AMERICAN MEDICAL SECURITY REFUSES TO PAY ELIGIBLE CLAIMS!

I BECAME ELIGIBLE FOR INSURANCE BENEFITS AT AMERICAN EQUITY MORTGAGE 12/01/98. I WAS TOLD BY HUMAN RESOURCES I NEEDED TO SELECT A GENERAL PHYSICIAN AND AN OB/GYN. I ASKED AROUND THE OFFICE FOR A RECOMMENDATION FOR A DOCTOR. SEVERAL OF THE OTHER WOMAN USED DR. MICHAEL JONES AT THE HARRISBURG OFFICE OF COPPERFIRELD OB/GYN.

I CALLED THE COPPERFIELD CLINIC TO REQUEST DR. JONES FOR MY CHOSEN PHYSICIAN. I WAS TOLD HE WAS NO LONGER TAKING NEW PATIENTS BUT DR. MICHAEL BRANDNER WAS ABLE TO SEE ME.

I CALLED MY INSURANCE COMPANY TO SELECT DR. BRANDNER. HE WAS IN MY DIRECTORY OF PARTICIPATING PHYSICIANS. ALSO, I INQUIRED ON MY ELIGIBLE BENEFITS UNDER THE PLAN I HAD SELECTED. I WAS TOLD THAT I COULD GO AHEAD AND SCHEDULE AN ANNUAL CHECKUP, COMPLETE WITH A PAP SMEAR. FURTHER, I WAS ALLOWED ONE MAMMYOGRAM PER CALENDAR YEAR. I THEN CALLED THE DOCTOR'S OFFICE TO SCHEDULE MY APPOINTMENT FOR 01/07/99.

SINCE THAT TIME I HAVE HAD REASON TO GO BACK FOR OTHER VISITS. IF DR. BRANDNER WASN'T AVAILABLE, I SAW WHOMEVER CAME INTO THE ROOM. ONCE YOUR NAKED, LYING DOWN WITH YOUR FEET IN THE STIRRUPS, YOU SHOULD NOT HAVE TO STOP AND SAY "OH - BY THE WAY - YOU ARE A MEMBER OF MY INSURANCE NETWORK LIKE THE OTHER DOCTOR'S IN YOUR OFFICE, RIGHT?

I HAVE TRIED TO GET MY CLAIMS PAID FOR OVER A YEAR NOW. I HAVE BEEN HARRASSED BY A COLLECTION AGENCY. THE DOCTOR'S OFFICE TELLS ME THEY DON'T UNDERSTAND WHY THE CLAIMS HAVE NOT BEEN PAID EITHER. THEY KNOW THE CLAIMS THAT HAVE BEEN SUBMITTED FOR THE OTHER WOMAN IN MY OFFICE HAVE BEEN PAID WITHOUT A PROBLEM. DR. MICHAEL BRANDNER HAS BEEN WITH THIS OFFICE SINCE 1998 AND FURTHER IS IN MY BENEFIT DIRECTORY.

AT TIMES THE INSURANCE COMPANY HAS TOLD ME HE WAS NOT IN MY DIRECTORY. I SENT THEM A COPY OF THE DIRECTORY WITH HIS NAME IN IT. NOW THEY SAY THAT JUST BECAUSE HIS NAME IS IN THE DIRECTORY DOES NOT MEAN THAT HE IS A MEMBER. THE INSURANCE COMPANY HAS CHANGED THEIR STORY SEVERAL TIMES. EACH TIME WHEN I GIVE OR SEND PROOF OF MY SIDE THEY CHANGE THE STORY AGAIN. TODAY, THEY TELL ME THEY HAVE NO RECORD OF ME CALLING FOR AUTHORIZATION PRIOR TO GETTING THESE CLAIMS PAID.

I HAVE VERY GOOD DOCUMENTATION. I HAVE SENT THIS TO THEM AS WELL AS TO THE DOCTOR'S OFFICE AND COLLECTION AGENCY. I HAVE SPENT SEVERAL HOURS AND DAYS TRYING TO GET THESE CLAIMS PAID. THE INSURANCE COMPANY SEEMS TO THINK THEY ARE BEYOND REPROACH.

AMERICAN MEDICAL SECURITY IS A THIRD PARTY ADMINSTRATOR FOR SELF-FUNDED PLANS AND FOR THE FOLLOWING INSURERS: UNITED WISCONSIN LIFE INSURANCE COMPANY, UNITED WISCONSIN INSURANCE COMPANY, PAN AMERICAN LIFE INSURANCE COMPANY, CONTINENTAL ASSURANCE COMPANY AND OTHER INSURERS.

PLEASE HELP ME IN ANY WAY YOU CAN. I CANNOT AFFORD THE FIGHT IN COURT WITH AN INSURANCE COMPANY THAT NOT ONLY HAS WEALTH TO GO TO COURT BUT ALSO THE STAFF.