Trustmark Insurance Company Trustmark Voluntary Solutions Read contract carefully Worcester Massachusetts

I pay Trustmark for wellness and accident insurance.  They "hook" you during enrollment by stating that if you take care of yourself, they reward you.  Basically, each covered person may receive up to $200 per year if you receive at least two routine medical examinations, immunizations, and/or tests, $100 for each. 

For the past several years, I have received $200 back for getting my annual exam and my mammogram.  This year, when I went for my annual exam, the office personnel indicated that there was a spot open for a mammogram that same day if I wanted to take care of it then.  Of course, I took advantage of that rather than set an appointment for another day.  I then filed my wellness claims with Trustmark, as I normally do.  

I received a check for $100 and a letter stating that they were "unable to provide additional benefits".  Unsure of what this could mean, I called customer service.  The representative stated that I could not receive benefits for two services provided in the same day.  To clarify, I stated, "So what you are saying is that if I had scheduled my mammogram for the next day I would be receiving another $100, but since I took the open appointment when I was already there, the benefit is being denied."  She replied, "Yes."  I asked how that made any sense, and she replied, "It's in your policy."

Last year, I had a similarly frustrating experience with an accident insurance claim.  I had fallen down some stairs and, after waiting about a month and realizing that the pain and soreness were not going away, I called to make an appointment with an orthopedic doctor.  I took the soonest appointment they had.  When I went to the doctor, I could not recall the exact date I fell so I stated "early January".  I had x-rays and physical therapy, and I filed these claims with Trustmark.  Trustmark told me I had to enter the specific date of the accident on my claim forms, so I just entered January 1st since I could not remember the exact date, but I knew it was early January.

Trustmark subsequently denied my claims because the doctor appointment was more than 60 days from the date of the accident listed on my claim forms.  I called to explain that 1) I had no control over the date of the doctor appointment but definitely called within 60 days and took the earliest appointment I could get, and 2) I stuck a date on the form because I was told I had to, but the date of the accident could have been any day in that first ten days or so of January. 

I was informed that if I could prove the date I fell, I could appeal the decision.  My husband and I reviewed what happened and determined that it could not have been on January 1st.  We also remembered other details that indicated it was on a weekend.  Therefore, I appealed and stated that it had to have happened on the weekend following the first of January which would have placed the accident within 60 days of the appointment.  My claim was still denied.  

When you ask Trustmark why they deny claims, they direct you to the contract.  When you read the contract, you realize how unreasonable the fine print is and that you have to "play the game" to get your benefits.  And when you appeal, you put in all the work for nothing because they are rigid in their decisions.