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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 response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
I was never informed by my employer or Coventry that I needed to call to "terminate" after my employer sent in the paperwork, until I received the notice in mid-January regarding the policy continuation. I contacted Coventry according to the paperwork I received to advise them I was not interested during the time frame given to me by said paperwork. This is documented in Coventry's call logs.
If the problem is with refunding the money directly to me as it was paid by my previous employer, then by all means, refund the entire year's worth of premiums to my employer, and I will contact them for the reimbursement. Please send advice of this payment to my previous employer via US Mail to my address.
It is of great concern to me that a company would promise a refund to their customer so many times, and advise it would be 7-10 days, and then going so far as to tell her the check had been sent, and then to go back on that promise when she complains that she has not seen the money promised.
Based on the comments on the Revdex.com site, this is not the first time this has happened to a customer of Coventry's. Please abide by the oral contract agreed to by a representative of Coventry and send the refund henceforth.
Regards,
[redacted]

Dear [redacted]...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on June 16, 2015.
We are unable to conduct our review with the information provided.  We could not locate the member’s record without a name or a policy number. In addition if, under applicable law, an executor, administrator or other person has authority to act on behalf of a deceased individual or of a deceased individual's estate, we are permitted to treat such authorized person as the personal representative of the deceased.  As such, [redacted] would need to submit the appropriate documentation to show she is legally authorized to act on behalf of her deceased mother before we can review her request.
I apologize for any difficulties this situation has caused [redacted]. 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].com.
Regards,
Julian C[redacted]
Executive Resolution Team

The original setup of the automatic billing process was done through the Marketplace at the time the insurance process was started, so unfortunately I have nothing to provide since it was all done online. 
 
Please let me know what else I can provide to you.
 
Thanks,
[redacted]

Dear Ms....

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 25, 2015.
We are showing that Mr. [redacted]’s policy through Coventry has been terminated effective 02/28/2015.  All premiums have been paid for his policy so nothing further is owed at this time.  Due to the billing statement process, it is possible that he will still receive a bill but any statements requesting that a premium payment be made to Coventry can be disregarded. 
The $5 paper billing fee has also been credited back to Mr. [redacted] in Coventry’s system.  We respectfully request that he allow 7-10 business days for the refund to be issued.  The refund will be made as a direct deposit to the bank account we have on file for him.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

[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]
 Complaint: [redacted]
I am rejecting this response because:
All I got from the letter forwarded from Coventry is a lot of double talk.  No where in her explanation does she say why I received a letter stating my cancellation date was August 4, 2014, or where my billing history shows coverage discontinued  for period 8/1/2014 and this was printed on 8/27/2014.  I do not think I should have to go to the Marketplace for this problem since the Marketplace is not the one that was debiting my bank account. You can spout your policies all you want, the fact remains I have paperwork showing you cancelled my policy August 4, 2014.  You sent these papers to me and I went the whole month thinking I didn't have this insurance.  That was your companies doing! When you saw that your "policy" would not allow this cancellation date, then someone should have sent me another letter letting me know or an e-mail.  If I was one of the millions of people that don't balance their checkbook, I would never have known that an unexpected $289.19 was gone from my account until I ended up with a returned check.  This is not right and I should not have to pay for poor management on Coventry's part! It's not right that an American citizen can so blatantly be robbed by an insurance company! This is fraud on the part of the insurance company and I guarantee I am not the only one that you have done this to. I am just the only one who didn't think it was useless to fight it.I still stand with what I have stated:  Coventry owes me my $ 289.19 refund and that is the only thing I will settle for!
Regards,
Cristy Henderson
Attached you will find copies of paperwork proving my account was cancelled as stated

Dear [redacted],
Thank you for allowing us to...

address the concerns reported in complaint #[redacted] for [redacted]d that was received by us on November 19, 2014, regarding issues with correcting the spelling of his name, our processing of the premium payments he has attempted to make, and the termination of his policy.  Our Executive Resolution Team researched your concerns and we would like to share the results of the review with you.
We reached out to our Enrollment department for assistance during our investigation. Our records show that we received a file with the corrected spelling of his name from the Marketplace, but they assigned a different case number than the case number assigned to his initial enrollment.  The new case number is [redacted]. The initial case number was [redacted].  The premium payments he sent to us were linked to the initial case number.  This caused us to be unable to activate the policy associated with his new case number.  We were also unable to accept the premium payments for the policy associated with the initial case number, due to that policy being terminated.  The policy associated with the new case number is eligible for reinstatement.  Upon reinstatement, after we apply the credits for all payments received to date, the policy would only be paid through September 30, 2014.  **. [redacted]d would then be responsible for making premium payments for October and November, to bring the policy current. 
I contacted **. [redacted]d by phone November 25, 2014, in order to determine if he wished to proceed with the reinstatement.  He stated he would like time to consider the offer and will call me with his decision November 26, 2014.  We respectfully request an extension of the due date to December 4, 2014, to allow us to process his decision and provide further response to the complaint.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **. [redacted]d’s concerns.  If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@aetna.com.
Regards,
Chris B[redacted]
Executive Resolution Team

Dear...

Ms. [redacted],
Please see our response to complaint #[redacted] for Chad [redacted] that was received by us on January 20, 2014.
We were unable to locate a phone call to Coventry on October 26, 2014, requesting termination of Mr. [redacted]’s policy.  As he had applied for his policy through the Marketplace, all termination requests must be made through them.  A request for termination was received from the Marketplace on January 22, 2015.  The date given to us for the termination to take effect was February 2, 2015. 
We are showing that the premium payment that was scheduled on January 18, 2015, in the amount of $591.06, was for Mr. [redacted]’s coverage for the months of January and February 2015.  This does represent an overpayment as he is no longer responsible for the full premium for February 2015.  He will receive a prorated refund in the amount of $274.42 for the 26 days in February for which he no longer has active coverage. At this time, no refund is due for the premiums collected for his coverage through February 2, 2015. 
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

Dear...

Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 28, 2015.
We have reviewed the documented call history for Ms. [redacted] and have been unable to locate any phone calls to Coventry of the nature she describes.  Coventry does train our customer service representatives to provide a high level of customer service.  While a supervisor is not always available to speak with immediately, the representatives are able to document complaints and forward them for review so speaking with a supervisor is not always necessary.  If a supervisor is not available, the representative would also normally offer to forward the information to the supervisor or transfer the caller to the supervisor’s voicemail.  The supervisor would then research the issue and make a call back when they are able.  
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted]’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Chris B[redacted]
Executive Resolution Team

Dear...

Ms. [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 30, 2015.
We reviewed Ms. [redacted] claim history in an attempt to determine which specific claims might have been causing the issue.  Several claims were located that had not been processed correctly including those from [redacted] and Dr. [redacted] that were mentioned in her message.
The issue stems from Ms. [redacted] being placed in a grace period status after we did not receive the monthly premium payments for her policy during part of 2014.  When first received, claims for members in the second or third month of the grace period are denied until the grace period expires or until the premium payments are made.  After receiving the payments that brought Ms. [redacted] account up to date, the claims were reprocessed but an error occurred that caused them to deny once again. 
We were able to have all the claims that were affected by the error reprocessed again on February 9, 2015.  New statements will be sent out that explain the processing of the claims and any amounts that Ms. [redacted] owes for deductibles or copays.  If she has questions regarding a specific claim, she may contact the Customer Service department for her plan at ###-###-####
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms. [redacted] concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
 
Regards,
Chris B[redacted]
Executive Resolution Team

October 31, 2014Dear [redacted]:Your letter of October 29, 2014 to Coventry Health Care of Iowa, Inc. (Coventry) was received in our office, and referred to my attention for review and response.In his objection submitted to the Revdex.com, [redacted] voiced displeasure with Coventry’s response to his complaint. [redacted] did not receive an Advance Premium Tax Credit (APTC) per the Marketplace during his initial enrollment. The APTC is a federal subsidy used to assist qualifying individuals and families obtain health insurance by reducing the monthly premium amount in order to make health insurance affordable. The amount of APTC an individual or family gets is based on the individual’s or family’s annual income compared to the Federal Poverty Level (FPL) and the cost of the second cheapest silver plan available to that individual or family through the Marketplace. The APTC is designed so that, if an individual or family is enrolled in the second cheapest silver plan, the premium would equal to a percent of annual income.Coventry is unable to process any changes to a policy initiated through the Marketplace. The Exchange rules and regulations that we and other insurance companies must follow stipulate we must follow the information provided to us by the Marketplace.The Marketplace sent an initial enrollment file to Coventry reporting that [redacted]’s monthly premium amount was $325.60 effective May 1, 2014. On July 26, 2014, Coventry was notified by the Marketplace that [redacted]’s premium would be $61.60 effective September 1, 2014. [redacted] was not eligible for the APTC until then. However, in order to keep his policy active, [redacted] needed to pay $325.60 for August. [redacted] may contact the Marketplace at ###-###-#### for additional assistance.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

October 15, 2014Dear [redacted]:Your letter of October 14, 2014 to Coventry Health Care of Nebraska, Inc. (Coventry) regarding the rejection by the above-referenced member to our previous response was received in our office and referred to my attention for review and response.On October 14, 2014, I contacted [redacted] per his request. After discussion, [redacted] decided that he will utilize his policy appeal rights. [redacted] will file an appeal regarding the denied authorization for [redacted] eye drops on [redacted]’s behalf. I will wait to receive information from [redacted] for the appeal.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

Dear [redacted],
Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted] that was received by us on November 10, 2014, regarding the amount of his monthly premium.  Our Executive Resolution Team researched your concerns and we would like to share the results of the review with you.
We reached out to our Enrollment department for assistance during our investigation. Our records show that $168.74 was the correct premium amount for the plan [redacted] was enrolled on beginning in May.  The premium increased from $116.20 on May 1, 2014, due to being moved to a different plan, because his previous plan was not compliant with the Affordable Care Act.  No record was found of a plan change request being made after that date.  We also spoke with Adrianna, the assistant for the member’s broker, Frederick E[redacted].  She stated that they never requested a plan change for the member because he did not experience a qualifying event that would allow a plan change in the middle of the year.
Letters were sent out June 11, 2014, July 10, 2014, and August 6,2014, but were sent due to the draft date not being on the usual date of the 5th of each month and were not related to a changing premium amount. 
The NSF fee that was applied was due to a failed premium withdrawal attempted by Coventry on September 9,2014.  The last premium we were able to successfully collect was drafted on August 19, 2014, and was for coverage for the month of August 2014.  A premium was not collected for September, so his policy was terminated effective August 31, 2014.  No refund is due as the NSF fee was legitimately applied, and the premiums collected were only for his months of active coverage.
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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].com.
Regards,
Chris B[redacted]
Executive Resolution Team

February 26, 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 his CoventryOne policy purchased on the Marketplace exchange effective January 1, 2014. The request was received by CHC Carolinas on February 26, 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 ###-###-#### between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.Sincerely,Stephanie * H[redacted], LPN Manager, Complaint and Appeal Programs Coventry Health Care

[redacted]
face="Calibri">Please see our response to complaint #[redacted] for [redacted] that was received by us on March 26, 2015.
During our review, it was determined that [redacted] policy was terminated January 31, 2015, after the January’s premium had already been deducted and caused the member’s account to still draft for the month of January . 
[redacted] will be issued an expedited refund in the amount of $693.02 due to the incorrectly collected premium.  The refund will be sent as a direct deposit to the bank account we have on file for him.  The expedited refund process takes 5-10 business days depending on the bank.
We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Regards,
Julian C[redacted]
Executive Resolution Team

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on January 23, 2015.
In reviewing [redacted]’s policy, it was noted that she had contacted Coventry’s Enrollment department to request the cancellation of her policy on January 2, 2015. The cancellation was processed the same day.  Unfortunately, on January 13, 2015, a separate representative reinstated her policy in error.  This caused us to attempt to draft the premium for her policy on January 14, 2015. 
On January 16, 2015, [redacted] called the Enrollment department to report the error.  They reentered the cancellation of her policy and immediately began the process to refund the amount we had attempted to draft from her account. We are showing that the refund was completed by Coventry on January 20, 2015.  The amount of $225.15 was deposited directly into the bank account we have on file.  The actual date displayed on bank statements for the deposit may vary by 1-5 business days depending on processing times required by her financial institution.
We also found a notification from January 29, 2014, stating that the initial premium draft from January 14, 2015, was rejected due to insufficient funds in the account to complete the transaction.  As the premium was never actually successfully withdrawn from her account, the previous refund of $225.15 should not have been issued and will need to be paid back to Coventry. 
Reimbursement of any overdraft fees that were applied is still possible.  In order to determine if any reimbursement can be sent, we will require a bank statement showing the rolling balance of her account , any overdraft fees that were applied, and the dates that any affected transactions occurred.  This information will be reviewed by our Enrollment Department, along with the circumstances that caused the situation, in making the determination on whether or not to pay the overdraft fees. 
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].
Regards,
Chris B[redacted]
Executive Resolution Team

November 10, 2014Thank you for your inquiry received on November 04, 2014, regarding complaint #[redacted] for [redacted] and his request for termination of his policy. Our Executive Resolution Team researched your concerns and I would like to share the results of the review with...

you.We reached out to our Enrollment department for assistance during our investigation. No letter was found requesting termination of the policy. Regardless, the member obtained his policy through the Marketplace so all termination requests must be made with the Marketplace. The member made three payments that covered May, June, and July 2014. The policy has now been terminated effective August 31, 2014, due to nonpayment of the premium. The member was allowed a 90 day grace period and when a payment was not received by the end of the grace period our Enrollment department processed the termination on October 31, 2014. Even though no payment was made for the month of August, the policy remained active for the first month of the grace period in accordance with the policy setup for the Marketplace members with subsidized premiums.The member did request to terminate through the Marketplace in November and a termination file was sent on November 03, 2014. This file had an effective date of termination of November 30, 2014. However, this file did not process as the policy was already being terminated for nonpayment.The phone number ###-###-#### is a valid number for reaching Coventry Enrollment representatives. We apologize that the member was not able to reach someone. We have shared the member's experience with the management team in our Customer Service department for improvement opportunities.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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@aetna.com.Sincerely,Christopher B Complaint and Appeals Consultant Executive Resolution Team

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.

January 24, 2014
Dear **. [redacted]:
This letter is in response to your request for Coventry Health Care of the [redacted], Inc. (“CHC [redacted]”) to respond to a complaint submitted by [redacted] regarding his CoventryOne policy effective January 1,...

2014. The request was received by CHC [redacted] on January 23, 2014.
CHC [redacted] does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing him in this matter. CHC [redacted] 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.
Sincerely,

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

[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 [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

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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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