Complaint Review: Mega Life And Health Insurance Company - North Richland Hills Texas

Barry, I am so sorry you had the experience you did with Mega. Most of what you have complained about is the fault of the agent not properly explaining the coverage and also not giving you the option to join NASE or not. The plan you had or have is not one of the best we have ever had and when I sold it, I sold it on the premise that it was not a major medical policy and would only pay what it states based on what benefits you purchased. It was a difficult plan but the people I sold who understood its limitations were glad to get it. I have been with Mega for 11 years and of all the plans we have offered, that was the one most lacking. There were so many limitations and agents who wanted to make fast money and who had no conscience sometimes "skipped" over or left out facts. Mega has always says it pays what it says it will pay and no more or no less. That is what most health insurance companies do. The problem usually lies with a clear understanding of what is being purchased. I found that while we had that particular plan that if I clearly pointed out what it would do and what it WOULDN'T do was the best policy. I had no reduction in sales because of it. Honesty is always the best policy. I write business in Georgia and we do not require membership into NASE of AFS, it is strictly an option and I might add, with lots of benefits for the money. Most of us talk about the NASE after presenting the insurance, as an option. Some want it, some don't and some are like you, prefer to purchase more insurance coverage rather than pay $40./mo for NASE. My district manager's husband broke his arm this weekend and he will receive a check for $750. from NASE for that. He also has an accident rider on his policy which will pay all but $50. of his accident. After he gets his NASE check, his accident will have cost him -0-. Over the years, I have had customers call and thank me for their coverage because it paid so well.

If you want even better advice, purchase health insurance only from an experienced broker who has an actual office - not someone working out of their home who may or may not be in the business a year from now. NEVER purchase any health insurance from a captive agent. No single company offers plans to fit everyone's needs. You need to work with an agent who can compare what's available on the market. Underwriting is drastically different for each company. Take high blood pressure. One company might rider it, another might rate increase it but another might issue it standard. One company will rider a condition, another might decline. Again, you need an independent broker. Also, don't put money down for health insurance. Almost without exception (Mega Life) companies don't require money with an application. Why? There might be an adverse underwriting decision - be it a rate increase, rider or decline. You don't want to wait 30 days to get your money back in those situations. Don't sign up with ANY company until you've had a chance to review, in detail, the policy details on your own - without an agent pressuring you. If any agent does not want to give you time to review the brocure/plans that means there's something they don't want you to read....or they're captive and they're scared and fear you'll sign up with another company. You should always meet in person with your agent and I agree with the above state that this should not be done on the phone. I love sitting down with my clients or having them come to my office so we can go over all the available plans.

The agent in question at the top in my opinion violated the trust of his clients and should not be an agent for any company. What he did was wrong. During training we are specifically told to go through the entire plan and make sure the potential clients know what they are buying and what they are not buying. I highly encourage anyone purchasing insurance to NEVER purchase it over the phone or over the internet because you don't know what you are getting. Also make sure the agent you actually meet with has a business card and an office so you can actually get in contact with them or some one else in the office if they are not there when you call. I always give my clients my home, office, and cell numbers so they can get in contact with me regardless if I am in the office or not. I tell every client that I now work for you and that if you have any problems, questions or claims call me first so I can get the ball rolling for you. When I work for a client I treat them like family. I work to keep my promise to taking care of them and their family. I perosnally feel that it would be wrong to even think about not explaining how everything works. It is the clients right to know how everything works and why it works that way. Please, everyone, no matter what company you purchase from make sure you know what you are buying. An agent from any company may tell you about a product but that doesn't mean you purchased it. After you go through everything make sure you go over with the agent what you have on your plan. If you have any questions make sure you ask them at that time. Also make sure when your policy arrives in the mail that you read it because an agent might not see anything wrong with an application but when underwriting gets your medical records they may see something and rider it. No one can remember everything that has happened to them and agents understand that but clients need to understand that this information can cause riders or even declines. I call every client after their policy is issued to make sure they are happy and make sure any riders, if any, are explained how they are exlcuded and how they limit the plan. Buying insurance is not like buying a car. If you don't read your car manual you are not going go bankrupt because you didn't refill your window washer fluid. An insurance plan is more complex and every party needs to understand exactly how it works. All insurance policies have a 10 day "free look" period and for good reason. It is designed so you can look over your coverage after your policy is issued to make sure you like it and understand the coverage. I just hope that I have educated everyone at least a little bit on what to look for and what to ask. Best Regards,

I was browsing and came accross this article. I just wanted to let people know about my experience with MEGA. I purchased a MEGA PPO health insurance policy on August 21, 2006. I was tired of getting rates raised by Golden Rule by up to 100% per year. My effective date on my new Mega policy was October first because I wanted to avoid double coverage and Golden Rule made swithching really difficult. On September 20 I was still covered by Golden Rule, by then they knew I was leaving. On that day I had a serious sports accident and tore a tendon in my shoulder. I was not even covered by MEGA when the accident occured! Anyway I ignored the pain in my shoulder thinking it would heal itself with time until the first week in October, and now covered by MEGA for a few days. At that point I decided to see a doctor. He sent me for an MRI which I knew was not going to be covered because I did not choose to buy the optional rider on the Mega plan that covers outpatient diagnostic tests. My agent presented it but I chose not to add it thinking I would not need it. So I ended up getting #30,000 worth of outpatient surgery on my shoulder and even though I had disclosed the date of the accident to Mega they paid the claim off within ten days of receiving proper bills from the doctors and facilities. Yes I had to pay a deductible of $2000 and some 20% coinsurance to a max of $2500 but I knew all this before. I don't know what policy the others bought but the policy I purchased from MEGA works exactly as presented by the sales agent, Wayne Stein, from Denver. I think all health insurance companies have complaints against them and I think there are lots of unethical agents but for me I am a satisfied MEGA customer and the premium is reasonable. Bottom line is maybe because of the date of the accident MEGA would have room to wiggle free of paying a claim but they did not do this. They paid as promised. I guess you need to make sure you understand what you are buying and feel 100% sure that you trust the person you are buying health insurance from.

I was browsing and came accross this article. I just wanted to let people know about my experience with MEGA. I purchased a MEGA PPO health insurance policy on August 21, 2006. I was tired of getting rates raised by Golden Rule by up to 100% per year. My effective date on my new Mega policy was October first because I wanted to avoid double coverage and Golden Rule made swithching really difficult. On September 20 I was still covered by Golden Rule, by then they knew I was leaving. On that day I had a serious sports accident and tore a tendon in my shoulder. I was not even covered by MEGA when the accident occured! Anyway I ignored the pain in my shoulder thinking it would heal itself with time until the first week in October, and now covered by MEGA for a few days. At that point I decided to see a doctor. He sent me for an MRI which I knew was not going to be covered because I did not choose to buy the optional rider on the Mega plan that covers outpatient diagnostic tests. My agent presented it but I chose not to add it thinking I would not need it. So I ended up getting #30,000 worth of outpatient surgery on my shoulder and even though I had disclosed the date of the accident to Mega they paid the claim off within ten days of receiving proper bills from the doctors and facilities. Yes I had to pay a deductible of $2000 and some 20% coinsurance to a max of $2500 but I knew all this before. I don't know what policy the others bought but the policy I purchased from MEGA works exactly as presented by the sales agent, Wayne Stein, from Denver. I think all health insurance companies have complaints against them and I think there are lots of unethical agents but for me I am a satisfied MEGA customer and the premium is reasonable. Bottom line is maybe because of the date of the accident MEGA would have room to wiggle free of paying a claim but they did not do this. They paid as promised. I guess you need to make sure you understand what you are buying and feel 100% sure that you trust the person you are buying health insurance from.

I was browsing and came accross this article. I just wanted to let people know about my experience with MEGA. I purchased a MEGA PPO health insurance policy on August 21, 2006. I was tired of getting rates raised by Golden Rule by up to 100% per year. My effective date on my new Mega policy was October first because I wanted to avoid double coverage and Golden Rule made swithching really difficult. On September 20 I was still covered by Golden Rule, by then they knew I was leaving. On that day I had a serious sports accident and tore a tendon in my shoulder. I was not even covered by MEGA when the accident occured! Anyway I ignored the pain in my shoulder thinking it would heal itself with time until the first week in October, and now covered by MEGA for a few days. At that point I decided to see a doctor. He sent me for an MRI which I knew was not going to be covered because I did not choose to buy the optional rider on the Mega plan that covers outpatient diagnostic tests. My agent presented it but I chose not to add it thinking I would not need it. So I ended up getting #30,000 worth of outpatient surgery on my shoulder and even though I had disclosed the date of the accident to Mega they paid the claim off within ten days of receiving proper bills from the doctors and facilities. Yes I had to pay a deductible of $2000 and some 20% coinsurance to a max of $2500 but I knew all this before. I don't know what policy the others bought but the policy I purchased from MEGA works exactly as presented by the sales agent, Wayne Stein, from Denver. I think all health insurance companies have complaints against them and I think there are lots of unethical agents but for me I am a satisfied MEGA customer and the premium is reasonable. Bottom line is maybe because of the date of the accident MEGA would have room to wiggle free of paying a claim but they did not do this. They paid as promised. I guess you need to make sure you understand what you are buying and feel 100% sure that you trust the person you are buying health insurance from.

I was browsing and came accross this article. I just wanted to let people know about my experience with MEGA. I purchased a MEGA PPO health insurance policy on August 21, 2006. I was tired of getting rates raised by Golden Rule by up to 100% per year. My effective date on my new Mega policy was October first because I wanted to avoid double coverage and Golden Rule made swithching really difficult. On September 20 I was still covered by Golden Rule, by then they knew I was leaving. On that day I had a serious sports accident and tore a tendon in my shoulder. I was not even covered by MEGA when the accident occured! Anyway I ignored the pain in my shoulder thinking it would heal itself with time until the first week in October, and now covered by MEGA for a few days. At that point I decided to see a doctor. He sent me for an MRI which I knew was not going to be covered because I did not choose to buy the optional rider on the Mega plan that covers outpatient diagnostic tests. My agent presented it but I chose not to add it thinking I would not need it. So I ended up getting #30,000 worth of outpatient surgery on my shoulder and even though I had disclosed the date of the accident to Mega they paid the claim off within ten days of receiving proper bills from the doctors and facilities. Yes I had to pay a deductible of $2000 and some 20% coinsurance to a max of $2500 but I knew all this before. I don't know what policy the others bought but the policy I purchased from MEGA works exactly as presented by the sales agent, Wayne Stein, from Denver. I think all health insurance companies have complaints against them and I think there are lots of unethical agents but for me I am a satisfied MEGA customer and the premium is reasonable. Bottom line is maybe because of the date of the accident MEGA would have room to wiggle free of paying a claim but they did not do this. They paid as promised. I guess you need to make sure you understand what you are buying and feel 100% sure that you trust the person you are buying health insurance from.

Megalife is not major medical insurance. Each day hard working family businesses are giving up legitimate health coverage, and exposing themselves to major financial risk, even if something minor happens to them. The high pressure sales presentation is leaving people underinsured. $50k to cover for cancer, I dont think so, It is definately not going to cover all of the $175,000 quadrupule bypass heart surgery my mom had last year. Mega agents are trained to do a one shot do-or-die sales presentation in person. Think about it Why do they need to be there in person? I sell insurance all day long to people on the phone and with emails. I don't need to meet them in person to sign them up. I do not need to wear someone down till they sign. Only reason why one would go in person, is because one only has one chance at it. If they dont get the signature they most certainly know they will not get the sale later, I heard on NPR they being investigated right now for sales guys making false promises. The main idea of this posting is to illustrate Megalife puts limits on what THEY WILL PAY. And REAL Major Medical insurance puts limits on how much YOU WILL PAY. Again, underinsuring americans. I was an employee for megalife, But never worked for them. Fortunately they canned me. Imagine getting canned from Megalife? I am TELLING ALL about my experience. An what to do to protect yourself. I responded to a job posting from a MegaLife recruiter. He told me to not disclose on my employment application, that I had a DUI since he knew about it. He sang the praised of Mega, and I went to a state licencing school. When the president did a background check, he said I lied on my application. Great. I ended up working for a real insurance broker. I then realized how dumb I was. I could have been working as a mindless drone selling people on something which could leave them financially devistated if a major medical claim was made. Now I work for my own agency making lots of real money selling real insurance. I am truly blessed. Dont get lured in. Run David P

Happy Mega Agent - you're every single agent I know in UGA. Let's cover just a few things: A) You've never sold or been formally trained on a single insurance carrier except for UICI. B) 100% of your insurance training comes from UGA managers who have never sold another insurance product. C) 100% of what you know about other carriers comes from articles your managers have showed you. That's ironic because a TON of nasty articles have been written about Mega. I guess those don't count. So please don't come here acting like an insurance expert. I sold Mega so I know how they work. But guess what, for the last several years I've also sold plans from 8 other health insurance companies so I know how they work. You don't see me wanting to come back to Mega do you? (Or anyone else who's quit) So unless you can come here and say that you've had a 5 million dollar book of business of clients from other insurance companies let's agree that you don't have the slighest clue as to what you're talking about. Agreed? And the next time you read a bad article about HMO's just type in - Mega Life scam - into Google and have fun reading.

I have worked for Mega for well over 15 years and in those years I have seen many plan types come and go, but the focus has generally always been on higher deductible, more catastrophic plans. Luckily, and one of the reasons for Mega's and the parent company's success, is that the self employed marke we serve, in general, WANTS this type of coverage. Self employed folks don't run to the doctor every time they sneeze. Self employed folks don't care about higher deductibles as long as they have decent coverage for higher end stuff, etc. Doctor visits and co pays and all the low end stuff does not make good business sense in most cases, certainly not when it's attached to heavily managed plan and also a much higher price tag; Mega plans make sense to who we market to for the most part, but NOT everybody. It sounds like the examples listed here reflect one specific plan we sold that is designed to be a scheduled plan, with very noticeable limitations and caps on surgery, room and board, etc. It would be impossible for a customer to not see these things in the very bold print and of course throughout their contract that was mailed to them with a big note in the front of the package mentioning it should be read carefully. This scheduled plan serves a great purpose for those on a very tight budget, but surely it's possible some less than savory agents have spun this plan into something it's not, and based on my experience the company has taken a no tolerance policy with these folks, and they have been fired, as they should have been. However, just because our company sells ONE plan that's not as strong as our PPO, higher level catastrophic plans, etc and because some agents chose to be snakey when selling those lower end plans, does not in any way mean the company as a whole is "bad" or that we don't help FAR MORE people than are ever in some way harmed by a plan we sold them. How many times do you write a letter when you have a great experienc with your medical plan? What about when something happens you don't like? What about if that same negative feature of your plan is printed IN THE BROUCHURE and also your contract? Mega does a great job for a great number of customers, but because the cover the whole spectrum of products, complaints are always focused on the weaker plans because they're an easy target. However, they do everything they say they're going to do in the contract, and cost far less than many competitors. It's also somewhat comical to argue medical plans sold by Mega when their contracts are for the most part far less managed than many competitors and with HMO's etc, you never know what you're going to get until it's too late becasue the wording of the contract's and Managed Care definitions are so vague. The reason I have been here so long is the plans do a great job for the majority of the folks we market to and the contracts do just what the say they'e going to do, plain and simple. Happy Mega Agent, CT, USA

I am a state licensed health/and life agent and I would agree with the other person who posted a response to report the agent to your state insurance dept. He's a poor excuse for an agent. I am appointed with several major national companies and none of them have the exclusions that were in your policy as I never would have picked them up. I am not associated with Mega in anyway. I shop major companies all the time to find the best in the business to offer to my clients. I would never sell a policy that I would not want for myself. However I have seen several companies that have what I consider junk policy's like the one that was sold to you. Health insurance is very complicated and there are many options and policys to choose from and the average consumer doesn't understand them and shouldn't be expected to understand them and a good agent should explain them to a client. That is the agent's responsibility. For the future call your state dept. of insurance and get the names of licensed health insurance companies in your state. You can also call your local Chamber of Commerce and ask them to refer you to local licensed agents in your area. Now when you find a good licensed health agent you can begin to ask questions. A lifetime cap is the amount an insurance company will pay in a person's lifetime. You will be looking for a policy that states the lifetime cap is PER PERSON and you want at least 3 million each. I sell 5 million and up. There are policy's such as Blue Cross plans that may have unlimited but that is not on all their plans and they may not be offered in your region. Next you want to know what NETWORK you are in. The network consists of doctor's you can use so that the company pays for their service. Now you want to check that the doctor's and hospital's you want to use are in the network so call them YOURSELF and ask them do they accept the name of the network at their facility. Now you look at your deductible. The deductible is what you pay out of pocket before the company begins paying. Now you have to be careful with this as some plans offer a single deductible and others offer a deductible PLUS co-insurance which is what you had. co-insurace is the amount you agree to share with the company such as 80/20 meaning that after you reach your deductible and pay it now you will pay 20 percent of all other covered expenses until you reach your stop/loss cap. Ask the agent what is my total out of pocket costs that you'd be responsible for each year. look for a policy that the deductible is for EACH year not per occurance and there are more company's out there that do that besides the Mega one. Look for a policy that may have co-pays for doctors, drugs, labs, etc. a co-pay is what you pay up front for a service such if you have a 25.00 co-pay to go to doctor, thats all you pay is the 25.00. look for a policy where the co-pays do not have anything to do with the deductible. Make sure you understand that there may be what I call hidden co-insurance or deductibles such as some companies charge an extra 100.00 per day for first 5 days if you are a patient in a hospital so you know up front that you have to add that to your deductible. Unless you have specific co pays for mri's, cats, lab tests, etc. the general rule is that they are considered hospital expenses and they would be applied toward your deductible but you have to pay out of pocket for them. A utomatic withdrawals are very common in the insurance industry to receive their premiums. Some companies still offer billing each month but they charge you for that service and I've seen fees as high as 25.00 a month the client pays if a company has to mail you a bill. I tell my clients to set up a savings account and just keep enough money in it to basically cover your premuim each month and that cuts down on mistakes or gives a company access to alot of money sitting in an account. Even the best companies can make an error although it would be corrected immediately it can happen. Now look at what the policy covers. Make sure it covers all the most serious illnesses such as cancer and chemo, surgery, ICU, diabetes, transplants, etc. Think the worst and make sure it's covered. I know of a major company that does not cover chemo in their middle policy so I refuse to carry their plans. Now check the exclusions and they are what the company does not cover. Common exclusions may be suicide or self inflicted injuries or injuries resulting from substance abuse such as if you were intoxicated and injured yourself in a car crash. If drugs are covered see what type. There's generic brands, middle class brand name drugs and then the top class brand drugs. Some plans require a small co-pay for generic but do not cover brand name or will have a yearly deductible before they cover them. Often a policy will refer to these drugs as a 3 tier system so ask what class of drugs the plan will pay for. Some plans offer a wellness benefit per person each year up to a dollar amount such as 500.00 per person. this benefit is used to have a physical each year and the company will pay up to that dollar amount. states have laws also and each are different but some states require for example all insurance companies to pay for children's vaccines or a woman's mammagram. Some people do shop a policy based on price but if the policy's were explained to them correctly by a good agent most people realize that coverage matters more than price. I know you are unhappy with Mega but never drop coverage until you have been approved by another company because worse case scenario you would not have any coverage at all. As your wife has had some medical issues it may be more difficult to obtain a better policy now due to strict underwriting guidelines all companies have today. Most policy's will have a er charge of 75.00 give or take if you use the er and you are treated but not admitted. Insurance companies do that to discourage people from using an er instead of a doctor's office and that is common today but ask so you know if it's an added fee or not. A good rule of thumb is the higher the deductible and the more co-insurance there is in a policy the cheaper the premium will be but you have to think about what you can really afford to pay out of pocket if you do need hospital/surgical services. You also have to end up with a premium you can afford to pay so there are alot of factors involved in choosing a policy that is right for your family. I definitely believe you that Mega does have gapping holes in the policy and that's why I wouldn't sell them to anyone but the fault really lies with the agent that sold it to you as it doesn't sound like he took any time to explain it to you. He should have realized right away that your weight would be a rate up as all agents should know their underwriting guidelines and he should have been honest with you about what the premium would be and why. There is weight and height guidelines in all insurance policy's that pertain to health. This is just really a brief description of what you need to look for in a quality health insurance policy. A good agent in your state would be able to answer all your questions. Best of luck

My husband and I own our own business and bought Mega Insurance believing we were adequatetely covered for the not so small price of $6833.00. We've had the insurance for two years and needed to use it when my husband was hospitalized with chest pains. After 1 day hospitalization and several tests later he was diagnosed as healthy (thank goodness). We now owe over $10,000.00 dollars. I can not even begin to explain our anger. I hope this helps at least one person to not make the same mistake we did by purchasing Mega Insurance.

Barry & Anyone out there looking for Health Insurance at a low Cost I am an Independent Agent in Oklahoma and spend a great deal of my time talking to people who want just the bottom dollar monthly premium for a low cost health insurance plan. This scares the daylights out of me. There is more to a health insurance policy then the monthly premium. I realize health care has sky rocketed but what your buying for the monthly premium is MORE important then the premium itself. Due to the high cost of Medical Insurance (group and individual PPO/HMO) the insurance industry has come up with ALTERNATIVE PLANS for those who just simply can not afford to buy a Major Medical Policy or keep the one they have. This doesn't mean the policies aren't good ones just a different type of coverage. Public, please be aware it's important to sit down with an agent who represents more then one company and understands the policies they are selling. Talk to them, pick their brains and find out if they really know what they're talking about. If it's not a Major Medical then they have to inform you it's not, you are entitled to a schedule of benefits and the agent is required to go over this information with you before you buy so you do indeed understand what you are buying. It's important to remember the old saying "you get what you pay for". If the premium is low then ask yourself and then the agent "why is the premium so much lower then XYZ company", chances are it's not a major med but an indemnity type policy. Another reason you want to rethink these alternative plans is future insurability. If you take out one of these types of plans they generally (I don't know about every plan out there, there's to many) do not qualify as prior medical insurance. What that means to you the policy holder is if your health declines and you do end up getting say Group Health insurance or decide to change companies and are approved (maybe with a higher rate due to your current health) by underwriting then your pre-existing condition may have a 12 month waiting period or even a rider attached to the policy excludeing coverage for that pre-existing condition all together. The rate for a Major Medical Policy is high but if you can afford it you are much better off in the long run having the PPO/HMO high rate vs an alterntive plan. Brenda Tulsa OK

THis note is to the Agent that rebutted...It is true that it is sickening the way this sale was made but...you didn't disagree with the way the claims are handled...this is typical of all MEGA policies and how the claims would be handled...so my question is... How would you be able to ever sell a single policy if you actually disclosed all the holes in coverage to a perspective client...My belief is that you don't...which makes you just as guilty as sadeh...I know for a fact that MEGA agents are taught by management to leave out important gaps in coverage because they are never taught the gaps...When was the last time your manager told you that it was very important to tell your client that the company would only pay a maximum of $1,000 for a chemo-therapy treatment before you consumated a sale??? Have you ever told this to a client??? Where you aware of this??? Well if you weren't you are now so good luck selling a product that costs more and covers less...I don't know how you are going to do it ethically!!!

I am an agent for Mega Life and Health, NASE. I find it VERY disturbing that one of my "own" would have so purposefully deceived you. There should have been an explaination of benefits AND exclusions and limitations left with you to review, whether it was prior to the sale or not. Your benefits should have been clearly explained, along with any gaps in coverage. There should have been no mystery. My personal recommendation is to contact your State Insurance Commissioner and report this agent individually. It is clear he has violated the terms of his license by failing to be ethical and honest. He has misrepresented both the NASE and UGA in his practices. As a side note (and this is in NO way intended to rub any salt in the wound, but rather to warn the rest of the public): PLEASE make sure, as a consumer, that any documents signed are first read and explained before signature; and that once a policy has been issued it is reviewed carefully by you, the consumer, for any errors or discrepancies real or understood before agreement of the policy going into force. This is advised of ANY insurance that is purchased. It is a bitter part of life that those who chose to be dishonest affect the standing and perceived integrity of those who are.