Florida Blue
reviews and complaints

The agent had no clue what COBRA was... after I gave her all my information for a quote, the agent proceeded to ask me how much I wanted to pay instead of giving me a quote... and lastly refused to give me her employee number when I stated that I was going to file a complaint due to the lack of basic healthcare terminology and refusal to provide a healthcare quote.

My Doctor gave me a tiering exception for my Generic drug, Florida Blue had it as a tier 4, so the exception lowered it to a tier 3, but I don't really understand why they told me I lost that tiering exception.
I checked with my Doctor today at my appointment and he told me he gave me that tiering exception for 1 year which should expire 1/1/ 2019, and not in Sept. 2018.

Please explain why Florida Blue took my tiering exception away making my Co-pay go from $40.00 to $211.00 for September, & I assume will be for the rest of this year, quite a jump which I don't believe is fair.

Please get back to me and explain it, or refund my Co-pay.

I called several times about a bill I was getting from my Doctor that Florida Blue had denied payment, Florida Blue paid nothing on this bill zero, and yet the Doctors office was sending me the balance of that bill.
I had this itching feeling in my brain that even though Florida blue had told me on three different calls, that I talked with & to three different supervisors, none of them knew a thing about balance billing being illegal. I had to do my own research and then I found out that as a matter of fact in April of 2016 Governor Scott signed a bill making Balance Billing illegal.
FLORIDA BLUE AGENTS I SPOKE WITH ON THREE DIFFERENT CALLS KNEW NOTHING ABOUT IT. SHAME ON YOU FLORIDA BLUE.
So what's the problem? Are you hiring uneducated unqualified people to do a job that elderly retires are looking to get correct information from?
If the Insurance company Florida Blue in this case paid nothing, why should the patient pay what the Insurance company didn't mention on that bill or the balance?
The answer was clear, they just had to know it, and when I called the 4th time all of a sudden the guy I spoke with knew all about it, he called the Doctors billing dept. and while I waited on hold he explained to them that I found a law that's against balance billing and makes it illegal to charge patients any balance.
I think we deserve answers, you can't keep telling folks on the phone that we know the answer, but you really don't.
That's why we call to get answers, but we are talking to unqualified untrained people that sound like they know what they are saying, but they really don't.

I called to make a payment with Florida Blue and they were incredibly rude from the beginning of the call. I had fallen behind in payments and was in a grace period. I had the confirmation number from a previous call stating that I could pay a certain amount of my balance to stay current, and I wanted to pay that amount. I was told I could that amount, I could pay a dollar and it wouldn't stop my insurance from being cancelled. When I tried to make sense between what I had been previously told and what I was being told now, he continuously interrupted me. He went on to be extremely condescending and suggested I pay my bills on time. When I asked to speak to his supervisor because I no longer felt comfortable speaking with him, he hung up on me. I called back immediately and received someone different. I'd like to state that I am not a confrontational person and was not being unreasonable or aggressive but I received yet again more rudeness and condescension from this Florida Blue employee as well. I became frustrated and told him he was being unprofessional and that I just needed to know if I made this payment that my insurance would remain active and he said it would but this was after he'd made similar statements as the previous guy suggesting that it might not remain active. It was a horrible experience and I am unsure about my status even after I made him confirm multiple times for the recording that the partial payment I made would keep my coverage from being cancelled. It is telling that they do not have an accessible way to reach corporate by phone or email.

They did Nied my insurance claims stating they were Medicaid codes and that they do not recognize Medicaid codes I do not have Medicaid I paid for these procedures myself so I'm submitting the claims by myself I spoke to the outpatient facility they told me these are not Medicaid codes I also submitted these codes back in 2016 with Blue Cross Blue Shield of Publix when I had that insurance they paid for them they told me that these are also not Medicaid codes but Florida blue keeps telling me they are and they refused to pay

I have spoken to Latoya a representative of Florida Blue 7/2018 she told me that when I went to my Dr appointment 8/2018 to call her that she would be more than willing to help with my lack of communication between the Dr and Florida Blue as usual no answer left a voice mail so did my doctor Ramon Castellano to get this procedure done I have called repeatedly Latoya with no return calls and no progress with my Dr it is very sad situation that I am about to be thrown out on the street because if missing work due to my aggressive pain she Latoya gave me some story I have lost more faith in Florida Blue than I could explain it has been a terrible experience and I am still suffering but as they say if your not in those shoes who cares that is what this country and businesses have come to it is a shame to say that I am an American really have brought my hopes down next step is to get it over one to the head and it's over may God forgive me and my family that I have gotten to this point in my life but my life us worthless to all because it comes down to money the devil of society may God forgive your companies for taking advantage of people who are suffering and have found hope to have it taken away

My complaint is in regard to unethical behavior on the part of Alignment Health, a provider of Florida Blue Cross Blue Shield.
Date of incident is 7/30/18 tp present day.
The issue is unresolved as of today August 8, 2018.

I am a BlueMedicare Preffered HMO SNP Member ID#XJCH26718031
I am status post Bome Marrow Transplant and i have chronic Graft Versus Host Disease (GVHD) and i am immune suppressed. I am also a cardiac and diabetic patient.

On July 30, 2018, I found that there was no appropriate referral for a scheduled visit to Dr Edgar Espana MD Opthalmologist University of South Florida( USF) .Diagnosis Severe Infection of Left Eye Rule out GVHD.
Alignment Health ( AH) previously approved a referral to return to Moffitt Cancer Center for Evaluation of Possible GVHD .
It seems that Moffitt set up the telephone referral to USF and I was told that a new referral should have been generated by AH prior to the visit.
I requested that AH approve referral for 7/30 /18 visit urgently and gave the update of the visit which was Left eye surgery by Dr Bajric MD USF Opthalmology on Friday August 3, 2018.
I spoke to the financial coordinator at USF Opthalmology Darrius.
Darrius contacted me that he had faxed the referral requests to AH after speaking with AH supervisor Norma.

Waited all week and no response from AH. Requested an escalation to a supervisor
spoke to Norma but no response back regarding eye care/surgery review.
To date no response from AH I have called day after day and still no response from AH regarding urgent eye surgery request

Filing a FORMAL COMPLAINT regarding UNETHICAL BEHAVIOR ON THE PART OF ALIGMNMENT HEALTH. Alignment Healthcare is holding back on authorization for care due to no financial arrangement with USF . Alignment Health claims they have not spoken to anyone at USF regarding this. Ih ave repeatedly demanded that AH prioritize my urgent medical need in regard to my eye to date no response
Contacted local eye doctor urgently as eye condition has deteriorated. I will visit on 8/9/18.
Please contact AH and call me back immediately at [protected]
Kathleen McEntee
2600 B Hidden Lake Drive North
Sarasota Florida 34237
Cell [protected]

Hello, my name is David Justin Carnley.

I'm just writing to voice a complaint. I'm very dissatisfied with Florida Blue. I have suffered from depression for many years, have taken 17 different antidepressant medications over a two year period and hospitalized three times, attended psychotherapy, have suicidal ideation, and still have been denied twice (once in May 2018 ans second in July 2018) for TMS (Transcranial magnetic stimulation) therapy. TMS has been highly successful in treatment resistant depression such as I have. Yet, Florida Blue has denied me the treatment. Must I continue to suffer taking more antidepressants that fail to work? I have been a loyal member of Florida Blue for over two years. I don't deserve to be treated so poorly.

Policy number: VMAH17993469

Address: 118 N Varner St.

Bonifay, FL 32425
Phone: [protected]

On May 2018 I called during my open selection at work. I had to take a decision on taking my son out of my benefits. An agent named Betsy [protected] told me that we can get a health insurance for $288 monthly and a dental for $25.35. We only needed to wait for my company to provide a certification that he was no longer covered by me. His coverage was until June 30th. Immediately we received the letter and called Betsy. It has being impossible to reach her again. Yesterday we spoke with another agent who never let me explain the situation, and on top called me disrespectful. My son is 22 and he is an adult who has the right to chose his own plan. Besides he receives the money for it. So here we are without insurance, an agent that never answers the phone and another judgmental and dictatorial who never let me explain.

Florida blue had autopay set up for me. My Bank of America card had been changed without my action to prevent fraud a choice by Bank of America. I thought the autopay was through my checking which is what most car insurance companies due to avoid autopay failure. So it failed for 2 months. I received mail that with a bill balance but it said I was on autopay and it was just for my records. So then I finally get a letter 3 months saying my policy is about to be cancelled. So I call them and ask them why did they notify me that my payment failed they said we don't notify people it's up to you to check your bank account transactions.
Took me 3 hours of talking to people to get no where on the fact that I felt they should notify me of my failed payment. If they send you bills saying your autopay is fine then why would you make a payment. So anyways made my payment for 920$ for two months premium missed. So then I asked could my autopay be canceled so I could be sure my payment was going through since they will not notify you if our auto payment fails. I'm not sure how they could not code their email server to send these emails after failed payments. They are making billions and they can't even have a working pay system. Last year in 2017 the same thing happened and I ended up having to drop my coverage because my premium was 600 and when I found out my autopay failed they wanted 1800$ to re instate my plan. Which is bogus because if I had to have open heart surgery that day missing 3 months payments I don't think they would have covered my bill and allowed me to re in state.
So after I canceled autopay somehow the bums from the call center who don't know what they are doing changed my autopay to the payment I made for the two months. For 920$ then it took me 2 hours to make my payment. One lady I first talked to I asked her could I make a payment and she told me you made a 920$ payment but it was canceled it was autopay. I explained I canceled my autopay already Months who and she said hold on and put me on hold for 45 minutes. My phone died i called again and a more intelligible man answered and I was able to make my payment In 5 minutes. So this other rep left me on hold for 45 minutes for no reason. Florida blue is [censored]ty shotty service with a failing web payment. Call reps that have no clue on earth how to fathom to just get your bill paid. I promise you when you call to sign up they will be so attentive they have their best call reps in sales. The call reps for customers service reps do not give a [censored] about you or your time. I had one good rep probably in about 5 calls. When I'm giving a company $460 a month and all I'm trying to do is make a payment or get an email regarding my payment that tells you they are [censored]ty.

When calling in I was speaking with a rep named Joan with a ref# of [protected]. I asked to speak with a supervisor and she refused to let me and placed me on a silent hold without my knowledge that she was even placing me on hold. During the call she kept interrupting me and speaking over me and asked me the same question 10 times, then got frustrated when I asked for a supervisor. She left me on hold for over 15 min before coming back to state that she is waiting on an available supervisor then she would place me right back on hold. The ref# above is so you can find the rep I am speaking about, she was not unprofessional during that bit of the call.

Why do pre-Authorizations take so long!

I have had chronic lower back pain since December 2017. So bad that I cannot walk most of the time. I have tried to get an MRI and an Epidural Shot. These were from different doctors and different organizations. For the MRI, I waited weeks for the authorization. For the Epidural Shot, I waited weeks and could not wait any longer, the pain was so bad. I paid out of my pocket to get 2 shots. Why should a person wait in agonizing pain to get an authorization?! I have called Customer Service numerous times and they have no record of the pre-authorization being submitted. I call the doctor and they tell me everything has been send in appropriately.

Something is wrong with your processes!

your letter
Hello Member,

A new insurance bill is ready for your review.

To view your bill online ...

Log in to your member account.
Click on Pay Your Bill.
We're here to help you in your pursuit of health. If you have any questions, please call the customer service number on your member ID card or visit us at a Florida Blue Center.

Sincerely,

Your Membership & Billing Team
Florida Blue

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Please do not reply to this e-mail notification. This is an automated email that does not accept reply or forward emails.

The View and Pay Bill capabilities are offered to members of Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue affiliates Health Options, Inc. DBA Florida Blue HMO, and Florida Combined Life Insurance Company, Inc. DBA Florida Combined Life. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue accepts payment on behalf of Florida Combined Life for dental, life and ancillary products.

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85767 0716R

EmailID:2B0000A0451A01
My answer
MY ANSWER
No payment whatsoever! There will be no payment, automatic or not. This is a scam perpetrated by malefactors. The proprietor of the above e-mail is not living in the US and has no connection with Florida Blue. If Florida Blue continue to use this e-mail address to harass its owner, Florida Blue would commit a serious fault and would have to answer before the Federal Civil right law

They took 3 payments out of my account date March 29, 2018 one out of my personal account and two out of my business. I talk to Supervisor Blamca Lamca on April 4, 2018 at 10:11 Am. She stated she would fix both charges on April 5, 2018. Still on my bank accounts. I will never call & make a payment on there system. I never get my bill on time as well. I lived in my home for over 25 years. I have my Iberiabank for over 5 years as well. Please don't let this company do this to some one else. Sincerely Patricia A. Billings

YOUR LETTER
Hello Member,

Thank you for using automatic payments. Your balance of $20.55 is scheduled to be drafted on 04/01/2018.
About Autopay

Your total amount due will be drafted. If your account is past due or changes were made to your plan, your draft for this month will be different from the normal amount.
You can cancel automatic payments anytime by logging in to your member account or calling us.
To view your bill online ...

Log in to your member account.
Click on Pay Your Bill.
If you have questions, log in to your member account at floridablue.com or call us at the number on the back of your member ID card.

Sincerely,

Your Membership & Billing Team
Florida Blue

MY ANSWER
No payment whatsoever! There will be no payment, automatic or not. This is a scam perpetrated by malefactors. The proprietor of the above e-mail is not living in the US and has no connection with Florida Blue. If Florida Blue continue to use this e-mail address to harass its owner, Florida Blue would commit a serious fault and would have to answer before the Federal Civil right law

I received approval from Fla. Blue to receive shots in my knees. Euflexxa. Then Fla. Blue said not medically necessary. Now Watson Clinic is looking for me to pay $1, 800.00.They say I can't see any of my doctors in Watson clinic until I pay the bill. I don't have that kinda of money. I think I have sleep apnea. And I do have multi modules and goiter on thyroid. So I need my doctors.

After receiving my renewal premium for 2018, my husband and I decided to remove our children from my policy and add them to his under his work insurance.in december of 2017, I submitted an application for insurance for an individual plan effective january 1, 2018. I have had access to my policy online since becoming a policyholder of florida blue and make my premium payments via the online billing. On december 29, 2017, I noticed that my bill still reflected the premium amount for the family plan instead of the individual plan that I requested so I reached out to florida blue. I spoke to a victor and he told to just pay the premium amount for the individual plan, that he would send my bill to escalation, which they would adjust it and all would be fine. So, I did exactly that and I thought everything would be ok. On january 10, 2018, I noticed the situation still had not been resolved, that the policy still reflected a family plan and I was still being charged an outrageous premium amount. I spoke to bianca. She ensured me that everything was still being worked through the system and that it would be resolved. On january 25, 2018, I again called florida blue because the situation was not resolved yet. This time I spoke to cindy. Cindy told me that she could see where my children were to be removed, that she was going to have this worked on again, to only pay the premium amount for myself and gave me a reference number. She also told me to give them 3 to 5 business days to process and that they would call me back. I received no call back after 5 business days, so I called them again on february 9th. I spoke to an elizabeth and she told me that everything looked like it was corrected and to go ahead and pay my bill. I told her that I did not have access to the bill online for some reason and she replied that sometimes their system does that and to try again later. I trusted her and felt better about my situation, so I listened to what she advised me to do. I tried to pay my bill every day since the 9th via online and was unable to. So, I again called florida blue and was informed by a catherine that my policy terminated on january 31st and that is why I did not have access to my billing. This was news to me. I demanded to speak with her supervisor, multiple times and had to get loud with her before she actually agreed to get a supervisor on the phone. Well, the supervisor belinda was worse. She was rude and condescending. After being put on hold multiple times to "review their notes", she again got back on the phone and told me my policy terminated because of not paying the full premium amount for the family plan for the month of january and that the agent who wrote my policy put on my application to keep my children on the policy until 1/31/18. If that was the case, why did no one tell me this from the very beginning? Belinda also informed me that someone tried to call me in the beginning of february but the phone number that they called was not mine. It was not even the same area code. As of today, I have had to cancel my appointment with my oncologist for life-saving preventive care all because no one communicated with me from the get go that my application stated that my children had coverage until january 31st! I was told on more than one occasion that my application would be processed, corrected and escalated. So, here I sit, having to wait for my agent to rewrite me a policy and hopefully she can. I have never been so disgusted with a company before in my life. Belinda should not be a supervisor and should be fired, along with every person who I spoke to from the beginning of this problem. It is their fiduciary responsibility to communicate all pieces of the puzzle to their policyholders. They left out the one vital piece and I am now without coverage for the first time in my life. And today, having that coverage, truly, truly matters.

On December 26, 2017, I called Florida Blue to cancel my insurance because I was no longer eligible for the BCBS plan through the ACA. The cost would be $1238.07/mo which I could not afford. I spoke with agent Latriesha Johnson who told me this would be take care of it. I have since been told there is no record of my call or that my call was on a different date but no notes were written about the call.
The $1238.07 was taken out of my checking account anyway the first week of January which caused me to take money from my savings to cover the withdrawal. I called Florida Blue back on January 9th and spoke to Angie who told me I should have called the Marketplace to cancel, and that was why the money was taken out, something which Latriesha neglected to tell me when I called on Dec. 26, 2017.
I immediately called the Marketplace and canceled at which time I was told the cancelation would not go through officially until Jan. 23rd. I called BCBS back to request a refund since the insurance had not been used... didn't even know I was considered covered until the middle of January when I was told I could not get a refund. I spoke to a couple of agents between Jan. 9-16... names were Angie and Tasha... trying to find out how to get a refund.
I called again on the 17th and spoke to Monique who said there was no way to get a refund and gave me a hard time when I asked to speak to a supervisor. I was finally transferred to a supervisor named to Kanesha who said I would get a refund of about $280. I asked to speak to a higher up and she said there were none, but she could have another agent or supervisor call me back... like that was going to make a difference.
I am extremely upset that $1238.07 was taken from my account without my permission after I canceled the policy and am being told that I will not get a full refund. I cannot afford to lose that much money. I do not have a lot of money and work hard for what I do make.
I am appealing to you according to what you say you stand for on your website..."doing the right thing at all times, in all circumstances," providing solutions that surpass ordinary standards, no matter the size of the project, "and"striving to positively impact lives every day with our clients, communities, region, and within our own families." These are the companies own words, and what happened to me was not the right thing. I was misinformed by your agent back in December and now your company is taking advantage of that by not refunding me the $1238.07 that was taken from my bank account. You have no idea how that amount of money being taken effects me. I should have been told by Latriesha back in December to call the Marketplace to cancel, but she told me this would take care of it. I request the $1238.07 be returned to my account.
I have no further information to attach.

My 3 years with Florida Blue has always been a hassle. From rising premiums to representatives lacking knowledge. This month, trying to get a new plan for the new year (due to a sky rocking premium) I've spoken with over 5 representatives over the course of the last two weeks who have all given me different information. Firstly, my "pay by phone" payment went to the old plan instead of the new one, when I called to fix this they said they would transfer the payment and told me to call back this week to confirm. When I called today, apparently the transfer had been denied the day after I spoke with someone last week and my payment was refunded via check in the mail, BUT I NEVER RECEIVED NOTICE OF THIS. When trying to make a new payment over the phone today, the first representative told me to make a new FL Blue account with my 2018 member number. I tried to do that immediately following the phone call, the website said my new member number was invalid. I called again, this representative kindly informed me that since my new plan is not active until the 1st, that I could not create a new FL Blue account to make this payment (Meanwhile a few weeks ago, another representative told me that I did not have to make a new online account, once the 1st of the year hit my old plan would be gone and the new plan would show up in my exisiting online account.) Furthermore, when today's second rep said she would transfer me to another "billing rep" instead of the automated phone service that messed everything up in the first place, SHE TRANSFERRED ME TO THE AUTOMATED SERVICE. I had to call A THIRD TIME TODAY to finally connect with a human to make my payment. Once I finally made this payment to the correct new plan (hopefully) the rep said they could not send an email confirmation of the payment until after the plan was active. So who knows, maybe the payment won't go through again and I won't be notified again, and I'll be stuck without health insurance for the new year. GET YOUR ISH TOGETHER FLORIDA BLUE.

Please help! I am disgusted and heart wrenched over the guidelines and protocol of florida blue insurance company (obama care). I am also baffled that florida blue insurance company can deny a request by a doctor regarding a patient's care. The following is an explanation per my telephone conversation with florida blue. My surgeon's office put in a request to florida blue for me to have back surgery on 10/18/2017. On or about 10/11/2017, I was informed by my surgeon's office that florida blue denied my surgery. I was also informed that every patient that has gone through their office with this insurance has been denied for some reason or another. The surgeon's office scheduled a peer to peer with florida blue, which was also denied. I contacted florida blue myself several times before I was able to get answers. At first, I was told that it was approved; I was given a reference number, codes, and dates of service. After contacting my surgeon's office back, they informed me that the codes and authorizations that were given were for the hardware that was going to be used in my surgery. After contacting florida blue again and asking for a supervisor, I was connected with jennifer trout. Jennifer told me that the surgery was denied due to: my bmi being a little too high, I was smoking cigarettes at the time, and I did not have an mri, physical therapy, or injections in the last 6 months. I explained to jennifer that I had back surgery in 2013 and 1 in 2014 and had 2 rods in my back already. Last year before my visit with the surgeon, my neurologist ordered a ct myelogram, which is an extensive test showing results or damage around the hardware in my back and previous surgeries. It took me 5 months to get into a visit with the surgeon's office. I had therapy last year before I went to the surgeon and the ct myelogram.in july 2017, I had a spinal stimulator trial put in my spine with the hopes that it would work and I could avoid surgery. Spinal stimulator: a type of implantable neuromodulation device (sometimes called a "pain pacemaker") that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions. Scs is a consideration for people who have a pain condition that has not responded to more conservative therapy. Unfortunately, it did not work. I have been out of work since last november, no income whatsoever, homeless (staying at a friend's house for now), and I have $75 copays every time I go to therapy or surgeon. My help from people is running out.
In my last conversation with jennifer, she told me that the surgery was denied due to: my bmi being a little too high, I was smoking cigarettes at the time, and I did not have an mri, physical therapy, or injections in the last 6 months. I have complied with everything. I had an mri, my last cigarette was october 11, 2017, I have been to therapy a few times which is not helping, my bmi is lower, because the weight the doctor's office had was the weight I gave them at my first visit. I actually weigh less with a lower bmi at the present time. I also had the spinal stimulator trial, which would be considered another "conservative therapy" before surgery. I had an appointment with my primary doctor, so everything is documented. I told florida blue if I needed to be tested for nicotine, I would have no problem complying.
Last week, my surgeon's office resubmitted a request with updated compliance for authorization for the same surgery on levels l2-l3 and l5-s1. The surgeon's office contacted me to inform me that florida blue is now approving l5-s1, but is denying surgery on level l2-l3. This morning, I contacted customer service once again, only to be told that they have more stipulations. Apparently, the person from florida blue reviewing the surgeon's notes, radiology reports, and being involved in the peer to peer process does not feel that the surgery is warranted. There are currently 2 rods placed in 2 levels of my spine. I am not able to walk any distance without severe pain, I cannot attend art shows, walk stores, walk malls, carry groceries, hold or play with my grandkids, it's hard to walk stairs, and find it difficult to walk, stand, or sit for long periods of time without pain. I live in pain every day 24/7. I applied for disability several times and was turned down, because they feel there are jobs that I can do. I need help; I need back surgery.
While speaking to a representative from florida blue, I was informed that I can file an internal appeal then an external appeal. I have emailed the florida blue complaint board, bill posey, insurance commissioner, consumer affairs, bbb, 3 tv stations, and the local newspaper.
Today, I received an email that I was no longer connected to the patient portal for my surgeon's office. I contacted the patient advocate who informed me that I was discharged from the practice, due to florida blue denying 2 requests for authorizations for surgery and 2 peer to peer sessions, and cannot do anything else for me.
How can florida blue get away with this?
Please help!

Sincerely,
Donna zerlin
[protected]