michaela's complaint:
February 08, 2013

Insurance Company: HealthSpring
Coverage Type: Health Insurance

• PolicyHolder Service - Inadequate Service
• PolicyHolder Service - Incompetent Employees
• PolicyHolder Service - Delays/No Response
• PolicyHolder Service - Denied Access to Services
• PolicyHolder Service - Unfair Negotiation
• Claim Handling - Denial of Claim
• Marketing & Sales - Misrepresentation
• General - I feel abused by this company

I recently signed up with Healthspring medicare supplimental insurance.The first problem---- Before I signed up I talked to the representative in lenght about their prescription coverage, specifically MARINOL, a very expensive ($1300/30 day supply) drug, I asked him what my cost would be and was told $8 copay. I asked if it was covered the donut holeand was told yes. I asked him this no less than 6 times to the point of him getting annoyed, but wanted to be crystal clear that this drug was covered. I was covinced that this would be the best plan knowing that it would cover well over $15,000 cost of just that 1 medication, not including the other 10 medications I take. After I got my first prescription filled (with the $8 ccopay) I was sent a letter saying that I needed a letter from my DR on the reason why I needed this drug. He gladly sent a letter explaining that all other medications did not work and the marinol was the unly drug with successful results. I hadnt heard from them , so I called them. The person told me that that drug would only be covered for peopele with HIV or taking chemotherapy, something that should have been told when I inquired more than 6 times if was covered, something that would have taken 3 seconds to do. Now they want myself or my DR to file an appeal, saying if I did it , it would take quite a while but if the Dr did it would go faster. Now I have to bother my DR again to write an appeal.
The second problem---- There are no dermatologists in their network anywhere near me so I neede a referal to go to one here, I told her that the referral was faxed Friday. Their booklet says a referal takes 24 hours((Emergency)or 72 hours normally. I told her its been 3 business days and need to know if was approved, At that point she became very rude telling me "DONT YOU KNOW THERE 8 HOURS IN A DAY" I was kid of shocked a bit but said , sorry but there 24 hours in a day, She came back at me saying 'we go by 8 hour days here', I referred her to the booklet saying 72 hours and asked if thats the case a refeal would take almost 2 weeks, in 8 hour days, to find out if its approved she said yeah thats right, At that point i was so upset(I had triple bypass surgury a few months ago) that I started to get chest pains and lost my temper and said something to the effect that thie whole *&%$#$* company is a scam and hung up
This has been one of the most exasperating and rudest phone call I have ever had. I'm not sure if this is going to the right place or to the right person , if it does and you can give me some help Thank you, If not it felt good to vent this out to some Thank you
Mike

0 0

Tweet