This insurance advertises that it provides so many benefits, yet in the fine print, it has exclusions/limitations to every one!
I have carried a Assurant Health RightStart policy for three years now, paying about $100/month in premiums. I am a healthy 26 year old female. When I sat down with my insurance agent to get this policy, I told him my needs. I work full time but my company does not offer insurance, I don't mind a $1,000 deductible, and I am looking for good hospital coverage in case of emergency. I was told from the get-go were anything to happen to me (broken arm, cancer) I would just be out of pocket the $1,000 deductible plus the $2,000 in-network out of pocket. $3,000 isn't cheap, but I can handle that if need be, and it didn't sound bad as a max to pay yearly!
I recently had to have thyroid surgery (totally unexpected, a growth came out of nowhere). Prior to surgery, I went in to the insurance office to figure out exactly what I would be out of pocket, as I like to plan ahead financially! She assured me it would be $3,000 $1,000 for the deductible and another $2,000 for the network out-of-pocket. I told her this would probably be a pricey procedure, and from what I had read on the website and my generic policy sheet, they cover 100% of outpatient surgery. I even traveled to another town to have the surgery (as opposed to the hospital my father works at) to stay in-network (another thing Assurant Health customers must be very careful about!) Later I was to find out that they cover not 100% of all charges, but 100% of your outpatient max. What I had yet to hear from anyone (at any point) was the term outpatient max.
Most hospital procedures done these days are outpatient, be it a minor surgery, broken bone, minor illness I was thankful to see that so far, they had been paying as planned, and every bill I had gotten was one bill closer to satisfying the $2,000 out of pocket max. Today, I opened my latest bill eager to see that they had started paying for all of the charges. On the bottom line of the bill, it said "*$5,200 patient responsibility." I thought there must be some mistake! I called Assurant directly and was told matter-of-factly the terrible news. Apparently, my plan has a $2,500 outpatient max. This was the first time I had even heard this term. The lady on the phone explained that an outpatient max is the maximum per calendar year they pay towards any outpatient hospital procedure. Nowhere on any of my previous bills was this outpatient max even mentioned, not even on the $5,000 bill. I am convinced they are keeping this information from the consumer from the get-go. I mean, who would purchase a policy knowing it had this clause?
I called my agent and he said you have the option when signing up of a $2,500, $5,000, $10,000, or $25,000 max. I was never given a choice. I wasn't even told I had this max. When I told him that, he said well, $2,500 is Assurant's default option, so it automatically set you up on that. I was blindsided. I think I'm still in shock. Although I work full time, I can't afford this. I have paid over $3,600 into this policy to have it cover $2,500 of my expenses. I called the hospital and so far, I will be paying around $8,000 out of pocket, and every charge hasn't even come through yet.
People need to know they have an Outpatient maximum per calendar year, and be told exactly what that means. I'm not sure who to blame here. It's too late to do anything about these charges, but I can tell you I am no longer doing business with Assurant Health nor my insurance agent once this has all been settled. The health insurance I was paying for was actually nothing in disguise!
It hurts me to see they advertise directly at students. There is no way a student could afford what this plan doesn't cover. Sure, it looks great on the cover sheet. Low premiums, affordable deductibles... But just read on in to the fine print, and you will find out you're paying for nothing.
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