CrossAmerica Health Plans Maternity rip off Parippany New Jersey

My wife and I signed up for CrossAmerica after learning about their wonderful maternity coverage. Basically, they treated a birth like any other operation. As long as my wife was not pregnant at the time we signed up, which she was not, we would be covered.

Our plan was supposed to cover 80% and with no deductible. This was a very big deal for us, because my first son was born via c-section and my wife would almost assuredly have to have a c-section again the next time she gave birth. And a c-section is not cheap! It cost about twelve thousand dollars.

We signed up and the first time I went to the doc I was very surprised to get a bill for several hundred dollars, while CrossAmerica had only paid about $50.00. This was par for the course the next few times we attempted to use our health plan. It got so bad that I actually started paying cash and not using the insurance at all, because it came out cheaper in the end!

Also, during this time my wife had gotten pregnant, so we were essentially stuck with CrossAmerica. In spite of the problems we were having, we were reassured that when it came time for the birth, we would be covered for 80%, minus the cost of anesthesia. I called CrossAmerica and they assured us that they would cover 80% as long as our hospital, St Vincent's in Jacksonville, FL, billed "per the global fee." I didn't know what the "global fee" was, so I called St. Vincent's. The Hospital said they did bill per the global fee. Great! I was covered... At least, that is what I thought until the bills started coming in. So far we are being billed for over $9,000 of the $12,000 procedure.

I am a reasonable guy, but this is completely unreasonable. It has to be criminal. CrossAmerica is built entirely upon deceit. When you sign up they wow you with their lists of participating providers, but it is all a lie. No one we talked to on the list had ever heard of CrossAmerica. All CrossAmerica does is pay a little bit of your bill.

Essentially, they don't care how much you are billed and it doesn't really matter who you go to. As far as I can tell, their list of participating providers is simply a list of doctors. Be sure you understand what I just wrote. Their list of participating doctors is just a list of doctors. There is no agreement between CrossAmerica and the doctor. All CrossAmerica did was to put doctors' names on their list. Also, they have made no attempt to adjust the fees charged by doctors' offices, as they claim on their website. Adjusting, is a common practice where a doctor will charge X, then the insurance will contact the doctor's office and argue the charge down on your behalf.

It is appalling. I am still trying to work this out.

One final note: CrossAmerica is not really even insurance. They are a price plan so they do not abide by laws governing insurance companies. For example, it is Florida law that a newborn is automatically covered by your insurance for their initial check up. Not so with CrossAmerica.

Joe
Cusseta, Georgia
U.S.A.