Recommend a good health insurance policy

[jose123]

YOU need to call the institution and ask WHY they don't fill the forms for vaccines ( 1st I'm hearing of this crap ). If you are paying for something they have to record it on your file / claim forms......if your agent isn't well informed , they will go along with whatever the nursing home / new staff at insurer tells them.....higher management will advise best. A csr, may not be as well informed as a claims officer , manager etc......go to the top if needed. Remember , if it's stated on your benefits, it's covered. The fact the nursing home refuses to fill the form is beyond the insurer control. A John Q approach might help with the paperwork, then guardian can settle I'm sure .

To avoid these things is why I think I'm paying a "professional" company for insurance coverage. CSR's, agents, even the janitor should be aware of the organisation's business and not make up lies or "go along" with anything being said.

This is why we drive Japanese cars, use Japaneses electronics and follow the model of Theory J - Japanisation. We could never ever reach developed nation status, nor any form of efficiency/ effectiveness of them.

My situation here is a prime example. Guardian enjoys the bottom line with my premium, but refuses to give any sort of proper service...

[Premchand1976]

Guardian will not pay a claim without proper documentation ( completed claim form and receipts ).

[jose123]

jose123
the clinic/hospital should fill out your claim form. it costs them nothing to do so, & boosts goodwill between office & patient. The mere fact that they are refusing to fill out a claim form for vaccination is evidence of something being wrong, either the CSR doesn't know they should do it when requested or there may be something more insidious going on you might not be aware of. First thing you could do is demand they bring you your medical file, & confirm your vaccination is noted there & once it's there tell them to fill out your claim form for it. If they still refuse then tell them you need to see the person in charge of the department that handles vaccinations & lodge your complaint there. After that direct your request to the billings dept, they may be able to assist.

Now, there's a reason for asking to see your file if they do in fact have one on you. It have plenty racket & deliberate inaccuracies that takes place in the private healthcare sector, from CSR's, to nurses to doctors to upper management.

I do not have a file at St. Joseph Private. I've never used their services before. It seems to be the company's policy for walk-in patients because it is the same at St. Augustine Private. Same company, but for some reason it is more expensive at St. Aug. I am wondering if I ever need to use the services of any hospital listed in their network if I will really be covered. So far, thank heaven and knock on wood, I am perfectly healthy. However, one never knows what can occur, hence the reason for insurance.

Imagine I go in for a multiple fracture of a limb. According to the schedule it is covered 100% in the schedule. I hand over my pretty card. Five scenarios:
1. The hospital says they do not take any insurance for any procedure
2. They swipe. It shows I have insurance, but only if i have one fracture on multiple limbs and not multiple fractures on one limb!
3. The insurance says adults cannot break limbs, only anyone under 18 named on the policy (I have no children)
4. I pay with cash. The hospital does not fill out forms because they no longer use ink based pens or graphite based pencils
5. I pay cash, hospital fills out forms, Mr Joel Angelo, Team Leader, Customer Service Department, Head Office says out of the top of his head, wishy washy, I am not covered for anything although the policy is paid up.

I always tell my snake oil sellers, I mean insurance agents, I don't trust them as far as I can crumble the policy and throw it.

[jose123]

Guardian will not pay a claim without proper documentation ( completed claim form and receipts ).

Hence the catch 22. Hospital refuses to fill out, insurance refuses to pay unless filled out. Hospital will not fill out. Insurance will not pay. Hospital happy, they got paid cash. Insurance happy, they don't have to payout. My premium is now a charity to the bottom line of Guardian Life.

[Premchand1976]

An insurer cannot demand an institution to complete a form, that's not how it works. You go do your treatment , spend your money, submit the completed forms and receipts and you will be reimbursed. Try telling BIR that they have to pay you without a completed tax return / accepted receipts nah ???? The issue here has shifted from an insurance benefit being not covered, to submitting a completed form / processing of a claim ? I ( Guardian ) am not responsible for YOUR forms and it's completion.


Get the forms completed PROPERLY and you will get your reimbursement. It's that simple .

[jose123]

An insurer cannot demand an institution to complete a form, that's not how it works. You go do your treatment , spend your money, submit the completed forms and receipts and you will be reimbursed. Try telling BIR that they have to pay you without a completed tax return / accepted receipts nah ???? The issue here has shifted from an insurance benefit being not covered, to submitting a completed form / processing of a claim ? I ( Guardian ) am not responsible for YOUR forms and it's completion.


Get the forms completed PROPERLY and you will get your reimbursement. It's that simple .

Agreed. All the consumer/ insured fault

Somehow my point got lost to the fact about them not filling out the form. Sorry if it got to that. My point is a Guardian rep saying it is not covered. Yes, you say CSR's and others may not know the procedure. I don't believe that...

[Premchand1976]

Question Jose, why did you go to A&E for a vaccine ???? Was it required due to an illness / injury, accident or emergency ?

[jose123]

Question Jose, why did you go to A&E for a vaccine ???? Was it required due to an illness / injury, accident or emergency ?

That's how they give it. Even if the doctor there requests it they send you to the A&E to get it.

[Premchand1976]

Ok. Noted

[jose123]

Update: Call received from the above mentioned officer at Guardian to confirm it is covered by the policy. I can only hope wrong info like this is not given out again.
Now let's see how they respond to the situation of Medical Associates refusing to fill out the forms or accept their card. So far they have had me fill out a Provider Situation Form. Also the advise to get the form filled out at the hospital and submit was offered.

[Premchand1976]

Not to toot my horn but, you got to know what you sell inside out and who to deal.with when things get cloudy. Med assoc will.fill the form also and stamp.for you. I will inbox a name to use if they decide to give trouble when you go to have same done.

[jose123]

I am going to switch from Guardian Provisor to Maritime AdMed.
Anyone got experience with AdMed?

[Dizzy28]

^ My sister has the group plan with Admed that teachers have through TTUTA I believe.
Heard her recently complaining about very long wait times for all reimbursements. Her backlog of due payment goes as far back as March.
Not sure if this is an isolated case or how Admed is working in general.

[jose123]

Is it with Maritime or M&M insurance?

[Dizzy28]

Is it with Maritime or M&M insurance?

Not sure if teachers have a broker nah.

[Premchand1976]

Remember that admed is an emergency plan only ok. Get the details properly this time around

[jose123]

It has many other facets than emergency only. My experience with Maritime has been if someone does not know something they usually find out rather than sending wrong information.
I asked a few agents about car insurance from Guardian last week and have not heard back from any yet.
Thinking all my business should go to Maritime. My vehicle is already insured and I have an annunity there.

[K74T]

Is it with Maritime or M&M insurance?

M&M Insurance is UniMed

[Premchand1976]

It has many other facets than emergency only. My experience with Maritime has been if someone does not know something they usually find out rather than sending wrong information.
I asked a few agents about car insurance from Guardian last week and have not heard back from any yet.
Thinking all my business should go to Maritime. My vehicle is already insured and I have an annunity there.

There are riders to the basic plan obviously, life cover, critical illness and even a savings portfolio under ONE policy. No policy is perfect, no company either, get the one that best suits you individually.

Guardian definitely left a sour taste in your mouth so wanting " better " is an obvious choice. Many here may say " careful yuh eh jump from the pot, into the fire ". Read yuh fine prints thoroughly ok.

[jose123]

Sour taste, bad smell, icky feeling, brown noise.

I can only hope Guardian clients have not been fleeced out of coverage or benefits because of this sort of misinformation.

This was the response when asked if I was covered, AKA the made-up answer:

Hello Mr. Mohammed,


Apologies for my delayed response; have been in and out of office this week.

Vaccine is claimable under particular plans that has it included under their Preventative Care benefit for adults.

Upon review, you plan however, does not have this benefit for adults. This being so, you will not be able to claim for this vaccine.

Regards,



Trust • Integrity • Quality •
Serving People

Joel Angelo | Team Leader
Customer Service Department
Head Office
#1 Guardian Drive, Westmoorings
t: 868-226-2116 | f: 868-226-2686
www.myguardiangroup.com



I am sure no action was taken against this individual for betraying "Trust • Integrity • Quality • Serving People." What a model Team Leader. Wonder how the subordinates operate?

[V2NR 3.0]

Prem - are you the Horner man ?

[Premchand1976]

Lol....more like the " helper man ".......with no pay......

[jose123]

Yes. He was the outside agent with benefits

Seriously though it should never have come to that.

[vaiostation]

“Live fast, die young and leave a good-looking corpse!”

[Chimera]

wait na premchand you does drive/use to drive a silver benz with the name "PREMCHAND" on the bumper/trunk in black letters?

[bronze_mercury]

had guardian individual provisor for me and the wife, then got group plan in work but guardian says its a clash coverage and cannot claim from both at same time so have to remove myself from the individual plan. never really had any problem with getting the discount upfront with doctors just say to the provider you're on the panel and you'll get the discount. my wife saw a dermatologist $400 visit end up paying $100 same with the prescription meds around $400 only paid about $100. the clash of coverage thing dunno how true that is though because its 2 different plans one from work and one individual.

[jose123]

They said you have to remove yourself from one? I can understand that you can't claim on both for the same issue, but why remove one set of coverage?

[agent007]

May I offer a tip with Maritime’s ADmed? Make sure and get the gold package, not the silver and not the bronze. I feel cheated a bit by Maritime and I am actually considering switching to Guardian. When that time comes, I shall discuss same with Premchand.

[jose123]

What were the issues with Maritime.
With Guardian the experience was one of nontruths being offered to the customer. In other words was a major betrayal.

[Premchand1976]

What were the issues with Maritime.
With Guardian the experience was one of nontruths being offered to the customer. In other words was a major betrayal.

If I remember correctly , this was resolved and it wasn't a matter or betrayal. Your agent misled you, you did not read your contract as well.....don't blame the company for the unethical agent. The manager did in fact resolve the issue as I remembered.

Feel free to shop around tho.....provisor works for me to this day and I've had lots of admed come across the last 2 years.......I doubt they all would be misled......and continue to stay on after being misled.

Insurance isn't for everyone I guess ?????