CareFirst

This is one of dozens of problems I have had with CareFirst BlueCross of Maryland Federal Employee Plan. I wanted to go to a local urgent care facility about a persistent cough (because I was out sick and PPP is closer to work, this was closer to home). I called facility and asked if they took my plan. Yes, $30 co-pays.

Three weeks later (after I had returned to the same facility for a follow-up visit), I received a bill in the mail for $100. Turns out FEP Blue has changed their plan and no longer covers urgent care. This is their game. You literally need to scan and memorize your policy every year, then call them ahead of time to make absolutely sure. At this point, FEP Blue is a discount program, not an insurance plan.

My monthly rates for my PPO health insurance policy just increased by almost $100 per month.

I found myself without health insurance in January 2011 due to my ex-husband losing his job. I applied for health care with Care First Blue Choice in March and was informed that I had to have continuous coverage, therefore, had to pay for February as well. The person responsible for submitting the information sent it, it was complete with a physician chosen. I did not receive a card until March 28 and the insurance will be canceled on April 1 due to my loss of job, thereby, giving me no time whatsoever to use any of the insurance. I was also turned down twice for prescription refills. I requested my $1000 to be returned as they did absolutely nothing.

We had a baby son in October of 2010, and three weeks later we called to add him to my wife's insurance policy. When she spoke to the representative, she was told the insurance would be $356/month. Now it is January 1 and the bill arrived and it is retroactive to October for our son, and comes to $2226.71. Needless to say, we are overwhelmed with the bill, it is due by the 1st of February.

How are we expected to come up with that much money and still pay our monthly expenses? Why would we not have gotten any documentation stating the cost hike to $733/month? So after getting the statement we called and spoke to a representative again, and they stated there was no way we were told it would be $356/month. When we reaffirmed that we were told that, they said we could file a complaint with the state commission if we wanted to.

Why do we continue to allow this insurance company to fleece us, and nothing is done? Why are we passing health care bills when the lobbyists are allowed to buy politicians votes, and dilute the bills to nothing again? How do I make the insurance company accountable for their actions?

I have been paying on my son's health insurance with Blue Cross/Blue Shield and in August 2009, it was cancelled because they said a payment was not sent in in July 2009. However, I did not know of the cancellation and continued to pay on his policy. I paid $404.00 every month even in August, the month they cancelled the policy, on up until March when my son went to get a prescription filled and was told he had no insurance. CareFirst advisor told me the money stays until I call concerning what I want done with it. If my son had not had a prescription to be filled, he would not have known he had no insurance and I would have continued to pay on a policy that was cancelled. I was told if I wanted to have him reinstated I would have to pay $1120 plus the money I have already paid since August 2009 over $1550.00 to get him reinstated.

I asked them if he had gotten sick, they would not have paid for his claim so why should I have to pay for the time he was not covered by them August 2009-March 2010, that the money they were holding on to and collecting interest on it until they heard from me should least go toward future premiums. I was told that they would not do that and I can cancel the policy and they would refund the $1550 that they had and I would not have to send the $1120 which would have gone toward the two missed premiums July, September and for the present one in March. I wanted my son to have insurance without having a long waiting period to get one so I paid the $1120 along with them keeping the $1550. It seem that that is insurance fraud to keep people's money knowing that their insurance has been cancelled.

They should have contacted me regarding cancellation. If I had known his insurance was cancelled, surely, I would not have been still paying on his premium. I wonder how many other clients they see have they done this same thing to. I'm sure a lot of money has been collected because of their policy of not letting people know their policy is cancelled and still holding and collecting money on the policy along with interest accrued on the money they are collecting. I am asking for restitution by returning the money they held when he was not being insured and to continue his benefits with the $1120 that has been sent in to cover his premiums until April 2009.

Multiple attempts to speak with a representative blocked by the automated system. It needed an address to send a cancelled policy due to the death of the applicant. The policy was never used. This wasted time and caused aggravation since my request is unusual and should be handled by a representative, not an automated system.

I became unconscious due to acute hypoglycemia in Cancun, Mexico (there for a wedding). After the doctor at the Hilton revived me, I was transported by ambulance to the hospital emergency room. The ER doctor advised me to be admitted for overnight observation. I contacted Carefirst for authorization to be admitted, but they told me nobody was available to help me (this was on July 4, 2007.) I have a $10,000 deductible individual policy, so based on my experience (I am 46) and the advice of the ER doctor, I admitted myself to the hospital. My estimate was that I would be responsible for about $600 of the actual charges. The next day I was discharged, and Carefirst refused to help me or pay any part of the bill. They insisted I file with them for reimbursement which I promptly did upon returning home on July 7. After a lengthy wait, Carefirst initially imposed a 20% penalty for failing to obtain preauthorization and still refused to pay any part of the bill. Furthermore, they never provided me with information on the negotiated rate I was to receive (the Cancun Hospital is one of their approved providers.)

Ultimately, they removed the penalty only to apply it to my deductible. They were not able to explain how they could impose a penalty, remove it and then give it a new name and still charge me for the 20% that they agreed was erroneously applied. I paid the hospital $1,800 US upon discharge. Had Carefirst been responsible, they would have likely allowed about 1/3 of $1,800 charge and I would have paid the hospital $600 upon discharge as I had estimated prior to admission. I am now trying to recoup the difference between the actual charge and the billed amount. Carefirst has yet to discuss this with me, and I have submitted my second and final appeal to them as of the last week in November. No, I have not heard anything from Carefirst about this second appeal. They responded to my first appeal by saying the claim was properly processed. They continue to stress to me that I have a $10,000 deductible. I am well aware of my $10,000 dedutible, but I know that the $10,000 is reached by applying successive allowed amounts and not billed amounts. They have not explained why they have denied my claim.

I am almost certain that they have violated laws for not explaining this denial to me in a timely manner. Furthermore, to not even have a polite conversation with me about why nobody was available to assist me when I was in an emergency room 1,500 miles from home is beyond belief. Lastly, I think that they know they have made a serious misjudgment and are now hoping I just go away.

I would like to give you another example of how this firm operates. In August, my doctor suggested I get an MRI on my sore left shoulder. Because of my $10,000 deductible, I wanted to get an estimate of my out-of-pocket expense. I made two calls to the MRI provider and one call to the radiologist after Carefirst instructed me to do so. I reported the procedure code to Carefirst, and Carefirst told me the allowable charge was $419. As my budget was $450, I had the MRI done. After the procedure was done, Carefirst sent me an Explanation of Benefits that now showed my out-of-pocket expense was $793. I called Carefirst and asked them what happened to their estimate of $419? They explained to me that it must have been a mistake. I told them that that was not my fault ,and I wanted them to correct the estimate to $419. They told me they would not do it and I would have to ... you guessed it...file an appeal. By now, I doubt it would surprise you to let you know that they denied that appeal, too. This company needs to be stopped.

Once I tried to uncover and set a market for these fees, the providers and insurers treated me disrespectfully and kept fee information well guarded. The MRI provider and the radiologist will now likely submit my accounts to collection. I have excellent credit and have decided to accept a blemished credit record to make my case. It is worth noting that I contacted the two providers and explained that their contractual business partner Carefirst caused this problem. The MRI provider has tried to contact Carefirst, but has not heard from them in two months. The radiologist refused to speak with Carefirst and indicated that only I had the problem with Carefirst, not them. I would like to think this is merely an aberration, but I somehow suspect that I am being mistreated because I was able to obtain my non-medically underwitten health policy because I was HIPAA-eligible. Althought I manage my hypertension and diabetes very well, perhaps Carefirst loses money on my policy and would like to see me cancel. In any event, they have treated me poorly. I have been trying to get coverage elsewhere, but other companies are slow to respond to my insurance needs. I could sure use your help to correct they way Carefirst has treated me. Thank You.

I'm mis-charged a total of $1,574. Also, I spent about 30 hours of uncompensated time trying to recover these expenses.

A claim for $1136 for emergency medical services on a cruise ship was filed in September 2006. Despite 10 phone calls over that last 3 months,resends of information and the promise that the claim takes 2 weeks to process, NO ONE can give me any status of the claim or an estimate of when it will be processed. A supervisor, Ms. Stewart, supposedly has this claim for "manual Handling" since early November, but will not speak to me or call me to explain any issues related to the claim. I feel this is horrible customer service and until resolved I am unable to move forward with any trip insurance claims. Please help me find the responsible correct person for escalation and help.

In Oct 2005 I recieved testing for ADHD after consulting my insurance, to make sure it would be covered. After recieving a go ahead from Carefirst, I paid out $1575 toward the testing and my psychologist sumbited the claim, only to have it first lost and then rejected. When I inquired about why it had been rejected they said because there was not enough information to determine if it was a pre-existing condition. I then had my primary doctor send all of my records, and still that was not enough information for them. It seems to be logical that if there is not any prior information about a perticular problem that should be proof enough that it is not pre-exsisting.

After countless phone calls and faxing of my medical information still to date (Apr 2006) I have had no feedback from Carefirst, and when I call, I am always told that they haven't recieved my information. I am then given a direct fax number and reassured that this is not typical and that it will be gathered by, the person I am speaking with, and taking personally to the review board. I have had this same conversation with over ten people at Carefirst, all stating they will call and keep me updated, including supervisors and customer care speacialists, and still no response.

Finally, yesterday, I spoke witha customer service rep and was then trasfered to a supervisor, who never returned my call, even after stating that I will not call Carefirst again, instead my next calls will be to the Insurance Commissioner and a lawyer. It is now the next day and still no phone call. I have had insurance through BC/BS since I was born, always through a employer, and never had a problem. Now that I am an individual member it seems that Carefirst could care less if I am a very dissatisfied.