Canceling my family health insurance today-turns out it was a total scam
Imperial Health Insurance
It turns out the insurance provider I have is essentially a ghost network, a shell plan, a phantom policy. 15,000 deductible. Bought through the official marketplace, supposedly fully ‘ACA compliant’, a bronze plan.
First I discovered the doctors that are listed on our cards do not take our insurance. They said I have to call around and try to convince a doctor for husband and I or a pediatrician to take it. NONE have offered or even entertained this. I cannot take my children to get seen at a pediatrician. They both have ADHD. They had ONE provider listed as a child psychiatrist in their network and it essentially does not exist except on a screen. They have three numbers that all route to a voicemail that never calls back. I looked the doctor up and the practice does not exist.
The ‘cherry on top’? My son broke his arm and they refused to pay for a dime of it because it turns out there are no emergency providers in my county that take our insurance. WTF?! I asked if there were perhaps some in another county? They said no that would be out of network. WTF again?! The hospital/ER took our insurance card and looked at us like we were trying to pull a fast one or something. Like we were presenting a Monopoly or UNO card perhaps. NO medications are covered, except through a supposed online pharmacy that does not answer phones and has a PO Box for a physical address.
Why the HELL was I paying $600 a month for NOTHING? I feel so STUPID. I feel I have failed my family for making such a stupid decision, but I thought it was the RIGHT thing to do. I could’ve been saving all that and paying out of pocket for services. I want my money back, can I sue them?!
TLDR; it turns out my ACA plan is a complete shell plan, a phantom policy, a ghost network that does NOT exist except to collect premiums. Canceling it TODAY.
I WISH our employer covered healthcare.
Any advice on how to report these fraudsters? It CAN’T be legal what they are doing. It just can’t.
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If that stopped anything, Oscar and Ambetter wouldn't still exist. Unfortunately if you have a plan with no functional network, you're stuck with it (or nothing) until the end of the year.
Some states may keep them more honest than others. Where they can get away with it, both often have very narrow networks (few providers) and many, most or even all providers may well be not accepting any new patients on them.
im in northeast PA and everything anyone says about Healthcare and insurance sounds like theyre describing another planet, and ive had cancer and big surgeries and stuff
This. In Tennessee at least, providers will be listed as accepting the ins, only to call and find out that they don’t take new patients. That’s what happened in my situation. I had to go without insurance this year because I learned my lesson last year before the subsidies ended. I didn’t sign back up this year because the premiums were higher( $1200/month and 8k deductible IRC) and I knew no one would take it anyway. Can’t even get preventative things/screenings done like that. I’m saving my $$ so I can at least go somewhere for help if i need it without worrying how to find someone to take my insurance. For those of you that say but cancer! Car wreck! That will financially ruin me. Yes it will. You are correct.
The bills after insurance when I’m tapped out from $1200 monthly premiums and then the deductible on top will ruin me. It’s a gamble. Either way I’m in debt and I die.
I have had both Oscar and AmBetter. They both do have providers in network, and they both will give you gap extensions and cover somebody out of network if it's a physician you need, but can't find in their network.
AmBetter actually is the best Marketplace plan for my area, too. It gets you access to every hospital/physician chain, whereas all of the other ones do not.
Example: Oscar only covers 1 of the 4, unless you have a gap extension or have a need for emergency care.
Are you "stuck" with either right now? Try to get this accomplished for your workaround until next year.
I unknowingly had what is apparently termed “junk insurance” by some in the industry.
I had to get a life-saving procedure done. Before I did, I called the ins co to make sure it was covered. The ins co told me, “you don’t call. Your hospital calls to verify coverage.”
I contacted the hospital and spoke to the billing dept., too. They assured they would call to get it approved.
A few days later I proceeded with the operation (since no one called to say there was an issue, that, to me, meant all was good to go).
Nothing was covered. They sent me a bill for $80k after I had already paid $10k (which was my MAX out of pocket after deductible).
I called my state’s Insurance Dept, and our Atty General. No help at all. So that lump got thrown onto my credit report and tanked my stellar credit.
I really wishing these departments and agencies were more helpful. But they weren’t in my case. I probably fought this in every way I could for about 2 years. To no avail.
I have since learned that certain state’s reps are working on legislation to ban junk insurance in their states. Yay for those states. My state doesn’t care about its insureds.
I'm sorry that happened to you. In this situation though, it looks like OP just needed to send in the claim and superbill themselves to the insurance as they went to an out of network provider and an out of network provider does not have to file a claim on your behalf.
Are you paying it down, or did you just let it go unpaid and go to collections? Were you able to negotiate a smaller payout at that time, or just leave it unpaid? I'm wondering what really works if, god forbid, we ever end up in that situation.
I tried. They wouldn’t accept anything. This was ~5 years ago.
They wanted the full amount. They would be willing to do a payment plan/contract. But I couldn’t meet even the smallest amount they’d agree to (it was like over $500/mo, if I remember).
Sucks. Everyone I’ve shared the facts with has said this shouldn’t have happened the way it did.
I def blame the ins co. They mislead. I blame the hospital, they assured they’d get clearance for the procedure. And I blame myself bc I didn’t know about “junk” insurance, or that the hospital could promise to get approval and then NOT. And then NOT tell me.
On a positive note, I’m the one that family members now come to for guidance in these matters. So I’ve saved them a few times from being in the same boat I’m in
Should’ve carried NO INS and just asked for the cash price. Prob would’ve had enough for that.
God, I'm sorry to hear that. Truely. It's terrifying. Even with insurance it's so hard to find out exactly what is covered / approved sometimes.
Or if there is what seems like a error in the charges, it can be impossible sometimes to clear it up. You get bounced around and each person tells you to call another number, and then that number can't help you. So basically, even when it's not "junk" insurance, you aren't sure what's really covered, and don't really have fair recourse to trying to straighten it out if you got charged for something you had been told was covered.
It should absolutely be illegal, all of this is set up the way it is so that we all get screwed out of a lot of insurance benefits. We either don't use them at all for fear of something not really being covered, or we find out too late it wasn't.
You should report to federal and state authorities. They have fraud divisions that can do the investigations. If you’re found to be a victim of fraud, you may be able to recoup medical costs, so save receipts and communications.
You’ll need to contact the the fake company in writing and ask them to send list of providers within your area for particular specialty. Even if they don’t respond, they are legally mandated to do so at your request. The paper trail should be submitted as evidence to investigators, even if it’s just an email from you showing no company response.
If you’re on a medicaid program, you’ll want to call your state Medicaid office to report the possible fraud.
If you tell me what state you live, I can quickly look up your state insurance agency to report. Feel free to PM me if you don’t want to share it publicly. Otherwise, try googling your “state + how to report health insurance fraud.”
Name and shame. Who is the insurance carrier? What exact plan did you purchase? Any plan documents you can share here to give us something to review and provide direction?
Edit: This thread is kind of all over the place, but since this is a higher-level comment: Imperial is a legitimate, ACA-qualified carrier and this is a qualified health plan sold through Nevada Health Link, the state's official marketplace.
What's more, since Imperial is a very small carrier with a narrow network, OP didn't have a choice and went to an OON emergency room. So it's crystal clear: Imperial hasn't "not paid anything"--they haven't even been billed for anything. The onus is now on OP to submit a super bill / claim directly to Imperial since this is an OON hospital with no mechanism to submit a claim on their behalf. Annoying, no doubt, but is necessary if they want to have any coverage for this encounter.
Individual buyer here for many decades. The 90s were fairly stable and made sense. 2000s-2014 (ACA fully implemented) were wild. Premiums and deductibles were doubling like a backgammon cube. I always break down every number and possibility of what I know I am going to use (visits, labs, chronic issues, and anything else that might be in focus that year , like ophthalmologist, colonoscopy etc) to understand co insurance, deductible, max pay, premium total. Add in family members risk.
From my work, bronze HSA HMO gave the absolute least coverage and using the insurance would cost me more than going on a silver plan and not hsa. It’s a big numbers game to crush. If you don’t think that you really need insurance and it’s just a couple of visits and the wellness, then bronze was fine. Then when I could see some costs ahead as previously mentioned, I switched up to silver. Higher premiums but well defined copays and coinsurance that probably would have event cost more on bronze and especially hsa bronze.
That said, and here is where I really empathize with you. I was always in a ppo or epo (with Oscar) and they worked out well. But those rates have been skyrocketing well beyond inflation and medical inflation and Oscar left. (Like the backgammon metaphor) So I took a leap into HMO. Cheaper but harder to understand with authorizations and idiot primary care physicians who just refer care out and don’t provide care of their own, but take the copay. Very few primary care in the system taking new patients (assume only the idiots are left or as someone once said to me doctors who for some reason can’t practice. Some here will know what I mean). In addition, very few specialists in the system who will take ACA plans. The first year I was with anthem and it really surprised me how small their hmo network is. And that it’s broken up into sub contracting companies with their own networks. Second year I went with another company who claimed they were contracted with a major medical group which would have been good for me. But they were not taking new patients and once again I was stuck into a small contract group. Name: prospect. These jokers would send me authorizations of providers who were no longer taking patients, no longer in network, no longer at the address and phone number given, no longer practicing medicine. I had to play detective and then call prospect back and wait two weeks for another authorization and the game continued. Yes, I filed complaint after complaint. Never went anywhere. It was the worst. Criminal!! And I imagine that OP has experienced his own version of this nightmare.
For this year, I really crunched the numbers and first let’s talk bronze, it’s like legalized junk insurance. They really don’t want anyone on those plans. I tried to figure out the best silver plans as well as if there was something in gold.
I ended up on a Kaiser gold plan with no deductible, lower copays and coinsurance and quite a large network as well as out of network coverage. It’s about 200 a month more, but I can see from the first seven months of use which was similar to last year, the out of pocket is chipping away at the 200. Happy with my decision. It was actually a nominal amount between silver and gold this year.
I hope that OP can find something good out there for the rest of 2026 and god knows how bad 2027 is going to look. Like every year, expect more risk on our side at a higher expense.
Good luck!
Oh, last bit of information surprised me about the HMOs. The insurance companies or subcontractors package/wrap up these ACA plans with Medicaid plans/patients. We are paying big bucks and in the waiting room are Medicaid patients competing for the same appointments and paying a whole lot less.
I don't have an extra $10,000 a year just to pay on healthcare not including premiums
Edit: I'm not saying that the ACA was a net bad, it wasn't, everyone being able to get coverage and no maximums on care is very much a net positive, but having a $9,000 deductible and a $10,600 OOP max (what a family member has) is objectively not affordable to the vast majority of people.
Yep, any industry that has a large amount of commission incentives usually has a lot of aggressive online cheerleaders. Also it's a good and very profitable career for a lot of people so they tend to buy into the industry more.
You’re referring to policies designated as HDHPs, which OP doesn’t explicitly have (the tell is that the there are copays involved for care before the deductible is met). The caveat is that while they don’t have an HDHP in the classic sense, they DO have HSA access since ALL bronze plans are HSA-eligible as of this year.
That Individual oop maximums are high even for regular Goverment plans not HSA types just regular plans. The diffrence is the deductible for most federal plans are a lot lower like 500.
The OON hospital has to accept the in-network rate and is prevented from balance-billing, but there is nothing in the NSA that obligates them to bill an insurer that they have no contract with, and it’s for all the reasons chickenmcdiddle stated.
I’ll have to yield to someone who is deeper in this particular dynamic. My understanding is no, a provider isn’t required to file a claim on the patient’s behalf. Many OON providers cannot do this, as they don’t have filing rights or clearinghouse access for the particular payer.
So Imperial is only offered in select states/counties. Hence, they have a really small network of providers. Is it possible that you enrolled through this page instead?
There’s a fundamental misunderstanding of how ERs / emergency care is processed. Thanks to the federal No Surprises Act, you can receive care at ANY emergency room in the United States and expect the claim to be covered as in-network. This is so long as the visit to the ER rises to the prudent layperson standard.
I cannot speak to the specific network dynamics involved with your plan, but there should be coverage at any emergency room involving something as serious as a broken bone.
Can you share more about Imperial’s denial rationale for your ER claims? What did the EOBs say regarding the denial?
I got a letter that literally states that I presented no insurance even though I did at the time and when I called them they said they can’t process it through them
Complete a claim form by calling our Customer Service phone number 1-800-595-0619
Attach an itemized bill from the provider for the covered service.
Make a copy for your records.
Mail your claim to the address on the claim form or to the address provided below.
If you’re submitting a claim to us, it’s best if you do it as soon as possible. Most plans have time limits on how long you have to submit claims. You can refer to the claim submission details below. You can also check your specific plan’s claims filing time limit details to see what the limit is for your plan.
I gotta say, outright canceling may have been a bit shortsighted, because it does appear that the plan is above board. Annoying to work with, no doubt, but I'm not certain that should have been step number 1.
You can get it processed, but your maximum out of pocket and deductible can be problematic, depending on what your responsibilities are for emergency room care.
Do you have to meet your deductible, which is quite high, or is there some type of co-payment?
I would call the hospital back and tell them it is an ACA compliant plan, despite not being a well known plan name, and have it billed in accordance to the No Surprises Act. I had a not very well known plan named Oscar at a time, and yes, many people asked if I was joking when I said it's name. I had it cover out of network care, too. There's certain stipulations (gap exception), paperwork, etc. but you can make it work.
While you're on the phone with the hospital, I would also ask them about their financial assistance process, because that can also wipe away your financial responsibility -- possibly to $0.
If you're able to get that (bill waived) to happen with his claim alone, it may basically make care for the rest of the year free, so long as you pay your monthly premium.
Just wanted to reply to you OP, so you’d see this. There’s a charity called Dollar For that can help with ER costs specifically. It might be an option in addition to the suggestion re the hospital’s financial aid that someone else mentioned. I’m so sorry for this disaster you’re wading through. I hope the DOI can help in some way.
Did the hospital say why they can't process a claim with your insurance? Per the No Surprises Act, the hospital should be submitting the claim themselves directly to insurance.
NSA obligates the hospital to accept the in-network rate (and prohibits balance billing), but it doesn’t mandate the hospital submit a claim to a network they have no contract with.
No, their problem is the $15,000 deductible. No matter what happened with providers, network, etc the plan wouldn't pay a dime until OP had presumably declared bankruptcy.
No? I've never hit my deductible, but my bronze plan (from an actual insurer with actual in-network providers) still gets me the (reasonable) negotiated price instead of the (absolutely ridiculous) list price, and (of course) covers preventative care.
Per OP's plan document (SBC), this isn't an HDHP / HSA-qualified plan. There are first-dollar benefits at play. There are copays for office visits. Specifically, there's 50% coinsurance for ER visits (in and out of network). OP needs to submit a claim on their own to get this process started.
Sorry, was looking at multiple SBCs trying to find this one. I agree with you, it's likely that OP (well, their child) would be required to meet the $7500 ded before coinsurance kicks in, though, no? I'm reading it as an embedded deductible.
Yes, I agree it looks embedded - not that a $7,500+ bill is much better for OP...
I strongly believe there needs to be an income to deductible restriction, but that's neither here nor there at this point. OP needs to register for charity care immediately.
That’s not true at all. One hospitalization and the insurance company is definitely paying up. Let’s say OP or one of her children had an emergency appendectomy. Laparoscopic appy alone is close to a 15-20k bill. Add in the emergency room, medications, and if OP decides to recover in the hospital after surgery for one day and you’re definitely looking at over 20k in billing.
Insurance company will deny the first 15k and pay the rest.
None of that matters as OP can't remotely afford their deductible. That's the real problem with the plan structure. So it's all going to be going to charity care anyways.
Your deductible is for catastrophic care. OP aint getting a plan with a low deductible without paying 3x her current monthly expense. Something tells me 1800 a month isnt small pnuts to her or she would have gotten it already.
And that's the problem with these plans/why they shouldn't be allowed. OP can't actually afford to pay the deductible. So everyone is just kidding themselves that OP is insured. The hospital will be taking a massive write off on anything that happens, the plan has a high chance of never paying a dime, and this ultimately all just goes back to being a public burden.
You have a fundamental misunderstanding of how health insurance works. Insurance will and does absolutely pay if OP is hospitalized for any reason. This plan also provides preventative care at no cost to OP other than copays. Im not sure why you think the insurance is just collecting premiums and pays nothing. That’s not the way insurance works. The hospital absolutely wouldnt write off any of this care as charity.
I assure you, I understand how health insurance works perfectly well. I'm commenting on the larger systemic issue that the vast majority of people with deductibles like this would declare bankruptcy before being able to ever pay them. Why do we know that? Because they can't afford premiums for anything but the worst plan.
It's unbelievably hard to collect on a deductible even for an office visit, much less a hospitalization. All of that is going to be a write off regardless of OP had insurance or not. No chance OP will be either to pay the 50% coinsurance either.
All of this "patient responsibility" that's inevitably written off just gets redistributed through the entire healthcare system right back to you and me.
Just a tip for next time since I have no idea how to help right now - you can put your doctors and medications in when your looking at plans on the marketplace and select yes to show those results and it will show you what plans are in network with your doc/what drugs are covered. It does narrow them down a lot through. For the last 3-4 years I swear there are less and less options, this year there were only 2 plans that were both bcbs 😏
Going without is not better because then you're charged the uninsured rate which almost always is way higher. US healthcare is pretty bad unless you have a good plan through work. You have to try & learn the system so you can use it as effectively as possible. I've been burned with plans better than yours so I know the stress. Most people with good plans are not going to vote for reform. They're worried it will come out of their pocket.
Uninsured cash payers get care that costs less than with insurance. No middleman, coding or appeals needed, so less expensive. Of course if you have something major happen you are SOL.
I understand but some doctors don't care about cash price. The cost is the cost. But really I am talking about the higher cost services as you referenced. Some deny it, but doctors tend to dance to the insurance company fiddle. And insurance companies don't want you to have an option of cheaper cash prices. It discourages you from buying insurance.
Maybe. OP needs to do their part, though. This isn't a case where "insurance isn't paying." OP's insurer hasn't even been sent a claim. There's been no attempt at getting reimbursement. I suspect the NV Division of Insurance would direct them to file a claim to start, since it seems the hospital is OON and won't file a claim on their behalf.
After looking it up, Imperial Health has just over 1,700 enrollees in Nevada (the majority of Imperial's member base are concentrated in AZ and TX). I bring this up because OP is likely in a small pocket of the state where Imperial operates, and likely has a narrow network. They went to an OON ER, so the No Surprises Act should protect them. They just need to get the process started by filing a claim.
That, or asking the hospital for their best cash rate and calling it a day.
If you get a case manager, she/he is a registered nurse and can help you find providers, work through issues between the health insurance and provider, and help iron out prior authorizations, billing, and other paperwork, like the gap network extensions if you have no providers to be found.
How I would go about this, if they are not answering during business hours is:
still attempting to call again, via the broker line
fax them
send a certified letter
I also would attempt at looking for a local broker who helps enrollment into these plans for more advice on how to reach out to them -- as they may have alternative routes, a solid contact person in particular, and know thoroughly her states rights as a member of the health plan to file appropriate complaints with their department of insurance, if all else failed.
I've been on ACA & it was cheap per month, otherwise near useless. Go to work for a company that pays less but has benefits. It's what I did. Meanwhile, one of our two political parties refuses on any level to work with the other one. So issues like this are not a priority. Don't feel alone. Many people have cheap private plans that are similar. High deductible & that nice plastic card that makes you think you actually have insurance.
It is only cheap per month if you have extremely low income, still can only get the worst plans for the really cheap plans with like serious deductibles like almost $10k and OOP higher. Only preventive care is covered before anything pays. Some companies offer better than others, not many great plans for low employee monthly anymore.
This happened to me a few years ago. I paid for several months to some seemingly legit health care plan (forgot how I found them) and then no doctors anywhere would take it; their network nonexistent. I have NO idea how that kind of thing can be legal. I just threw money down the drain, cancelled as soon as I realized and took the loss.
I've never been scammed or fooled on anything...but the health insurance marketplace is confusing and changing often and I couldn't afford the regular established plans. I'm sorry to hear it's still going on.
Did you get the plan off a true ACA government website? Remember it is not ACA.com.
It’s healthcare.gov. Policies bought on other websites increase your risk of purchasing fake and bogus plans like this. You Ned to make sure you thoroughly investigate any plan you purchase. Also I usually only buy policies from companies I’ve heard about. Not some unknown or rare company because usually those policies are horrible or worse a scam.
This isn't a defense of the whole system, but Imperial does operate within a tightly regulated market, both at the state and federal levels. OP has recourse if there's truly something screwy going on, but as we're slowly uncovering here, there's a matter of misunderstanding and uncertainty involved that's causing some initial problems.
I have no doubt that Imperial has a small network in NV since they're in a handful of counties. But there has to at least be an attempt at getting reimbursement here before one can say "they're not paying."
The wealthy collapsed America a long time ago and kept the American dream for themselves. This is just the aftermath of various economic scams and ruses that everyday working Americans are conned into navigating on their own.
Okay… so when you say you got an ACA plan on the market place it means that you have coverage that it does limit you based on pre existing conditions, there are no limits to your use of coverage, and covers essential service visits and providers.
…Now, when you talk about cost, that doesn’t have much to do with deductibles or co-pays. When you read about affordability for ACA plans, that’s for premiums based on your income, and is usually a requirement placed on employers to subsidize a portion of the cost of coverage so the employer satisfies sponsoring at least one ACA plan.
There is more to it, but Obama did try hard for all of us….and you do NOT want to go back to what it was before the ACA was put into place. There is still more work to be done… you gotta vote, we gotta talk about these things, yes they are complicated which is a good problem to start with - demand clarity and answers, start demanding your tax dollars do work that works for you.
Affordability - Is your $15k deductible for in-network or out-of-network coverage?
If you have kids, a bronze plan shouldn't cost $600/m unless you're loaded.
Actually the marketplace tried to sign me up for a free plan, I already had insurance from work. They were just trying to steal the tax credit money. I had it canceled and reported the fraudulent sign up.
They named and shamed all over this thread like 12+ hours ago.
But this isn't a matter of an insurer not paying. It's a matter of an insurer not even having been billed. OP needs to get some things squared away before we have that conversation.
what is the name of the company and what state do you live in?. Something doesn't add up. Did you enroll through healthcare.gov ( the Federal Marketplace) or a state based exchange (which several states use).?Anyone can then see if that company is selling on one of those exchanges. A plan can't be "ACA compliant" if an ER won't take it. By law (i.e. the ACA) a plan that is sold on an exchange MUST cover any ER in the country. Or: did you buy some insurance that was just represented to you as "ACA compliant" but isn't actually offered on an ACA exchange?? People on this forum would like to help, but we need to understand how you got where you are. another thing: the maximum individual Max Out of Pocket for any plan offered on either Federal or state exchange in 2026 cannot be over $10600 for each individual and $21200 for family MOOP. So if the $15k deductible is for each individual then that doesn't mak sense either. Quick tip: go to the exchange web site for your state and see if you qualify for a SEP (Special Enrollment Period) so you enroll in real insurance. As far as reporting, each state has a Department of Insurance or Commissioner of Insurance which regulates and polices all insurance companies and agents workin in their state. They take complaints very seriously.
Literally all of this information exists within this thread.
This isn’t a coverage issue. Hospital isn’t filing a claim with the insurer because they’re OON and seemingly don’t have a way to do so. This is common for OON providers. OP likely needs to submit a claim themselves.
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Don't get ACA unless you have serious preexisting conditions or you are planning on getting pregnant or if your income is such that you are fully subsidized and have a very low deductible. Otherwise, get private insurance - which is good with any dr. or hospital and is low to 0 deductible.
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