Coventry Health Care

Coventry Health Care respectfully requests that the member wait until he receives the response mailed on this day to him directly by our Company to determine whether our actions have met his needs Thank you, [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: After numerous conversations with Coventry since Early May this is rather insulting! I received none of the paperwork mentioned, which was explained in many of the calls with Coventry I received no follfrom Coventry, as requested in many of the calls I received none of the calls from Supervisors, as was requested in at least of the calls Coventry failed to do their part and now I have thousands of dollars of medical bills and providers refusing to see me because of this nightmare, which effects both my health and well being as well as financially and puts me in a position to find new treatments elsewhereAll because Coventry did not withdraw the premiums from my account as was originally slated to be done when the purchase on the Marketplace was made I did not find out about this terminated policy until Early May If payment was not received, why did it take months? That does not make sense The new policy took MONTHS to get straightened out and was not confirmed by Coventry until August, though the policy date was 07/ It took 3-CONFERENCE CALLS with Marketplace to finally get somewhere and yet still there are issues Each time, Marketplace confirming files were sent while Coventry simply kept saying to check back in a week or two I had to call regularly to finally get confirmation that I had insurance and request my cards be sent because I had not received them Coventry has the opportunity to accept the file from Marketplace with the May changes and tax credit applied, to retroactively apply it to Feb 1- June 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 November 10, 2014, regarding backdating his termination date to September 30, 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 investigationA phone call was located from September 9, 2014, requesting termination of his policy The termination date has been changed to September 30, 2014, in line with that request, and the representative he spoke with has been educated on handling verbal termination requests A refund was issued to him on November 18, 2014, in the amount of $408.94, for the premiums paid for October and November 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 November 24, In our previous response, we were not stating that a qualifying event was not experienced or that one would be required to make a plan change midyear for an individual policy However, that was the reason provided to us by MrE [redacted] ’s assistant, Adrianna, as to why the plan change process was never completed The letter that was sent as Coventry’s response to the previous Revdex.com complaint was fully reviewed prior to our initial response, so a copy is not needed The adjusted pull letters are generated with predetermined text, which does not change whether the adjusted pull process is occurring due to a nonstandard draft amount or a nonstandard draft date We were not previously notified by our Enrollment department that an adjusted pull letter was sent in September It has been confirmed that one was sent on September 4, 2014, as the scheduled draft for September had been cancelled, so it had to be set up as an adjusted pull We have verified that [redacted] ***’s policy has been fully terminated on both the enrollment and benefit sides of the system We will not be attempting to collect any further premiums or fees from him at this time 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 Our standard process is to offer the e-mail address for the Executive Resolution Team, but if he has additional concerns regarding this matter, he may call me directly at ###-###-#### 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 responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: MsM [redacted] and I did discuss yesterday my issue and concerns regarding the way conventry has handled my wife's prescription for [redacted] While I did agree to get information from tHe doctor that recommends [redacted] as the treatment, I did express my belief that there would not be a good resolution, but rather the same outcome I provided some previous documentation to MsM [redacted] relating to the history of all previous requests including the previous coventry supervisor who tried to have this resolved, to no availMsM [redacted] was very professional and seems to want to help resolve this, which will be using a different approach in the appeal process As such I will not accept this as a resolution which may close my complaint If the process that MsM [redacted] results in a positive outcome, I will accept and close my complaint But until this happens I will not accept this as resolved Regards, [redacted] ***

October 28, 2014Dear [redacted] : Your letter of October 20, to Coventry Health Care of Iowa, Inc(Coventry) was received in our office, and referred to my attention for review and response [redacted] was on a CoventryOne policy with a May 1, effective date [redacted] *** enrolled for coverage through the Health Insurance Exchange (Marketplace).In his complaint to the Revdex.com, [redacted] expressed that he believed he was overcharged on his monthly premium [redacted] also advised that his policy was terminated without noticeOn April 15, 2014, [redacted] applied for health coverage through the Marketplace for an effective date of May 1, The monthly premium payment for the policy was $On April 29, 2014, Coventry issued an Electronic Funds Transfer letter to [redacted] confirming his enrollment in having his monthly premium payments automatically withdrawn from his bank account.On July 26, 2014, Coventry was notified by the Marketplace that [redacted] ***’s premium would be $effective September 1, Because [redacted] was enrolled in an Electronic Funds Transfer program with Coventry, Coventry automatically withdrew monthly premium payments in the amount of $for June and July as the premium reduction was not in effect until September 1, 2014.On July 28, 2014, [redacted] contacted Coventry to confirm that his new premium of $would begin in SeptemberThe Customer Service Representative confirmed this, but advised [redacted] that he still needed to pay $for August in order to avoid his policy termination [redacted] asked if he could terminate his policy and re-enroll for September [redacted] was referred to the Marketplace to request a policy changeOn July 29, 2014, Coventry issued a Policy Change letter to [redacted] confirming the policy changes he requestedOn August 7, 2014, Coventry issued a Payment Due letter to [redacted] advising that his monthly premium payment of $for August was not receivedThis was due to the fact that [redacted] had deleted his automatic payment information.On August 2, 2014, [redacted] contacted Coventry to request a premium change due to his income [redacted] was referred to the MarketplaceThough it might seem to our customers that we as carriers should be able to make changes to health insurance policies ourselves, certain changes (such as changes in effective and termination dates) must be done through the federal MarketplaceThe structure of the Affordable Care Act requires that these types of changes occur only through the federal level.On September 10, 2014, Coventry issued a Policy Termination letter to [redacted] because his premium for August was not receivedOn September 10, 2014, Coventry retroactively terminated [redacted] ***’s policy effective July 31, for non-payment of premiumCoventry did not terminate [redacted] ***’s policy in error or without noticeCoventry did not receive the full payment due for August [redacted] is not eligible for a refund for the months of June and July, as he received health insurance coverage during that timeOn September 25, 2014, Coventry mailed a premium refund of $to [redacted] for the payment received on August 25, 2014.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

July 14, Dear ** [redacted] :The Member is participating in the Coventry Health and Life Insurance Comp any (“CHL”) HealthAmerica One individual HMO Health Care Reform health benefit plan[redacted] (the “Member”) has filed a complaintThe Member’s complaint concerns poor customer service provided by CHLThe Member states that she requested and has not received an explanation as to when her automatic debit premium payment would be processed and also requested a detailed policy premium for her daughter and herself and has yet to receive anything from CHL.Below is a timeline of events leading up to the resolution of the Member’s complaint.07/02/2013- The Member called to update address.12//2013- The Member called to get a breakdown of premium.05/01/2014- The Member called to see if she can get the breakdown of premium mailed to her.06/13/2014- The Member called about her recurring payment and stated her premium is incorrectCHL representative advised renewal came and premium changedMember wanted to speak to a supervisor.ROOT CAUSE:The Member requested a letter of premium breakdown, however it was sent to an email on file and not home address.RESOLUTION:We have provided the information being requested as well as a payment historyMember’s premium changed effective May 1, due to renewalA migration letter was sent out advising so and the CHL has provided all documentations requested by the Member.We apologize for any inconvenience this may have caused the Member.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

September 23, Dear Sir or Madam, The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter in response to your request received by our office on July 18, This letter is in response to the consumer complaint filed by [redacted] regarding a needed correction in the subsidy on her policy.This member is currently enrolled in a fully insured, non-grandfathered, PPO, individual health insurance plan with Coventry Health Care as of January 1, through the on-exchange MarketplaceThe member's instant complaint is regarding a change in premium and subsidy she believes should have been effective since May, Coventry Health Care received a file from the Marketplace on May to change the member’s premium amount to $60,Unfortunately, this file contained an error which did not allow it to process the change automatically in our system as intendedWe identified the issue on July 7, and manually adjusted the member's premium to $effective as of July as listed in the Marketplace fileThe member's billing was adjusted to correctly Show the amount due in response to this change in premium, and a payment history is attachedThe member's premium is now current through September Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me at ###-###-####, extension ***My fax number is ###-###-####, and my e-mail address is [redacted] Very truly yours,Neil M Regulatory Compliance Analyst

Complaint: [redacted] I am rejecting this response because: --------- Forwarded message ----------From: Revdex.com of Metro Washington DCDate: Mon, May 18, at 10:AMSubject: Fwd: Revdex.com Complaint Case# [redacted] (Ref# [redacted] - [redacted] )To: [redacted] < [redacted] @myRevdex.com.org>---------- Forwarded message ---------- From: [redacted] < [redacted] @***.com>Date: Sat, May 16, at 3:PMSubject: Re: Revdex.com Complaint Case# [redacted] (Ref# [redacted] - [redacted] - [redacted] )To: Revdex.com < [redacted] .***@ [redacted] .com>, [email protected], [redacted] @***.com Dear Revdex.com, [redacted] ***, First, thank you for your helpThis is regarding Complaint Case: [redacted] which was originally filed as Complaint ID [redacted] and Complaint ID [redacted] Please transfer this to the right Revdex.com person if this is not the right Revdex.com contactThe best way to communicate with me is via my professional e-mail address at [redacted] @***.com History: previous to 4/22/- Neither the Marketplace nor CoventryOne will correctly communicate with me in this previous months about the policy for member ID [redacted] The Marketplace representative signed me up for Medicaid in February 2015, but made the error of NOT cancelling the CoventryOne policy for member ID [redacted] in February 4/22/- Two complaints were filed with the Revdex.com, Complaint ID [redacted] , and Complaint ID [redacted] in regards to this issue4/22/- CoventryOne customer service was called and Coventry didn't wish to speak with me about the issue, promptly transferring me back to the Marketplace 4/22/- The Marketplace representative submitted an escalation case ID: [redacted] for policy of member ID [redacted] , which assigns a retroactive termination date and asks for the removal of any previously assigned fees in relation to this caseIn this case, the amount of fees is $They asked me to call Coventry to review the status of my escalation case in 5-business days at###-###-####I am not sure if Coventry reviewed this caseThe Marketplace asked me to call them back in approximately a month4/30/- Julian C [redacted] from CoventryOne/ [redacted] stated, "Once we receive the termination file from the Market Place, we will be able to process [redacted] ’s request." 5/16/- The marketplace case ID: [redacted] is checked on by calling the MarketplaceThey stated my escalation case was closed because they were "unable to terminate policy due to health insurance..." for whatever reasonThey will not file another escalation case for whatever reason Please retroactively terminate this policy to February 2015, and cancel the $in chargesThis policy for February, March, and April was never supposed to exist as I was on Medicaid at the timeIt is not my fault the Marketplace representative forgot to cancel it at the same time he/she signed me up for Medicaid insteadThank you again, Daniel I [redacted]

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on June 08, During our review, it was determined that [redacted] ’s banking information was entered on the incorrect policyWe had our Premium and Enrollment department immediately remove the banking information from the incorrect policyWe confirmed that the member’s refund has now been processedAn agent from our Premium and Enrollment department attempted to contact [redacted] but was unsuccessful and left a message advising that her refund had been processed 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

October 17, 2014Dear [redacted] : The Health Plan received your request to our initial response on February 5, In response to [redacted] ’s rejection: [redacted] states that he has no knowledge “WHAT” the plan meansThe Health Plan has no record that [redacted] contacted us regarding these concernsThe Health Plan has enclosed a copy of [redacted] ’s Summary of Benefits material that he can review for benefits information, a copy of which he has received previouslyIf [redacted] has questions regarding his coverage, he may contact the Customer Service Department which is available to answer any questions he may have about his coverage [redacted] can reach them at ###-###-#### Monday through Friday, 8:a.mto 6:p.mEST [redacted] may also access his benefit information hours a day, seven days a week by registering and logging in at [redacted] In regard to [redacted] receiving monthly letters stating that “next month your premium will go back to level,” the Billing and Enrollment department has confirmed that an “Adjusted Pull” letter was sent to the member in error, for which we apologizeThis letter should only be sent to those members who will be drafted an amount different from their standard premiumThis was not the case for [redacted] Finally, the Health Plan does not make a change to a member’s policy without prior notice [redacted] was given prior notice on two separate occasions regarding changes to his policy and the opportunity to either make a selection or contact Customer Service for assistanceSince the Health Plan did not receive the required documentation back from [redacted] , in order to prevent a lapse of coverage or termination of the policy, the default choice was selected as was explained in the notificationsCoventry 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 Ms [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 26, During our review, it was noted that the termination of Ms [redacted] ’s policy was processed on February 26, That termination was retroactive to December 31, This caused the premiums she had paid for January to show up as a credit on her account on February 27, The previous termination was processed with an effective date of January 31, This caused the Coventry system to not show that a refund was due prior to the update on February 26, Ms [redacted] will be issued the refund in the amount of $due to that credit now showing The refund will be sent as a direct deposit to the bank account we have on file for her The refund process takes 7-business days, which has not yet passed We respectfully request that Ms [redacted] allow 2-additional business days for Coventry to complete the refund process We will continue to monitor the situation as well and will ask that the refund be expedited if any further issues are encountered If she has any additional questions or concerns in the meantime, she may contact me directly 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] ’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