PJP Health Agency review: Fraud 127

PJP (Health Essencial Health Care) is a FRAUD and SCAM, after speaking with the REP., not even 5min., he started to ask for my bank acct.( a light-bulb) immediately pop in my head. i said to him im not comfortable with giving that info over the phone, besides ive never heard of (Health Essencial) before. I then ask, are you with the BBB, yes were rated A+ excellence. I started to ask ? about the quote he had given me(steady talking over me) you're never going to find a better rate than this, and true enough, he was right $169 everything included. Meanwhile, still asking for acct. info atleast 5x's. well sir im going to have to contact BBB, i understand he said, but your not going to find a better rate(continiously). mam all i need is your acct info...ha! I then said to him, let me call you back, i need to find out more about your company. True enough i did, BBB rated them a F, scored a 4.2 out of 5 and does'nt have sufficient info on the company. Please BE AWARE OF THESE TYPE OF COMPANIES. It's also GOOD to ask QUESTIONS on what they DONT COVER as well as what they DO COVER.

I am glad I read this board after I thought I purchased insurance...No sooner that I did I ran to the bank to stop paymnet so I wasn't scammed like the rest on here...I currently have great insurance but not my girlfriend as we are not married yet but tried to help her in the mean time until we do, wow what a wake up call..Soon as I typed their info in the computer this page came up and ...BOOM...Called the bank before they could even process the payment (cost 30$) but well worth it...Called them back to let them know what I know about them and they were a stuttering mess, almost laughable to say the least..Stay away from them as it is only a matter of time before they all end up in jail...

wow, , guys i don't know what to say. i was there for an interview recently; and they have huge place in lake success, ny which fascinated me that they are running successfully. i was searching about the experience of working for this company and found this website. i am glad that i did not made my mind to work for this. company. thanks a lot guys. God Bless all of you. thanks

PJP Health Agency is the absolute worst company I have EVER had to deal with. They signed me up with an insurance company and they have been holding onto money they owe me for months and months, collecting interest on money that is not theirs. They cannot give me a reason as to why they deny the claims I submit. Only after hours and hours of fighting, do they finally pay the claims. I am going through this for the third time, and have now reported them to BBB.

Their customer service reps have no idea what they are doing. They are rude, they don't listen, they talked over me constantly, they gave my OBGYN incorrect information which ended up costing me HUNDREDS of dollars in treatment that was not covered. They told me I would "only" have to pay a copay for my prescriptions. NOPE.WRONG. They only pay a small % of the prescription, so I have started a medication that I really can't stop now and it's costing me about $200 a month...

They don't follow through, they are a horrible horrible HORRIBLE company! I canceled my policy with them and after reading all the complaints I also closed out my bank account. I don't need PJP Health agency to continue taking money from my account after the policy was canceled.

I have been unemployed since December 2008 and due to the fact that I recently lost my health insurance coverage under COBRA, I began searching online for reasonably priced health insurance. I entered my name and contact information at ehealthinsurance.com, and was contacted within minutes by a guy named Donald Ulrich at PJP Health Agency.

I told him that I wanted health insurance coverage to replace the coverage I had under COBRA. He told me he had just what I was looking for and quoted me a price of $639 per month for a health insurance plan under the Oxford Liberty Plan. He told me that in order to qualify for this "incredibly low" monthly rate, I had to give him my checking account number and pay by automatic monthly withdrawals from my checking account. I asked him if I could pay by credit card instead, and he said no. I found this to be a bit odd, but I foolishly gave him my checking account number, and the next day, a debit was made from my account in the amount of $789.

Since I was charged $150 more than I was quoted, I sent Mr. Ulrich an email asking why I was charged more than the amount I was quoted. He responded and told me that the extra $150 was for a one time "membership fee" in the American Benefits Association. He said that he "thought that he mentioned it to me" when I gave him my checking account number during our telephone conversation. I know that I didn't authorize this "membership fee", so I replied to his email and told him that I never authorized this fee and wanted it refunded. He responded by telling me that I had to be a member of the American Benefits Association to qualify for the "low monthly premiums" with Oxford. Foolishly, I bought into his lies and instead of just cancelling my policy, I decided to wait for the arrival of my insurance cards from Oxford.

After about 3 weeks, I finally received something in the mail... not from Oxford, but from the American Benefits Association. The documents were all low-quality copies, and my information was handwritten and not printed. I called up the telephone number for the American Benefits Association, and the woman who I spoke to told me that I had purchased a medical discount plan and not a health insurance policy. I called up Mr. Ulrich at PJP Health Agency, but I was unable to contact him. Since his voicemail was full, I wrote a certified letter to him asking PJP Health Agency to refund all of the money which was debited from my checking account. The letter was received and signed for two days later, but I didn't receive a reply. However, three days later, my checking account was debited again, this time in the amount of $639. I tried calling Mr. Ulrich once again, but I was still unable to reach him. I went to my bank and filled out an ACH Form, which revoked PJP Health Agency's authorization to make future debits from my checking account. I also changed my account number, as the bank employee who I spoke with told me that the company might try to make future debits from my account using another name.

It was at this time that I believed that I was the victim of a scam and decided to file a complaint against PJP Health Agency with the Nassau County Office of Consumer Affairs. The woman I spoke with at the Office of Consumer Affairs told me that they had received many complaints against PJP Health Agency and gave me the number of a woman by the name of Janet Davignon at the New York State Insurance Department in Albany who was now handling the investigation. I called and spoke with Ms. Davignon, and she told me that her office had received many complaints against PJP Health Agency and that she was currently involved in a joint investigation with the fraud departments of a couple of health insurance companies. She listened to the details of my complaint and told me that she would be in contact with me in the future.

My advice to anyone who is reading this and has been ripped off or deceived by PJP Health Agency is to call Ms. Davignon as soon as possible to add you name to the list of victims of PJP Health Agency! I am also going to take the advice contained in a previous post and call up the producer of "Shame, Shame, Shame". The only way to stop scammers like PJP Health Agency is to share your story and file complaints with the proper authorities!

I had health insurance that I bought from PJP health agency. I went to see a primary doctor, and then I received a notice from the health insurance plan stating they would not cover this doctor visit because their records showed I had other health insurance.

I stated that their records were wrong. I asked what other health insurance the records showed I had, and they wouldn't tell me. I asked how to fix this, and they said I would have to have my other insurance company call them. The problem is I don't have another insurance company, and they won't even tell me what other insurance plan it is they think I have. To me, this seems like nothing short of a scam to steal from me. I pay for a service, then when I need to collect the service, a ridiculous situation is created to prevent me from being able to do anything.

PJP health agency is a scam and a ripoff. I read all the other complaints about this company and my bank suggested I not close out my account. They suggested I block PJP health agency from being able to debit my checking account. Avoid this online scam! I wish I did.

Do you want to stop these clowns from ripping people off? File a complaint against PJP Health Agency with the Better Business Bureau (BBB):

http://www.bbb.org/new-york-city/business-reviews/insurance-health/pjp-health-agency-in-garden-city-ny-123192/

On January 20th a letter was written to me to advise me that my Medical Coverage that I had purchased with PJP Health Agency was cancelled as of December 1, 2010. As you can see, this is 6 weeks later! In the last six weeks I have had several expensive tests and a surgery at the hospital.

All of the tests were pre-approved during the past 6 weeks. I was not aware that my coverage was cancelled, even though they accepted my payments and now I will be responsible for thousands of dollars in medical bills. This is an atrocity! Something must be done about PJP health agency and they need to be held accountable for their fraudulent activities.

This company is a fraud and a ripoff.

Cut and paste the following web address into your web browser for more information:

I was called by an agent of PJP Health Agency and I signed up my family for a policy with them. I have been fighting with PJP Health Agency to pay for my son's COVERED doctor visit.

In total I have spent over 900 minutes on the phone trying to straighten this mess out and not one person will give me an answer as to why these COVERED services are being denied. We have had alerts put on our account to inform the processors that this is a covered service, we have had supervisors manually process the claims. But for some reason they are still getting kicked out as not a covered service.

There are four dates of service, 11/9/10, 11/19/10, 12/05/10, 12/20/10 that my doctor's office has resubmitted 6 times now and they are still not being covered. These total 278.00. The 11/09/2010 visit is about to go into collections and PJP Health Agency is leaving us absolutely no choice but to pay these claims or risk a ding on our credit. We have worked long and hard to have the credit ratings we both have and I don't want them destroyed because of this company.

PJP Health Agency is a total fraud. They collect your premiums and don't pay out on claims.

If you are considering insurances, DO NOT consider this one, you will pay the price. After visiting the doctor last month, I come to find out after receiving both a doctor bill and medical lab bills that I wasn't insured. I just about paniked, and I called them to have them tell me that even though I had paid my bill, had documents stating I was insured, I somehow happened not to be.

After over 4 hours on the phone, (they don't have a universal computer system) and accepting I will have to pay my bills with no explanation, I received a letter from PJP Health Agency stating I had been insured that entire month. Now, I called back and they are claiming, oh yes, it was our fault, in fact you are insured. So, after being transferred many more times, I got someone who claims that they will contact all of the labs and Dr. offices and send a check to cover what they should with an explanation. Now, this isn't the first time I have had a horrible experience. I am honestly expecting them to screw this up to, so I called the billing departments and updated them myself. They seem to mysteriously uninsure people. My sister who had been insured through them gave birth, and found out a month later that they had decided to cancel her insurance claiming her labor and delivery weren't going to be covered by them.

So, save yourself time, give yourself peace of mind and don't even consider PJP Health Agency for your insurance, you will be sorry. PJP Health Agency is the biggest scam artists on the planet!

Here are the names, titles, telephone numbers, and email addresses of some of the individuals who are currently investigating the dubious business practices of PJP Health Agency. I would like to urge all those who have been ripped off, lied to, or deceived by the con artists at PJP Health Agency to contact the individuals listed below as soon as possible!

Angela Cascarano
Segment Producer, Fox5 News
[protected]
Email address: Angela.Cascarano@FOXTV.COM

Janet Davignon
Associate Insurance Examiner,
Consumer Services Bureau,
New York State Insurance Department
[protected]
Email address: jdavigno@ins.state.ny.us

James Pescetti, Jr.
Associate Director,
Special Investigations Unit,
MVP Health Care
[protected]
Email address: jpescetti@mvphealthcare.com

I needed coverage as a full time student, so I went online an I was contacted by a repesenative of PJP Health Agency. Not only is the plan cheap, but it covers NOTHING. Knowing it covers next to nothing, I called the company in August 2010 to ensure that a "well-woman" exam was covered under my plan. I was informed it was, so I saw my doctor for the first time in 3 years.

After the visit, I received a prescription I needed to take, which, come to find out, ARE not covered. So, as a full time student, living on my own, I am paying full price for prescriptions. Fine, no big deal. About 4 weeks later, I got a bill from my doctor saying that PJP Health Agency was refusing to cover that bill because it JUST SO HAPPENED on that day that I went to see my doctor, my insurance plan was invalid. I was not covered. So, after some debate, they decided to pay it.

Last week, I received the SAME bill from my doctor, saying PJP Health Agency again refused to cover the bill. This time, their reasoning was that my exam is not covered under my plan. I find this comical because I CALLED TO RECEIVE ORAL CONSENT TO SEE MY DOCTOR. THE INSURANCE REP TOLD ME IT WAS COVERED. And now all of a sudden it is not. With numerous phone calls between PJP Health Agency and my doctor, it has been determined that PJP Health Agency just does not want to pay. The rep I spoke with first said the visit wasn't covered, but then 15 minutes later he said it was indeed covered, but he didn't know what to do. I demanded to quit my plan and get my refund check, but he said I had to cancel my plan within 31 days of signing up. That too is hilarious because another representative told me my plan was not activated for the first 30 days, so essentially after those 30 initiative days, I had ONE day to decide if I liked my health insurance coverage or not. I could not use my plan for the first 30 days, so how in the world was I suppose to know if I wanted to be under their insurance if I wasn't allowed to use it? To me, it's a complete scam ripping off college students.

I asked PJP Health Agency what they covered and they said accidents and sicknesses. Well, if I'm sick, I can't get prescriptions to be healed because they don't cover prescriptions, so really, WHAT THE HECK AM I PAYING FOR? I was ripped off by PJP Health Agency and I'm mad at myself because I believed all the lies the agent told me.

I am not an employee of PJP, nor am I an ex-employee. I also have not been ripped off, or scamned by them. I am a small business owner from Utah, that has been in business for over 23 years. My business does well, and I have allot of customers that are pleased with the service we provide. However, we have had past customers, ex-employees that have for some reason or another have gotten thier nose bent out of joint, and have bad mouthed us, and have tried to put us out of business, to no avail. Beldar, I have to agree with whysobitter, when they say you must be a disgruntled ex-employee, why else would you take so much time bad mouthing a business...you sound so bitter, that it makes one wonder if your reason is more personnal than money. There have been others that have submitted complaints besides you, but there has also been as many positive comments for the company. I'm sure that not many of you have been scamned out of over one million dollars, well I have, yet I don't spend all of my time on the internet, bad mouthing the company that cheated me. Don't you have anything better to do? Why have you made this your life's agenda? I am presently looking for health insurance, and I plan on doing my due dillagence. I plan on calling my doctor and pharmacy to see if they accept this insurance. I will also call BBB, NY State Ins. Dept., Consumer Services Bureau of NY, and anyone else I might be able to think of whom would have accurate info. on PJP. I will report back to this site what I find out. My best to all of you whom are for or against PJP.

Ms. Neutral: You say that there have been "many positive" comments posted here about PJP Health Agency, but all of the comments I can find defending this company were obviously written by ringers. These charlatans are seeking to defend their company, not by telling the truth, but by belittling the intelligence of those who have been ripped off, deceived, and lied to by PJP Health Agency. It is unfair to blame the victim of a con artist.

If you are really an objective person seeking the truth about this company and not a just shill for these guys, I suggest that you enter the name "PJP Health Agency" in a Google search. Not only will you find dozens of different complaints about the conduct of this company, but you will also discover that this company was originally known as "Health and Life Direct" and "Phil Teseo, Sr. Insurance". Two of the people associated with this company have been convicted of stock fraud, and PJP Health Agency is currently the subject of an investigation by the New York State Insurance Department.

I'm interested in knowing why you are so interested in PJP Health Agency that you are going to spend your time calling the BBB, the "Consumer Services Bureau of NY", and anyone else you might be able to think of who would have accurate information. Don't you believe the dozens of complaints about this company which have been posted not only here, but on other internet consumer complaint websites? Are you in the market for health insurance and have an interest in doing business with PJP Health Agency, or do you have an ulterior motive? If the New York State Insurance Department determines that PJP Health Agency is engaged in a pattern of deception and fraud, I have no doubt that the appropriate actions will be taken against them.

Dear PJP Health Agency sucks, this is Ms Neutral---I chose to do my own investigating on PJP, instead of believing or disbelieving anything written on this website. I do not know, nor does anyone else know that the positive comments are made by ringers, nor does anyone know that the complainers are disgruntled ex-employees. I am a single mother, widow and cancer survivor that has absolutly no insurance, and I have lost my home, and are currently broke because of medical bills. I probably came across PJP the same way allot of you did. They presented themselves as health INSURANCE, until I recieved my "insurance" card that states on the bottom----this is not health insurance. I truely wanted to believe that what I was told by Danielle, Erin and Mark at PJP was the truth, however, I'm very disapointed to admit that I was decieved. Now, one can say that I misunderstood what I was told, or that I'm stupid cause they said from the start that they're a discount plan, but this is not the case. I'm a small business owner, I run an honest opperation, but get complaints about my business, as I'm sure is the case with any business, so I'm usually not the type to complain, however, I stated a few days ago, that after doing my own investigating, I would report my findings . PJP is NOT an INSURANCE company. It is a discount health plan, which may be wonderful for those looking for that service, but for us that need health insurance, and were misled into believing this is health insurance, well all I can say is, I got a hell of a screw, and didn't even enjoy it. I still believe everyone should check this company out for themselves, it may be what YOU'RE looking for, but I suggest not to part with any of your money until you do check them out, you may have a hell of a time getting it back.

WOW I have no idea how all that sh--- got put into my above comment. I swear I didn't type that IƉm, " and $#039;re crap...WEIRD, oh well, please read between the mess.

I contacted the customer service dept. of PJP Health Agency, but to no avail. I used to have Blue Cross, but when I lost my job I switched to insurance offered with PJP Health Agency. I went to pick up my prescription and I was told that PJP Health Agency is not covering this medication and I have to pay $185 which is outrageous. The agent I spoke with said I would have a $30 co-pay.

This is my first dealing with PJP Health Agency. I spoke to a Customer Service Rep and they again said all I could do was file an appeal, which I did over the phone. They said it would take 7-10 days to hear back and if they denied my appeal, they said I could file another one. I told them this was ridiculous. I am not waiting to file another appeal. It is not fair that a patient should be forced to pay such a high price for a prescription when the agent said the co-pay was $30.

PJP Health Agency is a nightmare to deal with. They want to play doctor and they are not physicians. They have no right to dictate to me what medication I should take and then refuse to cover a medication when they said it would be covered with a co-pay. I have reported them to the Better Business Bureau. PJP Health Agency doesn't have any problem with collecting the premiums, but they seem to have a big problem in paying out on prescriptions.

The first time I go to get a prescription they would not cover at all, even though Blue Cross covered it prior to this. The damage is I cannot get my medication because of these people. I am sure this is only the beginning of things they refuse to pay for even though they have no problem collecting my money every month.

The agent I spoke to was dishonest with me. Why would he promise me a $30 co-pay knowing they would not cover the drug? I canceled my policy and I am looking for other insurance.

Upset with Vito Spatafora!

I bought a NY Choice policy from him. He told me the doctor visits would be a $25.00 co-payment. It turns out that it is a discount plan. He told me this was a major medical policy.

Vito told me the best part about the policy is that I would be getting him. Well he is a con artist that is not to be trusted. I found his picture on a social network site.

I would not want a guy that looks like this handling my health insurance needs.

Wasn't Vito Spatafore a character on the Sopranos (see the photo below)?

http://en.wikipedia.org/wiki/Vito_Spatafore

It figures, since PJP Health Agency is a scam and was created by gangsters!

Please cut and paste the following web address into your browser to read a very intersting FOX 5 New York blog post about PJP Health Agency:

http://community.myfoxny.com/pjphealthagencysucks/blog/2011/03/15/beware_of_pjp_health_agency_-_they_are_a_bunch_of_thieves_who_will_will_rip_you_off!

Vito Spatafora sold me a health policy in New Jersey. He told me the hospital would cover me for the first $15, 000. He failed to mention to me it was $250 a day, which is equal to about $7500 a month. He told me this is "real" insurance. It is nothing more than a discount plan that is $163.00 a month.

Vito Spatafora is a bully over the phone and a complete liar. I can't believe I got duped by this low life.

I don't understand how PJP Health Agency is allowed to operate the way they do. In 2010, I had a problem with PJP Health Agency paying a in network doctor bill that they clearly owed. It took a year, and the involvement of the state's insurance board to finally get them to pay. However, it took a lot of stress and grief on my part to stay with it. MY ADVICE: Put every request to them in writing. I called PJP Health Agency repeatedly over the year, and everytime, I was told that it was their error and they would fix it. They never did until they were forced to pay. I was just denied the cost of a visit to my family doctor who is in their network. This time around, I am again sending my compliant to the state insurance department immediately and I will put all complaints in writing until they pay the bill. I have had enough of this insurance company and I have canceled my policy. PJP Health Agsncy is fraudulent in every possible way and I will continue to report this dishonest behavior to every consumer advocacy agency and website to inform consumers. PJP Health Agency is most foul.

My family switched our health insurance coverage from Blue Cross Blue Shield to PJP Health Agency. We have had only used our coverage twice in the last 6 months and both times PJP Health Agency refused to pay.

The first time my husband had a fever and he went to the doctor. We called a customer service represenative at PJP Health Agency and he said the doctor was in network and my husband would only have a copay for the visit. He went to the doctor and was treated. We received a bill for the entire amount. I called PJP Health Agency to ask why we were responsible for all of the charges and they said it was a coding issue of the doctor's office. I contacted the doctor's office and they said that every other insurance company accepts their coding and said they couldn't change it. I called PJP Health Agency back and they refused to pay the claim because of coding.

The second experience was that my two year old son had a 105 degree fever and had to go to the doctor. It turned out my son had an ear infection. After about a month we got a bill in the mail from the doctor's office but we assumed that the insurance hadn't posted payment yet. We then got another bill and an explanation of benefits from PJP Health Agency. They wanted us to pay the entire 128.00 and they would not cover anything.

In the general remarks on the bill it stated the insurance company does not cover doctor visits. Why did the agent tell me I had a copay if the insurance does not cover doctor visits. Why did they tell me it was a coding error if the insurance does not cover doctor visits? This is insurance fraud.

I don't know one person that would ignore a 105 degree fever in a toddler. I have also read numerous other reports on this sight and it seems pretty apparent that PJP Health Agency does not want to pay their claims.

There is obvious stress involved. Also we had already paid upwards of 160 for the first claim that went unpaid and now we face paying another 128 out of pocket.

Don't get PJP Health Insurance. I hate this company, they were a waste of my money, patience, and time

My wife and I signed up with PJP Health Agency and purchased medical and dental coverage for individuals as I am self employed and her employer at the time didn't have a good plan. We paid our premiums for three months and then I had a pain in my leg and I went to the doctor and they called PJP Health Agency to get my policy information and PJP Health Agency told them I would only have to pay a copay out of pocket and they would cover the rest. Great, we thought.

So three months later, we get a bill from the doctor for another 280 dollars. When I called them to ask, they informed me that the insurance denied my claim. After going back and forth with the insurance company, they told me they would pay the claim. A few days later PJP Health Agency calls me and tells me that I don't have coverage for doctor visits. When we signed up for the policy we were told that the doctor visits would be covered and now they are refusing to pay.

Over the course of my policy, which was only 3 months as I dropped them as soon as I found out about their scam, we paid our premium on time . They first tell me I have coverage at the doctor and now they are refusing to pay the bill . I wasted all that money by giving it to PJP Health Agency for NOTHING.
I have since found out that they are CONSTANTLY being sued by their customers for not paying claims. I heard this from several doctors offices. After reading other reviews, I found out that most everyone who used them switched because they are so horrible.

We all need health insurance. The point of it is so that just in case something happens we aren't stuck with a out of pocket bill that in these times, we just can't afford. Insurance is supposed to help you in unexpected times, right? PJP Health Agency doesn't feel this way. They believe that you pay them money and they don't have to pay a thing. STAY AWAY FROM THIS SCAM!

Folks, if you think you're covered in case of an emergency by PJP Health Agency, THINK AGAIN. I suggest you read the fine print in your policy terms. That is, if you can find the fine print. I thought I was covered until about 6 weeks ago when I suffered a pulp amputation in my right thumb. I spent a day at the emergency center having surgery performed on my thumb to re-attach the pad.

Although badly disabled after the surgery, I was relieved that at least I had insurance. WRONG. They denied almost every single claim submitted to them by the various providers that worked on me.

Even when treated by their so called "Participating Providers, " they only pay what they consider a "usual and customary" amount for that service. I ended up having to pay for the entire bill minus $35. The bill runs into the thousands. What's my complaint? Buried in their website, which of course is full of beautiful smiling people and is oh so user friendly, this "usual and customary" amount information is almost impossible to find. Nobody at their own customer service center could find it!

Don't waste your precious dollars with this immoral company. Their health insurance is a fraud and a scam. I can only imagine the pain and desperation caused by this company to people who have a much more serious illness.

I was insured by this fraudulent company for 2 months before I finally actually needed to make a claim. when I went to the ER, I soon found out that this policy is a scam.. The most frustrating part was that they had a slick way of addressing every question posed to them in regards to not covering me. It is my conclusion after I filed a "Appeals" and "Grievance Panels" that I will never get back even a minute fraction of what I have paid into this policy, and the policy itself is a complete joke. To anyone who reads this, please don"t ever give a penny to PJP Health Agency no matter where you live and no matter how desperate you are for health insurance.

My left hand was stabbed by a metal object when I was working on my 9 year old son's bicycle. The spoke penetrated nearly all the way through my hand and was infected within 24 hours. I am completely healthy and I figured it wasn't a big deal, but I went to the Emergency Room where I received treatment. Subsequently, all services rendered were administered by the Hospitals Emergency Room, where I was treated and then held overnight for observation. I was in the ER for hours and it was there that my hand was treated. They would not permit me to leave the hospital and I just figured it would all be taken care of by PJP Health Agency.

To my dismay, I was later informed by PJP Health Agency that they were NOT considering this an emergency room visit and that I would be required to pay approximately $8700.00 in unpaid bills to the Hospital, and the doctor who worked on my damaged hand..

Thus far, my “Grievance Appeals” have been flat denied due to a misrepresentation of billing and a clear lack of good faith effort by PJP Health Agency. It is their contention that I admitted myself to the Hospital, and that this was NOT an emergency room visit, which it clearly was. This is outrageous, and the so-called “Appeals Process” at PJP Health Agency is a complete fraud and has consumed many hours of my time since the incident. Needless to say, I have gotten absolutely nowhere with my “Appeals” and the charade of a “Grievance Panel” only ended with me in the same place where I began.

Something must be done to stop this corrupt business from deceiving the public and operating what is basically a scam. It is clear to me after dealing with them over the past few months that it is their intent to do whatever possible not to provide the coverage that I have paid a lot of money for. The fact remains that this was an Emergency Room visit, which is clearly covered by the policy. I must point out that when I purchased this policy, the sales representative assured me that I would be covered for ALL emergency room visits without exception. This was actually the cornerstone of their sales pitch to me at the time.

I have canceled my policy. I will not let these con artists continue to rip me off.

We love to feel like we are always covered if we get hurt. We were with Aetna. PJP Health Agency called us with cheaper (we thought better) rates. Nothing major happened for the first 6 months. Well, a month ago my wife fell down the stairs and broke her foot. We thought she were covered. After some checkups and surgery, we come to find out we owe $35K. They are now telling us there is a limit to what they can cover. Then why do you offer insurance? We don't need insurance because we have a cold and need medicine. We need to make sure we are in good hands. PJP Health Agency has the worst possible hands. We have now left the company and are back with Aetna. The agent who sold us the policy lied about everything. Don't trust these crooks!

PJP is a rip off they will not answer my call to cancel. they told me by law they can't sell discount cards but thats what i got a discount card. i guess i have to cancel my credit card because there still charging me . even after i told them i got new insurance

I have been so upset I needed to share this with all readers. I am a 59 year. young woman who has been taking blood pressure meds for 30 yrs. I have tried so many different kinds and finally eight years ago started taking Micardis. It has kept my blood pressure under control. I exercise and am in very good shape. About a month ago I switched my insurance from Blue Cross Blue Shield to a policy with PJP Health Agency. PJP Health Agency will not pay for my medications as they have decided it is too expensive. I was only paying a $30 copay with Blue Cross Blue Shield and PJP Health Agency will not pay for any of the drug. They want my Doctor to "experiment" with another medication on me that's less expensive.

Can you believe they are actually "experimenting" with someone's life? I just hope someone can do something about these people in charge of PJP Health Agency. This is the worst insurance in the world! I will be applying for other coverage and cancelling this scam of a policy.

I am trying to help my niece get this company to pay her claim. They have a real knack for not paying/stalling on payments with unwarranted excuses and they are making it very difficult to talk to someone. I have been on the phone with them for hours and still not resolved anything. They say after being given certain information again they will re-submit the claim. But nothing changes.

I am not a medical billing expert, and this is such a mess I'm not even sure where to begin. It has been almost 6 months since this started and the bill is now going into collections. My niece originally went to the doctor and saw a doctor who was in their network. She is young and is unable to cope with this kind of run-a-round. In fact, it has exasperated the circumstances considerably, hence, why I am trying to help.

After doing some internet research, I have found many complaints about this company for various reasons.

I would just like to get some help in how to fight them. Like I said, it is such a mess with this bill and their Explanation of Benefits do not seem at all easy to understand. I know I'm not a professional billing expert, but we personally have Blue Cross/Blue Shield insurance and I've never had a problem figuring out their system. My niece has canceled her policy with PJP Health agency and now she has Blue Cross/Blue Shield insurance.

I purchased insurance through PJP Health Agency and every time a claim is submitted, the say they never received it. I finally gathered all the claims from my doctors and sent them via overnight mail with a signature required. when I had not recieved payment in a month, I called and again they claimed not to have received them. When I told them that I had proof of their receipt, the lady called me back and said they had received the claims but no benefits would be paid. I paid premiums for over a year and did not have even one claim paid by this company. I have finally filed a complaint with the Dept of Insurance and am waiting to see what they will do now. My claims are now 8 months old and I am being turned over to a collection agency. PJP Health Agency is a scam.

PJP Health Agency has an "F" rating from the Better Business Bureau!

Cut and paste the following web address into your web browser to see the Better Business Bureau's Business Review/Reliability Report for PJP Health Agency:

http://www.bbb.org/new-york-city/business-reviews/insurance-health/pjp-health-agency-in-garden-city-ny-123192/

If you have been the victim of PJP Health Agency, in addition to filing a report with the Better Business Bureau, I would also file complaints with the New York State Insurance Department and the New York State Attorney General's Office.

As a personal victim of the PJP Health Agency, I wish I had seen this website earlier. My experience is that they will not pay my doctors bills. The doctor visits have not to date been paid. And those bills are mounting. It seemed like a dream come true, that I could receive coverage for so little money. The old adage, " if it seems too good to be true it probably is" comes to mind. Meanwhile, I have been put on hold, hung up on, sent to the supervisors supervisor's supervisor and all to no availe. I'm begining to believe that person does not exist. I am also looking for a new insurance company as we speak. The money I saved is not worth the spanking I'm getting. Oxford might be expensive, but I was never ever put on the wheel of no return. I'm going back as soon as I can afford it. This economy crunch hit hard on my industry. All I can say at this point is HELP! My frustration in trying to deal with these people is driving me crazy. Also, the supervisors are all unable to communicate effectively. I told the same story 12 times, to get nowhere. I must say it feels good to get this off my chest. I hope it benefits someone. I now know where to look for the truth. Avoid PJP Health Agency and this online fraud. They will not pay for anything.

DO NOT BY ANY MEANS SIGN UP! I have had insurance with PJP Health Agency since 04/10 and when I finally sent in 2 claims on 11/10 they said I wasn't covered because I didn't send in the right paperwork! How did I get my card and acceptance letter then?!?! They took my monthly premium for 8 months and didn't say a word, then when I filed a claim they play dumb and say "oh by the way" BS!
I am boiling mad now that I didn't do my research! Please do not sucker into this scam. I am now out $2500.00 from the policy and another $1250.00 from unpaid claims. I have filed complaints with the NY insurance board and am waiting to hear back.

PJP HEALTH AGENCY NO WAY!

you think the discount plans that are sold are a scam just wait! i worked there so i'll admit it, the discount plans at least the way i sold them, wasnt that unethical. the leads were generally geared towards mostly people who didnt qualify for insurance and/or were lower income so yeah 60 a month if you take expensive meds or need dental work etc and cant qualify due to pre x conditions and havent had coverage for 63 or more days ok fine it did work for people. however this fraud of a company after getting a license decides to tell you in the interview you'll sell real insurance once your licensed. ###! the stuff they call "health insurance" was just a more expensive discount plan! they told us THEY DECIDED to sell limited plans bc they payout better. it was awful, i felt really guilty selling it so to people bc it was robbery. your job as an agent is to get someone the best coverage not lie and tell them oh next cheapest in your area is 400 a month, no when i researched all those states offer insurance for 200 a month same price as the crap they forced us to sell. i eamn someone healthy no pre x (a lot of my leads) should definately not buy this trash! why do they sell bottom of the barrell garbage? bc the two dirtbag teseo brothers are being investigated for insurance fraud and had all the top carriers pull the policies away from them so THEY DIDNT DECIDE TO STOP CARRYING THEM, THE CARRIERS TOLD THEM NO WAY! seriously i feel bad to anyone who was scammed into thinking they bought insurance bc if you paid over 200 a month for it your being robbed! make sure you dont go to the er for sickness, do take any rx not on the very small list, dont need labs done dont end up in the hospital bc i mean 500 or 250 a day? its 4 to 10 thousand a night in the hospital! do the math your still gonna be bankrupt with or without there ins. warning to all never buy from these people, i left the company (voluntarily so no brokeragent1 dont try saying i was fired i wasnt i got a real job get this selling REAL insurance wierd concept right? i got in this industry yes to make a lot of money also help people protect themselves from catastrophes) the only way to succeed there is to be blind and dumb and not realize what your selling or have no conscience whatsoever. neither applies in this case, im very good at sales but prefer to do it ethically and morally you know close the sale hard... just give people something of real value when they pay you in return. i dont need to wish anything bad on them bc i have a feeling that ship is about to sink on its own soon. heres a tip american medical and health essentials (the policies they had us sell primarily), not worth the paper you wipe your ### with!

I obtained Insurance through PJP Health Agency on December 1, 2010. I had an emergency appendectomy on January 9, 2011. I started receiving bills for thousands of dollars. When I called PJP Health Agency I was given the run around. I spoke to various people who wouldn't take responsibility for the error. I was told various times that someone would be calling me back and no one ever returned my calls. Eventually, after numerous attempts on my part I got a hold of someone who told me that the reason I was receiving these bills was that I didn't have hospital coverage. The sales agent I spoke with lied and said I had hospital coverage.

At this point I argued with the company and was assured that my problems would be forwarded onto a supervisor who would review my case, including the recording of the original phone call when I bought the policy. They have never gotten back to me. It is currently April and I started the process of calling them in January. Eventually I reported them to the New Jersey Board of Insurance.

Since all of this they have also denied two different claims saying that my coverage had been terminated on the dates of service - which it definitely had not been. One of these was for my son's well child check up, the other was the surgeon's bill for my appendectomy - both medically necessary claims. I called them out on these claims and they are supposedly reprocessing them. Then yesterday I open yet another bill for my surgery for another $4, 914.

This company has not provided me with the coverage that they sold me and has denied one claim after another. When I call their customer service department, I cannot get a straight answer out of anyone and they keep me on they phone forever transferring me from person to person. They have never returned my calls in a timely fashion. This is the worst experience with insurance I have ever had. I highly recommend that NO ONE out there purchase insurance through PJP Health Agency.

PJP Health Agency has repeatedly denied claims that are perfectly valid. When I call them or email them they give BS reasons why the claims are not covered. When I ask them why they are violating their own policies, refusing claims that are clearly covered according to the information the agent said to me, and lying to their paying customers, I get no response whatsoever. All I get is "you are responsible for the full amount of this claim".

So far the amount they have refused to cover is under $1000, so I am not going to bother calling a lawyer. From reading the many other complaints against PJP Health Agency I can see I am not the only person who has been ripped off by them.

If you have a choice, DO NOT use PJP Health Agency for anything. I canceled my policy with PJP Health Agency.

I bought health insurance with PJP Health Agency. Months later, a serious problem was detected in my lower back. I called and PJP Health Agency said my surgery was covered. My surgeon called and was told it was covered. The hospital called and PJP Health Agencyt told them it was covered. I had the surgery. Now they have decieded that I am NOT covered, and I owe $22, 000.

I am unemployed and have been for twenty months. PJP Health Agency lied and cheated me badly. They refuse to tell me how to appeal this decision or to provide any guidelines for doing so. They refuse to tell me who made this decision, and they hang up on me when I ask. THESE PEOPLE ARE THE WORST OF THE WORST. I BEG YOU TO NOT HAVE ANYTHING TO DO WITH PJP HEALTH AGENCY. THEY WILL SCREW YOU BECAUSE THEY SCREW EVERYONE. THEY ARE UNFAIR LIARS AND CHEATS.

In September 2010, I purchased a health insurance policy from PJP Health Agency. All application questions were answered accurately and truthfully and this qualified me for coverage. On February 26, 2011, I fell ill and was checked into the hospital from the emergency room.

PJP Health Agency did not want to pay my bills so they simply decided to rescind my insurance policy without cause in April of 2011 effective from the date it was activated on September 1, 2010.

They still refuse to pay the outstanding bills. I need payment for all bills as contracted in September 2010, as well as payment for my battle with them to urge them to honor the contract. Their actions have caused other financial harm in terms of credit, interest rates, and otherwise, in addition to lost work.

I'm still battling this issue through the Insurance Commissioner's office and reporting them to the Better Business Bureau. I'm still sorting through the best legal firm to handle the case.

Warn every alumni group and business about PJP Health Agency and their negligent and unethical practices. Insurance is an important investment because nothing is more important than your health. It's unfortunate that this company seems to feel that money is, in fact, so much more important that they will defend their breach of contract.