Molina Healthcare Of Texas, Inc

Dear Ms***, Molina Healthcare of Texas, Inc(MHT) apologizes for our delay in responding to your attempts to resolves the complaint related to the above complainantThis is the information we have through Monday 21, related to the complaintPrior to Ms*** *** being enrolled with
MHT on February 1, as a member of one of our Medicaid program called State of Texas Access Reform plus Long Term Supports and Services (LTSS) also reference as STAR+PLUS, Ms*** was a Medicaid recipient of the Personal Care Services (PCS) program covering eligible Texans under years of agePCS is a program for those individuals who require assistance with various daily activities and other health maintenance due to physical, cognitive, or behavioral limitations related to a disability or chronic health conditionEffective on Ms***'s 21.5t birthday, she was no longer eligible for the PCS program based on the State of Texas eligibility requirementsUpon Ms*** became enrolled with MHT effective Feb1, 2016, a health care professional employed with MHT (Texas-Licensed Registered Nurse) scheduled and conducted a face-to-face assessment at the home of Ms***The face-to-face assessment was conducted on January 12, 2016, with her mother, Ms*** *** presentThe state of Texas through the Medicaid Agency, Texas Health and Human Services Commission (HHSC) made the determination after the results of the Assessment that Ms*** did not meet the requirements for Personal Attendant Service (PAS) also known as "provider hours"Ms*** was notified of HHSC's decision on February 26, However, MHT allowed Ms*** to maintain the current provider hours until her next assessmentOn February 29, 2016, Ms*** *** called MHT and requested a call back from the supervisor of the RN who conducted the assessmentOn March 7, 2016, the Molina assigned Case Manager attempted to contact Ms*** ***The Case Manager left a message/voicemail for the mother to call backSince the call was not returned, the Molina Case Manager called again later that day and left another voicemail for Mrs***.On March 9, 2016, Ms*** *** called the Molina Case Manager backThe Molina Case Manager was not available to receive her callThe Molina Case Manager Phone Coordinator accepted the mother's call on behalf of the Case Manager and inquired the best time for the Case Manager to return her call.On March 18, 2016, the Molina Case Manager successful reached Mrs*** ***Mrs*** *** was under the impression that her daughter, *** would not have an opportunity during the remainder of the to be re-assessed for possible increase/change in her provider hoursShe added *** is planning to have surgery in July and was concerned she would be restricted to the current hours per week of provider hours until her next annual reviewThe Molina Case Manager explained and assured Mrs*** that her daughter, *** can be re-assessed for services at any time, more specifically, if there is a change in her condition that warrants it as represented by the upcoming surgery planned for JulyHowever, MHT cannot re-assess an enrollee/member for services in anticipation of the changeMs*** *** stated she understood and is planning to contact MHT after her daughter has her surgery to request a re-assessment for an increase in provider hours.MHT's clinical management representative attempted to reach out to the Mrs*** to see if we can be of further assistanceHowever, we were only able to leave a message requesting a call back to MHT

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Regards,
*** ***
I believe the issue is resolvedI will contact you again if we
have another issue.
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Regards,
*** ***I believe the issue is resolvedI will contact you again if we have another issue. *** ***

Good afternoon, Please accept Molina's resolution for this case Thank you, ***

Good Afternoon,
Attached is Molina's response re: Revdex.com Complaint#***. Please review and advise if additional information is needed at this
time.
August 23,
Revdex.com Corporate Office
*** ***
Dispute Resolution Specialist
Complaints Resolution
La Posada Drive
Austin, TX
RE: *** ***
Complainant: *** ***Re: Revdex.com Case # ***
Plan: Molina Marketplace Silver Plan
Dear *** ***:
Molina has researched this case and found a Molina representative contacted subscriber/complainant, *** ***, on August 16, to discuss her concern. Per Ms*** she received monthly premium statements with erroneous information, indicating she had a credit and is requesting not to be charged for past due premiums. The Molina representative escalated Ms*** case to Molina’s Marketplace Enrollment Department for further review
After Molina’s Marketplace Enrollment team revisited Ms***’s account, it was found that Ms*** was effective under Molina Consumer Choice Silver Plan effective January 1, and on March 2, Molina received a voluntary cancellation (term) file via the federally-facilitated marketplace (FFM), terming Ms*** on February 28, 2015. Because the term file did not reflect retro-termination for Ms***, she does not qualify for a credit
To mitigate Ms*** concern, Molina provided Ms*** the option to waive her premium for June and Ms*** would only be responsible to reconcile past due premiums for July and August, along with September’s premium, to bring her account up to date. However, per Ms***, she does not agree with Molina’s determination indicating that she would contact the FFM and file a Health Insurance Casework System (HICS) case obtain clarification on her credit
If you have any questions, please call me at *** extension *** or email me at ***
Sincerely,
*** ***
Member Inquiry Research and Resolution Specialist

***Please see attachment

Molina has researched this case and found on February 2, 2017, Molina’s Call Center received a telephonic call requesting eligibility information for subscriber, *** ***. Mr***’s health plan was terminated due to exceeding the grace period allotted under the Affordable
Care Act (ACA) for non-payment of premiums. The Molina Call Center representative advised that Mr*** would have to contact the Federally-Facilitated Marketplace (FFM) and inquire if he qualified for a Special Enrollment Period (SEP), as Molina does not make that determination. On March 09, 2017, a Molina representative contacted *** ***, complainant/subscriber’s mother, via telephone to discuss this Revdex.com complaint. Ms*** is aware the subscriber’s account has been updated to reflect start date 03/01/to current and confirmed receipt of Mr***’s health plan benefits and guidelines from Molina. As per Ms***, no further assistance was needed at this time. Ms*** was encouraged to contact Molina if additional assistance was needed

Complaint: [redacted]
I am rejecting this response because: After speaking with Ms. [redacted] I called Molina Healthcare and again, I attempted to make payment for February and March....

The [redacted]. placed me on hold for several minutes and returned and told me that after speaking with his [redacted], [redacted] that my son's policy was, indeed, terminated and that it had also been confirmed with the Marketplace. I told him I was aware of that, but I'd filed a formal complaint and after speaking with Ms. [redacted] I was told my account would be reinstated after I made the February and March payment. The rep STILL would not take my payment and told me I needed to contact the Marketplace to see if I would qualify for a special enrollment. I asked for his name and he was very cocky and even spelled it out for me as if he were insulting my intelligence.By that time I was very upset and told him I will be filing another complaint, as well as possibly sending my emails and recordings to the news media and maybe an attorney. I am DONE with trying to be diplomatic and cordial with such incompetent individuals. 
Regards,
[redacted]

Complaint: [redacted]
I am rejecting this response because:I did receive a phone call from Mr. [redacted] with Molina healthcare, he did explain to me that there was a billing error and that he tried to, and will continue to try to contact the hospital's billing department. He said that he felt I was correct on what I stated in my complaint. I'd like to keep this case open until it has been resolved to my satisfaction. 
Regards,
[redacted]

Dear Ms. [redacted], Molina Healthcare of Texas, Inc. (MHT) apologizes for our delay in responding to your attempts...

to resolves the complaint related to the above complainant. This is the information we have through Monday 21, 2016 related to the complaint. Prior to Ms. [redacted] being enrolled with MHT on February 1, 2016 as a member of one of our Medicaid program called State of Texas Access Reform plus Long Term Supports and Services (LTSS) also reference as STAR+PLUS, Ms. [redacted] was a Medicaid recipient of the Personal Care Services (PCS) program covering eligible Texans under 21 years of age. PCS is a program for those individuals who require assistance with various daily activities and other health maintenance due to physical, cognitive, or behavioral limitations related to a disability or chronic health condition. Effective on Ms. [redacted]'s 21.5t birthday, she was no longer eligible for the PCS program based on the State of Texas eligibility requirements. Upon Ms. [redacted] became enrolled with MHT effective Feb. 1, 2016, a health care professional employed with MHT (Texas-Licensed Registered Nurse) scheduled and conducted a face-to-face assessment at the home of Ms. [redacted]. The face-to-face assessment was conducted on January 12, 2016, with her mother, Ms. [redacted] present. The state of Texas through the Medicaid Agency, Texas Health and Human Services Commission (HHSC) made the determination after the results of the Assessment that Ms. [redacted] did not meet the requirements for Personal Attendant Service (PAS) also known as "provider hours". Ms. [redacted] was notified of HHSC's decision on February 26, 2016. However, MHT allowed Ms. [redacted] to maintain the current provider hours until her next assessment. On February 29, 2016, Ms. [redacted] called MHT and requested a call back from the supervisor of the RN who conducted the assessment. On March 7, 2016, the Molina assigned Case Manager attempted to contact Ms. [redacted]. The Case Manager left a message/voicemail for the mother to call back. Since the call was not returned, the Molina Case Manager called again later that day and left another voicemail for Mrs. [redacted].
On March 9, 2016, Ms. [redacted] called the Molina Case Manager back. The Molina Case Manager was not available to receive her call. The Molina Case Manager Phone Coordinator accepted the mother's call on behalf of the Case Manager and inquired the best time for the Case Manager to return her call.
On March 18, 2016, the Molina Case Manager successful reached Mrs. [redacted]. Mrs. [redacted] was under the impression that her daughter, [redacted] would not have an opportunity during the remainder of the 2016 to be re-assessed for possible increase/change in her provider hours. She added [redacted] is planning to have surgery in July 2016 and was concerned she would be restricted to the current 24.5 hours per week of provider hours until her next annual review. The Molina Case Manager explained and assured Mrs. [redacted] that her daughter, [redacted] can be re-assessed for services at any time, more specifically, if there is a change in her condition that warrants it as represented by the upcoming surgery planned for July. However, MHT cannot re-assess an enrollee/member for services in anticipation of the change. Ms. [redacted] stated she understood and is planning to contact MHT after her daughter has her surgery to request a re-assessment for an increase in provider hours.
MHT's clinical management representative attempted to reach out to the Mrs. [redacted] to see if we can be of further assistance. However, we were only able to leave a message requesting a call back to MHT.

Dear [redacted]:   Molina strives to provide good customer service.  Molina only identified and acknowledged receipt of this grievance on 03/09/2017.   To ensure timely responses, Molina respectfully requests that all communication that has been identified as a complaint be...

sent via e-mail to [redacted]@MolinaHealthCare.Com.   Molina has researched this case and found on January 9, 2017 Molina received a telephonic call from subscriber/complainant, [redacted], requesting assistance with activating his account to reflect coverage for January 2017.  Mr. [redacted] is not an Advanced Premium Tax Credit (APTC) recipient and as such is not eligible for a three (3) month grace period that would otherwise extend the amount of time to bring his account to current.  Mr. [redacted] paid his premium after the due date, which caused his account to reflect inactive status.  However, after reviewing Mr. [redacted]’s Health Insurance casework System (HICS) record received on January 23, 2017 via the Federally-facilitated Marketplace (FFM) Mr. [redacted] was successfully reinstated.  On March 20, 2017, a Molina representative spoke to Mr. [redacted] who requested he be credited one (1) month’s premium to a subsequent month.  Thereafter, as onetime courtesy, Molina approved the credit and will be applied to April’s due premium.  Mr. [redacted] was apprised of Molina’s amenability to apply the credit for April.

Good Afternoon, Attached is Molina's response re: Revdex.com Complaint#[redacted].  Please review and advise if additional information is needed at this time.  August 23, 2016   Revdex.com Corporate Office [redacted]Dispute Resolution Specialist Complaints Resolution1005 La...

Posada DriveAustin, TX 78752 RE: [redacted] Complainant: [redacted] Re: Revdex.com Case # [redacted]Plan: Molina Marketplace Silver 150 Plan                                      ...⇄ Dear [redacted]: Molina has researched this case and found a Molina representative contacted subscriber/complainant, [redacted], on August 16, 2016 to discuss her concern.  Per Ms. [redacted] she received monthly premium statements with erroneous information, indicating she had a credit and is requesting not to be charged for past due premiums.  The Molina representative escalated Ms. [redacted] case to Molina’s Marketplace Enrollment Department for further review. After Molina’s Marketplace Enrollment team revisited Ms. [redacted]’s account, it was found that Ms. [redacted] was effective under Molina Consumer Choice Silver 150 Plan effective January 1, 2015 and on March 2, 2015 Molina received a voluntary cancellation (term) file via the federally-facilitated marketplace (FFM), terming Ms. [redacted] on February 28, 2015.  Because the term file did not reflect retro-termination for Ms. [redacted], she does not qualify for a credit. To mitigate Ms. [redacted] concern, Molina provided Ms. [redacted] the option to waive her premium for June 2016 and Ms. [redacted] would only be responsible to reconcile past due premiums for July and August, along with September’s premium, to bring her account up to date.  However, per Ms. [redacted], she does not agree with Molina’s determination indicating that she would contact the FFM and file a Health Insurance Casework System (HICS) case obtain clarification on her credit. If you have any questions, please call me at [redacted] extension [redacted] or email me at [redacted]   Sincerely,  [redacted]Member Inquiry Research and Resolution Specialist

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.
Regards,
[redacted]

Complaint: 11630775
I am rejecting this response because:I don't want to say that Ms. [redacted] is lying, but one part of her statement is untrue, or at least incorrect. As I previously wrote you, per our conversation on August 23rd, Ms. [redacted] told me that out of the three months I had "outstanding" (June, July, and August), Molina was willing to waive June. That left an amount of $146.76 for July and August, which they wanted by August 25th. August 25th was when my September premium was supposed to be due not my August one. As she has made quite clear to me before, the due dates for payment are for the upcoming month (6/25 for July, 7/25 for August, etc.).If Ms. [redacted] had said that July was the only outstanding premium I had, that would have meant that I only owed $73.38.THE SAME THING I HAVE BEEN SAYING THIS ENTIRE TIME! And I would have been willing and able to pay that. That would have reactivated my account. Then, I would have had another $73.38 due on 8/25.Molina budged in the tiniest way but was still unwilling to come all the way across. Fine. But, please, don't misrepresent what was said, especially if the misrepresentation doesn't make sense and can be easily disproven.
Regards,
[redacted]