In April of I was interested in getting health insurance for my husband, our baby and myself. I filled out an online application to receive offers for health insurance from multiple companies.
Later that day several health insurance companies called me including a man by the name of Christian Zimmerman from Protective Smart Health. He took my information and gave me a quote for $139.95 a month for the three of us to have health insurance. I was shocked by the low price and asked him what the catch was. He said there was no catch and he was very happy to be able to offer people like me health insurance for less. I was skeptical and spent at least 45 minutes with him on the phone asking him questions about the plan. I called him several times throughout the day. I had never bought health insurance before and wanted to make sure I made the right choice. He was very sure of himself and made the insurance sound like a great plan.
Christian told me they would pay for 60% of all medical bills as long as we used doctors in their network. He said generic prescriptions would only cost us a $10 co-pay, brand name prescriptions would cost us a $20 co-pay and select prescriptions would cost us a $40 co-pay. He told me that in the event that we go to the emergency room, we would only pay $100 and they would pay the rest up to $5,000 a day. Anything beyond the $5,000 a day they would pay 60% of the excess. They would also fully pay for all ambulance and airlifting charges. He said we could go to any hospital in the country for an emergency, not just in their network of doctors. He told me we would only need to pay 35% of dental costs and 50% of chiropractic costs. He also said that we would receive five $25 certificates per person for a total of fifteen certificates per year to pay our part of the medical expenses. He said we could mix-match the certificates and use them all for one person, if we wanted. Christian made it sound like this was a regular insurance company that would fit our needs.
I asked Christian if I could see something in writing before making a commitment. He referred me to the Program Details section of their website at http://www.protectivesmarthealthpremier.com/Details. Aspx (attached). I looked at it briefly while on the phone with him. I noticed that it didn't read exactly as he had described the terms to me. He said the website hadn't been updated but the information he had in front of him was definitely correct.
I signed up over the phone with him and paid a $100 activation fee and $139.95 for the first month of service. Christian said we could start using the insurance right away.
The next day, I read on the website that it said The Protective SmartHealth Premier discount program is not health insurance. I was surprised since Christian had called it insurance. I called Proactive. Christian Zimmerman was out so I spoke with another man. He said Proactive is not technically health insurance but assured me that it works the same way and I wouldn't have a problem with it. My husband wanted to confirm that they would cover catastrophic accidents, so I asked about that as well. The man on the phone said Proactive would cover up to $5,000 per INCIDENT instead of per DAY, as Christian had told me. I was irritated at being misled by Christian and said I wanted to cancel and get my money back. He said I couldn't get the activation fee back and tried to convince me to stay with the program. I felt uncomfortable, but decided not to cancel.
Four days later, my husband got a toothache and decided to go to a dentist on the Proactive network. He setup an appointment, and visited that day. We paid $147 for the visit and repair to a filling.in this experience, we discovered that Proactive doesn't pay any of the cost, but simply negotiated with the dentist to charge a set price for clients of Proactive. So, in essence, we paid 100% of a discounted price. We figured it was still an okay deal and expected to be able to pay the $147 with some of the $25 certificates that Christian had promised to send us.
The next couple months we paid Proactive $139.95 for May and another $139.95 for June. We did not yet receive the certificates, but figured they were just slow.
On June 25th my husband woke up coughing and having trouble breathing. It was Saturday and we couldn't set a doctor's appointment until Monday. He got worse throughout the day and we rushed him to the emergency room. He was diagnosed with bronchitis and a sinus infection and he was prescribed some medication and an inhaler. We couldn't get the prescribed items using Proactive because all the pharmacies in the Proactive network were closed.
On June 27th (Monday) I called Proactive to ask when and how we pay the $100 deductible on the emergency room visit and also to ask where our certificates were. The lady who answered the phone told me she had never even heard of the certificates Christian told me about and that they wouldn't pay for the emergency room visit. I asked to speak with the manager.
A man by the name of Steven Sturm came on the line and told me that they do send out certificates and that we would be receiving ours soon. When I asked him about the emergency room deduction, he told me that they would not cover the cost because my husband was sick not hurt. This was the first time anyone had told me that they would only cover the cost if the person was hurt and wouldn't cover the cost if they were sick.
My husband got on the phone with Steven and asked for our money back. Steven refused. He spent over an hour and a half on the phone talking with Steven and Christian.in the end, my husband had canceled the insurance plan; Steven had promised that Christian would never be allowed to sell that plan again because he gives incorrect information to customers; and that we would still receive the fifteen $25 certificates to pay back the money we had paid the dentist and part of the emergency room bill.
On September 8th we still have not received the certificates and had to pay the emergency room bill on our own. We have paid $519.85 to Proactive with nothing in return but broken promises. I'm frustrated and feel taken advantage of. They are falsely advertising their program and do not fulfill their commitments. They lied to me and I don't want them to mislead others.
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