Coventry:

policy doctor · 02-18-2007, 07:38 PM

I thought I would start a new thread specific to Coventry sales, claims, problems,, etc. THis way we all can pitch in to share our experience with this particular compay.

Watch those Part D claims!! I had a client call me because her prescription claims were not being processed, even after 3 separate mailings, phone calls,( including a certified receipt proving she sent something to them). By now these claims are 5 months old.

Bottom line: they had sent her a form with an address to San Antonio, Texas for processing. Problem, TX handles commercial accounts.

Individual claims should be sent to Phoenix, Arizona. The brain-dead over there never bothered to research her ID # and forward to the appropriate place.

Ask them to send you a couple claim forms..keep in your file as needed.

*midwestbroker* · 02-18-2007, 10:33 PM

In Kansas City, they have gotten some bad press over claims as well, but for medical procedures. One hospital here has a lawsuit against them for unpaid claims.

But I have talked to the Medicare sales director out here and he said that all the plans are designed and pretty much maintained at the local level. Kind of like BCBS, there is BCBS of Kansas and BCBS of Kansas City, same mothership, different management.

healthagent · 02-18-2007, 10:47 PM

Have an extremely good friend of mine on the group side of things who will no longer sell them. Too many unpaid claims and failing to authorize treatment for illnesses. He claims in MD it's apparantly they are trying to under-cut the competition in rates yet are making up for it on the claims side.

maryjd123 · 02-20-2007, 11:35 AM

I have had no complaints here in wyoming as of yet with claims

Keeping my fingers crossed

policy doctor · 02-26-2007, 07:12 PM

Whew...i've been trying to fax in apps all day today.....with Coventry lines busy all the time !! Anyone else have this experience?

I even got alternate #'s......at this point, would it be better to just mail in the suckers..... Any tips would be appreciated.

Guess they're just jammed .....

maryjd123 · 02-27-2007, 06:27 PM

Hey Doc

I do all of mine online at the website

Its much easier

sman · 02-28-2007, 08:31 AM

Quote:

Originally Posted by policy doctor

Whew...i've been trying to fax in apps all day today.....with Coventry lines busy all the time !! Anyone else have this experience?

I even got alternate #'s......at this point, would it be better to just mail in the suckers..... Any tips would be appreciated.

Guess they're just jammed .....

I'm with mary, I do my enrollments online.

policy doctor · 02-28-2007, 11:00 AM

Well./....I was never told I could enroll clients online.

Good to know. And just shows why this forum is so needed.

Looks like the FMO was derelict in this dept, but thanks to the respondents.

When i called Coventry, it took 3 reps and 3 diff depts to give me the link. LOL....hope their claim handling is better.

*midwestbroker* · 02-28-2007, 01:41 PM

Ask North Kansas City Hospital. They have a $5 million lawsuit against them for unpaid claims.

But people love the $0 premium they have out here...

policy doctor · 03-08-2007, 06:18 PM

Coventry is wearing me down with their mishandling of my clients' advantra rx.

Since my last post about the 3 reps, let me add I spoke to another 5. Nobody seems to know anything, the claims are not in the system, they have been mailed to 2 different addresses, (1 in TX, 1 in Az) plus I just faxed in claims yesterday to Penn as requested by another rep.

Today, nobody knows anything, . I even asked to speak to someone higher up, and when she started that the claims needed to be mailed to San Antonio, (which is where they were mailed...certified, receipt request in front of me),I blew my cool.

I'm ashamed to say that I asked if they were hiring the mentally disabled for tax credits, instead of being concerned for the client. I'll prob get s*** canned. Called Mutual of Omaha also, and left message for their Part D coordinator to call me...which he hasn't yet.

Spoke with Medicare, and they informed me 'THIS IS NOT UNUSUAL" . What????

Seems they are having problems with all of them on timely claim filing. So folks, wishing you a claim free year.

maryjd123 · 03-08-2007, 06:56 PM

Hey Doc

for your advantra rx clients -- are these clients that are doing mailorder? or are they if i understand you right -- sending in claims to be paid that they have already paid for at the pharmacy? im not sure i understand -- could you elaborate?

sman · 03-08-2007, 07:56 PM

Quote:

Originally Posted by policy doctor

I'm ashamed to say that I asked if they were hiring the mentally disabled for tax credits, instead of being concerned for the client.

Love it.

That's part of the frustration with anything new. I just spoke to a client yesterday who went to the ob gyn and was told they didn't accept Medicare Advantage plans becuase they weren't contracted with them. The client called me. I then called the ob gyn office (they are part of a much larger corporation). The girl who handles claims read me the memo she received from corporate that stated,

"We are not accepting Medicare Advantage plans that are PPO and HMO. We will accept Private Fee for Service plans such as Humana GoldChoice and SecureHorizons".

I explained that Today's Options is a Private Fee for Service plan. She then told me it wasn't on her list (only Humana and Secure Horizons). I tried to explain that the letter was only referencing two of the many PFFS plans. She stated the reason they didn't accept them was because they didn't reimburse as much as Medicare. I calmly explained to her that the reimbursement rate is the same as Medicare. She proceeded to tell me I needed to check my facts and then made this statement, "We have a special contract with Medicare". Again, I calmly explained to her that Medicare does not make individual arrangements with providers. She assured me they had one.

At this point (well, really much sooner) I realized I was talking to a genius and was in over my head. So I asked for the number to the person who sent out the memo she read to me. After speaking to this lady, she assured me they DO take Today's Options since it is a Private Fee for Service plan and that they DON'T have any type of special arrangement with Medicare. I asked that she clarify that with all of their offices.

Just another day at work.

***Melmunch3*** · 03-08-2007, 08:47 PM

Nice work. However, you were lucky in that there was someone on top of her who actually did know what was what. Many claims people think that they know everything about insurance, and there is no one to go to over their heads. Then you have a real problem.

policy doctor · 03-08-2007, 09:11 PM

This is the one I referenced when I started this thread. Client paid at the pharmacy because it was rejected bY Coventry at that time. Part of the mixup client caused when she enrolled in Humana, and 3 days later disenrolled. However, although Coventry took her premium without a break, they are not covering claims for last June, July, August.of '06.

BTW...is there a way to track client status online? I would like to track those apps I faxed in to be sure they are logged in.

henryj · 03-10-2007, 02:57 AM

hi guys i have just started with conventry need to know if people with medicaide can benefit with this plan? sorry allow me to introduce myself i am new independent agent was captive with a home service company and I'm now looking into the senior market so far i like you infromative discussions and look forward to learn from you all.

*midwestbroker* · 03-11-2007, 12:09 AM

Medicaid all depends on the state. In Kansas they can have a MA plan and Medicaid. In Missouri, Medicaid will not pick up any co-pays, so it will not work (unless they have a larger spend down).

The real joy is that if you call 3 different social workers, you will usually get 3 different answers. I would find an agent who is selling Coventry in the state you are in and ask them.

maryjd123 · 03-11-2007, 01:05 AM

Quote:

Originally Posted by policy doctor

This is the one I referenced when I started this thread. Client paid at the pharmacy because it was rejected bY Coventry at that time. Part of the mixup client caused when she enrolled in Humana, and 3 days later disenrolled. However, although Coventry took her premium without a break, they are not covering claims for last June, July, August.of '06.

BTW...is there a way to track client status online? I would like to track those apps I faxed in to be sure they are logged in.

Hey Doc -- so the question is -- at that time was she enrolled in the gold plan for humana? or the regular pdp? -- reason i ask -- it takes a little time for the disenrollment from the pffs plan -- it might be covered under humana --- if you want -- give me a call on monday afternoon and if you have her paperwork where she enrolled and disenrolled -- via humana and coventry -- i will call and see if i can help

307-256-7136

policy doctor · 03-12-2007, 10:13 AM

thanks.....no i don't have that paperwork but it got straightened out last Aug '06. Referring to her quick disenrollment.

I have involved Mutual of Omaha and CMS on this....if they can't solve this that's it for me. I'll rewrite her PDP in the fall.

This is a typical example of how a little claim (under !00) can bog you down as an agent. (not to mention the low renewal comm). For years majority Med sups would not pay drugs because of the high claim handling/processing.