Business ProfileforUltimate Health Plans, Inc.

I would give ZERO STARS if I could to this company for wrongful denial of medical coverage for an emergency my Father had a few weeks ago. He will NOT be renewing with this health care plan for 2024. My 80 year old Father fell and fractured his ankle and hit his head at about 3:30AM. We went straight to the ER, closest hospital to my Father's home. Unfortunately, it was an out-of network hospital. He received a CT scan of his head and an X-Ray to his Left ankle that indeed showed a bilateral ankle fracture. No head trauma. He was then transported to another hospital for emergency surgery to repair his fractured ankle, since the ER hospital didn't have an Orthopedic department and didn't have a way to perform the surgery. After transport, he was admitted to this hospital as "in-patient status" for emergency "medically necessary" surgery under an Othropedic surgeon for ankle repair. Now that Ultimate Health Care Plans are receiving the claims for this unfortunate hospital emergency visit and surgery, they have sent my Father a "denial of medical coverage" for acute hospital admission. It states that he should have gone to an "outpatient facility" in an observation setting (for about 48 hours), if no improvement is not seen, and "inpatient admission" maybe necessary, as the services he received could have been obtained in an out patient or observation setting. REALLY? WTF? SO BEWARE, if you're a senior and you fall, hit your head, fracture your ankle, and it's in the middle of the night (3:30-4:00AM in the morning), your doctors office isn't open, the local urgent care isn't open, BUT the ER is, DON'T GO IF you have this Ultimate Health Care Plan. THEY WILL NOT PAY FOR YOUR MEDICALLY NECESSARY EMERGENCY OR SURGERY until YOU are observed for at least 48 hours until ULTIMATE HEALTH CARE PLAN can give YOU the authorization for medical sevices or they WON'T PAY! If you value your life and want medical insurance and piece of mind, DO NOT SIGN UP FOR WITH THIS COMPANY.

We are sorry to hear about your experience regarding the denial of medical coverage. One of our Grievance Specialist will be in touch with contact with you to address your negative experience. You can also reach us by calling ****** Services at ************** (*** ***).