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American Medical Life Insurance Co, Florida Complaints & Reviews - Non-payment of claims: Fraud

American Medical Life Insurance Co Contacts & Informations

American Medical Life Insurance Co

Posted:    rolex452

Non-payment of claims: Fraud

Complaint Rating:  94 % with 34 votes
Contact information:
AMLI
Florida
United States
IMPORTANT: American Medical Life Ins. Co. (AMLI) located in New York, NY is a fraud. They underwrite "limited liability" health insurance plans under different plan names: "AIM", "CYNERGY", "I CAN", and "CORE VALUE" insurance programs. Bascially, you go to a doctor or hospital which accepts the "Mulitplan PPO", who writes down the claim (you get a discount off the full price). Then, AMLI kicks in a little bit of their money toward the doctors visits (5 per year), some tests, or the hospital stay. The grabber is that the premiums are reasonable and THEY ACCEPT PEOPLE WITH PRE-EXISTING CONDITIONS AS WELL WITH NO WAITING PERIOD. This is as close to a "real" health insurance policy as many people can get. I signed up with the "Core Value" plan through a licensed Fla. agent as of Jan. 1, 2010. In late January and early February, I visited a Multiplan Opthamologist three times, and these claims were submitted to AMLI quickly. IT HAS BEEN FOUR MONTHS NOW, AND THEY REFUSE TO PROCESS OR PAY THESE LEGITIMATE CLAIMS! They have been sent the claims FOUR TIMES, and over two dozen telephone calls to the claims office number. They say they are having "computer problems" and promise to pay the claims, which they have not done! The doctor must get paid, and I have to pay the doctor myself, even though I have "valid" insurance. I filed a complaint with the State of Florida, who wrote a letter to AMLI, gave me the name of a contact person there, who would get things started if we send the claims to her office. HOGWASH! She never got the claims processed, and refused to communicate with my provider or myself. I told the Florida State office that nothing was done, and AMLI ignored both me and the State of Florida. What does the state say? "Sorry, that's as far as we can go...we have no legal jurisdiction in these cases." Yes, the State government gives every fly by night bunch of creeps with minimum amount of assets a license to sell insurance in their state, but when the company takes your money and gives you nothing, "we have no legal jurisdiction. you will have to sue them". THAT'S OUR GOVERNMENTS IN ACTION! So, here's the bottom line: DO NOT, UNDER ANY CIRCUMSTANCES BUY ANY POLICIES UNDERWRITTEN BY AMERICAN MEDICAL LIFE INS. CO. No matter how good the premium prices look, no matter what the agent tells you (by the way, my agent washed his hands of the whole thing, gave me a couple of complaint numbers, and backed off...no help from him), do not sign up with any policy connected with them. They have complaints against them in New York and Florida, and they have been fined for false advertising of their services. Stay away, PLEASE!!!
Comments United States Health & Life Insurance
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 28th of May, 2010 by   Lenny10 0 Votes
The latest is they were scammed themselves! They were approached by who they thought were legitimate insurance representatives -Phoenix Ins.- and then found out this year that they were not-tried to scare them into doing right, and when that didn't work they bailed. Just got their letter yesterday.
Now I know why my claims haven't been paid and my drug card is no good. The generic prescription card rider I've used for years didn't work. I finally found out that the bill was not paid by Aim. Stay away from them!!!
 28th of May, 2010 by   rolex452 0 Votes
Lenny, thanks much for the update on these crooks. What many people who have AMLI policies do not realize, is that the end of the line is coming for their policies, like it did for ours. I've repeatedly contacted various television stations who have "investigative consumer complaint" reporters who try to help the public at large (like "Help me Howard), but NOBODY CONTACTS ME ABOUT TRYING TO HELP ME OR OTHERS WITH THIS PROBLEM! There are going to be a hell of alot of people ripped off when this company officially goes belly up, AND NEITHER THE STATE GOVERMENTS OR THE MASS MEDIA IS TRYING TO HELP US CONSUMERS. Sorry for shouting, people, but this is why the crooks and gamblers who rip off the general population almost always get away with it. If anybody else has had problems with any AMLI policy, PLEASE post it here, and tell others. Thank you!
 18th of Jun, 2010 by   Linda BAuer 0 Votes
Myself and my domestic partner just learned yesterday, June 17, 2010 that we are no longer insured here in Florida with AMLI. These folks were not scammed themselves. Since joining on September 15, 2009 this company has moved our underwriting around twice. We were about to get our 3rd set of insurance cards within the next 10 days as of June 10, 2010. I was told this by Darlene when I called to verify that we were infact covered under Sun Life Financial. I learned yesterday that Sun Life Financial has deceided not to take over the contract that we were informed on June 1, 2010 that they were doing. I wonder how CEO group, who we were transfered to on January 01, 2010 is handling Donald Trumps claims. They bragged in their letter to us that we were in great hands and that this group took care of people like Donald. The phone numbers you call go right into voice mails which are full, so you cannot leave a message. As far as I see it the company owes me back $330.00, one half of this months premium because we did not have coverage. Our coverage went from the 15th of the month to the 15th of the month. Also am receiving claims back for blood tests done in April of this year and the reason for non-payment is "Termination of Coverage"...how can that be when we were covered?? Tried calling the number on the rejected claim, was hung up twice while being transfered and the third time I was told by the representative that they did not have to talk with me because they were no longer insuring us. I too am trying to get this to FOX NEW, Glen Beck or anyone who will listen...Now that health care is passed I guess the insurance industry is going to stick it to the public the way the banks have. Where is our Country going??? STAY AWAY FROM AMLI!!!
 18th of Jun, 2010 by   kmiles90 0 Votes
I have been making calls ALL day about this. We received a call in January 2010 that IIM would be taking over our AMLI coverage. Luckily, I hadn't made a doctor's visit since then. I received the packet from IIM today & my suspicions went up because there were aout 3 different "insurance providers" listed in the packet. I received no ID cards as they had promised so I started calling around. I called Phoenix Insurance Company & they said Frank Karns (supposedly the CEO) is just slapping their name on the cards and that they don't even do healthcare. I then called AMLI who said I was only covered for 6 months out of the whole time I have been paying. They said that in January, AIM cancelled their partnership with them. As I continued calling EVERY NUMBER I could get my hands on, none of them worked. I finally found a old card of mine with a website which had a number. I called the number & it redirected me to a man's personal cell phone. When I explained why I was calling, he said he gets these calls everyday. He said they took over his company using all of their information and were able to do so because they called it Association OF Independent managers instead of the real company Association FOR Independent managers. He said they FBI has been made aware of what is going on and that there will probably be no money ever seen by all of us who were scammed because the governmet is now involved. The two men doing this, Frak Karns and his partner have done the same thing to CEO Club and NOVA. Apparently the transactions are being taken out by IRG in NY but nobody can seem to find these men. I called the FL. Dept. of Insurance and they basically told me they couldn't do anything because there is no license anywhere in the country to look up. Thousands of dollars down the drain & nobody will do anything...PATHETIC!
 21st of Jun, 2010 by   rolex452 0 Votes
To follow up on Linda Bauer & Kmiles90 complaints: NOW, YOU APPRECIATE THE SCOPE OF THIS SCAM! You see, AMLI is a fourth rate insurance company with very few assets left (this is a fact). But the scam is all spread out so we victims cannot even FIND the people who screwed up our claims and don't pay: The sorry ass agency who put together the AMLI "Core Value" program I used, is known as IBN (Insurance Brokers Network), and they collect the money from you every month. The actual claims processing is done by some other independent outfit (Preferred Care Inc., Hammerman & Gainer Co.), then, the repricing is done by the Multiplan Company, and the provider payments are finally made by AMLI! Quite a circle, huh? But when something goes wrong, NOBODY knows where the foul-up is, NOR do they want to help you find it. And all the while, the State Insurance Commissioners office (the dingbats who let the crooks sell insurance in their state), tell you they have no legal power to get the company to pay out, or pay you back...GO SUE THEM PRIVATELY! People, I'm still trying to get my story on the air (Help Me Howard, CBS I-Team Investigates, etc.) AND ALL OF YOU KEEP TRYING TO BE HEARD AS WELL...we may have been ripped off permanently, but we can warn others not to go near these crooks at AMLI, IBN, AIM, Synergy, Core Value, IIM, etc. AND, don't expect help from the State Government, either. All the best to you...
 8th of Sep, 2010 by   MDahlinNYC 0 Votes
I am fighting AMLI to process claims and have existed for over ten months. They keep giving me the run around. I am to receive physical therapy benefits if in the event of an accident physical therapy is perscribed. It was perscribed to me by my Orthopedist who determned I injured my shoulder in a bike wreck. I confirmed coverage multiple times as did the Physical Therapy company. AMLI has had over ten months to process these claims but have a whole list of excuses, I've heard everything from 1) They have a new system that isn't updating properly 2) They have a new company processing claims and they haven't received my information 3) They never received any of the (ten) mailed and faxed accident reports I gave 4) Eventhgough I also gave accident report statements over the phone to their claims department several times, their representatives were misinformed that they could even take those statements.

This company has given me the run around for far too long, it's fraud at this point. There Claims Department has been of absolutely no help.

If anyone has an idea on what I can do to get my rightful coverage, I'm open to suggestions. I have complained to the NY State Insurance Department, whom by the way kicked AMLI out of New York, which in turn made me get on another plan - something I'm grateful for now.
 16th of Sep, 2010 by   rolex452 0 Votes
MDahlin, thank you so much for your update on the disgusting crooks at AMLI. New York City is their home office, by the way, so if they were KICKED OUT OF NEW YORK, then the company is obviously doomed.

At this point, let me welcome you to the club of "good folks screwed by AMLI"...

Let me make a suggestion, if you are still in the market for a "limited policy": Homeland Healthcare. They offer the same type of policy as AMLI, but they use the "Beech Street" network (better than Multiplan), and they use a different insurance co. to pay claims (a company with a good rating). They are more expensive than the AMLI policies, though, but I have put in claims and they were processed promptly and fairly. All the best in your search.
 11th of Feb, 2011 by   rolex452 0 Votes
To MDahlin and my fellow victims of the crooks at AMLI: In my last comment about five months ago, I mentioned and recommended a company called "Homeland Healthcare". Time heals all wounds, but also MAKES ALL WOUNDS: the Homeland company late last year informed everybody that the insurance company they were using (a GOOD company), pulled out of the plan, and Homeland was looking for a new company to keep the policies going. GUESS who they picked??? AMERICAN MEDICAL LIFE INSURANCE OF NY (AMLI)!!!
I almost took a dump in my pants right then and there! There was so little time to find a new plan, that I reluctantly signed up with the new AMLI plan for ONE MONTH ONLY...or risk having no insurance at all for a month. Anyway, during the one month I was covered, I placed one legitimate claim for an Opthamologist visit. The claims were sent to AMLI...TWICE! Over a month and a half, and the claims were never sent to their processing company, (Hammerman & Gainer, another bunch of negligent idiots), and I'M IN THE SAME BOAT AS LAST YEAR! AMLI throws away my claims, they won't talk to me directly (they simply forward me over to H & G, the processing company, who knows NOTHING, and NO PAYMENT IS MADE TO THE DOCTOR! DO YOU BELIEVE THIS??? I have since filed ANOTHER complaint with the Florida Dept. of Financial Regulation, and they are trying to convince the crooks at AMLI to pay the claim.

EVERYBODY READING THIS: I BEG YOU...STAY AWAY FROM ANY PLAN WHICH USES THE AMERICAN MEDICAL LIFE INSURANCE COMPANY OF NY AS THE UNDERWRITER...PLEASE STAY AWAY AND WARN OTHERS...PLEASE!!!

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