Coventry Health Care

"Times New Roman";">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] and [redacted] that was received by us on January 19, In reviewing the policy for **and [redacted] , it was found that it did become effective December 1, 2015, with a premium of $owed for the month of December The policy had been applied for through the Federal Health Insurance Marketplace On December 20, 2015, an enrollment file was received from the Marketplace with a new premium amount of $starting January 1, Coventry is required to charge the amount sent to us in the enrollment files by the Marketplace It is the Marketplace’s responsibility to notify people who have applied through them of premium amount changes Any dispute on the amount collected for January would need to be taken to the Marketplace It was noted that we received an enrollment file from the Marketplace advising that the policy should be terminated with the last day of coverage being February 1, As our system does not have the capability of accepting only prorated amounts, we will seek to collect the entire premium for February which was $833.42, due to separate files received on January 5, 2016, that lowered the premium from the $owed for January If the premium is paid for all of February, a refund would then be issued for the days past February 1, 2016, for which the policy would no longer be active Otherwise, **and [redacted] can contact the Marketplace to request that the policy be terminated January 31, 2016, instead of February 1, We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **and [redacted] ’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] @***.com Regards, Chris B [redacted] Complaints and Appeals Consultant Executive Resolution Team

Dear Ms [redacted] , Please see our response to complaint # [redacted] that was submitted by [redacted] on behalf of her son [redacted] and was received by us on March 13, During our investigation, it was determined that Mr [redacted] ’s policy has been terminated as of March 31, All premiums have been paid for the months of active coverage Coventry will not attempt to perform further premium withdrawals from Ms [redacted] ’s bank account 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

October 10, 2014Dear [redacted] : This letter is in response to the aforementioned Case Number [redacted] regarding [redacted] ’s complaint.After review of this complaint, the Health Plan has confirmed that [redacted] is not currently enrolled with the Health Plan’s PREM 25/$PPO effective June 1, to May 31, [redacted] is currently enrolled with the Health Plan’s BRONZE $HMO PD PLAN effective June 1, 2014.On September 11, 2013, the Health Plan sent [redacted] a letter (enclosed) advising that the Affordable Care Act (ACA) would begin in January 1, With the launch of federal and state exchanges, also known as marketplace, the Health Plan offered [redacted] the option to keep the benefits he has todayThis would allow [redacted] to start a new policy, with the same benefits he currently had, which would have become effective December 1, This new policy would have replaced [redacted] ’s current plan with the new Health Plan, and would remain in force until December 31, Enclosed with this letter was a “New Policy Confirmation Form” that he could sign and returnAs indicated in the letter, if [redacted] had any questions about this new policy, he could have called us at ###-###-####Our team of experts is available from a.mto p.m., Eastern Time.In addition, on March 28, the Health Plan sent [redacted] a Migration letter (enclosed) advising that his plan design(s) would not change until his policy period ended on May 31, At that time he would need to have a new plan in place so he did not have a gap in health coverageWhen his policy ended, he would have three (3) optionsHowever, when the Health Plan did not receive back either form, [redacted] was auto-enrolled onto a new ACA plan, option Option states:OPTION - Allow us to automatically move you to a plan that based on your current coverage may meet your needs, and also meets all of the ACA requirementsIf we do not hear from you or you do not take any action, we will enroll you into our Bronze $Copay HMO PD, effective June 1, At this time no plan changes can be made without a qualifying eventThe premium for this plan is $per monthVisit http://www.coventryhealthcare.com/flto view the Summary of Benefits and Coverage for this planYou can call ###-###-#### to obtain a Certificate of Coverage and/or a Schedule of BenefitsFurther, on July 8, 2014, the Health Plan received a complaint from the Department of Financial Services regarding the same issue from [redacted] On July 10, 2014, the Health Plan addressed [redacted] ’s complaint with the Department of Financial ServicesWe have not received any additional phone calls or request for additional information to date.Coventry Health Care hopes this explanation provides the necessary information to complete the investigation of this matterIf you have any additional questions, please contact me directly at ###-###-####, Monday through Friday from 8:am until 5:pm.Sincerely, Siana L Senior Complaint and Appeal Analyst Grievance and Appeals Department

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on July 16, It was determined that the delay in the enrollment for [redacted] ’s daughter’s policy was due to a document that had been requested that was needed in order to confirm her eligibility Upon receipt, the document was reviewed by our Underwriting department and the policy was created We noted that two payments were collected from [redacted] One was authorized through the application process and the other was scheduled on to a phone call to our Billing and Enrollment department The agent who she spoke with should not have scheduled the second payment and has been educated on the proper processes A refund check has been mailed to [redacted] for $ She will be responsible for the August premium once it becomes due if she wishes to continue the coverage A recording of the phone call with the supervisor that [redacted] spoke to could not be located so regrettably we are not able to determine the content of the call However, the person that she spoke with will be provided with coaching to ensure that high quality service is always provided Finally, we were able to speak with the doctor’s office that treated [redacted] ’s daughter We gave them the policy information and the instructions for claim submission The claim was received and processed on July 17, A payment was made to the provider on July 21, At this time, the claim is showing that the only member responsibility is a $copayment Any additional amount [redacted] paid to the doctor’s office will need to be refunded to her or issued as a credit on her account with them 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, Chris B [redacted] Executive Resolution Team

--------- Forwarded message ----------From: # F*, Deborah < [redacted] >Date: Fri, Aug 15, at 8:AMSubject: Complaint # [redacted] To: " [redacted] > Dear [redacted] : Coventry Health Care respectfully requests that the attached response be entered into the record regarding the Complaint filed by [redacted] in order to accurately reflect the current status of this matter If you have any questions, please do not hesitate to contact me Thank you, Debbie Deborah [redacted] F* Paralegal Aetna – Law and Regulatory Affairs

[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: [redacted] I am rejecting this response because: I'm rejecting this answer because: Coventry raised their rates, being an insurance for people with very limited resources,the Withdrawn amount from my account, is the salary of a week and a half of work.I paid for the month of January according to this subject, two companies: Coventry and [redacted] .I think I must have a reimburse from Coventry,since I had another insurance company [redacted] ,with rates according Obama care Policy Regards, [redacted] ***

October 2, 2014Dear [redacted] :Your letter of September 24, 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, 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] [redacted] also expressed concern that [redacted] would have to switch her prescription eye drops, [redacted] .Policy LanguageSection 2: Benefit InformationThe following rules apply to Prescription Orders and Refills: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 CoveredThese 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 abusePrescription Drugs requiring Prior Authorization are identified within the Formulary with “PA" next to the name of the drugPrescription Drugs requiring Step Therapy are identified within the Formulary with "ST" next to the name of the drug.Section 5: DefinitionsPrior 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 CoveragePlease see of the Benefit Information Section for more informationStep 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 CoveragePlease see 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, Coventry approved the request effective July 17, to July 17, [redacted] and his provider were notified of the approval on July 17, 2014.**sStack’s pre-authorization request for [redacted] was denied due to Step Therapy requirements for the medicationStep Therapy requires [redacted] to try two therapeutically equivalent prescription eye drops, Xalatan (latanoprost) and Travatan Z (travoprost)Once complete, **sStack’s provider can submit to Coventry a request for prior authorization indicating [redacted] tried and failed the two therapy agents listed aboveIf 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***Sincerely,Shawn MComplaint and Appeal Analyst

Dear [redacted] , Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on January 16, It may be possible for [redacted] to receive reimbursement for expenses that she paid for out of pocket Unfortunately, the Executive Resolution Team is not able to send reimbursements directly In order to review to determine what Coventry would have initially been responsible for, a claim must be filed If the provider of services is not in network with the plan, she may file it herself as a request for member reimbursement In order to properly process the claim, we will need the provider’s Tax Identification Number, the procedure codes for any services that were rendered, and the diagnosis codes that indicate what condition was being diagnosed or treated Most providers are willing to send statements reflecting this information even after an account has been sent to collections 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, Chris B [redacted] Executive Resolution Team

February 26, 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, 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 matterCHC Carolinas will respond directly to [redacted] .Please contact me if you have any further questions involving this issueI can be reached at ###-###-#### between the hours of 8:a.mand 5:p.mMonday through Friday.Sincerely,Stephanie [redacted] H***, LPN Manager, Complaint and Appeal Programs Coventry Health Care

October 31, 2014Dear [redacted] :Your letter of October 29, 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 enrollmentThe 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 affordableThe 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 MarketplaceThe 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 MarketplaceThe 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 $effective May 1, On July 26, 2014, Coventry was notified by the Marketplace that [redacted] ***’s premium would be $effective September 1, [redacted] was not eligible for the APTC until thenHowever, in order to keep his policy active, [redacted] needed to pay $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***.Sincerely,Shawn M.Complaint and Appeal Analyst

Thank you for the attempted phone call I am out of the country and unable to take phone calls at this time However, I have resolved the issue myself by signing up for another health insurance program, [redacted] Regards, [redacted] ***

Dear [redacted] , Thank you for allowing us to address the concerns reported in complaint # [redacted] for [redacted] that was received by us on December 15, 2014, regarding an incorrect premium being charged for her daughter’s policy Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you We are showing that an incorrect amount was being requested for the premium for the months of October, November, and December The amount being requested was $per month but should have been $ The system has been updated to reflect the correct premium amountsThe policy for [redacted] ***’s daughter is currently showing as terminated effective September 30, 2014, due to non-payment of the full premiums for October through December, but it is eligible for reinstatement The premiums for the months of September through December come to a total of $ At present, we have received one payment for that period in the amount of $In order to bring the policy current, a payment needs to be made in the amount of $ This is the amount of the premiums owed for those four months of coverage minus the amount we have already received We will waive the $NSF fee that was applied when the previous premium draft for $was rejected On December 22, 2014, we made an outbound call to [redacted] using the phone number we had on file to determine if she still wished to continue with the reinstatement Our call was not answered but a message was left with my name and contact information She is able to contact me directly at [redacted] with her decision Once a response is received, I will notify our Enrollment department to advise them on how to proceed 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] Regards, Chris B [redacted] Executive Resolution Team

Coventry Healthcare has been a nightmare to deal with I called them BEFORE I scheduled a doctor's appointment to confirm my costs and what they would cover After receiving additional bills from the doctor's office, I called Coventry customer service and was told that they would cover $I informed them that I had already spoke with a representative before I went to the doctor and they said they had NO record of my call Sorry! This is in the least, negligence but it seems from reading other complaints that this is a common practice

[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: [redacted] I am rejecting this response because: That is not correct at allI spoke with your Customer Service Supervisor Jenee on 3-30-I faxed over proof of payment from my previous company that was received on 3-30-This document shows that my previous employer had paid $1,for January and FebruaryJenee confirmed receipt of that document and sent over to billing again to apply funds to my accountAttached is a copy of the List Bill that was sent from Coventry to my previous employer where Coventry Confirmed payment (highlighted in blue)Coventry conveniently lost these records of the $1,that had been paid to them Jenee and I walked through each months balance due and what was paidAccording to her for December I owed $301.55, for January I owed $356.53, for February I owed $and finally for March I owed $Total amounts due $ My previous employer has paid $1,239.85, I paid $on 2/6/for the remainder due in February, I have also paid $on 3-2-15, and finally I have paid an additional $on 3-27-The payment for $was made after being threatened that Coventry would cancel my policy despite me knowing that I should not have a negative balanceThe total amount I have paid to Coventry is $2587.91, which is an over payment of exactly $Please review your Coventry Customer Service Notes to confirmJenee gave me reference number: [redacted] & [redacted] that should have all of this detailedShe also sent in a request to refund my overdue payment of $and said that it should be paid back within 5-business daysJenee said that my policy will be canceled as of 3-31-so I do not receive and additional charges Every single person I have spoke with at Coventry has had a completely different storyI have been given different information from every single customer service rep I have spoke withIts extremely difficult as a consumer to have consistent miss-informationThere is a reason Coventry is rated so poorly with the Revdex.comPlease confirm the conversation I had with Jenee via reference number [redacted] & [redacted] , that I am receiving my over payment of $and that my policy was cancelled as of 3-31-Regards, [redacted]

[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: [redacted] I am rejecting this response because: I finally spoke with [redacted] after I called and left several messagesShe is the young lady I spoke with beforeI told her that she never finished helping me the last time we were in contact because we never located a covered doctor [redacted] told me that the problem is not with my coverage, it's with a doctor that will prescribe me [redacted] I told her she was mistaken because I am already on [redacted] and I have been asking Coventry since day one (01-01-2014) to please help me find a provider that's in networkCoventry assured they would and once I was sign up and paid, nobody helped me My conversation with [redacted] ended with her saying there is no doctor in their network that prescribes [redacted] I told her I am extremely upset at having been strung along for 1/months, but at least I have an answerI need to file an official fraud complaint against Coventry because they gave me the wrong information in order to get me to sign upIt's misrepresenting the policy, it's fraud, and it's illegal I'm requesting the Revdex.com refer me to an agency where I can file a formal complaint against the insurance company for wasting my time and costing me hundreds of dollars in uncovered healthcare charges due to them not being up front and honest with meI'm EXTREMELY upsetThere really are no wordsThis has been a 1/month battle with them for nothingI was assured when signing up that my current medicine could be switched to one of their doctors Regards, [redacted]

I am rejecting this response because: Nature of Complaint: Customer Service Issues - Customer service failed to provide assistance Problem: I filed complaint # [redacted] previously, but the company failed to resolve the issue as promised, and has in the process created more issues that they refuse to resolveFirst, calling customer services is unreliableRepresentatives hang up on me when I use LucyPhone software to wait on hold for me, and this is unacceptably poor customer serviceThis was mentioned in the previous complaint and nothing was done to address itThe previous complaint was that my wife was not in the system, and ultimately she had no insurance card since January Now (months after the previous complaint was filed, and after I have repeatedly called customer service since then) she is apparently in the system, but she has yet to receive an insurance cardAlso, in the process of selecting a doctor for my wife ***, Coventry changed my Primary Care ProviderIn setting up an online account, I noticed that they had an incorrect address for my wife ***Although we are on the same account, my address is correct but hers is notThe site said to call the Healthcare Marketplace to change it, but the Marketplace assured me that they had the correct address because it was submitted with mineI called Coventry then, and they initially refused to change her addressFinally they promised they would, along with changing the doctorTwo weeks later I called back because neither had been changed, and it turned out they changed my doctor to the one I had requested my wife's be changed toI again requested that the address be corrected and explained who our doctors needed to beThey changed my wife's doctor finally, to the one I requested, but they still have not changed mine back to correct their mistake, and they still have not changed her address in the systemAt this point calling them again seems pointless because they agree to do what I request but fail to do itAlso, the previous complaint requested a refund for [redacted] since she was not put on the insurance as of January Coventry promised that they would look into this, but I have heard nothing about itThis is a subsidized insurance plan under the ACA, but my income is going up this year and I may lose the subsidyIf that occurs, I do not wish to have to reimburse the government on my taxes for months of healthcare which my wife DID NOT RECEIVEI expect a refund for the difference in cost between two people having insurance (what was paid to them) and one person having insurance (the service I received), from January to July 1, While the account was paid by the ACA, this refund should be sent directly to me as I will have to repay it on my tax return Desired Outcome: I want my doctor set to [redacted] as I had previously requested (times now!), and I want my wife's address set to the same as mine, [redacted] as I have requested twice nowI am also reiterating my request for the refund for ***'s portion of the premium, to apply from 1/to 7/1/ Regards, [redacted]

Complaint: [redacted] I am rejecting this response because: Billing or Collection Issues - The company has failed to correct billing errorsNOTE: This issue is regarding Coventry Health Care of the Carolinas (specifically NC) I have talked to countless people and spent countless hours on the phone getting lied to and redirectedThe fact of the matter is they changed my health insurance policy without telling meAlso, I called in to confirm whether or not they changed my health insurance policy and they said it was the sameAfter the change I went to the doctors and now I am left with a 1,doctor billEven though I pay for high end health insuranceI was them to pay for my doctors billI opened up a previous case # [redacted] that was closed without my consentPlease do not close this case until there is confirmation from meCoventry health insurance lies and they will lie to you that is why their Revdex.com is a D-Please help me get this resolvedI do not have $1,to pay for these doctors bills and this has gone on for too longDesired Outcome: I would like Coventry Health Insurance to pay for all of my doctors bills outside of the $co pay per visit I originally agreed uponThe only reason I am in this situation is because my health insurance department has lied and acted inappropriately to me as a customerI have spent countless hours with them over the phone and they continue to lie and cheat it's too muchI need a 3rd party to please helpPlease do not close this case without my consentThe last case I opened Coventry just lied about the situation and the case was closed Regards, [redacted]

May 22, Dear [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 BRZ $HMO PD CARELINK, effective May 1, In order for [redacted] to change his plan he will need to reach out to his agent of record, ** [redacted] located at [redacted] , FL *** [redacted] ’s phone number is ###-###-####.In an effort to assist [redacted] with his complaint, the Health Plan has reached out to ** [redacted] regarding [redacted] ***’s complaint.• st attempt - ***, [redacted] on 5/22/at 2:26pm called ** [redacted] at ###-###-####** [redacted] spoke to ** [redacted] ’s assistant [redacted] ** [redacted] advised [redacted] that [redacted] contacted the Revdex.com with concerns of his current policy [redacted] stated that she would contact ** [redacted] to contact [redacted] ***.• 2nd attempt- [redacted] contacted ** [redacted] regarding [redacted] ***’s policy** [redacted] advised [redacted] that she would need to contact the Billing and Enrollment department for additional options for [redacted] ***In regards to the wait time, with the unprecedented growth of membership with our Affordable Care Act (ACA) plans the wait time is a little bit longer than usually, but the plan is working diligently to rectify this issueCoventry 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 directly at ###-###-####, Monday through Friday from 8:am until 5:pmMy fax number is ###-###-####, and my e-mail address is [redacted] .Sincerely,

[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: [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 meIf I had known, I would have paid my payments in advanceFurthermore, they need to send out notifications to all clients apprising this of the situation of a "RED FLAG" I personally have never heard of itThank 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]

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 our Eligibility department to verify that the member’s coverage was active and we had the correct requested termination date on fileWe confirmed the member’s policy is still active and paid through the end of the monthThe Marketplace file we have received shows a future termination of September 30, We confirmed with our Claims and Benefits department the member has the ability to submit his claims until September 30, Please have the member re submit any claims they may have and reach out to the Claims and Benefits department at ###-###-#### for reimbursement for any out of pocket expenses We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] ’s concernsIf 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