Performax Insurance ripoff-- after three letters of pre-determination prior to surgery Performax denies payment (only after medical services are rendered) King Of Prussia Pennsylvania US

Performax is not listed on either Dept. Of Insurance websites as a licensed insurance company. It does appear they may be a health discount/saving plan company according to their website but they are not licensed to sell health insurance in the state of Pa. or Indiana. If a salesperson sold you this plan stating this was health insurance that would be considered FRAUD in both states.

I suggest you contact the Indiana Dept. of insurance to report this company at 317-232-2385 and at 317-232-5695 to file a complaint.

Also contact the Indiana Attorney General's Office to report this company at their consumer protection division at 317-232-6330 or 800-382-5516 and your BBB and your local consumer affairs office.

Please provide them with all printed material you have received from this company as they will want to see it.

Performax should not be removed from this website unless they can provide their INSURANCE company's license number for the state of Indiana where they sold this INSURANCE plan to Michelle so it can be verified by the owner of this site.

In this case I think the true problem is quite obvious. Currently the legal system protects insurance companies from having to help sick people who have gone without insurance. This is actually the law and to some extent is pretty easy to understand why it is the way it is. The Dilemma is that American employers rarely give insurance when an employee starts a new job. Although employees have the "right" to continuous coverage, very few actually do, since as I expect was stated by the previously mentioned cobra letter, a person losing/changing jobs can pay for the health insurance themselves for up to a certain length of time to maintain coverage.

Unfortunately the plans often cost more then a person can afford, especially after losing a job unexpectedly. This leaves millions of Americans (not counting the 47 million fully uninsured effectively uninsured every time they change jobs. This is clearly a flaw in our legal system and needs to be addressed. I would suggest that you write a letter to your elected officials worded as strongly as you feel necessary, start a petition, and be proactive.

I am Vice President of PERFORMAX and have a great deal of respect for this sight. Upon reading the complaint against PERFORAMX I felt it very necessary to defend my companies actions as we are a well respedted national administrator of employee benifits. It is our job to administer claims on behalf of self funded employers. We are strictly monitored by the Department of Labor and are required to follow all Federal Law under the Employee Retirement and Income Security Act of 1974 (ERISA)as well as COBRA and HIPAA legislation.

Under Federal Law if a health plan member goes 63 days without continuous health coverage they are subject to a plans Pre Existing Condition Limitations, meaning that if they have a gap in coverage for more than 63 days any pre existing conditions are NOT covered by an employers health plan. Again, this is a federal law, NOT a decision by PERFORMAX, we have to administer the plans according to these laws.

With respect to the Pre Determination letters. All Pre Determination letters come with a BOLDED disclaimer stating that a Pre Determination is NOT a guarantee of benefits payment, please check with your plan administrator to insure proper coverage (a fact conveniently left out of the complainants submission to rip off report).

Having sais that the complainant does have rights. Her employer upon being hired is required under federal law to notify her in writing of her COBRA rights which clearly outlines the "gap" in coverage issue at hand. My guess is her employer complied with this requirement and that the employee did not pay attenition to it. Further, the employer is required to provide a Summary Plan Description (SPD) which further outlines the employee's rights and any limitations on the plan. This should be given at time of enrollment (most employee's fail to read this document, but ignorance is not a good defense). My recommendation to the complainant is to research whether or not her employer gave her proper notification of her rights and benefits limitations as that is their responsibility, again ours is to administer benefits according to the SPD within the legal requirements of the DOL and ERISA which we did do.

Based on this information I respectfully request that you remove this complaint from your web-site. If I can be of any help at all in doing so please feel free to contact me.

Best Regards,

PERFORMAX VP