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afederalemployee
June 19, 2011
Think long and hard before choosing them
This begins my second and last year with SAMBA Health Insurance Plan. They have a practice of frequently denying legitimate claims. (I was too busy and let the open season come and go without changing plans. Now I am literally paying once again for my failure to change insurances.) Here is but one example: My daughter. age 21, is covered by my insurance. She saw an active PPO provider with SAMBA for a couple of dozens chiropractic sessions. SAMBA has a separate $300 deductible for such and then covers 12 treatments in a calendar year. SAMBA applied none of these treatments to her calendar year deductible. They have paid a total of ZERO. After numerous e-mails and calls, they admitted they did wrong and said they would pay. They never did. Instead I received yet another statement rejecting all chiropractic claims. Unbelievable. This has been going on five months. A second example: Last year my husband paid thousands out of his own pocket for medication because SAMBA tried to claim a third party was responsible. I asked them to look into the matter and get back with us. Months later I had not heard anything back from SAMBA. I finally called SAMBA and was told they had made a mistake and that he was covered. We haven't yet resubmitted those claims for payment. My husband believes it would be just a waste of time. He is probably correct. OPM should drop this plan.
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ShoK08
August 27, 2009
Scam
SAMBA Insurance Plan with OPM is something to be watched closely. After ten years with our same doctor and several support systems we have come to rely on for great health care, we have to make a change. During the seasonal insurance network shopping, SAMBA switched to a plan, Cigna PPO, that is not accepted by our primary doctor and a huge chunk of other support such as our hospital of choice, etc. They are saving us money and it was a business decision, (like switching to Nextel from Verizon. In a city, no problem, but on the reservations and remote sites, no service. By the way, they switched back after a year of this improvement.)
Of course, I let the change in providers slip by us, because I did not pay attention the month of and through what is called Open Season with the government agencies. It amounted to a two month window of notice. Not only is this my fault but in twenty years this agency has never put us in this position. I guess I should have been better prepared for this switch. After all, two months notice is sufficient for anyone on the ball after all those years. Besides, Cigna is well thought of in Maryland and on the east coast. Never mind there is not that consensus on the west coast or in Arizona. This is just a simple case of BUYER BEWARE. Being an old dog, I have learned another trick. But I am going to complain, complain, and complain. I would suggest that other people dealing with this same scenario do the same. Cigna stinks and I am so angry that I missed the opportunity to switch because stupid me did not suspect that SAMBA would go to an insurance that did not service the entire nation as well as it does the east coast constituency. Never mind the fact that it appears that a chunk of the previous health support in our area simply will not do business with Cigna. Does that tell anyone anything????
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