Attention self-employed folks: Before patting yourself on the back for finding that deal with Mega Life & Health for health coverage, think twice, put the pen down, sign nothing and step back.
Anyone reading this blog for any length of time knows I have no great love for health insurers. I believe they bend backwards as far as possible to avoid paying claims while hammering their policyholders for more and more money. One of the primary reasons I supported Barack Obama for President was his promised pragmatic and transparent approach to health insurance.
With that bias disclosed, I have this to say about Mega: There is a special place in hell for insurance companies that victimize individuals who are forced to pay far too much for far too little, especially self-employed individuals who struggle daily to stay above water, much less tread it.
This all started with a friend’s recent onset of chest pain. It continues, and without going into detail that would maybe violate privacy, it should have been resolved already. After all, if one pays exhorbitant premiums to insure for potential catastrophic health conditions, it stands to reason that chest pain is something that should be viewed as an emergency, right?
Maybe it’s not a heart thing. Maybe it’s one of a zillion other things, but without actually getting to an emergency room and being hooked up to an EKG there’s not much chance of knowing for sure. Heart attacks don’t exactly wait until the appointed time to threaten one’s life, after all.
Only one problem: Under one of the weirdest provisions I’ve ever seen in a health insurance policy, if someone goes to the ER and pays for it themselves (because ER services aren’t covered), there is a risk that treatment for the diagnosed condition won’t be covered.
That’s a problem. So instead of being examined, put on that EKG, monitored and diagnosed, another day goes by before getting to an approved non-emergency provider.
Chances are it’ll all be fine, but would YOU willing to roll the dice on that? I wouldn’t. If chest pain isn’t a potential life-threatening emergency I can’t imagine what would qualify. Death? Coma?
This is not cost management. It’s not case management. It’s flat-out profiteering on the backs of hard-working people who pay premiums with a good-faith expectation that claims will be paid and benefits available when they need them. Insurance is not a charity; it’s a contract between insurer and insured. In Mega’s case, it seems that they view it as one-way: Insured pays; they withhold or deny.
Here are some stories from the first page of Google results for this company:
From The Health Care Blog:
Over at Colorado Health Insurance Insider I found this tale of woe of an electrician earning $40,000 a year with no benefits who joined Mega’s front organization the National Association for the Self-Employed after being sold a bill of goods by a commissioned sales rep. His son had cancer and ran up bills of $500,000 of which Mega paid out $45,000.
From the same post, some interesting background on Mega (a wholly owned subsidiary of Health Markets):
Who owns Health Markets? Like many companies it’s owned by “private equity”. But in this case these are not just any private equity companies. The three owners are a) the biggest and now publicly traded private equity firm, Blackstone Partners, b) the most prestigious and most profitable investment bank, Goldman Sachs, and c) a unit of giant European investment bank Credit Suisse. While the owners and employees of these august organizations are making their mega-millions, it’s about time that they paid some attention to what their “investment” is doing to the people it’s supposedly serving.
This post was written in July, 2007, long before the financial market meltdown, but still it’s worthy, particularly since Goldman Sachs has been given preferential treatment by Congress.
It’s also worth noting that just like Firstline, Mega uses inexperienced agents with little knowledge beyond what training they’re given by Mega (which means they’re taught the company line with no knowledge of what they’re selling or whether it’s really best for the client).
BusinessWeek has a report from 2004 about Mega’s involvement with the National Association for the Self-Employed entitled “It’s Enough To Make You Sick“. I agree. It is. From the article:
A few months after Doug started chemotherapy, Cedars-Sinai Medical Center refused to treat him anymore, saying he had already used up the MEGA coverage. The problem: It capped chemo coverage at $1,000 a day, even though Doug’s cost up to $18,000 — fine print Dana says they were never told about. The doctor got Doug transferred to another hospital. But after he died in October, 2002, at the age of 48, Dana was stuck with almost $500,000 in medical bills that MEGA refused to cover, and now lives on her boat to save money on rent. “He said to me one day, ‘I know it’s too late for me, but this should not happen to people,”‘ recalls Dana, who says the NASE rep never told them that it functions as MEGA’s marketing arm and only sells MEGA insurance. Last year, she sued MEGA and NASE for failing to disclose the caps and for endorsing a “sham” policy by pretending NASE was an independent group
If I wanted to, I could rant about how unethical it is for a company to send an agent out posing as a representative of this so-called association for the self-employed. But I don’t want to rant; I want the facts to convince anyone reading this to either change insurance companies or not sign up with this one.
Being self-employed is difficult enough in these times without being victimized by investment banks that are being rescued by those same hard-working people, the taxpayers here in this country.
As I said, hell has a special niche for the masterminds of these schemes. I hope that those CSPAN debates that Obama promised will take place soon, rendering companies like this irrelevant. In the meantime, please read the links here before signing on with them.
If you’re already insured by them, look for a Blue Cross/Blue Shield plan or equivalent. It will be more expensive, but they are at least somewhat more reliable about claims, and certainly will cover a trip to the ER for chest pain, particularly when that trip is recommended by the first-line provider.
Excuse me while I consult with Satan about the decorations for the rooms he’s preparing for the executives of this company. I want to be sure they are able to view the hells on earth they created for their insureds while raping their wallets.
- Shards of Light and Seconds
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