Discovery Benefits, Inc.

Initial Business Response /* (1000, 5, 2015/09/16) */
The participant used her debit card on June 4, 2015. Due to IRS substantiation requirements (IRS Code Section 1.125-6(b)(2), 1.125-6(d)(7)), documentation of the expense was required in order to approve the transaction as an eligible expense. No...

documentation for the claim was received within 72 days, the claim was denied, and the card suspended on August 25, 2015. Even though the claim was denied, the service provider remains paid.
Discovery Benefits received documentation for the June 4, 2015 claim on September 10, 2015. The documentation did not include a date of service or type of service and was denied. A denial notification was sent to the participant on September 15, 2015.
The participant also used her debit card on July 20, 2015. Due to IRS substantiation requirements, documentation of the expense was required in order to approve the transaction as an eligible expense. Documentation for this claim has not yet been received. If sufficient documentation is not received within 72 days of the payment, the claim will be denied due to an overdue receipt. The service provider will remain paid.
The participant's debit card will be suspended until eligible documentation has been received.
Discovery Benefits has advised the participant that an Explanation of Benefits from the service provider will provide the information necessary to substantiate the claims and re-activate her debit card.

I am rejecting this response because:
DiscoveryBenefits is using the IRS rule as a mask and is not responding to issue at hand, is not putting a process into place to respond to an issue and is freezing an account preventing access to medical continuity of care because of a lack of system in place.  Discovery Benefits has also put a file blocker in place making the transferring of data into their system by limiting file sizes when EOMB have had to add federal mandated files for various language requirements. I have now sent all of my EIMB statements without the added language files and this is a violation of my right privacy.  I have provided a complete utilization with no response from Discover Brnefits.

The participant is enrolled in an employer-sponsored flexible spending account under a cafeteria plan both of which are governed by IRS regulations.  The employer’s plan document and SPD determine how the plan is to be administered, including deadlines for submitting expenses for active and terminated employees. Discovery Benefits contracts with employers sponsoring these types of plans to provide administrative services.  Discovery Benefits is required to administer in accordance with the employer’s plan.    In addition to information provided by the employer, information concerning the plan, including the final filing date, is made available to each participant through the consumer web portal.  It is ultimately each employee’s responsibility to be familiar with the requirements of the employee benefit plans in which they are enrolled. IRS regulations do not permit employers or administrators to return forfeited funds to a participant.  There is nothing more Discovery Benefits can do to assist in this matter.

Discovery Benefits stands by its previous response that it sent the initial notification to the carriers for the reinstatement of coverage for this participant on December 6, 2017. Discovery Benefits also sent urgent update requests to the dental and vision carrier for this participant on December 14, 2017, January 15, 2018 and January 19, 2018. As promised in our earlier response, on January 30, 2018 we called the participant and left a voice mail letting her know that we received confirmation from the carrier on January 29, 2018 that her vision coverage was also reinstated without lapse in coverage.  Discovery Benefits is not an insurance carrier and does control the insurance carrier’s processes or system updates.  Many times the carrier customer service representatives are not aware of what has been sent until the carrier updates their systems.All premiums received are remitted in accordance with the agreement between the employer and Discovery Benefits.  Discovery Benefits does not retain premiums paid by the individuals.

I am rejecting this response because: The issue still remains and discovery benefits does not seem to want to address the issue.

Initial Business Response /* (1000, 5, 2015/10/06) */
Discovery Benefits mailed to the participant on June 5, 2015 the required information for the reinstatement of his benefits. The Notice he received provided the first day of coverage, last day of coverage, plan information and premium amounts as...

well as instructions for enrolling.
The participant completed his enrollment by making his initial premium payment. The initial premium payment was received and processed by Discovery Benefits on August 10, 2015. According to its standard process, Discovery Benefits notified the carrier of the reinstatement on August 11, 2015. Discovery Benefits is able to confirm the carrier picked up and opened this notification request on August 11, 2015.
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 began communicating with Discovery Benefits regarding his coverage on August 31, 2015. His concern was his dental coverage was not active for the month of August 2015. The participant was advised his initial premium payment was applied to his June 2015 premium and he needed to remit payment for July and August 2015 if he wished to have coverage for those months.
The participant requested a refund of his June 2015 premium on August 8, 2015. Due to the nature of insurance, a retroactive refund is not a possibility. This was explained to the participant by a Discovery Benefits customer service representative.
Discovery Benefits received and processed premium payments for July, August and September 2015 on September 14, 2015.
The participant contacted Discovery Benefits by phone on September 21, 2015 and indicated his dental coverage was not active. Discovery Benefits sent an urgent update request on behalf of the participant to the carrier on September 22, 2015. The participant was advised his dental carrier could contact Discovery Benefits to obtain eligibility information. When the participant called at 4:46 p.m. on September 21, 2015, the Discovery Benefits carrier relations department was closed for the day and participant was advised the carrier relations department could be reached the following morning.
Discovery Benefits' Participant Services operates as an incoming call center to respond to inquiries from participants. The phone lines are kept open to the extent possible for incoming calls. When a supervisor is available at the time requested, the call is transferred. If no supervisor is available at that time, a callback request is processed and the participant will receive a call back from a supervisor within 24 hours. We 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 provides online payment as an option for participants in the event they would rather pay using that method than by check or money order. It is not a requirement for payments to be made using this method.
Due to an urgent request, Discovery Benefits received confirmation from the participant's dental carrier on October 5, 2015 of the reinstatement of his coverage effective June 1, 2015.
The participant has requested a refund of September and October premiums. The participant has not paid for October 2015. A Discovery Benefits customer service representative will follow-up with the participant to determine if termination of coverage effective August 31, 2015 and a refund for September 2015 is still desired.

Discovery Benefits will provide a detailed response to the participant via letter since we cannot post the detail on the Revdex.com site.  However, we can say that Discovery Benefits has provided notification to the carrier for this participant on five different occasions in order to have the carrier update its records to reinstate coverage. We continue to work with the carrier and will provide a final update in the letter that will be mailed to the participant.  As stated earlier, Discovery Benefits does not control a carrier's records or processes and it is the carrier's responsibility to ensure its records are updated in a timely manner for their members once notification is received.

Initial Business Response /* (1000, 13, 2015/07/16) */
Due to the detail required in the response to this complaint, Discovery Benefits is mailing a letter to the participant. As a summary, Discovery Benefits has communicated with the carrier via file, telephone and email on several occasions to...

ensure the participant's coverage is the correct coverage and properly updated. However, Discovery Benefits is not the insurance carrier and does not have access to or control of the records or processes of insurance carriers. We have received confirmation from the carrier that the coverage for the participant is correct and updated with the exception of the dependent information. Discovery Benefits has provided dependent information to the carrier multiple times. We will continue to work with the carrier until the dependent information is properly updated.

Initial Business Response /* (1000, 5, 2015/07/28) */
The employer sponsoring the Transportation Plan in which this participant was enrolled moved to another administrator effective January 1, 2015. The last day to file claims for the Transportation Plan was December 31, 2014. As of that date, the...

funds were turned over to the employer along with reporting indicating December 31, 2014 balances. The Discovery Benefits portal does not reflect $0.00 balances so that we are able to reconcile with the reports provided to the employer.
The participant in this case will need to communicate with his former employer in order to request reimbursement for claims from the 2014 plan year.

I am rejecting this response because: They have not been willing to work with me directly, I want this worked through the Revdex.com.

Initial Business Response /* (1000, 5, 2016/01/29) */
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 does not sell directly to individuals and does not have...

individual service agreements with employees, participants or qualified beneficiaries.
Discovery Benefits' client, the former employer of this participant, became a client of Discovery Benefits effective January 1, 2016. Discovery Benefits was notified of the continuation of this participant on December 4, 2015 and mailed takeover information to the participant on December 8, 2015.
Under COBRA, a domestic partner is not a qualified beneficiary and does not have independent COBRA election rights. As a result, while the domestic partner is eligible to be covered as a dependent of a qualified beneficiary, if the qualified beneficiary does not continue coverage, under the regulations, the domestic partner is not able to continue on the coverage alone.
The participant first contacted Discovery Benefits on December 21, 2015 with questions regarding terminating his own coverage and continuing coverage for his domestic partner. The participant was not provided complete information by the Discovery Benefits customer service representative.
The participant called Discovery Benefits again on January 7, 2016 asking how to remove coverage for himself while keeping it for his dependent. The customer service representative addressed the process required to accomplish the change in coverage but did not catch the fact that the dependent in question was a domestic partner and not a spouse.
Discovery Benefits reached out to the client on January 18, 2016 regarding this matter to ask if they would allow a domestic partner to continue COBRA on their own. The initial response received from the client on January 25, 2016 was no, the domestic partner was not eligible to continue COBRA on their own. Discovery Benefits called the participant on January 26, 2016 letting him know the client's decision.
On January 28, 2016, the client contacted Discovery Benefits stating that it would now allow the continuation of benefits for the domestic partner only. The account is currently being set up with coverage for the domestic partner as originally requested by the participant.

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. Discovery 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 flexible spending accounts (FSA), including expenses paid using the debit card.  See 1.125-6(b)(2) and 1.125-6(3)(i).  The IRS requires all claims to be substantiated. The debit card is provided as an option for participants to use to pay eligible expenses directly from their account rather than paying out-of-pocket and requesting a reimbursement. Use of the debit card is not required and Discovery Benefits does not benefit from a participant’s use of the card. In the case of this particular type of expense, upon receipt of the initial contract Discovery Benefits is able to automatically approve recurring debit card claims that are for the same amount to the same provider.This participant chooses to submit manual claims in order to include eligible mileage. Each manual claim for reimbursement must include the date of service, type of service, amount and the name of the provider. Discovery Benefits processes substantiation at face value. If the documentation provided for each claim does not include this information, the claim cannot be approved.

I am rejecting this response because: There was no reason for me to believe my auto payments would not be active  from the date in which I set them up. Nowhere during the process of setting up auto billing was I told to wait 5 days to confirm payment had gone through. I also went to the dentist throughout the month of February where I was never told my insurance was invalid.  This is is a way for discovery benefits to cancel said benefits at their discretion and without informing participants. Extremely poor business practice and very misleading. The customer service representative should have informed me when setting up auto payments of the rules and regulations associated with this process.

I am rejecting this response because:The provided documents submitted proves the amount paid was the amount charged, and the date of service the transaction conducted.   I will happily provide the documents to the Revdex.com if they would like to see for themself.

Initial Business Response /* (1000, 7, 2015/12/09) */
The participant called Discovery Benefits on September 9, 2015. She had questions regarding her current account balance. The customer service representative provided her with her account balance and advised due to the plan year-end date of...

August 31, 2015 the participant had until October 30, 2015 to submit requests for reimbursement for claims incurred prior to the end of the plan year.
The participant called Discovery Benefits again the same day with questions regarding the type of documentation required for specific services. The participant was provided with the information as requested. The customer service representative provided the option to submit requests for reimbursement through the online portal or by emailing the request to Discovery Benefits. He provided the email address as the participant stated that she did not have online access.
The participant contacted Discovery Benefits on September 29, 2015. She requested the email address to send an invoice or receipt for a claim. The customer service representative provided the Discovery Benefits email address. The participant also requested the claim number of the claim she for which she was submitting documentation. The customer service representative was able to provide the claim number for the only outstanding claim for her account.
Discovery Benefits received an email from the participant on September 29, 2015 that included a claim number in the subject line and the same claim number in the body of the email. As the claim referenced was a claim for the prior plan year (September 1, 2013 to August 31, 2014), the claim was denied on September 30, 2015 and a denial letter emailed to the participant on October 1, 2015.
Separate emails were received from the participant on September 30, October 1 and October 2, 2015. The emails included the same claim number from the prior plan year as the September 29, 2015 email. In each instance, the claim was denied.
The participant called Discovery Benefits on October 23, 2015. During the call, it was discovered the Discovery Benefits system reflected an incorrect Social Security number for the participant. This information was provided via file from the participant's employer in 2013. Upon correction, the participant had access to the online portal. Discovery Benefits' records indicate the participant successfully logged into the portal on October 23, 2015. No claim was filed that day.
Discovery Benefits received an email from the participant on October 31, 2015 indicating she was unable to file claims that day. The final filing date for claims for the August 31, 2015 plan year was October 30, 2015. No claims can be filed after the final filing date.
Because the participant attempted to submit documentation for the claim prior to the final filing date using an incorrect claim number, Discovery Benefits has contacted the participant's employer requesting that the participant be reimbursed for the eligible claims. Since this employer is no longer a Discovery Benefits' client, the employer will handle the processing of the reimbursement.

Initial Business Response /* (1000, 5, 2015/12/23) */
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 received and processed the participant's plan elections and initial payment on...

November 5, 2015. The initial reinstatement request was provided to Kaiser CA on November 6, 2015.
The participant contacted Discovery Benefits twice on December 9, 2015 regarding the reinstatement of his coverage. On each call he was advised that Discovery Benefits had communicated his reinstatement to Kaiser CA on November 6, 2015 and that an urgent request to update coverage would be sent to Kaiser CA. Discovery Benefits sent an urgent request to update coverage to Kaiser CA on December 9, 2015. The request was sent to the eligibility email address provided to Discovery Benefits by Kaiser CA.
The participant contacted Discovery Benefits twice on December 17, 2015 and advised his coverage with Kaiser CA was not active. The customer service representative indicated Kaiser CA had been notified of the reinstatement on November 6, 2015 and December 9, 2015 and advised Discovery Benefits would send an additional request to Kaiser CA.
Discovery Benefits sent another urgent request for reinstatement to Kaiser CA on December 18, 2015.
Discovery Benefits received verbal confirmation of the reinstatement of the participant's coverage effective September 1, 2015 on December 22, 2015. The Kaiser CA representative provided a confirmation number. If the participant is in need of the confirmation number, he should contact Discovery Benefits.
Discovery Benefits' Participant Services operates as an incoming call center to respond to inquiries from participants. The phone lines are kept open to the extent possible for incoming calls and the Participant Services team does not make outbound calls to carriers as this responsibility is handled by a dedicated Carrier Relations team at Discovery Benefits.
Discovery Benefits takes customer service very seriously and upon review of the calls with this participant finds that the representatives with whom he spoke were courteous and professional when speaking with the participant.
Complaint Response Date bumped because: Holiday
Initial Consumer Rebuttal /* (3000, 7, 2015/12/23) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The facts recounted are largely correct and the coverage problem has been corrected. However, no one I spoke with at Discovery Benefits was ever courteous or professional and the wait time to speak to a very rude person was sometimes over 30 minutes. The representatives took no ownership of the problem whatever, and it required the combined efforts of County Of Sonoma HR presonnel (the employer) people at Kaiser Permanente and an ombudsman for the county to get this resolved. At every step, Discovery was more hindrance than helpful. Their response above completely whitewashes their profound indifference to the people, like myself, who have to depend on them to correct mistakes with life or death implications.
Final Business Response /* (4000, 9, 2015/12/28) */
Discovery Benefits respectfully disagrees with this participant. At no time were the representatives rude with the participant. The representatives were courteous and professional. In each case, Discovery Benefits took steps through its standard process to assist the participant in order to resolve the issue. We were unable to accommodate requests made by the participant to speak with the Carrier Relations team, as speaking with participants is the responsibility of the Participant Services team; to be included on Discovery Benefits internal emails; or to have our Participant Services representative contact the carrier, as this is a role of another team. As was stated in the earlier response, Discovery Benefits contacted the carrier on several occasions requesting the carrier update its records. Also as stated earlier, Discovery Benefits does not have access to or control of carrier systems and it is up to the carrier to follow through by updating its systems when notifications are received.

I am rejecting this response because:In good faith I paid $96.99 per month to Discovery Benefits  for COBRA coverage. I did not receive the coverage that I paid for. Discovery Benefits  failed to communicate properly to Delta Dental to assure Dental and Vision coverage for me and my wife. I would like for the Revdex.com to continue to work on my behalf to investigate how this could happen because I do not have the resources to do this. I would like to have my money returned so that I can go else where to find coverage. To date, I have not received a letter from Discovery Benefits.  Please continue to help me. Thank You, Dennis [redacted]

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits does not sell directly to individuals and does not have individual service agreements with...

employees or participants. Flexible spending accounts (FSA) are employer-sponsored plans governed by IRS regulations.  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).  The employer-sponsored plan is also governed by the requirements included in the employer’s plan document and summary plan description.  The final service date for this plan’s 2017 plan year was December 31, 2017. Because of this, the participant’s debit card will only access 2018 funds. The participant still has full access to the 2017 balance but any reimbursements from that balance will need to be filed using any one of the following methods: submitting a form, going online or through Discovery Benefits’ mobile app. The last day for the participant to file for reimbursement from the 2017 plan year is March 31, 2018. The plan under which the participant is enrolled allows for a carryover of unused funds up to the statutory limit of $500. This participant has forfeited no funds.  Discovery Benefits does not retain any funds forfeited by participants.  All forfeited funds are returned to the employer-sponsored plan.During this time of year when a large number of employers’ plan years come to an end our call volumes and wait times may increase at any given time during the day. We place the utmost importance on customer service and strive to respond to calls from participants as quickly as possible and keep the wait times as short as possible. Discovery Benefits also provides an email and chat option for participants through discoverybenefits.com.

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 does not sell directly to individuals and does not have individual service agreements with employees,...

participants or qualified beneficiaries. Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. 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. However, Discovery Benefits can confirm that it reached out to the carrier regarding this individual’s coverage on five separate occasions between March 30, 2017 and May 11, 2017 to ensure coverage was correctly reinstated by the carrier.

I am rejecting this response because:I was never given notice that Discovery Benefits was going to take fees out.  They waited until 10 months of fees were owed then took out the money,  I was never given the chance to take my money out of the account before the fees were taken out.   I would have taken the money out of the account after the 1st time if I would have been given the opportunity.  I feel like this is a very sneaky business practice.