Paying premiums, but still losing health coverage

7 On Your Side reporter Nina Pineda has the story
Seven On Your Side
November 8, 2013 3:13:19 PM PST
A Long Island woman says she paid her health insurance premiums every month. But one day she went to the doctor and got stunning news: her coverage was gone.

An insurance broker had promised to shop around and get the best rates. But the woman was left without coverage, and now the broker is on the hot seat.

"I have a simple question: you're taking money out of clients accounts and not paying premiums?", we asked at the broker's office.

After our visit to the PJP health agency, we understood the frustration of their client, Janet Danforth.

"Oh I am absolutely furious, I have become like a really wild crazy yelling person," Danforth said.

That's because after a routine annual mammogram, the self-employed author got shocking news.

"I got a letter denying the claims saying that I had no insurance," said Danforth.

Yet every month for the last year, the insurance brokers at PJP were taking premiums out of her bank account.

She pays $1000 each month. But Emblem Health says it never received 2 months premiums so it dropped her.

"It just had to be a clerical error," said Danforth. ('One that's taken a year to resolve?') "Yeah."

And with no insurance, Janet got stuck with nearly $900 in unpaid medical bills. Now that bill has gone to collections.

Each time she tried to clear it up: "No one will return my calls," she said.

She encountered what we did at the office. "Hi, we're 7 On Your Side," we said. The response: "I'm just a salesperson, I have nothing to do with anything!"

A rep from the New York State Department of Insurance said PJP Health Agency is under investigation for not paying premiums, leaving clients uncovered. Their broker's license, now revoked.

The bosses turned their backs on us, but just minutes after our visit PJP express mailed out a check to Janet: $2,000, 2 months of premiums, refunded.

"A day after 7 On Your Side got involved they called me and they were very happy to reconcile," Danforth said.

And Emblem Health agreed to pay all her medical bills.

"Thank you, thank you, thank you, thank you!!!", she told us.

So whose mistake was it? We'll never know. Emblem said they never got the money from PJP, and PJP said the money was sent out.

Before hiring a health insurance broker, don't be so quick to give out personal information, like your date of birth and social security number until you check the company for complaints.

You can call your insurance department and ask if there's any disciplinary action against them or simply do a web search.

And finally, search with your state department of insurance. Brokers have to be licensed with the state.