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Coventry Health Care, Inc.

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Coventry Health Care, Inc. Reviews (639)

October 2, 2014Dear [redacted]:Your letter of September 24, 2014 to Coventry Health Care of Nebraska, Inc. (Coventry) was received in our office, and referred to my attention for review and response. **. and [redacted] are on Qualified High Deductible Health Plan Preferred Provider...

Organization (QHDHP PPO) policy with an April 1, 2014 effective date through [redacted]’s employer.In his complaint to the Revdex.com, [redacted] expressed concern with the request to switch his prescription medication, [redacted] also expressed concern that [redacted] would have to switch her prescription eye drops, [redacted].Policy LanguageSection 2: Benefit Information2.1 The following rules apply to Prescription Orders and Refills:2.7 Prior Authorization Requirements Regardless of where a Prescription Order or Refill is filled, some drugs require Prior Authorization or Step Therapy in order for them to be Covered. These include, but are not limited to, medications that require special medical tests before use, that are not recommended as a first-line treatment, or that have a potential misuse or abuse. Prescription Drugs requiring Prior Authorization are identified within the Formulary with “PA" next to the name of the drug. Prescription Drugs requiring Step Therapy are identified within the Formulary with "ST" next to the name of the drug.Section 5: Definitions5.19 Prior Authorization A process where the Health Plan or its designee determines, prior to dispensing, that a Prescription Order or Refill, otherwise Covered under this Rider, has been reviewed and, based upon information provided by the Prescribing Provider, the Prescription Order or Refill satisfies the requirements for Coverage. Please see 2.7 of the Benefit Information Section for more information.5.23 Step Therapy Step Therapy is an automated form of Prior Authorization based on previous pharmaceutical treatment where a trial of an alternative medication is required prior to Coverage. Please see 2.7 of the Benefit Information Section for more information.[redacted]’s provider submitted a pre-authorization request to Coventry for prescription medication [redacted] on July 17, 2014. Coventry approved the request effective July 17, 2014 to July 17, 2017. [redacted] and his provider were notified of the approval on July 17, 2014.**s. Stack’s pre-authorization request for [redacted] was denied due to Step Therapy requirements for the medication. Step Therapy requires [redacted] to try two therapeutically equivalent prescription eye drops, Xalatan (latanoprost) and Travatan Z (travoprost). Once complete, **s. Stack’s provider can submit to Coventry a request for prior authorization indicating [redacted] tried and failed the two therapy agents listed above. If prior authorization is not requested, but [redacted] meets the step therapy pre- requisites, the claim submission for [redacted] will process systematically and no other action will be required by [redacted] or her provider.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted]Sincerely,Shawn M. Complaint and Appeal Analyst

October 23, 2014Dear [redacted]:
Your letter of October 22, 2014 to Coventry Health Care of Virginia, Inc. (“Coventry Health Care”) was referred to my attention for review and response.
In her objection submitted to the Revdex.com, [redacted] voiced displeasure with Coventry’s response to her complaint. [redacted] advised that she received the same response as before.
Providers are responsible for coding their claims correctly in order to receive reimbursement for services rendered. The [redacted] submitted an obsolete diagnosis code of [redacted] on claims for [redacted]. The appropriate diagnosis code is [redacted]’s letter dated September 12, 2014 advised [redacted] that her claim for October 29, 2013 in the amount of $3,700.00 would be processed as a one time exception. Claim number [redacted] processed according to [redacted]’s policy benefits on September 17, 2014 with $475.52 applied to her deductible, $503.51 applied to her coinsurance, and $1,546.13 applied to the amount above the allowable charge.
The [redacted] was reimbursed $1,174.84 with check number [redacted]. The Explanation of Benefits (EOB) detailing this information is dated September 25, 2014. [redacted] may contact the Customer Service Department to request a copy.If you have any questions, please contact the Customer Service Department at ###-###-####.
Sincerely,
Shawn M
Complaint and Appeal Analyst

September 26, 2014
Dear [redacted]:Your letter of September 18, 2014 to Coventry Health Care of Virginia, Inc. ("Coventry Health Care") was referred to my attention for review and response.
[redacted] objected to Coventry's original response regarding the cancellation of her policy and the August premium she was charged, Coventry addresses these concerns below.
It was identified Coventry issued an incorrect date on [redacted]'s Certificate of Creditable Coverage (CoCC). However, Coventry will honor the incorrect date and [redacted] will be issued a pro-rated refund of the August 2014 premium.
Based on the additional documentation Coventry has retroactively terminated [redacted]'s policy effective August 4, 2014. Please be advised [redacted] will be without medical insurance August 5, 2014 through August 31, 2014.Coventry apologizes for any inconvenience this has caused [redacted].
If you have any questions, please contact the Customer Service Department at ###-###-####.
Sincerely,
Teresa EComplaint and Appeal Program

[redacted],
Hi Hope this is the closing letter about my past relation with Coventry.I believe that the lack of evidence if my second monthly  payment does not constitute other than payment was done by other means.
I regret that coventry never informed me until the last letter on june 22 2015, that such "missing" payment was the reason of all the misunderstanding and the great loss of time for both parties.
Sincerly,
[redacted]
P.S. ENCLOSED ARE COPIES OF BANK STATEMENT OF ALL PAYMENTS MADE ON 2014 and 2015

[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:
As today ( Wednesday February 5th, 2014) we have not received the insurance package or ID cards. We received an statement date January 21st, 2014 and the statement does not contain an ID number. We received a letter last week with the ID # for the policy but without the proper ID cards we have not been able to use the coverage. Prescriptions for my wife and regular visit for my son has been denied.
Why should we pay coverage for January if we were not covered? payment should be applied for February, but only if we receive the required docs and cards and we can have coverage for February 2014. Right now we are still the same a Jan 2014, no coverage, no ID cards.
Regards,
[redacted]

[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:
Regards,
[redacted]

Hello,
Thank you for your inquiry, regarding complaint #[redacted]
for [redacted]. 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
see how we could obtain the member’s receipt and process the reimbursement. We
were able to locate the reimbursement request and were able to have it
processed for the reimbursement. The check was mailed to the member’s home
address yesterday, February 17, 2016. We apologize for providing the incorrect
form in the original response. If the member has any further questions or
concerns there will be contact information provided with the check
reimbursement or he can contact the email address listed below.
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.
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

October 31, 2014Dear [redacted]:Your letter of October 29, 2014 to Coventry Health and Life Insurance Company (CHL) HealthAmerica was received in our office, and referred to my attention for review and response.In his objection submitted to the Revdex.com, [redacted] questioned the monthly premium rate assigned to his policy. Additionally, [redacted] advised that he does not want any further investigation into his policy. [redacted]’s policy terminated with CHL on August 31, 2014.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

Hello,
Thank you for your inquiry, regarding complaint #[redacted] for [redacted]. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
Upon receipt of the rejection we verified that we had the claims [redacted] is requesting we reprocess were completed today May 28, 2015. Please allow 24 hours to reflect this change for your explanation of benefits online. The member is now responsible for a $250 copay.
In regards to the termination letter request, as stated in our previous response this is going to come from the Marketplace, not Coventry. Once we have on file, from the Marketplace, that this policy was terminated per the member's request, we will then be able to send a confirmation letter reflecting that a termination was made per the your request instead of for non-payment. [redacted] needs to contact the Marketplace at ###-###-#### to cancel her policy. We as Coventry do not have the authority to cancel a policy that was purchased through the Marketplace.
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].
 
Thank you,
Ashley S.
Complaint and Appeal Consultant
Executive Resolution Team

September 29, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s refund. Please find below the requested information.
Our record indicates that [redacted]’s coverage became effective on April 26, 2014, and terminated...

on July 2, 2014. The plan initially received a file from the Marketplace on June 3, 2014, to initiate the policy for April 26, 2014, effective date. Another file was also received on June 3, 2014, to change the APTC (Advanced Premium Tax Credit) amount to $7.00, leaving the new premium to be $643.33 effective May 1, 2014. On June 17, 2014, a file was received from the Marketplace to terminate the policy effective July 2, 2014.[redacted] will not be able to get a refund unless his termination and/or effective date is changed. [redacted] must contact the health insurance Marketplace in order to discuss the issue with the termination/effective date. Only the Marketplace can alter the termination and/or effective date. With the termination and effective date as is, [redacted] would actually owe $792.06 to be paid through for July 2, 2014. This is because $107.22 is being charged for the coverage from April 26, 2014, through April 30, 2014; $643.33 for May; $643.33 for June; and $41.51 for coverage from July 1, 2014 – July 2, 2014. This equals a total amount billed of $1435.39. [redacted]’s total amount due is $792 because he made a payment of $643.33 on June 16, 2014. If [redacted] is able to change the termination and/or effective date, then the billing will have to be changed to reflect that. [redacted] will need to contact the healthcare marketplace at ###-###-#### if he is not satisfied with the termination and effective dates. Please be advised that Coventry does not have access to change termination and effective dates.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.Sincerely,Tracy T
Complaint and Appeal Analyst

February 27, 2014
Dear **. [redacted]:
The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.
[redacted] has filed a complaint on behalf of her spouse, [redacted] (the “member”). The Member’s complaint concerns premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $737.41
Upon further review, the member’s contract will terminate effective December 31, 2013. The payments have been “ returned” by the bank to the member’s bank account. Also, a request to refund the $40 in bank fees that may have occurred during the process has been submitted.
If you have any questions or concerns regarding this matter I can be reached at ###-###-####.
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: I did not receive a notice telling me, once I paid my account current, mymedication would not be available to me. If I had known, I would have paid my payments in advance. Furthermore, they need to send out notifications to all clients apprising this of the situation of a "RED FLAG"  I personally have never heard of it. Thank God my Pharmacist had a benevolent spirit, otherwise there is no telling what might have happened.  So the resolution is to make all of their clients aware that if they are late making a payment, a "RED FLAG" will be placed on their accounts,which in turn will delay for up to a week their ability to receive critical care or critical medication.Or is this done to only a select few?
Sincerely,[redacted]

July 28, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding payment issues for her policy.
Research into this...

matter revealed that payments were received by the company from this member; however, the payments were not being posted to her account. Instead, the payments were going to the company’s Escrow (or holding) account. Generally this can happen for a number of reasons. For example, if the member does not put a billing case number on the bottom left hand corner of the check and does not send the check with the remittance slip attached to the bill, the payment will go to the Escrow account to be manually researched and applied to the proper policy which can take an extended amount of time. With online bill pay (which apparently this member is using) this happens frequently because the member fills out the payee information online, and then the bank actually cuts a physical check and sends it to the desired destination. If the member does not put the “Account Number” online as their billing case number, the bank will not send the check with the case number on it, which is crucial. Even if the member does fill in the billing case number for the account number on the online bill pay, the bank (depending on how they operate) may print the check without the account number, or they may print it in another place that our computer systems do not detect. This is most often the cause of the delay in posting the payments. After reviewing the copy of a check that the member sent in, the member ID number was being used for the Account Number and that will send the check to the Escrow account.In this case, we have made an exception to reinstate the case as if the checks were posting timely by not going to escrow, so that the member would have never been terminated. We have four payments that have now posted to the policy, and one that we received after the policy had terminated so it has not posted yet. We have sent a request to have that payment posted as soon as possible so there will be a total of five checks on file. This will pay the member through June. If there is any more payments that the member feels should have posted to the account, if she will send the front and back copy of the check in question, we can post the funds. The member needs to keep in mind that the August payment is due on July 31, 2014. Loni Campbell from our customer service department has attempted to contact the member to review the above and to ensure that the member stays current with the upcoming payment. Ms. Campbell left a detailed message for the member who is urged to return Ms. Campbell’s call if she has not already done so.
Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted]Very truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

[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]

Dear...

[redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on February 13, 2015.
During our investigation of the complaint, it was determined that [redacted] was given the wrong information by Wanda on the phone call on January 29, 2014.  Due to this, we had offered to reinstate [redacted]’s policy.  A phone call was placed to [redacted] on February 16, 2015 to make payment arrangements but was not answered.  A voice mail was left with contact information for the Billing and Enrollment representative that had placed the call.
Upon noting that Coventry had not received any premium payment from [redacted], we called and spoke with her on February 23, 2015.  At that time, she stated that she no longer wished to proceed with the reinstatement.  We will provide this information to our Billing and Enrollment department who will make the appropriate updates to our system. 
We have also forwarded the information contained in the complaint to the appropriate area to address the service issues that [redacted] had reported.  While the outcome of the review will be kept internal, the matter will be thoroughly researched and steps will be taken to remedy any problems that are found.  
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

face="Calibri">Dear [redacted],
Please see our response to complaint #[redacted] for [redacted] that was received by us on April 22, 2015.
During our review, it was determined that in order for [redacted]’s policy to be terminated, we would need to receive a termination file from the Market Place. A complaint would need to be filed to the Market Place in order for the policy to be retroactively terminated. The member’s billing cannot be adjusted until the termination file is received from the Market Place.
We contacted [redacted] in order to have a conference call with the Market Place to request a retroactive termination. In the conference call, the Market Place representative stated there was an escalated complaint already submitted for this member on April 22, 2015. However, there was currently no identification number assigned to the complaint as of yet.
The Market Place representative advised [redacted] that it may take up to 30 days to process this termination request and that he could follow up with the Market Place to verify the status. Once we receive the termination file from the Market Place, we will be able to process [redacted]’s 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

August 20, 2014
Dear Sir of Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding termination of her policy for non-payment.
We have...

researched [redacted]'s complaint and our records indicate that the member was set up on the “Paper billing” method. This means [redacted] would have been sent a paper bill in the mail with instructions on how to send the payment. It appears that she had not been on an automatic billing method at any point in the policy. In order to be set up on auto payment, [redacted] would have needed to sign and return an auto withdrawal form that authorized Coventry to take the payment monthly. Also, the [redacted] could have set up automatic payment online at the member website (member.cvty.com). This is why Coventry never automatically withdrew from [redacted]’s account. On January 1, 2014 [redacted] was mailed an initial payment letter indicating that her payment was due. On March 9, 2014 she was mailed a past due letter. [redacted] did not respond to either letter.[redacted] has a new policy. This policy is effective 07/01/2014 for a $0.00 premium on the Silver Integrated $10 Copay PPC plan. Due to the other policy being terminated for January 31, 2014, there will be no coverage for [redacted] from February 1st to June 30th. The older policy cannot be reinstated to cover for the lapse of coverage as it was terminated for nonpayment. After further research it was concluded there was no error on the behalf of Coventry as the proper documentation was sent to [redacted] reminding her of the payment that was due.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter, If you have any further questions or concerns, please feel free to contact me at ###-###-####. My fax number is [redacted], and my e-mail address is [redacted].Very truly yours,Kimberly S RN, BSN,  CPC
Health Services Manager, Appeals

Thank you for allowing us to address the concerns reported in complaint #[redacted] for [redacted]...

[redacted] that was received by us on 11/10/2014 and was regarding cancellation of her 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. Our records do not show that we received a verbal request from the member to end her coverage in September 2014. We do show that the member had called us on October 7, 2014 and was informed at that time that her request must be sent in writing. We received the member’s written request to cancel her policy effective November 4, 2014.  The request was dated October 10, 2014. Since policies are terminated at the end of the month and the member indicated that she had employer coverage effective November 1, 2014, the coverage has been terminated effective October 31, 2014.
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.
 
Regards,
Chris B[redacted]
Executive Resolution Team

Dear [redacted],
Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on April 27, 2015.
[redacted] requested a refund for this policy. During our review, it was determined that no refund is owed to [redacted] for her policy. This policy was paid for by [redacted]’s employer. We do not take funds from the members pay check. The employer deducts from the member’s pay and submits funds on her behalf. For any reimbursements, [redacted] will have to contact her previous employer. In addition, we cannot change the non-payment status because [redacted] did not call or send a termination request before December 31, 2014, which was the cut off day for the December 31, 2014, termination date.
I apologize for the 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 you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted].
Sincerely,
Julian C[redacted]
Executive Resolution Team

May 1, 2014Dear **. [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s complaint.**. [redacted] is currently enrolled with the Health Plan’s SILVER $10 HMO #2 CLK, effective March 1, 2014. Please be advised of the following...

call history for **. [redacted]:TIME LINE:•    3/10/2014 @ 1:23pm    **.    [redacted] contacted the Health Plan regarding changing his address and requested to speak with a Supervisor.•    3/21/2014 @ 8:37am    **. [redacted] contacted the Health Plan regarding how to create an online account with the Health Plan.•    4/8/2014 @ 1:51pm    **.    [redacted] contacted the Health Plan to change his mailing address and to find a PCP in zip code [redacted] who has over 10 years experience.•    4/14/2014 @ 9:07am    **.    [redacted] emailed the Health Plan to request his PCP be changed to a provider in zip code [redacted] or [redacted].•    4/22/2014 @ 9:47am    The Health Plan received **. [redacted]’s complaint that was filed on April 18, 2014 at 1:29pm with Revdex.com.•    4/29/2014 @ 11:01am    **. [redacted] emailed the Health Plan with a complaint of dissatisfaction.In an effort to assist **. [redacted] with his complaint, the Health Plan has made several attempts to reach **. [redacted] for clarification/additional information on this correspondence. We attempted to reach **. [redacted] on the following dates and times:•    1st attempt - [redacted], [redacted] on 4/22/2014 at 11:34am called **. [redacted] via phone    ###-###-#### and left a voicemail message with call back name and contact number    ###-###-####.•    2nd attempt- [redacted], [redacted] on 4/24/2014 at 12:35pm called **. [redacted] via phone  ###-###-#### and left a voicemail message with call back name and contact number    ###-###-####.•    3rd attempt- [redacted], [redacted] on 4/30/2014 at 2:21pm called **. [redacted] via phone ###-###-#### and left a voicemail message with call back name and contact number ###-###-####.At this time, we will await **. [redacted]’s return telephone call in order to be able to assist him as he has requested.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. My fax number is ###-###-####, and my e-mail address is [redacted].Sincerely,

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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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