OKLAHOMA -- I had an accident when my grandson was sitting in my lap and jumped backwards and got me in the mouth and nose, he broke 2 teeth and knocked the rest of my front teeth lose I went to a dentist and had an exam and x-rays but after being total 12K to repair damage, I told them I was going to get a second opinion and I found a wonderful dentist. They fixed my mouth for 9K. I filed it on my dental insurance and called blue cross and blue shield to see if this was covered on my policy they said yes, that I just needed to download a claim form and send it in that it takes 30-45 days to process a claim, I said OK. That was in August 2009 and that claim still has not been paid.
I have done everything they have asked and sent copies after copies but still they have not paid the claim. I received a letter from them telling me that the dentist that fixed my mouth was not the first dentist I seen. I told them the same thing, he wanted too much to fix this damage 12K and I found another dentist that fixed everything for 9K and I paid out of my pocket. What the dental insurance did not cover which was almost 5K and I was told it was covered by my policy but now they refuse to pay my claim. I have been fighting this from August 2009 and still am.
They said they will be willing to pay the 196.00 for the exam and rays that the first dentist did but not the treatment and surgery. This is crazy! Then I went to see the surgeon about fixing my nose I was not going to get bit by that dog again so they sent in a Pre-authorization which I have a letter that says they received it on Dec. 17 2009, surgery to be done on Dec. 29th 2009. They came back on that one and said Oklahoma got it on Dec 17th but California did not get it until Dec 31, 2009, so it was denied. I lost coverage on Jan 1 2010 due to leaving the company I was working for.
Now I have a preexisting condition that no insurance company will touch and a claim they refuse to pay that was covered on my policy. I still can't breathe out of my nose which causes me serve sinus infections and my savings is gone. I paid my half of my insurances which was 360.00 per month and then had to use everything I had in savings to pay for what my dental did not cover which is what I was told my medical with blue cross and blue shield would cover, that it was a covered item on my policy accident injury. I have tried to play their games and tired of the excuses. I have been left with nothing to do but call and hire a lawyer. Thanks for nothing blue cross.
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OKLAHOMA -- Ok, I try not to rant too much unless I get REALLY pissed. Blue Cross and Blue Shield of Oklahoma are the biggest group of morons I have ever dealt with. Every time I have to call in I feel like they actually get less intelligent. Not only do they always ask to talk to my 4 yr old to see if they can talk to me, I filed claims - per their instructions that they received Dec 15th - they still have not processed. 1.5 weeks ago I received a letter saying that they finally finished one of the claims and would be sending money to the provider.
I called in and said no, they needed to send me check because I had paid that bill in full. They said ok. Now I call in to check the status of my other claim and get told neither were processed. Oh and the refund I was waiting on is my extra I had paid for my monthly premiums. They are refunding me that. I guess I magically pulled that claims pd letter out of nowhere and Blue Cross and Blue Shield of Oklahoma doesn't like people to pay their bill in advance.
ROCHESTER, NEW YORK -- Excellus BlueCross BlueShield is the worst health insurance company I've ever had to deal with. I encourage all employers and customers to avoid this company at all cost. I was diagnosed with Narcolepsy 23 years ago and have been treated for it since then. A clinical pharmacist from Excellus has determined that my medication is "Not Medically Necessary" and they refuse to pay for it.
The medication helps me not to fall asleep at inappropriate times. It's not a cure but it does help. Excellus BlueCross has trumped my neurologist. When did we get to the point of an insurance company determining what's best over a Medical Doctor! I've filled an appeal. While they go on with their lives, they deny me the right to just have a half way normal life.
CALIFORNIA -- My wife was in rehab at calif rehab to learn how to walk, talk and think after being hospitalized for over a month. My wife was doing well, but still need close supervision when out of bed. One night she was left unattended and fell (Friday evening) took them almost 6 hours to take x-rays & get results (they say nothing broken.) The days following my wife is in pain, a lot of pain. That Sunday her doctor, ** saw her, she observed that my wife couldn't lift her legs and was in a lot of pain. The doctor said she would order stronger pain meds and some pain patches.
A day later my wife still hadn't received this pain medicine. On top of it they refused to keep ice on her, I had to purchase our own ice pack so my wife could get some relief. The minute we complained that she wasn't getting the treatment she should due the fall the director called facey and had someone there within an hour stating my wife was fit to be released from rehab. When I called this person representing my wife doctor she told me she witnessed my wife get from bed to a wheel chair and that was all that was needed for her rehab to be complete.
We asked for a doctor to look at her, they refused, we requested a 2nd opinion, they refused. We were told our 2nd opinion was doctors reviewing her records. No doctor saw my wife, or witnessed that she couldn't function in or out of bed. Then 3 pig women from blue cross got on the phone with me and told me there would be someone there every day to make sure my wife was taken care of, and that my wife would receive all the therapy she needed at home. GUESS WHAT, we got nothing. All this time my wife is in so much pain she is crying all day and night. We go to her HMO doctor, he takes x-rays and sees 3 fractures.
Now these pigs at blue cross stated there were no broken bones so she can go home, they told us my wife would just have to work through the pain. Now that they know they did wrong, are they trying to correct things? Nooooo, in fact they are making sure any service my wife should be getting takes as long as they can make it before she receives this service. Trust me you do not want to have Blue cross as your medical provider. All of this is documented, I would love to provide you with all my notes, names, phone numbers and x-rays to prove what I am saying is correct.
There is more, because we complain they are refusing any treatment any doctor puts in for her to have, they have gone so far as trying to say I am abusing my wife. I have done nothing but fight to make sure my wife gets the medical treatment she deserves and everyone will tell you that. Do I get mad? Yes. Do I get in their face? Yes. But they think they have so much power no one can touch them. Trust me they will be touched, everyone that hurt her, left her for dead will pay, god see's all and they will get what they deserve.
ATLANTA, GEORGIA -- I have had so many problems getting refills for my drug that has to be pre-authorized. Even when the drug is pre-authorized I have to call to get it sent. They seem to make excuses every time I ask for a refill not to get it to me on time. I suppose they have to cut costs somehow to enable the CEO to get $60 million a year. I have no option but to use Blue Cross so I can't even do anything about it. Blue Cross blames Express Scripts and vice versa when anything goes wrong.
ARIZONA -- My husband set up our payment as an automatic monthly payment. We got a notice in the mail on the 25th dated 22nd stating we had until the 29th to pay for coverage (27th and 28th were weekend)?!? When I called customer service the recording stated that we were paid up by auto payment and owed no money. I stayed on for the operator and she said we owed that month because a mistake was made on setting up the auto payment. We were set up to fail! We ended up sending the check overnight/certified. Don't trust these guys!!!
KANSAS CITY, MISSOURI -- Beware of Blue Cross & Shield hidden charges high deductible, so outrageous. It's ridiculous just go to see $100, out of pocket. Then Blue Cross will say "that's not in the coverage plan. You will have to pay extra." What is in Blue Cross plan - to take your money, don't pay the medical coverage, leave you with big expenses that will take you forever to pay the medcial expenses off. Some insurance Blue Cross is leaving you with medical expenses so Blue Cross can save money. All Blue Cross is is a bunch of money hungry vultures who will clean out your savings.
KANSAS CITY, MISSOURI -- I went to the doctors 3 times. I paid my $40 co-pay 3 times in a row. I get one bill for $158. Another bill for $105, $263 that blue cross did not pay, which blue cross did bother to tell me that this was not covered. Blue cross is only paying 20% of your medical bills. Then blue cross raise my insurance of me 2 times in a row. Blue cross CEOs salaries alone $200000 a year. Blue cross will not tell you about deductible and the co-pay just go to the doctors' offices.
If your doctor's bill is $300, Blue cross will only pay $50. Then you got to pay $250 out of your own pocket. Why? Blue cross only pays a little bit of money, then you got to pay the rest out of pocket. Blue cross is nothing but a bunch of money hungry vultures draw your life savings.
NEW JERSEY -- They have the worst customer service. Ask you for all details for 10 minutes and transfer to another department. There, you will repeat the details for 10 minutes and then again transfer. How frustrating. With the changing advanced technologies, these type of services don't help. A smarter system with smart people is needed. Worse.
ALLEN, TEXAS -- I lost my job and my insurance ends in 3 business days. I was having a difficult time find doctors that were available and accepted my plan so I called Blue Cross to get a list of doctors to call. The lady assisting me went above and beyond! She placed me on hold and called doctors for me and gave me a list of the ones that could see me before my insurance ended! I wasn't expecting that and I wish I had her name because Blue Cross is lucky to have an employee like her representing them!