Complaint / review text:
I am unemployed and my COBRA insurance ran out so I enrolled for health insurance with Golden Rule as they had the best prices for what I needed. I listed my child's Attention Deficit Disorder (ADD) and her medication as a pre-existing condition.
I chose this policy because my child's doctor is in there network and the medication she needs is on the list of covered drugs. I didn't try to hide anything. Why would I enroll for a policy that did not cover a pre-existing condition? They have covered the medications for the first 9 months and now they have denied the pharmacy coverage for this medication because I didn't enroll for "Mental Heatlh" coverage.
I asked them why they have covered it for 9 months and they told me that it was an "error" in their system, but they weren't going to try to collect any additional money from me (like they are doing me a favor). I asked why I wasn't notified of this "change" so I could make other arrangements. The first person I spoke to said they sent a letter, which I told them that they did not. The next person I spoke to pulled up my account and said that there was no record of notification sent out.
I then asked about adding the coverage and they said that I couldn't change the policy. I asked if I could cancel my policy and then enroll for a policy with the needed coverage. I was told that if I re-enroll with their company within 6 months of cancellation that I have to enroll in the same plan that I had before. I told them that no where in the enrollment was I made aware that I needed additional coverage and that the approved contract they sent me included the pre-existing condition but did not note that it was not covered.
I asked to speak with a manager and the customer service rep refused and said she would have someone contact me within 24 hours. I got a voicemail from another person who just read me the same script that the others did, and never explained why I wasn't notified, and they did not leave me a direct phone number to contact them if I had any questions. They only left a first name and the customer service 800 number so I may never be able to track this person down. I have reviewed my policy and enrollment papers and while in the billing section there is no dollar amount being charged for Mental Health Coverage, I found that the pre-existing ADD I disclosed on the questionaire is listed under "Brain and Nervous System".
There were no medical conditions or any sub-category listed as "Mental Health" on the questionaire. This sure smells like Golden Rule has reclassified the condition as "Mental Health" in order to deny prescription coverage and save money.
If the insurance company doesn't get this fixed it will cost me 3 times more to purchase this medication without the insurance coverage. I have already contacted the Insurance Commissioner's Office in my State and will also register the complaint with the Better Business Bureau.