TriState Health & Life Insurace

Review: [redacted] sold me an insurance plan that had a $500 deductible for name brand prescriptions and he told me after I fill that $500 I just have to pay a small co-pay each time during the term of my insurance plan. I agreed with giving him payment and got my plan Id number from [redacted] which he sent to me on Dec. 31, 2013 and I called in my prescription to [redacted] then and picked up my medicine in Jan. 2014 and paid $425 (thinking I would only have to put $75 down more to reach my deductible. Though [redacted] failed to tell me that plan works on a calendar year, so since I put down on Dec. 31st when he gave me my RX number I should of waited till the next day to put in the order for the medicine. Now I have to put up $425 again to count for my deductible. [redacted] failed to tell me that my plans deductible starts Jan. 1, 2014 and told me it started Dec. 15, 2013. Very misleading and I would of definitely waited till the next day to fill my prescription if I knew this information from my sales person I was counting on to help me. I wasted $425 and would like it back. I wrote [redacted] many times and called him and he never returned my calls or emails. When I finally spoke to him he shrugged me off the phone and hung up on me as I was talking mid sentence. He was very nice selling me the plan, but as soon as I had one problem he ignored me and wanted nothing to do with me. Extremely bad business practice.Desired Settlement: I want my $425 back and for [redacted] to treat future customers with respect if they ever have issues with a service they purchase through him,

Business

Response:

in response to your letter of a Filing of a complaint form [redacted] concerning his [redacted] health insurance policy andbenefits:I spend a considerable amount of time explaining in detail each service and component of a health insurance plan,how the services are to be utilized and how claims are to be paid for each service when used,I recall the several conversations that [redacted] and I had about the [redacted] health insurance plan that he choose to purchase.[redacted] had a copy of the plan ,and he asked questions about each and every service and component of the plan before placing the application with me.l also explained in detail how the RX-prescription plan is paid out.The generic portion of the Rx card has no annual deductible-but the brand name potion of the Rx card does have an annual $500 deductible to meet first-and then the brand name Rx is covered at a $35 copay.[redacted] purchased the [redacted] PPO 1500 plan for a 12/15/2013 effective date. His was well aware that the brand name portion of the Rx card had the annual deductible,and the deductible was not met for 2013-due to the policy being a new policy with a 12/1/52013 effective date.I informed [redacted] that he can call and work with the [redacted] Pharmacy dept to try to settle this matter.Phone # ###-###-####.As the insurance agent,I cannot monitor a client usage of their health insurance plan,I can only explain in detail and educate a client on how to use the plan.If a client does not follow the guidelines and stipulations of how the plan I setup and designed,that should not be my liability.I trust that you will expunge [redacted]'s complaint and I will have a clear and clean record with your Bureau.Thank you!

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

Mr. [redacted] is not correct as he never told me that my $500 deductible will start Jan. 1, 2014. He said I would be in effective coverage starting December 15, 2013. He said I have one year to pay a $500 deductible and never said I need to wait till January 1, 2014. If he did I would of never filled a $425 prescription on December 31, 2013. I would've simply waited till January 1, 2014. He sent me my insurance information on December 31, 2013 only because I asked for it because I said I will need my medicine soon and said nothing of the matter that I need to wait till January 1, 2014 before I start working towards my deductible. I feel at that point that would be his responsibility and his knowledge of his business to tell me a such a thing at that time. I had trust in using his services and feel like I was misinformed. When I emailed him about the situation he never responded to me. I waited a few more weeks and emailed him again and he did write back to that one. When I did call him he Hung up on me two times or rushed me off the phone and then would hang up.

Regards,