TN -- My husband went to the hospital (on a Wed.) to get 2 bags of blood because he was malnourished and his levels were EXTREMELY low. He was eventually admitted b/c 2 bags turned into 8 with no improvement. BCBSTN (Marketplace insurance) denied his first claim for admittance saying it was unnecessary. Friday morning around 1:30 a.m. he was transferred to a bigger, better, trauma-level hospital to be evaluated b/c they didn't know what was wrong. After testing/x-raying/scanning all day, it was determined around 5 p.m that he had a bowel obstruction which needed immediate surgery but there were two other cases that went before him.
He didn't get into surgery until Saturday morning. His bowel obstruction turned into a perforation and all but 100 cm of intestine had to be removed to get necrotic tissue out. He was left open and kept in a medically induced coma until surgeons could decide how best to put it back together. Two weeks of a coma (even after medication for sleep was discontinued) and four surgeries later, his kidneys had shut down requiring dialysis (which I had to fight for) and all of intestine eventually necrotized and he was left with no way to connect his pancreas to his colon requiring him to be fed intravenously for the remainder of his life.
I found out he coded and was basically was being kept alive by medications and a ventilator. I allowed him to go peacefully after discontinuing all medications that were keeping his heart beating -- truthfully he had been dead for 12 days but his body was going through the motions.
After he died in August I called the insurance company to report his death and have him removed from my policy. I was told just to let it ride until the end of the year and he would drop off automatically. After losing his income I was no longer eligible for a tax premium credit (which was my concern in the first phone call to BCBS) and my premium jumped $110/month.
In November we were informed that my employer would offer affordable insurance the following year so I called to cancel my policy for January and the rest of the year. I was advised NOT to pay the premium and it would cancel on its own (2nd bad advice) at the end of December. My employer's insurance (also BCBS) was over $100 less/month so I switched as of Jan. 1, 2015 (so I thought). Fast forward one year (I switched to a Cigna policy) and I file my income tax in Feb. 2016.
At the end of Feb. I get a letter from the IRS stating that the HealthCare Marketplace/BCBSTN had "informed them" that I had been given a tax premium credit for the month of January 2015 that I "Failed to file" on my return so they were reviewing it and would hold it until after I filled out an amended return to pay back the $316 that had been paid "on my behalf" which included my husband who had been dead for FOUR months!!!
After placing blame on each other (HC Marketplace vs. BCBS/TN), at least 3 one hour plus phone calls, and giving me the run around for two months, I get a call yesterday from BCBS big-wig saying basically this: because my pharmacy had incorrectly billed two prescriptions the wrong BCBS policy and they paid a whopping $23.29 my policy would/could not be retro-terminated for Dec. 31, 2014. IF they changed the date of my termination from Jan '15 to Dec '14 they would be "forced" to (a veiled threat) also retro-terminate my dead husband as of Aug '14.
The reason this upset me is that without husband's income I lost the tax premium credit and would OWE BCBS $150/month for the higher premium I SHOULD have paid in 2014. OR I could keep quiet and leave things the way they were and owe the IRS for the unreported tax credit in 2015. Blackmail so either way I get screwed because of THEIR mistake. I will NEVER AGAIN have BCBS insurance even if it means paying a penalty for no insurance!!!
In the midst of all this, I also fax proof of my employer insurance date of enrollment and explained the situation and the IRS approved my refund and sent it to me. NOW I have to figure out what to do with an amended return and pay more money and probably a huge penalty to the IRS. BCBS not only kicked me while I was down but they ruined me for life. The year I lost my husband I had to PAY IN thousands of dollars to the IRS for taxes on his 401K. Now this -- the IRS will audit me every year for life.
RALEIGH, NORTH CAROLINA -- My wife got a new job at the university and the employer will pay for health insurance, which by the way is also BCBS. I called BCBS on Monday asking how I can terminate her policy (she is in my policy as dependent). The attendant told me fill a termination form, put my wife's name, and send back to them. I did.
Today (Wednesday) I was checking for bills and found out that myself and my child will be terminated from the policy as well. I called BCBS and the attendant told me I cannot terminate just one dependent. It is either everyone or no one. I explained that my wife is going to get a new BCBS policy through her employer but the attendant just repeated the same. I ask her if I could make a new policy for my child and myself after the current one is terminated but the attendant told I have to wait for the next enrollment time, which is in July 1st. I asked to talk to her supervisor who told me the same story.
After I complained that this makes no sense, that BSBC is pushing me to keep her in my plan, and BSBC will be absurdly receiving two payments to cover the same person, the attendant told me to ask her employer to postpone her coverage until July 1st and I keep paying for her. I asked them to suspend the termination form and the supervisor told me she is not sure whether they can do that either. She is going to call me back whenever to give their decision. What kind of unreasonable people work for BCBS? What silly rule is that? It makes no sense. They would keep the same number of subscribers as none of us is leaving BSBC anyway.
KNOXVILLE, TENNESSEE -- They dropped my family coverage stating that we were no longer using their coverage, without any notice to me. I found out when I had a check up during my pregnancy. They were still taking my monthly payment, just not giving us coverage. This all happened one month before I delivered my daughter.
NOW, 7 months later they still have yet to pay the amount that they were suppose to cover for the delivery. They have constantly put us off and given us terrible answers. I would NOT recommend anyone to use this insurance. Not only was the coverage terrible, but the people were unhelpful and unfriendly. If their part is not covered soon, we are looking into legal advice in order to get them to pay what they were supposed to cover.
CHICAGO, ILLINOIS -- Blue Cross Blue Shield denies me coverage of medication I need without consulting my doctor or myself. Couldn't valuable information be found by contacting the person who prescribed this medication? Does Blue Cross Blue Shield believe that they know what is better for your health than a doctor I see every two to three months? Why don't we pick and choose when and if we should pay our premiums without consulting a huge corporate conglomerate based on falsities? That makes just as much sense.
The death panels are already here, and they work for the insurance companies to deny you the medicines and procedures we need. Insurance companies use their own employed doctors to come up with more and more ridiculous reasons to deny you have proven medical treatments that have been commonplace for years. The hide behind the statements of a "doctor" solely under their employ. This "doctor" makes bonuses off of how many claims they can deny to people who need them.
The best thing this country can do is implement a single-payer healthcare system like every other developed country in this world. Even Cuba has free health care to all citizens and they don't have a car built after 1950 or the internet. The richest country in the world leaves it citizens to deal with the hypocrisy of an insurance company that does not pay out to its customers when needed.
Jan 25, 2011 I injured my back in a fall at my house and was taken to the ER by EMS. CT done, nothing broken. Was given some meds and told to follow up with my PCP. Started feeling worse and having pain moving down my legs within a week. Went to Walk in at my PCP and they ordered a Stat Same Day MRI, the results of which, they sent me to a Neurosurgeon for consult due to the issues found on the MRI as well as my symptoms (MRI showed a bulging/herniated disc at L4/L5). I couldn't do PT after 6 additional weeks of trying to hopefully get better, nothing was working.
They scheduled a discogram to examine the Disc structure. The discogram confirmed the suspicions. Not only was the disc herniated but I had a Grade IV tear in the disc with significant leakage into the canal. The MD who did the discogram agreed with my neurosurgeon that due to the damage and the DDD in the disc that fusion was the only sensible option due to likelihood of reinjury or disc space collapse resulting in major issue potentially. I was 2 weeks from having surgery and then the BCBS of NC brick wall came up. They denied my surgery. My Surgeon put in an immediate appeal and he was denied... all because they said it "wasn't medically necessary."
I went through 1st level internal appeal at BCBS which was a bloody joke. Their supposed internal review physician was a bloody family practice MD, they don't know anything remotely about spinal surgery or surgery in general for that matter so WTF... DENIED again!!! This was July... I had a setback and major pain issues that nearly had me admitted due to exacerbation of pain issues and my pain meds were increased... OK filed 2nd appeal. Hearing was Aug 26 (same day as Irene is about to come barreling through our fine town). Thought it went well... Got letter this past Saturday, DENIED again.
Neurosurgeon on appeal says I don't need fusion, I need disc resection (oh the moron also asked about disc replacement but I find it funny because bloody BCBS of NC still think disc replacement is experimental despite the fact that several other BCBS affiliates DO cover it). My neurosurgeon will not do the disc resection because he doesn't think it'll solve the problem long term and is concerned about I'm sure legitimately being held liable if the surgery fails and I end up worse. I think he's dead on on what needs to be done, but once again BCBS thinks they know better.
The sad truth is BCBS of NC only cares about one damn thing. Getting my money and not paying out theirs despite their responsibility to their members. The less they pay out the bigger the higher up douchebags bonuses are (don't lie, we know the truth). I'm sick and tired of my life being ruined by these **. If I could pay for my surgery myself I would and then sue the hell outta them for the cost plus bad faith actions on their part leaving them WIDE OPEN to punitive damages in the millions potentially. I can't be the only person fighting with them over this. If you are in my same situation feel free to contact me please.
COLUMBUS, GEORGIA -- There are too many months, days, and countless hours during the year of 2014 that I spent on the phone with numerous incompetent and rude employees of BCBS GA. They literally drove me insane to the point I ended up having to go to the hospital for stress related illness on top of my physical illness. They are continuing to cause me stress to this current day over claims that they filed inaccurately (paid the incorrect provider of service... one that I had never heard of, or been to, and that had never heard of me or received the payment that BCBS GA sent me an EOB as having paid incorrectly to them)!
Now, if your head is spinning over that one, BCBS GA was rude to me again when I called them to bring this to their attention and rectify! I filed two formal complaints over issues with them and never heard from them regarding any resolution to the complaints. I am so sick of them... they are like a nightmare that won't go away and leave me alone! I will never, ever, have anything else to do with this company or speak to anyone representing the company! They have proven to me that even the numerous supervisors and recorded phone calls that I had with them that they are also incompetent! You've been warned now so use them at your own risk!!!
CHAPEL HILL, NORTH CAROLINA -- My daughter was in rehab at Pavillon in Mill Spring, North Carolina. They do not accept BCBS insurance so I had to pay the entire amount $24,000.00 out of pocket which I cannot afford. At her discharge they gave me paperwork to file with BLUE CROSS BLUE SHIELD of NORTH CAROLINA and for 4 months now BLUE CROSS BLUE SHIELD of NORTH CAROLINA keeps contacting me with petty reasons why they should not pay, reasons that are completely unrelated to the fact that she had a legitimate reason for admission like the hour code of her admission was incorrect or the code for her daily detox was incorrect or TONIGHT the incorrect place code was entered.
As a physician, it is obvious to me that BCBS is fraudulently avoiding paying my daughter's claim. Also, Pavillon is A SCAM OPERATION more interested in profit than in helping patients.
CHICAGO, ILLINOIS -- BUYER BEWARE! On the healthcare marketplace website they list plans for you to choose from. They are not outright fraudulent but there is vital information that they purposefully do not disclose regarding the BCBS Blue Choice PPO plans. That is the fact that very, very few doctors, many hospitals, clinics and other medical institutions do not accept this form of coverage. It makes the insurance close to useless and you end up paying $500 or so a month for insurance that you cannot use and still have to pay the majority of your medical bills.
If you have to go to a specialty doctor, it may almost be impossible to find one that accepts it. Their regular Blue PPO plans are accepted by a wide variety of medical professionals, however their BLUE CHOICE PLAN should only be taken with awareness of this caveat - it may be hard to find medical treaters who will accept that insurance.
OKLAHOMA CITY, OKLAHOMA -- My wife does not like doctors, has not been to one in over 2 years. After she turned 50 I made her get a blood test. Guess what? BCBS denied the claim completely! Did not even bother to get the insurance reduced rate. Now she has canceled all the tests the doctor requested that are normal for her age. BCBS does not care about preventing anything!!! If you are not dying, do not expect BCBS to pay a penny. Don't know if they will pay anything at that time either. Will not be with them long enough to find out.
HOUSTON, TEXAS -- I would give this a negative rating if I could. Let me explain why. My in-laws switched their Medicare Supplement Care from Aetna to BCBSTX because my father-in-law's prior company dropped all retiree plans. We applied, were accepted, and have made payments for both my mother-in-law and father-in-law. We even put BCBSTX on auto bill pay and made payments well in advance of due dates. Effective date is 1-1-14. They've never received ID cards. Here is my problem. Every time I phone and enter the member number and DOB as requested - no application found.
I have to hold "in excess of 60 minutes" (on hold right now - 1 hr 30 minutes and counting) while waiting "for the next customer advocate to be with me shortly. (Shortly?? Advocate??) When I try to order the cards online I have to set up an account online and enter the member ID number, group number, email address, etc. OK, the ID number is on the invoice so that's not an issue. The problem is the Group number - that is found ON THE CARD. Hello?? This is the most time-wasting, non-customer friendly, absurd process I have ever seen. My advice? Go elsewhere.