In June I started shopping for a policy that would provide hospitalization & surgical benefits only for my husband. I was not looking to get doctor office visits covered for colds and routine examinations, because I knew no one was going to cover a pre-exsisting condition.
My husband has a seizure disorder described as Nocturnal Mio Clonis (periodically he will have a seizure in his sleep only). Nor was I looking for prescription reimbursements. I first applied to Blue Cross/Blue Shield of Florida for the Essential Care Policy. The premium for both of us would have been somewhere around $125 per mos forthe type of benefit I was looking for. The deductible was $250. They would not write the coverage because of my husbands pre-existing condition.
An agent from M & M Insurance Advisors in Sarasota FL contacted me advising of a similar plan that was guaranteed issue with a $500 deductible and cost of $197 per mos. He sent me the United American Insurance Companies Flexcare brochure (Sensible Health Insurance for Todays Lifestyles). The front indicates a Limited Benefit Basic Hospital, Medical & Surgical Expense Coverage. The "limited benefit" I construed as no doctor office visits, no prescription coverage, etc., just hospitalization and surgery coverages.
In the brochure the agent highlighted the $50,000 Hospital Expense benefit, the Surgical Expense Benefit 100% up to $7500. I though OK-this looks like a good plan. There were 2 other benefit plan amounts, $75,000 and $100,000. Each and all of the plans were based on 80% co-insurance. Of course the higher benefit plans would have increased the premium and like everyone else,
I don't want to let insurance premiums break the bank. So I take the policy which becomes effective 7/13/05.in June my husband goes to the doctor because he has a small protrusion in his groin area. The diasgnosis is a hernia. So out-patient surgery is schedule and done. The total cost of the hospital, pre-op lab tests, anesthesia, physician who did the surgery, radiology, etc is $12,546.57 to date.
As of todays date United American has paid out $2160.02 and it doesn't look like they are going to pay anymore. So now in addition to the premiums that I have paid out over the last year ($2581) for
coverage that we thought would cover this type of circumstance, we are left with a $10,386.55 balance to the hospital.
Also, I am now aware (after the fact) that the policy is not worth the paper it is written on. This product should not be allowed to be presented to anyone. I sent a letter to the writing agent to let him know how his misreprensation will be costing us dearly and his response to me was "I never offer this plan to anyone who can get true insurance coverage, but anything is better than nothing". This I have in writing.
He also advised that he does not offer this plan anymore. I don't agree with his "anything is better than nothing" because at this point we may as well have had nothing and our premium back to go toward the balance. Even if we would have taken the $100,000 plan we still would have ended up owing somewhere around $8000. So don't let anyone try to convince you this plan is worth anything.
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