My companies heath insurance doesn't cover gastric bypass surgery. On 5/11/07 I found one that told me it was covered under there policy. Tracy, the girl I signed up my policy, stated it was a covered procedure and told me if the surgery cost 24,000. 19,200 is covered, owing the hospital was 4,800. But if I signed up for the preferred plan. I would have hospital stay coverage of. 1,000 the first day and 500 each additional day. The average stay for this surgery is 5 days. This would help cover an additional 3,500 twords the deductible.
I started the policy that day 5/11/07 for 299.95 which included the first monthly premium of 199.95 and a 100.00 fee for paperwork and startup fees. I was also told there was a no pre-existing condition clause and a no waiting period on the policy to have the surgery.
I made sure that my doctor was a covered doctor on the plan. Which he was. Then I scheduled the appointment with my Dr's. Office to get the pre-surgery plans started. After seeing the doctor and having all the tests done. The surgery was all set except the insurance. The insurance company refused to call the office back regarding the benefits.
I spoke with the company myself multiple times and was told the surgery would be covered. But my Dr. needed something in writing. Thinking it was just my drs. offices being slow. I switched the Dr's office and did the whole thing over again with the Cleveland Clinic. Finally able to get through to the company and was told that the surgery is an uncovered procedure.
I also tried to use the prescription coverage at a local CVS. They were unable to find the insurance company as a way to bill through. I payed the 75 dollars for the prescription and called the company. They said they were unsure why CVS was not on they're the policy and would look into it. I never heard back from them or received any help for the prescription that should have been 15 dollars.
I canceled the policy due to false advertisement. I tried to get a refund with no luck. Paid 4 months into my policy, which was not used. I'd like to get my money back total of 899.80. The last payment was convienently taken out the day I canceled my policy. I told them that they falsely advertised the insurance and they had nothing to say about it. The #(888)539-0391 that I reached to sign up for the policy, still states that it is a covered procedure, but the insurance company (866)470-4959 states its not covered. My policy # is/was 511257962. please help.
I would like a full refund from the company that falsified there insurance coverage to make a sale.