MEGA HEALTH INSURANCE Question about coverages & Coinsurance Ripoff Dallas Internet

You are an idiot. RI is the smallest state in the country. I sell in multiple states. Things are actually going great, and sales for me are up 20% from last year.

What do you think of that?

You are an idiot. RI is the smallest state in the country. I sell in multiple states. Things are actually going great, and sales for me are up 20% from last year.

What do you think of that?

You are an idiot. RI is the smallest state in the country. I sell in multiple states. Things are actually going great, and sales for me are up 20% from last year.

What do you think of that?

Lee, since you are in RI, how are things going now?

MA and CT should be seeing all the agents from RI heading there to prospect

The term "COVERED EXPENSE" is in EVERY company's policy. This includes my wife's policy (she has Blue Cross). I have a MEGA plan and have no issues. My wife just got stuck with a big bill from BC herself.

Additionally, your comment "anestesiologist 20% of the Surgeon's 'covered expenses'" is grossly inaccurate. I see your post is from Rhode Island. Just so you know, the current plan sold in that state says "anestesiologist 50% of the Surgeon's covered expenses", which is quite high.

I also work for the company, and the agent from Michigan is dead on correct. Show me a company that has zero complaints. PLEASE. Prove me wrong. They do no exist.

Funny how those people that say "I used to work for the company" have to use that as a way of showing that they know something. The fact is, the company is a 100% commission job. So if they can't hack it, do you think they will blame themselves for their failure? Of course not. It must be the company's fault they failed...never their own.

Get real.

Remember that the word 'covered expense' is all through the policy, so things that are not 'covered' do not count towards the co-insurance maximum or deductable.

keep in mind that they only pay the anestesiologist 20% of the Surgeon's 'covered expenses'

anything that is not a 'covered expense' does not count in these calculations which can leave you responsible for much more than the co-insurance maximum of $4,000.00 SCARY stuff.

oh, and by the way, in most states you can cancel the 'association' after you get your insurance and save $10 or $40 per month! and still keep the 'so called' insuraance

I guess my concern as being a licensed agent in Michigan, is, what is better?

Looking at the numbers for Blue Cross (since that is what was optioned) there are 18 complaints against Blue Cross on this same site. While on the Mega side, there are only 6. Additionally, there are 4 complaints based out of one office in North Richland Hills. So realistically, there are essentially 3 complaints as opposed to 18 complaints. Looking further:

Assurant health has 6 complaints.
United Health Care has 3 complaints.

The list can go on and on and on.

Every company, well every major company, is going to have issues. For any of these companies to only have this little of complaints for the amount of people they have insure is nothing short of amazing from my perspective. If you quantify the % I have to believe that the number is less that a half of a percent. Apply that to anything and I'm sure that if most companies out there would take a 99.5% satisfaction rating from their customers. This conversation on this is absurd at this point. The original post wasn't even a complaint here either, it was merely asking for clarification as well. There is going to be good and bad to all plans, the key is to educate oneself for what their needs are and then make the BEST decision for their needs and their financial situation.

I'm a broker from nearby Livonia. I used to work for Mega. After learning the facts I left that company.

I'm now a broker carrying all the quality plans in Michigan.

You can't go wrong buying Blue Cross Blue Shield of Michigan, and its where I would start if I were you.

They can help you obtain information or recommend a quality independent broker for you.

the 4000 dollar coinsurance maximum is the max you have to come out of pocket at the 30% of what your medical bill is. example below:

for ease of understanding, your medical bill is 100,000 dollars. and you chose a 2000 dollar deductible CareOne plan with 70/30 as you stated.


Bill = $100,000

you pay deductible = 2000 dollars
you pay 30% of your bill of 100,000 dollars until you come out of pocket 4000 dollars, hense the coinsurance maximum. Once you come out of pocket 4000 dollars, mega covers 100% up to 1 million dollars.

so

deductible = $2000
coinsure max = $4000
______
total out of pocket expense for you $6000
mega pays 100 percent of the rest or $94,000

I have a license in Louisiana and that is how it works here. It should be the same for you there. Hope I helped in the understanding of this confusing topic.

Jerry,

G is correct(at least in the state Florida)! If you have a $2500 deductible and your coinsurance max is $4000, your out of pocket per incident would be up to $6500. The way MEGA writes the policy, the co-insurance is IN ADDITION to your deductible. The deductible is not included in your co-insurance as Dave suggested.

Remember, that the deductible is PER CONFINEMENT on a MEGA plan. That means that if you are hospitalized for a heart attack this week you are out of pocket $6500, and if you fall off your house and get a head injury next month you will pay the $6500 again.

And let's not forget that your policy (if it is similar to the policies in Florida) has a cap on things like out-patient testing ($500-$2000/day max coverage) and chemotherapy ($1000/day max). So you will never really hit a point where the plan will cover you 100%.

Please, please, please contact a legitimate insurance BROKER that has experience with many companies. Open up your policy and READ, and then compare it to what else is out there. Educating yourself about your coverage will save your family a lot of heartache in the future.

Check your policy carefully. My policy has the deductable and co-payments separate, so I have paid both amounts ($7500+$4500=$11000 total).

G

Jerry,

Please do a little more research on MEGA Life & Health. There are a lot of postings on this website if you have time to sift through it all, but the best thing to do is to compare it to other options out there and check with your state's insurance commission.

As a former agent for MEGA, I can attest to the shady practices they train their agents to utilize to sell the policies. I was trained to explain as little as possible about the program in order to avoid losing the sale. The truth is there are so many limitations on the policies that if you did your homework and compared it to other programs out there, you may not have signed up. I am not saying that your agent didn't fully disclose the information, I am just saying that you may not have known what questions to ask and what to look for, and if you did ask the questions, your agent may have danced around the answers.

Chances are your agent has little to no experience in the insurance industry, and has never compared what they sold you to the competition out there. That agent only sells MEGA products, and has to blindly believe that what he sells is the best product out there simply because that is what his leaders told him.

I worked for MEGA in the state of Florida. I realize MEGA's policies are different from state to state and they are supposedly making changes to the plans, but I also understand that the biggest consistant loop hole in every state is the per occurance deductible rather than an annual deductible, not to mention the countless limits they put on things like out-patient testing, chemotherapy and ER visits.

Please do some more research and call an independent insurance broker that offers more than one company. They can help you compare programs from many companies and find a more appropriate plan for your family. Good luck. Please keep us posted.

One more thing...even though that MEGA policy is substandard--do not cancel it until you have another plan in place. You don't want to get caught with no coverage at all.

For every dollar of medical expense that you have
the insurance company will pay 70 cents and you will have to pay 30 cents until you have paid $4,000.

This means that to reach the co-insurance amount, you will have to have total Medical cost of $13,333. Now you did not say what your deductible is, and that is included in your total co-insurance amount.