I feel SCAMMED! (Twice) Can I sue??

Two months ago, on March 12th, I began receiving numerous calls from health insurance agents. I decided to speak to one since I was in need of health insurance and enrollment for major insurances was closed. I ended up making three payments, including two payments in one month for the First Health PPO insurance.

During my conversation with the agent, I asked multiple questions. I inquired whether this insurance was accepted in most places, to which she assured me it was. She told me it covers doctor visits, and when I asked about physical therapy, she confirmed it did cover such services. After she read the terms over the phone, I agreed and signed up. I also agreed to a 30-day trial during which I could get a refund if I was not satisfied.

Fast forward to after paying the second month of insurance, I fell ill. I looked up providers that accept my insurance on the site, which listed several doctors near me. I made an appointment at an urgent care center a block away from me, but they messaged me to say they did not accept my insurance. I called the insurance agency (or the brokers), and they insisted that the urgent care should accept it. When I called back, the urgent care center got annoyed and reiterated that they absolutely do not accept it. So, I called four or five other places on the list. None of them accepted it, so I ended up not going to the doctor at all.

A week later, I tried to make an appointment to see a dermatologist. I called the insurance provider so they could give me a list of dermatologists and confirm that my insurance covered it. They gave me a list of four dermatologists. I called all of them, and they all told me they do not accept my insurance. I called the insurance agency again the next day, and the representative spent 15-20 minutes searching for a dermatologist. She finally found one that accepted my insurance. I booked an appointment for later in the week. On the day of the appointment, I received a call from the dermatologist’s office saying they do not accept my insurance. I was furious at this point because no one accepts this insurance.

I called the agency, and the lady who had looked up the dermatologist answered. I explained the situation, and she was surprised, saying, “Oh wow, what? I thought they accepted it.” When I told her they didn’t, she remained quiet for about 30 seconds until I asked what was going to be done. I asked for a refund, and they said, “Well, it’s past the 30 days so you won’t be refunded,” even though no one has accepted this insurance!

She then claimed that there was a location miles away from me that would take 4 hours to get to that accepts the insurance.

Later that day, I called and spoke to an agent about my issue, who said, “Oops, we don’t cover dermatologist visits; you are on a low-tier plan.” I explained that I was told differently and asked to speak to a supervisor.

Finally, I got through, and the supervisor said, “You were mistakenly placed on the wrong plan. We are going to put you on the correct insurance.” She transferred me to another agent and remained on the call. She was helpful, and the other agent explained that the agent who originally sold me the insurance had misled me. They told me that I would be placed on better insurance but that I’d have to pay the first month along with the enrollment fee. I asked the supervisor before she transferred me if the insurance I was being placed on was under the same name, “First Health PPO,” and she claimed it was not and that it was different. I was told I’d be able to choose my own provider because everyone would accept it.

The agent gave me some name of the insurance. He sold me on the amount of benefits it comes with. I asked for the name of the insurance, and he told me it was “Med something.” I agreed. I asked to get a refund since I was misled the first time. He said he was going to work on getting a refund and that he wouldn’t be able to use the previous month’s payment for the enrollment payment. He said it would take 3-5 business days for a refund. This is why I signed up and decided to make a payment to enroll.

I agreed to the terms, and after hanging up, I checked the insurance. IT WAS THE SAME INSURANCE UNDER ANOTHER TIER! He didn’t give me the insurance name; he gave me the name of the tier, almost as if he was purposely trying not to let me know it was the same insurance.

I immediately called my bank and charged back all the months. I then contacted the insurance agency to request a refund so I wouldn’t have to deal with my bank contacting them, then making some decision on whether I am keeping the chargeback or not. They said they could refund me only for the new insurance. The other two months, they said, I had already signed for and it was past the 30 days. The supervisor then told me I would most likely not be refunded.

This has been an awful experience and I’m thinking of even suing them.

Do you think I’ll be able to keep what my bank chargeback gave me back? I’m worried they will take it back and claim I already signed and have no grounds for refunds. Could I have grounds for a lawsuit?

If they record calls, they should have recordinfs of the agents on the phone admitting they misled me the first time and claiming I’ll get a refund as he was trying to put me on another insurance.

submitted by /u/BedroomLower8058
[comments]