Core Value Health Insurance / Not reimbursing for claims

1 TX, United States Review updated:

I was sold this Health Insurance with Core Value/AMLI, by a broker who told me it was foolproof I paid an extra $100 per month for it to cover more. It was supposed to pay for $1, 000 per day while in the Hospital plus other limited charges. I was in the hospital from October 11 thru 16. Because Christus St. Elizabeth's in Beaumont, Tx did not accept this insurance, I had to pay up front $6, 400 just to be admitted, then the balance of $12, 800 on November 1, 2011. I have been trying to get reimbursed since November 1, 2011 and it is now March 18, 2012!!!
Everytime I would call, they would need another bill or a different type of bill. I have sent 5 copies of the statement, copies of my payments, called the hospital to get them UB lists...anything to stall!!! I keep being told it is being "Processed"????? Just how long should processing take?
I am vary frustrated, but will not give up! I have cancelled this"crappy, costly insurance" and would not recommend it to anyone! I
am a Cancer survivor from 2005 and a Diabetic, getting insurance is a nightmare! I finally found Good Insurance through another company. $19, 200 is a lot of money to be lost when one is facing retirement!!!

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  • De
      25th of Mar, 2012

    My husband and I just saw Dateline on Sunday night regarding the fraudulent policies AMLI, Core Value and other companies are selling. Unfortunately we too have been "duped" by this medical scam. We should have known it was a fraud when my husband had a problem with his shoulder went to the Dr. and the Dr. asked him if his policy was purchased in a discount store! These are hard times with everything these days, it is so messed up that people prey on individuals and we fall for it. I guess we should go by the old saying "if it sounds too good to be true it is", or as Oprah Winfrey says, when you hear the whisper LISTEN! We have called our bank and stopped payment immediately...

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  • Jm
      7th of Jun, 2012

    I too am in the middle of a dispute with amli/ core value. They refuse to pay even thoug I submitted every type of bill imaginable and the complete medical records. They have a complicance officer named Ann Smith and she keeps intervening and saing what I submitted was I adequate or she implies I somehow submitted claims for services not received. This cOmpany is a total rip off and I paid over 12k in premiums for two years and never made any claims until recently. As an example I submitted a bill and she said it didn't have the CPT or ICD code to which I responded how do I as a layperson know that. I then contacted the provider who send me their billing statement with the codes and Ms smith then said oh it doesn't have the specific physicians name on it. If she was in front of me I would have punched her in the face. Im filing a complaint with the insurance commissioner for whatever good that will do.

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