Consumer Reviews and Complaints
I had an appointment with a eye specialist in December 2016. He had to refer me to an eye retina specialist, but he warned me that Blue Cross Blue Precision Silver was dropping out of the Market Place and they were not informing any of their customers. He advised me to wait until after the first of the year and when I'm on a new carrier then follow-up with my retina appointment otherwise I might get stuck with an unpaid bill. Well he was right about the unpaid bill. Blue Cross kept playing around with my bill from the eye specialist and after six months it is still unpaid and now they are nowhere to be found. I've spent hours calling one number only to be told to call a different one. I'd forward the bill to them and it would come back saying wrong office. I hate to think how many other people got stuck with bills. I paid all my monthly premiums and what good did it do me. Will never purchase any Blue Cross insurance again.
I am a member with this horrible company customer service... what can I do.? Nothing. Every time I call for a question I have to wait several minutes before any rep. answers, when they answer they put you on hold more than 25 minutes only to answer my question. On 7-10-17 I called around 1:25 p.m. and Shaney answered, after 10 minutes, I asked her to check for me something on a claim, asked me if I am on the policy, she repeated my phone number she had on file twice and she said AFTER 25 minutes that she can't find my name still. 25 MINUTES a BCBS cannot find my name on the policy? Come on. I called before hundred time and they always have my name. I decide to complain about their horrible service. You may deal with them, they take your money but they will give you a ** service.
False Statements and bad customer service - When you get your insurance statement of services, be aware that the insurance portion of the billing - The so-called reimbursement to the provider is 100% false. In most cases, for smaller services like chiropractic care, there is no reimbursement at all! It's just price fixing and way for you to think you received a benefit. Or, in a best case, a small portion of the number posted was sent to the provider. There is no such thing as insurance anymore - Only managed service contracts that are essentially marketing tools to push patients to providers accepting the bad terms of the insurance company to bring in patients that believe it will be financially good for them. You are much better off paying cash prices which will be less than your out of pocket with insurance! Most providers take cash, especially those trying to build a practice.
I've had BCBSIL PPO for at least two years. I took a buyout in 2012 from a multinational telecom company, who sold off our division. Shortly after retiring from that company, I had an injury, which led to a disability, which was finally approved in 2016 and retroactive to 2012. Due to the retroactive approval, I was being forced to take Medicare, as the SSDI was covered for more than two years. Shortly after the SSDI was approved, I received a letter from the benefits dept. of my previous employer stating that all retirees who had become disabled, regardless of age, would no longer be covered under the existing plan and then be forced to use their broker, AON Exchange.
But, when I called AON, I was told I had not been on the transfer list and could renege my existing BCBSIL plan for 2017, which I did. My SSDI approval was made after the transfer list had been sent to AON. So I renewed my plan and waived Medicare and BCBSIL told me I would have coverage as usual. Now, it's May 2017 and BCBSIL is not paying my medical providers the contracted 90 percent IN and nothing or very little on OON. They are telling me I should not have waived MC and it's my fault! THE ONLY REASON I waived MC was because I couldn't buy supplemental insurance and was told I could keep my current coverage, for one more year.
After being patronized on the phone by BCBSIL customer service rep., I asked for the resolution dept. who said they would listen to the recorded conversation I had with their rep in Dec. 2016 and call me back the next morning. That was on Monday, today is Thursday and still no callback! Be very cautious when speaking to BCBSIL and take notes of who you spoke to and when. IF YOU DON'T UNDERSTAND A TERM OR ARE NOT FULLY CLEAR OF WHAT THEY ARE TELLING YOU, HAVE THEM EXPLAIN IT, UNTIL YOU DO! I never had such issues with UHC!
In need of cancer treatment side effect surgery. Pain from side effects could be relieved but the Director of medicine at BCBS of Illinois Exelon said it is not medically necessary and for cosmetic only. Are you kidding me? Two University of Wisconsin doctors and a top Surgeon get a peer to peer and what does BCBS say in the peer to peer, "Sorry this is out of my realm." What a joke, how are they allowed to make decisions? All about the money and numbers, who cares about the people. Director of medicine go back to your cozy office and charity dinners and never put a name to a face, and do us all a favor and don't call yourself a doctor.
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I have been paying for their mediocre coverage for years, well over what my surgery would cost, never bringing in my kids for things unless absolutely necessary and now that I am disabled from my job due to a low back problem they deny my surgery 1 week before. Due to their MD who probably sits in a cozy office all day says it is not necessary due to the MRI not showing enough narrowing to pinch the nerves. Not taking into account the painful discogram I went through that showed two large tears in the discs. Able to get my MD to go peer to peer and still lost. Now I am out of a job, paid a HUGE COBRA payment so there would be no lapse in coverage for this and they deny me at the last minute. I am now on long term disability, which will only last me 24 months, then what. The narcotics dull the pain but I still can't move the way I should. I could easily live another 60 years but this is not living.
I have canceled my health plan on December 16th, 2016 and is February 2nd, 2017 and every time I called customer service they tell me my refund is denied. I need help getting my money back. I got health insurance thru my job starting January 1st that's why I canceled but I was paid. I even got the letter stating it was canceled. BCBSIL got me very upset. I can't believe it. All I want is my $414.32 back!
Back in mid-December of 2016 I canceled my individual PPO plan through Blue Cross to keep it from renewing in 2017. I honestly didn't have a problem with Blue Cross last year, I was just offered insurance through my job and had to choose that because it was significantly cheaper, what with insurance premiums in Illinois skyrocketing this year. During this phone call, the representative assured me that my plan and auto-pay had been canceled. Maybe a week later a $368 premium had been taken out of my account for the plan I had canceled.
Long story short, I have since spoken to about 4 different representatives to get this money back. After being on hold for nearly two hours the first time trying to sort this out, the woman I spoke with said I needed to allow 10 business days to receive my refund. After significant time had passed and still no refund, I called and it turns out she had made a mistake which caused the refund to be denied.
January 18th was the last time I called to set up the refund process once more, and now 11 business days later, still no money. I'm infuriated because it's not easy to go without that kind of money for me and I feel there should be more urgency to correct their mistake, rather than taking over a month now to refund me. I've also had problems with a claim from October that has yet to go through their system, but I'm still unsure why. I do have to say all representatives I've spoken to have been kind. It's their system and flaws that's creating this mess.
This insurance company has the most horrible customer service as far as I know. I spent more than five hours on the phone waiting for them to answer. There is no answer at all. The reason of my phone call was to have an answer why they charge me $289.94 on January 3 and $212.88 then they charge me again $154.95 on January 9. The agent appointed is neglecting me because he does not remember conversations involved during the process. As far as I know BBS is neglecting customers because of the horrible customer service they have. Besides that it is impossible to register online if you do not have an ID#. I do not like this health insurance at all. I hope the Obama Care will take care of this right away.
Right now... I've been on hold for 51 minutes and counting. This is after I waited 25 minutes for rep to call me back. It's 1/26th... and BCBS can't find my plan that I signed up for and Paid for to be active 1/01/2017. My son has severe flu and we just paid $137 for Tamiflu because BCBS hasn't confirmed our policy or sent out cards w/ a member I.d. #. Our premiums are just under $900/month. We've been w/ BCBS for years... It's always the same story when you call in for customer support. You're either on hold Forever, you can't understand the person/or they can't understand you, rep is inexperienced and gives you misinformation... or they disconnect you when they don't have an answer for you. They refuse to let anyone speak to a supervisor.
I having been trying to get pre-authorization for surgery but BCBS of Illinois is very slow in replying. My surgery has been delayed by one week and still no response. I have been messaging them since last week, my messages get a reference number but still no call. What happened to this insurance company; it used to be a good company. Premiums are outrageous and customer services sucks.
Blue Cross Blue Shield mistakenly canceled my health insurance in August 2016. I called them many times to try to get it resolved because I paid all my premium on time. While they were working on reinstating my health insurance, I needed to refill my prescription. The Blue Cross Blue Shield representative told me to refill my prescription on my own and reassured me that the cost will be 100% reimbursed once my insurance was reinstated.
My insurance was finally reinstated in November 2016. I submitted a claim for reimbursement for my prescription but was denied for reimbursement. I paid $185.99 for my prescription, which if I had insurance, I paid less than $20. They said the entire cost of my prescription will go towards the deductible so there will be no reimbursement to me. I should have paid $20 instead of $185.99. It was Blue Cross Blue Shield's mistake in canceling my insurance, not mine. Now, I am penalized for the mistake they made. Every time I called, the wait time was 45 minutes to a hour. Worst company I every dealt with. Very disappointed.
As of 2017 Blue Cross requires you to use Walgreens as your pharmacy. This couldn't be a bigger debacle, with Walgreens being probably the poorest rated pharmacy when it comes to service. I guess this should come as no surprise considering Blue Cross's track record, in fact they're a match made in hell. Between my wife and I, we had two of 12 prescriptions transfer correctly from our previous pharmacy. One prescription with refills was lost altogether. There are no words that accurately describe my dissatisfaction with Blue Cross & Walgreens. STAY AWAY AT ALL COSTS!!!
I signed up for Blue Cross Blue Shield of Illinois in mid-December and paid more than $1000 for my first month's premium Dec. 22. It is Jan. 13 and I still have no ID card or even an ID/group number. I have called about a half dozen times to ask why the delay, sometimes being put on hold more than an hour. They did receive payment right away, but my ID "fell through the cracks". This is incompetence at its worst.
Blue Cross Blue Shield of Illinois is incompetent. When you call, expect inaccurate wait times that are already obscene. If you get coverage in the New Year, do not assume that your insurance is active because it says so on their website. Mine wasn't when the hospital ran it, and then I was unable to get a customer advocate on the phone. I had a good experience with Blue Cross Blue Shield of Texas but it's important to understand that the companies are largely independent of one another. Avoid the one in Illinois.
So to start, as of Jan 1st my policy states it was active via the Blue Cross Blue Shield website. I tried to get my prescriptions filled and I was unable. So the pharmacy called Blue Cross Blue Shield of IL and they stated that my policy was inactive. I paid my premium and everything was in place that should have been. Frustrated as I was I proceeded to call Blue Cross and Blue Shield of IL and waited on hold for over an hour as usual. A young lady answered by the name of Melissa ID ** or **.
She first asked me for my identification number which I provided. She told me she was unable to locate my policy. So then she asked me for my social security number, trusting in her, the confidentiality and trust that Blue Cross and Blue Shield is supposed to represent. I willingly gave her my SSN. She then found my policy and stated it was activated. Naturally, I thought to myself for a moment and then thought of a different question after she gave me an answer I already knew.
I introduce another yet seemingly simple question, "What is the difference between Blue Cross Blue Shield of IL PPO and Blue Care Preferred PPO of IL..." She was unable to answer that question for me and said she could give me a number for blue access. I then said "well, my plan is shown on the Blue Cross Blue Shield of IL website and I called Blue Cross Blue Shield of IL customer service." This is where things got funky. (Mind you, I told her and started recording from this point on.) I asked her what department she worked in and she answered my question with, "Sir how may I better assist you today?"
I calmly asked her again "yes you can tell me what department you work in..." Again she said, "Sir how may I better assist you today?" She proceeded to tell me the call was being monitored and recorded, only at that point did she tell me that. She asked for my social security number again and I then stated that I did not feel comfortable giving that information out to someone who cannot tell me what department or what company she worked for.
Then for many brief moments of silence between me asking for her name and ID number she responded by telling me her first name and her ID number in a manner that was so fast I could not even understand her. So I asked her to repeat it multiple times and each time she forgot a single digit alternating the number in her ID in and out each time. I asked why she was lying to me and she wouldn't answer. I only assume because she knew she was being recorded and she knew she was lying.
After all this I asked to speak to a manager and that I didn't want to be put on hold. She then stated, "Please wait while I find someone to better assist you." I then said "I don't want someone to better assist me, I want a manager." I was told, "one moment please..." I heard her typing and I asked her what she was doing and she said she was updating her policy and I said "you're updating your policy?" She replied, "sir no." So I asked "are you updating my policy" and she did not answer.
She then put me on hold and I waited for a manager as fifteen minutes went by and then the music stopped playing and the line was silent. After about two minutes of silence she finally disconnected me. In total it was two hours of being lied to, taken advantage of, and witnessing a gross exercise of non-compliance, negligence, and the worst customer service I have ever had in my life.
I felt completely violated that a woman who lied to me for over two hours took my personal information and treated me the way she did. This is why I feel like a victim. Like Blue Cross and Blue Shield of IL stole my sense of personal security. If I could rate this 0 stars I would and I will be contacting The Better Business Bureau and any other entity that will further help restore my sense of security.
Blue Cross raised my family premium from $1900 per month to $2990 per month that is a 54% increase. That requires our family of 5 to pay nearly $36,000 per year for insurance. Under the Affordable Care Act insurance has become Un-affordable. Excessive wait times and poorly trained customer service representative add insult to injury. Maybe they should stop spending money on their Bear Tickets for the Blue Cross Blue Shield Seat Upgrade and lower the Rates.
This the worst medical plan I have ever had. You send generic card with fictitious doctors names so you don't have to cover a visit. I have been searching for months and paying out of pocket because your insurance and customer service are a nightmare. BEWARE anyone thinking of purchasing this EXPENSIVE WORTHLESS INSURANCE.
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.
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.
Blue Cross of Illinois Company Profile
- Company Name:
- Blue Cross of Illinois