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PJP Health Agency, Inc., Melville, New York Complaints & Reviews - I was looking for Health Insurance, but I got swindled instead - Medical and Prescription Discount Plan masquerading as Health Insurance

PJP Health Agency, Inc. Contacts & Informations

PJP Health Agency, Inc.

Posted:    Benny Blanco from the Bronx

I was looking for Health Insurance, but I got swindled instead - Medical and Prescription Discount Plan masquerading as Health Insurance

Complaint Rating:  95 % with 74 votes
Contact information:
PJP Health Agency, Inc.
3 Huntington Quadrangle Suite 400N
Melville, New York
United States
Phone: 631-465-8100
pjphealthagency.com
After searching online for health insurance, I was referred to a company called "PJP Health Agency" of Melville, New York which promised me affordable health insurance coverage. Their coverage plan sounded good, so I gave them my checking account number, and they quickly debited my account.

However, I was never issued legitimate health insurance.

In fact, I have received nothing that I was promised! After doing some research on this company, I have discovered that the health insurance which they allegedly offer through their affiliate (American Benefits Association of Blackwood, New Jersey), is not health insurance at all, but a medical and prescription discount plan.

I have been scammed by "PJP Health Agency", and the money that was debited from my checking account was done under false pretenses! I now feel like the biggest schmuck on two feet!


Comments United States Health & Life Insurance
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PJP Health Agency, Inc. - Shady/Questionable Sales Tactics


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 9th of Apr, 2011 by   HelpJ +1 Votes
I am trying to help my niece get this company to pay her claim. They have a real knack for not paying/stalling on payments with unwarranted excuses and they are making it very difficult to talk to someone. I have been on the phone with them for hours and still not resolved anything. They say after being given certain information again they will re-submit the claim. But nothing changes.

I am not a medical billing expert, and this is such a mess I'm not even sure where to begin. It has been almost 6 months since this started and the bill is now going into collections. My niece originally went to the doctor and saw a doctor who was in their network. She is young and is unable to cope with this kind of run-a-round. In fact, it has exasperated the circumstances considerably, hence, why I am trying to help.

After doing some internet research, I have found many complaints about this company for various reasons.

I would just like to get some help in how to fight them. Like I said, it is such a mess with this bill and their Explanation of Benefits do not seem at all easy to understand. I know I'm not a professional billing expert, but we personally have Blue Cross/Blue Shield insurance and I've never had a problem figuring out their system. My niece has canceled her policy with PJP Health agency and now she has Blue Cross/Blue Shield insurance.
 10th of Apr, 2011 by   8months +1 Votes
I purchased insurance through PJP Health Agency and every time a claim is submitted, the say they never received it. I finally gathered all the claims from my doctors and sent them via overnight mail with a signature required. when I had not recieved payment in a month, I called and again they claimed not to have received them. When I told them that I had proof of their receipt, the lady called me back and said they had received the claims but no benefits would be paid. I paid premiums for over a year and did not have even one claim paid by this company. I have finally filed a complaint with the Dept of Insurance and am waiting to see what they will do now. My claims are now 8 months old and I am being turned over to a collection agency. PJP Health Agency is a scam.
 14th of Apr, 2011 by   Beldar +1 Votes
PJP Health Agency has an "F" rating from the Better Business Bureau!

Cut and paste the following web address into your web browser to see the Better Business Bureau's Business Review/Reliability Report for PJP Health Agency:

http://www.bbb.org/new-york-city/business-reviews/insurance-health/pjp-health-agency-in-garden-city-ny-123192/

If you have been the victim of PJP Health Agency, in addition to filing a report with the Better Business Bureau, I would also file complaints with the New York State Insurance Department and the New York State Attorney General's Office.
 16th of Apr, 2011 by   Victimmm 0 Votes
As a personal victim of the PJP Health Agency, I wish I had seen this website earlier. My experience is that they will not pay my doctors bills. The doctor visits have not to date been paid. And those bills are mounting. It seemed like a dream come true, that I could receive coverage for so little money. The old adage, " if it seems too good to be true it probably is" comes to mind. Meanwhile, I have been put on hold, hung up on, sent to the supervisors supervisor's supervisor and all to no availe. I'm begining to believe that person does not exist. I am also looking for a new insurance company as we speak. The money I saved is not worth the spanking I'm getting. Oxford might be expensive, but I was never ever put on the wheel of no return. I'm going back as soon as I can afford it. This economy crunch hit hard on my industry. All I can say at this point is HELP! My frustration in trying to deal with these people is driving me crazy. Also, the supervisors are all unable to communicate effectively. I told the same story 12 times, to get nowhere. I must say it feels good to get this off my chest. I hope it benefits someone. I now know where to look for the truth. Avoid PJP Health Agency and this online fraud. They will not pay for anything.
 17th of Apr, 2011 by   Unpaid1 0 Votes
DO NOT BY ANY MEANS SIGN UP! I have had insurance with PJP Health Agency since 04/10 and when I finally sent in 2 claims on 11/10 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 my monthly premium 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 NY insurance board and am waiting to hear back.

PJP HEALTH AGENCY NO WAY!
 23rd of Apr, 2011 by   MattSS 0 Votes
I obtained Insurance through PJP Health Agency on December 1, 2010. I had an emergency appendectomy on January 9, 2011. I started receiving bills for thousands of dollars. When I called PJP Health Agency I was given the run around. I spoke to various people who wouldn't take responsibility for the error. I was told various times that someone would be calling me back and no one ever returned my calls. Eventually, after numerous attempts on my part I got a hold of someone who told me that the reason I was receiving these bills was that I didn't have hospital coverage. The sales agent I spoke with lied and said I had hospital coverage.

At this point I argued with the company and was assured that my problems would be forwarded onto a supervisor who would review my case, including the recording of the original phone call when I bought the policy. They have never gotten back to me. It is currently April and I started the process of calling them in January. Eventually I reported them to the New Jersey Board of Insurance.

Since all of this they have also denied two different claims saying that my coverage had been terminated on the dates of service - which it definitely had not been. One of these was for my son's well child check up, the other was the surgeon's bill for my appendectomy - both medically necessary claims. I called them out on these claims and they are supposedly reprocessing them. Then yesterday I open yet another bill for my surgery for another $4, 914.

This company has not provided me with the coverage that they sold me and has denied one claim after another. When I call their customer service department, I cannot get a straight answer out of anyone and they keep me on they phone forever transferring me from person to person. They have never returned my calls in a timely fashion. This is the worst experience with insurance I have ever had. I highly recommend that NO ONE out there purchase insurance through PJP Health Agency.
 24th of Apr, 2011 by   Refusedme 0 Votes
PJP Health Agency has repeatedly denied claims that are perfectly valid. When I call them or email them they give BS reasons why the claims are not covered. When I ask them why they are violating their own policies, refusing claims that are clearly covered according to the information the agent said to me, and lying to their paying customers, I get no response whatsoever. All I get is "you are responsible for the full amount of this claim".

So far the amount they have refused to cover is under $1000, so I am not going to bother calling a lawyer. From reading the many other complaints against PJP Health Agency I can see I am not the only person who has been ripped off by them.

If you have a choice, DO NOT use PJP Health Agency for anything. I canceled my policy with PJP Health Agency.
 30th of Apr, 2011 by   notcovered 0 Votes
I bought health insurance with PJP Health Agency. Months later, a serious problem was detected in my lower back. I called and PJP Health Agency said my surgery was covered. My surgeon called and was told it was covered. The hospital called and PJP Health Agencyt told them it was covered. I had the surgery. Now they have decieded that I am NOT covered, and I owe $22, 000.

I am unemployed and have been for twenty months. PJP Health Agency lied and cheated me badly. They refuse to tell me how to appeal this decision or to provide any guidelines for doing so. They refuse to tell me who made this decision, and they hang up on me when I ask. THESE PEOPLE ARE THE WORST OF THE WORST. I BEG YOU TO NOT HAVE ANYTHING TO DO WITH PJP HEALTH AGENCY. THEY WILL SCREW YOU BECAUSE THEY SCREW EVERYONE. THEY ARE UNFAIR LIARS AND CHEATS.
 1st of May, 2011 by   Breachofcontract 0 Votes
In September 2010, I purchased a health insurance policy from PJP Health Agency. All application questions were answered accurately and truthfully and this qualified me for coverage. On February 26, 2011, I fell ill and was checked into the hospital from the emergency room.

PJP Health Agency did not want to pay my bills so they simply decided to rescind my insurance policy without cause in April of 2011 effective from the date it was activated on September 1, 2010.

They still refuse to pay the outstanding bills. I need payment for all bills as contracted in September 2010, as well as payment for my battle with them to urge them to honor the contract. Their actions have caused other financial harm in terms of credit, interest rates, and otherwise, in addition to lost work.

I'm still battling this issue through the Insurance Commissioner's office and reporting them to the Better Business Bureau. I'm still sorting through the best legal firm to handle the case.

Warn every alumni group and business about PJP Health Agency and their negligent and unethical practices. Insurance is an important investment because nothing is more important than your health. It's unfortunate that this company seems to feel that money is, in fact, so much more important that they will defend their breach of contract.
 7th of May, 2011 by   Worstinsurance 0 Votes
I signed up with an insurance policy with PJP Health Agency because they stated that they were considered "credible coverage". Later, after trying to get insurance with BCBS, I found out that they were not "credible coverage" and that I would have a one year pre-existing condition waiting period if I signed up with BCBS. The same was true for a few other major insurance companies. I kept my insurance with PJP Health Agency for another few months and realized that the coverage was not good enough and I would've had to pay for most of my major medical issues. In the end, I would've saved myself a ton of money if I had just paid for everything out of pocket. With that said, I canceled my policy with PJP Health Agency. Today is 5/6/11 and I still have two claims that I have been desperately trying to get paid. I have sent them everything they requested and STILL have no received my payment from a 5/10 claim and a 7/10 claim. They claim to "never receive" papers I send. But they have no problem receiving my premium payments!! I have called probably 15-20 times in the last 9 months, leaving messages and NOBODY WILL CALL ME BACK! This is the worst "insurance" ever! No customer service and no help what-so-ever in getting my claims paid! The only thing they have insured me is that they will take my money and treat me like a nobody!
 8th of May, 2011 by   Notscammedd 0 Votes
PJP Healh Agency is a company that insists that you purchase their product before they are willing to send you information on exactly what you are paying for:

I went on their site and requested a quote; I got a call within a minute and the caller was very agressive and rude. Anytime I started to ask a question he interrupted me and gave me an answer that had nothing to do with my question, or told me that the question I was trying to ask was not important! When I asked him to please allow me to finish even a single sentence, he hung up on me.

I had an experience like this with a similar-sounding scam, about a year ago. Maybe it's the same people using a different name so they won't be recognized. Their sales guy did let me ask my questions, but was nonetheless evasive anytime I asked for real details. He told me there was a non-refundable application fee, so I asked him to provide me with the exact terms and conditions of coverage before I coughed up money I couldn't get back. He told me that the only way to get the terms and conditions was to pay the application fee and the initial premium - but if I didn't feel the coverage was worth the premiums after reading the terms and conditions, I would still lose the application fee.

Has anyone been able to get a full disclosure of terms and conditions without having to risk losing their application fee?

Aside from all that, I was not impressed (from the very little information the sales person did provide) with what I was being offered. It seems that MAYBE I'd save a few bucks here and there, but if something really nasty came up medically, the coverage wouldn't come remotely close to the disastrous bills that could result.

Google PJP Health Agency you'll find more than a couple of MAJOR complaints.
 14th of May, 2011 by   DontbuyPJP 0 Votes
I took out a policy with PJP Health Agency because the agent said it had great mental health coverage, that included Attention Deficit Disorder, which I thought that I had. I went to a psychiatrist to have an ADD screening. As soon as I start receiving care and medication for it, they changed their tune on everything.

My doctor had been trying to receive payment for my initial visit for 3 months, they said they wouldn't pay it because they believed it was a pre-existing condition, and they told my doctor that. When I called, they said that nothing to that effect was written in my file, and there were no notes that said anything about that.

So I went to my doctor and I paid her out of pocket (and had been paying for all of my prescriptions out of pocket as well) and I had never received a single benefit...EVER. I called again and I was assured that everything was fine and that they should file the claim again. It went back and forth for a couple of weeks.

They still denied the claim. When I called, they told me that 'they don't recognize ADD as a condition in adults' and that it was stated in my policy packet. With this policy, they never even send you a paper packet in the mail. It's all on their website and you access it with your policy number. There is no way for you to really know if you're looking at the same information the agent went over when you originally took out the policy, so it's easy for them to change it and back it up. Call me paranoid, but it's a bit unsettling.

They also told me that if I had symptoms of ADD in the past, even if I wasn't diagnosed with it, that it would be viewed as pre-existing and it would not be covered.

I canceled my policy with them, but they made sure to take out their next payment before they canceled it, even though I asked them to cancel it before the date that they deducted it from my bank account.

I would be very cautious if you ever decide to take out a policy with them. Actually, I just wouldn't take one out as they make every excuse not to pay claims.
 15th of May, 2011 by   misleading 0 Votes
PJP Health Agency offers WORST insurance company without question. After paying high premiums for my son and myself, PJP Health Agency has refused to pay for any of my doctor visits so far. Out of a $300-$400 bill for a pap test (routine cervical cancer test), PJP Health Agency payed a whopping $16 for the lab fee, and I had to pay the rest. For visits to have a wart removed, once again, I paid about $250 for 2 doctor visits while PJP Health Agency paid about $30. I just got a bill from my allergy doctor saying I owed $463 for a $500 bill for allergy tests and treatment. So PJP Health Agency coughed up a whopping $37 for that. I have called the company numerous times, filed a complaint, etc., but they weasel out of it every time. RUN from this company. They love to dissect each and every doctor claim and refuse to pay based on unclear wording in your policy. I would love to see a class action lawsuit against this company for their refusal to pay claims based on unclear/misleading wording in policies.
 21st of May, 2011 by   scamdontpay 0 Votes
My wife signed up with PJP Health Agency for health insurance. 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 $70 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 involved with them. PJP Health Agency is a scam.
 22nd of May, 2011 by   myinformation 0 Votes
I signed up for insurance with PJP Health Agency and I finally got my information in the mail along with 2 other peoples personal information. I have there social security numbers, date of birth, address, and phone numbers. I have all thre personal information and the original application they filled out for PJP Health Agency. Ive tried to contact PJP Health Agency but they are not open on the weekend. Ive called one of the guys and let him know i have his info and will be shredding it. The other guy has yet to answer his phone. Isn't there a law against releasing personal information this easily??? Was my information mailed out to random people in the US like there info was???
 23rd of May, 2011 by   Beldar 0 Votes
Message to myinformation:

The reason why this happened is because PJP Health Agency employs idiots whose only job is to sell you worthless health insurance. They have no concern whatsoever about customer service or securing customer's private personal information.

If I were you, I'd call up some of the local media outlets and tell them about this security breach. There is currently an open file on PJP Health Agency at Fox 5 New York's 10 O'Clock News. Call Angela Cascarano at (212) 452-5816 or contact her by email at Angela.Cascarano@FOXTV.COM if you are really serious about doing something.

Your first mistake was signing up with PJP Health Agency without first doing some reasearch about them. If you would have simply entered their name in a Google search, you would have discovered that there have been dozens of complaints filed against them on various consumer complaint websites.

I suggest that you read a couple of the previous complaints filed against PJP Health Agency on this website which detail how they refuse to pay the legitimate claims of their customers. Then decide if you want to continue to do business with such a company.
 4th of Jun, 2011 by   Rick_ 0 Votes
I truly hope that this message makes it to at least one person who is considering purchasing insurance with PJP Health Agency. If I can help one person avoid the headaches that have resulted from dealing with this company, it will be worth the time I took to submit this review. PJP Health Agency is a deceptive, dishonest, manipulative company that couldn't care less about members' healthcare as long as they collect the premium each month.

They will raise your premium and simultaneously deny more and more of the claims that they are responsible to pay. You will pay unbelievable premiums each month, and most of the claims (be it routine office visits or prescriptions) will be denied. Trying to reach the salesman who sold you the policy is almost impossible and, when you do, you will be given a vague and nonsensical answer with no resolution.

You will be left with a simple response..."no exception." Take my word - if you are considering buying insurance with PJP Health Agency, reconsider.
 12th of Jun, 2011 by   F rating 0 Votes
My young healthy family of 3 pays almost $400 per month for our policy with PJP Health Agency and when I went for my first gyno exam they did not pay a penny for the visit or the lab. I was out of pocket over $200. Seems to me I would be better off paying the doctor visits out of pocket than giving PJP Health Agency $400 per month. The agent who sold us the policy mislead us. After doing some research I found PJP Health Agency has an F rating with the Better Business Bureau. I'm going to cancel my policy and shop around for something more sensible.
 19th of Jun, 2011 by   Everytime 0 Votes
If anyone is thinking about signing up with this company for health insurance...DON'T THIS COMPANY IS A FRAUDULENT COMPANY. I signed up for this insurance last November and as of today they haven't paid one cent of my medical bills and the prescription coverage is pretty much non-existant if there is any medications that aren't generic you might as well forget it, I take two inhalers and they would only cover about $15.00 of the cost of $250.00 for each medicine. Everytime I call to see if they have paid any of my medical charges I get a different excuse of why nothing has been paid. I am contacting the Insurance Commissioner and also the Attorney General as someone needs to stop this company from scamming people.
 26th of Jun, 2011 by   EricEric 0 Votes
I just had the same issues as the previous posters. I was told three seperate times that this was a major medical health insurance, they just didn't call it that so we could recieve lower priced premiums. I spoke with a sales guy to make sure I was getting all the details correctly. He said it was a copay for the doctor (which it NOT true), a copay for a specialist visit (which is NOT true) among other false statements about the coverage. After I waited the 7-10 days for my information in the mail, I contacted the customer service department and spoke with another person. I explained to her everything that I had been told and she told me it was all FALSE! The company's own employee told me it was all false and that it was a discount only plan. I immediatly cancelled my 'coverage' and demanded a refund along with the application fee. I called a few days later to see when the money will be refunded and she said they take 10 days and they could only refund my premium and not the application fee. I can't believe they are still able to operate a business. Then again, by charging everyone a application fee they probably make all there money that way. I am not sure how to go about getting that application refunded, but I'm going to try. They say the conversations are recorded, so they should have it recorded exactly what was said to me on the phone. I have contacted the state insurance department and they are looking into this.

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