Mega Strikes Again NASE/UGA/HEALTHMARKETS

[NHB_MMA]

IT'S A nice-sounding idea: Ban health insurance that lacks comprehensive coverage. Defined-benefit plans, one activist says, should "never hit the market" ("Low-cost insurer leaves some with bills and a bitter taste," Business, Oct. 31).

That's like requiring everybody to drive a Lexus. Trouble is, not everyone can afford Lexus-style health insurance. More than 1 million insurance customers choose HealthMarkets companies because we offer value, flexibility, and affordable rates.

The fundamental problem is that when I was with NASE, we were trained to leave the clients with the impression that this coverage was more than adequate for most situations (and were new to the business and actually believed it). In the spring of 1998, we were told that room & board charges were about $180 per day, total maternity charges were often around $3500 (I think that one was addressed a few posts ago), and that miscellaneous expenses are usually the smallest portion of a hospital bill. It's amazing how blind I was. I don't know why I didn't say "Hey, why not just charge a little more and take away the limitations, so they're not even an issue?" Well, MEGA had it's reasons.

Aside for clients believing that they had far better coverage than they did, most would never realize just how much out-of-pocket liability they have until it's too late. Take the maternity example. MEGA paid $4100 and the client was left with $24,000. Know where managers that teach rookie salesman to say maternity is around $3500 should be? In prison.

Here is how MEGA makes its profits. They walk-in with a five-year old Kia, look at your Lexus, and convince you that you're paying too much and that you can actually get better quality by buying the Kia. And, as John mentioned, in some cases they'll actually charge more for the junked Kia. It sounds laughable that anybody would do such things, as nobody would ditch the Lexus for a used Kia...but the prospect doesn't know any better.

We work to ensure our customers fully understand the products they buy. We contact every new customer who purchases a defined-benefit policy to review selections. We have made approximately 160,000 benefit confirmation calls since 2005.

Things weren't that way when I was with them.

Because of the high cost of comprehensive insurance, many people face the difficult choice between limited coverage and no coverage at all.

Only a colossal dumbass would replace a major medical policy with a policy that might not pay 1/4 of the bill at times, to save let's say 25% on their premium. Again, the scheme works because the public doesn't know any better.

 

[STIBROKER]

Eric2000...how proud you must be.....


http://www.sacbee.com/103/story/73084.html

Health fraud suit is tossed

Couple wasn't duped by insurer, judge says.

By Andrew McIntosh - Bee Staff Writer

A Nevada County Superior Court judge has dismissed a lawsuit filed by a Penn Valley husband and wife who claimed they were duped when they bought health insurance from a Texas firm and were plunged into a financial crisis after falling ill.

Judge Albert P. Dover rejected the claims of David and Darlene Henderson, saying they received exactly the benefits they signed up for when they bought a policy from Mega Life and Health Insurance Co. of North Richland Hills.

Dover suggested consumers must read the fine print before they buy any insurance policies, adding he saw no evidence that the insurer or its sales agents engaged in any fraud or made misrepresentations.

Michael Heenan, a Sacramento spokesman for Mega Life and Health, said this fall's ruling totally vindicates the Texas insurer, which maintained from the start that the couple's lawsuit was without merit.

"The court has sent a message to trial lawyers and their plaintiffs: Lawsuits that allege misrepresentation will not succeed under fair consideration and scrutiny without supporting evidence," Heenan said.

Henderson said the couple were saddened by the loss.

"My wife took the news very hard. We've gone through so much," Henderson said. "We feel the ruling didn't serve justice. It's devastating."

Antony Stuart, the Los Angeles attorney acting for the Hendersons, said he is appealing the verdict. The notice of intent to appeal was filed in late October.

The case will likely be heard in 2007, possibly in coordination with a half-dozen other cases filed by dissatisfied Mega Life consumers, Stuart said.

"The court's decision is rather frighteningly: 'Buyer beware,' " Stuart said. "Dave Henderson was promised catastrophic coverage, and he got limited coverage. He got a mild discount on his expenses."

The Hendersons, who run a small directory business from their Penn Valley home, went to court in 2003. The couple bought health insurance through the National Association of Self-Employed and its sales agent.

For $400 a month, the couple said, the Mega agent told them that they could have a catastrophic group health insurance policy that would cover 80 percent to 100 percent of their hospital costs up to $1 million.

In 2001, Darlene Henderson became ill with breast cancer. David was later felled by an aortic aneurysm the size of a baseball and needed emergency surgery.

Those medical misfortunes left the Hendersons with more than $210,000 in medical and hospital bills.

Mega Life covered $33,428 of the Hendersons' bills. The couple were left stunned and quivering when they learned they still owed more than $180,000.

The Hendersons asserted their agent didn't emphasize or explain critical information:

• There was no cap on their out-of-pocket expenses with Mega Life, unlike traditional health insurance available through large employers.

• Their benefits had daily maximums far below the average cost of modern-day medical procedures and hospital stays.

The Hendersons said that they hadn't read their policy's fine print but acknowledged they looked at an agent's term sheet describing the policy.

Heenan said there were no misrepresentations.

The California Foundation of Taxpayer and Consumer Rights has denounced Mega Life policies as "skeletal."

The group said Mega Life's policies are so technical and riddled with jargon that the Hendersons were unlikely to have understood its limits if they had read it.

Heenan dismissed such criticisms, saying Mega Life's low-cost insurance plans give consumers access to medical care discounts and services. "They work well for the vast majority of people who buy them," he said.

"We work hard to make sure our customers have quality insurance and excellent service at prices they can afford," Heenan said.

 

[James]

Eric2000...how proud you must me.....


http://www.sacbee.com/103/story/73084.html

Health fraud suit is tossed

Couple wasn't duped by insurer, judge says.

By Andrew McIntosh - Bee Staff Writer

A Nevada County Superior Court judge has dismissed a lawsuit filed by a Penn Valley husband and wife who claimed they were duped when they bought health insurance from a Texas firm and were plunged into a financial crisis after falling ill.

Judge Albert P. Dover rejected the claims of David and Darlene Henderson, saying they received exactly the benefits they signed up for when they bought a policy from Mega Life and Health Insurance Co. of North Richland Hills.

Dover suggested consumers must read the fine print before they buy any insurance policies, adding he saw no evidence that the insurer or its sales agents engaged in any fraud or made misrepresentations.

Michael Heenan, a Sacramento spokesman for Mega Life and Health, said this fall's ruling totally vindicates the Texas insurer, which maintained from the start that the couple's lawsuit was without merit.

"The court has sent a message to trial lawyers and their plaintiffs: Lawsuits that allege misrepresentation will not succeed under fair consideration and scrutiny without supporting evidence," Heenan said.

Henderson said the couple were saddened by the loss.

"My wife took the news very hard. We've gone through so much," Henderson said. "We feel the ruling didn't serve justice. It's devastating."

Antony Stuart, the Los Angeles attorney acting for the Hendersons, said he is appealing the verdict. The notice of intent to appeal was filed in late October.

The case will likely be heard in 2007, possibly in coordination with a half-dozen other cases filed by dissatisfied Mega Life consumers, Stuart said.

"The court's decision is rather frighteningly: 'Buyer beware,' " Stuart said. "Dave Henderson was promised catastrophic coverage, and he got limited coverage. He got a mild discount on his expenses."

The Hendersons, who run a small directory business from their Penn Valley home, went to court in 2003. The couple bought health insurance through the National Association of Self-Employed and its sales agent.

For $400 a month, the couple said, the Mega agent told them that they could have a catastrophic group health insurance policy that would cover 80 percent to 100 percent of their hospital costs up to $1 million.

In 2001, Darlene Henderson became ill with breast cancer. David was later felled by an aortic aneurysm the size of a baseball and needed emergency surgery.

Those medical misfortunes left the Hendersons with more than $210,000 in medical and hospital bills.

Mega Life covered $33,428 of the Hendersons' bills. The couple were left stunned and quivering when they learned they still owed more than $180,000.

The Hendersons asserted their agent didn't emphasize or explain critical information:

• There was no cap on their out-of-pocket expenses with Mega Life, unlike traditional health insurance available through large employers.

• Their benefits had daily maximums far below the average cost of modern-day medical procedures and hospital stays.

The Hendersons said that they hadn't read their policy's fine print but acknowledged they looked at an agent's term sheet describing the policy.

Heenan said there were no misrepresentations.

The California Foundation of Taxpayer and Consumer Rights has denounced Mega Life policies as "skeletal."

The group said Mega Life's policies are so technical and riddled with jargon that the Hendersons were unlikely to have understood its limits if they had read it.

Heenan dismissed such criticisms, saying Mega Life's low-cost insurance plans give consumers access to medical care discounts and services. "They work well for the vast majority of people who buy them," he said.

"We work hard to make sure our customers have quality insurance and excellent service at prices they can afford," Heenan said.

Yea I imagine Mega people were celebrating! Yet I wonder, $400 amonth? I wonder how much a HSA with the largest deductible would of been for this couple! Hell of a lot less then $180,000 IMHO.

 

[Crabcake Johnny]

This is my favorite line from the judge:


Dover suggested consumers must read the fine print before they buy any insurance policies

 

[Eric2000]

The Health Choice Plan they are referring to in the article is a scheduled plan with caps, we all know that. This is not the right plan for people who can afford a more comprehensive plan such as the signature, the Premier PPO or Care One Plus. When signing up for a Health Choice plan, the customer has to sign a work sheet stating all the caps etc. This is something these people went through when getting the plan. They also get a phone call verifying these caps. They also received the policy very clearly outlining the caps along with a note giving them a 10 day free look. As a Mega agent, obviously they are only going to offer Mega plans. If the customer wants to look at more options they will. Does that make a Honda dealer bad for not offering Mazda? I have sold 10 or so health choice plans in the last 12 months and that is what the customer chose after receiving all the options. They all signed an explantion of benefits page and all received a call. If they are hospitalized, they know exactly what is covered.

Oh and another thing. Any fool can look at the choice plan and know the caps. Also any fool can research what a hospital room etc costs. So using the excuse that as a new agent you did not know that the caps were not enough is a stupid excuse.

 

[Crabcake Johnny]

Hey man, if you believe in what you're doing then more power to you. I no longer believed that I was offering the best policy for my client's money so I left.

 

[STIBROKER]

This is not the right plan for people who can afford a more comprehensive plan such as the signature, the Premier PPO or Care One Plus.

and your telling me that all these plans do not cap cemo at $100,000 life time and $1,000 a day.......and your Premier PPO has cap's all the way down it....and my clients like a calender year deductible...NOT PER OCCURRENCE...

http://www.insurancepad.com/quote.php#

Oh and another thing. Any fool can look at the choice plan and know the caps. Also any fool can research what a hospital room etc costs.

NOW....what kind of fool sells a plan that still has caps....priced out cemo treatment lately...and RX at a thousand per year....come on....there are $300 a pill drugs out there......

 

[Eric2000]

Ever heard of spell check? This is an outdated brochure as well.

 

[STIBROKER]

Ever heard of spell check? This is an outdated brochure as well.

iz that right........so tell me watts diffrent......or maybe your GA is tearing pages out of your boucher's ........

 

[sman]

Ever heard of spell check? This is an outdated brochure as well.

It's amazing to me that most carriers offer their brochures and rates right on their website, but Mega and Mid-West do not. Why is that? Could it be that they don't want independent agents tearing their product apart and showing the customer the many pitfalls? If you're so proud of your plans, upload the brochures here on the forum. I'm sure none of us would have any problem uploading the brochures from the carriers we represent.