ComplaintsforCoventry Health Care, Inc.

• Initial Complaint

  04/16/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  DO NOT DEAL WITH THIS COMPANY (FIRST HEALTH OPEN ACCESS PPO) My partner and I recently moved to the USA and were seeking health insurance. After searching briefly online and imputing her phone number, she was contacted by a First Health agent. This agent rushed my partner to sign up that day, as she was told if she didn't pay her first month immediately, she would have to wait an entire month before being covered. The agent gave my partner (verbally) figures for our co-pay, deductible, and out of pocket, as well as including two free dentists appointments and two free vision appointments per year. We paid the agent, and were told our cards would arrive within 7-10 days. We never received any documentation email from the company, just what was verbally spoken over the phone. We were not told that this is NOT HEALTH INSURANCE, but a discount program. It took me a whole day of phone calls, being transferred endlessly, before being told that i signed up for a discount program and that in the case of a catastrophic health event, I was not covered. There were no free dentists appointments, and the co-pay and deductible that were promised do not apply to discount programs. It has been 23 days and we have not received our cards from this company, I imagine they are waiting until the 30 day cancellation period is up before we receive our cards (if we ever will.) We called to cancel and were told verbally that our plan is cancelled, but again, received no confirmation email. I am now aware what a PPO is, and I know that i am to blame for not researching that correctly, but I believe that the agent was predatory to rush the sale, and lead us to believe that we were receiving health insurance. Our only saving grace is that we recorded our phone call with the agent who made these false promises, and we hope that will benefit us when we seek our full refund.

  Business response

  05/12/2023

  Dear Dispute Resolution team,

  Please see our response to complaint # ******** for *********************** that was received by us on May 11, 2023. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the complaint, we immediately reached out internally for review. We confirmed that a First Health plan does not exist, their only purpose is to sell preferred provider organization (PPO) networks to health plans. First Health is only listed on the member identification card because they provide a service to the actual health plan. A member of our First Health team contacted **************** today, to advise. However, **************** stated he received a refund from his credit card company and is satisfied with the outcome.

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ******’s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at [email protected].
  
  Sincerely,

  Sincerely,

  ************
  Analyst, Executive Resolution
  Executive Resolution Team

• Initial Complaint

  04/04/2023

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  I had lost my job and I was looking online for for *** health insurance (*********). I was looking at the plans and wanted some help with finding a plan that suits my needs and not cost me a financial hardship. I called the number thinking it was the legitimate site. Apparently it was not. This company told me that my primary care doctor accepts this insurance which they didn’t. It was an absolute nightmare dealing with this company. They charged me $153 for the first month and $103 dollars monthly after that. Company name: First Health Network- Bethany Preventive. They mislead me all the way through. I tried canceling this insurance but they gave me a hard time. I had to show proof of my new insurance or else they wouldn’t start the cancellation process. I canceled another insurance and I didn’t have to show proof and they sent me a cancellation email immediately. This company is very difficult to deal with. I just want to cancel this policy because I signed up with another company. I don’t think it’s any of their business who I signed up with or who my primary care doctor name is. I wanted to cancel right after I signed up and wanted a refund but they refused to do it. They gave me false information. After a lot of run around I just stayed with this bad company and prayed I’d get a job and get health insurance through my employer. But I still don’t have a job so I switched insurances so I can keep all my doctors. I don’t know what kind of company they are but they are awful. They prey on people’s misfortunes. I canceled this insurance today 4/4/2023. I don’t want them to charge anymore premiums on my credit card. Please expedite ASAP. Thank you.

  Business response

  04/21/2023

  Dear **********************:

  Please see our response to complaint ******** for ***************************;that was received by us on April 17, 2023. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the consumers concerns, I immediately reached out internally to our First Health point of contact. He advised he made outreach to the member directly to obtain additional information to help identify where the issue occurred. With the additional information ****************** was able to provide, he was able to coordinate the appropriate outreach and both carriers have agreed to refund the member her money and she's satisfied with the outcome. I was informed this was not an issue with First Health.

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **. *********************;concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *****************.

  Sincerely,
  Destiny S.
  Analyst, Executive Resolution Team

  Customer response

  04/26/2023

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  

  ---------- Forwarded message ---------
  From: ********************* <********************>
  Date: Tue, Apr 25, 2023 at 4:55 PM
  Subject: Complaint ******
  To: Mybbb Info <[email protected]>
  

  
  Hello,

  
  

  I would like to close out my complaint. It was rectified by the company. 

  Complaint #******.

  
  

  Please advise what steps I need to take.

  
  

  Kind Regards,

  *********************
  Regards,
  
  *****************************
  

• Initial Complaint

  05/19/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I was not at all knowledgeable about health insurance, so I ******* ********* exchanges and this ad site was the first that popped up- https://*********-enroll.org/affordable-care-act-plans-and-health-insurance-quotes I filled in some info in this site, and immediately got a call from an insurance adjuster telling me about a zero deductible plan for around 250. This was on April 18th. I was eager to be done with this, so I said yes and signed up. Later, I realized that they had no out of pocket limit for if something huge happens, and I realized I made a big mistake. I discovered that they have a policy where you get all your money back if you cancel within 30 days, so I called to cancel May 6. They passed me around quite a bit, but finally I reached the policy adjuster who originally sold me the policy. He confirmed that the policy was cancelled, and that I would be able to receive my refund soon. I was passed to someone else, who told me that I would receive a confirmation email in a couple days and then my refund would go through. I waited a while, and sent an email to customer service, but nothing happened. I called this morning and was passed around to several people, put on holds that would just go dead after several minutes, etc. I spoke with a woman named Angie who said that the record showed I cancelled the policy on May 6, but it had just gone through today. When I asked for an email confirmation that my policy was cancelled immediately, someone name Marisol Flores from something called Association Health Care Management, Inc. finally sent me an email that just said "Member cancellation" when I asked about a refund, she started pretending she could not hear me or that I was on mute, and the line went dead after several seconds. I called back at the number in her email, and a man answered saying that my previous cancellation was not valid because I had not done it with the right people. He put me on hold, then the line was hung up after a few minutes.

  Business response

  05/24/2022

  Dear ********************************************************: 
  
  Please see our response to complaint #******** for ************************* that was received by us on May 22, 2022.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the members concerns we immediately reached out to our contact with ***** ******. Please note that ***** ****** does not sell insurance policies. They provide a rental PPO network, which allows access to discounted rates with Aetna providers. We reached out to the agent that sold the product and confirmed the member should be cancelled. The plan has been cancelled by the agent, and a refund will be processed. We requested an outreach be made to the member to discuss this outcome. Any further inquires should be directed to ***** ******, as the product is not sold or administered by Aetna.
  
  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **. ********* concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *****************.
  
  Sincerely,
  
  William B.
  Complaint and Appeals Analyst
  Executive Resolution Team

• Initial Complaint

  05/16/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On or about February 16, 2022, we needed affordable health insurance and we came across First Health. We called them and spoke to Tristen and we told her we were looking for health and dental insurance. She gave us a few quotes. While talking to her I asked her what was the name of the insurance company she worked for and she kept telling me First Health ran by AETNA. We finally settled on a dental and health plan for $375.90/per month. We had to pay them that same day with our debit card. She then proceeded to give me an ID#: ******. She said the cards would be mailed to us. A few days later I received a discount card for the dental insurance, which was not what we wanted. I canceled the dental portion of the plan with Tristen as it was not what we wanted and it was sold to us as an insurance plan. Tristen told me the health insurance cards were on the way. March 16, 2022 rolled around and it was time for another monthly payment which we did not know when the monthly due date was, as we had not received correspondence from them. They kept calling, emailing, and texting me asking for the monthly payment. I called back on March 18, 2022 and spoke to ******* and told her that I had not received our insurance cards yet. ******* then proceeded to tell me that they do not usually send out insurance cards, but she would put one in the mail for us. I should get it within 1-2 weeks. I then paid her our monthly payment of $345.95 with our debit card. Two weeks passed and I did not get the insurance cards, so we decided to investigate First Health ******************************** April 16, 2022 rolled around, they kept calling and emailing me because we closed our debit card account. I cancelled the insurance with Tristen; and I told her that I wanted my money back from First Health which was $721.85. Tristen told me that I would not get my money back. It is very sad these days that AETNA has become an insurance company scamming the elderly.

  Business response

  05/27/2022

  
  Dear **********************************************:

  Please see our response to complaint ******** for ***** ***** that was received by us on May 22, 2022.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the members concerns, we immediately reached out internally to have a complete review done. First Health tried to contact the member. No return calls or returned emails were received. Therefore,the policy has been terminated and a month of premiums were issued to **************,the policyholder, for herself and her spouses coverage.

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address Mr. Youngs concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *****************.

  Sincerely,
  Destiny S.
  Complaint and Appeals Analyst
  Executive Resolution Team

  Customer response

  06/03/2022

  [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 as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:
  
  

  ---------- Forwarded message ---------
  From: *********************** <************************>
  Date: Fri, Jun 3, 2022 at 12:38 AM
  Subject: Re: You have a new message from the BBB of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #********.
  To: Better Business Bureau <[email protected]>

  
  

  Thank you for your help in this matter, I only wish we were getting the full amount back. But we will take the month's premium. Is it being sent by check in the mail, as we will not be giving them our new debit account number?

  
  Regards,
  
  *********************
  

  Business response

  06/07/2022

  Dear ********************************************************: 
  
  Please see our response to complaint #******** for ********************* that was received by us on June 03, 2022.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
  
  We reviewed the members request. Please be aware that First Health is not an ************* nor a subsidiary. The members coverage is not with *****. First Health has purchased access to ****** provider network, but is a free standing company of its own. As a courtesy, our Network liaison with First Health passed along the members request to a contact with First Health, who independently resolved the members request and attempted to reach out to them via phone and email. Aetna has no access to details about the members refund, and ************** will need to reach out directly to First Health for more details about the method of the reimbursement. 
  
  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **************** concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *****************.
  
  Sincerely,
  
  William B.
  Complaint and Appeals Analyst
  Executive Resolution Team
  

• Initial Complaint

  05/13/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received a statement for my decease husband, ******************************* with my name on it. I paid the statement with a settlement of $117.00 on November 10, 2021. ******** Health Care stated the account was paid in full. I have continued to receive statements for the amount of $59.91. I have contacted ******** Health Care regarding this amount on numinous occasions with continued telephone calls. They assure me that this account is paid in full but I continue to receive statements.

  Business response

  05/20/2022

  Dear ************************************************************:

  Please see our response to complaint # ******** for ************************* that was received by us on 05/18/2022. Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the complaint, we immediately reached out internally for review. Our Pharmacy team was unable to locate **. or *** *************** in the system. To assist further, we must have the identification number and/or date of birth for the member. Also, if the member can submit a copy of the bill, that will be very helpful. Once additional verifying information is received, we can continue our review of the members concerns.

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **.********'s concerns. If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *******@aetna.com.

  Sincerely,
  
  Shay G.
  Complaint and Appeals Analyst
  Executive Resolution Team

  Customer response

  05/21/2022

  [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 as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:
  
  Regards,
  
  *************************
  

• Initial Complaint

  03/06/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On December 27, 2021 I signed up for the temporary health insurance advertised by a third party broker ******** ****** ******** *****. I made it clear that I only needed health insurance for January due to my husband changing jobs. They assured me that they offered temporary insurance and said that I would have the option to continue if I chose. They said nothing about the plan automatically renewing, nor did they give me any information about billing dates or cancellation policies. By January 31, I hadn't received any further communication about my plan or that option to renew, so I called to make sure that it was indeed ending. I was told that I needed to talk to the actual insurance company, ***** ****** ***** Corp. I called ***** ****** and was told that I had already been billed for February, with no notice via email or any other method. The First Health employee told me that I could get a refund since I was given inaccurate information by the third party broker. She told me to send proof of my new health coverage to the customer care email, which I did. I never received a response. I followed up on February 7 and was told that the refund request had been denied because of the 5-day cancellation policy (which had NEVER been communicated to me). That employee put me on hold for over an hour. I eventually reached a voicemail and left a message. I never received a response. I followed up again on February 23 and spoke to someone who promised to have the Billing Director call me back. She never did. I followed up again on March 2 and spoke to the same person again. He said he was moving my case "up the line" and that the Billing Director would call me back within the next hour or two. She never did. Please, somebody help me with this. $440 for January was hard enough, but I wanted to do the responsible thing. We can't afford another $440 for benefits we never used and never asked for.

  Business response

  03/08/2022

  Dear *** ****** **********************:
  
  Please see our response to complaint #******** for *** ********* **** that was received by us on March 06, 2022.  Our Executive Resolution Team researched the concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the complaint, we immediately reached out internally to further research the member’s concerns. We have confirmed that additional information is needed, as we cannot locate the member’s plan that she is enrolled in, by the name and address she provided. We will need the member to relay her member identification number as well as the plan name that she is enrolled in. If the member can provide a picture of her member identification card, that would be helpful as well.
  
  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ****’s concerns. 
  
  Sincerely,
  
  Jessica B.
  Complaint and Appeals Analyst
  Executive Resolution Team

  Business response

  04/28/2022

  Dear ****** **********************: 
  
  Please see our response to complaint #******** for ********* **** that was received by us on April 23, 2022.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.
  
  Upon receipt of the member’s concerns we immediately reached out to ***** ****** to assist with our investigation. They confirmed that the member’s plan has been terminated. We confirmed that her premiums were refunded for February, and the refund for January is in progress. We have requested that a representative reach out to Ms. Head to answer any questions she may have. We also previously provided Jamie G*** as a point of contact for the member at ###-###-####. The member may proactively reach out if they choose.
  
  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address *** ****’s concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *******@*****.com.
  
  Sincerely,
  
  William B.
  Complaint and Appeals Analyst
  Executive Resolution Team
  

  Customer response

  05/01/2022

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. Thank you very much for your help in resolving this matter!
  
  Regards,
  ********* ****
  

• Initial Complaint

  11/05/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I got health insurance through the provider known as First Health. I asked to only have one month of insurance (September 2021) and to not be put on auto which the rep confirmed. I was told I would get my health insurance card in ten days which never happened, I was never told I needed to call and cancel which was the point of contest when I called for a refund. I never got any email or documents explaining I NEEDED to call and cancel my service, the original rep confirmed I would only be charged for the one month I asked for. Furthermore, the reps I spoke to were extremely unprofessional and told me it wasn't their problem since they were leaving (it was five minutes to 5pm on Friday) which is completely out of the question to say to a paying customer. I was told I would not be paid back, they would not pull the call, and they would not let me speak to a higher up. I literally have no way to attempt to collect unless I sue which I will have to because this is predatory and outright false information they are providing which is unlawful. I would like to be refunded for this past October which I never asked for, specifically said I did not want, and was not provided with any documentation or explanation how to cancel regardless of the fact that I specifically said I only wanted a month and no auto pay. They have illegally taken my funds from my account and this is grounds for a lawsuit.

  Business response

  11/17/2021

  Dear Dispute Resolution Team:
  Please see our response to complaint #******** for ************************** that was received by us on November 6, 2021.  Our Executive Resolution Team researched your concerns, and I would like to share the results of the review with you.

  Upon receipt of the complaint, it was noted that ************** had indicated that the insurance provider involved was First Health.  However, First Health does not offer individual insurance policies.  First Health is a program where other insurance carriers contract to use our network of providers.  Thus, our First Health Network team was asked to assist with locating the insurance carrier that **. ****** coverage was through.

  The Network team was able to reach out to some of the carriers that use the First Health Network and found that **. ****** coverage was through ******* ******** *****.  His concerns were then forwarded to ******* who were able to reach out to ************** and resolve the issue directly with him.

  We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address **. ****** concerns.  If there are any additional questions regarding this particular matter, please contact the Executive Resolution Team at *****************.
  
  Regards,
  **************
  Complaints and Appeals Consultant
  Executive Resolution Team

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