POMCO Group reviews and complaints

This is a terrible self insurance company- they have incompetent manager's running this place! I am an employee of utica national group, we have been waiting for our prescription's to be paid back for going on 4+ months now, we call all the time, and are told they are in processing awaiting review. We then are given the manager, Sandra Valerio's extension and she NEVER HAS returned our calls to this date. What a mess, nobody to go to help us out! Stay clear of this company, you are better off getting your own insurance coverage from another insurance company! Our medical claims have been held up for weeks/ months and they lie to you every time you call!
********TERRIBLE TERRIBLE COMPANY************************

PEOPLE AND SELF INSURER'S OUT THERE- THIS company is a big PHONEY COMPANY! The Owner doesnt even give a damn about his employees- he works in another separate building from the employees/ and his building and the employees he works with all have top of the line luxeries- including hot water/ top of line bathrooms!
THIS COMPANY Is run by incompetent manager's who can't even process a claim/ and or answer provider or member questions themselves. BOB POMFREY PAYS THESE MANAGER'S good money, and pay his Claims Representatives/ Processor's $12 hr and gives them a terrible 2% a year pay raise that's if you are liked by the manager/ they claim to use this STUPID SYSTEM to evaluate you- it's a waste of time! THE PEOPLE IN HUMAN RESOURCES ARE TERRIBLY INCOMPETENT AND THEY ARE ALL CLICKY AND STICK TOGETHER! I FEEL SOOOO SORRY FOR THE MEMBER"S OF ONEIDA INDIAN NATION, and UTICA MUTUAL GROUP, AND OSWEGO HEALTH AND CITY OF SYRACUSE SCHOOLS, the processors most of them are seasoned but a good majority of them dont' even know what THEY ARE DOING- THERE AUDITING DEPARTMENT IS SOOOOOO SMALL- cause POMFREY IS TOO CHEAP TO HIRE AND EXPAND THE DEPARTMENT SOO AS A RESULT CLAIMS ARE HELD UP FOR WEEKS AND WEEKS AND THEY LIE TO YOU THE MEMBER'S GIVING YOU ALL KINDS OF SORRY EXCUSES! STAY CLEAR OF THIS HORRIBLE COMPANY! I can attest to the incompetency of this place! THEY ALLOW EMPLOYEES TO BE BULLIED AND MISUSED BY INCOMPETENT MANAGER'S IN THE COMPANY, AND THE OWNER NEVER NEVER EVER COMES ON THE FLOOR OF THE PROCESSING AREA TO SEE WHAT IS TRULY GOING ON!YOU POOR PEOPLE NEED TO WAKE UP- THEY BUILD YOU UP TO GET YOU BUSINESS- THERE TELEPHONE SYSTEMS AND COMPUTER SOFTWARE ETC ARE OLDER THAN YOU GRANDCHILDREN! THE OWNER HAS ALL KINDS OF TOYS AND DRIVES TO WORK WITH THEM, BUT HE GIVES HIS EMPLOYEES TERRIBLE WAGES, TERRIBLE PAY INCREASES, AND GOES ON STAGES TELLING EVERYONE HE WANTS TO MIRROR WEGMAN'S! HOW DARE HE! MAURICE PROMFREY WAS AN HONORABLE MAN, HIS SON IS NOT! I HOPE THESE PEOPLE'S CLIENTS SEE WHAT THIS COMPANY REALLY STAND'S FOR! THERE A BIG JOKE!STAY CLEAR OF THEM!

Last year, my new doctor's staff called to verify my benefits with POMCO. They were told nothing else besides my co-pay amount. Now, after 13 months - and after having received no explanations of benefits - POMCO has paid nothing on any of the claims that have been submitted. I've called repeatedly to find out what the problem is. I finally left a message stating that I was seeking a civil rights attorney and invoking my rights under the Patients Bill of Rights. I got a phone call...

The POMCO rep said that they told my doctor's office they needed to pre-authorize my visits because this provider is out-of-network. There are no qualified in-network providers who are familiar with my conditions; my doctor was highly-recommended and specializes in my problems, so in-network doctors were just not an option here. The thing is, my doctor's office still has a record of the call they made to POMCO detailing that nothing was said about pre-authorizing my visits/care - and that all they were told was my co-pay amount. The POMCO reps are so snide and condescending! The rep told me I "need to choose a network physician" - which is none of their business! They are interfering with my plan of care, and that is a violation of the Patient Bill of Rights!

I also had surgery last summer - and the hospital & doctor WERE in the POMCO provider network. They pre-certified. Everything should have been fine. However, POMCO has not paid the bill - and has failed to give any explanation for the lapse. I am also getting calls galore from places I've been sent for labwork and MRIs... and yes, those were in-network and calls were made to pre-authorize/verify coverage. But POMCO has not paid these claims!

They never sent me any plan booklet explaining the coverage. I had to beg to get a provider directory. Even though I didn't have those, these unpaid claims are not related to any lapse on my end - because the communication was between POMCO and the providers. I know all these providers aren't wrong. The common denominator here - is POMCO! It doesn't matter evidently if a provider is in their network... they'll still reject the claim!

My doctor's office informed me last week that my balance is so high that they're going to have to stop providing treatment. The problem is, I have several chronic problems and a permanent injury that is deteriorating - and if I miss one month of treatment from this doctor, I am confined to bed and very sick. I am permanently disabled.

POMCO is essentially causing my medical treatment to be interrupted because of their poor communication, disorganization and cold, uncaring representatives who are not helpful - but rather, hateful. Only one POMCO representative has been nice - when I can get her on the phone. I was told that this particular plan was not rolled out well at all, it was a real mess and it is very disorganized. That was a shock to hear, but as time went by, I understood what the representative meant by that!

I am being hounded by these providers who want me to pay what POMCO was supposed to pay. POMCO does not want me to contest these unpaid claims, but I'm not backing down. They've gotten nasty with me and just want me to go away. I've never had service THIS BAD!

For those who may be experiencing a similar situation, here is the Patients Bill of Rights:

1. Information Disclosure. Consumers have the right to receive accurate, easily understood information and some require assistance in making informed health care decisions about their health plans, professionals, and facilities.
2. Choice of Providers and Plans. Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
3. Access to Emergency Services. Consumers have the right to access emergency health care services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity -- including severe pain -- such that a "prudent layperson" could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
4. Participation in Treatment Decisions. Consumers have the right and responsibility to fully participate in all decisions related to their health care. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators.
5. Respect and Nondiscrimination. Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.
6. Confidentiality of Health Information. Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records.
7. Complaints and Appeals. All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
8. Consumer Responsibilities. In a health care system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities. Greater individual involvement by consumers in their care increases the likelihood of achieving the best outcomes and helps support a quality improvement, cost-conscious environment.

Wish me luck! This is very stressful and is making my health problems worse! If I lose this doctor, I may as well die.