Blue Cross / Blue Shield - Page 2

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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 by 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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Most Unprofessional
Posted by on
Rating: 1/51
NEWARK, NEW JERSEY -- I have invested a month or more calling this company and these customer service representatives. Every time I speak to a different person and there is no direct number I can call. It is like starting over EVERY TIME I speak to someone. I have to reiterate everything again. They have a computer in front of them and I have reference numbers for the calls and they till can not give me one simple answer. I am trying to get in-network coverage for a dental device that helps a medical condition. The provider I am working with has called them also about their services. Earlier, this week I talked to them for the 10-15th time. They told me I would receive an answer in two days. I called today and they don't have any of the information I PROVIDED for them this week!!! Last week they emailed me a list and I called 26 companies to see if anyone within a 50 mile radius had this device. None of them did and most didn't even know anything about what I was talking about. When I called back to give them this information, they said that policy stated THEY now had to call all the 26 companies also. I have provided them tax ID#'s, diagnosis codes, and appliance codes. This has gotten ridiculous and now they want to start all over. These ploys or incompetence to give me a timely answer have made me very frustrated. I would NEVER NEVER NEVER choose this company again or suggest to ANYONE else to use them. The only reason to use them is if you want unprofessional, incompetent, unreliable and negligent insurance provider to work with whom will ignore you and NEVER GET YOU ANSWERS IN A TIMELY MANNER. I am now waiting for a supervisor to call me. YEAH like that will happen!!!!!!!!!
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jktshff1 on 08/31/2012:
I've gotten better responses with the online chat feature many companies provide
Anonymous on 09/01/2012:
Call center reps don't usually have direct extensions. When you call a call center, you get the first available person. I work in a call center for health insurance and I hate it when a customer tells me to look at previous notes and figure out what's going on. I don't know if the customer is calling about the same issue as a previous call. I don't read minds. And sometimes the previous rep doesn't document the call thoroughly enough. And I like to hear what the issue is for myself so that I get a clear understanding of what is going on. My company tries to give callbacks within 2 days but that isn't always possible if it's too busy. We don't always get time off the phones to make outbound calls back to customers. But a sup can usually do a callback in 24 hours. Regarding this complaint: is this a device that requires an authorization from the insurance? Or are they trying to figure out if it's covered? Devices like this may not be covered under your medical insurance but instead covered as dental. Is this a medical and dental plan?
sita pfalz on 09/20/2012:
Your frustration is understood. They are the most incompetent "claims SPECIALIST" in the entire business. I can bet my 11 year old son can do a better job. They just occupty a seat and are not well trained at all. They read off the comments that the previous idiot wrote and offer no solution. Our company is dropping them too.
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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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Apparently they Don't Want My Business
Posted by on
OKLAHOMA CITY, OKLAHOMA -- I have never in my life heard of a company making it this difficult to do business with them. It's laughable.

It's a simple thing, really. I only want to give Blue Cross Blue Shield of Oklahoma my business. My husband and I reside in Arizona. He and his previous wife are divorced. Under the custody order we are required to pay his son's insurance premium. We currently have him covered under Regence Blue Shield in Washington, but he and his mother recently moved to Oklahoma.

First, we tried to transfer the policy. We were almost through with the process when we recognized that the policy Blue Cross Blue Shield of Oklahoma was signing him up for was not the standard Health Check policy we were trying to transfer. This after waiting more than FOUR months for ANYTHING to transpire! At that point we were instructed to call a different number in order to proceed with the policy we needed - in effect, start over. We declined and thought it might be quicker to start fresh and not work directly with the company.

We filed an application through Esurance, for the Health Check policy, as their rates were most competitive. Still, Blue Cross Blue Shield of Oklahoma put roadblocks in our way. We explained to them from the start that we needed the insurance premium billed to us but that the insured resided in Okla. This is how we currently have it set up through Regence Blue Shield, with no problems.

After many emails and phone calls it turns out the ONLY way for us to get coverage for him is if we provide an Oklahoma bank account for automatic withdrawal. NO EXCEPTIONS.

The first thing that pisses me off is not once, through the entire process (which was started in March)were we told we were required to have an account in Oklahoma for this policy. My Arizona bank provides electronic withdrawal, and last I checked, the value of a dollar was the same from state to state. But no, I HAVE to open a special bank account in the fine Oklahoma City so they can withdraw the premium. How CONVENIENT!!! Now THAT is what I call great customer service!!!

Let me reiterate: I have never in my life heard of a company making it this difficult to do business with them. It's laughable.

Proceed with the application, let me provide you with a billing address or bank info and let's do business! Why is this so hard?

Oh, and forget transperency. YOU try to find a customer service email ADDRESS on their website. If I had it, believe me, I'd provide it.
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tnchuck100 on 08/01/2008:
It definitely sounds like they are jerking you around just because they can.

Personally, I would NEVER give any company direct access to my bank account.

Check with the Oklahoma insurance regulators and see if, in fact, this company can force these requirements on you. It should not matter how they are paid as long as they are paid on time. Don't give up yet.
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BCBS of GA Sucks!!!!!!!!
Posted by on
Rating: 1/51
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!
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