Medical...please humor

Allianz.....refuse to pay....does not respond...claim entered 12/31/2010....JUST TRYING TO MAKE ALL AWARE....We have paid insurance for 6 years....they have yet to respond........also have info of people paying New York Life and fighting for reimbursement.....Buyer be Ware.... Bottom line....like us you pay, and may not have coverage you paid for........ My agent claims it..... is my responsibility to translate policy...not their's. Again FYI

jw












responsibility.

jim w

Jim:

I´m not sure what you are trying to say. We insure through AXA and have had no experience with Allianz so can´t comment. Our experience with New York Life and their dishonest Ajijic agent in those days was beyond awful but that was years ago (2002) so we can´t comment on that company today except to say it would freeze in hell before we EVER did business with New York Life/Seguros Monterrey again. More dishonorable and disreputable people we have never encountered but, as I said, that was years ago and we did business with them through the equally disreputable and unprofessional geezer circle jerk Lake Chapala Society and its then medical director in those days who seems to have been grossly incompetent. I understand that fellow is now in a nursing home which seems to be an assignment long overdue.

I am trying to share with all...been insured for 6 years....originally with Carmen Garcia...Allianz....apparently they dumped her, sometime in 2008.

We don't even recall filling out insurance form....just signing documents....moved our account to Parker in 2007. I was @ Parker Ins., renewing policy, when she called Allianz, asking them if we needed to fill out new application, and they said no, just use the same number for renewal. We have no preexisting, we are into our 4th month trying to recover....Allianz has yet to respond to us. The bill is 18k.....we have hired attorney, as they renewed insurance.....after we thought they had paid....now are fighting for reimbursement.......

BOTTOM LINE You don't know if you have insurance until you file claim!!

Jim W wrote:I am trying to share with all...been insured for 6 years....originally with Carmen Garcia...Allianz....apparently they dumped her for not proper filing.
We don't even recall filling out insurance form....just signing documents....moved our account to Parker in 2007. We have no preexisting, we are into our 4th month trying to recouver....Allianz has yet to respond to us. The bill is 18k.....we have hired attorney, as they renewed insurance.....after we thought they had paid....now are fighting for reimbursement.......

BOTTOM LINE You don't know if you have insurance until you file claim!!

Jim:

This is important enough that I am willing to share my experience with you. You are 100% correct that you only know the value of your insurance once you have a claim and experience the response of your insurance company and your agent in resolving that claim. When we were with New York Life and their dishorable agent and had bought a group health policy through the incompetent LCS, we were screwed to the wall. After we left New York Life and went with ING, now AXA, we had nothing but the absolute best experience imaginable and we have had several serious claims both with ING and AXA under both health and auto policies. Fabulous and immediate service through our agent who is by far the best in the book. If you are being stonewalled or ignored by the Allianz people and/or their agent(s), about whom I know nothing, then something is seriously wrong unless there is some doubt on their part as to the validity of your claim. It would be improper for me to presume to know why you are being stonewalled but if they are, in fact, stonewalling you, something is amiss and who knows who is right and who is wrong. To this day, however, some nine years after the LCS and New York Life acted disgracefully, I still remember that despicable and lying New York Life agent sitting there in his office at the LCS telling me that I had better do his bidding or I would never be insurable again by anyone. I (figuratively) spit in his eye and walked out of the LCS never to return. Life is too short to spend your last years voluntarily on your knees if you don´t have to do so.

Here we go again with Hound Dog bashing New York Life and their agent. It isn't fair since Hound Dog has not COMPLETELY explained the scenario, which the Agent had NO CONTROL over. Hound Dog should be blaming lame brained LCS for not looking into the cancellation and further making you aware that Seguros Monterrey (New York Life) cancelled ALL the group policies of LCS members which they HAD THE RIGHT TO DO because they were losing money on the old timers because of claims. Instead they issued new Individual policies. I was insured withj them then too as was my frioend

We simply switched to a new policy and I having had much experience with Seguros Monterrey and Agent Edgar Cedeno Cadeas can tell you that in the 10 years I've been with them, my quality of service and Agent's response has been excellent. I have had two operations at Del Carmen Hospital, one a Hip Replacement and the other Knee Arthroscopy with no deductible and EVERYTHING was paid for. ALL follow up visits to Doctor's, X Rays. medicatoions, bandages, antiseptics and daily wound changing was paid for. I have had unbelievable PT and my Fosamax paid for monthly.

Edgar Cedeno Cadenas picks up my Facturas and delivers my checks monthly. As far as I'm concerned, and others here like simpsca he is the best.

I cannot recommend a better company. Those of you ho have other Health Insurance companies need to look at your policies and see what is not covered compared to what is covered by Seguros Monterrey. You will be unpleasantly surprised at what is not covered.

There you go again John. You cannot deny HoundDogs experience with your "best" agent. He wasn't good for HD. So get over it. I know who HDs agent is today, he's my agent and I have never had a better agent here or NOB. It is not the responsibility of LCS to verify the products and services of the vendors they allow on the grounds. It's the reponsibility of the consumer. You're happy, HD was not. Case closed and leave it at that. Having heard the story of New York Life from several people I concluded that I would NOT do business with them or their agent. You have no right to criticise the decisions of others based on their own experience. In short, knock it off.

johninajijic wrote:....You will be unpleasantly surprised at what is not covered.

Well, at least we can agree on that John. You will definitely be surprised at, "...what is not covered."

The then medical director of the LCS, Gil Silverman (a really nice and intelligent guy by the way) and the then chairman of the board whose name I no longer remember, told me in 2003 that, and I must paraphrase here, the LCS board knew nothing about insurance and that they had bought into a program, they failed to understand. Actually, I understand why New York Life freaked when they figured out what their agent had sold in those days and wanted to cancel that product as totally irrational and, by its very nature, a group policy to a bunch of old folks, a money losing proposition defying all underwriting principles. It was the lies and deceit spouted by the then agent on the LCS grounds and enjoying, inferrentially, their endorsement, to which I objected.

Shortly after this disgraceful episode I walked out of the LCS and never returned. I would never buy another product or service recommended by those incompetents again. That is not to say that the rest of you need follow my lead.

Let´s just say that when New York Life screwed me over in 2002, I was 60 years old and could walk down the street and find another company at my liesure. I have often wondered what others more elderly than I, who had been absolutely assured of guaranteed lifetime group health coverage by the incompetent LCS board and medical director, did when shopping for alternate health insurance. The New York agent at the time threatened me that if I did not accept his two-bit and entirely unacceptable alternative to the LCS group insurance policy, I would never be insurable again. A disingenuous and deceitful posture. Despicable.

You want to continue this crusade on behalf of these bunglers, John? I really don´t care to continue this and I have a lot of respect for you in many ways but why you roll over for these people escapes me. If you wish to joust, it´s your move. I would like to simply call a close to this entire matter. You go with your guy and I´ll go with mine.

Dawg, I know the agent you are talking about for New York Life back in 2002, and he was terminated by New York Life about a year or two after the cancellation of the group policy for some dishonest practices on his part. I doubt LCS had any idea of what they were doing in sponsoring a "group insurance program".

The new agent Edgar Cedena - I have not had any problems with him. In fact when I needed to be hospitalized for pneumonia immediately in November last year, I called him on his cell phone, asked what to do, and he sent me to San Javier Hospital where Seguros Monterrey New York Life has an office. The insurance company came up to my room with the claim forms immediately and my doctor filled them out. That way I only had to pay the deductible and co-insurance upon leaving.

Edgar gave me a lot of information on the insurance coverage including the fact that if you get prior approval (before going to the hospital), and use an in-network service provider that will accept NY Life payment directly, you only pay the deductible and co-insurance. However, if you just go to any hospital without approval, you have to pay out of pocket and seek reimbursement. and reimbursement may not be 100% depending on the charges of that service provider. They do have limits for certain services clearly printed on the deck page of the policy and other limits throughout the policy.

Like JohninAjijic, I have had many claims paid by NY Life over an 11 year period with no problems. Having said that I don't trust any insurance company or any insurance agent any further than I can throw them. This comes from some professional experience in mu former employment. Some are better than others, so you just have to look for the best. I hear AXA is very good, but I don't know anyone with claims experience with them.

I asked my agent for a translated insurance policy, and was advised she couldn't provide as she would be liable if errors occurred. In our case, this was an emergency covered by the international portion of policy. Allianz, subcontracted to a company in USA ....Olympus....

Allianz is now asking , thru our agent, that we pay in USD, submit ORIGINAL payment receipt for reimbursement.....in PESOS, even though the policy states emergency treatment requiring over 24hour hospital stay will be direct bill and payment.

Jim W

You can have a legal translation done. I use Notario #5 (Macias) in Chapala.

It sounds clear that if they used the provider specified in the US, the provider should pay those bills directly. To light a fire under the agent's bottom I would post on every web board that you are having and insurance dispute and Parker is your agent. You don't have to say they aren't doing their job, but they aren't, and if that gets around no one will be using them.

Given the high percentage of Gringos buying Allianz, shouldn't the agent provide translation? After all, US provides translation for policies in English, Spanish, and French. As you know I am frustrated by Allianz failure to provide anything in writing relative to this claim.....In nearly 4 months, as it is an International claim. We have hired Spencer to set up with GDL Attorney.....our biggest screw up.....Debbie should have said she was last name Gonzlaz....Illegal Immigrant.....would have been NO CHARGE....LOL

JW

Yes, but she doesn't look the part! The only agent I know of who used to do a translation of the policy was the agent who had the "group policy" through Seguros Monterrey New York Life. He translated it himself. But he disappeared after doing something wrong - think it had to do with handling the money. I was due a minor refund and never got it. Since then I don't know anyone who does policy translations. It wouldn't be that difficult, but there may be a liability issue if the agent says there is coverage for something that is not in the policy. My agent did go over many aspects of the coverage with me and keeps me informed of any changes and what they mean.

You are so Lucky Simspsca....We have been screwed and tattoed....Personnally I wish I had gone self insured 6 years ago....with a 25,000 pesos deductible....factored in annually set aside with annual insurance.....we would have 400,000 pesos in bank for emergency today. furthermore paid for travel insurance 1 or 2 weeks per year. For us travel insurance to USA this year for 2 weeks....cost less than $400.00 for 500k coverage per person $250.00 deductible.

I would take your advice posting on the other board....can't...kicked off tooo many times....and they are a total waste of time.

For the record, Allianz has not sent us a letter of denial of claim, nor communicated with us in 4 months............I am so pissed...we are now negotiating for settlement with USA Hospital. The thing that really pisses me off is..Allianz renewed Deb's policy on March 1st....yet denied her claim..of 12/25/2010..and refuses to refund money!....for 2011-2012 premium, including IVA @ 16%.

To all...your agent may be good...however...they are in sales, and easily replaced by the Multi Billion $ Insurance HOG! We collect...we are not in business to pay.

jw

I can't understand why your deductible is so high and premiums also - you are my age and Deb is younger. My deductible was 3,000 pesos, went up to 4,000 pesos, then 6,000 pesos last year and in April renewal went to 10,000 pesos- but half that if I go to in network hospital - which are some of the best. I have not paid half your premiums (1/2 of your total being for one person) and I've had insurance for 11 years with 4 hospitalizations.

Something is rotten in Denmark. Your premiums and deductibles don't make any sense. You can self insure but you have to have your money available - my friend had open heart surgery about 3 or 4 years ago and the all in cost of a quadruple by-pass was $50,000 US. He did have US insurance but had to pay out of pocket and get reimbursed. And I hear you can negotiate the price of surgery and hospitalization.

simpsca wrote:I can't understand why your deductible is so high and premiums also - you are my age and Deb is younger. My deductible was 3,000 pesos, went up to 4,000 pesos, then 6,000 pesos last year and in April renewal went to 10,000 pesos- but half that if I go to in network hospital - which are some of the best. I have not paid half your premiums (1/2 of your total being for one person) and I've had insurance for 11 years with 4 hospitalizations.

Something is rotten in Denmark. Your premiums and deductibles don't make any sense. You can self insure but you have to have your money available - my friend had open heart surgery about 3 or 4 years ago and the all in cost of a quadruple by-pass was $50,000 US. He did have US insurance but had to pay out of pocket and get reimbursed. And I hear you can negotiate the price of surgery and hospitalization.

Simpsca, I regret buying Allianz....I think New York is a far better option, as our rates have doubled over 5 years, and this is our first claim. The rates @ the time I signed up were cheaper....significantly....than New York......however, Allianz seems to feel they have a free ticket for rate increases....yes we have a 25,000 pesos deductible....no claims prior to 12/2010....no preexisting conditions.

For all Allianz insured, with International coverage....the 877 number that appears on the back of your card, is answered Allianz Mexico, yet is subbed to Olympus Miami. Olympus contacted hospital in Oregon, and outsourced providers, claim is denied, on Feb 9, 2011, yet Allianz Mexico, requested more info on the same date. They....Olympus....sub of Allianz, as of April 29, 2011, has not provided us with anything in writing, yet they have our address, voip number, obviously this is stressful, as we don't have the money to pay....given we have paid medical insurance to Allianz for 6 years. Including renewal On the 28th of Feb, 2011.

We have hired Spencer to communicate on our behalf, as our Spanish is limited....to say the least....I share this with all, and hopefully can save you some grief.

Jim W