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ALLIANZ MEDICAL INSURANCE

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Post by Jim W Tue Mar 15, 2011 6:17 pm

We signed up for Allianz medical insurance in January 2006. Paid for international insurance as well. We switched agents in 2007, as the previous agent charged for two policies, rather than one. Long story short, wife had a stroke in USA, on Christmas Day 2010. Two days in hospital $18,000.00 USD. It has been 90 days, no contact from Allianz, except from agent. They are denying claim, as they claim our policy is fraudulent, that she didn't disclose she had her ovaries removed in 1994, as a pre-existing condition. Color me stupid....pre=existing is high blood pressure, diabetes, etc. According to our current agent , Allianz refuses to provide copy of our application, probably can't find it.
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Allianz is asking us for a copy of our application, which we were not provided when we were approved, in 2006. They are also asking for affidavits from Surgeons that removed a skin cancer, and her gall bladder in 2010....which did not come up to our 25,000 pesos deductible, none are relevant, None of this has anything to do with a stroke, as she has never had high blood pressure.

Insurance in Mexico is similar to USA....they love your payment....fight payment. Does anyone know of consumer advocate group regarding Allianz breach of contract, in Mexico? I would be happy if they refunded the 200,000 pesos we paid!




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Post by David Tue Mar 15, 2011 6:23 pm

Consumer protection organization is PROFECO. Talk with Intercasa about proceeding.
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Post by Jim W Tue Mar 15, 2011 6:31 pm

Thank You, my friend, will do
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Post by johninajijic Wed Mar 16, 2011 10:29 am

Jim W - Sorry to hear of your problems. If you did not disclose of ANY of your wifes pre existing conditions, they can and will deny you both in Mexico and the US regardless if it had to do with her stroke. Insurance companies are very strict on this. I doubt you will win, but ask Intercasa as he is more knowledgeable.

Honesty in your application for Health Insurance is most important. I have a policy with Segurous Monterrey whom I consider to be the best, but my pre existing condition of Epilepsy is excluded.
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Post by Jim W Wed Mar 16, 2011 7:39 pm

John, we were honest, Alliaz, can't provide copies of our apps., They are now requesting us to provide copies of our original app. We are now in 4th month.....we have no pre-existing.....unless one conciders ovary removal pre existing condition....furthermore, in USA , If you have coverage, Pre existing is a non isssue as coverage continues...with proof of continued coverage Smokealot
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Post by simpsca Thu Mar 17, 2011 5:24 pm

This is the Profeco web page for filing a complaint: http://www.profeco.gob.mx/Servicios/quejas_denun.asp

If you use Google Chrome it translates the page into English for you. And here is the Jalisco page, address and phone number:
http://www.profeco.gob.mx/delegaciones/DelegaEdos.asp?edo=jal

Jalisco Del.
Address: Marseille 49, 2 nd Floor, Sector Juárez, Colonia Americana, CP 44160, Guadalajara, Jalisco.
Phone: 01 (333) 615 7383, 01 (333) 615 7393, 01 (333) 616 7667

I wonder if you are using Parker Agency? A friend has Allianz and had a stent put in - non emergency - and so the doctor's payment was in question - full amount or out of network - which it was. And Parker got the full amount paid. I don't have any experience with Parker so I can't speak from experience. I wonder if a different agent can help you.

And yes, it seems they should be the ones who produce the application since they are denying coverage based on the application.

Thanks for the heads up. I know you are busy but if you could post the name of the agent you have, I want to warn a friend of mine who has Allianz through an agent named Tejeda. PM me if you are not comfortable posting here.

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Post by David Thu Mar 17, 2011 5:45 pm

Jesus Tejeda is the agent who DOES go to bat for his clients. I have all my insurance with him including Allianz Medical. You don't need to warn your friend if Jesus is his/her agent.
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Post by simpsca Thu Mar 17, 2011 5:51 pm

Yes, Jesus Tejeda is his agent, but I am worried about Allianz now. Years ago when I had to buy insurance for a company I worked for, Allianz was considered a good company. And what concerns me is Jesus advised my friend to switch from Allianz to AXA for his health insurance. Friend didn't because he had two years in with Allianz. Now I'm thinking maybe he should have switched. Anyway I just let him know about the problem above.
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Post by David Thu Mar 17, 2011 6:41 pm

Jesus has Allianz for himself and his family. He's been an AXA agent for many years. Only in the last year did he become an Allianz agent at the urging of many of his clients, most of whom are too old to switch companies. BTW, the problem JimW is having is not with Allianz itself but with their US affiliate for out of Mexico coverage.
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Post by simpsca Thu Mar 17, 2011 7:15 pm

Oh, that explains how they found out about things - US computer records. But I wonder how they can say they didn't declare things when they don't even have the application. In the US the insurer has to produce the ap.

I don't have a copy of my application for health insurance here either. The agent filled it out while he asked me questions, I signed it and never saw it again.
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Post by David Thu Mar 17, 2011 7:22 pm

Same for us. I hope it gets resolved for JimW.
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Post by Jim W Tue Mar 22, 2011 8:27 pm

I would recommend everyone sit down with their agent, for complete explanation of policy. We use policy as major medical, as we have 25,000 pesos deductible. Allianz is now asking Doctors that performed two surgeries in 2010, that were less than deductible, to complete questionnaires, regarding same.

I asked my agent to show me where it says we must advise them of everything we do, medically in our policy....not that this is a bad idea....and why we weren't informed 5 years ago.

I explained to our agent, that in USA, medical coverage is based on deductible, and not per incident. At years end, if expenses do not exceed deductible, nothing is submitted. THE FIGHT GOES ON!!! Smokealot

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Post by simpsca Tue Mar 22, 2011 8:40 pm

Thanks Jim,

I also had procedures done well under my deductible and never reported it to my insurer. I will be having a conversation with my agent to see what I need to notify them about. They are probably trying to find out from the doctors if any of the conditions were pre-existing and not reported prior to insuring you. You have passed the three year window where in Mexican policies unless there is an explicit exclusion, after three years all pre-existing conditions are covered. But if they don't have your application they can't prove anything.

I really hope you are not smoking all four of those cigarettes over this!
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Post by Jim W Fri Apr 08, 2011 7:21 pm

THE BATTLE GOES ON! Blackeye PROFECO will not entertain proceeding unless we have something in writing from insurance company denying our claim. Allianz refuses to provide anything in writing. Dr. Leon has provided letter, that there is nothing in medical history that would be related to stroke, and he has been her primary care for her since 2007.

Our agent has been in contact with Allianz repeatedly for 3 months. They blame their contracted agent in the USA for blocking payment. (International Coverage). At first they claimed we had not disclosed prior conditions. We have proved this is not correct.....now they ask for a copy of our application for coverage 2/2006, which we don't have a copy of, and they can't provide.

Allianz is now stating we must pay claim out of pocket....now $20,000.00USD, and submit request for reimbursement. Since we have been paying for 6 years, and now have a claim, we don't have the money to pay.(200,000 pesos todate)

They are now demanding we pay, in USD to USA Hospital, and they will reimburse in pesos, however, they will not commit to 5, 10, 20 days for reimbursement.

Our agent admitted this is the first International claim they have dealt with, and have advised Allianz they will not offer this coverage in the future. No good for us.....Anyone with advice, much appreciated.....Hopefully, you won't have to deal with this type of issue!

Jim W. Smokealot
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Post by simpsca Fri Apr 08, 2011 8:48 pm

There is one place you can complain, since her hospitalization took place in California, and I assume the hospital bills are unpaid - California Department of Insurance. No insurance company likes to be reported to any state insurance commission (in the US insurance is regulated by the states) - and I am sure Allianz does business in California. You can draft a letter in English to the department of insurance - here is the website with their address: http://www.insurance.ca.gov/contact-us/0200-file-complaint/

I would give a copy to your agent first and tell him you plan to report Allianz and exactly what happened. The "threat" may get them to do something. This is a summary of what you can report in California:

Examples of the Types of Problems That You May Submit to the Department:

Improper denial or delay in settlement of a claim.
Alleged illegal cancellation or termination of an insurance policy.
Alleged misrepresentation by an agent, broker, or solicitor.
Alleged theft of premiums paid to an agent, broker, or solicitor.
Problems concerning insurance premiums and rates.
Alleged improper handling of an escrow transaction by a title insurer or underwritten title company.
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Post by Jim W Fri Apr 08, 2011 9:13 pm

Thank You Simsca....happened inOregon....look forward to seeing you again next week.....I am sooooooooooo pissed off....they are forcing us to file legal action, ...again....not agent....Allianz is culpert. Smokealot Smokealot

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Post by David Fri Apr 08, 2011 9:38 pm

Well done Simpsca!
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Post by simpsca Fri Apr 08, 2011 10:21 pm

OK - don't know why I thought she was in California but here is the same info for Oregon. Website of Oregon Insurance Department and form to file a complaint against insurance companies and agents: http://insurance.oregon.gov/consumer/tomake.html

They have the forms to file a complaint on line in Word or Adobe format or you can file electronically. I would print out the complaint form which has the address to mail it to. Fill it out and give a photo copy to your agent and let him know if they don't negotiate a satisfactory settlement you plan to mail it. If you have an attorney you may want to consult them first, but you don't have to mail it you can just tell them you will and see if that improves their position.

PS - One of the things I did working in corporate finance for big companies was to buy insurance and do battle over claims with insurance companies when they wouldn't pay. No I'm not a lawyer.

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Post by Jim W Sat Apr 09, 2011 12:33 pm

Thank You simpsca,

jim w Dead Horse
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Post by Jim W Tue Jun 07, 2011 5:13 pm

Thank You, Simpsca......finally got commitment to pay by Allianz It appears, our insurance coverage is question, unless we submit claims.....even though falling below deductible. I think we should file all medical for paper trail....Would like to hear other opinions!
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Post by simpsca Tue Jun 07, 2011 7:32 pm

I haven't had to do that (report all incidents under the deductible that might be big issues later) although I've had claims similar to Deb where they could question my past medical information. Hospital stay for a week in November 2010 was for pneumonia and they diagnosed severe asthma. They could have required medical records from the US even though I've been insured 11 years by them. Despite the fact that my doctor wrote on the admission paper that I was no longer responding to traditional antibiotic treatment they didn't ask any questions about my past medical even though I've had a history of respiratory infections for about 3 years.

I've had 3 surgeries and one hospitalization for pneumonia with this insurer and no questions asked except in one prior surgery; the test referred to an earlier test and they asked to see that before approving surgery. The prior test showed I did not have the condition prior to them insuring me - this was in year two of buying insurance.

I think the issue involved Deb being in the US and the expense was much higher than they are used to. I would report any major event, skin cancers, and anything that may become serious. Since your deductibles are so high there is a lot of important stuff that your insurer may not know about. But I wouldn't report every little thing. Just my opinion.

PS if you are moving back to the US and plan on using Alliance as your insurer - take a close look at your policy and make sure that if you have a residence in the US you don't have an exclusion or condition pertaining to that (residency outside Mexico).
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Post by wilsonjohn Sun Jul 03, 2011 6:24 am

I am happy to find this post very useful for me, as it contains lot of information. I always prefer to read the quality content and this thing I found in you post. Thanks for sharing.


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Post by Jim W Thu Jul 21, 2011 7:25 pm

UPDATE: Allianz agreed to pay International Insurance claim ....Late June...still not paid, as their subcontractor in USA, is now trying to negotiate for lower rate....after denying coverage 7 months ago....meanwhile we have been turned over to collection, by non member Doctors. I stand by previous statements......Insurance companies suck...they take our money, and put us in unfortunate positions.

Had I been smart, I would be self insured living in Mexico, bought travel insurance, and been $15,000.00 USD ahead of the game Smokealot Beer Beer
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Post by wilsonjohn Fri Sep 23, 2011 1:54 pm

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Post by David Fri Sep 23, 2011 2:15 pm

Informative yes, effective no.
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