American Medical Security (United Wisconsin Insurance Company)

American Medical Security (United Wisconsin Insurance Company)

September 21, 2005

Health Insurance

3100 AMS Boulevard

Green Bay, WI 54307

800-232-5432

We are self employed and purchased private health insurance for our family through American Medical Security (United Wisconsin Life Insurance Company) effective November 1, 2004. We filled out an application and completed a phone interview in good faith with this company, disclosing all medical conditions we were aware of for the four members of our family. During the first week of April, 2005, our daughter Kaitlyn became violently ill, eventually jaundiced, and was seen by our primary care physician. He ordered tests, gave a referral to a pediatric gastrointernologist (Vidal Goie). Dr. Goie ran many tests, most of which were questioned and refused by American Medical, and she eventually discovered 2 gall stones. She recommended immediate removal of my 13 year old daughter's gallbladder. This condition was first diagnosed in late May, early June of this year. Although Dr. Goie suspected a liver function issue, this was not the case. Kaitlyn's gallbladder was never considered prior to an ultrasound ordered by Dr. Goie as a preliminary test before a liver biopsi.

American Medical initially questioned several of Dr. Goie's and Vasovski's routine tests, then informed us that the recommended surgeon, Dr. Charles Howell - Augusta, Georgia, was not in our network. When we asked for alternative pediatric thorasic surgeons in a 6 hour radius of our home, we were given 4 names, three of which were podiatrists and one number was disconnected.

At this time, Dr. Howell began the process of applying to become a part of their network, no small task as his group of doctors exceeds 5000. At this time, American Medical informed us they were investigating whether this was a pre-existing condition. It was not.

At this point, they honed in on an obscure blood test result conducted by our primary care physician's office to detect whether Kaityn had been ill with mononucleosis the previous winter. The tests came back negative for mono, although three liver markers were marginally off. Our physician attributed this to her many doses of Nyquil (acetametaphine) over the course of her numerous colds over the winter.

Our focus was that she was not infected with mono and this test never entered our radar when asked by American Medical whether any of us had received abnormal test results in the past. In our doctor's opinion, and ours, the tests were not abnormal, but expected and within a normal range considering her immediate history of Niquil doses over the course of the winter.

Coincidently, Dr. Goie has stated that the liver markers in questions (SGOT, SGPT and Bilirubin) are NOT indicators that would point a diagnostician to gallbladder disease.

In any event, American Medical is not only refusing to pay for Kaityln's surgery, but they are resinding her coverage back to November of 2004. If we do not agree to this, they are threatening to resind our entire family's policy. We feel STRONGLY that although we acted in good faith, were truthful about disclosing other medical issues present in our family, that this company acted in BAD FAITH at the very least and CRIMINALLY at the most. We are unable to pay for our daughter's surgery and are forced to watch her struggle with extremely painful gallbladder contractions, jaundice, nausea, weakness and the inability to eat without severe symptoms. As I write this, she is jaundiced and in severe pain. We have a high deductible ($5,000.00) with this company. We never intended American Medical to cover minor family medical expenses. We bought it to insure that our children would be taken care of in the event of surgery or some other emergency. Our family doctor, an Insurance Regulatory Analyst for the state of South Carolina and several nurses we have spoken with have all remarked to us that this company is notorious for their history paying and/or delaying claims, disputing routine medical procedures and canceling policies when insureds needed them most. Our family doctor refuses to even deal with them any more

Our family is in the process of obtaining passports so that we may take our daughter to Thailand to have this procedure done. Her operation there will be approximatley 1/10 of the costs here, including travel and hotel. Our only fear is that her gallbladder will become gangreness before we can arrange international travel. As a side note, Kaitlyn's surgeon in Augusta, Georgia is approximately a fifteen minute drive away.

Health Insurance? Don't get sick, and if you do, pray you don't have American Medical Security as your provider because you WILL BE OUT OF LUCK. Click this link to e-mail the message author: Email User

Comment On This

I am an agent in Oklahoma and have a lawsuit pending against AMS regarding these practices. Would like to talk with you(the insured) jerry hayden-- agent