Discovery Benefits

Final Consumer Response / [redacted] (2000, 6, 2015/09/28) */ As of 9/my insurance was activated! I called and told them I had filed a complaint with youPerhaps that did the trickI am going to try and pick up my prescriptions todayI will let you know if there are any problems

Initial Business Response / [redacted] (1000, 10, 2016/01/20) */ Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers. Discovery Benefits does not sell directly to individuals. Discovery Benefits generally acts on instructions from employers,... qualified beneficiaries, and/or insurance carriers. Discovery Benefits (i) is not an insurer or an insurance carrier and (ii) does not have control over the records or assets of an insurance carrier. Discovery Benefits received and processed the participant's online election and initial payment on December 3, 2015. According to its standard process, Discovery Benefits notified the 2015 carriers of the reinstatement of coverage for this participant on December 4, 2015. Due to a change in carriers by the employer, Discovery Benefits notified the 2016 carriers on December 8, 2015 of the addition of the participant's coverage effective January 1, 2016. Discovery Benefits was first made aware of the inactive coverage for the participant on January 18, 2015. On January 19, 2015, Discovery Benefits reached out to each the carriers to confirm coverage. As of January 20, 2015, each of the carriers for this participant has confirmed the reinstatement of coverage. The medical carrier for the participant has provided a reference number to Discovery Benefits. If the participant would like the reference number, he should contact Discovery Benefits. Initial Consumer Rebuttal / [redacted] (3000, 12, 2016/01/21) */ (The consumer indicated he/she DID NOT accept the response from the business.) The response is not acceptable. Moreover, as described below, Discovery Benefits is now refusing to accept my phone calls. There are three aspects of my insurance coverage: health, dental and vision. With respect to all three, Discovery Benefits did not reach out the providers on December 8, as they claim. None of the insurance providers has any record of Discovery Benefits contacting them anytime in December. In light of the fact that more than one provider has confirmed that Discovery Benefits did not contact them, it is clear that the error was made by Discovery Benefits rather than the providers. When I requested from Discovery Benefits any evidence that they had, in fact, reached out to the providers in December, they refused to produce it. It now appears that, after repeated phone calls to Discovery Benefits, they have finally contacted my health insurance provider. However, given that Discovery Benefits waited until mid-late January to do so, I am entitled to a pro rata refund of the premiums that I paid for the period of time that Discovery Benefits did not contact my health insurance provider. As indicated earlier, it is clear that, in the period from December to mid-January, Discovery Benefits simply stole my premium payments and did not do its job to contact the providers as promised. Moreover, with respect to dental and vision, Discovery Benefits has STILL not reached out to that provider (both plans are administered by one company). I spoke to a representative of the vision and dental company on 1/21/16, and they have no record of me or of contact from Discovery Benefits. Accordingly, the statement above that "As of January 20, 2015, each of the carriers for this participant has confirmed the reinstatement of coverage" is a lie with respect to my dental and vision coverage. On 1/21/16, I attempted to call Discovery Benefits. After putting in my identifying information (Social Security Number and date of birth), I was placed on hold and the call was never answered. It appears that Discovery Benefits has blacklisted my account and is refusing to work with me to resolve my issues. This is unprofessional and a further attempt by Discovery Benefits to refuse service to me. Final Business Response / [redacted] (4000, 14, 2016/01/22) */ Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers. Discovery Benefits does not sell directly to individuals. Discovery Benefits generally acts on instructions from employers, qualified beneficiaries, and/or insurance carriers. Discovery Benefits (i) is not an insurer or an insurance carrier and (ii) does not have control over the records or assets of an insurance carrier. Discovery Benefits notifies carriers of eligibility using the method and contact information provided to Discovery Benefits by the client. Most frequently, the information is provided to an eligibility or membership department of the carrier. It is Discovery Benefits' understanding that a carrier's call center representative may have access to see only whether coverage is in force and not whether the appropriate documentation has been received. Discovery Benefits has also been advised by numerous carriers that the processing of updates may take up to 15 business days. Discovery Benefits notified both of this participant's 2015 carriers of the reinstatement of coverage on December 4, 2015 and due to the employer's change in carriers, Discovery Benefits notified both of the 2016 carriers on December 8, 2015 of the addition of this participant's coverage effective January 1, 2016. Discovery Benefits was first made aware of the inactive coverage for the participant on January 18, 2016. On January 19, 2016, Discovery Benefits reached out to each of the carriers to confirm coverage. As of January 20, 2016, each of the carriers for this participant has confirmed the reinstatement of coverage. Discovery Benefits contacted the dental and vision carrier for this participant again on January 22, 2015. Discovery Benefits was advised the coverage is not active but the representative located the information sent by Discovery Benefits on December 8, 2015 and advised it would be updated as a priority. The representative expected the coverage would be updated by Monday, January 25, 2016. Discovery Benefits collects premiums from qualified beneficiaries and remits on a monthly basis based on the pre-determined agreement between Discovery Benefits and the employer. Discovery Benefits does not retain premiums collected from qualified beneficiaries. Discovery Benefits has record of one call from the participant on January 21, 2016. The call was concluded mutually. If the participant attempted to call and did not get through the automated system, we do not have record of it. Discovery Benefits Participant Services never screens phone calls. The purpose of requesting the information in the automated introduction to the call is for the participant's account to open automatically when the Participant Services representative answers the call.

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 provided I do in fact hear from DBI within 10 business days. If not I will reinstate my complaint.

Initial Business Response / [redacted] (1000, 5, 2015/11/03) */ The participant contacted Discovery Benefits on June 8, and asked questions about the remaining balance in his transit accountHe advised that he was moving away and wanted to stop the deductions from his last two checksThe Discovery Benefits customer service representative advised that he would need to contact his employer to change his payroll deductionsHe wanted to know if the balance in his account could be refunded to himHe was advised the balance could not be refunded to him and would likely be forfeited unless he could transfer the funds to his transit card and use it to pay eligible mass transit expensesDiscovery Benefits did not have record of the participant's termination or termination date at the time of this callDiscovery Benefits was notified of the termination date of June 15, on June 26, When a participant is terminated from employment, the transit card is de-activated and claims are limited to filing through the online portal According to the plan in which the participant was enrolled, terminated employees have days from the last day active to file any claims incurred while the employee was an active participant The participant's final filing date for eligible expenses was September 12, Discovery Benefits did not receive any claims from the participant following his termination of employment The participant contacted Discovery Benefits on October 16, 2015, after his final filing dateDuring the call, he was advised incorrectly that he had days to submit claims and that he could submit claims using an Out of Pocket Reimbursement formOnly active participants are provided days to submit claims via the online portalTransit claims cannot be submitted via paper formDiscovery Benefits places the utmost importance on customer service and takes consumer feedback very seriouslyWe apologize for the frustration caused by the incorrect information provided during the October 16, callThis situation has been addressed internally with the customer service representative

Initial Business Response / [redacted] (1000, 5, 2015/08/17) */ The participant used a debit card to pay for services in the amount of $on May 13, Discovery Benefits emailed to the email address on file for the participant a request for substantiation on May 16, A reminder for substantiation for the same claim was emailed to the participant at the email address on file on June 14, On July 26, 2015, the claim was auto-denied due to the overdue receiptA Notification of Denied Claims and a Repayment Request were emailed to the participant at the email address on file on July 27, Each of these notifications indicates documentation is required and should include an itemized receipt or statement indicating the date of service, type of service and the dollar amountBecause the claim has remained unsubstantiated for more than days, in accordance with IRS regulations, the card has been temporarily suspended until the claim is substantiated, repaid or offset with out-of-pocket expensesWhile the card is on hold, the participant still has access to the funds by filing online through the portal or by submitting a manual request for payment as long as the appropriate documentation has been submitted as well The participant logged into his account several times between the beginning of June and August 11, Each of the emailed notifications can be found on the participant's online account as well Discovery Benefits received one call from the participant on August 6, The participant's debit card will remain in a suspended status until the appropriate documentation is received, the claim has been repaid or the claim has been offset with other out-of-pocket expenses Initial Consumer Rebuttal / [redacted] (2000, 7, 2015/08/27) */

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 the requirements for the health FSA, including when expenses are deemed “incurred” and eligible for reimbursement during the plan year At no time did the customer service representative indicate that the participant could use their debit card to access the account balance or that the participant should not file expenses In order to provide the participant with a more detailed response, Discovery Benefits will also send a letter directly to the participant in response to the comments

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 provided initial COBRA enrollment information to this participant on November 20, 2017 based upon the information supplied by her former employer. On December 5, 2017 the former employer provided updated information to Discovery Benefits and the system was updated on December 5, 2017. Correspondence was mailed to her on December 6, 2017. The participant was able to log in to her online account on December 6, 2017. Discovery Benefits has record of only one phone call from this participant on December 4, 2017 and there are no emails from the email address on file for this participant.

I am rejecting this response because: Discovery Benefits is requiring copies of the initial contract be submitted with EACH manual claim, which is redundant, unnecessary, discriminatory, and provides NO additional (substantiated claim) information that DB doesn't already have in their files DB is requiring a higher level of substantiation standard for a client because they don't want to use DB's debit card The manual claim (referencing the existing copy of the contract in DB’s files) we submitted contained the exact same information that using DB's debit card would, per supervisor Dan N, so there should be no difference in approval Use of DB's debit card provides NO additional information than isn't already provided by manually providing a receipt from the Orthodontic Dr (backed up by an existing contract copy in DB’s files) which also includes the date of the on-going monthly payments, the amount of the payment, and the Dr's name, which is backed up by the original copy of the Drcontract that DB has on fileSince the manual process provides the exact same information that is provided by using DB's debit card, there is no legal, IRS based, logical or practical difference Therefore justification for why DB cannot approve the same process for using a personal credit card copy of a receipt, that also refers DB back to their own files, which includes a copy of the initial contract, applies a different standard and discriminates against a client who wishes to use this process, and include mileage reimbursementWe are not asking for special treatment, or "automatic approvals", rather we are asking for DB to be consistent in process standards, and stop denying manual claims because they are unwilling to add a note to a client’s account (as they would with their debit card process) to document the original contract is on file, or to look up the prior claim referenced, which clearly shows the copy of the original contract already exists in their files

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDuring this time of year when a large number of employers’ plan years come to a close, our call volumes and wait times may increase at any given time during the dayWe place the utmost importance on customer service and strive to respond to calls and emails from participants as quickly as possible and keep the call wait times as short as possibleDiscovery Benefits provides a chat option in addition to email.The participant was enrolled in a flexible spending account (FSA) for the plan year and is not enrolled in an account for the plan yearThe final service date for the plan year was December 31, As a result, the debit card will not work after December 31, The participant has until March 31, to submit expenses for services incurred through December 31, Even though the debit card is no longer an option for the participant, he can submit reimbursement requests from using our paper form or uploading through his online account or the Discovery Benefits mobile appDiscovery Benefits will reach out to the participant with this information and to answer any questions he may have

I am rejecting this response because: Just send the response through the Revdex.comI am an attorney and plan on filing a lawsuit if this is not resolved in a timely mannerI have been railroaded by the company since January and am tired of itBased upon the large number of complaints on the internet I do not anticipate I will be getting a reasonable response from them

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 In response to only one phone call they should know that their call in automated system would not allow me to leave a call back number I waited on hold for over minutes and no one ever picked up While they resolved the issue their statement is and people should know that their customer service is horrendous The time and energy that was put into contacting this business was a waste of time When will they accept accountability for their poor service and wasting their customers time?issue resolved but still a very disappointing experience with 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 reached out to the employer regarding their runout period for terminated employees and was informed that it was the employer’s intent to allow terminated employees a runout period of days following the end of the plan yearAs a result, this participant is allowed to file expenses for services incurred prior to his termination date until March 31, The participant may file for reimbursement through online through the portal, via the mobile app or by completing an out-of-pocket reimbursement request formWe will reach out to the participant by phone to let him know of the extension to file claims

Initial Business Response / [redacted] (1000, 5, 2015/12/22) */ 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 The participant contacted Discovery Benefits by phone on November 2, and November 4, She was advised her issue was being researched and she requested a call back with results The participant contacted Discovery Benefits by phone on November 16, She was advised a Discovery Benefits customer service representative would contact herUnfortunately, the participant did not receive a call back Discovery Benefits places the utmost importance on customer serviceWe sincerely apologize to the participant for the frustration caused by the calls with Discovery Benefits and wish to advise that the situation has been addressed The participant contacted Discovery Benefits by phone on December 16, and advised she wanted a refund of all premiums paid to Discovery BenefitsA Discovery Benefits supervisor called out to the participant on December 16, and advised a refund was not possible Upon review of the circumstances in this situation, Discovery Benefits has approved a full refund for this participantBecause of the refund, coverage will be terminated effective August 1,

I am rejecting this response because: This company is the "Administrators" for our company's HSAAlthough the plan date had passed when the provider swiped my card once for different transactions, one of the services were within the previous plan periodwhen I discovered the payment error, I sent verification that the covered charged were for the previous plan yearThey advised me after the fact that I had until 4/to submit for a reimbursement, which would have resolved my issueIf they would have done there job and responded appropriately to my email inquiry I could have submitted the proper paperwork with their guidanceI was told they did not tell me what to do to get reimbursed because my email did not have a "specific question"It's very clear in my email that I'm trying to resolve the payment issueI want Discovery to reimburse me for my money because they did not do their do diligence as "Administrators"I do not know the rules or how they operateI understand the government has their own rules and can not be broken or bentI want Discovery as Administrators to refund me my $because the government will not

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 coverageWe 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 / [redacted] (1000, 5, 2015/10/28) */ The participant submitted a manual claim on October 21, The documentation included a statement of services and a payment receiptOnly expenses applied to the insurance deductible are eligible under the employer's plan in which the participant is enrolledThe documentation did not indicate the type of expense (deductible, coinsurance, copay) and the claim was denied requesting an Explanation of Benefits (EOB) Documentation is processed in the order it is receivedThe participant uploaded additional documentation on October 22, The additional documentation did not indicate the type of expense and was again denied on October 23, requesting an EOB be submitted Discovery Benefits received additional documentation on October 22, 2015, separate from the other documentation submitted on the same dayThis documentation included an EOB and was approved on October 26, A check was mailed for the reimbursement on October 27, The employer's plan requires each participant pay a portion of the deductible out of pocket before being eligible to receive reimbursementThe reimbursement paid on October 27, was reduced by the required out-of-pocket amount and the check processed for the remainder Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/11/07) */ (The consumer indicated he/she DID NOT accept the response from the business.) They have paid this claim after doing everything they could to try to and deny itThey are currently preventing me from using other benefits that have been paid for I have paid all of my current COBRA payments for insurance through November My dental and vision coverage has been terminated effective September 30th so I have paid for insurance I cannot useI am incurring out of pocket expenses that should be coveredIn addition to this I have $in my Medical FSA accountThis has been shut off as of October 31st even though I have paid the premium through November 30th My daughter went to the Orthodontist on 11/7/and Discovery will not let me claim FSA funds to cover the expenseInsurance claims being submitted for this expense will be denied because they terminated our insurance even though the premiums are paid This company makes it as difficult as possible to access benefits that have been paid forEither they are incompetent or intentionally denying benefits that have been paid for If the Revdex.com cannot solve this legal action may be necessary Final Business Response / [redacted] (4000, 9, 2015/11/11) */ Discovery Benefits received and processed the participant's continuation elections and initial payment on October 19, and notified the carriers of the reinstatement on October 20, according to Discovery Benefits' standard procedure 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 numerous carriers the processing time for reinstatement can be between and business days Discovery Benefits again communicated the reinstatement of benefits to the carriers for the participant on October 26, Discovery Benefits received and processed the participant's November payment on November 6, and reached out to the carriers to confirm coverage on November 9, Discovery Benefits received confirmation from the carrier today, November 11, 2015, of the reinstatement of dental and vision coverage effective October 1, for this participant A participant's debit card is deactivated upon termination of employmentWhile this participant's debit card is no longer active, eligible claims may be submitted using paper reimbursement forms or via the member portal

I am rejecting this response because: I don't feel that it should have taken phone calls and contacting HR at my company to get in contact with someone at Discovery who could assist me and review my claim and clearly see that I submitted the proper documentation I submitted exactly what the representative told me to submit on the 16th, and yet whomever was reviewing the documents made an error resulting in more than hours of my time having to contact Discovery Benefits over and over and over, and not until I complained to my employer did a supervisor from Discovery contact me The particular claim has been approved, but I will not fully accept the response from Discovery Benefits until my next claim is approved with submission of the "request for substantiation document," and no additional phone calls or hassle Additionally, I was told by the rep on the 14th during our phone conversation that I only need to have the "request for substantiation documentation" signed by my provider ONCE, and it would be sufficient for subsequent claims According to the supervisor who called me, this information was inaccurate and I will actually need to have the daycare provider sign every time I use by benefits card to pay for childcare, an inconvenience and also a bit discouraging that the representatives are not knowledgeable enough to provide an accurate answer or advice, even more unfortunate because supervisors are not easy to get in touch with

Initial Business Response / [redacted] (1000, 5, 2015/12/23) */ The participant used her debit card to pay for a service on March 30, Discovery Benefits emailed a Request for Substantiation Documentation reminder to the participant on April 3, and again on May 2, When no documentation was received, Discovery Benefits denied the claim with a repayment request on June 13, Because the claim remained unsubstantiated for more than days, the debit card was placed in a suspended statusA Denial Letter with Repayment notification was emailed to the participant on June 17, Discovery Benefits received documentation for this claim on December 15, IRS regulations require that documentation include a date of service, type of service and amount chargedThe documentation provided showed a balance forward but no date or type of serviceThe claim was denied as Previous Balance and Discovery Benefit emailed a Denial Letter with Repayment notification to the participant on December 16, All other claims from this participant for the current plan year were auto-approved at the point of transaction If the participant has questions regarding the denial or communication, we recommend she contact Discovery BenefitsThere is no record of this participant contacting Discovery Benefits Complaint Response Date bumped because: Holiday

The participant contacted Discovery benefits by phone on November 20, and requested assistance logging into her account The Discovery Benefits customer service representative assisted her and stayed on the phone with her until she was able to access her accountAccording to Discovery Benefits record of system access and phone calls, the participant did not log into her account between November 20, and April 6, and Discovery Benefits did not receive any phone calls from the participant between November 20, and April 6, Discovery Benefits did receive an email from the participant on November 17, Discovery Benefits responded with a request for further information to verify the participant on November 21, and did not receive a responseAll communications for the Dependent Care FSA are sent to the participant's email address on her account and are available through the online participant web portal Emails notifying the participant that her account statement is available are sent monthly Participants have the ability to change or update their notification preferences online at any time

Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers It is the carrier’s responsibility to update its records once notifiedDiscovery Benefits contacted the carrier three times on behalf of this participantAs noted previously, confirmation from the carrier was received twice that the coverage was updated on the carrier’s records