Blue Cross / Blue Shield Consumer Reviews - Page 6

My company provide health insurance in which company pay major amount & I pay some about but it is still huge ($380 month from my pocket). I took my son (1 year) to emergency because of de-hydration. Because of he was vomiting, not drinking anything so I have call doctor ask him what to do. We try different option as per doctor suggestions & but after 4 hours, there was no tear coming from his eyes while crying.

We took him to ER at 1 am in Sunday night. ER people realize that kid is de-hydrated so they immediately did some test & admit him in room. They start give some water through vein. Finally after 4 hours they let us go home when they conclude that now he is fine.

Insurance company didn't have pay saying that it was not required to go to ER. I said that we have to go in ER because lack of water in his body. Doctor also suggest that. There were treatment occurs on him at hospital. They say that when hospital submit claim they didn't mention that it was life threatening situation. I said that should I have wait until my son about to die & then took him to hospital? It was rude answer from customer. They said that you can write letter to specific department to re-review your claim. They said that you have write letter via mail only. They will reply back within 6-8 week2 (2 months).

Why they have online system to make payment any time or get quote or get policy? There is no time delay. They make all re-review process time consuming so people like me get frustrated and don't send that much time in following up. I pay money from my pocket.

I went for regular check up. They said if anything goes in your body (including ear cleaning) it will count as surgery & you have pay outpatient surgery deductible. Don't you think that it rude? If you have billed check they will count as surgery & I have to pay large deductible for every time. I HATE THIS COMPANY... NEVER USE THIS COMPANY.

INDIANA NO PLACE, INDIANA -- This is a good one and more of the same stuff. In 2007 we moved from sunny California to dismal Indiana (I know, big mistake). We got taken by every con man and average contractor Hoosier in the Indy region. To top it off, Anthem Blue Cross was the health insurer through my wife's company in Indy. We did not have coverage in Indiana from our SoCal provider (out of geographic range) and were in the process of cancelling the policy.

I had a heart attack in 2006 and needed to see a doctor (i.e. quack in Indiana) for blood tests and ongoing care. Anthem authorized a nuclear heart stress test for me after a blood work up and a few office visits with my primary. Not only was this test archaic, but a total waste of time and it may have actually caused damage to my liver and kidneys.

At a later date, 6 months later actually, we start getting bills from the hospital that did the testing. Anthem had decided not to pay the bills and that the charges were excessive. Then a few weeks later, Anthem stated that our coverage in California was covering the same thing and that we were trying to dupe Anthem in to paying twice for the tests. Huh? Seems someone in Anthem Billing noted that we used to have coverage in California and that it did not cover us in Indiana. From that they tried to disallow all charges. Now this is over $5k and nothing but typical Hoosiers trying to take advantage of someone for money.

We have been fighting them on it ever since and they have consistently lowered the amount they say we owe. Now a new bill comes in for the original office visits with the primary care physician! Ridiculous. Don't waste your money on these idiots!

MADISONVILLE, KENTUCKY -- To this date October 8, 2008 I have been fighting BC/BS of Oklahoma to pay for my son's COVERED speech therapy services since April 24, 2008. My son has been going to speech therapy since August of 2007 for a congenital speech disorder caused by autism. These services, according to the benefits package that came with our PPO and the benefits adviser from my husband's job are covered 100%. No co-pay, no exclusions, no deductible are being kicked out of the system as "Not a covered service", for no reason at all.

In total I have spent over 900 minutes on the phone trying to straighten this mess out and not one person will give me an answer as to why these COVERED services are being denied. We have had alerts put on our account to inform the processors that this is a covered service, we have had supervisors manually process the claims. But for some reason they are still getting kicked out as not a covered service. There are four dates of service, 4/9/08, 7/9/08, 7/20/08, 8/20/08 that my doctor's office has resubmitted 6 times now and they are still not being covered.

These total 178.00. The visit from April is about to go into collections and BC/BS is leaving us absolutely no choice but to pay these claims or risk a ding on our credit. We have worked long and hard to have the credit ratings we both have and I don't want them destroyed because of this company's incompetence. I would pay these claims out of pocket, but I will not be reimbursed. I will get a 178.00 credit on our account at the doctor's office. If anyone here has any advice that will help us get these claims resolved I would greatly appreciate it. Should I just pay these claims and eat the 178.00, or should I keep fighting this and refuse to pay?

METRO AREA, MARYLAND -- Blue Cross /OPM has constantly changed the rules to suit their needs (avoiding paying claims). In documentation that I included BCBS ruled that the procedure was not medically necessary, even though they made the decision based on the wrong records, which they admitted. They also appear to be making medical decisions (a violation of HIPPA) even though 2 physicians who are in the BCBS plan agree that I should continue with the medical treatment. Now both of these events are aggravating and frustrating but what is upsetting is that the rules for filing an appeal have changed for BCBS not for the patient.

You may ask yourself what I am talking about - According to the disputed claim process:
1) The individual has 6 months to dispute the decision.
2) Within 30 days from receiving a request BCBS has 30 days to respond.
3) If BCBS requests additional information the individual has 60 days to respond.
4) After those 60 days have expired BCBS will make a decision.
5) If an individual disagrees with BCBS the person has 90 days to respond.

The procedures are not complicated but as I stated the rules have changed for them. Working backwards OPM has an address to file your disputed claims, the address is correct but mail seems to get lost, no problem, you decide to send it overnight, another minor problem no room number, you cannot deliver a package without a room number. After calling OPM and being transferred 10-15 times you get a room number. Most logical individuals would think that OPM does not want you to dispute a claim, but I am sure that's incorrect!

If that sounds that I am sarcastic I am. My new contact at OPM David ** has stated it is my responsibility to make sure that I receive the final decision from BCBS. The handbook does not state that I have to walk my appeal from start to finish; the handbook only states the time frame in responding. Prior to 2 years ago, I had received notification by mail, that my appeal was rejected, now I seem to get the runaround. BCBS in the past 2 years has not mailed me a final decision. Can someone explain why BCBS does not follow their own rules as stated in the handbook they wrote!

JACKSONVILLE, FLORIDA -- Beware of using your BCBS Medicare supplement while out of the state. They will not cover out of the state coverage other than Physician, Accident, and Emergency. I found out the hard way. My out of State Physician and heart Specialist sent me for tests at what I thought was approved network providers for specialist tests.

I had checked on the BCBS site to see what out of state provider was listed and had asked the provider if they were approved providers and was told they were. Later I began receiving bills that had not been paid by BCBS.

I wrote them a letter contesting the non-payment and never received a reply from them. As I began to discover they had turned down numerous bills and never notified me that they were denying me the coverage I called them and stated I had checked on their site to make sure that I was using BA approved provider. I was then told that BCBS of Florida does not provide out of state providers in network.

Since this has transpired over a period of several months and BCBS never notified me that they were not covering me while out of state it has resulted in me having to pay quite a large sum out of pocket. I have paid a monthly fee for me and my wife of over $135 each pm for Medicare advantage 65 premier select and now have found out my coverage is only good if I am in the state of Florida. I have now asked for BCBS to terminate my policy with them and have taken out another Medicare advantage program with another provider.

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!

This is the most ridiculous position taken by an Insurance Company yet of not paying for ER stitches (WITH MY SON BLEEDING AWAY WHEN WE GOT THERE). My 3 year old son fell down and got a gash on his forehead. We rushed to the hospital at night and they determined he needed stitches. The hospital said they had a plastic surgeon on call who could do the stitches. We obviously needed to move quickly with whoever was available and the doctor did a great job giving my son about 6 stitches - poor baby was so weak with the bleeding so we had to stay several hours with drips till he had some energy to leave.

Next thing we get a $2200 bill from the plastic surgeon as BCBS refused to pay because he was OUT OF NETWORK in the ER. We wrote a letter to protest at the suggestion of the customer service representative to which the response was that the claim was still denied.

I can protest this a 100 times as this is absolutely ridiculous - How can anything be denied for an emergency? How am I supposed to know which doctor will be on call the day of my emergency??? Should I have let me son bleed away and how am I supposed to even know to check the network status of an ER doctor?? How can BCBS would actually think of not paying in an emergency situation???

BCBC has separate service departments for customers and providers. Customer Service is not allowed by policy to speak to a provider nor let a provider listen to a conversation between them and a customer. A customer is not allowed to speak to Provider Service nor listen to what Provider Service tells a provider. This is the case even when the provider and customer approve of the other listening in for the purpose of resolving contradictory information. WHAT ARE THEY HIDING?

It is obvious that they tell providers one thing and customers another and they don't want each to know. They want customers to blame the provider for not doing what BCBS says the provider should do but won't let the provider do!!! I won't do business with them anymore. This is nothing less than FRAUD!

INDIANAPOLIS, INDIANA -- Anthem Blue Cross/Blue Shield is, by far, the worst insurance company I have ever had to deal with as a provider. The unethical jerks who run the company decide about 18 months ago to pay patients the fees due to out-of-network providers so they could then, ostensibly, pay the provider. Yeah, right!!! The only reason these psychopaths came up with this policy is to strongly discourage out-of-network providers from seeing Anthem policyholders. Period.

I have lost thousands of dollars as a result of patients keeping the money that Anthem sent to them for MY services. Anthem damn well knew that this would happen. It is the primary reason why they implemented the policy. They truly have degenerated into one of the worst insurance companies subsequent to them going from not-for-profit to profit around 1999. Stay away, run away from these jerks!!! Check out all other options for insurance. You will be glad that you did, believe me!!!

MINNEAPOLIS, MINNESOTA -- Blue Cross Blue Shield has to be one of the worst health insurance companies in the country. I called them up prior to purchasing a device for treating sleep apnea because I wanted to make sure I picked an in-network provider. The customer service rep directed me to their website, which in turn referred me to hundreds of different dentists. So my options were to either start getting on the phone to determine which dentist of these hundreds might actually treat sleep disorders, or I could go with the dentist recommended by my sleep clinic. Of course, this particular dentist is out of network. Fine, after the deductible they'll pay 80%, right? Wrong. My dental appliance was $2200.

BCBS paid $500 based on an allowable amount of $700. This was after I was assured by yet another CS rep that they would pay the 80% without mention of the cap. So I called them. Again. Unfortunately, instead of just being ignorant, the CS agent I got this time was also incredibly rude. Ultimately, they can place some arbitrary amount on what they consider "allowable" depending on which providers they're in bed with. And you better hope you pick the right one.

It's disgusting and the only thing a consumer can do is hope you never need medical care, set aside a kitty for your own health care needs and hope that karma takes care of all these dirt bags that are profiting off people's suffering. They're not in business to keep you healthy, they're in business to line their own pockets.