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Avoid BCBS!
Posted by Jga165 on 03/26/2011
GEORGIA -- I truly hope that this message makes it to at least one person who is considering purchasing BCBS health insurance. 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. BCBS 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 customer service 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 BCBS as your health insurance carrier, reconsider.
     
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Posted by Anonymous on 2011-03-26:
What is driving rising health care costs in the U.S. are increased utilization created by increased consumer demand, new treatments, and more intensive diagnostic testing. People in this country are living longer. The population in the U.S. is aging, and a larger group of senior citizens requires more intensive medical care than a young, healthier population.

Advances in medicine and medical technology can also increase the cost of medical treatment. Lifestyle-related factors can increase utilization and therefore insurance prices, such as: increases in obesity caused by insufficient exercise and unhealthy food choices; excessive alcohol use, smoking, and use of street drugs.

Other factors include the movement to broader-access plans, higher-priced technologies, and cost-shifting from Medicaid and the uninsured to private payers. My monthly premiums are extremely reasonable, have not gone up, and my coverage has not changed at all.
Posted by oldisgood on 2011-03-27:
I must lead a charmed life. I have had BCBS since 1989 and have very seldom had a problem with charges not being paid. On the rare occasion that I had a problem, I called on the 800 number, got a person in the US and asked my question and received my answers. On some occasions I was told they would review it and I did indeed receive payment and on a very few occasions I was told why the charge was not being covered. At the same time I was told, if I did not agree with the finding that I could write a letter and explain why I thought it should be covered and they would consider it. I was talked to like an intelligent person, and I talked to them like they knew their job. On one occasion I wrote about a denial and did end up receiving all the payment I thought was due. I found out long ago that you get more by being nice that by throwing a fit. I, myself, worked with the public, and if a person was nice to me, I bent over backward to help them with a problem. If you treated me like a lowly peasant, I suddenly became the worker with the low IQ that didn't quite undeerstand what you were talking about.
Posted by my 2 cents on 2011-04-01:
I am glad I am not alone out there as I have experienced only incompetence by BCBS. Our premiums continue to go up every year, and their customer service gets worse and worse. Since January I have been trying to chance my policy. When I sent it in on February 22nd, I then received notification they did not receive my signature page. Once I sent it in, I received a letter on March 8th telling me they are NOT considering my application because they did not receive my signature page.
This is now April 1st, and I still have no answer on the application as I sent them another letter stating I sent in the application page, dated and signed. How long should I wait until they get their act together before I tell them I am no longer interested in be3ing a policy holder?

Oh one more thing, when I called them today, I was told a supervisor was not available for me to talk to. So, I need to wait at least 24 to 48 hours before one gets back to me.
Posted by Anonymous on 2011-04-01:
jga, is it possible that you have a very high deductible on your policy? If this is the case, then your initial yearly visits, tests, etc. could very well be applied to the deductible. Once the deductible is met, then they will start paying the claims out as per your policy. It really depends on how your policy is set up.

For instance, routine office visits are covered under my policy with Cigna. They tried to apply mine to my deductible until I brought their error to their attention with a phone call. Then they paid it out correctly.

All of the insurance companies operate differently and not all are easy to navigate. Yes, they do make mistakes--many from what I've seen after working in the medical field. If you feel they are wrong, keep trying until you get an explanation that you can live with, or better, payment.
Posted by Buttons810 on 2011-06-07:
Concerning those who support BCBS in the above comments this is what I can say: I have never seen such poor customer service and given the run around in my life. We have had other plans in the past HMO and decided to get a PPO this year (and pay the higher premium) in hopes that we would get what we paid for better service and people who are knowledgable. Everytime you call there you get a different person, but that is not the problem. The problem is you get different answers to the same questions, and if you try to get something pre-approved you can ask one person what exactly do you need to get authorization and they will tell you one thing, you get a denial letter, you call back again to tell someone new what the first person said you needed, and they say you need something more, and the cycle continues itself. I have excellent people skills so I totally understand what they one person said you can get more cooperation by being nice, but when you are giving the run around and can't get answers you need in a timely manner that is not acceptable. Without going into my whole story (and you would be amazed) either this company is incrediably dishonest in it practices or the most incompetent company I have ever dealt with. Having an HMO in the past does not look so bad anymore after dealing with Blue Cross Blue Shield of Illinois.
Posted by FrustratedConsumer on 2012-07-01:
I asked my husband to bring home the list of preferred providers on HMO Blue New England, and he was told they no longer publish it. I've spent about 2 hours online trying to find it, still no luck. They have everything on the website except what the customer needs.
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Intentional misrepresentation
Posted by Changing companies on 08/20/2010
BCBC has separate service departments for customers and providers. Customer Service is not allowed by policy to speak to a provider nor let a provider listen to a conversation between them and a customer. A customer is not allowed to speak to Provider Service nor listen to what Provider Service tells a provider. This is the case even when the provider and customer approve of the other listening in for the purpose of resolving contradictary information. WHAT ARE THEY HIDING? It is obvious that they tell provders one thing and customers another and they don't want each to know. They want customers to blame the provider for not doing what BCBS says the provider should do but won't let the provider do!!!!!!

I won't do bussiness with them anymore. This is nothing less than FRAUD!
     
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Posted by Anonymous on 2010-08-20:
Are you a customer or a provider?
Posted by goduke on 2010-08-20:
It's because the type of conversation they have with a provider is exceptionally different than the type of conversation they have with a provider.
Posted by goduke on 2010-08-20:
OK...so I can't type. I meat to say "the type of conversation they have with a customer is exceptionally different than the type of call they have with a provider."

Make a bit more sense. Sorry for that.
Posted by pissedoffchicka on 2010-10-26:
goduke is correct. i work for one of the bcbs. when it comes to provider services, those reps go more in depth with CTP (service codes) and icd9 (diagnosis codes) and tax id's. also out of network provider's can't talk to either, because there is no contract with them to do so. but in member serivces, they explain everything in simple terms and percentages. provider serivces can get prices because there are contracts with the providers that can be looked into with certine programs that member service don't have access to because they have other systems for enrollment and cordination of benefits. providers also call for more then just on member's claims and benefits. if they get through to a member serivces rep, they can't look into contracts. theres only so much they can make one person learn and memorize for a pay of only $8/hr. there are also different departments for different products and so many departments for strickly comunication between blue cross blue shields. but due to HIPAA, if a member request a provider be on the line, even if it's a non contracted provider, we have to allow them on the line with the member's authorization. vice versa, if a provider wants the member to be on the line while the conversation is going on, it has to be allowed. but a lawyer can not talk to either. they need to go through the department of banking and insurance. you don't file lawsuits over the phone. you need to do that in person or writing. too many call centers, too many employees.
Posted by george on 2013-10-06:
Sounds like a bunch of double talk. If I was you, I would be ashamed to tell people you work for those crooks
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Mammograms
Posted by JNYGRL on 09/22/2010
GEORGIA -- I was at a regular doctor checkup and I am 33 years old, they found a lump on my breast and referred me to have a mammogram and ultrasound to diagnose the lump, I got 2 bills one form the facility and one from the radiology clinic. BCBS paid a total of $67.00. I am paying out of pocket $500. They state a routine mammogram is paid at 100% by them. but if you have a diagnostic due to a lump or anything else they are not responsible for 100%. Why is it if you have a medical issue that is really needed to be looked at they will not pay? I think this should be looked into further and ALL mammograms should be covered by 100%, it's bad enough to go through the stress of finding a lump, then finding out you have to pay so much out of pocket when it does not state that anywhere in the benefits book. Shame on them to make one any more important than the other!
     
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Posted by Ytropious on 2010-09-22:
I think it has to do with age. "Routine" mammograms don't usually start at 33.
Posted by Anonymous on 2010-09-22:
Routine mammograms start after age 40. This was not routine since they found a lump. So they don't have to pay because it's not routine
Posted by JNYGRL on 2010-09-22:
the age is completely understood, but it is not something you can choose to have happen to you if you are under 40. That was why i think it should cover all Mammograms no matter the age, Breasts are on a woman before she is 40.
Posted by Anonymous on 2010-09-22:
Doctors reccomend mammograms after after age 40. Insurance companies are following that recommendation. It may not make sense, but that's their guidelines
Posted by Ytropious on 2010-09-23:
Yes OP, breasts are on a woman before 40, but most women don't develop breast cancer before 40. The insurance world is a game of statistics. Statistically some women will have breast cancer early, but the majority will not have it before 40. Unfortunately, this means that routine mammograms before the age of 40 will be a waste of the insurance company money. What, you think they're there to make sure you stay healthy? They're in business to make money, which is largely contributing to the health care crisis in this country.
Posted by jktshff1 on 2010-09-23:
with our "new health care rules" it's only going to get more costlier.
Posted by PepperElf on 2010-09-23:
that's the idea jkt - they want to make it so that the government option is the only affordable choice
Posted by pissedoffchicka on 2010-10-26:
actually, routine mammography guidelines are , 1 between ages 35 and 39, then one every year after. if the woman is at high risk, because of a family history, that is still considered routine under the ages of 39. it's not so much the insurance that decides this but medical standard and the medical board on staff in our medical policy department. the payment difference between routine and diaogostic is stickely a problem with the benefits you or your benefit admin (HR if you get it through work) selected. there are a lot of different insurnace products with many different benefits in what's covered and how. be sure to talk to your broker if you perchased this policy your self. if what they say doesn't match up to what i'm saying. then call a sales department for your insurance, give a fake name and say you don't have a ssn and see if they tell you something different.
Posted by Sharleen Placek on 2012-10-01:
The simply answer is that the doctors on the board for any insurance company are idiots when they choose not to pay for diagnostic exams and it only proves that they only pay for what they really are forced to by the government. If they spot something on yearly screening exam and do the diagnostic exam it means they will catch something sooner possibly requiring less treatment and costs, but idiots don't get that. But wait I think they vote to pay for that stuff called Viagra when it comes to a man be able to have sex, yes that is very important!
Posted by Michelle on 2013-06-05:
This has happened to me three times. I have always had quite a few lumps in my breasts, and have had to pay out of pocket $700 for my mammograms since they were diagnostic. I have asked the doctor to code them as routine, but she says the lumps "concern" her. Apparently the stress I am under when paying for these tests does not. BCBS sucks.
Posted by Annie on 2013-10-15:
BCBS refused to pay for my yearly mammogram because I had breast cancer 3 years ago. Although I am cancer free due to medical standards all my mammograms are now considered diagnostic for 10 years. Unless I meet my $2000 a year deductible they will not pay for them. I am over 40. According to my dr's office bcbs is the only co with this policy
Posted by Danielle Ferrara-Schellbach on 2013-12-06:
When you're dealing with insurance, there's a difference between preventive, and diagnostic. All preventive testing IS covered at 100% having any copays and deductibles waived. However, if they find something, it's then classified as diagnostic. Any diagnostic goes towards your deductible and coinsurance. Unless, you have a group policy through work which has this benefit structured differently. The only insurance company in the individual market that will help pay for the first $300-$500 per person per year for diagnostic tests is Humana.
Posted by Lee on 2014-03-07:
I had the exact issue with BCBS in spite of calling in advance to confirm that a follow-up mammogram (diagnostic) would be covered. The reimburesement problem isn't because of your age, it's becasue diagnostic mammograms (not routine) have a deductible (which in my case is $350). I too feel deceived by BCBS and feel that additional diagnostics related to mammograms need to be covered.
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They Just Don't Care
Posted by My 2 cents on 04/05/2011
ILLINOIS -- If anyone is considering BCBS, I would think twice about it. In addition to their increases annually, they also add on additional increase when your Birthday ends with an ) or a 5. In investigating options, I decided on another plan to reduce my monthly premium. When I requested an application to be sent to me, it took about a month, meanwhile my premiums has already been increased by 33%. When I sent in the new application, I waited and waited for a response. I was told in a letter I was missing a page that needed to be signed. I prompted faxed in the page. All of a sudden two weeks later I received a letter stating they are closing the application process because they did not receive my signed page. When I called them, I was told I could re-fax it, and request the application process to be re-opened. Now one would think that process should not take that long. I also requested that a rush be put on this since it was their incompetence that caused the delay. I am guessing it was that remark that put my application on the bottom of the pile. When I called 21 business days later, they said it was still being process. Not knowing what that meant, I asked to speak to a supervisor. Oh my gosh, that request takes 24 to 48 hours before one will call you back. I think I have spent more than enough time trying to get a status of my application. I was told yesterday by another supervisor, I should check in 7 to 14 business days to get a status. To add insult to injury, the supervisor ends her call with "is there anything else I can do for you today?" Seriously?, she did nothing for me today and nothing for the last 41 days when I initially sent in my application.

There has to be a company out there who will provide good health insurance, and at the same time act like they really care about their members.
     
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Son's Forehead Bleeding Away/BCBS refuse to Pay for ER Visit
Posted by MomBee on 09/07/2010
This is the most ridiculous position taken by an Insurance Company yet of not paying for ER stitches (WITH MY SON BLEEDING AWAY WHEN WE GOT THERE) My 3 year old son fell down and got a gash on his forehead. We rushed to the hospital at night and they determined he needed stitches. The hospital said they had a plastic surgeon on call who could do the stitches. We obviously needed to move quickly with whoever was available and the doctor did a great job giving my son about 6 stitches - poor baby was so weak with the bleeding so we had to stay several hours with drips till he had some energy to leave.

Next thing we get a $2200 bill from the plastic surgeon as BCBS refused to pay because he was OUT OF NETWORK in the ER. We wrote a letter to protest at the suggestion of the customer service representative to which the response was that the claim was still denied.

I can protest this a 100 times as this is absolutely ridiculous - How can anything be denied for an emergency? How am I supposed to know which doctor will be on call the day of my emergency????? Should I have let me son bleed away and how am I supposed to even know to check the network status of an ER doctor ?? How can BCBS would actually think of not paying in an emergency situation???
     
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Posted by clutzycook on 2010-09-07:
That's the downside of HMO's. Out of network is out of network. They're not going to make exceptions for emergencies unless someone was minutes away from dying and then they would be transferred the minute they were stable enough to be moved. That's why it's a good idea to identify the nearest in-network hospital/ER/urgent care before things like this happen.
Posted by Anonymous on 2010-09-07:
I always thought they would pay in an emergency. It's not like you have time to shop around. I guess things have changed in that area too.

If my child was bleeding, I would not take the time to drive further than necessary to get him the care he needs, even if I knew ahead of time where the in-network facility was. I suppose I would be paying extra too.

I would appeal their decision and also check your benefits to make sure they didn't make an error. They do that all the time with my insurance. I appeal, then they pay. Even if they pay at a lesser amount for out-of-network, you won't be out everything. Let us know if you get any resolution.
Posted by macdave on 2010-09-07:
Why wouldn't the doctor in the ER do the stitches? That is probably why BCBS determined that the plastic surgeon was out of network in the ER. If there is some reason it had to be plastic surgeon to give the stitches submit that reason along with your appeal.
Posted by Anonymous on 2010-09-07:
A lot of doctors work in ER's that they are not contracted in. They may work there, but are contracted thru another practice or office. The hospital cannot refuse treatment to patients in cases of emergency. But that doesn't mean thay the insurance will cover it.
Posted by Anonymous on 2010-09-07:
Maybe the Hospital can work out a payment plan for you. Or reduce the payment to a more affordable level.
Posted by Anonymous on 2010-09-08:
Most hospital's/doctor's can reduce the bill by at least 20% if you don't have insurance coverage, wally, so good idea. They may even reduce it more than 20%, but, it sure doesn't hurt to ask. Of course, I would still appeal first.
Posted by Helpful on 2010-09-08:
The difference was having a specialist come in compared to an E.R. surgeon. If the stitches were sutured by the E.R., then the copay for only the E.R. visit would have been due. You elected to bring in the specialist, which would have been billed as either in network or out of network. In your case, he was out of network, not working with the predetermined pricing BC/BS agrees to. As such, you have the responsibility of covering the entire amount.

I don't necessarily blame you for the decisions made. Money was not the issue when your son was in danger. You just have to remember that now. I believe someone else already suggested contacting the hospital, as they may be able to cover, at least, part of the cost. If not, work out a payment plan.

Best of luck.
Posted by Anonymous on 2010-09-08:
Helpful, you're right. I somehow missed the part about the plastic surgeon doing the stitches.
Posted by Anonymous on 2010-09-08:
Another factor--If you have a high deductible for out-of-network benefits, (say $2,500), you would still have to pay the entire amount in many cases. Sometimes we just can't win and get stuck with huge medical bills even with insurance.
Posted by clutzycook on 2010-09-08:
I think I overlooked the fact that it was the surgeon not the ER that was out of network. My bad. My sister was in the same prediciment when she had her daughter two years ago. The hospital she wanted to go to was definitely in network but the laboratory (which was run through the outpatient clinic bearing the same name as the hospital) was not. I'm kind of surprised too that the ER doc didn't just stitch him up himself. Isn't that what they're there for?
And on the note of $2200 for six stitches, I only have to say that for $366 per stitch, I'm obviously in the wrong line of work :).
Posted by rockfishing on 2010-09-08:
Did you ask if this was covered before the specialist sewed up your son? The same thing happened with my daughter over 10 years ago. The real emergency is to make sure there is no brain injury or concussion. Cuts to the head Are notorious for bleeding. We were asked if we wanted a plastic surgeon. They told us most likely it wasn't covered. They also told us that young children heal nicely and there most likely there would be a faint scar. They were right, she is in her late teens and you have to look hard to find the scar. Lucky for us we live near a terrific childrens hospital and trusted their advice. Keep fighting BCBS, maybe you can beat them down.
Posted by CrazyRedHead on 2010-09-08:
Head gashes are usually worse looking they really are and are really not considered a medical emergency (as long as there is no fractures or serious injuries associated with it, so it wouldn't have hurt to ask before sewing him up as some ice and a compress would have helped slow the bleeding. I know that it was really bad in your eyes and were scared as it is your child but it wasn't as bad as it looked. Plastic surgeons do work that is usually considered cosmetic and is not covered under any insurance. Luckily, by the time he is teenager the scar will probably have faded and should be gone by adulthood. I would call the hospital and ask for an itemized list of what was done for that visit and make sure that they didn't bill you for unnecessary or for things that weren't done, hospitals are notorious for things like that.
Posted by pissedoffchicka on 2010-10-26:
crazy red head is right in the fact that a gash on the forhead was probably not a medical emergency. most insurance companies will state in your benefits "emergencey rooms and services are only covered in the instant of a medical emergency" so if a bandage or first care (like in a wallgreens) would have serfices, you shouldn't have gone to the ER. it's prity much a waist of your time, the dr's time and you insurance company's time to explain that you're a moron. i hate when people call in and say "of course it was an emergency! it was done in the er" since when does a room make the "situation" an emergency. you over reacked. and your insurance will explain that to you when your apeal denied and department of banking and insurance will also explain it again when you try apealing again, because all insurance is bad...in stupid people's eyes, smart emough to buy it, but not smart enough to read what you bought!
Posted by Chris on 2014-03-10:
Sounds very dramatic! It's always nice to read posts like this AFTER joining BCBS
Posted by Diane on 2014-03-28:
I used to work in health insurance, and accidents were an exception to that PPO in network stuff. I don't know what your plan documents say about accidents, but I would look at it from the light of: when you have no time to plan for the surgery and your son is bleeding, you don't really have the luxury of hunting down a preferred provider. See what they say to all that -- best yet, put it in writing.
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Childhood Immunizations
Posted by Emilymarshall on 04/13/2008
SALT LAKE CITY, UTAH -- BCBS is horrible. My son had to get some suggested immunizations before college so he went in and got them on his 18th birthday. BCBS refused to pay a dime towards them because the were considered pediatric immunizations (as if the chicken pox virus only infects children . . . a ever heard of shingles BCBS) and he was over 18. It was on his freaking birthday!!!!!

They suck, the whole industry sucks. Socialize primary care and get rid of these bums.
     
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Posted by spiderman2 on 2008-04-13:
yeah, lets have socialism so your son could wait 2 years to get those immunizations. That would be a good plan.
Posted by Principissa on 2008-04-13:
Problem with this is, at 18 he is considered an adult. The childhood immunizations are meant for children. Try the health department in your area, they give free immunizations to people regardless of income.
Posted by jenjenn on 2008-04-13:
Hey brainiac...shingles has it's own vaccine!
Posted by Anonymous on 2008-04-13:
(Picture Ghost humming The Hymn of the Soviet Union)

Comrade poster-The komisars are working on your request. Soon mediocre health care will be universally available to all US cadres. Of course you will have to wait 5 years to see a specialist (if you can find one). Vaccines will be provided by the lowest bidder (pay no attention to the stuff floating in the bottle). Don't want to share your room with 5-10 other sick people? You must rid yourself of such bourgoise ideals! And, we at the Ministry of Health want to remind you...it has been 4 years since your 'mandatory colonoscopy'...if you don't show up this year, your benefits will be cancelled.
Posted by Nohandle on 2008-04-13:
Perhaps I've been "brainwashed" but I personally have never expected my BCBS to cover every medical expense I had. There are times I go in for a checkup, things are not covered, so I pay for them out of pocket. When I went in for surgery and the bill was akin to $14,000.00 and I wrote a check for $100.00 and BCBS handled the rest I was delighted to have health insurance and certainly don't want socialized medicine. At one time health insurance was intended only for stays in the hospital. Now it seems folks expect insurance to cover every medical expense they have. There are free services out there for routine shots that, regardless of income, are offered. Check them out next time and be delighted you have insurance for those costly expenses.
Posted by Anonymous on 2008-04-13:
emilymarshall, I feel your pain and I hear what you are saying but I can assure you like Doc has said it is only going to get worst with in insurance companies and look for another place if national heath care gets into the hands of the government.

I also had an experience like Nohandle and mine cost $65,000.00 for three days in the hospital I too was glad I had insurance. Read your contract and it will tell you (almost) everything they will and will not pay for.
Posted by Nohandle on 2008-04-13:
The stay I was speaking of at the hospital was as an outpatient and lasted perhaps 4 hours. I was still drugged when I left so don't know for certain. I think the point some are trying to make, myself included, is check the provisions on your particular policy. If you ever have a MAJOR bill you will be grateful for your insurance coverage and the cost of some shots will be minor.
Posted by Anonymous on 2008-04-13:
I think it's important to mention that insurance companies make mistakes all the time when they pay claims. Just last week, they applied my husbands deductible of $500 to a claim they should have paid in full. It was for a yearly exam that is covered 100%. They did the same thing last year.

I used to be heavily involved with health insurance coverage at my last job and know all the angles in which they screw people out of money. I feel for anyone (young and old) who doesn't understand that they need to check every claim their insurance company pays. If you're not sure, find someone that can help you--human resources, a friend or family member (in other words, someone you trust).

When I called our insurance company on the error, they checked it out and said, "You're right" and said they would expedite payment. If I hadn't known better, I would have been billed and paid $545 out of our pocket. We don't have many bills, but with what we pay out monthly, I expect a lot better service.

Canadians have socialized medicine and say it works great until you have a problem. We had people coming to our office from Vancouver, BC for sleep studies because there was a 14 month wait. They paid us in full (and we gave them a customary discount) rather than wait that long for a test.
Posted by Anonymous on 2008-04-13:
Good advice dianec. I would add that the final responsibility for coverage lies with the insured. Very few insureds know what their policy will, or will not, cover. When a provider is denied benefits, the insured will get a bill for the non-covered services. It is an unpleasant surprise for the insured, who often takes it out on the hapless office staff. Read your policy BEFORE you go to a provider. I have two books filled with the nonsense insurance company 'provider assistance specialists' have told my staff. I swear, most of it sounds like the 'specialist' made up the coverage criteria as the conversation went along.
Posted by Principissa on 2008-04-13:
Ghost, another thing people can do is talk to their benefits adviser at work. Not only will they be able to tell you what is covered and what isn't, but they can also help with any claims issues that you have.
Posted by Anonymous on 2008-04-13:
DocJ--I hear you. I can't tell you how many times that happened in our office. You could speak to someone from the insurance company one day to get benefits and call the next day and get completely different information. It was ridiculous. Hate to say you can't trust them--but you just can't. One of my jobs was to be a patient advocate and as hard as I tried, sometimes you just couldn't get straight answers. I think Michael Moore's movie told the story.
Posted by Anonymous on 2008-04-13:
Good comment Princi. Try to avoid asking the insurance company directly. One of the worst places a beneficiary can try to get coverage information is from the insurer. The goal of the company CSR is to make the company look like a noble hero...and everyone else look evil or incompetent. The CSR will tell insureds, "Yes, it's covered." When the provider bills for the non-covered service it is declined (because it never was covered). The provider sends a bill to the patient. Guess who looks like a horse's rear end to the consumer?
Posted by Anonymous on 2008-04-13:
I want to LOL dianec. It would be hilarious if it were not so serious. The WORST provider info (in our experience) came from Medicare and Medicaid provider relations. My favorite? "We never got the claim." My biller had CMRRR ticket showing they received it. Next attempt by the 'specialist'? "You did not put your provider number on the claim." The biller had a photocopy of the claim...showing no info was omitted. I had to take a 10 min break (I was laughing so hard) when the biller said, "Please insert another 25-cents and thank you for playing claims roulette."
Posted by Anonymous on 2008-04-13:
DocJ--I know what you mean. I did laugh with my co-workers about all the excuses (after I went into a closed room and said every swear word I knew). They were the worst (Medicare/caid) and a joke. We actually ended up writing off claims (when we could) because we knew the patient would never be able to pay. It's just not fair to the patient at all.
Posted by Sunny1981 on 2008-04-14:
You need to know what your plan does and does not cover prior to going to the doctor, read your benefit booklet.
Posted by jcgg on 2008-06-11:
I have BlueCross BlueShield of North Carolina - Blue Options. This insurance is absolutely the worst I have ever had. I am seriously considering leaving my job just because of this piece of CRAP!!!
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Failure To Pay Bills
Posted by on 02/22/2013
LOUISVILLE, KENTUCKY -- My premiums are 400.00 dollars a month and my annual deductible is 2000.00 dollars a year. But I consistently get medical bills over 2000.00 dollars. I have MS and the medication to treat it is very expensive. One company that makes it offered it to me for free which was fine and dandy for BCBS but the medication made me sick so I could not take it anymore. The new medication my DR put me on wants payment after three months of taking it I get a bill for 4000.00 dollars. I called them and told them my deductible was 2000.00 why isn't the insurance company paying half? They said they would reach out to them after a couple of days they called me back and said BCBS told them my deductible was 4000.00 LIE. Then I applied for financial assistance they came back and said well your deductible of 4000.00 dollars has been met but your health insurance company said you should be getting your medication from another pharmacy.

Basically the one that gave me free medication that makes me sick so they have no financial responsibility. These people are greedy money hoarders and have no business in healthcare if you are sick and have BCBS you are out of luck.

I will cancel my insurance and deal with the government I can not afford to treat my illness anyway so why give them 400.00 dollars a month. Single payer please.
     
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Posted by Jeff on 2013-02-22:
Welcome to corporate bureaucracy America.
Posted by Old Timer on 2013-02-22:
Can you say Obama care? Hope BCBS Wellmark comes through sooner than later.
Posted by JR in Orlando on 2013-02-22:
Insurance company has a duty to everyone else to keep costs down so that premiums are lower. Apparently this is a medicine which they do not approve for use. If they authorized payment for every medication, no matter how experimental or which can be replaced by cheaper medicines, then premiums would go up astronomically for everyone. There is not free lunch, someone pays for it. Insurance is not suppose to be where one pays in a little and then gets whatever medication they convince a doctor to give them. The insurance company works to keep costs low.

The OP still has the right to pay for her own medication, or try again with the free medication or some other medication approved by the insurance company.
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The epitome of arrogance and evil
Posted by Djewel73 on 09/06/2011
Jan 25, 2011 I injured my back in a fall at my house and was taken to the ER by EMS. CT done nothing broken was given some meds and told to follow up with my PCP. Started feeling worse and having pain moving down my legs within a week. Went to Walk in at my PCP and they ordered a Stat Same Day MRI the results of which they sent me to a Neurosurgeon for consult due to the issues found on the MRI as well as my symptoms (MRI showed a bulging/herniated disc at L4/L5). I couldn't do PT After 6 additional weeks of trying to hopefully get better nothing was working they scheduled a discogram to examine the Disc structure. The discogram confirmed the suspicions not only was the disc herniated but I had a Grade IV tear in the disc with significant leakage into the canal the MD who did the discogram agreed with my neurosurgeon that due to the damage and the DDD in the disc that fusion was the only sensible option due to likelihood of reinjury or disc space collapse resulting in major issue potentially.. I was 2 weeks from having surgery and then the BCBS of NC brick wall came up. They Denied my surgery.. My Surgeon put in an immediate appeal and he was denied.. all because they said it 'wasn't medically necessary' I went through 1st level internal appeal at BCBS which was a bloody joke. Their supposed internal review physician was a bloody family practice MD, they don't know anything remotely about spinal surgery or surgery in general for that matter so WTF.. DENIED again!!!! This was July.. I had a setback and major pain issues that nearly had me admitted due to exacerbation of pain issues and my pain meds were increased.. Ok filed 2nd appeal.. Hearing was Aug 26 (same day as Irene is bout to come barrelling through our fine town). Thought it went well.. Got letter this past Saturday DENIED again Neurosurgeon on appeal says I don't need fusion I need disc resection (oh the moron also asked bout disc replacement but I find it funny because bloody BCBS of NC still think disc replacement is experimental despite the fact that several other BCBS affiliates DO cover it).. My neurosurgeon will not do the disc resection because he doesn't think it'll solve the problem long term and is concerned about I'm sure legitimately being held liable if the surgery fails and I end up worse. I think hes dead on on what needs to be done but once again BCBS thinks they know better. The sad truth is BCBS of NC only cares about one damn thing. Getting my money and not paying out theres despite their responsibility to their members. The less they pay out the bigger the the higher up douchebags bonuses are (don't lie we know the truth). IM sick and tired of my life being ruined by these ********. If I could pay fo rmy surgery myself I would and then sue the hell outta them for the cost plus bad faith actions on their part leaving them WIDE OPEN to punatitive damages in the millions potentially.. I can't be the only person fighting with them over this. If you are in my same situation feel free to contact me please
     
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Posted by leet60 on 2011-09-06:
Do you have an insurance commissioner in your state that you might be able to contact?

As for the surgeon being concerned about being held liable, it is likely he would insist you sign a waiver as to any liability - as for whether that would hold up in court - that is another question.
Posted by BEJ on 2011-09-06:
Contact the insurance commissioner in your state and file an appeal.
Posted by Chris2fer on 2013-02-22:
I have MS and they refuse to pay for my medication.I am firing them and will deal with the government.
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Get It Right!
Posted by IfitsNotOneThingItsYourInsurance on 12/16/2009
screaming mad
screaming mad
HELL -- So, my Doc tells me she thinks I have ulcerative colitis this morning. Oh happy day, NOT! Really, it came as no surprise. UC is not a pleasant illness (not that any illness is), but imagine bleeding from your rectum daily in addition to severe stomach cramping, diarrhea, bloating, and gas, not to mention the interruption of your daily life.

Anywho, I call BCBS to get my CT scan and colonoscopy preauthorized and the jerks have the nerve to ask me why am I having the procedure performed! "Oh gee, I thought I would stick a tube up my a$$ just for kicks and giggles." It's because my Dr. ordered it, you idiots! Because I crap myself day and night, if you really must know.

Then, after a day of being stuck with needles 1,001 times (dehydrated from constant diarrhea) I drag myself to the pharmacy to get my medicine. Of course, I call my insurance company before I drop off the script to make sure they will pay for the meds and am quoted a price. I even asked the rude man to repeat himself (these people act like they are doing me a favor every time they call). It's expensive, but at least I know in advance. There will be no surprises at the pharmacy. WRONG!!!!!!!

I am given an incorrect quote. Now, the jerks want to know what they can do to make it right. How about give me my frickin medicine at the price you quoted me, morons! The representative had the nerve to tell me that since I had a 5 day supply that I would be fine until they get the problem resolved. Well, just in case you missed a little important factoid about this month, Christmas is in one week. I'd rather not wake up in the morning doubled over in pain, bleeding from my butt, covered in my own poo. I'd like to have enough medicine to last me until the day after Christmas so my poor children do not have to deal with their mother pooping herself under the tree.

This is just one small issue I have had with BCBS. Can you hear the anger? I'm sure this will be the first of many more complaints to come since I will be in the hospital for a CT scan in two days followed by the old tube up the butt procedure. Great, can't wait.
     
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Posted by goduke on 2009-12-17:
It is obvious that you are angry.

But they kind of have to ask what the procedure is for before they can authorize a CT scan and/or a colonscopy. Those are expensive procedures and they can't just say "ok, sure" when someone says they want one without some sort of medical necessity.
Posted by spiderman2 on 2009-12-17:
I understand your frustration and your condition as I suffer from Crohns disease which is quite similar. I am going to direct you to the CCFA.org. where you can get some good information. Also, you should ask your gastroenterologist if there are any support groups in your area to help you deal with this disease. Please believe me that it will get better once things are under control. The times leading up to my diagnosis and until I found meds that worked for me were rough, but it does and can get better once they figure out what you are dealing with. Good luck to you.
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Insurance companies and cost of Remicade
Posted by Bookworm_rh on 02/01/2012
NORTH CAROLINA -- After 2 years of an undiagnosed illness, I was referred to a University Hospital. First visit was basic - previous history, getting new bloodwork done, etc. Second visit, doctor starts me on an infusion of drug Infliximab or "remicade". I had never heard of it, but went ahead with the process. Tiny bag - 400mg, no big deal, it was just a slow drip that was all. Went back again next month for another dose, same amount. Doctor said bloodwork looked good. I was feeling much better. Doctor says I have an immune disorder. Go again 3rd month. Feeling like a human being again. Doctor is glad I've improved. New bloodwork looks really good. BIG problem. Blue Cross sends me statement for "pharmacy" charges it will not cover for $38,000 for (2) Remicade infusions. And they still have one more bill for about $20,000 yet to send me!!. Found out the hospital failed to get a pre approval from insurance company before using this medicine on me. Several hospital officials told me, since it was the hospitals fault, I would not have to pay. The drug would just be replaced by the drug representative. Not so. My statements are now in collection agency hands
and I have to find a lawyer. I am at my wits end. Insurance company paid for everything but the medicine. Oh, I checked with a local pharmacy to see if I could by "remicade" if I had a prescription. Yes, I can, but it would be in a 100mg vial at a cost of approximately $825.00 to me. Multiply that times four and you still don't get $20,000 like the hospital was charging my insurance company for 400mg.
     
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Posted by FoDaddy19 on 2012-02-01:
I someone who is also on Remicade, I can sympathize with you. The stuff is bloody expensive, but man, does it ever work. I get the infusions every 8 or 9 weeks, and while Remicade is pricey it's not $19,000 a dose pricey. I had a similar experience in that the hospital where I get the infusion didn't get pre-aproval for the infusion, and I didn't find out about it until I got my insurance statement. Apparently I was on the hook for $1100 (which I guess is what my insurance company pays). But fortunately I was able to get everything straightened out with both the hospital and the insurance company. The explanation I was give was that there was some kind of screw up with their systems and the new calender year.

You need speak with the billing department of the hospital you use, that's where the foul up was when I was going through a similar situation. Speaking with the actual doctor's office probably won't help you. However since this has already gone to collections,it may be too late. Good luck.
Posted by Anonymous on 2012-02-01:
I am starting Remicade infusions in a few weeks. I made sure my dr got a prior approval from my insurance. But this review is a good warning to others to make sure a prior auth is obtained
Posted by Kristina on 2012-05-03:
i am in the same boat! however, the insurance company accepted me knowing i have this disease and my office did get an approval for the remicade. the insurance company was paying for it for a while until they discovered how often i needed it done. they had some outside doctor look at my files and decide it was "medically unnecessary". my doctor tried appealing it and they still denied me. the only thing left for me to do is go to court.
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