Insurance companies

Navigating insurance companies can be incredibly challenging. The effort put into due diligence often feels overlooked. Before purchasing plans from @Unum, I contacted my employer's Human Resources/ Benefits representative directly. I asked very specific questions to ensure clarity. First, I inquired if the critical illness policy had exclusions for Myotonic Dystrophy, a genetic disorder related to Muscular Dystrophy; the response was no. Next, I asked if Myotonic Dystrophy was covered under the critical illness policy, and was told it fell under the childhood diseases clause. I also asked if sudden cardiac arrest was included, to which the answer was yes. Lastly, I confirmed whether there was a waiting period after the policy was issued before claims could be filed; I was assured that claims could be submitted immediately upon the policy's issuance. I received consistent answers from both the employer benefits representative and Unum regarding the voluntary life insurance and critical illness policies, though there were discrepancies concerning health, hospital, vision, and dental insurance. Based on this information, I chose to enroll in all plans except for vision and added my dependent, Zayden, under the voluntary life, accident, and critical illness policies, as I have custody and neither of his parents have jobs that offer benefits. I signed the necessary consent forms requested by Unum and received policy certificates for all enrolled plans. I verified that my name was correctly spelled on my policies, as well as Zayden’s name on the plans where he was added as a dependent. Policy premiums were deducted from my paycheck weekly without issues.

Yet, months later, when I filed claims, Unum denied one claim outright and is intentionally delaying the second. Unum representatives apologized for the misinformation regarding my employer's group critical illness policy, which supposedly does not cover Myotonic Dystrophy or sudden cardiac arrest. They suggested that their mix-up occurs often since many of their critical illness policies do cover those conditions. When I questioned how my employer's specific critical illness information could be confused with a different policy—especially since their representative asked for my employer’s name to pull up the correct details—the response was to contact my employer's benefits representative for clarification. Unum's representative could not answer my query and directed me to my employer's benefits rep as the only source of the definitive answer.

Following their advice, I contacted the employer's benefit department. However, as per usual after filing claims for the voluntary life and critical illness policies, any representative who answered my calls stated they would relay my message to the benefits director. I've also left voicemails and sent emails to the benefits director, including responding to a recent email from them requesting proof of custody for Zayden as per the Unum claims department's requirements. Unfortunately, I still haven’t received a reply or a return call.

When I inquired with the Unum representative about why the physician's form sent to Zayden's PCP listed both Muscular Dystrophy and sudden cardiac arrest as covered diseases, I was informed there is a standardized form used for all policies, but not all of them cover every condition listed. I attempted to reach out to the employer’s benefits representative again, but as before, I was met with voicemail and no return call. After leaving multiple messages, I finally received a call back that provided little more than reassurance that the benefits person would reach out to the insurance company and would contact me once she had updates. The employer benefits person stated their team always refer employees to contact Unum  to verify specific plan coverage.

It very much seems to be a pass the buck so in the end so that the employer can feel hoof that they offer a "great benefits package," while the insurance company gets to take both the employers money and the employees' hard earned money to screw them out of benefits. Hopefully time will prove me wrong and this situation will resolve itself correctly. Otherwise, it will be back to the drawing board to figure out another funding route to fully launch Zayden's Crusade Foundation.