Purchased January 2014 under ACA and have had problems since. Second year Our Premium doubled. We have always checked to be sure a doctor is listed as participating in this plan but but have often been faced with “not covered” by the insurance company because 1) another doctor within the same practice filled in for the primary doctor. 2) The doctor sent a specimen/lab/x-ray/etc out to another company (lab company or radiologist, etc) and Consumers Choice said the lab/etc was not approved. 3) In hospital for prior approved work some part of surgery performed by someone (example anathisologist) was not “prior approved”. In other words they require “prior approval” for everything. If your approved doctor does some blood work, then the laboratory that analyses the blood must also be “prior approved”. | Handbook states that emergency services are paid same as “in-network” services. They fail to say that they pay a lower rate for emergency services done by an out of network hospital. They also fail to state that they will not “go to bat” for you at the foreigh hospital emergency room to try to get the invoices reduced to a regular rate. My wife got sick out of state and we called Consumers Choice. They told us to go to nearest emergency room. Consumers Choice has paid $230.00 of the emergency room bill and said that the rest is not covered. I am faced with paying approximately $3000 for the balance of the bills. Emergency room charges were from February 2015 and their last payment was made in August. The reason it took so long is that they refused to pay anything at the start. Their EOB said “out of network”, even though their handbook clearly stated that emergency room is considered same as in network. They took so long that I’ve now been turned over to a collection agency. I’ve also got approx $1100 in bills to my wifes regular doctor for work billed by his associate. Also got several hundreds of dollars of bills for lab work done for my approved doctor by a lab company that was not on their “approved” list. This has been a real disaster and added much stress in our lives.
Name: Consumers’ Choice Health Plan
Country: United States
State: South Carolina
City: North Charleston
Address: 4995 Lacross Road, Suite 1300