Health Network America Was told one thing,billed for another.They agreed it was their error but would not do anything about it Eatontown New Jersey
On August 30,2006 spoke to Robert Allen at Healthplan Network about health insurance.I was assured 3 times that pre-existing conditions were covered. I signed up my wife and myself.After visiting the doctor for several things we got a bill for $425 saying pre-existing conditions weren't covered for one year and we had to use the doctors in their group(Galaxyhealth.net).I was never told this either.They were very emphatic that I could use any doctor anywhere,anytime.
I called and explained that this was not what we were told.They agreed that the person I spoke to was in error telling me that,but that was how the policy worked and they were not going to do anything about it.I feel I was purposely misled and not given complete information.This company agrees with me but is unwilling to do anything about it.
Brian
Cross Lanes, West Virginia
U.S.A.
2 Updates & Rebuttals
Hilary
Murray,Utah,
U.S.A.
Your responsibilities
#3Consumer Comment
Wed, November 22, 2006
I work for a health insurance company, and I call other health insurance companites every day. Every single one I have ever called says something on the lines of "quotation of benefits does not guarantee payment." Yes, you were mis-quoted, and your insurance company might have some kind of appeals/exception process, but it is still YOUR responsibility to be aware of your benefits. "Nobody told me" is NOT a valid excuse.
Your health insurance company is required by federal law to send you notification if you are in a pre-existing waiting period. If you were in that period, why would you even think that something pre-existing would be covered??? If you had a year's worth of previous coverage and less than a 63 day break, you can send your new company a Certificate of Creditable Coverage from your old insurance company. That may waive some or all of your PEC period. If it is waived, any claims that were denied as pre-existing would have to be reprocessed.
Sue
USA,Pennsylvania,
U.S.A.
Healthplan network
#3Consumer Suggestion
Sat, November 11, 2006
You are in luck as I know NJ has very strict insurance guidelines that companies and agents MUST adhere to. Call the NJ Dept. of Insurance and find out if this company is even licensed to sell in NJ and also see if the agent is licensed. If it is and he is, file a complaint with the NJ dept. of insurance. If it's not call the NJ attorney general's office and speak to someone in consumer protection and file a complaint. Also call the BBB and Consumer affairs and both have online complaint forms. The agent misrepresented this policy to you and that is serious offence under NJ insurance laws. Best of luck!