Complaint Review: The Mega Life And Health Insurance Co - N. Richland Hills Texas

Elizabeth, report MEGA now. The complaints and the state Insurance Commissioners reports have a lot to say about the horrible workings of mEGA, and how they don't pay on time (in one case over 600 days). Make your report directly to your state insurance commissioner. Also, don't listen to anything Pat from Arkansas has to say. As an employee of this company, all you will get is smoke and more smoke from him.

Hi, I am a licensed health and life agent. First, United health care is a good legitmate company as is Golden Rule. The complaints from these people about Mega is valid reason to report the company to their State Department of Insurance and file a formal complaint immediately. Just put your state name in search follow by dept. of insurance. You may also contact your attorney general's office and file a complaint. I will not even respond to the "reasonable customary" excuse with an answer that someone else posted. File a complaint now against Mega.

Pat, IF you consider a "sizable gap" $200.00 then you may be right. But from 1 procedure that United was billed $1,000.00 they paid the 80% as per my policy. I have no problem with that. The fact that MEGA has refused to pay the other 20% is mind boggling. Especially when the policy says that they will pay up to 75%. United has shelled out close to $10,000 on this accident. Alot of the money that Mega is being asked to pay falls in the 80/20 gap. For example, United pays for the doctor visits minus my $20 copay. Frankly I think Mega should be responsible for that $20. I was told they would be. Also, I think you missed the point that as a sports policy sold by the public school system in the state of Florida MEGA's policy is in fact designed to be secondary. On the day of her accident I called my health provider and they told me they were primary, school's sports policy was secondary. The facility is "IN Network" for both insurers by the way. We are 9 months out from her accident and I have to take her back to the orthopedist next week where I hope and pray he finally releases her from his care. If he doesnt I am concerned what ny next step is going to be. Elizabeth

It sounds to me (like usual) that the primary carrier created a sizable gap that Mega was left to pick us as secondary. That doesn't say much for the primary. If Mega would have been the Primary, you wouldn't have needed a secondary (depending on the plan and if it was in network etc.) If you need a number to call, look on the policy provided by the school. Please understand that the main focus of Mega is NOT to be a secondary insurance. If you want to see a real scary event, go out of your network with your current primary and have: say a $100,000 bill. Ask them what they will pay. They will tell you that it is an undetermined amount and that info is not available to you as a client. If you look in your policy with United Health Care (Golden Rule) you will find a clause that states that they will not pay more than what is deemed the "reasonable and customary amount." If you have a $200,000 bill and reasonable is deemed to be $70,000 for example, you would have to pay every dime of the difference. That would be $130,000 out of your pocket. That is not far fetched if you are out of network. Typical for out of network care is 50% or lesswill be paid on your claim. Usually it is much less. Go to the American Medical Association website and there is an article on lawsuits against insurance companies because they don't allow enough for many procedures. Mega does not bill based on allowable amounts. It bills based on usual verses reasonalbe (allowable) By the way, our new Careone and Careone plus without another carrier as a secondary would be a great option for you. Our clients are loving it. I hope this helps. Pat, Cabot, AR