Sendero Health Plans

Than
size="3">k you for the opportunity to address the concerns mentioned within this complaintSendero Health Plans’ (Sendero) Member Advocate spoke to Mrs*** on January 6, We advised the member that we did not have any request on file for home health services by her referring provider
We informed Ms*** that her Case Manager (CM) had contacted the referring provider on December 29th, 2016, and advised the provider that a request for home health was needed in order to proceed with approvalAs of January 6, 2017, Sendero does not have a request from the provider for the service
Ms*** was advised that she had not made her premium payment for JanuaryMs*** was assisted on how to make a payment so she could obtain her medication which was mentioned during the conversation
Ms*** was referred to Case Management for additional assistance on obtaining the care she was seekingThe CM called Ms*** to provide assistance, but at that time she was not availableThe CM spoke to the home health agency, and they stated that they received the order for home health from Dr*** on January 3, 2017, but they had contacted the surgeon who submitted the orders in order to confirm the member’s location/residence and had not received a response Afterwards, the home health agency submitted a request, and it was approved for Ms*** to receive the serviceSendero understands how important member experience and satisfaction isWe will use this situation to assist us with
improving our processes going forward

The consumer contacted Sendero's customer service department at 1:PM on 1/6/regarding an attempt to obtain his son’s medicationThe consumer could obtain the prescription because his premium payment had not been posted to his accountThe consumer was advised that his payment was not
posted, but that it had been received and it be processed as soon as possible.The consumer made a payment on 12/28/2015, and it posted to his account on 1/7/2016; there was a slight delay in posting the payment due to the holidayThe consumer's ID Cards were mailed on 1/7/after the premium payment was posted to the accountOn 1/7/at 10:AM the consumer was advised that the RX was ready for pick up, and the consumer picked up the prescription on 1/8/Sendero will review the payment posting process, and we will make improvements to assist with preventing this concern in the futureWe appreciate the opportunity to be able to assist with resolving this complaint. Sincerely,Sendero Health Plans

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Regards,
*** ***

February 9,
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*** ***
Revdex.com Corporate Office
La Posada Drive
Austin, TX
On 2/1/2016, Sendero Health Plans (Sendero) received complaint ID *** which was filed with the Revdex.com on 1/28/We appreciate the opportunity to respond and provide you the resolution to the complaint presented
The complainant was enrolled with Sendero effective 5/1/2014. Sendero mailed the subscriber two invoices which totaled $to ensure continued coverage. The complainant’s health coverage was later canceled for non-payment on 8/31/per CMS guidelines. The subscriber does not have a balance with Sendero for the benefit year
On In January 2016, CMS sent Sendero an enrollment segment for 2016. The subscriber was sent an invoice due to the active enrollment segment sent from CMS. After the subscriber contacted CMS, CMS provided Sendero guidance to terminate the current coverage for the subscriber effective 2/12/
Sendero staff contacted the subscriber on 2/4/at 4:PM regarding this concern. On 2/9/at 12:PM Sendero staff spoke with the subscriber and confirmed no payment is due. In addition, the subscriber was ensured that Sendero received the term segment from CMS for the benefit year and no payment is due
Sendero understands how important member experience and satisfaction is. We apologize for the inconvenience created due to the subscriber receiving an invoice, and we will use this situation to assist us with improving the process going forward
Again, thank you for the opportunity to respond to this complaint and assist the subscriber

Thank you for the opportunity to address the concerns mentioned within this complaintSendero Health Plans’ (Sendero) Member Advocate spoke to Mr*** todayMr*** received a letter that he "Voluntarily Withdrew", therefore, he inquired about the status of his January refundOn December
21, Sendero received an eligibility file from the Marketplace indicating that Mr*** voluntarily withdrew his enrollment application with SenderoAt this time, Sendero’s Advocate attempted to explain what information was received from the Marketplace, but Mr*** stated that he enrolled in another planOn February 3, Mr*** called Sendero’s Customer Service Department, and was advised that his refund check would be mailed in two - four weeksA refund check was mailed to Mr*** on February 13, Mr*** should expect the check within five to seven business daysSendero understands how important member experience and satisfaction isWe will use this situation to assist us with improving our processes going forwardAgain, thank you for the opportunity to respond to this complaint

March 8, *** *** Revdex.com Corporate Office La Posada Drive Austin, TX On March 2, Sendero Health Plans (Sendero) received complaint ID *** which was filed with the Revdex.com on February 24, We appreciate the opportunity to respond and provide you
the resolution to the complaint presentedThe complainant obtained active health coverage with Sendero on January 1, 2016. On February 24, 2016, the complainant contacted Sendero for a refund for January due to her termination request. Sendero directed the complainant to also contact the Marketplace/CMS in order to complete her request to terminate her coverage. As of today, the complainant has not paid a full month’s premium. Sendero’s process is to mail ID cards and member materials once the member has paid their monthly premium in full Subscribers who have not paid their premium in full will only receive an invoice and a welcome letter which explains payment directions, options and locationsThe complainant did not receive her ID cards due to her January balance. Therefore, no claims are on file for this member as she did not receive an ID card to receive services. The complainant’s health coverage will be canceled on March 10, per CMS’s direction and not January 1, as the complainant requested. On February 25, 2016, CMS sent Sendero a file with direction to terminate the member effective March 10, 2016. Sendero understands how important member experience and satisfaction is. We apologize for the inconvenience the complainant experienced, and we will use this situation to assist us with improving the process going forwardAgain, thank you for the opportunity to respond to this complaintSendero Health Plans

Thank you for the opportunity to address the concerns mentioned within this complaintWhen Sendero Health Plans (Sendero) originally received this member’s reenrollment file from the Marketplace Exchange, on October 31, 2016, Mr*** was given a $advanced premium tax credit (APTC)
On November 2, an invoice was mailed to Mr*** with the new premium amount of $484.00, because Mr*** updated his information with the Marketplace Exchange his APTC increased to $ On January10, Sendero received an escalated ticket from the Marketplace Exchange advising us that the member’s APTC had increased, and to make the necessary updates as we had not received and updated file with the APTCMr***’s account was updated on January18, 2017, and a letter was sent to the member advising him of the updateSendero tried to contact the member via the number listed account which is what Sendero received from CMSThe attempts to reach Mr*** were not successful because the rings busy / unreachable. Sendero’s last attempts to reach Mr*** was today, January 19th at 8:AM and January 18th at 12:PM. The overage of $that Mr*** paid for January has been credited to his amount due for February Sendero understands how important member experience and satisfaction isWe will use this situation to assist us with improving our processes going forwardAgain, thank you for the opportunity to respond to this complaint

Sendero Health Plans website is full of bugs and glitchesI could not use it to find a doctor that is covered on a healthplan I pay them forI tried calling, but was able to reach only robots that placed me on hold for thirty minutes before dropping me offI have called three doctors directly and none of them accept SenderoBuyer beware, Sendero has already cost me hours today and I still do not have a doctor nor am I any closer than when I began

Complaint: ***
I am rejecting this response because: they did not clearly communicate any of this information to me, clearlyThe right hand does not know what the l ft hand is doing in their offices. They falsified their recordsMy phone has not been disconnected, has never been disconnectedThey did not record all of the times I called and was given incorrect information. Also, in regards to the coverage question, this was not the first time I had called to ask about my coverageI spoke with an individual in April who confirmed that a procedure would be coveredIt was notThis was for a colposcopy I had to have performedMy husband and I ultimately decided it would be easier to just not pay out insurance bill and get cancelled as opposed to dealing with Sendero any longerThis experience has been terribleI have never worked with such an awful insurance company before
Regards,
*** ***

Thank you for the opportunity to address the concerns mentioned within this complaintSendero Health Plans’ (Sendero) Member Advocate spoke to Ms*** on 2/1/Ms*** enrolled with IdealCare effective 1/1/2017. At the same time, Ms*** called IdealCare, because someone referred her
to our off-exchange plan and she enrolled againThis additional coverage had the effective date of 2/1/2017. Per Ms*** she did not want an off-exchange plan On 1/19/she spoke to IdealCare’s customer service department, and she confirmed her eligibility, in-network doctor, and was able to obtain her medicationBetween 1/19/and 1/23/our customer service department assisted her with cancelling her off-exchange plan, and Ms*** was reinstated on her on-exchange planAt the conclusion of the phone call on 2/1/2017, Ms*** was satisfied that her account was corrected Sendero understands the importance of member satisfactionWe will use this situation to assist us with improving our processes going forward Again, thank you for the opportunity to respond to this complaint

January 8, 2016*** ***Revdex.com Corporate OfficeLa Posada DriveAustin, TX 78752On December 31, 2015, Sendero Health Plans (Sendero) received complaint ID *** which was filed with the Revdex.com on December 8, We appreciate the opportunity to respond and provide you the
resolution to the complaint presented.The complainant obtained active health coverage with Sendero on June 1, 2015. The complainant’s health coverage was canceled for non-payment on September 16, 2015; per CMS guidelines, the complainant’s health benefits termed on August 1, 2015. On September 17, the complainant submitted one monthly premium payment after his coverage canceled which initiated Sendero’s refund process. Sendero’s refund process can take up to weeks after the request is received and validation is complete. On October 14, 2015, the refund request was sent to Sendero’s finance department, and the complainant’s refund was mailed on December 2, 2015. Two days after this complaint was filed with the Revdex.com the refund was deposited/cashed on December 10, 2015. Sendero understands how important member experience and satisfaction is. We apologize for the length of time it took to process this refund, and we will use this situation to assist us with improving the process going forwardAgain, thank you for the opportunity to respond to this complaint

From: *** *** [mailto:***] Sent: Tuesday, March 21, 10:AM To: *** *** ***g> Subject: Id#*** Howdy,As requested on the phone:I spoke with sendero and they have agreed to fix the issue.please cancel the complaint.Thank
you. *** ***~Steel is hard because it has felt the hammer and seen the fire~Say what's right, few will listen; do what's right, and there's no need to say anything

September 16, *** ***, Dispute Resolution Specialist Revdex.com serving Central, Coastal, Southwest Texas and the Permian Basin Soledad StSteSan Antonio, Texas On September 14, 2016, Sendero Health Plans (Sendero) received complaint ID *** which was filed with the
Revdex.com on July 26, We appreciate the opportunity to respond and provide you the resolution to the complaint presentedSendero reviewed the complainant’s account which reflected on July 25, the member contacted Sendero, because she could not get her medications Customer Service advised the member that the reason she could not get her medication was because her premium had not been paid in full According to Sendero’s records, the member was enrolled in the automatic monthly back draft program, but her March-May transaction attempts returned non-sufficient (NSF)On June 20, the member was advised of the NSF barrier, and she made a payment on June 21, for March and April. On July 6, she paid her premium for May and June As of today, the member owes her premiums for both July and August. In regards billing codes, the member called on Friday, March 25, to ask if a particular code was covered (a benefit). The Customer Service Representative wanted to confirm the answer with her manager, who was not available, and asked if she could call her back after she received confirmation. The member agreed, and on Monday, March 28, the Customer Service Representative attempted to contact the member to advise her that the specific code was a covered, but the member’s phone was disconnected or out of serviceSince March 28, 2016, Sendero has made several attempts to contact the member on four different occasions, and she has not returned the phone calls or voicemail Sendero called the member on July 26, 2016, July 27, 2016, August 2, and August 8, 2016. Sendero understands how important member experience and satisfaction is. We will use this situation to assist us with improving our processes going forwardAgain, thank you for the opportunity to respond to this complaintSincerely, The Member Services Team

Thank you f
"letter-spacing: 0.05pt;">or the opportunity to address the concerns mentioned within this complaintOn 2/1/2017, Sendero Health Plans' (Sendero) Member Advocate spoke to Ms[redacted] who stated that she did receive her member ID card and Welcome PackageAfter reviewing Ms[redacted]'s account her ID card and Welcome Package were mailed on 1/3/ During the conversation, Ms[redacted] was asked if she received any medical care, prescriptions, and if she was not able to provide insurance information during those encountersMs[redacted] stated that she did go to a doctor's appointment, and she could not provide insurance information at the time of the visitOur Member Advocate offered to call the doctor's office to confirm eligibility, but Ms[redacted] could not recall the doctor's name that she had the appointment with Sendero understands the importance of member satisfactionWe will use this situation to assist us with improving our processes going forward Again, thank you for the opportunity to respond to this complaint

Thank you for the opportunity to address the concerns mentioned within this complaint. On 2/1/2017, Sendero Health Plans’ (Sendero) Member Advocate spoke to Ms. [redacted] who stated that she did receive her member ID card and Welcome Package. After reviewing Ms. [redacted]’s account her ID card and Welcome...

Package were mailed on 1/3/2017.   During the conversation, Ms. [redacted] was asked if she received any medical care, prescriptions, and if she was not able to provide insurance information during those encounters. Ms. [redacted] stated that she did go to a doctor’s appointment, and she could not provide insurance information at the time of the visit. Our Member Advocate offered to call the doctor’s office to confirm eligibility, but Ms. [redacted] could not recall the doctor’s name that she had the appointment with.   Sendero understands the importance of member satisfaction. We will use this situation to assist us with improving our processes going forward.   Again, thank you for the opportunity to respond to this complaint.

Thank you for the opportunity to address the concerns mentioned within this complaint.  Sendero Health Plans’ (Sendero) Member Advocate spoke to Ms. [redacted] on January 11, 2017. After speaking to Ms. [redacted], she stated that she was concerned as she had not be able to reach our Customer...

Service Department last week. On Tuesday, Ms. [redacted] received a voicemail asking if she wanted a call back from our Customer Service Department’s automated system do the overwhelming number of calls being received.  Ms. [redacted] responded that she did want a call back, and a Customer Service Representative called her. She stated that she did need additional assistance with obtaining an appointment with a primary care physician, and she was assisted and an appointment was scheduled.  Ms. [redacted] confirmed that her premium is $4.90 not $650.00. Ms. [redacted] was satisfied with the follow up she received, and did not need any additional assistance. Ms. [redacted] also stated that she would remove the complaint as she was satisfied with the outcome.

The consumer contacted Sendero's customer service department at 1:15 PM on 1/6/2016 regarding an attempt to obtain his...

son’s medication. The consumer could obtain the prescription because his premium payment had not been posted to his account. The consumer was advised that his payment was not posted, but that it had been received and it be processed as soon as possible.
The consumer made a payment on 12/28/2015, and it posted to his account on 1/7/2016; there was a slight delay in posting the payment due to the holiday. The consumer's ID Cards were mailed on 1/7/2016 after the premium payment was posted to the account. On 1/7/2016 at 10:41 AM the consumer was advised that the RX was ready for pick up, and the consumer picked up the prescription on 1/8/2016.
Sendero will review the payment posting process, and we will make improvements to assist with preventing this concern in the future.
We appreciate the opportunity to be able to assist with resolving this complaint.
 
 
Sincerely,
Sendero Health Plans

Thank you for the opportunity to address the concerns mentioned within this complaint.  Sendero Health Plans’ (Sendero) Member Advocate spoke to Mrs. [redacted] on November 8, 2016.  Sendero has a filed PHI form allowing Mrs. [redacted] access to [redacted]’s account who is the member...

enrolled.  The Member Advocate explained to Mrs. [redacted] that her spouse’s (Mr. [redacted] / subscriber) account was termed, because Sendero did not receive the August premium payment prior to the due date; the last day to pay August’s premium payment was on August 31, 2016, and Sendero did not receive the August premium payment until September 23, 2016.     The initial file from the Marketplace Exchange included enrollment for the subscriber for the Gold Plan.  The premium rate was $269.89, and then the subscriber changed to the Silver Plan with a premium rate of $228.66. On January 21, 2016 Sendero received a HICS (CMS Escalation) ticket to update the subscribers file as he had changed from the Gold to the Silver Plan effective January 1, 2016. The file was updated on February 17, 2016.   The premium payments received by the subscriber are listed below: ·         December, 28 2015 the initial payment for the January was received; premium amount paid was $230.00 which resulted in the subscriber credit of $1.34 towards February’s premium ·         January 27, 2016 a premium payment of $60.00 was received; at this time the subscriber had a credit of $61.34 that went towards his February’s premium. ·         February 19, 2016 a premium payment of $175.00 was received; the subscriber had credit of $7.68 towards his March premium. ·         March 16, 2016 a premium payment of $235.00 was received; the subscriber had credit of $14.02 towards his April premium. ·         April 15, 2016 a payment of $230.00 was received; the subscriber had credit of $15.36 towards his May premium. ·         May 25, 2016 a payment of $230.00 was received; the subscriber had credit of $16.70 towards his June premium. ·         June 28, 2016 a payment of $235.00 was received; the subscriber had credit of $23.04 towards his July premium. ·         August 5, 2016 a payment of $229.00 was received for July; the subscriber had credit $23.38 towards his August premium.  ·         September 23, 2016 a payment of $240.00 for August; the subscriber was termed because the August payment was 23 days late. o   On August 8, 2016, a grace period letter was sent to the subscriber to inform him that the August payment needed to be received by August 31, 2016.   The information above was advised to Mrs. [redacted].   Sendero owes the credit of $263.38 to the subscriber. Sendero refunded $240.00 on November 8, 2016 via reversing the credit card payment received on September 23, 2016. Sendero has issued a refund check in the amount of $23.38.   Sendero understands how important member experience and satisfaction is.  We will use this situation to assist us with improving our processes going forward.   Again, thank you for the opportunity to respond to this complaint.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Regards,
[redacted]From: [redacted] [mailto:[redacted]] Sent: Wednesday, January 11, 2017 12:57 PM To: info <[email protected]> Subject: Complaint #[redacted] Regarding my complaint lodged against Sendero Health, I would like to withdraw the complaint after I was contacted by them by 2 different people who addressed and resolved my issues and had adequate explanations of why there were issues in the first place. I'm not sure if this is the proper way to proceed, but I didn't see a way to do so on the Revdex.com website.Thank you,[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Regards,
[redacted]
From: [redacted] [mailto:[redacted]] Sent: Wednesday, January 11, 2017 12:57 PMTo: info <[email protected]>Subject: Complaint #[redacted]
 
Regarding my complaint lodged against Sendero Health, I would like to withdraw the complaint after I was contacted by them by 2 different people who addressed and resolved my issues and had adequate explanations of why there were issues in the first place.
I'm not sure if this is the proper way to proceed, but I didn't see a way to do so on the Revdex.com website.
Thank you,
[redacted]