Discovery Benefits, Inc.

Initial Business Response /* (1000, 5, 2015/07/24) */
Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers
Discovery Benefits processed the participant's online election on July 6, and mailed on July 7,
a Day Notice With No PaymentThis Notice confirmed the receipt of the election and advised no payment was receivedThe Notice advised the full initial premium must be received by the end of the initial premium grace periodDiscovery Benefits received and processed payment for $on July 13,
On July 14, 2015, Discovery Benefits notified the carrier of the reinstatement of the participant's medical coverage effective May 21, in accordance with Discovery Benefits' standard process
Discovery Benefits reached out to the carrier again on July 24, and received confirmation that the participant's coverage was reinstated on July 16,
Discovery Benefits reviewed the call with the participant and our customer service representativesAt no time did Discovery Benefits representatives become hostile with the participantThe call ended when the Discovery Benefits representative was in mid-sentence and did not end due to an action on the part of the Discovery Benefits representative
Initial Consumer Rebuttal /* (3000, 7, 2015/07/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
No I do not accept this responseDiscovery Benefits never calls me back nor did I ever get a chance to talk with a managerThey lied about when my payment of $was mailed to themI was initially supposed to have surgery June I over night $to Discovery Benefits through the US Postal service on 7/6/As soon as I contacted the Revdex.com my payment amazingly arrived at BCBS of Tennessee the next dayIt is s shame someone going through a termninal illness and using every penny to pay for insurance out of their own pocket would have to go through such an ordealThis company is known for not making timely payments and many complaints about this very issue have been madeI can assure you if I would not have reached out to the Revdex.com, I would still be waiting for BCBS of Tennessee to receive my paymentI will now watch Discovery Benefits closely as I have read the Contract of Cobra closely and have found a lawyer to assist me until I can start a new job and get from under this deceitful companyI feel this company works for the company a person just left and not the Cobra person who can see what is being done with their hard earned moneyThank you Revdex.com, I couldn't have received justice with out youI'm grateful, *** *** ( Suffering from Breast Cancer), again Thank you for saving me from this lying, deceitful companyI will contact you again if I need further assistance
Final Consumer Response /* (2000, 8, 2015/07/27) */

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participants. IRS rules govern substantiation requirements for the FSA, including expenses paid using the debit card See 1.125-6(b)(2) and 1.125-6(3)(i).In this situation, there were multiple reasons the documentation submitted over several occasions could not be accepted and a “please call” notice was sent to the participant so that we could explain what was required With each documentation submission, there continued to be missing or incomplete information.Due to the amount of personal information required for a complete response, Discovery Benefits will send a letter directly to the participant providing the participant with what is needed to substantiate the outstanding transaction

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participants
The participant's termination date was provided to Discovery Benefits by the employer as December 12, In accordance with IRS Regulation, debit cards are deactivated upon termination of employmentThe participant continues to have the option to submit claims online, via fax or mail that were incurred prior to the date of termination through the final filing date defined by the terms of the PlanThe Plan under which this participant was covered allowed for terminated employees to submit claims for services incurred prior to the termination date up to days past the participant's termination dateThis participant's final filing date to file claims was March 11,
The terms of the plan are included in the Summary Plan Description provided to all enrolled participants by the Plan Sponsor
The participant did not file any claims following her termination and did not contact Discovery Benefits until March 22, 2016, outside of the final filing date for her claimsAs a result, any remaining funds have been forfeited to the Plan and are unavailable for reimbursementDiscovery Benefits does not retain forfeited funds

The participant has one outstanding expense requiring documentation The expense was paid using the debit card, which means the merchant is paid and remains paid The account is not frozen and the participant may file claims incurred in through March 31, Access is available through the online account or the mobile app The debit card may no longer be used, however Substantiation is required in accordance with IRS regulations The participant has the option of faxing in his documentation making sure to include the claim number or copy of the receipt reminder emailed to him with the documentation He may also take a picture of the documentation with his phone and upload that picture to the claim through the mobile app He may also email a PDF copy of the EOB to Discovery Benefits, making sure to include the claim number Lastly, he can mail a copy of the documentation along with the receipt reminder to ensure we receive the claim number with the documentation The documentation must be legible and the copy must be complete, otherwise it may not contain all of the required documentation The system does have a MB size limitation, which amounts to approximately pages of documentation If there are multiple pages above the size limit, the participant can split the documentation and upload separately

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me Interestingly enough, when I called United Health Care on 1/10/they said I DID NOT have coverage I just checked, and now I do.Thanks for your help,*** ***

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance
carriers. On February 25, 2018, upon completion of the participant’s enrollment, Discovery Benefits notified the carrier of this participant’s reinstatement effective January 25, 2018.Discovery Benefits reached out to the carrier with an urgent update request on February 28, and again on March 5, Discovery Benefits received confirmation from the carrier of the reinstatement of coverage effective January 25, on March 5,

Initial Business Response /* (1000, 5, 2015/06/08) */
Discovery Benefits provides administrative services for the former employer of this participantDiscovery Benefits is not an insurance carrier and does not exercise control over the records of insurance carriers nor do we process insurance
claims
The carriers for this client require Discovery Benefits to provide paid through dates for participantsCoverage is reinstated monthly once the carrier receives confirmation from Discovery Benefits that the participant has paid for that month of coverageDiscovery Benefits currently provides the carriers with updates on a weekly basis each TuesdayThe carriers have indicated a two to three day turnaround time for updating their system once they receive the information from Discovery Benefits
Discovery Benefits initially notified the carrier(s)of this participant's reinstatement on April 28, 2014, the day after the initial premium payment was received
The participant contacted Discovery Benefits five separate times by phone on May 4, indicating that her coverage was inactiveDiscovery Benefits contacted the carrier and received confirmation from the carrier that the coverage was activeDiscovery Benefits reached out to the participant and advised of the reinstatement
The participant contacted Discovery Benefits three separate times by phone on June 3, and indicated that her coverage was not activeDuring one of the calls, the participant called with the carrier on the lineWhile Discovery Benefits is able to confirm paid through dates with participant authorization, the carrier is not able to accept confirmation over the phone
While this participant has made payment for coverage at the beginning of the month, the timing of the receipt, the processing of the payment and the update by the carrier has consistently caused the participant to experience a temporary suspension of coverage at the beginning of each month
Discovery Benefits, the employer and the carriers are working to implement a process that would allow us to send updates to the carrier on a more frequent basisUntil the new process is implemented, the participant can either mail her payment two weeks earlier or, if that is not an option, continue to call Discovery Benefits after her payment has been made and request an urgent update
Initial Consumer Rebuttal /* (3000, 12, 2015/07/02) */
The consumer did respond in writingThe same problem has once again occurred and I'm unable to utilize the pharmacy benefitsAdditional phone calls were made to Discovery Benefits, Incwithout any help being obtainedI have asked to be called by a supervisor, but no call has been receivedAgain, I need to fill an expensive prescription that I'm unable to obtain if it can't be processed through the medication administratorDiscovery Benefits has been made aware that I will suffer irreparable harm if the prescription is not filledIt may be time to seek legal representation as I am unable to pay the large cost of COBRA benefits weeks early
Final Business Response /* (4000, 14, 2015/07/06) */
The carriers for this client require Discovery Benefits to provide paid through dates for participantsCoverage is reinstated monthly once the carrier receives confirmation from Discovery Benefits that the participant has paid for that month of coverageDiscovery Benefits currently provides the carriers with updates on a weekly basis each TuesdayThe carriers have indicated a two to three day turnaround time for updating their system once they receive the information from Discovery Benefits
The participant's payment was processed on June 27, On July 1, 2015, the participant contacted Discovery Benefits regarding her coverageDiscovery Benefits sent an urgent update request to the carrier on July 2, and notified the participant the same day that an urgent update had been madeDiscovery Benefits received notification from the carrier on July 2, that coverage for all plan members had been updated
As stated in the original response, Discovery Benefits, the employer and the carriers are working to implement a process that would allow Discovery Benefits to send updates to the carrier on a more frequent basis than weeklyUntil the new process is implemented, it is recommended that the participant either mail her payment two weeks earlier or, if that is not an option, continue to call Discovery Benefits after her payment has been made and request an urgent update

I am rejecting this response because:I did upload my receipt and fileI spoke with a customer repwho helped inform me of the process and said it needed to be uploaded to avoid not being able to get the moneyI was also directed to a PDF of the instructionsThat day I filedThe total receipts paid to childcare exceeded what I had left so I filed for the balance that was in my acctmy online acct stated it would be 10-days before I would get my refundWhen I spoke with a supervisor after filing my claim he was very rudeI told him the file a claim option was on the same drop down under manage my expensesHe tried rudely arguing over me speaking that I was wrong that wasn't where it was so clearly I didn't file I waited for him to stop and informed him of the process that I went through to file a claimThere is a drop down with options manage expenses and underneath it the file a claim option which was no longer showing up under my acctlast week, explaining everything I went through he conceded that I was correct but that it must not have submitted properlyI told him I submitted it correctlyIf I had known that my submissions for expenses I paid for was not going to be paid I would've taken a picture of the final screenAs you can understand this is extremely frustrating since you took money out of my paycheck to pay for daycare expensesI had to pay them out of pocket and filed correctly for reimbursement of said expensesPlease refund so this doesn't have to escalate further

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits has been working to obtain all of the information required to add the dependents as requested by the
participantThe requested changes have been made to this participant’s account and Discovery Benefits has been in contact by phone with the participant to advise of the next steps to resolution. Discovery Benefits places the utmost importance on customer serviceAt this time of the year we do experience times of very high call volumes and longer wait timesWe apologize to this participant for the difficulties she had in getting in touch with our customer service team

Discovery Benefits is a third party administrator that provides continuation administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees,
participants or qualified beneficiariesDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers
Discovery Benefits was notified of the participant's continuation on October 7, and received the initial payment on October 14,
Upon notification from the participant on November 19, that her coverage was not active, Discovery Benefits sent update requests to the carriers to ensure the continuation of coverage
The participant notified Discovery Benefits on February 29, that her dental coverage was not activeDiscovery Benefits sent an urgent update request to the dental carrier on March 1, to ensure the continuation of coverage
The participant again contacted Discovery Benefits on March 16, indicating her dental coverage was not activeDiscovery Benefits again reached out to the dental carrier on March 19, to ensure the continuation of coverage
Discovery Benefits received confirmation of the participant's continuation of coverage on March 23, The carrier provided a confirmation number to Discovery BenefitsIf the participant is in need of the confirmation number, she should contact Discovery Benefits so that we can provide it to her

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***.While the response identifies that I am now covered, it was my employer who uses Discovery Benefits (for COBRA services), that actually resolved the issue for me (not Discovery Benefits). Meanwhile, I lost my dental appointment and now have to wait until late November Discovery Benefits conveniently waited until the end of September (days from my last day of employment) to send my COBRA package (making sure I lost coverage for September even though I would have to pay for September)The process then required me to pay September and October in advanceDiscovery Benefits received my Sep/Oct payments around Sept and waited a good days before depositing the checks and then failed to provide timely information to United Healthcare further making sure I lost most, but basically all of October coverage if I didn't file a complaintMy experience seems to align with other comments that I see and it seems very suspicious. Even so, I thank you very much for jumping so quickly on this issue for me--I really appreciate the Revdex.com service! .............*** ***

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits places the utmost importance on customer serviceUpon review of the chats and phone calls with this
participant we find the participant was provided with responses to her questions in a professional and respectful manner throughout. Due to the amount of personal information required for a complete response, Discovery Benefits will send a letter directly to the participant and not respond through the Revdex.com

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participants. This participant was enrolled in an employer-sponsored flexible spending account (FSA) for the plan year ending December 31, The participant’s last day of service as an active employee with the employer was November 1, According to the loss of eligibility rules governed by the employer’s plan document, a participant has days to file claims for expenses incurred while active in the plan The last day for the participant to incur services was November 1, and the last date to file for reimbursement of eligible expenses was January 31, Because the employee was no longer an active employee with the employer in 2017, he was ineligible to participate in the FSA for the plan year and as a result, any funds remaining in the account were not eligible to be carried over into the plan year. This information is included in the employer’s plan document and the Summary Plan Description provided by the employer to all participants upon enrollment into the Plan. Any funds remaining after the final filing date have been forfeited to the employer’s plan and no further reimbursement can be made to the participant Discovery Benefits does not retain any forfeited funds

Discovery Benefits is a third party administrator that provides pre-tax reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participants
The reimbursement process for this employer’s plan is outside of Discovery Benefits’ standard reimbursement processReimbursement requires manual entry of information in addition to a review and additional processing time each month on the part of Discovery Benefits and the employerThe entire monthly process may take between one and two weeks from start to finish
The reimbursement process for this employer’s plan was not completed before the cutoff for May reimbursements due to a one-time extraordinary eventThis process has now been completed and reimbursements for May and June will be made in June once the contribution file is received from the employer
It is our goal to provide high quality customer service while at the same time ensure plan complianceWe understand that the various regulatory requirements and internal processing can be confusing and are often frustrating to participants and their family membersWe do our best to try to simplify and streamline the process to make it easierUnfortunately, the participant’s experience for the May reimbursement was not a smooth one and we apologize

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participantsThe participant’s balance has not been forfeited. However, due to the amount of personal information required for a complete response, Discovery Benefits will send a letter directly to the participant and not respond through the Revdex.com

Discovery Benefits provides third party administrative services on behalf of employersThe services and the processes related to those services are governed by IRS regulationsThe account in which this individual participates is provided through her employerRequests for documentation are
required under IRS regulations
The participant used her benefits debit card to pay an expense with a November 9, date of serviceDiscovery Benefits emailed the participant Receipt Reminder notifications on November 13, and on December 12, When no documentation was received by January 23, the claim was auto-denied and repayment was requested on January 24,
Discovery Benefits received documentation for the claim on February 10, but it did not include identifying information (copy of Receipt Reminder, Denial Letter or claim number) so processing was delayed until it could be identifiedThe documentation was processed on February 26, and denied as it did not include the type or date of serviceThe only documentation that was submitted was a credit card receipt which is not accepted as third-party documentationThe Receipt Reminder sent to the participant includes this language: “Please note that credit card receipts do not satisfy all of these requirements and therefore cannot be accepted as third-party documentation.”
A new Denial Letter with Repayment was emailed to the participant on February 27,
Discovery Benefits received documentation on March 3, This documentation did not include identifying information (copy of Receipt Reminder, Denial Letter or claim number) so processing was delayed until it could be identified
Documentation was received on March 14, and again did not include identifying information
The documentation received on March 3, was processed and denied again on March 21, because it was only a credit card receiptA new Denial Letter with Repayment was emailed to the participant on March 22,
The documentation received on March 14, was processed on March 23, following a call from the participant to confirm which claim the documentation pertainedThis documentation included the itemized information required and the claim was reprocessed and approved on March 23,
No further documentation is required for this expense

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employer. The participant accessed his online account and entered his banking information on January 31, at 10:a.m The
pulling of data for the ACH file is an automated process conducted on a monthly basis and in this case, the February ACH file was pulled prior to the ACH information being entered by this participant When setting up recurring payments through the portal, the participant is provided with this statement: “Please be sure to confirm when your ACH payments will begin before stopping other payment methods to ensure you remain current in your premium payments.” The statement is provided when the banking information is entered and again as part of the summary of the recurring payment information entered. The participant did not contact Discovery Benefits or access his online account to ensure his February payment had been made

I am rejecting this response because:
While I understand the benefits group can state that the notification is incumbent upon the employer, there should also be a notification process on the part of the benefits group I understand I will not get the resolution that I am hoping for, but I hope that by raising awareness of the issue I encountered it can help others and perhaps result in a change in process on the part of the benefits group

Initial Business Response /* (1000, 5, 2015/07/21) */
Under IRS regulations, a debit card transaction may be auto-substantiated in limited circumstancesAuto-substantiation is allowed when the transaction amount and merchant match both the co-pay dollar amounts and type of provider set up within
Discovery Benefits system using information provided by the employerDebit card transactions may also be auto-substantiated if the purchase is made at an approved IIAS pharmacy or when the debit card transaction exactly matches a previously substantiated and approved claim
The debit card transaction that originally placed the debit card on hold is a $transaction with a date of service of March 26, The provider used a merchant category code (MCC) for dental and orthodontia servicesThere are no copays set up within the Discovery Benefits system to match this amount or providerThe transaction does not match a previously substantiated (recurring) claim and the service was not provided by an IIAS merchant that would allow for automatic substantiation
Discovery Benefits mailed a receipt reminder to the participant on April 28, for this transaction and a denial notification and repayment request on June 16, The claim was auto-denied due to no substantiation on June 9, and the debit card was suspended on June 16, Discovery Benefits has not yet received documentation for this transactionEven though debit card transactions are denied when substantiation is not provided as requested, the merchant remains paid
Another debit card transaction with a March 28, date of service was denied on June 11, due to no substantiationThe denial notification and repayment request was mailed to the participant on June 17,
The participant called Discovery Benefits on July 14, and was advised that her card would be temporarily activatedAccording to Discovery Benefits' internal process, temporary activations are automatically reset on Tuesdays and the card was deactivated again the same day
Discovery Benefits received documentation for the second claim on July 14, The documentation was processed on July 16, and all but $was approvedA denial letter and repayment request for this amount was emailed to the participant on July 17, The participant contacted Discovery Benefits on July 17, and was advised that she could offset or repay the denied amountThe participant was also reminded of the original transaction that was keeping the debit card on hold
At this time, the debit card remains on hold until the $and $debit card transaction denials have been clearedThis can be accomplished by doing any one of the following: providing proper substantiation, offsetting the amount with another claim or repaying the planIf the amounts are repaid, the funds are added back to the participant's account and available for use for another claim or transaction

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees,
participants or qualified beneficiaries
The participant submitted several claims via Discovery Benefits’ mobile application on April 17, Two of the claims were approvedThe remaining claims were initially denied as Not Within the Plan Year on April 19,
Upon request from the participant, all but one of the previously denied claims was reprocessed on April 22, Each claim was again denied due to no type or date of service on the documentation
The participant submitted additional documentation via email on May 3, but the documentation did not reference any claim numbers or denial notifications sent to the participantAs a result, Discovery Benefits emailed the participant on May 6, indicating the documentation could not be processed and provided the reason
The participant’s spouse contacted Discovery Benefits on May 16, by phoneShe requested a supervisor callback the evening of May 16, and was called back by a supervisor at 10:a.mon May 17,
The claims have now been reprocessed and approved on May 17, as claim numbers were confirmed