Expat policyholders say insurance company has not paid claims, has broken coverage commitments

Feb 10, 2018 | 122 comments

By Robert Bradley

Complaints against a health insurance company used by Cuenca expats are on the rise, with many policyholders complaining about poor service and claims that have gone months without being paid. Even when claims are paid, some say their checks have bounced.

Bellgenica policyholders say that hospitals have severed ties with the company.

Other policyholders of Bellgenica, which has offices in Cuenca, Guayaquil, Quito and Loja, report that health practitioners and health care facilities that were once part of Bellgenica’s network, and which they relied on, have severed ties with the insurer.

Several policyholders say that delays in payment have caused financial hardship.

Complaints about Bellgenica prompted a January 9 meeting at Cuenca’s Hotel Oro Verde between company management and policyholders. The announced purpose of the meeting was to allow the company to provide details of improvements it planned to make in its service and to address other policyholder concerns.

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Instead, the discussion by company managers centered around the company’s failure to properly manage its own finances and employees  — a matter of little concern to the policyholders in attendance. Of special interest to this reporter was management’s opening statement that the press and social media coverage was an unwelcome distraction.

One frustrated policyholder, who asked not to be identified, said she has tried for months to get a claim paid. “I have an outstanding $110 reimbursement due since September 2017 for x-rays at Santa Inez Hospital,” she says. “I’ve made numerous trips to Bellgenica and have been promised the claim would be paid but five months later nothing has happened.” She adds that she knows others who have much larger unpaid claims.

Another customer, who also asked to remain anonymous, said he did, in fact, receive a reimbursement check but that it bounced when he tried to cash it. “It was only for $5.48 but the bank said there was no money in the Bellgenica account,” he said. “When I went to the Bellgenica office, the secretary at the front desk paid me out of her purse. I left thinking this was a lousy way to run an insurance company.”

The same customer says he joined the health plan based on the relationship Bellgenica said it had with high quality doctors, labs and hospitals. “I originally enrolled in Bellgenica because I was told by Mady (an employee of Bellgenica) that Hospital Del Rio was ‘on their plan’, and before enrolling I had used them for an exam and treatment and was highly impressed. So when I later needed medical procedures there Viviana (another Bellgenica employee) told me Del Rio was no longer associated with Bellgenica but that I could still use their services and file a reimbursement claim. Later, I found out that Santa Inez hospital had also severed relations with Bellgenica. Why was this not announced to policyholders? As clients we have a right to know where our medical providers are in relation with Bellgenica.”

Following the January meeting at the Oro Verde, CuencaHighLife and Cuenca Disptach secured an interview with representatives of Bellgenica on Wednesday, January 31, where we presented a list of questions of about the company’s operations. We were repeatedly assured the questions would be answered, translated into English, and emailed to this reporter by Friday, February 2.

The date came and went without a response. A second request for the list of questions went unanswered as well.

The questions we asked and for which we are still awaiting answers include: In the period from January 2016 through December 2017, what percentage of insurance claims were paid by Bellgenica within the 90-day period stipulated in the policies?; What percentage of claims remain unpaid beyond 90, 120, 180, and 240 days?; and, on what date will all claims be paid in full?

We also asked for the names of hospitals, doctors and other healthcare professionals and services that had once been associated with Bellgenica but no longer are.

As we await answers from Bellgenica, this reporter will continue to follow this story closely and report back to the expat community with the latest developments.

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