Consumer Complaints and Reviews
I am a pharmaceutical sales representative and my company insurance is BCBS Illinois. What a mistake I made! I left a great job with a great insurance company to go to work for another company and they over me BCBS Illinois. I was thinking that it was ok but it's been my worst nightmare. First they didn't want to cover my husband. I had to produce tons of documents to prove I was married. Then my migraine treatment that is been cover for the last 2 years with my previous insurance now is not cover. I get headache every day and migraines 2 or 3 times a week. With the treatment I had only 2 migraines in 2 years that had been a life saving for me. But now with a lot of tears in my eyes I have gone to pre-authorization, to an appeal of the pre-authorization that was denied.
Now my next step is going for an External Review Request with an Independent Review Organization. I pay more that $700.00 a month for this coverage. I am so upset and sick of getting this headaches and the insurance company I am paying does not care about my health. They just want my money. BCBS you meet your worst nightmare because now I am getting a lawyer that will fight this for me. Please don't buy coverage with BCBS. They are literally stealing our money and they are not giving the service to their associates.
I (like most) have had BCBS for a long time. I originally had CIGNA before switching to BCBS. I got a notice from my doctor saying that I was no longer insured and I was incredibly confused as to why. I immediately called my insurance asking about it and they said I was late on a payment in January. Obviously I questioned them about it saying things like, "I've always paid on time and am still getting billed", etc. I sent both BCBS and BCBS Marketplace/Silver my bank statements since they claimed it was a billing issue. Both statements had the same information, stating the time/date of when I made payments and showing the company that everything had been paid on time.
I called and the company said they needed 2 weeks to process both statements. I understand that things like that take time so I agreed to the two week waiting period. I called after two weeks, asking BCBS what was going on since I did everything on my end. The BCBS supervisor said that it wasn't a billing issue after all. It was a lack of communication between the BCBS offices and the BCBS Marketplace/Silver.
I spent 2 hours on the phone (I kid you not) on a conference call with both offices notifying them that I wasn't insured and it was on them. They told me that they needed to work out the problem between both departments saying, "I would be insured by the end of the month", and that "getting insurance was guaranteed & the process was infallible." I was hesitant of course, informing them that I needed to buy medicine (I'm Epileptic) and I didn't have enough to wait a month-month and a half. Both departments said that I would be reimbursed for my 'Out of Pocket' payment. I was pretty relieved knowing this since my pills are $700/month.
After the horrific experience I had, I decided to check up with them after two weeks (even though they said it would take a month). The woman I talked to on the phone said that there was no record of the phone call and that I wouldn't be insured. When I gave her the date/time of the phone call she then asked for the names of the people I had talked to for the past 10-15 calls. Of course, I didn't have them thinking that names wouldn't be relevant. I ended up having to describe what the people sounded like over the phone... seriously. She then told me I'd have to file an appeal. She gave me the address and paperwork (through e-mail).
The appeal process is about 1-3 months (keep in mind I am paying 700/month for medicine) so I knew that I would have to wait a good chunk of time. Finally, I got a phone call from the appeal office however; it wasn't good news at all. The woman at the office asked why I had sent the letter there. I told her that BCBS gave me the address and the paperwork. She notified me that BCBS gave me the wrong address and that she felt incredibly sorry for me. So right now, I have paid over 3,000 in medicine and have been thrown for a loop with my insurance. I am currently thinking about suing the company due to emotional distress & the whole scenario. I am beyond upset and am going to call them but if I hear, "I'm sorry and I understand", one more time I will freak out. - Universal Healthcare NOW!
My husband got sent to collections for not 1 dos but 2. Wrote a review a few months ago on 1st and now here I am again. This is for dos back in Feb 2016, he went to a few doctor visits trying to rule off a diagnosis and has been sick since 2015. He goes to a total of 3 doctor facilities in the beginning year 2016 due to 2 facilities not telling him any accurate diagnosis. We just needed some answers. So after a few weeks of finally finding a proper facility and answers. We start receiving bills from 1 facility. We have a yearly deductible and it was met in the beginning of the year.
Now after all my research and findings he got sent to 2 separate bill collectors and is in collections today. I called these bill collectors called BCBS of IL and they stated that the 1st was a error but they are waiting on more data. No response from the bill collectors and now the 2nd claim for 2016 is our responsibility?? I am lost for words with BCBS of IL. How does any health insurance determine when a deductible is to be dropped from not 1 but 2 facilities to the 3rd health facility? So yes just because the 1st facility in whom we paid our deductible to was faulty on doctor notes BCBS of IL dropped our deductible to the 3rd health facility.
This is so confusing on how billing works today. I asked BCBS of IL how and why this even can occur. Their response was "well when some facilities do not require your deductible we choose the next one in line"??? They tell me to not pay our deductible to anyone 'til we receive our EOBs. I tell BCBS that it shows on our EOBs deductible met some show patient resp when I know how to read EOBs. BCBS of IL has no true answers on how they do their billing. Some are quick on answers and some just give away their lies and errors on their behalf. I know that BCBS of IL is faulty and part of the reason why my husband is in collections today. I am a well-experienced biller/payment poster for health and feel that my family has had enough with billing errors with BCBS of IL.
I have had BCBSIL for the better part of 23 years. I have never had much of a problem until now - I need spinal surgery. My surgeon had me do all kinds of pre-surgical testing that took me over a month of continuous work to get completed in time. I have spent a lot of money on these pre-surgical tests that now seem like a waste of time. My surgery date was all set but the day before the surgery it had to be cancelled. According to BCBSIL, my surgeon's office was given the wrong fax number and the insurance co. said no clinical information received. Surgery was postponed until the following week and an appeal had to be submitted. Once all the information was sent to the proper fax number they still denied my claim stating that they no longer cover that procedure.
I suffer in pain every minute of every day. Legs are weak and numb. I get spasms in my lower back and shooting pains in my back and legs. I can no longer do my job functions as required by my company and I risk losing my job. I have a safety sensitive job and am not allowed to take my meds while at work. Problem with not taking my meds is I cannot sit, stand, or walk for more than 10 minutes without debilitating pain. I suffer from depression and my medical problems are making my depression worse. I can barely get out of bed anymore. I live on pain killers and they are affecting my stomach.
I also stand a very good chance of addiction. Constant debilitating pain makes my life unbearable if I am not on my pain meds. I have tried physical therapy, injections, inversion therapy, and numerous pain meds. I am now on Morphine and the pain is still there. I am never pain-free. My spine is bone on bone and BCBS does not think the surgery is effective enough.
What gives them the right to play with people's lives and decide that we have to stay miserable. They collect money from me and my employer every month and it doesn't seem to matter. My surgeon, who I really trust and is very reputable, thinks this is the best measure to correct my back problem but the insurance company is playing god and is almost telling him he is wrong. What happened to Blue Cross Blue Shield of Illinois, they went from being a good insurance company to a HORRIBLE insurance company. If I had a choice, I would never get another insurance plan with Blue Cross Blue Shield of Illinois. Buyers beware. This company stinks.
Medicare Advantage PPO through Blue Cross Blue Shield of Illinois - the Medicare Insurance industry is big bucks. And confusing. I had a Medicare Advantage HMO last year 2015 and changed to a PPO this year. While I understand, Doctors, Hospitals, and Pharmacies have to be in the plan to get full coverage. It is hidden that Labs that Doctors routinely send their tests to have to be in network. When I got a EOB from Blue Cross I called and asked for explanation because an accompanying bill reflected that any extra was my responsibility. Not having been fully informed of this part of in network, I was shocked.
I have spent countless hours with customer service from Blue Cross Blue Shield of IL. including their corporate offices in Chicago, the Labs, Medicare and filed several complaints. I am still waiting on results. I also filed a complaint with Medicare trying to get out of BCBSIL Medicare Advantage. Because of times to enroll, I cannot at this time get out of it. And the BBB got stonewalled because BCBS said they cannot discuss my case because of HIPAA guidelines. I need help, this is a billion dollar corporation. Please help. The date I filed my Medicare Complaint was 4/2.
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BCBS denied reimburse for my gym usage for December 2015 because they said I wasn't covered, when in fact I was. New coverage information was keyed in on December 25, 2015 for calendar year 2016. This in fact goofed up hundreds of reimbursements. After calling BCBS complaining, I was given a new ID number to use. Which in turn I give to gym just to use this one time for December 2015. Now it just so happens that this number is not useable. Did CSR just give me a line of "crap" to get me off the phone? Who knows if I'll ever receive this $20.
My daughter has degenerated disks, one is bone on bone and another is more than halfway to being bone on bone. She was scheduled for surgery in Arizona where she works for State Farm Insurance. Unfortunately, State Farm headquarters is in Illinois, consequently all SF employees have BCBS Illinois. BCBS Illinois denied my daughter's surgery a week before the surgery based upon BCBS claim that my daughter's surgeon did not provide documentation on the non-surgical treatments. This is a total lie by BCBS Illinois! Even the BCBS doctor agreed with my daughter's surgeon regarding the necessity of surgery.
I have spoken with other people who also have BCBS and their surgeries were also denied with this same lie as well as claiming that BCBS never received any documents at all. This is the worst insurance company on the planet. I would like to thank BCBS Illinois for coercing my daughter into becoming a drug addict as only class 4 narcotics will mask the extreme pain she is experiences 24/7. I do not live in the same state as my daughter. I made arrangements with my own company to allow me to work from another state. I am also out the cost of airfare between Michigan and Arizona. A small price to pay when considering my daughter's quality of life is diminished significantly. If I could give BCBS Illinois negative stars I would do so. If you are unfortunate enough to have insurance with BCBS Illinois, I recommend you change your insurance to a better provider.
The phone line experience is horrible!! Deceptive. It so disrespectful to keep a client waiting for 2 hrs only to get in touch with a customer agent. 3 days and no answer? Give a break. If this is the best portrait of the BCBS in Illinois, what can you expect when you are in the doctor's office? Dump Blue Cross Blue Shields in Illinois.
BCBS of Illinois has really disappointed this time. I've had them for over 20 years and the past 15 I have suffered from chronic migraines averaging about 20 per month. I have tried every drug, acupuncture, hypnosis and nothing has helped until I found out about Botox injections a year ago. My migraines have now been reduced to about 3 to 4 a month and I feel like I finally have my life back... until now. They just sent me a letter denying my claims for the Botox because my migraines have decreased by 60% so they don't feel it's medically necessary. What?! The reason why my migraines have decreased is because of the Botox you idiot!!!
Now they'll be paying my bills when I have to go to the emergency room at least 3 times a week. All these people care about is money and not the well-being of their customers. So now I will suffer and probably lose my job all because they won't pay for the treatment I need to live a normal life. Thanks BCBS, I'm glad I've been so loyal to you... I will be sure to never recommend you to anyone.
I was a member in Blue Cross and Blue Shield of Illinois for almost 2 years. I have always been so unsatisfied with their customer service(took months to change my PCP, long hold time when you contact and etc) so I decided to cancel my membership. Unfortunately I have already paid my premium fee one month in advance so I was told I would get refunded. I have never did!
I called 8 times, spending hours on hold and nobody ever answered me. What makes me really upset is that every time I called I was told a different thing! Two times I was told I would get a call back and I never did! Once I was told my request is rejected and she does not know why! Two other times I was told I have been refunded by them 2 days ago and I will receive the money soon! But when I asked her which account is the money paid to? She said she does not know! And of course I have never received a cent nor a right answer why! I just feel so sorry for myself and people who has to deal with this insurance company!
We were loyal BCBS customers for over ten years. Being self-employed, we paid our premiums for our PPO plans out of pocket. With the healthcare reform, our premiums increased significantly for our plan. To maintain the same premium payment, we had to change to a lesser (Bronze) plan with higher deductible. Fine with us, as long as our basic preventive services were covered. Our physicians have always accepted BCBS PPOs, and we were informed by BCBS that the Blue Choice PPO was comparable to our last plan. Great. We enrolled in the Bronze PPO 06 plan figuring we would pay visits out of pocket, but basic, well-child and adult physicals would be covered. I go for my physical and receive a bill one month later for $1700 from the physician indicating BCBS did not cover the physical and associated preventive tests.
I called BCBS immediately to find out if the claim was submitted incorrectly as our basic preventive services should have been covered, per the policy. Per my physician website, they accepted BCBS Bronze PPO 6. The representative, whose name I have on file with the date of the call, indicated yes, my plan covers "100% of preventive care… adult and child physicals and tests". She stated she was resubmitting the claim, not to worry about the physician bill as BCBS would correct the matter. Given this, I proceeded to make my son's well-child appointment for one month later. I then received a bill for his visit ($1100) and a past due notice for my visit as they indicated BCBS did not cover my exam or tests.
Immediately, I called BCBS to dispute their failure to pay. I spoke to two individuals who stated my dispute was being referred to their claims department and would be handled within ten days. While I never received a call, I did get a collection notice for the bill associated with my physical. I immediately contacted my physician group's billing department to inform them I was disputing the insurance denial. At that time, the billing rep stated other Blue Choice patients were experiencing the same difficulty and frustration that BCBS was not covering services. It was not just me.
After getting a stay on my account with the physician, I again contacted BCBS as ten days passed and I did not receive a call. It was during that call that the BCBS rep informed me the preventive services were not covered as our doctors, who we have been seeing for 10+ years, we’re out of network. This was the first time I was given that information. We would never have signed up for a plan of which our physicians are out of network and I certainly would never had scheduled my son's physical if I had been informed that his well-child visit would not have been covered. I would have appealed to change plans immediately.
I have sent two letters to appeal and will be submitting a complaint to the state, but this seems to be a larger issue of misinformation by the insurance company because now our physician's website explicitly states that take BCBS PPOs but NOT Blue Choice. We must not be the only people that have been misinformed. I hope this gets investigated further.
Diagnosed with Lynch Syndrome after having uterine cancer. I am at 4 times the risk for breast cancer. After thinking I might feel a lump they denied the MRI suggested by my doctor since I have dense breasts. When they told BCBS of IL I was at risk for breast cancer they said, "Well she's at risk for many cancers!" Denied.
I had a back injury, 3 herniated disk in my lower back. It took them a month and a half to let me get an MRI When I knew something was terribly wrong. I've broken bones and never had pain like this before. Now my doctor requires I have back surgery so I can go back to work (been off for almost 4 months now). He does a new procedure that has a higher success rate And doesn't do the old fashion way of taken out bone to get to the disk. Results in a better long term effect this way. After having my MRI I was informed I have arthritis in my lower back so as I get older it will get worse. So BCBS will only pay for old way of doing the surgery Resulting in a weaker lower back from time of surgery till I kick the bucket. I quad, work out and play sports. I'm too active to have a weak lower back I'm 32. If I have surgery done way they want I will have to watch what I do and how I do it until end of my days.
I have appealed and again appealing. They do not want to spend a little extra money to get it done the right way. Both doctors have said if I proceed the way they want it done I will be back in surgery within a year because of my slight abnormal spine and making it more weaker Or become a couch potato. Not my lifestyle. Frustrated beyond belief for something I'm paying for and not receiving the benefit I pay for. Would be like having your car insurance fixing your car with parts that are lesser value and won't last as long as what they are supposed to. Never had BCBS before but I am not impressed by any means. I would highly recommend not having them if at all possible.
I contacted Blue Cross in March 2015. I was told if my primary faxes a prescription for ortho massage, I would have 20 visits covered. If I went out of network, Blue Cross would only pay 90%. I have had 6-7 denial letters. Yesterday they called to inform me: My total claim's $2,300. They are only reimbursing me $324. How do these people sleep at night knowing they are denying coverage to people that are sick?
Insured through husband's employer with a half-way decent policy, but Blue Cross inconsistently pays dental claims and has denied needed procedure estimates in the past! We get the feeling they'd like to eliminate our dental coverage altogether, since they hate paying anything! Most recent claim on an emergency root canal, after the deductible was covered, they only paid $160! That is nuts! Leaving us with a huge bill with the dentist! Is that why we pay thousands of dollars a year? For crappy coverage?! Of course we filed an appeal and of course they sent a letter saying it was covered correctly... but still no actual explanation! These people have no consciences! We are not dropping this. Will make phone calls and if necessary file a complaint with state board of insurance!
I can't tell you how many cases I've worked on where the claims weren't adjudicated correctly, or the member is misinformed by the carriers' customer service staff. It's even confusing to us! But we make it through it, and help the members resolve the issue. I don't think the carriers do what they do maliciously, they just have way too many people interpreting the coverage and the law, and a lot of them aren't educated enough to make an informed statement. It really is maddening. My advice? Find yourself an agent who's licensed to help you through your future enrollment. No only do they help you enroll, they help service your account and advocate on your behalf with the carriers. At no additional cost to you!
My policy was written in 8/2013 as a Blue Edge HSA policy with access to BCBS's largest network of providers. Now this Winter 1/2015 we start to have problems with our long term providers suddenly being denied as out-of-network providers. What!!!??? Come to find out BCBS has altered our policy without our knowledge or consent to a health reform network... "Blue Choice".... that was created after our grand-fathered policy. I have tried several months to resolve this with BCBS! No one is listening and their reviews system is useless. I have a contract for a specific policy! I did just sign up for a lesser quality substitute! Please comply with our contract and process our claims!!!
We also have a deductible issue! I was to have a 3500 individual with a 7000 family. Do you think they processed as such...! No way! It's a scam!!! I have reference numbers of documented phone calls with pre-certifications. All to no avail! Their consumer support is setup in such a way to deny deny deny and reject even if you have many supporting documents to prove your cause. I am now taking this to The Illinois Dept. of Insurance! BCBS is no longer a premiere insurance company. BCBS of IL is a corrupt mess!!!
I have been fighting with this issue since the beginning of 2014 when the new Obamacare plans were being implemented. A Blue Cross employee received a new enrollment from a woman with a similar name to mine, so they decided we were the same person. BCBS entered her information on my policy that I have had since 2006. I met with the Blue Cross department in Naperville, IL in 2014 and was told the situation had been rectified. But I still have confusion paying premiums, and now I received an explanation of benefits today for lab work that is not mine. I know it is this other woman's. Now my health history and her health history are combined. I do not know what to do.
With all these HIPAA regulations and privacy regulations, I am appalled that BCBS would let this happen, and that they would not realize what a big deal it is to me. If this other woman has significant health issues, it can follow me the rest of my life. I do not know what else to do. I already filed a complaint with the Illinois Department of Insurance last year, and they blew me off. Does anyone have any suggestions?
I have a BCBSIL Gold PPO plan for which I pay an exorbitantly high monthly premium. I am pregnant and currently have to visit my OB/GYN every other week. The coverage outline clearly states that I do not need to pay any co-pay after the first prenatal visit for maternity services. Still, every time I visit my doctor, I receive a bill stating that BCBSIL did not pay the complete amount and that I need to take care of the co-pay.
As per BCBSIL, the services done at the doctor's office are not necessary, and because I receive the services at my OB/GYN's office, I need to pay a co-pay every time the doctor provides any treatment to me. If BCBSIL feels that the doctors are overcharging, then why do the patients have to take care of the extra charge!! If there is so much of an issue, why doesn't BCBSIL set up their own hospitals and have their own doctors who will know exactly what treatment needs to be performed! At least the patients will be spared of spending exorbitant amounts on both, the monthly premium and the medical services. Someone, please advise if this is the case with other insurance companies too.
I went to have a Pap test done. I handed my insurance card to the lady at the front desk who quickly handed it back and said "we don't take this insurance" I then asked who does and she laughed and stated "no one!" I paid out of pocket for the Dr. Appointment which was $100.00 and then got a bill for $420.00 for the lab work! I understand being "out of network" and paying more! But the whole point of having a PPO is so you can go wherever you want! I also received an order to get a mammogram done. I left that appointment so upset that I was given a script for an antidepressant. I came home called the number on my insurance card and was given the name of a facility that does take my insurance. I made an appointment with that facility because I had to get a new mammogram order from someone in my network to prevent having to pay out of pocket $500.00 or more for this mammogram.
I got the order and had the mammogram done at an Advocate Good Shepherd Imaging center which took my insurance card, did the mammogram and I was on my way no problem. The next day early morning I received a call from the "Breast Care Center" at Advocate Good Shepherd Hospital stating "something came back on my scans" and that I needed additional scans done and an ultra sound that could only be done at the hospital location. I show up at the hospital location and gave the lady at the registration desk my Insurance card and she informs me that Advocate Good Shepherd doesn't take my insurance and I will have to sign papers saying that I will pay for all the scans and test out of pocket. I refuse the test explaining my $500.00 recent Pap smear and explain I will call my insurance and find out where to go for these additional scans so that my insurance will cover it. I head to my car, upset again about my crap insurance!
I start calling my insurance and proceed to ask where I can go for these additional tests/scans that my insurance will be taken. The person on the customer service line gives me 2 different places Centegra imaging center in Woodstock and McHenry Medical center in McHenry. I call the McHenry number and they are just a call center and only deal with chiropractic issues and I call the Woodstock place and they don't take my insurance. Fortunately the nice lady at the Centegra place in Woodstock voiced understanding and stated she was familiar with the issues people we're having with what she referred to as "Blue Choice plans". She actually gave me information stating "I believe Alexian Brothers takes your insurance, here is their central scheduling number." Mind you she doesn't even work for my crappy BCBS insurance company!
I then called the BCBS member customer service number at 1-800-538-8833 and simply asked, if I were to need to go to the emergency room because I was dying, which hospital takes my insurance? After several minutes of searching he couldn't find not 1 hospital! I explained that I didn't want to wait until I had an actual emergency to find this info out. The customer service person then went on to explain that I had a $500.00 deductible no matter where I went. This only pissed me off more because I am aware of my deductible and that isn't what I asked.
I explained I understood the deductible and that if I needed emergency treatment I would gladly pay that but if I was admitted to the hospital because of this emergency that 1 day in the hospital could cost thousands of dollars and I pay over $230.00 a month for insurance so I need to know what hospital I need to go to if I am dying and going to be admitted so that I can afford to have treatment after my $500.00 deductible was met??! Crickets! Nothing! He could not give me one hospital that takes my crap insurance!
He then informed me that open enrollment is next November so hopefully I can make it until then without dying!!! I could see if I opted for a cheap $50 a month plan or some Obama care but I didnt! I don't receive any help from the government! I pay all my own expenses! I only rely on myself! How can a company such as BCBS offer a plan that no hospital will accept? And if there is a hospital that will accept this insurance why can't customer service give me the name of that hospital? Guess I will rely on prayer and luck to avoid any life crisis until November when Open enrollment happens!
As of today I have spoken with approximately a dozen customer service reps from BCBS and still no one has been able to help me. Blue Cross Blue Shield took my premium and money from March, 2014 to August 2014 and did not cover one penny of my medical costs causing me financial damage and emotional pain. Someone dropped the ball and REMOVED me from their system, this caused me to not be covered when I thought I was. It is too long of a story to write in here. It is just very upsetting--thanks to "Obama don't care."
Our policy started Jan 1st 2015. We paid for Jan and prepaid for Feb for a total of $1,660. We called to cancel the policy on Jan 12th 2015 because we were able to get COBRA coverage that is better. We were told that a refund will be processed in 45 days. We called again the next week or so to make sure that the refund was being processed and it was for both months Jan and Feb. We were assured that it was for both months and were told to wait. We called again a couple of weeks ago to check the status of the refund and were told that it's being processed and if we don't get our refund check by Feb 20th to call again. Well I called today, Feb 19th as I didn't want to wait one extra day as I had a feeling the check didn't come so it's probably not coming.
Today, Feb 19th I was told that the they never actually processed the refund because the request has never been forwarded to the financial dept of Blue Cross Blue Shield of IL. Really??? We have called 3 times and every time we called we were told that it was being processed and we were going to get our refund by Feb 20th. So today, I was told that they forwarded the message to the financial dept and it's going to take an additional 14 BUSINESS DAYS for the refund. This is crazy! Blue Cross Blue Shields of IL owes us over $1,660 and no urgency to refund our money!!! How do I know that this time they actually forwarded the message to the financial department to get our refund??? Am I going to wait another 14 business days only to find out that someone didn't get the message??? This is unbelievable! I will NEVER get health coverage with BCBS of IL!
I was sold an health insurance by Blue Cross & Blueshield hmo pos. I switched to this one due to 2 reasons 1. Doctors and Hospitals are close by, 2. I spend winter time with my daughter in Fl. BB told me before I go to FL, they will assign a PCP in FL so that I would have the same coverage as I have in Illinois. It was a total lie to get you enrolled. When I called BBC, they said there is no such thing. If any one else has the same issues, I think this is good for a class action law suit.
Secondly, it is very hard to get through the line. Their communication is worst than third world countries. Another issue I had is false info on doctors in their Network. I was given a PCP printed in my BBC Insurance Card. I took an appointment and went to see the doctor. The secretary in the office said, the doctor is not in their Network. I lost the good part of my day. The office tried to call them and I also tried to call them. After hours of on hold, they said, I have to pay $60 to see him. My co pay on the card is $10 to see the same doctor. This means I will not be able to fill up my prescription for 6 months. I pay medicare for part B and no coverage till end of May unless, I pay for everything separate. To me, this is an insurance fraud by BBC and I am looking similar case so that we could file a case against Blue Cross & Blue Shield of Illinois.
My doctor ordered a test. The hospital administered the test just as has happened for years. Not anymore! BCBS denied it stating "Member did not meet BCBS Medical Policy Criteria for Coverage". I have to ask why would I know the criteria better than the doctor or the hospital at which the group health insurance plan is through. If I was a doctor or worked for BCBS maybe I would know but that did not seem to work for my doctors. So we got hit with an $1,800+ bill for something that should have been less than $200.
To make it worse they are now doing it again to one of my son's bills this time for $2,100+ and this one we had pre-authorization on. I have not seen a doctor, my back doctor this year, as I am afraid of getting stuck by BCBS. My handicap placard expires in November and he will not renew without seeing me but I cannot take the $2,000.00 BCBS challenge anymore. My whole family is hoping we make it until next year safe and sound when we switch from BCBS.
While away from home my wife required emergency surgery on Saturday, May 31st, 2014. The hospital Mother of Frances Hospital called BCBSIL for "Preauthorization". BSBCIL does not staff on weekends and did not accept the preauthorization. These facts are not disputed. Neither is the fact that on the BCBSIL card and they state that notification needs to be done within two days. These are the issues I have with this requirement:
1) The fact that the hospital called BCBSIL on Saturday, May 31, 2014 is not disputed by BCBSIL. They admit that they are not staffed to receive "Preauthorization" calls on the weekend. If this is important to them, then they should be staffed.
2) The fact that BCBSIL puts the onus on patients to notify them and not on the hospitals. They're putting this requirement on the patients when, especially in an emergency, they are the least able to navigate the health care bureaucracy.
3) The requirement to notify BCBSIL is the responsibility of the Patient, but actually performed by the Hospital in the vast majority of cases. This causes confusion when confirmation is not given to the patient that authorization was accepted. If in every encounter in the past, the hospital was the one that contacts BCBSIL for authorization and in this case tried, but preauthorization was not successful because BCBSIL does not staff on weekends, how is the patient supposed to know that preauthorization was not successful.
4) The amount of the "Penalty" is arbitrary and is not based on actual damages caused by not pre-authorizing. There is no claim by BSBCIL that any unnecessary procedures were performed or that Preauthorization would have been denied if they had been staffed to take the call.
5) That there was no prior notification on the amount of the penalty.
6) That whatever the point of the preauthorization is the operation was done on Saturday and my wife was released on Sunday. On Monday there was obviously nothing to preauthorize, it was already done. There was no "Cost Containment.." issue, which is the bases of the denial. My complaint is while BCBSIL has a rule, the rule is fundamentally unjust, arbitrary and illegal.
7) The term preauthorization is used on the members card, but this use of the term does not meet any of the accepted definitions: McGraw-Hill Concise Dictionary of Modern Medicine: "Managed care The requirement by an HMO that a costly surgery, specialist referral or non emergency health care services be approved by the insurer before it is allowed." Invalid because "non emergency".
Farlex Partner Medical Dictionary: "A prerequisite, often intended as a rate-limiting or cost-containment step, in the provision of care and treatment to an insured patient. A practitioner who expects to be paid for a service must use paperwork and telephone contact with a designated entity (often clerks, but sometime medical professionals), often a TPA, To determine whether the proposed treatment or procedure is deemed medically necessary for the health and welfare of the covered party." Invalid because the BCBSIL was not staffed on the weekend to determine medical necessity, and the penalty was not based on medical necessity but on failure to notify.
Medical Dictionary for the Health Professions and Nursing: "In the U.S. authorization of medical necessity by a primary care physician before a health care service is performed. a referring health care provider must be able document why the procedure is needed."
I was on hold for over 3 hours today, trying to talk to someone in the benefits department in IL - I have been left on hold, disconnected, been given wrong information and even transferred to some other number that had nothing to do with BCBS. I am shocked at how poor the customer service is. Last time I was given incorrect information about a provider being in Network, then actually went there to find out they were not - that was after an hour phone call!! I signed up for this plan BECAUSE hospitals close to me and my Drs. were in Network, only to find out after open enrollment that they were no longer in network.
This is not fair, and not the coverage I paid for. The in network providers should not change after you buy the plan - bait and switch!! I finally, after 3.5 hours, asking for a supervisor, got a person who was knowledgeable and could answer my questions. It is not right to have to invest 4 hours of my workday being on hold and disconnected, just to find out my benefits. They should have people there to take calls for the fortune we have to pay for this. And who takes care of 100% of the bill from the provider they told me to go to that was in network, that was no longer after I went there? I would not recommend BCBS of IL to anyone!! This was Blue Choice Gold PPO.
My doctor put me on a CPAP machine. I stop breathing excessively during the night. I have met my deductible but it starts over in 1 week. They will not go ahead and buy me the machine now. They will only pay to rent it for 3 months first and then they will pay for the machine if my deductible has been met. By then my deductible will have not been met as it starts over in 1 week. This blows and is so unfair. I called them but they just said that was their policy. I asked them could they waive the 3 months of renting the machine first if my doctor sent them a letter stating that I had no problems with the machine during my sleep study and they said no. In other words I'm screwed and will end up having to buy the machine.
I purchased the BCBS Blue Choice PPO that went into effect Jan 1, 2014. One of the reasons I chose this plan was because our pediatrician accepted it. The first few office visits for our newborn were considered in network and were billed as such. In April 15, 2014, we got an email from Town & Country Pediatrics stating that BCBS was no longer allowing them to be "in network", so all of our visits from Feb through mid April were billed as "out of network". Blue Cross blames T&C, T&C blames BCBS and I get caught holding the bills.
We had changed from our regular BCBS ppo for years to the one offered by this thing called obamacare, saving $200 a month, with the same coverage, a $6000 deductible and a 100% coverage after that. We were in the hospital on January 1 2014, and as of today 8/11, I am still on the phone with a BCBS rep for more than 2.5 hours now trying to manually work on the computer glitches that the new obama systems have.My deductibles from medical and prescription are not matching up because they are on 2 different systems that do not automatically match up. I have to pay Walgreens each time we pick up prescription, because our deductibles are not met. My hospital bills are sent to collection because they are still not being paid.
I have paid $7000 out of pocket even though I am only responsible for $6000, and I still have providers after me every week, and I am still calling BCBS every 10 days spending hours on the phone. Oh, and there was a dumbass BCBS rep that doesn't even know how to read my coverage. Ahhhh!!! UGH!! Super frustrated. Someone should start a class action on this for my time loss on these phone calls, and grey hairs!
It is correct they are cheaper but they stab you in the back anytime they see that they can. I am covered only on ER. If I needed ER, I make sure I go to see a doctor first just because it will be cheaper for me if it is not emergency. So last time I went to a doctor for a boiler on my back neck and I was told to go ASAP to an ER. I did and when the bill came, they said I am not covered even though the ER doctor stated I needed ER. They deny me in a letter sent to me. I went to my agent who introduce to deal with BCBS. He wrote a letter to ILLINOIS DEPT. OF INSURANCE, all that after the collection agencies started on giving me all the **.
Long story short, IL Dept. of Insurance solved the issue and made BCBS to pay. I called the idiots to see why they changed mind after 1 year of all insults I had, and why they paid and for what reason... The lady I talked to at BCBS had no answer and said she'll call me in 2 days to give me an answer and still now after 3 weeks I didn't know why they paid it. NOW, I am dealing with my attorney that said he'll be glad to hold and start the case. Hope I would screw them as they treated me. They deserve it.
Blue Cross of Illinois Company Profile
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- Blue Cross of Illinois