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Review 4/17/2009
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I agree with the first review. The exact same thing happened to me. I was self-employed and needed coverage that every other insurance company was denying me. I needed to have surgery, and the Cinergy representative told me, after I asked repeatedly, that they would for sure cover 80/20 of my bills as long as I had a letter of creditable coverage from my previous insurer. Long story short, now I owe about $10,000 to the hospital because Cinergy denied all my claims, and I also have bills in collections due to Cinergy not paying claims on time.
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Business's response - by William W.on 5/18/2009
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Stephanie S., we sincerely apologize for any confusion or inconvenience you have experienced regarding your membership and the policy limitations. While we are sympathetic in regards to your unpaid medical bills, our investigation into your complaint has revealed that you were correctly informed of the insurance coverages and limitations. You are correct in that we informed you that you would be subject to a waiting period for your pre-existing conditions unless we received a certificate of creditable coverage from your previous insurer. Once we received this certificate, then your pre-existing conditions would not be subject to a waiting period. However, at no point were you ever informed that this was an 80/20 policy, but rather, you were informed that the plan would provide coverage at 80% of the Medicare rate for covered surgeries. Prior to your surgery, the medical provider called in to discuss the insurance policy and to determine what was covered. They were correctly informed of the policy coverages and specifically the limitations of what was not covered for your surgery. The following day, you called in to discuss what your medical provider had informed you regarding our limitations. We again correctly informed you of the policy coverages and the specific limitations as to what would not be covered. We can understand your frustration that certain benefits are not covered under a limited medical benefit insurance plan that may have been covered under a major medical policy, however, the limitations in certain benefits are why the insurance coverage is affordable. If you have any questions or would like to discuss this further, please call us and ask to speak with the Chief Compliance Officer (x105).
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