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Coventry Health Care, Inc.

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Coventry Health Care, Inc. Reviews (639)

[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 called in November of before the 10th when the premium was sueI spoke to someone in enrollment that my premium would not be changing until the new year, they then sent me to a supervisor to confirm this and then to a marketplace representativeAll three of them stated to me my premium would not be changing until the new year and that the premium of $was for myself and my daughter.
When I called in January regarding the bill that was over $1,I was told that it was incorrect and I should not have been charged that and to give them 7-business days to reflect the changes, that the payment of $for November and December was correct and that I only owed $for January which I paid.
Then in February I called to cancel the policy and to see if the billing changes had taken effectI was told I was overcharged by several people on several different phone calls that this was the caseFrom April 2014-October I was told I would receive a refund for those paymentsI was then told that yes the premiums had changed for November and December but that they would deduct the amount due from the refund I was getting.
This company has been nothing but frustrating and inconvenient to work withThis is not the only issue I have had with them, hence the reason I terminated my policy.
Regards,
*** ***

Dear
*** ***,
Please see our response to complaint #*** for *** *** that was received by us on February 15,
It was noted that *** *** stated that he had actively acquired other health insurance that began January 1, 2015. His Coventry policy had passively renewed for 2015. In these situations we have been given the approval by the Centers for Medicare and Medicaid Services to terminate the passively renewed policy back to December 31, 2014. The termination process was completed on February 25,
We are not aware of any damage to *** ***’s credit rating by our attempts to collect the premium for the coverage for 2015. As the policy was paid through and it has been terminated back to December 31, 2014, *** *** no longer owes any money to Coventry for premiums. We were able to remove the $NSF fee that was applied when the payment we collected on December 31, 2014, was returned due to *** *** revoking the authorization for the draft with his bank.
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

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
Upon receipt of the complaint we asked Coventry to again verify if there is a tax credit that we have received from the MarketplaceWe were advised that we have not received a tax credit from the Marketplace, therefor you only had a grace period of days
If you feel this is incorrect please contact the Marketplace directly and verify this informationPlease have the Marketplace send this to Coventry in writing and we will reconsider the complaint
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
Executive Resolution Team

Dear ***
***,
Please see our response to complaint # *** for *** ** *** that was received by us on April 17,
During our review, it was determined that the member’s old plan should have been terminated effective December 31, 2014. On March 31, 2015, that policy was terminated effective December 31, 2014, and the funds of $were applied to new active plan on April 01, 2015, causing no refund to be due in the terminated plan. The funds were applied to the active plan on April 02, 2015, to cover the January, February and March premiumsBy that time, the member was due a refund of $On April 06, 2015, the member made a payment of $360.26. There is a refund due to the member of $
A refund of $has been requested for the overpayment on April 06, 2015. The member was never billed for January, February or March coverage when the new policy was reinstatedThis caused the bill to reflect the incorrect credit amountAs for the $additional funds the member is requesting, we are unable to approve this amount at this timeIf the member has any overdraft fees from her bank, we will be able to reimburse those feesIf there is proof of the $charge, the member can submit a copy of her bank statement showing this amount for reviewWe will confirm with our Billing department if this amount can be reimbursed
I apologize for the frustration and 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

July 8, 2014Dear *** ***:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter in response to your request dated June 25, and received at our office on June 26, This letter is in response to the
consumer complaint filed by *** *** *** regarding payment issues on her account.*** *** complains that although she has made payments, she has received non-payment letters and her account has been put on holdShe states that she checked with her bank and the bank shows that the checks have clearedAfter research, we were able to ascertain that *** *** was not providing the appropriate identifier on her payments which prevented the payment from posting correctlyDue to the payments posting late, the red flag was issued onto the policy*** *** is currently paid through 7/and the flag has been removedIn order to prevent these issues from occurring in the future, *** *** must provide her billing ID on all her payments*** ***’s billing ID is ***.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension My fax number is ###-###-####, and my e-mail address is ***Very truly yours,Neil M***, B.ARegulatory Compliance Analyst Coventry Health Care

July 9, 2014Dear *** ***:Coventry Health and Life Insurance Company (Coventry) received the above referenced consumer complaint in our office on July 01, We appreciate the opportunity to respond.*** ***, a CoventryOne member, has filed a complaint regarding a
termination.The file to terminate the policy was received from the Marketplace on 05/07/to terminate the policy as of 05/22/The file however, had an error on it that caused the change to never load into our systemsThis is why the policy stayed active.The file was processed manually so the policy is terminated as of 05/22/A refund has been requested for the excess funds that have been paid by the memberThat is $for the remaining days in May after the 22nd, $for June, and $for JulyThis is a total refund of $Because all of the payments were paid electronically, the refunds should be sent to the member as an electronic credit to their bank accountThis will take approximately 7-business days.We trust this information has addressed the issues raised in this complaint.Respectfully,Brandy H*** Appeals Department Coventry Health Care

Hi,
Yes, the hold on my coverage for prescriptions has been lifted, and for the first time this month, August, I received a corrected billHowever, all this that happened has caused me a great amount of inconvenience, stress (I developed a kind of eczema on my hands) and time (I'm self employed and I cannot count the hours I spent on the phone with Coventry!), with calls to the insurance every month, at least once, in order to have their mistake rectifiedIt took ONLY months for the bill to be corrected, and not before having this hold put on my coverage for almost three weeks, in which I could not get my prescriptions, for their own same mistakeAs I stated in my initial message to Revdex.com, I request to have the amount of my whole policy for the year reimbursed.
Best 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:
I have contacted Coventry One on multiple occasions, have provided copies of bank statements by email, fax, and standard mail on multiple occasions showing the amount of $total for over draft fees that have yet to be refunded by Coventry OneI have called at least once a month and spoken with members of Customer Service and been informed that I would receive the refund within - days each time I have spoken with someone, yet I have not received any form of a refundAt one point I was told that amount was being applied to my premiums, only to find out that my premium was not covered by this and my insurance was being red flagged, so I was unable to use my insurance for costly prescriptionsEach time I contacted Coventry One and each time I was given a run around about being able to use coverage and a refund either being applied or being mailed to me
As a result, I have had to spend much needed money on prescriptions of $- $every week for several weeksI have also had to take action further by going to the state of Illinois to report problems with insurance failing to cover bills that I was told would be covered, prescriptions not being covered, over drafts to my account, extra expenses carried by myself, and the aggravation of continuously being told refunds will be issued that have never been issued
All of this began the first week of March At that point I had only had coverage from Coventry One for one monthI have not had a good experience sinceI only get run around responses and clearly based on this letter from Coventry One, they accept no fault and do not seem to have the intention of reimbursing my expenses caused by their negligenceRegards,*** ***

face="Calibri">Dear *** ***,
Please see our response to complaint #*** for *** *** that was received by us on January 7,
We determined that *** ***’s reported issue required handling through our appeals process as it involved denied claimsOur Appeals department has performed their review and has upheld the denial of the claims. A letter was sent to MsM*** on January 15, 2015, advising of the full rationale behind the decision that was made and providing her with information on any additional options she may have for requesting further reconsideration of the denials. The letter contains Protected Health Information so we are unable to include it as an attachment to our response here.
It was noted that several of *** ***’s inquiries that were submitted through the Secure Messaging section of our My Online Services member portal did not have a direct reply sent. This was due to the messages being viewed as duplicates to other messages that were submitted or phone calls that were received. While these messages would not have affected the outcome of the situation, we do apologize for any frustration this caused herThe Customer Service representatives do appear to have responded to each unique inquiry.
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:
When I originally brought this matter to the attention of Coventry one they told me to have my physician call for a Coverage Review of the ***Dr*** *** did so on 11/25/2014 and Coventry One was adamant that they would not cover the drug because it is not on their FormularyThat was the only reason given to my doctor and to meI cannot reach anyone at Coventry One other than a general benefits customer service agent or supervisor and they cannot authorize the changeHow can I get person who wrote the response to my complaint to actually do something about my issue?
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 they did not address the issue at allThe problem is that I sent a payment that was never credited to my accountThey did not reference the actual complaint, let alone take time to address itWhoever wrote the reply is an it who should be fired from their jobRegards,*** ***

[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 Thank you
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 must say that CoventryOne does NOT take their customer complaints seriously It took months for me to get this issue resolved, and it wasn't until I involved the Revdex.com and the Missouri Department of Insurance that I was able to finally get it resolved I will never recommend this Insurance company to anyone
Regards,
*** ***

May 23, Dear ***:Thank you for giving Coventry Health Care of Georgia, Inc(Coventry) the opportunity to review your Revdex.com complaint regarding your request for a Magnetic Resonance Imaging (MRI) of the brainWe appreciate your feedback in regards to our
Customer Service process.*** *** ***, Inc(***) reviews certain radiology requests on behalf of CoventryOur records indicate, on 5/8/14, *** received a prior authorization request for an MRI of the brainBased on the clinical information provided, *** issued a medical necessity denial on 5/14/On 5/20/14, Dr***'s office provided additional clinical information and the MRI of the brain was approvedPlease see the attached approval letter.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,

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.The member didn't provide a statement that showed the amount of the feesHowever, 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 closedCoventry 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 ***@cvty.com
Very truly yours,Neil M., B.ARegulatory Compliance Analyst

-------- Forwarded message ----------From:
"">Revdex.com of Metro Washington DC Date: Mon, Sep 15, at 4:PMSubject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].To: [redacted]
---------- Forwarded message ----------
From: [redacted]
Date: Mon, Sep 15, at 11:AM
Subject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted]
To: [email protected],
I recently filed a complaint with a business, Coventry Health Care, IncThe business just responded to my complaint, and has resolved my issueTherefore, I no longer wish to proceed with the complaintThe number of the complaint is ID [redacted]. I greatly appreciate your help in this matter
Thank you,
[redacted]
###-###-####

"Times New Roman"">Dear
[redacted],
Please see our response to complaint
#[redacted] for [redacted] that was received by us on February 4,
Upon receiving the complaint, we noted
that our Billing and Enrollment department had already begun the process of
correcting the issue that led to [redacted]'s policy not activating after the
first month's premium payment was received.
Unfortunately, we were not able to meet the hour deadline he had
requested but the system has now been updated to show his policy active with an
effective date of February 1, 2016. We
have been in contact with [redacted] and advised him of this resolution.
We take customer complaints very
seriously and appreciate you taking the time to contact us and giving us the
opportunity to address [redacted]'s concerns. If there are any
additional questions regarding this particular matter, please contact the
Executive Resolution Team at [redacted]@[redacted].com
Regards,
Chris B[redacted]
Complaints and Appeals Consultant
Executive Resolution Team

Coventry Health Care requests an extension of time as we are simultaneously working with the DOI, and a response will be sent to both institutions upon completion of the investigation
">Thank you,
Deborah F[redacted]

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 G
Complaint and Appeal Consultant

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Description: Insurance Companies, Insurance - Dental, Health & Medical - General, Hospitalization, Medical & Surgical Plans

Address: 6705 Rockledge Drive, Suite 900, Bethesda, Maryland, United States, 20817

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