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.
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.
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.
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.
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.
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.
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.
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.
TOPEKA, KANSAS -- I have had a health insurance coverage through my husbands work with Blue Cross Blue Shield of Kansas for 12 ys. March 1st of this year my husband retired from his job and is on Medicare. I was told I could continue my insurance for 36 months through the cobra plan. I was on this plan for one month when I went to my pharmacy for a medication refill. I was told the insurance denied payment because I was no longer covered. What a shock that was!
After many many phone calls in which I was transferred to probably almost everyone that worked for the company (it seemed like I was transferred that many times anyway) in which most had no idea what they were doing or why I was dropped I finally got someone in management. After a lengthy conversation it was my understanding that my coverage was dropped because of a minor misunderstanding at the time I changed to the cobra plan. Now they refuse to reinstate my insurance. It took me over 20 phone calls in a two week period to find this out.
Is this the way to treat a person that has been a loyal customer for 12 ys?
All they want is your money. They don't care rather you are covered by health insurance or not. Stay away from Blue Cross Blue Shield of Kansas. They are not a reliable insurance company anymore.
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.