My family switched our health insurance coverage from Blue Cross Blue Shield to PJP Health Agency. We have had only used our coverage twice in the last 6 months and both times PJP Health Agency refused to pay.
The first time my husband had a fever and he went to the doctor. We called a customer service represenative at PJP Health Agency and he said the doctor was in network and my husband would only have a copay for the visit. He went to the doctor and was treated. We received a bill for the entire amount. I called PJP Health Agency to ask why we were responsible for all of the charges and they said it was a coding issue of the doctor's office. I contacted the doctor's office and they said that every other insurance company accepts their coding and said they couldn't change it. I called PJP Health Agency back and they refused to pay the claim because of coding.
The second experience was that my two year old son had a 105 degree fever and had to go to the doctor. It turned out my son had an ear infection. After about a month we got a bill in the mail from the doctor's office but we assumed that the insurance hadn't posted payment yet. We then got another bill and an explanation of benefits from PJP Health Agency. They wanted us to pay the entire 128.00 and they would not cover anything.
In the general remarks on the bill it stated the insurance company does not cover doctor visits. Why did the agent tell me I had a copay if the insurance does not cover doctor visits. Why did they tell me it was a coding error if the insurance does not cover doctor visits? This is insurance fraud.
I don't know one person that would ignore a 105 degree fever in a toddler. I have also read numerous other reports on this sight and it seems pretty apparent that PJP Health Agency does not want to pay their claims.
There is obvious stress involved. Also we had already paid upwards of 160 for the first claim that went unpaid and now we face paying another 128 out of pocket.
Don't get insurance PJP Health Agency. I hate this company, they were a waste of my money, patience, and time
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