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 website. 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 and do the right thing and start helping people that want the help, after all, you wouldn't exist without us.
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.
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!
PHILA., PENNSYLVANIA -- I was paying $155.00 per month for current coverage. Then their new system came through. I waited too long to pick a new plan and they picked one for me at over double the rate $375.00. Now, they are demanding a one thousand dollar payment by September first. I should point out that they refunded the last payment before they "doubled my rate". I had a hard enough time with $155.00. I think they should at least review the new rate before they put it in place. I am not paying a dime of it! I'll take my chances with Obama's fine.
CHICAGO, ILLINOIS -- Spent hours on the phone trying to gain an understanding of why my claims were refused. In the end it appeared because they would have not made any money off of me. Only had 900 dollars in claims and had already paid them $200 for 3 months. Thanks to the Obama (everyone must have insurance). The process here is you call them and email and they get back to you saying "I can't answer your question but I'll forward;" followed by no one ever getting back to you.
Forward ahead a few months and you call back and they say no luck for you but thanks for the money; I take that back, not even a thanks. I would advise you to run from this place because I am and even though I am not writing all the crap I just want to say they are awful and best of luck to all.
RHODE ISLAND -- Not that I think they will do a damned thing about it if I complain... Please tell me why I am paying $200 a month for insurance I can't use. I hate this HSA bologna. I need to pay $200 a month, pay for all meds, doctors visits and procedures out of pocket until I have paid $4500 (NOT including the premiums in that $4500) and THEN they might cover something??
I cannot afford $4500 plus $200 premiums. THAT is the reason I have insurance. And THEN I get a claim rejected because the procedure isn't "recognized" as effective in diagnosis? It was effective, it let me know whether or not my 6 year-old was extremely sick. However now I can't even afford to pay for the surgery he needs. I feel like it would be better if I quit my job and went on state insurance. Money hungry JERKS. They aren't out to help ANYONE. They have made it impossible to be healthy. WAY TO GO.