Coventry Health Care

face="Calibri">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on April 22, 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 PlaceA complaint would need to be filed to the Market Place in order for the policy to be retroactively terminatedThe 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 terminationIn the conference call, the Market Place representative stated there was an escalated complaint already submitted for this member on April 22, 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 days to process this termination request and that he could follow up with the Market Place to verify the statusOnce 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

May 22, Dear [redacted] : The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan [redacted] , (the “member”) has filed a complaintThe Member’s complaint concerns plan coverage retro termination effective date and refund of premium payments withdrawn by the PlanThe member is requesting a plan coverage retro termination effective date of November 1, and premium payment refunds for all months since November of 2013.Upon review, as per business rules and the member contract, term requests must be submitted prior to the requested term dateWhen proof of coverage is received, CHL can retro term back days from receipt of the proof of coverageThis policy has been terminated per business rules for February 28, A refund has been requested for March through May of premium paymentsThe refund will be processed within 3-business days and, once processed, will appear back in the member’s account within 1- business daysThe total amount of the refund is $169.98.To go any further back with the termination, outside of the established business rules, would require CFO (Chief Financial Officer for the Plan) approval or member validation of prior submissionThe Subscriber may terminate Coverage for himself/herself and any enrolled Dependents under the Group Contract for any reason immediately (same day) upon thirty (30) days prior written notice (including facsimile or e-mail) to CHL after the first days of Your ContractSuch terminations will be effective at 11:p.mon the termination date provided by the Subscriber in the notice to CHLRetroactive termination will be permitted up to a sixty (60) day time frame provided proof in writing is supplied that other insurance was in effect during that time frameAll business rules were followed for this memberCHL received the proof of coverage May 20, (copy attached)If the member has proof that notice was submitted earlier, he must provide that proof in order for a different determination to be consideredIf you have any questions or concerns regarding this matter I can be reached at ###-###-####Sincerely,

Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on June 18, During our review, we found the confirmation receipt from our bank, [redacted] ***, which confirms that [redacted] was provided with his refund of $on March 18, I have attached a copy of this receipt for his records If [redacted] has bank statements that show this refund did not enter his account, he may e-mail it to [redacted] @healthplan.comOnce received, our Billing and Enrollment department will review and send out the refund again if necessary 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

February 17, Dear ** [redacted] : This letter is in response to your request for Coventry Health Care of Virginia, Incto respond to a complaint submitted by [redacted] regarding termination of his CoventryOne policy which was effective January 1, ** [redacted] is also requesting a refund for the premium paid for January and February The request was received by Coventry Health Care of Virginia, Incon February 7, Coventry Health Care of Virginia, Incdoes not have a signed authorization release form from ** [redacted] indicating that the Revdex.com is representing him in this matterWe will respond directly to ** [redacted] 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 Sincerely,

May 16, 2014Dear [redacted] :Your letter of May 15, to Coventry Health Care of Iowa, Inc(Coventry) was received in our office, and referred to my attention for review and response** [redacted] ’s family coverage will terminate effective May 31, 2014.In his complaint to the Revdex.com, ** [redacted] advised that he experienced frustration with long hold times and system problems when he contacted Coventry regarding cancelling his coverageCoventry has experienced a high level call volume after the first of the year regarding the Marketplace ApplicantsOn May 13, 2014, during ** [redacted] ’s initial phone call, Coventry’s system was downThe representative did not have access to his policy, therefore ** [redacted] was asked to try calling laterCoventry understands ** [redacted] ’s frustration and apologizes for any inconvenience this may have caused him.On May, 16, 2014, [redacted] contacted ** [redacted] to personally apologize for the inconvenience he experiencedCoventry looks for opportunities to improve the customer experience and his concerns will be addressed.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext***.Sincerely,

Hello, [redacted] I am adding the resolution for Revdex.com case # [redacted] for [redacted] ***Please confirm receipt of the emailThank 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 view with youUpon receipt of the complaint we immediately reached out to Coventry's Billing department to request that they cover your overdraft fee you acquired due to two premiums being taken out of your account in one monthWe were advised that it was approved and a check was mailed to the home address on file in the amount of $I sincerely apologize for difficulties you have experienced surrounding this issueWe 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 m***er, please contact the Executive Resolution Team at [redacted] Thank you, Ashley SComplaint and Appeal Consultant Executive Resolution Team

Coventry Health Care, Increspectfully requests an extension of time in order to further its investigation of the above-referenced Complaint Thank you, [redacted] ***

July 28, 2014Dear [redacted] The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual off exchange HMO health benefit planThe Member’s complaint concerns overdraft fees applied due to premium payments drafted from the Member’s bank account for months in errorThe member is requesting a refund of her overdraft fees in the amount of $961.Below is a timeline of events leading up to the resolution of the member’s complaint.January 13, – The Member contacted Billing & Enrollment department in regards to his copayHe was transferred to the Claims & Benefits department.May 5, – The Member contacted Billing & Enrollment department to terminate his coverage because he has had another policy for a yearThe member was advised to send in proof of other coverage to seek approval for a retro-termination.May 21, –The Member contacted Billing & Enrollment department to check the status of his policyHe was advised that his policy was terminated effective May 31, The member states that he is seeking a termination date of April 30, 2013.June 9, –The Member contacted Billing & Enrollment department to inquire on the status of his policyThe call was lost.June 9, –The Member contacted Billing & Enrollment to check the status of his refundThere is no refund due because the member’s payment returned.June 13, –The Member contacted Billing & Enrollment department to request a change of address.June 25, –The Member contacted Billing & Enrollment department to request a refund for the past year of coverageThe member was advised that the refund was not approved.July 18, – The Member contacted Billing & Enrollment department to check the status of his termination and refund.July 23, – The Member contacted Billing & Enrollment department to check the status of his refundThe member was advised that at this time no refund was due.On July 24, – The Member spoke to a CHL representativeThe representative read the notes left by the resolutions team and went over the billing with the memberThe representative who took the call stated the member understood the breakdown of the billing and now understands why there is no refund due.ROOT CAUSE:The member had coverage through another carrier effective May 1, 2013, but did not terminate his plan with Coventry.RESOLUTION:A request has been sent to the home office for a retro-termination.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,Emily M Appeals Coordinator

[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 received a letter from Coventry, that THEY were terminating my coverage as of December I was working with one of their sales repswho was to enroll me in a plan for $per month for my husband and myself, to begin in January They then tried to deduct $per month from my checking, which is what I stopped payment on.I NEVER agreed to this amount!! I spoke to SEVERAL people at Coventry, who were to cancel my coverage completelyWhy would you then in February deduct two months of $plus late fees that for a policy that is canceled!! Your company dropped the ball several times, and will not admit it!! I have enrolled with another provider! Do you continue to try to collect premiu [redacted] for someone who obviously does not want your coverage!! This is THIEVERY!! I still have not gotten any call-backs from any supervisor! Great customer service! Regards, [redacted]

It appears from the Complaint that [redacted] is the mother of, not one of, our insureds In order to investigate this matter, Coventry Health Care would need the daughter’s information and a HIPAA authorization form signed by our insuredIf the daughter is a minor, we would still need the daughter's information and a signed form from whomever has the authorization to do so Thank you, [redacted] ***

--------- Forwarded message ----------From: Revdex.com of Metro Washington DC Date: Thu, Mar 12, at 9:AMSubject: Fwd: [redacted] To: [redacted] < [redacted] @myRevdex.com.org>---------- Forwarded message ----------From: [redacted] *** < [redacted] @***.com>Date: Wed, Mar 11, at 11:PMSubject: Re: [redacted] To: [email protected] Hello, My complaint ID [redacted] has been resolvedThank you very much for your assistanceI believe it was your contact that probed the actionAll best, [redacted]

"Times New Roman";">Dear [redacted] , Please see our response to complaint # [redacted] from [redacted] for [redacted] that was received by us on January 19, We reviewed the renewal notice that was sent for [redacted] ’s policy in September 2014, which was for the plan year beginning January 1, It was found the letter stated that the plan from would no longer be offered, but did also state that [redacted] would be automatically enrolled onto a different plan with Coventry The first request for termination of the policy that we located was from November 9, Our guidelines allow for retroactive terminations of policies going back days from the first request As such, we were able to grant a termination date of September 9, With the retroactive termination date we will issue a prorated refund for the month of September as well as refunds for the total amount paid for the October and November coverage Since the premiums were drafted from a bank account through Electronic Funds Transfer, the refunds will be deposited directly into the same account using the same method The standard timeframe for refunds to be deposited is to business days We did have a request reviewed to determine if we could go back farther than days, but as there was no indication that Coventry had been contacted to cancel the policy before November 9, 2015, the request was denied Also, Coventry does not provide reimbursement to individuals for the time they spend on the phone with our representatives 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] Complaints and Appeals Consultant Executive Resolution Team

February 13, 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 PlanThe member is requesting reimbursement in the amount of $ Below is a timeline of events leading up to the resolution of the member’s complaint May 9, 11:AM: [redacted] and [redacted] contacted billing and enrollment to update their addressThe new address was provided and a request was sent to processing to have it updated February 10, 10:AM: [redacted] contacted billing and enrollment in regards to the termination of the policyShe stated that she had spoken to several people that informed her that we would cancel the policyThe member was advised to submit a written request with proof of other coverageA supervisor advised the member to submit the information to him and he would terminate the policy ROOT CAUSE: The member had two policies, the other policy was sent to our department as terminated for May 15, The termination email was applied to the old policy Per business rules the member would need to submit a written request with a handwritten signatureThe email did not include a handwritten signature The policy has been terminated for January 31, based on email that was receivedIf the member wishes to back date their termination any further, they will need to submit a written request with proof of other coverage A refund has been requestedPlease allow 7-business days for processing and an additional 7-business days for mailing timeIf the funds are reversed back into the members account it may take an additional 1-business days for the funds to post after the refund is processed If you have any questions or concerns regarding this matter I can be reached at ###-###-#### Sincerely,

Dear [redacted] , Thank you for allowing us to address the concerns reported in complaint #for [redacted] that was received by us on December 12, 2014, regarding her Medicare Part B premium reduction Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you We would first like to apologize for any frustration or inconvenience [redacted] has experienced during the process of resolving her issue The particular problem she has reported often requires an extended length of time to correct Our research has found that Coventry’s systems and the Center for Medicare and Medicaid (CMS) systems reflect the Part B premium reduction However, the Social Security Administration (SSA) systems do not have this information and consequently they are deducting the full Part B premium from her monthly payments We were able to determine that the issue is related to a change in the last character of her HICN from a “T” to an “A” during Beyond that we may never know what exactly caused this, as the research and resolution is handled by entities not affiliated with Coventry Unfortunately, this means we also do not have control over the resolution timeframes and can only give our best estimates on how long it may take to be corrected Coventry’s role in resolving these issues is confirming that we have correctly identified the person as being eligible for the reduction which has already been done Currently, a ticket is open with CMS and they are working to resolve the issue Our last contact with them occurred on December 10, Other members who have experienced the same situation as [redacted] have reported that any refunds come from SSA and will usually be noticed as an electronic deposit into a checking account prior to receiving a written notice advising that the refund is being deposited We will be making regular calls to [redacted] to keep her apprised of the situation, even if we have not received any updates, in order to ensure that she knows her request has not been lost or forgotten We will also be requesting that outbound calls be made from CMS if the issue has not been resolved within three weeks in order to reinforce what Coventry is stating We can not make promises that CMS will place the calls but the request will be made 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]

[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: this date of payment is not in question I am aware that this payment was taken out of my account, as I was called and my account number was verified I have also cancelled my insurance effective July 31st, so no more payments will be taken out of my account My initial complaint is that I did not have a payment of $taken out of my account on June 2nd as I was told, even though it's "posted" to my account I have verified this with the bank, and made multiple phone calls to your office, and received no help at all I never received a phone call back from a supervisor, was never allowed to speak with a supervisor, nor was the payment ever taken care of I do not want this to mess up my taxes, or my bank account for that matter This is still not being addressed Regards, [redacted] ***

January 24, Dear ** [redacted] : This letter is in response to your request for Coventry Health Care of the [redacted] , Inc(“CHC [redacted] ”) to respond to a complaint submitted by [redacted] regarding his CoventryOne policy effective January 1, The request was received by CHC [redacted] on January 23, CHC [redacted] does not have a signed authorization release form from ** [redacted] indicating that the Revdex.com is representing him in this matterCHC [redacted] will respond directly to ** [redacted] 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 Sincerely,

June 11, 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 Katie Boyer regarding a question of the effective date of her policy and the subsequent charge for the month of December.After a review of the situation, we requested approval to update the effective date to December 31, Once approval was received, the effective date of the policy was updated and a credit of $(days of premium for the pro rate) has been applied.The bill should now show correctly on the member portal[redacted] cannot have a plan with an effective date of January 1, because that would require her to be on a new ACA (Affordable Care Act/Obama Care) plan [redacted] ***’s current plan is only available to those with an effective date prior to January 1, To satisfy [redacted] ***’s needs and also following business rules, we were able to make the member effective December 31, and issue a refund for days of December instead of a full month (days).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,

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 policyResearch into this matter revealed that payments were received by the company from this member; however, the payments were not being posted to her accountInstead, the payments were going to the company’s Escrow (or holding) accountGenerally this can happen for a number of reasonsFor 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 timeWith 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 destinationIf 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 crucialEven 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 detectThis is most often the cause of the delay in posting the paymentsAfter 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 terminatedWe 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 yetWe have sent a request to have that payment posted as soon as possible so there will be a total of five checks on fileThis will pay the member through JuneIf 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 fundsThe member needs to keep in mind that the August payment is due on July 31, 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 paymentMsCampbell left a detailed message for the member who is urged to return MsCampbell’s call if she has not already done soCoventry 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***, B.ARegulatory Compliance Analyst Coventry Health Care

August 21, Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc(“Coventry Health Care”) writes this letter as its response to the consumer complaint filed by [redacted] regarding billing issues for her insurance policy.Our investigation into this matter shows that [redacted] ’s application for a policy was received by the Marketplace on April 22, with an effective date of April 1, Because the member made an initial payment of $130,to an older policy ( [redacted] ) instead of the new policy ( [redacted] ) with a monthly premium of $162.69, the new policy was terminated for non-payment of the premium by the Marketplace on May 24, with an effective termination date of March 31, (as if never in force)As part of the investigation, the premium payment of $was moved from the older policy ( [redacted] ) to the new policy ( [redacted] )Then on May 24, 2014, the member made a payment for the difference due of $Once the payment of $posted to the policy, the premiums due generated for May and JuneTherefore, on June 4, 2014, ** [redacted] 's policy was reinstated with an effective date back to April 1, 2014.Coventry Health Carc 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,

August 22, 2014Dear [redacted] :This letter is in response to your request for Coventry Health Care of the Carolinas, Inc(“CHC Carolinas”) to respond to Ms [redacted] regarding maternity coverage for her CoventryOne® policy purchased on the Federally Funded Marketplace for an effective date of April 1, The request was received by CHC Carolinas on August 12, 2014.CHC Carolinas does not have a signed authorization release form from ** [redacted] indicating that the Revdex.com is representing her in this matter, however we will contact ** [redacted] within three business daysWe will inform ** [redacted] that her case is being reviewed and that CHC Carolinas will respond to the complaint in writing within calendar days of receipt of her request.I trust that I have addressed this matter sufficientlyHowever, please contact me if you have any further questions involving this issueI can be reached at ###-###-####, extension [redacted] , Monday through Friday from 8:a.muntil 5:p.m.Sincerely,Melody CComplaint and Appeal Analyst