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.
DECATUR, GEORGIA -- I was approved for IUD (merina) at the doctor's office, which I go ahead getting done. 2 months later, received a bill of $1300 that am supposed to pay, BCBS didn't pay a penny. Am still figuring out what to do, if I call them they say "Give us a week, we'll call you back." The procedure I did is preventive which should be cover by BCBS.
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.
RHODE ISLAND -- I recently keep getting a bill for a service Blue Cross has refused to cover. Now, said bill is about $1500.00. I had paid Blue Cross since 1995, and HARDLY ever needed medical insurance. Now, in my mind I am thinking "where did all that money go if I did not use it?" I guess I paid some overpaid office worker's salary. It just does not seem fair that I contributed, hardly used it and when I did, my coverage was about to run out. Had not run out yet though due to change in jobs.
Regardless, I think I had sunk enough into Blue Cross that I should have never gotten that bill especially when I never used it! That was anywhere between $34.00 biweekly at start, up to 200.00 bi-weekly since, as I stated "1995". How do these jerks get away with this stuff? When you go to the website they make it so difficult to ask questions, or email them, that it is a hassle just to get a hold of them. So, now I will complain to anyone who will listen! No one can really help because we all take a defeatist attitude. I will NEVER pay that bill, so the Dr really is the one who has lost out on the deal. I think his staff submitted the claim too late or I would have never gone to him.
Blue Cross stinks. I am planning on going the route everyone else is, get free medical care on disability. Why work and pay for it? They keep your money (even when you did not have any procedures etc). I see plenty of patients getting free housing, free medical everything because they do not work, cannot work d/t knowing how to scam the system? Come on we all em. Thanks for your attention.
FRESNO, CALIFORNIA -- Insurance companies like to collect premiums, but they do not like to pay claims. Well at least Blue Shield seems that way. Back in February I changed the venue of the treatment I was receiving for a venous stasis ulcer from a vascular clinic at UCLA to the Burn Unit at Community Medical Center in Fresno. The treatment was identical to what I had received at UCLA, but when the change was made the Blue Shield Explanation of Benefits stated "Supplies" instead of what they really were: "Office Visit" and "Treatment Room" Now I cannot imagine how any INTELLIGENT person could confuse those procedures, can you?
Upon investigation, I discovered that these charges were submitted electronically to B.S., WITH the correct codes embedded. The person I spoke with at B.S. admitted that the codes were CHANGED, but offered only puzzlement at how or why that could have happened, and asked for hard copy from the Burn Unit.
To make a short story longer, this has been going on since Mid-March without resolution and now I am getting warning letters from the Hospital because I haven't paid my bill. They (the Hospital) have even gone to bat for me at B.S. and have not gotten anywhere. My next step is to file a grievance and tell my story to anyone who'll listen.
I at one time owned a company that used Blue Shield as a benefit for our employees. I hope they didn't have the kind of trouble I'm having. If they did, I didn't hear about it. It's a good thing I'm retired, so I have plenty of time to spend on the phone over this. It's a sad commentary that my wife and I spend just shy of $2,000 per MONTH on a PPO plan with $1,500 deductible and get jacked around like this.
Not only does our premium go up $100 per month every January just like clockwork, at other times during the year we get a restatement of our plan that undoubtedly results in a reduction or elimination of benefits. I understand the need for a business to make a profit, but it should be a fair one and not achieved at someone else's expense! To say that I would NOT recommend Blue Shield to anyone contemplating selecting them would be an understatement of catastrophic proportions.