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Horizon Blue Cross Blue Shield Of New Jersey Basic & Essential Epo Plan / Horizon ignores my claim and won't pay bill

1 NJ, United States Review updated:

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.

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  • An
      2nd of Jul, 2010
    0 Votes

    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.

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