NEW MEXICO -- Customer Service at BCBS of NM is nothing but a wall of obstruction to keep customers from being serviced. After numerous calls, hours on the phone, and 6 weeks of having to repeat my story over and over, each time to a different person, when the call center representative (that's all they are) says to me, "I *am* trying to help you," or "You can believe me," I now challenge them with, "I will believe you on one condition: Give me a direct number so I can call you back and continue to work with you directly." Of course, they can't. It's a call center.
They're all working off a huge switchboard. No one has a "phone" -- they're outfitted with headsets & have no control over what calls go where. As soon as they get off the phone with you, another caller is passed along to them on their headsets. There is no follow-up. There is no real concern with helping customers. Needless to say, I am still waiting for my issue to be resolved, and in the meantime I am being denied health insurance coverage I was paying for, up until this month when BCBS took it upon themselves to *return my money and cancel my coverage.*
Every time I call they have a different reason for the screw-up. They are good at rationalization, but as bad as can be on resolution. You, Blue Cross Blue Shield of New Mexico customer, are at their mercy, and they have NONE.
PROVIDENCE, RHODE ISLAND -- When I got hired at my current job, I was pleased to find out that Blue Cross Blue Shield of Rhode Island allows girlfriends/boyfriends/common law spouses to receive healthcare coverage through someone else. My girlfriend has been without insurance for far too long, and this looked like the perfect opportunity to finally get her some. And she needs it, too-- she's got varying medical conditions that are far too expensive to be paid for without insurance. Nothing life threatening, mind you-- but they're conditions nonetheless.
When a year passes, that's when you're allowed to put a spouse/significant other on your insurance as a "domestic partner." Great. BCBSRI mailed me a list of documents they'd need to prove that we weren't trying to screw them over (as an aside, this took nearly a month to arrive in my mailbox, despite the fact that they're about 4 miles from my house). The list had 6 or 8 items on it, only two of which were required for proof. No problem. I picked the "prove you've been living together for over a year" and "get a notarized relationship agreement" options.
I mailed them a copy of my lease (that she and I are both listed on) as well as a document I wrote up and had notarized, stating that we've been in relationship for the past 36 months. Everything is going fine, and my girlfriend will have insurance within a week or two. Or so I thought. Two weeks went by and I didn't hear a peep from BCBSRI. I finally realized that something probably got messed up, so I called.
They informed me that her coverage was denied. When I asked why, I was told it was because I "didn't supply the sufficient documentation," which, as you know by reading this, is untrue. So I asked what I should do, and they told me to send it all again. So I did. I call them again, explaining my whole story. I'm now told that what I mailed them wasn't enough. They need something like a joint checking account or joint ownership of a vehicle. I told them that was insane, because the paper I have says "Here's 8 options, PICK TWO." And that's exactly what I did. They ask me to send the stuff again. So I did.
Another week goes by with no notice from them whatsoever, so I call again. This time, the story is different: They claimed that they never got the notarized agreement, but they did have the lease. This is false. They were mailed in the same envelope, so unless some employee lost the paper (which is my guess), they have both documents. The guy asks me if I can fax over the contract again. Once I do that, he'll put in a request to get everything done quickly and he'll be in touch. I faxed over the agreement and never heard from him again.
Yesterday, I called again after I got a letter saying that she was denied coverage. The reason for her denial was that (you guessed it) I provided insufficient documentation. Again, this is entirely untrue. I spoke with a customer service representative and explained the situation for the billionth time, and he said that he'd put a note on it marked "urgent" and he'd call me back in the morning (today). I never got that call. About an hour ago I called again and really gave the guy a hard time-- I need this fixed not now, not yesterday, but THREE MONTHS AGO.
"Immediately" doesn't begin to describe how quickly this needs to be done. He said he has no say in the matter, which is true, but he'd put another note on it to get it expedited. He informed me that since she was denied coverage (the reason doesn't matter), I might have to file an appeals claim that could take up to a month to be resolved. I explained to him that an appeal was absolutely not even close to a viable option, and that this has to be fixed NOW. We don't have another month to sit around and wait. He says he's going to have someone call me in the morning, but I refuse to believe that.
The long and short of it is this: BCBSRI is an abysmal company, full of people who A) have minimal-to-no-intelligence, and B) apparently never, ever speak to one another. What they're doing (and continue to do) to my girlfriend and I is unacceptable, and you can bet if I had another insurance option, I'd leave them in a heartbeat.
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.
MEMPHIS, TENNESSEE -- I suffer from Allergies which is not uncommon in TN or for most individuals around the country. I go to a Little Clinic at Kroger to see a Nurse Practitioner because she is good and knows my allergy history. Per my insurance card, I pay an office visit of $25. The Little Clinic billed BCBS of GA the $25 office visit but it turns out that BCBS of GA changed the billing because apparently they made a secret decision internally without communication to its customers that you will be charged a Specialist Office Visit Co-Pay for seeing a Nurse Practitioner.
How the hell is that fair? One, they don't tell anybody and two, why should I pay a Nurse Practitioner a Specialist Co-Pay when she is not? To add insult to this situation, the Little Clinic is setup in the BCBS of GA systems as a regular office visit. They are GREEDY and this company is a complete SCAM!
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!!!
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!