More MEGA Life concerns were raised by a lawsuit filed by the Attorney General’s office yesterday. Here is today’s Boston Globe article by Chris Rowland about MEGA Life’s alleged illegal practices, including failure to offer mandated benefits, unfair denials of coverage, and failure to explain coverage limits and exclusions.
As noted yesterday, Insurance Commissioner Julie Bowler has publicly supported allowing MEGA Life to expand its plan offerings in Massachusetts through the Connector. The AG suit shows why this is a bad idea. Though Bowler says the Division of Insurance will monitor company practices, what she means by “oversight” is far from clear. Without a clear monitoring plan, allowing its plans to be offered through the Connector will do more harm than good to consumers.
Low benefit/high cost-sharing plans put consumers at risk – especially economically vulnerable consumers. Expanded choice is great in theory, only if choice is backed by clear and accurate information. Choices that leave consumers exposed to financial ruin should not be part of the equation. Expecting consumers to do a comprehensive comparison of benefits and costs of Connector plans is unrealistic. The purpose of the Connector is to aid this process. The Connector needs to ensure full transparency of plans offered through it, especially any plans that include limited benefits or high cost sharing. If being required to purchase insurance is scary, think about being required to buy something and then discovering it won’t cover you when you get sick.
What do you think? How much choice is too much? What can the Connector do to protect consumers and make the choices meaningfully distinct?
Lisa Kaplan Howe
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I am health insurance agent in MA with 12 years of experiance. Time & time again I come across these people who have bought “mega Life policies” It is alway the same thing after the people used the plan they wanted out. Mega Life is a scam, the management only hires inexperianced sales people this way they can be told how to sell deceptivly and not know that there doing anything wrong. Mega Life should be closed down!
Before the great leveling of the health insurance playing field in this state, insurers like MEGA made a profit selling insurance by asking applicants questions about their health and making intelligent decisions about whether or not to issue a policy. Expressed this way, the process of insurance underwriting comes across as an innocuous way to conduct a useful business. But when the practices involved are labeled “cherry picking” we have a different opinion.
If underwriting HEALTH INSURANCE on the basis of HEALTH is forbidden then we may still have HEALTH INSURANCE, but we have clearly altered the rational basis on which an insurer will attempt to make the profit that is its reason for existence.
If the plans the Connector ultimately makes available–especially to those vulnerable people in the 100-300% FPL range–policies that they see as unaffordable, there will still be offered plans like the one on my fax this morning [not insurance!] (“$99.27/individual/mo”, “Call 877-xxx-xxxx”, “THIS FAX WAS SENT…FROM NICOSIA, CYPRUS”). And there will be people willing to buy them!
A larger percentage of Massachusetts citizens are covered by quality health insurance plans than most of the industrialized states in the nation. Whether that is the CAUSE of the fact that we have the highest per capita health care costs in the nation or not is unimportant. A marvelous congeries of opportunities, resources and political will may just let us here, in this unique corner of this grand country, follow through on a grand experiment.
Chapter 58, if fully implemented by the post-election administration, can, at the very least re-allocate the jury-rigged system we have for funding uncompensated care and, at best, cover maybe 10% of the 15% of our residents not now covered.
We cannot expect something as complex and unproven as Chapter 58 to realize 100% of its goals. We shouldn’t try to engineer the law and its attendant regulations so tightly that everyone is covered nor should we prohibit insurers like MEGA from trying to sell plans that, like the Lottery, comprise a tax on the foolish.
If we do not permit failure, how can we be sure that we have avoided it?
How open is this lawsuite. I am one who has been finacially devastated by Mega Life and their lack of paying medical bills. I would love to get in on a class action law suite to try and recover my losses.
I too am a victim of Mega Life. Months before my son was diagnosed with leukemia we decided that we had let the children go without insurance for too long. I found an inexpensive insurance for the self employed and called. The woman who set up our policy, was a quick speaking, spastic, all over the place mess. She explained to us how wonderful a hospital based plan was and my husband and I were not well educated in health insurance to doubt what she was saying. Now, the bills are so high that we are going to have to file bankruptcy. The woman at mega life completly misrepresented her company and duped us into purchasing our policy. My son is healthy and in remission. Even though we are struggling with getting these bills paid. The doctors and hospital have never denied my son care. Thank God! I shudder to think of how many people out there are going through the same thing that we are. I hope these rats get what they deserve!
I have the mega policy and have had no problems what so ever. All my claims have been paid in a timely manner and wonderful customer care. I’ve been with Mega since April 2006. I think i have there new plan called Care One through Mega. In Sept.2006 I had a back surgery everything my agent told me was true. Never had issues with claims and i have no out of pocket costs when i see my doctor, also i have not received a large rate increase like my Golden Rule plan had. I’ll recommend this insurance to anyone. You people must of had an old Mega policy or your agent gave you a cheaper plan.
>>Shaun Says: “I have the mega policy and have had no problems what so ever.”
Well, Shaun is probably from the Mega Life PR department (damage control division) trying to patch things up in the forums and blogosphere that are revealing the truth about his crappy piece of sh_t company. Notice the promotion of the “Care one” package that I guess we should all rush out and sign up for… Please! Advertisers couldn’t write a better piece!
Pardon my language, but I recently (last july actually) underwent surgery for several boils located on my body and the hospital bill came to $7500 with the anesthisologist bill and other related bills coming in at around $2500. Thank God the surgeon was a friend of my wife’s family and did not send me an outrageous bill. And to date Mega Life (crappy piece of sh_t company)Insurance has not ponied up a single penny! They keep saying that coverage does not apply, and even though I have missplaced the copy of my policy somewhere, it would not surprise me that there is some misleading fine print somewhere that may vaguely state something to this effect.
How many of us really read every single word of every single line of these insurance policies that are the length of a short novel in some cases? We, or at least in my case, I have a business to run and cannot be absorbed by every detail of every single document. This was the first policy I bought on my own as every previous insurance policy was offered through my employers. I did not know much about buying insurance coverage then. When I met with the guy who sold me the policy I believed what he was saying about the company’s coverage and how most of my needs would be met. I guess I did put a bit of blind faith in this company. Boy was I a sucker!
All of my providers are saying the same thing. that is most of these claims should be honored, or at least most every insurance company they deal with does pay them.
I know my situation is not as dire as some of the ones I have read about and i feel very bad for all of those who are going through worse times than me, but it is really crappy when self employeed individuals such as myself put their trust and hard earned $$ into a company such as Mega Life (crappy piece of sh_t company)Insurance only to be screwed.
I don’t have 10 grand laying around so this is going to hurt me financially. I too hope these suckers get exactly what they deserve.
I have the Mega Care one plan – In fact I dropped Blue Preferred for many of the reasons those above mention. I was getting the royal runaround and my rates went up 50-60 a month every year. Bottom line is that ALL insurance companies suck in one way or another. Word of the wise – READ your contract and CALL the insurer to ask questions during your 10 day review period. I asked Mega about 10 questions when I got my contract – more or less affirming what the salesman told me (I don’t trust salespeople!) – all were answered (one reply I didn’t like but it is what it is). I was satisfied with my coverage. I think Mega is pretty fair – I know people who have had them for years and years and they have good things to say for the most part (all insurers have issues). I have not had any major health problems but if I ever do I am pretty sure (based on the info provided from the contract and HQ conversation) that I am reasonably covered. I hate hearing stories about people getting ripped off – but in most cases the holes were there they just did not take the time to see them in the contract. In the case of insurance it is truly Caveat Emptor “Let the buyer beware” most people treat insurance as if they were buying a magazine – looks good, must be good. They buy on line, they buy over the phone. BAD IDEA! Insurance should be purchased like you would purchase any other thing that has a potential to cost you a ton of money if improperly done (i.e. used car, house, business, etc ,etc). If you don’t understand what you are buying, have a friend or legal person help you out! You only have yourself to blame if a company rips you off via a bad contract! A consumer who is aware of this will never lose. DR
”’Shaun Says:
February 6th, 2007 at 1:26 pm
I have the mega policy and have had no problems what so ever. All my claims have been paid in a timely manner and wonderful customer care. I’ve been with Mega since April 2006. I think i have there new plan called Care One through Mega. In Sept.2006 I had a back surgery everything my agent told me was true. Never had issues with claims and i have no out of pocket costs when i see my doctor, also i have not received a large rate increase like my Golden Rule plan had. I’ll recommend this insurance to anyone. You people must of had an old Mega policy or your agent gave you a cheaper plan.””
Shaun, get serious. You couldn’t sound more like a Mega agent if you tried. No out of pocket costs huh. Yeah sure bud.
Look, I myself was an agent for this group, NASE & Mega Health and Life. I worked for them for over a year, and I to fell for all the RAH RAH B.S. that everyone else does who works for this cult. I will tell you first hand that we were told to keep things hidden. To say this and not say that. What finally burned me down was the fact that any type of function with the “UGA” group always started out with money. Here is such and such’s bonus check of $8,000 dollars. Oh here is another one for $12,000. The sickest thing about this is, I have clients calling me about unpaid claims, and my boss is getting two bonus checks a year and each one is over $20,000. And the total number of different bonus checks, I think is now around 14 different types of bonuses per year. Wow what a group. Make the clients suffer so I can live the good life. Also my clown of a boss says to me, Kevin you can’t worry about people who are having claims problems, that’s not your job. Are you kidding me, not my job. That is the least I could do for these people. Sorry guys, I have to much integrity to let that crap happen. So I got out and now work for a company that really “helps” people out by getting the coverage that they number 1 need, and number 2 deserve.
So enclosing Shaun, WAKE THE F**K UP
Is there a class action lawsuite going on against Mega Life?
Hmm, I just had a two-hour visit from a Mega agent. It all sounded good, not too good, but good…different if nothing else. However, when I asked her to leave the booklet she brought along, she wouldn’t. She told me I’d have to first register for the Care One plan, then I could have the book with all the coverage details. Well, I may look stupid, but I’m not stupid enough to buy something I can’t read about first. So, I did a quick Web search and found this page which enough to help me make up my mind. Sorry MEGA, looks like your policy of not leaving literature with potential clients bits you in the butt.
I just met with an agent in VA.
I still have time to cancel as my start date and 10 day period have not started.
If you buy the health plan and all the great riders, is this still not a good plan.
The riders supposedly bring the deductible down to near zero for Dr visits, ER, low presciption costs, AFLAC-like immed cash coverage (cheaper they say),and hospitalization.
What specific questions should I ask the agent or the actual company underwriters.
Thanks.
..Mike.
I also worked for Mega Life and Health for 6 yrs in TN and MS. I was even a manager for 1 1/2 yrs. I left because I had alot of customers calling and complaining that their claims were not being paid. They not only screw the customers but they also screw the agents when they leave. Questions to ask before buying Mega-
1. Is this a major medical policy-no
2. What is your total out of pocket
3. How does the doctor visit and out patient coverage work/ how much coverage do you have for this and how often can it be used
4. How many deductibles are you reasponsible for annually
5. Ask your doctor’s office about a company before you apply. Call you insurance commissioner and ask about any complaints that may have been filed.
6. If an agent can’t leave you a brochure explaining your coverage then you should be leary
Please reread Kevins comments above again. He is so right. Mega seemed to be more focused on sell,sell,sell and make a bonus. It didn’t matter that we were not telling our customers everything. Alot of us didn’t even realize what we were selling until customers statred complaining. We were told not to leave a brouchure unless the customer purchased a policy.
I am a new agent with MEGA and I know exactly how there scheme works. I got in the health insurance business because I thought I could do well financially and help people at the same time. I am yet to officially write any business for MEGA, UGA, NASE, or AFS (Americans for Financial Security… same thing as NASE, just different name). The cult like atmosphere is hard to swallow especially when they disguise it as the red-white-and blue American dream. My question is, what happens when you quit because I do not feel confident that I’m doing the right thing and I have not written any business yet but I do have a couple appointments tomorrow. I’m feeling a bit lost to say the least especially since I just got my credit card bill in the mail. I like to tell myself that all the bad publicity I found is dated in 2004 but this page so recent I can not deny it. Any former agents that are reading this please take the time and respond to a person that is only trying to do good for the people around him and explain to me what happens when you leave UGA
In regards to Mega Health Insurance out of TX. When I was in nursing school, the college offered health coverage through Mega. I had an acute MI in 2001, no previous history of cardiac issues. Mega at first refused coverage stating the MI was pre-existing. After a number of months, and after sending a letter to the Colorado State Insurance Commissioner, Mega provide coverage. I wouldn’t recommend buying any of their products.
Thanks,
I had an appointment today for an interview with UGA… after reading their website and several internet links regarding complaints against UGA/MEGA/UCIC, (and their other AKA’s), I can skip the interview and save myself a lot of time and aggravation.
1st of all, Kevin…Get a life! Its obvious that you were not very succssful with UGA. Its sad when unsuccessful people have to complain & cry when they fail. Todd, please don’t throw away a great opportunity because of 1 unsuccessful guy that you’ve never met. All sales companies use cash as incentives. If you do not want to make any $, do volunteer work. Do you really think Blackstone would have bought UICI for about $1.2 Billion if the company is fraudulent? Please… comments like Kevin’s are just weak attempts from ex agents and brokers to sell on price. What a broker does… email clients 2 pages of nothing and lure them in on price. Who’s really doing the dis-service here??? Bottom line Kevin, why didn’t you sell better Mega policies? If someone told me to keep things hidden, it wouldn’t take me over a year to figure out that this might not be the right company to work for!!!! Move on Kevin! You’re the one who needs a wake up call!! Its ringing now…ANSWER IT and MOVE ON!!! Don’t bother to respond, I will not waste any more time with an unsuccessful & jaded person.
Funny anwser Win.. I like that.. Interesting that UGS still has an A rating if they are so unscruplus.. Just my thoughts.. I happen to have an interview with them tommarrow, will see what I think after that meeting!
Remember as a general rule. A salesperson is just that.. SALES… Would you trust every word of a car salesman? Furniture Salesman?, Real Estate Salesman? I DON’T. Not all sales people are created the same, but you have a 50/50 chance of getting all the information without asking probing questions.
I would NEVER make a big purchase without doing some research prior and following a meeting. Thats just me. But then again I have been in sales for years.
If you cant get direct anwsers about things, DON’T BUY.. That goes for anything.
This is in interesting website though.. Makes for a nice learning curve and allows me to come up with good questions before getting to my interview!
I recently quit Mega and NASE after about a week, after reading all the bad press and all. They do tell you not to leave a brochure on NASE until you get $115 from the customer. Anyway, I was wondering if any former agents had any luck getting their $250 back? Probably not. That was the first red flag – a co. that charges $250 to go to work for them. They probably are trying to cover the cost of all the new agents who quit when they find out how bad the company sucks.
I work for a chiro office and we had a patient who recently switched to MegaLife, his policy premiums are $227.00 per month but the policy provisions only allow for $250 to be paid out quarterly. I have seen a few of these policies and in addition to this rediculous premium amount vs what they pay out, there is a never ending pre-existing clause and we have yet to be paid on the two dates of service we submitted for payment over two months ago. It really is in the best interest of anyone looking into health insurance to go with a reputable, bigger named company. Good luck to anyone still dealing with this company
I am a health insurance agent who started out with Mega. It took me three months to figure out what this group was all about. Don’t fall for their sales pitch as a prospective agent and for God sakes don’t buy the insurance. If you take the time to look around you will find there are much better values out there.
BOOKLET: It is good business for agents to leave their booklets behind if customers request them. I leave mine behind when customers ask. I have seen my boss leave his presentation booklet behind as well. The problem starts with the salersperson who thinks he/she might get in trouble for leaving the material behind…those who claim to have unreasonable bosses must remember that they are not there to watch you during the presentation. Do the right thing for the customer. I treat people the way I want to be treated.
HIGH PRESSURE: This varies based on the salesperson approach. I personally follow a consultative approach. If the customer is not interested in the product I thank them for their time and leave. If the cust wants time to ponder I set a time to follow up with them. I treat people the way I want to be treated.
CRAPPY COVERAGE?: Health insurance is expensive across the board. Mega allows customers to customize their plan based on their needs and budgets. The problem might arise when customers who cannot afford a beefed up policy choose one with inexpensive premiums…then to find coverage holes when the care is needed. Certainly some coverage is better than no coverage. A good salesperson should freely explain the limitations and exclusions of any policy being presented. I do. Understand that when I am in front of a customer it is my reputation on the line. If my boss were to ask me to “hide” things, which he has never asked me to do such thing, it is my moral compass which would override that request. I just treat people the way I want to be treated.
INEXPERIENCED SALES FORCE: One of the comments above stated that Mega hires inexperienced people so they can be told how to sell deceptively. I can tell you that training is spread out over time not all up front before going out of the floor. Who could absorb all that? In my case, most of my training comes from customer questions I do not know the answer to. During a presentation I call my boss on the phone, ask the question, provide the customer with the answer, then move on. If the custmer has too many questions I cannot answer, I write them all down and get back with them on a timely basis. I pride myself in researching the official company answer, then following up with the customer. I just treat people the way I want to be treated.
CLAIMS: Sorry to hear that claims are not being paid consistenly. I have not heard this at my end, perhaps I do not have a large base of customers submitting large claims. Cannot comment on the root cause. Again – was this an issue with not purchasing the right coverage, not understanding the coverage, perhaps taking the salesperson summary for granted and not reading the policy details? It would help if there were more details behind the coverage issues listed above.
For the readers, claims payment is an issue that will never make anyone happy, regardless of the insurance company. Most insurance companies pay on a “reasonable” basis…what they feel is reasonable. Mega pays on a Usual and Customary basis, which is a higer std of claim payment.
However, when your insurance company does not respond well to your claims, regardless of the company you do business with, remember to report issues to the State’s Insurance Commissioner. It is a good way to keep all insurance companies honest.
CHIRO PAYOUTS: Randi above made a comment about a premium costing $227 per month but the chiro benefits only covering $250 per quarter. I do not understand the issue here. Part of the premium provides hospital stays when needed, part of it to cover for surgeries when needed, part of it to cover doctor’s visits, etc. I hope the thought is not for the policy to payout same or more than the isured pays in monthly…or the insurance company would go broke. Regarding the concern about the chiro payments being 2 months late, every state defines the turnaround time for insurance companies claims. When the claims are submitted electronically you can expect shorter turnaround times. When claims are submitted in paper format, it takes longer to process, yet it could still within the timeframe allowed by the State’s Insurance Commissioner. You may find situations where claim is submitted in paper format, and it is incomplete or incorrect – the state might allow up to 90 days to process. Hang in there!!!
Wow!
Am I glad I found this sight.
I was getting ready to pull the trigger and buy this piece of crap for myself, my family, and my employees.
Everthing I have read is true. I keep asking my obviously new and uninformed Mega agent specific questions and his answers is always “look, this is good coverage”.
My monthly premium would be about 25% lower than what I pay thruogh Anthem….but at least I know whats covered and what’s not.
I even called the 800 number for Mega and was told I wouldn’t recieve a coverage booklet until AFTER I signed up.
Thanks to all.
I laugh at you ignorant naysayers. If you want the cadillac plan then pay the $1500/month family plan price and move on. For those of you looking for “affordable” insurance listen up. Do you actually think that for a $400 month family plan all of your financial health woes will be taken of? Mega is designed to give you the most help you can get for the dollar spent! I think UGA and Mega are wonderful companies that put their clients first! For you former looser agents, wipe the tears from your sorry faces and move on and face the fact that you just don’t belong with a progressive company that puts the agents and clients first. So, go get your dishwashing job at the local diner and settle in to your new career, scrub, scrub, scrub. Loosers!
I have been a field rep w/MEGA & AFS for about 2 1/2 months and I am very proud to represent this company and our products. My team leader and district manager are two of the finest individuals I have been associated with in my 16 years as a health insurance professional. Our mission statement is H.O.P.E. – Helping Other People Everyday – and they remain true to this purpose and inspire our team to do the same.
There are a lot of people out there who are simply never happy and are never accountable for anything – there always has to be someone to blame and malign because of their problems. Being successful at commission-only sales is not easy and many people do not succeed simply because they lack the discipline to do the things that successful people do (which is primarily to work your ass off), and the inner conviction to stay positive through frustrations. In my former positions in the health insurance industry, I learned that there is a certain percentage of the population that suffers from serious anger management problems and love to get attention and stroke their own ego’s whining and complaining about how they’ve been wronged. I’ve been verbally abused by insureds plenty of times where it became evident that they were more interested in berating and abusing me and my company than they were in resolving the matter at hand. This is exactly the kind of person who will put their energy into destructive endeavors – use a format like this to spread negativity – instead of investing their time and energy in creating a great life and making the world a better place. A successful winner will take the time to listen to their agent, and then make the best decision they can for themselves. They don’t expect people and companies to be perfect because they are not perfect. If an issue arises they get clear on what they want, and stay focused on resolving that issue to their satisfaction, and because they treat others with respect they likely are able to resolve the matter to their satisfaction. If they can’t afford the most expensive coverage they are grateful for what they can afford and are grateful that a lower cost option was there for them. They will set a goal to improve their situation and when they can afford better coverage they will get it. In my former positions I found it amazing how many complainers come in saying that xyz!&@ company didn’t pay my claim, and when you research it you find out something like they submitted a claim that occurred before the policy effective date, or we sent you a denial because you billed us twice and we already paid the claim so we denied it the second time because we had paid you so quickly the first time around but you don’t have your act together enough to figure out we already sent you a check yet you are coming at us full court press saying we don’t cover anything. At which point they sheepishly say – oh. sorry.
I encourage potential agents & customers to ignore the naysayers – HealthMarkets/MEGA has helped countless people gain access to affordable health care and coverage, and has provided a great career opportunity to many people who are willing to work very hard and help other people.
Note to Hesper Main -
I am very sorry to know your child had leukemia and am glad to know the child is now healthy.
I found your comment very curious – you stated you were a “victim” of Mega. You stated that the woman who set up your policy was a quick speaking, spastic, all over the place mess. I assume you consider yourself to speak at an optimal pace and are very perfect and organized all the time and superior to anyone who isn’t – of course it’s ok for you to speak cruelly of others and devalue them when their way of being is different from your own. I’m curious – when you so obviously thought so little of this person – why did you buy from her? Is it possible you are one of those people who goes through life creating dramas and situations where you are not happy because you love being a victim? Personally I like dealing w/ others who speak at a fast pace. If I don’t understand something I ask them to clarify. But that’s just me. I also don’t buy from people I don’t like. That said, I like almost everyone I meet, and I am never anyone’s victim. And I am a successful, happy, grateful Mega agent.
I signed up for the Mega Care One plan not too long ago. I got a bit suspicious when after 2 weeks I still didn’t get my “booklet” of coverage from them. Good thing I cancelled cause then I would be without a good plan. Read the fine print and you will see that you will have to pay 3 that’s 3 deductibles per year. When you have a deductible of $5,000 per occurence that’s a hell of a lot of cash being forked over before the insurance will kick in. Oh and if you get sick or injured, do you really think that $2,000 per 24 hour period will really cover you when you are in the hospital…not!! Look into the costs of how much a hospital room is now a days and you’ll see that at the least these rooms go for are $3,000-$5,000 a day.
You have to realize this stuff is not major medical insurance, it is a supplemental plan that will only cover you for so much and then you are left to pay the rest…wise up and get something that you know will pay those bills!!
Another former agent here….
there are two different scam here, one is the consumer and the other is the agent. In the end it is a bad deal for both.
As an agent part of what is appealing are the “free fresh leads” they give you. Who wouldn’t want to work their leads and the clients you currently have in your book. But to get those free leads we need $250 from you to get you the “supplies” you need to be a successfull agent. The supplies amount to a bunch of garbage but even if you leave they made some money off you. Do not join a company that makes you pay them first. If it is a legitimate offer/company they will get their money back in the long run. By paying them up front they are in a win/win situation already. What they don’t tell you is the leads they entice the agents with are already worked (by the manager showing off the big checks) which isn’t bad if you know it up front but that isn’t the way it is presented. So I spent my time trying to contact people that had already been spoken to or no one was able to contact. They do focous the training on other companies insurance policies but never really go into their own policy and what everything means. They also trained me to use a yellow pad of paper to do my presentation and leave that behind because it will be much more difficult to pick apart the plan by the consumer, another agent or pin me down if I ever ended up in court. Yes, they also train us not to leave behind the specifics of the plan because you will get an “oficial contract” in the mail in 7-10 days. They also don’t tell you the advance you receive up front for the first six months is at a much higher rate than the following months. So when I compared my commissions to other plans and the commission rates I thought I was getting something comparable. When the second six months came around the rate was much, much lower. (not good for making up chargebacks from people who read their contract and understood it when they received it)By the way, once you stop selling with them the renewalls no longer offset the chargebacks so you have to come up with a bunch of cash.
As a consumer run!! There are a ton of moving parts with these plans and even if you buy the top plan it still does not come close to comparing with a real health insurance plan. Even their best plan has a ton of holes they will use to avoid claims. If an agent comes to you and only gives you one company as an option shop around and do your research. I currently use and have access to several different companies for life and health. If I write ten policies this month I will probabbly write with four different compainies. Not one company is best for everyone. Insurance companies have a target market they want and you need to fit that market.
You strong reputable companies will give you an outline of coverage up front or a specimin policy. If you are uncomfortable or just don’t understand ask an another agent for help before buying.
Every policy I sell I put my self in the clients shoes. If I would not own the policy I will not sell it to the clients. I will never again sell a MEGA policy.
Wow….I’ve heard of Insurance Co. bashing, but what I’ve read today takes the cake! I just finished a 2 day “Senior Health Expo” where I could have easily bashed my competition who were there as well, but I didn’t.
I guess I need to clear a few things up for those who were or still are Agents with UGA. First, I’ve been with UGA for just about 3 months. I first learned about Mega when I received one of those recruiting calls on the phone in California. I went and checked them out, sat in on their Sales pitch meeting (which they made it sound like an interview). Yes, they did ask for something like $189 to join, but advised me that part of that was to defray cost of getting my license with the State of California.
I decided to make a bold move and relocate to another state which I had been contemplating for some time. When I arrived, I found the local UGA office and met with the Division Leader. First, at NO time did anyone ask me to pay to join the company or buy leads. I did not pay a penny to start working outside of the $88. I paid the state to take my state license and the $160 I paid to a private school to help me study for the test.
I have enormous success in only my first 2 months working with UGA, as they have spent a significant amount of time training me. My District leader has done nothing but dedicate his time to making my start a succes (I’m not stupid, I know my success will only benefit him, there’s nothing wrong with that!).
Third, when I went through my TTAC training (this is training that is madatory for all new agents with Mega), they spent 100% of the training discussing our policies we would write and all of the “fine print” that is in our products! Yes you heard right, we have a ton of fine print and so does everyone else and they spent the time to actually tell us what each of the fine print means for each product! I doubt it another organization will go through what our office does to prepare new agents to PROPERLY represent the product.
Forth, as far as my second six months commission going really low, I haven’t been on board six months yet, so I wouldn’t know. But it sounds like the individual mentioning this above didn’t understand the commission process. Let me clear things up first! I don’t think ANY company pays out all or 100% of the commission upfront. Mega dishes out advances, because they know we need to be able to put food on our families tables while we put business on our books! Yes, they charge interest on that advance, it’s like a loan, but they advised me of all those little details when I signed up. What some may not understand is that during your first 13 weeks of what they call “Quick Start”, your advances are protected and fixed at 75%, so that you have a head start and build some business. After the first 13 weeks though, then commissions are based solely on a rolling 13 week average and if you get a bunch of your customers drop their policies, then of course your commission advance drops for a period of time while you attempt to get your pipe line filled back up. I think it’s a very FAIR way of doing business, for it builds incentive for you to write QUALITY business and not just sign up every Tom, Dick and Harry that comes along!
Mega products are NOT for everyone and agents should be intelligent enough to figure this out! I don’t sell Mega to everyone and if my clinet has a better product, I will tell them that up front and advise them to stay with their current company! I have potential clients who call me weekly and when they advise me they have a Humana plan or an Select Health plan that is better, I tell them “Congratulations, make sure you don’t let your plan lapse, it sounds like a great plan”! If someone is already on a great health plan and has some health issues, I advise them of the consequences UP FRONT that could take place if they switch to Mega with a pre-existing condition and most decide to stay put then to change!
I think for the most part, it’s all about how the individual Sales Agent conducts their business that determines how the customer will fair in the end. If you conduct your business in an honest and respectible manner, your customers will appreciate your honesty and respect you more for the truth! Yes, I turn away some business because of it, but after only being in the business just almost 3 months, I have over 120,000 of business on the books and counting! I am #1 in my quickstart and business is good! I sleep well at night because I treat my clients fair, I am brutally honest with them with regards to our coverages and benefits and a MEGA Summary of benefits IS left with every client I meet! Yes, we are taught to leave a Summary of benefits after EVERY appointment!
So you see, we are not all bad folks out there and we are not all just looking for the next sucker! There are honest, hard working agents out there who spend a great deal of time educating our client base and taking the time to explain the type of products we have and how they differ from conventional policies!
I wish all of you the best in your business, but for those who only have an axe to grind…sorry, my give a damn is busted!
Oh….my full name is David Dene and I am a captive agent for UGA “Health Markets”, underwritten by the Mega Life and Health Insurance Company!!
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Mega Life has lots of cute little exclusions and maximums that the agents never mention. For example, the daily maximum for chemotherapy is $1250. It can easily run 10 times that much. There is also a monthly or quarterly maximum. Bottom line: my late wife’s medical bills were over $150,000. Mega Life paid less than a third of that. If you buy a policy from them you will regret it unless you never get sick.
I purchased Mega life and Health in October of 2006.I was 19 yrs old at the time.Itime student I was told by PBCC to contact Mega Life for heath insurance needs.I paid the policy in full for one year.
I was admitted to the hospital on 3-307 and found out to have Gullian Bare Syndrome. After a few days in ICU I was informed my coverage was exhuasted.Mega pd 22K of a 285K bill.They lied at the time of sale!
I needed to continue. I was sold on the fact of a “major medical” ands “hospitalization plan” from the Mega sales team.I was told I would only pay a small deductable for doctors visits or a hospital stay.I tried to even cancel after I left the hospital and was told by them I could not. I can not believe the deception that is allowed from this company.It has ruined me financially to be in debt for over 200K at (20 years old now)
I would like adress the agent David, current UGA agent and some of his issues. Stick around for a while and you will see what so many have clients and agents figured out. You are a new agent, your perception is very narrow and inexperienced. You only know what they have shown you. It sounds brutal but I have been there and know this first hand. I also entered into the business with a carrier/captive agency…not MEGA or what ever name they are curerently wanting to go by. When I left there I discovered there are so many more dimensions to this industry. As I said before if I sell ten policies most of them will be with different compainies. I have no reason to bash any insurance compnay. I simply tell the truth and let the consumer make an educated decision. I am an unbiased agent that represents multiple different companies. I made an active decision to never sell another Mega/ UGA/ Nase realted policy again because it is simply the worst policy I could offer. When looking at a comprehensive plan I can ALWAYS get my clients with a reputable carrier for about the same cost. My decision was not comission related, drop rate related but simply that the deception across the board made me question who I was dealing with or sending my cleints to. The responses fronm agents and clients relating to this company should be evident. The commissions were just another part of the deception not the only reason. Understand that the dollar I make for selling a policy is secondary to the clients needs and options. It was the fact that the reduced rate for policies in-force for more than six months was not adressed up front that added to the deception. personally I do not care who sells these ppolicies, it just allows me more opportunity to show the clients what they have, get them into a real policy (for the same or less premium) and build a lifetime client.
MEGA agent visited took the and came back with an exclusion on their policy for anyting related spine or back, because my wife had a bulging disk. This would exclude cancer or ANYTHING. Instead of excluding the disk for 2 years or someting which i would have expected. They also excluded ANY disease or treatemnt for ANY reproductive organ, because my wife had a benign cyst on an ovary. The doctor wrote to them explaining that the cyst was not cancer and was a common occurrence among women her age. MEGA wouldnt reconsider. So I didnt take the policy of course, and thought..if thats the way they are, imagine when you DO have a claim. I bet they’re loking for every loophole they can find. We got an Anthem policy, no problems. I really hope this country’s leaders deal with the healthcare crisis, and soon. Companies like this, drug companies advertising like they sell candy, medical sales reps making 200K..if they get knocked out by a visionary leader and all healthcare becoes non profit, with a Medicare like program for all,THEY DESERVE IT.
..and Im not buying all the nonsense conjured up about long waits, lines for health service etc etc which I see as just fear tactics. The ones who say that are the very same ones who are threatened by national health care. So they will say anything to prevent it. Even if it were true, people like my daughter would like the OPTION TO WAIT IN LINE FOR FREE HEALTHCARE SERVICE. Maybe others can afford it, but she cant afford insurance, her job doesnt provide it, and she is afraid to see a doctor because of the money she doesnt know what they will charge. Is there any other industry in the world that has the ability to not disclose the costs of their services until after they do it, and bill any amount they wish? Nope, just our medical system. Imagine buying a dinner..when they dont tell you what it wil cost until after you eat it. And if you dont pay it, regardless of satisfaction, they have a team of bill collectors with phones, ready to harrrass the sh__t out of you, garnish wages, file court papers. Isnt it absolutely ridiclous.
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This really makes me sick to hear these comments from people who used to represent Mega. Obviously you didn’t make it and now have to bash them. Didn’t you realize when you started your career there you were self employed? Perhaps you lacked the dicipline to go to work every day and do something. If you are bashing the policy then you didn’t sell it correctly. No insurance plan is perfect. The fundamentals are there with Mega. Do you really think that Blackstone would have purchased them and not do their homework? I choose not to bash any company because I believe in what I am selling and have no need to put down other companies to gain clients. It’s unfortunate that you brokers out there have to bash Mega because you are not allowed to sell it! Noone in this industry has what Mega offers the client. We have no competition unless you are talking price. I personally would not want to purchase the lowest price insurance for my family. You get what you pay for. Any by the way, why would anyone try to sell insurance over the phone? Don’t you care who you are putting into your programs? I think it would be very difficult to gain respect with a phone call.
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All I can say is that “Selling Power” magazine would not give us Stevie Awards unless we were a just company. If some one thinks an international company that is a journalistic company would credit a bad company with awards needs to rethink how they think. “Selling Power” will give awards to companies that deserve them plain and simple.
If you want to know how your policy works, read it. I encourage and tell every one of my clients to read their policy and if they have questions I will make time to come out and sit down with them explain what a limitation for a pre-existing condition entails and how we will go about coverage on it. Again since I covered it at the point of sale already. Make no mistake I am in business of helping people and I wouldn’t be helping them if I lied, would I?
If anyone has any questions go to :http://www.naic.org/index.htm and look up your current company and see how many complaints they have filed with the departments of insurance. I suggest you first call your company and ask what their actual name is for your state because most companies call themselves different things in different states to hide whats going on.
On the other hand Health Markets is the same company nationwide.
I feel that what I say is a mute point because no matter what the NAIC says, the Departments of Insurance say, or people say the internet is a powerful tool and for some reason people whatever people write on here is true no matter how insane is seems.
Has anyone heard about Britney Spears and her kids…exactly, tabloid topics are everywhere and the telephone game runs wild in our world so beware of what you hear.
You only have to look at HeathMarket’s SEC filings to see where their money goes. Nearly half goes to advertising, commissions and acquiring new clients.
Less goes out to paying claims. Name another health care provider that has been investigated by the Attorney Generals of 36 states for deceptive sales tactics and consumer fraud issues. If you have been deceived by Mega Life, scream loudly to every available media and government consumer protection agency you can find. Turn over the rock and see what scurries out.
I was a top producer for Mega three years running. Anyone want to buy my million dollar ring? Or my wife’s UGA pendant? Now I am an independent broker representing every A-rated carrier in 12 states. I make more than $1000 net profit every day, never leave my house unless I want to thanks to webconferencing software, and don’t even have to make prospecting calls–we have a system where our prospects contact us and we just wait for the phone to ring. If you are or were at least a steady producer for Mega, Cornerstone or United American, shoot me over a quick email at exmegaagent@yahoo.com so we can talk. I would be happy to point you in the right direction. This TOTALLY changed my life and I can look in the mirror now knowing that I am providing my clients with true major medical plans at the lowest prices, instead of Mega’s watered down overpriced crap. I can also advise you how to deal with that alleged-debt they claim you have, and how to milk those bonuses for every penny they are worth on your way out. You earned that money the hard way–YOU DESERVE IT!
What those of you who defend this company refuse to acknowledge is that the reason WHY independent agents pound this company is because of what we see and hear in the field maybe every time we come across one of these plans and hear the way the policies were explained.
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I’ve been with HealthMarkets for some time now and I am used to the stupid, childish bickering about how awful Mega is. I see alot of “Ex agents” who are trying to quote the coverage out of the CareOne book and they don’t even have it close to being right, no wonder your clients suffered. you sold them an incomplete plan. One dumbo stated chemo is covered at $1250 per day and that it could cost 10x that amount. The coverage actually reads that way WITHOUT an approved course of threapy from your doctor, similiar to all other insurance companies. The fact that Mega will pay without an approved course of therapy is amazing because it could go towards this not considered routine by your precious BlueCross or Kaiser plans. Fact of the matter is, if you are a Mega agent and you leave the holes in the coverage to make the sale, you are a real piece of dirt. If the coverage has all the riders, the coverage is as good as anyone else’s coverage or better. But really, stop the lies about Mega and their coverage. Get it right before you post it and almost no one does. Oh, and has anyone seen the amount BlueCross has been fined lately the past few years. (I think it is now in the BILLIONS.) And Assurant has a 15 state investigation for failure to pay claims as well. Nice pot calling the kettle black all you jerks. [edited by moderator to remove obscenities]
Mega Life & Health & Midwest National Life Finally Get What They Deserve!
This is a great day in the health insurance industry! Rarely is an insurance company held liable for improper conduct. The majority of the time the “Big Guy” takes advantage of the “Little Guy” and sadly the “Little Guy” has no recourse. But this is not the case today! After many years of repeated violations of insurance conduct laws the NAIC- (National Association of Insurance Commissioners) has levied one of the largest market conduct fines in insurance history against Mega Life & Health insurance company, Midwest National Life insurance company, a.k.a. Health Markets, a.ka. NASE – National Association for Affordable Services, formerly known as U.I.C.I. The fine is 20 Million Dollars and in my informed opinion, it is not nearly enough and it has come much to late!
Health Markets has been slinging their garbage for many years across the country to many thousands of innocent consumers who had no idea the extreme limitations included with the so called insurance coverage provided by Mega & Midwest. They have consistently offered “schedule plans” which pay out an average of only $100,000 per illness (even though the policy is sold as a plan that covers you to One Million or Two Million lifetime). Their coverage traditionally also has no “stop loss number”. This has lead to many innocent consumers suffering catastrophic financial losses.
The lack of a “stop loss number” is a very dangerous policy design. To further explain. The term 80/20 is often used when describing how a health insurance policy works. The typical major medical health insurance policy has an 80/20 of $10,000 “co-insurance” percentage split. This quite simply means that after you have satisfied your calendar year deductible the insurance company will pay 80% ($8,000) and the insured will pay 20% ($2,000) of the first $10,000 in medical bills that you incur. This first $10,000 is known as the “stop loss number”. After this brief sharing arrangement is over the insurance company pays 100% up to $5 Million per insured for the rest of that calendar year for in network treatment. Everything starts over again on the first of each subsequent year. This greatly reduces the risk to the insured and it is a standard policy design feature included with most legitimate health insurance policies.
In stark contrast, in the case of the “schedule plans” offered through the two aforementioned companies, the terms “co-insurance” and “stop loss” are very rarely if ever discussed with a prospective insured. This is because they have a direct effect on how much the insured will pay in the event of a worse case scenario. Worse yet, Mega & Midwest have traditionally been offering their policies with No Stop Loss Number. This means that if the bill is One Million Dollars, the consumer would pay 20% of that amount ($200,000) before the insurance company would pay 100%. However, with the $100,000 maximum pay out per illness clause included with their insurance contract, Mega & Midwest would still only be responsible for $100,000 regardless of the size of the bill! What a sweet deal for Mega & Midwest. Arguably the worse part about the coverage they offer is the fact that it costs the same or more than a major medical policy without all of the dangerous limitations included with their schedule plans.
Would you buy a policy like that if it was fully explained to you? Most definately not, and the NAIC apparently agrees. This is the primary reason why after a 3 year 29 state investigation, Health Markets has finally had to face up to all the fraud they have been responsible for. On May 29th, 2008 they were hit with a $20 Million fine. Furthermore, a scathing “Market Conduct” report has been written as well. To read all about it visit: http://www.insurance.wa.gov/oicfiles/marketconduct/2007mc/RSA05292008Final.pdf
Market Conduct Report: http://www.insurance.wa.gov/oicfiles/marketconduct/2007mc/MegaReportFinal.pdf
If you or a loved one have fallen victim to this organization and have purchased one of their “insurance products” please do not hesitate to contact me via the contact us page of our web site @ http://www.smallbusinessinsuranceservices.com for a complete review of your situation and an immediate replacement of your coverage. The risk to you and your loved ones is much to great if you remain “insured” by any of the policies offered by this organization. You can also contact me directly toll free @(866) 724 7123 or via email: steve@sbisvcs.com or click on the “LIVE HELP” button on any page of our web site here: http://www.sbisvcs.com
“The Best Policy Is A Great Agent”
I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.
The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.
For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.”
Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.
Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they “want” and the benefits they really “need.” Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not!
In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?
Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?
Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.’s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.
In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or “ripped-off” by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, “I have to run my business, I don’t have time to be sick! “I think I have gone to the doctor 2 times in the last 5 years” and “My insurance company keeps raising my rates and I don’t even use my insurance!”
As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer. Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.
So what do you think happens almost 100% of the time when I ask these individuals “BASIC” questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let’s see how many YOU can answer without looking at your policy.
1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-”Basic Blue”)
2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)
3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)
4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)
5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)
6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans)
7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)
8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).
9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).
10. Do you have to pay a separate deductible or “access fee” for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health’s “CoreMed” plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit “caps” or “access fees” for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit “caps” could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 “access fee” per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).
Now that you’ve read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn’t answer all ten questions don’t be discouraged. That doesn’t mean that you are not a smart consumer. It may just mean that you dealt with a “bad” insurance agent. So how could you tell if you dealt with a “bad” insurance agent? Because a “great” insurance agent would have taken the time to help you really understand your insurance benefits. A “great” agent spends time asking YOU questions so s/he can understand your insurance needs. A “great” agent recommends health plans based on all four variables; wants, needs, risk and price. A “great” agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a “great” agent looks out for YOUR best interest and NOT the best interest of the insurance company.
So how do you know if you have a “great” agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a “great” agent. If you were able to answer the majority of questions, you may have a “good” agent. However, if you were only able to answer a few questions, chances are you have a “bad” agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.
Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don’t be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don’t feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the “fine print” in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.
If you can’t understand something, or aren’t quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification. Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, “Is this a company that I would trust to pay my health insurance claims?
Additionally, find out if your agent is a “captive” agent or an insurance “broker.” “Captive” agents can only offer ONE insurance company’s products.” Independent” agents or insurance “brokers” can offer you a variety of different insurance plans from many different insurance companies. A “captive” agent may recommend a health plan that doesn’t exactly meet your needs because that is the only plan s/he can sell. An “independent” agent or insurance “broker” can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.
Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use Ebay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make….your health insurance policy.
Lastly, if you have any concerns about an insurance company, contact your state’s Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn’t being honest with you, your state’s Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.
In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: “If it sounds too good to be true, it probably is!” and “If you only buy on price, you get what you pay for!”
For more information about the author please visit http://www.smallbusinessinsuranceservices.com
To the Mega Angent. Quit drinking the cool aid. I am paying less now for my Coventry policy than I would be paying for similar coverage with Mega. Oh and by the way. The preventive care plan for office visits is just awful and would make all pay more for office visits than my 80/20, deductible plan.
And it is now 40 states that Mega has been investigated and sued.
Liars, Liars, Liars. Our agent quit representing Mega Life several months after our 23 year old son was diagnosed with Hodgkins disease. He felt terribly guilty that Mega was not paying our claims or answering our questions. Reason being, they lied to him and to us. Currently, we are about $30,000.00 out of pocket on a policy that was supposed to have a maximum deductible of $7,000.00. Cheats, and liars, all of them!
So I am about to start my Mega /UGA/NASE career and I read this “AND THIS IS ACTUALLY NICE”about mega I really am wondering if I should sell their policy if what I read is correct
Mega Life & Health & Midwest National Life Finally Get What They Deserve!
This is a great day in the health insurance industry! Rarely is an insurance company held liable for improper conduct. The majority of the time the “Big Guy” takes advantage of the “Little Guy” and sadly the “Little Guy” has no recourse. But this is not the case today! After many years of repeated violations of insurance conduct laws the NAIC- (National Association of Insurance Commissioners) has levied one of the largest market conduct fines in insurance history against Mega Life & Health insurance company, Midwest National Life insurance company, a.k.a. Health Markets, formerly known as U.I.C.I. a.ka. NASE – National Association for the Self Employed & Alliance for Affordable Services. The fine is 20 Million Dollars and in my informed opinion, it is not nearly enough and it has come much to late!
Health Markets has been slinging their garbage for many years across the country to many thousands of innocent consumers who had no idea the extreme limitations included with the so called insurance coverage provided by Mega & Midwest. They have consistently offered “schedule plans” which pay out an average of only $100,000 per illness (even though the policy is sold as a plan that covers you to One Million or Two Million lifetime). Their coverage traditionally also has no “stop loss number”. This has lead to many innocent consumers suffering catastrophic financial losses.
The lack of a “stop loss number” is a very dangerous policy design. To further explain. The term 80/20 is often used when describing how a health insurance policy works. The typical major medical health insurance policy has an 80/20 of $10,000 “co-insurance” percentage split. This quite simply means that after you have satisfied your calendar year deductible the insurance company will pay 80% ($8,000) and the insured will pay 20% ($2,000) of the first $10,000 in medical bills that you incur. This first $10,000 is known as the “stop loss number”. After this brief sharing arrangement is over the insurance company pays 100% up to $5 Million per insured for the rest of that calendar year for in network treatment. Everything starts over again on the first of each subsequent year. This greatly reduces the risk to the insured and it is a standard policy design feature included with most legitimate health insurance policies.
In stark contrast, in the case of the “schedule plans” offered through the two aforementioned companies, the terms “co-insurance” and “stop loss” are very rarely if ever discussed with a prospective insured. This is because they have a direct effect on how much the insured will pay in the event of a worse case scenario. Worse yet, Mega & Midwest have traditionally been offering their policies with No Stop Loss Number. This means that if the bill is One Million Dollars, the consumer would pay 20% of that amount ($200,000) before the insurance company would pay 100%. However, with the $100,000 maximum pay out per illness clause included with their insurance contract, Mega & Midwest would still only be responsible for $100,000 regardless of the size of the bill! What a sweet deal for Mega & Midwest. Arguably the worse part about the coverage they offer is the fact that it costs the same or more than a major medical policy without all of the dangerous limitations included with their schedule plans.
Would you buy a policy like that if it was fully explained to you? Most definately not, and the NAIC apparently agrees. This is the primary reason why after a 3 year 29 state investigation, Health Markets has finally had to face up to all the fraud they have been responsible for. On May 29th, 2008 they were hit with a $20 Million fine. Furthermore, a scathing “Market Conduct” report has been written as well. To read all about it visit: http://www.insurance.wa.gov/oicfiles/marketconduct/2007mc/RSA05292008Final.pdf
Market Conduct Report: http://www.insurance.wa.gov/oicfiles/marketconduct/2007mc/MegaReportFinal.pdf
If you or a loved one have fallen victim to this organization and have purchased one of their “insurance products” please do not hesitate to contact me via the contact us page of our web site @ http://www.smallbusinessinsuranceservices.com for a complete review of your situation and an immediate replacement of your coverage. The risk to you and your loved ones is much to great if you remain “insured” by any of the policies offered by this organization. You can also contact me directly toll free @(866) 724 7123 or via email: steve@sbisvcs.com
After reading many of these comments, I have to say firstly, Shaun is DEFINITELY working for Mega Life. Secondly, I too was duped by one of these overly aggressive, smooth talking salesmen. I feel like such a fool! There were several red flags going up throughout the meeting but the combination of a professional con man and the desire to get affordable insurance can be deadly. This company should be stopped and why Julie Bowler and the Division of Insurance hasn’t done just that, is a question that needs answering.
I was just reading some of these posts and what is funny to me is that in any business you are going to have people who are not totally happy with you. I ran a business of over 30 years and I busted my ass to keep my customers happy. I don’t care if your selling bread, insurance, or air planes, you can’t make everyone happy. I was always told that for every knock a person has to say about a company or product, is just another plug that has been given about it. Why this past year when Bush and congress approved the stimulus check, that everyone was complaining that it was only $600.00, hey it is better than nothing
I have been a member of Mega for 15+ years. It is a wonderful insurance company – as long as one doesn’t need or use them.
I am outraged about being uninformed about the psychotherapy benefits that the state of Massachusetts mandated about ten years ago. Mega has offered me three months of free coverage to compensate me for this
“oversight”. No oversights when it comes to raising premiums, however.
Furthermore, they have denied my claims in retaliation, claims which I am entitled to according to the terms of my policy. They also contacted a practitioner of mine based on a phone conversation but I did NOT grant permission of any type. I believe that these actions constitute violations of my rights and the law.
I’ve been promised phone calls back at least a dozen times within the past few weeks, but they never come. When I spoke with Sandy Booker in the CEO’s office and asked her straight out what happened to the call she promised me would come 8 days ago, she actually HUNG UP on me!
ANYONE KNOW OF ANY LAWYERS WHO HAVE HAD SUCCESS DEALING WITH MEGA, OR ANY CLASS ACTION SUITS?
Thanks.
megalife sucks there agents are the worst why work for a company with this reputation?
Im an ex-agent and would be happy to offer testimony to any lawsuit that ever arises for mega or “Healthmarkets”
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After being lied to and deceived. Mega is now suing me for over $20,000 for my back end not clearing,after duping people out of over $1,500,000 in policies. What an odoit I was. But they LYE ! LYE!!! What do I do about them tring to sue me????
I am looking to communicate with anyone who has had a bad experience with MEGA Health & Life Insurance Company (sponsored by the National Association the Self Employed – NASE), especially in regard to paying excessive premiums for insurance coverage that left them stuck owing unexpected and excessively high out-of-pocket expenses that they believe the company lied to them about when they were sold their policy.
I have a law firm preparing to sue the company, and it would be helpful if others can share their experience and/or want to join in the suit at absolutely no cost to them.
I can be reached at: tmitche22@att.net
Thank you.
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