Premera Blue Cross

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Premera prescription service SUCKS
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MOUNTLAKE TERRACE, WASHINGTON -- I have been taking several medications for years. One of which is an injection that must be refrigerated, no big deal. I have been getting it for over 30 years at a retail pharmacy (I get some through the mail order - but it's a pain in the butt and customer service is non-existent). I was recently put on another injectable med (Enbrel) and was told I have to get it through a 'specialty pharmacy' because it is an injection and must be refrigerated (funny, that sounds just like my other medication!). Shelf life of Enbrel is over 3 years, no other strange dealings with it. Then to top it off, I have to be at the specified address (ALL DAY) to receive it AND I only get a 30 day supply AND I have to deal with these PAIN IN THE ASS TELEPHONE CALLS FROM THE SPECIALTY PHARMACY IN ORDER TO RE-ORDER THE MED! What MORON thought this process up? All of my meds are 3 month supply because I travel quite a bit (internationally too), but not this one. Someone at Premera is getting a big kickback for this! Customer service? GONE! Care about the patient's well-being? POOF - GONE!

I am NOT AT ALL in support of Obamacare, but it's stupid things like this that PISS PEOPLE OFF enough that the idiots in DC think they know better and should butt in. Wise up Premera, you really stink at giving your customers warm fuzzy feelings, you are part of a problem that should not be this bad (yes, our health system is broken - BUT DO YOU HAVE TO BE THE POSTER CHILD FOR WHAT'S BROKEN IN THE INSURANCE INDUSTRY?)! AND, YOUR NEW NON-GRANDFATHERED (BECAUSE OF THE 'HEALTH CARE AFFORDABILITY ACT')PLANS REALLY REALLY REALLY SUCKS. IT'S SLIGHTLY LESS EXPENSIVE ON PREMIUMS, BUT WILL DRIVE YOU INTO BANKRUPTCY IF YOU HAVE TO USE THEM!

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Anonymous on 03/24/2011:
Love your nic! Reminded me of Little Lulu & Nancy and Sluggo.
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Repeated denied claims...
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SEATTLE, WASHINGTON -- I just recently had my braces removed. It was tough having them as an adult, but when I was a kid, even though I needed them, we couldn't afford them. As an adult, working a good job, making decent money, I was able to afford them. My dental insurance was through Premera Blue Cross.

The insurance plan for the company I worked for had an orthodontics benefit with a maximum of $1500 paid out. The way it worked for insurance was there was an initial fee of $250 from the orthodontist for when the braces were put on my teeth, followed by a $50 charge each month for an adjustment.

The $250 initial charge was covered by insurance no problem. The first $50 monthly charge was also covered, no problem. Then the second month, I received a statement saying the $50 charge had been denied due to me reaching the maximum benefit amount. In what world does 250 + 50 = 1500? I called them and they apologized, and corrected the error.

Two months later, the charge was again denied for the same reason. Once again I called them and they apologized and fixed it. The next month, again denied, same reason. This happened every couple of months over the course of two years. About every other month on average, they'd deny the claim saying I'd reached my maximum benefit and each time I'd have to call them to correct the issue. Each time the person I talked to would say the same thing "I don't know why it denied your claim. We'll fix it." But obviously they weren't fixing the root problem.

Now to me, this doesn't seem like a mistake. Once or twice would be a mistake. This seems more like a policy. Why would they do such a thing? I don't know. My guess would be that a certain percentage of people simply pay the bill rather than call the insurance company and argue with them about it. If that's the case, then this would clearly be a case of fraud.

Or maybe their system is just so screwy that they can't add simple numbers like 250 and 50. Admittedly this could have been much worse with them completely refusing to pay the claim even after I called. But still, I know most insurance companies are reluctant to pay out. After all, they're not a charitable organization; profit is their primary goal. The repeated denials just make me very suspicious of the way this company does business.
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Noneill on 12/07/2006:
I agree it sounds like that have it set up to deny every claim automatically. I am not sure if dental insurance is regulated by your state's insurance commissioner but might be worth asking them about this.
Sparticus on 12/07/2006:
I used to work for an insurance company. I overheard a conversation once on the elevator regarding how they are supposed to deny first in most cases just to see if they can get away with it. Insurance is a crappy business to deal with.
Happy2BMe on 02/23/2008:
Sadly, this company is a NOT FOR PROFIT. That means beyond operating costs, their revenue is intended for the members medical needs. But, I worked at Premera Blue Cross not long ago and they hand out huge bonuses to the highest paid employees rather than use the profits to pay the Providers at a higher percentage of their billing costs. Employers really need to look closer at the policies and financials of the medical insurance companies they contract with for their employees.
DisgustedAtPremera on 06/24/2013:
My company switched from Aetna to Premera this year, so I had to switch. My wife is a cancer survivor and has ongoing after effects from the radiation, to where she required hip surgery. Aetna forwarded all referrals and authorizations to Premera including all medical notes. Premera upon taking over our insurance DENIED these surgeries even after seeing the MRI's of her hips and the labrial tears present. What a rip off, I have to watch my wife suffer when she tries to move on a daily basis, while Premera arbitrarily denies the referrals that would allow these surgeries to proceed.
Pierre Pullins Indianapolis, IN on 12/16/2013:
I worked at Amazon until 9/26/13. I had the highest premium an individual could pay because I like in network care and do not like high deductibles. My primary referred me to an eye specialist and a podiatrist. Bills were submitted but not paid. My eye doctor told me what all of you just talked about. This deliberate fraud in my opinion.
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Cruel And Unusual Punishment
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SEATTLE, WASHINGTON -- Who do you complain to when you have a problem with your insurance company? I have been on the same anti-depressant for several years. PBC has covered my prescription. But it was so expensive through them that a drug representative friend helped me out for over a year so that I wouldn't end up in debt. After my stash ran out, I tried to refill my prescription but the insurance company told me that I needed Pre-Authorization from my doctor before they would fill it. So, no prescription. My doctor filled out the form last week. PBC keeps saying they never got it and that my doctor hasn't sent it in. My doctor said that they are strong-arming us so that she will go with a cheaper drug. But this one is working. Now I find myself in withdrawal - sweaty, shaky, dizzy, nauseous, and PBC doesn't care. Would they prefer that I end up in the emergency room? Especially when I find myself zoning out while driving?

Or, should I find some other drugs to make myself feel better? And then they would have to pay for the long-term health problems associated with that? But, no, they won't help pay for my prescription but prefer to pay thousands more for other things. They are so stupid.
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DRVROFRED on 06/09/2009:
I know on prescriptions that if you don't fill them in a certain amount of time the refill is no good. I also found out the hard way.
I just read your question and I'm going to do some research as I admit I have been on Zoloft of 7 years now along with another prescription to take when I need the extra help. The warning on the medication printout states clearly that these medications can not be stopped abruptly or can just as you have stated cause serious effects and can on mine anyway be fatal. I know the stress you are going through is going to make going without even more overwhelming. This is a good place to get information. Keep checking and hopefully we can get you the information you need.
Suusan B. on 06/09/2009:
Many insurance companies will try to get their policy holders to use generic drugs whenever possible. However, most of them will allow doctors to prescribe branded drugs over generic if they provide documentation that the branded drug is required. Also, insurance companies are covering less and less of the cost associated with branded drugs can be quite high. Have you tried the drug Blue Cross wants you to take? It sounds to me like that would be a better idea than going off an antidepressant cold turkey. If it doesn't work after 3-4 weeks then your doctor could tell Blue Cross that the branded drug is required at which point you will have to pay the higher cost.
Suusan B. on 06/09/2009:
In California prescriptions are good for one year from the date they are written. I don't know if this holds true for other states ....
goduke on 06/09/2009:
To answer the first question -- in each state there is an agency which governs the insurance companies, and that's where you complain. It Washington, it's the office of the Insurance Commissioner (1-800-562-6900).

Hope your drug rep friend doesn't get canned for dispensing meds without a license. It's a bit illegal.
DRVROFRED on 06/11/2009:
Actually, I live in California and it depends on the medication and maybe the doctor as to the length of time to refill the prescription. A couple of them that I take must be filled within 3 months time. Others can be filled at a later time. My doctor told me to just refill them when they're due as the shelf life is pretty good. Even when it says they are expired they just aren't as strong.
Also to the OP my antidepressant was also changed to a generic and the price went from $45.00 to $10.00 and it works just the same. Indeed give it a try.
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