After waiting for nearly a year for my employer to offer health insurance, a fax come to our office offering "medical insurance" from the National Alliance of Associations. It sounded like a good deal so my boss signed us all up for benefits.
My employer had monthy premiums deducted, but I was the only employee who actually tried to use the insurance. I went in for a routine check-up and paid the co-pay amount listed on the back of my member card. This part worked fine, but looking back there were many red flags that I should not have ignored. First, my name was misspelled on my member card. Second, when I tried to purchase my monthly generic prescription, I was told that my policy, member ID, alas my insurance company, could not be found. So I've been purchasing my prescriptions at the retail price. Still, I never investigated further as to why my benefits were not being covered.
Four months later I received a bill from my doctor's office asking for payment due to the fact that my insurance company was not responding. At that time I tried to contact the insurance company myself to find out why the claim was not paid. For an entire week I waited on hold, left messages, and was repeatedly disconnected before I finally spoke with someone. She told me that NAA was no longer the owner of my policy and that I needed to contact CWA (Consolidated Workers Association) to follow up on my claim. Again, it took forever to speak to a human, at which time I learned that they never received my claim. They asked me to have the doctor fax the claim again, which I did.
Just recently (now almost 6 months from the date of my doctor visit) I received another bill for non-payment and a threat to send me to collections, in addition to a new bill for my lab work. This time I called CWA directly, and again they told me they never received the claim and to fax it again.
I started thinking this was pretty bogus so I did some research online and found all kinds of complaints against this company. Most of the complaints are from people wanting refunds on their montly premiums, which is understandable but perhaps unlikely to ever happen. I am not after a refund (although it would be nice for the six months of prescription bills I've been paying). All I really care about is getting my claim paid. Both bills, plus late charges, are over $800, not to mention the long-term damage to my credit if they report me.
This was not my fault! I did not fall for a scam just to get a good deal on insurance....I trusted my employer to perform due diligence and provide ligitimate health coverage. To make things worse, the company I work for might be forced to declare bankruptcy so they probably won't be able to reimburse me if I pay the bills myself. Do I have any recourse? How should I proceed in order to get my claims covered?
Thank you for any advice or insight you can provide.
Kat
Sonoma, California
U.S.A.