Coventry Health Care

Dear Ms [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 23, During our investigation, it was determined that Ms [redacted] is not set up to have recurring EFT drafts for her premiums for The premium collected on February 19, 2015, was a debit card transaction that had been requested through the Health Insurance Marketplace at the time of her active renewal The initial payment request was made in December and would have been for the premium for January 2015, but a hold was placed on it The hold was lifted in February causing the transaction to process Ms [redacted] had already paid the premiums for January and February at the time of processing so the payment was applied to her March premium If a refund is issued, the amount would be removed from her March premium She would then owe the exact same amount of the refund back to Coventry Due to this, we are unable to determine a benefit to issuing a refund at this time However, if Ms [redacted] was charged any overdraft or NSF fees due to the unexpected transaction, we may be able to reimburse her Requests for reimbursement of any fees applied would need to include bank statements that show the rolling total of her bank account as well as the dates that any fees that were applied and their amounts 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

May 30, 2014Dear 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 4-15-This letter is in response to the consumer complaint filed by *** [redacted] regarding the billing for his health insurance policy.Please note we received a MO Department of Insurance complaint (# [redacted] ) regarding this matter on 5-15-and have been corresponding with MsKathleen T [redacted] at that office concerning this complaint[redacted] complains of wanting to return to his pre-health insurance policy (which carried a lower premium) and of being unable to do soPlease note that on 10-Coventry Health Care sent a letter to [redacted] advising him of the changes coming as of 1-1-and of his ability to renew his current plan earlyWe did not receive this back from the member suggesting he wanted to keep his old policy.Upon received of the instant complaint, a representative attempted to contact [redacted] by phone on 5-16-14, but there was no answer and no ability to leave a voice mail on that lineOn 5-19-14, the same representative sent an email to [redacted] regarding the plan and premium discrepancyShe requested a working phone number to reach him as she was unable to reach him or leave a message at the number we have on file.On 5–19-we received a return email from [redacted] in which he listed his frustrations and refused contact that did not funnel through the Revdex.com, the Attorney General’s office, or the Missouri Department of InsuranceWe contacted the MQ DOI on 5-19-to attempt to expedite this issue before the due date of this responseWe assume the DOI has yet to hear back from the member regarding the options we provided.There are three options available to this member we are making available to remediate the situation:• If he wishes to return to his pre-ACA plan, he needs to be aware there will be an effective date change, premium change, and that his claims will have to be reprocessed to reflect the 12/l effective date.• Before we move the member back to the pre-ACA plan, we need confirmation from [redacted] of accepting the new rate of $for the plan 80/There was an annual rate increase for this member's plan although this new rate is still less than the $quoted in his complaintHe would not be paying the $474,premium he previously had .• [redacted] has options — (1)Agree to the effective date change and new premium, (2) Stay on the ACA plan he migrated to on 2/1, or (3) terminate his Coverage.Coventry Health Care hopes this explanation provides your office 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 [redacted] , extension ***My fax number is [redacted] , and my e-mail address is [redacted] Very truly yours,Neil M***, B.ARegulatory Compliance Analyst Coventry Health Care

October 23, 2014Dear [redacted] : Your letter of October 22, to Coventry Health Care of Virginia, Inc(“Coventry Health Care”) was referred to my attention for review and responseIn her objection submitted to the Revdex.com, [redacted] voiced displeasure with Coventry’s response to her complaint [redacted] advised that she received the same response as beforeProviders are responsible for coding their claims correctly in order to receive reimbursement for services renderedThe [redacted] submitted an obsolete diagnosis code of [redacted] on claims for [redacted] ***The appropriate diagnosis code is [redacted] [redacted] ***’s letter dated September 12, advised [redacted] that her claim for October 29, in the amount of $3,would be processed as a one time exceptionClaim number [redacted] processed according to [redacted] ***’s policy benefits on September 17, with $applied to her deductible, $applied to her coinsurance, and $1,applied to the amount above the allowable charge The [redacted] was reimbursed $1,with check number [redacted] The Explanation of Benefits (EOB) detailing this information is dated September 25, [redacted] may contact the Customer Service Department to request a copy.If you have any questions, please contact the Customer Service Department at ###-###-####Sincerely, Shawn M Complaint and Appeal Analyst

Complaint: [redacted] I am rejecting this response because: I had contacted Revdex.com previously because my insurance company cancelled my health insurance without notifying meAfter sometime and many hour long phone calls spent mostly on hold with Coventry and after the Revdex.com contacted them they agreed they were in the wrong and said they would reinstate my policyI informed them I no longer wanted their policy as I had by this time, obtained another oneI received a letter in the mail this saturday 12/that they were ach withdrawing $1,from my bank account for payment for months of coverageI contacted them immediately but nobody there will do anything to help and my bank is unable to stop the pending withdrawalBelow is the original complaint: Sent Via: Email (ODR) From: Revdex.com serving Metro Washington DC & Eastern Pennsylvania To: [redacted] **Subject: Message received from the business about your complaint Date Sent: 11/21/8:24:AM Attachments: Click here for printer friendly version [redacted] Berlin MD [redacted] Dear [redacted] : This message is in regard to your complaint submitted on 11/10/10:25:AM against Coventry Health Care, IncYour complaint was assigned ID [redacted] The business has sent the Revdex.com a message regarding this complaint, and we are passing it on to youThe contents of this message are below or attachedPlease respond to this message in written form within daysThe text of your complaint may be publicly posted on Revdex.coms Web site (Revdex.com reserves the right to not post in accordance with Revdex.com policy)Please do not include any personally identifiable information when you tell us about your problem or in your desired outcomeBy submitting your complaint, you are representing that it is a truthful account of your experience with the businessRevdex.com may edit your complaint to protect privacy rights and to remove inappropriate languageRegards, [redacted] The Revdex.com MESSAGE FROM BUSINESS: 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 policyOur Executive Resolution Team researched your concerns, and I would like to share the results of the review with youWe 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 longWe 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] Regards, Chris B [redacted] Executive Resolution Team return my $1,immediately Regards, [redacted] ***

Complaint: [redacted] I am rejecting this response because: Please see attached handwritten response Regards, [redacted] * [redacted]

Good Afternoon [redacted] , We reviewed the complaint on behalf of [redacted] under your department file number of [redacted] . **. [redacted] contacted your office asking that we cancel her coverage and provide a premium refund. After reviewing our records we were unable to locate an... account or application for [redacted] . As you are aware, we service five counties, [redacted] , [redacted] , [redacted] , [redacted] , ***. Per [redacted] 'somplaint she resides in Florida. If you find that this information is incorrect, please provide the members identification number and plan coverage. Sincerely, [redacted] ***, Specialist Executive Inquiries .

Hello, size="3">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 your complaint we immediately reached out to Coventry to verify if you were being refunded $as the complaint statedWe were advised that as per business rules, the employer is the only one who can request to remove the member from the premium billingOnly the member can request to terminate the entire policy and we did not receive a termination request from this memberPer the member’s contract it states that we must receive notice within days from the date the termination is being requested to terminate the policy This policy was terminated effective December 31, per the employer request, and there is no refund dueThe employer paid this member’s premium for the life of the policy and the policy was never unavailable to use for medications or doctor visitsWhen the member was disassociated from the employer, she was responsible for her own premium if she wished to continue the policy in Since no payments were made after the disassociation she was terminated for non-paymentThe billing history is available and was not deleted, I am sorry that you were advised incorrectlyI have attached the payment history for the member’s records Concerning the customer service you experienced, our goal is to provide exceptional service to our customers, and immediately resolve issues when they do occur I sincerely apologize for the frustrations and difficulties you experienced and that we did not provide the level of service that you rightfully expect and deserve These actions are not consistent with our service standards and we appreciate you notifying us of your experience We have addressed your customer service concerns directly with the managers of the representatives who handled your calls 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

Dear Ms.... [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on March 9, 2015. During our investigation, it was determined that Mr. ***’s card was not accepted for several prescription claims due to ongoing updates to the coverage dates for his policy. The updates have been completed and Mr. ***’s policy is currently showing that he has active coverage and that it has been active since April 1, 2014. At different points of time in 2015, Coventry’s systems did not accurately reflect this. We apologize for any inconvenience this may have caused Mr. ***. We will continue to work to improve the service we offer. We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. ***’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

April 18, 2014Dear ** [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 premium payments deducted from the member’s checking account by the PlanThe member is requesting reimbursement in the amount of $Upon review, the member’s policy has been terminated as never in force and a refund for the amount of $has been expedited.If you have any questions or concerns regarding this matter I can be reached at ###-###-#### Sincerely,

June 17, 2014Dear [redacted] ***:Thank you for giving Coventry Health Care of Georgia the opportunity to review your Revdex.com complaint regarding the termination for coverage and the refund of premium payments deducted from your bank account We appreciate your feedback in regards to our Customer Service process.After a thorough review, our records show that your coverage was termed on 9/30/Coventry collected premiums for $for the month of October through April in errorThe premium rate for each month has been correctedThe total premium amount for your spouse from October through June should be $1,The adjustment was made and you will be refunded $within 3-business days(See Attachment A)We apologize for any inconvenience this may have caused.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,

--------- Forwarded message ---------- sans-serif;">From: Revdex.com of Metro Washington DC< [redacted] >Date: Wed, Apr 29, at 12:PMSubject: Fwd: complaint 10601120To: [redacted] < [redacted] > ---------- Forwarded message ----------From: [redacted] < [redacted] >Date: Wed, Apr 29, at 11:AMSubject: complaint 10601120To: " [redacted] " < [redacted] >I received an e-mail from Coventry stating that the claim has been paid Thank You

September 26, 2014Dear [redacted] :This letter is in response to the aforementioned Case Number [redacted] regarding [redacted] ***'s complaint[redacted] is currently enrolled with the Health Plan's SILVER $HMO #CLK, effective January 1, Please see the following correspondence timeline with [redacted] ***:TIMELINE:01/24/@ 9:09am [redacted] contacted the Health Plans Customer Service Department to request a list of providers in her areaThe representative advised [redacted] that they would mail her a list [redacted] was assigned to Dr[redacted] from January 1, to April 23, 03/21/@ 9:33am [redacted] contacted the Health Plans Customer Service Department stating that she needed to find a primary care providerThe representative advised [redacted] that they would email her the list of the following providers: Family Practice, Internal Medicine, Gynecologist, OB/GYN and plan information to email: [redacted] ***04/24/@12:25pm [redacted] contacted the Health Plan regarding PCP in her area, urgent care benefits and copaymentsThe Representative advised [redacted] that urgent care copayment was $and that once she selected a pcp she can call back the Health Plan04/24/@ 2:28pm [redacted] contacted the Health Plan to advise that she did not change her pcp to Dr [redacted] The representative advised [redacted] that there was a glitch in the system which changed the pc? 04/25/@ 12:07pm [redacted] contacted the Health Plan requesting to change her pcp back to [redacted] The representative advised [redacted] that the change would take effective on May 1, 05/05/@ 5:57pm [redacted] contacted the Health Plan to change her pcp back to [redacted] officeThe representative requested the pcp changeIn an effort to assist [redacted] with her complaint, the Health Plan spoke to Dr [redacted] and [redacted] at Dr [redacted] ’ office regarding the complaint, ** [redacted] and [redacted] were advised that since they are a Participating Provider with the Health Plan, claims would need to be submitted for the services renderedOnce the claims have been submitted and processed according to [redacted] ***'s Schedule of Benefits, they will need to refund [redacted] the difference in what she paid out of pocket [redacted] also confirmed that on January 24, 2014, [redacted] went to see Dr [redacted] for a sick visit and did not present her insurance card at the timeOn April 24, 2014, [redacted] had services rendered again without presenting her insurance card [redacted] stated that the office received a copy of [redacted] ***’s insurance card on May 24, 2014, but a different provider was listed so they were not able to submit the informationPursuant to the Schedule of Benefits, Section 1, Using Your Benefits, page 9: Payment to ProvidersI In Network Providers (Participating Providers): For In-Network Covered Services, the Participating Provider will bill the Health Plan directly for the servicesYou do not have to file any claims for these servicesYou are responsible for payment of: A, The applicable In-Network Copayment, Deductible, and/or Coinsurance amounts; B, Services that require Prior Authorization, which were not Prior Authorized; CServices that are not Medically Necessary; and DServices that are not Covered ServicesCoventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matterIf you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:am until 5:pmMy fax number is ###-###-####, and my e-mail address is [redacted] Sincerely,Siana L Complaint and Appeal Analyst

Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on January 20, In reviewing [redacted] ’s policy, we found that an issue with our systems had caused the policy to be terminated as never in force back on December 31, While correcting that issue, her spouse was inadvertently left off of the reactivated policy He has been added back to the policy effective January 1, The process of adding him to the policy and assigning an ID number was completed on January 22, 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

March 19, Dear ** [redacted] : Re the enclosed response from [redacted] , Appeals Coordinator I contacted Coventry Health America One's customer service department several times in late in and throughout February for my insurance member id and welcome package so that I could create my new profile athttps://member.cvty.com/memberPortalWeb/appmanager/memberPortai/menriber, but more importantly, provide my new insurance information to my doctor.Every time I called, Coventry Health America One's customer service informed me no member id had yet been established for meI was NOT able to set up any medical appointments nor procure medical services of any kind because the company failed to create a member id for meMy many follcalls in February to Coventry Health America One went unresolvedTo add insult to injury, the company did not send me any acknowledgment regarding my calls or an ETA for when I would receive a member id and welcome packageWhen I still had not received a member id and welcome package by February 28, 2614,I selected and signed up with another insurance company on March 3, (I intend to stay with this alternate insurance company!)Coventry Health America One finally sent me a member id card In the mail on March 10,and a welcome package the following dayHowever, it was too late; I had already signed up with another insurance company as stated above.I have NOT used the Coventry Health America One member id and the welcome package remains unopenedI sent a letter, dated March 12, (enclosed) to the company asking if and where I could mail back the member id card and welcome package, I also stated I wanted my reimbursement and to terminate the contractAs of March 19, 2014,I still have not received a response from the companyAlso enclosed for your reference is a short letter from Coventry Health America One, which prompted my questioning of their billing practicesAs you can see, there is NO reference as to a $December charge (How was this charge calculated?), nor a specific premium breakdown of $for February and March $215,78, When I called Coventry Health America at ###-###-#### on February about the contents of this brief letter, I was told "computer systems are down; we cannot answer any billing inquiries at this time,"Had the February 22, letter from Coventry Health America One been more detailed oriented, I wouldn't have assumed a mathematical error on the part of the companyThe so-called "premium payment" of $for December mentioned in ** [redacted] 's letter doesn't make sense, as I registered for this insurance via [redacted] com on December 26, Her response letter to the Revdex.com is the first time I've even seen a charge of $referenced for December In summary, I don't have faith in this company to cover me for any medical services, after what I've had to deal with during mid-January to late February I just want a reimbursement for the January premium ($216.73) and an official letter from the company terminating the contract.Please advise me Thank you

March 10, Dear ** [redacted] : Your letter of February 26, to Coventry Health and Life Insurance Company, Inc(Coventry) was referred to my attention for review and response On December 6, 2013, *** [redacted] contacted Coventry’s Billing and Enrollment Department to discuss alternative plansThe Customer Service Representative (CSR) advised *** [redacted] to contact the agent on record On January 5, 2014, Coventry attempted to collect the recurring premium payment for insurance coverage via Electronic Funds Transfer (EFT) in the amount of $1,On January 9, 2014, the [redacted] ’s financial institution informed Coventry that the payment could not be drafted from their accountTherefore, on January 10, 2014, Coventry issued a letter to ** [redacted] advising of the returned EFT Draft and advised a $service fee would be assessed for non-sufficient funds On January 22, 2014, *** [redacted] contacted Coventry’s Billing and Enrollment Department to terminate their policy coverageThe CSR advised *** [redacted] in order to cancel the policy the primary insured, which is ** [redacted] , would need to call Coventry to terminate the policyAdditionally, *** [redacted] was advised that the policy would be prospectively terminated through the paid date of the current month On February 14, 2014, *** [redacted] contacted Coventry’s Billing and EnrollmentDepartment to terminate the policyAdditionally, *** [redacted] advised she contacted Coventry in December to terminate the policyThe CSR advised only one call was received in December to discuss alternative policiesThe CSR advised she would submit a request for a refund for both the January and February premium and to have the policy retroactively terminated as an exception According to business rules only a primary member can request to terminate a policyCoventry did not receive a written request or a phone call from ** [redacted] requesting to terminate the policyAdditionally, Coventry did not receive a phone call from *** [redacted] requesting to terminate the policy until January 22, During this call *** [redacted] was advised ** [redacted] would have to submit the requestBased on the details of this case, there was no error on Coventry’s part as the primary member never requested to terminate the policyTherefore, Coventry will not refund the [redacted] $for the charges the bank assessed for over draft fees and stop payment fees If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext*** Sincerely,

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 26, During our investigation, it was noted that a request had already been sent to have the claim in question processed at the in network level on February 26, The request was handled on February 27, and the claim was reprocessed The reprocessed claim shows [redacted] as no longer being responsible for making any payment 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

July 25, 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 miscommunication between she and the customer service representative whom she reached on the telephone.We regret that [redacted] did not have a good experience when she contacted Coventry to discuss her policyBecause we realize that there could be several explanations as to why the call between [redacted] and the customer service representative was prematurely disconnected, Stephanie H [redacted] from our Local &Regional Business Operations department reached out to [redacted] According to MsH***’ notes, she originally spoke to the member on July 15, in the late afternoon around 4:44pm Pacific timeAt that time [redacted] asked MsH [redacted] to call her back in the morning because her phone was about to quitMsH [redacted] called [redacted] twice on July 16, once in the morning and the other time in the afternoon, but only got a voicemailShe left a voicemail, both times, with her direct number to call her back.MsH [redacted] called again on July around 9:47amShe called [redacted] ’s home phone number and reached her husbandHe asked MsH [redacted] to call [redacted] ’s cell number, which he gave to her againMsH [redacted] called the cell number and reached [redacted] ’s voicemail againShe left another message with her direct phone number and that fact that she could be reached until 5pm Pacific timeMsH [redacted] never heard back from [redacted] .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] certainly is entitled to a good experience when speaking with a Coventry customer service representativeIf there is difficulty communicating with whoever answers her call and, if at any time the call is inadvertently dropped, she should call back and explain the situation to the representative.Very truly yours,Neil M, B.A.Regulatory Compliance Analyst Coventry Health Care

face="Calibri">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on December 30, [redacted] ’s policy has now been terminated The termination date was entered as January 1, This caused our system to consider the policy as active for January 1, 2015, and prorate her refund amount We collected $through the EFT draft on December 31, for her premium for January This calculates to a premium amount per day of $for the days in January A refund was deposited into her bank account on January 9, in the amount of $ We are still working to determine if we are able to backdate the termination to December 31, 2014, which will allow us to refund the additional $that was kept as payment for the premium for January 1, We respectfully request that she allow 7-days for additional action to be taken regarding that situation We do apologize for the frustration [redacted] has experienced in seeking resolution for this issue We are unable to offer any reimbursement for her time spent However, if any overdraft fees or ACH return fees resulted, we can review those for possible reimbursement if a bank statement supporting the amounts is provided 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

Dear [redacted] , Thank you for allowing us to address the concerns reported in complaint # [redacted] for [redacted] h that was received by us on November 19, 2014, regarding unauthorized premium drafts 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 investigationOur records are not showing any unauthorized premium drafts The standard authorized monthly draft of the premium for coverage for the month of November was processed successfully on November 5, [redacted] then called and authorized another payment on November 11, This second payment was applied to his premium for December, so his policy is currently paid through December 31, If [redacted] wishes for us to review for possible reimbursement of any NSF or overdraft fees, the Premium Accounting department will require a copy of a bank statement showing the account activity and the running balance The bank statement must show the name and at least the last four digits of the account number We will not require full details of any transactions other than the Coventry payments and drafts, but we will require dates and amounts for all transactions [redacted] ’s concerns regarding the service issues he experienced have been reported to the appropriate department for handling and education Any decisions made regarding termination of employees are confidential and will be handled internallyAs both payments that were made were authorized and have been applied to his policy, we are unable to identify an issue that would require software revision or replacement 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

May 21, 2014Dear [redacted] :The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO Exchange health benefit plan[redacted] , (the “member”) has filed a complaintThe Member’s complaint concerns termination of coverage effective dateThe member is requesting reimbursement of premium payment in the amount of $588.69.Below is a timeline of events leading up to the resolution of the member’s complaint.February 20, – Member contacted Billing & Enrollment because her daughter had a doctor’s appointment and she didn’t have a card yetShe was advised that she can print a temporary card off of the member portal.February 25, – Member contacted Billing & Enrollment because she wanted to know when the member would be billedShe was advised that she will be billed the 5th of every month.March 1, – Member contacted Billing & Enrollment called to ask why the next draft will be April 5, and not in MarchShe was advised that it was too close to the new bill, and she is going to be drafted for two months.February 18, – Member contacted Billing & Enrollment because she wanted to terminate her coverageShe was advised that her policy would terminate for February 28, 2014, and once the plan receives proof of other coverage the plan will be able to retro-terminate the member’s policy and issue a refund for February.February 27, – Member contacted Billing & Enrollment because she wanted to terminate her coverageShe was advised that her policy was terminated effective February 28, and we could not issue a refund until the plan receives proof of other coverage.April 21, – Member contacted Billing & Enrollment to check to status of her refund.May 7, – Member contacted Billing & Enrollment and spoke to a supervisorThe member called requesting a refund for the month of JanuaryThe member was advised that we need proof of coverage with the new policy’s effective dateThe member was also advised that we can only retro-terminate a policy back to days.ROOT CAUSE:The member requested to terminate the coverage effective January 31, There is no refund due.RESOLUTION:The member’s policy has been terminated effective January 31, There is no refund due because the member placed a stop payment for February’s draft, making the member paid through January 31, 2014.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,