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Fidelis Care New York

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Reviews Fidelis Care New York

Fidelis Care New York Reviews (10)

Fidelis is in receipt of your correspondence dated and received on July 3, 2017, regarding a complaint filed by [redacted] ***Ms [redacted] reported that she received several calls from Fidelis asking for someone and although she explains they have the wrong telephone number and to remove the number the calls continueFidelis investigated the complaint and the results are as follows: Fidelis determined that the Ms***'s telephone number was incorrectly reported on a Fidelis member's record by the New York City Human Resources AdministrationOn July 5, 2017, Fidelis removed Ms***'s telephone number from its systemFidelis apologizes for the inconvenience this may have caused Ms [redacted] and appreciates Ms [redacted] bringing this to our attentionIf you require any additional information, please contact Robert F., Senior Vice President at ###-###-####Sincerely, Robert F., Senior Vice President

Fidelis is in receipt of your letter dated May 13, and received on May 18, regarding a complaint filed by [redacted] on behalf of Fidelis members, [redacted] and [redacted] Ms [redacted] reported that she did not receive a recertification package from Fidelis, she experienced difficulty paying the monthly premium on line, and the children were disenrolledMs [redacted] is requesting a refund for the month of FebruaryFidelis investigated the complaint and the results are as follows: [redacted] and [redacted] were enrolled in Fidelis' Child Health Plus (CHP) Plan effective January 1, through the New York State of Health (NYSOH)Fidelis' Retention Department attempted to contact Ms [redacted] twice in November to remind her that the children were due to recertify and to complete the recertification paperwork sent by NYSOHFidelis received termination transactions from NYSOH for the children effective December 31, 2014.Fidelis received a transaction from the NYSOH to reinstate the children's coverage effective February 1, Fidelis received the February premium on March 3, 2015, and the children's coverage was effectuated February 1, Please note that as the premium was received late the enrollment should not have been effectuatedOn April 30, 2015, the children's coverage was terminated for nonpayment of April's premiumFidelis did not receive the April premium until May 2, The children's coverage was reinstated without a lapsePlease note that Fidelis determined that there were no system issues related to Fidelis' on-line payment portal in AprilUpon receipt of this inquiry, Fidelis adjusted the eligibility and effectuated the children's coverage for March 1, instead of February and applied all of the paymentsThe children are now covered and paid through July 31, Accordingly, no refund is due, Fidelis regrets the inconvenience Ms [redacted] experiencedHowever, Fidelis processed the payments received and transactions from NYSOH accuratelyIf you require additional information, please contact me at ###-###-####Sincerely, Reverend Patrick FPresident and Chief Executive Office

Fidelis is in receipt of your letter dated January 4, and received
on February 28, regarding a complaint filed by *** ** *** on behalf of her daughter Child Health Plus member *** ***Ms*** reported that she paid $for September and Fidelis split
the payment
between her son and daughterMs*** is requesting to cancel
the coverage for September and October and apply a credit towards future
monthsFidelis investigated the complaint and the results are as follows: Fidelis reviewed *** ***'s eligibility history and confirmed that the New York State of Health (NYSOH) enrolled *** into Fidelis' Child Health Plus (CHP) plan effective September 1, On September 11, 2017, Fidelis received a premium payment in the amount of $However, the payment was split between Ms***'s children, *** and ***'s accountsSince the full premium payment was not received for ***, the coverage was not effectuated for September 1, Ms*** contacted Fidelis' Member Services on October 2, stating that her son ***'s account has an overpayment and her daughter *** was not active, but her CHP coverage was to start September 1, Fidelis determined that due to an administrative error the payment was not applied appropriately to ***'s account and her coverage was updated to reflect
September 1, Fidelis is unable to reimburse Ms.*** for September and October premium since the coverage was updated in October for September coverage, In addition, Fidelis did not receive a transaction file from the NYSOH terminating ***'s coverage for September and OctoberTherefore, Fidelis cannot reimburse
her for those months since *** had active coverageIf you require additional information, please contact Robert F., Senior Vice President at ###-###-####Sincerely, Reverend Patrick FChief Executive Officer

Fidelis is in receipt of your correspondence dated March 8, and received on April 4, regarding a
complaint filed by *** *** on behalf of Fidelis member *** ***Ms*** reported that her
daughter's insurance was terminated on two separate occasions with
minimal
level of notice which resulted in missing a medical appointment Ms*** was advised by a Fidelis Member Services Associate that the coverage was terminated due to a premium processing errorMs*** is requesting an apology from Fidelis with acknowledgment of the error and a review of the premium payments to verify if a premium refund is owedFidelis investigated the complaint, and the findings are as follows: Fidelis reviewed the account of Ms***'s daughter, ***Fidelis determined that her daughter was covered under Fidelis' *** *** *** (***) Plan effective June 1, through November 30, and reinstated effective January 1, through March 31, According to New York State Department of
Health guidelines and communicated to the member via the *** *** *** Subscriber Contract, the monthly premium payment for the *** Plan is due one month in advance of the month of coverage, otherwise coverage would be terminated at the end of the month the premium payment is dueThis information is in Sections and Section of the Subscriber ContractMs*** was sent an invoice for the December premium on October 21, stating the premium was due by November 1, Fidelis did not receive the premium and sent another invoice dated November 3, On November 15, Fidelis sent Ms*** a notice
advising the December premium was due November 1, and the grace period to receive the premium would end on November 30, Fidelis did not receive the premium payment and terminated the member's coverage effective December 1, in accordance with Section and Section of the Subscriber ContractMs*** was notified of the termination via a letter dated December 6, Fidelis received a premium payment on December 3, and credited the payment towards January's coverage month and reinstated the member effective January 1, Fidelis did not receive a premium payment for the month of March and the member was terminated effective March 1, in accordance with Section and Section of the Subscriber ContractFidelis determined that in February the Ms*** was provided within correct information regarding
the status of ***'s coverage for MarchAs a result, Fidelis made a one time exception and reinstated the coverage for the month of March even though the premium was not receivedFidelis reviewed the premium payment history and determined there is no credit owed to the Ms***Fidelis apologizes for the inconvenience Ms*** may have experienced, however, the premium payments were applied appropriately to the account and notifications were sent timelyIf you require additional
information, please contact Robert F., Senior Vice President at ###-###-####Sincerely, Reverend
Patrick F. President and Chief
Executive Officer

I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear belowMr*** was informed on 12/29/that *** was approvedHowever, this occurred only after initiating an external and fair hearing requestThe fact that Fidelis Care is unaware of this demonstrates the lack of organization and improper management of the insurance agency.
Regards,
*** ***

Revdex.com received the following response from the consumer on behalf of the business: I eventually was sent a refund check

Fidelis is in receipt of your email letter dated December 5,
received on December 6, 2017, regarding a complaint filed by *** *** regarding the difficulty she is experiencing with receiving her flex
reimbursement for her glassesPlease note this was the first time Fidelis was
in
receipt of this inquiryFidelis investigated the complaint and the results
are as follows: On June 1, 2017, Fidelis received from Ms*** the flex reimbursement request along with the appropriate receipts in the amount of $On June 7, 2017, Fidelis issued a check in the amount of $to Ms*** at * *** *** ***, NY *** which was Ms***' s address on fileOn October 19, 2017, Fidelis' Member Services
Department received a call from Ms*** regarding the reimbursement
checkPlease note at that time Ms*** identified she had not received
the check and she requested that the check be re-issued to a different address, *** *** *** ***, NY ***The Fidelis Member Service Associate
updated Ms.***'s address and also completed
a request for the check to be re-issuedMs*** was advised to allow
- weeks for the check to be re-issuedOn December 6, 2017, the check was
re-issued to Ms*** at the *** Road addressOn December 19, 2017, a Fidelis Quality Improvement Specialist confirmed that Ms*** was in receipt of the checkIf you require additional information, please contact Robert F., Senior Vice President at ###-###-####Franceen SAssistant
Vice President, Government Relations

Fidelis is in receipt of your letter dated December 8, 2016, and received on December 16, regarding a complaint filed by Fidelis member, *** ***Mr*** reported that Fidelis denied the request for the *** PenHe stated that three providers have submitted authorization
requests and Fidelis denies the requests because the documentation included did not meet medical necessityMr*** stated he requested an internal and external appeal, and a fair hearing regarding this denialFidelis investigated the complaint and the results are as follows: Fidelis' Pharmacy Services Department received prior authorization requests for ***Per Fidelis Pharmacy Services policy, *** may be medically necessary if the member has demonstrated treatment failure with two or more conventional formulary treatment regimensFidelis determined that two of the providers requesting prior authorization, did not include chart notes with their request documenting treatment failure with formulary agentsThe third provider that requested prior authorization, submitted chart notes, however the chart notes did not contain documentation that treatment failure occurred with the formulary agentsFidelis appropriately notified the providers of the denials and the lack of documentation supporting medical necessityAs of the date of this response, Fidelis has not received additional documentation from the providers supporting medical necessity or intolerance to at least two conventional treatments for Mr***'s condition as requestedIf you require additional information, please contact Robert F., Senior Vice President at ###-###-####Sincerely, Franceen SAssistant Vice President, Government Relations

Fidelis is in receipt of your letter dated May 13, 2015 and received on May 18, 2015 regarding a complaint filed by [redacted] on behalf of Fidelis members, [redacted] and [redacted]. Ms. [redacted] reported that she did not receive a recertification package from Fidelis, she experienced...

difficulty paying the monthly premium on line, and the children were disenrolled. Ms. [redacted] is requesting a refund for the month of February. Fidelis investigated the complaint and the results are as follows: [redacted] and [redacted] were enrolled in Fidelis' Child Health Plus (CHP) Plan effective January 1, 2014 through the New York State of Health (NYSOH). Fidelis' Retention Department attempted to contact Ms. [redacted] twice in November 2014 to remind her that the children were due to recertify and to complete the recertification paperwork sent by NYSOH. Fidelis received termination transactions from NYSOH for the children effective December 31, 2014.Fidelis received a transaction from the NYSOH to reinstate the children's coverage effective February 1, 2015. Fidelis received the February premium on March 3, 2015, and the children's coverage was effectuated February 1, 2015. Please note that as the premium was received late the enrollment should not have been effectuated. On April 30, 2015, the children's coverage was terminated for nonpayment of April's premium. Fidelis did not receive the April premium until May 2, 2015. The children's coverage was reinstated without a lapse. Please note that Fidelis determined that there were no system issues related to Fidelis' on-line payment portal in April. Upon receipt of this inquiry, Fidelis adjusted the eligibility and effectuated the children's coverage for March 1, 2015 instead of February and applied all of the payments. The children are now covered and paid through July 31, 2015. Accordingly, no refund is due, Fidelis regrets the inconvenience Ms.
[redacted] experienced. However, Fidelis processed the payments received and transactions from NYSOH accurately. If you require additional information, please contact me at ###-###-####. Sincerely, Reverend Patrick F. President and Chief Executive Office

Fidelis is in receipt of your correspondence dated and received on July 3, 2017, regarding a complaint filed by [redacted]. Ms. [redacted] reported that she received several calls from Fidelis asking for someone and although she explains they have the wrong telephone number and to remove the number...

the calls continue. Fidelis investigated the complaint and the results are as follows: Fidelis determined that the Ms. [redacted]'s telephone number was incorrectly reported on a Fidelis member's record by the New York City Human Resources Administration. On July 5, 2017, Fidelis removed Ms. [redacted]'s telephone number from its system. Fidelis apologizes for the inconvenience this may have caused Ms. [redacted] and appreciates Ms. [redacted] bringing this to our attention. If you require any additional
information, please contact Robert F., Senior Vice President at ###-###-####. Sincerely, Robert F., Senior Vice President

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Address: 9525 Queens Blvd, Flushing, New York, United States, 11374-4510

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