Approximately two months ago I was diagnosed with a fast spreading type of breast cancer, which is already in stage three. Thanking everything that was holy that I had taken out insurance through my employer, I immediately started life saving appointments and began setting up a treatment regime. My understanding was that I was covered in the following manner:
CO Pays and Maximum out of pocket expense:
Office visits in network: $15 in-network per visit, 50% after deductible, annual max out of pocket $1,000
Specialist Office visit: $15 in-network per visit, 50% after deductible, annual maximum out of pocket $1,000
Emergency Room: 80% after deductible, annual maximum out of pocket $1,000
Inpatient Care: in-network, 80% after deductible in network
Outpatient Surgery: in Network: 80% after deductible.
I also purchased prescription drug coverage, and vision coverage
Based upon the information provided on the coverage by my company, I entered my treatment knowing that I was going to have fairly heavy out of pocket expenses, but with the knowledge that I was covered and didn't have to worry over much and could go ahead and follow through with my treatment as quickly as possible in order to save my life.
Please imagine my shock when I got a call from my doctors office with the advice that Aetna, as an agent of my company and SRC, REFUSED TO COVER ANY OF MY EXPENSES.
Thinking there must be some sort of mistake, I called SRC myself, and was told that I am not covered for any real medical problem. Apparently, the payments I have made to SRC have been a scam pulled off either with or without the knowledge of my company. I am allowed to make all the payments that I want, but if I actually NEED the coverage, I can forget it. I am not covered - FOR ANYTHING dealing with my cancer.
When I told the agent at Aetna that I had been paying for my insurance under the understanding that I would be covered in case anything happened, and that I would die without this treatment, her attitude was "well I guess you will just die then, won't you"?"
Through later intense discussions with my company and SRC agents, I find that they will cover $500 in expenses - PERIOD.
Today, I got a letter from SRC saying that have to pay back what they DID pay, and am subject to criminal penalties because my cancer was a 'pre existing condition' - as if i waited a year with fast spreading cancer to get treatment so i could have my insurance in force for a year before going to the doctor!?!?!?!
Research on the internet shows multiple lawsuits against SRC for this type of behavior. Even cursory examination of online records of reports of individual, state, and class action lawsuits against SRC allege that "... The plans (provided by SRC) are designed to help employers recruit and retain employees by misleading them into thinking they will have sufficient health coverage if they become ill."
A $500 cap on health care coverage certainly qualifies, under these lawsuits, as misleading and clearly falls under the definition of misleading and intentional fraud under both state and federal law.
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