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Refuse to pay for covered claims
Posted by on
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 a exam and xrays 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 down load 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 to 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 xrays that the first dentist did but not the treatment and surgery this is crazy... Then I went to to see the surgeon about fixing my nose I was not going to get bit by that dog again so they sent in a
pr-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 pre existing 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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Alain on 03/23/2010:
Hiring a lawyer was an excellent idea on your part. I've read this a couple of times and it still leaves me confused. Hope your attorney can resolve this for you and good luck.
yoke on 03/23/2010:
Was the second doctor an inplan doctor? Did you get authorization for the second visit? It sounds like the OP went and had the work done and then billed the insurance company for it.
As for the nose surgery if the surgery was done before the 31st they should have covered it. Our insurance changed on Jan 1 and my husband had a procedure done on the 28th and it was covered under the old insurance.
Disaster Worker on 03/23/2010:
Get used to the idea of out-of-pocket medical payments! Insurance companies will find ways to not pay insurers so that they'll come out ahead on our new socialist healthcare program.
BEJ on 03/23/2010:
Most dental insurance does not cover what it considers cosmetic dentistry. For example, my husband had to have a dental implant. Insurance paid for the surgery to remove the tooth but not for the implant as it was considered cosmetic dentistry. Did you have in writing what they told you they would cover? If not, not sure there is much you can do.
Starlord on 03/25/2010:
That is a terrible situation, and I hope you find resolution soon.
momsey on 03/25/2010:
What was the reason they gave for not covering the dental work? In my experience, dental insurance is very poor, it doesn't cover a whole lot, and there's a cap to how much they will pay out per year. That might be the case here, and while it's unfortunate, I don't think you'll have any luck getting more money out of them.
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Blue Cross Lies
Posted by on
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 Johnson saw her, she observed that my wife couldn't left 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 minuet we complained that she wasn't getting the treatment she should due the fall the director called facey and had someone there within a 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 everyday 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 See's 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? Noooooooooooooo, 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 e 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 obusing my wife. I have done nothing but fieght 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. rust 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.
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Anonymous on 03/20/2010:
This sounds like a problem with the health care providers that Blue Cross contracts with and that should definitely be addressed. If you still feel that it is in fact the insurance company that is the problem and not the providers, then you should contact the insurance commissioner in your state and file a formal complaint.
Starlord on 03/20/2010:
I see this is BCBS of California. Each state's BCBS is a separate entity. You are tarring all of them with the same brush. My mother retired from BCBS of Indiana. I agree, it sounds like your beef is with the health care providers, not BCBS. I would recommend you contact the state incurance commission. I got hurt on the job in California, and the surgeon who worked on me should be paying dues to the meat cutter's union. Traveler's, which was my employer's carrier provided excellent service and paid everything. The hospital and doctors were less than stellar. I would cool it on the pig women and calling people pigs. I can understand your frustration, but stuff like that does not help, believe me.
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Worse Experience of My Life.
Posted by on
Rating: 1/51
SAN ANTONIO, GEORGIA -- I applied on marketplace in Dec of 2013 for Insurance from 2 separate companies, one for medical and BCBS for dental. Within weeks I received information from my medical insurance, which I paid for. I never received anything from BCBS. I assumed that because I never received anything that they didn't get my application or I would get info in April because the deadline was set back.

I finally received information from them (a welcome packet, bill, and my BCBS dental card) in April. I paid my premium in May. After paying my premium I received a bill for $216.XX. I called BCBS to find out why I was being billed that amount. I was told that it was everything I owed them from Jan until present for coverage. I explained the situation only to have them tell me that they couldn't change the date on my insurance and I told them I wanted to cancel. Then I got a notice that said that my insurance had been canceled Feb 1, 2014.

I called to request a refund for the amount that I paid. The insurance was cancelled before I had ever paid it and the whole thing is a mistake with their system. I was told by a CSR that I should have never been allowed to pay for the insurance and that I should expect a refund check in 7 - 10 business days. That was July 21st. The lady gave me a reference number, her name, and her employee ID number. Today Sept 3rd, 2014 I called to find out where my refund was. I was told that the CSR should have never told me that I would be getting a refund and that the money I paid in May went to my Jan 2014 bill and that's why I got a letter saying I was canceled in Feb for non payment, which does not make any since what so ever.

After spending at least 4 hrs on the phone over a course of 3 months, I am being told I am not getting a refund and that I could appeal it if I wanted. So I paid for insurance I never had and BCBS is trying to keep my money and some how pinning their system errors on me. BCBS is a NIGHTMARE!
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Prescription Drug Coverage
Posted by on
Rating: 3/51
PHOENIX, ARIZONA -- Blue Cross/Blue Shield of AZ lists on their Prescription Benefits Web Page drugs covered. Even though Chantix is listed on their Covered Prescriptions my prescription was denied. After speaking with a representative at BCBS prescription Benefits, I was told that MY PLAN did not include a benefit for that prescription (smoking cessation products/devices). I asked why was it listed on the web under my prescription benefits? I was told that the majority of BCBS plans do not provide for smoking cessation products. With all of the anti-smoking campaigning that goes on these days, why on earth would a health insurance provider deny someone the opportunity to quit smoking? That is just ludicrous! It's time that insurance providers like BCBS get their act together and start providing people with the benefits that really count. I guess I will need to wait to get some type of cancer, since they WILL cover that! How STUPID is that! Blue Cross/Blue Shield it's time you stopped misrepresentation/misleading information posted on your web-site. Or at least get your tiny letter disclaimers correct "Coverage may vary by benefit plan". Maybe it should really read "This Item may not be covered under your plan." When you say "Coverage may vary by benefit plan" you are giving the false impression that benefit plans cover this item, but in some other degree. That's just like if you bought a box of waffles and on the box in very small print it said "Waffle count may vary by box."

So in some cases you get 12 waffles, other times you get 4 waffles and sometimes you get no waffles at all. Sounds like a sweet deal for the waffle maker but not for the consumer. Come on BCBS step up an do the right thing and start helping people that want the help, after all, you wouldn't exist without us.
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Suzy on 05/14/2013:
Blue Cross is looking out for their bottom line with not offering coverage on smoking cessation products. These products are expensive, as much or more so than smoking in some cases. The fact that paying on this now may cost them a bit versus costing them a great deal more for coverage of cancer related treatment and drugs escapes their mentality. But if a person is determined to quit they will find a way to do so. Chantix is not the only option and given the page of side effects, in my opinion not even the safer way to do so. You might try contacting Quitline. I've been told they will send two weeks of a smoking cessation product, an otc one I am sure, for free. I don't know if they will do this more than once but even for the once it's worth a try.
Johnnyappleseed on 05/14/2013:
My BCBS covers stop smoking products. It is all about how the company setup your coverage.
Susan on 05/14/2013:
BC/BS is not misrepresenting or misleading anyone. Their website clearly states that "coverage may vary by benefit plan" and the plan you have doesn't include this medication.
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Nothing but trouble even before any claim ever filed
Posted by on
Rating: 2/51
MASSACHUSETTS -- I joined BCBS on 12-7-12 during the enrollment period and selected the check box election to have premiums deducted from SSA benefits and immediately began getting premium bills for the $28 monthly cost. I called and was told auto-deduct would begin in March, and was given a confirmation number for the call/incident, but the paper bills kept coming so I called again and got a 2nd ref. # after hanging on my prepay cell phone for close to half an hour. The representative promised all would be well beginning in June. I then sent a double payment for the 2 month period til June. I then received another paper bill for a rate increase, completely unexplained, and another bill for a full month, plus the rate increase.

It seems that explaining anything to customers is the worst form of torture for the reps at this company.

I had already tried to register at the BC website in order to send a detailed msg of this incident, but after two hours of trying to jump through all the cyber hoops to complete the registration and trying this application at least 6 times and getting dead end msgs. I called the "problem with captcha" number on the button and learned from the representative that online registrations were not allow for Medicare recipients, so rather than posting this anywhere on their comprehensive website, they've decided to just let us folks dangle trying to do the impossible while pseudo errors are cited as appearing in their registration info & of course the members think it's their error. This lengthy description is the definition of corporate disdain. Nowhere does it state on the site that Medicare members can't register, so it seems BC has decided that their wasting a few hours trying to do the impossible is a good exercise to impart the lesson.

At this point all that's left, as intended by them, is to make another phone call - the only means of communication provided for us 2nd class members.
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Alain on 04/20/2013:
Maybe the Massachusetts Health & Human services agency can give you some assistance in dealing with the company: [615] 573-1770
Ummm, bacon!!! on 04/20/2013:
I usually get a better reply by writing letters and sending through the mail. Try that see if it helps.
Jaspin527 on 04/23/2013:
Thanks Alain
Jaspin527 on 05/01/2013:
For those that need it I think this # above comment is at 617, not 615, but thanks for the rest of it.
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Failure To Pay Bills
Posted on
Rating: 1/51
LOUISVILLE, KENTUCKY -- My premiums are 400.00 dollars a month and my annual deductible is 2000.00 dollars a year. But I consistently get medical bills over 2000.00 dollars. I have MS and the medication to treat it is very expensive. One company that makes it offered it to me for free which was fine and dandy for BCBS but the medication made me sick so I could not take it anymore. The new medication my DR put me on wants payment after three months of taking it I get a bill for 4000.00 dollars. I called them and told them my deductible was 2000.00 why isn't the insurance company paying half? They said they would reach out to them after a couple of days they called me back and said BCBS told them my deductible was 4000.00 LIE. Then I applied for financial assistance they came back and said well your deductible of 4000.00 dollars has been met but your health insurance company said you should be getting your medication from another pharmacy.

Basically the one that gave me free medication that makes me sick so they have no financial responsibility. These people are greedy money hoarders and have no business in healthcare if you are sick and have BCBS you are out of luck.

I will cancel my insurance and deal with the government I can not afford to treat my illness anyway so why give them 400.00 dollars a month. Single payer please.
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Jeff on 02/22/2013:
Welcome to corporate bureaucracy America.
Old Timer on 02/22/2013:
Can you say Obama care? Hope BCBS Wellmark comes through sooner than later.
JR in Orlando on 02/22/2013:
Insurance company has a duty to everyone else to keep costs down so that premiums are lower. Apparently this is a medicine which they do not approve for use. If they authorized payment for every medication, no matter how experimental or which can be replaced by cheaper medicines, then premiums would go up astronomically for everyone. There is not free lunch, someone pays for it. Insurance is not supposed to be where one pays in a little and then gets whatever medication they convince a doctor to give them. The insurance company works to keep costs low.

The OP still has the right to pay for her own medication, or try again with the free medication or some other medication approved by the insurance company.
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Insurance companies and cost of Remicade
Posted by on
NORTH CAROLINA -- After 2 years of an undiagnosed illness, I was referred to a University Hospital. First visit was basic - previous history, getting new bloodwork done, etc. Second visit, doctor starts me on an infusion of drug Infliximab or "remicade". I had never heard of it, but went ahead with the process. Tiny bag - 400mg, no big deal, it was just a slow drip that was all. Went back again next month for another dose, same amount. Doctor said bloodwork looked good. I was feeling much better. Doctor says I have an immune disorder. Go again 3rd month. Feeling like a human being again. Doctor is glad I've improved. New bloodwork looks really good. BIG problem. Blue Cross sends me statement for "pharmacy" charges it will not cover for $38,000 for (2) Remicade infusions. And they still have one more bill for about $20,000 yet to send me!!. Found out the hospital failed to get a pre approval from insurance company before using this medicine on me. Several hospital officials told me, since it was the hospitals fault, I would not have to pay. The drug would just be replaced by the drug representative. Not so. My statements are now in collection agency hands
and I have to find a lawyer. I am at my wits end. Insurance company paid for everything but the medicine. Oh, I checked with a local pharmacy to see if I could by "remicade" if I had a prescription. Yes, I can, but it would be in a 100mg vial at a cost of approximately $825.00 to me. Multiply that times four and you still don't get $20,000 like the hospital was charging my insurance company for 400mg.
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FoDaddy19 on 02/01/2012:
I someone who is also on Remicade, I can sympathize with you. The stuff is bloody expensive, but man, does it ever work. I get the infusions every 8 or 9 weeks, and while Remicade is pricey it's not $19,000 a dose pricey. I had a similar experience in that the hospital where I get the infusion didn't get pre-approval for the infusion, and I didn't find out about it until I got my insurance statement. Apparently I was on the hook for $1100 (which I guess is what my insurance company pays). But fortunately I was able to get everything straightened out with both the hospital and the insurance company. The explanation I was give was that there was some kind of screw up with their systems and the new calender year.

You need speak with the billing department of the hospital you use, that's where the foul up was when I was going through a similar situation. Speaking with the actual doctor's office probably won't help you. However since this has already gone to collections,it may be too late. Good luck.
Anonymous on 02/01/2012:
I am starting Remicade infusions in a few weeks. I made sure my dr got a prior approval from my insurance. But this review is a good warning to others to make sure a prior auth is obtained
Kristina on 05/03/2012:
I am in the same boat! however, the insurance company accepted me knowing I have this disease and my office did get an approval for the remicade. the insurance company was paying for it for a while until they discovered how often I needed it done. they had some outside doctor look at my files and decide it was "medically unnecessary". my doctor tried appealing it and they still denied me. the only thing left for me to do is go to court.
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Posted by on
I bill for DME companies all over the United States. BCBS is by far the hardest company to bill for. Getting intouch with the correct department is almost impossible. I spend hours just trying to get intouch with correct department to tell them about their mistakes. I absolutely am baffled by the way BCBS is set up. If your employers cooperate office is in a different state then where you are getting service, or for whatever reason, claim go through local BCBS, then to pts actual Home plan, response/denial/payment, sent back to local then to provider. I can not get benefits from local, and I can not get claim status from Home Plan, so say a home plan wants info. they always so "please have provider send additional information", then most times local BCBS doesn't even tell us until we call to see why 3 months later no response on a claim. OR we are told send all medical documents, but local forgets to send to home plan or its home plan tells local that this is not what they are looking for and local does not tell us. We call back to local- because home plan will NOT discuss claim even tho they are the ones to ultimately approve of processing of claim- they say home plan was looking for something else, we say what are they looking for? Response: I don't know I'll send inquiry to home plan, and the viscious cycle continues. Sometimes our claims are held up for over 6 months!!!!

Why do they make it so difficult to get information. We are not doing anything illegal, these patients pay their hard earned money for health coverage, yet the providers who give the services to better their health can not get paid without exteme attention to detail and mistakes made on BCBS end. Also, deductibles are so high pts might as well pay out of pocket! Instead of having to pay out of pocket and for "coverage". Some days I am so disgusted by this company I feel no hope for the health industry. It should be illegal to opperate this way.
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spiderman2 on 03/22/2011:
What is DME? I am the Group Administrator for our BCBS plan and I have no troubles getting through to anyone.
KateBird on 03/22/2011:
Durable Medical Equipment
Anonymous on 03/22/2011:
DME is durable medical equipment.
Anonymous on 03/22/2011:
Its because its an insurance company, and they only like to TAKE money, not GIVE it away, so of course they are going to make it as difficult as they possibly can to get you your money.
Starlord on 03/23/2011:
Kate, my mother retired from BCBS of Indiana, and she made me aware of something you seem not to be aware of. BCBS is not a huge national company. According to my mother when she worked there, there are actually like 50 BCBS companies, and they normally honor the other entity's policies. If this is in error, I apologize, or if they finally merged or whatever. My mother did the job of a supervisor for two years without the pay or title, so she applied for the position. She was told they had never had a female supervisor and would not start with her. I tried to get her to sue, but she "didn't want to rock the boat."
Nohandle on 03/23/2011:
Starlord is correct. There are even now a multitude of BC/BS plans. They vary nationally and then within state. Claims in my state are paid promptly, thank goodness. I even have an additional card for Air Medical Services should I be injured or hospitalized more than 150 miles from home or any emergency should air transport be necessary.

Some states probably might be extremely lax with paying claims but I declare I think a lot of it depends on the claims clerk at the medical facility or with a clerk at the insurance company. Some just don't give a rip and leave it for someone else to deal with later. That certainly doesn't help the company needing payment. I don't blame you for being frustrated at this point.
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Posted by on
GEORGIA -- I was at a regular doctor checkup and I am 33 years old, they found a lump on my breast and referred me to have a mammogram and ultrasound to diagnose the lump, I got 2 bills one form the facility and one from the radiology clinic. BCBS paid a total of $67.00. I am paying out of pocket $500. They state a routine mammogram is paid at 100% by them. but if you have a diagnostic due to a lump or anything else they are not responsible for 100%. Why is it if you have a medical issue that is really needed to be looked at they will not pay? I think this should be looked into further and ALL mammograms should be covered by 100%, it's bad enough to go through the stress of finding a lump, then finding out you have to pay so much out of pocket when it does not state that anywhere in the benefits book. Shame on them to make one any more important than the other!
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Ytropious on 09/22/2010:
I think it has to do with age. "Routine" mammograms don't usually start at 33.
Anonymous on 09/22/2010:
Routine mammograms start after age 40. This was not routine since they found a lump. So they don't have to pay because it's not routine
JNYGRL on 09/22/2010:
the age is completely understood, but it is not something you can choose to have happen to you if you are under 40. That was why I think it should cover all Mammograms no matter the age, Breasts are on a woman before she is 40.
Anonymous on 09/22/2010:
Doctors recommend mammograms after after age 40. Insurance companies are following that recommendation. It may not make sense, but that's their guidelines
Ytropious on 09/23/2010:
Yes OP, breasts are on a woman before 40, but most women don't develop breast cancer before 40. The insurance world is a game of statistics. Statistically some women will have breast cancer early, but the majority will not have it before 40. Unfortunately, this means that routine mammograms before the age of 40 will be a waste of the insurance company money. What, you think they're there to make sure you stay healthy? They're in business to make money, which is largely contributing to the health care crisis in this country.
jktshff1 on 09/23/2010:
with our "new health care rules" it's only going to get more costlier.
PepperElf on 09/23/2010:
that's the idea jkt - they want to make it so that the government option is the only affordable choice
pissedoffchicka on 10/26/2010:
actually, routine mammography guidelines are , 1 between ages 35 and 39, then one every year after. if the woman is at high risk, because of a family history, that is still considered routine under the ages of 39. it's not so much the insurance that decides this but medical standard and the medical board on staff in our medical policy department. the payment difference between routine and diaogostic is stickely a problem with the benefits you or your benefit admin (HR if you get it through work) selected. there are a lot of different insurnace products with many different benefits in what's covered and how. be sure to talk to your broker if you perchased this policy your self. if what they say doesn't match up to what I'm saying. then call a sales department for your insurance, give a fake name and say you don't have a ssn and see if they tell you something different.
Sharleen Placek on 10/01/2012:
The simply answer is that the doctors on the board for any insurance company are idiots when they choose not to pay for diagnostic exams and it only proves that they only pay for what they really are forced to by the government. If they spot something on yearly screening exam and do the diagnostic exam it means they will catch something sooner possibly requiring less treatment and costs, but idiots don't get that. But wait I think they vote to pay for that stuff called Viagra when it comes to a man be able to have sex, yes that is very important!
Michelle on 06/05/2013:
This has happened to me three times. I have always had quite a few lumps in my breasts, and have had to pay out of pocket $700 for my mammograms since they were diagnostic. I have asked the doctor to code them as routine, but she says the lumps "concern" her. Apparently the stress I am under when paying for these tests does not. BCBS sucks.
Annie on 10/15/2013:
BCBS refused to pay for my yearly mammogram because I had breast cancer 3 years ago. Although I am cancer free due to medical standards all my mammograms are now considered diagnostic for 10 years. Unless I meet my $2000 a year deductible they will not pay for them. I am over 40. According to my dr's office bcbs is the only co with this policy
Danielle Ferrara-Schellbach on 12/06/2013:
When you're dealing with insurance, there's a difference between preventive, and diagnostic. All preventive testing IS covered at 100% having any copays and deductibles waived. However, if they find something, it's then classified as diagnostic. Any diagnostic goes towards your deductible and coinsurance. Unless, you have a group policy through work which has this benefit structured differently. The only insurance company in the individual market that will help pay for the first $300-$500 per person per year for diagnostic tests is Humana.
Lee on 03/07/2014:
I had the exact issue with BCBS in spite of calling in advance to confirm that a follow-up mammogram (diagnostic) would be covered. The reimburesement problem isn't because of your age, it's because diagnostic mammograms (not routine) have a deductible (which in my case is $350). I too feel deceived by BCBS and feel that additional diagnostics related to mammograms need to be covered.
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Does not cover Mental Health???
Posted by on
We have had both of my (healthy) daughters on BCBS for many years, paying ridiculously high premiums. Last year, my oldest daughter told me she thought she had ADD. To save ourselves and BCBS, we did a study through Future Search. After free testing, my daughter was indeed diagnosed and put on ADD medicine. The changes were remarkable!!!!! She went from a B and C student to straight A's almost overnight. It also boosted her self esteem as she thought she was "dumb". After a year in the study and no out of pocket to us or our longtime Insurance carrier, we then took our first RX to be filled. To our amazement, the $156 a month medication that was Prescribed and that she had done so well on was not covered???? I informed out Dr. who then wrote a different Rx for a much less expensive medication that we could afford (no thanks to BCBS who had faithfully been taking our money every month for YEARS) but would not cover a much needed medication for our daughter. I then called to ask if we used or any Mail in Rx to save money what portion would they pay. I got an extremely rude man who told me the system was down, try back in an hour or two. I asked if he could answer "general" questions about this Rx coverage. He then in formed me BCBS offers no mental Health Coverage. Wow, really. I wish I had had my daughter tested by a Physician that was not doing a study. I would have been out of pocket some money, but would have learned a year ago to quit giving money away to a Provider that does not Provide!!!! What a waste!!

I am actively searching for a different company this minute. I will let EVERYONE I come in contact with hear this story as well. When choosing a Health Plan, check into what "Mental Health" is and if it is covered. I do not believe my daughter has a Mental Health issue, but they say ADD is. I guess as just an excuse not to pay. Very sad.
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drugdoc121 on 04/12/2010:
You said "I do not believe my daughter has a Mental Health issue, but they say ADD is. I guess as just an excuse not to pay. Very sad" Now I am not excusing how BC/BS treated you but on this one point, I am afraid, they are right.
Attention Deficit/ Hyperactivity Disorder is listed in the The DSM or The Diagnostic and Statistical Manual of Mental Disorders. It is published by the American Psychiatric Association and covers all categories of mental health disorders and physicians consult it as their "bible" to help diagnose psychiatric illnesses. So yes, ADD IS considered a mental health illness. On the plus side, your daughter is doing wonderful and that is nothing to sneeze at. Good luck.
sumdog on 07/14/2010:
Which BlueCross? Keep in mind, each state has its own BlueCross and they're all independent. BlueCross BlueShield of TN isn't the same as Empire BlueCross BlueShield of NY or Anthem BlueCross BlueShield of Ohio. They're totally separate companies.

I'm guessing you were on an individual plan? If you get a plan through an employer, it usually includes a lot: medical, mental health, prescription drugs, vision and dental. But most Blues only offer one or two of these services. Everything else is contracted out.

For instance, BlueCross Blueshield of TN contracts out all prescription drugs to Caremark/CVS. Employers usually go with the health insurance contract for the subplans, but some companies are large enough to be self-funded and they might select their own RX or mental health insurers. For long term drugs (ADD medication, anti-depressants, et cetera), they'll even have a second company that provides those drugs cheaper by mail.

Very few insurance companies offer these subplans by themselves, especially to individuals. So you're likely to run into this with which every health care provider you get.

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