Blue Cross / Blue Shield Complaint - And I Used To Be An Employee Of Blue Cross!!
CALIFORNIA -- I could tell you horror stories from my exp with Blue Cross, but will keep it to my own story here.
Last fall due to rate hikes I had to go from PPO to HMO. I had an issue that needed attention so I tried to go to my assigned doctor, she was full and not taking patients. I was then assigned another doctor, which I went to. The doctor's office verified my coverage and benefits. Fast forward several months I get a collection notice from an outsourced medical billing company. I begin making calls and find out finally my claim for service last fall was denied because I went to a doctor before I was not authorized to go until 11/1, and my doctor visit was 10/31. A supervisor at Blue Cross said they could not retro-actively make that doctor cover that time period, because I did not appeal WITHIN THREE MONTHS - even though I didn't hear a word of it until 6 months after the fact so could NOT have appealed it! I am a former employee of Blue Cross and I know how these things work.
Apparently even if your assigned doctor is NOT TAKING patients and won't see you -- you basically have NO coverage unless you go the ER (and there are hundreds of dollars there, needlessly), because there is waiting period to change doctors - never mind that the doctor in question I actually went to WAS my assigned doctor, noted on my membership card. It is very Alice in Wonderland.