- Report: #523225
Complaint Review: Cinergy Health Insurance - Aventura Florida
Reported By:
Jerry -
Captain Cook, Hawaii, United States of America
Submitted:
Updated:
-
Author Not Confirmed
Why?
Cinergy Health Insurance
19495 Biscayne blvd Aventura, 33180 Florida, United States of America
Phone:
8008471148
Web:
cinergyhealth.com
Categories:
Business Rating:
(0)
Tell us has your experience with this business or person been good?
Cinergy Health Insurance Avoiding paying claims Aventura, Florida
I have been paying premiums to them since June I 2009 and went for a Doctors visit on July 1 2009 with a network doctor who ordered a routine blood workup since I have not had any exams in years.
The clinical lab bill was sent direct to me and I filed a claim with them on 7/31/09. I have had to call them every month inquiring about the status of payment, first the run around process, then the lab is a network provider so billing has to be adjusted on the rates, then claims department is checking on it and now the latest twist is I need the Doctor to sign a form showing it is not a pre existing condition for the claim to be paid.
Now this would be funny if they actually paid for the blood test but the policy is clear a fifty dollar reimbursement for diagnostic test, so what is there game, re rate the whole bill great that might save me some money for my cost portion if and when the EBO
( explanation of benefits) is finally sent out. But Please a pre existing condition for a CBC complete blood count which is so standard for any doctor to assess the general state of health and perform a physical.
Now after some research I see the underwriter AMLI is barred from selling these policies from the NewYork insurance commissioner and just where does that leave us with pending claims?
I was looking forward to the "credible coverage" of this policy to help in getting major medical from a real health insurer but now realize I should probably cut my losses and cancel from this company before they charge next months premium and by the look of other reports that might mean canceling the credit card since they do not accept cancellation request and now I have spent premiums for nothing.
I will have to check with the doctors office and see if my exam was paid for or not and am hoping the 50.00 dollars they are contractually bound to pay for the diagnostic test does come, not very confident of that after all that I have been through and now researched about this company.
The clinical lab bill was sent direct to me and I filed a claim with them on 7/31/09. I have had to call them every month inquiring about the status of payment, first the run around process, then the lab is a network provider so billing has to be adjusted on the rates, then claims department is checking on it and now the latest twist is I need the Doctor to sign a form showing it is not a pre existing condition for the claim to be paid.
Now this would be funny if they actually paid for the blood test but the policy is clear a fifty dollar reimbursement for diagnostic test, so what is there game, re rate the whole bill great that might save me some money for my cost portion if and when the EBO
( explanation of benefits) is finally sent out. But Please a pre existing condition for a CBC complete blood count which is so standard for any doctor to assess the general state of health and perform a physical.
Now after some research I see the underwriter AMLI is barred from selling these policies from the NewYork insurance commissioner and just where does that leave us with pending claims?
I was looking forward to the "credible coverage" of this policy to help in getting major medical from a real health insurer but now realize I should probably cut my losses and cancel from this company before they charge next months premium and by the look of other reports that might mean canceling the credit card since they do not accept cancellation request and now I have spent premiums for nothing.
I will have to check with the doctors office and see if my exam was paid for or not and am hoping the 50.00 dollars they are contractually bound to pay for the diagnostic test does come, not very confident of that after all that I have been through and now researched about this company.
1 Updates & Rebuttals
Jerry
Captain Cook,Hawaii,
United States of America
Prompt resolution achieved
#2Author of original report
Mon, November 16, 2009
2nd update 11/15/09 attempt
After reading a lot of various internet post and rebuttals from Cinergy Health I called there Chief Compliance Officer (CCO) Mr David Dimlich on 11/13/09 and had a return phone call within 2 hours. David was concerned about what I was experiencing in service from Cinergy Health and the underwriter of the policy American Medical and Life Insurance ( AMLI ) which is the responsible party for paying claims. I have understood from the time of insurance purchase that I was buying a Limited Health Insurance policy and was clearly informed on phone sales and in policy documents.
The delays in processing my claim are a concern for Cinergy health and David is doing all he can to help expedite my payment. He has asked AMLI to contact me personally and to rectify this situation, I will advise him of any progress from his effort.
David understands my concerns in continuing to trust AMLI to provide the coverage they are obligated to under the policy. As the broker selling coverage and policies of insurance Cinergy Health can not control the service provided by the underwriter AMLI . David has accepted my cancellation request without problem and provided credit of some premiums paid to compensate me for my problems and time. I will apply the credits to the medical charges incurred and continue to pursue AMLI to provide the coverage contracted for.
I am pleased with service from Cinergy Health and the responsive action I have received from them and would consider purchasing coverage through them in the future if a proven reputable underwriter is providing the coverage and support services.
