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My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),

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Post by Jim W Thu Mar 15, 2012 9:01 pm

My 1st and only, approved for surgery @ Hospital Country 2000 for an accident which occurred on November 15th, 2011. My primary care physician and Surgeon submitted letters to Allianz, the cause of my broken/cracked knee was caused to my fall on November 15, 2011. The allianz overseerers of all that is good.....over ruled that there is evidence of pre existing arthritic problems, therefore accidental coverage is in correct, the insured must pay 25,000 pesos deductible, and because he has elected to use in plan medical/hospitals......will receive 5% discount , and his deductible is now 22,000 pesos...... My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   531444 I paid 22,000 pesos @ checkin....my deductible.....Hospital wanted open credit card swipe. NADA....One question, is there an public protection agency....that can interface decisions on behalf of wrong decisions by the company


At this point all I knew was total bill for service approved, me pay 22,000. Paid and done, convinced my surgeon My wife was driving and we want'd to be home before dark. (Btw) spinal and rushing home doesn't work well} Nother story. We go to get factura, they said they will prepare but not until the TV remote is returned......Now I am getting pissed.....WHO ME LMAO.....get back to get factura.....big problem bill for my share had gone to down 15,600 pesos, and they had contacted Allianze.....they wanted me to pay an additional 24,560 pesos, and I would receive a refund from Allianz for approx. 30,000 pesos

middle finger Allianz I told The Hospital.....Adious....no mas cambio.....they got all my cash.......After 1 hour plus left with refund of 6000 pesos...net cost 16000 pesos plus the bull shit fight with Alianz .

Anyway my day started looking forward to successful knee surgery.........MISSION COMPLETED.......Have a great night all......10 days to golf again Beer Beer Beer Beer Beer YA CAN'T MAKE THIS SHIT UP LOL
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Post by johninajijic Fri Mar 16, 2012 10:16 am

OMG!!! What a horror story. I know there's a special Agency that you can take your dispute to. I will try to find out for you when I see my Agent on Tuesday.

I don't know what Agency you bought your insurance from, but you should keep them posted. I was at Parker Insurance renewing my Auto insurance in Feb. and just happened to ask what Health Insurance companies they represent. I was surprised that one was Allianze. I had to bite my tongue from not telling them of your experience.

Who was your Doctor for the knee surgery?

Can you drop them and get another company? You should investigate AXA, GNP and Met Life. I've heard good reports
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Post by Jim W Fri Mar 16, 2012 2:08 pm

johninajijic wrote:OMG!!! What a horror story. I know there's a special Agency that you can take your dispute to. I will try to find out for you when I see my Agent on Tuesday.




I don't know what Agency you bought your insurance from, but you should keep them posted. I was at Parker Insurance renewing my Auto insurance in Feb. and just happened to ask what Health Insurance companies they represent. I was surprised that one was Allianze. I had to bite my tongue from not telling them of your experience.

Who was your Doctor for the knee surgery?

Can you drop them and get another company? You should investigate AXA, GNP and Met Life. I've heard good reports





John Dr. Gomez...He and his team were great. Unfortunately, Alianz...did the unspeakable....Dr. Gomez just called and advised Alianz refused direct pay because I did not spend the night @ hospital as directed. I must now pay Medical team, and submit factura for reimbursement................... My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   633732
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Post by johninajijic Fri Mar 16, 2012 7:25 pm

And who is your agent or the agency you bought this insurance from? They should have advised you.
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Post by Jim W Fri Mar 16, 2012 7:37 pm

johninajijic wrote:And who is your agent or the agency you bought this insurance from? They should have advised you.



John LMAO....Your agency for Auto Insurance company....6 years...Sells me Allianz....They provided documents...for hospital...for prepay....I am meeting with surgeon Thursday...he will provide factura for me to submit...to Allianz....i must now pay 30,000 pesos and wait for reimbursement, as I think he is a victem. This was a planned surgery....approved for direct bill. I paid deductible at time of admission.....22,000 pesos......this is a really suck ordeal...all will be good but a pain in the hemroid....LOL
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Post by johninajijic Sat Mar 17, 2012 12:43 am

You need to contact the owner of Parker, tell them the situation. And tell them to get on the phone with some big wig at Allianz. Tell them, IT'S THEIR RESPONSIBILITY AS AN AGENT!!! Or they shouldn't be selling ALLIANZ insurance.

That's what I did when AIG dragged their feet 4 1/2 months paying my auto claim.
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Post by simpsca Tue Mar 20, 2012 9:34 am

PROFECO is the organization for consumer complaints. I'll see if I can find a location and phone #. Being in the hospital is terrible when you have not done it before. I always ask for the detail of the stay - itemized - they won't give it to you unless you ask.

And you need an overnight with a spinal - doctor should have told you that.

And John is correct - you insurance agent should intercede and help you get things done to see this is taken care of.

PS how is the knee doing?
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Post by simpsca Tue Mar 20, 2012 9:39 am

Here is the link to telephone complaints to Profeco - http://www.profeco.gob.mx/Servicios/quejas_denun.asp

Phone number and address of Jalisco office - http://www.profeco.gob.mx/delegaciones/DelegaEdos.asp?edo=JAL

Most policies lower the deductible when there is an accident - so I am told by my agent. And you should be talking to Parker. If they don't work for you and you want to keep Allianz, you can switch agents.
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Post by raqueteer Tue Mar 20, 2012 10:51 am

The agency for consumer complaints regarding insurance and or banking institutions is Condusef. You will need a translator to go with you, so would suggest you speak to your agent.

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Post by Rolly Tue Mar 20, 2012 11:35 am

www.condusef.gob.mx
Comisión Nacional para la Protección y Defensa de los Usuarios de Servicios Financieros.

National Commission for the Protection and Defense of Users of Financial Services.
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Post by Jim W Wed Mar 21, 2012 6:40 pm

Thank You all, took all info to Spencer for help.....Not even funny that an insurance med, can over rule surgeon, and claim Bursitis, when surgeon says torn Meniscus caused by fall. In retrospect, wish I had the surgery 3 months ago, as sitting around in pain all day, makes one an angry person.....my wife now introduces me as her new husband....one that laughs again..

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Post by raqueteer Wed Mar 21, 2012 6:49 pm

Jim W wrote:Thank You all, took all info to Spencer for help.....Not even funny that an insurance med, can over rule surgeon, and claim Bursitis, when surgeon says torn Meniscus caused by fall. In retrospect, wish I had the surgery 3 months ago, as sitting around in pain all day, makes one an angry person.....my wife now introduces me as her new husband....one that laughs again..

Jim W

And that is why I cancelled my insurance when they put in a restriction, in small print, on smoking. According to the medical people virtually anything can be caused by smoking. The agent said get a letter from your doctor, and I said he's not going to be signing the cheque. Adios AXA, same deal with virtually the whole bunch of slimeball insurance companies with AIG being number one on my personal list.

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Post by Jim W Wed Mar 21, 2012 7:07 pm

Raq, The worst part of the whole thing is the anger and the subsequent deppression.......waiting for god...the insurance approval. Sadly, medical insurance was not what I anticipated 7 years ago.....it is far to invasive, rather than NOB, we pay as we go, and submit for reimbursement if we annually exceed our deductible.

Shitty part of the whole deal, I must meet with surgeon tomorrow, as Allianz didn't pay the team per contract....they paid NADA.....now they agree to pay, after I pay the team....whole thing sucks!

BTW...fine print says no smoking? Never saw than......was it tobacco, or Mary Jane?????? Smokealot Have a good night

lol

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Post by simpsca Wed Mar 21, 2012 7:11 pm

That is really a bad deal Jim. I have not had that happen in over 10 years with my insurer and I had lots of surgeries. I would start spreading the word about Allianz.
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Post by raqueteer Wed Mar 21, 2012 7:36 pm

Jim W wrote:Raq, The worst part of the whole thing is the anger and the subsequent deppression.......waiting for god...the insurance approval. Sadly, medical insurance was not what I anticipated 7 years ago.....it is far to invasive, rather than NOB, we pay as we go, and submit for reimbursement if we annually exceed our deductible.

Shitty part of the whole deal, I must meet with surgeon tomorrow, as Allianz didn't pay the team per contract....they paid NADA.....now they agree to pay, after I pay the team....whole thing sucks!

BTW...fine print says no smoking? Never saw than......was it tobacco, or Mary Jane?????? Smokealot Have a good night

lol

JimW

Well Jim it basically, in very small print, said exclusions, anything possibly caused by addiction to tobacco. Guilty as charged. Sorry not MJ, wish it was, but the stuff makes me cough.
Pays to read the small print!!!
I hope you're getting advice from Spencer like don't pay a cent until they prove their case for denying the claim.
Let the hospital sue Allianz, rather than you personally. You are no longer in the hospital, so they can hardly force you to pay up.

Cheers,
raq

P.S. Don't get mad get even. Very Happy

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Post by Jim W Wed Mar 21, 2012 7:49 pm

My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   531444 RAQ....I don't get mad any more....don't try to get even.....sole mission....GET ONE UP My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   531444 LMAO Thank you for good words

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Post by Jim W Wed Mar 21, 2012 8:23 pm

simpsca wrote:That is really a bad deal Jim. I have not had that happen in over 10 years with my insurer and I had lots of surgeries. I would start spreading the word about Allianz.


Simpsca, Welcome back, with saddened heart for sure! As far as Allianz or any other medical inurance company.....If you are from NOB...Do the math......Had my wife an I been uninsured over the past 6 years....We would be 210,000 pesos ahead......and not had to deal with the BS.......Mexican insurance is going thru the roof, while treatment cost has been somewhat stagent from a cost standpoint....I look forward to comment or PM


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Post by raqueteer Wed Mar 21, 2012 8:38 pm

Jim W wrote: My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   531444 RAQ....I don't get mad any more....don't try to get even.....sole mission....GET ONE UP My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   531444 LMAO Thank you for good words

Jim W

One up, is getting even. Very Happy

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Post by Jim W Wed Mar 21, 2012 9:01 pm

YOU ARE toooooooooooo funny RAQ....Have a good night....get my stitches out tomorrow

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Post by Jim W Fri Mar 23, 2012 4:14 pm

For all I will continue my mission against Allianz, and their agents. My surgeon advised they declined accidental coverage, was the MRI disclosed Bursitis as a previous issue. My surgeon sent letter to Allianz , Meniscus was damaged during fall, and that was what he repaired. They still decline.....Surgeon was great.....even though Allianz stiffed him.....He had no dog in this fight.....gets paid either way. In fact, he submitted factura, thru me, for reimbursement...when check arrives cash and give him money.....ALLIANZ SUCKS....Great meds will bow out of Allianz...group plan. Toooo all of you newbies....Stay as far away way from Allianz you can
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Post by Jim W Mon Apr 02, 2012 7:26 pm

simpsca wrote:PROFECO is the organization for consumer complaints. I'll see if I can find a location and phone #. Being in the hospital is terrible when you have not done it before. I always ask for the detail of the stay - itemized - they won't give it to you unless you ask.

And you need an overnight with a spinal - doctor should have told you that.

And John is correct - you insurance agent should intercede and help you get things done to see this is taken care of.

PS how is the knee doing?


Simpsca, the knee is doing great....hitting balls again after 7 days..... all is good.......except for Allianz.....I paid my contested deductible @ admission, 22,000, as this was an accident, and 2 weeks after surgery, Allianze has not responded to surgeon, as his professional opinion is everyone over 50 has some evidence of arthritis or bursitis in RMI, however he is repairing meniscus tear caused by fall. I convinced my surgeon, I was OK, and he released me....saving Allianz money, as if I care. Once Allianz discovered I was released early, they cancelled payment approval, stiffed the medical team, and demands reimbursement claim filed.

You know me well Simpsca, I flipped out, told my agent, Allianz is the worst, Including agent, and that I am offended that in 2 claims over 6 years, for 2 of us, resolution has been a nightmare. She now does not return my calls....she has a tough schedule....by appt. only....after 11:00, Ribaris agent.

Finally Deb intervened, and they committed reimbursement by the 4th, now out of pocket the entire cost of procedure, plus prelims, 50k..mxp, as I paid my medical team, as this is not their problem, and they don't deserve this.....color me stupid. I followed up via email...they now say the 5th or 6th....color me eltsupido....everyone is closed in this sector for Easter.
12 days delay, when all was pre approved. I would love to cut n paste her email, telling me to contact Allianz directly, as it is not her problem. They were really good taking annual fee.......2 claims this is total bullshit.

I hired Spencer to file with the consumer groups you suggested....and I Thank You for your input. I have asked John to do a stickie so all can share their experience with claims on the board. Happy Easter and look forward to seeing you at the "Bored Meeting" LOL

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Post by simpsca Mon Apr 02, 2012 8:58 pm

You are getting the run around from Parker Agency. No one is doing anything this week because it is Easter. I don't see why it makes a difference that you went home the same day. Lot's of procedures don't need an overnight stay now.

And yes, just turn it over to Spencer. It's not worth having a stroke over.
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Post by CheenaGringo Mon Apr 02, 2012 9:50 pm

Jim:

What I don't get is that you have been complaining about this insurance company for many months - why didn't you just cancel the first time they jerked your chain?

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Post by Jim W Mon Apr 02, 2012 9:52 pm

Neil, still fighting for reimbursement....hired Spenser...Paid 35,000 pesos for for new year.
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Post by hockables Mon Apr 02, 2012 10:34 pm

Jim W wrote:Neil, still fighting for reimbursement....hired Spenser...Paid 35,000 pesos for for new year.


My 1ST & ONLY Allianz MEDICAL approved claim..(.UNDER DISPUTE MY ME),   968748 now he hasta declare it!!
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