My husband and I were forced to shop for insurance when he left his job where we were under a group policy (oct 09). We wound up with HealthMarkets/Midwest Life Ins Co of TN/Alliance for Affordable Services. After reading about this company/companies online recently and their fraudulent practices I feel stupid for ever going with them.

"..we're a non-profit group..." (riiight...)
We were drawn in by the agent (who found us after I filled out a form on the internet for a insurance quotes) . His selling point was that he worked for a non-profit group and we could get low cost insurance with the same type of coverage or better than we had currently.

His words, "it doesn't matter to me whether you pay $100 or $1000/month, because we are a non-profit, I can get you the same, if not better coverage than you have right now."
(Right...and after that he may as well have tried to sell us a bridge...)

We had to meet him in person. For over an hour I stressed to him that I had fibromyalgia and other spine-related chronic pain issues which were all related; that I was on medication; and that in addition to medicine, I had been getting SI joint injections (Sacroiliac), facet injections, trigger point injections and epidurals throughout the years to relieve the constant pain in my neck, hips and lower back and that was the main purpose for us getting insurance.

The agent filled out our forms, and after going through them, there are so many mistakes that I should have caught early on, but didn't because I trusted him and we felt rushed since we'd been in his office for quite some time.

We even had to CALL to get our packet which we received far longer than ten days after the policy was signed.

I have been seeing the same orthopedic specialist for 2.5 yrs. . I asked several times while he was filling out the forms, if he wanted my specialist's information for the forms (which he filled out) -- to which he replied, it was unnecessary to put his information down -- all he needed was my primary doctor (who incidentally does not treat me for my fibro/back/pain).

"ALL insurance companies require automatic withdrawal."
Also, we were never given the choice of sending a check vs automatic withdrawal. We were told we had to use bank drafts. My husband NEVER uses automatic withdrawal. He hates it. He even called into the agent and we were told we had no choice. Due to paying over $225/mo plus outrageous deductibles for prescriptions, and being a single income family, it would have been helpful to pay via check - allowing us a little leeway with paying bills. As I understand, there should be SOME sort of grace period to pay premiums, but b/c we never had that choice, we've run into problems with our bank account, specifically when they began taking out the extra $40 we were never informed about.

HIPAA..? Who needs HIPAA?

At the time we met with him we were covered under my husband's group policy through work WHICH WAS ENDING.
He left his job on Oct 4th, 2009 and we met with agent Oct 9th, 2009. The policy was expiring on Oct 17th due to my husband's biweekly pay schedule. He had already paid for the benefits for that following week.

Prior to being added to my husband's group policy through his job, I had been covered through my job with the Charlotte police dept from Nov 1, 2007 - March 27, 2009 at which time I left my job to stay at home with my infant son.

After reading the paperwork again recently, the agent had put down that I WAS insured and by an INDIVIDUAL policy which thus made me ineligible for HIPAA portability coverage. WRONG!
(Truth be known that I was covered under a GROUP policy that was expiring due to my husband leaving his job). It clearly states in HIPAA documentation that I could have still qualified if I had group coverage that WAS ABOUT TO RUN OUT. I even brought this up to him when I called him a few weeks ago. All he kept saying was that I was only eligible for HIPAA if I had used COBRA. I had to read him the HIPAA document from the website. To which he replied, "Oh, well you don't want to be HIPAA eligible anyway."

He really stressed that non-profit card. He made it sound as if we were getting group coverage -- the plan even says GROUP on it. There were a lot of inconsistencies/indescrepancies that we had no idea about until recently, when my specialist threatened to release me from his care (and has since done so) due to non-payment of my $2000+ past due account and I was forced to become an informed customer, scrutinizing and researching everything.

I'd have known sooner, if the dr had had my correct address. I got all my bills within a week after I gave them the correct address.

Membership Dues? Separate unauthorized bank drafts?

Additionally, soon after the policy went into effect, there was an extra $40 being withdrawn from our account every month (separately from the premium withdrawal and under a different name of "Alliance") which we assumed was for the 25% increase we received a letter about after we bought the policy. NO. It was a membership fee.

Nowhere in my paperwork does it say ANYTHING about this fee. We also didn't authorize an additional transaction from our bank account for this fee. The only thing I could see on the policy was that the original premium was $xxx and for our convenience, our billing amount includes charges for our premium and any optional benefits chosen. We also have a cancer rider, dr visit option (WHAT PLAN makes you ADD doctor visits?), prescription and such...which is what I interpret the "optional benefits" to be.

Group, or not a Group? - That is the question...

Right at the top of the beginning of the policy is states:
Coverage is provided under GROUP POLICY NUMBER xxxxx
Issued to Group Policy Holder: Alliance for Affordable Services.

We were lead to believe this was a group policy under this Alliance non-profit organization, and therefore we would be benefiting from GROUP coverage!

In the policy, on my Physician Office Benefit Rider, it states that dr visits DO NOT COVER IMMUNIZATIONS, routine examinations, and preventative care...I have a TODDLER...he has now missed his last two check ups because we can't afford to pay full price on TOP of paying premium. Its my understanding that if a company offers "Group Coverage" there are certain laws they are required to abide by, certain things they are required to offer.

Though after researching, I am pretty certain (like 110% certain) this is NOT group coverage...the fact that it was sold to us with that implication was extremely misleading. The agent also pushed higher deductible plan to us stating premium would be lower. Great. He failed to mention that the $3k deductible for outpatient, hosp etc was PER PERSON...PER PROCEDURE. Therefore, my spine procedure back in December that cost around $2k (that my dr recommends 3-6x/yr and really helps my sacroiliitis pain) has to be paid by me.
My $170 dr appts every month - insurance would have covered only $75...OH WAIT, they would have covered $0 because it has to do with my EXCLUDED spine.


We're going to charge you 25% more for everything because of your Fibromyalgia...but we won't cover anything involving your back pain...(what?)

This lack of coverage is now going to dramatically decrease my quality of life, due to the fact that I can no longer get treated for my fibromyalgia-related and spine problems ... since I cannot afford to pay my doctor at this time.

The first thing I noticed that seemed ridiculous when I went through the policy was the "Special Exceptions/Exclusions" and Pre-Existing Condition addendum...which at the time I was clueless about.

It states:
The premium on the Health Coverage has been increased 25% on [me] due to Fibromyalgia

The premium on the Ambulatory Care Rider has been increased 25% on [me] due to Fibromyalgia

The premium on the Prescription Drug Plan has been increased 25% on [me] due to Fibromyalgia

and then the punchline:
[me] ---Shall not cover nor shall any indenity be payable for any injury, disease or disorder of the spine including its muscles, ligaments, discs or nerve roots and/or complications thereof.

First three lines, ok I get it.
What I DON'T get is the fourth line, I now understand is called an exclusion.

Here's the problem. MY FIBROMYALGIA directly affects my spine, both lower and upper. Read anything about Fibromyalgia pain and it'll tell you the same. See below.

[Fibromyalgia Definition: is a chronic musculoskeletal syndrome characterized by pain, achiness, tenderness, and stiffness in the muscle tissue, ligaments, and tendons. Fibromyalgia most frequently affects the neck, shoulders, chest, legs, and lower back. Pain is generally accompanied by sleep disorders, fatigue, gastrointestinal disorders, and depression. Many fibromyalgia symptoms are similar to symptoms of chronic fatigue syndrome, myofascial pain syndrome, and temporomandibular joint syndrome (TMJ).]

[Fibromyalgia is a fairly common condition marked by chronic, widespread pain and tenderness, and aches in the neck and back pain are one of its chief symptoms. The experience of constant fibromyalgia-related neck and back pain can be highly debilitating. Fibromyalgia pain occurs at 11 or more of the specific points that doctors examine when diagnosing fibromyalgia. These areas are called "tender points." Patients with fibromyalgia will experience significant pain even when tender points are pressed lightly. The neck and back contain 10 of the 18 tender points on the body, which helps explain why fibromyalgia-related neck and back pain is such a common ailment.]

References • Arthritis Research Campaign • Mayo Clinic • National Fibromyalgia Foundation


Let us give you 4 different answers, YOU pick the right one. We just can't decide...la di da di da

After realizing what the addendum was, I called the insurance company and agent several times. I asked why was I being charged more for my pre-existing condition of Fibromyalgia, but anything involving my spine was excluded.

I got different answers.

CSR, "K" said: "Get your doctor to write a letter stating that the treatment foir your spine is in no way related to your Fibromyalgia." (that makes NO SENSE) "...then file an appeal."
CSR, "CA" said: "Oh, just send in your proof of creditable coverage from your last insurance company, wait 24 hours, then call to confirm receipt and that should do it."

In the interum, I spoke to agent and he said the same thing 'CA' did.

So I called in after the weekend and was old by CSR, "L", "Well this isn't going to do anything. They aren't going to remove the exclusion"

Not once did anyone tell me how MUCH prior coverage I needed to prove.

FINALLY after researching online, I sent them BOTH my certificates of creditable coverage from my two previous insurance companies that totaled 23 months of coverage. No one told me that was all I had to do.

I sent agent my paperwork and a long email, called him several times. Finally, he said to call him back the next day after he got a chance to go over it with the insurance company. So I did.

Agent said: "OK, now that they have the proof of creditable coverage, they are going to go back and wipe out the pre-existing condition exclusion, and it'll be like 'starting fresh'. Just call me back next week after they've had a chance to talk to me."

Then came Tuesday, March 9th. I had to call them from my dr's office after my specialist refused to see me for my sched appt that day stating they needed proof the insurance would be covering the costs and/or I had to pay $590 (1/3 of the bill).

So I called from my dr's office and spoke to "Customer relations supervisor, "D" who assured me she'd make sure the claims were redone by wednesday. She gave no indication that they WOULDN'T be covering them.

On Thurs, March 11th, when I called them back to check progress on my policy being adjusted and claims being resubmitted.

I was told by CSR, "A" after she conversed with Supervisor "D"...they were NOT doing anything or paying any part of the bills.
This was after I was told by my agent that they would be redoing my policy because I sent in the certificates of creditable coverage.
This was after I spoke to a customer care supervisor, "D", on Tuesday who gave no indication of the sort.

I have been told so many things my head is spinning. Bottom line, they ain't payin'. I now have no doctor. No treatment. No medicine. AND no money.

***The problem and question still stands though, "Why are you charging extra for a condition and then refusing to cover treatment for that condition?"

After paying out money in premiums since november and this so-called membership fees and getting no care, help at all...we could have paid cash for my dr and I'd not be in the shape I'm in right now.


Lemme Tell ya What you want to hear...I get paid either way...

All I stressed I don't know how many times was, "I have to be covered so I can go to my specialist" and "we mainly need the insurance because of MY health problems"

All he did was placate us, saying not a problem, not a problem and push the nonprofit thing, "low premiums" and neglected to explain scheduled policies, per-incident deductibles and basically everything that, pardon me...SUCKS about their policies!!!

We trusted him.

I am more angry about the misrepresentation in their materials as well as the blatant sidestepping by the agent. I feel like we were lied to in order for us to sign up for this policy and after paying out hundreds of dollars in only a few short months for premiums and so-called membership dues, I literally have not gotten anything in any way shape or form to HELP me...in fact, they have ruined my long-standing relationship with a good specialist, have caused me to lose treatment and now I get to try and take care of a 1 yr old (who still needs a check up) and household while suffering from the full effects of my illnesses.

And to think we (my husband and I) went without much food for months in order to make sure we had money to pay for insurance...

Most laypeople have NO CLUE, and we rely on the salesperson/agent to inform us. That's what happened to us and we were sold a crap policy and grossly misinformed! It makes me sick, literally.

My husband is eligible for benefits through his current employer as of May 1, and we'll be enrolling. Unfortunately, the damage is done concerning our finances, my health and my dismissal by my specialist.

This company cannot get away with this.