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On july 2 2018 I spoke to mariano ortega on the phone regarding health insurance who was the sales representative who guided me to purchase the insurance I obtained. He stated the monthly premium is $251.00 with no deductable and a $250.00 per day co-pay for emergeny rooms and hopital stays, plus a $99.00 sign up fee. I felt $250.00 was a bit high, but I accepteds recomendation for the policy knowing that I would be using the plan shortly as an emergency room or out patient. Based on the information the sales rep provided me, I chose that plan that he recomended because it suited my requirements. All conversations and agreements were provided and recomended to me verbally by mariano ortega the sales rep who signed me up.
The next day on july 3rd, I felt severe pain running down my left leg. I checked myself into westside regional hospital in plantation florida which I knew in advance was covered on my plan where I stayed for july 3, 4 and discharged july 5. I knew the hospital was in my plan because I specifically asked mariano ortega the rep prior to accepting the policy knowing I would be using it very soon.
On monday july 9th, I called customer service at aci who verified that the information I received from the sales rep who sold me the policy did not match what he recomended. The policy the rep recomended was not what he told me, and only provided $250.00 towards payment per day and I then realized the rep only signed me up to receive his commission.
In the afternoon of july 9th I called e.R. Insurance and spoke to the supervisor by the name of rick who said he would discuss the issue with the sales rep and call me back immediately. Sadly. Rick never called. After 3 days of consistantly calling er insurance, I finally got rick the supervisor on the phone who stated unsurprisingly that his employee denied all accusation of any wrong doing and was unable to assist me further.
Upon looking at my hospital bill, aci/ encore insurance who is the carrier paid $750.00 and left a balance of $54, 250.00. If I knew in advance that this policy was like not having insurance, I would have accepted a more comprehensive policy which covered me completely at a higher monthy cost which would have covered my entire stay. However after I said I would think about it, mariano ortega assured me that this policy fitted my needs.
By all definitions, I was intentionally lied to and scammed by the sales rep for the purpose of making a quick sale on the phone which is a clear case of misrepresentation and fraud. I was directly and intentionally deceived. I am hoping all calls are recorded, so I can prove my case.
E.R. Insurance put me in a horrible financial position, and did so solely to make his commission and refused to discuss it further as per the sales manager rick
I am formerly requesting your office florida dept of financial services to investigate er insurance and to take action against their licence against fraud and misrepresentation to ensure they do not scam other customers.
Please feel free to contact me anytime via phone, email or usps
