ComplaintsforSouthern Guaranty Insurance Company

• Initial Complaint

  07/10/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  For my first month of coverage I paid over $400, the second month was just under $400. I was told preventative care is completely free/covered but am now being billed by my OBGYN, Labcorp, and *************** for a total of over $500. I would have been better off not being insured. These procedures (papsmear and mammogram) should be free once a year.

  Business response

  07/29/2024

  Thank you for the opportunity to respond to the complaint filed with the Better Business Bureau by *****************************.  We have had the opportunity to review the facts surrounding the matter, and the attached response will reflect our findings.  Any complaint received is taken very seriously as Southern Guaranty Insurance Company (SGIC) is committed to delivering quality service for programs which are completely understood by our covered members.

  Customer response

  08/01/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *************************

• Initial Complaint

  06/18/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  In Feb 2024 I lost my job and signed up for a private plan through SGIC for my disabled son as a gap filler. I was assured on the phone that both his PCP and his Psychiatrist were in network. When I took my son to his PCP, they had never heard of SGIC before and are not in network. I turned around and went home without having my son seen for a necessary appointment related to medication management. With my son's psychiatrist it was the same thing, they are not in-network and would not file a claim, so I ended up with a lofty bill. I called ****** Services and they told me I could submit the claim myself, I followed their instructions exactly and after two months called the ***************** for an update - they have no record of my previous conversations and no claim from me. The information I had been given was wrong, down the mailing address and even a special claim form I needed to complete. I have been given false information repeatedly and never would have signed up for this policy had I known that my son's doctors were not in-network. I have also wasted tremendous amounts of time on hold and back and forth phone call between insurance and the doctor's offices trying to figure out how to get the ONE visit that we actually kept, paid for. We have been avoiding all other doctor's ************ and waiting until my new work plan kicks in before getting my son the healthcare he needs because SGIC has been useless. If the calls were recorded for quality assurance, record of what I was told should be on file. This feels like deceptive business practices and I would like a refund for the cost of my son's insurance given we were lied to repeatedly and what we were promised was not delivered.

  Business response

  07/03/2024

  Thank you for the opportunity to respond to the BBB about this complaint.  Upon receiving the complaint, we immediately reached out to ********************** to obtain the necessary information about her son to fully investigate the matter.  The attached response reflects our findings.  Any complaint received is taken very seriously as Southern Guaranty Insurance Company (SGIC) is committed to delivering quality service for its programs, and we strive to ensure our programs are completely understood by our covered members.

  Customer response

  07/03/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***********************************

• Initial Complaint

  05/31/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  When I set the policy up in December of 2023 to begin Jan 1 2024 I specifically asked if my providers and Hospital were in network and told they were. I always do my wellness appointments in June so I called to verify information and they said they are NOT in network and I would be responsible for payment. The explanation I recieved is they must not have renewed contracts. I have paid 5 months of premiums only to find out I am out all this money and would have been responsible for all charges. I feel I was not told everything o needed to know and understand. This information was put in my application and I (and every other customer) should be informed if the providers are no longer covered.The customer service lines were very disappointing, I called on 5/28/24 and got transfered 3 times telling all 4 individuals the same information. I was on the phone for over 45 minutes and no resolution except to invite them to join network. That is a bit too late.I called back today 5/29/24 to cancel policy and spoke to 2 people stating same information to each of them. The **************** needs lots of work not to mention I was suppose to be connected with the original salesperson, that did not happen. I understand this is not insurance, but for paying these high monthly premiums you would think customer would not be stuck with a high bill at the end od treatment.I asked the last person to send me a survey and he said they do not use them. They really need to!I have still not recieved the email that was to have the cancellation information.Website portals are not user friendly, and not good for finding information. They need 1 website to house all products sold.

  Business response

  06/21/2024

  Dear BBB Serving ************,

  Respectfully, SGIC's investigation into the complaint filed by *************************** is ongoing.  SGIC appreciates and takes all member feedback very seriously.  To ensure SGIC provides a complete and accurate response to the BBB, may we request an extension until 6/24/2024?

  Thank you, in advance, for your consideration.

  Respectfully,

  SGIC Compliance Department

  Customer response

  06/21/2024

   
  Complaint: 21776291
  
   I am allowing the extension until 6/24/24 for the company to investigate.
  
  Sincerely,
  
  ***************************

  Business response

  07/03/2024

  Thank you for the opportunity to respond to the BBB about this complaint on behalf of Southern Guaranty Insurance Company.  We have completed a full investigation of complaint # ********.  The attached response partially reflects our findings, as well as our proposed resolution.  Any complaint received is taken very seriously as Southern Guaranty Insurance Company (SGIC) is committed to delivering quality service for its programs, and we strive to ensure our programs are completely understood by our covered members.

  Customer response

  07/03/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  04/08/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  When I purchased insurance on Jan.14 2023,I asked and was told my primary care giver was in the group and I was good to go.That was a lie.My doctor nor hospital is in the group.When I contacted them all they could say was "sorry".That is not acceptable,I need insurance that I'm paying for.Not happy at all.

  Business response

  04/22/2024

  Thank you for the opportunity to respond to the complaint filed by ************** on April 08, 2024.  We have had the opportunity to review the facts surrounding the matter, and the attached response will reflect our findings.  Any complaint received is taken very seriously as Southern Guaranty Insurance Company (SGIC) is committed to delivering quality service for programs which are completely understood by our covered members.

• Initial Complaint

  01/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I was told simple blood work was covered 100% that's the only thing I went in for and none of it's being covered why what's the sense of having insurance if I can't even have a simple routine checkup paid for

  Business response

  01/29/2024

  Dear Better Business Bureau,

  Thank you for allowing Southern Guaranty Insurance Company to respond to the inquiry you submitted on behalf of the above-referenced member.

  The Company has completed its investigation of the inquiry. To date, the Company has made two (2) attempts to make contact with the member by phone. After both attempts, voicemail messages were left.

  Enclosed is a copy of the Company's written outreach to the member, dated January 29, ****, which requests a call back to discuss his desired settlement. We will continue our attempts to make contact and look forward to reaching an acceptable resolution to this situation for the member.

  Please do not hesitate to call me with any questions or concerns about the inquiry, or our progress in reaching a resolution with the member.

  Respectfully,

  Isis *******

  SGIC Compliance Department

• Initial Complaint

  07/14/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I purchased this "insurance" to cover my routine Dr's visits while having a job that didn't offer medical insurance in April. I was signed up for a plan costing me $287 monthly, and after going to my ********************** on 6/6/23 I find out that they won't cover any of the visit. I made sure my Dr was in network and was told that I'd only have a copay for these routine appointments, which I only go to to monitor and refill my prescriptions. According to my eob treatment for an est patient visit isn't covered under this plan. I now owe ****** for a visit that I was lead to believe would be covered. I had a follow up visit on 7/6/23 that I'm assuming I'll now owe another ****** for. If dr visits aren't going to be covered they need to disclose that information

  Business response

  07/21/2023

  Good afternoon to Whom it may concern,

  It am reaching out on behalf of Southern Guaranty Insurance Company (SGIC)  and would like to request an extension on a formal and concise response to this matter.  We would like to make sure this is done with complete accuracy and have all the related facts at hand.  May we request a two week extension on this please?  We would be able to provide an accurate response no later than August 4th of 2023. 

  Please let us know if you have any further questions regarding this matter. 

  I appreciate you time and have a great day.

  SGIC Compliance

  Customer response

  07/21/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and will wait for their reply 
  
  Sincerely,
  
  *************************

• Initial Complaint

  05/25/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  we were with ****. Until this health insurance reach to us in Dec and they pretend they are better than the other insurance and they cover everything. and they sell us with thier sweet talk health insurance. as they start drafting from our bank account. it hapoened that I had screw in my right foot and was hurting me. it was suppose to be done at my doctor office but the screw was stuck really bad. I was at my doctor office when his insurance lady called our insurance to get thier approval to remove the screw as out patient. if they would have not approved I would have not gone through with it. Now they refuse to pay for it and they called pre existing condition. they lied about protecting my health and refuse to pay for my hospital bill. I can provide you with my bone doctor and her insurance lady and verify my statment.

  Business response

  06/02/2023

  Dear Ms. *****,

  Southern Guaranty Insurance Company (SGIC) is still investigating your case.  We will provide a fulsome response to your complaint within the next couple of business days.

  Very respectfully,

  SGIC Compliance Department

  Customer response

  06/03/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  **** *****

  Business response

  06/14/2023

  Please see the attached response.

  Customer response

  06/15/2023

   
  Complaint: 20100621
  
  I am rejecting this response because:if we did not have vetbal ok from the ********************** company to go head  and do it as out patient surgery we would have never done it and also they can contact my doctor ********************** lady that we were sitting at her office when she called them. I have never liedabout this situarion and this is accurate. I have provided the doctor ***** number. and ask for lady that does the ********************** and she will verify the call she made
  
  Sincerely,
  
  *******************

• Initial Complaint

  05/17/2023

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  I signed up for this insurance after being told over the phone that I would have great coverage and be able to go to get my mammogram mammograms and colonoscopies will be $100 for $100 co-pay. I even confirms that the doctors office that I go to was in network with them, I recently went and had a procedure and received a bill in the mail for $4029.64. They only covered $711.11 even though when I signed up for this policy I was informed this procedure would only cost me $100 out-of-pocket. I was told that if I went to a primary care doctor it would only be $25 as long as they were in net work and if it was a special list it would be $75 now I am finding out when I called today that I don’t have any type of coverage like what I was told over the phone. I have been paying a $291 premium monthly since June 2022 for what if I don’t have any of the coverage that I was told that I had and then I was signing up for over the phone. When I called the customer service today, I was handed through three different associates and then hung up on and have no resolution except the fact that I was able to cancel my policy. I would appreciate to be in contact with somebody in the corporate office to explain to me what my policy exactly was and how I’m going to get reimbursed for all of the policy premiums that I have paid in since June 2022.

  Business response

  05/23/2023

  Attached is our response from Southern Guaranty Insurance Company for ***** **********

  Customer response

  05/27/2023

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely, They lied to me about my coverage and I don’t understand how they can do that.. I want my money back so I can pay my doctor bill…
  
  ***** *********

  Business response

  05/30/2023

            May 30, 2023
  
            BBB,
  
  
  
            RE:  *** *********                                                                                               
            Policy Number: ************                                                                                   Claim Number: ********                                                       
  
            Thank you for the opportunity to address Ms. *********** concerns one additional time.  The AWA products underwritten by SGIC are distributed through independent insurance agents.  SGIC’s position is that misrepresentation,              whether it is about the scope of coverage or the status of an Agent, is completely unacceptable.
  
            With that said, we believe we provided a thorough response to the original complaint submitted, including describing the efforts we make to ensure that members understand the benefits they have purchased. We also provided                  details of the claims we have handled for Ms. Vanhousen.  At this point, if Ms. ********* is rejecting the services of our Advocate to try to negotiate the costs of her procedure, we consider this case closed.
  
            Respectfully,
  
            Glenn M********
  
            Claims Manager,  Southern Guaranty Insurance Company | ********************** |
            NAIC Number: *****

  Customer response

  06/01/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  I’m sorry I did not understand first response from you but thank you for taking the time and getting back to me ..
  Sincerely,
  
  ***** *********

• Initial Complaint

  02/20/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  We purchased this, we thought was a form of health care from a rep over the phone. We were told that our doctors were associated and in network with the company. When we visited the doctors we found out that none of them accepted SGIC. This is not health care coverage as we thought after paying a premium for at least 7 months. I paid out of pocket for the doctor visit, cancelled the policy and was told to submit my receipt for reimbursement of the payment. This was ***** 12,2022 and to date I am still waiting for payment. I have spoken with a rep named ***** 5-13-22 I was told to email receipt which I did. ******************* the supv on 6-1-22 said pymt **** days, *ontaye C 6-14-22 said show no paperwork sent, 6-14-22 ******************* said resend, ***** 6-27-22@1:55pm said **** will call me ***** days. **** @4:02pm ****** said would have ***************** next day and that she showed no information on screen and no call. 7-18-22 *ee * transferred me to **** who said showed no information on screen. ****** another supervisor told me to resubmit form because SGIC need to be on the form, which I did and sent. 9-19-22 spoke with *****:21 pm said submitted to claims, 10-13-22 spoke with *****. 12-7-22 spoke again with **** and promised within 10 days, spoke again with **** 1-18-2023 and promised within 10 days. I have mailed and scanned the requested paperwork at least4 times and still no results. As you can see all I keep getting are void promises and no results. The management team is unorganized and lack professionalism. Please help in resolving this frustrating matter Thank you Received from **** verification of paperwork and attachment received On Wednesday, *ecember 14, 2022 at 10:02:55 AM CST, LisaMason<*****************************************> wrote:Good morning ,I have received the attachment and forward to the claims examiner sent new email to **** on 2-19-2023

  Business response

  02/27/2023

  We would like to apologize to Mr. and ******************* related to their experience with SGIC.  Our apology is based on a significant amount of miscommunication with them on what should have been very simple claims to process for them.  We have re-trained our staff on the information which must be collected in order to reimburse members who have paid for their medical care at the time of service.

  
  We received two claims from ******************* for her husbands office visit and lab testing as she wrote in her complaint.  Neither included close to what was needed to create and process a claim in our system or the system of any insurance company.  The medical claims business is complicated and involves identification numbers for the medical providers,codes which identify the medical conditions for the patient, and codes which identify the services that were provided.  We did not receive any of those codes when ******************* initially submitted the paperwork. Our failure in communication occurred with Representatives more concerned with setting an expectation of time than explaining clearly what was needed.

  
  ******************* noted in her complaint that they had purchased a form of healthcare.  This was true.  The Johnsons purchased a Limited Indemnity Medical Policy from SGIC.  This Policy, called Well Protector 3, provides a fixed benefit for a limited number of medical services per year.  In this case, the Policy provided for a payment of $50.00 per day for physician office visits (up to 3 per year) and $25.00 per day for diagnostic services (up to one day per year).

  
  ******************* also noted in her complaint we were told that our doctors were associated and in network with the company.  When we visited the doctors, we found out that none of them accepted SGIC.  We provide access to the MultiPlan provider network, which contracts with 506 Internal Medicine providers and 480 Family Practice providers within 10 miles of ***********************.  When we did receive the information needed from the doctor, it was coded as the first time ****************** had seen the doctor.  One of the requirements of a doctors contract with a PPO network is they must be willing to accept insurance and file claims with the insurer.  When they selected a new provider, the Johnsons neither called us, nor accessed the on-line Directory indicated in their Welcome Kit to ensure the provider was contracted.

  
  Upon receipt of this complaint, we reached out and obtained the information needed to process the doctors office visit claim and the lab claim.  ********** is contracted, and gladly provided a claim for the services. They noted they would have done so when services were provided, if Mr.******** ** card had been presented.  We have completed processing these claims and have issued payment to the Johnsons for $75.00, which includes the $50.00 office visit benefit (communicated on Explanation of Benefits #*******) and the $25.00 lab (diagnostic) benefit (Communicated on Explanation of Benefits #*******).

  
  Because we feel badly for the miscommunication with the Johnsons, we are also going to refund their last month of premium, which is $187.00.  We will attempt to refund to the payment arrangement which is on file. If the Johnsons would like to use an alternative method, they should please call our Member and Provider Services Department.  We apologize, again, for the length of time it took to resolve this claims issue for the Johnsons.

  Customer response

  02/27/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *****************************

  Customer response

  03/22/2023

   
  Complaint: 19433558
  
  I am rejecting this response because:

  Regarding a previous complaint ID ******** dated 2-19-23 I reached a resolution with the company and as par for the course regarding their administrative procedures, they have not followed thru on the full promised resolution. I appreciate the quick response to resolve the matter and the issuance of some of the amounts promised. However we have not been reimbursed the amount of ****** as promised. I called on **** spoke with an agent named ******* @ 2:15pm Central time and she informed me that she was trying to contact the claims department but was getting no response. She assured me that she would call me the next day with an answer. She called on the 21st as promised with the usual response that I dealt with for over a year with this company, she said NO ONE has answered my request. ( I wanted to say LET ME GIVE YOU MY SURPRISED VOICE) but I reframed from doing so.. I appreciate SGIC agreeing to refund the ****** but follow thru on your promise. I should not be AGAIN contacting anyone regarding this matter. It was indicated that they would refund to the same account that the ****** was deducted from. At this point PLEASE issue a check just as you did for the other amounts and lets move forward. All I can say out loud is OMG!!!!!!!!!!!!!!!! This is like pulling a full set of teeth without pain medication. JUST PLAIN PAINFULL!!!! Help once AGAIN. Thank you
  
  Sincerely,
  
  *****************************

• Initial Complaint

  07/27/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  i purchased a 300.00 plus per month insurance plan..stating that i wanted decent coverage in case of emergencies..after almost a year i had an emergency room visit and they refuse to cover any of it..i have no income right now..and have since stopped their coverage and i'm on medicare..but i'm being sent bills i can't pay..on top of this the coverage over all was horrible

  Business response

  08/25/2022

  Business Response /* (1000, 5, 2022/08/09) */ While SGIC is not the selling entity for the above-mentioned policy, it is important to us those potential enrollees understand and agree to all terms and conditions of enrollment. Therefore, SGIC requires that the potential enrollee review, understand, and agree to all terms and conditions prior to enrollment. Enrollees are sent enrollment forms and documents by text message as well as email address. We have included the document that Mr. ****** reviewed and acknowledged electronically. The system captures IP address on the device as well as date and time the terms were acknowledged. ******* ****** enrolled in a Limited Medical Indemnity Plan (Well Protector 3), which is different from any Major Medical -like programs that you may encounter and is not subject to the objectives of the CARES Act. It covers a small number of medical services and provides a fixed payment related to those services. The Well Protector 3 plan does not offer Outpatient Hospital or Emergency Room coverage There is no variation for this based on diagnosis, medical necessity, or any other factor.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩