Health Care Reform

Welcome to Coventry Health Care of Iowa's resource library for health care reform.  The documents below will help you understand what heath care reform means to you.

• Uninterrupted coverage for young adults to age 26
• Grandfathered health plans
• Health Savings Account (HSA)
• Medical Loss Ratio
• Notification Requirements
• Preventive Care Coverage
• Small Group Tax Credit
• Summary of Benefits & Coverage (SBC)
• W2 Reporting
• Women's Preventive Care Services

Complaints and Appeals

Complaint and appeal policies are in place to ensure that we have effective procedures for addressing, documenting, and resolving complaints or appeals.

The complaint procedure gives a member the right to express dissatisfaction with any aspect of the organization and to request review of any matter related to:

• The quality of health care service received 
• General inquiries about covered services 
• Member rights and responsibilities

The appeals procedures give members the opportunity to ask us to review any matter related to:

• Issues about the scope of coverage for health care services
• Medical necessity of services requested
• Denial of care/services/claim
• Other adverse benefit determinations

 

Contact Information:

Phone:  800-470-6352

Fax:  866-769-2399

Address:  4320 114th Street, Urbandale, IA 50322

Financial Compensation – Doctors Make the Decisions

People sometimes do not understand Utilization Management (UM) programs. At Coventry Health Care, UM is a system for reviewing the care that has been provided to our members.

Our policy about payment for services is to make sure that decisions are made because they are what our policies say we will do. There are no financial incentives in the review process.

• UM decision-making is based on whether the care and service were proper. It also is based on if the member had health coverage.
• In some cases, Coventry Health Care pays providers and staff who are involved in UM review. We do not reward individuals for denying coverage.
• The payment that Coventry Health Care provides does not encourage decisions that result in denial of care.

How We Evaluate New Technology

Doctors and health care manufacturers are constantly developing new technologies. They can include anything from a new way to perform a procedure to a new use for a piece of equipment. So Coventry Health Care, Inc. established a system to review and evaluate new technologies.

When a new technology is presented to Coventry, we do a thorough review of existing literature. The opinion of experts in the field may be requested. They may also contact the accrediting body of the appropriate medical specialty.

Coventry compares the information against established criteria. Then we decide whether to provide coverage. All of our decisions are based on making sure you have the appropriate care and services. We continue to focus on providing our members with quality health care products.

Member Rights and Responsibilities

To ensure that our members are treated fairly, we have a list of member rights and responsibilities. We encourage you to become familiar with them.

Members Rights and Responsibilities

Your Privacy Matters

Coventry Health Care works hard to keep your personal and health information secure and private.
We need information about you to manage your benefits. We collect your information from many sources. And keeping your information safe is one of our most important jobs. We make sure that only people who need to use your information have access to it. We may use and share your information for:

• Treatment
• Payment
• Health care operations

These uses are covered under state and federal laws. Our policies will reflect the most protective laws that apply to you.

Your Quality of Care

Coventry Health Care’s quality improvement (QI) program works to ensure that all of our services meet high standards of quality and safety.

• 2011 Quality Improvement Program Description

Advance Directive

In the event of a serious illness or injury, you may not be able to make your wishes known to your physician or health care provider.  In those instances, your doctor, with the help of your family, will try to decide what is best for you and what you would want. Sometimes it is not easy to reach an agreement, and it would be helpful to know what you would have wanted, or to know whom you have chosen to make these decisions on your behalf.  Learn more about how to make your wishes known with an Advance Directive.