We apologize for the delay, as we needed to get all of the appropriate information from the Marketplace and the transactionsThe complainant had a Marketplace plan with Health AllianceHealth Alliance received a termination from the Marketplace for a termination date of 12/31/Health
Alliance received a case from the Marketplace in May that the member was requesting an earlier date of 11/14/Due to Marketplace rules we cannot retro back a termation date further than days from the date the Marketplace provides usThus, Health Alliance did go ahead and retro back to 12/17/the member failed to pay premiums within the grace period timeframe provided and per Marketplace rules, she was terminatedThe member does still owe premium for the last month she was covered in the amount of $
Thank you for providing Health Alliance the opportunity to responseWe have reviewed the Complainant's account and the termination date of 1/31/is correctHealth Alliance received termination information, aside from non-payment of premiums, from the MarketplaceHealth Alliance originally
received a termination from the Marketplace for February 28, In March, we received additional information from the Marketplace via a HICS caseWe retro terminated based on the date received at that time and per the Marketplace guidelines to February 15, The complainant owed premiums through that dateWhen no premiums were received after the grace period, the account was rightfully terminated for non payment of premiums through 1/31/He still owed through January which is why he was sent amount due letters and noticesHealth Alliance has not received anything from the Marketplace stating that this account should have ended 12/31/to date
Initial Business Response /* (1000, 5, 2016/10/31) */
Health Alliance reviewed his account, as well as the calls he made to the call centerWe believe he was unintentionally misinformed regarding his termination dateHis plan requires ( per his policy) a day notice and then termination is the
end of the month in which notice is receviedThis was 8/31/However, in one of his calls to the health plan, he seems to have been told it could be earlierHealth Allinace is honoring this and updating his termination to 8/17/He did however still owe for the days in AugustA call center supervisor has contacted him and advised him of this and he has paid the balance dueWe are considering this resolvedThank you for the opportunity to review
Initial Consumer Rebuttal /* (2000, 7, 2016/11/03) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Initial Business Response /* (1000, 10, 2015/05/14) */
Enrollment in Medicaid does not preclude a person to be covered by a group health planIn these scenarios, the group health plan is always the primary coverage
Initial Consumer Rebuttal /* (3000, 12, 2015/05/21) */
(The consumer
indicated he/she DID NOT accept the response from the business.)
Following is the response from Health Alliance Meidcal Plans, Inc(HA) regarding the previously filed Revdex.com complaint filed by ***(***)
On May 14, 2015, the business provided the following information:
Enrollment in Medicaid does not preclude a person to be covered by a group health planIn these scenarios, the group health plan is always the primary coverage
The response does not address the complaintThe complaint was that HA only refunded a portion of the over payments on behalf of the employee, specifically, payments***'s position is that *** is entitled to a refund of over payment on all over payments made since the employee was employed
Final Business Response /* (4000, 16, 2015/06/05) */
*** did not provide information accurately on his application to indicate he had MedicareHealth Alliance learned he had Medicare via Medicare in Health Alliance followed up with *** in regard to this information with a Medicare inquiry letter, which he returned in March and stated he did in fact have MedicareHealth Alliance corrected this due to the misinformationAs a courtesy, Health Alliance provided a refund from the beginning of the current plan year - this is not a requirementThe refund was based on his new premium and this new informationPrior to 2015, Health Alliance had been paying primary and collecting the appropriate premiums for *** based on the information he had providedIf the member had Medicaid prior to coming on this plan in or to date, there is no impact to his premiums or how Health Alliance would process claimsWith this Medicare coverage information, ***' Medicaid status is irrelevant
Scott McAdams::
Final Consumer Response /* (4200, 18, 2015/06/09) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Two wrongs do not make a rightThe employee was remiss in not indicating he had Medicare coverage on the original applicationHealth Alliance receives quarterly reports from Medicare indicating the names of the individuals who have Medicare coverage
Health Alliance should have realized that the employee was remiss by not completing the application correctly in June 2012, when the report from Medicare was available to Health Alliance
The reason the government furnishing the said report, automatically, without request, is so the insurance company has a basis for audit of the employee application
Initial Business Response /* (1000, 5, 2016/05/24) */
After reviewing the Complainant's account, Health Alliance found that his plan was appropriately terminated for non-payment of premiumHe called into Health Alliance and spoke with Customer Service on 12/24/to ensure Health Alliance received
his information from the Marketplace( Health Alliance had), and to make his initial paymentHe made this payment over the phone in the amount of $which was his first payment for January 2016, Reference # XXXXXX provided to himHealth Alliance listened to the call and aside from making his initial payment he did not ask at the time about auto drawing from his accountHe would have received invoices for the next month's payment, which he did not pay timely or within the day grace period that his policy allowsThus his plan endedHe did call into Health Alliance again after the plan ended and he stated " he called the exchange several times and they said we were behind and to give it more time and everything would be okay." He acknowledged at that time, he did not contact Health Alliance to check on or make any premium paymentHe paid his February premium at the time of this callThere was no record he signed up for auto draw online through our online vendorOn 03/26/16, he went online to pay March and April( for which he was already terminated) so a refund was made to his credit card on 04/22/Health Alliance also received a case/appeal via the Marketplace on 03/30/16, he was contacted by phone call that this was deniedHealth Alliance has followed all of the required guidelines, as determined by the Marketplace for this plan, regarding termination and payment of premiumThe member also purchased a short term insurance policy directly from Health Alliance that began 05/21/and ends 08/19/unless otherwise cancelled by him
Initial Consumer Rebuttal /* (3000, 7, 2016/05/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Thanks for finally taking the time to look into my case, Health Alliance, but I'm afraid it's too little, too lateFirst, you still owe me $263.63, paid by credit card on 3/22/Second, I never got any bills, invoices, or statements from Health Alliance until my notice of termination on 2/29/What was the 30-day grace period, the month that I had already paid for? Third, I just received an invoice from you saying, "Members whose premium is automatically withdrawn will not receive monthly statements...we have received your check for $527.00"This invoice is dated 6/1/and I received it on 5/24/Not only are you post-dating your invoices by more than a full week, but you sent it to me a full month after receiving my payment, and three full months after terminating my policy! I was told by one of your representatives that there has been some confusion in your accounting department, and I find it unacceptable that you would continue to blame the customer for your oversightsMoreover, by terminating my policy you have effectively banned me from purchasing health insurance through either the marketplace or any company connected to the marketplace, forcing me to attempt to purchase short-term coverage (which I will be fined for because it doesn't meet minimum coverage requirements)Please also note that although you claim my short-term coverage began on 5/21/16, as of 5/25/I still have not received any reply, response, or confirmation of coverage from Health AllianceCommunication is clearly not a strength in this companyBy the way, is does happen to be a strength of mine, and I will involve my state and federal representatives in finding a solution to this conundrumAll I wanted was to buy health insuranceI wasn't asking for anything for freeAnd somehow Health Alliance has both failed to make that happen and exposed their apparent organizational disaster
Initial Business Response /* (1000, 7, 2016/08/04) */
The member's credit card that they had set up to pay was declined May 4, 2016 and a letter was sent to the member advising of this and their options. They called in on May 9, 2016 to make an over the phone payment with a Customer Service...
Representative. In June, they did not pay and they had not set up auto draw with their new credit card number( they did not set it up in May, they only made a one time payment). The member has a 30 day grace period in which to pay. On July 5, 2016, it was determined Health Alliance never received a payment for June, thus per Marketplace guidelines, they were cancelled for nonpayment of premiums. The member did call in July 12, 2016 after the cancellation and made a payment via the automated system. The automated system only takes payments it would not know at that time if they were active or not. On July 19, 2016 Health Alliance noticed the payment and started the refund process for the subsequent July payment since they were cancelled. The member also called in the same day and was advised that the grace period been exceeded by the time they made a payment through the automated system and the policy cannot be reinstated at this time.
Health Alliance can provide either of the letters sent regarding the credit card decline or cancellation as needed.::
Initial Consumer Rebuttal /* (3000, 9, 2016/08/05) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I recognize that a notice was sent in May 2016, but interpreted this as a paper bill. I tried changing my online payment information after this conversation, but as the online account was already set up, it did not allow me to log in. As the May 2016 notice was interpreted as a paper bill, I assumed that additional bills would be mailed for the subsequent months. They were not, and as mentioned in the initial complaint, I also did not receive any notice that the coverage would be cancelled.
Health Alliance's response attempts to position my payment made on 7/19 for June and July's bills as misguided. As also noted in the initial complaint, I was specifically told that if both month's bills are paid, I would be reinstated.
I recognize that, in hindsight, I could have handled this better in respect to being proactive in notifying the company about my new credit card and the difficulty in logging into my account online. However, there are three issues that Health Alliance's response did not attend to:
1 - The lack of a notice of nonpayment for June and the lack of warning of potential cancellation
2 - Being told that the coverage will be reinstated based on payment of June/ July bills, then not actually reinstating coverage after payment
3 - Due to the difficulty in obtaining new coverage now that it isn't open enrollment, I may be stuck without coverage for multiple months, which would result in over a thousand dollars in fines. My requested resolution was to have the company reinstate coverage until the next open enrollment and take my business elsewhere. This requested resolution was ignored.
As mentioned in the initial complaint, this type of business practice is unheard of in other industries and particularly poor when I will reportedly be fined after not having coverage for 60-days. Also, it has been 24-days since I have made my payment, yet I have not received any refund that they have reportedly made. This issue only compounds the dispute that I have at this point.
Final Consumer Response /* (4200, 15, 2016/08/08) */
Thanks for closing the file guys. I'm probably stuck with $1000+ in fines. I made an honest mistake and the company had no desire to retain their customers, which is a first for me. You've been a big help
Initial Business Response /* (1000, 5, 2015/08/17) */
We listened to the 5/08/15 recorded call/ conversation between Ms. [redacted] and the Health Alliance Customer Service Representative. There was no mention of requesting to terminating policy.
We also listened to the 8/10/15 recorded call/...
conversation between Ms. [redacted] and the Health Alliance Customer Service Representative. On this call, Ms. [redacted] did inquire about terminating her policy. The Health Alliance Customer Service Representative (CSR) appropriately directed Ms. [redacted] to the Marketplace; the CSR provided her with the contact information.
As of today, 8/17/15, Health Alliance has not received a Marketplace termination request.
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
The complainant is on an Illinois Marketplace individual plan. Enrollment and Disenrollment is completed by the FFM. Health Alliance did not receive any termination information on this member from the FFM to change her termination date. She mentions cancelling her insurance online, there is not an...
option to do so with health Alliance as it would go through the FFM. It is likely she did so with the FFM. She stated in her call, in September, to the Health Alliance Representative that she did so on 8/31/16. The FFM usually does so in 14 days and does not retro. The member first contacted Health Alliance on September 27, 2016, and advised that she had other insurance and wanted to cancel her policy and back date it. She was advised at this time that she would need proof of other insurance otherwise her termination date would remain 9/15/16. She told the Representative at that time that she did not have proof of other insurance. No additional contact or information has come in since that time via the member or the FFM. Her termination date continues to be September 15, 2016. She owed premium through that date but as of November 1, 2016 she has paid in full. Tell us why here...
Initial Business Response /* (1000, 7, 2015/05/18) */
The initial address provided to Health Alliance by the FFM did not contain an apartment number.
Mr. [redacted] is responsible for ensuring the FFM has the correct address on file.
On 4/7, Health Alliance did receive from the FFM an updated...
address, after his termination due to non-payment.
Mr. [redacted] did not set up auto draw on his account.
Invoices were sent each month for the next month's premium. There is also a statement on each invoice that states you will be terminated for non-payment if not paid within the grace period.
Mr. [redacted] grace period was thirty (30) days and he was given this timeframe to pay.
Initial Business Response /* (1000, 5, 2016/01/26) */
Thank you for the opportunity to respond to this concern. We reviewed the recorded calls and notes from her calls to us. She contacted our customer service on January 12th as she had not yet received her ID card. The Rep explained her to that it...
can take up to 10 business days( her payment was just received on the 5th) but did reorder the card for her. She said she had prescriptions she needed. The Rep offered to fax a copy of a temporary card to her or her pharmacy in the interim as well as the Rep made a conference call with her and her pharmacy. The Rep provided on the call all of the information such as member number that they needed to fill her prescriptions. She then called back again on Jan 21st stating she still had not gotten her ID card knowing it was reordered on Jan 12th. It was explained to her that once it is ordered to allow 10 business days, it had not yet been that long however they can provided a temporary card either via fax or she can go online to her account and view. She said she wanted a credit because she hasn't been able to use her insurance. The Rep explained to her she has had the insurance since the 1st of the month and can and has been able to use it. They did offer to reorder, and advised her to allow mail time of 10 business days. This member has also had prescriptions filled on the 12th so she has utilized the insurance thus far. We feel at this time there is no reason to credit a month of premium as she has had access to it since January 1, 2016, she has utilized it and she has had access to her insurance information via phone calls, offers of the website and faxing temp cards. Please let us know if we can assist with anything further.
[redacted] was enrolled in a Health Alliance plan in 2017. In October Mr. [redacted] went out to the FFM and made an active selection for plan year 2018. His selection was a plan type change. On 10/24/2017 Health Alliance received a BAR file that included this change. When a...
member makes a plan type change Health Alliance follows the same process they would for a new member. This process would include sending the member a binder letter. This member was sent a binder letter on 11/09/17, which states if he didn’t make his first payment in time his plan would be cancelled. As this member was an existing member when we didn’t receive his payment for January, he went into the 30 day grace period. After the grace period expired and no payment was received he was terminated for non-payment, thus creating a balance owed for January. Since the member made the plan type change in October, he should have been termed never effective for 1/1/18 (when Health Alliance didn’t receive the binder payment).Health Alliance has corrected this. Mr. [redacted] has been termed never effective (01/01/18) because Health Alliance didn’t receive his binder payment. Once billing runs again, around April 16th, the member will receive a new bill showing a $0 balance.
Initial Business Response /* (1000, 5, 2016/03/30) */
After reviewing the complainant's account and the phone calls she made, Health Alliance concurs with her that a refund of $95 is owed for the month she determined she didn't need or want the plan. The fact that she hadn't received her refund yet...
was brought to our attention with her phone call 03/28/16 to our customer service department.The refund check should go in the mail by Friday this week and she should allow mail time. We apologize for any delays or confusion.
We apologize for the delay, as we needed to get all of the appropriate information from the Marketplace and the transactionsThe complainant had a Marketplace plan with Health AllianceHealth Alliance received a termination from the Marketplace for a termination date of 12/31/Health
Alliance received a case from the Marketplace in May that the member was requesting an earlier date of 11/14/Due to Marketplace rules we cannot retro back a termation date further than days from the date the Marketplace provides usThus, Health Alliance did go ahead and retro back to 12/17/the member failed to pay premiums within the grace period timeframe provided and per Marketplace rules, she was terminatedThe member does still owe premium for the last month she was covered in the amount of $
Thank you for providing Health Alliance the opportunity to responseWe have reviewed the Complainant's account and the termination date of 1/31/is correctHealth Alliance received termination information, aside from non-payment of premiums, from the MarketplaceHealth Alliance originally
received a termination from the Marketplace for February 28, In March, we received additional information from the Marketplace via a HICS caseWe retro terminated based on the date received at that time and per the Marketplace guidelines to February 15, The complainant owed premiums through that dateWhen no premiums were received after the grace period, the account was rightfully terminated for non payment of premiums through 1/31/He still owed through January which is why he was sent amount due letters and noticesHealth Alliance has not received anything from the Marketplace stating that this account should have ended 12/31/to date
Initial Business Response /* (1000, 5, 2016/10/31) */
Health Alliance reviewed his account, as well as the calls he made to the call centerWe believe he was unintentionally misinformed regarding his termination dateHis plan requires ( per his policy) a day notice and then termination is the
end of the month in which notice is receviedThis was 8/31/However, in one of his calls to the health plan, he seems to have been told it could be earlierHealth Allinace is honoring this and updating his termination to 8/17/He did however still owe for the days in AugustA call center supervisor has contacted him and advised him of this and he has paid the balance dueWe are considering this resolvedThank you for the opportunity to review
Initial Consumer Rebuttal /* (2000, 7, 2016/11/03) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Initial Business Response /* (1000, 10, 2015/05/14) */
Enrollment in Medicaid does not preclude a person to be covered by a group health planIn these scenarios, the group health plan is always the primary coverage
Initial Consumer Rebuttal /* (3000, 12, 2015/05/21) */
(The consumer
indicated he/she DID NOT accept the response from the business.)
Following is the response from Health Alliance Meidcal Plans, Inc(HA) regarding the previously filed Revdex.com complaint filed by ***(***)
On May 14, 2015, the business provided the following information:
Enrollment in Medicaid does not preclude a person to be covered by a group health planIn these scenarios, the group health plan is always the primary coverage
The response does not address the complaintThe complaint was that HA only refunded a portion of the over payments on behalf of the employee, specifically, payments***'s position is that *** is entitled to a refund of over payment on all over payments made since the employee was employed
Final Business Response /* (4000, 16, 2015/06/05) */
*** did not provide information accurately on his application to indicate he had MedicareHealth Alliance learned he had Medicare via Medicare in Health Alliance followed up with *** in regard to this information with a Medicare inquiry letter, which he returned in March and stated he did in fact have MedicareHealth Alliance corrected this due to the misinformationAs a courtesy, Health Alliance provided a refund from the beginning of the current plan year - this is not a requirementThe refund was based on his new premium and this new informationPrior to 2015, Health Alliance had been paying primary and collecting the appropriate premiums for *** based on the information he had providedIf the member had Medicaid prior to coming on this plan in or to date, there is no impact to his premiums or how Health Alliance would process claimsWith this Medicare coverage information, ***' Medicaid status is irrelevant
Scott McAdams::
Final Consumer Response /* (4200, 18, 2015/06/09) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Two wrongs do not make a rightThe employee was remiss in not indicating he had Medicare coverage on the original applicationHealth Alliance receives quarterly reports from Medicare indicating the names of the individuals who have Medicare coverage
Health Alliance should have realized that the employee was remiss by not completing the application correctly in June 2012, when the report from Medicare was available to Health Alliance
The reason the government furnishing the said report, automatically, without request, is so the insurance company has a basis for audit of the employee application
Initial Business Response /* (1000, 5, 2016/05/24) */
After reviewing the Complainant's account, Health Alliance found that his plan was appropriately terminated for non-payment of premiumHe called into Health Alliance and spoke with Customer Service on 12/24/to ensure Health Alliance received
his information from the Marketplace( Health Alliance had), and to make his initial paymentHe made this payment over the phone in the amount of $which was his first payment for January 2016, Reference # XXXXXX provided to himHealth Alliance listened to the call and aside from making his initial payment he did not ask at the time about auto drawing from his accountHe would have received invoices for the next month's payment, which he did not pay timely or within the day grace period that his policy allowsThus his plan endedHe did call into Health Alliance again after the plan ended and he stated " he called the exchange several times and they said we were behind and to give it more time and everything would be okay." He acknowledged at that time, he did not contact Health Alliance to check on or make any premium paymentHe paid his February premium at the time of this callThere was no record he signed up for auto draw online through our online vendorOn 03/26/16, he went online to pay March and April( for which he was already terminated) so a refund was made to his credit card on 04/22/Health Alliance also received a case/appeal via the Marketplace on 03/30/16, he was contacted by phone call that this was deniedHealth Alliance has followed all of the required guidelines, as determined by the Marketplace for this plan, regarding termination and payment of premiumThe member also purchased a short term insurance policy directly from Health Alliance that began 05/21/and ends 08/19/unless otherwise cancelled by him
Initial Consumer Rebuttal /* (3000, 7, 2016/05/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Thanks for finally taking the time to look into my case, Health Alliance, but I'm afraid it's too little, too lateFirst, you still owe me $263.63, paid by credit card on 3/22/Second, I never got any bills, invoices, or statements from Health Alliance until my notice of termination on 2/29/What was the 30-day grace period, the month that I had already paid for? Third, I just received an invoice from you saying, "Members whose premium is automatically withdrawn will not receive monthly statements...we have received your check for $527.00"This invoice is dated 6/1/and I received it on 5/24/Not only are you post-dating your invoices by more than a full week, but you sent it to me a full month after receiving my payment, and three full months after terminating my policy! I was told by one of your representatives that there has been some confusion in your accounting department, and I find it unacceptable that you would continue to blame the customer for your oversightsMoreover, by terminating my policy you have effectively banned me from purchasing health insurance through either the marketplace or any company connected to the marketplace, forcing me to attempt to purchase short-term coverage (which I will be fined for because it doesn't meet minimum coverage requirements)Please also note that although you claim my short-term coverage began on 5/21/16, as of 5/25/I still have not received any reply, response, or confirmation of coverage from Health AllianceCommunication is clearly not a strength in this companyBy the way, is does happen to be a strength of mine, and I will involve my state and federal representatives in finding a solution to this conundrumAll I wanted was to buy health insuranceI wasn't asking for anything for freeAnd somehow Health Alliance has both failed to make that happen and exposed their apparent organizational disaster
Initial Business Response /* (1000, 7, 2016/08/04) */
The member's credit card that they had set up to pay was declined May 4, 2016 and a letter was sent to the member advising of this and their options. They called in on May 9, 2016 to make an over the phone payment with a Customer Service...
Representative. In June, they did not pay and they had not set up auto draw with their new credit card number( they did not set it up in May, they only made a one time payment). The member has a 30 day grace period in which to pay. On July 5, 2016, it was determined Health Alliance never received a payment for June, thus per Marketplace guidelines, they were cancelled for nonpayment of premiums. The member did call in July 12, 2016 after the cancellation and made a payment via the automated system. The automated system only takes payments it would not know at that time if they were active or not. On July 19, 2016 Health Alliance noticed the payment and started the refund process for the subsequent July payment since they were cancelled. The member also called in the same day and was advised that the grace period been exceeded by the time they made a payment through the automated system and the policy cannot be reinstated at this time.
Health Alliance can provide either of the letters sent regarding the credit card decline or cancellation as needed.::
Initial Consumer Rebuttal /* (3000, 9, 2016/08/05) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I recognize that a notice was sent in May 2016, but interpreted this as a paper bill. I tried changing my online payment information after this conversation, but as the online account was already set up, it did not allow me to log in. As the May 2016 notice was interpreted as a paper bill, I assumed that additional bills would be mailed for the subsequent months. They were not, and as mentioned in the initial complaint, I also did not receive any notice that the coverage would be cancelled.
Health Alliance's response attempts to position my payment made on 7/19 for June and July's bills as misguided. As also noted in the initial complaint, I was specifically told that if both month's bills are paid, I would be reinstated.
I recognize that, in hindsight, I could have handled this better in respect to being proactive in notifying the company about my new credit card and the difficulty in logging into my account online. However, there are three issues that Health Alliance's response did not attend to:
1 - The lack of a notice of nonpayment for June and the lack of warning of potential cancellation
2 - Being told that the coverage will be reinstated based on payment of June/ July bills, then not actually reinstating coverage after payment
3 - Due to the difficulty in obtaining new coverage now that it isn't open enrollment, I may be stuck without coverage for multiple months, which would result in over a thousand dollars in fines. My requested resolution was to have the company reinstate coverage until the next open enrollment and take my business elsewhere. This requested resolution was ignored.
As mentioned in the initial complaint, this type of business practice is unheard of in other industries and particularly poor when I will reportedly be fined after not having coverage for 60-days. Also, it has been 24-days since I have made my payment, yet I have not received any refund that they have reportedly made. This issue only compounds the dispute that I have at this point.
Final Consumer Response /* (4200, 15, 2016/08/08) */
Thanks for closing the file guys. I'm probably stuck with $1000+ in fines. I made an honest mistake and the company had no desire to retain their customers, which is a first for me. You've been a big help
Initial Business Response /* (1000, 5, 2015/08/17) */
We listened to the 5/08/15 recorded call/ conversation between Ms. [redacted] and the Health Alliance Customer Service Representative. There was no mention of requesting to terminating policy.
We also listened to the 8/10/15 recorded call/...
conversation between Ms. [redacted] and the Health Alliance Customer Service Representative. On this call, Ms. [redacted] did inquire about terminating her policy. The Health Alliance Customer Service Representative (CSR) appropriately directed Ms. [redacted] to the Marketplace; the CSR provided her with the contact information.
As of today, 8/17/15, Health Alliance has not received a Marketplace termination request.
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
The complainant is on an Illinois Marketplace individual plan. Enrollment and Disenrollment is completed by the FFM. Health Alliance did not receive any termination information on this member from the FFM to change her termination date. She mentions cancelling her insurance online, there is not an...
option to do so with health Alliance as it would go through the FFM. It is likely she did so with the FFM. She stated in her call, in September, to the Health Alliance Representative that she did so on 8/31/16. The FFM usually does so in 14 days and does not retro. The member first contacted Health Alliance on September 27, 2016, and advised that she had other insurance and wanted to cancel her policy and back date it. She was advised at this time that she would need proof of other insurance otherwise her termination date would remain 9/15/16. She told the Representative at that time that she did not have proof of other insurance. No additional contact or information has come in since that time via the member or the FFM. Her termination date continues to be September 15, 2016. She owed premium through that date but as of November 1, 2016 she has paid in full. Tell us why here...
Initial Business Response /* (1000, 7, 2015/05/18) */
The initial address provided to Health Alliance by the FFM did not contain an apartment number.
Mr. [redacted] is responsible for ensuring the FFM has the correct address on file.
On 4/7, Health Alliance did receive from the FFM an updated...
address, after his termination due to non-payment.
Mr. [redacted] did not set up auto draw on his account.
Invoices were sent each month for the next month's premium. There is also a statement on each invoice that states you will be terminated for non-payment if not paid within the grace period.
Mr. [redacted] grace period was thirty (30) days and he was given this timeframe to pay.
Initial Business Response /* (1000, 5, 2016/01/26) */
Thank you for the opportunity to respond to this concern. We reviewed the recorded calls and notes from her calls to us. She contacted our customer service on January 12th as she had not yet received her ID card. The Rep explained her to that it...
can take up to 10 business days( her payment was just received on the 5th) but did reorder the card for her. She said she had prescriptions she needed. The Rep offered to fax a copy of a temporary card to her or her pharmacy in the interim as well as the Rep made a conference call with her and her pharmacy. The Rep provided on the call all of the information such as member number that they needed to fill her prescriptions. She then called back again on Jan 21st stating she still had not gotten her ID card knowing it was reordered on Jan 12th. It was explained to her that once it is ordered to allow 10 business days, it had not yet been that long however they can provided a temporary card either via fax or she can go online to her account and view. She said she wanted a credit because she hasn't been able to use her insurance. The Rep explained to her she has had the insurance since the 1st of the month and can and has been able to use it. They did offer to reorder, and advised her to allow mail time of 10 business days. This member has also had prescriptions filled on the 12th so she has utilized the insurance thus far. We feel at this time there is no reason to credit a month of premium as she has had access to it since January 1, 2016, she has utilized it and she has had access to her insurance information via phone calls, offers of the website and faxing temp cards. Please let us know if we can assist with anything further.
[redacted] was enrolled in a Health Alliance plan in 2017. In October Mr. [redacted] went out to the FFM and made an active selection for plan year 2018. His selection was a plan type change. On 10/24/2017 Health Alliance received a BAR file that included this change. When a...
member makes a plan type change Health Alliance follows the same process they would for a new member. This process would include sending the member a binder letter. This member was sent a binder letter on 11/09/17, which states if he didn’t make his first payment in time his plan would be cancelled. As this member was an existing member when we didn’t receive his payment for January, he went into the 30 day grace period. After the grace period expired and no payment was received he was terminated for non-payment, thus creating a balance owed for January. Since the member made the plan type change in October, he should have been termed never effective for 1/1/18 (when Health Alliance didn’t receive the binder payment).Health Alliance has corrected this. Mr. [redacted] has been termed never effective (01/01/18) because Health Alliance didn’t receive his binder payment. Once billing runs again, around April 16th, the member will receive a new bill showing a $0 balance.
Initial Business Response /* (1000, 5, 2016/03/30) */
After reviewing the complainant's account and the phone calls she made, Health Alliance concurs with her that a refund of $95 is owed for the month she determined she didn't need or want the plan. The fact that she hadn't received her refund yet...
was brought to our attention with her phone call 03/28/16 to our customer service department.The refund check should go in the mail by Friday this week and she should allow mail time. We apologize for any delays or confusion.