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Conventry Health Care Summary
Coventry Health Care was founded in 1986 as Coventry Corporation, Inc. The company moved quickly to acquire a long list of other health care companies, and changed to the current name in 1998, setting up headquarters in Bethesda, Maryland that same year. In 2013, Coventry became a subsidiary of Aetna Healthcare.
Coventry offers health care products in most states, although not all products are available in each location, and they can differ even by county within a covered state. They provide both individual and family plans as well as group plans, including both managed care and PPO plans, and also work with Medicare and Medicaid plans in some states.
Coventry’s website has a member services portal that allows members of health plans to review claims and benefits, access health care tools, and search for providers, among other online services.
Insurance Products
Health care products from Coventry cover a wide variety of individual and group needs.
CoventryOne Individual Plans
Individual and family plans through CoventryOne are available in 27 states, although in some of those states the plans are actually written through Coventry’s parent company, Aetna. Plans direct from Coventry can be purchased in Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Missouri, and Utah. Availability and type of plan varies by state and county.
Plans meet the requirements set out by the Affordable Care Act and are available at varying levels of coverage and with a wide range of premiums, co-pays, and deductibles.
Group Health Plans
Coventry’s group plans allow businesses to create a benefits package and offer options to their employees for their health care needs. They offer HMO, PPO, and POS plans as well as HSA and FSA products. As with the individual plans, availability varies by state and in some cases plans are offered by Aetna.
Medicare
Coventry offers Medicare Advantage and Prescription Drug Plans at a national level and across 20 states. Coverage type and options vary by state and county, but options include HMO, PPO, and POS plans.
Medicaid
Coventry currently offers Medicaid plans in nine states, some of which are serviced by Aetna or other subsidiaries. Medicaid plans are available in Florida, Kentucky, Missouri, Michigan, Nebraska, Pennsylvania, Virginia, and West Virginia.
Worker’s Compensation
Providing one of the most necessary basics of business insurance needs, Coventry’s Worker’s Comp plans include claims management systems to help provide fast services while keeping costs down.
Behavioral Health Services
Through MHNet, Coventry offers a comprehensive plan for managing and treating behavioral and mental health concerns, including depression, mood disorders, eating disorders, and addictions.
Unusual for a health care company of this size, Coventry does not offer add-on coverage such as dental or vision plans, although these may be available through affiliated companies and through the parent company, Aetna.
Providers and Networks
Coventry has a wide range of plans, each with access to a different level of provider network. Networks depend on which of the Coventry companies, either subsidiaries or parent company Aetna, the plan is written through, as well as whether it is a PPO or HMO type plan.
First Health provides PPO network services for many Coventry plans, which gives members access to a large range of providers, hospitals, and services. As with all health plans, larger provider networks are generally available at the higher premium levels, while HMO plans have more limited networks and a lower premium.
Conventry Health Care Rates
Prices and premiums from Coventry vary greatly by the type of plan, the level of coverage, the deductibles and co-pays, and of course the location. As a growing health insurance company now owned by a very large company, Coventry is likely to be able to offer competitive rates.
Quoting is available for both Coventry and plans through Aetna online, although for some products consumers should contact the company by phone for accurate quotes.
Claims
Claims submission for Coventry Health plans depend on what type of plan you have and what state the plan is in. There are different claim procedures and contact information for claims through the First Health network, for Medicare claims, and for plans written through subsidiaries or through Aetna.
Claims are handled through healthcare providers, but Coventry offers online access to statements of benefits and claims information. This allows members to track their health care costs and out of pocket spending over time.
Consumer Research and Complaints
Although Coventry is not Better Business Bureau (BBB) accredited, it carries a an A+ rating from the BBB based on their multi-factor system. In the last three years, there have been 317 complaints listed, 27 of which have been closed in the past 12 months. A large majority of the complains concern Coventry’s product and service, 230 of them to be exact. Next in line, 73 complaints, are in regards to billing and collection.
There also a large number of complaints filed against Coventry on websites such as PissedConsumer.com, resulting in a one star rating overall. Most complaints seem to revolve around issues with billing and customer service. There are also numerous complaints regarding items that were not covered as expected, although it is difficult to say whether the complaints are valid without further knowledge of the consumer’s health care plan.
Financial Strength
| Rating Company | Grade | Financial Outlook |
|---|---|---|
| AM Best | N/A | N/A |
| Fitch | N/A | N/A |
| S&P | N/A | N/A |
Bottom Line
With the acquisition by Aetna, Coventry is certainly well backed financially and is likely to remain a stable insurance company for a long time to come. They have a very good range of products, it is disappointing to see that there is no option to add vision or dental plans to their health care plans, although the website does state that some Coventry Medicare Plans might offer some coverage.
For a list of companies that we recommend, visit our Best Insurance Companies page.
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Review Information
I am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.
lorrie says
FOLLOW THE MONEY…….read the teeny tiny small print……..ACUSA, First Health,Cofinity,and Coventry are all part of AETNA……Now Aetna makes it really clear in the fine print that they aren’t responsible for ANYTHING…….They take no responsibility for any false advertising, misrepresented sales pitches, holes in coverage, contract vagueness, misrepresented perscription costs, ….
Now that isn’t even the interesting part……. Guess who owns Aetna???????? CVS pharmacy (at the very least shouldn’t they know about the drug coverage?)
Next is an article from the NY Times that kinda sums it all up……
N Y TIMES
CVS agrees to buy Aetna in $69 billion deal that could shake up health-care industry
CVS Health to acquire Aetna for $69 billion
Drugstore chain operator CVS Health Corp said on Dec. 3, 2017. It had agreed to acquire
health insurer Aetna Inc for $69 billion. (Reuters)
By Carolyn Y. Johnson
December 3, 2017
Pharmacy giant CVS Health has agreed to buy Aetna in a $69 billion blockbuster
acquisition that could rein in health-care costs and transform its 9,700 pharmacy
storefronts into community medical hubs for primary care and basic procedures, the
companies announced Sunday afternoon.
The pharmacy chain agreed to buy Aetna for about $207 per share, broken down into $145
in cash and the rest in stock. The deal — the biggest health-care merger announced in
more than a year — is expected to close in the second half of 2018, subject to approval
by shareholders and regulators.
If approved, the megamerger would create a giant consumer health-care company with a
familiar presence in thousands of communities. Aetna chief executive Mark T. Bertolini
described the vision in an interview as “creating a new front door for health care in
America.”
“We want to get closer to the community, because all health care is local,” Bertolini
said. “What was going to draw people into an Aetna store? Probably not a lot. We looked
for the right kind of partnership.”
CVS would provide a broad range of health services to Aetna’s 22 million medical members
at its nationwide network of pharmacies and walk-in clinics, and further decrease the
drugstore titan’s reliance on the retail sales that have faced increasing competition.
“You can imagine a world where health care is better designed around the people who use
it, which is one of the challenges we have today,” CVS chief executive Larry J. Merlo
said in an interview. As part of the deal, Bertolini would join the CVS board and Aetna
would be run as a stand-alone business unit.
The deal is likely to set off even more mergers in the health-care industry, which has
been undergoing consolidation and faces potential new competition from Amazon.com. It
could position Aetna to be more competitive with UnitedHealth Group, the nation’s
largest insurer, which has already expanded beyond its core business into pharmacy-care
services, clinics and surgery-care centers and health-care data.
“I think it will create more consolidation among the insurers and retailers, blurring
the lines,” said Ana Gupte, an analyst at Leerink Partners, who recently pointed to
retail giants Walgreens Boots Alliance or Walmart as potential “dark horse acquirers”
of the health insurer Humana.
Wall Street analysts have said the deal could lower health spending — if, for example,
CVS can push customers to use walk-in clinics instead of emergency rooms for minor
problems. But consumer advocates argue the deal would limit consumer choice and could
make it even harder for new companies to enter into a market increasingly dominated by
behemoth companies.
[Expensive specialty drugs are forcing seniors to make hard choices]
Even before the announcement, the familiar drugstore chain has been a dominant player
in the big business of negotiating drug prices for insurers and employees. The merger
would give CVS an even broader role in managing health care.
The combined company could leverage massive amounts of data from both Aetna’s medical
claims and CVS’s vast number of touchpoints to consumers, including its 9,700 retail
stores and 1,100 MinuteClinics.
CVS plans to transform its locations into a kind of community health hub, where
pharmacists and nurses can provide follow-up and monitoring to patients recently
released from the hospital — reviewing and managing their medications and helping them
to stay out of the hospital. (Hospital re-admissions are seen as a major, avoidable
cost in health care.)
The storefronts could also transform preventive care, offering wellness, nutrition,
vision, hearing and other medical services — saving costs by keeping people healthier
and providing care in a lower-cost setting than a hospital.
Pharmacists and nurses could help make sure patients with chronic diseases stay on their
meds and provide counseling between doctor’s visits, which would keep those conditions
in control.
Bertolini and Merlo said the combination could fundamentally transform consumers’
experience of health care. Traditionally, insurers put up obstacles, such as co-pays or
paperwork that needs to be submitted by a doctor, to make sure that medical services and
drugs aren’t being misused. Those barriers could be eliminated or reduced as CVS
pharmacists and nurses worked with the patient directly to make sure they were getting
the right treatments and most effective care.
“Every health insurance company wants to get closer to the consumer,” said Dan Mendelson,
president of Avalere Health, a consulting firm. “If a patient is better off by getting
a home health visit to have someone go through their medications to take them off 10 and
eliminate those medications, I want that to happen — as opposed to someone just filling
prescriptions.”
The merger would also better insulate CVS and Aetna against looming competition on two
fronts.
[What Amazon could do to the business of selling prescription drugs]
The mere possibility that Amazon will soon begin selling drugs has shaken the stocks of
companies up and down the drug supply chain, from wholesalers to pharmacies.
(Amazon’s founder, Jeffrey P. Bezos, also owns The Washington Post.) The deal would
expand CVS’s business beyond selling drugs and negotiating drug prices, to managing all
aspects of a patient’s health — and could shift its storefronts to become medical hubs,
rather than aisles stocked with consumer goods that people can easily buy in other
stores or online.
The deal would protect against competition from health insurers, particularly
UnitedHealth Group, that have brought the business of negotiating drugs in-house instead
of buying services from a middleman. It will effectively cut out the middleman in
negotiating drug prices for health insurers, because CVS is that middleman today, and
lock in Aetna’s medical members for the pharmacy management side of CVS’s business.
The health-care space has already undergone considerable consolidation — but it has also
faced challenges. Last year, two health insurance megamergers between Aetna and Humana
and Anthem and Cigna crumbled under antitrust opposition. But a merger between companies
that don’t directly compete is thought by many to have a better chance.
“They’re going to be able to offer you a better-functioning insurance package,” said
Craig Garthwaite, associate professor of strategy at Northwestern’s Kellogg School of
Management. “There’s some sense in which we’re seeing a reshuffling of the organizational
structure, such that insurers are owning providers.”
That fundamental restructuring is part of an industry-wide move away from managing
different aspects of patient care — such as drugs or hospitalization — in isolation.
Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University,
said that while a CVS-Aetna merger doesn’t strike him as a deal that would clearly
reduce competition, it wasn’t clear why the companies needed to combine at all, because
CVS already has Aetna’s business as a pharmacy benefit manager.
“A big question mark for me is how does it make the merged company better?” Gaynor said.
“I wonder about a lot of these mergers, whether they’re really driven by a true increase
in the long-term value of the company — as opposed to seeking a short-term bump in stock
prices.”
David Balto, a former policy director at the Federal Trade Commission who led a
coalition opposing the insurance mergers, said that he thought the merger would reduce
competition and harm consumers.
He pointed to the Justice Department’s recent challenge of a different merger — between
AT&T and Time Warner — as evidence that such mergers could raise antitrust concerns.
JoJo N. says
I got a phone call from them also. Were quick to sign me but I said I would need to research the company as I never heard of them. The agent got mad and said the quote won’t be there for me if I didn’t sign today. Big red flag.
AL Larsen says
Same experience for us….. great deal… no copays…. no deductible…. prescriptive benefits… all for the low price of $638 per month for our entire family, with a one-time enrollment fee of $125. Then they asked for payment of the enrollment fee and first month today without us being able to review the written documents/benefits/coverage attached to the plan we were signing up for. We told them to send the documents first because we were not paying for something over the phone without reviewing it first. The insurance agent told us that is not how insurance companies work and they needed payment before they could send a thing.
We hung up without giving them our payment info.
Our neighbor is an insurance agent and always sends links to the plans we are considering with details of coverage before we pick something or pay for a thing….
Don’t be fooled or bullied.
If it sounds too good to be true, then it probably isn’t what it seems. Buyer beware!
Ken Talbot says
I only had a Coventry Medicare advantage plan for about 6 weeks. Luckily for me, I was still eligible to Medi Gap coverage and I have changed. My first problem came with requesting a test for my heart calcium score to judge my heart healthiness. They made me pay for it out of pocket! This Advantage plan charges no premium as they take payment from Medicare to cover me. So I paid. The results of the test were not good. The upper limit is a score of 1000. Mine was 1500. I went to see a Cardiologist who recommended a Heart Catheterization. It was scheduled 2 weeks before for a Monday. On the Friday before, we were told it was not authorized! My doctor called the NIA contractors that Coventry/Aetna uses for pre-authorization and talked with them for 1 hour but they would not relent. He said he would like to file an appeal and they told him he could do so once he received their decision by snail mail!!! He could mail it back. I could not believe this. I called as the subscriber and talked to customer service and NIA who told me they had a “peer review” with my doctor. Sounds impressive if you’re just a bureaucrat reviewing documents. I asked who the doctor was. They gave me his name and I looked him up on the registered medical sites. He is 89 years old, graduated from med school in 1968, has no active practice and lives in Miami, FL. I guess his job is to just deny coverage if it is not done the old way. My doctor is 46 with a modern appreciation of heart medicine. NIA cited their “procedure” in their denial complete with paragraph numbers meanwhile I am denied medical coverage from a company under contract to Medicare. I complained to Medicare who processed it. As I stated, I was still eligible for Medi Gap without having to complete a questionnaire so I applied with a different company and that was approved. It will be in place tomorrow. I will have my heart cath the next day. Coventry eventually approved the appeal but I already had the new insurance and did not want to go through the “peer review” fiasco again. These guys put my life in danger in the name of Medicare. Be wary…
ECart says
Was looking to change my insurance when I answered this first health insurance persistent call. I was offered a PPO, no deductible insurance that includes medical, prescription, dental & vision(50%) deal which sounds like a very good deal to me. They wanted me to pay an initial payment of $170 plus the monthly cost of $478.29 or $648.29 total. While I was researching for reviews, I asked why the reviews online were low? I was sent to their manager who insisted that the company is now owned by AETNA, Bluecross & Blueshield. When I looked online, I found Coventry & I told her, I had a bad experience with Coventry & a bad feeling about your offer. She lowered down the $170 initial payment to $44.99 but I said, I don’t want to be rushed, I need to research & compare your offers & hang up.
CW says
I just got off the phone with those that represent Aetna’s First Health Coventry. After I saw what the company was, the director was extremely rude. They ran through the information. They wanted to make sure everything was recorded. Wanted money immediately! VERY SCARY!
Belinda Edwards says
Had someone from this company call me to give a quote then was being harassed because I wouldn’t give my credit/debit info to him over the phone. Since when does giving quotes mean the customer must give payment info and if this company is rated an A 1 company then I really do not see that happening with the type of customer service they are giving ..being Rude and harassing and hanging up when you can’t bully people into something definitely is NOT the way to get and keep customers!
Donna Jean says
The same thing happened to me today. Would not send me anything in writing but insisted that I had to sign up over the phone. Scamming people looking for healthcare coverage. How can you have a plan with no copays and no deductible in the US? I’m not sure if this is a First Health issue or a third party company selling their insurance, but whoever it is what they tell you is totally false.
Amy Furlong says
I had a very similar experience. I received a phone call from a rep. while looking online for health insurance. He gave me a quote which seemed like an amazing deal, no deductible, dental covered, and full coverage on everything. When I said that sounds like a deal (a little too good of a deal) He automatically assumed I wanted to sign on and said okay cards will be going out today, I will need a payment of $581.36 due right now. I told him that I had to discuss it with my husband first, he then got really annoyed and rude. He tried to bully and pressure me into signing on right away, and said if I didn’t I would not be able to get Health insurance for the 2018 year. He made it seem like this was my only and last option. I told him I did not have $600 to sign on today, that I was only getting quotes, and then he hung up on me.
Aaron Nieto says
They told me I was covered and I was not covered for ANYTHING! I really believe strongly that this insurance company is a SCAM!
Charles says
Just got off the phone with a agent named [Redacted], when she told me to give her my CREDIT CARD info over the phone I said no!!!!!!When I get a bill i will send you a check…When her boss heard this he got on the phone and demanded the info!!!!!!!When I told him NO,,he began to yell and LOUD talk me saying he was in the business for years and who was I not to give out my info!!!!Finally he couldn’t bait me into giving out my CREDIT CARD info and hung up on me!!!!!!!..NICE COMPANY…LOLLL
Jessica Miller says
I just had the same thing happen! What are these people THINKING??? Only an IDIOT would give out personal information (never mind credit card numbers and data) to complete strangers that call you out of nowhere!
tiana says
hahaha, funny thing, I got it too. I got an agent called me, told me about this coventry insurance, I told him that I never heard before, he started to tell how good this company is and ask me I can search on google. Instead of searching this company, I searched company review, found 1.4 out of 5 stars. I was like…ok, review is not good, maybe I can ask around see if any my friends use them. The guy said: Oh ok, you can just ask google agent to buy insurance for you! He hung up on me!!! UNBELIEVABLE !!! will never consider this company!! WHAT A JERK !
F. Teresa Walsh says
Coventry is a very bad insurance company!
Doesn’t cover their customers even when the plan said you would be covered.
BEWARE! You pay for insurance you don’t get!
Christine J says
Horrible to deal with. Called to verify doctors were in plan and everything was covered- then I get a bill. I’m not covered after all. Nasty representative told me she couldn’t ‘read my mind’ as to why i was calling to ask about an in-network doctor. This place is awful.
Mrs. El-saidi says
I made a call to Coventry, to discuss an issue with my insurance. Before, I could be help the with my problem, the representative told me, I would have to prove, I was not in jail, to continue my insurance. Now, I do know when I am being insulted and this is one of those times. This was hurtful and racial remark. How did we get from insurance to jail? I have no clue. If they had read the file, it would show that I walk in to the Health Market ( or whatever it’s called) and that I work at Hampton Inn and Suites.I refuse to give you my money and be treated like crap. I know your are not asking other people of various races this same question. I am going to check with the NC board on this insurance question. I have never been asked this question and I am trying to clarify why your company is asking this question? I am very unhappy with my treatment. If this is good customer service, this company’s in trouble. I work as a cook and deal with people all day, this is not how you treat or speak to your customers. : This little Coventry-ism:most people in jail or prison will never call for this insurance. State Owned Prisons, have their own health care providers, Last I checked, Inmates can’t choose a doctor and keep the appointment.
Nancy says
I am in need of help with insurance. Coventry just changed the policy and now has no pharmacy. I need a plan with pharmacy benefits in the $200.00 range for my husband. He can no longer work. He has degenerative disc disease and is 46 years old