Coventry Health Care

Dear [redacted] , Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on February 23, The documentation for the phone call we received from [redacted] on December 15, 2014, specifically states that the amount of premiums quoted as owed at that time was $ We were also unable to locate any changes made to the terminated policy with Coventry by the Marketplace in Unfortunately, this means we are still unable to reinstate the policy 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] Executive Resolution Team

[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 Regards, [redacted]

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on March 16, During our investigation, we were unable to locate a phone call made to Coventry at any time in December requesting termination of the policy As [redacted] stated, we did receive an e-mail on February 7, that supported her family had obtained other coverage for This allowed us to terminate the policy back to December 31, The refund was requested multiple times but errors prevented the refund from being issued We apologize for any inconvenience caused by the delay in sending the refund and will seek to prevent the same issue from happening to others We are showing that the refund process has now been successfully completed Our system is showing a processed date for the refund of March 23, The refund was done through [redacted] directly to the bank account of record that we have for the policy The amount of the refund was $ The actual date the funds became available may vary depending on the time required by the receiving bank to process the transaction We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address MsMiller’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

face="Calibri">Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on June 09, Based on our records, [redacted] ’s policy, case# [redacted] , was created on May 07, 2015, with an effective date of June 01, 2015, per the file received from the Marketplace on May 06, The members, [redacted] **and her daughter, [redacted] are covered by the [redacted] Coventry Silver $Copay MIPP plan, with a monthly premium due of $and an Advance Premium Tax Credit (APTC) of $Per our Claims and Benefits department, the member’s ID # had processed in their system but did not feed over to the billing and enrollment systemsAs a result, a manual feed request was sent and the process was completed to update in all systemsThe member ID [redacted] is now reflected in all systems Currently, the policy is active effective June 01, 2015, and paid through June 30, On June 10, 2015, [redacted] s was contacted by one of our health concierge via phone but [redacted] s asked the representative to call her backThe representative called back several times but was not able to reach [redacted] s and left a voice mail messageOn June 11, 2015, the representative sent [redacted] s an e-mail to offer assistance in selecting in-network providers and advised her to contact customer service at ###-###-#### should she need any additional assistance I apologize for any difficulties this situation has caused [redacted] sWe take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted] s’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

Coventry Health Care Advantra Gold Medicare Advantage Plan – Ohio TERRIBLE CLAIM HANDLING Even a claim that was appealed and approved did not get handled -- it's been months since the procedure was doneI paid the bill to the hospital to keep it out of collection and I am out $at this pointMy Ophthalmologist has been fighting claim problems for months and now refuses to accept customers (old or new) with Coventry insuranceHow many more providers will take that approach???? I made the mistake of renewing my coverage for That was a POOR choice on my partThis isn't "cheap" Obamacare insurance or free Medicare Advantage insurance; I pay a premium every month for Advantra Gold insurance

Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 18, During our investigation, we found a renewal notice dated October 25, 2014, which was mailed to [redacted] *** The renewal notice gave the new premium amount of $for her policy for A draft change letter was also sent to [redacted] on December 19, 2014, to advise that $would be withdrawn from her bank account on December 31, The policy was allowed to passively renew since Coventry didn’t receive notification to cancel it prior to the draft taking place A file from the Marketplace processed on January 6, 2015, gave us a termination date for the policy of January 20, As the premium had been collected for the entire month of January, [redacted] was sent a prorated refund for the eleven days of January that her policy was no longer active Coventry posted the refund to her bank account in the amount of $on January 12, It was noted that [redacted] indicated she has secured other coverage, but didn’t provide the date it became active We have been given the approval to terminate passively renewed policies if the person had other coverage active on January 1, If [redacted] had other coverage starting right away in 2015, Coventry would be able to terminate our policy back to December 31, 2014, and issue a refund for the remaining premium collected for January [redacted] may contact the Billing and Enrollment department at ###-###-#### or myself at ###-###-#### to provide the date her other insurance became active 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] , Please see our response to complaint # [redacted] for [redacted] that was received by us on March 13, During our investigation into the complaint, it was noted that two separate premium payments had indeed been collected in February Both payments show a processed date of February 26, Our Billing and Enrollment department stated that the payments were taken by EFT and that the requests for the payments were made via Coventry’s automated phone system They were unable to determine why two payments were taken but suggested that either multiple phone calls were made or the button to confirm the payment at the end of the call had been pressed multiple times Coventry did refund one of the payments to [redacted] by EFT The date of the refund shows March 11, The actual date that the funds became available in her account may vary depending on the processing time required by her bank for the EFT notification 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

CID: Date Filed: 3/26/12:AM Nature of Complaint: Customer Service Issues - No Detail Provided select Problem: Company has been asked repeatedly to fix this issue including in Revdex.com.org Complaint # [redacted] No action from Company to resolveApplications from Marketplace processed incorrectly and double billedAfter resolved issue with Marketplace (1/15) will not accept paymentMember Number: [redacted] Initial application of 3/accepted and paid through 8/Move to new county reported for move date 6/30/was not made effective until 9/1/Inproper billing was reported to CoventryMultiple calls placed with same issueNo response and threatening calls demanding paymentCall to Marketplace and assigned case workerCase worker finished adjustments to second half of in 1/Payments are not accepted by Coventry for the second premium after 10/31/regardless of error being on Coventry's partMultiple phone calls to billing were placed and at least half resulted in operator hang-upRequested Manager/Supervisor in multiple instances and was given to another non-managerial operatorPayment has been tried to be paid since 10/in multiple callsOperators repeatedly state unable to take or process payment because of errors on the account and/or they do not see the account after the move to the new countyNo resolution suggestedNo cooperation or 3rd party call to MarketplaceMarketplace notified of potential they may have closed an application which should be open and was thoroughly researched and discredited as a potential issueMultiple operators rude and threatening during calls with attempt to pay correct premiumSame behavior has been experienced when called by billing department demanding incorrect payment of hundreds of dollars higher than premiumThough the Marketplace states Coventry will cover for Nov 14-Jan no one in Coventry able to accept payment and multiple operators state will not be covered due to lack of paymentmonths straight attempting to assist with or talk about the need to have account updated to the correct billing and multiple involvements with Marketplace have still not resolved anything with Coventry no matter how many times they are calledComplete disregard for Marketplace case worker and resolution reported to Marketplace not instatedCompany please address properly with new information submission concerning letter from Company acknowledging there is an issue which they did not resolve within the stated time period needed to pay billCompany continues to state payment is not possible while Healthcare Marketplace states they are required to take payment for the time in question due to the need for the Healthcare Marketplace intervention on account billing issueReference issue # [redacted] Translate Desired Settlement / Outcome Desired Settlement: select Desired Outcome: Accept payment as per terms stated by the Marketplace and coverage for November 2014, December 2014, and January with retroactive claims processing from July through January without further issueReview of 80/spendingUpdate to the deductible to have full year correctly billed as deductible was met in prior (March to June)portion of the yearSame for the other account held by the household under second policyAll resolutions effective as soon as possible with payment to phy CID: Date Filed: 3/26/12:AM

[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: your bureau is not helping that allis their abused policy against a customer they have more money thank you Regards, [redacted] ***

October 10, 2014Dear Sir or Madam:This letter is written in response to the consumer complaint filed with the Revdex.com by [redacted] regarding a refund of her CoventryOne policy which was terminated by her on August 31, [redacted] received her refund on October 2, It was credited back to her card in the amount of $Regarding the $NSF, if [redacted] would submit a rolling bank statement to reflect her balance before and after the transaction that resulted in the $NSF, we would be happy to handle that for her.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.mSincerely, Melody C Complaint and Appeal Analyst

Dear [redacted] , Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on March 13, Unfortunately, if [redacted] did not have other insurance that began January 1, 2015, Coventry will not be able to change the termination date for her policy As an insurance carrier offering coverage on the Health Insurance Marketplace, we are bound by their established guidelines At this time, the termination date for [redacted] ***’s policy is correctly listed as January 20, No further premium refund is due 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] Executive Resolution Team

May 23, 2014Dear [redacted] :The Appeals Department of Coventry Health Care of Georgia, Inc(“Coventry Health Care”) writes this letter in response to your request dated May 15, and received at our office on that dayThis letter is in response to the consumer complaint filed by [redacted] regarding termination of her policy and refund of her premium.Coventry’s records show that on March 17, 2014, the member called to terminate coverage as of April 1, and to change the address of record to [redacted] , GA ***On May 12, 2014, the member called in to advise that her account had been drafted when the policy should have been terminatedA review of Coventry’s records found that the termination was not processed in enough time to avoid the draft.On May 15, 2014, the policy was terminated as of March 31, as requested and a refund issued on May 19, The amount deposited back to the drafted account is $which is two premiums of $(for April and for May)Depending on the members banking institution, funds will appear within 1-days from May 19, 2014.If you have any questions, please contact the Customer Service Department at [redacted] .Sincerely,

Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on July 23, As stated in our previous response, during our review, we found that [redacted] ’s policy was terminated on March 11, 2015, effective December 31, 2014, for non-paymentThe member’s day grace period started on December 01, and ended on February 28, [redacted] owed $for December, January, and February because the initial payment for December was used to cover the premium never collected for the month of June The member was refunded the amount of $which was the remainder of the funds after the premium of $was applied to the June premiumBased on our records, there is currently no refund due for $as the payment was posted to the December premium that was past due If the member feels a refund is still due to her, she can send in a copy of the bank statements from May 01, to December 31, This was previously stated to her in our phone conversation on July 02, 2015, and she understoodUpon receiving the bank statement for the month of June 2014, we can have our Premium Accounting department research that payment and verify if any additional money is owedThe bank statement that we received in this rejection did not include the month of June 2014, which is the month we are stating was never collected from the member 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 24, Dear [redacted] : The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual HMO off exchange health benefit plan[redacted] (the “Member”) has filed a complaintThe Member’s complaint concerns premium payments withdrawn from an incorrect bank account by the PlanThe Member is requesting a refund for premium payments taken out of the member’s bank account after a request for termination of coverage was madeThe Member is requesting reinstatement, reimbursement for medication that was paid out of pocket, and month of free insurance for the hassle.Below is a timeline of events leading up to the resolution of the Member’s complaint.November 14, – The Member contacted Billing & Enrollment to change his addressThe zip code has changed, so the member was advised that he needs to send a written requestNovember 27, – The Member contacted Billing & Enrollment to update his addressDecember 10, – The Member contacted Billing & Enrollment to update his addressThe member was advised he was now out of areaAugust 5, – The Member contacted Billing & Enrollment to advise that the account that funds come out of is currently closedThe member was advised that we draft on the 5th of every month, and was advised that there is a non sufficient funds fee NSF fee if the payment returnsAugust 13, – The Member contacted Billing & Enrollment because there was not enough money in his account to cover the draft, but he added the fundsThe member was advised he was paid in advanced.October 9, – The Member contacted Billing & Enrollment to see if his payment postedDecember 20, – The Member contacted Billing & Enrollment because funds were not availableThe member advised that he will send in a paymentFebruary 11, – The Member contacted Billing & Enrollment because he moved to NYThe member was advised to send in a written request, as he may be out of areaFebruary 11, – The Member contacted Billing & Enrollment to get a refund of overpaymentAugust 7, – The Member contacted Billing & Enrollment to update his banking informationThe member was sent an automated clearing house (ACH) formAugust 19, – The Member contacted Billing & Enrollment to see if we received his updated banking informationThe member was advised that it was not received and was advised to fax it inSeptember 4, – The Member contacted Billing & Enrollment advising that we have drafted the wrong account although he sent in new banking informationSeptember 4, – The Member contacted Billing & Enrollment to make a paymentOctober 10, – The Member contacted Billing & Enrollment because he did not understand why his policy terminated because he made his paymentsOctober 10, – The Member contacted Billing & Enrollment because his policy was terminatedThe member was advised that he is paid thru August 31, The member stated that he will send in bank statements of the payments he has madeThe member had been paying the old premium of $but he had migrated onto a new plan with the new premium of $October 16, – The Member contacted Billing & Enrollment about his premiumThe member was advised that he will need to follow the reinstatement processROOT CAUSE:The member’s premium increased upon his renewal but he did not pay the increased premium amountRESOLUTION:The policy has been terminated effective August 31, due to non-payment of the total amount of his new premiumThe member will need to proceed with the reinstatement process, as he was sent his renewal information.If you have any questions or concerns regarding this matter I can be reached at ###-###-####Sincerely, Emily M Appeals Coordinator

11/21/2014Dear [redacted] :This letter is in response to your grievance (complaint) that you filed with us on 11/19/2014.Based upon our review, we received your written grievance expressing your dissatisfaction with the customer service you receivedPlease accept our apologies about the service you receivedCoventry expects that our members are given accurate information in a professional, friendly and timely mannerPlease be assured that feedback and coaching have been provided and leadership has been made aware of this incident.On 11/03/you paid $for [redacted] 10mg because the preferred pharmacies in your area did not have your medication in stockYou may go to any of our network pharmaciesHowever, your cost may be less for your covered drugs if you use a preferred network pharmacyWhen requesting an adjustment you can send us your request for payment along with your bill and documentation of any payment you have madeIt is a good idea to make a copy of your bill and receipts for your recordsTo make sure you are giving us all the information we need to make a decision, you can fill out our claim form.We are including a claim form with this letterYou do not have to use the form, but it will help us process the information fasterKeep in mind that you must submit your claim to us within months of the date you received the service, item, or drug.We apologize for any inconvenience that you have experiencedPlease be assured that this was filed as a grievance and all grievances are reviewed by upper management for future plan process improvements.If you have any questions, please feel free to contact Customer Service at ###-###-####, hours a day, seven (7) days a weekYou can request language translation services when you callTTY/TDD users please call Telecommunications Relay Services.Once again, we apologize for any inconvenience.Sincerely, Advantra Silver (HMO)

May 23, Dear [redacted] :This letter is in response to the aforementioned Case Number [redacted] regarding ** [redacted] ’s Primacy Care Provider (PCP) and service issuesBelow please find the information requested.** [redacted] became effective on April 1, 2014, under the Gold HMO Carelink PlanOur records indicate that ** [redacted] was assigned to Dr [redacted] - [redacted] at [redacted] , FL ***Dr [redacted] - [redacted] is approximately miles from ** [redacted] ’s zip code.On May 13, 2014, ** [redacted] contacted the plan in an effort to change his PCP** [redacted] ’s PCP was changed to Dr [redacted] at [redacted] FL, ***Dr [redacted] is approximately miles from ** [redacted] ’s zip code** [redacted] was also contacted on May 22, According to ** [redacted] , he received the Identification (ID) card showing Dr [redacted] as his PCP** [redacted] expressed his satisfaction with his new ID card and PCP.Additionally, because of the unprecedented growth of membership with our ACA plans, the call volume is higher than usuallyThe plan is working diligently to rectify this issue** [redacted] has been provided with my direct contact number in the event he has any further issues and cannot reach the appropriate department.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:am until 5:pm.Sincerely,

Thank you for allowing us to address the concerns reported in complaint # [redacted] for *** [redacted] that was received by us on 11/10/and was regarding cancellation of her 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 investigationOur records do not show that we received a verbal request from the member to end her coverage in September We do show that the member had called us on October 7, and was informed at that time that her request must be sent in writingWe received the member’s written request to cancel her policy effective November 4, The request was dated October 10, Since policies are terminated at the end of the month and the member indicated that she had employer coverage effective November 1, 2014, the coverage has been terminated effective October 31, 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

Coventry Health Care did not receive the above-referenced Complaint until 11/6/and respectfully requests an additional few days in order to complete its investigation into this matter Thank you, Deborah F*

September 9, 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 billing issues for his insurance... policy. [redacted] ’s complaint states that his policy was set up so that payment was to be drafted monthly in the amount of $59.10 beginning in March 2014. According to [redacted] , it wasn’t until August when he discovered a charge of $729 had been drafted out of his account that he realized that the monthly payments had not been deducted and that there was an increase in fees. [redacted] claims that he was unaware of any changes to his policy or increase in fees. Additionally, [redacted] states that he should not be responsible for payments that were not timely drafted from his account. Coventry Health Care regrets that there apparently was a glitch in our system that prevented us from withdrawing [redacted] ’s monthly payments. However, [redacted] ’s insurance policy was in effect during that entire period and therefore the money was due and owing to Coventry. If at any time [redacted] had desired to use his insurance coverage, there would not have been any problems with him doing so. After investigating [redacted] ’s statement that he was unaware of a change in policy, according to our records [redacted] contacted customer service on July 23 to confirm that his plan had changed as of June 1 and that the payments should be $185.05. When [redacted] spoke with a supervisor on August 15 and requested that his policy be terminated as of August 31, 2014, the supervisor accommodated [redacted] . As of that time, [redacted] ’s payments for coverage were up to date. Therefore there is no refund due. [redacted] indicated that because of the amount of money that was withdrawn in August, he had over drafted his bank account. If he can send a copy of his bank statement to me showing the overdraft fees, I will be happy to look into the matter of reimbursement of those fees to him. Coventry Health Care hopes this explanation provides the BBB with the necessary information to complete the investigation of this matter. If 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 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 The deposit posted to my account today (2/11/15) Thank you for your assistance in getting this matter settled Regards, [redacted]