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Summary of benefits coverage

Question asked by aka51115425989 on May 15, 2019
Latest reply on May 15, 2019 by communitymanager

Your Summary of Benefits Coverage (SBC) should be reviewed and revised. The language in the "If you are pregnant" section does not align with the information phone reps are providing. The SBC indicates there is no charge for office visits in-network, while the details section states no cost sharing for preventative services. I called the phone rep trying to clarify if all office visits were free when pregnant or what is considered preventative when pregnant. One rep told me to disregard everything in the SBC and that the entire document was generic and not plan specific. She said that I could google an SBC and see it's the same for all plans. I told her that was untrue and asked to speak with someone else - she transferred me to someone that sounded just like her and the rep mysteriously hung up mid call. A second rep I spoke with explained that the first visit when you find out you are pregnant is free of charge but all other visits would apply the specialist co-pay. If this is the case, then the language in the SBC is grossly misrepresentative and needs revising. Reps also need to be trained on providing consistent responses as understanding the specifics of health care coverage is extremely important. I'm using the answers to select between two different plans and need to be able to trust the plan documents and answers from your company reps.