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.
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 Compensation claims (NYS WC) ref. ** 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 **, I had Medicare Part-A & Part-B.
Blue Cross Blue Shield of The State of Georgia (BCBS of GA) were the Administrators of my husband's 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 **, RN, was employed with Excellus BCBS, South Salina St, Syracuse, NY said she worked & reported to Excellus BCBS 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 paychecks @ 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 **, RN reported to @ Excellus BCBS involving the HIPPA Law violations, Ref. US Postal Service Office of Inspector General file 01IH029I011.)
Empire/Excellus BCBS cancelled Dr. **, GYN the only physician I had in the PPO network that **, RN has set me up with. I went to Dr. **, GYN for my yearly healthy woman's exams. BCBS of Ga, Warm Springs Rd. Columbus, GA guaranteed us in a letter issues with (Empire BCBS) "Excellus BCBS" would NOT affect us. BCBS of GA then CANCELLED DR. ** 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 NYS WC 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 stage 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.
SANTA FE, NEW MEXICO -- When Blue Cross Blue Shield bought out Lovelace, we were promised that the coverage would not change for 2014. Lovelace in 2013 paid for the entire yearly physical. In spite of promises, Blue Cross Blue Shield refused to pay, and I had to pay $160. Sign up with Humana Medicare advantage... Much better coverage!
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.
GEORGIA -- I truly hope that this message makes it to at least one person who is considering purchasing BCBS health insurance. If I can help one person avoid the headaches that have resulted from dealing with this company, it will be worth the time I took to submit this review. BCBS is a deceptive, dishonest, manipulative company that couldn't care less about members' healthcare as long as they collect the premium each month. They will raise your premium and simultaneously deny more and more of the claims that they are responsible to pay. You will pay unbelievable premiums each month, and most of the claims (be it routine office visits or prescriptions) will be denied.
Trying to reach customer service is almost impossible and, when you do, you will be given a vague and nonsensical answer with no resolution. You will be left with a simple response... "no exception." Take my word - if you are considering BCBS as your health insurance carrier, reconsider.
BCBS OF GA, GEORGIA -- I filed for health insurance in mid September, around the 11 or 12th. Never heard anything back. On October the 1st, I received a letter congratulating me that "I had been accepted", BCBS. The letter stated that my application was accepted on 22 September 2010. The letter was dated the 23rd of September and mailed. I received it on 1 Oct 2010. The letter stated I owed 254.00, so I called and made my payment.
A few days later, I got another letter stating, I owe $254.00. I called and gave them my confirmation number. 2 weeks later, I got another letter stating I owed $254.00 due on the 22 Oct 2010. This letter was received on 14 October 2010. So I called again, the first lady I talked to didn't have a clue and told me it was a prorated amount for the month of October... Now, my total amount was only $254.00 a month. My policy is for $254.00 a month. She couldn't help me. The second lady I talk to told me it was for September the 22 to October the 1st. She told me it was prorated for those days.
Now, I wasn't notified until October the 1st that I even had insurance with BCBS, but they were wanting me to pay for those days anyway. I didn't receive my card until October 6, 2010. Am I the only one that sees the problem here. I not going to pay you for something I had zero knowledge of having. All they could say is "We sent the letter." This is the very reason why the federal government is taking over the insurance industry. And if you think it's bad now, wait till they get it.
If I'm having these kind of problems in the first 2 weeks, just imagine trying to file a claim. So I cancelled BCBS. I asked the 2nd lady, "Why didn't they just email me or call me to notify me about the start date?" She said, "It was against policy, for them to call a customer." Guess what? She called me a few hours later asking me about my policy. What a joke!
METAIRIE, LOUISIANA -- I dealt with an inept agent from the local Blue Cross Blue Shield office in Metairie, LA. If you can avoid doing business with this agent, I strongly advise it. His business practice is unprofessional and inefficient. In the four weeks I tried to use him as an agent, he never returned a phone call once, sent an important form to an incorrect email address for me, failed to shorten a waiting period by making a phone call himself, and had an assistant phone me once for something he could have done himself.
He concluded the service to me by sending a particularly nasty email to me telling me I had been rejected... after I waited four weeks to buy insurance (expensive plans at that). For our first meeting about my plan options, he did not tell me any information I couldn't just read in the pamphlets he handed me. He sold us one of the most expensive insurance plans he offered but really did not go over the benefits or the problems with it.
He did not bother to go over my other options or to even tell me what might happen if I am denied. The drive to Metairie was a huge waste of time. BUT, it gets worse. He then never answered any of our calls in the following week and then when we finally emailed him, he said email was better for him. He emailed a very important form to my boyfriend's email instead of to mine and then never called to follow up to make sure we received it. I was waiting for it to arrive by US Mail, like he said it would.
When I finally did not receive it after a week, I left a near frantic voice mail for him. In response, I got an email saying it was attached to a former email sent to my boyfriend. (We were buying the plan together). I then asked that he please call me if something important is sent this way again.
BUT, then it gets worse. When my doctor failed to fax a complete form for the application, he emailed me and asked me to call her and have her resend the form. He could have saved time and possibly kept our business if he just would have called her himself and skipped about six extra days and extra phone calls. He was completely ineffectual and the whole business left a bad taste in my mouth for this company. We are taking our business elsewhere.
PROVIDENCE, RHODE ISLAND -- I highly recommend that you look elsewhere when considering BCBS of RI as your healthcare PROVIDER. After the birth of our third child, my husband took the day off of work so that we could take a special trip up to Blue Cross in person to add our daughter to our insurance plan. We did this, so as not to have any "mishaps" in light of all the health insurance nightmares attacking Americans in every state.
We purposely asked, more than once, if all of the paperwork needed was there, since we did have a home birth and did not have the blessing from administrative staff at a hospital. We clearly did not have a competent or experienced agent, but she assured us that our file was complete and that we took all of the necessary steps to insure our infant daughter under our EXISTING plan. I continued to receive bills and paid my premium on time.
A month passed and I brought our daughter for her next checkup and lo and behold, our daughter was not in the system. When I called about it, they did not even have record that she was born. At that point, the application period had ended to add new family members, and now we would have to go through underwriting to have our daughter added. Also, in the meantime, we would have to pay the highest premium for that month plus a month in advance to the tune of $3226.67, paid in full immediately, or we would lose coverage for a family of FIVE. We are self employed of a new business and at that point did not have access to that kind of money.
Talking to BCBS representatives was like communicating with people speaking a different language, they all looked at the same file and they all said something different. I spent days on the phone trying to sort this mess out. They sent a letter claiming they just needed paperwork, but clearly when speaking to an agent looking at our file, they had never even heard of our third child.
They simply used our lack of paperwork from our pediatrician, as a cover. Since we were getting a discount under the Plan for Individuals and Families program, they apparently did not need our business and dropped us as members. It was the most shocking case of incompetence and negligence that I have experienced with a business.
I have proceeded to warn people about this business and tell them to look elsewhere. But I am afraid it is just the health insurance industry as a whole. It is robbing the American people blind. They have used the safety and vulnerability of our loved ones against us. They have us by our throats and by our checkbooks. We, as a people, need to speak out!
AUGUSTA, GEORGIA -- I have had a Conversion policy for the last several years. I always wondered why it was so expensive. I found out a couple of things since doing a little research: if you had existing coverage through an employer, lost your job, switched to COBRA until it runs out, by law, the same insurance company HAS to give you a conversion plan. They are expensive. Plus, if you have pre-existing conditions (I did), they cannot turn you down. After thoroughly reading the policy, I pretty well knew that the plan was not good. Also, nearly every year, they sent me a letter informing me that my monthly premium would go up again.
Then, I called BCBS of GA, and asked for a higher annual deductible. Answer: they would only raise it another $500. That only would decrease my monthly payment $74. Big deal. Rudeness. I called to ask a question another time and the lady only tried to sell me more stuff so my insurance would go up even more! Additionally, in my experience, if they are late sending out their bills, the bills are notated as "late fees notices", or something to that effect, with a threat to cancel the policy if you don't pay.
Yes. I was paying close to $800/month out of pocket. Because I was never seeing doctors enough to meet my annual deductible, I paid for my prescriptions out of pocket (I think). I cancelled my policy recently due to my being sore about everything, and so far being refused by other companies. I thoroughly suggest to anyone to bear in mind that insurance has its own language.
Also, thoroughly read your policy. Notice all the fine print on the back of your statements. Finally, it may be a good idea to go to your agent and have him/her help explain the lingo. Hey! They received a commission when you signed up with the company! Recently, after being denied by a competitor, the agent recommended that I put money in the bank each month, in order to cover the unexpected.