Health Care Reform

Welcome to WellPath's resource library for health care reform. The documents below will help you understand what health care reform means to you.

• New or Expanded Health Care Reform Benefits
• Preventive Care Coverage
• Changes to Medical Spending Accounts
• Grandfathered Health Plans - What you can expect
• New Small Group Tax Credit
• Health Care Reform Bill Timeline
• Uninterrupted Coverage for Young Adults to Age 26
• The Affordable Care Act and Medical Loss Ratios
• The Affordable Care Act and Women's Preventive Care Services
• The Affordable Care Act

Coventry's Health Care Reform Information

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:

• Medical necessity of services requested
• Denial of care/services/claim
• Other adverse benefit determinations

Authorization For Disclosure of Health Information To Appeals Representative

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.

• 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.

WellPath Member 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.

Designated Release of Information

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.