Coventry Health Care

I am rejecting this because the problem has not been resolved. I did not receive ID Cards/policy from Coventry Health Care in a timely manner and no longer need their services. I applied for coverage in November 2013 and requested coverage beginning on Dec. 1, 2013. I received a email from them on Dec. 9, 2013 stating that I had been accepted. I made several phone calls to Coventry Health Care and was told something different each time. Then on Jan. 28, 2014 I contacted the BBB of NC and also the NC Department of Insurance. I am now covered with another insurance company and would like a full refund of $869.62. Tried to contact the person on this email letter on 02/05/14 and this is a call center. Requested her phone number ( [redacted] - [redacted] )and left a message. I have had no response from her. Also called back the NC Department of Insurance on 02/05/14 and I was told there was no mention of a refund. In a letter he received it said that a policy had been issued. I have not received anything from Coventry at this time nor do I want to. The money I am requesting to be refunded was for the Dec. 2013 & January 2014 premiums. Checks were mailed to Coventry Health Care P.O. Box [redacted] on 1/3/14 and cleared our bank on 1/8/14. [redacted] *. [redacted] ###-###-#### E-mail: [redacted] 02/06/14 Complaint ID [redacted]

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 youWe reviewed the complaint and verified we attempted to send ID cards to *** [redacted] but they were being returned to us due to a bad address on fileUnfortunately, we are unable to reimburse [redacted] for May and June premiums that are being requestedWe are currently working towards shorter wait times when our members call inConcerning the customer service you experienced, our goal is o 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 deserveThese actions are not consistent with our service standards and we appreciate you notifying us of your experienceWe have addressed your customer service concerns directly with the representatives who handled your callsWe 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 ConsultantExecutive Resolution Team

Dear... [redacted] , Thank you for allowing us to address the concerns reported in complaint # [redacted] for [redacted] that was received by us on December 5, 2014, regarding an adjustment performed on the claim for services provided to him on April 26, 2013. Our Executive Resolution Team researched your concerns, and we would like to share the results of the review with you. Our research determined that we had initially applied $75.20 as [redacted] ***’s responsibility due to the deductible on his plan. The provider of services later discovered that the allowed amount on the claim did not match to their expected allowed amount and requested that the error be corrected. The correct allowed amount was $199.84. This corrected allowed amount was also applied to [redacted] ***’s deductible, so he became responsible for an additional $124.64. Due to the length of time that had passed between the initial processing of the claim and the correction, a business decision was made to waive the additional deductible applied and instead have the plan pay the $124.64 to the provider. The initial deductible amount of $75.20 was still applied, but as long as [redacted] has paid that amount, he will not owe any additional money to the provider for this claim. I have forwarded the information submitted in the complaint to our Legal department to ensure our reprocessing of the claim was in accordance with Georgia state law. I will send out additional information once that department has reached a decision. 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

---------- Forwarded message ---------- From: [redacted] Date: Tue, May 6, at 10:AM Subject: Complaint ID # [redacted] To: [email protected] I was able to get a hold of people at Coventry this morning [redacted] provided me with confirmation number for the cancellation They stated that they had no record of the letter sent to me on 2/13/in my file [redacted] claims that the May payment is for May Every insurance company I have dealt with bills a month in advance I requested a print out of my account history be sent to me Ken stated that will be sent in the mail the confirmation numbers he gave me are: Cancellation of Policy conf #: [redacted] Billing History conf #: [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 the company as a whole has yet to take responsibility for their employees who they trainI received my refund on Dec 16th which is actually business days after I had called to terminate my policyYour employees said nothing about writing a letter and signing that letter to terminate my policyI called your company on November 5th, 20th, December 1st and 3rdIn all four of these phone calls was that not mentioned You can listen to these phone calls for proof at your leisure since your company records themYou can not expect your customers to know your policies, if your employees do notFurther more you have never discussed the "Manager Eva" who would not tell me who her supervisor was nor transfer me to any other personnelYou also never touched base on why Missy S [redacted] from your Advanced Solutions was unable to call me in 24-hour period as I was toldYou also have not said anything about how I was treated as a customer or what your plans are to ensure this does not occur to another customerEverything I have read says you do not take responsibility as a company for lack of training, wrong information and flat out liesI understand that you can not refund October even when your employee said you could, which you haven't apologized for eitherAmericans are being told to purchase health insurance or pay a fineI as a consumer believe that your company is taking advantage of this and not holding your employees responsible or accountable for the lack of customer service or knowledge of your company and its policies Regards, [redacted]

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,Upon review of the complaint we reached out to Coventry to confirm that [redacted] *** received her refund of $We confirmed that a check was mailed out on June 20, 2014, but was returned to us for a bad addressWe sent a check again on November 10, 2014, and our records show this was received by [redacted] and cashed on November 18, 2014.Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attentionI would also like to thank you for sharing your experience with usIt is feedback like yours that helps us address issues and prevent them from reoccurringWe take customer complaints very seriously and appreciate 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 at [redacted] ,Thank you,Ashley S.Complaint and Appeal ConsultantExecutive 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: I do not accept the response made by Coventry to resolve this issueFirst of all, no one from Coventry or the Marketplace has attempted to contact me to resolve this issueSecondly, the Marketplace did not take my insurance premiums in the amount of $1,744.90, Coventry didCoventry took this money every month as an automatic withdrawal from my bank account, not the MarketplaceI understand that I signed up for Coventry through the Marketplace, but the Marketplace never took any money from meAll this money was paid directly to Coventry!! Regards, [redacted]

September 30, 2014 To Whom It May Concern:Coventry Health Care of Kansas, Inc. and Coventry Health and Life Insurance Company (collectively “Coventry”) received the complaint filed with the BBB of Metro Washington DC & Eastern Pennsylvania in our office on September 12,... 2014.A letter of explanation has been mailed directly to the member on this date. A refund of $481.75 will be returned to [redacted] ***’s account within 7-10 business days. We apologize for any inconvenience or confusion this has caused.Coventry hopes this 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 ###-###-####.Respectfully,Brandy HAppeals Department

September 29, Dear [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 #Carelink, effective April 1, Please see the following correspondence timeline with [redacted] ***:TIMELINE: 03/24/8:23am [redacted] contacted the Billing and Enrollment department to enroll her children into a policyThe representative transferred [redacted] to the Sales department for further assistance04/25/5:58pm [redacted] contacted the Billing and Enrollment department to inform us that she received a bill for the bronze plan, but initially requested the silver planThe representative transferred [redacted] to the Marketplace for further assistance with changing the plan- 04/29/6:32pm [redacted] contacted the Billing and Enrollment department to inquire about her new silver plan [redacted] stated that she had not received any correspondence about the new planThe representative stated that the new silver plan could not be found in the system06/03/4:09pm [redacted] contacted the Billing and Enrollment department to inquire about the policyThe representative advised [redacted] that the policy only included her, and did not include her husband07/09/1:21pm [redacted] contacted the Billing and Enrollment department to inquire about the bill [redacted] stated that the premium should be $0, but she was billed for the older premiumThe representative advised [redacted] that the bill would be rerun to correct the balance to reflect $dueIn an effort to assist [redacted] with her complaint, the issue was forward to the Billing and Enrollment department for further investigationOn September 26, 2014, the Billing and Enrollment department completed their review and responded with the following information: [redacted] ***’s policy was created on March 4, with an effective date of April 1, per the file received from the Marketplace on March 3, The monthly premium due was $296.36, and the initial binder premium was paid on March 11, to effectuate the policy [redacted] ***’s policy also included her husband, and covered them under the Bronze $Copay HMO [redacted] planHowever, [redacted] submitted a request through the Marketplace to remove her husband, and switch to the SILVER $HMO # [redacted] planIn addition, a subsequent file was received from the Marketplace on March 24, for a [redacted] - SILVER $HMO # [redacted] plan and a $premium effective April 1, This change in the policy did not include [redacted] ***’s husband or dependentsThe file was processed on April 22, 2014, [redacted] was billed for the older plan, before the new plan took effect [redacted] was billed twice in the amount of $296.36, and paid a premium of $once [redacted] was refunded the initial binder premium paid on August 5, in the amount of $for the Bronze $Copay HMO [redacted] 6Kplan.Therefore, [redacted] was moved from the SILVER $HMO # [redacted] plan and her husband and dependents were moved from the Bronze $Copay HMO [redacted] 6Kplan on September 22, Their new policy is the SILVER $HMO #CLK with an effective date of April 1, 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 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

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 youWe have reached back out to Coventry to verify why this member’s payment was lost and if we were ever able to locate the member's checkWe verified that the member sent a check in for her premium payment with the member ID listed as the account number with her online bill pay systemThis caused the check to go to our holding account, where checks are sent when they are unable to locate a policy to apply them toOur system is set up to separate and apply checks using the billing case numberA policy will be flagged when a member's policy is reflecting past due amountsThe member's fund were applied in June and the flag was removed.Please accept my apology that we did not provide the level of service that you rightfully expect and deserve, and my assurance that your concerns are getting the highest level of attention at ***, would also like to thank you for sharing your experience with usIt is feedback like yours that helps us address issues and prevent them from reoccurringWe 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 ConsultantExecutive Resolution Team

September 30, Dear [redacted] :The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual off exchange HMO health benefit plan.The Member’s complaint concerns premium payments refund due to premium payments drafted from the Member’s bank account for months in errorThe member is requesting a refund of premium payments.The member’s request for back premium is denied and will continue to be deniedHe did not follow the terms of his contract with Coventry which state the following:The 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 Us 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 UsRetroactive 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 frame( [redacted] 12/11)• The first documented termination notification was received on 05/05/14.• As a business rule applied to all cases, according to his contract, we will retro-terminate back days.• If the member has proof, that can be validated, of a written termination notification prior to 05/05/14, we will be glad to reconsider the termination date.I have included a copy of the Member’s contract language for your review.We trust the above information is fully responsive to your requestShould you have any questions or concerns regarding this complaint, please do not hesitate to contact me at ###-###-####.Sincerely,Emily M Complaint and Appeal Consultant

Dear [redacted] , Please see our response below to the additional concerns reported in complaint # [redacted] for [redacted] that were received by us on December 29, We do apologize for the frustration ** [redacted] has experienced during this situation We have issued refunds for the $dollars that were applied for overdraft fees on her bank account in the form of paper checks The initial check for $was dated December 29, The second check was for $and was dated January 2, 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 response. If no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: Because they still have not refunded me my money ... Any of it and they told me multiple time that they were going to refund the full amount then said they wouldn't refund the full amount... Also I called and cancelled late February not March 4th as they say... They are liars and continue to lie.. Regards, [redacted] ***

Dear [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on February 9, During our investigation, it was noted that [redacted] policy for was terminated due to nonpayment of premiums The last payment received was for September The policy was applied for through the Health insurance Marketplace and [redacted] family was eligible for an Advanced Premium Tax Credit This meant that they were given a grace period to allow them an extended period of time to pay the premiums prior to our termination of the policy The policy entered the grace period beginning October 1, 2014, as we did not receive a payment for that month In order to keep the policy active, Coventry would have needed to receive payments that brought the amount owed for premiums back to $by December 31, The amount owed for October through December would have been $or $per month Since no payment was made by the end of the grace period, the policy was terminated back to the end of the first month of the grace period The exact termination date is October 31, An error did occur that left her policy active past the October in our claims processing system This error has been corrected and any claims that were allowed past October 31, will be reprocessed and denied We are not able to reinstate the policy We were only able to locate one call to our billing and enrollment department during the grace period It occurred on December 15, The amount that was quoted as owed at that time was $ This included the $that was owed for October through December 2014, and also $that would have been owed for January if the policy had remained active Letters were sent on October 7, 2014, November 18, 2014, and December 6, 2014, advising of the amount owed to bring the policy back to current and the consequences of those payments not being made A full review of the claims for [redacted] family was also done to determine if any deductible had been applied on claims from March to June We found that no deductible had been applied as all services had been billed by in network providers and the policy did not have a deductible for in network servicesThe first claims we received that had deductible applied were for services rendered beginning in August Those services were performed by an out of network provider The total amount of deductible applied on the out of network claims for the family for was $ This total amount applied for the whole family would not have been enough to satisfy even one person’s individual out of network deductible for either of the plans that covered them in 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

October 27, 2014 Dear [redacted] : I am writing in response to the additional concerns expressed by the Consumer, [redacted] , regarding his BBB case, Specifically, [redacted] indicated he rejected Coventry Health Care's original response because: 1) no one from either Coventry or the Marketplace had contacted him to resolve his issue; and 2) Coventry, not the Marketplace, had Collected his premium payments. He understands that he had enrolled in his coverage through the Marketplace, but states he had paid his premiums to Coventry. At noon on October 17th, we coordinated a three-way conference call with the Marketplace, [redacted] and us. The parties spoke to Marketplace representative, Shanna P***, to discuss a retro-termination of [redacted] 's Coventry policy as never-in-force during 2014, Ms. P [redacted] took the retro-termination request; she informed the parties that she would send the request over to the Marketplace's Escalation Department. The Marketplace would then contact [redacted] with a decision on his request within approximately 30 days from the date of the three-way conference call. Though it might seem to our customers that we as Carriers should be able to make changes to health insurance policies ourselves, certain changes (such as changes in effective and termination dates) must be done through the federal Marketplace. The structure of the Affordable Care Act requires that these types of changes occur only through the federal level. [redacted] should hopefully hear from the Marketplace on his request by some time mid-November. However, should you require additional information or have any questions, please contact our Customer Service Department for more information.Sincerely,Linda LRegional Director Regulatory Compliance

Hello, Thank you for your inquiry, regarding complaint # [redacted] for [redacted] Our Executive Resolution Team researched your concerns, and I would like share the results of the review with youWe verified that [redacted] was sent the refund for $on November 21, 2014, to his home address on fileI sincerely apologize about how long it took for you to receive this money back and for the administrative hassles you encountered trying to retrieve this money.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 ConsultantExecutive 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:As noted, we received a notice that our application was being processed by Coventry This letter from Coventry was dated September 24, and was not received until Saturday, September 27th The following day, Coventry sent their first and only demand for payment on September 25th As noted in my complaint, this letter was not received until September 29th Our cancelled check from Coventry shows it was cashed and deposited by Coventry on Monday, October 6th, not October 15th as alleged by MrB [redacted] Perhaps the Coventry system did not update to reflect payment was not received until October 15th, but our check clearly shows a deposit date of October 6, by Coventry Furthermore, a demand for payment made days before threatened cancellation is exceptionally poor business practice at best Taking said payment, depositing the payment and then cancelling the policy without sending a refund (except on request) borders on illegality and reflects extremely poor business practices morally and ethically As noted previously, I request payment for the doctor's services rendered when we should have had coverage as well as punitive damages for Coventry's deceptive business practices.Regards, [redacted] ***

Dear *** [redacted] , Please see our response to complaint # [redacted] for [redacted] that was received by us on July 27, We show that [redacted] and his spouse were enrolled on the Gold $Copay plan with Coventry Health Care of Missouri through the Federal Marketplace effective January 1, 2015, to April 30, The initial enrollment file we received from the Marketplace on December 4, 2014, set the Advanced Premium Tax Credit (APTC) for the policy at $ This left the remainder of the premium, $834.50, as the portion for [redacted] to pay All premiums were paid for January through April On April 9, 2015, a new file was received from the Marketplace that removed the APTC from the policy effective May 1, This meant that the entire premium, $1992.50, needed to be paid by [redacted] by May 31, 2015, to keep the coverage active A payment was received for a portion of the May premium, $834.50, on April 24, Since that was not enough to cover the entire premium, the policy was terminated back to April 30, The payment that was received for the May premium was refunded to [redacted] on a paper check on June 19, [redacted] may contact the Marketplace appeals department at ###-###-#### to have them review the APTCThe Marketplace would need to submit a new file to update or correct the APTC if an error is found On all the enrollment files Coventry received from the Marketplace, we were given [redacted] ’s physical address The Past Due and Cancellation letters were sent to that address Coventry is required to use only the address provided by the Marketplace for the plans applied for through them A previous application for a non-Marketplace policy that we had received for [redacted] had a P.OBox address but that policy was never instated 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

September 18, 2014Dear [redacted] :I am writing in response to the Revdex.com complaint filed by [redacted] regarding his individual health insurance coverage with Coventry Health CareIn his complaint, [redacted] states he signed up for health insurance coverage with Coventry through the Marketplace in December of He received notification of his coverage and premium amounts; then, on May 28, 2014, he received a letter from Coventry stating that the coverage he had selected was not available in his areaHowever, Coventry continued to take premium out for coverage at the end of May and June, and he had to put a stop payment on his account to prevent further withdrawalsHe is asking for a full refund of the premiums he has paid for the past seven months, since he was not eligible to have coverage through Coventry during this time periodHe has been trying to get this issue resolved through Coventry and the Marketplace without successHe has filed the instant complaint in order to try and achieve resolution of this matter.Our records reflect that [redacted] did enroll in individual health insurance coverage with Coventry through the Marketplace effective January 1, 2014, with a monthly premium payment of $However, in May, the Marketplace notified Coventry of an issue with healthcare.gov that allowed a limited number of consumers to enroll in plans outside of their service areaThe Marketplace identified the impacted states, legal entities and issuers, and then the issuers, such as Coventry, were to identify those members who were allowed to enroll (in error) in a plan outside their service area during a specified time frameThe Marketplace then required issuers such as Coventry to send out letters to members impacted by the healthcare.gov system errorThat letter mailed on May 28, 2014, to [redacted] , and he has included a copy of that letter with his complaintWe also did subsequently send a termination letter to [redacted] terminating his coverage effective as of July 24, [redacted] received a partial premium refund in the amount of $for the July premium paid on June 30, In order to receive a refund for the premiums paid in the amount of $1,and request to have the policy terminated as “never-in-force,” the member will need to contact the MarketplaceCoventry will have a representative contact [redacted] and the Marketplace to request this change.I hope this addresses your concerns in this matterShould you require additional information or have any questions, please contact our Customer Service Department for more informationSincerely, Linda LRegional Director Regulatory Compliance

February 7, Dear ** [redacted] : The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan 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 review, the member’s policy is still active and the member was drafted on February 5, for the premium owed for January and February plus a $service charge for the January premium that was unpaid by the bank because the member stopped payment on that draftIf the member wants the policy terminated, the member would need to send a signed termination form to enrollment(attached) If the member wanted her policy termed as of December 31, we need the signed term form requesting a December 31, term date, and proof of new coverage in effect as of January 1, Without the proof of new coverage, we would process the member’s term request now for a February 28, date If you have any questions or concerns regarding this matter I can be reached at ###-###-#### Sincerely,