PENNSYLVANIA -- The guidelines to qualify for Special Care insurance are as follows...those who are ineligible for any private or governmental group health care plan or program, or who would otherwise be uninsured, and meet established income guidelines. You would think this insurance co. would recognizes the fact that the people who are purchasing this type of insurance can't afford to pay 30% of a hospital stay and preoperative testing. I was billed $3,600 for preoperative tests and expected to pay %30 of the balance of the hospital side. It took me two months to get the answer for what is covered by the insurance company. When I realizes that I may be billed $14,000 on the hospital side I canceled the surgery. I also received a bill for the doctor visit for $408. I will be sending my payment in today for my health insurance that I can't use. Something is wrong with this picture and I think it reads deceive the people. It's like buying a car you can afford, but it doesn't run until you put $20,000 into it! The seller didn't tell you that, they just wanted to make money. It's hard to understand the booklet they provide explaining benefits. I don't think they want you to understand, because you wouldn't purchase the insurance.
Health insurance is BIG BUSINESS their attorneys know how to MAKE MONEY for them. Special Care, affordable insurance? I don't think so!!
P.S. remember it's all about the money they really don't care about you!
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Disenrolled over $5
Posted by Leslieann226 on 07/23/2009
PITTSBURGH, PENNSYLVANIA -- I am disabled and have been on Medicare A&B since 2002 and receive social security. I subscribed to Highmark Freedom Blue PPO for this calendar year and I became $5 behind on my premiums. As of July 1st, I have been disenrolled over this. I have filed a verbal appeal and was denied. I am in the process of appealing with Maximus, as I have been charged $3 each month for a late enrollement penalty that is should have never been charged. Medicare has twice verified over the phone that there was no gap in my prescription drug coverage, so there should never have been this fee. Medicare has filed a complaint for me as well.
The fact is, that I was disenrolled over $5 and the penalty should have never been applied. Without the penalty applied, I would have actually have paid ahead by $13. Medicare has confirmed on the phone that there should never have been the penalty. I was also told over the phone by Highmark that the "delinquency letter" was only sent out because my payments are received just after that billing date (usually 2-3 days) and that if payment was on the way, I should ignore it.
Also, when I called Highmark many months ago to ask about the fee, I was told over the phone it was because Medicare did not get my original application processed before Dec 31, 2008, even though it was received before that date. I was told nothing about a gap in drug coverage.
The real shame, for me, is that my disability is a brain condition and that is the reason my billing is set up to automatically leave my bank each month, so I can't forget or mess it up. My mom has helped me with this. My short term memory is a big problem, and many days, I can do or read something and an hour later, I have no recollection unless I see it again or reread it. I'm sure there are many, many seniors with the same issue. I feel there should be some kind of limit of a certain percentage or dollar amount needed to be delinquent in order to disenroll someone. I just can not believe this can happen when my last 4 payments to them have been for almost two hundred dollars. If I understood, I obviously would have sent them an extra $5.
I have faxed the reconsideration requests to Maximus. If there is anything you can do to help, I would really appreciate it. I am without prescription drug coverage and running out of medications and fearing I'll run out of time with the second appeal to Highmark.