Complaint Review: Mega Life And Health AFS Membership - North Richland Hills Texas

Hello I just met with a NASE agent and he was selling mega insurance. But one thing he keyed on was that Mega does not adhere to reasonable fees, they only adhere to customary, and reasonable. He stated that the difference was Mega would not deny any claims by a provider because the company cannot claim it was not reasonable. The smoke cloud over the usual and customary. In my research I am not seeing any difference in the insurance definition for usual, customary, or reasonable. So am I to assume he placed a big smoke screen over exactly what he said mega insurance would not do? Would anyone recommend mega insurance, and or NASE. Also there is a $40 fee added for NASE, Does Mega offer individual policies outside NASE that is affordable. I have been denied by many insurers now for sleep apnea, even though it is cured using CPAP. Anyone have suggestions for good health insurance companies that will not deny for sleep apnea?

do you also tell your clients that there are plans on the market that do not have caps and limitations and most likely at a better rate......now that would be honest....

I am an agent for the NASE and Mega Life and Health and only have a few things to say about this report. It makes a difference who your agent is and what they say doesn't matter until you get your policy. I am one of the agents who tells the truth on my appointments and the fact is, most people like our policies because they are affordable. Most of my sales come from people who couldn't afford a major medical plan or another providers plan because we allow the customer to customize their own plan, and if that is the only thing that the person can afford anyway, than it is better than no insurance at all. We do have plans that cover with an annual deductible, and plans that cover 100%. BUT, we don't sell many of them because people don't want to pay that much and the rate increases are usually more than our other plans. It is all perspective. I feel very bad for the cancer patient, but what plan did you have, maybe the agent didn't put Chemotherapy on your plan. I am very pleased with the plan we have through Mega and I will continue to sell them to people who need them. On another note, you can't just request cancellation, it must be done in writing.

As a former MEGA customer, I can only say that there was a class action lawsuit filed against them in 2004. I am bound by the terms of contract and can not disclose any details. Suffice it to say I am a former customer

As a former MEGA customer, I can only say that there was a class action lawsuit filed against them in 2004. I am bound by the terms of contract and can not disclose any details. Suffice it to say I am a former customer

In response to Chris from Baltimore. My partner was diagnosed with breast cancer last month and is a policy holder with Mega Life and Health. Due to the severe limitations in coverage, we've estimated that we will have to spend over $100,000 in medical care this year alone. Not to mention the coming years now that it will be impossible for her to find adequate coverage. She is 27! What I object to is the sales tactics used by this company to peddle sub standard care to consumers who are looking for affordable health coverage. Unless faced with a health crisis, the cost of chemotherapy treatment, diagnosic services and the like are not common knowledge. Feeling secure with health insurance that she thought was reasonable, my partner stopped looking for additional coverage. Had we realized the limits to this policy before her cancer, we would have certainly continued to look for a better policy.

First of all, I will state for the record that I am a licensed insurance agent in the Life and Health and Accident fields in Tennessee. I am not contracted with Mega, Mid-West of Tennessee or any of its various incarnations. The gentleman who posted above is basically correct. It is all about reading the policy. 1. Benefits - Look for the phrase 'usual and customary', it obligates the insurance company to pay the typical fee in the area for the typical treatment for a covered condition. If you see a schedule of benefit, Mega/NASE and the like, run! If you see 'usual, customary and reasonable', run! The insurance company decides what is reasonable in that situation. Yes, that does mean your insurance company probably will not pay for an experimental procedure because it has no idea of its cost or effectiveness. 2. Covered Conditions - Yes, a lot of conditions are excluded in health insurance. Some are excluded in every single policy issued by a company, while some are excluded only in certain policies, pre-existing conditions. I have seen pregnancy mentioned elsewhere on the site in reference to this company. Pregnancy is not a sickness or injury, it is a normal part of life. Yes, most policies will exclude normal pregnancies unless a maternity rider is added, don't be surprised by that. 3. Policy - I do have to disagree with the first response in this regard. No, I would not show any prospect a policy. Why? Its simple, I don't have a policy for that person until they apply for one and are approved. Policies are issued to specific individuals, so even to show them another policy would require getting someone else's policy with their personal information (which I am prohibited by law from revealing). I also do not know of any company that would show a policy in this situation. Now, I will show someone an explanation of benefits, and by law I will leave it, signed, with an applicant. 4. Free Look - Most states have a free look period. During this time, you can return your policy and receive a full refund of any premium paid. This varies from state to state as to the period, in Tennessee an applicant has 10 days after receiving the policy. Our company gives the person 30 days to simplify things as we do business in numerous states. Additionally, with our company we consider the free look period to include the time the application is in underwriting (I don't know if that is law or not). 5. Financial Stability - I have seen this mentioned in various places, about insisting on companies with A+ or better ratings from A.M. Best. Mega has that high a rating, while our company is rated A- at present. While I would be cautious of a company with a B rating, once you get into the As, I don't think it makes as big a difference. I certainly believe someone would be vastly better off with my company with Mega despite our having a lower rating. We sell major medical health insurance, while what most people get through Mega is a Hospital and Surgical Expense Policy. 6. Co-Pays - The fact is, co-pays are bad. They are ruining health care in this country. We mainly sell Health Savings Account compliant policies. Why? Its simple, you are no longer pre-paying for health care when you have a co-pay. Insurance companies know that people with co-pays will over use them, and thus they charge more in premiums to cover this cost. If your doctor's office visit would have actually cost you 40-something with a PPO discount, what did a $20 or $30 co-pay really save you? Not much, because the insurance company will get that difference back, plus fees for its time. 7. High Deductibles - People need to face reality, high deductibles are to their benefit. It lowers premiums and discourages the abuse of health care. As long as its an annual deductible, not per instance like with Mega, having a $1000 or higher deductible isn't that bad a thing. It will keep down claims and premiums, and if something serious happens it really isn't that much money. I have seen people who smoke or are in poor health save more in a year than the difference between two deductibles. 8. Companies - While there certainly are some bad companies out there, there are many others that really do want to provide high-quality, affordable health insurance. I firmly believe I work for one of them. No, we are not the cheapest out there, but I believe the we deliver quality, value and service that more than makes up for any price difference. Talk with your state's insurance department, check out the National Association of Insurance Commissioners' website, naic.org, and look into the complaint ratio of various companies. Many companies have ratios well below 1, which is the median, while there are some that are way above 1. 9. Value - Next time you think about buying insurance, step outside and look at your car, your home. Did you buy the cheapest car you could find, the cheapest house you could find? I suspect not, instead you found a car, a home that was a balance between cost and value. There are reasons why some cars always sell at a premium, that do not constantly engage in price discounts. Why? Its because they deliver high quality and value. And that is exactly what you want from your insurance, health or otherwise.

The gentleman who wrote the first rebuttal is exactly right. If you read your policy, then you will not be surprised about how they pay their claims. Fact is, you probably did not reach your medical deductible (typically over 1000 for an individual policy), and that is why you had to foot the bill for the entire 1000 or 1200 or whatever it is. If you had gotten cancer, and your medical bill turned out to be a quarter million dollars; believe me, you would be very happy that you were insured with MEGA. That is what medical insurance is for, not doctor visits or minor outpatient surgery. Its just like a car, your car insurance isnt going to pay for a broken window because it doesnt reach the deductible. If you want a full-on medical insurance policy that pays for absolutely everything with no deductible, then get a full-time job with group benefits. Hope this helps.

I have a consumer awareness web site (non profit) which helps consumers with health care insurance information. I feel for Sheila. But, by the same token, all the information she needed to make an informed decision on her health care insurance was available to her before she signed the contract, and, she even had a chance to cancel it when she received the policy. In all liklihood, Sheila wanted to believe what the agent told her rather than do a due diligence herself. Health care insurance is absurdly expensive. As a result we "hope" we can find a bargain, but, "bargains" don't exist. I won't shamelessly recommend my site on understanding this insidious (health care insurance) industry, but I can offer a few suggestions and hints to prospective buyers: 1) First and foremost, you must understand, that except in exceptional, and rare, circumstances, insurance companies are NOT going to pay out MORE for your health care than you PAY IN to them in premiums. There is no free lunch. So if you think you can find a plan, or have found a plan, which pays out more than you pay in, then you are in for a rude and possibly expensive lesson. 2) If you "shop price", you will surely get burned. There are NO bargains in health care insurance. The less you pay, the less protection you have. 3) You must READ the policy! It is actually easy to read. The problem is you typically get the policy only AFTER you have applied and spent the money. You don't need to do this. INSIST the agent give you a copy of the policy BEFORE you sign. Ignore anything he says: a) Look in the "definitions" section. If there is a "medically necessary" definition in which the insurance company is the "sole determiner" of what is "medically necessary" for you, then the insurance company has a wide open door to deny any serious claim (and will). b) If there is a "resonable & customary charges" clause where the insurance company is the sole determiner of how much it will pay for some service, then that is the second wide open door for it to weasel out. It will only take you a few minutes to read those two portions. 4) The insurance company will pay what is in the contract, NOT what the agents tell you. Try explaining to a judge 5 years from now that your "family friend" insurance agent "told" you your triple bypass would be paid for in full when you bought the policy from him, rather than what your contract actually states. 5) STOP buying health care insurance to cover your doctors' visits, runny noses and shots. Your auto insurance doesn't pay for wiper blades and oil changes. Why do you think health care insurance should pay for "maintenance"? Insurance is there for the big stuff. Pay for your own "little stuff" and save big! 6) Insurance is about "risk". Any couple thinking they can buy maternity coverage to get "someone else" to pay for their baby has been smoking the drapes too long. Maternity coverage is just a simple PRE payment savings account for you. You will ALWAYS pay MORE to the insurance company for having your baby than you would have paid if you just paid your ObGyn and his hospital yourself. Sorry to pop that bubble! 7) Did I mention "read the contract"? 8) Get a copy of the "Insurance Industry Watch List". Find out which companies have too many lawsuits filed against them. Or complaints. Or are not financially sound. A triple bypass costs $250K. A financially weak insurance company will spend a lot of resources DENYING that claim rather than pay up - it's just business! The list goes on. Do your homework. Ask questions. Read the contract. Forget about the insurance companies paying for your "mainenance". Compare policies, NOT rates. Base your decision on how much risk YOU are willing to shoulder versus how much you want to pay out in premiums. It's just good sense. Then you won't end up like Sheila.