I have a myocardial infarction on Sept. 13, 2008 and I underwent emergency coronary artery bypass surgery on Sept.15. I was readmitted for chest pain and I have a second admission for another myocardial infarction. BCBS FL pay for the services since I was under my wife's group insurance plan. After 2 years, the doctor's office called that BBCBS is asking for a refund and that I owe more than $25,000 and $200,000 to the hospital.
Consumer Complaints & Reviews
I was denied in-patient substance abuse treatment by BCBS although it is a covered benefit under my plan. My treatment team filed an urgent appeal requesting treatment. It was denied by Martin ** at BCBS. Martin claimed that he spoke with my MD and based on that information, the claim was denied as not medically necessary. My doctor has never spoken to Mr. ** and when he tried to confront him about the lie, Martin never returned the phone calls. My treatment team has made 10 phone calls requesting treatment on an urgent appeal and no call has yet to be returned to my treatment team members. In twenty four hours, I will leave the hospital without any treatment for my drug problem. I am scared for my family and for myself if I do not get the treatment.
I was diagnosed with breast cancer in June. I have never been diagnosed nor treated for any cancer before in my life. I have had 2 surgeries and am now having chemo treating. Blue Cross Blue Shield is claiming it was pre-existing and denying all my claims. They have provided me with no proof as to how they determined this.
We filed two applications in early May 2011; one for me and the other for my wife and kids (2 year old and a 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 the children wouldn't be denied, they just had to go through the 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 two 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 four 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 fifteen business days for underwriting, but they have exceeded this.
My son has gotten sick; we had to pay for the 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:
1.) 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.
2.) They have taken almost two 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.
I moved from Florida on 6/2/10. Prior to that, I was living in Pensacola, FL and had Medicare Supplement Coverage through Blue Cross Blue Shield of Florida. They were auto-deducting the payment of $124.60 every month from my ING bank account. I called them to inform them that I was moving to Arizona. They told me that once I left the state, my supplement coverage would only be good for emergencies. Since I planned to get a new policy once I got to AZ, I told them to let June be my last month of coverage, thinking at least I would be covered were I to have an accident on the trip and until I had set up new coverage in AZ.
BCBS deducted a payment on 5/3/10 and again on 6/3/10. After I got to AZ, I called my ING account and told them I wanted to make sure that BCBS do not take any more auto-deductions after the June. The June payment had already been auto-deducted from my account so I wasn't expecting a problem. ING mistakenly reversed the June payment and when I realized what they had done, I called them immediately and they said they would stop the reversal. However, that did not happen. So now, BCBS has my May payment, but the June payment had been reversed. BCBS kept billing me for May 2010 and June 2010, saying neither has been paid. I have called them more than 10 times and talked to customer service reps trying to straighten this out, and they have refused to let me speak to a supervisor. I have asked to have a Supervisor call me, all to no avail.
I was not aware until into July that ING had reversed the June payment after telling me they didn't do it. So the June payment was, in fact, reversed and my coverage would have lapsed the first of June rather than June 30 as I intended. However, the May payment was received and kept by BCBS and now, they are telling me my coverage has been canceled effective May 1, 2010. Since I had a doctor appointment in May before I left the state, I want to make sure my coverage is acknowledged as having been in place.
This has been one of the most abysmal customer service experiences I have ever had. I have sent them my bank statements and on one call, the BCBS rep told me the statements had been received and even told me what months were received and said she could see where they had been scanned into the records. The next call I made when they kept billing me, they denied that they had received them. I want them to acknowledge that they have my May payment and that I was covered through May. I got CIGNA coverage in Arizona starting in July because I thought I had been covered by BCBS for June. I accept that I mistakenly didn't have June coverage, but they did get my May payment, it was not reversed and they need to acknowledge that I was covered in May.
I got insurance on June 1st, the premium was $166, the sales person told me that had to add my daughter after they approve my policy. I sent a letter asking to add my daughter (she already had insurance with BCBS for 2 years), but few weeks later, I received 2 bills, 1 for $335 and the other for $142. When they usually took the money from my bank, I called them, and they explained me that I have to pay those bills. And in October they will take money from the bank again, plus they increase the policy, now I have to pay $190 for me and $71 for my daughter. When in the contract say that the premium may increase each year on the anniversary date due. I was paying $230 and they send me 2 bills for the total of $477. I have a budget for $230 not for two months together.
My doctor has prescibed Zocor for my chlosterol and they will not pay for it or for a generic either and we pay out of pocket evry week for this plan and i really need this medicine! I could have a stroke if I do not start taking this medicine!
Health insurance is practicing medicine. My doctor gives me a prescription and the health insurance changes it. My doctor puts on that he does not want a generic and they change it anyway. I have GERDS, a Shatski ring and scaring of the esophagus. I had an endoscopy and they stretched the ring. They gave me a prescription for the only thing that works and the insuranced company would not fill it. I had to go back to the doctor and they had to make a ton of phone calls before the prescription was ok'd.
I went back to the pharmacy and since it took so long they were backed up three hours. I had to leave and come home. I am now not able to lay flat due to acid reflux and recuperate from the procedure I had this morning.(I have been told that the acid in my esophagus will cause cancer eventually.) I have to go out in an hour and pick up my perscription. I chose my doctor but who knows why my faceless insurance person gets to make my medical decisions.
Our local insurance agent came into our office due to the fact that our group health insurance thru BCBS was due for a renewal. During the conversation our agent asked one of our employees how the coverage was doing for them and about a recent visit for some medical testing that he had done. The employee noted to the agent a fee that was charged as his co-pay for a MRI ordered by his doctor. The agent stated that was the incorrect amount and that he should have been charged less than what he was. The employee then showed her his insurance card and she stated that was the wrong coverage plan and she would contact BCBS and have them correct the coverage. She has paperwork renewing the groups coverage on June 2006 thru June 2007 and proof that she sent it to BCBS.
BCBS has since contacted the agent and has sent an email stating that they have no record of the changes and renewel on this policy, but because the premiums were sent in they renewed the plan as it was in 2005. They also state that they cannot help the group with any incorrect charges on claims or premiums. The new plan had a diff. premium and diff. co-pays for drs visits etc. BCBS said they no longer send out notices of canellations if a group does not renew.They simply renew the plans under the existing contracts. How can this happen when I as the consumer elected to change my group coverage for a lower premium and better co-pays.
I don't understand how BCBS can legally get away with charging consumers for a policy that they wanted to be changed. As the consumer I was not sent any letters explaining the lack of a renewel submission. My insurance agent assures me she has the proof that she sent in the renewel. She asks me what purpose is it for people to renew if BCBS is not going to enact cancellation notices or changes of policy plans. Please help me .
In April 2007 the employee was charged $671.95 for a MRI where he should have been charged $300 under the new policy if renewed in June 2006 effective until June 2007. He was also charged $ 181.60 for diagnostic tests where he should have been charged $ 75.00. The company pays the premium for this policy which is $597.84 from June 2006 until now when they should have been charged $437.02 according to our insurance agent from June 2006 until now. BCBS has other claims for this group policy that were overcharged. These are just a few examples.
