Discovery Benefits, Inc.

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 participant emailed to Discovery Benefits documentation for a claim on Thursday, December 1, and it was added to Discovery Benefits’ work queues on Friday, December 2, Discovery Benefits may take up to two business days to process documentation once receivedThis documentation was processed on Tuesday, December 6, and will generate based upon a pre-determined reimbursement date with this participant’s employer on Wednesday, December 7, The funds will then be deposited to this participant’s account via ACH within two to three days
Discovery Benefits' Participant Services operates as an incoming call center to respond to inquiries from participantsThe phone lines are kept open to the extent possible for incoming callsWhen a supervisor is available at the time requested, the call is transferredIf no supervisor is available at that time, a callback request is processed and the participant will receive a call back from a supervisor within hoursWe understand this may frustrate some participants, but it is done so that participants who are waiting in the call queue to speak with a representative are not unreasonably delayed due to a participant needing to wait for a supervisor to be available

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. The participant’s enrollment was completed when Discovery Benefits received and processed her initial premium payment on January 23, 2018. According to the standard process for updating carriers agreed upon between this participant’s former employer and Discovery Benefits, the enrollment information for this participant was passed on a file to the carrier on January 30, Upon receipt, it may take the carrier up to business days to update their system. We understand and apologize for the frustration caused by long call wait times During this time of year our call volumes and wait times may increase at any given time during the dayWe place the utmost importance on customer services and strive to respond to calls from participants as quickly as possible and keep the wait times as short as possibleDiscovery Benefits also provides both an email and a chat option for participants through discoverybenefits.com

A letter containing the payment documentation was mailed August 21, to the account holder's attention The participant may use that letter to submit to the third party providing reimbursement, making as many copies of the letter as needed for the third party

Parking and mileage expenses are only eligible for reimbursement if the parking or mileage expense is primarily for and essential to medical care (for example, the expense is not eligible if the reason was to visit a patient or to receive services for an ineligible expense).In order to substantiate
and approve parking and/or mileage expenses, in addition to the parking receipt, documentation showing the valid medical service that includes the date the service was incurred and the type of service that was received is also required.The participant will need to submit documentation for eligible services received on the date the parking or mileage expense was incurred in order to be reimbursed for the parking or mileage expenses.The receipt was uploaded again today and was denied this morning The notice sent to the participant asked them to “please call” so that we could explain what is needed

I am rejecting this response because: First, the message states that they forwarded information on the 6th which was Saturday and then again on the 8th. The DB representative that I spoke with yesterday said that the information did not go to the carrier until the 8th. The reason it got resolved today is because I sat on hold with the carrier for over minutes this morning after which the carrier was able to connect DB with the carrier's eligibility department. Had I not done this with the help of an incredible representative of the carrier, I still would not be in the system. They also provide a great deal of language about being busy this time of year but having customers hold for over an hour is inexcusable and unacceptable. At the very least, I deserve an apology for that. If they are that busy then they should add staff to handle the peak call volume. Even holding for minutes this morning was wrong (especially since the recording said the call would be answered in minutes and seconds; yesterday when holding for over an hour the recording said the call would be answered in minutes and seconds). If you are going to tell the caller how long they will wait it is imperative that the information be somewhat close to accurate. I want some type of assurance from them that they are investigating these issues and will implement measures to ensure that these types of delays do not happen in the future, even when call volume is high

As stated in the earlier response, and also included in a letter mailed to the individual, the message that appears when setting up the banking information and again when clicking on "submit" includes 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 participant did not contact Discovery Benefits or access the member portal to confirm the January payment

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 beneficiariesDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriersDue 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

Initial Business Response /* (1000, 5, 2015/10/20) */
Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers
The participant enrolled online on August 17, and made his first payment on August 25, On
August 26, 2015, Discovery Benefits sent the appropriate notification to the carrier to reinstate benefits effective July 1,
On September 15, 2015, Discovery Benefits processed plan and rate changes effective September 1, on behalf of the participant's former employer and mailed a Plan Change Notice to the participant on September 15, This Notice advised of the change in the medical carrier effective September 1, and provided an updated payment schedule and payment coupons beginning with the October premium
Discovery Benefits also notified the new medical carrier of the coverage for this participant effective September 1, on September 15,
Discovery Benefits received confirmation from United Healthcare on October 19, of the participant's coverage from July 1, through August 31, Additionally, Discovery Benefits received confirmation from Aetna on October 19, of the reinstatement of coverage for the participant effective September 1, The representative from Aetna indicated a 24-hour period before the participant's coverage is reflected in the Aetna system
The participant will need to work with United Healthcare and Aetna directly to reprocess any claims previously denied
Initial Consumer Rebuttal /* (3000, 7, 2015/10/21) */
(The consumer indicated he/she DID NOT accept the response from the business.)
As of October 21, 2015, 12:p.m., I have contacted Aetna to verify whether or not Discovery Benefits has enrolled me into a plan with AetnaAs of today which has been more than hours since Discovery Benefits communicated with Aetna, there is still no active plan in place despite me returning the required payments and paper work to Discovery BenefitsSo it will be impossible to submit claims that I have paid cash for since September 1, to Aetna since technically I still have no policy in place with them as Discovery Benefits has not enrolled me
Final Business Response /* (4000, 9, 2015/10/22) */
After posting the response on October 20, stating Discovery Benefits received confirmation from Aetna of the reinstatement of coverage, we were advised by Aetna that a system issue was causing a problem with the reinstatementDiscovery Benefits received confirmation from Aetna this morning that the reinstatement of coverage was successful for this participantThe Aetna contact provided an ID number for the participant to useDiscovery Benefits will be calling the participant to advise him of the situation and provide the Aetna ID numberThe participant will need to work with Aetna directly to reprocess any claims previously denied using the Aetna ID number provided

Based upon a review of the calls the participant made to Discovery Benefits it is clear the participant did not have a positive experience with the online member portalAs a result, a Discovery Benefits customer service representative attempted to improve the experience by making a change that
would allow the participant to receive paper statements and notifications rather than emailed communicationThis went outside Discovery Benefits’ standard process and the customer service representative did not advise the participant of the nominal monthly fee for paper statements
In accordance with the participant’s request, Discovery Benefits is re-setting his account to receive email notifications and will be reversing the monthly fees for the paper statements charged to his account
It is Discovery Benefits’ goal to provide high quality customer service while at the same time ensure plan compliance and protect a participant’s personal informationUnfortunately, the customer service provided to this participant did not meet with Discovery Benefits’ high standards and for that, we apologize

Initial Business Response /* (1000, 7, 2015/12/07) */
The participant has both parking and mass transit accountsThe merchant terminal used by the participant uses a Merchant Category Code (MCC) of - Transportation and Local Commuter Passenger, including FerriesThis MCC is used for transit
expenses as well as parking expenses
The debit card is set up to use plan ordering to pay claimsThe plan order is to pay from parking first because parking is used, in general, more frequentlyOnce the parking account is depleted or the monthly maximum is met, the funds pull from the mass transit account
Per IRS regulation, documentation for transit expenses is required but not necessarily for parking expensesIn order to "reclassify" the parking expenses to transit expenses, Discovery Benefits must intentionally deny the parking expense to allow the reclassification and documentation for the transit expense
Several claims were transferred from parking to transit on October 9, but the transit plan funds were already exhausted and no further claims could be transferredThe transit expenses must remain denied until further funds are available in the transit planIf additional funds are not made available, the transit expenses will need to be repaid
In the short-term, one option is for the participant to pay the parking expense out of pocket and then file for reimbursement through the online account to avoid the necessity of having the claims transferred from parking to transit
For the long-term, effective January 1, Discovery Benefits will utilize a terminal restricted debit card that maintains two separate "buckets" for parking and transit accounts on the card, which will ensure the appropriate account is accessed for the payment

A letter is in today’s mail to the participant with additional detail. We can share that in 2016, out of transactions for this participant, only required documentation that is still outstanding The remaining were auto-approved in accordance with IRS regulations In 2017, out of transactions for this participant, only transactions require documentation that is still outstanding. Discovery Benefits processes approximately one million claim transactions a month and it is the participant’s responsibility to provide the necessary documentation when requested to do so in accordance with IRS regulations governing these employer-sponsored benefits. When the debit card is suspended, a participant maintains access to funds in the account. Requests for reimbursement may be made by filing an online claim through the member portal, submitting an expense via the mobile app or using an Out of Pocket Reimbursement Request Form. Even though debit card transactions may be denied due to lack of or insufficient documentation, the merchant remains paid. Discovery Benefits does not retain funds forfeited by participants. All forfeited funds are returned to the plan

I am rejecting this response because:Discovery Benefits never reached out to me about any dependent status. I was told specifically by 'Michael', a supervisor and 'John' a manager that I was not permitted to know what the problem was or what the timeline was. Other than calls initiated to me by 'Michael' Discovery Benefits has NEVER tried to contact me. Those calls were because I had complained to Mercer about discovery Benefits.Their statements are not true

Initial Business Response /* (1000, 5, 2015/12/02) */
The participant is questioning a specific claim with a September 1, date of serviceDocumentation for this claim was received on September 5, and denied on September 8, due to the fact the documentation did not include the date
and type of service, as required by the IRSThe same documentation for this claim was received on September 16, and again denied on September 17, for the same reasonAdditional documentation was received for this claim on November 16, The documentation included the appropriate information; however, the documentation showed the full amount of the service was paid by insuranceAs a result, there was no amount to be reimbursedAn Explanation of Benefits (EOB) for this claim was received on November 19, The documentation was reprocessed and again denied as the EOB indicated a member responsibility of $
While the participant's debit card remains suspended, the participant may file claims for eligible out-of-pocket expenses manually through the online portal or via the mobile appShe may also submit a completed Out-of-Pocket Reimbursement Request Form along with appropriate documentation for processingThe funds are not frozen; they just cannot be accessed using the debit card

I am rejecting this response because:Yes this is the same brick wall that I have already encounteredThey don't get to tell me how I can or have to submit my receipts for reimbursements, nor do they get to demand who it is that is requesting my submissions to be a certain way as they have, in a threatening tone. The people at DB have provided individual, monthly receipts on different occasions. In fact, the REASON they have done this in the past is because I called in January and asked for receipts and they told me the only way I could get them was to call back each time I wanted them. They did the same thing in the SpringI DID WHAT THEY SAID I HAD TO DO TO GET WHAT I NEEDED! I called back recently under this same understanding only to encounter this new-found corporate stubbornness. By telling me back in January that I could get these by calling in and then getting them on two different occasions, that implies that this is how it is done I recently proceeded under this arrangement and they changed the rules and I can’t get my back receipts? Bait & switchThey don't get to tell me that I have to call to get receipts in Januaryand then do it for me...then I follow up in the Spring and they do it again...and then have them change the rules and suddenly NOT honor what they told me they would do for me as long as I called in and requested it This is called "bait & switch"To be clear, they CAN do it (because they've done it twice before) they just WON'T now This is not about money this is about documentationIt is NOT unreasonable to expect a payment receipt for timely paymentsThey'd rather spend their time arguing with me when this all could have been done last week I'd be willing to grab the current payment info off the website moving forward (as I can only see the current payment) but I NEED to get the receipts for the past months as they told me they would do as long as I called in and requested it

I am rejecting this response because:
Discovery Benefits claims they operate on contracts made to the employers, however they do accept money as paid by the employees which thereby institutes a formal transaction and agreement of services providedTo that end, Discovery Benefits operates as a first-party and by accepting payment are obligated to provide services to the payeeIn this case, services were not provided, therefore payment should be refunded for lack of services provided

As a third party administrator for this participant's employer's plan, we are required to comply with IRS regulations. Those regulations state that all claims must be substantiated. In certain circumstances we are able to auto-substantiate if the expense matches a co-payment amount under the employer's plan or the expense is purchased at a pharmacy that offers the IRS approved IIAS system. Outside of these situations, we must request substantiation documenting the expense is eligible under IRS rules and has not been paid or reimbursed by any other source, such as insurance. As shared earlier, if the expense is not substantiated after a certain period of time, the rules require that we suspend the debit card until the documentation is received. The merchant remains paid. The participant also continues to have access to the funds in his account by submitting claim documentation online, through the mobile app or sending via fax. In order to release the hold on the debit card, the participant will need to submit documentation for the expense. The documentation can be uploaded through the member portal or faxed to us, making sure to include the claim number so we can match the documentation to the participant's claim, allowing us to release the hold on the debit card

Initial Business Response /* (1000, 5, 2015/06/02) */
There was miscommunication between the participant and Discovery Benefits regarding claims filed by the participantAfter further research into this particular situation, it was discovered that the participant was attempting to use the mobile
application to file her claimThe mobile application did not include the ability to file a claim to this plan type until the beginning of April Unfortunately, the participant's method of filing a claim was not communicated to Discovery Benefits until April 15, when she submitted a screen shot, which fell after her final filing dateDue to Discovery Benefits being able to confirm the participant's attempt to file the claim as well as contacting us regarding the missing claim prior to the final filing date, the claim has been approved and paid
Initial Consumer Rebuttal /* (2000, 9, 2015/06/10) */
(The consumer indicated he/she ACCEPTED the response from the business.)
My claim was paid and I received my check in the mail yesterdayThank you!

I am rejecting this response because: Discovery Benefits hides behind IRS and HIPAA references that may be true but are also subject to interpretation This company requires receipts and further documentation from the CUSTOMER that we have to get from the provider - which is not always easy as it's often months in the past - AND then they often will not accept the receipts that they request.Their response basically states that they will HOLD MY FUNDS HOSTAGE until I jump through their hoops And if I can NEVER provide them with the right information - which is what often happens - I can never access my money and then at the end of the year - guess what - THEY keep my money!It's a total rip-off and they should NEVER have been given ANY kind of positive Revdex.com accreditation - and certain not an A+ rating!Their customer support is non-existent and runs in circles around a scripted response (look at the reviews and most of their responses are the same exact information just copied and pasted from one person to the next) and offer NO REAL SOLUTIONS to customer problems.I reject their response because it is NOT A VIABLE RESPONSE to the issue

Initial Business Response /* (1000, 5, 2015/12/03) */
The participant's preferred reimbursement method has been via direct depositOnce approved for reimbursement the payment is generated and the participant receives payment within one to three days
The participant submitted four claims for
reimbursement for the July 1, to June 30, plan yearTwo of these claims were approved and payment generated via direct deposit within four days of submissionOne of these claims was for an amount over $and one was for an amount under $The two other claims for the plan year were both for amounts over $and both required additional documentation
Documentation showing payment for an expense on February 26, was received on July 31, The claim was denied on August 3, as the date and type of service was not includedAdditional documentation was received on September 28, and the claim was approved and payment generated on September 30,
Documentation showing payment for an expense on June 30, was received on September 21, The claim was denied on September 22, as the date and type of service was not includedAdditional documentation was received on September 27, The claim was again denied and an Explanation of Benefits (EOB) requestedUpon receipt of the EOB on September 28, 2015, the claim was approved and payment generated on September 30,
The participant has submitted eight claims for the July 1, to June 30, plan yearThree of these claims were approved and payment generated via direct deposit within three days of submissionOne of these claims was for an amount less than $and two were for amounts greater than $
Two of the claims for the current plan year were denied as the documentation received indicated the expenses were incurred in the plan year and therefore not eligible expenses for the current plan year
Documentation was received on October 2, for a claim with an October 2, date of serviceThe claim was denied as requiring more information specific to the type of expenseFurther documentation was received on October 3, and the claim denied again on October 5, for the same reasonUpon review, the claim was reprocessed on October 6, and approvedThe payment for reimbursement generated on October 7,
Documentation for an additional claim with a date of service of October 2, was received on October 2, This claim was denied as requiring more information specific to the type of expenseAdditional documentation was received on October 3, and was again denied as requiring the same information requested previouslyDiscovery Benefits received the required information on October 14, and the claim was approved on October 14, Payment was generated on October 15,
One additional claim was filed by this participant and was appropriately denied as a duplicate expense
The participant currently has no outstanding claims for the plan year

Due to the amount of detail required for a thorough response, Discovery Benefits will be sending the participant a letter and will not be responding through the Revdex.com site