D & G Sales

Initial Business Response / [redacted] (1000, 5, 2015/04/23) */ Contact Name and Title: [redacted] Agent Contact Phone: XXX-XXX-XXXX x Contact Email: [redacted] @pmgagency.com The consumer's employer dropped their employer sponsored group major medical insurance April 1, I helped the employees who needed it enroll in Marketplace plans; this consumer includedA section reimbursement program was installed at the same timeEmployees were instructed how to pay their premiums and request reimbursement The former HR person took it upon herself to set up EFTs from the employer's bank for employees who did not have checking accountsThis is one of the many reasons she is the former HR personThe consumer was one of these peopleWhen I enrolled him in his plan I explained the procedure to him again In our December 4th meeting the consumer informed me he needed to add his daughter per a court orderIt took me several attempts to get her correct date of birth and an address (she lives out of state)...I was on site conducting enrollments December 4th & 9th but did not get this from the consumer until December 12thActually I never did get her address, just her date of birthIn the process I spelled her name as "Ashley" rather than "Ashli"Because we are dealing with a Marketplace plan the misspelling can only be corrected through the Marketplace with a copy of a birth certificatethe consumer has never gotten me a copy to submit I have been on site at the consumer's employer seven (7) times this year to help those who needed assistanceThose dates were 1/6/15, 1/13/15, 2/3/15, 2/23/15, 3/25/15, 3/26/15, and 4/1/I met with the consumer on at least four (4) of those occasionsI felt there was no need to return the calls from his wife as they came immediately prior to my visits to the consumer's employer The former HR person also took it upon herself to make additions and deletions to the consumer's employer's dental and vision plansThis bypasses my office, my involvement, and my oversightSomehow Ashli was added to another employee's coverage as a dependentThe consumer was only aware of this because I caught the error, and corrected it, then notified Mr ***'s supervisorCoincidentally that was on April 10th which seems to be what prompted this meritless complaint The consumer's daughter has medical insurance coverage with UnitedHealthcareClaims cannot be processed because of the misspelling I am at fault forHowever, the ball is in the consumer's court to supply a birth certificateHe is also now in his plan's grace period and needs to post a payment soon in order to keep his plan OFFER: I need a copy of Ashli's birth certificate to send to the MarketplaceThe Marketplace will then notify UnitedHealthcare to correct the spellingWe can then work with providers to resubmit her claims If you'd prefer, you may send that directly to the MarketplaceIf that is the case I will supply the information In the meantime, if the providers will call UnitedHealthcare (the member # on the back of Ashli's card) they may be able to walk through a few claims that way

Initial Business Response /* (1000, 5, 2015/04/23) */
Contact Name and Title: [redacted] Agent
Contact Phone: XXX-XXX-XXXX x118
Contact Email: [redacted]@pmgagency.com
The consumer's employer dropped their employer sponsored group major medical insurance April 1, 2014. I helped the employees who...

needed it enroll in Marketplace plans; this consumer included. A section 105 reimbursement program was installed at the same time. Employees were instructed how to pay their premiums and request reimbursement.
The former HR person took it upon herself to set up EFTs from the employer's bank for employees who did not have checking accounts. This is one of the many reasons she is the former HR person. The consumer was one of these people. When I enrolled him in his 2015 plan I explained the procedure to him again.
In our December 4th meeting the consumer informed me he needed to add his daughter per a court order. It took me several attempts to get her correct date of birth and an address (she lives out of state)...I was on site conducting enrollments December 4th & 9th but did not get this from the consumer until December 12th. Actually I never did get her address, just her date of birth. In the process I spelled her name as "Ashley" rather than "Ashli". Because we are dealing with a Marketplace plan the misspelling can only be corrected through the Marketplace with a copy of a birth certificate. the consumer has never gotten me a copy to submit.
I have been on site at the consumer's employer seven (7) times this year to help those who needed assistance. Those dates were 1/6/15, 1/13/15, 2/3/15, 2/23/15, 3/25/15, 3/26/15, and 4/1/15. I met with the consumer on at least four (4) of those occasions. I felt there was no need to return the calls from his wife as they came immediately prior to my visits to the consumer's employer.
The former HR person also took it upon herself to make additions and deletions to the consumer's employer's dental and vision plans. This bypasses my office, my involvement, and my oversight. Somehow Ashli was added to another employee's coverage as a dependent. The consumer was only aware of this because I caught the error, and corrected it, then notified Mr [redacted]'s supervisor. Coincidentally that was on April 10th which seems to be what prompted this meritless complaint.
The consumer's daughter has medical insurance coverage with UnitedHealthcare. Claims cannot be processed because of the misspelling I am at fault for. However, the ball is in the consumer's court to supply a birth certificate. He is also now in his plan's grace period and needs to post a payment soon in order to keep his plan.
OFFER:
I need a copy of Ashli's birth certificate to send to the Marketplace. The Marketplace will then notify UnitedHealthcare to correct the spelling. We can then work with providers to resubmit her claims.
If you'd prefer, you may send that directly to the Marketplace. If that is the case I will supply the information.
In the meantime, if the providers will call UnitedHealthcare (the member # on the back of Ashli's card) they may be able to walk through a few claims that way.