I was contacted by a broker in September after submitting an online request for affordable insurance quotes. He made the plan sound like the best plan ever and that it was the answer to all my insurance needs! He said it would be great coverage and I would have no issues. 9 free office visits a year, no deductibles, no copays, medications would cost 10/20/40&generic/brand/specialty. He named off many benefits that he stated was 100% covered and then would change to a copay / coinsurance if the number of visits were exceeded.
It was important for me and my family to have insurance and after being denied health insurance due to preexisting conditions the plan sounded great. He stated that at the time they were offering a special with no preexisting condition review. The Broker said that this was a group policy similar to the ones employers use so the pre-existing condition limitation does not apply. Sounded reasonable to me. He said he could get me a rate of $530 a month and a $135 "enrollment" fee required by the state of Colorado to be charged.
The Broker stated that in order to review the policy I had to pay the enrollment fee and the premium before I could see the benefits in writing. The Broker would only say it was a multi plan and because of this it offered affordable cost with wonderful coverage since it was offered across the United States. I would get a 30 day review however I could not use the benefits until the 30 days was up or forfeit the review time.
When I got the policy I called customer service and complained that the policy was completely different then what was described over the phone. They did nothing.
We had to forfeit the 30 day review because it turned out my daughter had to get some immunizations for school so we had to take her to get them. The claims came back that immunizations were not a covered benefit even though it stated in the policy they were covered.
After a few more discussions with customer service fighting about the benefits and how bad they were they told me to call "Anthony" the quality assurance coordinator and he would assist me in reviewing my policy. He would not address how the previous broker misrepresented the policy but was more than happy to send out a comparison on how to upgrade to better coverage. When I reviewed the coverage I called him back at the end of December and he never returned my phone calls.
I was unfortunately hospitalized in February for 5 days and found out how bad the coverage was when I started receiving EOBs for non covered benefits. I have put in multiple complaints regarding the insurance and finally terminated the coverage since I didnt want to sink any more premiums into a "discount" program... Because that is what it is! A more descriptive term would be legalized extortion, misrepresentation and fraud!
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