As a busy, self-employed person, I responded to NASE's, (National Association for the Self-Employed's) brochure that said they recommended Mega-Life Health Insurance. I thought The NASE was an association that looked out for the welfare of self-employed, and had chosed MEGA LIFE because of the excellent coverage vs. Cost... Only to find out through recent research that the practice of "insurers" using (non-profit) "associations" to market their plans is now rampant... And as far as I'm concerned it's not only a conflict of interest, but a fraudulent/deceptive sales practice if the affiliation is not declared by the insurance "agent."
Now you can check me if I'm wrong, but either NASE and/or Americans for Financial Security (the other non-profit) are actually owned by the owner of MEGA LIFE (UICI out of Dallas). So those "association fees" you pay (Between $8 and $45/month) go right into the pockets of the owner. Why should you be forced to pay the fee, when wouldn't it make more sense to use that money to buy extra coverage? The association that the customer thinks had chosen, through many comparisons, an excellent plan... Is actually owned by the insurance company... Or is getting kick-backs from the insurance company. Brilliant!!!
The reason to hide behind a non-profit association is not only to make the sale easier, by making it seem as though it's been chosen by an organization (like NASE) that you think's looking out for you but it also provides MEGA LIFE with less stringent laws about things like fair rate hikes that in-state insurance companies have to adhere to.
Now to get to the heart of the scam. The "independent rep" (ROBERT SADEH) came to our business and showed us a "slick" computer presentation of the AMAZING coverage, stating that the plan (after choosing a deductable) would cover 80% percent of everything up to $10,000... Then MEGA LIFE would pay the rest, and he said that that included Mega Life paying 100% in many instances... And he was making it seem as though he couldn't believe why I would even wait to sign on (with my wife), and made me feel "weak" for not immediately understanding how strong the "coverage" was.
He mentioned no limitations other than the $Million dollar "cap.". He said not to wait long, because if we didn't sign in 24-48 hours so he could get the paperwork in before the end of the month, the rates were going up.
Additionally, Sadeh explained that we were also going to have a membership in AFS (Americans for Financial Security) that would give us a great amount of business benefits (that presentation took up at least 1/3rd of the time). Unfortunately, he sold us the "GOLD PLAN", not mentioning the $45/month price, at the "BRONZE PLAN" price, saying that it was included in our $8/month membership fee that we had to pay to get the "low rate" from MEGA (see below).
After spending the night with the coverage figures that he had begrudgingly written on a piece of paper (no pamphlet of limitations!!!) he came to our house the following day to sign papers. I then stressed that I wanted our company to start paying for our insurance, so the check would be coming from our company. Strangely he mentioned that state law required that the first check be a personal one. I questioned that, but gave Sadeh a personal check anyway, which also included a one time/lifetime association start-up fee of $100, which was separate feom the monthly fee.
As it was late on a Friday, he was rushing me to sign everything because he said he had to get back to watch a football game (He came to the house in a Miami Dolphin's jersey to bolster his story) So thinking everything was in order, and that I'd understood the coverage "HE" explained, I hurriedly signed documents that he said were relating to coverage we'd chosen. Well when we got our next bank statement I was angered to find that one of the documents he'd run past me was an automatic bank withdrawal form. When I told MEGA that I'd never authorized automatic withdrawals, they sent me the document I'd signed... And I asked, "Well, were's the "voided" check (which I know I'd never given) they said they could not release a copy of the check, but that it had been sent by the agent.
What ROBERT SADEH, the agent did, (Which is my fault) was run a withdrawal form by me to sign, and then he filled the "Bank Routing" information in from the personal check... After he left. The other document I signed was what I thought to be the "association" Americans for Financial Security (AMF) $8.00/month fee. Sadeh had actually signed us up for the GOLD PLAN, which was $45.00/month!!! Which was also added to the "AUTOMATIC WITHDRAWAL." I was so beyond angry.
I was able to call AMF and get a refund for the difference, but it still took time out my day to figure out what had happened. Needless to say, the agent (ROBERT SADEH) had no "FIXED CORPORATE ADDRESS" and had only left his cell phone #. When I tried to call to confront him, his line was either busy, or there was no answer.
Separately, we were quoted around $220/month after signing everything, but when the actual quote came back with my weight added (though the agent knew I was overweight), it quickly rose to $292/month... And then was raised again at year's end to $340 / month... With a form letter citing even the cost of physicians' malpractice insurance helping to raise the cost of private medical insurance.
After the "withdrawal" and "fee" situation was resolved I though I was in the clear... Well, last year they found a cancerous lump in my wife's foot, which was removed in a 2 hour surgery, and found to be benign (thank God).
Then the actual bills start arriving. After a $3,000 deductable, the hospital sent a remaining bill for about $19,000 that didn't even include the foot surgeon's or anesthesiologist's bill. The hospital then reduced the remaining bill to $9,000, which MEGA LIFE said was not covered (WHAT???) "Well, sir, if you read your contract (fine print) it says that if you have "day surgery/outpatient surgery" where you are not confined for 24 hours or more, MEGA ONLY COVERS A MAXIMUM OF $1500.
Well, that doesn't even cover the recovery room fees!!! And whatever they pay the surgeon (separately), the anesthetist only gets 25% MAX. The surgeon's bill was about $1500, so they only paid the anesthetist $359.90 out of an $1140 bill. I'm paying off the rest of the $780.10 that MEGA LIFE didn't cover in payments, and that's just ot start... After an hour of complaining to MEGA of their not covering the remaining bill, MEGA LIFE ended up paying the other $9000... But only after I calmly threatened to call the show "60 MINUTES, " because a relative knows Mike Wallace (true).
I got a call from a "manager" at the end of that day saying that they would now classify the operation as a 24 hour stayover. But what would have happened if I hadn't fought in that instance??? And how many other less fortunate people have had to just take it, and have had to take out second mortgages to pay for MEGA LIFE's lack of coverage.
The next eye opener was when late last year (a couple months after my wife's foot surgery) they found a lump in her breast that had to be biopsied. The hospital bill, including the bill from the Dr. Who did the biopsy, was about $3,000. Well, guess what, it turns out that that $3,000 deductable that anyone else would be crazy not to believe applied to a one time, full year of coverage... Through MEGA LIFE it means PER OCCURENCE!!!
So nearly the total biopsy was not uncovered, and was to be applied to the "deductable." That didn't include the majority on uncovered lab bills and OB/GYN exams that weren't covered or poorly covered leading up to the biopsy. This time when I called to declare how fraudulent a "per occurence" deductable was, the MEGA LIFE phone rep. Tried to get me to say (knowing that it was being recorded) that I hadn't read the contract closely enough.
The fact is that the contract is very hard to decipher even if you are versed in insurance lingo. The message boards I've seen have insurance agents stating that with MEGA LIFE they often didn't even know the complexity of the plans and the coverage they were selling... And many agents said that there's no way a decent/honest agent would sell this product, especially claiming that it was a "major medical" policy.
The bottom line is that if you could understand the "fine print, " as I do now, and have seen a couple REAL HOSPITAL BILLS, you would see that MEGA LIFE sells policies that have gaping holes and limitations that potentially can and do expose the policy holder to extreme risk of financial loss for uncovered hospital/surgical bills. I would call the policies "HIGHLY EXCLUSIONARY."
The positive "agents" for MEGA LIFE responding to complaints will say that the customer was purely "bottom fishing" rates, period, and didn't check the contract in the "time allowed by law" to review. Well $200-$300 (now $340/month) is no cheap rate for a couple in their mid-30s, and couples like us believe that most people are basically honest, especially when backed by a non-profit organization touting their chosen insurance company as though their were other insurance companies they had screened... And those same agents say that you might find a bad egg once in a while when it comes to sleazy agents.
I personally (and others agree, including other agents) think that the agents MEGA LIFE hires/contracts are either just out of school, and quit when they realize what they're selling, or they're blinded by the high commissions to look the other way, and just keep selling to customers with no regard for their families or the risk they could be walking into if & when they really need the insurance.
The sales tactics are high-pressured, condescending, rushed, evasive and factually incomplete in declaring where a policy is lacking in coverage or has specific limitations... And I believe it all comes from the top executives and owners at MEGA LIFE (Owned by UICI/Jeffrey Jensen, out of Dallas). Most "hometown" insurance agents couldn't come up with a scheme as sophisticated as hiding a ruthless and deceptive marketing plan behind a non-profit organization that on the surface would seem to help the potential buyer of a policy. I believe that there should be nationwide class action suit to shut these types of operations down.
The last part of the whole MEGA LIFE & HEALTH scenario that truly bothers me is that seemingly untold colleges and universities have MEGA as their insurance of choice to their students. Are these universities getting kickbacks???
GOOD LUCK, and please don't make the mistake we have. Bring the contract to someone who understands the wording, even if its the agent you're about to drop for MEGA's plan.
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