HealthFirst Refused to honor contractual obligation to provide 100% coverage for preventive care New York NEW YORK
I had a routine screening mammogram in January 2018 with an in-network provider. My HealthFirst 2018 Member Handbook for my Silver Leaf Premier plan states clearly, "Your recommended preventive care services are covered 100% when you see an in-network doctor."
Ever since my mammogram, I've been getting demands from the provider to pay more than $100 on top of what HealthFirst paid them. I called HealthFirst repeatedly to clarify this matter. Each time, the helpful and polite representative assured me that my mammogram was included in my free preventive care screenings and that I owed nothing.
As the demands from the provider escalated, I called HealthFirst yesterday and insisted that they sort the matter out. At this point, after a very long wait, the representative informed me that in two "appeal decisions" in March and April, HealthFirst had decided that I had to pay the provider.
They never mailed me these "decisions," not to mention the fact that their representatives gave me the exact opposite information over the telephone multiple times. Now I have to go through an onerous "external appeal" process with the NY State Dept of Financial Services, wasting my time on top of the rage and stress HealthFirst has inflicted on me in this matter.
This company is completely unethical, and I will not renew my policy with them next year.