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rolex452
May 27, 2010
Non-payment of claims: Fraud
IMPORTANT: American Medical Life Ins. Co. (AMLI) located in New York, NY is a fraud. They underwrite "limited liability" health insurance plans under different plan names: "AIM", "CYNERGY", "I CAN", and "CORE VALUE" insurance programs. Bascially, you go to a doctor or hospital which accepts the "Mulitplan PPO", who writes down the claim (you get a discount off the full price). Then, AMLI kicks in a little bit of their money toward the doctors visits (5 per year), some tests, or the hospital stay. The grabber is that the premiums are reasonable and THEY ACCEPT PEOPLE WITH PRE-EXISTING CONDITIONS AS WELL WITH NO WAITING PERIOD. This is as close to a "real" health insurance policy as many people can get. I signed up with the "Core Value" plan through a licensed Fla. agent as of Jan. 1, 2010. In late January and early February, I visited a Multiplan Opthamologist three times, and these claims were submitted to AMLI quickly. IT HAS BEEN FOUR MONTHS NOW, AND THEY REFUSE TO PROCESS OR PAY THESE LEGITIMATE CLAIMS! They have been sent the claims FOUR TIMES, and over two dozen telephone calls to the claims office number. They say they are having "computer problems" and promise to pay the claims, which they have not done! The doctor must get paid, and I have to pay the doctor myself, even though I have "valid" insurance. I filed a complaint with the State of Florida, who wrote a letter to AMLI, gave me the name of a contact person there, who would get things started if we send the claims to her office. HOGWASH! She never got the claims processed, and refused to communicate with my provider or myself. I told the Florida State office that nothing was done, and AMLI ignored both me and the State of Florida. What does the state say? "Sorry, that's as far as we can go...we have no legal jurisdiction in these cases." Yes, the State government gives every fly by night bunch of creeps with minimum amount of assets a license to sell insurance in their state, but when the company takes your money and gives you nothing, "we have no legal jurisdiction. you will have to sue them". THAT'S OUR GOVERNMENTS IN ACTION! So, here's the bottom line: DO NOT, UNDER ANY CIRCUMSTANCES BUY ANY POLICIES UNDERWRITTEN BY AMERICAN MEDICAL LIFE INS. CO. No matter how good the premium prices look, no matter what the agent tells you (by the way, my agent washed his hands of the whole thing, gave me a couple of complaint numbers, and backed off...no help from him), do not sign up with any policy connected with them. They have complaints against them in New York and Florida, and they have been fined for false advertising of their services. Stay away, PLEASE!!!
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