Coventry Health Care

Dear Ms [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on January 8, We have determined that Mr [redacted] ’s policy was processed as an automatic renewal for A letter had been sent to him on September 26, explaining the automatic renewal process and advising him of his options At any time in between receiving the letter and the end of the year, he could have requested that we terminate his policy instead of proceeding with the automatic renewal Unfortunately, we did not receive a request from him until after January 5, 2015, which is the date we performed the draft from his bank for the premium Mr [redacted] is still able to submit proof of other insurance to request termination of his policy back to December 31, We received some documentation from him on January 9, 2015, but that documentation did not include the effective date of coverage for his policy with his new insurance carrier If he has any additional information to provide, it can be faxed to ###-###-#### He will also want to include the termination request form that he had sent previously to ensure timely processing We understand that there are drawbacks to performing the automatic renewals and policy changes for our members but there are benefits as well One benefit is that a person doesn’t lose their coverage entirely, which could result in large medical bills or having to pay for expensive medications out of pocket Obviously, one drawback is the issue that Mr [redacted] has experienced Coventry feels that the benefits outweigh the drawbacks and will continue to use our current process The communications that we send out to our members regarding the automatic renewal explain the options they have if they do not wish to accept the offer 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

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 the Coventry Billing and Premium department to verify that you were currently set up for EFT paymentsThey confirmed that you were set up on EFT and that it was an error inputting the member’s information in the system which caused a returned payment and the EFT to turn offWe have switched the EFT back on and show the policy paid through April 30, We have received notice from the Marketplace that your premium will change effective May 1, 2015, to reflect $owed a monthIf you have specific questions regarding this change please contact the Marketplace for the details To receive reimbursement for your medications that you paid out of pocket for please fill out the form from the link listed below and send to the address listed at the bottom of the second pagePlease submit this form filled out with the pharmacy receipt (the page that the pharmacist staples on the front of your prescription that shows a quantity, refills left, and amount paid)If you do not have these documents anymore you can request your pharmacy reprint them for you http:// [redacted] .pdf Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attentionI would also like to thank you for sharing your experience with usIt is feedback like yours that helps us address issues and prevent them from reoccurring 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] Thank you, Ashley S Complaint and Appeal Consultant Executive Resolution Team

"Times New Roman";">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on November 30, It was found that [redacted] was not considered as an authorized representative to act on his son’s behalf We were able to reach out to his son, [redacted] , to obtain the necessary authorization for this situation and have mailed him a form that can be completed to authorize his father to act on his behalf in the future Upon receiving the authorization from [redacted] , we provided the details of the resolution reached directly to [redacted] and he accepted our resolution Due to the protected health information involved, the details are not being given in this response We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MrKhattak’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

[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 read the review [redacted] / Coventry Health sent to you folks. Almost none of it makes sense to me. They stated that I had a call In January asking about a Copay on something. I didn't even realize that I still had an option to do this. I didn't know I was covered by these people at all. I have no recollection of this phone call. Last time I talked to somebody in the collection department, they said that because of a particular call, I only had 60 days to receive my refund. I feel like I have been getting the run around for two months so they can avoid giving me a refund. The first call I made this year was to tell them that I didn't want to be charged for a policy I did not want. I asked them to stop the payment. They did not. My bank account was overdrafted, then they put the money back in. I have received no compensation for the bank fines, and I am okay with that. The first call I made this year was to inquire about why a new policy was being started for me. The gentlemen on the phone found out that I had coverage somewhere else and HAD coverage somewhere else, while they were supposedly covering me.... He told me if I provided proper documentation of this coverage, then I was due a refund. That at some point a mistake was made.... I provided that information. I was told I was due a refund and it would be in the mail. I assumed that it was taken care of and gave them an adequate amount of time to send the refund. I was never alerted that something went wrong or didn't go through. I made a call, they told me they had recieved the letter and the check was in the mail. I have been lied to many times in the past few months. Lied to about who I was talking to, who I can talk to. People were supposed to call me from upper-management, it never happened. By all means I did not accept the resolution that they gave me on the phone, I was just about to explode with anger so I politely hung up. The June 9th part of the statement they sent you is an example of my frustration. I was never inquiring about the payment that was taken out of my bank account then put back in. It was the about the 11 months of payments taken out. The June 13th part of the explanation they sent you is wrong. I was calling to inquire about the refund. They ask for your address every single time you call so I may have updated my address. But that is not why I called. They also kept telling me I had more than 1 active policy when I didn't believe I had A single active policy. But it's never why I called. I really don't know what else to do. Please help me, and hopefully the others that this company has tormented. Regards, [redacted]

Dear Ms [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 25, We reached out to our Billing and Enrollment department for assistance during our investigation They confirmed that the statement on the bills is correct and the due date for premiums is the last day of the month prior to the coverage period Ms [redacted] is receiving an Advanced Premium Tax Credit which means that she is allowed a grace period for making the payments but to avoid disruptions in coverage and claim processing the payments should be made on time The due date statement on the bills will not be changed In reviewing Ms***’s payment history, it was noted that she has not made her $premium payment for February or March As she is in the second month of her grace period at this time, claims for dates of service from March will be denied We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Ms***’s concerns If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted] Regards, Chris B [redacted] Executive Resolution Team

February 24, Dear ** [redacted] : Thank you for giving Coventry Health Care of Georgia the opportunity to review your Revdex.com complaintWe appreciate your feedback in regards to our Customer Service process After a thorough review based on the information submitted, ** [redacted] submitted a request to terminate his children from his policy, effective 12/31/due to the children going on their mother's health plan Unfortunately, ** [redacted] written termination request was received on 1/13/The dependents were termed based on business rules, which indicate that we are not able to retro-terminate until the end of the monthThe dependents were termed 1/31/ On 2/21/14, a determination has been made to retro terminate your dependents from your CoventryOne policy back to 12/31/All dependent term dates have been corrected and your account will be updated to reflect the changes to your policy If you have any questions, please contact the Customer Service Department at ###-###-#### Sincerely, Appeals Department

February 6, Dear ** [redacted] : The Health Plan received your request to our initial response on February 5, In response to your rejection: ** [redacted] would have to call the exchange for this or see if they were willing to move his effective date due to the circumstancesAs this is an on exchange plan and the binder payment is a requirement to hold the policy, we could not make an exception to refundEither way the Health Plan is limited to what is fed to us by the exchangeMaking a payment prior to issuance is part of the requirements for polices offered on the exchangeThere is no consideration for partial month; that is not an option the Health Plan can offer, according to Federal Guidelines In addition, on February 5, 2014, a replacement request was made to have ** [redacted] ’s cards mailed** [redacted] can go to our website, www.chcflorida.coventryhealthcare.com to download a temporary member ID card to fill prescriptions and schedule appointments** [redacted] can contact our Customer Service Department to verify his policy and coverage If you have any additional questions, please contact me toll free at ###-###-####, extension [redacted] or directly at ###-###-####, Monday through Friday from 8:am until 5:pmIf you are hearing impaired please call TTY 7-1-Relay Sincerely,

August 21, 2014Dear [redacted] ;The Appeals Department of Coventry Health Care of Virginia, Inc. ("Coventry Health Care") writes this letter in response to your request dated August 8, 2014 and received at our office on that day, This letter is in response to the consumer complaint... filed by [redacted] regarding termination of her 09/01/2014 policy and refund of her premium.Coventry is unable to process any changes to a policy that was initiated through the Marketplace per the Exchange rules and regulations that we as an insurance Company must follow, [redacted] has requested these changes through the Marketplace. On 08/06/2014, [redacted] contacted the Marketplace to discuss her case. It was escalated to a dedicated Caseworker and a Case ID Was generated. On 08/27/2014 the Health Insurance Marketplace Caseworker informed Coventry of the pending retro-termination date request, which is still in process and advised that the policy slated to begin on 09/01/2014 is now cancelled. No further action is required from Coventry. If you have any questions, please contact the Customer Service Department at ###-###-####. Sincerely,Appeals Department

face="Calibri"> [redacted] Please see our response to complaint # [redacted] for Kelly Layburn that was received by us on May 11, During our review, we found that the member’s policy was created on December 04, 2014, with an effective date of January 01, [redacted] policy was terminated as of March 31, 2015, due to non-paymentThe member has a current amount due of $2,for April, May and June premiums [redacted] needs to contact the Marketplace at ###-###-#### to cancel her policy According to [redacted] ’s benefits, the in-network deductible is $5,per person and $10,per familyThe out-of-network deductible is $12,per person and $25,per familyThe claims in question were never denied, but were processed at the out-of-network benefit level because the member went to an out-of-network providerHowever, after further review of claims in question and the member’s benefits for emergency room services, we determined they were processed incorrectly According to [redacted] ’s emergency room benefits, the claim should always be paid at the in-network rate regardless if the services are provided by an out-of-network provider These rates are as follows: $co-pay per visit (both in-network and out-of-network)The three claims in question will be reprocessed and paid at the in-network ratesOnce the claims are reprocessed, the member’s responsibility should be $Unfortunately, we are unable to provide the member with the refund she is requesting for January, February and March premiums, as the member did have available coverage during these months I apologize for the difficulties and frustration 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] or ###-###-#### Regards, Julian C [redacted] Executive Resolution Team

Complaint: [redacted] I am rejecting this response because: The first three times were unscheduled phone callsI have set work schedule and cannot answer unscheduled phone callsThe fourth time was scheduled, but they did not honor the arrangementThe call was scheduled at 1:PM sharp on 6/11/2015, and I did not receive a call until 1:PMI assumed that they forgot the call by by 1:PM and was indisposedIn 10+ years of business, I have never received a business call that was not either minutes before the stated time or exactly on the time stated.Regards, [redacted]

Yes, [redacted] is my father and my client and I have his permission to file this complaint on his behalf

Coventry Health Care respectfully requests an extension of time as we work directly with the member to secure the proper authorizations Thank you, Deborah Finch

[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 gave you a copy of my house loan bank statement showing that I had to pay an extra $because my payment was late The reason my house payment was late was because I was double charged by Coventry for the month of April automatically taken out I then called Coventry different times, talked to different people, who all assured me I'd have a refund of over $in 3-business days So I waited and waited to get my refund so I could make my house payment and not bounce After none of those employees came through with what they told me they'd do, I had to wait until I got paid again from work to make the payment, days late, thus having to pay an extra $ If I would have made the payment before my promised refund hit the bank, taking their word (glad I didn't), I would have had an additional $fee from my bank plus a daily fee for being negative until money was put in there It is completely ridiculous that you won't agree to just pay this fee Broken promises from separate employees, hours on the phone trying to get this figured out, and having to reply to these emails is exhausting You will be losing my business and $next year if this doesn't get resolved to my satisfaction versus $if you just pay the late fee Obviously customer satisfaction is not important to Coventry-this experience has been very unpleasant Regards, [redacted] ***

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on May 21, During our review, it was determined that [redacted] had two cases with our Billing and Enrollment department, [redacted] and [redacted] The initial case [redacted] had an effective date of January 01, 2015, and a termination date of January 31, The new case, [redacted] , was set to have an effective date of February 01, However, a premium payment for the first month was not received causing the enrollment to be cancelledThe member was making payments to case [redacted] and should have been making the payments to case [redacted] We were able to work with our Billing and Enrollment department to have case [redacted] reactivatedThis will allow [redacted] to make a payment for the owed premium to activate the policy, the payment required to activate the policy is $He can contact the Billing and Enrollment department at ###-###-#### to make the payment We would like to advise [redacted] that since he is on a Health Insurance Exchange policy and is receiving an Advanced Premium Tax Credit, we will not be able to waive any of the premiums for any months of coverage for which the policy is showing as effective We are also not able to change the effective dates for the policy without receiving files from the Marketplace This means that any premiums that become due upon activation of the policy will need to be paid in order for it to remain active 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] 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 Ms [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on January 13, We have been unable to locate any calls from Ms [redacted] attempting to set up payment for her policy in December The last contact we found where a payment was made was from September 19, At that time, the payment made brought her premiums current through September 30, It was noted that the confirmation number she provided is not a valid payment confirmation number or call reference number We were also not able to locate a current or former employee of Coventry named Alison M*** If any additional information can be provided, we can certainly continue to attempt to locate the contact that she indicates took place Helpful information that would aid us in any future searches would be the exact time and date of her call and the telephone number that she had called Unfortunately, as we were not able to find an error on Coventry’s part, we can’t reinstate Ms [redacted] ’s policy As stated above, the last month that we received payment for was September She was given a day grace period starting October 1, 2014, to bring her premiums current The process for policies that are given grace periods is to terminate coverage at the end of the first month of the grace period if the policy is still past due after the days This means her coverage ended on October 31, 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 [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 17, We are showing that [redacted] currently owes premiums for January and February The plan that had covered his family for was no longer offered for so he was renewed automatically renewed with a similar plan The premium owed for the new plan after factoring in the Advanced Premium Tax Credit (APTC) was $ Coventry received an update from the Marketplace advising that [redacted] ***’s family was to be changed to a different plan effective February 1, The new plan has a premium of $after the APTC [redacted] ***’s premium payments have all been made for While payments for some of the months were made after the due date, they were eventually received and nothing is currently owed for The current amount owed for premiums for is $ This includes $for January and $for February An attempt to pay $by EFT was made on February 9, 2015, but the transaction was unable to be completed due to invalid account information according to a notice we received on February 12, At this time, the policy is in the three month grace period that is granted to those who are receiving APTCs The grace period guideline is that all premiums must be paid to current by the end of the grace period If the policy is still past due at the end of the grace period, it is to be terminated back to the end of the first month of the grace periodIn this case, if the full amount is not paid the termination date of the policy would be January 31, We are showing that Coventry received a file from the Marketplace on February 19, 2015, requesting to terminate [redacted] ***’s policy effective February 28, In order to keep the policy active for February, we would need to receive the premium payments for January and February 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

February 20, Dear [redacted] :This letter is in response to your written inquiry received February 20, In that correspondence you asked about the following:Member, [redacted] , contacted the Revdex.com regarding his concern over the premium for his First Health Part D (PDP) Plan and wants to dis-enroll due to not being notified.We will contact ** [redacted] separately via a letter to address his concerns regarding the premium change.Please note the resolution that will be provided to ** [redacted] has not been included in this letter in an effort to keep our member’s personal and health information confidential.We appreciate you contacting us, and trust the additional information that we have provided satisfactorily addresses your inquiryYour inquiry provides us with valuable insight as we continuously seek opportunities to improve our member communication materials.Should you have any further questions, please contact Customer Service at ###-###-####, hours a day, seven days a week your local timeTTY/TDD users please call Telecommunications Relay Services.Sincerely,

Member monthly billing statements are generated between the 8-13th of every month; premium payments are due by the 30th of the prior monthUnfortunately, a refund will not be issued to the member since the policy is currently activeOur records show [redacted] obtained her coverage through the Marketplace; therefore a request for termination must also be done through the MarketplaceOnce the policy has been terminated, then the member will receive a refund for any additional premiums paid after her termination date If [redacted] has any further questions she may contact our Executive Resolution team directly at [redacted] @aetna.com Thank you

July 17, Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc(“Coventry Health Care”) writes this letter in response to the above-referenced complaint filed by [redacted] regarding insulin affordability.** [redacted] chose an individual full-risk PPO Silver Plan effective May 01, ** [redacted] is currently receiving [redacted] insulin [redacted] is on the Tier prescription drug listThe pharmacy benefit for Tier Preferred Brand Drugs is the preferred pharmacy deductible + $** [redacted] ’s annual deductible is $2,After her deductible is met, benefits will be paid minus the $copayIf ** [redacted] wishes to consider a different plan, plan changes must be processed by [redacted] and can only be made following timelines and guidelines set by ***It is not something over which Coventry Health Care has any controlPlan change may impact eligibility and premium, and therefore must be processed by ***.The only other option ** [redacted] may have is to do a web search for Manufacturer CouponsShe may need to consult with her pharmacy to determine if there are any discount programs.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 ###-###-####My fax number is ###-###-####, and my e-mail address is [redacted] .Very truly yours,

January 31, 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] * [redacted] regarding termination of his CoventryOne policy effective December 31, and premium refund for January The request was received by CHC Carolinas on January 30, 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 *** Please contact me if you have any further questions involving this issueI can be reached at ###-###-####- [redacted] between the hours of 8:a.mand 5:p.mMonday through Friday