Cinergy Health review: are they legitimate 109

Beware of this company. They do not pay claims. The now have 2K outstanding to me and keep providing excuses instead of payment. It's amazing companies can continue to swindle the American public as our politicians turn a blind eye.

I thought Cinergy Health TV ads were too good to be true and they are. There are many complaints on the net about them, so I wrote to the Office of Insurance Regulation. I received an answer and THEY ARE NOT REGISTERED IN FLORIDA and are not legitimate. No matter that they are located in Miami, they are not licensed in the state.

So avoid this scam.

I was a customer of Cinergy health and I recently canceled my plan so imagine my shock when I received a call from my doctors ofice that saying that I have an outstanding bill fron April 2011. Which at the time I was stil a customer, before I even got the plan I was told that all doctors visits and testing were covered after a certain period. I did not have a problem with that so when i went to my doctors office and they contacted Cinergy and was told that I would not be covered until after April 18, 2011 I rescheduled my appointment. Now when I get to call in October and I call Cinergy clam they statrt telling me that since this look like a preexisting condition that unless I had insurance 6 days before I started with them or have been on the plan for 1 year I am not covered. The claims person that i spoke with tried to tell me that they do not give approval. Well unless the nurse that call this in to them was carzy or senile then I must be to because I stood there and listen to her speaking with a rep in the company. Now I really know what Cinergy is and it is called a rip off. They would be that last company that I would ever go to or recommend to any one. If for some reason that someone is considering them dont is all I can say save you money for Insurance that is real and that will cover you.

I have this insurance and I have had not problem with them. I did medical billing for a living so I knew what I was getting into when I signed up. They have paid what they said they would. The first time I had to use this insurance is when my daughter broke both of her arms. My ER visit I paid $125 out of pocket and ortho I paid $200. Reg insurance you would pay a least $100 copay for ER plus 20% of bill and ortho you would pay a copay and deduc. For people with pre ex conditions, this insurance is great.

I SIGNED UP AT CINERGY.GETYOURFREEQUOTES.COM. BIG MISTAKE! THEY SELL YOUR INFORMATION TO EVERY INSURANCE COMPANY IN THE US AND YOU WILL GET CALLS EVERY 5 MINUTES! PLEASE BE WARNED AND DO NOT LIST YOUR NUMBER ON THESE SITES. IN ONE DAY, I RECEIVED OVER 12 PHONE CALLS! AND THEY ARE STILL CALLING TODAY. 3 PHONE CALLS SINCE 9AM. THIS IS RIDICULOUS.

Why doesn't the Attorney General prosecute companies like this?

Did you *REALLY* think you could get full, high quality, medical insurance for $75 per month?
If it sounds too good to be true... just avoid them.

Ever since inurance started online there are a lot of people who telemarket for policies. I am an actual licensed agent who works with all of the major carriers in Ohio and get angry people who have a bad taste in their mouth from fast talking telemarketers who try and push them in to plans quickly. This will be changing soon because with the reform those marketing rooms won't be able to make a profit anymore.For people with preexisting conditions go to your state's department of insurance site and you will find information on guaranteed issue plans and the high risk pools. Those plans are headed up by major carriers with good standings. That is much safer than limited policies or companies like Cynergy. A real agent you want to work with will take time with you and be willing to help you in choosing a good plan, not throw one out and see if you will take it then get mad if you don't. The telemarketers in this industry give good phone agents a difficult time making up for their mistakes.

Deb,
We're sorry that you've had a problem - please call our online support team at [protected]. As we stated above and many times before, we are working with our insurance company partners on an ongoing basis to make sure they're improving their procedures. We want to make sure our customers can obtain affordable insurance options.

We hope that you will call us, so that we can discuss your problem, thank you.

-Cinergy Health Team

Whatever you do, DON'T get insurance from Cinergy, can't be put any other way just DON'T. Believe me you will get absolutely nothing in return except aggravation and most probably an empty wallet. When will people learn: do business with legitimate companies and do your homework before you give a company your hard-earned money!

We are sorry that you've experienced a problem with the insurance purchased through Cinergy Health & Life Agency. We are committed to helping our customers obtain affordable insurance options.

At Cinergy Health, we work with insurance companies to deliver coverage to people, which can include a limited benefit health insurance plan or a short term medical plan. Our plans allow customers to be more prepared for common medical expenses.

Again, we are sorry that you've had a hard time. We are working with our insurance company partners to improve their procedures. In the mean time, please call our online support team at [protected].

DO NOT SIGN UP FOR CINERGY HEALTH. Cinergy Health SUCKKKSS! You will only lose your money and be stuck with a billion bills uncovered.
I signed up for my pregnancy till birth for about 7 months. I read EVERYTHING, they told me no co-pays etc. THey told me about 10 times, different people that they cover 80 % of the delivery. I rung numerous times to confirm. They even told my doctors that they will cover 80% of the bill. None of my doctors, clinics, labs. had heard of this coverage.
At the end of it all-
They covered 80% of only the "delivery" portion of the bill. Not the inhospital checkin stuff, the labor, none of the pain killers, or afterwards. So i received a $10, 000 bill, and they covered about $2, 000. I was left with $8, 000 to pay. They don't cover epidurals, which was another $2500 added. They only covered $150 of my checkups which averaged $300/visit. And they only covered 5 of those visits. So i had about another 10 to pay myself. They didn't cover any of the lab or clinical work, which came out to around $1500.
FORTUNATELY, i was able to get covered under a proper insurance 3 weeks before i gave birth, but i still had to pay most of the lab work and check ups.

As for the customer service they are TERRIBLE. Their was probably one guy who was alright, but the rest were rude, impatient. One time the lady sounded tired and i could hear her chatting with another worker in the background. They never answered anything clearly, and just kept repeating what you already know from the website- which isn't specific either. The claims are the WORST! It took them about 7-8 months to finally repay the first claim. So by then the hospital was pretty much billing me. I rung them so many times, and sent the same claim forms again and again photocopying them. After 1 year i kept receiving these slips that pretty much showed me how much they didn't cover, and how much i was gonna have to pay. It was frustrating receiving hundreds of forms in the mail, about 30 of them a duplicate of one already received. When i finally went to cancel, the guy was extremely rude, demanding why i was quitting, and just hanging up on me when i wasn't finished asking questions.

So please, take my advice and steer clear! A painful lesson for me to learn, never ever trust these small unfamiliar plans!

Dear P. Taylor,
We're sorry that you've had an issue with your coverage. Please call our online complaints support team at [protected]. We want to walk through your issue over the phone and deal directly with your problem.

Thank you,
Cinergy Health

I have been with Cinergy since Aug. 15, 2009. They have paid most of my claims without too many problems, but those that are in dispute with them have not been resolved, and one is pending since Aug. 29th, which was NOT due to a pre-existing condition, which my doctor has documented multiple times to them. I've received EOBs from them showing that they have paid this, but no one has ever received a check. Now they are coming back to me with the same forms, asking once again that my doctor provide previously provided information. I'm going to be canceling as of the end of this month. They DO provide a certificate of creditable coverage, so that much is valid. However, you can do better for the money that they charge!

We've setup a special phone line to handle all of our online complaints, questions and concerns. Please contact someone from our online support team at [protected].

AVOID CINERGY LIKE THE PLAGUE THEY ARE.
THEY CHANGE THEIR ADDRESS CONSTANTLY.
NEVER ISSUE CLAIM FORMS. AND DON'T HAVE THEM OPNLINE. RED FLAG #1
LIE THRU THEIR TEETH SBOUT EVERYTHING.
PAY OUTS FOR ANYTHING ARE NILL.
SIDNEY PHILLIPS

I too had cinergy insurance. I went into the hospital for 3 days. they did pay the $3000 ($1ooo per day) but it costs alot more per day than $1000. Also they do not tell you that they DO NOT PAY FOR IN HOSPITAL DOCTOR VISITS. Also they do not pay on lab fees. So I am stuck with hospital, doctor &lab fee bills. And I was informed that my coveraged was over for that time period.

Cinergy Health provides affordable health insurance options so that people around the country don't have to be uninsured. We understand that health insurance and healthcare reform can be complicated and confusing. At Cinergy Health we partner with insurance companies to deliver unique insurance solutions to help cover the cost of medical care.

Thank you for your feedback.

We're trying to make an engaged effort to handle all of these types of problems and we're working with our insurance company partners to improve their procedures.

Please call our online complaint team again - [protected].

I have called. Here it is, six months after the fact. You paid $72 on a $450.00 anesthesia bill in April for the above mentioned surgery. I have filed a complaint with Florida's BBB, but noticed Cinergy no longer qualifies for membership.

What about payment to my doctor, since you've already denied the facility charges. Like who gets surgery done outside a medical facility anyway? The facility charge was the most expensive part of my medical bills, but you haven't even paid a cent to the doctor for his services...

All health insurance companies are worse than the next one Cinergy, Blue Cross Blue Shield, Assurant, etc. are all the same. They prey on the sickly and hope they get sicker. Now Blue Cross is offering a scam insurance for $30 dollars a month called Go Blue. What I don't understand is why do laws have to be passed in order to have health insurance companies conduct business above board. Heath insurance companies essentially run a ponzi scheme like Burne Madoff. They take your money for years, and as soon as you have a health issue all the sudden it is not covered. If you have a pre-existing condition and try to obtain health insurance with any company good luck. You have a better chance of getting a seat on the next space mission to the moon.

Take a look at bcbssucks.blogspot.com. It is a very informative site which examines the perils of the filthy corrupt health insurance system.

Hi Felicity,

Thank you for your feedback. I'm sorry that you've had a hard time. We're trying to make an engaged effort to tackle all of these types of issues and we're working with our insurance company partners to improve their procedures too.

So we've setup a special number you can call to reach somebody on our team. Call [protected] so we can get you back on your feet. Thank you for the chance to help you.

I have attempted since December 2009 to get reimbursed on a claim submitted the 7th of December, with January and February now in their court and $567 out of my pocket and still waiting for reimbursement. All the claims have been sent via fax and they continue to state they haven't received the claims.

I contacted the claims dept on April 9th still stating they haven't received the claims resend them and I was finally able to get another fax number. The I was told to call back in 10 days on April 26th I finally had a Rep say that they had received a fax on the 20th of April but couldn't tell me anything about them because they handle all diabetic claims manually and until the claims are processed it wouldn't be able to help me anymore, please call back in 10 days.

On May 4th I called again to check on the claims. Claims Rep JC tells me that they hadn't been entered into the system and has to be done manually so I need to give them another 2 weeks. I told him that $566 was a lot of money they owed me and he was direct in saying that they hadn't been entered into the system and there was nothing else he could do to help me. Grrrrr

May 26th I called again Claims Rep tells me that the claims hadn't been entered into the system and processed completly and until they are processed completly she wouldn't be able to help me. I asked her if there is any time frame that she might be able to give me when they would be done - she told me that many diabetic claims come in daily and that she couldn't do anything until the claims were manually entered into the system and processed completly to call again in 10 days.

At this point I am drafting a letter to the insurance commission. Enough is certainly enough.

I'm sorry to hear you've experienced a problem with the insurance you purchased through the Cinergy Health & Life Agency. We are committed to helping our customers obtain affordable insurance options at a time when many are facing enormous financial challenges. At Cinergy Health, we work with insurance companies to deliver the type of coverage people need for their personal circumstances and to avoid being uninsured. With either a limited benefit health insurance plan or a short term medical plan, customers can be more prepared for common
medical expenses as a result of illness or injury.

We've setup a special phone line to handle all of our online complaints, questions and concerns. Please contact someone from our online support team at [protected].

We're sorry to hear that some of you have experienced a problem with the insurance you purchased through the Cinergy Health & Life Agency. We are committed to helping our customers obtain affordable insurance options at a time when many are facing enormous financial challenges. At Cinergy Health, we work with insurance companies to deliver the type of coverage people need for their personal circumstances and to avoid being uninsured. With either a limited benefit health insurance plan or a short term medical plan, customers can be more prepared for common medical expenses as a result of illness or injury.

We've setup a special phone line to handle all of our online complaints, questions and concerns. Please contact someone from our online support team at [protected].

Hi K Edgar, Thank you for your feedback. I'm sorry that you've had a hard time. We're trying to make an engaged effort to tackle all of these tough problems and we are working with our insurance company partners to improve their procedures. So we've setup a special number you can call to reach somebody on our team. Call [protected] so we can get you back on your feet. Thank you for the chance to help you.

I am not happy with this bunch either! I just received a statement from them regarding a Pre existing" condition that does not and has not ever existed! It appears that this a way to avoid paying. They are a scam as far as I am concerned. It was more than 6 months ago that the claim was fifled, and insurance was not cheap. It has been so long now I receive bills from the provider and they want the money NOW! This phoney company is/are SCAMMERS, which I have learned first hand. After I lost my job and had no insurance, I qualified for Cinergy and now I know why, they took money from bank account ACH every month, and still didn't have insurance. What is the insurance industry coming to any way, DUH? ? ?

WARNING:: DO NOT DO BUSINESS WITH THESSE CRIMINALS, THEY WILL STICK IT TO YOU AND NEVER PAY FOR A THING, EVER! NKW

I am so angry right now We have had cinergy since 1/09 just after my husband was laid off. At first we thought that it was a great deal. We were so wrong! It wasn't until Nov they had denied a claim for an emergency room visit. Then my husband had a stroke on Dec 30 we now have over $20, 000 in bills and they are denying everything. We are not sure what to do from this point on. Do we have a case against them? Where do we go to find out? What can we do?

DO NOT BY ANY MEANS SIGN UP! I have had Cinergy Health sine 04/09 and when I finally sent in 2 claims in Nov.09 they said I wasn't covered because I didn't send in the right paperwork! How did I get my card and acceptance letter then?!?! They took $241./mo. for 8 months and didn't say a word, then when I filed a claim they play dumb and say "oh by the way" BS!
I am boiling mad now that I didn't do my research! Please do not sucker into this scam. I am now out $2500.00 from the policy and another $1250.00 from unpaid claims. I have filed complaints with the PA insurance board and am waiting to hear back.

CINERGY HEALTH NO WAY!

My wife signed up with Cinergy. She only made 1 claim in 6 months and they have never paid it even though 5 months have passed and all we get is promises! The claim only amounts to $100 and if they will not pay that amount think about having a major claim? This is a bad company to deal with, we are sorry we got involvewd with them.

Richard

My wife and I got Cinergy health insurance because of the "No pre-existing condition exclusions" advertisement. We are expecting our 3rd child on Dec 30th and just found out that as of Nov 11 that they stopped covering maternity! We deliver by cesarean tomarrow and now we have no coverage. I would like to file a class action law sute...

Cinergy Health is a FRAUDULENT COMPANY. I just got off the phone with thir "customer service rep" and I am livid, so excuse any typos. they told me that they wold cover existing prgnancyfor my wife. as I have recently returned to the states with my wife, we got pregnant before we had a chance to settle down and find a real insurance provider. Now we are 2 months away from delivery, and without any medical insurance. They explained that what they told me was true at the time they told me they would cover the pregnancy, but that the underwriter chose not to renew the contract, and the new underwriter no longer covers the pregnancy in any way. when I informed them this was unethical, they transfered me to a recorded message, which asked me to try again later.

I believe that there should be a class action law suit filed against this company so that all the people who have been conned out of their hard earned dollars can recoup their losses, and be compensated for the emotional and financial losses incurred because of counting on the insurance that was in fact not there.

I am currently looking into what forms of legal recourse are available, and would appreciate any information available if there are any class action lawsuits pending against this company.

We paid nearly $500/month for my wife and a daughter to be on Cinergy--thought they'd pay 80% of serious medical claims. After a year of payments in auto debit account they stripped away our maternity benefits (switched to different underwriter") 3 days before we delivered a baby.

We are being stuck with $10, 000+ in maternity bills even though we paid Cinergy 6000 last year. So in essence I'm out $16, 000 for NOTHING!#! Stripping away our maternity benefits right before giving birth is wrong! This is should not be allowed in the United states.

there must be a class action lawsuit out there to seek $$$$ justice.

Who is organizing this? Aren't there aggressive lawyers reading this stories?

you can reach me at jay underscore seville at hotmail.com

Diagnosed with severe carpal tunnel. 2 Days before surgery found out Cinergy would not cover any of the associated costs. I could have paid 50% of the hospital bill I now owe rather than throw away money on a useless medical plan. I too was duped into thinking I had some kind of medical coverage through these scam artists. They are paying $0 towards surgery I desperately needed, and I am now stuck with 100% of the bills. I understood it wouldn't pay it all, but believed I had some coverage. $400 a month for nothing...Pitiful company, they need to be brought up on fraud charges in all states...

Southern Oregon...

I have a friend who has this insurance and she says that the company has treated her well. She was not misled as to what the insurance covers, but I am sure others have been. After I read these complaints, I researched the company and found out that they are pursuing a massive public relations campaign. Part of the problem stems from Cinergy Health not being fully aware of the unethical practices of the company or companies for which Cinergy Health is affiliated with, the "underwriters." I also researched other health insurance companies and found just as many complaints. I am shopping for health insurance and I will make sure to take the fine print and enlarge it to discern whether or not it covers what I need. Part of the blame can be attributed to the hospitals, I mean $33, 885.00 to have a baby, come on!

If you are seeking this ins. for PREGNANCY coverage, DONT GET THIS SORRY F***ING EXCUSE of a company. We chose them as a desparate attempt to cover pregnancy and they stiffed us with a $33, 885 bill from the hospital (due to an emergency C-section) and they said they would cover only $1000 a day. $4000 TOTAL for our four day stay. We were told over the phone by a shyster, crooked, liar Cinergy employee that the pregnancy would be covered 80% of the total bill plus $1000 per hospital day. Our monthly ins. bill was $241 a month plus a $50 registration fee. We had been paying three months of this crap before her delivery. All was well until we saw they only covered $4000 of the TOTAL bill, which took the total down to $29, 885. I about went ballistic on this crooked company. The hospital billing dept. says unfortunately this is what happens to desparate couples seeking pregnancy ins., and esp. when the insurance carrier is a no-name, small company. So the guy we talked to to sign up for this insurance F***ing LIED TO US. CINERGY HEALTH INSURANCE IS THE ABSOLUTE WORST INSURANCE. I PROMISE YOU FROM PERSONAL EXPERIENCE, PLEASE DON'T GET THIS SORRY FREAKIN INS. I AM ALREADY IN THE PROCESS OF DEFINATELY REPORTING THEM TO THE BETTER BUSINESS BUREAU (BBB). HONESTLY I HAVE NO REASON TO LIE, THEY WILL SCREW YOU AND TAKE YOU TO THE CLEANERS!

as a provider of service, I find the customer service claims dept to be very unsatisfactory...you talk to a rep who just says, clm is processing...then to get more details as to why it is taking months to get pymt, they send you to another rep and you just sit on hold ...not good...

DO NOT GET Cinergy Health! I am a medical billing specialist and I have never had them process a claim. After seeing this site my fears have been confirmed. I've spent so much time on hold. They tell me that a claim is stuck in processing and that they will make sure it get processed in 7-10 business days - 9 months later the claim is still not processed. I'm at the end of my rope with them. They keep telling me the same thing with no follow through. I call SCAM, Please don't get ripped off!

New York State
Insurance
Department
New York State seal
NEWS
RELEASE
Contact:
Public Affairs
[protected]
www.ins.state.ny.us

Kermitt J. Brooks Acting Superintendent of Insurance 25 Beaver Street New York, N.Y. 10004
ISSUED: AUGUST 13, 2009 FOR IMMEDIATE RELEASE
GOVERNOR PATERSON TAKES ACTION AGAINST MISLEADING SALES OF LIMITED BENEFIT HEALTH INSURANCE PLANS
Health Insurer Fined $700, 000 for Misleading Sales Practices; Insurance Department Blocks Sale of Limited Benefit Health Plan

* Limited benefit health plans often pay far less than those who buy them expect
* National TV ad squashed
* Broad crackdown on misleading sales practices announced
* Another company suspends sales
* Hearings planned on usefulness

Governor David A. Paterson announced today that New York is cracking down on companies that sell limited benefit health insurance plans in ways that mislead people into believing they have full heath insurance coverage. As a result, the New York State Insurance Department has moved to protect New Yorkers by stopping one company from selling the product in New York and from advertising nationally and is examining the marketing practices of all companies selling this product.

"Many New Yorkers are desperate for affordable health insurance. More than 2.5 million have no coverage, and with tens of thousands losing their jobs, that number is growing. Unfortunately, some businesses are taking advantage of that need to sell limited health insurance in ways that mislead consumers into believing they are getting full coverage. If they get seriously ill, consumers who buy this product can find themselves with huge bills they are unable to pay. New York will not allow disreputable businesses to take advantage of consumers, " Governor Paterson said.

"At Governor Paterson's direction, the Insurance Department has taken a number of steps to protect consumers, " Acting New York State Insurance Superintendent Kermitt J. Brooks said. "Especially in this economic climate, we will not allow consumers to be twice victimized - first by paying for insurance that covers much less than they were told it would, then by having to pay thousands more for the health care that insurance did not cover."

Governor Paterson announced the Department fined one company, American Medical and Life Insurance Company (AMLI), $700, 000 for numerous violations, and imposed new restrictions on the company. The company can no longer sell its limited benefit products in New York, and has been forced to pull its nationwide television commercial. The commercial was the company's main marketing tool.
"We are working to help AMLI customers and we urge anyone who has had a problem to call the Insurance Department so that we can help, " Brooks said, noting that the company is now cooperating with the Department.

Brooks said AMLI agreed to:

* Discontinue all of its limited medical benefit group policies in New York;
* Offer to convert terminated group policies to individual policies upon request;
* Fully cooperate with the Department in resolving customer complaints;
* Retain an independent outside counsel to review its operations and make specific recommendations for changes; and
* Prepare a compliance monitoring plan to ensure compliance with applicable laws and regulations.

Limited benefit health insurance plans normally provide less than comprehensive hospital/medical coverage, but with healthcare bills being the leading cause of personal bankruptcy filings nationally, many consumers searching for affordable coverage buy limited benefit health plans as one way to insure against potential liability. Limited benefit health plans may leave consumers with large medical bills. If injury or illness occurs and an insured files a claim, they may find that they have less coverage than they thought (see Appendix A for comparisons).

A sampling of complaints received by the Insurance Department about AMLI's coverage illustrates this gap:

* A Rochester-area woman purchased health insurance from a telemarketer and agreed to have the $419 a month premiums paid by automatic charges to her credit card. She was provided no written documents spelling out details of the coverage. Soon afterward, she needed hospitalization, which cost nearly $28, 000. It turned out the policy, sold by an agent unlicensed in New York, paid only $1, 164 of the expenses. AMLI paid in full only after the Department intervened.
* A young man suffered a stroke at the age of 36. AMLI paid only $250 toward his medical bills. The insured had to pay a total of $29, 917.04.
* A woman went to the emergency room with stomach pains and a day later received an appendectomy. AMLI paid $1, 416.10, leaving the insured a balance of $19, 437.59.
* After being given misleading coverage information by an agent, a man purchased a limited medical benefit plan from AMLI. He understood, and the information sent to him indicated, that the plan required a $10 co-pay for doctors/specialists (10 covered visits per family member per calendar year) and would pay $25, 000 for hospital inpatient services (100 days maximum per calendar year). Therefore, he was surprised to find that AMLI only paid $39.65 toward an ENT bill for $237.42 and $250.00 toward an inpatient hospital bill for $3092.73. His total medical bills were $4197.79 and AMLI paid $807.29. With regard to the hospital stay, AMLI contended that the insured should have known that a $250 per day limit applied to the $25, 000 limit for hospital inpatient services, since the maximum days were limited to 100. AMLI agreed to pay only after the Department intervened.
* A man bought a limited medical benefit plan issued by AMLI. When he bought the policy, he was told that there would be a $20 co-payment for doctor's visits and a $100 co-payment for emergency room services. He was not made aware of any other limitations on his benefits and never received a Summary Plan description from the carrier. AMLI paid less than he expected for two hospital emergency room visits. The first time, the bill was $1, 720.61 and AMLI paid $150. AMLI denied the second claim for $731 saying the emergency room benefit maximum had been met because it was his third visit to the emergency room that year. Only when he complained to the company was he told that emergency room benefits were limited to a maximum of two visits per policy year and a maximum of $150.00 per visit. After the Insurance Department intervened, the company agreed to pay the remainder of his claim.

The actions against AMLI were triggered by an Insurance Department investigation begun after consumers complained to the Department, Brooks said:

* The Department investigated American Medical and Life Insurance Company after receiving consumer complaints about a limited medical benefit plan sold by the company. The company is licensed to sell this product and other life and health products in 38 states and the District of Columbia.
* The company describes itself as a "virtual" insurance carrier, outsourced all underwriting, sales and marketing and claims handling functions to third parties, and exercised little or no oversight of such functions.
* The investigation revealed that AMLI violated numerous New York insurance law provisions in its sales and marketing of the limited medical benefit plan from the fall of 2006 through the fall of 2008:

o Sold thousands of limited benefit plans to New York residents using unlicensed agents employed by telemarketing firms located in New York and Florida.
o Received approval in New York to use a written policy application form that contained important disclosures about limitations in the coverage, but then conducted its New York sales via Internet and phone without using the approved application form.
o Sold many of its policies as group coverage through an association known as the National Congress of Employers, which the Department determined violated New York law because the association was not formed and maintained for a primary purpose other than selling insurance.
o Conducted a nationwide marketing campaign through an intermediary called Cinergy Health, Inc. that, in violation of New York Insurance Law, created the misleading impression that the limited benefit plan offered major medical or comprehensive coverage.
o The company continued to use the misleading advertising as part of its national marketing campaign, even after the Department had the company stop such marketing in New York.

Governor Paterson announced further Insurance Department action:

* Another insurer has agreed to suspend sales of a similar product nationally while the Insurance Department investigates its marketing practices.
* The Department will consider whether to propose new regulations to guarantee consumers are properly informed about just how restricted limited benefit health insurance plans may be.
* The Department directed insurance companies to provide information to the Department about any limited benefit health plans they sell in New York.
* The State will hold public hearings to determine if the proper course is tighter regulation or banning the product completely.

In addition to the limitations inherent in these policies, marketing and sales practices surrounding them may add to the confusion, Brooks said. Many limited benefit plans are solicited via the Internet and through television commercials. Some of these advertisements imply the policies provide comprehensive or major medical coverage. Exclusions and policy limits are not completely revealed. The sales are completed via the Internet or telephone without the benefit of a written application, circumventing specific disclosures that are required by New York Law. The mandatory disclosures are either not provided, are not prominently displayed or are lost during the sales pitch and thus are ineffective. Investigations have also revealed that some policies are sold through telemarketing firms using unlicensed agents, which is in violation of New York Insurance Law.

"We will hold hearings to look at the larger issues surrounding limited benefit health plans, " Brooks said. "Are they being sold properly? Should they be sold at all? What else can we do to protect New Yorkers? We want to hear what the public thinks about these plans."

Hearings are scheduled for September 21 in New York City, September 24 in Newburgh and September 30 in Rochester. More information on the hearings, including how to testify, is available at the Insurance Department's website at www.ins.state.ny.us.

Consumers with insurance questions or concerns can call the Insurance Department's consumer hotline at [protected]. The hotline is open from 9 a.m. to 4:30 p.m. Monday through Friday. Consumers may also ask questions or file complaints at the Insurance Department's website, www.ins.state.ny.us.
###
APPENDIX A
AVERAGE SERVICE COST/AMLI COVERAGE COMPARISON
Services New York State Average Cost American Medical and Life Insurance: National Congress of Employers Group Plan Coverage

Hospital Room & Board

$5, 516- average daily charge
(*Includes insured & self insured data & excludes Medicare and Medicaid)

$1, 000 / day
(max. 30 days)

Diagnostic Tests-High tech (MRI, PET, CT, etc.)

$1150-$2500 (MRI)
$500-$1250 (CT Scan)
$850-$4200 (PET Scan)
(*www.comparemricost.com and www.americanwellnessandimaging.com)

$100 per day
(max. 3 test days/yr)

Diagnostic Tests-Low tech (x-ray, lab, etc.)

$83-$1, 100 per test

Included in above

Doctor’s Office Visit

$45-$150 (minor problems)
$84-$185 (low to moderate severity)
$130-$250 (moderate to high severity)
$200-$355 (moderate to high severity, more complex)
$373-$550 (moderate to high severity, highly complex)
(* Taken from The Attorney General’s Report “The Consumer Reimbursement System is Code Blue” (2009))

$100 per visit (max. 5 visits/yr)

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I am a licensed insurance agent in Fort Worth, TX and you can imagine how many times I get asked about Cinergy or Homeland HealthCare, etc. The problem with these companies is that they do not fully disclose their benefits and information up front. Check out any 'limited benefit plan" website and try and locate the Outline of Coverage.

My best advice to you is to contact a local, licensed agent. You don't pay them a cent! I can't speak for all 50 states, but in Texas the prices are the same whether you purchase from a company like ehealthinsurance.com, directly from the carrier, or through a small local guy such as myself. Our commission is set by the carriers and built into the pricing. I can also tell you that in TX we are not allowed to rebate any of the commission back to the client as per the TX Dept of Insurance. So...having said that, you will get the same price REGARDLESS of where you buy coverage.

Now, for those of you with pre-existing conditions or any reason why you are being told you cannot get insured by a major carrier; ask about what options you DO have. In Texas we have a TX Health Risk Pool that is expensive because it is guaranteed issue. However, they pay agents a one-time $50 commission, so your agent may not be upfront to tell you about it since he/she has to work to get the app filled out, submitted, etc. all for a one time fee. If that's the case, they aren't going to help you when you need them anyways!

As you are already doing, be sure and do your homework. I noticed a comment earlier about 'portability' after your COBRA. That is not 100% true as in TX these carriers have every right to decline you or add exclusion riders, etc. Keith may have been referencing the State plans as mentioned above. But your best resource is a good agent that can inform you of the options. They cost nothing, and will hopefully be honest with you and let you know what options you do have. While I probably can't help the majority of you in other states, I'll be happy to help you find a reputable agent in your state if you need. Feel free to email russ@gusbates.com.

Insurance is a necessary evil. We have to make the best of what we have or take our chances and go without. Whatever your final choice is, call around and get competitive price quotes on MRI's, drugs, lab work, etc. You'll be amazed that an MRI may be $1, 500 more at a hospital over an outpatient imaging facility. I myself found a $30 savings on the exact same drug when calling 4 pharmacies. If you aren't asking your docs about the $4 generics...do so next time you see them! Good Luck!