TN -- My husband went to the hospital (on a Wed.) to get 2 bags of blood because he was malnourished and his levels were EXTREMELY low. He was eventually admitted b/c 2 bags turned into 8 with no improvement. BCBSTN (Marketplace insurance) denied his first claim for admittance saying it was unnecessary. Friday morning around 1:30 a.m. he was transferred to a bigger, better, trauma-level hospital to be evaluated b/c they didn't know what was wrong. After testing/x-raying/scanning all day, it was determined around 5 p.m that he had a bowel obstruction which needed immediate surgery but there were two other cases that went before him.
He didn't get into surgery until Saturday morning. His bowel obstruction turned into a perforation and all but 100 cm of intestine had to be removed to get necrotic tissue out. He was left open and kept in a medically induced coma until surgeons could decide how best to put it back together. Two weeks of a coma (even after medication for sleep was discontinued) and four surgeries later, his kidneys had shut down requiring dialysis (which I had to fight for) and all of intestine eventually necrotized and he was left with no way to connect his pancreas to his colon requiring him to be fed intravenously for the remainder of his life.
I found out he coded and was basically was being kept alive by medications and a ventilator. I allowed him to go peacefully after discontinuing all medications that were keeping his heart beating -- truthfully he had been dead for 12 days but his body was going through the motions.
After he died in August I called the insurance company to report his death and have him removed from my policy. I was told just to let it ride until the end of the year and he would drop off automatically. After losing his income I was no longer eligible for a tax premium credit (which was my concern in the first phone call to BCBS) and my premium jumped $110/month.
In November we were informed that my employer would offer affordable insurance the following year so I called to cancel my policy for January and the rest of the year. I was advised NOT to pay the premium and it would cancel on its own (2nd bad advice) at the end of December. My employer's insurance (also BCBS) was over $100 less/month so I switched as of Jan. 1, 2015 (so I thought). Fast forward one year (I switched to a Cigna policy) and I file my income tax in Feb. 2016.
At the end of Feb. I get a letter from the IRS stating that the HealthCare Marketplace/BCBSTN had "informed them" that I had been given a tax premium credit for the month of January 2015 that I "Failed to file" on my return so they were reviewing it and would hold it until after I filled out an amended return to pay back the $316 that had been paid "on my behalf" which included my husband who had been dead for FOUR months!!!
After placing blame on each other (HC Marketplace vs. BCBS/TN), at least 3 one hour plus phone calls, and giving me the run around for two months, I get a call yesterday from BCBS big-wig saying basically this: because my pharmacy had incorrectly billed two prescriptions the wrong BCBS policy and they paid a whopping $23.29 my policy would/could not be retro-terminated for Dec. 31, 2014. IF they changed the date of my termination from Jan '15 to Dec '14 they would be "forced" to (a veiled threat) also retro-terminate my dead husband as of Aug '14.
The reason this upset me is that without husband's income I lost the tax premium credit and would OWE BCBS $150/month for the higher premium I SHOULD have paid in 2014. OR I could keep quiet and leave things the way they were and owe the IRS for the unreported tax credit in 2015. Blackmail so either way I get screwed because of THEIR mistake. I will NEVER AGAIN have BCBS insurance even if it means paying a penalty for no insurance!!!
In the midst of all this, I also fax proof of my employer insurance date of enrollment and explained the situation and the IRS approved my refund and sent it to me. NOW I have to figure out what to do with an amended return and pay more money and probably a huge penalty to the IRS. BCBS not only kicked me while I was down but they ruined me for life. The year I lost my husband I had to PAY IN thousands of dollars to the IRS for taxes on his 401K. Now this -- the IRS will audit me every year for life.
I am survivor OF a severe labor Law discrimination retaliation (LLDR) & personal permanent injuries to me resulted from the retaliation. My husband and I were going to law enforcement reporting the LLDR deadly death threats, property damage, ethnic acts of hate resulted from my New York State Workers Compensation claims (NYS WC) ref. ** The retaliation from my NYS WC claims & complaints rolled over on to my husband & breach of his employee elected benefits that were contracts for medical that covered him and myself. I received Social Security Disability (SSD) after **, I had Medicare Part-A & Part-B.
Blue Cross Blue Shield of The State of Georgia (BCBS of GA) were the Administrators of my husband's employee elected contracts for "the medical" for him and myself. Empire BCBS Butternut Dr. Syracuse, NY were the Medicare Secondary Payer Recovery Contractor (MSPRC) involved for recovery billing/HIPPA with Excellus Blue Cross Blue Shield, (former address) South Salina St. Syracuse, NY now located @ Butternut Dr. Syracuse, NY. They denied me medical treatment.
A former friend of mine **, RN, was employed with Excellus BCBS, South Salina St, Syracuse, NY said she worked & reported to Excellus BCBS Director, who is a physician in the Syracuse, NY area who was involved. BCBS of GA stated Empire BCBS/Excellus BCBS were responsible for the PPO in-network physicians in the contract & denied me physicians who were “IN-NETWORK.” I could not find a PRIMARY CARE PHYSICIAN (PCP) from 9/2005 until 3/2010.
My husband employer "General Electric Polymershapes" continued deducting premiums from his paychecks @ work for him & myself after the contract was breached (he wrote to General Electric CEO, Fairfield. CT & contacted CT Insurance Department). He never recovered the loss.
BCBS of GA stated it was Empire BCBS/Excellus BCBS that denied me the in-network physicians stating they were not in the PPO network, when in fact, they were in the PPO network. (Question of Empire/Excellus BCBS Director, who was the physician that **, RN reported to @ Excellus BCBS involving the HIPPA Law violations, Ref. US Postal Service Office of Inspector General file 01IH029I011.)
Empire/Excellus BCBS cancelled Dr. **, GYN the only physician I had in the PPO network that **, RN has set me up with. I went to Dr. **, GYN for my yearly healthy woman's exams. BCBS of Ga, Warm Springs Rd. Columbus, GA guaranteed us in a letter issues with (Empire BCBS) "Excellus BCBS" would NOT affect us. BCBS of GA then CANCELLED DR. ** GYN (after we received the letter from them).
I had gone from September 2005 to March 2010 without a PCP & no preventative care. I had to go to Emergency Rooms/Urgent Care Facility when I got sick and never had follow up care. Medicare WOULD NOT AUTHORIZE.
preventative care for me because my husband was an active working employee with employee elected medical benefit contracts for him and me.
Finally, a Health Advocate Group in the State of Pennsylvania got involved and authorized a PCP for me (the PCP could not get involved with my NYS WC claims). I was approved on 3/2010 with the PCP & requested a gyn exam from him also due to having my GYN cancelled. By then, I had stage 3 ovarian cancer involved in major surgery & 6 month of chemotherapy treatments.
When I was in the hospital after the surgery for ovarian cancer, BCBS of GA cancelled our health insurance & a certificate of cancellation was issued for me. We have filed tons of letters with BCBS Warm Springs Rd Columbus, GA Corporate Attorneys & also with supervisors and tape recordings etc, etc. so their Legal Corporate Team are well briefed on the situation & what was going on.
RALEIGH, NORTH CAROLINA -- This is a very unhelpful and rude company, I tried for over a month to cancel and they charged me again. When I contacted the online chat service they told me they were unable to help and cancel my insurance. Don't waste your time or money, they do not help you and overcharge you.
RALEIGH, NORTH CAROLINA -- My wife got a new job at the university and the employer will pay for health insurance, which by the way is also BCBS. I called BCBS on Monday asking how I can terminate her policy (she is in my policy as dependent). The attendant told me fill a termination form, put my wife's name, and send back to them. I did.
Today (Wednesday) I was checking for bills and found out that myself and my child will be terminated from the policy as well. I called BCBS and the attendant told me I cannot terminate just one dependent. It is either everyone or no one. I explained that my wife is going to get a new BCBS policy through her employer but the attendant just repeated the same. I ask her if I could make a new policy for my child and myself after the current one is terminated but the attendant told I have to wait for the next enrollment time, which is in July 1st. I asked to talk to her supervisor who told me the same story.
After I complained that this makes no sense, that BSBC is pushing me to keep her in my plan, and BSBC will be absurdly receiving two payments to cover the same person, the attendant told me to ask her employer to postpone her coverage until July 1st and I keep paying for her. I asked them to suspend the termination form and the supervisor told me she is not sure whether they can do that either. She is going to call me back whenever to give their decision. What kind of unreasonable people work for BCBS? What silly rule is that? It makes no sense. They would keep the same number of subscribers as none of us is leaving BSBC anyway.
ATLANTA, GEORGIA -- On December 19th of 2012, I went in for a preventative doctor's appointment. Today, March 22nd, two of those bills are still unpaid and the providers are telling me that they will send these to collections if payment is not made in the near future.
BCBS initially denied my claim because of "other coverage." When I called to address this issue, I was told that their system had not been updated and I had to have the Customer Service Rep contact my prior carrier to verify that there was no overlap in coverage. Now mind you, I have had the BCBS policy since Jan 01, 2012 and a claim had already been paid without this issue arising nor is it customary for individuals to carry more than one health coverage.
Why they would assume that their coverage which I pay them for would not be primary is beyond me. They didn't have any prior carrier info on me, just that someone might be out there. Regardless, I did as I was supposed to do, promptly addressed the issue and my claims were marked to be paid on January 09. Between that period and today, I have made quite a few calls and was told basically to be patient, their claims office is taking up to 30 days to process things. It's been close to 90 at this point.
The CSR that I spoke with could not connect me with anyone in claims nor did she appear to know how to even reach claims. I don't doubt this, none of the prior reps ever offered it as an option. I have spent 15 years in auto and injury claims with two major carriers, 5 of that in management. If a CSR could not address the issue, they got the call to me and I addressed it.
I ended today's call requesting a callback and payment of these claims by end of day March 30th. If I get no response, I will simply pay these bills out of pocket and file a Department of Insurance Complaint. With my experience in claims, I understand that volume increases or staffing issues can throw a kink into even the best run organization but that is not the customer's problem and I have been more than patient. Unfortunately, based on their past performance, I don't look for this to be resolved without that formal complaint. For the record, this is my first ever negative review regarding any company, I am just that ticked over this.
LOUISVILLE, KENTUCKY -- My premiums are 400.00 dollars a month and my annual deductible is 2000.00 dollars a year. But I consistently get medical bills over 2000.00 dollars. I have MS and the medication to treat it is very expensive. One company that makes it offered it to me for free which was fine and dandy for BCBS but the medication made me sick so I could not take it anymore.
The new medication my DR put me on wants payment after three months of taking it I get a bill for 4000.00 dollars. I called them and told them my deductible was 2000.00 why isn't the insurance company paying half? They said they would reach out to them after a couple of days they called me back and said BCBS told them my deductible was 4000.00 LIE. Then I applied for financial assistance they came back and said “well, your deductible of 4000.00 dollars has been met but your health insurance company said you should be getting your medication from another pharmacy."
Basically the one that gave me free medication that makes me sick so they have no financial responsibility. These people are greedy money hoarders and have no business in healthcare if you are sick and have BCBS you are out of luck. I will cancel my insurance and deal with the government. I cannot afford to treat my illness anyway so why give them 400.00 dollars a month? Single payer please.
ATLANTA, GEORGIA -- Blue Cross Blue Shield of Georgia has some of the worst customer service I have ever dealt within my life. To speak to someone, you have to first go through the robot representative hell then wait for another 5-10 minutes to be connected to a person. Once you get to a person, they generally have a terrible attitude and are completely clueless about even the most simple of issues. You are passed from one call center to another to find anyone that might remotely be able to help you out with your problem.
This company does not care at all about their customers. Unfortunately, I have a pre-existing condition so I am stuck with them for now. At least in 2014, I will be able to shop for new health insurance, and I intend to drop this company as soon as humanly possible. Thank God that Obamacare will finally allow me to dump this loser company.
QUINCY, MASSACHUSETTS -- 6 years ago, my wife had a brain tumor. After surgery, she had severe cognitive and motor impairment. She needed rehab but BSBC and their desktop physicians denied coverage, and 4 days after coming home, she fell down the stairs and required further hospitalization because of their stupidity and inability to put care before cost and deciding a patients fate using Dr. who only practices with a calculator.
Now, my wife a severe reaction to medication which aggravated the injury from the brain surgery and she is impaired mentally and physically. Can't walk without a walker presently and can't tie her shoes, and hospital and Drs. say she needs rehab before they can release her from the hospital, and again, they deny coverage.
I sued last time after they put her in harms way and found out they are protected by congress and ERISA. They are above the law and when my company decides who will be our insurance carrier next year, BCBS will not be one of the choices. Bad company, terrible customer service and health insurers should not dictating health care. The national health care changes are going to make it even worse.
NORTH CAROLINA -- After 2 years of an undiagnosed illness, I was referred to a University Hospital. First visit was basic - previous history, getting new bloodwork done, etc. Second visit, doctor starts me on an infusion of drug Infliximab or "remicade". I had never heard of it, but went ahead with the process. Tiny bag - 400mg, no big deal, it was just a slow drip, that was all. Went back again next month for another dose, same amount. Doctor said bloodwork looked good. I was feeling much better. Doctor says I have an immune disorder. Go again 3rd month. Feeling like a human being again. Doctor is glad I've improved. New bloodwork looks really good.
BIG problem. Blue Cross sends me statement for "pharmacy" charges it will not cover for $38,000 for (2) Remicade infusions. And they still have one more bill for about $20,000 yet to send me!! Found out the hospital failed to get a pre-approval from insurance company before using this medicine on me. Several hospital officials told me, since it was the hospital's fault, I would not have to pay. The drug would just be replaced by the drug representative. Not so. My statements are now in collection agency hands
And I have to find a lawyer. I am at my wit's end. Insurance company paid for everything but the medicine. Oh, I checked with a local pharmacy to see if I could buy "remicade" if I had a prescription. Yes, I can, but it would be in a 100mg vial at a cost of approximately $825.00 to me. Multiply that times four and you still don't get $20,000 like the hospital was charging my insurance company for 400mg.
TAMPA, FLORIDA -- I have health and dental insurance with Blue Cross Blue Shield for both myself and my daughter. When I signed up the salesperson sold me a health plan and I was debited for it and waited for my cards that never came. A month went by and I got sick and needed to go to the doctor and when I had them try to look me up in their system since I didn't have a card they couldn't find me. Come to find out, I was never insured.
When I spoke to their customer service team, they couldn't find my contract or anything about me in the system with a health plan. Then I tried to go back to the salesperson and he would either never answer his phone or return my calls. After two weeks of trying and even asking for supervisors to no avail, I left a very fed up voicemail for the guy that sold me the policy and he finally called me back.
He acknowledged there was an issue but that I couldn't get the money back. I was insured I guess in that 30 day window, but then wasn't because something on the paperwork didn't check that it was an auto-debit ongoing from my checking account. So I decided to just hang up and find another company to get insurance with since it was such a production. One little fun fact is about a week later I did get a refund for the amount... But seriously so much hassle for nothing.