This is a very long story so I can not go into all of the details here. But beware of this company if you are on Medicare. They are a provider for prescription drugs (Part D).
I am on Medicare due to disability. My husband added me on to his insurance last March. This company sent me a notice that they would disenroll me if payment was not received within 30 days. We did not pay the premium because we no longer wanted or needed them. I also spoke to someone about this. Their book also states they will disenroll you if the premiums are not paid. I recently found out that their rates are the highest of all Part D insurers in Fl.) So, avoid them even if you do not have other issues with them as I have.
I did not hear anything more from them until near the end of Dec 08 when I was awakened on a Sat morning by one of their Reps who informed me I owed over $1000.00 for and that it had to be paid if I wanted to continue enrollment in 2009.in Jan I received a statement from them that I owed over $700.00. (Gee, what happened to the $300?)
I wrote a grievance letter giving them all of the details, which are more than I am writing here.in that grievance letter I stated that if it were to be denied I wanted it elevated to the next higher level. According to their book and website, they have "protocols for escalation of grievances if they feel it warranted, or if it is requested." The following is straight from their website: Grievances: It is the policy of Envision Rx Plus to provide meaningful procedures for timely hearing and resolution of grievances. This process enables us to to use listening and problem solving skills to resolve the issues presented. That sounds like a committee to me, and it certainly should be!
Please do tell me that the following sounds likes it comes close to the above statement on the website. A couple of weeks after sending in my grievance I received a form letter response from them. No name, no signature, no department, no committee. Only the name of the company. Under the name of the company, was the word enclosures. There were no enclosures. This form letter was dated 3 days after my grievance letter, and postmarked 16 days later. It said I did not meet the criteria for disenrolment. It also stated that a secondary insurance had no bearing, as they were responsible. It did not mention even one single issue which I brought to their attention in my grievance to them. It went on to state that they would make payment arrangements with me, and that I should call the Billing Department. There was no mention of it being escalated to the next grievance level, which I had already requested. No information about anything I needed to do to escalate it.
Last week I sent another grievance. I was very explicit regarding all of the issues. I also requested the name (s), Title (s), and credential (s) of the person (s) who denied my first grievance, and the same information for this last grievance. I let them know that my insurance had covered a lot of prescriptions for me during 2008. I told them to send me exact, duplicate copies of all statements and any other correspondence mailed to me in 2008. So, this is where we are right now. We shall see how they proceed. I do not expect an ethical outcome.
Their Grievance process is a joke. If it is true that they cannot disenroll you due to non-payment of premiums, they should not be allowed to threaten to do so. Their book, correspondence, and communication with people is confusing and contradictory. This is especially true for the elderly, and the disabled, especially those with cognitive impairment. (I am one of them)
This company needs to be thoroughly investigated by Medicare.
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