Discovery Benefits

Initial Business Response / [redacted] (1000, 5, 2015/12/29) */ The participant enrolled and made his initial payment on December 7, On December 8, Discovery Benefits notified the carriers of the reinstatement of the participant's coverage effective December 1, 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 also been advised by numerous carriers that it may take up to business days for coverage to be reinstated once notification is receivedAs a result, Discovery Benefits' practice is to allow the business days to pass prior to submitting a follrequest to carriers 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 calls and the Participant Services team does not make outbound calls to carriers The participant contacted Discovery Benefits on December 16, and again on December 18, indicating his coverage was not updated with the carriersThe participant was advised of the carrier processing time during both of these callsSince it had not yet been business days since the enrollment, Discovery Benefits suggested the participant ask the carrier to contact Discovery Benefits to confirm the enrollment and paid through date Discovery Benefits reached out on December 28, and received confirmation of reinstatement of benefits effective December 1, from each of the carriers for this participant

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 IRS rules govern substantiation requirements for the health FSA, including expenses paid using the debit cardIncluded below are excerpts from the IRS regulations governing substantiation requirements 1.125-6(b)(2) All claims must be substantiatedAs a precondition of payment or reimbursement of expenses for qualified benefits, a cafeteria plan must require substantiation in accordance with this sectionSubstantiating only a percentage of claims, or substantiating only claims above a certain dollar amount, fails to comply with the substantiation requirements in §1.125-and this section 1.125-6(d)(7) The employer follows all of the following correction procedures for any improper payments using the debit card— (i) Until the amount of the improper payment is recovered, the debit card must be de-activated and the employee must request payments or reimbursements of medical expenses from the health FSA through other methods (for example, by submitting receipts or invoices from a merchant or service provider showing the employee incurred a section 213(d) medical expense); The participant used his debit card on January 6, for an expense that required substantiation under IRS regulationsOn March 10, 2016, Discovery Benefits requested substantiation documentation from the participant via the email address on fileOn May 8, 2016, a Denial Letter with Repayment Notice was emailed to the participant’s email address on file when no documentation was receivedThe denial reason was Receipt Overdue and included the verbiage: “This claim cannot be approved for processing because the necessary documentation requested in our previous notification was not receivedIf this is a debit card transaction, the card(s) have now been placed on a temporary hold (if applicable).” Since no documentation has been received to substantiate this transaction, the debit card was suspended on May 10, Once this transaction is appropriately substantiated, the hold on the debit card will be liftedThough the debit card remains on hold, the participant may continue to access funds in his account by submitting claims through the online portal or mobile app

The participant attached a copy of the denial and repayment notice to his complaint Documentation submitted on August 4, did not include a form or the claim number so additional research was required in order to determine the claim The documentation was processed this morning and the full amount was approved in full

Discovery Benefits will be calling the individual so that we can explain what action is needed on the individual’s part in order for claims to be approved and reimbursement made We will also confirm the correct mailing address with the individual as all reimbursement checks mailed were returned by the Post Office as undeliverable, resulting in all claims being denied

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 Discovery Benefits received confirmation of the reinstatement of coverage for the participant on September 13, We place the utmost importance on customer service and understand that the participant’s experience has been frustrating and we apologize for her frustrationThe situation causing the delay in processing the continuation coverage for this participant has been addressed Discovery Benefits will send a letter to the participant that provides additional detail on this matter

I am rejecting this response because: I want a resolution without hassleSo far they have been circling around and looking for excusesI feel like I have aiming at a moving goal line

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 meI would like to add that it is disappointing that it took a complaint the the Revdex.com to get this matter resolved, Discovery Benefits should make supervisors more accessible to clients in order to resolve issues like this in a more timely mannerI now have the frustrating task of getting all my claims re-submitted because they voided my insurance

In order to protect the individual's privacy and allow us to include full detail in our response, the individual will receive a letter directly from Discovery Benefits

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 carriersDiscovery Benefits processed annual plan and rate changes on behalf of the former employer of this participant on January 5, and according to its standard process for updating eligibility, notified the carriers of updates to coverage on January 6, and January 8, Discovery Benefits reached out to the new medical carrier on behalf of this participant with an urgent update request on January 9, Discovery Benefits was advised by the carrier that members from this group were currently being added to their system and there was not a way to reinstate coverage until the member was addedDiscovery Benefits receive verbal confirmation of updated coverage from the medical carrier on January 10, Discovery Benefits was informed it may take hours for providers to see the coverage as activeA Discovery Benefits representative will reach out to the participant by phone with this information todayDuring this time of year when a large number of employers and their employees are going through open enrollment, 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 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 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 According to its standard process for updating eligibility with carriers, Discovery Benefits notified each of the carriers of the reinstatement of coverage for this participant upon her enrollmentIn addition, Discovery Benefits has reached out to the carriers on six other occasions to ensure the continuation of coverage for this participantMost recently Discovery Benefits reached out to the medical carrier on August 13, and received confirmation on August 18, of the continuation of coverage for this qualified beneficiary since her first day of COBRA

It is DBI's policy not to include detailed information in its Revdex.com responses in order to protect an individual's privacy A letter was mailed to the individual yesterday In the letter, we provided detail regarding the paperwork submitted and noted that the outstanding check originally issued to the accountholder has been voided and another check will be issued in the same amount payable to the estate of the accountholderThe check will be mailed to the address we have on record for the accountholder's HSA by the end of the week

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 Due to the personal nature of the information included in Discovery Benefits’ response, we will respond to the participant directly via written correspondence

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerIRS rules governing substantiation requirements for the flexible spending accounts require that all claims must be substantiated, even those paid using the debit cardSee 1.125-6(b)(2) and 1.125-6(3)(i) All expenses must be substantiated by information from a third-party that is independent of the employee and the employee’s spouse and dependentsThe independent third-party must provide information describing the service or product, the date of the service or sale, and the amount.The original documentation submitted by this participant did not include the type of serviceDiscovery Benefits received additional substantiation which included the required information The request has been reprocessed and the substantiation requirement has been satisfied.Even though debit card transactions may be denied due to lack of or insufficient documentation, the merchant remains paid

I am rejecting this response because: This is the canned response to all similar complaints I have readThey just fill in the blanks with the specific dates.It was probably my former employer's error in stating my last day was 11/even though I submitted a timesheet through 11/But that does not excuse the fact that DiscoveryBenefits intentionally chooses to remain silent with the intent to gain from "forfeited" funds that are rightly owed to the consumerAnd as I stated in the original complaint, the excuse that the consumer is advised of this period when he/she is hired is just "passing the buck" of responsibility

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.Discovery Benefits does not retain premiums collectedThis participant’s April premium was remitted in May according to the process agreed upon between the employer and Discovery BenefitsDiscovery Benefits has been in contact with the participant’s former employer and was advised the participant needs to contact the former employer regarding this matter

I am rejecting this response because: While I agree they do not sell insurance directly they took my payment and information with the understanding they would forward this to the insurance company so my benefits would continueThe insurance company informed me on multiple occasions that they did not receive the informationI requested that Discovery resubmit this information on multiple occasionsIt is now over months later and my coverage for June still is not showing as active and I had to pay for my doctor visits from June out of pocketI requested a refund and was denied for JuneI did receive a refund for JulyThey have accepted no responsibility for dropping the ball on my paperwork

I am rejecting this response because: Discovery Benefits did not respond to my chief complaint, which was that I was told I could substitute a valid claim for claims that were not reimbursed but deducted early on in the plan period due to card use with no invoice I have had another flex plan for over years with ZERO issues Discovery Benefits has been very difficult to deal with On another note, their response does not comply with the law and mistakes the IRS code

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 Due to the amount of personal information required to provide a complete response to the participant, Discovery Benefits will send a letter directly to the participant

I am rejecting this response because: The same day that Discovery Benefits added my dependents to my COBRA plan, they terminated my coverage, stating I hadn't paid the additional amount for the dependentsThis is nonsensical and infuriating, as I had been trying to add them to my plan the entire timeHow could I pay for their coverage if they weren't on my plan yet? Someone from Discovery Benefits called me and recognized their errorThey gave me hours to send the amount for addition of my daughtersI sent a check the same day for about to cover their addition, back to their birth date in DecemberI thought that would be the resolution of the issueHowever, I called my insurance company to verify my dependent coverage and they said they had not received any communication from Discovery Benefits and my daughters are still not on my planI have reached out many times to Discovery to try to add my daughters, paid for their addition, mailed the check the same day, and still do not have coverage for my daughters