Complaint Review: Coventry Health Care - London Kentucky

Shortly after receiving my coverage this year; I developed painful and debilitating issues with my gall bladder (no previous history).  The condition sent me to the ER 3 times in the month of March alone, not to mention the myriad specialist visits and procedures required after that to diagnose a very common; but apparently difficult to diagnose condition.

I can say, I have been nothing but 100% pleased with the speed and reliability that Coventry has handled these claims.  I think the important thing is to understand your benefits and what they mean.  If you have any questions, as I did...a quick call to their customer service line will solve that immediately.

I have a plan with a higher deductible - because prior to this condition, I rarely went to the doctor.  I understood clearly that a great deal of the radiologoy and specialty procedures were my responsibility financially until the deductible was met.  I will say that seeing the claims come through - Coventry was able to negotiate much lower prices for me to undergo these procedures.  They saved me $500 on an endoscopy and several thousand dollars for a HIDA scan - negotiating with the healthcare providers to give me the price that Coventry would authorize if the deductible was met.  I love the member claims function on their site.  Allowing members to see in real time what the doctors are charging and the status of claims.

We have had to pay some pretty high bills while waiting for our deductible to met; however all of that money is applicable to the deductible.  I'm keeping track of what I've paid so far and it matches perfectly with what Coventry is applying to my deductible.

For someone without serious health concerns (as I was prior to this year), I honestly feel the coverage cannot be beat for the premium price.  They cover feminine health screenings (paps, mammograms, etc) for free.  And regular doctors' visits are only $45 - urgent care and specialty visits in network are $75.  ER visits have a $500 copay.  That might seem high to some people; however when one realizes that most specialists charge $200-300 just to walk into their office, I'm happy to pay that amount.   Considering I would have shelled out thousands of dollars in ER fees, quite frankly, $500 doesn't seem that bad to me.   Incidentally one copay paid on the first ER visit covered the two subsequent visits as well - we were not charged an additional copay for the two trips to the ER after our first.

I have had no issue finding quality doctors in network to help me with these gall bladder issues.  So far, I have had zero complaints about Coventry's willingness to pay for any procedures. 

I am amazed at some of the bad press I have read about Coventry. As a private individual, I've been very happy with them.  It's important for customers to understand clearly what their medical needs are and choose a plan that works for you.  If you are having trouble navigating information on their site, then I encourage you to call their customer service line and have them walk you through it.

I also had Coventry in the past, and during the time I had it I had crashed my dirt bike breaking my collar bone. It required surgery, all seemed to be fine. Coventry paid their portion and I have been paying the percentage they did not cover. I was down to about a mere $400 I owed the hospital and bam! My hospital bill says I owe $5,270!! The same bill I have been paying on. I also got a claim to fill out from Coventry to "see if this was someone elses fault" so they would have to pay not Coventry...next thing I know is surprise surprise...my hospital bill shot through the roof...all the money Coventry paid was back on my bill.

I'm not an employee of Coventry and cannot say I am aware of their practices; however, as a prior employee of multiple dental practices, in which I also overseen billing procedures, I have noticed that there are several insurance companies that practice such as you describe with Coventry. 

I am aware that at times, although a pre-authorization is approved, it is possible that the billing procedure codes may have been changed, or possible the amount, date range for approval etc., which will/could reflect a denial by the insurance company later.  You might want to double check on this. I would recommend you cross reference this yourself and not rely on your provider to do so.  Your provider submits billing as a courtesy, but you are the sole person responsible, so depending on your provider and their ethics, they may or may not presue payment from the insurance company.  Most providers will only work the account for a few months.  Although it is in the provider's best interest to persue, because of the lump payment, if the billing/collection staff is not being monitored successfully, a lot of errors can and most likely will occur.  Again, they are not under any obligation to the insurance company.

The many insurance companies will say they never received a bill, this might be true due to the high volume, but can also be a stall tactic.  I recommend being agressive with them, keep notes of your communications, dates/times/names and don't give up.  If they state they didn't receive the bill, and it's (i believe) been one year, then they are under no obligation.  So, the first protocol is to ensure they have received the bill.  Then take it step by step, if they deny then ask specifics, ask if it's the billing code etc.

I don't know if this information helped any and I'm not saying their right.  I particularly don't know all the circumstances and I'm not the billing expect.  In searching the internet, I see few complaints regarding Coventry and what I observed where older ones.  The company is still new and I'm certain are going through a learning curve.

Best of wishes

I would like to start by saying sorry that you are having a hard time. I would then like to offer an explanation or two and a little help as well. I can tell you first and foremost..that your issues with glasses and contacts and eye exams stem from the fact that Coventry does not directly handle your vision insurance. Most vision insurance with Coventry is through Vision Service Plan(VSP) so if yoou are having problems with that you should probably contact them at 1-800-877-7195. Secondly, in regards to the problems you are having with your medical benefits, do you have specific details..ei..the dates the authorizations were requested on and for..the CPT(procedure codes) that the doctors were trying to have authorized..the diagnosis suspicion that would confirm medical nessecity for these services to be performed..and if you have all of those..do you have the claim numbers that you are reffering to? If you have this information you can respond back to me here and I will let you know what I have found out. If you do not have that information, please obtain from your doctors office(the claim numbers can be found on "My Online Services" through Coventry) and then let me know what you have. I can be a lot more of a help than I am sure you are willing to believe. I understand being frustrated, upset or better yet angry. It is a lot of money and our health is not something we like to have messed around with, so please get that information for me and I will see what I can do!!

Because the CEOs/CFOs of the health insurance companies need to be compensated in the millions of dollars every year as they have made so much money for their companies in denying claims/coverage.....I strongly recommend renting the DVD called "Sicko, about America's sleazy health insurance industry.