Mega Life Insurance Company Deception, Misinformative and Rude!!! North Richland Hills Texas

Well, I can tell you that I too know Chuck Taggart, and he is one of the "good guys" and is the top agent that company ever had. He also recently left Healthmarkets because they had to stop selling in Massachusetts. Not because the products were bas as Massachusetts is a VERY regulated state, but because of the company's past mistakes.

But, a couple comments:

You say not to expect a call back from Chuck, but if you read his post, he actually said for the customer to call him, and had tried to explain the scenario.  So you really don't know if the customer and he worked out the customers issues.

I can tell you from experience that I have sold Assurant, GoldRule, Mega, Midwest, Blue Cross, and a bunch of others and the BS fed by the customer on this post is the same crapt I see day in and day out.  The guy "John" is obviously a cheapskate who flat out doesnot want to take responsibilities for his decisions. Why you people drag this garbage on and on is beyond me, but simply put, you really have no idea about any of the details here as even "John" never commented back.

The issue is with Chuck telling the John that if there was an unintended hospitalization, something that was not planned on, but happened (and that is why we have insurance), that John would not have to pay the deductible. If there was advance notie about the hospitalization, Chuck told John to contact him and the plan could be changed. Did you two morons miss that point? Seeing red because someone bad-mouthed your precious company? Go play in traffic! I worked with Chuck a few years ago. He easily wrote the most business out of the office. And he was in the room when we were told the exact same thing he told John - "as long as (you) do not have an overnight surgery, (at least a procedure that can be scheduled in advance) a ER vist would be 150.00 and a doctors visit would be 25.00. If you know you have to be hospitalized, give him two weeks, and he can change (y)our plan."

Don't expect a call back. Not because Chuck is a bad guy. He's not. He's a really good salesman. Why? Because he can sell this stuff. Don't expect a call because Chuck is being told by his manager (a close relative) and other managers in the office to just "let it go, it is just someone who didn't read their policy." (Doesn't matter if the agents were led to believe that they could parrot whatever their managers said, true or not, written in the fine print or not. It's never the agents fault, because then it would be the managers fault, and pretty soon Joe would have to trade in his Jaguar).

It's simple John. File a complaint, get a lawyer, do what you need to do. And for the record, I couldn't sell this stuff. I did get off my butt and tried. I made the calls, I asked for help, I got answers, some that worked and some that didn't. I left once the families I signed up started having to go to the hospital or the doctor, and once they ran into issues listed above and in other similar threads, they started cancelling, leaving me a huge debt. I put 2 and 2 together and realized if this were to continue, I would never get out with a dime. It wasn't until after I had left and was able to read more on the company (yes, more than just this site, Will) that the exact stuff that was being investigated and Mega was getting sued for was the same stuff that I had experienced in the Monday meetings, during training, 1 on 1 help from my manager (who I did parrot when I went on sales calls. I glossed over just the right amount of details, and got really excited at just the right time talking about the NASE benefits).

Get a life, azzweepes. You are defending this company, you obviously have nothing to do. No sales today? Go make your manager rich.

You should read the posts before you tell someone their post is not relevant to the Authors post!

The original post:
'We had to change insurance in less than a year due to Chuck Taggerts lack of attention, and Mega Life's sketchy practices.'

From the settlement:
'In many instances, the agent or the company did not adequately explain the benefits covered by the health plan.'

If You could prove my post wrong, there would be no need to 'dodge' the contents as you just did.

It just doesn't 'cut' it to dodge the post and throw out the 'ignorant' word to try and say something that is useless in order to look like a 'big shot'.

Nothing you said disproved what I said. In fact you had to completely dodge it. You are 'stuck' with it being correct until you can prove it wrong. No one else is going to be able to help you. You may have to call in Will again to help you with a lowly Consumer post. But then Will is never any good either!

Lee, I dare you to show me where the above post is wrong. Use the words in my post so you can't 'dance' around the issue again.

Once again, you show your ignorance. I am absolutely astounded by it. This thread has been show repeatedly that it is completely unwarranted. I even spoke to the agent about this thread and discussed the coverage. You obviously have not taken the time to actually read the relevant posts and have nothing better to do with your time. Get a life.

To whom it may concern.

All of my comments in this thread concerning Mega and/or its agents and/or its representatives or any other individuals are purely my own opinion, and were/are not intended to harm any company or individual in any way.

Andromeda

To whom it may concern.

All of my comments in this thread concerning Mega and/or its agents and/or its representatives or any other individuals are purely my own opinion, and were/are not intended to harm any company or individual in any way.

Andromeda

To whom it may concern.

All of my comments in this thread concerning Mega and/or its agents and/or its representatives or any other individuals are purely my own opinion, and were/are not intended to harm any company or individual in any way.

Andromeda

To whom it may concern.

All of my comments in this thread concerning Mega and/or its agents and/or its representatives or any other individuals are purely my own opinion, and were/are not intended to harm any company or individual in any way.

Andromeda

Will,

You should read the posts before you tell someone their post is not relevant to the Authors post!

The original post:
'We had to change insurance in less than a year due to Chuck Taggerts lack of attention, and Mega Life's sketchy practices.'

From the settlement:
'In many instances, the agent or the company did not adequately explain the benefits covered by the health plan.'

If you can't see the connection, go back to school.

Look,

You have your facts mixed up. The "Author's Post" is with regard to a claim that he had agains Mega. If you do actually take the time to read the above posts, as that would take less time than you responding to something, you would see that the issue that "John" had is that he had to pay his deductible because his kid was overnight in a hospital.

Every insurance company...let me stress this...EVERY INSURANCE COMPANY considers and overnight stay a hospitilization. Not just Mega. That includes Blue Cross, Health Net, Humana, Cigna, Tufts, United Health Care, and any other place you can think of.

John picked a deductible for hospitilization. There is a cost savings to him for having a deductible. His kid ends up in the hospital, so therefore he has to pay his deductible and should either a) use the cost savings he had for the deductible; or b) recognize that there was a savings.

If there was ever an open and shut case for Mega, this is it. Then, some random person puts in something completely unrelated, and now you are sidetracked.

Read the post and the responses.

This post should be deleted as it is not a legitimate complaint. It is a customer who saved money and now wants Mega to pay for something they should not have to. Every insurance company on the planet would have responded the same way.

Will,

I just can't let this meaningless crap go unchallenged.

All quoted are direct copy of earlier post.
"Mega Life Insurance Company Deception, Misinformative and Rude!!! North Richland Hills Texas."

"The regulatory settlement follows a three-year multi-state exam that found multiple problems involving consumer disclosure, oversight and training of agents, claims handling and complaint-handling practices. HealthMarkets faces up to $10 million in additional penalties if it fails to meet performance standards outlined in the settlement."

"Sending a notice to all policyholders with policies issued prior to Aug. 1, 2005, that includes a toll-free number, mailing address and e-mail address where policyholders can ask questions about their coverage. The notice also must include a Web site address for each company."

"Ensuring each method of communication is staffed by someone able to provide detailed information about the policyholder's specific plan.
Establishing a Web site with a frequently asked questions section, general coverage descriptions, a listing of contact information and information on how to appeal a claim or file a grievance."

"Agent training and oversight
Claims handling
Identification of company
Transparency of the companies' relationship with associations
Complaints and grievances
Cancellation, nonrenewal and discontinuance notices
Establishing and maintaining a compliance program
The multi-state examination was initiated as a collaborative action under a single umbrella through the NAIC because the companies were the targets of separate investigations and consumer lawsuits in several individual states. Although violations were documented and fines levied in individual state exams, the companies' actions and complaint histories had not significantly improved at the time the multi-state examination was initiated."

"The examination covers a five-year period ending Dec. 31, 2005, and stemmed from the volume, scope and nature of complaints made against the companies by consumers in many states."

"According to the findings, the companies targeted their sales to self-employed individuals and sold the health plans through associations. MEGA agents sold policies through the National Association for the Self-Employed (NASE), and Americans for Financial Security (AFS). Mid-West agents sold plans through the Alliance for Affordable Services (AAS). In many instances, the agent or the company did not adequately explain the benefits covered by the health plan.
The $20 million penalty will be divided among the participating jurisdictions based on the companies' premium volume."

You really can't see any similarity between the above quoted facts and the authors complaint "Genius" "Quickstart winner?" I am not at all surprised. If you don't see it, no one is going to waste their time assisting you. You might need more practice associating things mentally.

The authors complaint is contained in the settlement facts above. You gave it a nice spin and brush-off try though.

Everyone who reads this thread can see you are apparently trying to suppress any and all Mega problems, but you can't do anything about the settlement facts can you? Why don't you try to re-word the settlement facts, instead of trying to spin them this time? You should learn somehow that you can't explain problems away by just saying they are in the wrong place. That never gets rid of them. Especially when they contain the authors concerns.

The 20 million dollar case and settlement, and rating reduction are documented history for all consumers and agents to read. No one cares about the money. the disclosure of all the Mega problems is many times more valuable to consumers and agents than any monetary value.

Nice to See you again. I will keep in touch.

Your post has no purpose here.

The fine as you say is minor when you divide it out. It come to less than $140k/per state /year.

So what?

The purpose of the post was about a particular situation, which I think is unwarranted based on the above.

Unfortunately this is only a 'slap on the wrist'


KANSAS CITY, Mo. (July 24, 2008) State insurance regulators, working together through the National Association of Insurance Commissioners (NAIC), today announced the details of a $20 million regulatory settlement agreement between 29 jurisdictions and HealthMarkets, Inc., and its affiliated companies, MEGA Life and Health Insurance Company, Mid-West National Life Insurance Company and Chesapeake Life Insurance Company.



The regulatory settlement follows a three-year multi-state exam that found multiple problems involving consumer disclosure, oversight and training of agents, claims handling and complaint-handling practices. HealthMarkets faces up to $10 million in additional penalties if it fails to meet performance standards outlined in the settlement.



The multi-state examination was initiated by Washington State Insurance Commissioner Mike Kreidler and Alaska Insurance Director Linda Hall in 2005 and coordinated through the NAIC's Market Analysis Working Group.

This is a good multi-state settlement that addresses some serious violations of our consumer protection laws, said Montana State Auditor John Morrison, who chairs the NAIC Market Regulation and Consumer Affairs Committee. By coordinating our efforts through the NAIC, we are better able to expedite a collective regulatory response that protects consumers on a nationwide basis.


According to the terms of the settlement, the companies must implement an outreach program that includes the following:


Sending a notice to all policyholders with policies issued prior to Aug. 1, 2005, that includes a toll-free number, mailing address and e-mail address where policyholders can ask questions about their coverage. The notice also must include a Web site address for each company.
Ensuring each method of communication is staffed by someone able to provide detailed information about the policyholder's specific plan.
Establishing a Web site with a frequently asked questions section, general coverage descriptions, a listing of contact information and information on how to appeal a claim or file a grievance.

In addition, the companies must report progress twice a year through Dec. 31, 2009, on performance standards targeted for improvement. Led by Washington, the other states involved in overseeing the insurer's ongoing activities are Alaska, California and Texas.
There are 13 areas in need of improvement, including:

Agent training and oversight
Claims handling
Identification of company
Transparency of the companies' relationship with associations
Complaints and grievances
Cancellation, nonrenewal and discontinuance notices
Establishing and maintaining a compliance program
The multi-state examination was initiated as a collaborative action under a single umbrella through the NAIC because the companies were the targets of separate investigations and consumer lawsuits in several individual states. Although violations were documented and fines levied in individual state exams, the companies' actions and complaint histories had not significantly improved at the time the multi-state examination was initiated.

The examination covers a five-year period ending Dec. 31, 2005, and stemmed from the volume, scope and nature of complaints made against the companies by consumers in many states.

According to the findings, the companies targeted their sales to self-employed individuals and sold the health plans through associations. MEGA agents sold policies through the National Association for the Self-Employed (NASE), and Americans for Financial Security (AFS). Mid-West agents sold plans through the Alliance for Affordable Services (AAS). In many instances, the agent or the company did not adequately explain the benefits covered by the health plan.
The $20 million penalty will be divided among the participating jurisdictions based on the companies' premium volume.

I enrolled with Mega Life and Health as an individual and not part of a group policy. Small beans to any company....

After a couple of months, I experienced unexpected health problems. I contacted Chuck Taggart, told him about what was going on and asked him how I could best pursue making a claim. After a couple of calls on my own, I called Chuck back. He placed a conference call so I could participate and was my advocate with Mega Life.

Every time I called or emailed Chuck (which was many, many times) he promptly returned my call/email. I was really impressed and grateful for his help. I can only speak highly of my experience with Chuck Taggart and have recommended him to several of my friends who are looking for health insurance.

Thanks to Chuck, my claim with Mega Life has been approved.

I enrolled with Mega Life and Health as an individual and not part of a group policy. Small beans to any company....

After a couple of months, I experienced unexpected health problems. I contacted Chuck Taggart, told him about what was going on and asked him how I could best pursue making a claim. After a couple of calls on my own, I called Chuck back. He placed a conference call so I could participate and was my advocate with Mega Life.

Every time I called or emailed Chuck (which was many, many times) he promptly returned my call/email. I was really impressed and grateful for his help. I can only speak highly of my experience with Chuck Taggart and have recommended him to several of my friends who are looking for health insurance.

Thanks to Chuck, my claim with Mega Life has been approved.

I enrolled with Mega Life and Health as an individual and not part of a group policy. Small beans to any company....

After a couple of months, I experienced unexpected health problems. I contacted Chuck Taggart, told him about what was going on and asked him how I could best pursue making a claim. After a couple of calls on my own, I called Chuck back. He placed a conference call so I could participate and was my advocate with Mega Life.

Every time I called or emailed Chuck (which was many, many times) he promptly returned my call/email. I was really impressed and grateful for his help. I can only speak highly of my experience with Chuck Taggart and have recommended him to several of my friends who are looking for health insurance.

Thanks to Chuck, my claim with Mega Life has been approved.

I am so tired of seeing the absolute ignorance of people (primarily so-called "ex-employees") on this site.

The fact that someone can easily read that "John" above is responsible for his deductible because of the plan he picked and yet say that the agent that sold it to him should have his license removed is absolutely stupid.

You really think that John gave the full story? I read all of the responses above, and I know the policy that was discussed. The agent did absolutely nothing wrong.

So, hypothetically, let's say John only bought catastrophic coverage only, as in no doctor's visits or ER coverage. Then he sees a doctor and gets whacked with a $200 bill. You a are saying that he can gripe about it and should have the agents license revoked? You really think that the agent's career should be over for John's decisions?

I am disgusted with the losers who have no intelligence on this site.

Hey - can you not read English? Read the above posts. The guy had a policy that he chose and specifically it says (like any other policy in the country with any company besides Mega) that Emergency Room coverage ends when someone is overnight in the hospital. The guy himself picked a big deductible to save money. His kid ends up in the hospital and he is responsible for the deductible.

It does not matter whether he had Mega, Blue Cross, Harvard Pilgrim, or whoever. He is subject to the deductible first.

Case closed. End of story. That is all she wrote.

There is nothing to file a complaint about.

Very simply put, you need to file a copmplaint and report wioth the MA Department of INsurance. These kind of misleading tactics from greedy agents should be stopped and the acting agent should have his licensed stripped.If you go on line for the MA DOI, you will find a link that you can file complaints.

My name is "Nunya", which stands for "Nunya business".

If you have access to information on sales, then you are flat out lying as to who you are...you would have to be currently with the company.

Like I am sure "ex-hm-agent" is your real name. And I am sure you really live in Brighton. Why are you not using your real name? hmmmm????

Again, your response here is unwarranted. Money is not the issue either. Most of us have 20,000 plus weeks. You brought money up.

And we are still supposed to be discussing Massachusetts not Iowa. In Massachusetts, any issue including maternity, asthma, and the other things that you listed are not presenting conditions as long as someone has had health insurance in the last 63 days. That is the same with mega as it is with every other insurance company in this state. So whatever your point, it is completely out of place.

We can send out information, and we can talk to people over the phone, just like you. Yes we have to go sit down with people face to face to discuss plans. But big deal.

It seems to me, that you and your friends were just tired of working for a company. Gee, was that your first job? Or had you never been tired of working for a company and needed a change previously? Again, the point of this post is not to hear your Sob story about how good you feel about yourself now or what you currently do for a living. It's a waste of anybody's time who is reading all of this. This post is specifically about a set of events, which obviously have been addressed. I and everyone I know that works for mega, enjoy our jobs and like the company.

So please, if you do not have anything relative to discuss with regards to a Massachusetts policy, stay out of it.

What's really funny is that according to the Mass DOI agent site, there are no Mega agents in Scituate. According to the Mega site, there is only one person named Lee in New England and that person isn't licensed in Mass. According to the Mega site that "Lee" has done about 178,000 QPCs this year. Now we all know about double and triple QPCS and taken rate calculations. I'm guessing that this "Lee" has done about 150K in business from mid-October thru now. That's a good living?

The difference is for me it's less about the money and more about how I choose to make a living.

I want to match my client's to the proper plan. If my client wants an immediate maternity benefit I want to offer it...not do "fuzzy math" and try to talk them out of it.

If my client does not want a condition excluded I want to offer carriers that don't issue exclusions. There are many. Asthma? Allergies? Depression? Covered from day one.

Carries all have underwriting niches. Why allow my client to be rated for high blood pressure when I can get them issued standard?

I simply enjoy offering my clients a choice of all major medical plans in my state and helping them choose the one that best fits their needs.

To me, it's more in line with my personality then sitting down and launching into a sales presentation.

If I get a referral that happens to be a 3 hour drive each way I enjoy writing that case online. If I get a referral in another state I enjoy writing that online.

I like full disclosure -being able to email detailed rates and plans to my client so they can review the material.

I'm not sure the "we failed as Mega agents" mentality plays out. The three top agents in my state are former district managers - years spent with Mega - highly successful.

All finally got sick and tired of the BS. One of my better friends was in the top five district managers in the country for UGA. He now runs one of the largest independent agencies and has around 500 agents under him country-wide.

I guess he's making just a tad bit more then when he was with UGA. The week I left Mega I wrote 22,000. I was simply tired of....well everything that has to do with Mega and UGA.

Hey, what a coincidence! I am a Quick Start Winner Also!!!!!

I wrote $275,600 QPCs, and I too make a great living!

Good for you in your new job. Obviously you could not make it at Mega because you preferred to stay at home.

John - You still have no reason to post on this blog as you have nothing to add. Your comments show you are misinformed and wrong.

FYI - I was a Quickstart winner too and wrote over 300,000 QPCs. There are 12 a year. The company has been around for almost 30 years. There are hundreds of them.

My income last year was significantly higher than yours. And I like to get out of the house. You live in Des Moines. I have been there. So of course you would stay at home.

What is your point?

Why not wait for an Iowa post to comment on?

I was a Quick Start winner - wrote $260,000 in QPC - had a 94% taken rate. Since I left I now average around $25,000 per week in placed business however I'm at 25% commission so my weekly commish is $6,000+

I have two young boys and now instead of driving all over creation I'm home with them and sell online. I also win trips, get bonuses and free leads.

So yes, my family and I are both glad I left.

Actually (John in Des Moines), Sales in the Northeast U.S. for Mega are up almost 30% from last year. It is true that overall for the year across the country, sales are down a bit, but the majority of companies across the country are having a slow year (Helllllooooooo????? do you look at the business section on other companies or just Mega?). But Massachusetts has never been better.

The reason why is insurance is required, and people are beginning to see the usefulness of a catastrophic plan for healthy people and then setting up an HSA or Association 105 account.

Too bad you are such a pessimist, but if you expect that whatever company you work for will always have a good year, you will never find a job.

Will in PA - I agree with you. i am well-versed in Mass plans as I am in Mass, and you are correct. The "ex-agents" here are not addressing the issue. Just wining about not being successful. We have not sold a scheduled plan in a couple of years now and sell the Signature Plan only. HSA Plans will be replacing those beginning in August!

If you failing ex-agents want to challenge an HSA Plan, you will have to fight the Federal Government as they are the ones who came up with it.

Too bad you left. You must be greatly successful in your new careers.

Of course all insurance will one day be sold online. But (Des Moines) you are wrong about a couple things.

First of all, Mega has a A- (Excellent) on AM Best as of this morning. That has been its ranking for years. Additionally, in the State of Massachusetts, it is the highest ranking a health insuance company can get. Harvard Pilgrim is listed as B++, Health New England is listed as B++, Tufts is listed as B, and Blue Cross is not rated and in most states is A-. Healthmarkets (the parent company) is not rated either, but one listing gives it a bbb-. However, if you are familiar with the company you would know that the plan by Blackstone Equity is to put it back on the stock market in the next few years, which is why.

Second, the majority of insurance is not sold online. It is sold through the mail. Maybe in Iowa they do that, but not here in PA and not in MA. Mega policies are face to face sales, which is unusual and maybe is outdated, but most of the sef-employed customers I have had like that. However, that does not mean that 10 years from now that will still be the case. With the introduction of HSA plans, there is no reason why the company could not have online sales if a State allows it.

Healthmarkets and Mega just got downgraded - lost their A rating and outlook now is negative due to declining sales.

The Mega model was great....for the 80's and 90's however they are getting killed by both rising gas costs, losing the ability to recruit agents (since prospective agents Google Mega Life and UGA) and a dwindling sales force.

In a few years Mega will not be here...if not sooner. Remember, there once used to be a company that sold buggy whips.

Right now over 70% of all health insurance is sold online. Within 5 years it will go over 90% sold online...and UGA will be done.

If you still want to drive around with limited plans - fine. Don't lose your resume.

You are going in circles, but you still are not addressing the point of this post, which is about John at the beginning. Obviously, this is because you are not familiar with policies in Massachusetts. So let me help you. I did some digging and got hold of an old Health Choice policy fo Massachusetts, the same one that John had apparently. Here is what the Emergency Room rider says in black and white:

"This optional benefit will pay for covered expenses of an insured person, for a medical emergency (as defined in the Certificate) treated in a hospital emergency room. These benefits are payable only for a medical emergency that does not result in a hospital confinement."

NOTE the last sentence. It is no hidden anywhere. It is not buried in the Exclusions and Limitations. It is the first 2 sentences of the rider! John's daughter was kept over night. Every insurance company in the country to my knowledge considers that a hospital confinement. At that point, ER coverage is waived and the issue is addressed as a hospitilization. John has a $5,000 deductible. The overnight stay is $3,000. He has to pay the $3,000. This is not rocket science. There is no "big bad insurance company" that is the crook here. The issue is that John wanted to save money, got a policy with a deductible for hospitilization. His daughter ended up in the hospital, and now he has to deal with it, but does not want to. He would rather complain about it.

So why don't you for once actually address the issue and point of this blog?

Now, let's get into specifics on your post:

1. As far as an ad hominem attack, you are making broad statements about all agents and all claims in one company, which are false. The company does pay claims, and my past customer is proof of that. So you are wrong. All you can do is say "congratulations on having a satisfied customer." Guess what? I have tons of customers that are satisfied, and hundreds of statements just like the above. What do you think of that? Should I include them too?

It does not matter that Blue Cross is the largest insurer. I did not state that Blue Cross had the most settlements. I said they had the LARGEST settlement in the history of the State of Massachusetts (or Commonwealth as they call it there).

Point - type in "Mega Health" in this website alone and you get 14 reports found. Type in "Blue Cross" and you get 37 reports. The vast majority of issues for Blue Cross are addressed by customers. The greatly vast majority of issues for Mega are addressed by wining ex-agents who failed miserably in sales and can't live with it.

2. You did not answer anything about the "issues" you have claimed with the Attorney General in Massachusetts. You brushed it aside and now bring up the NAIC. That is what we call a "Bait and Switch"...or you could call it "Smoke and Mirrors". Or you could call it "that you don't have a clue about the nature of the issues in the State of MA". With regard to your statement of the NAIC. That is a complete joke. The only thing that came out of it was they felt that agents needed to be trained more, which they are. There were some paperwork issues too, but minor details. Read the report. I did. That was over 3 years ago. Get over it and move on with your life.

3. So let me get this right...you were with Mega for "over a year and specifically trained not to get into exclusions and limitations" by your district sales manager? That is odd...you have made it clear in earlier statements that you were not with the company very long because you "promptly left" after an issue.

So here is the problem. You apparently had one issue in this year plus situation, because you left the company "promptly" afterwards. hat does not sound like very many issues...During that year, you either did or did not go through the Exclusions and Limitations of the policies? You claim to be knowledgeable about the policies in your state (which you still have not addressed the point of this blog which is a MA policy). So does that mean you purposely did not go through them b/c someone told you not to? In which case, again, shame on you. Or did you go through them? Because if you did, then there should be no issues here. When I was trained many years ago, I was told to point them out and go through one or 2, but to go through them all would take a long time. Eventually, I just decided to go through all of them, which no one ever has had any issues with. If you want, I can put them in here.

4. No. The point was with regards to your statement, "I made the situation right as I could and then I promptly left the company. Plenty of other ex-agents have been forced to do the same, sometimes with huge financial losses to themselves." That was specifically at the agents, not the consumers. Name one insurance company in the history of the country that has never denied a claim and a customer has been out of pocket.

It's Monday morning. What better way to pass the time than to answer Will's latest stuff point by point?

>Will says, "So when did you move to NY? and from what State? I am afraid that I think you are not an ex-employee but actually work for a discount company out of NY called Health and Life Direct, FirstChoice, American Medical, or NAPA. Those companies out of NY are major scam artists, and it would seem possible that you actually work for them and are badmouthing another company. Otherwise, unless you are unemployed, I don't see how or why you would have the time to type in information in the middle of the day."
In the business of philosophical logic and law, people call this a paragraph an example of an ad hominem attack: if you can't assail the person's logic, attack the person himself. Suffice it to say, sir, that I do not work for any of the companies you mention, nor do I work for a scam company (anymore), nor am I unemployed or selling pencils or apples for a living. I was in fact employed by MEGA in, as I say, a nearby state; but as you know, where I am, who I am and what I do to keep the lights on has no logical bearing on the points that I present.

>Will says, "1. You did not give a response to my question about my customer with over $400,000 worth of claims that the company paid everything but her deductible."
Some people in Massachusetts made money off the original Ponzi scheme, too. You can look it up. But congratulations on having a satisfied customer.
In matters of scale and proportion, as you well know, MEGA has (and has had) one of the highest complaint ratios in the business - well above the national average, for all the reasons I presented above - non-covered expenses, poorly informed newbie agents, and ridiculous claims classifications being just some of these. Yes, other insurance companies have issues like this too...but not in the proportion that MEGA does. So when you say that Blue Cross has the highest settlement in the history of the Commonwealth of Massachusetts, I would say, "Of course they did. They're the largest insurer."
For the folks watching at home, log onto the NAIC website and check the complaint ratio of MEGA to the national average in your state versus the major health insurers.

I've covered his second point here, so I'll take the liberty of jumping to #3.

>Will says, "3. You are dead wrong about not knowing limitations as an agent. If you were an agent, then you must have been at the company the briefest of times, which means that you either a) did not take the opportunity to learn the exclusions and limitations; or b) sold a policy to the person without properly informing them. I don't know anyone that has been around longer than a year that can't describe the ins and outs of the policies."
I was with the company for over a year and was specifically trained not to get into exclusions and limitations by my District Sales Manager. In fact, I was considered an oddball by my peers for leaving the summary of benefits with the client. If YOU'VE been an ex-agent, as you claim you are, this can't shock you one bit.
That aside, knowing the stated limitations and exclusions in print isn't the same as knowing them as they operate in the real world. It'd be like saying you know how to operate on someone's brain because you read a book. Agents don't really know how Healthmarkets treats the client until they get their first frantic phone call. And that, I submit, is when they find out about a lot of the non-covered expenses they were told to gloss over in the sales presentations.

>Will says, "4. None of the ex-agents that you are speaking about left with a financial loss..."
Red herring. My point has been about losses to the client. Losses to the agent in time, opportunity cost, sanity and personal reputation would be so lengthy as to require its own thread, and I do have to get back to work here.

>Will says, "So why bother responding with accusations that are wrong, unfounded, and liable?"
Simple proof against defamation, sir: It ain't libel if it's true.

So how to you feel about the results of the multi-state market conduct?

http://www.naic.org/Releases/2008_docs/exam_national_health_problems.htm

So when did you move to NY? and from what State? I am afraid that I think you are not an ex-employee but actually work for a discount company out of NY called Health and Life Direct, FirstChoice, American Medical, or NAPA. Those companies out of NY are major scam artists, and it would seem possible that you actually work for them and are badmouthing another company. Otherwise, unless you are unemployed, I don't see how or why you would have the time to type in information in the middle of the day.

1. You did not give a response to my question about my customer with over $400,000 worth of claims that the company paid everything but her deductible. Here is the unedited text from her email to me:

"Great talking to you on the phone. I will call and add dental to my plan. Just wanted to also say how happy I am with Mega Life excellent insurance company! It is still amazing that with all the issues I have had with my knees, etc MEGA has had no problems paying the bills. And you were so helpful in getting everything set up for me and helping me choose the right plan for me out of the options available! Coming to my house and going over everything with such care was a wonderful thing since insurance can be very confusing these days.

Thanks again!"

2. I know the full details of the Attorney General in Massachusetts. And there has been absolutely no fines, fees, etc that have had to be paid. In fact, the whole thing is winding to a close with no issues. The only thing that will likely come out of it is that the NASE or AFS memberships that are currently required may be optional, just as they currently are in many other States (and most of the agents in Massacusetts want it that way). There are no issues that the State has found with sales practices of ANY of the agents that they have met with. That, my friend, is a fact. Another fact of trivia is that the LARGEST settlement with a health insurance company in the history of Massachusetts was with Blue Cross.

3. You are dead wrong about not knowing limitations as an agent. If you were an agent, then you must have been at the company the briefest of times, which means that you either a) did not take the opportunity to learn the exclusions and limitations; or b) sold a policy to the person without properly informing them. I don't know anyone that has been around longer than a year that can't describe the ins and outs of the policies.

4. None of the ex-agents that you are speaking about left with a financial loss. They all were paid on advances, which you would be well aware as to what they are. But in case you don't (which it sounds like you may not), when they sold a policy, they were paid 6 months commission up front. This was their choice to take. If a policy cancels after one month, then they owe the company 5 months of commissions. This is to keep unscrupulous people from stealing money from a company, and it is not a new concept to Mega. Many of the insurance companies today pay based on the exact same deal. So the agents that you are speaking of were obviously in it for the "quick buck" and thought that they could sell a policy to a friend, cancel it, and collect a commission. It does not work that way. Before you retort, keep in mind that Mortgage Brokers are paid the same way. Many of them do not get paid until several months after a house sale has stayed on the books.

You have not responded in any way that is relevant to what was presented above. John has a $5k deductible by his choice, which he states himself. He has a $3k bill for a hospitilation, which he states also. Therefore, the company would not paythe $3,000. If had a $50,000 bill and had a 100% Sinature plan, then the company should pay $45,000.

So why bother responding with accusations that are wrong, unfounded, and liable?

First...I am in New York. I have moved recently from a nearby state. I'm allowed to do that, right?

Second...I did not knowingly sell policies that were, as you say, "minimal coverage". I would not consider or assume a $2500 deductible, $6500 OOPM plan to be "minimal coverage" and if I was selling an Aetna or United Healthcare policy, it wouldn't BE "minimal coverage", because Aetna and UHC's plans have far less loopholes - far less "non-covered expenses". An agent cannot possibly know about these loopholes until he or she is confronted with a client crisis, something that illustrates to the agent how shoddy the limited coverage, high profit policies are. And then the agent has a choice: leave the company, or close his or her eyes to the truth and keep taking the money. In my case, I made the situation as right as I could and then I promptly left the company. Plenty of other ex-agents have been forced to do the same, sometimes with huge financial losses to themselves. But at least they can sleep at night.

If I'm so far off base, then please explain to me why Massachusetts Attorney General Martha Coakley found enough cause to label MEGA's practices in the Commonwealth a "campaign of deception and unfair practices," in the lawsuit she filed against MEGA to protect Massachusetts consumers last August. Tell me why the State of Maine had cause to fine MEGA $1,000,000 and refund another $4,600,000 to customers for overcharging them for this shoddy insurance two months ago. Not 2000, not 2005...two months ago.

Every agent who has a line of authority to sell Health and Accident policies can take that license and sell whatever paper they want provided they secure the proper appointments. Every agent has a choice to either sell reputable policies or policies that have a real risk of destroying their client's finances and livelihood.

So maybe you're right. It does add up...right in the crooked agent's pocket.

Whoever you are in New York, you are greatly misinformed and your comments do not apply to what Chuck is saying. I am an ex-employee and I can tell you from many years of experience that you are dead wrong.

First of all, you are in New York, and Mega does not sell in New York and I don't think it has ever sold in New York. So if you sold a policy to someone "several months ago" that would be impossible.

Second, whatever state you may actually be in is different from Massachusetts. I am in Pennsylvania, and also used to work for Mega. Policies differ from State to State. Some states have Signature and others have CareOne, and there are allot of others. I am familiar with the policies that Chuck is talking about because I use to work for the company for years and had to leave due to medical reasons, not because of the policies. If you sold a policy to someone and then they had the issues that you stated above, then SHAME ON YOU for selling them that policy with minimal coverage. You should have known the policies exclusions and limitations. Your definition of "covered expenses" is used by EVERY health insurance company. The problem is not the company, it is new or inexperienced agents who don't know what they are doing when they sell one.

Third, the Signature Plan in Massachusetts (as in other states) pays a "Regular Charge" as opposed to the "usual and customary" you are referring to. Big difference between the two. It does NOT have a limit for doctors, or cat scans, MRIs, etc if in the hospital or in a catastrophic event. The limit is $2 MILLION. There are limits for outpatient testing, but those go against the base plan deductible.

Fourth, Chuck indicates that he went over the HealthChoice and Signature Plans with this person. The Healthchoice plan is similar to what you are talking about, but John chose the Healthchoice himself. He has to own up to his decisions. It seems clear to me that he was given a choice, new the coverage, and picked something basic to save some money.

Fifth, John has stated that his daughter was in the hospital and he had a $5000 deductible. The cost for the hospital was $3,000. The plan appears to pay exactly how it was supposed to pay. He has to cough up the $3k because he has a deductible. He has a cost savings over the course of a year and should apply that.

Sixth, I have a customer who I sold two years ago (before I left) that called me recently. She has a Signature Plan with a $3,500 deductible. She had both knees replaced, and then got a staph infection while in the hospital, which then ate her femur (impossible to make up this story). She had a new femur put in and the total cost is around $400,000 in claims. I spoke with her recently and she told me Mega paid THE ENTIRE BILL 100% except for her deductible. The plan paid exactly how it is supposed to pay.

So how do you explain that? Mega paid exactly what is was supposed to pay. I actually have had a number of people who were hospitalized, and I too, was confused when I first started. But every single time I looked into the claims made, the policies paid exactly how they were supposed to. When I explained the coverage to my customers they all understood, and the majority of them always kept their plans.

It seems Crystal Clear to me and my past customers.

I want to preface this by saying that I have met many such agents and know them to be extremely hardworking people who are devoted to their families. I'm of the school of thought that if a person loves their family and works hard, they're better than most in this world.

But I have never understood why these people then sell MEGA Life products.

Almost everyone who knows anything about insurance knows MEGA to be borderline fraudulent paper. I used to sell it myself, and was quite successful at it, until one day a client called me up and told me they had a similar situation to John's above. The person had bought a $2500 deductible plan with a $6500 out of pocket maximum from me several months ago. Some months afterward, the insured was diagnosed with a catastrophic illness.

Now, the fatal flaw to MEGA is what is considered "covered expenses". The phrase "covered expenses" is a gigantic loophole through which Healthmarkets and MEGA continually pass the hospital bill on to their insured population. Suffice it to say that the insured, instead of having a $6500 out of pocket maximum as promised, had (and still has) a bill that was several times that.

As an insured, I can accept my cable television bill as a non-covered expense. I cannot, however, accept necessary medical testing, such as CAT scans, MRIs, and many other outpatient tests, being classified as such. I cannot understand why a health insurance company would only allow a $100 reimbursement for any number of doctors who happened to visit a patient per day. If five doctors visit this patient in a day, and they charge $125 usual and customary, the patient is responsible for the remaining $525 - over and above the alleged "out of pocket maximum".

That's what this is really about. Not the deductible, not even the out-of-pocket maximum. It's about MEGA's classification practices and covered expenses - and most specifically MEGA and its agents' lack of due diligence in informing their prospective clients about what really is considered a non-covered expense. That is what is borderline fraudulent, and that is what is unequivocally morally unsound about selling MEGA products. MEGA takes advantage of people's assumptions about what health insurers should consider covered expenses. The fine print never sees the light of day - not by the client, and certainly not by the agent. If it's seen and understood, no reasonable person would buy a MEGA policy.

Some agents have done a historic amount of business for Healthmarkets. I have to think that given those odds, at some point they would have encountered a client crisis - a crisis of such magnitude, deserving of such empathy, that the agent feels compelled to look at their own family and ask themselves if it is worth it to make a career of abusing the trust of others.

I have to conclude that, for many, the money wins out.

Hopefully, people who actually read these blogs realize that they have to be taken with a grain of salt, because no one ever posts positive things, as that would not be interesting, would it?

Let me preface the following response by using the following analogy:

If you have an insurance policy with dental coverage, but you never go to the dentist, and so decide on your next policy that you don't need dental, would you expect that company to pay for a cavity that popped up? Of course not. Keep this in mind and read on.

I am the agent listed by John, and John, of course, is leaving allot out of his story. Here is the real story:

John works with a family business and was shopping for coverage for 4 employees (himself included). His interest was saving money for the business.

When I spoke to him the first time, he told me that he had worked with an insurance company in the past and understood policies. At the time, he had coverage with either Harvard Pilgrim or Tufts, and understood his current policy. He had already met with a representative from Midwest National of Tennessee. Then he met with me.

We went over the two plans that were available. The first plan is called the Signature plan, which is a pretty decent catastrophic hospital expense plan and is fairly expensive. The second is called the HealthChoice plan, which has a lot of limitations but is cheaper (and has not been offered in MA in a while now).

We went over both plans in detail. This took between 2 to 3 hours (yes, 2 to 3 hours). Then I had to explain the plans to the business owner (his mother), which also took some time. I left copies of the materials with him and his employees to review. This he did and called me during the next week with a couple minor questions.

Next, he had me come in again to go through the plans a second time. In the end, he decided that he wanted 2 employees to go on the Signature Plan, and 2 employees (himself included) to go on the HealthChoice Plan. He, in fact, separated the 2 sets of employees between two subsidiary companies that they owned to accomplish this task, because if they were in the same company, then they would have to have the same plan. But he wanted to save as much money as he could for the business.

I then had to explain the policies to each of the three other employees individually. One of the employees, (his sister) had a husband who was going to have some sort of operation around the time of the switch, and John wanted to delay the start of their plan for a month to get that out of the way first because of the deductible that would apply.

Each of the policies also had a 10-day Free Look period for any changes in coverage, or a customer can cancel with a refund if they did not want the policy. This is all proof that the policies were reviewed IN DETAIL by him. He chose the deductibles based on cost. If you take a high deductible, you save more in premiums. If you take a low deductible, you pay more in premiums. Folks, a deductible is a deductible. If there was a concern about this, then why did he not take a lower deductible in the beginning or pick a better plan? The reason, is that we cannot forecast the future, and unfortunately things happen to people.

John specifically wanted high deductibles. This would save the business approximately $20,000 over the next year. With the savings, the business would then pick up any deductible incurred for a hospital stay by an employee.

I do not know about the exact nature of the hospital stay, but the policies are pretty specific that an overnight stay (in essence) becomes a hospitalization. This is fairly standard throughout the insurance world. Hospitalization is subject to the base plan deductible that he chose and was fully aware of. They had their plan for almost a year. What happened to the savings that business had from the plans, I have no idea. But I can tell you for a fact that he understood his plan. He and I spoke numerous times over the next 6 months about changing his coverage for some other personal issues, but he never made any attempt to do so. Every time he called me, his call was returned. Every single time.

Now let's discuss former agents that have responded. Mega and Midwest National pay the agents on commissions. This is true. However, fact is, that is actually standard in the industry for virtually any insurance company and most sales forces in the country. People cannot work for free. Almost any time there is an agent that left a company that pays based on commissions, the actual reason is that they just could not get off their behinds and work. Not because of issues with the policies. They just say later that they did not like the products offered by that company to justify to themselves and others that they could not hack it in a sales world. But believe me, they had no problems collecting and cashing their advance checks while they were working.

As I have said previously, there are multiple products that have been offered, with a lot of choices for coverage. If someone understands a policy and purposely removes coverage to save a few bucks, they have to understand that was their choice and accept responsibility. Most of us have a $500 or $1000 deductible for our car insurance because we know we will typically save more than that deductible in premiums over the course of some period of time. When we get into a car accident, however, we all hate to pay the deductible, but that was our choice, wasn't it?

I have many customers who have purchased our products and are quite happy with the coverage. For any negative story about MEGA, I can provide dozens of positive emails about the company. You just have to understand that any savings should be put into a savings account to offset deductibles (just like your car insurance deductible). If you are not hospitalized every year, it usually works out great. If you go out and buy a new Lexus with the savings, well don't blame the company.

As for John, my door has been and is always open.

Sincerely,
Chuck

As a former DSL for Mega/Mis West, I have found that you must file a DOI complaint against the agent and the company. That is the only way that they will budge on your issue. Healthmarkets won't bother with your issue if it only is an internal company complaint. Agents can have numerous complaints and the company won't reprimand them at all. Internal complaints get ignored. I have seen agents with dozens of complaints get rewarded for being top agents. They run scared when there is a DOI complaint.

Call the DOI at 617-521-7794 or fill out this form. http://www.mass.gov/Eoca/docs/doi/Consumer/css_complaint_form.PDF

Do this and see how fast Mega jumps to resolve your claim. If you need more info, just respond to this post and I'll forward my email address to you.

keep on Chuck,
he is one of if not the top sales people in UGA / Mega Life.

I left Mega because of exactly what you are going through, and the sad thing is that all agents know how Mega pays (or actually doesn't)

your 'agent' should pay your out of pocket for you!

UNDERSTAND THIS: Mega Life Insurance co....is really one of the biggest rip offs in the medical insurance business...they hire sales people on a commission basis to encourange small business owners to buy their policies.....Mega Life pays out very little benefits, thats why their main advertising themem is, "finally, affordable insurance"...i had high cholestrol which was under control with medication, i got a policy through them, but in the exclusions, it stated that as long as I live , they will not pay for any heart related problems......their policies are written in such a way, that practically everything goes under a high deductible or its excluded......dont trust the sales staff, they dont care about you, they want their commission....Mega Life has been sued many times, even the Government has gone after them....SCREW THESE GUYS...DONT DEAL WITH THEM......