PJP Health Agency review: Fraud 127

I signed up with an insurance policy with PJP Health Agency because they stated that they were considered "credible coverage". Later, after trying to get insurance with BCBS, I found out that they were not "credible coverage" and that I would have a one year pre-existing condition waiting period if I signed up with BCBS. The same was true for a few other major insurance companies. I kept my insurance with PJP Health Agency for another few months and realized that the coverage was not good enough and I would've had to pay for most of my major medical issues. In the end, I would've saved myself a ton of money if I had just paid for everything out of pocket. With that said, I canceled my policy with PJP Health Agency. Today is 5/6/11 and I still have two claims that I have been desperately trying to get paid. I have sent them everything they requested and STILL have no received my payment from a 5/10 claim and a 7/10 claim. They claim to "never receive" papers I send. But they have no problem receiving my premium payments! I have called probably 15-20 times in the last 9 months, leaving messages and NOBODY WILL CALL ME BACK! This is the worst "insurance" ever! No customer service and no help what-so-ever in getting my claims paid! The only thing they have insured me is that they will take my money and treat me like a nobody!

PJP Healh Agency is a company that insists that you purchase their product before they are willing to send you information on exactly what you are paying for:

I went on their site and requested a quote; I got a call within a minute and the caller was very agressive and rude. Anytime I started to ask a question he interrupted me and gave me an answer that had nothing to do with my question, or told me that the question I was trying to ask was not important! When I asked him to please allow me to finish even a single sentence, he hung up on me.

I had an experience like this with a similar-sounding scam, about a year ago. Maybe it's the same people using a different name so they won't be recognized. Their sales guy did let me ask my questions, but was nonetheless evasive anytime I asked for real details. He told me there was a non-refundable application fee, so I asked him to provide me with the exact terms and conditions of coverage before I coughed up money I couldn't get back. He told me that the only way to get the terms and conditions was to pay the application fee and the initial premium - but if I didn't feel the coverage was worth the premiums after reading the terms and conditions, I would still lose the application fee.

Has anyone been able to get a full disclosure of terms and conditions without having to risk losing their application fee?

Aside from all that, I was not impressed (from the very little information the sales person did provide) with what I was being offered. It seems that MAYBE I'd save a few bucks here and there, but if something really nasty came up medically, the coverage wouldn't come remotely close to the disastrous bills that could result.

Google PJP Health Agency you'll find more than a couple of MAJOR complaints.

I took out a policy with PJP Health Agency because the agent said it had great mental health coverage, that included Attention Deficit Disorder, which I thought that I had. I went to a psychiatrist to have an ADD screening. As soon as I start receiving care and medication for it, they changed their tune on everything.

My doctor had been trying to receive payment for my initial visit for 3 months, they said they wouldn't pay it because they believed it was a pre-existing condition, and they told my doctor that. When I called, they said that nothing to that effect was written in my file, and there were no notes that said anything about that.

So I went to my doctor and I paid her out of pocket (and had been paying for all of my prescriptions out of pocket as well) and I had never received a single benefit...EVER. I called again and I was assured that everything was fine and that they should file the claim again. It went back and forth for a couple of weeks.

They still denied the claim. When I called, they told me that 'they don't recognize ADD as a condition in adults' and that it was stated in my policy packet. With this policy, they never even send you a paper packet in the mail. It's all on their website and you access it with your policy number. There is no way for you to really know if you're looking at the same information the agent went over when you originally took out the policy, so it's easy for them to change it and back it up. Call me paranoid, but it's a bit unsettling.

They also told me that if I had symptoms of ADD in the past, even if I wasn't diagnosed with it, that it would be viewed as pre-existing and it would not be covered.

I canceled my policy with them, but they made sure to take out their next payment before they canceled it, even though I asked them to cancel it before the date that they deducted it from my bank account.

I would be very cautious if you ever decide to take out a policy with them. Actually, I just wouldn't take one out as they make every excuse not to pay claims.

PJP Health Agency offers WORST insurance company without question. After paying high premiums for my son and myself, PJP Health Agency has refused to pay for any of my doctor visits so far. Out of a $300-$400 bill for a pap test (routine cervical cancer test), PJP Health Agency payed a whopping $16 for the lab fee, and I had to pay the rest. For visits to have a wart removed, once again, I paid about $250 for 2 doctor visits while PJP Health Agency paid about $30. I just got a bill from my allergy doctor saying I owed $463 for a $500 bill for allergy tests and treatment. So PJP Health Agency coughed up a whopping $37 for that. I have called the company numerous times, filed a complaint, etc., but they weasel out of it every time. RUN from this company. They love to dissect each and every doctor claim and refuse to pay based on unclear wording in your policy. I would love to see a class action lawsuit against this company for their refusal to pay claims based on unclear/misleading wording in policies.

My wife signed up with PJP Health Agency for health insurance. She only made 1 claim in 6 months and they have never paid it even though 5 months have passed and all we get is promises! The claim only amounts to $70 and if they will not pay that amount think about having a major claim? This is a bad company to deal with, we are sorry we got involved with them. PJP Health Agency is a scam.

I signed up for insurance with PJP Health Agency and I finally got my information in the mail along with 2 other peoples personal information. I have there social security numbers, date of birth, address, and phone numbers. I have all thre personal information and the original application they filled out for PJP Health Agency. Ive tried to contact PJP Health Agency but they are not open on the weekend. Ive called one of the guys and let him know i have his info and will be shredding it. The other guy has yet to answer his phone. Isn't there a law against releasing personal information this easily? Was my information mailed out to random people in the US like there info was?

Message to myinformation:

The reason why this happened is because PJP Health Agency employs idiots whose only job is to sell you worthless health insurance. They have no concern whatsoever about customer service or securing customer's private personal information.

If I were you, I'd call up some of the local media outlets and tell them about this security breach. There is currently an open file on PJP Health Agency at Fox 5 New York's 10 O'Clock News. Call Angela Cascarano at [protected] or contact her by email at Angela.Cascarano@FOXTV.COM if you are really serious about doing something.

Your first mistake was signing up with PJP Health Agency without first doing some reasearch about them. If you would have simply entered their name in a Google search, you would have discovered that there have been dozens of complaints filed against them on various consumer complaint websites.

I suggest that you read a couple of the previous complaints filed against PJP Health Agency on this website which detail how they refuse to pay the legitimate claims of their customers. Then decide if you want to continue to do business with such a company.

I have been pursuing PJP Health Agency for a measly amount for a doctor visit they agreed to cover. Months have passed since submitting a pathetic claim for $124. First they said they had sent it to the Doctor who I had already paid. That took about 6 weeks up, then they said they had mailed out a check, after weeks of not receiving the check and numerous calls to them, they kept assuring me they had sent the check, finally they said they had mailed it to the wrong address, even when each time I called I asked them to verify the address they mailed it to. Finally they said they would re-issue the check and once again we could expect to receive it in 7-10 business days. This was 3 weeks ago, I called again today to be told that "oops sorry" they have not cut a check, again I have been given the story that we need to wait 7-10 days to receive the check. Now to begin to convey the frustration and anger I feel towards this company leaves me almost without words. They act like criminals running the most unbelievable scam. I asked for an email from them verifying our conversation and was told they can't do that! Also I asked for the full name of the person I was talking to and again was told "Sorry" we don't give out names! WHAT! I am at a loss as to how to proceed with this. The other comments I have read from other very pissed off customers does not fill me with hope, they are a disgraceful bunch of crooks, do not do business with this company.

I truly hope that this message makes it to at least one person who is considering purchasing insurance with PJP Health Agency. If I can help one person avoid the headaches that have resulted from dealing with this company, it will be worth the time I took to submit this review. PJP Health Agency is a deceptive, dishonest, manipulative company that couldn't care less about members' healthcare as long as they collect the premium each month.

They will raise your premium and simultaneously deny more and more of the claims that they are responsible to pay. You will pay unbelievable premiums each month, and most of the claims (be it routine office visits or prescriptions) will be denied. Trying to reach the salesman who sold you the policy is almost impossible and, when you do, you will be given a vague and nonsensical answer with no resolution.

You will be left with a simple response..."no exception." Take my word - if you are considering buying insurance with PJP Health Agency, reconsider.

My young healthy family of 3 pays almost $400 per month for our policy with PJP Health Agency and when I went for my first gyno exam they did not pay a penny for the visit or the lab. I was out of pocket over $200. Seems to me I would be better off paying the doctor visits out of pocket than giving PJP Health Agency $400 per month. The agent who sold us the policy mislead us. After doing some research I found PJP Health Agency has an F rating with the Better Business Bureau. I'm going to cancel my policy and shop around for something more sensible.

If anyone is thinking about signing up with this company for health insurance...DON'T THIS COMPANY IS A FRAUDULENT COMPANY. I signed up for this insurance last November and as of today they haven't paid one cent of my medical bills and the prescription coverage is pretty much non-existant if there is any medications that aren't generic you might as well forget it, I take two inhalers and they would only cover about $15.00 of the cost of $250.00 for each medicine. Everytime I call to see if they have paid any of my medical charges I get a different excuse of why nothing has been paid. I am contacting the Insurance Commissioner and also the Attorney General as someone needs to stop this company from scamming people.

I just had the same issues as the previous posters. I was told three seperate times that this was a major medical health insurance, they just didn't call it that so we could recieve lower priced premiums. I spoke with a sales guy to make sure I was getting all the details correctly. He said it was a copay for the doctor (which it NOT true), a copay for a specialist visit (which is NOT true) among other false statements about the coverage. After I waited the 7-10 days for my information in the mail, I contacted the customer service department and spoke with another person. I explained to her everything that I had been told and she told me it was all FALSE! The company's own employee told me it was all false and that it was a discount only plan. I immediatly cancelled my 'coverage' and demanded a refund along with the application fee. I called a few days later to see when the money will be refunded and she said they take 10 days and they could only refund my premium and not the application fee. I can't believe they are still able to operate a business. Then again, by charging everyone a application fee they probably make all there money that way. I am not sure how to go about getting that application refunded, but I'm going to try. They say the conversations are recorded, so they should have it recorded exactly what was said to me on the phone. I have contacted the state insurance department and they are looking into this.

This company seems to prey on those who are in the most need. We, too, have been bold-faced lied to. When we confronted this company by phone telling them we wanted a FULL refund, including the application fee, they retorted they they have us agreeing to this fee in a recording. So we asked them if they have the four seperate conversations recorded where they lied about the coverage for presciptions they promised would be covered. They hung up the phone at that point. We explicitly asked about the medication on four different phone calls. This company runs a despicable scam.

I just have been ripped off by this company as well, how can they continue to do this to the public? They assured me, if I give them my bank name and account number they could hold my insurance until that date the money would be in the account. I went to my bank account and low and behold they had already submitted it for payment. The person told me that as long as they didnt have my routing number that they couldnt deduct the payment. I feel like they lied to me and stole my money. They just kept asking me if I wanted to cancel my insurance, and why should I have to cancel something that is not even suppose to be activated yet. So who we report them too?

OLNM: So you want to know who to report PJP Health Agency to? I would call Janet Davignon at the New York State Insurance Department at [protected] and Angela Cascarano (Segment Producer of "Shame, Shame, Shame") at Fox 5 New York at [protected]. These two individuals have been investigating the dubious business practices of PJP Health Agency.

I would also go into my local bank branch and close the checking account which they are withdrawing funds from. If you keep this checking account open, PJP Health Agency will continue to make unauthorized withdrawals from your checking account.

The "people" at PJP Health Agency are the ### of the earth. Besides James Struss, Phil Teseo, Sr. and his sons (Joe and Phil, Jr.), some of the people who run things at PJP Health Agency's Melville, NY location (in other words, "The Scam Masters") are Dan Hardwick of Farmingdale, NY and Dawn Ann Raccuglia of Smithtown, NY.

Additionally, if I were you, I would record all of my telephone conversations with PJP Health Agency employees and I would keep records of all written communications.

PJP Health Agency is manipulating Google in order to bury all of the online complaints filed against them!
Now that the word is out about PJP Health Agency and their fraudulent business practices, the creeps that run this racket have come up with a scheme to hide all of the online complaints that appear in a Google search of their company. They enter their company's name on all kinds of business to business websites and then have their employees contantly click on the links to these websites in order to bury the complaints that appear in a Google search.

Even though they have lied to and ripped of hundreds of customers, they now even have the audacity to brag about the fact that they now have an A- rating with the Better Business Bureau! How did their rating with the BBB magically change from an "F" to an "A-"? They had Gina Monteforte (their so-called "Operations Manager") contact the BBB and lead them to believe that they were going to become a member. As you may know, the BBB is an organization that gives letter grades to various businesses. You may think that they are on the "up and up", but this is not the case. They sell higher letter grades to businesses that either become members, or promise that they will become members.

Read the truth about the BBB: http://www.thebluesmokeband.com/bbb.php

Don't be fooled by the smooth-talking con men at PJP Health Agency. They have not "reformed". They are as crooked as they have ever been. Sure, a couple of "sacrificial lambs" such as Dan Benazzi and Vito Spatafora were let go after the NYS Insurance Department revoked their insurance broker's licenses, but this company still lies to and rips off those customers stupid enough to give them their bank account information.

If you have been the victim of PJP health Agency, my advice to you is to call Janet Davignon at the New York State Insurance Department at [protected] and Angela Cascarano (Segment Producer of "Shame, Shame, Shame") at Fox 5 New York at [protected]. These two individuals have been investigating the dubious business practices of PJP Health Agency.

If you were stupid enough to give PJP Health Agency your checking account information, I would also go into my local bank branch and close the checking account which they are withdrawing funds from. If you keep your compromised checking account open, PJP Health Agency will continue to make unauthorized withdrawals from your checking account.

The "people" at PJP Health Agency are the ### of the earth. Besides James Struss, Phil Teseo, Sr. and his sons (Joe and Phil, Jr.), some of the people who run things at PJP Health Agency's Melville, NY location (in other words, "The Scam Masters") are Dan Hardwick of Farmingdale, NY and Gina Monteforte of Patchogue, NY.

Additionally, if I were you, I would record all of my telephone conversations with PJP Health Agency employees and I would keep records of all written communications.

It may take a while (thanks to the "slow as molasses" bureaucrats in the NYS Insurance Department), but eventually, PJP Health Agency will be permanently put out of business!

Well Yes I too was lied to. This seems to pretty common practice for this company. I contacted the attorney generals office and the local business administration in my state. They both informed me to immediatley discontinue the electronic withdrawals from our account and asked me to file a formal complaint with the attorney generals office. I urge you all to do the same. This is the only way to stop this company from victimizing anyone else. I am also going to contact my local consumer news advocate. Please do the same!

I'm so tired of the paper chasing/denial of claims/long button pushing waits for customer service only to get the same answer--"Well, that's what your plan covers---sucker". We pay for a coverage that essentially doesn't even help with preventative care. PJP Health Agency finds every loophole in the book to deny coverage. I have had my doc check ahead of time before sending out bloodwork, and PJP Health Agency denies it, because they sent it out. I've had three kids get the same preventative care on the same date from the same doctor, and only one got covered. We've gone the generic prescription route at the cheapest pharmacy, only to have generic prove to be unhelpful, so when we get a prescription for a non-generic, we get hit for the full cost. Their solution: "Go to a cheaper pharmacy; try generic"---Been there done that! From what I can see, they love pushing paper, denying claims, and watching the little guy jump through hoops. How do they sleep at night?

I have been recieving medical bills from various labs and hospitals for medical work done. I have contacted PJP Health Agency over and over and over again and even spoken with various supervisors who always inform me THIS TIME the problem is resolved. I have now recieved several thousand in medical bill that now state we have tried several times to bill your insurance company and they have not responded so this is now your responsibility. I have now been notified that they will be sending the matter over to a collection agency . At this point I dont know what else to do or where else to go. I cant get anyone to just pay the bills they were responsible for. The stress of this alone is enough but now I am beong threatened with collection agencies and I have already recieved one letter from a collection company. Why can't anyone resolve this problem?

This company or should I say companies because when you call there 1-800# they may answer to one name but then you ask to speak to someone aboult health care coverage they tell you to call one of the other names I mentioned. I DO NOT LIKE TO POINT FINGERS but all the money I have lost because of this company I really don't care at this point. I changed jobs which meant I had to change insurance as well.

I got online and found a website for Affordable Health Insurance so I applied and the guy who called me told me all about the insurance. I asked all the right questions he gave me all the wrong answers instead of telling me the truth he told me what I wanted to hear which might I add were nothing but lies. I asked if my Dr. was in the network he assured me that she was that was lie #1, I asked if my medicine was on the $10, $20, $40 list he assured me it was lie #2, I asked what my co-pay was he told me $30 lie #3, I could keep listing but I would eventually run out of room. I never received my insurance cards or whatever you call it. When I called them to ask what I needed to due because I had a Rx that needed to be refilled I was given a run around that kept me on the phone for 47 minutes with no results. Finally I called back and was told I needed to call yet another company name. They told me they had no info to call back to customer service you see how the pattern goes. Finally after 3 days of telephone calls I got a member # only to find out my Rx was not on there list and it cost me a $180.00 on what I WAS ASSURED WOULD ONLY COST $20.00

I called PJP Health Agency and they asked me what I would have had to pay without the " DRUG CARD " I told him $204.00. He told me I ought not to complain as I was saving $24.00 I won't even bore you with the rest of that conversation you can draw your own conclusion on that one. I then went to the Dr. later on a few weeks and gave them my new insurance or whatever you want to call it information. Two days later the Dr. office calls me back to tell me that they are not in the network and what I have is not insurance but a health discount plan to some people they may think it is one in the same BUT DON'T IT IS NOT!

I called back to the customer service# spent a whole day being given a run around not to get any results. I left voice messages for my salesman who has not yet to return my phone calls, but finally someone put through to his office AND YES HE ANSWERED.

Only to tell me he couldn't do anything for me and that I should have read between the lines. I told him I wanted to cancel my membership he told me I would have to call yet another 1-800# which was no longer in service. I called back to the customer service # again and tried to explain to them what was going on and that I wanted to cancel my membership she rudely interupted me and told me to email them a letter stating I wanted to cancel it and hung up. I called the customer service # again and again and again until I got a live body on the phone got the email address and sent them an email and they still drafted my account .I had to go to the bank to put a stop payment on any further drafts which they still tried to draft then when they could no longer draft that amount they changed it to a even amount little did they know I placed a stop payment on the amount as well as anything from any of there AKA's so beware if they can't get your money one way they will try try again no matter what they have to do.

By the way I never received my insurance cards. And they are still trying to draft my account.

PLEASE BEWARE OF PJP HEALH AGENCY AS THEY ARE DISHONEST.

I agree with S jersy guy who worked at Runnemede shop..I have them doing my lawn and have watered to no end and still brown spots all over the lawn, its rediculouse..They had a young guy last year put something on my lawn that burned it out completely that was not suppose to be put on the lawn in heat..You know what scotts lawn says to me...Just water it real good and it will come back..Well I did that and I got charged from my water company for over using the wayer $150.00..They suck and it has been a week since I complained and still no call back for the current issue..I am doing the lawn myself next year f*** it!

I was a member of PJP Health Agency. I had an insurance policy before but I gave it up. Since they represent self-employed persons alledgedly, they have extra benefits that I thought would be useful.

I think I paid somewhere in the area of $200 to $300 a month for a single person, age 35-40, non-smoker, and living in New York.

At any rate, when I actually USED any service I always had to pay the vast majority of the bill! I'd get a lab test done that cost $90 and they would pay something like $7 of it. I'd have a doctor's visit for $125 and they'd pay something like $14 of it. It was ridiculous. A total waste of money.

It wasn't really an "insurance" plan so much as a "discount" plan. Nothing at all like any other plan I've been on. I would highly recommend you get a real schedule of service with real dollars for various types of tests that they will pay and compare it with the same from another carrier.

Aside from all this, it was presented to me as an association for self-employed which also just happened to provide a health plan. In reality they are just insurance salesmen, not looking out for the welfare of their customers as self-employed. Just abusing that perspective to sell insurance.

Last Wednesday I called PJP Health Agency to get help finding a doctor that accepts the plan. The customer service rep then transferred me to another lady. The lady answered the phone and told me to look at their online website to find a list of providers. I did just that and found a list of over 30 providers within a 25 mile radius. Going down the list, I called. I called every one of the providers. 6 were not taking new patients, 9 were inpatient only, 14 of them said that they are not contracted through the plan and have no idea why they are even on the list, and one only sees children.

So I called PJP Health Agency back and talked with a male this time. He told me that he would have someone confirm that what I was telling him was correct. (Basically telling me that I was a liar). He said that it would take 24 to 48 hours and that I would get a call back during that time with an appointment scheduled.

Fast forward to Tuesday of the following week. Still no call back from PJP Health Agency. So I call them back. I get the same lady that helped me last week with the list of providers. I again have to explain the whole situation. She proceeds to tell me that I am lying, and that I should have been able to find a provider out of those 30. When I asked to talk to the male that helped me last week, she refused to give me his name, and when I asked her what we could do to make this situation better, she HUNG UP ON ME!

I am so tired of this. If someone like me really needs help with a doctor, should it really be this much of a hassle to get an appointment?

PJP Health Agency needs to work on customer service and do a better job getting contracts signed so that finding a provider in town is not an issue. They also need to go through their list that they gave me, call every provider personally on the list, and delete the providers that are not contracted through them. I kept the list and marked every one of them that were not taking patients, not contracted through PJP Health Agency, and were inpatient only. PJP Health Agency did not want anything to do with my results. I now have canceled the policy. I want nothing to do with the jerks at PJP Health Agency.

If you have been ripped off by PJP Health Agency, my advice to you is to file a complaint against them with the department of insurance.

Instructions on how to file an online complaint
1)Visit http://www.ins.state.ny.us/complhow.htm (cut and paste the link into your browser)
2)Click on the blue letters Online Consumer Complaint form
3)Click the submit button next to file a complaint
4)On the consumer complaint forum fill out all the information that you know.
5)You will receive immediate confirmation and be assigned a file number. The department of insurance will
investigate your complaint.

I had Health Insurance with PJP Health Agency.I had paid all the premiums.
My kids went to regular health / well being visits with vaccinations.
We even called ahead of time to make sure we were ok visiting these doctors, and got verbal oks from PJP Health Agency.

One month later all claims were denied. The explanation was because I had coverage thru Blue Cross Blue Shield. A Policy that ended a year before.

I spoke with PJP Health Agency. (20 attempts at calling and 50% of the calls resulted in being disconnected) They looked into it, apologized and told me it would be corrected

One month later another collection notice.

I called again to PJP Health Agency (more problems reaching a rep), they said they had no record of any phone conversation. They asked me to fax in documentation of termination of coverage with Blue Cross Blue Shield. I did. This time I requested written documentation the problem would be fixed. THEY REFUSED TO SEND ANY WRITTEN CONFIRMATION that they corrected the error, would not give an explanation. They assured me it would be corrected.

One month Later more Collection Notices.
Faxed in documentation again to PJP Health Agency, they claimed to have no previous records of conversations. Followed up again one week later to check. The person handling my claim is 'out of the office this week'. Another representative claims that there is no record of any conversations and asked us to fax in the documents again.

This cannot be incompetence. The only plausible explanation is that this is a CRIMINAL practice of repeatedly refusing to pay. I canceled my policy with PJP Health Agency.

I had health insurance with PJP Health Agency for about 2 years and have had no major health problems. Last year I found out I needed minor surgery. The surgery cost about $10, 000. I figured I finally got about 2 years of premiums back - so to speak. I take it they didn't like that because just after my surgery when my premiums were due, they didn't deduct it from my checking account.

I called when I realized the deduction was late and they said that "somehow" their computers had the wrong account number for me. Yeah right.

The customer service person asked me my account number, typed it in, and said "hmmmm that's weird, the computer says that account number is fine". Duh, you have been deducting payment from my checking account for 2 years with no problem. Somehow after I had surgery, they had the wrong checking account number. How convenient for them. They blamed it on the computer system, yet no one at PJP Health Agency tried to contact me to get my correct account information. PJP Health Agency canceled my policy and left me with a $10, 000 bill.

I would like to know how you get the job of the person at PJP Health Agency who goes through the computer erasing parts of the account numbers of people who have big claims. Betcha he/she gets paid a lot of money.

I am having IN NETWORK problems with PJP Health Agency. Have only had their plan for 3 months. I verified with the sales guy that our Doctor and his office are in network. Now, even though most of the customer service people that I talk to assure me that my Doctors office is indeed in network and say they will resubmit the claim and get it paid...nothing happens. Some of them are down right rude and tell me that my Drs office is billing wrong or that it is up to me to file a dispute. If the customer service people can't figure out whether or not some one is in network...how the heck do they expect me to know? I'm will not be stuck with this scam insurance policy and I'm switching to another company. People warned me and I should have listened but they were so nice when they wanted my business.

A few months ago I woke up and had a severe sore throat. I had a temperature of approximately 102F. My throat hurt and it was hard to swallow, breathe and eat. I felt that there was a lump in my throat that I could not swallow. Being that my PCP office was closed, I decided to go to the Emergency Room for treatment.

At the Emergency Room, the Doctor told me I was suffering from a bad case of Strep Throat. He finished treating me and I went back home. I had missed two days of work due to my throat infection. A few months later, I get a bill from the hospital saying that I owed them $3715 dollars. I felt there had to be a mistake, so I called and found out that PJP Health Agency had declined to pay the claim for service rendered. I spoke to two different employees in the financial department of the hospital and both of them said that PJP Health Agency was the worst at paying claims. They said PJP Health Agency is the only company that requests every single piece of paperwork relating to your claim and they scrutinize it in an attempt to not pay.

I called a customer service person at PJP Health Agency and he offered no help. The impression I got was that he and PJP Health Agency did not care about me as a member at all. He was very un-caring and almost seemed bothered that I was trying question the reason my claim was denied. I asked to speak to a supervisor and he told me there was no one that I could talk to. I told him that there had to be someone I could talk with about my situation and he said you are talking to me.

He told me that my claim was denied because I went to the Emergency Room for a non emergency situation. I was told that my only course of action was to file an appeal in writing. I wrote a very detailed letter as part of the appeal process and submitted it to PJP Health Agency. After a few weeks I received a letter from PJP Health Agency that once again they chose to decline my claim. The letter stated that an "Average lay person" would not have felt my health/safety was in jeopardy and would not have deemed this an emergency.

The funny part about their reasoning is--it is incorrect. I have spoken to several "Lay people" such as co-workers and people have come in contact with and everyone has said they would have gone to the Emergency Room. This is the reason I felt my situation was an emergency. When I was 16 years old, I had an infection in my throat known as Epiglottis. I had the same type symptoms, including the lump in my throat, as I did in August 2009. My parents took me to the ER and within a few minutes, I passed out due to lack of oxygen. I was rushed into the operating room and en emergency tracheotomy was performed. My parents were told by the doctor that if I would have been a few minutes later getting to the hospital, I would have died. I spent 2 weeks in the hospital with a tube in my throat so I could breathe. I now have a nice scar on my neck as a reminder of my ordeal.

How am I to know what they are going to consider an emergency PRIOR to going to the emergency room? If I knew what was wrong, I might as well have prescribed my own medicine too. I equate my situation to someone that is having chest pains, shortness of breath and other symptoms. He goes to the hospital thinking he may die from having a heart attack, but is told at the hospital that it was just gas. So I guess in this case PJP Health Agency would not pay because it was a non-emergency.

The bottom line is, I work very hard for a living and I paid PJP Health Agency my payment every month. I am not one that misuses the heath care system or takes advantage of anyone. I just feel that I should not have to be scared or hesitate to go get medical attention because of fear that I won't be covered. Based on my situation and reading other comments, I feel that PJP Health Agency has their profit margin as their number one priority and not its members. I plan to appeal this with the State of New Jersey HMO appeals process. If that does not work I will contact the New Jersey Insurance Commissioner. I will also contact and make complaints to anyone and everyone that will listen.

PJP Health Agency sucks. I learned the hard way. I used to use them but after I did the math I realized what a rip off they were. PJP Health Agency is just one big scam to suck money out of your pocket! I had to pay the monthly payments and they wouldn't cover anything. I would be better off just saving the monthly payments in a special account. Even things they were supposed to cover they would not and then have some wordy excuse as to why they wouldn't cover it.

They do not want to help you they want to rip you off and scam you for your money. They also threatened to drop my coverage 3 times. When I was 19(I am 31 now) I had a UTI and I forgot to report it to the agent. Who can remember every single time they have ever been sick!?! They threatened me and said it was fraud to not disclose everything to the agent. Every time there was a bill they would find some time in the past (even over 12 years ago) that I was sick and that I did not tell them about. Then they would use that to place my account under investigation and make me pay the bills they should have covered.

They were always rude to me and I wrote numerous complaint letters. Nothing ever became of that and in the end I was out thousands and thousands of dollars. When I spoke to the agent to sign up for the policy hey lead me to believe they would cover a lot more then they would. What a rip off. PJP Health Agency is probably one big scheme that makes profit by taking advantage of the sick.

Please be careful when ordering your medication from PJP Health Agency's mail order pharmacy. Today we received the wrong medication in a wrong quantity and wrong dosage. Of course they billed us for the more expensive prescription they didn't send and refuse to honor the original prescription because it has already been submitted. I guess we have to go to the doctor and pay for another appointment to get a new one. So anyway please make sure to closely check any medication shipped from them, because if your life depends on it...well, there is a real possibility it is not what you should be taking.

My 3 year old son had extensive tooth decay. We were told due to his age, the 5 crowns, 2 cavities, and caps would need to be done under general anesthesia as an out patient procedure. Because we were told both dental and medical would be filed, I called PJP Health Agency before giving the go to have the procedure done to make sure this procedure would be covered. The customer service rep reviewed my plan after keeping me on hold to look through it and returned to the line telling me that she did find where this procedure would be covered due to his age. Because he was under 7 years old, it was covered as a medical necessity. My decision to move forward to with the procedure was based on this information. Had I been told it was not covered, I would have never allowed it. We would have had to find another alternative because my husband and I cannot afford to pay out of pocket over $12K. Now the procedure is done and the EOB's are coming back denied because the decay was not caused by illness or injury. I called to inquire about this and was told by another rep I was told incorrect information and that she did ask her supervisor and the only thing I could do is file an appeal. But that was after I told her this was not right and I would continue to fight the denial. Now I'm appealing my case and feel the storm just starting. I would like to know who gives some pencil pushing idiots the right to determine what your doctor has requested as "medically necessary" as not? I am so frustrated and ready to file a complaint the the insurance commissioner in my state and contact my local news. I feel like I have to do something to expose this type of issue. This is fraud reversed! I was told it was covered by PJP Health Agency. I had no reason to doubt the PJP Health Agency employee when I called. I canceled my policy with PJP Health Agency.

PJP HEALTH AGENCY DID NOT PAY MY BILLS.
I had surgery done on December 2010. Called PJP Health Agency: "Will you cover the procedure?" answer was "Yes". I got on the table under the knifes. Two months later hospital sending me bills. I called my insurance, they refuse to talk to me, I called again, they said they will take care of it. Now I'm in collections $50, 000.00 Because PJP Health Agency said that they sent me paper work to fill out if I have or not, another Insurance Provider. I never received the paper work. I was in my bed for 4 months, going through the healing process. All my mail was brought to me and I organized it. I never dispose of any important material, especially like this one. Now they are telling me, because I did not fill the paper work out, I have to pay the bill myself. That is their words! My dear people, who have been hurt by an evil company like PJP Health Agency, why don't we all get together and get rid of the evil. We are innocent people who got mislead by a company that likes the MONEY but DOES NOT CARE about US.

I CANCEL THIS INSURANCE A YEAR AGO AND THEY KEEP TAKING MONEY OUT OF MY ACC, I CALL THEM EVERY MONTH AND TELL THEM THAT I DON'T WANT THAT INS.IT GOT ME A $120 000 HOSPITAL BILL THAT THEY TOLD ME THAT INS COVER EVERTHING. B/S THANK PHIL

I went to the doctor several days ago and was given a prescription for a topical gel. The doctor apparently ordered this prescription directly with PJP Health Agency during my visit. I phoned PJP Health Agency to find out more about the prescription and what it would cost. They told me it would be 124 dollars! My medical insurance is with PJP Health Agency and this cost is crazy! I told them to cancel the prescription because that is too expensive. The person said it was too late the order had been shipped to me already. I said I would ship it back then. He said they cannot accept it back. I said I would not be paying for it. He said then I would have a balance on my account. How can they ship you stuff without you authorizing the charges for it? How can this be legal? Seems only fair that people should be able to authorize these things before they can be shipped, otherwise they can ship you anything and say that your doctor ordered it.

I was a PJP Health Agency policy holder residing in NYC. I am writing to express my extreme frustration and dissatisfaction with PJP Health Agency. I've suffered a series of health mishaps in the last year and the process of trying to get them to pay for my medical and prescription claims is an exercise in futility. Wait times on the phone are insufferably long, paperwork is lost, calls are not returned. Once a claim is finally received, the process of documentation is so mangled and inconsistent as to drive a sane person crazy. I began a generic blood pressure medication in September and they have yet to pay for it. The claim is not denied, but just sits in limbo.Then, every time I call there is a different reason why the claim isn't paid. The customer service rep promises to check the inconsistencies and call me back. I receive a call-back roughly 25% of the time. I have received ZERO communication on my prescription being covered. Theclaims are not even processed yet, nearly a month and a half after submission. This is fraud.

I had insurance with PJP Health Agency. I have been trying since December of 2010 to file a claim for a doctor visit they never paid. This is an in- network office and I have been told repeatedly that I am covered for the visit. When I first sent the claim in there I was missing a diagnosis code and another code. The director of the clinic that I go to called PJP Health Agency and sent them a letter with all of the information that they requested. However I keep getting the run around. One person will say that they have all of the information and the next person will say no we have never received anything. I asked if I could speak with the same person when I call and I have been told no. Every time I call I get a different person who has no idea what I am talking about. I have never in my life delt with such a horrible company with the worst customer service EVER! The claim is for over $200.00 and to be honest I just don't think they want to pay me any of the money. I desperately need help! All it would take is for one person to take just 10 minutes of their time to look over my account and FOLLOW THROUGH! This insurance is a rip-off.

I took my wife, a registered nurse of 18 years, into the er for chronic pain radiating in the lower back and down into the front groin area. She was unable to move from bed when she woke up. She was examined and given a Ct looking at the possibility of kidney stones. Nothing was found some drugs were administered to relieve the pain and discomfort. 2 weeks later she finally came around from what caused this problem. PJP Health Agency has denied the claim stating that this was not an emergency. Now the hospital, which she is an employee of has told her we can pay the 6k or they will garnish her wages. PJP Health Agency is a scam that doesn't pay claims.

 
Ask for a copy of the policy: they provide you with the coverage info. If they are correct, you need to shop around for different insurance or accept what they offer. If they lied to you, contact the insurance commissioner.

bought insurance with PJP Health Agency and I decided to get all my checkups done, so I went to a bunch of doctors that were listed as included on my plan. I paid the copay for all of them and now, even after writing the company about it, I have received several bills from the doctors and the labs claiming that I owe them thousands of dollars. These fees were supposed to be included in my health care and they didn't even cover the bloodwork! Ridiculous. I am now receiving collection notices out the wazoo because PJP Health Agency has not paid my claims. PJP Health Agency is a ripoff!

I have been with PJP Health Agency on of their plans. I have had two separate instances where I have gone to search for a provider and found none of the doctors they list or give by phone accept this insurance. I need to see a psychiatrist for extreme depression and PJP Health Agency found one psychiatrist within 30 miles of my area who can only see me in April. Meaning, I must wait two months to receive treatment. The website is misleading and has false advertisements as many doctors do not participate with PJP Health Agency. Even the rep I spoke with agreed to that.I must not continue paying for insurance while I am being delayed treatment for extreme depression, a serious condition that should not be ignored. I am now looking to get another insurance company.