Subject: Re: One Health Plan

Comments:
: We had One Health Plan for the past two years. In 2000 I was in the hospital 3 times, 3 for diverticulitus and the last for colon resection surgery. I had numberous doctors during the 3 visits and my family doctor. I had hospital claims, and specialist claims...just all kinds. One Health Plan was not paying my all of my claims as IN NETWORK even though they were IN NETWORK. One day I had to fax back 22 copies of claims that were misfiled. Everytime I called the insurance company and asked if my providers were network I would be told no. I would then call the insurance office for each doctor or claim and they would tell me yes, they were In Network. They would have to contact my insurance company and tell them the provider was IN Network. : Imagine how difficult it is to call and ask the insurance department for each claim to contact my Insurance and tell them they are IN NETWORK. I did have to ask each one before to them that the burden of proof was on them. Right now I am trying to find out if a Emergency room D.O. is IN Network. I have found one person in the hard copy directory that matches this person, but he uses the name Ray instead of Alvin R. I can't get to the department who filed my insurance for him. The hospital he was working at in the ER does not do his billing. So what can I do? : The largest clinic in our area with all the specialists dropped this insurance (One Health Plan) August 2000. I could understand why after all those claims I had to have refiled as In Network. : I cannot find any other posts about this insurance company so I would be greatful to know if anyone else has experienced this problem. I consider it fraud for One Health Plan to pay all of my Network claims as Out of Network. Ok, not all... they have paid a low percentage without a problem.

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