Coventry Health Care, Inc.

Review: I began my due diligence in November 2013 to enroll in a healthcare plan. I search the internet, checked if my doctors were covered, called my doctors office to confirm their participation and enrolled. Lo and behold I found I was put into a Coventry one Carelink plan that none of my doctors were in and I did not choose. I filed a formal complaint w/the state of MO, only for it to go nowhere. Soooo, upon the national announcement open enrollment, on November 15, 2014, I again began my due diligence. I went to review plans and found two. I went into my doctors office and asked if he took either plan, he did. I then went on to the internet, only to find that the outline in the bottom left corner of the plan (fees) did not match the summary of benefits. I called the marketplace. They in turn referred me to Conventry. I called and spoke to Steve. Steve informed me that he was NOT aware that these numbers did not match and that he does NOT have access to these plans as they have NOT YET been approved by Coventry! I asked Steve how can a national commercial be run for open enrollment and Coventry not even be on board with finalizing their plans? Steve also did not know when Coventry might get around to approving these plans. Now not only do I see that it is virtually impossible for ANYONE TO MAKE AND INFORMED DECISION, when Coventry has not made their decision, as well as the fact that this is what happened to me in 2014. it is apparent that my plan was not approved I got dumped into a plan that I could not use for 2014. Coventry's practices are fraudulent, misleading and they are playing with peoples lifes'. Shame on them, but more importantly, shame on our state and government for allowing these sub-standard businesses pray on your constituents! Fix it!!!!!!Desired Settlement: I WANT THIS BUSINESS TO BE HELD ACCOUNTABLE THAT WHAT THEY POST AS INSURANCE BEING OFFERED HAS ACTUALLY BEEN OFFERED AND APPROVED BY THEM BEFORE OFFERING IT TO THE PUBLIC. BY NOT DOING THIS, IT IS FRAUD. I NEED HEALTH INSURANCE BUT CANNOT CHOOSE A PLAN THAT HAS NOT BEEN APPROVED BY THEM BECAUSE I WILL END UP WITH WHAT I HAD THIS YEAR, "A POLICY I COULD NOT USE!"

Business

Response:

Dear

Review: Denied to pay for my prescribed medicine which I have been using for 12 years for [redacted]'s disease. They want me to try cheaper medicines first.

I am a patient of [redacted]'s disease. For that I use [redacted](influx iamb ) for last 12 years. My previous insurance was okay with it. I have medicaid and had to switch to Coventry health care of florida. They decline to authorize my doctor's request for [redacted]. The reason was that I should try other 2 cheaper medicines first and it fails then they'll consider. In other words they need to see me suffer twice before they get convinced. My doctor explained my situation and strongly advised against it as it can flare up the disease and most probably require hospitalization. Complication of [redacted]'s disease are diarrhea, lost of blood, significant lost of weight, anemia, rectal abscess and more. It not wise or rather foolish to try something new go through months of suffering or even surgery so insurance can save some money.

I called the customer service but they could not do anything. I am already 3 weeks over due.

Further more they denied to pay for my monthly pills which they paid for last month but not this month and the costumer service could not give me a reason.

Please have some compassion.

Thank you

9544656286

Member ID no. 83144745101Desired Settlement: Authorize my doctors request for [redacted] as soon as possible.

Business

Response:

November 12, 2014Dear [redacted]:This letter is in response to the aforementioned Case Number [redacted] regarding a complaint filed by [redacted], apparently submitted to the Revdex.com on August 16, 2014 but not received by Coventry Health Care until November 10, 2014. [redacted]’s complaint states that the Health Plan denied his prescription medicine [redacted].[redacted] was enrolled with the Health Plan’s Medicaid HMO plan effective July 1, 2014 to August 31, 2014. On July 28, 2014, the Health Plan received a prior authorization request from Dr. Jorge [redacted] on [redacted]’s behalf for [redacted] 100mg Intravenous Solution. The request and medical records submitted were reviewed by a Medical Director and denied on August 11, 2014.Per the Health Plan denial, the prescriber must submit information to meet the criteria used for medical necessity. In this case the Medical Director could not determine this request to be medically necessary based on the information received, and it was denied because the Health Plan did not receive the following: Approval for [redacted] (to treat [redacted]’s disease) in adults (older than 18 years) is granted only after trial and failure of [redacted] and [redacted]. The Health Plan did not receive any information that trial and failure of [redacted] and [redacted] was done.On August 11, 2014, the Health Plan sent a denial letter to [redacted] in which he was advised of his appeal rights. The Health Plan also sent Dr. [redacted] a denial letter advising that upon his receipt of this letter, he was to notify the member of the decision to ensure that he/she was aware of this adverse benefit determination. Additionally, Dr. [redacted]’s letter included the information that if he is the treating provider and would like to discuss this case with a physician reviewer, to please call ###-###-####. If he has substantive information that was not available at the time of the decision, the Health Plan would be pleased to reconsider this decision.At this time, as the member is no longer effective with the Health Plan, and has not been since August 31, 2014, there is no leave of appeal right available to [redacted] or Dr. [redacted]. Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter.If you have any further questions or concerns, please feel free to contact me directly at ###-###-####, Monday through Friday from 8:00 am until 5:00 pm. My fax number is ###-###-####, and my e-mail address is [redacted].Sincerely,Siana LComplaint and Appeal Analyst

Review: Coventry terminated our insurance on 10/31/2014 for no reason and now will not reinstate the policy for the remainder of the contract. they gave no reason for termination and the policy is on automatic withdraw from our checking account. The money was withdrawn on 11/5/ 2014. Everytime we call we are switched over to 4-5 different people only to be put on hold for 30 minutes and than the call drops. they have our phone number to call back but will not. We believe they are dropping coverage because my son needs a MRI on his right knee and they do not want to pay for anything.

Product_Or_Service: Health Insurance

Account_Number: [redacted]-**Desired Settlement: DesiredSettlementID: Other (requires explanation)

Have our policy reinstated until the end of the year so we have health coverage.

Business

Response:

Dear

Review: Unable to Find A In Network Doctor who actually accepts this insurance.

CoventryOne has been collecting payments from me since the time I have been enrolled. A PCP was supposed to be selected for me according to the insurance card I received in the mail. When I spoke to a representative they provided me with a list of doctors. Come to find out - the majority of the doctors on this so called list are not even accepting the insurance. I paid $70+ per month so I know I can be covered in case of emergency. I find this practice extremely deceptive and I feel like this is fraudulent. I was promised that I would receive $20 Doctor Visits as one of my benefits and I am unable to use that. I would like a refund of the charges placed on my account if this company is unable to find me a Primary Care Physician who is actually accepting this health insurance. Apparently the doctors are able to decide whether or not to accept Coventry One patients even though they are listed in network. I have made multiple phone calls that have yielded no resultsDesired Settlement: I would like a refund of the charges placed on my checking account if this company is unable to find me a list of Primary Care Physicians who are actually accepting this health insurance and who can see me for $20.

Business

Response:

October 6, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s PCP selections and assignment. [redacted] also requested to be reimbursed if a PCP is not found.Please be advised that after review of your grievance, [redacted] is effective with the CATASTROPHIC $20 HMO plan as of April 4, 2014. [redacted]’s plan does require PCP assignment. This is important to the coordination of care, and members are encouraged to contact their PCP when medical care is needed.[redacted] can select a PCP from one of the following specialties: Family Practice, Internal Medicine, General Practice, OB/GYN, or Pediatrics. [redacted] may choose one PCP for the entire family, or each Dependent may select a different PCP. To locate the most current Directory of Health Care Providers, please visit our website at [redacted] . Our online Provider directory is updated at least monthly. Please find (enclosed) a list of General Practice and Internal Medicine PCP’s within 20miles of [redacted] zip code. If [redacted] wishes to change her PCP, she must contact our Customer Service Department at ([redacted]. [redacted] may also visit our website at [redacted] to make this change,In regards to a refund for coverage, [redacted] must request to have her plan terminated through the Marketplace. However, [redacted] currently has access to many benefits of her coverage such as PCP visits, Urgent Care, Pharmacy and Emergency Room care.[redacted] has no refund due at this time. Please see the termination section of the policy below:Termination by Subscriber:The Subscriber may terminate Coverage for himself/herself and any enrolled Dependents under the Contract for any reason by providing fourteen (14) days advance written notice to the Health Insurance Marketplace. For notices received on the 1st through 15th day of the month, termination will take effect on the first day of the month in which the notice was received. For notices received on the 16th through 31st day of the month, termination will take effect on the first day of the month following the month in which the notice was received, unless the Health Plan agrees to an earlier termination. The notice of termination should be sent to the Health Insurance Marketplace through which You enrolled.If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm or you may reach me directly at ###-###-####. If you are hearing impaired please call 7-1-1 Telecommunications Relay Service.Sincerely,Yanique MAppeals Coordinator Grievance & Appeals Department

Review: I am complaining about two health insurance claims denied by [redacted] . The first was denied because it improperly labeled a “pre-existing condition”, the second because I was told my cavity was “in the wrong tooth.”

The first claim from 11/20/13 concerned a hemorrhoidectomy, a procedure I had never undergone. Still [redacted] denied coverage saying it was pre-existing. This was a new and separate outbreak, and denying coverage on a new incident is like denying a flu victim’s medication costs because he had the flu in 2010.

The second from 1/2/14 concerned a dental filling never paid for. When I called [redacted] they confirmed my coverage includes cavities. “Then why didn’t you pay for it?” I asked. “Because it was in the wrong tooth,” they replied. Bizarrely they only cover cavities on a few front teeth, a fact buried in an obscure code in the policy description. No one would guess that “Dental Plan ([redacted])” meant molars are exempt from coverage.

All told these bills total $17,845, a crushing burden for someone who faithfully paid premiums to a company shirking its contractual obligations in a clear and repeated strategy of nonfeasance. I am including copies of bills, payments where applicable and supporting documentation. I fully appreciate anything your office can accomplish on my behalf.Desired Settlement: I would like a refund of my premiums.

Business

Response:

Dear [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL") [redacted] individual PPO health benefit plan. The Member's complaint concerns two issues, which I will address.1) The member's complaint for the denied of services on November 20, 2013. Services were denied as a Pre-Existing Condition 2) The member's complaint for dental services not covered on January 2, 2014.Below is a timeline of events leading up to how the member has come to the Revdex.com with her complaint.The member has a The Member is participating in the Coventry Health and Life insurance Company (“CHL”) [redacted]'s [redacted] individual PPO health benefit plan was effective October 1, 2013 through January 1, 2014.Medical records were requested by MCRN Department. March 26, 2014 – records were reviewed by M. H[redacted] RN,. HPS previously reviewed. Member eff 10/1/13, termed 1/31/14. Activity ID = [redacted], attach 1, Colon and Rectal Associates, 6pgs – OV11/11/13; c/o anal pain, with prolapse and bleeding. Hemorrhoids. OV 11/20/13; hemorrhoidectomy. Per SOH listed Dr [redacted]. Activity ID = [redacted], attach 1, [redacted], 26pgs – OV4/19/13; migraine has, pain, low back, hemorrhoids, polyp colon and GERD, anxiety issuers. On clexa. 6/3/13; chest pain, episodic, migraines. OV 8/9/13; meds; celbrex, robaxin, allerga D, ranitidine, imitrex, flexeril, xanac, levaquin, sumatriptan, ergocalciferil, niacin, celexa. Migraine & anxiety. OV 9/19/13; wt loss, appetitie loss, HA, anxiousness, meds; celbrex, robaxin, allerga D, ranitidine, imitrex, flexeril, xanac, levaquin, sumatriptan, ergocalciferil, niacin, celexa. Migraine, adjustmemnt disorder and influenza.1/Confirm codes [redacted]. Process claims accordingly. 2/Clear codes [redacted]. Process claims accordingly. MHWith this information the member's claims were adjusted accordingly.On May 5, 2014 the member submitted an appeal for the claims that denied as Pre-Existing Conditions. June 2, 2014 – Member Appeal Committee, which included a Manager of Health services who is a Registered Nurse, Upheld the Appeal to continue to deny - claim should be denied due to pre-existing condition proven by the medical records. July 30, 2014 – Member filed a complaint to the Revdex.com. It is the Health Plan's determination to follow the contract, which the member read and signed (and has a copy of), which states:6.3 Exclusion of Coverage for Pre-Existing Medical ConditionsPre-existing Medical Conditions are those for which You received medical advice, diagnosis, care, treatment or recommended treatment from an individual licensed or similarly authorized to provide such services under applicable state law within the six (6) month period prior to Your application for Coverage. Pre-existing Medical Conditions may affect Your premium rate, may result in denial of Your application, or We may deny Coverage for them for a period of time after Your Member Effective Date. If You are accepted for Coverage, Your premium rate will be calculated to include any Pre-existing Medical Condition that You disclosed on Your Enrollment Form, and such conditions will be Covered under the terms of Your Group Contract beginning on Your Effective Date. Any Pre-existing Medical Condition(s) that is not disclosed on Your Enrollment Form will be excluded from Coverage for a period not longer than twelve (12) months after Your Effective Date.In this case, you are not eligible for coverage based on pre-existing condition proven by the medical records. Therefore, the request for services rendered on November 20, 2013 with Dr. [redacted] and CBL Path is not approved.Dental issueToday I contacted Coventry Dental/Group Dental [redacted], spoke with Member Service Representative Cherilyn F[redacted]. Cherilyn confirmed [redacted]'s benefits prior to termination with the Health Plan. While speaking with Cherilyn, she relayed to me that [redacted] did not have any claims on file. I asked her to double check her system and the member's call history because that was the point of my call today to find a claim for services rendered on 1/2/14. After some checking she did confirm that [redacted] did have one claim in the system but it was for after her termination, the service was for April 2014. Cherilyn asked if the member would submit the appeal to Coventry Dental? I told her | did not know if the member would appeal to Coventry Dental. I asked Coventry Dental to please send me a copy of the member's dental benefits and thanked her for her help. No further questions, call ended. May 5, 2014 – Member appealed to the Health Plan for reimbursement of dental services rendered on January 2, 2014 with Wegman Dental Group PC for a total balance due of $607 (DO140, DO220, D2392, D2954) May 29, 2014 - Member Appeal Committee, which included a Manager of Health services who is a Registered Nurse, Upheld the Appeal to continue to deny. Requested services are a noncovered benefit.R?S?LU????:After speaking with Coventry Dental/Group Dental there is no record of claims in there system for January 2, 2014. However, looking at the member's Dental Plan contract these services would not be a covered benefit. I will attach a copy of the Member's Dental Contract for your review. The Health Plan continues to follow Health/America One individual PPO's Exclusion of Coverage for Pre-Existing Medical Conditions (6.3).If you have any questions or concerns regarding this matter I can be reached at ([redacted].SincerelyGai W[redacted]Complaint & Appeal AnalystCoventry Health Care, Inc.

Review: I submitted 12 claims (several times) over the course of a year that needed to be reimbursed to me. They have repeatedly told me that the claims were approved and that a check had been sent to me. Upon not receiving the reimbursement check, I have called back inquiring about the claims only to find out that the claims were never processed and a check never issued. They do not return my phone calls and are unhelpful when they receive mine.Desired Settlement: I would like to have the claims reimbursed to me and sent to my address as soon as possible since I have already been waiting nearly a year. In addition, I would appreciate a phone call and an email from them stating that they have received my 12 claims and will be sending the reimbursement check(s) to my address and made out in my name.

Business

Response:

August 11, 2014Dear [redacted]:This letter is in reference to the complaint [redacted] filed to the Revdex.com (Revdex.com) that we received on August 1, 2014.The [redacted] ([redacted]) is a health benefits plan established under the [redacted], 5 USC sec. 8901 et seq., pursuant to a federal government procurement contract between its sponsoring employee organization and the US Office of Personnel Management (OPM). The [redacted] is underwritten and administered by Coventry Health Care, an [redacted] company on an ASO-basis. As a [redacted] ([redacted]), the [redacted] is not subject to state insurance laws or regulation in regard to the nature or extent of its coverage, its benefits, or payments with respect to benefits based on the extensive federal preemption provision contained at 5 USC sec. 8902(m)(1). That provision provides:The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any state or local law, or any regulation issued thereunder, which relates to health insurance or plans.The resolution of disputed enrollment and claims matters under [redacted] plans is governed exclusively by OPM pursuant to the implementing regulations promulgated by that agency, see 5 C.F.R. sec 890.104 (disputed enrollment issues) and 5 C.F.R. sec. 890.105 (disputed claims issues).However, the Plan responded to [redacted]’s concerns and sent her a letter dated August 11, 2014.If you have any further questions, please do not hesitate to contact me at ###-###-####.Sincerely, Britt P. [redacted] Client Advocate

Review: I called in on December 18,2013 and spoke with an enrollment agent by the name of [redacted]. We spoke for about an hour during the application process and when she asked what kind of coverage I was looking for I explained very thoroughly that my wife and I were going to be trying to have our second child and I will need coverage that will cover this including physician visits and delivery. She then said she could get me into a 2013 plan that would save us a little money on premiums. I explained that would be great as long as the pregnancy was covered. She assured me that it would be. Fast forward a month and when my wife visits the doctor and they tell her that she is pregnant and we give them our new medical insurance coverage and they tell us there is no maternity coverage. I am extremely upset and at a loss of what to do now.Desired Settlement: I am either seeking plan coverage with pregnancy included, or a lump sum payment that will cover the full cost of the pregnancy as another insurance will not cover the existing pregnancy.

Business

Response:

February 24, 2014Dear [redacted]:I am writing in response to a complaint filed with your office dated 1/17/14 and received by our plan on 1/24/14. The complaint involves our member, [redacted] and his wife, [redacted], who are currently enrolled in a Non-Grandfathered Individual PPO plan ([redacted]) effective 12/31/13 to present.**. [redacted] writes that he contacted Coventry on 12/18/13 looking for coverage to include maternity office visits and delivery of their second child, that he was told by the agent for Coventry that he could enroll in a 2013 plan and that it would include maternity coverage. However, after his wife had maternity services performed in January 2014, she discovered that their insurance does not include coverage for her pregnancy.Based on **. [redacted]'s complaint, we listened to the phone conversation **. [redacted] had with our agent on 12/18/13, and it does appear that he called about several 2014 plans but was told by the agent that they could enroll in a 2013 plan to save money and that it would include maternity coverage.Because **. [redacted] was misinformed about the coverage they ultimately enrolled in, we are willing to retroactively enroll them in a 2014 plan effective 1/1/14 that includes maternity coverage. Per the enclosed documentation, there are two plan options available in his area. They are both part of the Select Network and would cost either $510.63 (Bronze Standard Deductible Only HSA plan) or $543.62 (Bronze Standard $10 Copay plan) per month.**. [redacted] and his wife can review the enclosed plan options and let us know if they would like to switch plans; if they want to switch, please advise [redacted] at the Revdex.com who can then contact us, and we will re-enroll them in a different plan in our system.Of course, the [redacted]s would also be required to retroactively pay the difference in monthly premium for January and February. Please note that the Select Network plans are limited network plans, so the [redacted]s are encouraged to visit our website at:[redacted] and use our interactive provider search tool to confirm that the providers they visit are in our network before switching plans.Should you require more information or have any questions, please feel free to contact me.Sincerely,

Review: Without warning or reason, cancelled my policy. They tried three times to auto debit the wrong amount, had to put a stop payment at my bank.

Established a policy with them effective 1/1/14, set up auto debit for the 5th of each month. In January they were supposed to take $141.43 from my account they took $ 520.75. I could not pay my mortgage, waited three months for a refund. Tried to debit wrong amount again in February, had to do a stop payment at my bank. Called in to make a payment, they told me my birthdate had changed and suddenly my premium was that of a 4 year old. I asked them if I sounded like I was 4 years old. Was told this ongoing issue was being sent over to a department where it would be reviewed, it never was. Called once a week to check status, was told still waiting on response from escalation department. Asked numerous times to speak with a manager, never could speak with one. Phoned in a payment on 4/6/14 for the correct amount, was at [redacted] on 4/9/14 to fill a prescription and found out I had been dropped. Have been trying to resolve this with Coventry and after almost 4 months have concluded I need help. Have filed a complaint with the Kansas insurance commissioners office and as I type this, am on hold with Coventry and have been for close to two hours. Cannot speak with a supervisor, am told one will call me back and they never do, my issue never was sent to the " escalation department" I am at my wits end. I am just trying to have a simple insurance policy but it has become a part time job of having to babysit this policy due to all of the mistakes that Coventry has made. Please help.Desired Settlement: Realize their mistake, stop trying to collect money from me and reinstate my policy, only debit the agreed upon monthly premium.

Business

Response:

June 30, 2014Dear **. [redacted]:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the above-referenced complaint filed by [redacted] regarding payment issues.**. [redacted]’s policy has been reinstated with an effective date of January 1, 2014. Due to the error inputting **. [redacted]’s birthdate, we have chosen to leave the January and February premiums as is. Therefore, **. [redacted] is responsible for $51.77 each for January and February and $141.43 each for March, April, May, and June. The total premium charged being $669.26.**. [redacted] was refunded for her February 7, 2014 payment of $103.54 on May 30, 2014. She was also refunded the March 6, 2014 withdrawal of $320.75 on March, 11, 2014. Her April 2, 2014 payment of $141.43 cleared and is reflected on her account.Based on the foregoing, **. [redacted]’s outstanding balance is $527.83. This amount does not include July’s premium. A representative will contact **. [redacted] to assist her with remitting payment.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####. My fax number is ###-###-####, and my e-mail address is [redacted].Very truly yours,

Review: I have to take [redacted] and I was told that I could pick it up at [redacted] but when I want to pick it up they told me that Coventry was not allowing them to fill it. They sent me a letter in the mail telling me that they would late me fill it at the [redacted] near me. I call them about that and they said that I had to get mail order and that they would not take the state of Maryland MADAP insures like the retail pharmacist that said that it was my problem and that they where not going to do any thing to help me and they do not have to tell me any thing when they make changes to my pharmacy.Desired Settlement: I would like them to do what they said and permit me to go to a local pharmacy.

Business

Response:

April 21, 2014Dear **. [redacted]:This letter is in response to your request for Coventry Health Care of Virginia, Inc. to respond to a complaint submitted by [redacted] regarding his medication [redacted]. The member would like to be able to refill his prescription at the local pharmacy instead of doing a mail order.Coventry Health Care of Virginia, Inc. does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing him in this matter. We will respond directly to **. [redacted].Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted] between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.Sincerely,

Review: On Jan. 14, 2014, I was approved for medical insurance with Conventry Health America One. The monthly premium offered on the ehealthinsurance.com website was $216.78, which I approved as "affordable." Conventry Health America One has my checking account on file for automatic monthly debit. The first month's premium of $216.79 was debited on Jan. 16, 2014.

However, it is now February 28, 2014 and Conventry Health America One has yet to create a member id for me, despite my numerous calls to them over the last six weeks. I have NOT received a member's "welcome" package or anything related to the ter** and conditions of my insurance.

Now, in a letter dated Feb. 22, 2014, which arrived at my house on February 28, 2014,Conventry Health America One infor** me that they will debit $440.57 from my checking account on March 6, 2014 and then "my premium will return to the regular scheduled premium next month."

Let's do the calculation. $440.57/2 = $220.285. I did not approve this monthly rate. I signed up for $216.78 per month! This is a formal complaint with the Revdex.com for fraud and "bait and switch" tactics. I want to cancel the Conventry Health America One insurance and ask for a refund of the Jan. 2014 debit ($216.79).Desired Settlement: Cancel the Conventry Health America One insurance for non-service, unauthorized increase in monthly premium rate, and failing to establish a member id.

I want Conventry Health America One insurance to refund the $216.79 initial premium that was debited from my checking account on January 16, 2014.

Stop future automatic debits from my checking account.

Business

Response:

March 14, 2014Dear **. [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.[redacted], (the “member”) has filed a complaint. The Member’s complaint concerns premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $216.79Upon review, the member’s effective date was December 31, 2013. This effective date was offered so members could have the option of non-ACA plans. Therefore, premium payments were processed for the month of December 2013: $7.01, January 2014: $216.78 (paid), February 2014: $216.78, March 2014: $216.78. The total due was $440.57. Please be advised that this a request to collect the amount due for the time frame in which the member received coverage. The member’s coverage remains effective.If you have any questions or concerns regarding this matter I can be reached at ###-###-####.Sincerely,

Consumer

Response:

March 19, 2014Dear **. [redacted]:Re the enclosed response from [redacted], Appeals CoordinatorI contacted Coventry Health America One's customer service department several times in late in 2014 and throughout February 2014 for my insurance member id and welcome package so that I could create my new profile athttps://member.cvty.com/memberPortalWeb/appmanager/memberPortai/menriber, but more importantly, provide my new insurance information to my doctor.Every time I called, Coventry Health America One's customer service informed me no member id had yet been established for me. I was NOT able to set up any medical appointments nor procure medical services of any kind because the company failed to create a member id for me. My many follow-up calls in February 2014 to Coventry Health America One went unresolved. To add insult to injury, the company did not send me any acknowledgment regarding my calls or an ETA for when I would receive a member id and welcome package. When I still had not received a member id and welcome package by February 28, 2614,I selected and signed up with another insurance company on March 3, 2014. (I intend to stay with this alternate insurance company!)Coventry Health America One finally sent me a member id card In the mail on March 10,2014 and a welcome package the following day. However, it was too late; I had already signed up with another insurance company as stated above.I have NOT used the Coventry Health America One member id and the welcome package remains unopened. I sent a letter, dated March 12, 2014 (enclosed) to the company asking if and where I could mail back the member id card and welcome package, I also stated I wanted my reimbursement and to terminate the contract. As of March 19, 2014,I still have not received a response from the company. Also enclosed for your reference is a short letter from Coventry Health America One, which prompted my questioning of their billing practices. As you can see, there is NO reference as to a $7.01 December 2013 charge (How was this charge calculated?), nor a specific premium breakdown of $216.78 for February 2014 and March $215,78, When I called Coventry Health America at ###-###-#### on February 22 about the contents of this brief letter, I was told "computer systems are down; we cannot answer any billing inquiries at this time,"Had the February 22, 2014 letter from Coventry Health America One been more detailed oriented, I wouldn't have assumed a mathematical error on the part of the company. The so-called "premium payment" of $7.01 for December 2013 mentioned in **. [redacted]'s letter doesn't make sense, as I registered for this insurance via [redacted]com on December 26, 2013. Her response letter to the Revdex.com is the first time I've even seen a charge of $7.01 referenced for December 2013. In summary, I don't have faith in this company to cover me for any medical services, after what I've had to deal with during mid-January 2014 to late February 2014. I just want a reimbursement for the January 2014 premium ($216.73) and an official letter from the company terminating the contract.Please advise me. Thank you.

Business

Response:

April 18, 2014Dear **. [redacted]:The Member is participating in the Coventry Health and Life Insurance Company (“CHL”) HealthAmerica One individual PPO health benefit plan.[redacted], (the “member”) has filed a complaint. The Member’s complaint concerns premium payments deducted from the member’s checking account by the Plan. The member is requesting reimbursement in the amount of $216.79. Upon review, the member’s policy has been terminated as never in force and a refund for the amount of $216.79 has been expedited.If you have any questions or concerns regarding this matter I can be reached at ###-###-####. Sincerely,

Review: I enrolled DIRECTLY with coventry one on 12/27 with [redacted] | Licensed Benefit Advisor | [redacted]. I paid the binder amound of $85.01 on 01/10/14. I called in on 01/23/14 to verify my coverage, the representative advised I am not in system as being covered. The call was then dropped by Coventry. I have received no documents showing any coverage.Desired Settlement: I want confirmation of coverage.

Business

Response:

January 24, 2014

Dear **. [redacted]:

This letter is in response to your request for Coventry Health Care of the [redacted], Inc. (“CHC [redacted]”) to respond to a complaint submitted by [redacted] regarding his CoventryOne policy effective January 1, 2014. The request was received by CHC [redacted] on January 23, 2014.

CHC [redacted] does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing him in this matter. CHC [redacted] will respond directly to **. [redacted]..

Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted] between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.

Sincerely,

Review: My wife received a letter stating an amount roughly double her monthly insurance premium was scheduled to be deducted 12/23/2013. After calling the number provided it was determined that Coventry had made a mistake on the account number of our checking set up for auto-withdrawal. Upon further investigation it was found that I also with Coventry was about to be canceled for lack of premium payment. They in my case had the correct account number but failed to withdraw the funds. I asked for a complaint reference she said there was none. I called Covenry Corporate the operator said she was not allowed to provide the name or contact info for the C.E.O.My wife received a letter stating an amount roughly double her monthly insurance premium was scheduled to be deducted 12/23/2013. After calling the number provided it was determined that Coventry had made a mistake on the account number of our checking set up for auto-withdrawal. Upon further investigation it was found that I also with Coventry was about to be canceled for lack of premium payment. They in my case had the correct account number but failed to withdraw the funds. I asked for a complaint reference she said there was none. I called Covenry Corporate the operator said she was not allowed to provide the name or contact info for the C.E.O. This places us in an extreme imposition ($500.00+ due premium) days before the holiday. If they did not have the account number to begin with there would have been no coverage. Had I not forced the investigation I may have been canceled for no reason.Desired Settlement: This places an inexcusable financial hardship days before Christmas at the least and could have resulted in serious consequences had one of us needed medical attention with lapsed coverage. We want a head on a post termination of the party guilty or at least not to be ignored.To find if any someone accountable for fielding complaints (and forward this issue) in the corporate office to justify the 6 figure income this individual makes. So that we might reference it for future such occasions.

Business

Response:

Dear Sir or Madam:

The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to your request dated 12-1913 and received at our office on 12-19-13. This letter is in response to the consumer complaint filed by **. [redacted] regarding billing issues for his and his wife’s policies.

This member complains that he received a letter stating his account is scheduled to be cancelled for lack of payment.. After receiving this complaint, we are able to confirm that there was a system error and a past due notice did go to the member. A “do not cancel” has been placed on his account to ensure he has time to make a payment or that it will draft from his account in January.

The complaint also refers to billing issues regarding his wife’s, [redacted]’s, account in that she received notice she will be billed twice the amount of her premium on 12-2313. After receiving this complaint, we investigated to find there were two accounts on file for this member. The last four digits of one account match those on the original application, but for the second account the last four digits do not match. To date we have not received a request to update the EFT information and the valid account is set up for subsequent payments. Therefore, this account will be drafted on 12-23-13 to pay premium due in total through the end of December and will resume normal monthly payments in January.

Please also note the following:

• No appeal was filed by the provider or member on this matter.

• No medical records were obtained or utilized.

• There was no U&C determination.

Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension 1917. My fax number is ###-###-####, and my e-mail address is [redacted].

Very truly yours,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: Since then we were advised to update our billing account information

because of an error on thier part leaving us both over two months behind in

premium. [redacted] to pay by USPS mail because (as we were informed) the automated

system would not update in time to prevent policy lapse. [redacted] was

scheduled for payment in January, 2014 to avoid us having to pay over $600.00

collectively for premiums normally in the $150.00 a month range. After following

the aforementioned we discovered a mystery withdrawal from our checking

account on 12_31_2013 ending in [redacted] for $304.94??? I was unable to determine

who's premium that was but clearly another error has been made. Please let us

know what the current state of our billing is and who's premium was withdrawn on

12_31_2013? Be advised that a check has already been mailed for [redacted]'s premium

for $305.94

Regards,

Consumer

Response:

---------- Forwarded message ----------

From: [redacted] <[redacted]>

Date: Wed, Jan 8, 2014 at 6:55 PM

Subject: [redacted]

To: [email protected]

This company has taken over 6 hundred dollars but will not answer our calls faxes or emails.

---------- Forwarded message ----------

From: [redacted] <[redacted]>

Date: Wed, Jan 8, 2014 at 7:54 PM

Subject: [redacted]

To: [email protected]

They say we are not communicating our complaint. We have tried to call left hanging on hold for over 30 minutes till giving up. Here's our Email

Hello,

We called in a few days ago ID#[redacted], [redacted]

Member id#[redacted]

Member id#[redacted]

were advised to update our billing account information because of an error on your part leaving us both over two months behind in premium. [redacted] to pay by USPS mail because (as we were informed) the automated system would not update in time to prevent policy lapse. [redacted] was scheduled for payment in January, 2014 to avoid us having to pay over $600.00 collectively for premiums normally in the $150.00 a month range. After following the aforementioned we discovered a mystery withdrawal from our checking account on 12_31_2013 ending in [redacted] for $304.94??? I was unable to determine who's premium that was but clearly another error has been made. Please let us know what the current state of our billing is and who's premium was withdrawn on 12_31_2013? Be advised that a check has already been mailed for [redacted]'s premium for $305.94. If we cannot get this straightened out promptly we will be forced to formally complain to the Dept. of Insurance.

[redacted]. [redacted]

And our fax

10:47 AM

To: [redacted]

Hello,

You deducted for monthly premium from our aoutopay checking $305.00 for [redacted] then received a check for $305.00 from us per your instructions for [redacted]s account. Post the check on [redacted]. We can not reach by telephone we have sent Email with no reply but are attempting to reach by Revdex.com. Please make the arrangements to help rectify the accounts you made delinquent. If necessary you can reach us by

Fax# ###-###-####

Member id#[redacted]

Member id#[redacted]

Please contact in regard to this matter at your earliest.

Thank you.

[redacted] & [redacted]

Review: Unable to cancel my Health Insurance policy

On Dec. 3, 2013, I called Coventry One to cancel my health insurance policy because I have obtained a health insurance policy through healthcare.gov. I was told to wait till next next Monday for my payment to be processed. I Called on Dec. 9, 2013, and after 1 hour hold, I talked to someone. They told me that their computers are down and asked me call back.

After this, I called several times. Every time, I was put on hold for more than 1 hour and finally somebody transferred me to another line. Once I got transferred, my line got disconnected.

On Dec. 17th, I wrote a letter asking them to cancel my policy. I sent the letter by Certified mail with return acknowledgement. The acknowledgement shows that they received my letter on Dec. 19, 2013.

Even after this they have not cancelled my policy. Today, I looked at my bank account and to my surprise they have charged $696.96 on 12/31/13. In my letter, I specifically asked them to cancel my policy and not take any money from my account.

I feel helpless because every time I call they make me hold the phone for more than 1 hour and I get tired. They don't do if I write a letter.

Please, I request you to do what is needed for them to cancel my policy and return the premium taken out of my bank accountDesired Settlement: I want them to cancel my policy effective Nov. 30, 2013 and return the premium they took out of my account on Dec.3 and Dec. 31, 2013: a total of $1393.92

Business

Response:

January 13, 2014

Dear Sirs:

This letter is in response to the aforementioned Case Number [redacted] regarding **. [redacted]’s cancellation of coverage and refund of premiums. Enclosed please find the documentation requested.

**. [redacted] became effective with Coventry Health Plan of Florida, Inc. on August 1,

2013. **. [redacted] contacted the Pharmacy Department via telephone on December 5,

2013, requesting to pay his premium before he could cancel his policy. The Member Service Representative provided **. [redacted] with the number to the payment center and also transferred his call to the Enrollment Department. On December 12, 2013, **. [redacted] contacted the Pharmacy Department requesting cancellation of his policy as of December 31, 2013, as he has a new policy effective January 1, 2014. **. [redacted] was given the number to the Individual Enrollment Department and was also transferred.

Our records indicate **. [redacted]’s policy was cancelled with an effective date of November 30, 2013. An expedited refund for two installments of $696.96 has been requested as of January 8, 2014. Please allow 24 hours for the refund to be processed and depending on **. [redacted]’s bank, the funds will appear within 1-5 business days. Please be advised that the refund will appear as two deposits.

If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.

Sincerely,

Review: Contacted a sales agent about options for obtaining better health coverage than I already had with the company. I have held a health insurance policy with this company for close to 5 years. After finding a plan with an acceptable premium, I began the application process for the switch. I was told that because I already held a plan with Coventry the switch and approval would be very quick and easy. I asked the sales agent about what needed to be done with my old plan once approved for the new one so I didn't get charged two premiums for double coverage. He said I would receive an email from someone in the enrollment department about what needed to be done. I got an email with a form to fill out and fax back that would cancel my old policy once approved for the new one.

After 2 weeks go by I hear nothing from the company about the new policy until I receive a letter in the mail from them saying I no longer have health insurance with their company. Meanwhile I have been going to the doctor the whole time resulting in denied claims against the policy I thought was still in place.

I contacted my sales agent to inquire about the issue, he said he was only a sales agent but would connect me to the department the would be able to help me. After waiting on hold for 30 minutes I hung up and called customer service on my health insurance card. The representative pulled up my account and said that my current policy was cancelled due to the application of my new policy. But that the new policy was also cancelled because you are not allowed to have double coverage. Leaving me with no health insurance at all.

I then contacted my sales agent again and demanded to speak with his boss or any supervisor with the authority to help me out. I was connected with a manager who reviewed what had happened and said she would reinstate my application. Which she did but now the monthly premium had increased over $50 dollars. Not what I was quoted from the beginning. I was told that this tends to happen all the time once an application good to underwriting. I understand that but had I known this increase would be as high as it is I would have kept my old policy.

Now I can't get my old policy back which I was told they could do because it was cancelled so recently. I have to reapply with no guarantee of similar coverage or premium.Desired Settlement: New policy for the premium I was initially quoted our my exact old policy with same premium as before.

Business

Response:

Attached please find Coventry Health Care's response to Complaint #[redacted].

Thank you,

Review: I am insured through Coventry Health Care of Virginia. Before contracting with The [redacted] midwifery practice, I contacted Coventry to make sure the services there would be covered. I was assured that the services for my child's birth would be covered. I would have to pay the provider myself and then submit, or have the provider submit, the expenses to Coventry. This was done after my daughter was born on October 29, 2013. There was an error in the first bill, but the midwives corrected it and resubmitted it to Coventry. After another submission and many phone calls to my midwife and Coventry, I still have not been reimbursed. Coventry claims the codes on my bills are incorrect, however they will not tell my provider what codes they want. The midwife is using the standard codes that work for all other companies. My midwife has had trouble with Conventry paying in the past, and I suspect that I am just getting a run around. Because the bill was so much lower than a hospital birth would have been, I think Coventry expects me to give up trying, but I do not think that is right.Desired Settlement: Payment of all covered birth expenses. I understand that some facility fees may not be covered, but the cost of my care and birth should be paid for as promised.

Business

Response:

September 12, 2014Dear [redacted]:Your letter of September 4, 2014 to Coventry Health Care of Virginia, Inc. ("Coventry Health Care") was referred to my attention for review and response.[redacted] expressed concern with the $3,700.00, October 29, 2013 claim denial for The [redacted]. Coventry addresses this concern below.On May 6, 2014, Coventry received a claim submission for the October 29, 2013 services, The $3,700.00 charge was denied due to an incorrect diagnosis code. On June 19, 2014, Coventry received a corrected claim with a corrected diagnosis and procedure code. The claim was denied due to an invalid procedure code.Providers are required to adhere to submitting claims correctly based on the Services rendered. However, [redacted] has been responsible for submitting a Superbill to Coventry on behalf of The [redacted], Coventry understands [redacted] is caught in the middle of this billing issue. As a one time exception, the $3,700.00 October 29, 2013 charge will be processed, [redacted] should receive an Explanation of Benefits within 7-10 business.If you have any questions, please contact the Customer Service Department at ###-###-####,Teresa *. E[redacted] Manager, Complaint and Appeal Program

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: This is the same response I have been receiving for months. The company will not tell me or the provider what codes are required. The provider is using standard codes that are accepted by all other insurance companies, and has given Coventry this information repeatedly. This seems to be just more stalling and avoidance. I had a natural birth of a healthy child. Conventry should need no other information to provide the payment that was promised for the services required for that event.

Regards,

Business

Response:

October 23, 2014Dear [redacted]:Your letter of October 22, 2014 to Coventry Health Care of Virginia, Inc. (“Coventry Health Care”) was referred to my attention for review and response.In her objection submitted to the Revdex.com, [redacted] voiced displeasure with Coventry’s response to her complaint. [redacted] advised that she received the same response as before.Providers are responsible for coding their claims correctly in order to receive reimbursement for services rendered. The [redacted] submitted an obsolete diagnosis code of [redacted] on claims for [redacted]. The appropriate diagnosis code is [redacted].[redacted]’s letter dated September 12, 2014 advised [redacted] that her claim for October 29, 2013 in the amount of $3,700.00 would be processed as a one time exception. Claim number [redacted] processed according to [redacted]’s policy benefits on September 17, 2014 with $475.52 applied to her deductible, $503.51 applied to her coinsurance, and $1,546.13 applied to the amount above the allowable charge. The [redacted] was reimbursed $1,174.84 with check number [redacted]. The Explanation of Benefits (EOB) detailing this information is dated September 25, 2014. [redacted] may contact the Customer Service Department to request a copy.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,Shawn MComplaint and Appeal Analyst

Review: I made my first payment to Coventry on 6/16/14. Coverage was cancelled on 6/17/14 and they will not issue a refund.

The insurance was purchased through the marketplace and because my son was born on 4/26/14 they used this date to process my application with a life event even though I indicated to them that I wanted to use my marriage date of 5/30/14. Because of this, my coverage was backdated to 4/26/14 and Coventry will not issue a refund because they are showing that I had coverage for 2 months. They at one point told me I owed more money for the coverage! I have called them several times, and even got on a conference call with Coventry and the Marketplace where we tried to have my cancellation date backdated to 4/25/14 to allow the refund to be processed. Today the marketplace told me that there is no way this can happen, and Coventry refuses to do anything without this cancellation date backdated.Desired Settlement: I want a refund for the $643 that I spent on 6/16/14 for a policy I cancelled the following day on 6/17/14.

Business

Response:

September 29, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s refund. Please find below the requested information.Our record indicates that [redacted]’s coverage became effective on April 26, 2014, and terminated on July 2, 2014. The plan initially received a file from the Marketplace on June 3, 2014, to initiate the policy for April 26, 2014, effective date. Another file was also received on June 3, 2014, to change the APTC (Advanced Premium Tax Credit) amount to $7.00, leaving the new premium to be $643.33 effective May 1, 2014. On June 17, 2014, a file was received from the Marketplace to terminate the policy effective July 2, 2014.[redacted] will not be able to get a refund unless his termination and/or effective date is changed. [redacted] must contact the health insurance Marketplace in order to discuss the issue with the termination/effective date. Only the Marketplace can alter the termination and/or effective date. With the termination and effective date as is, [redacted] would actually owe $792.06 to be paid through for July 2, 2014. This is because $107.22 is being charged for the coverage from April 26, 2014, through April 30, 2014; $643.33 for May; $643.33 for June; and $41.51 for coverage from July 1, 2014 – July 2, 2014. This equals a total amount billed of $1435.39. [redacted]’s total amount due is $792 because he made a payment of $643.33 on June 16, 2014. If [redacted] is able to change the termination and/or effective date, then the billing will have to be changed to reflect that. [redacted] will need to contact the healthcare marketplace at ###-###-#### if he is not satisfied with the termination and effective dates. Please be advised that Coventry does not have access to change termination and effective dates.If you have any questions, please contact me toll free at ###-###-####, or directly at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm.Sincerely,Tracy TComplaint and Appeal Analyst

Review: Purchased this insurance on april 5,2014 and never received insurance cards and ask for a refund of my money on august 1,2014

I purchased this insurance on april 5,2014 because of the Obama care. I purchased it online and they took 166.87 out of my moms account every month on the 5. I received a letter stating that I WOULD receive my ID cards and a new member kit within 10-14 days and my insurance would start on may 1,2014. I never received it, so today on august 1,2014 I need to go to the doctor still no card. So I call them at ###-###-#### and talkto a lady name Tavia telling her I need to go to the doctor today and haven't received any card she tells me to give her my case number which is L 81729 and comes back to tell me I don't have a member no and puts me on hold to talk to someone else gets back on the phone and tells me she will have to contact someone else and go to the doctor and pay and they will pay me back. I told her what has happen to all my money since april and I WANT a refund since I GUESS I really didn't have insurance she tells me to hold on and comes back and tells me that since it is due in a few days I cant get a refund then I told her this was crazy and I was reporting themDesired Settlement: seeking my money back from april 1 2014 at 166.87 a month up till july 5,2014 since I never received cards or didn't even have a member no

Business

Response:

August 21, 2014Dear [redacted]:The Regulatory Compliance Department of Coventry Health Care of West Virginia, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by [redacted] regarding his policy.[redacted] complains that he never received his identification card and that he never had a member number. An investigation into this matter shows that [redacted] did, in fact, have a member number and an active account. [redacted] was mailed identification cards on April 7, 2014 and August 6, 2014. [redacted]’s policy was active May 1, 2014 through July 31, 2014. A customer service representative attempted to contact [redacted] to confirm that the address we have on file is correct and to assist him in accessing the online services available to him. As of this date, [redacted] has not responded to the voice message left for him at the telephone number he supplied on his complaint. [redacted] is requested to return the telephone call from the customer service representative so that he can be assisted in accessing his account.Regarding [redacted]’s request for a refund of premium based on not receiving his member identification cards he will need to contact the Marketplace. Coventry is unable to process any changes to a policy that was initiated through the Marketplace per the Exchange rules and regulations that we as an insurance company must follow. [redacted] must request to have his policy never in force through the Marketplace. If the Marketplace grants [redacted]’s request Coventry will be notified of any policy update.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####. My fax number is ###-###-####, and my e-mail address is [redacted].Sincerely,Teresa E Manager, Complaint and Appeal Program Coventry Health Care

Review: I applied for insurance through the ACA marketplace and got a policy with Coventry-One. During the month of April I realized I had to remove myself, [redacted], from the policy as I had alternative coverage that I was required to utilize. I created a new application for my wife ONLY, [redacted], through the marketplace. This was supposed to cancel the old policy with both of us and create a new

one for ONLY [redacted].

After many phone calls to both the marketplace and Coventry it appears that in some departments the old policy is being canceled but not on the database. Also my wife cannot now received prescription medication because it comes back as being canceled.

My last communication was 6/24/2014 and they said everything should be good with 72 hours. Today, 6/28/2014, she still cannot get her medication

Also despite assurances that the old policy is canceled I still get bills for it. My objective s complaint is to get everyone on the same page. My calls do nothingDesired Settlement: honor health insurance contract

Business

Response:

---------- Forwarded message ----------

From: F[redacted], Deborah <[redacted]>

Date: Fri, Aug 15, 2014 at 8:56 AM

Subject: Complaint #[redacted]

To: "[redacted]" <[redacted]>

Dear [redacted]:

Coventry Health Care respectfully requests that the attached response be entered into the record regarding the Complaint filed by [redacted] in order to accurately reflect the current status of this matter. Apparently this letter was inadvertently not filed on July 22 when it was prepared.

If you have any questions, please do not hesitate to contact me.

Thank you,

Debbie

Deborah [redacted] F[redacted]

Paralegal

Aetna – Law and Regulatory Affairs

Review: I have been on my medication for 7 years now for a life threatening disease. I had to change my insurance in January to Coventry. I was under the impression that there would be no proble** with them covering my meds. However, when I went to get them filled they denied them because they say they are not a "medical necessity". My medicine is made up of 3 meds in 1. They want me to take all 3 individually which could put my life at risk if they don't work. They say if the 3 meds individually don't work they will then cover my current meds. The problem with that is once I stop taking my current meds I can never go back to them because my body becomes immune to them. It is then a race against time basically to find a new regimen that works which may not be possible. My doctor has filed an appeal and it was denied. I have also filed an appeal that I am waiting to hear back on. My doctor also scheduled a medical review with the insurance doctors and they have never contacted her back to conduct it. The worst part is there are a lot of other that are dealing with the same exact problem.Desired Settlement: I would like to get my current medication approved like I was told it would be before I signed up for Coventry One. I don't want to have to change my meds at all because it could be deadly.

Business

Response:

February 4, 2014

Dear **. [redacted]:

The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to your request dated 2/3/2014 and received at our office on that day. This letter is in reply to the above-referenced consumer complaint filed by **. [redacted] regarding a prescription coverage.

Both the member and his provider were notified of the appeal decision to approve the requested prescription the morning of 1/31/2014, prior to Coventry Health Care’s receipt of this Revdex.com complaint.

Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [redacted].

Very truly yours,

Review: I started my policy March 2014. The company misspelled my last name spelling it [redacted]G. I have been trying to get it changed to the correct spelling since April. I have made every payment but yet they have cancelled me at least twice (June and September) for lack of payment. Even though I have needed medical assistance I have not been able to use my policy because of their errors. Besides the 8 checks I have sent them I was also asked to make two credit card payments -- one at the end of Sept and one at the beginning of Oct. It was not until 11/14, I was told by Coventry that the two credit card payments were never processed. They also acknowledged that they have been holding my last check since 11/3.More specifics: Apparently they corrected the spelling of my name May 31st but never transferred my June payment to the new policy, and, never sent me a new invoice with the new policy. They then cancelled the [redacted]d policy in August.In August, I was told that they would be canceling the [redacted]g policy on the 31st and starting the [redacted]d policy on September 1st. Because I had already paid the Sept payment they said that they would apply it the [redacted]d policy starting the 1st. This did not happened, instead they cancelled the [redacted]d policy for lack of payment AND cancelled the [redacted]g policy Aug 31st as planned. At the end of Sept they took a credit card payment to start the [redacted]d policy as of Sept 1st. Oct 9th, I believe, they took another credit card payment stating that for some reason the first one did not go through.Around Oct 21st or 22nd, I received a letter from Coventry requesting a payment to start the [redacted]d policy as of Sept 1st. This letter was dated Oct 14th. I sent in the payment Oct 28th and they received the check 11/3 and have been sitting on it every since. On Nov 14th they advised me that I have no policies enforced and if I see a doctor they will not pay for it. They are currently reviewing my file. Their record so far is not hopeful.Desired Settlement: I want them to cover me and my family since I have paid them to do so. I want them to reimburse me for my cost to date. I want them to spell my name correctly if it is even possible for them to do so, and, send me my ID Cards with the correct spelling. I want to be able to get physicals for myself and my family before the end of this year (something that is covered under the policy I have paid for).

Business

Response:

Dear [redacted],