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.
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.
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.
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!!!
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 BCBS and fight with them to acknowledge the children on our plan. Today, ** (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 BCBS, 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 BCBS and that the problem lies with them. I called BCBS 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 BCBS is responsible as they get their information from them.
I AGAIN called BCBS, 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 BCBS and Medco several times since. Medco is now saying that the last update they received from BCBS concerning me was March 9, 2009. Again, I called BCBS. A BCBS supervisor named ** 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 unenroll 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.