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Blue Cross Blue Shield Association [BCBSA]

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United States - 60601
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Complaints & Reviews

refusal to allow a policy change to a lower cost policy

My name is Donald Deschene [protected]) I am a small General Contractor in Little Falls NY. I currently have health insurance coverage through Blue Cross/Blue Shield. The policy costs $1371 per month. With the business climate as it is, I can no longer afford this policy. I asked BCBS to change my current policy to a similar policy offered at $800 per month. I was told that their "Senior Management" does not allow such changes at this time, but may allow such changes in the near future. I was required to provide a formal letter of request, on my letterhead, signed by me. Such a change is of no effort to them, only a little paperwork. They wouldn't even take the time to give me a formal response signed by someone in "Senior Management". I find this totally arbitrary, and obviously profit driven. These people know where I would stand on my own in the current open market, and have basically told me to pay up or do without. This is not only unfair, but outrageous to think this "Senior Management" can place such a burden on my family with no repercussions at all. All I am asking for is a cheaper policy. Please help me change their minds.

overcharge

Bc/bd took 3 months to correct records that I did not have medicare and doctors complained that they were not paid.
First doctor's claim they charged me more that copay because I was 65yr old. Instead charged me copay plus 15% of plan allowance. (standard option).
Second doctor's claim they did not pay 75% as required by basic option plan. (page 22 of contract). Instead they found a way to make me pay full amout finding terms on page 53. Biopsy procedures are not covered.
Bc/bs is sneeky with 60 page exemption and conditon that get them out of paying for service even though patient has to pay high premiums.

condoning overcharge

I had health insurance with horizon blue cross blue shield of new jersey (horizon). In network outpatient...

underwriting time

We filed two applications in early may 2011, one for me, the other for my wife and kids (2 year old and newborn). Bcbs of fl approved me.in late may 2011, they denied coverage for my wife because she hadn't gotten her postpartum check up. Since my wife was denied, so were my two children under her application. The insurance agent told me children wouldn’t be denied, they just had to go underwriting process, but this was not the case. They were not approved and bcbs never explained why. I tried to get the kids switched over to my application. Bcbs of fl said that all we needed was a signed letter faxed to our agent requesting for the kids to be under my policy. I signed and faxed immediately. However, after more than 2 weeks bcbs of fl told me they had given me the wrong information and a formal application and underwriting process for my two children was necessary. Consequently, we applied for my two children to be under my policy on 06/01/11. Bcbs of fl approved my 2-year old daughter after 4 weeks of following up with the insurance agent and underwriters.

My newborn isn’t approved yet (as of 07/25/11). They are still reviewing his case. They asked for his medical records and we provided them on a timely manner. Bcbs of fl needed a maximum of 15 business days for underwriting, but they have exceeded this. My son has gotten sick and we have had to come out of pocket for vaccination and doctor visits. We follow up every day but no answer.

The bad business practices of bcbs of fl are: they denied my wife and kids coverage because of no postpartum checkup but they never told us she needed one. Because she was denied, my kids were automatically denied without reason. They have taken almost 2 months to underwrite my newborn’s coverage, even though their quality control timeline has been exceeded. We have tried to get the underwriters to move our case along, and the estimated wait time has been exceeded. We would have left bcbs of fl a long time ago, but we are all under them except for my newborn.

  • Ac
    Acarey Oct 22, 2012

    I am a BCBS FL Agent and have seen this happen before. BCBS IS known for Dragging out underwriting and making ALL changes nealy impossible. I have stopped selling them because of the reputaion they negativley caused me. Now that i stopped selling them they have decided to keep ALL comissions that i worked for. I would go to United Healthone ..they are my first choice and the best overall company. BC is BS!

    0 Votes

denial of needed health appliance

I have a condition called lymphedema and a letter of medical necessity was written via dr. Ellen tedaldi one of temple university hospital top doctor in this city of brotherly love for a medical appliance. The letter was sent to blue cross and blue shield of center city philadelphia. The initial contact started? 2008, two years in the process. I have been seen by a physical therapist as well as a lymph therapist trying to control my condition. My leg is getting bigger and more painful, especially when I walk. I am seeking your much needed help regarding this matter as blue cross and blue shield have shut the door in my face for a product that will keep me from becoming a cripple. I have been denied my appeals for the leg appliance by the people / panel who works for blue cross and blue shield. The insurance company admits that I have lympheda but they denied my claim because my lymphedema is a different lymphedema which is ridiculous, lymphedema is lymphedema if you get burned by fire from the stove or fire from a match youare stilled burned. Legitimate denial of a medical claim is one thing but to be denied a claim by a panel of people who is paid by blue cross and blue shield (from whom I am seeking the appliance) to deny the claim is very criminal. The panel seems only exist to deny claims, I now that this is not an academic explanation but this is the cheating behavior of the insurance company I paid faithfully for the last 15 years or more, I feel cheated and raped by thir decision of denial, would you and your team of investigative reporters go to blue cross / shield and see why their denial rate of medical equiptment is so high. I am becoming a cripple fast without the appliance, my leg is painful and is slowly growing as I sit to type this email. I need some help in fighting this big insurance company. The insurance comp said that their appeal decision of denial was final, ineede three on my side please help me mr donovan

  • Lt
    ltp132 Jan 05, 2011

    I went to WalMart to get medication and was told your insurance had been terminated so i tell them thats impossable cause i am still paying my premium which comes out of my check before i receive it try to call blue cross they said i need to call my job so know after being at wal-mart for three hours i have to figure out what happened. I call my job and leave a voice - mail, i wait an hour and call back still to receive voice-mail now i decide its time to try someone else . I ask for the buisness office manager she states they had got my message and was working on it, about thirty minutes later the payroll women calls me and states they cant get a holod of anyone so they suggested i pay for it out of pocket and let blue cross reimburce me. Know let me ask i dont know about everyone else but in this economy i do not have a spare hundred and twenty dollars laying around, could i have put it on my credit card yes but whos going to pay the interest when they decide to send me a check.

    0 Votes
  • Em
    emoj28 Jun 21, 2011
    This comment was posted by
    a verified customer
    Verified customer

    i sign up wit blue cross and blue shield health insurence i told the about my asthma AND ANOTHER MEDICAL CONDTION I HAD BUT THAT WAS 14 YEARS AGO on the phone and she said that snce i dont take medicine it fine .I PAYED THEM $101 there policy state that if you have not had a medcial condtion in 10 years then they can denie you for it THATS A LIE I WAS DENIED BECAUSE OF THIS MEDICAL CONDTION THAT I HAVE NOT HAD IN 14 YEARS AND MY HIGHT BLOOD PRESSURE WHICH IS ONLY 156/90 .WHICH WAS BECAUSE I HAVE WHITE COAT HYPER TENSION
    WHEN THE MEDICAL PERSON CAME TO MY HOUSE TO DO MY CHECK UP SHE WAS RUDE AND DID KNOW WHAT THE HECK SHE WAS DOING IM A MEDICAL ASSIANT AND I KNEW MORE THEN HER
    I NEVER $GOT MY $101 BACK FROM BLUE CROSS AND BLUE SHIELD AND THEY CHARGES ME AND TOOK OUT THE NEXT MONTH PAYMENT WHILE I WAITED TO FOUND OUT IF I GOT ACCPETED SO I CALLED M BANK AND PUT A STOP ON IT IT PRETY SAID WHEN I KNOW MORE THEN SOMEONE WHO SUPPOSSED TO KNOW MORE THEM ME.ALSO THEY KEEP SENDING ME MAIL TO GET HEALTH INSURENCE WITH THEM SO I CALLED THEM AND TOLD THEM I CANT BECAUSE THEY DENIED ME AND THEY STILL SEND ME MAIL TO GET HEATH INSURENCE WITH THEM

    PLEASE EXCUSE MY SPELLING I HAVE LEARING DISABILTY AND I CAN T SPELL GOOD

    0 Votes

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not paying for routine physical lab fees

I recently visited my doctor’s office for a routine physical. The doctor took a blood sample that day. It all seemed like a very routine check and never was I informed that any out of the ordinary tests would be conducted.

Sure enough, two weeks later I get a bill from quest diagnostics charging me $215 for a vitamin d-3 test.

Why is blue cross blue shield not paying if this is a routine physical?
Why did the doctor not warn me? Why is quest charging so much? I called all of them, and everyone blames everyone else. The bottom line is, this is a huge rip-off. Beware before you take any blood test and make sure your doctor does not order any tests that will result in such outrageous fees.

  • Ze
    Zero99 May 13, 2011

    Some of the lab charges have to be ordered for specific diagnosis before insurance carriers will cover it. They want to know why your doctor thinks you need your vitamin D checked. Do you have osteoporosis, have you been on long term steroids that could have resulted in bone loss e.t.c Your doctor has to provide a diagnosis that meets medical necessity before your insurance will paid for services. This is a quality initiative, which prevents doctors from ordering any test without medically necessary reasons. It prevents abuse and over-utilization of medical services and in long run reduces high cost of health care.
    Lateef Ayinde, BS, CCSP, ACS-EM.

    0 Votes

dogs death

I took my dog to the blue cross vet cause she was having trouble breathing the vet examined her but took no blood or x. Rays said she had a bit of chest infection so gave me antibiotics and sent her home 4 days later she was worse so we returned her to the same vet they kept her in doing tests to work out what was put down on 16th of march 2011 my complaint is if the vet had done xrays or blood work when I first briught her in would it of made a difference wouldnt she still be alive today

  • To
    Toiber Jul 02, 2010
    This comment was posted by
    a verified customer
    Verified customer

    The wait time is ridiculous. I just waited for 40 min to get benefits that took maybe 2 min. However the customer represenatives seem to be very cheerful and helpful. Please, please, please do something about your wait time. Some of us have other things to do besides sit on the phone for an hour.

    0 Votes

lies

I should have known better, than to trust this crummy, lying, sack of a company! Before I go to see any physician, other than my primary care doc, I call this company. I don't care if it's something like a hospital procedure, or an office visit, I call to make sure that they are indeed participating providers. This time, the doc was going to be reinstated as being on his own, after he and the other docs had a falling out. So, he was going to be on his own by 10-01-10. My appt. Was on 09-23-10, so they probably had him on file, under his old practice. They told me that he was ok to see, then I get a huge bill, to me anyway, of 250.00, so I call them. The person that I have the pleasure of speaking to, listens, and says there is nothing to do, but to file an appeal, through bc/bs, and then to opm. I don't have time for this. This is just bad consumer relations. The person I talked to lied, just like they told me that a doc was participating, and was on their books. When I called to make anappt., they told me they hated the company, and do not take it.

Bc/bs have no idea what they're doing, and they have a bunch of eejits who answer phones, and those same eejits don't give a crap about what they tell people!

I hate bc/bs, and now wish i'd gone with another company. What good does it do to pay for insurance, when they lie, and get away with it. Leaving their customers holding the s — t bag???

  • Th
    thiefflorida Feb 09, 2012
    This comment was posted by
    a verified customer
    Verified customer

    I am sure BCBS has a disclaimer somewhere that says buyer beware. I went through this also. I checked medicare.gov and BCBS provider page. Provider page says it may not be up to date check with doctor. Doctor says check with BCBS

    0 Votes

bill fandrich

On 2/9 bill fandrich and his challenged henchman ted marsh presided over yet another layoff in it. The...

unethical practice from a not-for-profit organization

Unethical practice from a not-for-profit organization On 6/24/2010 I and the entire group of developers I...

terrible service

Empire bluecross blueshield is the worst insurance provider I have ever had. My employer (a very large health care organization) reports that they pay over $ 13, 000 on insurance coverage for each employee every year. For this amount, I would assume that I would be provided with comprehensive health insurance. That is not the case. The empire bluecross blueshield plan recently became a pos - I have had intense pain in my lower back and lt leg for the past 4 months. The pain is disabling and has sent me to the emergency room three different times. My doctor has been trying to order a mri of my spine. Empire bluecross blueshield has denied covering the mri three times now. I'm not sure what they expect me to do. [censored] Them. I will now go to the urgent care center every day until they agree to pay for my mri. Let them be billed for that.

rip off company

I have had bluecross blueshield for over 2 years. I had my wife on the policy and they never paid a claim on her by saying everything was preexisting after a year I had her taken off because why pay for something that don't work. Last year I had a surgery and they wouldn't pay for that I had it to end up on my credit report and this has runt my credit, I had to get legal with a lot of money to get them to pay it. So after 7 months they paid part of it and it is still on my credit.in fact there is 7 things on my credit now that is blue cross blue shield but my company still pulls their money out of my check every week. So when people have to file bankruptcy on medical bills this is the reason for it. I hope they will read this and feel ashamed for their actions, but my luck they would set up there and see what I wrote and think well I shafted another one.

  • Ma
    Maldiva Feb 10, 2010

    My husband has been trying for months to get a crown for a root canal he received. BCBS of MA keeps denying the claim. They told the dental office that my husband needed to go see a specialist to find out if the crown would last 5 years. THAT'S REDICULOUS! Even though I've had 3 root canals and yes they've lasted around 5 years, my husbands tooth is in jeopardy of having to have ANOTHER root canal, because the dentist says after doing another x-ray, the tooth around the root has turned brown. THIS IS BCBS fault for not approving the crown. I had United Healthcare when I got my teeth done and they didn't give me any problems. Come to think of it, we NEVER had any problems with United Healthcare. If my job offered it again, I'd gladly switch. Can someone tell me what I need to do? My husband may as well have the rest of the tooth pulled. BCBS owes us something.

    0 Votes

fraud

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?

  • Bo
    bobtheman Oct 16, 2009

    THE GOVERNMENT prevents insurance companies from selling across state lines. Real healthcare reform would be allowing companies to sell over state lines and tort reform. Instead, braindead ###s think socialized, rationed medicine is the way to go. Liberals.. total ###ing ###s.

    1 Votes

policy stupidity

A month ago I visited my dermatologist. He wrote me 3 prescriptions to use with one another or his treatment...

health insurance

"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.

  • Em
    emmawatson Jun 26, 2009

    This is unfortunate that you cancelled your previous plan and then found out about the full rider on the back. Sounds like he must have had something seriously wrong with his back. Thats too bad. How were "no pre-existing conditions" applied the the plan? I thought all their plans excluded pre-existing for at least 12 months?

    0 Votes

I have ppo and still cannot get the medical treatment I need

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.

  • Th
    theguy May 11, 2009

    Garold,
    There are so many possibilities of what could actually be happening that it would really be best for you to contact your HR department and/or agent depending if you are on an individual or group policy.

    In my experience BlueCross BlueShield of Illinois is one of if not the best insurance company when it comes to customer service and claims payments.

    -1 Votes
  • Ro
    Ronald Cole Jul 20, 2017
    This comment was posted by
    a verified customer
    Verified customer

    @theguy Then that is very sad! They have lied to me and now tell me I'm not covered though they said I would have coverage this year. It doesn't matter what their employees say or not!

    0 Votes
  • Mi
    Michelle B 1984 Mar 11, 2013

    BCBSIL is trying to deny coverage for my allergy testing and treatment because it is a "pre-existing condition", meaning I had problems with watery eyes and itching as a kid and my doctor checked off "allergies" in my chart and gave my anti-histamines. As an adult i have developed serious life threatening allergies and had to be tested and they are trying to deny all doctors visits and testing pertaining to my "condition" because in my GROUP POLICY "pre-existing conditions" are excluded, which i did not know. WHo do I yell at about this?

    1 Votes

horizon ignores my claim and won't pay bill

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.

  • An
    AnnaLouise Jul 02, 2010

    I would call the customer service unit and check to see if they need your medical records to prove the condition did not exist before your coverage began. See if this missing information is the reason the claim is on hold or if they need your HIPAA Certificate of Credible coverage from any previous insurance carriers you had with no more than 63 day lapse between carriers.

    I would also inquire if the provider you saw is under investigation for fraud. That is a common reason for the claim being on "hold" that long, and the insurance company would not be able to specifically inform you of that. Innocent until proven guilty ... They may not be able to "volunteer" that information without your initiation due to legality issues, but you can certainly ask the question. You may get an answer of " I can't tell you that", or a simple "No". At least a no would be helpful. They can answer "No" if that is the case and if no review is going on with the provider itself. Providers will have no idea they are under investigation for fraud. The idea is to catch them and build evidence... and you won't catch them if the insurance company notifies their patients their provider is under investigation. It may not be the insurance company that is dishonest, but rather your provider (doctor, hospital, etc)...just a thought.

    Either way, you would owe your provider for services he or she performed. It is much more appropriate to think of your insurance plan as insurance against devastating financial ruin instead of thinking of it like a credit card where someone else pays the bill, or a portion of it, anyway.

    Hope this is helpful.

    0 Votes

if I were rich, I still couldn't get the coverage I have now!

I currently have health insurance coverage with blue cross blue shield of michigan through the cobra law. It...

scam and cheating

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?

  • Da
    dawn Mar 17, 2009

    I’m running in to the same problem. I call and was told i'm covered for 30 visits to the acupuncture. Then after i go they only cover 5 visits. When i was signing up for Blue Shield i was told 30 visits from blue shield when i need help i'm told to call another number to a 3rd party company. When i ask for a manager, i have to wait ten min. for the rep to tell me the manager not available. When i say than what, they said you can talk to a supervisor. duh. I said ok, wait 5 min for them to say the supervisor is on the phone. Stupid! There are so many people out of work; you would think they would be more considerate because they have a job.

    0 Votes
  • Th
    thiefflorida Feb 09, 2012
    This comment was posted by
    a verified customer
    Verified customer

    I agree with you. I have been scammed and cheated by BCBS of Florida. They find in 60 page contract (that changes yearly) ways to not pay and make patient pay for service, even when BCBS collects huge premiums each month. On page 22 BCBS says it will pay 75% then on page 53 BCBS says it will not pay for a long list of services which they classify as surgical ( remove wart, treat burns, put cast on broken arm, colonoscopy, or endoscopy) 1001 ways to cheat patients.
    2012 BCBS has improved call service. They know instantly why BCBS denied payment.

    0 Votes

bad business practice

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.

  • Br
    breeze21655 Sep 08, 2011

    I have been working with BCBS for months on a dental claim. I have been promised 3 times a copy of the check they said they sent me in March. The kicker is the service was by a physician in another town who I had never seen. Today I received a statement in the mail wanting the amount of the check back. I asked them to please come pick up the money because I would like to talk to a person face to face. No one has a clue what is going on at BCBS. Such a shame it was a good insurance. I think everyone should ask their employers to find a new company. They have too much power and our need to have a competitive insurance is gone. Thanks Obamacare.

    0 Votes

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