Coventry Health Care

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me I want to again thank the Revdex.com for helping me through this process Regards, [redacted]

September 26, 2014Dear [redacted] :Your letter of September 19, to Coventry Health Care of Virginia, Inc(“Coventry Health Care”) was referred to my attention for review and response [redacted] is covered under Coventry effective July 1, On May 8, 2014, Coventry initially received information from the Health Insurance Exchange (“Marketplace”) advising [redacted] would have coverage effective June 1, once she made her initial binder paymentCoventry received a corrected file feed from the Marketplace updating the effective date to July 1, 2014.On July 31, 2014, [redacted] paid the initial binder payment and her policy was issued with a July 1, effective date based on the enrollment information received from the MarketplacePolicies purchased on the Marketplace require full payment of the initial binder payment in order to enroll the memberTherefore, [redacted] would not have received any member materials until she paid the initial binder paymentOn September 26, 2014, Coventry reached out to [redacted] to discuss her concerns in detail and explained we were unable to change her effective date to the now requested August 1, based on Exchange rules and regulationsThe Marketplace has advised her effect date is July 1, and not August 1, [redacted] was provided with the premium amount required to bring her account currentCoventry 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 followCoventry apologizes for any inconvenience this has caused [redacted] However, as stated above the change must come through the Marketplace as Coventry is unable to change the effective date based on the Exchange rules and regulations.If you have any questions, please contact the Customer Service Department at ###-###-####Sincerely,Teresa E Manager, Complaint and Appeal Program

Dear Ms [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 26, During our investigation, it was determined that Mr [redacted] ’s policy was enrolled through the Health Insurance Marketplace His policy was passively renewed for but remained a Marketplace plan A notification was not received from the Marketplace advising us to terminate his policy or that he had gotten other coverage for We have been granted the ability to terminate passively renewed policies back to December 31, 2014, in situations where the person has other coverage effective January 1, We respectfully request that he allow 7-days for the termination to be processed Mr [redacted] may disregard any further premium billings from Coventry that are received as he has paid the premiums for his coverage Future bills will not be sent once the termination is processed 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

October 31, 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 rejection filed by [redacted] regarding payment issues for her policy which have led to her account being flagged [redacted] claims in her rejection that she had never heard of a “red flag” and that she should have been notified of suchAccording to her Plan documents that she received (a copy of which is attached hereto), Premium Payment and Grace PeriodThe monthly Premium is due on the first (1st) day of each monthThere is a one month grace period for Premium paymentsIn other words, if the required Premium payment is not paid on or before the first (1st) day of the month (i.e., the due date), it may be paid during the grace periodThis Contract will Stay in force during the grace periodIf the Premium payment is not received by the end of the grace period, Your Coverage under the Contract will be terminated as of the last date for which the Premium was paid in fullIf Your Coverage is terminated, You will be responsible for the cost of any health care services You receive after the last date for which the Premium was paid in fullIF THE HEALTH INSURANCE MARKETPLACE HAS DETERMINED THAT YOU ARE A PERSON ELIGIBLE TO RECEIVE ADVANCE PAYMENT OF THE PREMIUM TAX CREDIT THE FOLLOWING APPLIES TO YOUR COVERAGE RATHER THAN THE ABOVE SECTION Premium Payment and Grace Period for Persons Receiving Advance Payment of the Premium Tax CreditThe monthly Premium is due on the first (1st) day of each monthThere is a three (3) month grace period for Premium paymentsIf the required Premium payment is not paid on or before the first (1st) day of the month (i.e., the due date), it may be paid during the grace periodDuring the first month of the grace period, We will continue to pay claims for Covered Services During the second and third months of the grace period, We will suspend payment of any claims until We receive the past due PremiumsIf Premium payment is not received by the end of the grace period, Your Coverage under the Contract will be terminated effective at 11:p.mon the last day of the first month of the grace periodYou will be responsible for the cost of any health care services You receive after the last day of the first monthIn other words, it is not that [redacted] had to pay her premiums in advanceIt was that she paid very lateIf she had paid during the first month of the grace period, there would have been no noticeable different in her coverageIf she did so during the next two months of her grace period, although she would not have had her coverage terminated, she would have had it suspended until payment was made and processedThat is what happened in the instant matter [redacted] made payment at the very end of the three-month grace period; the “red flag” (or suspension as explained in the Plan documents) can only be removed after payment is made and processedBut because she did make payment before the end of the grace period, according to Section above, her coverage was only suspended, not terminatedCoventry 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 MRegulatory Compliance Analyst

face="Calibri">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] and that was received by us on April 15, We contacted our Billing and Enrollment department and they advised that [redacted] has only one policy that is active now The other policies were terminated as if never active [redacted] owes $for the month of May This payment is due by April 30, Any funds that were applied to the other two policies were moved to the active policy An adjustment has been applied to the account in order to correct the billing from when the invalid policies were terminated as never in force The bill should reflect that the $for the month of May is due in 24-hours I apologize for the difficulties this situation has causedWe 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

[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: The address for my wife [redacted] is still incorrect in the systemAlso, to clarify, she has never received an insurance card(Presumably these have all been sent to the incorrect address, jeopardizing our privacy by sharing this personal information with strangers.) The only reason she was able to visit the doctor now is because we signed her up for a separate online account and printed out the card, but her doctor is requesting the actual card on her next visitI will be keeping this open until we receive a physical card for [redacted] at the correct address Regards, [redacted]

May 30, 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 a claims payment determination for date of service February 19, The request was received by CHC Carolinas on May 26, 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 if she wishes to exercise her right to a grievance, CHC Carolinas will respond to the complaint in writing within calendar days of receipt of her request.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,

February 27, 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 $ Upon further review, the member’s contract will terminate effective December 31, The payments have been “ returned” by the bank to the member’s bank accountAlso, a request to refund the $in bank fees that may have occurred during the process has been submitted If you have any questions or concerns regarding this matter I can be reached at ###-###-#### Sincerely,

[redacted] *** [redacted] * [redacted] *** [redacted] *** [redacted] The issue has been resolved at this point I just hope we don't have additional issues with dealing with them in the future thanks for your prompt response on this.Sent from my ***

Complaint: [redacted] I am rejecting this response because:-------- Forwarded message ----------From: < [redacted] @ [redacted] >Date: Fri, Nov 14, at 9:AMSubject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Penn...To: [email protected] I sent a signed letter to the insurance company to give permission to get my medical records a few days after receiving this letterThank you and have a great day ! Regards, [redacted]

Coventry Health Care requests an extension of time as we are simultaneously working with the DOI, and a response will be sent to both institutions upon completion of the investigationThank you, Deborah F*

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

In response to Coventry response #- My name is not [redacted] #- My appeal was faxed on 1/15/- yet this response said it was already deniedHow exactly did that happen when there was no apparent review #- I nor my husband have never received a letter from Coventry regarding the appeal nor have EVER received a phone call FROM them despite REPEATED messages both via email and phone #- I find the notion that the denials have been upheld ridiculous as [redacted] hospital stated we were never informed of coverage issues as we had no primary care AND how are they denied when the appeal was not reviewedTheir timeline or lack thereof shows Coventry's total disregard of their own stated process Regards, [redacted]

October 15, 2014Dear [redacted] :Your letter of October 14, to Coventry Health Care of Nebraska, Inc(Coventry) regarding the rejection by the above-referenced member to our previous response was received in our office and referred to my attention for review and response.On October 14, 2014, I contacted [redacted] per his requestAfter discussion, [redacted] decided that he will utilize his policy appeal rights [redacted] will file an appeal regarding the denied authorization for [redacted] eye drops on [redacted] ***’s behalfI will wait to receive information from [redacted] for the appeal.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

face="Calibri">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on May 18, During our review, we found that this policy was created on January 14, 2015, from a file received from the Marketplace on January 13, The policy had an effective date of February 01, 2015, with a monthly premium due of $and an Advance Premium Tax Credit (APTC) of $ [redacted] was sent a past due reminder letter dated March 05, 2015, and was given until April 07, 2015, to make the March’s premium payment of $The policy was terminated on April 08, 2015, with an effective date of February 28, Due to the policy not receiving an Advance Premium Tax Credit (NON-APTC), the member has a days grace periodThe last payment made was the binder payment on January 14, The policy terminated correctlyUnfortunately, per business rule, the policy does not qualify to be reinstated 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

August 11, Dear [redacted] :This letter is in reference to the complaint [redacted] filed to the Revdex.com (Revdex.com) that we received on August 1, 2014.The [redacted] (***) is a health benefits plan established under the [redacted] [redacted] ***, USC secet seq., pursuant to a federal government procurement contract between its sponsoring employee organization and the US Office of Personnel Management (OPM)The [redacted] is underwritten and administered by Coventry Health Care, an [redacted] company on an ASO-basisAs a [redacted] (***), the [redacted] is not subject to state insurance laws or regulation in regard to the nature or extent of its coverage, its benefits, or payments with respect to benefits based on the extensive federal preemption provision contained at USC sec8902(m)(1)That provision provides:The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any state or local law, or any regulation issued thereunder, which relates to health insurance or plans.The resolution of disputed enrollment and claims matters under [redacted] plans is governed exclusively by OPM pursuant to the implementing regulations promulgated by that agency, see C.F.Rsec (disputed enrollment issues) and C.F.Rsec(disputed claims issues).However, the Plan responded to [redacted] ’s concerns and sent her a letter dated August 11, 2014.If you have any further questions, please do not hesitate to contact me at ###-###-####.Sincerely, Britt P [redacted] Client Advocate

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 the termination of his policy Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you We reached out to our Enrollment department for assistance during our investigationWe confirmed that [redacted] ***’s policy has been reinstated [redacted] will still need to pay premiums for each month of coverage, but he will otherwise be able to remain covered on his current policy until December 31, [redacted] can contact the Enrollment department at ###-###-#### to make the payments or to cancel prior to December 31, if he does not wish to continue coverage for that long 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

[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 is the same response I have been receiving for months The company will not tell me or the provider what codes are required The provider is using standard codes that are accepted by all other insurance companies, and has given Coventry this information repeatedly This seems to be just more stalling and avoidance I had a natural birth of a healthy child Conventry should need no other information to provide the payment that was promised for the services required for that event Regards, [redacted] ***

February 4, 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 a premium refund for her CoventryOne policy effective December 1, The request was received by CHC Carolinas on February 4, 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 ###-###-####- [redacted] between the hours of 8:a.mand 5:p.mMonday through Friday

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 The services rendered for [redacted] were upheld under a level one appeal reviewed by CoventryThe member’s next option would have been to file the second level appeal with the member's employer within days of the level one appeal completion [redacted] was notified of the uphold decision by the previous consultant handling the original Revdex.com complaint, as well as a letter being mailed to her home address detailing the reasons that the appeal was upheld I was able to have the ambulance bill reviewed and was advised that it was paid in full to the provider, with no member responsibilityThe provider’s check was mailed on March 24, in the amount of $ 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