Effective Date of coverage for Special and Annual EnrollmentsThis limitation also applies to any prescription drug that is prescribed in connection with a Pre-existing Condition
While Ms*** had sent a document to attempt to show that she had creditable coverage, it was determined that the previous plan she carried was a Discount Medical Plan Organization (DMPO). Unfortunately, a DMPO is not considered creditable coverage and can not be used to waive any part of the pre-existing condition period. Referrals from primary care physicians are also not able to be used to waive the pre-existing condition exclusion
The Affordable Care Act no longer allows insurance policies to contain pre-existing condition exclusion clauses as of January 1, 2014. However, plans already in effect on that date were allowed to keep the exclusions until their next contract renewal date. Ms***’s employer had begun their contract with Coventry on June 1, 2013. This means the clause would have continued to apply until June 1, 2014, if her coverage had not ended on February 28,
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at ***
Regards,
Chris B***
Executive Resolution Team