Blue Cross Blue Shield Association [BCBSA]
Reviews and Complaints

Hello,

For the last 10 years I have been living in los angeles, and I have had medical insurance through blue shield. Since I never get sick I chose a high deductible plan that only costs $76/month.

I am now moving to clearwater florida. I called blue shield who informed me that blue shield california and blue shield florida are "different companies". They gave me two choices, 1 a "conversion policy" at $391/month (5 times the cost of $76), or 2. I can apply for a new policy at blue shield fl, which might approve or reject my application, since to blue shield florida I am now a "new applicant".

So in summary once a person has health insurance, one is not able to ever move to another state without either 1. An increase in premium of 5 times, or 2. Possibly losing ones insurance because the fl division does not recognize the ca division. This seems fraudulent and unethical to me. It seems that this state division scheme might have been done on purpose to harm consumers.

Fortunately I currently have no health conditions, but if I did, I would have to choose between losing the insurance (applicants with preexisting conditions get rejected), or not being able to move to florida.

This is a premeditated fraud.

Is there any health insurance I can get that allows one to move to different states without penalty? Or does anyone have any other advice for this situation?

"bait and switch" — long story short. My husband applied for insurance through bcbsil. He answered all of the questions on the application truthfully and had 4 recorded conversations with nurses prior to signing the amendatory endorsement. No pre-existing conditions were applied nor was a exculsionary rider applied to his insurance regarding his back. They paid the claims and then 6 months into the plan they sent a full rider on his back. He either signs it or the insurance is rescinded. Bcbsil did not do their due diligence during the application process. We don't know their underwriting rules, so how are we to know what to do... We had overlapping insurance for 2 months, just incase bcbsil didn't pay the claims, but they did, so we cancelled the other insurance. They misread his doctors reports, and our doctor even sent a letter stating that to the insurance. They disregarded or didn't read the letter from our doctor and stuck to their guns and will not budge on the rider. My husband now needs to go on the state plan and wait 6 months before he can get any treatment for his back. By then, he'll be crippled from the pain. We are both self-employed and pay through the nose for insurance. We will not go down without a fight. Bcbsil sucks and should be reprimanded for their evil ways. They are wrong and I have hired a lawyer and am ready to file a class action suit. "bait and switch" is illegal in most industries, so I don't understand why bcbsil should be exempt. I'm going to make so much nose on this they won't know what happened to them.

On May 1, 2009 I went to a Rhuematologist for pain. I have RA. He prescribed Celebrex and Darvocet. When I dropped off the RX, they told me that BCBS had put a hold on it - needed more info from the doctor. My doctor sent the info once on the 4th and once on the 5th. I called BCBS on Friday May 8th. They told me that it takes 3-5 business days. I was told it was not an emergency, and that I would know if they approved it by Tuesday. Well, here it is Thursday the 14th. I had to call the pharmacy and my Doctor. The doctor checked (for the 3rd time) and was told I was turned down for the medication.
I am a caregiver to a 4 year old - to me having medication helps me get through my day. Not an emergency for BCBS but pretty important to me. I had to wait almost 2 weeks for an answer and even then they did not notify my doctor or me. Poor Service

I have a medical condition where I need sclerotherapy. I have a venous disease. I need to know where I could go to file a complaint against Blue Cross-Blue Sheild for denying me coverage. This is serious. Left untreated could lead to disability, embolisms, painful skin ulcers(which I already have one).

They told my doctor they were denying me because I "never wore compression hose". Well, I never knew I needed them. I am not a doctor and neither are they. The insurance company needs to stop playing doctor and give people the medical treatment they need. What will they next tell a patient with heart conditions, "we're sorry, we can't help you because you should have done this or that to begin with". My doctor also told me the condition is hereditary.

I am unable to locate the physical address at this time, but I just want to know where I can file a complaint. I have PPO and STILL cannot get the medical treatment I need.

Horizon blue cross blue shield of new jersey refuses to answer my letters and pay a claim that is now over 6 months old.

I was aware of the preexisting condition limitation when I signed up for the policy in march 2008. I went to the doctor for a condition I developed after the policy began.

Horizon kept telling me they were reviewing my claim. To date, they have not answered my corrspondence and the doctor is now asking me for money.

Horizon have not denied the claim, but they are refusing to have anything to do with it and I am on the hook for this bill.

This is an example of bad faith insurance.

Do not do business with this company, they are dishonest.

I currently have health insurance coverage with blue cross blue shield of michigan through the cobra law. It expires january 1st of 2009... I have less than 2 months to find new health care. I contacted bcbsm and was told that, even if I could pay $1, 000, 000.00 per month out-of-pocket, I could not get the same plan that I have now. (of course... If I had that kind of cash, I wouldn't need health insurance! I'd buy my own doctor!) they instead offered me a crappy plan that had a $2, 500.00 deductible, covered 30% of only 2 allowed office visits, only 50% of prescription costs, and only a small fraction of hospitalization... Annually. Did I mention I am a type 1 brittle diabetic, newly diagnosed with heart disease (via. 3 heart attacks this past march) with a bucket full of other health problems on top of it? I wish I was as healthy as the people bcbsm would like to cover... How is it that the people who need health care to live, the ones who must buy it, are the ones who don't get the coverage they absolutely need? Oh, silly me, it's all about money... As usual. Does anyone know what I can do to insure I am alive for at least the next 5 years? Help!?!?!?!?

I'm so tired of the paper chasing/denial of claims/long button pushing waits for customer service only to get the same answer — "well, that's what your plan covers — sucker". We pay nearly $800/month for a coverage that essentially doesn't even help with preventative care. Anthem finds every loophole in the book to deny coverage. I have had my doc check ahead of time before sending out bloodwork, and anthem denies it, because they sent it out. I've had three kids get the same preventative care on the same date from the same doctor, and only one got covered. We've gone the generic prescription route at the cheapest pharmacy, only to have generic prove to be unhelpful, so when we get a prescription for a non-generic, we get hit for the full cost. Their solution: "go to a cheaper pharmacy; try generic" — been there done that! From what I can see, they love pushing paper, denying claims, and watching the little guy jump through hoops. How do they sleep at night?

We just recieved (each adult in the house got a separate one) a huge heavy envelope full of unwanted paper advertising which claimed that we had requested. I see this as an attempt to bludgeon us into accepting this unwanted service. We would like to protest the killing of trees for this specious purpose.

My company recently changed insurance providers to blue cross and blue shield of michigan.

As requested by blue cross and blue shield I provided all necessary paperwork on time and correct. I assumed that everything was all set and that my family was covered for health care until my wife recently went to the doctor and was told that we were not covered by our new insurance provider?

We called blue cross and blue shield and were told that due to the holidays and the large number of new accounts they simply were not staffed properly to input all new customers information into the system and provide them with contract numbers.

Advised to pay up front and get reimbursed once blue cross had caught up with their records administration.

Interestingly enought though, they did have the staff to bill my company as well as deduct the funds from my first paycheck. I never thought such a large company that claims iso certifications and process supremecy over other competitors would leave my family in this situation.

I am not the only person, many retirees from my company also have this same issue with no resolution as of this time.

Very disappointed... Staffed to bill, but not staffed to provide us with the services paid for.

My leg is falling off..
Wellmark blue cross is denying service

*very time sensitive*

*immediate attention*

Thank you for reading my plea.

My name is tim taffe, I am 63 years old and I live in iowa city.

I am writing you since I have exhausted every possible resource.

My problem has to due with multiple right hip replacement surgeries, all performed in iowa, at burlington general hospital and great river hospital. Next monday I am scheduled to have the third replacement installed at fort madison hospital, by the previous surgeon, dr. Mitchell paul, whom I trust and value.

My surgery is scheduled for next monday august fourth.

The first device was manufactured by depew corporation. It dissolved, and attacked my bones.. This is called polyethylene disease. The replacement device was sold by zimmer corporation, and the product has been withdrawn from the market. The device has shifted.

There is now no connection between my leg and my hip. Only muscles and soft tissue keep me connected.

I am in great pain, I cannot sleep well, and I walk on two crutches. My right leg is now two inches shorter than my left. A few years ago I could play tennis very well. Now I cannot walk.

I will be attaching a letter from dr paul herein, he describes my serious health jeopardizing situation.

The point of this letter is that wellmark blue cross blue shield of iowa is rejecting my claim.
They also will not return my phone calls.

I am actually a licensed iowa insurance agent, and know that they are totally in the wrong.
This is referred to as "claims control"

They claim it is a pre-existing condition. The definition of "pre-existing" is one that has been attended to in the six months prior to the effectiveness of a group policy. I had not visited or consulted for not six months, but rather for six years. There seems to have also been an inference that my problem may have been caused by a chiropractor. That is not the case.

I was unable to continue the job position, I am now essentially unemployed, and insured on cobra.

I have contacted the insurance commissioner's office, where everyone was very polite, however, no comments or actions have been taken against my claim against wellmark. I have not been helped.

Please note, I am also a wellmark independent agent, so this situation is rather precarious. And this is certainly not the impeccably miserable level of policy holder service which I have thought went with a wellmark policy.

I have shooting pains down the back of my leg, and wellmark is not even returning my telephone calls.

Please... I really need immediate intercession. Thank you. Again, fort madison hospital is ready for surgery on monday august fourth, mr. Tom amenell of fnch has been told that they may provide service to me but there is no guarantee that wellmark will honor the claim.

Thank you,
Tim taffe
Iowa city
[protected]

Tim,

Fyi – I spoke with scott potter at some length.in a nut shell, while he is getting a hcfa (cms 1500) and a ub (cms 1450) from dr. Paul’s office, he does not think that will cause them to state the procedure will be covered. Essentially (this is in my words), blue cross wants to allow for something to turn up in their records search after the physician, hospital, radiologist and anesthetist have billed for their services that would allow or cause them to deny payment. This does not mean they will deny, just that they reserve the right to deny payment. I asked if the records search could be conducted prior to the procedure to answer the question to which he responded – no.

Thomas m. Amenell

Thomas m. Amenell, cpam

Director patient financial services

Fort madison community hospital

5445 avenue o

Fort madison, iowa [protected]

(p) [protected]

(f) [protected]

I suffered an injury on the job on 10/09/06. I was hospitalized on 10/12/06. The injury and complications were submitted for worker's compensation with gallagher bassett.

I asked my human resources director at the lenexa cadbury schweppes distribution plant how long I had to submit a claim with blue cross of texas if gallagher bassett refused the worker's compensation claim. She told me I had 1 year to file a claim with blue cross of texas. Just to make sure of this, I called blue cross of texas, and they also told me that I had 1 year to file a medical claim.

Gallagher bassett had told me that when they reached a decision on my claim that I would receive written documentation and an explanation of their decision. The months passed by and I never received any correspondence concerning gallagher bassett's decision. As the 1 year deadline drew near, I had all of the health providers submit claims with blue cross of texas. All of these claims were filed before the 1 year deadline.

None of the claims had been paid so I called blue cross of texas to ask why. Blue cross of texas told me that all of the claims would first have to be filed with blue cross of kansas city, and that once blue cross of kansas city received the claims they would forward them to blue cross of texas.

Blue cross of kansas city told me that they had a 6 month period for filing a claim. They said none of the claims would be paid because of this, and blue cross of texas has not paid any of the claims.

The 6 month deadline, and the filing with blue cross of kansas city instead of blue cross of texas was never related to me or my health providers.

We just received (each adult in the house got a separate one) a huge heavy envelope full of unwanted paper advertising which claimed that we had requested. I see this as an attempt to bludgeon us into accepting this unwanted service. We would like to protest the killing of trees for this specious purpose.

Thank you,

Jim and marie fenn

I was in a bad car wreck and the accident was not my fault. I was hit head on by the on comming car. They said the hit was compared to hitting a tree at 110 miles and hour. I have alot of injuries and my health insurance is refusing to pay alot of my bills. Wal-mat blue cross blue shield of alabama says it is not covered by my health insurance I have thru wal-mart. Yes I am a wal-mart employee. I have been fighting with them over this and they are still refusing to pay these bills. Remember I am a wal-mart employee and I they do not pay well at all. On top of all this I can not pay these bills my-co-pay is 20% but I am getting bills for over $1,000.00's of dollars because they refuse to pay my bills and when I go to the doctor I am forced to pay or they will not see me I have to put this on my credit cards and now I owe thousands of dollars because of this! I need help and I need it fast! They have also told me several lies on why they do not pay the bills and says it is not covered by the policy and there is nothing in the policy on this at all what am I to do.

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.