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Get It Right!
Posted by on
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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goduke on 12/17/2009:
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.
spiderman2 on 12/17/2009:
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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Blue Cross Only Pays 20% of Medical Bills
Posted by on
Rating: 1/51
KANSAS CITY, MISSOURI -- I went to the doctors 3 times I paid my $40 co pay 3 times in a row. I get one bill for $158. Another bill for $105 $263 . That blue cross did not pay . Which blue cross did bother to tell me that' this was not covered . Blue cross is only paying 20% of your medial bills. Then blue cross raise my insurance of me 2 times in roll. Blue cross CEOs salaries alone $200000 a year. Blue cross will not tell you about deductible and the co pay just go to the doctors offices . If your doctor bill is $ 300. Blue cross will only pay $50. Then you got to pay $250 out of your own pocket. Why blue cross only pays a little bite of money. Then you got to pay the rest out of pocket. Blue cross is nothing but a much of money hungry vultures draw your life saving
     
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Slimjim on 11/19/2014:
$200k actually sounds kind of low for a CEO of one of, if not the biggest health insurance carrier in the nation. Regardless, completely irrelevant to the complaint. You clearly have a co-pay and deductible you have to meet. Is this through the ObamaCare exchange? That would explain your confusion on the benefits and coverage.
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Patient Dies While Waiting on Pending Litigation
Posted by on
TULSA, OKLAHOMA -- This is happening EVERYWHERE. Blue Cross and Blue Shield deny benefits to people who pay in good faith when they know that the cost of the litigation + the time spent waiting = dead patient before payout. RUNAWAY CORPORATE GREED! THEIR BLOOD IS ON YOUR HANDS BCBS.
     
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Anonymous on 12/04/2011:
Did someone actually die, or are you just saying that to get a point across?
clutzycook on 12/04/2011:
This isn't limited to BCBS. Pretty much all insurance companies give patients the run around. Unfortunately your post is too vague for me to comment further, but if it is related to a specific case, you might look into reporting BCBS to your state's insurance commission.
trmn8r on 12/04/2011:
Do you have a specific experience? This is a very general statement, and I personally haven't heard about this. Maybe the media is keeping it quiet.
JayByJay on 12/04/2011:
Is that what disgusted healthcare looks like?
Skye on 12/04/2011:
Sadly Clutzy is correct. It's all of them, and it all comes down to one thing, holding on to as much money as possible for themselves, and spending as little as possible on the people who need procedures.

Again, it's all about the "almighty" dollar.
CowboyFan on 12/05/2011:
From what I read, too often these examples are people who want medical services which are deemed experimental or cutting edge. Obviously, insurance companies are not going to pay for services that may or may not work but which are extremely expensive because of their new nature. While it is sad that people die from their illnesses, if such experimental services were routinely provided, the cost of health insurance would be astronomical so that other people would not have access to more normal care that would save their lives. Nothing prevents the patient who want experimental medical services from paying for these services themselves.
k on 01/27/2012:
yup.. they are so horrible.. submitted the claim for 6 month. all rep tried so hard never received.. and if you call and check for the status.. take longer because you call and check with them to be bothered.
reps are so bossy they tried to tell you what to do.. which is tried not to claim to be submitted.and make it to denied. so you won't get your benefit worth.
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The Worst-- Without A Doubt.
Posted by on
Rating: 1/51
PROVIDENCE, RHODE ISLAND -- When I got hired at my current job, I was pleased to find out that Blue Cross Blue Shield of Rhode Island allows girlfriends/boyfriends/common law spouses to receive healthcare coverage through someone else. My girlfriend has been without insurance for far too long, and this looked like the perfect opportunity to finally get her some. And she needs it, too-- she's got varying medical conditions that are far too expensive to be paid for without insurance. Nothing life threatening, mind you-- but they're conditions nonetheless.

When a year passes, that's when you're allowed to put a spouse/significant other on your insurance as a "domestic partener." Great. BCBSRI mailed me a list of documents they'd need to prove that we weren't trying to screw them over (as an aside, this took nearly a month to arrive in my mailbox, despite the fact that they're about 4 miles from my house). The list had 6 or 8 items on it, only two of which were required for proof. No problem. I picked the "prove you've been living together for over a year" and "get a notarized relationship agreement" options. I mailed them a copy of my lease (that she and I are both listed on) as well as a document I wrote up and had notarized, stating that we've been in relationship for the past 36 months. Everything is going fine, and my girlfriend will have insurance within a week or two. Or so I thought.

Two weeks went by and I didn't hear a peep from BCBSRI. I finally realized that something probably got messed up, so I called. They informed me that her coverage was denied. When I asked why, I was told it was because I "didn't supply the sufficient documentation," which, as you know by reading this, is untrue. So I asked what I should do, and they told me to send it all again. So I did.

I call them again, explaining my whole story. I'm now told that what I mailed them wasn't enough. They need something like a joint checking account or joint ownership of a vehicle. I told them that was insane, because the paper I have says "Here's 8 options, PICK TWO." And that's exactly what I did. They ask me to send the stuff again. So I did.

Another week goes by with no notice from them whatsoever, so I call again. This time, the story is different: they claimed that they never got the notarized agreement, but they did have the lease. This is false. They were mailed in the same envelope, so unless some employee lost the paper (which is my guess), they have both documents. The guy asks me if I can fax over the contract again. Once I do that, he'll put in a request to get everything done quickly and he'll be in touch. I faxed over the agreement and never heard from him again.

Yesterday, I called again after I got a letter saying that she was denied coverage. The reason for her denial was that (you guessed it) I provided insufficient documentation. Again, this is entirely untrue. I spoke with a customer service representative and explained the situation for the billionth time, and he said that he'd put a note on it marked "urgent" and he'd call me back in the morning (today). I never got that call. About an hour ago I called again and really gave the guy a hard time-- I need this fixed not now, not yesterday, but THREE MONTHS AGO. "Immediately" doesn't begin to describe how quickly this needs to be done. He said he has no say in the matter, which is true, but he'd put another note on it to get it expedited. He informed me that since she was denied coverage (the reason doesn't matter), I might have to file an appeals claim that could take up to a month to be resolved. I explained to him that an appeal was absolutely not even close to a viable option, and that this has to be fixed NOW. We don't have another month to sit around and wait. He says he's going to have someone call me in the morning, but I refuse to believe that.

The long and short of it is this: BCBSRI is an abysmal company, full of people who A) have minimal-to-no-intelligence, and B) apparently never, ever speak to one another. What they're doing (and continue to do) to my girlfriend and I is unacceptable, and you can bet if I had another insurance option, I'd leave them in a heartbeat.

     
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clutzycook on 03/07/2012:
I wonder if they wanted some sort of official affidavit, not just a notarized note from you. My job also provides benefits to "domestic partners" and they actually give you an affidavit to fill out and have notarized.
Venice09 on 03/07/2012:
If they need specific forms, they should supply them instead of rejecting what is submitted. It sounds more like they don't know what they're doing or are looking for reasons not to approve coverage.

Just get married. That will solve everything. ;)
BigAl on 03/07/2012:
The reason they are not approving the insurance is because she is not healthy. They will continue to stall and delay as long as they can. People have medical reports just like credit reports. I would bet my bottom dollar that if she had a clean medical report the info you sent would have been sufficient. Don't let these turds get the best of you.
traceylynn on 03/07/2012:
My job provides coverage to "domestic partners"......which they consider to be same sex partners who cannot legally marry in my state. Coverage between boyfriends and girlfriends is not allowed, if you are in a heterosexual relationship you have to be married or no dice.
CowboyFan on 03/08/2012:
As I read this, the proof that was sent by OP was inadequate. My parents were on my lease at college, even though I was an adult--they did not live with me. Likewise the "relationship affidavit" should be from a disinterested third person: parents, landlord, priest, not from the boyfriend himself.

From what the op sent, they could be just roommates, since the submission lacks indicies of a true committed relationship, e.g. joint checking, shared vehicle ownership, joint ownership of property, credit purchases made together. An insurance company is going to look closely at such things, especially when it seems the "girlfriend" is in need of expensive treatment.
Venice09 on 03/08/2012:
"The list had 6 or 8 items on it, only two of which were required for proof."

It sounds like the OP followed the instructions. If specific proof was required, it should have been made clear. And if they required special forms or affidavits, those documents should have been provided. This method seems to be designed to either drag out the process or utilize loopholes that result in outright denial.
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The epitome of arrogance and evil
Posted by on
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 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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leet60 on 09/06/2011:
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.
BEJ on 09/06/2011:
Contact the insurance commissioner in your state and file an appeal.
Chris2fer on 02/22/2013:
I have MS and they refuse to pay for my medication.I am firing them and will deal with the government.
Blondehed on 11/11/2014:
This is my story exactly ! I'm going through this exact problem with BCBS now ! They won't approve my surgery. Did you ever get approval? If so please tell me how. I'm suffering every day with this pain.
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How Messed Up the Entire Medical/drug Industry Is in General and How Stupid Obamacare Is
Posted by on
Rating: 1/51
TRAVERSE CITY, MICHIGAN -- Basically my family is pretty healthy and we've always seen naturopathic doctors or treated things ourselves. Which means that we take responsibility for our own health and wellness and take care of ourselves. But then Obamacare came on the scene and we decided to go with health insurance. So because insurance doesn't cover our usual naturopathic doctor, we had to get new doctors and we picked the best ones we could find in our area covered by our insurance. And I suppose for the industry they are doing a good job and being thorough. But every time I interact with drug industry-trained doctors I am frustrated by their limitations. They don't seem to understand health or eating right, or herbal supplements or anything that I regularly turn to for good health. What's more, if I pick up any drugs they suggest and read their labels, I cannot bring myself to take them because the possibility of negative side effects (worse than anything I am suffering) are huge. Basically with how expensive insurance still is and how little use I have for it (insurance doesn't cover useful things like nutrition supplements) and how much I still have to pay before the deductible gets paid off- it just doesn't make any sense financially. If anything catastrophic happened the hospitals in our area let us get on a payment plan with 0% interest. Insurance might be useful if they covered the naturopathic doctor and the nutritional supplements recommended by the ND. A single payer instead of regular insurance would be even better (like the Green Party suggests-the same plan as our good senators and their families get). I have had so many bad reactions to pharmaceutical drugs that I don't dare take them, and herbal supplements work so well for me, that it just doesn't make any sense at all to have insurance or see a regular doctor.
     
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Most Unprofessional
Posted by on
Rating: 1/51
NEWARK, NEW JERSEY -- I have invested a month or more calling this company and these customer service representatives. Every time I speak to a different person and there is no direct number I can call. It is like starting over EVERY TIME I speak to someone. I have to reiterate everything again. They have a computer in front of them and I have reference numbers for the calls and they till can not give me one simple answer. I am trying to get in-network coverage for a dental device that helps a medical condition. The provider I am working with has called them also about their services. Earlier, this week I talked to them for the 10-15th time. They told me I would receive an answer in two days. I called today and they don't have any of the information I PROVIDED for them this week!!! Last week they emailed me a list and I called 26 companies to see if anyone within a 50 mile radius had this device. None of them did and most didn't even know anything about what I was talking about. When I called back to give them this information, they said that policy stated THEY now had to call all the 26 companies also. I have provided them tax ID#'s, diagnosis codes, and appliance codes. This has gotten ridiculous and now they want to start all over. These ploys or incompetence to give me a timely answer have made me very frustrated. I would NEVER NEVER NEVER choose this company again or suggest to ANYONE else to use them. The only reason to use them is if you want unprofessional, incompetent, unreliable and negligent insurance provider to work with whom will ignore you and NEVER GET YOU ANSWERS IN A TIMELY MANNER. I am now waiting for a supervisor to call me. YEAH like that will happen!!!!!!!!!
     
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jktshff1 on 08/31/2012:
I've gotten better responses with the online chat feature many companies provide
Anonymous on 09/01/2012:
Call center reps don't usually have direct extensions. When you call a call center, you get the first available person. I work in a call center for health insurance and I hate it when a customer tells me to look at previous notes and figure out what's going on. I don't know if the customer is calling about the same issue as a previous call. I don't read minds. And sometimes the previous rep doesn't document the call thoroughly enough. And I like to hear what the issue is for myself so that I get a clear understanding of what is going on. My company tries to give callbacks within 2 days but that isn't always possible if it's too busy. We don't always get time off the phones to make outbound calls back to customers. But a sup can usually do a callback in 24 hours. Regarding this complaint: is this a device that requires an authorization from the insurance? Or are they trying to figure out if it's covered? Devices like this may not be covered under your medical insurance but instead covered as dental. Is this a medical and dental plan?
sita pfalz on 09/20/2012:
Your frustration is understood. They are the most incompetent "claims SPECIALIST" in the entire business. I can bet my 11 year old son can do a better job. They just occupty a seat and are not well trained at all. They read off the comments that the previous idiot wrote and offer no solution. Our company is dropping them too.
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They Just Don't Care
Posted by on
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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Avoid BCBS!
Posted by on
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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Anonymous on 03/26/2011:
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.
oldisgood on 03/27/2011:
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.
my 2 cents on 04/01/2011:
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.
Anonymous on 04/01/2011:
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.
Buttons810 on 06/07/2011:
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 knowledgeable. Every time 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.
FrustratedConsumer on 07/01/2012:
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.
JM on 05/18/2014:
I couldn't agree more. I am having the worst time with BCBS. We pay $940 a month for a family plan and I keep getting letters from my husbands on individual plan saying we owe them money, when they sent us a refund check. It is impossible to get them on the phone, and they don't respond to your online messages in a timely manner or with the correct information.
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Refuse to pay for covered claims
Posted by on
OKLAHOMA -- I had an accident when my grandson was sitting in my lap and jumped backwards and got me in the mouth and nose, he broke 2 teeth and knocked the rest of my front teeth lose I went to a dentist and had a exam and xrays but after being total 12K to repair damage I told them I was going to get a second opinion and I found a wonderful dentist they fixed my mouth for 9K I filed it on my dental insurance and called blue cross and blue shield to see if this was covered on my policy they said yes that I just needed to down load a claim form and send it in that it takes 30- 45 days to process a claim I said OK that was in August 2009 and that claim still has not been paid I have done everything they have asked and sent copies after copies but still they have not paid the claim, I received a letter from them telling me that the dentist that fixed my mouth was not the first dentist I seen I told them the same thing, he wanted to much to fix this damage 12K and I found another dentist that fixed everything for 9K and I paid out of my pocket what the dental insurance did not cover which was almost 5K and I was told it was covered by my policy but now they refuse to pay my claim I have been fighting this from August 2009 and still am. They said they will be willing to pay the 196.00 for the exam and xrays that the first dentist did but not the treatment and surgery this is crazy... Then I went to to see the surgeon about fixing my nose I was not going to get bit by that dog again so they sent in a
pr-authorization which I have a letter that says they received it on Dec. 17 2009 surgery to be done on Dec. 29th 2009 they came back on that one and said Oklahoma got it on Dec 17th but California did not get it until Dec 31, 2009 so it was denied I lost coverage on Jan 1 2010 due to leaving the company I was working for. Now I have a pre existing condition that no insurance company will touch and a claim they refuse to pay that was covered on my policy. I still can't breathe out of my nose which causes me serve sinus infections and my savings is gone. I paid my half of my insurances which was 360.00 per month and then had to use everything I had in savings to pay for what my dental did not cover which is what I was told my medical with blue cross and blue shield would cover, that it was a covered item on my policy accident injury. I have tried to play their games and tired of the excuses I have been left with nothing to do but call and hire a lawyer. Thanks for nothing blue cross
     
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Alain on 03/23/2010:
Hiring a lawyer was an excellent idea on your part. I've read this a couple of times and it still leaves me confused. Hope your attorney can resolve this for you and good luck.
yoke on 03/23/2010:
Was the second doctor an inplan doctor? Did you get authorization for the second visit? It sounds like the OP went and had the work done and then billed the insurance company for it.
As for the nose surgery if the surgery was done before the 31st they should have covered it. Our insurance changed on Jan 1 and my husband had a procedure done on the 28th and it was covered under the old insurance.
Disaster Worker on 03/23/2010:
Get used to the idea of out-of-pocket medical payments! Insurance companies will find ways to not pay insurers so that they'll come out ahead on our new socialist healthcare program.
BEJ on 03/23/2010:
Most dental insurance does not cover what it considers cosmetic dentistry. For example, my husband had to have a dental implant. Insurance paid for the surgery to remove the tooth but not for the implant as it was considered cosmetic dentistry. Did you have in writing what they told you they would cover? If not, not sure there is much you can do.
Starlord on 03/25/2010:
That is a terrible situation, and I hope you find resolution soon.
momsey on 03/25/2010:
What was the reason they gave for not covering the dental work? In my experience, dental insurance is very poor, it doesn't cover a whole lot, and there's a cap to how much they will pay out per year. That might be the case here, and while it's unfortunate, I don't think you'll have any luck getting more money out of them.
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