Shady health insurance practices at Fallon Community health care

[LostnDazed]

I was recently layed off last October, and since then had to start paying for insurance out of my own pocket. I signed up for a comprehensive (but quite expensive for someone who's unemployed and collecting) health care coverage. The first payment, which I specifically had set up to be taken automatically out of my checking account, was taken out in November. Ever since then, nothing. No further payments had been taken out, which essentially means I havent been covered for the past 2 months. In Massachusetts, the state can levy a very high tax penalty if you do not have proper health care coverage for more than 60 days. Furious, I called the company and complained over the phone, at which time I was informed by one of the customer service reps that they'd "get back to me within 30 days" with a resolution.

Not quite content with the response I received, I hung up the phone thinking I'm in deep s**t without any hope for further HC coverage. Absurd! In any case, I later received a letter from Fallon HC advising me that I had 30 days to file a formal grievance in writing or file for an external review from the Department of Public Health Office of Patient Protection. Then today (some two weeks later after I received the letter advising me about my rights to file a grievance), I got another letter in the mail from them. And in the letter??? A bill totaling the 2 months that they had willfully NEGLECTED to take out of my checking account. And this is their way to resolve my issue?? I do not think that what they're doing is legal, and I'm wondering what my next course of action should be. If anyone knows whether what my IP is doing is legal or not, please advise me. And please let me know what my next course of action should be.

[kazz99]

Hi there, LostnDazed,

I'm Kat and I work at Fallon Community Health Plan. We'd like to help you resolve your billing issue. Please call our Billing Operations Department at 1-800-333-2535 ext. 69409, and we'll work with you to fix the problem.

Best,
Kat

[amndalb]

Thanks for sharing!!!!

[Royale]

Thanks LotsndDazed for sharing..

[Royale]

A benefit is a health care service or supply that is paid for in part or in full by Medicare. There are substantial uncovered costs that a supplemental policy can help with.
It is important for you to understand that Medicare does not cover everything, and it does not pay the total cost for most services or supplies that are covered.
If the Medicare Part B was compared to an average insurance policy of the same cost, would one expect part B to be more deficient of coverage Part B covers doctors visits and outpatient care.