Blue Cross of New York

Hi, my name is Adela. I'm writing to you because my health insurance is giving me problems. They had cut me off in 2008 without informing me, I was still in school. In 2010, I wasn't feeling good; I knew it was just any cold so I scheduled an appointment in March. So I attended my doctor's office, did blood work and went home. After a few months, I started getting bills at home from the lab, which I couldn't pay. I was attending school and not working.

I called up my insurance that's when they informed me I was taken off by my father's union. I had called the union, that's when they told me I've been kicked off, and that my insurance was suppose to notify me but no one had. My bills cost about $3,000-4,000 and I can't afford to pay it, I'm currently unemployed. My union said that I have insurance as of July 2011 but didn't want to add me a few months earlier when I was charged for the lab work March, 20011, now dept collection. Please help me, I'm very much stressed. Please contact me back as soon as possible I appreciate it my phone number is (646) 546-8669. Thank you.

I purchased a traditional plus health insurance plan from this company approx. 8-9 months ago. I am unemployed and receiving unemployment benefits, but felt it was in my best interest to at least have emergency medical insurance. Sure enough I went to the emergency room about 7 months ago, thinking I have coverage.

My daughter hurt her nose while playing soccer. She needed a protective sports mask for her to continue playing soccer. I went to prosthetic place and they said we needed for insurance a doctor's note stating she needed this and prescription. I got all that information and gave it to the prosthetic place. I got letter in mail from BCBS saying that total responsibility to provider was $0 dated 9/29/09.

I received a call from prosthetic place beginning on Jan 2010 saying insurance did not pay or authorize and we have to pay bill. I have paid $150 towards the $500 bill. I need to pay the rest they are asking for payment. Why did this not get approved? We went back and forth several times on phone with insurance company. I have times/dates documented with who I spoke with what they said was going on. I put in an appeal to the insurance company on 2/17/10 and still nothing. I'm very frustrated. I keep getting different answers from Empire Blue Cross Blue Shield. I am paying for this bill $500 that I was told on 9/29/09 that I owe nothing to provider.

Under Empire's Direct Share policy, they claim to pay 90% of a physician's bill, with the insured paying 10%. If an insured had Medicare only, with no secondary insurance, the insured is liable for the entire 20% difference between what Medicare pays the physician and what the physician bills. As I understand it, Empire defrauds its insured in three ways. I will cite an example of a $200.00 physician's bill, for which he is reimbursed $160.00 by Medicare and there is a balance of $40.00.

1. Empire, instead of paying 90% of the $40.00, considers its obligation to be 90% of the entire bill, less what Medicare has already paid. In other words, Empire considers the Medicare $160.00 payment as if Empire---not Medicare---paid this amount of 80%---leaving a balance of only 10% as Empire's obligation to the insured. Instead of paying 90% of $40.00, Empire pays only 10% of $40.00, or only $4.00. As most physician's bills are under $200.00, Empire is taking premiums of about $5,000 per year for which it virtually pays no coinsurance, rendering this policy almost worthless.

2. Under this policy, there is a $40.00 copay for a specialist. This copay is as much as the difference between what the doctor bills and what Medicare pays. Therefore, there is effectively no secondary insurance. 3. If Empire deems the Medicare payment---as small as it is---to be in excess of Empire's reasonable and customary charges, Empire pays nothing, once again, rendering its policy worthless.

Damages to me, personally, about $2,000 to $3,000 over almost three years. I am less interested in recovering the damages than making sure that Empire does not perpetrate this fraud on the public. I have switched to AARP secondary insurance where I pay a far lower premium and have no out-of-pocket costs.

My husband recently received a cortisone shot for bursitis. When the medical invoice came--we were charged a $98 deductible for surgery. When I called to ask about this I was informed that Anything invasive to the body is considered surgery--even regular immunizations. I know that this is so that they get their $150 deductible per person per year. Bu to consider a shot surgery is ridiculous.

Multiple shots per year for the two of us will result in an additional $300 per year on top of premiums.

Blue Cross Blue Shield lost 5 of my dental claims and blamed the post office. The first form sent by BC/BS to me and was submitted by my dentist 2/2007 had the wrong mailing address. The next 4 signed forms, 2-3 months apart, were never received by BC/BS. In a telephone call the person at customer service said I can only claim visits that were under 6 months old. Whose fault is this? It seems they are at fault. This is a scam!

Received a letter last week, from BC/BS stating that all my private medical records and information went missing from a truck that was moving data on disks. I am now at risk for identity theft. My Social Security # and other sensitive info was on these disks. The letter states that this info was not coded so anyone who has the disks can easily get all my personal information.

Last year, I got a new job and new insurance. I decided to get all my checkups done, so I went to a bunch of doctors that were listed as included on my plan. I paid the copay for all of them and now, even after writing the company about it, I have received several bills from the doctors and the labs claiming that I owe them hundreds of dollars. These fees were supposed to be included in my health care and they didn't even cover the bloodwork!! Ridiculous. I am now receiving collection notices out the wazoo because BC/BS has routinely denied my claims.

This bill amounts to over $500 and I needed that money to take care of other bills.