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Blue Cross Blue Shield Of Georgia Involving Labor Law Discrimination In New York State
Posted by on
Rating: 1/51
I am survivor OF a severe labor Law discrimination retaliation(LLDR)& personal permanent injuries to me resulted from the retaliation. My husband and I were going to law enforcement reporting the LLDR deadly death threats, property damage, ethnic acts of hate resulted from my New York State Workers Comp. Claims (NYS WC) ref. [snip]The retaliation from my NYS WC claims & complaints rolled over on to my husband & breach of his employee elected benefits that were contracts for medical that covered him and myself. I received Social Security Disability (SSD) after [snip],I had Medicare Part-A & Part-B.
Blue Cross Blue Shield of The State of Georgia ( BCBC of GA) were the Administrators of my husbands employee elected contracts for " THE MEDICAL" FOR HIM AND MYSELF. EMPIRE BCBS Butternut Dr. Syracuse, NY. were the Medicare Secondary Payer Recovery Contractor (MSPRC) involved for recovery billing/Hippa with EXCELLUS Blue Cross Blue Shield ,(former address) South Salina St. Syracuse, NY now located @ Butternut Dr. Syracuse, NY.) They denied me medical treatment.
A former friend of mine Julie [snip], RN. was employed with Excellus BCBS, South Salina St, Syracuse, NY said she worked & reported to Excellus BCBC Director who is a physician in the Syracuse, NY area who was involved .

BCBS of GA stated EMPIRE BCBS/EXCELLUS BCBS WERE RESPONSIBLE FOR THE PPO IN-NETWORK PHYSICIANS IN THE CONTRACT & denied me physicians who were ' IN-NETWORK" I could not find a PRIMARY CARE PHYSICIAN (PCP) from 9/2005 until 3/2010.My husband employer "General Electric Polymershapes" continued deducting premiums from his pay checks @ work for him & myself after the contract was breached ( he wrote to General Electric CEO, Fairfield. Ct & contacted CT. Insurance Department) He never recovered the loss.
BCBS of GA stated it was Empire BCBS/Excellus BCBS that denied me the IN-NETWORK PHYSICIANS STATING THEY WERE NOT IN THE PPO NETWORK WHEN IN FACT THEY WERE IN THE PPO NETWORK. ( question of Empire/Excellus BCBS Director who was the physician that Julie [snip], RN. Reported to @ Excellus BCBS involving the HIPPA Law violations, (ref; you S Postal Service Office of Inspector General file 01IH029I011)
Empire/Excellus BCBS cancelled Dr, [snip], GYN the only physician I had in the PPO network that Julie [snip], RN has set me up with. I went to Dr. [snip], GYN for my yearly healthy woman's exams. BCBC of Ga, Warm Springs Rd. Columbus, GA guaranteed us in a letter issues with (Empire BCBS) "Excellus BCBS" would NOT effect us. BCBS of GA then CANCELLED DR. [snip] GYN.( after we received the letter from them)
I had gone from September 2005 to March 2010 without a PCP & no preventative care. I had to go to Emergency Rooms/Urgent Care Facility when I got sick and never had follow up care. Medicare WOULD NOT AUTHORIZE
preventative care for me because my husband was an active working employee with employee elected medical benefit contracts for him and me.
Finally a Health Advocate Group in the State of Pennsylvania got involved and authorized a PCP for me ( the pcp could not get involved with my NYSWC claims) I was approved on 3/2010 with the PCP & requested a gyn exam from him also due to having my GYN cancelled. By then I had state 3 ovarian cancer involved in major surgery & 6 month of chemotherapy treatments.
When I was in the hospital after the surgery for ovarian cancer BCBS of GA cancelled our health insurance & a certificate of cancellation was issued for me.
We have filed tons of letters with BCBS Warm Springs Rd Columbus, GA Corporate Attorneys & also with supervisors and tape recordings etc, etc. so their Legal Corporate Team are well briefed on the situation & what was going on.
     
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jktshff1 on 2012-07-06:
Sorry, you need an attorney.
Susan on 2012-07-06:
This is way beyond something that can be resolved on a consumer website - you need an attorney unless the statute of limitations has expired.
bridgetwills99 on 2012-07-08:
FYI read on under: SYRACUSE.COM RE; Hiscock Legal Aid Society,Syracuse.NY. ACLU Syracuse,NY, Satter & Andrews LLP ( law firm Syracuse,NY) & AVVO on Robert Bertrand Esq, North Syracuse,NY. Anybody reading it should be thankful " if they don't live in Onondaga County." My guess is the comments from Onondaga Lake smells like armpits is a resident of that County.
No Justice in all the Wrong Places.
Cozy on 2012-07-09:
See the comment report posted on Onondaga County Bar Association,SYR NY.
bridgetwills99 on 2012-07-09:
Regarding the Comment posted by Cozy.
If you are interested you can read my posting on Onondaga County Bar Association by going to Syracuse.com ( Business Finders) I originally posted it on their GOOGLE Home Page it was available until they made a change on their Google Home Page & it no longer show,That is why I posted it under Syracuse.com
The apple doesn't fall far from the tree on 2012-07-11:
Read on. "my3cents,com" review posted on Gigna
Corporate Consumer reviews on my3cents.com posting date 06/06/12
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Very Bad Experience With Handling of My Premium Payment
Posted by on
DETROIT, MICHIGAN -- BCBS of Michigan is in receipt of 3 premium payments for my fathers health insurance. The first 2 payments, sent electronically, were not applied to his account and I was forced to pay a third time to keep the insurance from being canceled. The total amount I have provided to them is nearly $1000.00. BCBS of Mich advised me last week, that they found the payments and had refunded them back in a check payable to me. This was strange because the policy is my fathers, not mine. I did not receive any check and called after a couple of weeks to inquire. They then advised that the refunds were sent to an address in Saginaw MI- where I have never lived. I live in Kansas. Undeterred, they asked if I "knew" someone at this address. I do not. They required my SS# to prove this person was not me. I provided it, although I am neither the member nor the payor. They finally admitted that this was an error and they had sent the refund to someone with my same name by mistake. They said my bank was at fault for this error. This other person cashed the check. Yesterday, BCBS indicated they will not refund this money back to me, since they feel they are not at fault.

As bad as this sounds, the money in this case, is not the worst part of this problem. The conference call set up between my bank, BCBS and me took place yesterday. I was told by the BCBS supervisor that I could not speak on the call. I asked if she would please allow me to speak. She said and I quote -"no you cannot speak".. She talked over me and indicated that I had "blamed BCBS 100 times for this mistake and it is not our fault". After being chastised, I had no choice but to be silent for the rest of the call. When she finally paused I responded "Since I am not able to participate in this discussion, I will hang up now, and would ask that my bank representative brief me on the outcome". I have not heard back from either BCBS or my bank.

Since this was an electronic payment the bank likely has a role in this error and I am not indicating otherwise, but the real issue is the way I was treated. I am considering filing a complaint and getting legal advice on this situation. Treating people the way I was treated must only add to the problems BCBS has with their members. Issues that could be resolved with a fair and balanced discussion end up escalated. This costs all BCBS members because rework and lawsuits drive up premiums. Bottom line- the BCBS of Michigan customer experience is horrible. I feel sorry for customers that do not have the means to defend against such abuse.

This supervisor was rude and abrupt to me - made even worse, considering that I had cooperated to help them identify the mistake, cooperated to be on conference calls with no notice and worked with them to rectify this situation and provide my SS# even though I am not their customer. I was insulted and degraded by the BCBS representative. They require regulation and oversight for a reason.
     
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dawicn on 2010-10-14:
I was treated the same way. There is a reason
they need to be regulated. Wait till, we are required bylaw to have insurance. What a nightmare. In Ga there are only 5 insurance co.
and we are not allowed to buy across state lines.
What a joke.
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Treated awfully
Posted by on
Here is a copy of the complaint my wife registered with the State Insurance Commissioner. It is accurate and happened just yesterday...

"I have been paying for family insurance from Blue Cross/Blue Shield through my employer (Catholic Health Initiatives) for around two years. On three occasions, I have tried to pick up prescriptions for either of my two sons, only to have to call BC/BS and fight with them to acknowledge the children on our plan. Today, Kristopher (my 3-year old) was diagnosed with Bronchitis and an ear infection. When I went to pick up his prescriptions, once again, I was denied. Upon calling BC/BS, they told me the problem was with Medco (apparently that's who they farm prescription coverage out to). I called Medco, they told me they have NOTHING under my name, Social Security number, date of birth, children's names, NOTHING. They told me they get their information from BC/BS and that the problem lies with them. I called BC/BS again. They told me that they have nothing to do with Medco, it's their problem, and that I must call them again. I REPEATEDLY asked to speak to a supervisor and was denied. I called Medco AGAIN. I realized that I've been paying for coverage that I have NOT been getting, so I asked to be reimbursed and that the problem be taken care of immediately as my son does not have the medicine he needs because I can't afford it, because I've been paying over 300 dollars a month for fake insurance. At this point, the representative began playing dumb and said that BC/BS is responsible as they get their information from them. I AGAIN called BC/BS, they said that they've been sending updates every Friday to Medco as recently as December 2009 and that they would have to play fax tag with their membership department to get my son covered and it could take 72 hours. I understand that these things can take some time, but I've been paying for coverage that doesn't exist and asked to be reimbursed. They also began playing dumb, eventually denying any involvement with Medco, and saying that they were a completely different entity. It's now 6 PM, I've been back and forth between BC/BS and Medco several times since. Medco is now saying that the last update they received from BC/BS concerning me was March 9, 2009. Again, I called BC/BS. A BC/BS supervisor named Jill has been lying to me, providing me with fake numbers to call, and being completely rude to me since I finally was transferred to her. She is now blaming my employer. I would like to be reimbursed for all premiums since March 9, 2009. I also would like to ENSURE that this will not happen again. My 3 year old is sick on the couch and I cannot tend to him as I've been on the phone for 3 hours and counting. He does not have the medicine he NEEDS. They have been lying to me, stealing from me, and they should receive some sort punishment along with paying me back."

They were actually giving her numbers to call that were not even numbers to Blue Cross/Blue Shield. She repeated one back TWICE to the "supervisor" (who was actually just another CSR that she'd reached in an earlier call) which was some random guy's home phone number. I'm shouting this from the rooftops until they resolve the problem.
     
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goduke on 2010-02-10:
The fact that you still have the portion of the insurance active which allows you to go to your MD says that it's not an issue of the employer sending a bad feed to BC/BS. It's clear that Medco, who manages the RX program for this particular Blue program, has not been given updates on your profile from BC/BS. They should be able to get it taken care of in less than 72.
It'll be interesting to see how the complaint turns out. Let us know.
Buddy01 on 2010-02-10:
Do you still have a prescription? If so, the antibiotic may be covered under Walmart or Target's $4 prescriptions. No insurance would be needed. Just pay the $4, then your son would have the medication he needs while you sort everything out.
momsey on 2010-02-10:
If he truly needs the medicine, you can pay for it out of pocket and get reimbursed. I have no sympathy for someone who would rather make a point and fight with an insurance company when it comes to medicine for their child.

This does sound very frustrating, however, and your complaint is valid. I don't think you'd be getting a reimbursement on the time that you weren't in a computer, since you didn't try to use the services for that time. If you had tried to use it and were denied, you should be reimbursed for the money you paid out in prescriptions, but not for the insurance premiums themselves.
Anonymous on 2010-02-10:
You will not get your premiums returned from March 2009. The insurance commissioner will make sure that your problem is resolved but they will not support a refund of your premiums. As momsey said, pay for the medication that your child needs for his illness. When this mess is straightened out, seek reimbursement.
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BCBSM Shady practices
Posted by on
DETROIT, MICHIGAN -- My husband signed up for BCBSM insurance in March 2009. We enrolled in Auto-Pay so we would have one less bill to worry about keeping track of each month (we used an account that we only keep money for bills in, so there is rarely more than $10-$20 more than our bills in this account). Since then BCBSM has decided to take money whenever they feel like it, however much they feel like taking and if it causes you to either overdraft or if you don't have as much as they want they won't pay the NSF fees.
This started in July. Our usual date is the 9th of the month for them to take their $81.38 premium out. This month they took it on the 9th, then again on the 30th. My mother had passed away on the 14th so we were helping my dad out with funeral costs and didn't have the extra money to spare (not to mention they tried to take $162.76 out, which is 2 months of premiums). It caused an NSF, which our bank charged us $25 for. When I called to ask why this charge was made I was told it was an error and the money would be refunded, pending me faxing a copy of the NSF detail from the bank. No problem I faxed it over. In the meantime, they tried to take it out AGAIN on the 3rd of August, which caused another payment to bounce, which we had enough to cover prior to them trying to take their money (2 more NSF fees). I called again, was told the same thing and that I should expect to be reimbursed for all 3 NSF fees.
August and September's payments came out on the correct date, but still no word regarding our reimbursement from July/August. Come October they tried to take $245.14 out on the 7th. (not our due date, not the correct amount) I called and asked what was going on. I was told the other case is still "pending" and that they had recently increased their premiums, thus the new amount. I get a copy of our bill each month, it showed that the new premium was $82.40. There is no way it was this amount (no matter how many ways you figure it). The attempted withdrawal cost us another $25, plus they tried to do it again on the 8th and the 9th, costing us $50 more for them and $50 for other payments being NSF. The woman denied any wrongdoing on their part and said my husband needed to call, since he is the account holder. My husband calls, they tell him it will be taken care of. My husband also advised them to un-enroll us in auto-pay as they can't seem to keep their record straight. He is told it will be done, not to worry and our open cases that are "pending" will be resolved shortly and we should expect a refund any day.
November 2 BCBSM cashed our check for our premium. November 4 they take $180.16 out of our account. That money was there to pay 3 other bills, which consequently bounced over the next 2 days, costing us $75 more. I called BCBSM and was told that they didn't take that money, they needed to talk to my husband and wouldn't discuss it with me, except to tell me "their accounting department decided that we wouldn't be reimbursed for July, August and October" (which the total for those month's NSF fees are $200) My husband calls them on his lunch break to cancel, to figure out what they are thinking denying any wrongdoing and why they tried to take money AFTER they cashed our premium check and AFTER he had un-enrolled the month before in auto-pay. He is told he has to write a letter to appeal the decision to deny those cases and that he has to fax a letter canceling his coverage. They said they didn't have a record of him canceling auto-pay and that the money they took was to cover "past premiums that were unpaid". He told them that they took them out automatically, the bill showed what we owed (which had already been paid by check)and that they needed to un-enroll him NOW. He faxed the letter to cancel coverage and also included them to cancel auto-pay (just in case). We thought it was taken care of. Until yesterday. They tried to take another month's premium out of the account. I called to ask why, was on hold for an hour. Hung up, called again. After being on hold for 20 minutes was told to have husband call. He used his entire lunch hour waiting on hold. Called back last night and was told they would review it and call back. They never called. So, today, he used his lunch hour again to be told that they would review the case and have a supervisor call back.
I advise anyone who is looking at BCBSM for insurance to run the other way. It has cost us $480.16 extra in NSF charges and unauthorized withdrawals to have him insured, with no refunds on the money in sight.
     
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Anonymous on 2009-11-11:
OMG. What a disaster.
Anonymous on 2009-11-11:
And this my children, is exactly why you never give a creditor access to your checking account.
Krazyky on 2009-11-12:
Ken: Normally we wouldn't have done auto-pay except that we wanted to make sure we had their premiums paid,on time. We know if you miss a payment they will cancel your insurance and you will have to wait a year to be re-instated on top of having to pay for 6 months premiums up front. (This happened to one of his co-workers when their company stopped paying for insurance. They had been getting it deducted from their paycheck and he didn't realize when it was due to pay on their own) My husband works construction, so anything can happen any time to him and we don't want him without coverage.
Parker's Wife on 2010-01-27:
Blue Cross has tried to screw me over twice in very shady, deceptive ways. Good for you for at least trying to fight back. I'm guessing they get away with a lot from people who are too timid and just take the loss, or are too old to know any better. I will go down fighting if necessary.
bhall on 2010-07-10:
BCBSM is scamming me in the same way. I have been waiting two months for money they took from my account. Access to my checking account was my mistake. Never again with them. I have talked to someone every day with long waits.
bhall on 2010-07-10:
BCBSM is terrible. They seem to steal money from everyone and then lie about the reibursment. I now have been told three times in two months that my money is in the mail but it is not! Worst customer service in any business I have ever come across.
Zevan on 2012-05-24:
I would prefer not to have these fools on auto pay, however, I don't want to dare take the chance of them playing a lost in the mail routine and being dropped. It's too risky. Blue cross denied me immediately when I applied 8 yrs ago because I had made the terrible mistake of getting breast cancer. I had to fight to get them to cover me and have since that time paid 25% more for my premiums. I was told once I reached the 10 year mark of my cancer not returning I could then have standard rates. They have refused since I've reached this mark to do that. They also claimed I hadn't had previous insurance, but I did have medi-caid. They claim that isn't considered insurance, but what else is it? It was the best insurance I ever had. I wish I could have it again.

At this time, I now have a $9,500.00 yrly deductible. I still have to pay out $300.00 a month on top of this. I'm told from people who know nothing about what an individual alone has to pay, who isn't fortunate enough to be part of a group insurance, I must not have looked enough to find good insurance. They are all alike & I only have three choices in the state I live in who will ALLOW individual plans. If I move out of state, which I'm considering, I cannot keep the insurance I have & that is not fair. I am scared to even switch, I would most likely be turned down. I feel like a prisoner being held hostage, and I fear if something happens they will figure out a way to not pay after I'm out all this money. A counselor told me just drop my insurance and go without. That's easy for her to say, I would lose my house if something happened & I don't care to be thrown into the street. Obama's plan has made things worse for me. My rates have gone up to pay for all the people who now getting FREE healthcare. He is doing everything he can to demolish medi-care which was an excellent program. I'm not old enough to get it, and I've attempted to get my SSDI because I'm disabled but the judge claims I'm not disabled. She never even gave me a fair trial or ever let me speak at my hearing. The lawyer I had was the worst you can get, and no other lawyer will now take my case since its reached the appeal level. The USA does not have health care they have health insurance companies who play games with people's lives & it is allowed to continue to happen. I had hopes with Obama but now all my hopes are gone!
Jim on 2012-06-28:
On 1 January etc I was forced to choose between BCBS or Kaiser of Colorado. Not much choice since most of my doctors are not with Kaiser. I have to pay them 79 dollars a month which I have never paid for healthcare, medicare and tri-care. Now they haven't paid one claim yet. I just don't get it.. Oh well, my wife will be 65 in 2.5 years and BCBS will be the first thing to go once she is there.
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StarEmpty StarEmpty StarEmpty StarEmpty Star
Upfront Denial and Delays in Claims Handling
Posted by on
Rating: 1/51
ATLANTA, GEORGIA -- On December 19th of 2012, I went in for a preventative doctor's appointment. Today, March 22nd, two of those bills are still unpaid and the providers are telling me that they will send these to collections if payment is not made in the near future.

BCBS initially denied my claim because of "other coverage." When I called to address this issue, I was told that their system had not been updated and I had to have the Customer Service Rep contact my prior carrier to verify that there was no overlap in coverage. Now mind you, I have had the BCBS policy since Jan 01, 2012 and a claim had already been paid without this issue arising nor is it customary for individuals to carry more than one health coverage.

Why they would assume that their coverage which I pay them for would not be primary is beyond me. They didn't have any prior carrier info on me, just that someone might be out there. Regardless, I did as I was supposed to do, promptly addressed the issue and my claims were marked to be paid on January 09. Between that period and today, I have made quite a few calls and was told basically to be patient, their claims office is taking up to 30 days to process things. It's been close to 90 at this point.

The CSR that I spoke with could not connect me with anyone in claims nor did she appear to know how to even reach claims. I don't doubt this, none of the prior reps ever offered it as an option. I have spent 15 years in auto and injury claims with two major carriers, 5 of that in management. If a CSR could not address the issue, they got the call to me and I addressed it. I ended today's call requesting a callback and payment of these claims by end of day March 30th. If I get no response, I will simply pay these bills out of pocket and file a Department of Insurance Complaint. With my experience in claims, I understand that volume increases or staffing issues can throw a kink into even the best run organization but that is not the customer's problem and I have been more than patient.

Unfortunately, based on their past performance, I don't look for this to be resolved without that formal complaint. For the record, this is my first ever negative review regarding any company, I am just that ticked over this.
     
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Anonymous on 2013-03-23:
I've been through this before with BCBS--every March they send out a huge questionnaire wanting to know if you have other insurance coverage. Its easily mistaken for junk mail. We just got ours the other day. If you don't fill it out, they refuse to pay your claims. Luckily for us, its a simple NO we do not have additional insurance coverage but if you do, its a real pain in the you know what. They want all of the policy information and a plethora of other info such as is it provided by an employer, or court ordered as part of a custody agreement. But once they have the answer, they are good about paying claims rather quickly.
Chaparrita on 2013-03-23:
People have two insurances all the time. They could have one with their employer, and then with their spouses employer, one through retirement and through Medicare. One through the military and one through an employer. So your statement that it isn't customary for people to have more than one health care carrier is false.
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StarEmpty StarEmpty StarEmpty StarEmpty Star
This company has turned rotten. :(
Posted by on
Rating: 1/51
ATLANTA, GEORGIA -- Blue Cross Blue Shield of Georgia has some of the worst customer service I have ever dealt within my life. To speak to someone, you have to first go through the robot representative hell then wait for another 5-10 minutes to be connected to a person. Once you get to a person, they generally have a terrible attitude and are completely clueless about even the most simple of issues. You are passed from one call center to another to find anyone that might remotely be able to help you out with your problem. This company does not care at all about their customers. Unfortunately, I have a pre-existing condition so I am stuck with them for now. At least in 2014, I will be able to shop for new health insurance, and I intend to drop this company as soon as humanly possible. Thank God that Obamacare will finally allow me to dump this loser company.
     
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FoDaddy19 on 2012-10-22:
Obamacare just says that they cannot turn you down for a pre-existing condition. They are still free to charge you whatever they want. Insurance companies can simply charge even more exorbitant rates to price themselves out of reach. So they can just say "Sure we'll insure you; that'll be $10,000 a month". Be careful what you wish for.

Back when I worked part time, I had to take a private health insurance policy out with Blue Cross, I too have a pre-existing condition, and I paid about $850-$900 a month. But other than the price, I had no complaints.
trmn8r on 2012-10-23:
What issues have you attempted to resolve with BCBS customer service?

I had troubles getting through to my mom's insurance company (not BCBS), but once I did, I was able to get problems resolved. Sometimes it took several calls and a bit of time.

Like FoDaddy, I have been wondering about what price we will pay for the privilege of being able to have pre-existing conditions. It stands to reason its going to cost us somehow.
CrazyRedHead on 2012-10-23:
I think that the only problem that I have with their reps is that they can't answer a simple question without putting you on hold for 10 min. Other than that I have never gotten a surly or unhappy rep. Now there robotic phone tree just to get to a live rep is another story altogether.
anniepie on 2012-11-04:
This company is powerful, I am a survivor of their retaliation, their legal department has insurance corporate attorneys and the attorneys were aware of the fraud involved in my case involving labor law discrimination retaliation and NY State Workers Comp,involving Medicare, I received social security disability after the workers comp.injury, Thurber Baker,Georgia State Attorney General ref.my husband and I to The State of Georgia Insurance Department. They ref.it back to U S Dept.Of Labor in Georgia, the labor dept in GA, would not respond Retaliation continued fraud spread. The representatives are NOT to blame they are controlled by the Supervisors and management Denial of treatment is their biggest priority because they reap big CEO and management profits,they even assigned a id# to me that belong to a person in the state of Georgia to deny a claim involving a personal retaliation injury to me.
Joe c. on 2013-03-14:
These are the real death panels. YOU pay your premiums, YOU pay your co-pays, YOU pay your deductibles, and you do so religiously. They make huge profits, the CEO's make millions in bonus', and then when you are in dire straights, they deny your claims or terminate your policy. The more denials, the more money for the CEOs and VPs. Denial of health care coverage and the subsequent lack of access to care leads to increased suffering and death.
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StarEmpty StarEmpty StarEmpty StarEmpty Star
Cost before care. Coverage is a lie.
Posted by on
Rating: 1/51
QUINCY, MASSACHUSETTS -- 6 years ago my wife had a brain tumor. After surgery, she had severe cognitive and motor impairment. She needed rehab but BSBC and their desktop physicians denied coverage and 4 days after coming home she fell down the stairs and required further hospitalization because of their stupidity and inability to put care before cost and deciding a patients fate using Dr. who only practices with a calculator, Now my wife a severe reaction to medication which aggravated the injury from the brain surgery and she is impaired mentally and physically. Can't walk without a walker presently and can't tie her shoes and hospital and Drs. say she needs rehab before they can release her from the hospital and again, they deny coverage. I sued last time after they put her in harms way and found out they are protected by congress and Erisa. They are above the law and when my company decides who will be our insurance carrier next year. BCBS will not be one of the choices. Bad company, terrible customer service and health insurers should not dictating health care. The national health care changes are going to make it even worse.
     
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Skye on 2012-03-22:
I'm really sorry for all the misery your wife and you have gone through.

You could try contacting your state department of insurance.

http://www.mass.gov/ocabr/government/oca-agencies/doi-lp/
Anonymous on 2012-03-22:
Insurance companies do use real dr's to make these decisions. A lot of it depends on how much information is submitted. The insurance isn't going to pay for costly rehab if they don't feel it's medically necessary. That medical necessity is determined by how much info they receive from the dr/facility that is trying to get the approval.
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Criminal Business Practices
Posted by on
I have Health Insurance through work. I have paid all the premiums. My kids went to regular health / well being visits with vaccinations. We even called ahead of time to make sure we were OK visiting these doctors, and got verbal oks from BCBS.

One month later all claims were denied. The explanation was preexisting coverage through Blue Cross Blue Shield of Western NY. A Policy that ended a year before.

I spoke with BCBS. (20 attempts at calling, avg wait 15 min, and 50% of the calls resulted in being disconnected) They looked into it, apologized and told me it would be corrected

One month later another collection notice.

I called again to BCBS (more problems reaching a rep), they said they had no record of any phone conversation. They asked me to fax in documentation of termination of coverage. I did. This time I requested written documentation the problem would be fixed. THEY REFUSED TO SEND ANY WRITTEN CONFIRMATION that they corrected the error, would not give an explanation. They assured me it would be corrected.

One month Later more Collection Notices. Faxed in documentation again to BCBS, they claimed to have no previous records of conversations. Followed up again one week later to check. The person handling my claim is 'out of the office this week' Another representative claims that there is no record of any conversations and asked us to fax in the documents again.

This cannot be incompetence. The only plausible explanation is that this is a CRIMINAL practice of repeatedly refusing to pay.

     
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madconsumer on 2011-07-12:
see if you can a letter from the past carrier that service was discontinued. or try to see if your hr department will give you one.

hopefully you can get this straightened out.
drugdoc121 on 2011-07-12:
Mail all your documents to them with proof of delivery and signature required. Then have this ready if they claim they need documents again. Won't force them to expedite the claim but at least they can no longer deny having received the documents.
olie on 2011-07-12:
Talk to your HR department. Your company is paying these premiums. Maybe that's the way to get everything worked out. After all, your company can "fire" them when it looks for better deals.

Or, contact your state's insurance department. Google your state's name and "insurance" and see what comes up.
fuming furious on 2011-08-04:
I am on my husband's insurance and have been denied for a much needed surgery 4 times. All claims have been exhausted and I have no recourse on the matter. The proof has been shown to these people yet they do not give a damn about my health or my well being. I am furious!!
William on 2012-10-15:
My experience with Blue Cheat Blue Steal had many similarites to yours. Of the claims they paid, I can't recall a single one that didn't require me to pay extra to make up the difference in what they would pay vs the actual bill(nickel and dimed me every time). But the big one was a 50k jaw surgery for my son which they refused to pay saying they hadn't received the documentation (The surgeon sent all xrays, etc, three times). They continued to say this for 8 months after the surgery. Phone calls resolved nothing. Then they changed the basis of denial a few times - now it's "pre-existing condition" even though it doesn't meet the definition in their 180 page policy guide. Then they refused to acknowledge my attempts to resolve in accordance with the appeal procedure. The entire process has been a blatantly obvious example of deliberate incompetence and delay tactics. My only recourse is to tell the medical providers "sorry, I guess you're not going to get paid. Do everyone a favor and refuse BCBS coverage at the start - this will force employers to drop them in favor of an insurance company that actually meets its obligations".
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Former Employee/Avoid this company!
Posted by on
OMAHA, NEBRASKA -- I worked for BCBS for years. This company is more deceitful and crooked than I can possibly explain here. I voluntarily quit because of their unethical conduct. Reimbursements owed to other companies and customers were intentionally pushed aside, reports were falsified, and employees were frequently bullied. If an employee did not "go along" with their dishonest tactics, they were forcefully coerced into complying or quitting. I highly recommend customers avoid this company.
     
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goduke on 2010-08-26:
Shouldn't you be contacting the state insurance dept to report them?
libby1 on 2010-08-26:
I'm not surprised! I have Blue Cross/Blue Shield of Florida. As far as insurance goes it really SUCKS! However I'm stuck with it, it's the insurance my employer choose. My employer pays part and I'm payroll deducted for part. It's almost like not having insurance at all. My deductible is so high I can't afford to go to the doctor or buy my prescription's. BCBS is making a killing off of the company and all of the employee's that have it. Since no one can afford to use it BCBS is not paying any claims. I call it Blue Crap/Blue S#*!
Nohandle on 2010-08-26:
With BC/BS it depends on the plan your company selected Libby plus the size of the company (number of employees) comes into play. I'm not defending any insurance company because I know of some who have BC/BS and their plan doesn't pay squat until it gets up into the big bucks but other plans cover just about everything.
Anonymous on 2010-08-26:
The sad thing is that it's not just BC/BS either. I have a feeling (from experience with multiple insurance companies) that most of them do this now. They try to make it as hard on the claimant as possible to collect.

As Nohandle said, it really depends on what your employer has chosen--and what they can afford--and what the employee can afford. On what I call "catastrophic policies", nothing is paid until you reach $1,000-$2,500 (or more) for the deductible. You can go through the entire year and never reach it. It's basic purpose is for people that have to go to the hospital or have an accident. Then it pays off to have it--if you can then get them to pay your claims. That is the worst insurance for people just needing well visits and checks ups for minor illness. Premiums are so high now, especially for small companies, that, if you want to gamble, you could bank that money and then use it for your doctor visits throughout the year and still have money left over.
Nohandle on 2010-08-26:
Nicely stated Singsing. I recall back when health insurance companies paid for stays in the hospital, not for visits to the doctor or for prescriptions at the local pharmacy. Times have changed and folks expect everything to be covered now. Perhaps some among us have become spoiled. Flip out that insurance card, smile and walk out the door.
Anonymous on 2010-08-26:
Yeah, my deductible through BC/BS jumped $3,000 this year, under our company's new agreement.
Anonymous on 2010-08-26:
The sad truth is that most of us pay out way more in premiums now than we get back. Insurance is definitely a gamble either way. If something happens that lands you in the hospital and you don't have it, you're in trouble. In the past, the premiums were much lower making it a good bet to have insurance. Now, it is becoming cost prohibitive for many. What to do, what to do?
Anonymous on 2010-08-26:
Well that's why they passed Obama-care to fix these problems right?
Anonymous on 2010-08-26:
Really, Wally? Will it take effect ever? It would be a miracle if any of that ever went into effect, let alone be in our favor. Whoa is us!
goduke on 2010-08-27:
Obama care only fixes access. It doesn't fix the cost. There's nothing to prevent the insurance companies from continuing to raise prices.

But let's think about why they are raising costs. It's because the amount they have to pay the hospitals, drug manufactureres, etc. Everyone wants to make the insurance company the only bad guy in the chain, but hospitals are charing $145 for a toothbrush and $200 for an aspirin.
Anonymous on 2010-08-27:
goduke, having worked in the medical field, I can tell you that the contracts being signed by the hospitals and doctors with the insurance companies greatly reduces what they are getting paid for their services. Some of the insurance companies are willing to reimburse the docs so little, that they just can't accept certain insurance. So, if you get a bill before the insurance company pays the doctor, check out the amount billed vs the amount paid by the insurance company. It can be 50% or less. I never have the problems with the doctors or hospitals that I have had with insurance companies. We pay them a lot in premiums for very little in return for the most part, even lousy customer service.
pissedoffchicka on 2010-10-26:
singsing, that's just making a deal for the member. the insurance isn't paying. it's paid with the member's premiums. the providers get a contract for client-tell. the members get insurance for lowered rates to pay. its for the members benefits. and to who ever posted this bashing bcbs. they can sue the s**t out of you if they ever find out you're leaking info like this. so either cut a deal with DOBI and eat the fine for violation of that contract you signed when you were hired by bcbs or go to jail when they find out. I still work for one of the bcbs's and I never seen or heard of any of that s**t you claim happens there
Button810 on 2011-06-07:
Thank you for making a stand because you are absolutely right about BCBS or Illinois. They are either incrediably incompetent or dishonest, but after a great deal of reflection we consider them both. We have never ever had such a run around and each time you get a new person you get more and more new criteria that they want for you for lap band and other surgeries it is crazy. Even if you are very detailed and ask specific questions the first time (to avoid denials) we have found you get vague generic denial letters that you are forced to call up to find out exactly what was denied. The process repeats itself over and over again. They have internal rules that are not posted and when you have to find out after the fact about these as well when you get yet another denial. We changed from an HMO to a PPO this year and after being with BCBS of Illinois I would say run don't walk away from this company. I understand costs are rising, and they can get people who can be difficult, but all of us deserve to get approved when we have done our homework and know we meet or exceed the criteria. Please I hope more people will send in comments on their experience with BCBS of Illinois. Thank you.
v leslie on 2012-01-24:
you are right about this company.how can you work for the government for more than 20yrs pay ins.still pay out of retirement get on medicare 80%- 20% bluecross-blueshield that looks like 100%to me if they can count in billing then they charge you another amount. where and what is our government working on,every person should not have to stay on the phone calling them for hour after hour every day.if you are disable and worked all your life for this country, we helped you why can't we rest and you support us now with our money that we put into the system.


v leslie
bridgetwills99 on 2012-07-06:
We have to be thankful to our president Obama and our U S Justice Roberts for putting " THE AMERICAN PEOPLE FIRST" in passing the health care bill.
You can read my complaint AGAINST BLUE CROSS BLUE SHIELD OF GEORGIAwhich will be available within 24 hours, I just completed it today 7/6/2012, Their Corporate Lawyers are powerful, they used a false ID# to deny me medical the ID# belong to a person In Marietta Georgia. Posted by;Bridget A Wills Liverpool,NY ,
Elbert Baldwin on 2013-10-30:
I had BCBS when I worked for a Hospital in Memphis.Almost had to hold a gun on them to pay for my surgery.I don't know how these crooks can get away with so much.They want that mounthly payment and they through with you.
Julie on 2014-01-28:
You are fortunate! My employer offers only CIGNA, which may as well be no insuramce at all. Takes 6 mos to pay claims.
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Denial Of Health Insurance For Nonexistent Reason
Posted by on
FORT WORTH, TEXAS -- BlueCross Blueshield of Texas accepted me for health insurance in January and attached a rider for a nonexistent condition. To appeal the rider, I had to submit my medical records. Four days before the policy was to go into effect, the rider was removed, but the policy was cancelled for another nonexistent reason. Again, I wrote an appeal, 3 pages with 13 attachments including a letter from my doctor. My appeal did not ask for acceptance of insurance. I wanted, and still want the denial of insurance, to be removed from my record. In addition, I filed a complaint with the Texas Department of insurance.

BlueCross again responded with a denail of coverage. I DO NOT WANT COVERAGE WITH BLUECROSS! I WANT THE UNWARRANTED DENIAL OF COVERAGE REMOVED FROM MY RECORD! It is obvious that BlueCross never read the appeal, looked at the attachements, most specifically the letter from my doctor. After reading the numerous complaints regarding BlueCross, I feel that I have somewhat "dodged a bullet" as apparently they are infamous for late payments and refusal of claims. In addition, my complaint with the state insurance board yielded this, "cannot compel them to change their decision to extend you coverage". Again, I don't want their coverage!

Sad isn't when the insurance company is allowed to ruin your chances of quality health care and even override your doctor's diagnosis? What's more, the government lets them do it. I will be posting my story wherever possible and I encourage anyone else to stay away from BlueCross.
     
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Anonymous on 2008-04-07:
"Sad isn't when the insurance company is allowed to ruin your chances of quality health care and even override your doctor's diagnosis?" YEP!!! Many Texas healthcare providers refer to Texas BC/BS as "Blue Cheat/Blue Steal". They regularly pay providers late (in violation of prompt pay laws), change diagnoses to benefit their company, and deny payment of claims for specious reasons. A doctor in my building (orthopedic surgeon) surgically treated carpal tunnel of both hands for a patient. Blue Cheat refused to pay for the second surgery on the opposite hand. Why? "The second surgery could have been completed through the same incision as the first (covered) surgery." HUH???!!! I want to see THAT!
Anonymous on 2008-04-07:
Hopper, the Texas department of insurance is very strict on Insurance providers. If you have not already done so, you should send them your complaint. Here is the URL to an online web form that you can submit to the agency. Good luck to you! https://wwwapps.tdi.state.tx.us/inter/perlroot/consumer/complform/complform.html
Anonymous on 2008-04-07:
John...FYI...The Texas Dept of Insurance is not strict with insurers. Why not? Insurers are huge donors in Texas politics and they have very active PACs. It only appears that they are strict...but the actual numbers of complaints compared to any collected fines tells the true story. Also, while the state collects a fine...a wronged provider or insured, seldom gets anything. It is a rigged system in favor of the insurance corporations.
Anonymous on 2008-04-07:
That could be true Ghost, but I work for one of the corporations that the TDI cracks down on if we don't dot our I's and cross our t's. Maybe my company doesn't doesn't kiss up to the agency very well? :)
mitjaypat on 2008-06-15:
Actually, you are lucky to not be covered by BCBS. I am a physician and have to deal with them all of the time. Let me tell you, they are BY FAR the worst health insurance company with which I interact. They don't want to pay for anything. They come up with all kinds of excuses for not paying. Consider yourself blessed that you are not covered by BCBS.
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