among the ten things required by the ACA:
5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
6. Your prescription drugs
December 26, 2013
Tristan D. Lear
16808 Landings Pointe Ln. #101
Tampa, FL 33624
Re: Service Request Number: 1-797636601
Company Name: Coventry Health & Life Insurance Company
Dear Tristan D. Lear:
We have received a response from your insurance company in regard to the request for service you filed, relative to your prescription coverage provided by Coventry.
Coventry stated the policy you are enrolled in does not cover drugs for the treatment of mental health care or substance abuse and that information is located in the “Exclusions and Limitations” area of the Pharmacy Rider #15268. They stated that on 12/10/13, Mr. Lawrence Lear called regarding ID cards not being received for the children. Also on 12/11/13, a call was made by Mr. Lawrence Lear discussing the PCN and BIN# to get prescriptions filled by Walgreen’s Pharmacy. It was a bad connection and he stated he would call back. No specific pharmacy benefits were given during the call. Coventry advised that in order for you to have coverage for Vyvanse, you would need to contact the Health Plan’s Enrollment
Department to change your current policy. As an administrative agency, the Department does not have the jurisdiction to adjudicate disputes of fact or law.
Insurers and Health Maintenance Organizations (HMO) must make available to a group policyholder (usually the employer), as part of the application and for an additional premium, coverage for mental and nervous disorders. However, this Florida Statute does not apply to individual health insurance policies.
We realize this letter does not resolve your specific problem, but we hope these comments help you better understand the handling of your concerns. For additional information on insurance or financial matters, please visit us on the web at www.myfloridacfo.com/Division/Consumers. If you would prefer, you can speak to one of our Insurance Specialists by calling our Consumer Helpline at 1-877-693-5236 between
8:00 am and 5:00 pm EST.
FLORIDA DEPARTMENT OF FINANCIAL SERVICES • DIVISION OF CONSUMER SERVICES
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4146 Pinelake Ln. Tampa, FL 33618
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