Comments:

My 21 yr old son has Blue insurance through a very prestigious UC where his father works. I(my son) has pars fractures in his low back which allow the bone to move forward and the discs to herniate pressing on nerves. He and his orthopedic surgeon (a blue HMO authorized one) have discussed surgery over the years but put it off opting to try other non-invasive treatments. Now flash forward and he has tried all the non-invasive treatments and it's time for surgery. He comes home from school in Feb where he is on a soccer scholarship and we proceed with the authorization process. HMO denied, this blue also has PPO, denied, its ironically called a POS which is apt, appeal by the dr, appeal by I, denied. Call my assemblywoman, call my senator both have aids that are very solicitous but have provided no assistance. Peer to Peer Dr from blue says the surgery is being denied because of XYZ, we remove and resubmit, denied. New doctor from Blue, who has never seen, never spoken to I and probably not read all the info calls and tells I's surgeon that we should get a lawyer because we can appeal but he will always deny. Thank God my surgeon was so shocked he got off that phone call and dictated it. Now I recall all the people I've already called and I submits a appeal to the New CA Dept of Managed Health Care. I send them everything, including crazy monolog by Blue MD and oh by the way my son keeps putting his back out sneezing because of allergies, and we are 2 months in. The CDMHC or whatever anonomously denies. Dr's #1, #2, #3 agree he has a very serious condition but should try stand procedures first???????? Didn't we do that??? What does that mean?? One dude with a phone number is called by I, he knows nothing regarding standard procedures. Reluctantly I decides on the most minimal procedure, fusion at one level in the hopes that it will stabilize his remaining discs. Guess what? Denied. I have recalled Senators, assemblywoman, UCHR and 7 on your side. So glad we have that great health insurance. B

Comments:

Please reply if you have paid your BCBS premiums on time, but were still cancelled as a result of non-payment of premiums. I have noted at least one comment below with a similar story.

Comments:
 

I am covered by my husbands policy through BCBS.

We are a very healthy family and though we pay alot of money into our insurance policy we do not use it often.

I am currently pregnant and was informed today that before delivering my new baby I have to pay a 5,400 dollar deductible! The "payment plan" is 341 dollars a month, on top of preparing for a child how does anyone afford that! the whole reason we got insurance was so that emergencies that cropped up would not cost us an arm, a leg and our first born. Can someone please explain to me the point of having insurance when it would have actually been cheaper to not have insurance?

Comments:

After 15 years of paying premiums to BCBS of NC through a self insured health plan I now have been canceled! Never any major claims! Deemed uninsurable bc of high BP 140/55. I'm 55 and I teach fitness classes at a YMCA, bike 100 miles a week, overall great health. But BCBS has marked me as a risk. That said other companies will not touch me! Thanks BCBS!! You sucked me dry!! I hope you get yours one day!!

Comments:

Illinois law requires BCBS to cover infertility, but BCBS has put at $7,500 LIFETIME MAXIMUM on prescription drugs for infertility.  That, essentially, means that one gets one or two (by which I mean one and half) chances at IVF and then you are DONE.  Now we are faced with (a) not ever having kids or (b) paying out of pocket every six weeks for however long it takes $5,000-$6,000 to keep going.  Eff BCBS.

Comments:

I have need of a great deal of medical supplies due to a non functional pituitary gland. After struggling to pay my $5000 in network and portion of $10,000 out of network deductible (not to mention the bimonthly fee) I finally saved enough money to get my deductable paid down 3 months into the New Year as opposed to 11 months in to it. Happy I could get my many prescriptions exactly when I needed them without rationing I set forward getting my past due bills caught up. One month after my deductibles were showing paid. The Dr’s and Pharmacies are telling me that there is nothing paid on my deductable. BCBS says they don’t know why but it is showing 0 paid on deductible. They tell me they will get it strait just pay the money and I will be able to go to the drug store for refund when it’s fixed. Now there saying the deductable was never paid, they “shut off the deductible” for some lame/lying reason and when they turned it back on it was showing 0 now they have it all figured out and I really owe over $1000 still on the deductable. So without any notification from BCBS they turned off the deductable function of there software for a month so when Dr’s look it is paid and I am good to go. To regular dummies like me that mean’s I’m good until the deductable resets (October) so now I spent any money I had saved on other needs, I’m out of medicine and have no money left to pay. I had it last month when I thought my deductable was paid. This is the biggest nightmare Iv had with them to date its very exhausting dealing with the constant changes in preferred drugs but this roller coaster has left me numb with no idea how to get my meds and broke. This seems impossible to believe. They turned the deductable off? Has anyone ever herd of such nonsense?

Comments:

Hate is a strong word that I never use.  I reserve it only the lowliest and sorriest entities this planet can offer.  Having said that, I HATE B--- C---- B--- S-----!! They have ruined me financially and, for the moment, psychologically.  I just had one of my hips replaced in October of 2011. Prior to this, my insurance card was passed through numerous channels.  All of which said this was approved.  So feeling good about it all, I went under the knife.  Now after the fact, I'm finding out that it was rejected and I have to pay for this surgery out of pocket.  How could this happen?  Here's how they got me. I've had health insurance with them since Jan. 2009. In February 2011, they had a campaign about adding dental to your plan for and extra $17 a month.  I thought this sounded great so I did it.  STAY AWAY FROM THIS!! What they did was, reset everything and began a new contract.  They said they explained this to me and I honestly don't remember that.  It may have been cloaked in hypertext that I didn't fully understand or maybe I didn't read the fine print.  But now they're saying I have to wait until February to get my next one done due to the 365 day exclusion period for certain surgeries, including joint surgeries. How was this approved and then rejected after the fact.  If I had known it was rejected I would've waited till Feb for the first one and I think my surgeon would have told me if it was rejected because I seriously doubt he would've done it knowing he may not get paid for it.  Just another example of where our hard earned dollars are going every month.  They act like they are the guardian angels of the human race but they are really snakes in the grass waiting to strike at your wallet and poison your life!  The whole thing is a sham and they probably have entire departments who sit through numerous brainstorming sessions per week devoted to screwing over Joe Schmoe and lining their already fat wallets.  Does anyone know a lawyer who handles this kind of thing?

Comments:

 

I am the Practice Administrator for my wife's Primary Care medical practice. We recently received a letter from the biggest insurer in the country saying they would be removing the "opt out" language from our contract in reference to publication of utilization, quality and other practice data citing that consumers now expect to be able to find reliable, standardized comparative performance data for health care providers. What a load of horse droppings and here's why:

 

Our paperwork for new patients always includes a space for "how did you hear about us?". We keep track of this information to see if our advertising dollars are making any difference. Eighty percent of the responses noted "from a current patient". I find this is very similar the same case with most primary care physicians. Specialists receive about the same number of patients (80%) as referrals from primary care physicians. You do the math...horse droppings!

I totally agree with the efficiency model that Medicare is striving for in that it saves the government unnecessary expenditures that lengthen the life span of Medicare. However, commercial insurance carriers have decided to adopt the same push for efficiency from the physicians, facilities and other providers. And, at the same time have continued to raise premiums, increase denial of services and increase out of pocket expenses for their members. So on the one hand we have the health service providers who are being squeezed to do more for less reimbursement. On the other hand we have the policy holders who are now receiving less care at a greater expense. And in the middle, we have the great and greedy insurance company who is taking the money from both hands and stuffing it in their pockets! See the big picture?

 

Comments:

I was diagnosed with allergies/asthma before I was 2 years-old, and had to receive weekly shots from that time until I was around 10. My mom just told me that we had Blue Cross/Blue Shield thru my Dad's work (he didn't get a choice), and that in the the late 1960's and 1970s BCBS denied that asthma was a physical medical condition. My mom was told that asthma was caused by psychological factors and therefore they would not cover anything. It's inconceivable to me that they listed asthma as a "mental condition", the reality is that they know how much allergy medication and shots cost, and didn't want to pay. My folks had to pay $60 a week for my doctors visits and shots (a lot of money back then) and didn't get a dime from BCBS. Did anyone else have this problem? Was there ever a class-action lawsuit? Thanks

Comments:

I’ve had continuous health/medical insurance coverage for 35 years, never having a break in coverage. In June 2005, I was diagnosed with Multiple Sclerosis. Now as of June 2011, I’m being denied coverage because our new medical plan has a pre existing condition exclusion of 12 months. Even though I submitted proof of Creditable Coverage for the last 18 months, they’re still denying payment of all expenses associated with my condition. When my Doctor and the medication program called to verify coverage of my medication in June, they were told, “YES, it’s covered”. Now it’s October and I just received a statement from the medical insurance of what WASN’T paid. Since I have PPO, I was expecting they’d want the deductible of $1,500 first. However, wasn’t expecting them to NOT paying my medication, now at a tab of 16K. Tomorrow I call the State of California Insurance Commissioner.  Will post later how this ends…

Comments:

Anthem...

 

I discovered that the only way to get Anthem to address a problem was by reverse engineering the e-mail addresses of the board of directors including the CEO of Wellpoint, the holding company.  (I did this by looking at the scheme for using names for the investors contact e-mail, which was first name dor last name) and sending them repeated e-mails.  As a plus this happened during a the summer and I got the "out of office" e-mails listing private phone numbers.  I called these too.  I avoided being threatening and being firm but unfailingly polite.  I was able to resolve this problem

I infer that the problem would have never gotten fixed if I had not done this.

 

When the CEO is handed a hot potato like this, it turns out they have a whole set of escalated support people that are NOT in Mumbai and actually try to resolve the problem to make you go away.  Even though this was the case, Anthem has been so busy gobbling up companies that its computer systems are in a nightmare state and it took forever to get my data correctly migrated.  I even eventually persuaded them to refund my employer one month of premiums.

 

So I highly recommend the reverse-the-board e-mails approach.

 

For example, if you go to Wellpoint's site and click on Investor Relations.

You will see a listing of contacts like

Michael Kleinman

Vice President, Investor Relations

...

michael.kleinman@wellpoint.com

 

So it makes sense to guess that Angela Braley, the CEO, woudl have angela.braley@welpoint.com.  Just go through the up to date list of the investor contacts and the board of directors and e-mail them all.

Good luck!

Comments:

My wife works full time for the YMCA and I am a full time student and therefore do not work.  I am "covered" through her Blue Cross Blue Shield of Florida policy, we selected the premium or best policy, and about half her paycheck goes towards paying for this benefit, probably 400-500/month out of her pocket and another 800/mo payed by employer.  After about a year of my wife paying into this, I went to the dermatologist for some preventative care from Dr. Cynthia Hensley in Bonita Springs Fl, they informed me that my insurance deductible was 3,000.00!! and that no care would be covered, I would have to pay the full price charged by the dermatologist instead of the much lower fair prices charged to insurance companies, I told them that I could not afford this and I was turned away and I was denied access to much needed preventative care for skin cancer.  I called Blue Cross 3 different times and was told I had no deductible, then I was told it was 500.00 dollars, then I was told it was 1500.00, either way, I was DENIED access to care by the "best" insurer in FL and was told by the Dermatologists that I would be billed for the full amount of care without the privilege of negotiating a fair price for care that the insurance companies enjoy, should they be unable to find a way to deny coverage to their customers.  I walked away from this experience disappointed and disillusioned learning that our healthcare system manipulates the sick for maximal profits and gives little consideration to those of us without much money to offer the MDs or insurance companies.

Comments:

 

I applied for health insurance through HMSA in March.  It is now July.  A few weeks after I applied, this snotty woman calls me for an interview, and I'm forced to tell her every single private detail of my medical history. Which incidently includes no serious medical conditions EVER unless you count psychotherapy which I haven't been to in years.  I ask her why she's asking me all this when it's illegal to deny people coverage based on pre-existing conditions now. she says in a nutshell that HMSA has faith that the Republicans can over turn it, so they "don't really know what's happening with that" (IT'S THE LAW!!!!!!), and when I pressed the issue, she flat out lied to me and said that the pre-existing condition thing only applies to children.  Tiny things come up over the next three+ months that I'd like to see a doctor for, but I neglect my health and avoid doctors at all costs because I'm afraid that once they approve me (and at this point, there's no doubt in my mind that they will approve me since i'm not and never have been even remotely seriously sick.) they'll see that I went to a doctor AFTER i disclosed my entire medical history, and then they'll say I lied about my medical history, and deny me coverage. About a month later, I call them to check on the process of my application. They tell me they have no record of me applying, or doing a phone interview. I'm totally shocked. I call them back at the start of the next work week to try to find out what happened, and re-apply. They tell me to call a different number.  I call the actual people who process the application, and the woman I speak to seems confused and says "No? We have all your information right here. Your application is being processed. They usually take between TWO AND THREE MONTHS to process".

So as of yesterday, it's coming up on the four month mark.  I give them a call.  They tell me that according to their records the person who did my phone interview left a voicemail for me and I never called back.  I try to get it sorted out and get a severe run around.  I finally get the number of MedLife who underwrites HMSA's applications.  They tell me that they sent me a rejection letter April 14th.  I've been waiting to hear from them for four months, why would I overlook such a letter in my mailbox???  I'm starting the appeals process tomorrow so this will be continued...

 

Comments

Health insurance providers claim that they have to raise premiums and lower coverage b/c of rising costs.  I recieved the SAME EXACT denial letter for a personal insurance claim THREE TIMES!  Even better, I work at a medical provider's office and all kinds of insurance companies send REPEATED denials/approvals/notices for the SAME THING.  So this seems to be a widespread issue....just saying, how much $$$ would insurance companies save on paper, ink and postage if they reduced the number of duplicate mailings???  "Well, it's not us, our 'system' generates denial letters."  FIX YOUR SYSTEM!!!!

Comments

I am a medical billing specialist - I have lots of horror stories, but this one comes to mind. I sent some paper claim forms to a managed care organization.  The claim forms were for different services, with 5 of them going in the SAME EVELOPE. I sealed the evelope myself - I know what was in there.  A few weeks later, I called to check the status of the claims.  I was informed that only ONE of the FIVE claims was on file - they showed NO RECORD of receiving the others!  THEY WENT IN THE SAME ENVELOPE!!! What did you do with the others???? A co-worker of mine used to work for an insurance company and claimed that she saw people throw claims in the trash...after my personal experiences (this is not the only instance similar things have happened to me), I believe it!  And we wonder why costs are so high...with the same claims being sent/processed/searched for repeatedly, that's a waste of everyone's time!

Comments

I had a minor heart condition when I was 13 yrs old, involving a racing heartbeat.  At age 15, I had CORRECTIVE surgery and have had no problems since.  I haven't seen a cardiologist since the follow-up exam after the surgery.  I am now 26.  I work 2 part-time jobs and attempted to apply for individual health insurance, as I am not provided with any coverage through my employers.  The insurance company got ahold of a medical record that stated I had had an ablation (the corrective surgery).  This surgery is by definition corrective - meaning I no longer have the condition.  (Just like once you put a cast on a broken arm and let it heal, your arm is no longer broken).  I was DENIED ANY coverage, on the basis of a condition I no longer have!  This surgery was 10 years in the past - the cardiologist NO LONGER HAS my records...so in order to even have a chance at coverage, I would have to go UNINSURED for a complete exam by a cardiologist to prove I am healthy.  The worst part - the SAME ins company that denied coverage, COVERED me until I was too old to be on my mom's policy.  So they cover me through a corporate policy, but not as an individual. Either way, I still have/don't have the same health issues.

Comments

I have anthem bluecross /blueshield, deductibles are so high that i recently was measured for a leg brace it is the last option for surgery at my age for being 45. insurance will not cover it because of my deductible. and this is a leg brace that costs 1500.00. hell I wonder if they rather pay for surgery then huh?? ha hainsurance companies are all about themselves and making their bonuses. I feel sorry for the kids coming up today what are they going to do when we are gone?? insurance will be so high by then that basically you might as well pay straight out of pocket and skip the insurance company

Comments

 

If you change health insurance, PLEASE don't use UHC.  My experience: Husband works for BellSouth/AT&T. We had no choice in health insurance. The Dr. we've been to for 20 yrs. doesn't accept UHC. I went to Drs. that accepted UHC and thought they were going to let me have a stroke! They were ER docs in a box and couldn't prescribe the right meds to keep my b/p under 210/113.. I had to go back to original dr. and paid cash. He corrected my meds in one visit. B/P was controlled.

  

    Our deductable with drs. that accept UHC is about $2400. The deductable for out of network drs. is over $6,000!! Then they only pay 60%.   Our meds (mail order) are $600+ per order, until we meet the deductable IF we go to an inservice dr. (I haven't found an internist I trust in my town, other than our original dr.-who doesn't accept the insurance)   We are out of some of our meds and I can tell my b/p is up, but we don't have the money to pay full price.      Another thing happened when husband had to go to ENT dr.  I called to get a gap exception, as no ENT were in network.  THEIR couselor told me I didn't need one as there was an ENT in town, which was the dr. he was to see.  We received a bill for FULL payment of the extended visit.  I called UHC and was told I didn't call for a gap exception!! I told the UHC rep. that I indeed called and was told I didn't need it as this dr. was in network.  They denied having any notation of them telling me this.  So, we had to pay for the full price of that visit.  

  

     I have begged them to please let us see the dr. we have always been to that knows our history.   Several times they told me different things to do; have the dr. write them saying it was medically necessary to stay in his care. (did this) another was to have the dr.'s insurance lady send in a notation asking for something like a gap exception (did this).

 

Weeks, maybe a month later I call UHC and they say they haven't received ANYTHING from my dr.  They then tell me to have the insurance lady do something elso,  by then I am totally embarrassed to ask my dr.s ofc. to do anything else.

 

    I would hope if I die from a stroke or heart attack that someone will do a class action lawsuit against this carpetbagger insurance.   The premiums are MONEY WASTED!!!

Comments

19yr. old post ACL reconstruction and partial meniscus removal.  Denied a Brace because he wanted to play sports.  Had his Doctor lied and said he had osteo arthritis or that the surgery was not successful the pigs would have paid for it. But not for Sports.  Yet the hypocrites promote healthy lifestyles and exercise when it saves them money.

Comments

I despite BCBS - my husband became very ill over a year ago and was diagnosed
with end stage renal disease. He was diagnosed in September 2009 and from
September 2009 to January 1, 2010 he had accumulated over $150,000 in bills
that BC denied because they said it was pre-existing. . . what a joke! Never in
his entire life had he been treated for any kidney/renal problems. I appealed
their decision, they absolutely refused to respond to my appeal in a timely
fashion. The bills continued to pile up as expected. We were at the mercy of BC
- I called and called, wrote letter upon letter, all of which went unanswered.
Even asked to speak with a supervisor, and was told I would have to be put on a
call list and a supervisor would respond within 48 hours, that was over a year
ago and I am still waiting. After 5 MONTHS of them not responding to my appeal
or any of my letters or phone calls I filed a complaint with the insurance
bureau and wrote a letter to the Attorney General and then and only then did
those crooks @ BC make a decision. In the meantime they put me through hell, I
was scared we would lose everything! My husband who was already very, very ill.
And to top it off, there is no legislation in the State of MI to fine or punish
them in anyway for what they did to us. I was actually told by a rep of BC that
they would automatically deny my husband (something I am sure I was not to
know). Even though I won my appeal I am still very angry for what they did to
us and are continuing to do to their insureds every day. I want to voluteer my
time to help people fight their insurance company's decisions! BC disgusts me
and the funny thinf is a rep who helped me @ BC dogged on them and how they
treat their insureds-

Comments

“Together, we can reduce the overall cost of health care and become better health care consumers.”

http://www.bcbsok.com/pdf/eco_health_care_part1_brochure.pdf

What you just read is an excerpt from the brochure series Economics of Health Care by BCBS, I find this particularly interesting since their your policy of a moratorium on any free standing radiology practices seems to be at complete odds with this statement. Elimination of competition is not a method in any business school I know of to help reduce cost. This brochure really does put an interesting spin on the parent company HCSC when only a few short years ago they were in the position of having the largest fine in history for Medicare fraud of 144 million.  I am not a CPA but can hardly believe HCSC built on 24 additional floors to its skyscraper in Chicago on a 1 percent profit margin this last year. While this non investor owned model sounds good on the surface, it certainly allows HCSC to pay unlimited wages to upper management and no oversight of how they operate by shareholders or government. As long as HCSC has policies in place to eliminate competition, and actually promote physician owned radiology practices which have some hospital ownership the number of exams and the cost to the members will go up. There are many studies which indicate if doctor ownership is present more exams are ordered, it’s not just an opinion. It seems the model in which a physician orders a medically necessary test to a hospital or radiology provider he or she has no financial interest in would be the most desirable, odd that BCBS of Oklahoma chooses to eliminate this scenario. I know the reality is that it’s not what makes the most sense but the politics of the situation and who is getting paid what.

What I feel we desperately need in our state is strong “any willing provider” and “freedom of choice” laws which will promote competition and give patients rights to go to the providers they choose. I’m sure you can remember when government forced the breakup of the Bell system. We were all paying 50cents or more for different types of long distance per minute, since that time, competition has dramatically brought long distance cost down. Every consumer who uses long distance now enjoys the savings as a direct result of competition, it has proven to work………Kevin E Sutter CEO Doctors MRI  sutterk2564@gmail.com

Comments

As a spine surgeon it's unbelievable the number of denials that Blue Cross of California provides.  It is truly not in their interest to provide 85 cents on the dollar toward patient care. They spent 85 cents on the dollar lining their inhumane blood lined pockets.  Shame on you Blue Cross of CA.

Comments

This is a great website for psychotherapists.

Is there any action that you are working on to change the problems? I am one of very few therapists specializing OCD with children in my area.Blue Cross refuses to allow me to participate despite letters from physicians endorcing my expertise.They do not say that they  are closed.They just do not respond to the letters of interest.

When I call they claim they have enough therapists in my area.  .The searches prove this is wrong.

It is unfair to the subscribers who need my specialization and unfair to me. Is there anything to be done?

lynne@lynnefreeman.net

Comments:

My Dad is Government retired after years of service with Veterans Administration. Also served in WW 2 with Pattons army in France and Germany (Battle of Bulge). He has alway's had excellent credit (financial) in his 84 years! He is member of BCBS and he received a bill for treatment for .01 CENT! He contacted the clinic for payment on his "Bill", and was told the amount had been "written-off". BCBS sent two more additional statements for their .01 CENT! The amount was paid to keep his 'good" credit rating he was informed on losing if the "Bill" was'nt paid... Just wondering where the penny went? Kim in Florida.

 

Comments:

I have Blue Cross too,and I'm looking at a process claim form Blue Cross of Alabama sent back that shows that they paid nothing for the consultation visit of a provider that specialises in colonoscopy testing. It had a note with it that said Maximum benefits related to this treatment or illness have been provided for this patient. I am 52 and never had a colonoscopy or even consulted about one. Lets face it, private insurance providers are set up to deny claims to make profits. We need a single payer system and get rid of these scum. There are too many posted comments in this website that can ever reassure that this kind of system can ever be fixed. The Bill HR676 in congress put out by Conyers and Kucinich would provide Medicare for all. We really need a strong grass roots cause to make this happen. Or else its more of these horror stories.

Comments:

Blue Cross is crooked, just like those fat-cat Wall St. bankers were. They are helping to break the infrastructures of this country. The are fat, money-sucking creeps and I hope they get theirs one day. They want me to work a whole week to pay just for their crummy insurance coverage, plus I have a big deductible. It is a shame the way they have people over the board or by the balls, in plain English.

Comments:
 

I work for the State of North Dakota, State Water Commission.  I had to go on the state BCBS health insurance June of 2008, because my husband was diagnosed with cancer and was forced to leave his job, which provided health insurance for both of us.  He turned 65 and got on Medicare.

 

I have worked for the ND Water Commission for going on nine years as a part time temporary employee.  So I don’t get any benefits of any kind.  When I went on the states BCBS it costs me out of pocket $318 each month.

 

On June first this year apparently BCBS raised the rate I have to pay to $400 each month which comes to a 26%  increase so I took an $84 hit in June.

On July first I received a 7.3% increase in salary that comes to  .73 cents an hour.  Since I am only allowed to work half time that adds up to $62.78 per month.  If you subtract my salary increase from the increase of the insurance premium I am losing $19.22 each month from what my earnings was last year.

 

How can BCBS of North Dakota be allowed to increase premiums by 26% .  I was not even told this was going to happen, I found it out when I checked my June pay stub.

Starving North Dakota resident.

Comments:

My mother died on February 27, 2009, while a member of Independence Blue Cross of Philadelphia. I informed B/C on March 2, and was told a form would be sent to me. It toke to about March 24 to get a blank standard from to me. I promptly faxed the form, with a copy of the death certificate to B/C. I called again, and re faxed the forms on April 16, 2009.

 

Blue Cross continued to take automatic payments from mother's checking accounts for two months. When that stopped, they sent an over due bill for May and June.

 

When I call, I am told the check is in possessing. It is now the end of May, and I have yet to receive a refund.

Oddly enough, Social Security was able to close the account, and automatically deducted the last overpayment to my mother's checking account within a week of her death. Seems Uncle Sam has a better system than Independence Blue Cross of Philadelphia.

Comments:

Blue Cross of CA is declining all claims. Don't sign up with Blue Cross of CA. Once you have a claim they pull all your medical records and anything whatsoever they find even a little inaccurate, they cancel your policy. I am a lic. agent. Any carriers in the state of CA are better than Blue Cross of CA.

Comments:

I was in a motorcycle accident 3 years ago and my health insurance denied my claim for the helicopter due to out of network , I fought the denial due to a life and death circumstance, and they agreed to pay the full amount of the helicopter. know 1 year later they are stating they shouldn't have paid and informing me to pay them back the full total of 11,ooo dollars. This is bc/bs ppo, what are my rights? need help  this is not right.

zachcarley@gmail.com

Comments:

My 5 year old was denied health insurance from Blue Cross of Arkansas because 4 years ago he had a VSD (small hole in the bottom of his heart). Even though the Heart Specialist told us he would swear that our sons VSD was completely cured and if he didn't know better he would have sworn that it didn't even exist. So thanks Blue Cross of Arkansas for nothing.

Comments:

 

My wife was turned down by Blue Cross because we started IVF treatments paid for BY US and infertility is considered a pre-existing condition
 

TIME FOR NATIONAL HEALTH CARE IN THIS COUNTRY SO EVERYONE HAS THE SAME CHANCE OF GETTING HEALTH CARE!  They filter out who they want to insure and it's not fair.

Blue Cross insurance are just blood sucking bastards who only want $$$ and not help people, especially the people who need it.

Comments

I want to know if Karla found any solutions.  Here is her story and I would love feedback.  We are in the same boat
 

My 16 yr. old son was taken by helicopter to nearest trauma center due to a motorcycle crash.  B/C ppo will not pay e.r. bill.  Stating it was an out of network hospital.  I had no choice which hospital he was taken to, state law says in a life and limb situation he must be taken to nearest trauma.  He had lacerated his pancreas cost for 8 day stay is 78,900.  Only for room and board.  BC has a special circumstance clause they are not following....What to do. Denied appeal.

Karla smccartney@indy.rr.com

Comments

My son had been addicted to drugs - heavy drugs. He entered treatment in Dec. 2005.  BC&BS was terrible with reimbursement, so I was told later by the [very nice]  treatment facility he entered. I was told by the center that BC only paid them for about one quarter of the total cost.  As a result of these financial abuses by BC&bS and others like them, many of the higher-end, nice drug & alcohol rehab. facilities have stopped taking medical insurance. Oh, there are still  warehouse and institutional-type drug & alcohol rehabs that accept insurance, but thanks to the GREED of  BC&BS and the rest of them,  the patients' choices are now very limited.  And you know what they say about beggars can't be choosers.  It all comes down to this: Your treatment must be in-network or it won't be covered. And even then, you must have a primary practitioner's letter prescribing/advising treatment or you will jeopardize your chances of being reimbursed.

Comments:

I am fighting with United Health Care over a medication which I need to treat my painful arthritis.  Blue Cross/Blue Shield covered Enbrel injections at 50 mg 2X week after my Doctor certified it is medically necessary.  The recommended 25 mg 2x week dose proved ineffective, which is when my Doctor increased the dosage.  The higher dose has not caused any side effects and has been effective in reducing inflammation and pain.  Then my office changed providers to United Health Care which Refuses to cover the dosage leaving me without the medication. 

We need nationalized health care.  The insurance companies are vampires, sucking the life out of their subscribers.

Comments

I was sold an Anthem HSA insurance plan labled as $2500/$5000 and told that it meant that my wife and I each had a $2500 deductible.  I had a bike accident in June and spent an afternoon in the hospital.  The bills are almost to $5000.  Anthem is telling me that I have a $5000 "family" deductible and that my agent should have explained it better.  even my agent thinks that I should have a $2500 deductible, but Anthem is definitely trying to scew me.  Health insurance in this country is a corrupt racket.  This is criminal.

Comments:

I recently watched the movie "Sicko" at home. It really lit a fire under my butt. I am so grateful that somebody has finally taken the time and effort to "out" the medical system in this country. It is about **** time!!! I worked in the allied healthcare industry for over ten years, up until I became disabled as the result of an auto accident.  That's when I became a victim to this horribly dysfunctional and corrupt system I was witness to for so long.  I am currently carrying COBRA coverage through Blue Cross / Blue Shield of Texas (HMO). And, let me tell you that they are absolutely wretched.  I have been in the Emergency Department of my local hospital with horrible abdominal pain, swelling, constipation and nausea several times this week. Earlier today, I noticed a large amount of dark black blood in my stools. Accompanied with a low grade fever, lightheadedness and yet more abdominal pain, I reported once again to the Emergency Room. The doctors there said they wanted to call in a gastroenterologist for an endoscopy. After several hours and some blood work, they returned to my room and stated that they were discharging me home. Feeling no better at all, I asked them the reason for this and they stated my blood pressure and hemoglobin were fine, and that my HMO would not authorize an endoscopy unless I had lost "a lot of blood," or my hemoglobin was low. Now, I don't know how all of you feel about this, but the half-pint I found in my toilet this afternoon was quite alarming.  I voiced this concern to the ER staff, only to hear, "well you really need to follow up with this referral we are giving you." Unfortunately, my HMO doesn't recognize referrals from the ER doc, only from my primary care physician, who I have phoned many times only to hear that he is not available to see me for several weeks.  I can't see anyone else because my HMO won't cover them. I can't even explain how horrible this is, to know something is horribly wrong with my body and to be hung out to dry like some menial financial liability.

Comments:

Last winter I was doing some work around my apartment and accidentally drank some paint thinner that I thought was water. I put the paint thinner in a drinking glass because it made it easier to clean the brushes. Anyway long story story short I must have been dizzy and confused from the fumes and was thirtsy. I ACCIDENTALLY drank the paint thinner. Right away, I knew something wasn't right.

 

My roommate rushed me to the emergency room and dropped me off because she had to go to work. I awoke 3 hours later in a pool of my own vomit in  a hallway of the hospital. They gave me a charcoal treatment and I stayed there for a day and half for observation.

 

Now BC not only has refused to pay for the visit ($3800), they dropped me from my ppo plan on the grounds that I had a substance abuse problem that I did not disclose. They accused me of drinking the paint thinner on purpose to get high or something.

 

I feel like I am being railroaded down a railroad that is going into the desert of financial and emotional ruin..and you know what? I'm thirty in this desert, and the only thing to drink is paint thinner...paint thinner served by BC.

 

Signed,

Thirsty and Broke.

Charleston, Wv.

Comments:

Blue Cross/Blue Shield of Georgia has repeatedly refused to cover my medicine, my office visits and my doctor ordered brain and heart tests.  Now I can't log in and when I call the 800 number they say it's after hours and they hang up.  I have surgery tomorrow and they won't pre-certify me! Blood-suckers!

Comments:

My 16 yr. old son was taken by helicopter to nearest trauma center due to a motorcycle crash.  B/C ppo will not pay e.r. bill.  Stating it was an out of network hospital.  I had no choice which hospital he was taken to, state law says in a life and limb situation he must be taken to nearest trauma.  He had lacerated his pancreas cost for 8 day stay is 78,900.  Only for room and board.  BC has a special circumstance clause they are not following....What to do. Denied appeal.

Karla

Comments:

Although it wasn't blue cross, but SRP that is really making me steamed.  Husband was in a bad car accident, and the lady who hit him and was 100% at fault had very minimal insurance--AllState--so our health insurance covered his emergency surgery.  Now, they want us to pay them back, even though we paid health insurance premiums for years!  And paid all our deductibles and co pays as well.  We haven't gotten a settlement or any money from our car insurance, Allstate only paid for my husband's car to be totaled out (which was under $2000) and that's it.  We didn't get some huge million dollar settlement, and my health insurance company wants to be paid back!?  Then why do I pay for health insurance in the first place?

Comments

To:     Debra

        Blue Cross Individual Services

From:   Don

        Los Angeles, CA  90043

        Re: Cancellation of my policy

February 23, 2008

 

Dear Debra and colleagues,

 

Your letter of Feb. 18, 2008 states that my BC Life and Health plan was cancelled for “non-payment of premium.”  No.  The policy was cancelled because I sent a letter cancelling it.

 

My experience in trying to enroll with BC has been a disaster:

1.      First I applied via eHealthInsurance.com. 

2.      A second application was sent to me via USPS.  I was confused.   I called one of the numbers in the letter and told the woman that I had applied online. She didn’t seem to know anything.  It turns out that your sales agents want to get their commissions and are therefore making the application process redundant.

3.      The underwriting office tacked on an extra $100 per month for a “shoulder injury, recurring”.  I had stated in my app that the shoulder was HEALED.  I signed the statement.  What does that mean to you people?

4.      More bureaucratic BS followed this.

 

I have gone with Kaiser.  They were very straightforward - $210 per month.  Done deal.  Good riddance to your confused company.

 

Sincerely,

Don

Comments:

We signed our infant son up with Blue Cross for his health insurance.  When he was about six months old we took him to a specialist to look at his eye.  Upon receiving the bill, they retroactively cancelled his coverage for all the well-baby checkups gone to up to that point: they actually received a refund from his health care provider.  Their excuse was a technicality, that we had failed to disclose a pre-existing condition which had nothing to do with his eye; and my wife was able, after months of wrangling, to prove to them that she had in fact disclosed all the relevant information.  They reinstated our coverage at a higher premium, but never reimbursed the doctor.  Furthermore they refused to pay the specialist, saying the issue with his eye was also a pre-existing condition.  Skipping the more pressing question of "what good is health insurance that doesn't cover a baby's pre-existing condition" we proceeded directly to the fine print terms of our agreement with them, which specified that a pre-existing condition is anything that had been diagnosed or treated prior to the effective start date of the coverage.  His eye had never been examined, diagnosed, or treated until we took him to the specialist.  They don't care, we have to pay the specialist out of pocket.  In the end, we have been paying them nearly a hundred dollars a month for more than a year, and they have paid out a net of nearly zero dollars, effectively stealing from our doctor and from us.  I believe they have committed fraud and I am looking into the option of taking them to court.

Comments:

Hello,

We have BC Ca as our health insurance.  Although we pay $10,000 a year for this great coverage, we have never had to use it until recently.  Our son was diagnosed with many serious and dangerous mental disorders.  He has been deemed the next “Jeffrey Dahmer” by many medical professionals.  At age 15 he tried to rape me (his biological) mother.  He has recently been committed to a mental hospital and his estimated length of stay is one to two years.  He has informed his Doctors that he wants to murder me and his father!  The doctor promises not to release our son because he is a “threat to society and is extremely homicidal”.  Here is the problem.  BC Dr. Paul, constantly states that our son is not ill and we should pick our son up and welcome him lovingly back into our home!  He went so far as stating that the “sexual incident of son upon mother is not considered sexual assault”.  He also stated that “the parents are the problem”.  Unbelievable!  We have contacted the Ca DOI and the physicians there have reviewed all of the medical records and progress notes.  Ca DOI has ordered BC to reverse their decision and to cover our son’s stay at the mental hospital ­ great huh?  One problem though ­ to this day 9/10/07, Dr. Paul at BC continues to undermine Ca DOI’s decision and still states that he will do everything in his power to get our son released into our custody!  We have been told by our insurance broker that Dr. Paul at BC has lost an extremely large bonus because of this.  No wonder Dr. Paul at BC is fighting so hard to release our son!  This is a true story and is still happening as we speak.  My husband and I have spent hundreds of hours speaking with dozens of professionals and are constantly fighting this appeals process.  On top of having to deal with my son attempting to rape me and wanting to murder me, I have Dr. Paul at BC constant harassment and belittlement!  Will it ever end?  No, not until our son is released and murders us.

admin@strandedwolf.com

Comments:

I am a self-employed male that was foolish enough to use A B C B S as my health insurance provider. I was paying about $90 a month for catastrophic coverage. I think health ins. is BS, but after fracturing my clavicle and being treated like a pariah at the hospital (I'm assuming they thought since I didn't have ins., that I couldn't pay), I figured I better get it so that doctors would treat me like a human being. I gave B C my hard-earned money for over two years w/o incident (of course I never filed a claim either) when, all of a sudden, they cancelled my policy for no apparent reason. I'm a healthy guy. Don't have any health problems or history of them so this surprised me. After contacting the company numerous times without ever finding out exactly why they were cancelling my policy, I contacted the state health ins. division. It turns out that

B C invented a child for me. Apparently after I (a male) had given birth to this child, I had neglected to pay for: 1. co-payment of charges for said miracle birth and 2. increased coverage rate due to the addition of my new baby. The state ins. division allowed B C   to get away with this preposterous means of taking my money and running and did absolutely nothing to punish B C or prevent them from doing the same sort of thing to someone who is far less fortunate than I.

The lesson I learned from all this is that health insurance is wothless and a waste of money if you have to pay for it yourself. If you get sick or injured, go to the emergency room and lie about your identity because the doctors don't care about your health either. The health "care" industry is America is just that- an industry. And like all other industries, they care about one thing above all else:

---

To Whom It May Concern: 

        

        I am an African-American who is HIV positive, who has been doing Hemo-diaylsis for about eight months. My problem is that I’m being deprived of services of a clinic or facility, because I’m not liked, or my personality is sturdy. However, I don’t think it’s aggressive, I think my personality is assertive. Meaning that I will not be allowed to be treated with contempt or stereotypical biases. I was kicked out of Davita in Thornton, for taking the bandages off my needles, in which I just thought I was helping out, but I was automatically rejected from the facility, and I begged for forgiveness, and asked for another chance and they said no, I would no longer be allowed to dialysis at the clinic. Not knowing what to do I looked on the internet and found Fresenius. Meanwhile, I was receiving my dialysis through the emergency room, at sanatorium such as, St. Josephs, Presbyterian St. Lukes and Rose. In all these hospitals, they all went by the Potassium level in order to get me dialyzed, meaning if it was low, the hospital would not give you dialysis for that day, resulting in you coming back, sicker, due to the hospital’s protocol. Plus, I have to wait five to six hours in order to get dialyzed, but you have to get a room so the hospital will get paid. I personally think this is ridiculous. If I come to a facility every week to get dialyzed you would think that they find a way or a clinic for me to attend to, but that is not the case instead they give me a lecture about how I need to find a treatment center and when I explain I’ve been listed as a ‘trouble maker’ and way to opinionated. So clinics will not take me, as a result, I get dialysis from the hospitals, if a clinic would take me and treat me “well” I’ll be more than glad to attend a clinic, but most clinics are way to aggressive and just plain have no compassion for clients as well as employees. Plus, if you have a grievance with a unit it will and can be used against you, how do you think I got the label trouble maker?

        Fresenius was a nice facility, but the employees were to busy singing and dancing to really be concerned with the patients. Plus, the Program Manager, Linda  was always insidious when dealing with me. If I asked her to wash her hands she would, become cynical and explain she did wash her hands, yet I see a blue ink mark on her hand and she became red in the face. Also, she decided one day she was going to put the needles in my arm, so of course in a clinic I had no choice and I allowed her to put the needles in my arm. Well, as a result of Linda not paying attention and laughing with her fellow employee’s she infiltrated my arm. So as a result, I couldn’t dialysis that day or for the next coming week. So of course I made a grievance, because I felt that it was done on purpose and not done in a professional manner. After, making the complaint against the program manager I was labeled a trouble maker. Everyday I came to dialysis I was given new regulations and new obligations which if I think about it, that were small irrelevant rules, just to put her at ease, I abided to this simplistic request. However, it just seemed the more I followed this rules, the  more she disrespected me or even worst give me a lecture, on my personality, that I was “angry” and I would constantly explain I wasn’t angry. However, I think because I listened to rap music, I was considered to be “angry”. So I would be asked every visit to talk to Linda in the facility to be talked to about my persona. Plus, she told me I could do three hours and I would be fine, then after all the rules she gave me she said ‘legally’ she can not allow me to do three hours, which at the same time I was signing a release form explaining that I was aware I was doing three hours. So as a result, of the strain I left the facility, thinking I rather go through the hospital then go through this facility. So I left and not thinking I would return. Yet, I get a call two days after the episode and the social worker is trying to persuade me back into the facility.

 

        At present, I go through the emergency of the hospital in order to get dialysis, I realize it’s expensive and time consuming and more than 91% of African-Americans who dialysis supposedly go through the emergency of the hospital to get dialyzed. In which I think is another racist form to oppress Black Americans. So in going to hospital they as well give me a hard time, they want me to get a chronic unit, but the problem is, no unit will take me, so my options with treatment is limited. Yet, the control, or the illusion is the control is in the chronic units, yet these units are unsanitary, the technicians are abrasive, rude, rough, Kurt, confrontational. What’s even more fascinating is I’m the man who is HIV positive dealing with E.S.R.D. (Kidney Failure). There is no compassion or empathy for us as clients, and I’m most definitely not the only one who has problems with units in Colorado. Many others have ‘major’ problems with facilities, but don’t say anything, because it most definitely will be used against you, in either treatment, or how that technician treats you. Even the way the doctor treats you. So one who is a patient must be ‘passive’ and silent and to express that the needles in your arm hurt in anyway makes the technician feel scared or makes them nervous. Also, many of the technicians ill inform patients, resulting in confusion on the patient’s part. Also, the discrimination in units is rapid and swift although African-Americans make up a large percentage of Kidney failure, you rarely see any African-Americans if one in a chronic unit.

        For Instance, as stated before I go through the hospital’s emergency room to get dialysis. Anyway, I met a young African-American women, whom was a patient at Davita in Littleton, they kicked her out as well with no warning no write up no protocol what’s so ever, and as a result for six months she’s been going through the emergency three times a week. Although, she said she didn’t mind, I really felt her pain, due to the fact I was in the same position, and her doctor is Mrs. Susan Babcock, who is nice but really doesn’t have any pull to get an individual into a clinic. She’s just a primary doctor who writes out prescriptions to patients, but to have her wait six months for a unit means Mrs. Babcock can’t really do anything if a unit decides they will or won’t allow you to get treatment. Finally, when I go the hospital’s they sometimes will not dialysis me because me blood work is good. For example, if my potassium is 6 or above they will dialysis me, even if my creatinine level is high and my BUN is high they still will not dialysis me. I think that is so “dumb’ if I’ve been coming to the hospital every week with the same diagnose then I should be able to get dialysis without lecture or confrontation. Plus, for the hospital to get paid with dialysis I have to get a room so the hospital will get paid this is, foolish to me because as soon as I get dialysis I feel good, and I don’t need a room, I only ‘need’ a room when I’m sick, really sick. Lastly, the hospital can be o.k. without the lectures of trying to get another unit, when no unit in Colorado will take me, for I’m non-compliant which means I’m too much of a trouble maker, to much into the details.

                Signed,

                        Disenchanted Patient

---

Comments:

 

Thanks to the grand blue plan, I have discovered that I have a friend: the North Carolina Department of Insurance.

 

The saga started 3 years ago when my twins were born via C-section.  The anesthesiologists at my local hospital, which was on the "Blue approved" list, had banned together and decided that they would no longer be included "in the network."  Luckily for me, I had out of network coverage as well, so even when the doctor's office sent a letter and $1000 bill, I figured I was okay.

 

Fast forward to over a year, and least 6 attempts to file, and about 12 phone calls to the blue plan later.  The blue plan evidently has decided that it won't pay bills to out of network doctors, so they just kept rejecting the claims (alternating reasons of wrong claim code and invalid dosing code.)  At this point they are also routinely rejecting claims from my out of network bloodwork lab and an out of network pathologist.

 

Enter MY HERO:  NC DOI.  I read about them in a article about consumer complaints against the blue plan.  They have a handy-dandy online complaint form, and within just 2 weeks of sending in all of my supporting rejection notices, the blue plan coughed up the money.  Of course, they weasled by saying that it was their Pennsylvania office (total untruth), but at least they finally paid up.

 

I'm about to contact NC DOI again about the blue plans systematic bungling of ALL of my claims from last year.

 

I LOVE YOU NC DOI!

---