Highmark Blue Cross Blue Shield

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Disenrolled over $5
Posted by on
PITTSBURGH, PENNSYLVANIA -- I am disabled and have been on Medicare A&B since 2002 and receive social security. I subscribed to Highmark Freedom Blue PPO for this calendar year and I became $5 behind on my premiums. As of July 1st, I have been disenrolled over this. I have filed a verbal appeal and was denied. I am in the process of appealing with Maximus, as I have been charged $3 each month for a late enrollement penalty that is should have never been charged. Medicare has twice verified over the phone that there was no gap in my prescription drug coverage, so there should never have been this fee. Medicare has filed a complaint for me as well.

The fact is, that I was disenrolled over $5 and the penalty should have never been applied. Without the penalty applied, I would have actually have paid ahead by $13. Medicare has confirmed on the phone that there should never have been the penalty. I was also told over the phone by Highmark that the "delinquency letter" was only sent out because my payments are received just after that billing date (usually 2-3 days) and that if payment was on the way, I should ignore it.

Also, when I called Highmark many months ago to ask about the fee, I was told over the phone it was because Medicare did not get my original application processed before Dec 31, 2008, even though it was received before that date. I was told nothing about a gap in drug coverage.

The real shame, for me, is that my disability is a brain condition and that is the reason my billing is set up to automatically leave my bank each month, so I can't forget or mess it up. My mom has helped me with this. My short term memory is a big problem, and many days, I can do or read something and an hour later, I have no recollection unless I see it again or reread it. I'm sure there are many, many seniors with the same issue. I feel there should be some kind of limit of a certain percentage or dollar amount needed to be delinquent in order to disenroll someone. I just can not believe this can happen when my last 4 payments to them have been for almost two hundred dollars. If I understood, I obviously would have sent them an extra $5.

I have faxed the reconsideration requests to Maximus. If there is anything you can do to help, I would really appreciate it. I am without prescription drug coverage and running out of medications and fearing I'll run out of time with the second appeal to Highmark.

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Anonymous on 07/23/2009:
I hope this gets resolved one way or the other soon. When/if it is, be sure to adjust your automatic bill payment setup so that it sends payment sooner than it has been. It sounds like that is the root of your problem.

As far as a set percentage you can be late paying before they kick you out of their program? There is one - zero.
Eloise on 07/23/2009:
Why didn't you just pay the $5? All of this could have been avoided by paying five simple dollars.
old fart on 07/23/2009:
I am a senior who's had a stroke and I know all about short term memory loss...
Half the time I can't remember what I ate for breakfast..
jktshff1 on 07/23/2009:
No offense, but anyone want to donate 5 bucks? we are already paying for everything else.
dunc461 on 05/12/2011:
This is typical of the industry. They make you use the phone instead of email so you have no record that they told you everything was O. K.
ali watson on 02/21/2012:
when you speak to highmark freedom blue you must use the same resources used by the insurance company no.1 turn your phone volume up as high as it will allow no 2 buy a hand held tape recorder turn to full volume press record you now have a accurate record of your phone call just like them
Thiago on 05/17/2013:
I switched dentist in Victoria BC, because my old dentist tried to use tactics like that to avoid leaving patients with accurate records.
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Deceptive Insurance; Special Care from Highmark
Posted by on
PENNSYLVANIA -- The guidelines to qualify for Special Care insurance are as follows...those who are ineligible for any private or governmental group health care plan or program, or who would otherwise be uninsured, and meet established income guidelines. You would think this insurance co. would recognizes the fact that the people who are purchasing this type of insurance can't afford to pay 30% of a hospital stay and preoperative testing. I was billed $3,600 for preoperative tests and expected to pay %30 of the balance of the hospital side. It took me two months to get the answer for what is covered by the insurance company. When I realizes that I may be billed $14,000 on the hospital side I canceled the surgery. I also received a bill for the doctor visit for $408. I will be sending my payment in today for my health insurance that I can't use. Something is wrong with this picture and I think it reads deceive the people. It's like buying a car you can afford, but it doesn't run until you put $20,000 into it! The seller didn't tell you that, they just wanted to make money. It's hard to understand the booklet they provide explaining benefits. I don't think they want you to understand, because you wouldn't purchase the insurance.

Health insurance is BIG BUSINESS their attorneys know how to MAKE MONEY for them. Special Care, affordable insurance? I don't think so!!

P.S. remember it's all about the money they really don't care about you!
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Suusan B. on 03/19/2009:
Did you receive care from a participating Special Care Hospital or other Highmark Blue Shield Participating Health Care Professional? I looked up this particular health plan (available in PA only) and it appears there are all sorts of restrictions that should be disclosed to you. If you don't understand the information in the booklet provided to you, call them and demand that your questions be answered.
pippi on 03/22/2009:
I went to a participating Special care surgeon with an x ray and CT scan that I had showing the problem that the surgeon said needed to be corrected. He suggested three other tests he felt were necessary for preparation for surgery. I had my doctor visit on Wednesday and Friday she scheduled me for a test and another on Monday and Wednesday. After the tests were completed I returned to the surgeon's office and at that time a day was set for surgery. The hospital was a participation facility and the stay would be anywhere for one to three days at maximum.I received a bill from Highmark saying my insurance only covered $1000 for diagnostic and I maxed it with the 3 test I had. I still had the $1000 for facility side. The hospital said it was billed as outpatient diagnostic. If I would have had the tests and stayed in the hospital I THINK they would have been covered. I thought the test would have been covered being they were needed for the surgery. I was shocked when I received those bills and my doctor visit of $408. I began to check if the hospital stay etc. was covered. For 2 months I couldn't get a direct answer for Highmark. One of their workers would say it was 100% covered then another would say I have to pay 30% of the hospitals bill. I canceled my first surgery and rescheduled. I found out 2 days before the surgery that I would be responsible for 30% of the bill. I can't afford the $3,600 I owe for testing and could no way pay for the facility. Highmark should not be allowed to offer this type of insurance to people with a low income. Like I said my income had to be in a certain range to qualify for Special Care. They know that a person with a low income could NO WAY afford these hospital and testing costs. The doctors office and the hospital encourages you to apply for medical assistance. I feel that the want you to get medical assistance because the can get full payment from the government whereas the insurance co. pays less. And don't forget one of the requirements to get on Special Care states.. who are ineligible for any private or governmental group health care plan or program, or who would otherwise be uninsured,and who meet established income guidelines. TO make a long story short, I'm responsible for a bill of $3,600 for tests that I won't be able to use if I wait to long to have surgery. Some will have to be done over. I guess the insurance company will save some money since I can't afford to pay the 30%. I'm paying on insurance I won't be using. I just hope my problem doesn't get worse and I can live with it. Remember...IT'S ALL ABOUT THE MONEY!
Kathryn Ross on 08/02/2012:
I believe this insurance is worthless. Every so often they send out several pages of information listing more stuff they don't cover. They only cover three doctor visits a year. They're supposed to cover hospitalization although they always seem to find a way out of paying. It's all about the money.
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