Employee Benefit Management Services

Refusal to pay claim for emergency care - EBMS stated that I had to fill out a medical release form to consider my claim and make sure that there were no pre-existing conditions. So I filled out the form and returned it to the medical records department. EBMS was called by me to verify if they had received the release for my medical records and they said no. So I called the medical records department and they said that EBMS was notified that the records could be released but there was a fee for them. So I called EBMS back again, they said they do not pay for medical records, but if I would like, I could pay for them myself, and submit them. Then they could review my claim.

The day that I went to the emergency room, I had severe pain and diarrhea. Never did I think that this would turn out to be such a nightmare. Consumer Bill of Rights states that if you have severe pain or sudden illness that convinces you that your health is in jeopardy, you have the right to receive screening and stabilization emergency services whenever needed, without prior authorization or financial penalty. This is posted on www.ebms.com.

My youngest son has multiple disabilities due to a genetic disorder. When I remarried, my husband and I went to genetic counseling to determine the risk of having another child with the same genetic disorder. The doctor ordered blood work and it was discovered that I am the carrier of the defective chromosomes. EBMS refused to cover genetic counseling, calling it "medically unnecessary." When I explained that my son required a two-week hospital stay at birth, heart surgery ($200K) and has ongoing medical issues that we were trying to avoid with another child, I was told "it is medically unnecessary for you (the covered person)." In addition, my husband went in for a yearly exam. They are currently refusing to cover blood work (cholesterol, etc.) as "medically unnecessary." Staff is pleasant but policies are unsettling and disappointing.

EBMS refuses to pay benefits on pre-approved procedures, and attempting to find any excuse they can to deny benefits. You cannot deal with one person, it must be several. They will tell the billing departments an excuse of denial and will tell you something totally different. They are denying all benefits for me, my wife, and children stating pre-existing or other when it does not apply or have merit. It does not matter what the claim submitted is for they deny them. We are expected to pay the premium each month only to be denied benefits.

EBMS cancelled my family's cobra health insurance because our check hadn't included their new 120$ a month rate increases ( our book keeping error ) the rates have gone up every month since we started with them. They decided to keep the money anyway and deny us coverage. The reason we are on COBRA is because I don't have a job, we are deeply overdrawn and facing an insurance company that is robbing us and our government (stimulus package pays 66 percent of the premium)

on insurance group to manage benefits.

On December 18, I was in an accident. I had been drinking and called for a ride home from my neighbors. While I was on the phone I told them that never mind someone came in that would give me a ride. There was an accident. I told the officer who arrived that I was not driving and kept on saying that...at any rate I had amnesia from a concussion and could not prove that I was not driving and was eventually cited with per se dui. From the onset of the insurance claim for my medical bills the insurance denied all claims due to a exclusion illegal acts paragraph. I appealed and just now was informed that they will not cover any medical expenses. I personally do not understand that when you pay to have coverage and pay almost $1000 a month and I have been covered by them for about 15 years that health insurance can condemn you and judge you before a legal system can. I plead not guilty and still believe I was not driving. However due to expenses of an attorney and the medical bills I am facing now I simply had to plead guilty. Anyway,...is there any reasonable dispute in this for me and would mediation if possible be viable. Thank you