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Prescription for Necessary Medical Equipment Denied
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

CHARLESTON, TENNESSEE -- Over two years ago I started having severe headaches every time I went to bed. Multiple doctor visits resulted in MRI, neurologist visit, physical therapy, and several medications. Nothing made any difference. By the middle of 2017 the occurrences increased in intensity. By now, I'm not able to sleep except between the attacks that came about every 90 minutes.

Finally, in December 2017 I found a description on Mayo Clinic's website that described in complete detail what I was experiencing. I immediately made an appointment with my doctor and he offered "an experiment." He sent me home with an oxygen machine to use while I slept. Mayo Clinic's website confirmed that the attacks I was experiencing were treatable with oxygen. After a three night trial, all my attacks stopped, I slept, I felt normal for the first time in over two years. I went back to tell my doctor and he told me to keep the machine until he could contact my insurance and order the machine for me.

What arrived was an oxygen tank that would only last 12-13 hours. I immediately knew that would not work. But because that was all that I was told my insurance would pay for, I tried it. Here is the result: I would go to sleep, and a cluster would wake me up. I would grab the oxygen line and turn on the machine. When it subsided, I would turn it off to save oxygen. Try to go to sleep, wake up again, turn it on, turn it off... Since the pain had already taken hold, I was never able to get complete relief because clusters will cause migraines. So for four days, I had migraines during the day, and the repeated cluster attacks at night.

I called BCBS to find out why I was rejected for a machine that would run all night. The woman on the phone told me she was "writing all this down." The next day I went back to my doctor to discuss options. He told me he would "investigate, and contact BCBS and let me know." The next day the oxygen company (Lincare) called and said they were bringing out another full machine to replace the empty one.

The very next day, LINCARE called and said, "BCBS has denied paying for a machine for you and an oxygen tank. We will be coming to take it back." After the call, I called BCBS to make an appeal and gave a detailed history to Michael (who was very patient and sympathetic). He told me he would submit it as an expedited appeal and I would get an answer in 72 hours. When I hung up, I had a good cry from all the frustration and confusion and also quite a bit of hatred for an insurance person that will deny a request based on a form.

In about an hour, BCBS called me back. They said they were reviewing my appeal, but needed my doctor's number. (WHAT?). So I gave it to her. Then, in a few minutes, she called me back and said, "Your expedited appeal has been changed to 'regular processing' because we could not reach your doctor."

Every medical prescription I have tried to fill with BCBS has been denied and I've had to appeal to get it covered. Overall, I am a healthy person and I've resorted to natural medication to replace the prescriptions. This, however, has me over a barrel. If I can't sleep, or rest, or function normally pretty soon the medical profession by the stupidity of BCBS will have me on multiple medications to get me what they will call "medically necessary." May God do to them and more also as they have done to me.

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Terrible
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

ATLANTA, GA -- I have had Aetna, MetLife, UnitedHealth Group, and Blue Cross, and Blue Cross is BY FAR THE WORST insurance company I have ever had to interact with. Everything they do is inefficient and terrible. Every time I call the wait is over an hour, only to be transferred or connect somewhere else, that also has an hour long wait. THIS IS A TERRIBLE USE OF CUSTOMER'S TIME AND LEAVES A MOUNTAIN OF UNRESOLVED ISSUES. If the company were efficient in the first place, I wouldn't have to waste my time calling.

Let me start from the beginning. I have time, because I am on yet another hold with BCBS that is predicted to be over an hour. I signed up for BCBS as an independent business owner, I pay out of pocket for all of my insurance coverage. It took them 3+ weeks to approve me for enrollment, even after I had sent over documentation from Aetna saying that my plan with them was no longer available and had been terminated. Finally, I found out I was approved, not by an email or arrival of an ID card, but because my account was charged $247 without a word.

During the process of trying to get approved for enrollment, having site login issues, etc., I would call BCBS and have a wait time of over an hour every single time. I reached someone and she offered to connect me to someone else, when she transferred me over, after already waiting over an hour, the wait time to talk to another associate was an hour. Basically BCBS asking me to spend two hours of my time WAITING without any resolution, only to maybe have to be transferred to another associate with more wait time.

After I was charged, I tried to avoid at all costs calling again because the whole process was just so incredibly inefficient. Lo and behold, here we are a month later, and I still have no ID card, no proof of insurance, no website login, and a bill lying on my desk. I tried to log in to pay the bill and it says I don't exist in their system (tried via email, member ID number that is listed on the bill, and social security number).

So currently, I have a $247 charge, another bill, and apparently no insurance. And am currently 15 minutes deep into what promises to be an hour long wait to speak to anyone at the company. You can't get a customer service email without successfully logging into the site, so I am forced to call.

I don't understand. Do you have 4 people working in the whole company? That's the only way that I could imagine would be an excuse for how inefficient and terrible your processes are. I would never recommend BCBS to ANYONE who can avoid it. If changing insurances weren't so troublesome, I would cancel this so fast. If anyone ever asked me about BCBS, I will send them running in the other direction. My fiance also has BCBS and has had the same issues, with hr long wait times for calls and unresolved issues. THIS COMPANY IS TERRIBLE. UHG and Aetna are 1000000 x better. Please heed my advice, and go elsewhere.

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High Deductible Out of Pocket
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

KANSAS CITY, MISSOURI -- Beware of Blue Cross & Shield hidden charges high deductible, so outrageous. It's ridiculous just go to see $100, out of pocket. Then Blue Cross will say "that's not in the coverage plan. You will have to pay extra." What is in Blue Cross plan - to take your money, don't pay the medical coverage, leave you with big expenses that will take you forever to pay the medcial expenses off. Some insurance Blue Cross is leaving you with medical expenses so Blue Cross can save money. All Blue Cross is is a bunch of money hungry vultures who will clean out your savings.

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Blue Cross Only Pays 20% of Medical Bills
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

KANSAS CITY, MISSOURI -- I went to the doctors 3 times. I paid my $40 co-pay 3 times in a row. I get one bill for $158. Another bill for $105, $263 that blue cross did not pay, which blue cross did bother to tell me that this was not covered. Blue cross is only paying 20% of your medical bills. Then blue cross raise my insurance of me 2 times in a row. Blue cross CEOs salaries alone $200000 a year. Blue cross will not tell you about deductible and the co-pay just go to the doctors' offices.

If your doctor's bill is $300, Blue cross will only pay $50. Then you got to pay $250 out of your own pocket. Why? Blue cross only pays a little bit of money, then you got to pay the rest out of pocket. Blue cross is nothing but a bunch of money hungry vultures draw your life savings.

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The Worst, Most Incompetent Customer Service Imaginable
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

GRAND RAPIDS, MICHIGAN -- My employer assigned my family to blue cross/blue shield recently after being with another provider for 15 years. We had dropped blue cross/blue shield 15 years ago because of extreme incompetence in their billing and customer service. I had suffered a back injury that required a lot of procedures and rehab 15 years ago. Blue cross/blue shield couldn't process the bills that my approved doctors submitted and failed to enter the right billing codes, etc..., then proceeded to send the bills directly for me. Then came the late notices.

Meanwhile, myself and the doctors worked to get it straightened out and the next thing that came in the mail were notices from Blue Cross/blue shield indicating the bills would be forwarded to a collection agency. That did it for me. The stress of dealing with this POS company was a negative factor in my healing process. It took about a year to straighten things out with these idiots, the whole time it took for my back to heal. I think I would have healed faster if it wasn't for BCBS. Now, though no choice of my own, we are assigned again by my employer to this so-called health care provider.

Earlier today I went to their website to register my new health card and set up an online account. Their site would not allow me to complete the registration so I called their toll free number. That's when the flashbacks of 15 years ago began. After going through their pathetically long menu, waiting and waiting and waiting, I talked to somebody for a few minutes, mostly answering inept questions and waiting, to find out she couldn't do anything. So she sends me off to somebody else. Same thing. After the 4th person, I finally got registered. The main problem was their system had a totally different Id # than what is on my Id card. Figure that out.

I then had a few questions about my coverage. She couldn't find the answers and transferred me to someone else. Same thing, so she gave me a phone number to call. I called it and after talking to 2 more people I was transferred back to the same people who gave me the phone #. The next person couldn't help me and suggested the phone # I had already been given and tried. I told her that phone number was not helpful. She then transferred me to somebody else. Same problem.

I hung up, called customer service again and was finally talking to somebody, after much difficulty, who dug in a little deeper and found the simple answers I needed about the copay required for x-rays and MRI's, lab work, and surgical procedures. Nothing difficult. After all, they are a "healthcare" company, aren't they? Hardly. They're no more than a profiteering company with the word healthcare in their name. They are an incompetent organization that should be involved in something else than healthcare.

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Worse Experience of My Life.
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

SAN ANTONIO, GEORGIA -- I applied on marketplace in Dec of 2013 for Insurance from 2 separate companies, one for medical and BCBS for dental. Within weeks I received information from my medical insurance, which I paid for. I never received anything from BCBS. I assumed that because I never received anything that they didn't get my application or I would get info in April because the deadline was set back.

I finally received information from them (a welcome packet, bill, and my BCBS dental card) in April. I paid my premium in May. After paying my premium I received a bill for $216.XX. I called BCBS to find out why I was being billed that amount. I was told that it was everything I owed them from Jan until present for coverage. I explained the situation only to have them tell me that they couldn't change the date on my insurance and I told them I wanted to cancel. Then I got a notice that said that my insurance had been canceled Feb 1, 2014.

I called to request a refund for the amount that I paid. The insurance was cancelled before I had ever paid it and the whole thing is a mistake with their system. I was told by a CSR that I should have never been allowed to pay for the insurance and that I should expect a refund check in 7-10 business days. That was July 21st. The lady gave me a reference number, her name, and her employee ID number.

Today Sept 3rd, 2014 I called to find out where my refund was. I was told that the CSR should have never told me that I would be getting a refund and that the money I paid in May went to my Jan 2014 bill and that's why I got a letter saying I was canceled in Feb for nonpayment, which does not make any sense whatsoever. After spending at least 4 hrs. on the phone over a course of 3 months, I am being told I am not getting a refund and that I could appeal it if I wanted. So I paid for insurance I never had and BCBS is trying to keep my money and somehow pinning their system errors on me. BCBS is a NIGHTMARE!

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How Messed Up the Entire Medical/drug Industry Is in General and How Stupid Obamacare Is
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

TRAVERSE CITY, MICHIGAN -- Basically my family is pretty healthy and we've always seen naturopathic doctors or treated things ourselves. Which means that we take responsibility for our own health and wellness and take care of ourselves. But then Obamacare came on the scene and we decided to go with health insurance. So because insurance doesn't cover our usual naturopathic doctor, we had to get new doctors and we picked the best ones we could find in our area covered by our insurance. And I suppose for the industry they are doing a good job and being thorough. But every time I interact with drug industry-trained doctors I am frustrated by their limitations.

They don't seem to understand health or eating right, or herbal supplements or anything that I regularly turn to for good health. What's more, if I pick up any drugs they suggest and read their labels, I cannot bring myself to take them because the possibility of negative side effects (worse than anything I am suffering) are huge. Basically with how expensive insurance still is and how little use I have for it (insurance doesn't cover useful things like nutrition supplements) and how much I still have to pay before the deductible gets paid off - it just doesn't make any sense financially.

If anything catastrophic happened the hospitals in our area let us get on a payment plan with 0% interest. Insurance might be useful if they covered the naturopathic doctor and the nutritional supplements recommended by the ND. A single payer instead of regular insurance would be even better (like the Green Party suggests - the same plan as our good senators and their families get). I have had so many bad reactions to pharmaceutical drugs that I don't dare take them, and herbal supplements work so well for me, that it just doesn't make any sense at all to have insurance or see a regular doctor.

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Group name is Children Health Care of Atlanta
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

GEORGIA -- I am with a providers office. I called 855-272-0693 about a claim/EOB received b/c the anesthesia shows no allowable charges which is incorrect. We are contracted with BCBS. The representative I spoke to, Joe, was of no help said to deal with pricing I need to call 404-842-8000 or 800-628-3988. Joe transferred me, I spoke to Sherry who stated she could not help me and that I need to call 855-272-0693. I told her that is who I called 1st but I was told they could not help me and transferred me to her. I asked what department she was in and she stated claims but her department does not handle ID's that has the prefix DJI. Sherry transferred me back to the 1st phone # I called. Spoke to Ivy (sounded like a man) I had to repeat myself more than once while giving information for him to verify who I was and patients information. Then placed me on a long hold, representative then tells me that the claim was reviewed by the local home plan and the anesthesia processed correctly as no allowable and as a full write off !!!! If I have concerns w/ pricing then I need to contact the local BCBS plan. Well we already tried that and I was told I needed to talk to you!! BCBS your ethical ways are disgusting and greedy. Your full of lies and your system is beyond unprofessional, you take advantage of too many innocent people who pay their premiums each month and expect for their insurance to cover what is stated is covered in their contract, but you always find ways to get around it. Not to mention that BCBS decided to change our contracted rates last year without our consent our any signed agreement and refuses to show us a copy of where we agreed to ANY changes. FRAUD!!! You hire people in different countries with language barriers who 1/2 the time doesn't understand what I am saying and vise versa. We know that is on purpose, you are taking advantage of not only the people who are your customers but also these foreigner just to save a buck, like you can't afford to pay on claims or someone in the USA! You already have several law suits out against you, no surprise there. I pray you go bankrupt and shut down forever and are banned from EVER starting another business again. Pride and greed always falls!

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Denied Coverage to an 87 Year Old Patient who needed Skilled Nursing
StarEmpty StarEmpty StarEmpty StarEmpty StarBy -
Rating: 1/51

ROCHESTER, FLORIDA -- If you are 65 or a loved on is and If your employer or agent offers a Medicare Advantage plan through BCBS do not sign that plan! I am relating this after the disaster that befell my 87 year mother who was denied coverage. She had to have a permanent colostomy after a week in the ICU and a bowel obstruction. Medicare Advantage plans are administered by private insurance who, in my opinion, study ways to cut coverage with much more scrutiny than standard Part A original Medicare Plans in order to make the company's federal expenditure look favorable and receive federal compensation for these schemes. My mom was denied over $20,000 in Skilled Nursing by Excellus BCBS after her surgery and prolonged recovery, which she is now 100% liable for. Every nurse, every doctor and everyone I have conferred with about this has said "If you mom had had original Medicare Part A, they would have covered her stay past the 28 days in skilled nursing". She was in Skilled Nursing for around 70 days. I was there and it WAS necessary. We think BCBS Medicare Advantage put especially stringent examinations to the determination of medical necessity of care in order to save money. In other words they sharpen their pencils when they examine a senior's claim. Remember Medicare Part A covers a patients Skilled Nursing through days 1-100. I can tell you, beyond a reasonable doubt, that my mom did indeed require this nursing care and it was appropriate and should have been covered. So my 87 year old mom will have to pay the $20,000. It was worth every dollar for the care that was necessary. We will also tell our story to everyone. Do not sign up for BCBS Medicare Advantage. Talk to your employer. Ask the to find a better insurer. One that does think age matters when it comes to skilled nursing and the necessity of care. No matter what you say in response, this is not right. If your parent has an Advantage plan, please switch, talk to your independent agent. Tell them my story. I'm sure they've heard many like it.

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Termination
StarStarEmpty StarEmpty StarEmpty StarBy -
Rating: 2/51

NJ -- I am a teacher, and the school where I was offered a job was enrolling its new employees in a plan with AETNA in an HRA as of 01/01/2017. I was used to having BCBS, but I was paying $347 a month in addition to a $50 co-pay to see a neurologist or any specialist. This was in addition to paying $15 for my medications monthly, which cost roughly $75 a month altogether. Keeping this plan was no longer a viable option.

I found the form for termination of coverage online. I filled it out, scanned it, and sent it in. I received an email stating the file was "completed and closed", thinking that my coverage had been terminated. I then received a bill in the mail asking for two premium payments in the amount of $347 each, which is what I'd been paying for all of 2016. One for January and one for February. I decided to call these people and settle this.

After being hung up on, told I was wrong, and should have "followed directions" (the only directions stated I had to either fax or e-mail the form to them, which they denied having) I was told to "call the Marketplace and terminate your coverage." I had the sent email AND form directly in front of me.

I called the Marketplace and dealing with them was much easier than dealing with these fools. You can barely understand them when you call for any type of assistance. All they know how to say is "I apologize", "Would you like me to transfer you to an escalation specialist?, or "This issue is not for my department. I will transfer you to such and such department." They are not receiving a premium payment for services I did not use in 2017.

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Blue Cross / Blue Shield Rating:
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1.3 out of 5, based on 54 ratings and
104 reviews & complaints.
Contact Information:
Blue Cross / Blue Shield
225 N. Michigan Avenue
Chicago, IL 60601
312-297-6149 (ph)
312-297-6609 (fax)
www.bluecross.com
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