Discovery Benefits

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 upNowhere during the process of setting up auto billing was I told to wait days to confirm payment had gone throughI 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 participantsExtremely poor business practice and very misleadingThe customer service representative should have informed me when setting up auto payments of the rules and regulations associated with this process

Discovery Benefits sent a very detailed letter explaining why the documentation submitted could not be accepted for each of the transactions that could not be approved Health care reform allows health FSAs to reimburse expenses for medicines or drugs only if the medicine or drug (1) requires a prescription, (2) is available without a prescription (i.e., an OTC drug) and the individual obtains a prescription, or (3) is insulinTo show that an OTC drug has been prescribed, employees must also submit the prescription, a copy of the prescription, or other documentation that a prescription has been issued, along with the other independent third-party substantiation required under IRS rulesIRS Notice 2010-59, 2010-I.R.B Not a Qualifying ExpenseThese are expenses in one of the following categories: Expenses that are generally known to be incurred or obtained primarily for personal, cosmetic, or general health purposes and not primarily for medical careThese “primarily personal” expenses almost never qualify for reimbursement from a health FSA or HRA or for a tax-free distribution from an HSAExpenses in this category theoretically could qualify in the extremely rare case where an individual can overcome a strong presumption of non-qualification and prove that, based on all the facts and circumstances and taking into account the prevailing IRS guidance, the item or service was incurred or obtained primarily to treat an existing medical condition diagnosed by a medical practitioner

Initial Business Response / [redacted] (1000, 8, 2015/06/03) */ The participant submitted a claim on March 15, A portion of the claim was approved and a reimbursement check mailed to the address on file with Discovery Benefits on March 18, The participant contacted Discovery Benefits on April 6, and indicated that he had not received the check mailed on March 18, The original check was voided and a check re-issued and mailed to the address on file with Discovery Benefits on April 6, The participant contacted Discovery Benefits on April 29, and indicated that he had not yet received the re-issued checkThe Discovery Benefits customer service representative confirmed the mailing address, walked the participant through the steps to set up direct deposit for his reimbursement and advised that once the direct deposit was set up the replacement check would be voided and re-issued as a direct depositThe Discovery Benefits customer service representative did not advise the participant that he would need to call in to confirm that he had completed the direct deposit set-up The participant contacted Discovery Benefits on May 14, and advised that he had not yet received the expected paymentThe Discovery Benefits customer service representative advised that the participant needed to call Discovery Benefits and advise that the direct deposit process had been completedAnother replacement check was issued and mailed to the participant on May 14, Due to the plan closing on May 13, the only option for reimbursement was by check A Discovery Benefits customer service representative contacted the participant by phone on May 22, and advised that reimbursement could not be done through direct deposit and a check was mailed on May 14, The participant contacted Discovery Benefits on May 28, and indicated that the check was received but was destroyed due to the understanding that the reimbursement would be a direct depositAnother check was issued on May 28, and mailed to the participant at the address on file

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 carriersAccording to its standard process for communicating eligibility to carriers, on December 12, Discovery Benefits notified the carriers of the reinstatement of this participant’s coverage effective November 2, As a result of phone calls from the participant, Discovery Benefits reached out to the vision carrier three additional times on January 8, 2018, January 18, and January 25, Discovery Benefits received confirmation from the vision carrier of the reinstatement of the participant’s coverage effective November 2, with no lapse in coverage on January 25,

I am rejecting this response because:The letter I received from Discovery Benefits yesterday provided no new information It just reiterated the dates that my account went inactive and then got cancelled It included a screen shot that showed those dates Unfortunately, I cannot find this information anywhere in my online account I checked again less than an hour ago, and it still shows that I have money available Nothing looks out of place, except the "submit" button for sending in claims is gone, and has now been magically replaced with a note that says "No active plan available" Every other part of the web site shows that everything is good to go.The letter did not address anything about the fact that I was not notified in any way of a major change in my account As I just said, my account shows nothing is amiss I continue to receive monthly account statements that say I have money available and my account is alive & well The notifications tab shows nothing out of place.If I go out and purchase a Groupon online, my money goes out into la la land When I use the Groupon, then I receive the benefit Sounds familiar But, the silly little Groupon sends out regular robo-emails reminding me of the end date As the date gets closer, I get more & more emails This is the 21st century The technology exists Yet Discovery Benefits did nothing to let their customer know of a major impending change in my account status Discovery Benefits did not do their due diligence Discover Benefits did not do their job Groupon handles people's money better than Discovery Benefits I should not have to pay for Discovery Benefits' lack of professionalism.Their letter says they don't keep the money "forfeited to the plan" I don't know why they told me that It makes no difference to me who has the money The bottom line is that I don't have it, and I don't have it because Discovery Benefits make a huge error They owe me $ I will not be satisfied until they fulfill their duty.I don't understand how it is possible for them to have an A+ rating AND a 1.4-star average at the same time???

Initial Business Response / [redacted] (1000, 5, 2016/01/25) */ 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 Discovery Benefits received and processed the participant's January premium payment on January 8, According to Discovery Benefits' standard process, there is a mandatory 14-day waiting period to ensure collected funds Discovery Benefits is currently working with its client, the participant's former employer, to determine the next steps with regard to the reinstatement of active coverage in order to ensure continuous coverageAny applicable refund will be processed upon confirmation from the client

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 carriersDiscovery Benefits has communicated with the carrier on four separate occasions concerning the reinstatement of coverage for the participant Discovery Benefits will send a letter directly to the participant with more detail

Discovery Benefits provides third party administrative services on behalf of employersThe account in which this individual participates is provided through her employerRequests for documentation are required under IRS regulations The participant contacted Discovery Benefits by phone nine times between December 8, and March 9, Based on a review of Discovery Benefits call records, each time she called Discovery Benefits she requested to speak to a supervisorIf there was a supervisor immediately available, her call was transferredSeveral times there was no supervisor immediately available and a request for a call back within hours was created Multiple attempts were made on the part of Discovery Benefits customer service representatives and supervisors to assist the participant with the additional documentation necessary to substantiate her claims We are unable to provide any additional assistance on this matter as the plan year is closed in accordance with the employer’s plan requirements and the participant’s contributions have been exhausted

Initial Business Response / [redacted] (1000, 10, 2015/09/04) */ The participant contacted Discovery Benefits by phone on August 11, requesting a reversal of his recent election and a full refundThe participant was provided with instructions on how to accomplish this reversal and was advised to return the Benefits Termination Form that same day Discovery Benefits has no record of receiving the participant's Benefits Termination Form until September 1, Based on a review of the circumstances surrounding this request, Discovery Benefits will allow an exception and will provide the participant with a full refund of premiums paid Initial Consumer Rebuttal / [redacted] (2000, 12, 2015/09/14) */

Initial Business Response / [redacted] (1000, 10, 2015/09/18) */ Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriersDiscovery Benefits does not process or pay insurance claims Discovery Benefits was notified of the participant's qualifying event on June 17, and mailed the election paperwork to him on June 18, Discovery Benefits received and processed the participant's election paperwork and initial payment on July 9, According to its standard process, Discovery Benefits notified the carrier of the reinstatement of coverage for this participant effective July 1, on July 10, Discovery Benefits did not receive payment for August and coverage for this participant was terminated effective August 1, A Termination Notice in this regard was mailed to the participant on September 8, Discovery Benefits has reached out to the carrier to confirm the reinstatement of the participant's coverage effective July 1, through July 31, The participant will need to work with the carrier directly to seek reimbursement for claims paid Initial Consumer Rebuttal / [redacted] (3000, 12, 2015/09/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) DISCOVERY BENEFITS----- GIVE ME THE NAME, ADDRESS, TELEPHONE AND COPIES OF ALL CORRESPONDENCE YOU SENT TO AETNAYOU CASHED MY CHECK AND IN TYPICAL AMERICAN BUSINESS ARE PASSING THE BUCK Final Business Response / [redacted] (4000, 14, 2015/09/21) */ Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriersDiscovery Benefits does not process or pay insurance claims According to its standard process, on July 10, Discovery Benefits notified the carrier of the reinstatement of coverage for this participant to be effective July 1, In response to the initial Revdex.com complaint filed by this participant, Discovery Benefits again reached out to the carrier on September 18, to confirm the coverage was reinstatedDiscovery Benefits received confirmation from the carrier today, September 21, 2015, of the reinstatement for this participant's coverage for the period July 1, through July 31, with no lapse in coverage The participant will need to work with the carrier directly to seek reimbursement for claims paidThe participant may contact [redacted] Customer Service at the number on the back of his insurance card or dial X-XXX-XXX-XXXX

I am rejecting this response because: per Mayo Health Solutions Discovery Benefits has not sent over my informationThey neglected to start the process for me when Mayo sent the initial forms overThis is not an acceptable way to do business or treat peopleIf I treated patients like this - people would dieThey have not sent the info to Mayo Health Solutions

Initial Business Response / [redacted] (1000, 5, 2015/07/17) */ The participant used her debit card to pay for services on June 15, Discovery Benefits mailed to her a reminder notice requesting substantiation for this claim on June 18, in accordance with IRS regulations (1.125-6(b)(3)(i))The participant supplied additional documentation to Discovery Benefits on July 8, and the claim has been approvedNo further documentation from the participant is required for this claim Initial Consumer Rebuttal / [redacted] (2000, 7, 2015/07/30) */ Yes I am satisfiedThank you so muchIt never would of been resolved with out your help [redacted]

Initial Business Response / [redacted] (1000, 5, 2015/07/21) */ The participant emailed Discovery Benefits on November 19, To ensure the security and privacy of participant information, Discovery Benefits' process requires that there must be verification of three identifying items from the participant in order to provide the requested informationAs Discovery Benefits was not able to verify three items from this email, a response was sent requesting additional informationThe participant responded and a debit card was ordered for the participant according to her request The participant emailed Discovery Benefits on December 19, with a general question regarding eligible expenses under the type of plan in which she was enrolledAdditional identifying information was not required to respond to this email because of the general nature of the information Discovery Benefits received an email from the participant on February 11, in which she indicated her employment was ending on February 13, Discovery Benefits responded on February 13, requesting additional information because the email did not include three identifying itemsA response was never received from the participant The participant emailed Discovery Benefits on May 26, inquiring how to access her fundsDiscovery Benefits responded on May 29, The participant was advised that she had days from the date of the receipt to file claimsThe participant was also advised that claims are required to be filed through the online account, mobile app or via the debit card On June 1, 2015, Discovery Benefits' system was updated by the employer to reflect the participant's termination date of February 1, Because of her termination date, her final filing date for any claims was May 1, according to the terms of the plan document The participant called Discovery Benefits on July 2, Discovery Benefits advised that the runout period for the plan was days and the funds had been forfeited

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 carriersDiscovery Benefits notified Blue Shield CA of the reinstatement of coverage for this participant on September 21, 2017, the day after the enrollment process was completedDiscovery Benefits reached out to the carrier with urgent update requests on October 18, and again on October 30, and spoke with two different Blue Shield CA representatives on the phone on October 24, and again on November 1, to confirm eligibility for the participant Discovery Benefits was advised on November 14, that the participant’s coverage was being updated by a consultant working on behalf of the employerUpon receipt of confirmation of the update, Discovery Benefits’ customer service will contact the participant to let him know

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 carriersDue to the level of detail required for a complete response, we will be send a letter directly to the participant with information concerning her account

Initial Business Response / [redacted] (1000, 5, 2015/10/16) */ COBRA allows for the continuation of an employer's group health plan coverage with no break in coverage for employees and dependents experiencing a COBRA qualifying event that causes a loss of coverageA former employee (qualified beneficiary) is entitled to a 60-day election period during which they may decide whether to continue with the former employer's group health plan or explore other sources of coverageOnce the COBRA election is made, the qualified beneficiary is allowed a 45-day grace period for their initial premium paymentThe qualified beneficiary becomes fully enrolled in COBRA once the election is received and the full initial premium payment is receivedUpon completion of the enrollment process, Discovery Benefits, according to its process, notifies the carrier of the COBRA election and reinstatement back to the loss of coverage date Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriersDiscovery Benefits has been advised by various insurance carriers it may take to business days to process update requests The participant was provided with a COBRA Specific Rights Notice on July 16, by Discovery BenefitsThis Notice included the first day of COBRA, last day of COBRA and information regarding the benefits in which the participant was enrolled as an active employee as well as instructions for electing and paying for COBRA continuation Discovery Benefits received the election and initial payment for this participant on August 7, As the participant's COBRA began on August 1, 2015, the initial premium payment satisfied the August premiumOn August 8, 2015, Discovery Benefits notified the employer's third party file vendor of the reinstatement for this participant effective August 1, The participant has subsequently made two more monthly payments and is currently paid through October 31, Discovery Benefits received confirmation of the reinstatement of coverage for the participant effective August 1, on October 16, Any claims incurred from August 1, through the current paid through date of October 31, should be submitted to or re-processed by the carriers The participant has requested through this forum a refund of premiums paid for coverage for August, September Due to COBRA requirements, there is no option to "skip" months of coverageIf the participant would like to continue COBRA for October 2015, the participant must have coverage for August and September Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/10/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) We mailed form to enroll in COBRA on 7/28/along with payment by checkThey processed it on 8/5/and deposited the check om 8/7/Letter of acknowledgement was received on 8/10/September premium was paid online using a credit card on 9/2/Starting October, payment was on auto pay from our account and was taken out on 9/30/Starting early august, we kept calling Blue Cross and they showed no enrollment in COBRA despite monthly premiums being paid to Discovery BenefitsOur multiple calls to Discovery benefits produced no results and my wife kept putting off seeing any doctor not knowing if she was coveredThis went on thru end of September and I got involved and got the same kind of run around by Discovery BenefitsChecking Fargo, ND Yelp review on Discovery Benefits opened our eyesThe are not new in thisThey have been doing it to lots of other people on their COBRA as well as FSA accounts.IN desperation, I posted a very negative but truthful Yelp review and at the same time emailed and/called several senior managers at Discovery BenefitsIt is only after that things started movingDiscovery Benefits transmitted into to Blue Cross on 9/28/and Blue Cross confirmed coverage on 10/2/Which begs the question why did it take so long (months) and how do we know Discovery benefits have not pocketed the August and September premiums? In our eyes, we were formally covered effective 10/2/and prior months premiums has to be refunded for services not renderedKeeping my wife in limbo for months while she lost sleep thinking she has no coverage is unforgivableUsing incompetence as an excuse just does not cut itWE looked in both Google Earth and Google street view and the street address of Discovery Benefits show a lamp post or street corner, meaning not a valid business addressThat adds to our suspicion on their business practices Our next stop is a formal compliant with the SD State Attorney General's Office Regards Final Business Response / [redacted] (4000, 9, 2015/11/02) */ 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 notified the employer's third party file vendor of this participant's reinstatement each business day beginning on August 8, through September 2, Discovery Benefits notified the third party file vendor again on October 4, and October 5, and reached out for confirmation on October 7, Discovery Benefits has been able to confirm the third party file vendor supplied the information to the carrier each week beginning on Monday, August 10, After receiving the first complaint filed by this participant dated October 6, 2015, Discovery Benefit received confirmation on October 16, of the reinstatement of coverage for the participant effective August 1, The participant is currently paid through November 30, Premiums for August, September and October have been remitted per the agreement between the employer and Discovery Benefits

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 Discovery Benefits received the first notification the check was not received or cashed by the intended party on April 10, Discovery Benefits is working with its bank to recover the funds in order to re-distribute the funds to the participant We apologize for the conflicting information provided by a Discovery Benefits customer service representative Steps have been taken to ensure appropriate responses are provided moving forward A Discovery Benefits customer service representative has been in contact with the participant regarding next steps toward resolution of this matter

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 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 notified the appropriate enrollment contacts of the reinstatement of coverage for this participant effective March 1, on March 6, The participant contacted Discovery Benefits by phone on August 5, indicating her dental coverage was not active and hadn’t been, according to the carrier, since March 1, Discovery Benefits sent an update to the enrollment contact for the carrier on August 12, The participant contacted Discovery Benefits again by phone on August 18, and indicated her dental coverage was not activeDiscovery Benefits sent another update to the enrollment contact for the carrier on August 18, On March 17, the participant contacted Discovery Benefits and indicated her vision coverage was inactiveDiscovery Benefits notified the enrollment contact for the vision and dental carriers of the continuation of coverage since March 1, on March 21, The participant contacted Discovery Benefits by phone on March 21, indicating her vision coverage was still not activeThe Discovery Benefits representative explained that an update request had been sent the same day and the carrier would need time to process the update The participant contacted Discovery Benefits by phone on March 23, and indicated the vision carrier showed her coverage as active effective April 1, rather than Discovery Benefits reached out to the carrier to confirm coverage on March 23, and again on April 7, On April 7, Discovery Benefits received confirmation of the participant’s vision coverage being effective on March 1,

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me

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 employerThe pre-tax reimbursement accounts are governed by IRS regulations as well as the employer’s plan document IRS regulations govern substantiation requirements for expenses paid using the benefits debit card The participant used his benefits debit card three times between April 13, and June 8, Receipt reminders requesting documentation for these purchases were emailed to the participant on the first day and the thirtieth day after each debit card swipeThe participant had days from the date of each transaction to submit the documentationDenial and repayment requests were emailed to the participant at that time when no documentation was receivedEven though the transactions are ultimately denied due to no substantiation being received, the merchants remain paidIn accordance with IRS regulations, the participant is being required by their employer to repay the planThe repayment is retained by the employer’s plan as forfeited fundsDiscovery Benefits does not retain forfeited funds, as they are part of the employer’s plan