Reviews

I echo ***** S's review of the corrupt frauds at C2C Innovative Solutions in her review exactly, with some additional info: I submitted my Part D LEP appeal via **** Certified Mail on 5/24/2024. *** picked it up from the ** in ************, **, on 5/30/2024. Today is 10/31/2024 (appropriate because its Halloween and C2C are the sole, monstrously incompetent, and pharmaceutical-industry owned-and-operated arbiters of Part D LEP appeals). So, it has been almost exactly 5 months, and I have not received any communications from *** at all: no adjudication, no assignment of a case # (so that I could try to get info from the website), no contact # for me to call them. As far as I know, C2C has simply discarded my appeal. And, Wellcare (WC), my Part D insurer, has been worse than no help at all: WC impeded my appeal by falsely claiming (to me AND TO A MEDICARE AGENT ON A CONFERENCE CALL) that they had sent me the paper appeal forms in the mail 3 TIMES over the course of 2 months! Today, WC said that they had declined to respond to *** regarding my appeal FOR THE VERY REASON I APPEALED! They refused to provide me with a means by which to speak with a human at ***, and stated that I could keep resubmitting my appeal to C2C and hope that *** might respond some day. A note on Part D (and probably ********** Advantage as well): ******** denies virtually any responsibility for enforcing any of the regulations that allegedly govern this private insurance. C2C is an arbiter selected by the Part D insurers and the pharmaceutical industry, as a cat's paw to deny Part D LEP and coverage claims. They are not responsible to ********* SSA, of the US **** of HHS, or ******** recipients. They are incentivized to deny (or simply ignore) LEP appeals, particularly because the *** IS NOT ASSESSED, COLLECTED, OR RETAINED by any government agency, but rather by the Part D insurer ALONE. Our Republican and Democratic representatives legislated and perpetuate this travesty.

We are in receipt of your inquiry regarding the above referenced complaint that was filed with your bureau. Unfortunately, we are not able to respond with any specific information regarding the complainant and/or the circumstances in the complainants letter since your inquiry was not accompanied by a signed authorization for release of Personally identifiable Information (PII) and Protected Health Information (PHI). We are prohibited from releasing any such information without signed authorization to do so. Accordingly, we will provide a general response to your bureau and a more specific response to the complainant directly.We are an Independent Review Entity (***) contracted with the ****************************************** (***) to adjudicate ******** ****** prescription drug benefit appeals and Late Enrollment Penalty (LEP) appeals on behalf of ***. Our jurisdiction is national. We work for the ****************************************** (***) and our charge is to provide independent on-the-record reviews and issue decisions for appeals filed with C2C Innovative Solutions, **** We adjudicate appeals in accordance with provisions set forth in the Social Security Act, CMS regulations, and CMS manuals. The *** regulations provide several levels of appeal that are available to ******** ****** beneficiaries who disagree with denials they may receive pertaining to ****** Late Enrollment Penalty (LEP). Level one is the ****** plan level. Level 2 is the *** (our company) level. ******** beneficiaries have the right to avail themselves of this step-by-step process and appeal denied services. When we issue a Level 2 denial for ****** services pertaining to LEP, we include detailed information in our letters pertaining to the decision and next steps if the beneficiary disagrees with the letter.I hope that this letter provides some clarity on who we are and our responsibilities on behalf of the *******************

They really shouldnt get any stars! What a crappy company! However, I did not choose to work with them, ****************** did. I have been receiving bills from Regence for 3 months now for a late enrollment fee for ******** Part D, which we should not be charged. Over a month ago I submitted a *********** Enrollment (LEP) Reconsideration Request Form to C2C as instructed by Regence. I still have not received confirmation that C2C has even received the request. In addition, when I call C2C it is impossible to get a human on the line. You can only leave your info and hope for a call back at some point. If you miss that call, youre screwed, and the process begins again. They publish no email address, but instead simply a web portal address, which has no way to contact them other than by mail to the street address. They do have a fax number. Welcome to the 1990s! I do not expect this to be resolved soon, and will continue fighting with C2C and Regence. I love the American medical system, dont you?

We are in receipt of your inquiry regarding the above referenced complaint that was filed with your bureau. Unfortunately, we are not able to respond with any specific information regarding the complainant and/or the circumstances in the complainants letter since your inquiry was not accompanied by a signed authorization for release of Personally identifiable Information (PII) and Protected Health Information (PHI). We are prohibited from releasing any such information without signed authorization to do so. Accordingly, we will provide a general response to your bureau and a more specific response to the complainant directly.We are an Independent Review Entity (***) contracted with the Centers for ******** and ******** Services (***) to adjudicate ******** Part D prescription drug benefit appeals and Late Enrollment Penalty (LEP) appeals on behalf of ***. Our jurisdiction is national. We work for the Centers for ******** and ******** Services (***) and our charge is to provide independent on-the-record reviews and issue decisions for appeals filed with C2C Innovative Solutions, **** We adjudicate appeals in accordance with provisions set forth in the Social Security Act, *** regulations, and *** manuals. The *** regulations provide several levels of appeal that are available to ******** Part D beneficiaries who disagree with denials they may receive pertaining to *********** Enrollment Penalty (LEP). Level one is the Part D plan level. Level 2 is the *** (our company) level. ******** beneficiaries have the right to avail themselves of this step-by-step process and appeal denied services. When we issue a Level 2 denial for Part D services pertaining to LEP, we include detailed information in our letters pertaining to the decision and next steps if the beneficiary disagrees with the letter.I hope that this letter provides some clarity on who we are and our responsibilities on behalf of the *******************

After my review I received a call from **** with C2C who offered to make my appeal that wasnt actually made by me go away or fix it. I faxed him at his request some 21 pages of information. He expressly requested information from 2006-2011. He said he had the rest all worked out. I got a letter from them yesterday saying my case had been reopened but then I got a call from my new insurance company saying C2C was waiting for information from me. Im very confused and again feel like no one is watching whats going on. They are contracted by ******** but ******** is not responsible for them. You cant file a grievance against them, only ********. And ******** says you have to call C2C and hope you get a call back.

We are in receipt of your inquiry regarding the above referenced complaint that was filed with your bureau. Unfortunately, we are not able to respond with any specific information regarding the complainant and/or the circumstances in the complainants letter since your inquiry was not accompanied by a signed authorization for release of Personally identifiable Information (PII) and Protected Health Information (PHI). We are prohibited from releasing any such information without signed authorization to do so. Accordingly, we will provide a general response to your bureau and a more specific response to the complainant directly.We are an Independent Review Entity (***) contracted with the Centers for ******** and ******** Services (***) to adjudicate ******** Part D prescription drug benefit appeals and Late Enrollment Penalty (LEP) appeals on behalf of ***. Our jurisdiction is national. We work for the Centers for ******** and ******** Services (***) and our charge is to provide independent on-the-record reviews and issue decisions for appeals filed with C2C Innovative Solutions, **** We adjudicate appeals in accordance with provisions set forth in the Social Security Act, *** regulations, and *** manuals. The *** regulations provide several levels of appeal that are available to ******** Part D beneficiaries who disagree with denials they may receive pertaining to *********** Enrollment Penalty (LEP). Level one is the Part D plan level. Level 2 is the *** (our company) level. ******** beneficiaries have the right to avail themselves of this step-by-step process and appeal denied services. When we issue a Level 2 denial for Part D services pertaining to LEP, we include detailed information in our letters pertaining to the decision and next steps if the beneficiary disagrees with the letter.I hope that this letter provides some clarity on who we are and our responsibilities on behalf of the *******************

I only have them a because I had to. I was sending my private information to my ******** drug company I had just enrolled in. They wanted my drug coverage prior to enrollment. I was given a number and told by ******** it was the fax for the enrollment department for my company. I sent it with a cover letter addressed to Amerivantage. If this is not the correct number please call me and added my number. It was not. It was C2C. I then called my company after finding out they had not received my fax and mailed that information and more I had received and found so they could determine if had to pay a penalty. I received a letter from C2C saying they had received my appeal. I called and informed I had not filed an appeal with them and that it was not for them while I was told it was all wrong. I explained it wasnt for them please disregard. I still had not received my initial determination from my drug company from my information which was late but still proved I had coverage. They went ahead and used my private personal information not addressed to them to file an appeal on my behalf. My drug company sent a letter determining I did not owe a penalty. Then after C2Cs appeal I now owe 54$ a month as a penalty despite having had drug coverage for all 18 yrs they claim I did not. Despite 2 more calls to C2C of which one person hung up on me when I repeatedly stated it was not addressed to you. I called back for a supervisor and never received a call back. I believe they used my private personal information illegally. Im still looking into how to even contact the company to file a complaint. They are not ******** which leaves no one to police them. But Im looking.

C2C Innovative Solutions, **** has reached out to ************************* and have agreed to reopen her case with new documentation she is going to provide (2/16/24).

I'm a provider and this company does an independent review of ******** claim denials. ******** normally pays for collagen dressings for wound care patients. I have a ******** DME number. So, a patient has a wound that was billed and office visit with a collagen dressing her 1st visit. On her 3rd visit another collage dressing was dispensed. ******** denied the collagen dressings that are dispensed for her convenience to do her dressing changes at home. Of course, I know my private doctors office is cheaper for wound care than a ****************** So, I will not offer this convenience to my ******** patients due to the denial for these dressings. This company states there is invalid or missing documents. The office notes states the presence of a wound and the need for this dressing. Of course this company denied the dressings due to be billed the same day as an office visit. Usually they will not pay for the dressings when billed with a procedure but no other procedure was billed, only an office visit. So I called this company to see what was the invalid documentation and no return calls. Very poor company and ******** for denying this in the first place when the do cover these dressings.

A C2C staff member reached out to the complainant's patient: "I called the patient and she understands that they billed the service to the wrong MAC (Palmetto RR ******** B). I explained if they believe it was *** they should bill the service to the *** MAC and that *** MACs are not our jurisdiction and she understood and thanked me for the call. I gave her my name and number for her records and she said she understands the disconnect." A letter was mailed to the ****** on 10/26/2023 explaining the denial and we also spoke with the ****** on the phone.

This company is supposed to be a prescription coverage company. This company denies coverage for ordinary medications approved for many years by the U.S. Food and ******************** Because of companies like this one, it is the reason why health care system in the **** is completely broken.

C2C is a Qualified Independent Contractor (QIC) to ******** Part D, not a prescription coverage company.  We process appeals strictly per the ******** guidelines regarding medication uses, as a completely neutral party.

To clarify, C2C an Independent Review Entity (***) contracted with the Centers for ******** and ******** Services (CMS) to adjudicate ******** Part D prescription drug benefit appeals and Late Enrollment Penalty (LEP) appeals on behalf of CMS.  Our jurisdiction is national.  We work for the Centers for ******** and ******** Services (CMS) and our charge is to provide independent on-the-record reviews and issue decisions for appeals filed with us.  We adjudicate appeals in accordance with provisions set forth in the Social Security Act, CMS regulations, and CMS manuals. 

The CMS regulations provide several levels of appeal that are available to ******** Part D beneficiaries who disagree with denials they may receive pertaining to Part D prescription drug benefits.  Level one is the Part D plan level.  Level 2 is the *** (our company) level.  Level 3 is the Administrative Law Judge (***)level.  Level 4 is the ******** Appeals Council level.  Level 5 is Federal court.  ******** beneficiaries have the right to avail themselves of this step-by-step process and appeal denied services that they believe should be covered under the ******** rules.  When we issue a Level 2 denial for Part D services pertaining to prescription drug benefits, we include detailed information in our letters on how to appeal to the next level, which is the *** level of appeal.

I hope that this provides some clarity on who we are and our responsibilities on behalf of the *******************