MVP Health Care

Thank you for your telephone inquiry received on May 16, 2017, in regards to yourconcern with the deductible applied for inpatient maternity services rendered October 5,through October 9, with [redacted] Please refer to the enclosed copy of your MVP Liberty HDHP Exclusive ProviderOrganization Certificate of Coverage, Section IV, Paragraph A:"Except where stated otherwise, You must pay the amount in the Schedule ofBenefits section of this Certificate for Covered Services during each Plan Yearbefore We provide coverageIf You have other than individual coverage, You mustpay the family Deductible in the Schedule of Benefits section of this Certificate forCovered Services under this Certificate during each Plan Year before We providecoverage for any person covered under this Certificate ••• "Based on your contract, the deductible was applied correctly for inpatient maternityservices rendered October 5, through October 9, with Paxton StLuke'sHospital, as you are enrolled under family coverage for the dates of service in question;therefore, you must meet the family deductible before benefits are paidEnclosed please .find a copy of your MVP Liberty HDHP Schedule of Benefits Gold 2, which provides thebenefit schedule for the services rendered.MVP's records indicate that on May 13, 2016, you contacted the Customer Care Centerto inquire on benefitsThe documentation indicates that the Customer Care CenterRepresentative informed you that for a high deductible health plan with a family policy,the total family deductible will need to be met, prior to any benefits being paid out of anysingle member on the policy.MVP's Employer Account Services Department has thoroughly reviewed the enrollmentinformation received from your employer group.On November 14, 2016, MVP received an enrollment change form to add your newborndependent effective October 6, On February 6, 2017, MVP received notification toterminate coverage as of October 6, Then on March 20,2017, MVP receivednotification to reinstate coverage for your newborn dependent from October 6, 2016through October 31,2016.Please find the enclosed copy of your MVP Liberty HDHP Exclusive ProviderOrganization Certificate of Coverage, Section XXII:Coverage under this Certificate will automatically be terminated on the first of thefollowing to apply:The end of the month during which the Group or Subscriber provides writtennotice to Us requesting termination of coverage, or on such later date requestedfor such termination by the notice.If you remain dissatisfied with our grievance determination, you may call the New YorkState Department of Health at ###-###-#### or write them at:New York State Department of HealthOffice of Health Insurance ProgramsBureau of Consumer Services - Complaint UnitComing Tower- OCP Room 1609Albany, NY 12237MVP would like to thank you for sharing your concerns with us, as it is throughcomments such as yours that MVP is able to improve its products and services to MVPmembersYou may appeal this decision; however, please note that the appeal must befiled within days from the date of the adverse determinationIf you wish to file anappeal, please contact MVP's Customer Care Center at ###-###-####Or you maysend a written request to the following address, MVP Health Care, Attn: MemberAppeals Department, State Street, Schenectady, NY Information regardingthe appeal process is enclosed.We sincerely apologize for any inconveniences that you may have encounteredIf youhave further questions or concerns regarding this issue, please contact me at [redacted] - [redacted] Si usted necesita esta informaci6n en espafiolllarne al ###-###-####Para los miembrosque tienen equipo de TTY, !lame al [redacted] Gracias.Sincerely,Lisa M [redacted] Member Complaints CoordinatorMVP Health Insurance Co.enc: MVP Liberty HDHP Exclusive Provider Organization Certificate of CoverageMVP Liberty HDHP Schedule of Benefits Gold 2Summary of the Appeals Process

RE: [redacted] on behalf of [redacted] Dear ***:I am writing in response to your recent correspondence in which you requested a reply toan inquiry submitted by [redacted] on behalf of [redacted] .After further investigation of this issue, MVP's Premium Billing & CollectionsDepartment confirmed that Mr [redacted] 's October premium payment wasreceived on October 17,During the time period of the member's enrollment, MVPwas in the process of changing billing systemsAs a result, Mr [redacted] 's paymentswere not updated in a timely manner, which also caused delays in updating Cooper'seligibilityMVP has identified the errors that have occurred and have worked internallyto correct this issue.We sincerely apologize for the inconveniences that Mr [redacted] has experienced, andwe are thankful for him bringing this issue to our attentionIf you have further questionsor concerns regarding this issue, please contact me at 1- [redacted] Sincerely,Lisa M [redacted] Senior Member Complaints CoordinatorMVP Health Plan, Inc

I am writing in response to your recent correspondence in which you requested a reply to an inquiry submitted by [redacted] Based on a review of Ms [redacted] 's claim For services rendered November 2015, MVP has determined to approve coverage For the venipuncture and lipid panel Ms [redacted] 's claim has been re-submitted for re-processing and payment will be made within 10- business daysIf you have further questions or concerns regarding this issue, please contact me at -800-331-3021, ext*** Sincerely, Lisa M [redacted] Member Complaints Coordinator MVP Health Plan, Inc

If the member has recevied a denial of coverage for the services rendered, the member may appeal the decision; however, please note that the
appeal must be filed within days from the date of the adverse
determinationIf the member wishes to file an appeal, they can do so by contacting
MVP’s Customer Care Center
at 1-877-742-Or they may send a
written request to the following address, MVP Health Care, Attn: Member Appeals
Department, State Street, Schenectady, NY 12305. Sincerely, Lisa
*** Member Complaints Coordinator MVP Health Care

The member's effective date of coverage is October 1, The member is currently paid through November 30, 2017The next payment for December premiums is due by December 1, in the amount of $

I am writing in response to your recent correspondence in which you requested a reply toan inquiry submitted by *** *** on behalf of *** ***.MVP originally received an enrollment file for *** *** from the New YorkState of Health on September 14,2017, with a coverage
effective date of December 1,On September 18, 2017, the New York State of Health sent an enrollment file toMVP to change the effective date to October 1, 2017, which did not automaticallyprocess in MVP's billing systemOn October 12, 2017, MVP's Premium Billing andCollections Department updated the member in the billing system to reflect the October1, start date.On October 13, 2017, the member was cancelled for non-payment of premiums effectiveOctober 1, 2017, based on the timing of the updated fileMr*** submitted thepayment on October 31, 2017, for the coverage beginning October 1, MVP'sEnrollment Department was advised of the reinstatement and Cooper's coverage wasupdated on November 2, to reflect the October 1, effective date.If you have further questions or concerns regarding this issue, please contact me at 1-800-331-3021, ext17603.Sincerely,Lisa ***Senior Member Complaints CoordinatorMVP Health Plan, Inc

I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me Thank you very much for following up on my complaint. Regards,
*** ***

I contacted MVP’s complaint phone line yesterday (12/9/2015)They told me that they could take my complaint, but they still would not accept my claimSo it would just end up at a dead endI asked them to take my complaint over the phone in any event, but then they hung up on me, and never called back
I want this complaint to remain on MVP’s file to want other consumers of this deceitful organizationThey only seek to maximize their profits, and that occurs on the backs of those who need healthcare, for such are these deceitful workmen, disguising themselves as healthcare professionalsSo uncaring, yet so greedy for ill-gotten gain
Complaint stands
Revdex.com: 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 below
Regards, *** ***

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 belowThe response from MVP is concerning as it is evident that they did not complete a thorough review of the complaint and their response contain inaccuraciesOn October 13th I received a call from MVP stating that my son's account was all set and that I was able to make my paymentAfter attempting several times I was still not able to make a payment through their phone systemOn October 17th I again reached a representative and explained what was happeningThe representative forwarded me a link to make my son's payment for his October coverageAttached is the e-mail trail from Kayla *** at MVP providing me the link followed by the confirmation that at 8:57AM the payment in full was madeThis contradicts MVP's claim that I did not make my payment until October 31stSince filing this complaint I have encountered additional issues with my son's coverageOn October 31st we presented my son's health coverage to his primary physician to schedule an appointmentThe doctor's office called us back to inform us that my son did not have coverage with MVPAfter additional phone calls to MVP on October 31st a representative named Jennifer said she would look into it and get back to meOn November 2nd I received a voicemail from Jennifer stating they were able to get my son's coverage fixed and that it was due to an error within MVPs systemsOn November 6th I attempted to make my son's November payment through the directions provided by MVPAgain I was greeted with a message stating that there was no payment due at this timeAfter speaking with representative Sue *** she informed me that there was an issue with the systems and she would research it an call me backLater that day I spoke with Sue again and she explained there was a billing issue and that I could now make my payment utilizing the phone systemShe informed me that my total due was for my son's coverageI questioned this amount as his premium is $a monthShe said I owed for October, November, and DecemberI explained that I had already paid October's premium on the 17th so I should not have to pay it twiceAs of this e-mail MVP was looking into this issue and I am awaiting a return phone call. So my concerns are as followsMVP's response stated my son's coverage was cancelled due to non-payment but then on the 31st was reinstated due to the payment I made that dayThis is flawed statement by MVP as I have the documentation and voicemail's to support differentlyIn addition, when I called on the 6th I was told I did not make my October payment which again is contradicted by the attachmentMVP representatives are now being untruthful and are not completely reviewing the complaint in order to protect their Revdex.com ratingThe lack of accountability by their part is extremely frustrating and unethicalOwn up to your mistakes and take appropriate actions to apologize and rectify the situationRegards, *** ***

MVP has approved a retro-termination of coverage for this member for the period of September 1, 2017 through September 30, 2017. As a result, MVP will be processing a refund which will be made to the member within the next 10-15 business days. MVP has contacted the member and she is satisfied with...

the outcome. She stated that she would be contacting the Revdex.com to withdraw her complaint. Thank you,    Lisa M[redacted] Senior Member Complaint Coordiantor  MVP Health Plan, Inc.

Please refer to the enclosed copy of Ms. [redacted]'s Contract of Coverage, Section XXI, Subsection C:  "Termination by You.  The Subscriber may terminate this Contract at any time by giving US at least 30 days prior written notice."Based on Ms. [redacted]'s contract, Ms. [redacted] may terminate...

her coverage at any time; however, 30 days prior written notice is required.  Sincerely,    Lisa
[redacted]  Member
Complaints Coordinator
MVP
Health Care

I am writing in response to your recent correspondence in which you requested a reply to  an inquiry submitted by [redacted].  Based on a review of Ms. [redacted]'s claim For services rendered November 3. 2015, MVP has determined to approve coverage For the venipuncture and lipid panel....

Ms.  [redacted]'s claim has been re-submitted for re-processing and payment will be made within 10- 15 business days. If you have further questions or concerns regarding this issue, please contact me at 1 -800-331-3021, ext. [redacted].  Sincerely, Lisa M[redacted] Member Complaints Coordinator MVP Health Plan, Inc.

Thank you for your telephone inquiry received on May 16, 2017, in regards to yourconcern with the deductible applied for inpatient maternity services rendered October 5,2016 through October 9, 2016 with [redacted]Please refer to the enclosed copy of your MVP Liberty HDHP Exclusive...

ProviderOrganization Certificate of Coverage, Section IV, Paragraph A:"Except where stated otherwise, You must pay the amount in the Schedule ofBenefits section of this Certificate for Covered Services during each Plan Yearbefore We provide coverage. If You have other than individual coverage, You mustpay the family Deductible in the Schedule of Benefits section of this Certificate forCovered Services under this Certificate during each Plan Year before We providecoverage for any person covered under this Certificate ••• "Based on your contract, the deductible was applied correctly for inpatient maternityservices rendered October 5, 2016 through October 9, 2016 with Paxton St. Luke'sHospital, as you are enrolled under family coverage for the dates of service in question;therefore, you must meet the family deductible before benefits are paid. Enclosed please .find a copy of your MVP Liberty HDHP Schedule of Benefits Gold 2, which provides thebenefit schedule for the services rendered.MVP's records indicate that on May 13, 2016, you contacted the Customer Care Centerto inquire on benefits. The documentation indicates that the Customer Care CenterRepresentative informed you that for a high deductible health plan with a family policy,the total family deductible will need to be met, prior to any benefits being paid out of anysingle member on the policy.MVP's Employer Account Services Department has thoroughly reviewed the enrollmentinformation received from your employer group.On November 14, 2016, MVP received an enrollment change form to add your newborndependent effective October 6, 2016. On February 6, 2017, MVP received notification toterminate coverage as of October 6, 2016. Then on March 20,2017, MVP receivednotification to reinstate coverage for your newborn dependent from October 6, 2016through October 31,2016.Please find the enclosed copy of your MVP Liberty HDHP Exclusive ProviderOrganization Certificate of Coverage, Section XXII:Coverage under this Certificate will automatically be terminated on the first of thefollowing to apply:7. The end of the month during which the Group or Subscriber provides writtennotice to Us requesting termination of coverage, or on such later date requestedfor such termination by the notice.If you remain dissatisfied with our grievance determination, you may call the New YorkState Department of Health at ###-###-#### or write them at:New York State Department of HealthOffice of Health Insurance ProgramsBureau of Consumer Services - Complaint UnitComing Tower- OCP Room 1609Albany, NY 12237MVP would like to thank you for sharing your concerns with us, as it is throughcomments such as yours that MVP is able to improve its products and services to MVPmembers. You may appeal this decision; however, please note that the appeal must befiled within 180 days from the date of the adverse determination. If you wish to file anappeal, please contact MVP's Customer Care Center at ###-###-####. Or you maysend a written request to the following address, MVP Health Care, Attn: MemberAppeals Department, 625 State Street, Schenectady, NY 12305. Information regardingthe appeal process is enclosed.We sincerely apologize for any inconveniences that you may have encountered. If youhave further questions or concerns regarding this issue, please contact me at [redacted]Si usted necesita esta informaci6n en espafiolllarne al ###-###-####. Para los miembrosque tienen equipo de TTY, !lame al [redacted] Gracias.Sincerely,Lisa M[redacted]Member Complaints CoordinatorMVP Health Insurance Co.enc: MVP Liberty HDHP Exclusive Provider Organization Certificate of CoverageMVP Liberty HDHP Schedule of Benefits Gold 2Summary of the Appeals Process

RE: [redacted] on behalf of [redacted]Dear [redacted]:I am writing in response to your recent correspondence in which you requested a reply toan inquiry submitted by [redacted] on behalf of [redacted].After further investigation of this issue, MVP's Premium Billing & CollectionsDepartment confirmed that Mr. [redacted]'s October 2017 premium payment wasreceived on October 17,2017. During the time period of the member's enrollment, MVPwas in the process of changing billing systems. As a result, Mr. [redacted]'s paymentswere not updated in a timely manner, which also caused delays in updating Cooper'seligibility. MVP has identified the errors that have occurred and have worked internallyto correct this issue.We sincerely apologize for the inconveniences that Mr. [redacted] has experienced, andwe are thankful for him bringing this issue to our attention. If you have further questionsor concerns regarding this issue, please contact me at 1-[redacted]Sincerely,Lisa M[redacted]Senior Member Complaints CoordinatorMVP Health Plan, Inc.