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SAMBA Insurance Plan with OPM is something to be watched closely. After ten years with our same doctor and several support systems we have come to rely on for great health care, we have to make a change. During the seasonal insurance network shopping, SAMBA switched to a plan, Cigna PPO, that is not accepted by our primary doctor and a huge chunk of other support such as our hospital of choice, etc. They are saving us money and it was a business decision, (like switching to Nextel from Verizon. In a city, no problem, but on the reservations and remote sites, no service. By the way, they switched back after a year of this improvement.)
Of course, I let the change in providers slip by us, because I did not pay attention the month of and through what is called Open Season with the government agencies. It amounted to a two month window of notice. Not only is this my fault but in twenty years this agency has never put us in this position. I guess I should have been better prepared for this switch. After all, two months notice is sufficient for anyone on the ball after all those years. Besides, Cigna is well thought of in Maryland and on the east coast. Never mind there is not that consensus on the west coast or in Arizona. This is just a simple case of BUYER BEWARE. Being an old dog, I have learned another trick. But I am going to complain, complain, and complain. I would suggest that other people dealing with this same scenario do the same. Cigna stinks and I am so angry that I missed the opportunity to switch because stupid me did not suspect that SAMBA would go to an insurance that did not service the entire nation as well as it does the east coast constituency. Never mind the fact that it appears that a chunk of the previous health support in our area simply will not do business with Cigna. Does that tell anyone anything?
The complaint has been investigated and resolved to the customer’s satisfaction.
Samba has destroyed our family through their repeated denial of legitimate claims for our son who has required non-surgical treatment for severe scoliosis. He was unable to undergo spinal fusion treatment due to the location of his spinal cord ($500k cost), so we were encouraged to look at non-surgical treatment which was out of our State. A 10 day intensive program that produced a 12 degree reduction in his curve. Prior to scheduling this program which was at a cost of $6, 000.00, I contacted Samba SEVERAL times to verify that we could submit this claim as it was a non-provider and they confirmed each time they would cover 65%. Upon the conclusion of the program, we submitted a super bill to them on August 2nd, 2016, and when I followed up with them after 1 week, I was advised they did not receive the 58 pages we sent. We also mailed it to them, never received, faxed it again for the second time, not received, the treatment program office re-mailed it 2 weeks later and it was not received, faxed it again and they showed they had it in their system, but claimed they did not receive the super bill. I faxed it to them again, and they confirmed they received it. This after now nearly 3 weeks. I was told they would have it done prior to 30 days (which I later found out that Care Allies by contract with Samba has 30 days to review any claim. And they WILL wait until 30 days without any concern for the medical bills that are due), and we now were moving towards the end of the first month. Then, going into September, still nothing done, and again, they required me to submit the documentation again! I then found out the Lead Specialist for this Deborah Dula, was not just a representative I was speaking with but the actual Lead. I asked her numerous times who the lead was and she told me she could not give that information out. Then through speaking with another representative, I was advised that Deborah Dula was the lead. Hmmmm? Deceitful already. I then corresponded with her from that point on, and she continued to advise me they did not receive paperwork, which I had faxed to them again in now mid-September. I called EVERY day to check on the status, leaving numerous messages, and receiving the same response of "It is being reviewed...". Then the first denial of the claim came on 09/26/2016 and it was noted as "Not Medically Necessary". So, a 15 year old boy with severe scoliosis, being told he would not be eligible for spinal fusion as it would cause paralysis, and recommended to go through the non-surgical treatment by several Surgeons, Doctors, Specialists, Nurses, etc., is having his 10 day intensive program over his summer break, away from home, staying in a Hotel with his father, not seen as necessary? We then submitted additional documentation from the Surgeon who stated this program would be very beneficial as the surgery was placing him in the greatest and highest risk. I submitted this to SAMBA, and appealed the decision, called every day up to yesterday with significant urgency, only to be called by Deborah Dula of SAMBA to say the denied it again. Now I would have to appeal through OPM. The Medical Director for SAMBA/Care Allies/Cigna, who Deborah Dula would not provide me with his/her name, said I will receive their decision in the mail. Would not tell me on the phone. WOW! This is the most incompetent, unorganized, all of profit, crooked, and black hearted group I have ever come across. They tell you in the beginning that everything will be fine, they will cover it, not to worry, etc. Then, they shut it down on you and leave you with ALL the bills. Disgraceful, unethical, and fraudulent. Untrained personnel who are not honest with you, lie to you about who they are, do not return calls, have it in their contract (which I do not believe was supposed to have been disclosed to me) to take 30 days to make their decision. This is a Federal Employee Benefits Program in which WE the members PAY your salaries which I am sure provide you all with a very comfortable lifestyle. You will be investigated, and I will make sure that every individual involved in this is investigated as well. You have destroyed my family and have left us with medical bills that YOU have all said you would pay. Disgraceful and definitely not over. I will tell everyone who will listen to me, and that is many people, to NEVER consider SAMBA as their benefits provider.
Sorry for your troubles but thank you for posting your complaint about Samba insurance. I was strongly considering Samba standard for Open Season 2016. Not that many reviews about Samba overall from consumers so this helps. I will stay away from Samba.
Try as I might, I cannot gain access to SAMBA's website in 2021. It should not be difficult. My initial password was rejected, and resets did not work to open the site. I susprct software bugs or a plain shutoff of access serevice. Calls and text messages receive courteous attention but no help. All I want is the ability to review claims paid in 2020. Nope, logins won't work.
Jim