Blue Cross of New Jersey

I had health insurance with Horizon Blue Cross Blue Shield of New Jersey (Horizon). In network outpatient lab work was provided by Laboratory Corporation of America Holdings (Labcorp). Due to the limitations of the policy, there was a limit of $500.00 per year for this benefit. During October 2010, I visited my primary doctor. Blood was drawn and sent to Labcorp. Horizon was billed for four (4) tests - two (2) were paid in full, one was paid partially and the last was not paid. The explanation of benefits sent to me did not show the remaining balance for outpatient testing. For the partially paid test, Horizon was billed at $104.00, allowed amount $20.21, and paid $1.85. The last test was billed at $66.00, allowed amount $11.68, not paid.

When this first started, I offered to pay the unpaid contract amounts of $30.04. It was not accepted. I see no reason why I should pay more than five times the contract amount for a test. Also, I have not worked since January 2008 and can't afford to pay $66.00. If you have Horizon for health insurance or any other health insurance that uses Labcorp as the exclusive outpatient testing service, then you should look for new insurance. Or, if employer provided, ask for new insurance. If enough of us stop using Labcorp and the insurance companies that cater to this company, we could put them out of business. Provide feedback to government agencies: Federal Trade Commission, FBI, US Postal Inspection Service, etc. For other states, find the state website or check the phone book for government listings. If you have already posted here, contact the agencies listed above.

Horizon Blue Cross had "loaded" my benefits information wrong into their computer system and gave out the wrong benefit information to my acupuncturist (in the chiropractor's office). Now I owe my chiropractor nearly $2,600 for acupuncture services. They told me on the phone they were responsible. After numerous calls and complaints, they rejected paying for their mistakes.

Dr. Rogena Cain, NP ENT ordered RAST test, which BCBSNJ says was medically unnecessary, so I am responsible to pay the $663 bill to Twin Lakes Regional Medical Center for the test.

I was admitted on August 13, 2010 at Brook Haven Hospital in Long Island and was discharged on August 14, 2010. It was an emergency. I had severe pain at my brother's funeral. I was rushed to the emergency room and stayed overnight. BCBS refused to pay my medical expenses. I have been with BCBS since 1972. I avoid any unnecessary medical expenses as my record can show that I am in good health. There seems to be a pattern with BCBS not paying insured expenses. Since I am a nurse, I know how to take care of myself not to incur overhead expenses. My subscriber ID is **. Please look into this matter.

My health insurance company has been playing games, giving me the run around for the last four months and now I have bills piling up to almost $1,000 and can't get the medications prescribed to me. I don't know what to do.

My employer rolled our insurance over from Aetna to Horizon Blue Cross back in August. We were told by a representative that our deductible for Aetna would pertain to Horizon. We were told that everything is "being taken care of" and that we wouldn't have issues. In September, when I went to the doctors, I was billed and told I didn't meet my deductible. I talked to other NAFA employees and they were being told the same thing.

My boss, Phil **, wrote this to me regarding the situation: By law, your deductible amount must carry over from one carrier to the next. You may have to get your last Explanation of Benefits (EOB) statement from Aetna, which shows your total deductible amount met to that point, and send a copy to Horizon. Jayne just went through this as well, so you can ask her for how to details.

I called Aetna and Horizon on November 3. I told Aetna the deductible didn't roll over to Horizon and they said they would send me a letter stating I met my deductible as of August 2010. I spoke with Horizon and told them my employer switched from Aetna to Horizon but my deductible was not carried as it should be. I told them Aetna was sending proof that I met my deductible. The reference # for this conversation/claim with Horizon is: **. Aetna sent the letter to me on November 11 and I mailed it out the same day to Horizon. I contacted Horizon as soon as I mailed this letter to let them know that they weren't covering me and let them know that someone messed up when rolling over the deductible.

They receive the letter till November 16. I called and was told it would take 20-30 business days to process this letter and "key it into the system". That in 20-30 business days it would show "in the system" that I met my deductible and all doctors visits and medications would be covered. I called Horizon on November 18 as well as wrote the help desk a letter stating the situation. I called several more times since mailing the letter and talked to a manager named Stephanie (on November 22) who put an emergency rush to key it into the system. I was told keying it into the system was done by another department, who cannot be contacted by phone - only email.

I called again on December 6 (reference number **) and spoke to Stephanie, as well as another manager, and was told that another emergency request would be put in. During this phone conversation the manager told me that it would take only 9 more days till the "deadline" was up and in 9 days I could walk into my pharmacy, pick up my medications, and be covered. That in 9 days my bills (doctor's claims from August till now) would be paid. I called again today and spoke to Megan McCormick, an escalator specialist. She told me that in 24-48 business hours the letter (which is called a conversion claim) would be entered into the system. But, once it's keyed into the system it could take up to 14 days for it to show - meaning it could take another 14 days till I could be covered for medications....another 14 days till the doctors claims are paid.

My health insurance with this group runs out on January 1. The deductible starts over again on January 1. Which means if something isn't done then ASAP medications sitting at the pharmacy won't be covered at all - by the time Horizon shows I'm covered in the system my deductible would have started all over again. I am more than fed up with the insurance company and they're going to get away with not covering needed prescriptions. Right now I have doctor's bills and claims totaling over $800 and pharmacy medications totaling over $300. I can't pick up medications and my doctors are threatening to go to a collection agency.

It really is a matter of someone just typing information into a computer and I'm getting the run around. Having it take over 4 months to roll over my deductible and waiting till the last minute when my insurance runs out can't be legal.

We have had several problems getting BCBS to pay our claims in a timely manner. CSR's all tell you different things and supervisiors aren't much better. We were always promised a call back and only recieved one out of about 20 promises. I am still waiting for a claim from 2007 to be paid and supervisors admit there is no reason it should be held up but no one can seem to actually process it. Now they are repeatedly denying charges that are covered, you basically just have to appeal everything to get a full payment. It is just plain fustrating and I am about to involve a lawyer. Stay away from this group if possible!!!

I have chronic back problems and have been taking several pain medications for years and never had a problem filling the scripts. This past week 2 out of 3 scripts were denied. I am insured through Keystone Blue Cross Blue Shield, who in turn uses Future Scripts to cover prescription benefits. Apparently, starting May 1st Future Scripts has implemented a new policy where any member can only fill one prescription for a controlled substance in a 30 day period. They failed to notify their members, the doctors, the pharmacists and the public of these changes. They failed to clearly communicate these changes to my pharmacy when my script was denied.

The end result is that I am now without the medications I need and must wait (in a barely tolerable level of pain) for the paperwork and procedures to be completed, if they are even approved. I have already filed a complaint with Keystone and Future Scripts and I will be posting, blogging and working to expose this unacceptable change and poorly managed implementation (along with the failure to notify) to as many media outlets and politicians as possible.

Based on what my pharmacist told me hundreds of thousands of people will be adversely affected by this change; I would urge all those effected to file complaints. I am shocked and dismayed by this irresponsible enactment; this is just another example of reforms or controls that are missing from our great country's terrible health care system.

I would urge Future Scripts to repeal this change and if they must re-instate it, then this should only follow proper notification of all effected. I believe Future Scripts is liable to anyone in a similar situation to myself, undue pain and suffering sounds about right. Once I have exposed the issue, I will consider hiring legal counsel. I can only hope that too many people are not suffering, waiting for approval to receive the medications they need.

I called regarding no payment of an anesthesia submission that was made as part of a colonoscopy which Horizon pre-approved. Their reason for non-payment was based upon the fact that my $1,000 deductible wasn't met until the day of the procedure.

By background, I changed carriers in Sept./Oct. of 08 and in fact had no deductible payments before that day. However, the entire procedure which they pre-approved cost $3,875 - so my $1,000 deductible was met that day. Horizon said that their rules state that the deductible needs to be met before the bill is submitted or they refuse payment. Why does it matter when I meet the deductible - I can't understand at all how they can separate work pre-approved? Kinda a chicken or the egg scenario but a lot more money.

Another clear example in my mind of the major problems that exists in our healthcare system - it is a disgrace that companies aren't held responsible. we need massive changes in the system. It cost me $875 more because I met my deductible on the same day as the procedure - what was I suppose to do - have it over 2 days?

I also believe that another premium may have been taken out 10/17/08, but will not be sure until I receive my pay stub. I have a 2 year old son who was injured and taken to the doctor, and found out my insurance was cancelled. I must now pay out of pocket, as well as dental work that I had done that was extremely expensive.

I have medical insuranace through my employer. On December 9th I had a vist to the hospital for a heart attack.

In April of 2007 I went in for a five bypass surgey.

All of the service providers have submitted my bills to my insurance and they were denied due to the number not being known as an active number and the number is correct.

The collection notices are now on my perrsonal credit and this is totally unfair.

The doctors want me not to have any stress and this situaion is very stressfull and has gone on far too long.