I am a customer with Mega Life and Health and have been astounded by some of the reports filed here! Let me give you a little background to my situation.

I used to be co-owner of a small business in Ga. Health insurance always gave me a headache, but it was 10 times worse when I went into business for myself and had to search for good insurance.

So, my business partner and I sat down with 5 different insurance agents. After many headaches, I chose to go with Mega because of their group philosophy and my partner went with Blue Cross Blue Shield because of their reputation and slightly cheaper rates.

Well, neither of us expected what was to come next. I was diagnosed with breast cancer and my partner was involved in a serious car accident on the way to see me!!

Blue Cross Blue Shield kept on waiting and waiting to pay out the claims. Eventually, creditors began to call my partner for the money that the insurance company owed! After several months, Blue Cross ended up paying roughly 30,000 of the 55,000 bill. Evidently, there's something called usual customary and reasonable... well, they deemed 25,000 of the bill to be unreasonable!!! Now, he's having to make monthly payments on the unpaid hospital bill (even though it should have already been covered!!) AND his rates have increased to over $4,000/MONTH!

On the other hand, my dr visits, consultations, surgery, hospital stay, chemo/radiation, and reconstructive surgery have been covered just as expected by Mega. I had to meet a 3,000 deductible and paid out another 4,000 to meet my coinsurance max. By my estimates, Mega has paid well over 150,000 in my claims and I have not had one single rate increase.

The way Mega has handled my claims (and continues to do so) never would surprised me.. I never would have even thought twice about it because that was coverage I signed up for. But, I am devestated for my partner and am shocked that such a well known company could treat him so poorly and find all sorts of loopholes so they wouldn't have to pay.

I highly recommend getting coverage with Mega. I only read through these reports when a friend of mine told me that he had decided against Mega after researching them here. Maybe they've had bad experiences, but not me! Good luck out there

Sandra

Roswell, Georgia
U.S.A.

Click Here to read other Ripoff Reports on Mega Life And Health Insurance

7 Updates & Rebuttals

Philip

Bensalem,
Pennsylvania,
U.S.A.

UCR and other thoughts

#2Consumer Comment

Sat, March 17, 2007

To the above person U&C rates are often 40%-50% of the billed amount. Contrary to what UCR is suppossed to be no provider that I have met in 28 years actually charges the UCR to people off the street. The UCR is set by the insurance company and in many areas has not increased in years. If this story is correct the accident victim may be getting billed even though BC paid because either the victim was out of network after initial stabilization or the provider is billing the person for the difference between UCR and the gross even though BC has paid. I get this all the time from in network providers. BC pays the UCR and then I still get a bill. Twice the bills went to collection agencies. I dispute the bills every time and haven't paid one yet. The providers are preying on people who don't know any better.

Philip

Bensalem,
Pennsylvania,
U.S.A.

UCR and other thoughts

#3Consumer Comment

Sat, March 17, 2007

Thomas

Anderson,
South Carolina,
U.S.A.

I vote: FAIRYTALE

#4Consumer Comment

Fri, March 02, 2007

The "customary and reasonable" part of a hospital bill is what the insurance WILL pay, if you have 100% coverage less your deductable or copay. That is the fee agreement between the hospital and BC/BS or Blue Choice, etc. So let's say the bill is $55K and "customary and reasonable" is $30K. Your insurance pays the $30K and you pay only your copay or your deductable. Now if you have Medicare then Medicare pays 75% of the "customary and reasonable" [$22,500] and you pay 25% of the "customary and reasonable" [$7500]. We pay ONLY a $150 copay for any hospitalization and our insurance pays the full "customary and reasonable" fee previously agreed to between the insurance company and the hospital less our $150. This Mega Tale makes me think Haloween is early this year, or maybe Paul Bunyon is back.... I'll go outside to look for Babe.

David

Gilroy,
California,
U.S.A.

Correct

#5Consumer Comment

Fri, March 02, 2007

Mike you are correct (I should have been clearer), it is predicated on the coverage being on the auto policy. Otherwise yes it would be covered by the health insurer. I personally carry 300/500/300 as I live in CA and everything costs way more here including healthcare and of course any property that might be damaged. Correct me if I am wrong but I believe most "full coverage" auto policies include the medical as part of the coverage. Liability only policies then do not. Another point, health insurers are prohibited by law from raising rates on any health policy by singling out individual subscribers. They can only be raised as a class (usually geographic area) and must be across the board for that age group. Claims on health insurance by an individual do not result in any change of premium rate. As to UC & R (which is Mega in spades since they have no negotiated contract with any provider and thus no hold-harmless agreement and no participating provider network), in a case like the above, the health insurer can pay UC&R on the claim and the member may be responsible for the difference. If as in this story the UC&R was almost half the cost, one would wonder exacly what kind of facility they went to? UC& R is exactly that, the prevailing rate for treatments in a certain area. I would be very concerned about any facility that would charge 50% above the standard costs of care in the same area. Also, most of the time the health insurer will review the claim and determine the nature of the emergency. I have seen many cases where they pay for it all above the UC&R as the type of emergency was critical and the provider was "closest facility". It is on a case by case basis and you need to work with your carrier.

Mike

Radford,
Virginia,
U.S.A.

Health insurance DOES pay for auto accidents.

#6Consumer Suggestion

Thu, March 01, 2007

Should you need health care for any reason, your health insurance will cover it. If the injury was someone else's fault, they will attempt to recover their money from that person or their insurance company, if there is one. Otherwise they will just pay it. In most states, your car insurance will not pay for your injury from an accident that was your fault unless you purchased that coverage as an option. You shouldn't buy it if you have other adequate health insurance. If you did get paid directly by an auto insurance company for medical bills then you do have to give that money back to your health insurance company. The whole original post is obviously a fairy tale to sell Mega by suggesting they're more reputable than Blue Cross. That seems unlikely, though Blue Cross has a share of problems too.

David

Gilroy,
California,
U.S.A.

Health Insurers Do Not Pay for Auto Accidents

#7Consumer Comment

Thu, March 01, 2007

Medical expenses related to auto accidents are paid for and the responsibility of the auto insurance carrier, not the health insurance carrier. If your partner was seriously injured in an auto accident, then your partner's auto insurer or the other driver's (depending on fault) would pay for all medical costs resulting from that accident including any further or ongoing costs for phyical therapy. If in fact Blue had paid for initial medical costs resulting from an automobile accident, and your partner is reimbursed those costs by either auto insurer, your partner is then required by law to reimburse Blue out of those proceeds.

Scott

Cedar Park,
Texas,
U.S.A.