Report: #1061773

Complaint Review: Optimum One Health Insurance

  • Submitted: Mon, June 24, 2013
  • Updated: Mon, June 24, 2013
  • Reported By: Amber — Crete Nebraska
  • Optimum One Health Insurance
    P.O. Box 9306
    Garden City, New York

Optimum One Health Insurance, IBA, UCA Gives FALSE promises of coverage--DOES NOT pay for medicines!!! Garden City New York

*Consumer Comment: Optimum One Health Insurance

Show customers why they should trust your business over your competitors...

I am convinced that this so called "health insurance company" is a fraud. 

I originally had BCBS health insurance, but am no longer on it because it was through my step-dad's work. Since I am not his biological child, I was kicked off of his plan when he and my mom got divorced. I then applied for Medicaid because I am a full-time college student and have two jobs, but can barely pay my bills as it is. When I was searching for health insurance in January of 2013, Optimum One seemed like the best option because:

-There would be no deductible 
-They would cover my seizure medication by 80-85% (That costs $500/month without insurance)
-They would COMPLETELY cover my birth control (Which is $40/month)
-They would pay for 4 doctor visits/year
-They would pay for 1 pap test/year
-They would pay emergency room visits ($100 copay) **This is key here**
It is now June, 2013. I have been to the doctor once (I had severe bronchitis). They did not pay for that visit, which was supposed to be covered. I have been to the neurologist once (they DID pay for the blood work done). They have NOT paid for my seizure medication at all, whatsoever (when they promised to pay 80%-85%). I had to switch to the generic brand, which had consequences. They have NOT paid for ANY of my birth control. And...they will not pay anything for an emergency room visit made recently.
So, from what I was originally told, I should have SAVED over $2,800. Instead, I have paid them $170.55/month and spent $850 on my meds/the one doctor visit. Total, in the past six months, I have paid this company $1,023.30+ the $850 = $1,873. PLUS, the emergency room visit (that should have only cost me $100) is actually costing me over $1,200. So, the $1,873 + $1,200 = $3,073.
I would also like to add that my medicine is actually more than what I have put on here, but that is because Walgreens Pharmacy has given me a discount card. 
To put the cherry on top, this is my BIGGEST complaint of all:
3 days ago, I was having very severe pains in my lower-left abdomen. I was very worried because the pain persisted for around 4 hours. I left work early and went to the emergency room because the pain was so severe. This emergency room visit was only supposed to cost me $100 (as I stated above). The doctors in the ER took a urine sample to make sure that I was not pregnant and did a blood test to make sure that I did not have an infection/appendicitis. They then gave me a shot of pain killer. The doctor concluded that I very likely have a cyst or a tumor on my left ovary. Cysts usually aren't VERY dangerous, but they can be. Obviously, tumors are no good either. The doctors begged me to get an ultrasound done to see exactly what is causing my pain. I told them I had to wait to see if my insurance would cover it. I doubted it because they haven't paid for anything else (beside the blood work at the neurologist).
Today when I called Optimum One to see if they would cover the ultrasound, the woman said "No."   Are you surprised? I wasn't. So I asked her how much of my emergency room bill they would pay for and she informed me that they would NOT cover ANY of it. I was clearly upset when I went to the hospital's billing office and learned that this visit is going to cost me over $1,200. I obviously can't afford that and can't afford to add a $600 ultrasound on to that. So, I have had severe stabbing pains for three days, and I will not know what it is because this insurance company fed me false promises. I really hope that I do not have a tumor. But I will probably never know. 
Beware of this insurance company. I pay them $170.55/month and they don't return anything. Now I will be in even more debt from adding this hospital bill to my school loans. As I said before, I am a full-time college student and I have two part-time jobs. This is so wrong for them to lie to me when I am in desperate need of help to pay my medical bills. 
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This report was posted on Ripoff Report on 06/24/2013 06:02 PM and is a permanent record located here: The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year. Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report. READ: Foreign websites steal our content

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#1 Consumer Comment

Optimum One Health Insurance

AUTHOR: Verydiscouraged - ()

 I too bought into the false promises of the insurance broker that sold me Optimum One Health Insurance.  Beware this is not health insurance it is a membership.  I was told that there was no deductible and I would have a $25 copay.   When I got the membership card and looked it up online I was concerned because most of the downloads to read about what was covered would not come up.  I called customer service and she explained for example if my doctor bill is $500 the claim is sent in to them and they pay anywhere from 10 to 50% of the bill so if they pay 50% I would pay $250.00 out of pocket.  To me that is not a no deductible plan.  She insisted it was not a deductible it was re-pricing.  I told her it was there way around the truth. 

Needless to say I cancelled this before using it.  They said they will refund my money except for $99.00.  So if they make 99.00 on every person they lie to they are getting rich quick.

I do not recommend this service at all.



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