Discovery Benefits

An individual's eligibility is updated once the individual makes their election and initial payment The enrollment and payment information was completed on January 23, and in accordance with the schedule in place for this employer, notification was sent via file on January 30, The carrier can take up to days to process the file and update their records Customer service representatives at carriers do not always have insight into the information that has been provided and is still in process at the carrier since it is not yet reflected in the carrier's system

Initial Business Response / [redacted] (1000, 5, 2015/12/23) */ Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers Discovery Benefits received and processed the participant's plan elections and initial payment on November 5, The initial reinstatement request was provided to Kaiser CA on November 6, The participant contacted Discovery Benefits twice on December 9, regarding the reinstatement of his coverageOn each call he was advised that Discovery Benefits had communicated his reinstatement to Kaiser CA on November 6, and that an urgent request to update coverage would be sent to Kaiser CADiscovery Benefits sent an urgent request to update coverage to Kaiser CA on December 9, The request was sent to the eligibility email address provided to Discovery Benefits by Kaiser CA The participant contacted Discovery Benefits twice on December 17, and advised his coverage with Kaiser CA was not activeThe customer service representative indicated Kaiser CA had been notified of the reinstatement on November 6, and December 9, and advised Discovery Benefits would send an additional request to Kaiser CA Discovery Benefits sent another urgent request for reinstatement to Kaiser CA on December 18, Discovery Benefits received verbal confirmation of the reinstatement of the participant's coverage effective September 1, on December 22, The Kaiser CA representative provided a confirmation numberIf the participant is in need of the confirmation number, he should contact Discovery Benefits Discovery Benefits' Participant Services operates as an incoming call center to respond to inquiries from participantsThe phone lines are kept open to the extent possible for incoming calls and the Participant Services team does not make outbound calls to carriers as this responsibility is handled by a dedicated Carrier Relations team at Discovery Benefits Discovery Benefits takes customer service very seriously and upon review of the calls with this participant finds that the representatives with whom he spoke were courteous and professional when speaking with the participant Complaint Response Date bumped because: Holiday Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/12/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) The facts recounted are largely correct and the coverage problem has been correctedHowever, no one I spoke with at Discovery Benefits was ever courteous or professional and the wait time to speak to a very rude person was sometimes over minutesThe representatives took no ownership of the problem whatever, and it required the combined efforts of County Of Sonoma HR presonnel (the employer) people at Kaiser Permanente and an ombudsman for the county to get this resolvedAt every step, Discovery was more hindrance than helpfulTheir response above completely whitewashes their profound indifference to the people, like myself, who have to depend on them to correct mistakes with life or death implications Final Business Response / [redacted] (4000, 9, 2015/12/28) */ Discovery Benefits respectfully disagrees with this participantAt no time were the representatives rude with the participantThe representatives were courteous and professionalIn each case, Discovery Benefits took steps through its standard process to assist the participant in order to resolve the issueWe were unable to accommodate requests made by the participant to speak with the Carrier Relations team, as speaking with participants is the responsibility of the Participant Services team; to be included on Discovery Benefits internal emails; or to have our Participant Services representative contact the carrier, as this is a role of another teamAs was stated in the earlier response, Discovery Benefits contacted the carrier on several occasions requesting the carrier update its recordsAlso as stated earlier, Discovery Benefits does not have access to or control of carrier systems and it is up to the carrier to follow through by updating its systems when notifications are received

I am rejecting this response because: This matter has been sorted out, but yet again Discovery Benefits fails to understand my complaint Five requests were made for a 2nd card in another person's (not my wife) name Nothing arrived, nor did I throw away a plain white envelope(s)

Initial Business Response / [redacted] (1000, 5, 2015/12/08) */ Discovery Benefits' reimbursement checks are preprinted with the statement: "This check is void after days." The plan year from which this claim was paid is closed and all forfeited funds, including funds that remain from uncashed reimbursement checks, have been returned to the planDiscovery Benefits no longer has the funds to reissue a check to the participantDiscovery Benefits will reach out to the employer to advise them of the situation and recommend that reimbursement be made to the participant Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/12/08) */ (The consumer indicated he/she DID NOT accept the response from the business.) I have the original checkNo where on this check are the pre printed words "This check is void after days." I am attaching a copy to this claim I'm not understanding why you would need to go back to my employerAt the end of the plan year are forfeited funds returned to the employer? I have also reviewed all plan documents available on your website and through my employers website and can find no mention of checks being void after days, or that uncashed reimbursement checks are considered forfeited funds Final Business Response / [redacted] (4000, 9, 2015/12/09) */ The participant's documentation shows that there was no day statement includedThis must have changed when changing vendors and Discovery Benefits will look at adding it back to future checks All forfeited funds, including funds from uncashed checks, are returned to the employer as forfeited fundsUncashed checks are deemed to be part of the forfeited funds provision when not cashed by participants and the plan year is closed Discovery Benefits no longer has the funds for the participant's uncashed check and we recommend the participant follwith their employer regarding these fundsNotification to the employer was made by Discovery Benefits on December 8, requesting that the employer reimburse the funds to the participant

All premiums collected were remitted to the employer The employer has instructed DBI to have the participant contact the employer directly regarding their request DBI does not have the premiums being requested and cannot provide a refund

Initial Business Response / [redacted] (1000, 5, 2016/03/01) */ Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees, participants or qualified beneficiariesDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers According to its standard process, Discovery Benefits notified the carrier on September 21, of this participant's reinstatement of coverage effective October 1, following the receipt of her complete enrollment Discovery Benefits was contacted by a representative from the insurance carrier for this participant on November 13, The representative requested Discovery Benefits resend the reinstatement request and provided an email addressDiscovery Benefits sent the reinstatement request to the email address provided the same day The participant contacted Discovery Benefits on November 18, and advised that her coverage was not active with the carrierDiscovery Benefits emailed the reinstatement request to the carrier again on November 18, and received confirmation from the carrier that the coverage had been reinstated Due to a plan coding change provided to Discovery Benefits by the participant's former employer, the plan under which this participant is enrolled was terminated and reactivated on December 20, Discovery Benefits notified the carrier of the addition of the plan with the "new" code effective January 1, on December 21, Discovery Benefits also notified the carrier of the termination of the plan with the "old" code effective December 31, on January 11, Discovery Benefits received a call from the carrier on February 4, The carrier requested the notification be resentDiscovery Benefits resent the notification the same day and received confirmation of the update from the carrier on February 8, Discovery Benefits was notified by the carrier and the participant on February 24, the coverage was again terminatedDiscovery Benefits sent an urgent update to reinstate coverage on February 24, and received confirmation on March 1, of the reinstatement of benefits It was later determined that on February 11, 2016, a duplicate of the January 11, termination notification for the plan with the "old" code was inadvertently resent to the carrierUpdates have been made to ensure this is not an ongoing issue and we apologize for the concern this caused the participant Initial Consumer Rebuttal / [redacted] (2000, 7, 2016/03/02) */ (The consumer indicated he/she ACCEPTED the response from the business.) This company erroneously canceled my insurance three timesIt took me well over three hours of phone calls to eventually straighten this mess outThe last two cancellations were only corrected with the help of Blue Cross agents, as Discovery gave me the runaround on almost every call I didn't expect more than an apology from them, but I DO expect continuity of service in the future as promised in their response

I am rejecting this response because: This is an unacceptable responseDiscovery benefits though they say they have been giving information to the insurance carriers, the insurance carries have not seen anything come through from discovery benefits Insurance carriers and discovery benefits are both saying they have done all they can Both of their hands are tiedThey will not activiate my coverage Both will not reach out to the other, however, one time the insurance carrier reached out to discovery benefits and discovery benefits said they would send the necesary information, however, did notThis is unnacceptable Discovery Benefits has deposited my money into their acount and they don't distribute it to the insurance carriers and they don't send necesary confirmation This is illegal Revdex.com I would expect that you would not allow this as a resolution either If Cobra highers a 3rd party to activate and distrubute insurance from the actual carriers then that should be a trusting party Not a theaf I am forced to switch insurance coverage becuase I keep sending money in and my insurance wont get activated and medical provides refuse to see us without the active coverage or we have to pay out of pocket of the entire visit I paid for insurance, this is unacceptableNOT TO MENTION, how much of my time this has taken up, especially with a brand new baby! Please confirm this is being moved to the next steps Thank you.Michelle

Initial Business Response / [redacted] (1000, 5, 2016/01/14) */ Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employersDiscovery Benefits does not sell directly to individualsDiscovery Benefits generally acts on instructions from employers, qualified beneficiaries, and/or insurance carriersIn its role as a third party benefits administrator Discovery Benefits (i) is not an insurer or an insurance carrier and (ii) does not have control over the records or assets of an insurance carrier Discovery Benefits received and processed the participant's enrollment and initial payment amount on September 10, According to its standard process, on September 11, Discovery Benefits notified the carriers of the participant's reinstatement effective October 1, Discovery Benefits was first made aware of the participant's lack of coverage on January 4, upon receipt of an email from the participantDiscovery Benefits reached out to the participant's medical carrier to ensure coverage on January 6, Discovery Benefits received confirmation from the carriers for this participant on January 14, that all coverage elected has been reinstated effective October 1, with no lapseDiscovery Benefits also received confirmation that any claims denied since October 1, will be automatically reprocessed Initial Consumer Rebuttal / [redacted] (2000, 7, 2016/01/15) */ (The consumer indicated he/she ACCEPTED the response from the business.) I am finally insuredI cannot prove if the fault was with Discovery Benefits or Blue ShieldMaybe Blue Shield didn't register the notice properlyIf I ever use COBRA in the future, I will verify my insurance on the date I am supposed to be insured instead of waiting until I need it

The plan in which this participant is enrolled is an employer-sponsored plan governed by IRS regulations and plan rules as defined in the employer’s plan document and summary plan description Discovery Benefits provides administrative services on behalf of employers pursuant to service contracts with the employer According to the terms of the plan under which this participant was enrolled, terminated employees are allowed to submit claims within days after termination for expenses incurred prior to the termination date This information was included in the Summary Plan Description provided to all eligible employees upon enrollment by the participant’s former employer In addition, the information shown below was available to the participant through the online consumer portal The Final Service Date is the last date for the participant to incur claimsFor this participant the final service date was July 28, The Final Filing Date is the last date to submit those claims in order to receive reimbursementFor this participant the final filing date was October 26, Because the final filing date has passed, additional claims cannot be acceptedAny funds that may remain in a participant’s account after the end of the plan year are forfeited to the employer-sponsored plan and are not retained by Discovery Benefits

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees or participantsThe final service date and final filing dates are defined by the terms of the Plan under which the participant was enrolledThis information is included in the Summary Plan Description provided by the employer to each participant becoming enrolled in the Plan A letter will be sent to the participant that includes additional information

I am rejecting this response because: Discovery Benefits tells me I should have seen that disclaimer, yet it is not accessible anywhere in my account or on their websiteThey can't link to it or show where that appears in their terms of useAdditionally, even according to the message they referenced, it says "This MAY require you to mail a payment" (emphasis mine)When looking at my account, it appears totally active, with scheduled payments activeA rational person would certainly rely on that representation and conclude that since I signed up for scheduled payments within days of receiving their takeover notice, I am not one of those that is requiretd to mail an additional payment

Initial Business Response / [redacted] (1000, 5, 2015/09/16) */ The participant used her debit card on June 4, Due to IRS substantiation requirements (IRS Code Section 1.125-6(b)(2), 1.125-6(d)(7)), documentation of the expense was required in order to approve the transaction as an eligible expenseNo documentation for the claim was received within days, the claim was denied, and the card suspended on August 25, Even though the claim was denied, the service provider remains paid Discovery Benefits received documentation for the June 4, claim on September 10, The documentation did not include a date of service or type of service and was deniedA denial notification was sent to the participant on September 15, The participant also used her debit card on July 20, Due to IRS substantiation requirements, documentation of the expense was required in order to approve the transaction as an eligible expenseDocumentation for this claim has not yet been receivedIf sufficient documentation is not received within days of the payment, the claim will be denied due to an overdue receiptThe service provider will remain paid The participant's debit card will be suspended until eligible documentation has been received Discovery Benefits has advised the participant that an Explanation of Benefits from the service provider will provide the information necessary to substantiate the claims and re-activate her debit card

The plan in which this participant is enrolled is an employer-sponsored plan governed by IRS regulations and plan rules as defined in the employer’s plan document and summary plan description Discovery Benefits provides administrative services on behalf of employers pursuant to service contracts with the employer IRS rules governing substantiation requirements for the flexible spending accounts require that all claims must be substantiated, even those paid using the debit cardSubstantiation documentation must provide information describing the service or product, the date of the service or sale and the amountSee 1.125-6(b)(2) and 1.125-6(3)(i) Credit card or payment receipts do not normally meet the substantiation requirement as they do not include the date or type of service incurred.Notices have been sent to the participant advising her what information is missing The participant will want to submit documentation containing the additional information, as well as the other information required by the IRS It is important to note that documentation is processed at face value, meaning only documentation received with the request is reviewed Due to the volume of documentation received, we cannot review documentation sent to us previously to determine if it could be combined The participant needs to submit all required documentation at the same time.If the participant has any questions about what is needed, we recommend she contact Discovery Benefits so we can help answer her questions

Initial Business Response / [redacted] (1000, 5, 2015/06/23) */ The participant filed a claim through the online portal on June 10, The documentation submitted included only a previous balanceIRS regulations require that documentation include a date of service, type of service, and dollar amount Due to the lack of required information, the claim was denied on June 11, The participant contacted Discovery Benefits on June 11, 2015, the same day the claim was deniedThe participant called several times as well on June 12, 2015, June 15, 2015, June 16, and June 17, The participant was advised to submit an explanation of benefits (EOB) so the claim could be reprocessed The participant submitted additional documentation on June 11, via emailThe email did not include a claim number or a form so the documentation could not be processed and was put into a research status (a form or claim number is required to process any incoming documentation)During one of the calls on June 16, 2015, the claim number was provided and the claim was submitted for reprocessing The participant was told on June 12, that the customer service representative would have the claim approved right awayThis was not accurate as customer service representatives, while they may request the reprocessing of a claim, do not have the authority to approve claims During a call with Discovery Benefits on June 15, 2015, the participant requested to speak with the customer service representative that advised she would approve the claimWhen advised that customer services representative was not in the office, the participant requested to speak with a supervisorBecause no supervisor was available at the time, the customer service representative requested a call back number for the participant and advised that a supervisor would call him back within hoursThe participant indicated he would holdThe customer service representative advised that because there were other calls in queue she would not be able to allow him to hold and again advised that a supervisor would call the participant back within hoursThe participant again indicated that he would holdThe customer service representative again advised that there was not an option to hold for a supervisorThe participant advised that he would just wait for the customer service representative to hang up on himThe customer service representative thanked the participant for his call and ended the call After reviewing the most recent documentation, it was determined the claim cannot be approved because the date of service was outside of the current plan yearThe plan year runs April 1, through March 31, The documentation submitted shows a December 9, date of service, which is outside the current plan yearIRS regulations require that claims must be incurred during the plan year in order to be eligible for reimbursementAll funds from the prior plan year election have been exhausted for this participantA notice advising of the claim denial will be sent to the participant

Discovery Benefits is a third party administrator that provides reimbursement account administrative services for employer-sponsored benefit plans pursuant to service contracts with the employerThe participant was enrolled in an employer-sponsored dependent care flexible spending account (FSA) for the January – December 31, plan year These plans are governed by IRS regulations and the rules outlined in the employer’s plan document and summary plan description.According to the employer’s plan design for the dependent care FSA, terminated employees are allowed days from the date of termination of employment to submit for reimbursement eligible expenses incurred prior to the termination dateThis information is included in the Summary Plan Description provided by the employer to participants upon enrollmentThe participant’s final service date was August 29, and the final filing date was November 28, This information was available on the participant web portal when the participant logged into her account on September 18, and November 21, Funds that are forfeited under IRS regulations are returned to the employer’s plan and are not retained by Discovery Benefits

Discovery Benefits is a third party administrator that provides pre-tax reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees or participants The participant’s termination of employment date as reported to Discovery Benefits was October 12, According to the design of the plan under which she was enrolled, the participant’s final filing date was January 10, Due to confusion on the part of the customer service representative with whom the participant spoke, an exception was made to allow the documentation after the final filing date The participant’s documentation has been accepted and the claims reprocessed and paid on April 4, Discovery Benefits places the utmost importance on customer service and we take participant feedback very seriouslyUpon review of this participant’s experience, a training concern has been identified and addressed with the appropriate teamWe apologize for the customer service experienced by this participant

Initial Business Response / [redacted] (1000, 5, 2016/03/04) */ Discovery Benefits is a third party administrator that provides pre-tax reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees or participants Discovery Benefits received a call from the participant's spouse on January 6, As she is not an authorized representative for the account, Discovery Benefits could only provide general informationShe had questions about a debit card being declined at the merchantThe claim was denied due to the merchant code not being a code used by medical or dependent care networksThe participant's spouse was also provided with information on how she could be designated as an authorized representative for the account and how to complete the necessary Dependent Care Form Discovery Benefits received a call from the participant on February 9, The participant was assisted with logging into the participant portal and locating the Dependent Care form The participant contacted Discovery Benefits again on February 25, and requested confirmation that he was completing the form correctly Discovery Benefits received a completed Dependent Care form on Thursday, February 25, A claim was processed on Monday, February 29, 2016, within Discovery Benefits' two-business day turnaround timeThe first reimbursement was sent on March 1, Under IRS regulations, reimbursement from the Dependent Care Account can only be made up to the balance in the account at the time the request is madeAny remaining amount will be reimbursed as contributions are made to the account Initial Consumer Rebuttal / [redacted] (3000, 7, 2016/03/05) */ (The consumer indicated he/she DID NOT accept the response from the business.) Discovery Benefits provided INCORRECT information to my spouse AND provided the documents, which were the INCORRECT documents for reimbursementMy husband can not wait over an hour to speak with any representative, as he needs to WORKDiscovery Benefits does NOT answer calls in a reasonable manner, which makes something such as a reimbursement, almost impossible to doIf it takes minutes to answer your phone calls, shouldn't the cs representatives give accurate information, in the most apologetic fashion, and NOT be argumentative? ??? My husband and I have contacted Discovery benefits before the card was charged, to be sure it would go throughThen we contacted them AGAIN once it was declinedThen my husband contacted them again AND had to resend the copy of the receipt, not once but TWICEThen he called to make sure it was receivedOnly to be told it was THE WRONG FORM AND HE WOULD HAVE TO RESEND ANOTHER FORM!!! Each time he calls or I call, it takes well over minutes just to answer the phone! We have better things to do than wait for this company to handle the call volume that they clearly CAN NOT handle! Only since I have escalated this to the Revdex.com had discovery benefits claimed to mail out our checkThis company clearly does NOT wish to reimburse any of its customers and makes you jump through hoopsWe should not have waited until March for a reimbursement that we were told only takes days!!! Our reimbursement has been sitting for weeks!! We had a supervisor say that they would escalate the process of our reimbursement since THEY failed to send my husband the correct form for my sons day care expenseWe had to keep calling and calling UNTIL this was escalatedStill no reimbursement checkDiscovery Benefits is NOT providing customer service or ANY type of service in timely mannerThey probably do this, hoping that the experience will sour ANYONE from pursuing reimbursements

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees or participants Due to the amount of personal information required for a complete response, Discovery Benefits will send a letter directly to the participant and not respond through the Revdex.com

Initial Business Response / [redacted] (1000, 5, 2015/05/26) */ We are in receipt of direct correspondence from this individual concerning another individual's coverage and are mailing a letter directly to the covered individual in this matter Discovery Benefits provides COBRA administrative services for the former employerDiscovery Benefits is not an insurance carrier and does not exercise control over the records of insurance carriersDiscovery Benefits remits premiums it receives from qualified beneficiaries to the employer on a monthly basis Discovery Benefits received and processed the individual's election form on February 13, According to standard process, Discovery Benefits notified Blue Cross Blue Shield of Texas (BCBSTX) of the reinstatement of coverage effective February 1, on February 18, using the contact information provided to us on behalf of the former employer Discovery Benefits was first advised that coverage was not active on March 3, Because the standard processing time of business days had not yet passed since the initial enrollment, Discovery Benefits did not re-submit a request to the carrier at that time Discovery Benefits received notification on March 24, that coverage was not updated with the carrierThe Discovery Benefits representative advised that the carrier could contact Discovery Benefits directlyDiscovery Benefits received a call from a BCBSTX representative on March 26, The representative indicated that coverage was not yet updated in the BCBSTX systemWhen the Discovery Benefits customer service representative confirmed the contact at the carrier, the BCBSTX representative did not suggest that it was incorrect, only asked that the information be sent again Discovery Benefits received three calls from a different representative with BCBSTX on April 1, This representative inquired as to how the information was being sent to BCBSTX as the information was still not updated in their systemDiscovery Benefits sent another urgent update request to BCBSTX while on the phone with this representativeDuring the last call with this representative, she provided a different contact email addressDiscovery Benefits sent another request to the email address provided Discovery Benefits received confirmation on April 6, that coverage had been updated According to our standard process, Discovery Benefits notified BCBSTX on May 11, of the termination of coverage effective April 1, due to the non-payment of premium Discovery Benefits received an email on May 19, indicating that BCBSTX had not received any notification from Discovery BenefitsDiscovery Benefits reached out to BCBSTX again to confirm coverage on May 20, Discovery Benefits received confirmation from BCBSTX again on May 21, that coverage had been reinstated

Due to the amount of personal information required to fully respond to the participant, Discovery Benefits will send a response directly to the participant