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 Drugstore.com 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 informed 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.
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.
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.
COLUMBUS, GEORGIA -- There are too many months, days, and countless hours during the year of 2014 that I spent on the phone with numerous incompetent and rude employees of BCBS GA. They literally drove me insane to the point I ended up having to go to the hospital for stress related illness on top of my physical illness. They are continuing to cause me stress to this current day over claims that they filed inaccurately (paid the incorrect provider of service... one that I had never heard of, or been to, and that had never heard of me or received the payment that BCBS GA sent me an EOB as having paid incorrectly to them)!
Now, if your head is spinning over that one, BCBS GA was rude to me again when I called them to bring this to their attention and rectify! I filed two formal complaints over issues with them and never heard from them regarding any resolution to the complaints. I am so sick of them... they are like a nightmare that won't go away and leave me alone! I will never, ever, have anything else to do with this company or speak to anyone representing the company! They have proven to me that even the numerous supervisors and recorded phone calls that I had with them that they are also incompetent! You've been warned now so use them at your own risk!!!
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.
CHAPEL HILL, NORTH CAROLINA -- My daughter was in rehab at Pavillon in Mill Spring, North Carolina. They do not accept BCBS insurance so I had to pay the entire amount $24,000.00 out of pocket which I cannot afford. At her discharge they gave me paperwork to file with BLUE CROSS BLUE SHIELD of NORTH CAROLINA and for 4 months now BLUE CROSS BLUE SHIELD of NORTH CAROLINA keeps contacting me with petty reasons why they should not pay, reasons that are completely unrelated to the fact that she had a legitimate reason for admission like the hour code of her admission was incorrect or the code for her daily detox was incorrect or TONIGHT the incorrect place code was entered.
As a physician, it is obvious to me that BCBS is fraudulently avoiding paying my daughter's claim. Also, Pavillon is A SCAM OPERATION more interested in profit than in helping patients.
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!
CHICAGO, ILLINOIS -- BUYER BEWARE! On the healthcare marketplace website they list plans for you to choose from. They are not outright fraudulent, but there is vital information that they purposefully do not disclose regarding the BCBS Blue Choice PPO plans. That is the fact that very, very few doctors, many hospitals, clinics and other medical institutions do not accept this form of coverage. It makes the insurance close to useless and you end up paying $500 or so a month for insurance that you cannot use and still have to pay the majority of your medical bills. If you have to go to a specialty doctor, it may almost be impossible to find one that accepts it. Their regular Blue PPO plans are accepted by a wide variety of medical professionals, however their BLUE CHOICE PLAN should only be taken with awareness of this caveat - it may be hard to find medical treaters who will accept that insurance.
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.