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Former Employee/Avoid this company!
Posted by KellyE on 08/26/2010
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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Posted by goduke on 2010-08-26:
Shouldn't you be contacting the state insurance dept to report them?
Posted by 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#*!
Posted by 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.
Posted by 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.
Posted by 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.
Posted by Anonymous on 2010-08-26:
Yeah, my deductible through BC/BS jumped $3,000 this year, under our company's new agreement.
Posted by 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?
Posted by Anonymous on 2010-08-26:
Well that's why they passed Obama-care to fix these problems right?
Posted by 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!
Posted by 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.
Posted by 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.
Posted by 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
Posted by 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.
Posted by v leslie on 2012-01-24:
you are right about this company.how can you work for the goverment 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 goverment 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
Posted by 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 ,
Posted by 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.
Posted by 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 Nonexistant Reason
Posted by The_Hopper on 04/05/2008
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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Posted by 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 wanna see THAT!
Posted by 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
Posted by 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.
Posted by 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? :)
Posted by 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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Blue Cross: Pls Stop Computerized Phone Surveys!
Posted by on 07/27/2004
We have Blue Cross Blue Shield medical coverage through spouse's employer.

Blue Cross Blue Shield has begun phoning our home number via *computer* and asking for us by individual name and demanding that we respond to computerized survey questions, on the spot!


In this day and age of identity theft and outsourcing our most private info, they can take their computerized survey and shove it up their posterior!

Blue Cross, knock it off. Grow up!

You are an INSURANCE COMPANY, not a medical-care provider. We don't owe you ANY of our private medical information, and certainly would NEVER provide it to an unknown computer-dialer purporting to be Blue Cross!

Get a grip!

I hope everyone who receives such calls RAISES A FURY OF PROTEST and puts Blue Cross in their place.

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Posted by Slimjim on 2004-07-27:
Blue Cross is a business I am sure must be accredited by a standards organization, such as ISO-9001, COA, or the like. To maintain certification, companies must have a client feedback vehicle and various tasks associated with them. If you don't want to participate, just hang up. It's a machine and won't take it personal. They don't need your response specifically to complete their requirements.
Posted by mad on 2004-07-27:
I have the same insurance company and haven't gotten any calls. But thanks for the warning. They should just mail out surveys. They should not be invading people's homes and privacy. If I get any calls, I'll definetly tell them to shove it.
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Criminal Business Practices
Posted by Jim H in NC on 07/12/2011
I have Health Insurance thru 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 thru 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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Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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!!
Posted by 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(nickle 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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Very Bad Experience With Handling of My Premium Payment
Posted by Utnanwp on 08/14/2010
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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Posted by 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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BCBSM Shady practices
Posted by Krazyky on 11/11/2009
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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Posted by Anonymous on 2009-11-11:
OMG. What a disaster.
Posted by Anonymous on 2009-11-11:
And this my children, is exactly why you never give a creditor access to your checking account.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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 accross.
Posted by 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 it's 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!
Posted by Jim on 2012-06-28:
On the 1st of January 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 payed for healthcare, medicare and tri-care. Now they haven't paid one claim yet. I just dont 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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Unethical Acts By Insurance Companies
Posted by Drk on 03/07/2008
RALEIGH, NORTH CAROLINA -- I have Blue Cross Blue Shield Health Insurance that I receive through my employer, and I do pay a premium each for this plan. I went to see a primary doctor, and then I received a notice from the health plan stating they would not cover this doctor visit because their records showed I had other health insurance. I stated that their records were wrong. I asked what other health insurance the records showed I had, and they wouldn't tell me. I asked how to fix this, and they said I would have to have my other insurance company call them. The problem is I don't have another insurance company, and they won't even tell me what other insurance plan it is they think I have. To me, this seems like nothing short of a scam to steal from me. I pay for a service, then when I need to collect the service, a ridiculous situation is created to prevent me from being able to do anything. There is no other type of business in this country that can get away with this type of behavior. Why are we forced to continue to accept this treatment?

This is not the first time I've had trouble with a health insurance companies, including this one. It seems that we can never just get the benefits we pay for, we have to waste time arguing and trying to prove to the companies that we should be getting what we paid for.
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Posted by GothicSmurf on 2008-03-07:
Do you have health insurance through another person? Spouse, partner, parents, etc? Are you under a COBRA plan from your last employer?
Posted by Principissa on 2008-03-07:
If you really do not have another health insurance provider, it is possible that you may have gotten confused as someone else. You need to go to talk to your benefits adviser in your HR department. And let them help you with this. It could be a simple error on your paperwork that could easily fixed by sending over new documents. You may also want to call your previous employer if you had benefits through them to make sure they dropped you off of their insurance plan.
Posted by jenjenn on 2008-03-07:
Depending on who you have coverage with, every year you may receive a COB (coordination of benefits) letter asking if you have other insurance. If you fail to return it, it will cause problems with claims. Send something to them in writing (with your signature) that you have no other coverage. When your file is updated, your claims will be
Posted by GothicSmurf on 2008-03-07:
Good point Princi! I've lived in 3 different states and each state I lived in, there was at least one other person with my exact name. I don't have a very common first name either. It's to the point I'm legally changing my last name to avoid confusion.

Check on that as well! Princi I love how on top of things you are!
Posted by Principissa on 2008-03-07:
Thank you Gothic. I would seriously get annoyed if I had to constantly resubmit paperwork to prove I am who I am.
Posted by Suusan B. on 2008-03-07:
This is not a "scam to steal from you". As other members have stated, there are a variety of reasons why Blue Cross/Blue Sheild thinks you have other coverage. My advice is to remain calm, not make any accusations and simply talk to your employer's benefits coordinator for advice. If this is a doctor you've seen in the past under another insurance carrier, it could be as simple as their records aren't up-to-date or a billing error was made.
Posted by Slimjim on 2008-03-07:
I agree with princi. Your HR department should be able to work in coordination with the agent that sold the group plan to your employer to get this quickly resolved.
Posted by Anonymous on 2008-03-07:
I'm confused with this. If Blue Cross is your primary health provider, what does it matter if you have additional coverage? Wouldn't they be paying first anyway?
Posted by forcomplaintsonly on 2008-03-21:
Insurance companies have gotten away with so much over the years, they feel invincible, and take them to court, they have the best lawyers and attorneys money can buy, so you still will not win.
Posted by frustrated on 2012-10-02:
I find it interesting to see everyone issues. I though health care insurance was to keep us healthy and reduce claims. However since I was recently diagnosed with MS I have had my interferon shipped 4 times and 3 times there was signficant issues. Now my doctor is perscribing medication for my migraines that flair every time I have to work with Curascript (provider of specialty meds for my Blue Cross Plan). I have to take additional meds and cost the plan additional funds because they can not get it right 75% of time. I really wish they would see the cost of all my phone calls and the additional meds.
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Worst Customer Service Ever! Worst than DMV
Posted by Pamc on 02/14/2006
BOCA RATON, FLORIDA -- I had recently chosen BCBS as a health care provider. I went through the long process of filling out an application with an agent over the phone by the name of Rose Clark ( I think this is a fake name, everyone at BCBS is Clark) She was very sweet and professional. I sent my application on 1/21 at the address that was given to me, only to find out today 2/14 that it was sent to the WRONG address,causing delay. The CSR that I spoke to was so uneducated, she knew nothing. Had the worse communication, did not answer any of my questions, then put me on hold, came back and said the same thing she said to me before. When I asked to speak to Rose Clark, she gave me extension. I asked if she could transfer me, she said no. You have to call back. I asked if I could leave a msg for that extension, she said I needed to call back. I called back the 1800 number and was routed to a live operated. I was not able to input an ext. I spoke to a gentleman who transferred me directly to Rose Clark. Clark answered and was rude to me right off the bat. She was so aggressive in her tone, as if her and the prior CSR had known of my prior conversation. She was so rude in explaining the details. When I asked her why it took so long, so said that I sent the application to the wrong address. "Don't forget, this is the same stupid idiot that faxed me 20 some pages of fax." I was stunned to hear her say I sent it to the wrong address, as if I magically knew the address of BCBS. Now she tells me that the application process started on 2/9/06 instead of 1/21/06 when my application was sent. can you believe these people? The paper trail, the long process of getting a policy. just imagine when I become a policy holder, I'll probably never get customer service or the TRUTH!!! Because they hire people who don't know what the hell their doing, and refuse to admit it, or at least do what they were hired to do, and research and find the answers to their customers. I'm beginning to wonder if this is what I want to battle with. Do I really want a company as incompetent as they are to handle my health needs? Yikes!

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Posted by NeveragainAmazon on 2006-02-14:
My experience with BCBS has not been favorable. In my opinion an insurance carrier should make prompt payments for all service(s) rendered to the client. On multiple occasions I did have to call BCBS myself regarding payment....and the response was that no one is perfect and that it was overlooked or they never got a bill from the physician . Needless to say, I am no longer with them. Good Luck to you!
Posted by BCBSstinks on 2012-09-20:
We deal with this horror daily as a physician office. BCBS is the only company who routinely bundle services ie say someting is part of another. Example: your hernia is part of a toe injury because your doctor addressed both surgeries on the same day. He could have done two different surgeries on two different days and got paid in full but BCBS does not see this. They just have a building full of people looking for ways not to pay the doctors and stick the members with a huge bill. Look over your benefits as they like to claim it was not a covered benefit so they can suck it up to the patients.
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StarEmpty StarEmpty StarEmpty StarEmpty Star
This company has turned rotten. :(
Posted by Thestarchedshirt on 10/22/2012
ATLANTA, GEORGIA -- Blue Cross Blue Shield of Georgia has some of the worst customer service I have ever dealt with in 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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Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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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Treated awfully
Posted by Kellyshull on 02/10/2010
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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Posted by 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.
Posted by 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.
Posted by 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.
Posted by 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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