Complaint Review: Optimum One Health - Syosset New York

Early December, 2014, needing to obtain Affordable Healthcare Act Compliant Insurance, I clicked and indicated this on an online broker's page and was contacted by LeSean Frazier from Optimum One Health.  I told him my specific circumstances, particularly indicating I needed insurance which would meet ACA requirements.  He asked what my budget was and called me back later with the Optimum One Health solution.  He told me this policy would meet the requirements needed, and that my Primary Care Provider was more than likely in the provier list because the coverage is like a PPO and virtually all providers are included.  I would be covered beginning January 1, 2015.  If I had anyting come up in December, they would cover it as long as it wasn't a pre-existing condition. I set insurance to rest as I had been assurred by Mr. Frazier that this covered my needs.

I wasn't sent a copy of the policy, only two cards, and a member number and later, two prescription discount cards which are worthless.  Ultimatley I contacted Optmum One Health, and they emailed me a membership letter and access to a "coverage guide."  This is not insurance, although they present it on the phone as if it is, and then have a disclaimer read to you over the phone which no one in their right mind can absorb it is so rapidly read. They do not send premium payment books, and cancel you without notice if your auto withdrawal doesn't work.  

Only yesterday, when I attempted to fill a presription at my local pharmacy, was I told that this provider is not insurance and I would have to pay full price for my prescription, $410.99 for 30 pills.  As I am unemployed and have been for the past 18 months, paying outright for my very expensive prescriptions isn't an option. Until this time I thought I was covered as with my COBRA plan, as I had been assurred by Mr. Frazier, that I would be covered as I had in the past.  What the SCAM part is, is that he told me all of ths information outside of his "official" sales call, which is recorded.  He absolutely intentionally misled me to think this was an insurance plan, and he absolutely misled me to think that it was compiant with the ACA.

As a result of thinking I had acceptable coverage, and it is after February 15, I now have no affordable insurance for 2015 and no way to obtain it. I have been given a special exemption to go to the marketplace; however, those policies are such high deductibles that I will be paying both a monthly premium and for all my costs out of pocket for the entire year. And, I do not meet the requirements for obtaining a catastrophic policy only.  Flat out, I'm just out of luck.  Both obtaining insurance and my medications are now not possible due to my unemployed status. Thank you, Optimum One Health!

I am livid and want to get the word out to everyone possible that Optimum One Health is a SCAM, they tread a very fine line in their presentatons to keep from being outright FRAUD, and they are very good at what they do. They are affiliated with a larger source provider named Unified Caring Association, which is a "membership" organization of feel good, do gooders, whose goal is "to share as much information, tools and products that will enhance your life in a healthier and happier way."  Their website doesn't provide much information as to who actually runs this organization.

Bottom line:  Optimum One Health is at the very least shady and misleading in their representations of their company and what they provide to the consumer.  I feel like I've been defrauded and cheated out of insurance for 2015 although they are cunning enough in their marketing schemes to cover most of their bases so they can't be sued.  BUYER BEWARE!