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Fortis Health Insurance

• Assurant • Fortis Health Insurance • John Alden Insurance --- News • Connecticut Accuses John Alden, Fortis of Improperly Denying Coverage

David of Cincinnati OH (08/14/06)
I switched my health coverage from Anthem BlueCross/Blue Shield to Fortis on July 11,2003. The coverage was for $7,000,000 lifetime limit and coverages subject to only that $7,000,000 limit. The original monthly cost was $382/month. I had no claims or significant interaction of any kind with Fortis until I received a letter dated November 11,2004. That letter said "we appreciate the opportunity to upgrade your existing Medical Insurance contract."

I had not requested any "upgrade" but they informed me that the old policy was being replaced with a new one. The cost of the insurance went up to $449/month. I winced but filed the new contract and got on with life.

On June 27, 2006, I was diagnosed with Non-Hodgkins lymphoma. It was a long 4 months of biopsies and tests. Shortly before my first chemo was scheduled (approx July 14) I was informed by the oncologist's office that my coverage was already beyond my $10,000 annual outpatient limit. I was astonished since I was unaware that there were any annual cost restrictions. When I checked my new contract, I found that it was one of several "upgrades" to my new policy that Fortis had neglected to tell me about.

They also changed my $7,000,000 lifetime limit to $2,000,000 and put an annual restriction on in-patient expense to $250,000/yr. When I checked my old policy limits, neither outpatient or inpatient was restricted by any annual amount.

The $10,000 outpatient limit effectively denies coverage for the treatment of my cancer.

The guy who sold me the policy is no longer with GT Benefits. The guy who replaced him , who I never met, is no longer with GT Benefits. When I contacted GT Benefits directly, I talked with a person named Julie. I asked her if this was a mistake or intentional degradation of my coverage. She said that it was the coverage that I had applied for. I told her I had applied for $7,000,000 in coverage with no annual restrictions not $2,000, 000 with in patient and out patient annual restrictions. The new policy with its new coverages was sent to me NOT AT MY REQUEST but totally at the behest of the Insurance company. She said she was sorry but there was nothing she could do.

I asked to speak to the owner, Ron Gadinzski but he has refused to call and made himself unavailable when I have called on several occasions. I did not log the dates but it was in the July 8,9,10 , 2006 time frame. On August 1st, I filed a complaint with the Ohio Department of Insurance via internet email.

By changing those limits they intentionally left me without coverage for financially catastrophic medical illness. This was no accident, they wrote a letter to deceive me into not checking the major changes they made in my coverage. As a result I have to pay for the huge cost of treatment and follow up for my cancer. This is just FRAUD. I was 53 almost 54 when I got the notice of the impending upgrade in my coverage. I am sure many other fifty-something customers got the same upgrade. Only those unlucky enough to get cancer find out how that upgrade works. I don't know if this has a legal name but I called FRAUD.

I am facing inexcess of $30,000 in chemotherapy and other medical cost this year and who knows what in the future. If the lymphoma reappears in the future, I face the same dilemna over again. I'm sure I'm not the only 50-something guy that this insurance comany has done this to. There have to be thousands out there in my circumstance.

Peggy of Darlington MD (06/01/05)
My husband and I have insurance through Fortis Insurance for the past year and a half. My husband went to the doctor for a pain in his back. Through testing, the doctors felt it necessary to operate to correct the problem. The day before the surgery, I personally called the insurance company and verified that everything had been approved and that everything was in line. I also checked on the total out-of-pocket expense, knowing that he would be out of work for a few months. This all took place in January 2005.

In April 2005 I received a letter stating that our insurance policy was being rescinded. The reason? As in the other complaints that I have read, the insurance company claims that our application was filled out inaccurately. How convenient that they never looked into any of this before a claim was filed. After many calls where I was verbally attacked, and without any help, I contacted the Insurance commissioner. I was directed to file a letter of appeal.

I mailed the letter the end of April 2005. I still am waiting for any type of response from them. I called the insurance company to check on the status of my appeal and have received many conflicting stories. I have heard that they have received the letter, they have not received the letter, the address that I mailed it to doesn't exist, I need to call the medical underwriting department, I need to call the claims and benefits department, etc. Now I can't even get a call back from anyone.

I have paid all of the original stated out-of-pocket expenses that I was originally supposed to pay. Fortunately, everyone else has been very cooperative due to the fact that they have seen this before and know that this is just the insurance company's way out of accepting responsibility. All of the doctors, including the surgeon, have stated that the insurance company is wrong and have offered their assistance in this matter.

Rita of Jacksonville FL (07/18/03)
I purchased a short-term heatlh ins policy from Robert White State Farm Ins agency in Stuart FL last November. I paid my premiums, went to a doctor in Dec, claim was not paid, then ended up in the hospital for possible food poisoning, which resulted in numerous tests, and the hospital wanted me to be admitted but since Fortis had not paid the 1st office visit I signed out into the care of my brother over concern about my coverage. After having CT scan of brain in the ER and the it was strongly recommended MRI and MRA of brain as a concerned was raised that I may have had a mini stroke.

It took until yesterday when I received a letter from Fortis, rescinding my whole coverage for a vague explanation. They say I answered "no" to had I been to a doctor in past 5 years for a garden variety of issues. I don't recall that, I know that I don't have any pre-existing conditions but who hasn't been to a doctor in past 5 years. So they now (July) have sent me a check for my premiums previously paid since November.

I feel that since they got claims, they dragged there feet and between the ER visit and the head scan it comes to roughly $9500 so they have sent check for roughly $500 to me and it's not right. They shouldn't be able to do this after the fact as they had no problem cashing my premium checks, until I actually needed to use them. Furthermore, I asked my original Dr. Hoffman, if there was anything in my chart that could be considered a pre-existing condition and there isn't. I have gone to the doctor over the years for normal everyday things. Fortis had reviewed her charts on my along with some other doctor's office in Jacksonville. I feel very cheated at this point.

I don't have the money to pay for these medical bills and it will ruin my credit. I have put off further investigation of the illness for now as I have been fighting with Fortis since late January over this. This has interfered with my health overall.

Kelly of New Iberia LA (4/9/05):
I had to have emergency surgery on December 1, 2004 for a herniated disc in my back. The medical providers obtained authorization. The reason this was an emergency was my left side of my body lost all feeling and bladder control and bowel control had began to be a very big problem.

It is now April 8, 2005, I have paid all of the medical bills out of my pocket except for the hospital and the doctor. Those are large bills. The insurance company will not return phone calls. I am prepared to file suit and have contacted an attorney. Believe they get their premium money every month drafted out of my checking account and I have never complained about that. These bills need to be paid.

Mary of Kemah TX (10/26/03):
They called me on the phone on July 11, 2003, and offered me 2 months (60 days) free accident and dismemberment insurance and informed me that I could terminate the policy anytime. They sent me a statement on September 15, 2003, billing me for the period of 10/01/03 through 10/31/03, which I promptly returned on September 20, requesting that they cancel the policy. They sent another statement on October 1, billing me for coverage for 10/01/03 through 11/30/03.

I called them to explain that I had canceled the policy, and their representative refused to cancel the policy as of September 20 and insisted that I owe them 2 months premium.

Anisia of Talco TX (9/9/03):
I purchased life insurance through Fortis that was to go into effect on May 1, 2003 (my start date at my new job.) The payments of $6.00 a month were to be deducted from my paychecks. The overprice of $15.50 was taken out for 4 months and I never received the policy. Fortis told me that my application has been "laying around the office waiting for someone to contact me about salary information". The Fortis rep told me that I did not have a policy.

I asked for a full refund and was given the runaround. I was told three days later that the policy had been sent to my school district rep. The school distict rep. told me that she did not have it. It was supposed to be sent to me. This particular Fortis rep. also argued with me and told me that she could not do anything for me and to contact the school district rep.

I had no life insurance for myself and my two daughters during the 4 months that Fortis was taking payroll deductions. I have no coverage to this date.

Rita of Jacksonville FL (7/18/03):
I purchased a short-term health insurance policy from Robert White State Farm Ins agency in Stuart FL last November. I paid my premiums, went to a doctor in Dec, claim was not paid, then ended up in the hospital for possible food poisoning, which resulted in numerous tests, and the hospital wanted me to be admitted. But since Fortis had not paid the first office visit I signed out into the care of my brother over concern about my coverage.

After having CT scan of brain in the ER, it was strongly recommended MRI and MRA of brain as a concerned was raised that I may have had a mini stroke, it took until yesterday when I received a letter from Fortis, rescinding my whole coverage for a vague explanation. They say I answered no to had I been to doctor in past 5 years for a garden variety of issues.

I don't recall that, I know that I don't have any pre-existing conditions but who hasn't been to a doctor in past 5 years. So they now (July) have sent me a check for my premiums previously paid since November. I feel that since they got claims, they dragged their feet and between the ER visit and the head scan it comes to roughly $9500 so they have sent check for roughly $500 to me and it's not right. They shouldn't be able to do this after the fact as they had no problem cashing my premium checks, until I actually needed to use them.

Furthermore, I asked my original doctor if there was anything in my chart that could be considered a pre-existing condition and there isn't. I have gone to the doctor over the years for normal everyday things. Fortis had reviewed her charts on my along with some other doctor's office in Jacksonville. I feel very cheated at this point.

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