- Report: #483497
Complaint Review: Mega Life & Health Insurance Company - North Richland Hills Texas
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Mega Life & Health Insurance Company
9151 Boulevard 26 North Richland Hills, 76182-8009 Texas, United States of America
Phone:
8005275504
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Mega Life & Health Insurance Company Slow Response, Terrible Customer Service, Deceitful or Poorly Trained Sales Staff, Ambiguous Insurance Coverage North Richland Hills Texas
This was the first time I purchased health insurance on my own. In the past my health insurance was provided by employers. I was introduced to a Mega salesman who made it sound as though Mega was the best choice for me. I was told that Mega was recognized by many doctors and health care institutions, and Mega had pre-negotiated rates with major health care providers.
My daughter required hospital emergency services in July 2007. Health Care Providers filed their claims with Mega, but Mega took so long to respond, that the Health Care Providers filed multiple claims for the same services. Each time a claim was filed, Mega would start a new claim with a new Claim ID #, and I would receive a notice that Mega was working on it. The paper really started to pile up and because of the duplicates tracking what Mega was doing became a real problem.
In some cases, Mega would request additional infromation from the Health Care Providers, and if Mega didn't get the information, Mega would just sit on the claim and not do anything. Consequently, I had to mediate the process. This is when I discovered that none of the Health Care Provider had heard of Mega, let alone have pre-negotiated rates with Mega.
Each time I called Mega I had work through a very tedious automated response system, and then, after an inordinate wait time, I would get on the line with someone who would need to refer me to someone else who couldn't help me. After more than 100 hours of worthless phone calls to Mega and at least another 100 hours of phone calls to Health Care Providers, and more than 2 years later, I m still trying to understand what was sold to me. In addition, I am still trying to get the July 2007 claims paid. I filled a large 3 ring binder with the paperwork pertaining to the Mega claims.
In April of 2008 (almost 1 year later) I contacted the Michigan Insurance Commission about my problems, and was told I needed to work through all the processes with the insurance company before they could help me. So, I filed a petition with Mega Consumer Affars for a Decision Review. I had lots of conversations, letters, and e-mails with the Consumer Affairs Department, and I think I actually made some progress getting claims paid.
Then in October of 2008 I received an explanation of benefits statement that said Mega overpaid a Health Care Provider nearly $2K. Since I paid more than $5K out of pocket money just to keep my credit from being destroyed, and because I only had a $3K deductible, I thought this money should be refunded to me, and not to Mega. I discussed this with the Health Care Provider, and was told the Mega had requested the refund, and that the Health Care Provider was waiting for information from Mega before the money could be released. The same Health Provider convinced me that I would only receive about $200 of the money that was to be refunded. I was really tired of dealing with the whole mess; and consequently, decided that the $200 just wan't worth any more frustration.
Just today, August 21, 2009, I found out what coinsurance is, and I am still not sure I understand it. My policy had a $3K deductible (notice I said had), and this deductible is not only refreshed yearly, it is also refreshed every time you are diagnosed with a different medical problem. You have a heart attack, $3K, you have an ulcer, $3K more, you have a hernia, $3K more. There is also some mumbo jumbo in the policy about a $4K coinisurance and 70% coinsurance. I think I understood the policy when I bought it, and the salesman made it sound great, but when Mega started sitting on claims and weasling out of paying, I guess I didn't really understand it at all.
A year ago I thought the Mega nightmare was over, and then I recently received a bill from a health care provider for nearly $2K. It seems as though Mega finally responded to the hospital about why they overpaid nearly $2K (a year later). Apparently the health care provider was satisfied with Mega's explanation and refunded the money to Mega, and now the health care provider is asking me to pay nearly $2K. I called Mega several times and went through the waiting game, and talked to 3 or 4 people who had to refer me to others who would refer me to others, and this is when I found out that I had to pay another $4K out of pocket, before Mega would pay. The Mega representative said after I paid $3K deductible and $4K coinsurance ($7K out of pocket), then Mega would pay 100%. I still don't understand the 70% coinsurance clause, and I guess I don't really care any more, but since I dropped Mega several years ago, and thought I was done with their ineptness, I celebrated by slowly feeding their piece of junk policy through my paper shredder. I asked Mega for a new copy of the policy so I could try to understand the screwing they are giving me. Who knows maybe I will get the policy in a year or so.
There is a lot more I could tell you about my Mega problems but I am tired of getting upset about it. I lived in Canada for several years and my wife was hospitalized. We used Canada's nationalized health care, the service was stellar, and I did not receive one peice of mail from any Health Care Provider, or from the government. For all of you who thinks the US Health Care system does not need reformed, I think you need to contact Mega and get yourself one of their Health Insurance Policies!
1 Updates & Rebuttals
Scrappy
Manassas,Virginia,
U.S.A.
Canada??
#2
Wed, August 26, 2009
That sounds like a nightmare you went through with Mega. Canada may not be the best choice for a solution.......
Canada's politician controlled healthcare system is falling apart
Overhauling health-care system tops agenda at annual meeting of Canada's doctors
By Jennifer Graham (CP) 1 day ago
SASKATOON The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.
"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."
The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium, Netherlands and France.
His thoughts on the issue are already clear. Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared."
In other words, Ouellet believes there could be a role for private health-care delivery within the public system.
He has also said the Canadian system could be restructured to focus on patients if hospitals and other health-care institutions received funding based on the patients they treat, instead of an annual, lump-sum budget. This "activity-based funding" would be an incentive to provide more efficient care, he has said.
Doig says she doesn't know what a proposed "blueprint" toward patient-centred care might look like when the meeting wraps up Wednesday. She'd like to emerge with clear directions about where the association should focus efforts to direct change over the next few years. She also wants to see short-term, medium-term and long-term goals laid out.
"A short-term achievable goal would be to accelerate the process of getting electronic medical records into physicians' offices," she said. "That's one I think ought to be a priority and ought to be achievable."
A long-term goal would be getting health systems "talking to each other," so information can be quickly shared to help patients.
Doig, who has had a full-time family practice in Saskatoon for 30 years, acknowledges that when physicians have talked about changing the health-care system in the past, they've been accused of wanting an American-style structure. She insists that's not the case.
"It's not about choosing between an American system or a Canadian system," said Doig. "The whole thing is about looking at what other people do."
"That's called looking at the evidence, looking at how care is delivered and how care is paid for all around us (and) then saying 'Well, OK, that's good information. How do we make all of that work in the Canadian context? What do the Canadian people want?' "
Doig says there are some "very good things" about Canada's health-care system, but she points out that many people have stories about times when things didn't go well for them or their family.
"(Canadians) have to understand that the system that we have right now - if it keeps on going without change - is not sustainable," said Doig.
"They have to look at the evidence that's being presented and will be presented at (the meeting) and realize what Canada's doctors are trying to tell you, that you can get better care than what you're getting and we all have to participate in the discussion around how do we do that and of course how do we pay for it."
For more detail see http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw
