Complaint Review: Reserve National Insurance Company - Oklahoma City Oklahoma

  In January of 2012 my husband quit his job and started an Oil & Gas consulting firm. Soon after, we received a letter from his previous employer. Our health insurance would no longer be available through the company but we were eligible to continue the insurance through Cobra. I found out that we could keep our insurance for only $1800. a month. I politely declined.

A few months later we received a postcard in the mail regarding "Health insurance for business owners - who don't have insurance. there was no company name on the card but it appeared to be somewhat official; maybe from some state/government agency, and somehow they knew that we did not have any insurance. I filled it out and forgot about it.

I got a phone call about a week later from a man named "Spencer Peavey; a field representative for Reserve National Insurance Company, out of Oklahoma City. He indicated that he would be in our area the following day and offered to come out and discuss health insurance options. I agreed and he arrived promptly the following day.

Mr. Peavey explained the different types of policies available to us; He filled out the application for coverage; asked about our general health, family disease histories, surgeries, medications taken in the last five years, smokers? drinkers? I told him that neither of us take medication for any reason, seldom got sick enough to visit a doctor and that the main reason we  needed insurance is because Obama said we have to have it, and just in case there was ever an emergency-we'd have help with the medical bills.

Upon completing the application, he suggested that we might consider a "Fixed Indemnity Insurance Policy". This type of policy provides a stated benefit amount each policy year for treatment of covered injury or sickness. It pays the stated amount for each covered visit and when that amount has been used up for the year, the rest of it is on you. It is a Limited Policy-it is NOT Major Medical Coverage. There are NO deductibles! NO co-pays and you can go to any doctor, specialist or hospital, worldwide!

This sounded like the right policy for both of us. Upon request  (by me) Mr. Peavey added a dental and vision policy, and he also added an Accident Policy (not at my request-just at my expense). 

Then he started the "break-down" of the costs of the policies for each of us. He gave me a total of $861.35 a month plus a one-time policy fee of $50.00 per person. (He told me the policy fees should have been $200.00, but he wanted to cut me a break.) Mr. Peavey then explained that he could give me an 8% discount on our premiums if I wanted to pay ONE annual payment of $8410.80. We would also have coverage effective immediately and he would personally get our insurance cards and deliver them to us within three days.

I told him I wanted to call my husband and discuss it with him first. I called (my husband) at work and let him know what we were getting and the amount of the monthly premium. When I mentioned the 8% discount offered for the annual payment he tried to negotiate; he offered to pay the annual payment if they (Reserve National) would give us a 12% discount.

Mr. Peavey said he wasn't authorized to increase the discount amount. I told him that was fine because I wasn't authorized to write him a check for $8000.00. He told me that if we wanted to make an initial, one-time , quarterly payment of $2632.35, our coverage would be effective immediately although we would have to wait for our policies and insurance cards (all to be delivered by him in about two weeks).

He told me that in the meantime if we needed medical services, the easiest thing for us to do would be to pay for the services; keep a copy of the receipt, and once the policy is issued-send those reciepts to Reserve National and they will "absolutely reimburse us". 

He made a phone call to Reserve National offices and after hanging up, told me that the office said this was all "contingent upon approval", but then assured me that after filling out the medical information sheets, there would not be any problems getting the policy issued just as we had discussed. He also assured me that this is something that the office folks are legally required to say.

I wrote him a check in the amount of $2632.35. He thanked me and said he should have our policies and cards to us within two weeks.

He did not.

About four weeks later my husband called me from work and said that his lower abdomen hurt and that it felt like there was a big knot in it.  He asked me to make a doctors appointment for him for the following week (when he came home).  Still no policies or cards.  I made him a doctors appointment for March 7, 2013.

After an examination, the doctor said that she was pretty sure that it was a hernia and she would like to refer him to Dr. Chainakul at Hillcrest Hospital, in Tulsa. Since we had no proof of insurance and payment is required at the time of service we paid for the doctors visit ($85.80) with a credit card.

He saw Dr. Chainakul on March 11, 2013 and was told that it was indeed a  hernia and should be surgically repaired. An appointment was made for "Same day surgery" at 7:00 am on April 4, 2013.

Before we left his office, Dr. Chainakul's nurse tried to contact Reserve National to see if she could get our policy numbers and to notify them of the surgery appointment. The nurse was told by the answering service that permission was not necessary on a Fixed Indemnity Policy. She also stated that she was only the answering service and did not have access to insurance policies or the database.

We still had no proof of insurance and payment was necessary at the time of service. We paid $160.00 with a credit card and the nurse told us that she would bill the remainder that was owed  to the insurance company.

When we arrived at the hospital on April 4, 2013, we still did not have our insurance cards or policy number. We told them that we had insurance coverage with Reserve National Insurance Company. I gave them Reserve National's customer service phone number. I also gave her Spencer Peavey's phone number.

We went to sit in the waiting area (for two and a half hours) and I tried to call Spencer Peavey. He didn't answer so I left him a message telling him what was happening at the hospital.

The hospital pre-admissions secretary called my husband's name again. We went to her office area; she told us that she called Reserve National for verification and was told that we did not have coverage. We would have to make a payment before admission. We paid ($1000.00) by credit card.

The surgery went well and my husband was dismissed in the early afternoon. We stopped and had his prescription filled (pain meds.) and went home.

I sent Reserve National all of the receipts for bills already paid by us (April 23, 2013) up until that date- along with explanations. I also sent them unpaid statements from Hillcrest Hospital. I mentioned to them what Spencer Peavy had told us to expect from him and Reserve National: how great they were and that they were going to "take good care of you".

Reserve National responded on May 22, 2013; acknowledging our claim for benefits and stating that more time would be needed to process the claim. They would be sending forms to sign for releasing medical records. They sent the forms which we signed and sent back.

On the same day(January 30, 2013) that I wrote the check for the quarterly premium payment, I also signed an authorization form, allowing Reserve National to automatically deduct our premium payments ($781.40) beginning on April 30, 2013. The first payment was automatically paid on that day. Another one on May 30, 2013. We were still receiving doctor and hospital bills; Reserve National was still not paying them, so to preserve our good credit, we started paying the bills that they should have been paying.

On or about June 20, 2013, we called Reserve National and asked why they weren't paying any of the doctor/hospital bills. The Reserve National representative looked up our policy and files and told us that it would not be paid because it was a "pre-existing illness". My husband had more "words" with the representative and then told her that we would no longer be using them as our insurance company and told her to put a stop on the automatic payments at our bank.

I have tried to call the field representative, Spencer Peavey, many times and have left messages for him to call us. He has not returned our calls.

We called the hospital and asked them to re-send the statements and let them know that Reserve National was refusing to pay.

On the first bill that we received from Hillcrest Hospital (dated 04/15/2013), they had us listed as "NO INSURANCE SELF PAY" and there were adjustments of $8,875.38, which left the Total Amount Due From (us) $4,212.53 (we had paid $1000.00 on the morning of surgery). When we finally received our policies and insurance cards, we called the hospital with the information.

And Reserve National refused to pay; then, when we called and asked the hospital to re-bill us, they re-adjusted the bill. We now owe $8,297.97-plus additional charges of $1,314.17. This makes a grand total of$9,612.14 that we still OWE!

Since the day we terminated our insurance (by phone) we have received SIX "Final Notices" to remit our premiums from Reserve National and a letter of acknowledgement of our requested cancellation. It also states that "In this day of ever increasing healthcare costs, your insurance can be one of your most valuable assets. Your policy can help to maintain your financial security."

We have paid $2,174.60 of the billed charges, plus the $4,195.15 that we've paid for monthly premiums (5 months). A total of $6,369.75. If we had paid the first hospital bill that we received-$4,212.53-we would have come out ahead.

Really!

I don't know what kind of scam Reserve National Insurance Company (of Oklahoma City) is running, or how they are getting away with it. I would strongly urge anyone who is contacted by them to hang up the phone and contact the authorities.

I never thought this would happen to me/us. I had never heard of Reserve National Insurance Company before this happened. I DID look them up on the internet before purchasing insurance from Spencer Peavey. They have a very nice looking website. But you CAN'T afford the insurance that they're selling. I know we can't.