I had a major surgery in Nov. Of 2005 (uninsured at the time). This prompted me to find some coverage for myself and family. My husband & I have our own business, so we have to find our own coverage. I look in the phone book and see an ad for insurance coverage targeting among other "targets" self-employed families. That's us!
I call and an agent named, Jessica Funk, talks to me, seems great, sets up appointment to come over. She comes over sits in my kitchen - at my table - over coffee and proceeds to sell me a useless policy!
We had alot of discussion over the type of policy our family needed. Key things I told her & explained adamently were; we had a previous surgery ($16,000) and another major emergency like that could financially devestate us. We had to be covered. She listened and explained a policy that seemed great. She went on and on about 100% surgical coverage after a $500 deductible, 80/20% splits, one free woman well visit, blah, blah, blah. Lies.
You can guess what happens next. My husband got in a freak accident in August of his tendons in his front ankle were severed by shattering glass from an old window. He went to the ER, was stitched up and they told him to come back in 48 hours. After two days, he still couldn't move his foot. He went back to ER, he knew something was really wrong and finally he got into a Orthopedic doctor. He had to drag his limp foot around for 2 weeks before he got an MRI & immediately after the results they scheduled his surgery the next day. Another Ortho. Dr. Pulled multiple tendons from each end of his ankle and sewed them back together.
When we scheduled the surgery, the front desk person told us we had a deductible of $500 and she thought that seemed like alot. We were like, yeah it's alot, but after the deductible the ins.Co. Pays 100%. Boy, were we stupid. Not stupid, trusting.
We did the right thing getting insurance and weren't really protected. Long story short, we had about a $14,000 hospital bill and ins.Co. Paid a little over $2000. Is this coverage? Why is UA even allowed to sell/market this as insurance coverage??? Especially to self-employed who have no way to fight back.
When the Ins.Co didn't cover hardly any of our DR. Visits as dumb as it sounds, I saw this as further confirmation that their big benefits were when something major happened. Dr visits - they paid $25 of them. I understood we had a $25 co-pay. Lies. But, like I said this wrongly made me think they skimped on routine visits to cover major ones.
Insurance company says when my husband went to the ER, they pay for one injury, one time. The first ER visit they paid barely covered 50% of the total bill. I look at my policy and I truly don't know what they cover and how they cover. They have all these paragraphs that will cancel out other benefits in other paragraphs. What I thought was covered via my discussions w/agent weren't true. Big surprise she no longer works for that company. At the time she sold me our policy, I found out later she had her license for only one month.
I get different answers from different people when I call. We never even got bills or knew things weren't being paid until Jan. Of 2007. I call my hospital billing dept. They tell me they have talked to lots of others with this insurance, who were shocked by bills or lack of coverage. I see this as a pattern. Please tell anyone you know, do not get this insurance, the agent lies, they sell you a supplemental fake policy and when you complain they tell you you should have cancelled it in the first 30 days.
I guess Insurance agents and Insurance companies do not have a code of ethics and they can lie, mislead hard working Americans. We currently don't have insurance. I immediately cancelled the policy once I realized it was useless. Now we are uninsured again I don't know what company to trust. I am scared to get insurance and have that faulty sense of protection blow up in your face.
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