Customer ReviewsforUSHEALTH Group

BUYER BEWARE!! I assure you, it's in your best interest to find another insurance company. Once they get you signed up, don't be surprised if you don't get a return phone call or email to any questions you have. My claim was denied stating "Patient cannot be identified". My EOB clearly shows my name and information, but now I have to spend my time trying to get in contact with anyone that will answer a call or request to get this bill paid. The medical providers I've spoken to said this is one of the worst insurance providers and in addition to their lack of coverage, they pull stunts like this to avoid paying. It's criminal and absolutely ridiculous.

Weve had an opportunity to review the comments provided by the reviewer above and provide the following in response. Our records show the reviewer applied for and was issued family coverage under three (3) separate Policies offered by our Company: an Individual ************************************ Policy, an Individual *********************** Policy and a ************************* Policy. The Policies (non-ERISA) were issued effective April 6, 2021. The availability of benefits under each of the policies is subject to the definitions, provisions, exclusions and limitations of each Policy. This health plan is not a major medical plan, comprehensive medical insurance nor is it eligible for mandated benefits under the *************** Act. A review of the family claim file found that we received the charges referenced by the reviewer on March 9, 2023. The claim was processed that same day and the Explanation of Benefits (EOB) statement was issued to the provider and reviewer. Please note, our Company did not advise the reviewer or her provider of service that the patient could not be identified. No benefit was issued as the charges incurred were for non-covered services under the Policies. Our review found that all charges have been processed in accordance with the terms and conditions of the Policies. We recognize that our products are unique and different from the typical ACA essential health benefits plan, the products that we offer are certainly innovative and provide valuable coverage for our customers. The Insured purchased a benefit package that offers the following:First dollar coverage, up to the applicable benefit amount listed in the Brochure and Policy.Provided the option to purchase additional coverage when decided circumstances require it, even in the middle of a claim, without additional underwriting or evidence of insurability.Freedom to seek services from any provider and the benefits provided under the Plan remain the same. Where many of the **** EPO, and HMO products available on the market today restrict their customers to one network of physicians or facilities and/or penalize their customers for using Out-of-Network providers by charging additional deductibles, coinsurance, or co-pays; our customers arent penalized.Automatically locked in rates for 15 months at no extra charge.With respect to the reviewers concerns with getting a call answered, our *************************** is available from 7:00 AM 7:00 PM. Monday through Friday (CST) and 9:AM - 1:00 PM Saturday (CST). A Representative is always ready to assist.Thank you for the opportunity to address this matter and we hope that we have adequately addressed all issues raised in the reviewers complaint.*************************Manager-Consumer Affairs

Terrible company and even worst policies. They cover maybe 20% at most and 20% of meds that's all. Do not consider USHealth you will be 100% disappointed

Weve had an opportunity to review the comments provided by the reviewer above and provide the following in response. Upon receipt of the negative review, a representative attempted to reach out to the reviewer at the email address listed on the review, to obtain the Insureds name and additional information regarding the benefit concerns. To date, no response has been received.We encourage the reviewer to contact our office at the toll-free telephone number on the Insureds ID card to provide additional information regarding their benefit concerns and to provide the Primary Insureds name or policy ID number. Once the identifying information is received, we would be happy to research the concerns presented in the review.The reviewer/Insured can also find assistance by logging onto the online portal at www.myUSHG.com.Thank you for the opportunity to address this matter and we hope that we have adequately addressed all issues raised in the reviewers complaint.*************************Manager-Consumer Affairs

Every review here is accurate. This plan is a waste of money, spend that money on another companies HMO or PPO and youll be better off. They preach about getting you plans with little to no deductibles and $0 copays, but leave out that you only have 6 visits a year and they only cover $75-$100 per person! Not to mention youre paying $700-$1000 a month for this coverage. The brokers and agents are swindlers and will say anything to get you a policy. Save your money for a better health plan. Youre better off paying reasonable copays and deductibles than messing with this company.

We have had an opportunity to evaluate the concerns brought forth in the review above and provide the following in response.By way of history, our records reflect that the reviewer was issued coverage under an Association Group ************************* Certificate, also known as (aka) the PremierAdvantage Plan, a Nonparticipating Five Year Term Renewable to Age 70 Group ************** With Group Term Life for Dependents and Critical Illness Accelerated Benefit Certificate, aka the MedGuard Plan, an Association Group **************** Certificate, aka the PremierVision Plan, and a **************** Certificate, aka the SecureDental Plan, all of which became effective on March 27, 2023. These non-ERISA Plans are considered excepted benefit plans under the *************** Act (ACA). They are not comprehensive major medical plans; they do not constitute minimum essential coverage under the **** and they are not subject to the mandates of the **** The availability of benefits is subject to the definitions, provisions, exclusions, and limitations contained in each section and every section of the Plans.The MedGuard Plan provides a critical illness accelerated death benefit to the reviewer if the reviewer is definitively diagnosed with a specified critical illness event or undergoes a Specified Critical Illness Surgery. The PremierVision Plan provides specified benefits for a comprehensive eye exam, frames and corrective lenses; while the SecureDental Plan provides benefits for preventive, basic, and major dental services. The PremierAdvantage Plan provides fixed indemnity benefit payments as specified in the Certificate Schedule for eligible expenses incurred as a result of an accidental injury or illness. The fixed benefit is payable whenever an Insured incurs an eligible expense, and the applicable benefit has not been exhausted. Services not listed in the Certificate Schedule are not eligible expenses. With the purchase of the PremierAdvantage Plan, the reviewer also purchased the Well-GIST Rider, which allows the reviewer the ability to enhance their coverage by adding Wellness and Health Screening Fixed Indemnity Benefits. In addition the Well-Gist Rider allows each Insured the option to purchase coverage under our Short-Term Medical-Surgical Expense Plan, aka PremierMed, on a one time right and guaranteed basis without any additional application, underwriting or evidence of insurability as long as the reviewer is not otherwise covered under a health insurance plan that constitutes minimum essential coverage under federal law.The PremierMed Plan, if purchased, provides reimbursement for eligible expenses for sicknesses or accidental injuries rendered by both in- and out-of-network providers at 100% of the maximum allowable charge (Usual and Customary Fee or Contracted Rate) as defined by the Plan after the satisfaction of an initial $3,000 benefit deductible, and if applicable a separate $6,000 out-of-network deductible. In order to exercise the option to purchase the PremierMed Plan coverage, an Insured is required to contact our ****************** by phone at ************ or by sending an email request with their Member ID to ****************** Please note that if the option to upgrade the coverage is elected, there is a separate monthly premium that is paid in addition to the monthly premium for the PremierAdvantage Plan coverage. Regarding the reviewers comment that the coverage is not what the salespeople describe, we can only advise that we recognize that our products are unique and have significantly different benefits from those that are available under the major medical plans to which most individuals are accustomed, and we realize that a lot of information about the specific benefits, exclusions and limitations is provided during the sales presentation that might not be fully understood or remembered. As such, we rely on the benefit information provided in our published materials.To make sure that the benefit information is available to prospective clients, we have established Company procedures and processes, such as providing access to the product brochures at the time of the sales presentation so that the sales agent can review with the applicant. Additionally, if/or when an application is submitted, the Company sends a Welcome email to the email address listed on the application. The Welcome email includes links to the electronic application as well as links to the product brochures for the Plan coverage as selected on the application. Specific to this review, our documentation supports that we sent the Welcome email to the reviewer on March 24, 2023.Once the application is approved, the reviewer also has the option to create a myUSHG.com account. Through the myUSHG.com account the reviewer has access to the Policy(s) and the Product Brochure(s) for the Plans purchased. In addition, during the underwriting of an application, it is the practice of our Company to contact our applicants on a recorded telephone line to verify the information reported on the application. According to our records, this call took place with the reviewer on March 24, 2023. We have reviewed the call documentation and provide the following information:When the representative stated, First we want to let you know this call is being recorded for quality assurance purposes and this recorded call will become part of your file at the insurance company. We will be relying on your responses and authorizations during this call to confirm information on your application, and to use as your electronic signatures on the Application, the Applicants Acknowledgments, and other authorizations in your application Package. If this is okay with you, can we get started? The reviewer replied, Yes. The representative advised the reviewer that the PremierAdvantage Plan does not constitute minimum essential coverage under the **** instead it is considered an excepted benefit plan. The reviewer responded yes, when the representative asked if the reviewer understood that the plans selected provide the specific benefits as described in each plans brochure or Health Coverage Summary that had been received and reviewed with the sales agent. The reviewer confirmed that the home and email addresses listed on the application were correct. Toward the end of the call the representative reminded the reviewer again that the plans selected provide the specific benefits as described in the brochure that had been received and reviewed with the sales agent.On March 27, 2023, upon approval of the reviewers application the Certificate(s) was sent to the reviewer via the US Mail. The Certificate(s) included separate sections, i.e., Benefit Schedule, Definitions, Exclusions, etc., which outline the coverage provided by the Plan(s). In addition, on page 1 of the Certificate, the following notice was provided: YOUR THIRTY (30) DAY RIGHT TO RETURN THIS CERTIFICATE If You are not satisfied with this Certificate, You may return it to Us within thirty (30) days after You receive it. You may return it to Us by mail or to the agent who sold it. This Certificate will be voided as of the Issue Date, and We will refund any premium We have received prior to Our receipt of the returned Certificate.The above provision provided the reviewer with the freedom and ability to review the Plans for a full 30 days, and if not satisfied, within that 30-day period, the reviewer had the option to cancel the coverage for a full refund of premiums. Unlike ACA essential health benefits plans, under which a covered individual must typically first satisfy a deductible every year before being eligible to receive benefit payments for sickness or injuries, coverage under the PremierAdvantage Plan provides our Insureds access to a large provider network that allows them the opportunity to obtain care at discounted rates if they utilize in-network providers. In addition, the Plan provides payment of the fixed dollar benefits as specified in the Certificate, with no deductibles or copays, for covered healthcare expenses AND it gives our Insureds the ability to increase their coverage if and/or when they decide their circumstances require it. With this option, our Insureds do not have to pay for more comprehensive coverage until or if they decide it is needed.As it pertains to the reviewers statement that the brokers and agents will say anything to get you a Policy, we respectfully disagree. We believe that we take every opportunity, both during the application process and afterwards, to make sure that our applicants are provided with the materials needed in order to make an informed decision. We even go as far as allowing an extended review period during which the applicant can cancel the coverage with no penalty. As a Company, we offer a portfolio of innovative products which provide first dollar benefits for covered services and substantial network discounts across a broad spectrum of providers. We take pride in our Products, which are typically more affordable than most ACA essential health benefits or major medical plans and are appealing to and a valid option for a vast number of people; however, we certainly understand that they are not suitable to everyones situation. In this case, since the reviewer contacted us and requested cancellation within the first 30 days of coverage, the Certificates are being nullified. Once the cancellation process is completed, the reviewer will receive a refund for all the premiums collected.*************************, Manager - Consumer Affairs

First off US Health group is a scam hiding under multiple scams that describe themselves as private health care providing the best insurance to individuals. Not to mention they're very misleading! I was called after filling out information on healthcare marketplace and my fault for assuming which I'll take but throughout our conversation that should be recorded my agent ******** whom I thought was awesome as much as the insurance salesman can be I guess but we would talk about subsidies that my husband will qualify for in the marketplace and I don't know how but it was just a smooth way of talking around and getting you to believe that I understand exactly what you need and I'm going to get you the best insurance without a high deductible. Perfect I'm thinking I tell him the specific needs of my major medical for my husband I mean the basic blood work colonoscopy and I actually have him on my vision and dental cuz I'm with Humana. He's like all right well let's get started and proceeded just to ask like I guess any doctor's ****** would about your present health and if you're at risk for certain things your age mainly your bank account and then we'll see Yes you're accepted and we'll be sending you you're welcome packet! I use too many characters and so look for the next review

Weve had an opportunity to review the comments provided by the reviewer above and provide the following in response. We attempted to reach out to the reviewer at the email address on the review, however, we have not received a response. We would greatly appreciate the opportunity to address the reviewers concerns. We hope that the reviewer will provide us with a telephone number and the best time to contact to discuss her concerns.Thank you for the opportunity to address this matter.*************************Manager, ***************************

They covered nothing there sales people lie for full coverage for everything that doctor ***** visits office visits for a family of three is little over $2000 their regular plan only allows six visits to office and only cover 75 bucks that would be fine if the sales people would tell you that but they dont they lie they say its $25 a visit do not believe any of their sales people, they will either a** off

We have had an opportunity to review the concerns brought forth in the review above and provide the following in response.By way of history, our records reflect that the reviewer was issued family coverage under a ************************* Policy, also known as (aka) the PremierAdvantage Plan, a Five Year Term Renewable to Age 70 ************** Policy With Term Life for Dependents and Critical Illness Accelerated Benefit, aka the MedGuard Plan, a **************** Policy, aka the PremierVision Plan, a **************** Policy, aka the SecureDental Plan, and a Ten Year Term Renewable to Age 70 ************** Policy, aka the Life Protector Plan, all of which became effective on September 13, 2022. These non-ERISA Plans are considered excepted benefit plans under the *************** Act (ACA). They are not comprehensive major medical plans; they do not constitute minimum essential coverage under the **** and they are not subject to the mandates of the **** The availability of benefits is subject to the definitions, provisions, exclusions, and limitations contained in each section and every section of the Plans.The MedGuard Plan provides a critical illness accelerated death benefit to the reviewer if the reviewer or one of his covered dependents is definitively diagnosed with a specified critical illness event or undergoes a Specified Critical Illness Surgery. The PremierVision Plan provides specified benefits for a comprehensive eye exam, frames and corrective lenses. The SecureDental Plan covers preventive, basic, major and orthodontic care services discounted at participating providers. The Life Protector Plan provides traditional Term ************** coverage for the covered individuals. The PremierAdvantage Plan provides fixed indemnity benefit payments according to a Policy Schedule for eligible expenses incurred as a result of a covered injury or illness. The fixed benefit is payable whenever an Insured incurs an eligible expense, and the applicable benefit has not been exhausted. Services not listed in the Policy Schedule are not eligible expenses. With the purchase of the PremierAdvantage Plan, the reviewer also purchased the Well-GIST Rider, which allows the reviewer or any of the covered dependents the ability to enhance the coverage by adding Wellness and Health Screening Fixed Indemnity Benefits, in addition to the option to purchase coverage under our Short-Term Medical-Surgical Expense Plan, aka PremierMed, on a one time right and guaranteed basis without any additional application, underwriting or evidence of insurability as long as they are not otherwise covered under a health insurance plan that constitutes minimum essential coverage under federal law.The PremierMed Plan, if purchased, provides reimbursement for eligible expenses rendered by both in- and out-of-network providers at 100% of the maximum allowable charge as defined by the Plan after the satisfaction of an initial $3,000 deductible, and if applicable a separate $6,000 out-of-network deductible. In order to exercise the Upgrade option, the Insured is required to contact our ****************** by phone at ************ or by sending an email request with your Member ID to ****************** Please note that if the option to upgrade the coverage is elected, there is a separate monthly premium that is paid in addition to the monthly premium for the PremierAdvantage Plan coverage. Regarding the reviewers comment about the coverage not being what the salespeople describe, we can only advise that we recognize that our products are unique and have significantly different benefits from those that are available under the major medical plans to which most individuals are accustomed, and we realize that a lot of information about the specific benefits, exclusions and limitations is provided during the sales presentation that might not be fully understood or remembered. As such, we rely on the benefit information provided in our published materials.To make sure that the benefit information is available to prospective clients, we have established Company procedures and processes, such as providing access to the product brochures at the time of the sales presentation so that the sales agent can review with the applicant. Additionally, if/or when an application is submitted, the Company sends a Welcome email to the email address listed on the application. The Welcome email includes links to the electronic application as well as links to the product brochures for the Plan coverage as selected on the application. Specific to this review, our documentation supports that we sent the Welcome email to the reviewer on September 9, 2022.Once the application was submitted, the reviewer also had the option to create a myUSHG.com account. Through the myUSHG.com account the reviewer has access to the Policy(s) and the Product Brochure(s) for the Plans purchased. In addition, during the underwriting of an application, it is the practice of our Company to contact our applicants on a recorded telephone line to verify the information reported on the application. According to our records, this call took place with the reviewer on September 9, 2022. We have reviewed the call documentation and provide the following information:When the representative stated, First we want to let you know this call is being recorded for quality assurance purposes and this recorded call will become part of your file at the insurance company. We will be relying on your responses and authorizations during this call to confirm information on your application, and to use as your electronic signatures on the Application, the Applicants Acknowledgments, and other authorizations in your application Package. If this is okay with you, can we get started? The reviewer replied, Yes. The representative advised the reviewer that the PremierAdvantage Plan does not constitute minimum essential coverage under the **** instead it is considered an excepted benefit plan. The reviewer responded yes, when the representative asked if the reviewer understood that the plans you selected provide the specific benefits as described in each plans brochure or Health Coverage Summary that had been received and reviewed with the sales agent. The reviewer confirmed that the home and email addresses listed on the application were correct. Toward the end of the call the representative reminded the reviewer again that the plans selected provide the specific benefits as described in the brochure that had been received and reviewed with the sales agent.Also on September 9, 2022, upon approval of the reviewers application the Policy(s) was sent to the reviewer via the US Mail. The Policy(s) includes separate sections, i.e., Benefit Schedule, Definitions, Exclusions, etc., which outline the coverage provided by the Plan(s). In addition, on page 1 of the Policy, the following notice was provided: YOUR THIRTY (30) DAY RIGHT TO RETURN THIS POLICY"If You are not satisfied with this Policy, You may return it to Us within thirty (30) days after You receive it. You may return it to Us by mail or to the agent who sold it. This Policy will be voided as of the Issue Date, and We will refund any premium We have received prior to Our receipt of the returned Policy.The above provision provided the reviewer with the freedom and ability to review the Plans for a full 30 days, and if not satisfied, within that 30-day period, the reviewer had the option to cancel the coverage for a full refund of premiums. In this case, since the Policy(s) was not returned to us as undeliverable, and we were not contacted by the reviewer during the 30-day period, it was concluded that the reviewer was satisfied with the coverage as issued.As it pertains to the reviewers statement that the Plan covers nothing, we respectfully disagree. Unlike ACA essential health benefits plans, under which a covered individual must typically first satisfy a deductible every year before being eligible to receive benefit payments, coverage under the PremierAdvantage Plan gives our Insureds access to a large provider network that allows them the opportunity to obtain care at discounted rates if they utilize in-network providers. In addition, the PremierAdvantage Plan provides payment of the fixed dollar benefits as specified in the Policy for covered healthcare expenses AND it gives our Insureds the ability to increase their coverage if and/or when they decide their circumstances require it. With this option, our Insureds do not have to pay for more comprehensive coverage until or if they decide it is needed.Specific to the claims for the reviewers family, our records reveal that we have received claims with charges totaling $4,884.35, we disallowed $3,242.63 due to network discounts, which lowered the amount due on the claims to $1,834.10. We issued payments totaling $1,186.82, which left the reviewer with out-of-pocket expenses totaling $647.28. In addition, based on the submitted charges, had the reviewers family been covered under a typical ACA Plan, most, if not all, of the expenses would have been applied to an annual deductible, which means the reviewer would have had to pay the full $1,834.10 out of pocket on top of paying a higher monthly premium for typical ACA Plan coverage. As a Company, we offer a portfolio of innovative products which provide first dollar benefits for covered services and substantial network discounts across a broad spectrum of providers. We take pride in our Products, which are typically more affordable than most ACA essential health benefits or major medical plans and are appealing to and a valid option for a vast number of people; however, they are not suitable to everyones situation. Based on the information as outlined in this response, we believe that we took every opportunity to provide the reviewer with the benefit information, both prior to and during the application of coverage, which allowed the reviewer to make an informed decision. Therefore, as this point, we do not feel that any further action is required of our Company.*************************, Manager Consumer Affairs

When you look for a doctor in the ** Health Group website, I find a doctor listed and set up an appt.but then told they don't accept US Health Group when I get there. My assumption would be that the doctor's ****** believed that it has United Healthcare coverage. Further, US Health Group needs to update their website as who accepts this health insurance because it seems many don't once you tell them of the health insurance company. It is frustrating that you have to go "fishing" to find a doctor when you get the list because many don't take this insurance.I am searching for another health insurance as we speak.

Weve had an opportunity to review the comments provided by the reviewer above and provide the following in response. Our records show the reviewer applied for and was issued coverage under two (2) separate Plans offered by our ******************** Group ************************************ Plan and an Association Group *********************** Plan. The Plans (non-ERISA) were issued effective October 1, 2018. The availability of benefits under each of the plans is subject to the definitions, provisions, exclusions and limitations of each Plan. This health plan is not a major medical plan, comprehensive medical insurance nor is it eligible for mandated benefits under the *************** Act. The available benefits under the Plans are the same for both in network and out of network providers. As a result of the reviewer comments, we reviewed the claim file and found that the only claim for 2023 was with a network provider and the available benefits have been issued to that provider. We do not have access to the provider contracts with the networks, therefore; we do not have the capability to update the provider website. A provider can participate or terminate at any time. Our *************************** can, and is always willing, to provide an Insured with the names of providers that are listed as in-network.Thank you for the opportunity to address this matter and we hope that we have adequately addressed all issues raised in the reviewers complaint.*************************Manager-Consumer Affairs

I would give 0 stars if I could. They straight out lied and said that my fiances doctor and prescriptions would be covered. They are not. I plan on helping my fiance *** them.

Weve had an opportunity to review the comments provided by the reviewer above and provide the following in response. Upon receipt of the review, a representative attempted to reach out to the reviewer at the email address listed on the review, to obtain the Insureds name and additional information regarding the benefit concerns. To date, no response has been received.We encourage the reviewer to contact our office at the toll-free telephone number on the Insureds ID card to provide additional information regarding their benefit concerns and to provide the Primary Insureds name or policy ID number. Once the identifying information is received, we would be happy to research the concerns presented in the review.The reviewer/Insured can also find assistance by logging onto the online portal at www.myUSHG.com.Thank you for the opportunity to address this matter and we hope that we have adequately addressed all issues raised in the reviewers complaint.*************************Manager-Consumer Affairs