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I am so mad that every time I call on my own claims they tell me I cannot because the insurance in my wife’s name even though she has given the insurance the authorization to do so. Their member services are by far the worst I have ever dealt with. Zero stars????
I am a state worker and even though everyone thinks we have the best plans with the best coverage, I beg to differ. We were recently forced into Horizon. I use to have Aetna which I’ve now learned was so much easier to deal with. I receive one round of Orthovisc knee injections per year. When I had Aetna the process was seamless. My doctor's office would request the medication, Aetna would deliver it, and the doctor’s office would call me when it arrives in to schedule my appointments. My doctor requested this medication in February and it is now April and still no medication.
Blue Cross uses a slew of different pharmacies for different meds to make things cheaper. It took two months for me and my doctor's office to figure out which pharmacy is filling this prescription. I’ve probably called the insurance company 5xs in the past two months and been on the phone at least a half hour to forty minutes each call. This is unacceptable when you are paying top dollar for an insurance plan. I’d take my Aetna plan back in a heartbeat. Blue Cross needs to get better management/training in their various offices and stop trying to cut corners.
Any plan can be improved. I have a federal government plan, which is different from the regular Blue Cross Blue Shield plan. I’ve been told the federal plan is the best plan out there by other companies where I have inquired.
Signing up with Horizon Blue Cross Blue Shield of New Jersey will cost you big in the years to come. They offer competitive rates when you are initially signing up, everyone is familiar with them and they seem like a good choice... Don't be fooled. When you turn 70 your premium will take a huge jump, beyond normal yearly increases. This is because their premiums are Age Rated. Most Medigap plans are Community Rated. What this means in plain English is that every 5 years from age 65 your premium will increase dramatically... 1st increase at age 70 was $75.00 per month for my husband, plus yearly increase. Be careful how long you live.
If that's not bad enough, new this year, 2019, the age increase is automatically given a nonpreferred rate. In order to get the preferred rate you must pass underwriting questions, which many are not able to pass. Perhaps the worst is that they lie by omission. You are not told about their outrageous increases when you sign up. They also will tell you that all the Medigap Plans are age rated. This is false, they may be the only one to do this. They found a loophole. They also lie and say that their new Preferred/non Preferred rates are the same as other insurers. Again, this is not true. Choose wisely. I switched my policy to AARP/Universal because they are honest, forthright and were shocked when I told them what Horizon is doing.
If I could give negative stars I would. This could be a total fraud company, nothing is OK and I know the plans are not inexpensive. I am begging our HR to change providers. Horizon has been the worst insurance experience ever and I've had to go through NY State plans which are not the best to deal with. 2 doctors prescribing the same medication I've been taking for YEARS and never had an issue with submitted prior authorizations MANY times. When pharmacy tries to fill, they are told Dr needs to submit PA which they have over and over again. They try to call but cannot get anyone on the phone for hours - both doctors think it is a rouse to make a person give up so this company does not need to cover anything. I agree. This company is completely horrible.
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I was a member of a group insured by Horizon. They said the group did not qualify for coverage any longer and canceled the group. I was told that if I enrolled in an individual plan with them, that the out of pocket expenses, that I incurred would transfer over to my new coverage. After a bout with pneumonia in the emergency room, they informed me that I had to transfer those expenses, only from one group to another group. And that I would have to start a new deductible, all over again. Nowhere in the handbook, is this spoken about. I was taken advantage of by a big company, with no chance of fighting this.
Absolutely horrible. It takes an hour on the phone to get ANYTHING done. They randomly added two of my adult kids to my policy, then cancelled me when I "didn't pay" (since I didn't realize my premium changed due to the addition of my kids - who have their own insurance and haven't been on my policy for several years!!!) They had my wife's birthday wrong, when she called to fix it, then changed my birthday to match hers - which screwed up my prescription coverage and eliminated my online access. Then they told me it would take 30 days to put my birthday back to the correct date. Many other issues and problems, every one takes hours of precious time. Their overseas based call center is useless - don't waste your time, demand that your concern be "escalated" so they bring the call back to U.S.
My daughters have had halter monitors for years and they have always been covered until last fall when my youngest daughter had her halter monitor done. Horizon denied the claim because they said it was experimental. I have filed an appeal and now they are saying it was an implanted monitor which it wasn't at all. It was a portable monitor. They had some internal/Anesthesiologist review her records and he stated an implanted monitor was not medically necessary and that there are multiple types of portable cardiac monitors available and that is what she had. They will not let me to talk to John ** MD who has made this decision.
Nowhere in the notes from her cardiologist was there anything about an implanted monitor. They won't let me talk to him nor explain to me where he got such incorrect information. They are denying claims fraudulently. I spoke to you Esa a customer service supervisor and she told me it is a covered benefit so why are they denying my daughter's claim. I am so tired of them not knowing what is going on and always getting different answers when I call. The insurance sucks.
From 7/1/2011 to 8/31/2017 Horizon has processed my claims with my PCP and Virtua incorrectly. Over the course of this time I have called both Virtua's billing office and Horizon to tell them that I should not be billed out of network or as having a deductible as that is my PCP to no avail and have been sent to Apex collections where me and my husband's credit has been ruined over Horizon and Virtua not handling their claims processing correctly. I finally took this matter to the BBB in 2/2018 and have not heard anything back yet but did receive another bill for an incorrect co-pay because that is what Horizon told Virtua to bill us retro to 8/2017.
Paid for the medical insurance online every month in 2017 till November. By November, received the letter from Blue Cross of NJ stated we do not have insurance started Oct 2017. We told them we paid online with proof. They said they will check and at the meantime they sent us refund check for the two months we paid (Oct. and Nov.). We call them all the time in November and December try to resolve this issue. When we called again in December they told us just deposit the refund check and made it as we do not have insurance started in Oct. 2017.
We agree with it and went ahead deposit the refund check and paid for the medical bill occurred during these three months. However as of now - March, 2018, they still said we owed them three months Oct, Nov, Dec in 2017. We call every few days trying to resolve this issue but no one care... The billing system is horrible and customer services even worse... Don't know what to do yet. Very sick and tired dealing with the company like this.
This insurance company should be shut down for fraud. My father was enrolled in November 2017. I have paid his premium every month since November 2017. I get a bill every week stating his premiums are overdue for 5 months and that they will cancel his insurance. I have sent them proof of payment, that has not worked. I think they are stealing my father's money. The Horizon portal has my dad paid up to date but they are not linked to Horizon BC/BS. Can anyone explain that because they can't.
I call every week and every week they tell me they have not received any payment on my Dad, meanwhile they keep asking for more and more money. At this point not only have I paid my dad's premiums to date I have overpaid so that they won't cancel my father's insurance. My dad is 93 years old and he is not rich. When you ask for a supervisor they say there is no supervisor. How can that be. Poorly run company. Horrendous customer service and fraudulent company. Please run run run from this horrible insurance company or they will steal your money.
I am happy to have this insurance but everything is pay more get less... It's getting harder and harder to pay bills and live in New Jersey. The increased cost of emergency care is ridiculous. I was afraid to take my daughter to the E.R. when she was in a car accident due to the increase. It's all too much.
Live people, telephone line closes at 5:00 pm and most people are at work. Should customer service have shifts to handle late calls.
This is not about the actual services rendered (only used it a few times in the year) but about trying to get out of the plan after I enrolled. I called to cancel my health insurance the first time in early December 2017, and they told me it was canceled. Then I got a charge on my account for January 2018 and I had to call them again to cancel. Same process. Now it's 1/2/2018 and they've charged my account for the full premium despite calling to cancel 2x already. It's just a mess and is completely unprofessional. It's no small sum of money so each time I get a charge I have to scramble to make sure my account isn't overdrafted. I'd highly recommend looking elsewhere if you have the option. I personally chose Oscar, which I'm very happy with.
They failed to pay a claim because they had the wrong termination date of my plan and they cannot fix it or will not fix it and have nobody to talk to fix it - I kid you not that you go from person to person for HOURS and nobody can fix it and nobody knows what's going on. CEO should be fired, jailed or both for fraud and ineptitude.
Our oldest son has had ear "issues" since he was 5.5 years old. He has been in the care of an ENT in all 3 states he has lived in, had multiple tube surgeries w/ adenoids initially removed, and was fitted multiple times for specialized ear plugs when he was younger (b/c he can't even get water from a shower in his ear w/o risking an infection). We have never had any issues with insurance approval and payment until now...with Horizon Blue Cross Blue Shield of New Jersey. Our son is now 20 years old and because the fluid in his ears does not properly clear and builds up excessive wax (affecting his hearing), we continue to visit the ENT as infections occur or every 6 months for wax removal, along with hearing tests as dictated by necessity. The most recent visit in October showed a declining hearing level that was due to his Eustachian tube collapsing.
Our newest ENT (who for 3 years has supported our "don't fix it unless it is broken" stance...ie. not an insurance money grabber) requested Horizon BC/BS approve: a new tube to replace the tube that was pulled out with wax build up, a procedure to re-"inflate" the Eustachian tube along with a fixing a deviated septum (b/c the Eustachian tube cannot be reached without this step). Horizon BC/BS denied it. I was told it is because they see no history of breathing difficulty.?! The ENT's office was given other non-sensical excuses. Our ENT requested a peer review and when he called in for it, the reviewer said there would be no discussion or review...it's still denied. This has never happened to him in all his years of service.
We must now cancel the surgery we had planned to have for our son over his Winter break from college (so he wouldn't miss 2 weeks of class time during the required recovery and have to sit out a semester), and his hearing continues to be "fuzzy" and ears are constantly popping (and breathing through the one side of his nose is diminished). Our ENT is filing an appeal, as will we. We are both filing complaints with the Governor's Insurance Commission, and my husband's employer (a very large, well known appliance manufacturer) will be made aware of this situation as well...in hopes that perhaps the HR/insurance rep can rock the boat a bit. A health necessity in life has arisen, and Horizon Blue Cross Blue Shield is not in the business of providing for this necessity. Shame on them.
Anthem Blue Cross/Blue Shield Silver Plan. Been using it since May 2017, had three doctor's visits, one blood test, and 4 prescriptions (one pending), they overcharged me for both doctor's visits and all 4 prescriptions - by roughly 50% on average (over the co-pay and last one was 92%). What's the point of a co-pay?
Took my daughter to a dr and called Blue Cross to make sure the dr was ok to use, they said yes. The dr office said yes and they called Blue Cross. Dr said my daughter needed a surgery and she could do it next week. The dr assistant called Blue Cross and got a verification for the surgery, They have the name of who they spoke to and they have a confirmation number. One week after the surgery Blue Cross calls me and says they refuse to pay since the dr is out of network. Dr assistant calls them and Blue Cross says that number means nothing. WOW.
I wish I could rate them zero stars. I've never had a worse experience with an insurance company. They make excuse after excuse not to reimburse for psychotherapy sessions that they previously reimbursed without a problem. Every month it's a new and more absurd excuse. First they said my provider information was not on the form (um, it was on the provider's letterhead and on the paperwork), then they said it was the wrong state (I have NJ insurance although I live in CA, because my husband's corporation is based in NJ), then they said they were confused by the provider's paperwork and needed her to redo everything (before it was never a problem). It is now September and I have eight months of unreimbursed claims.
Not only that, when I had cancer two years ago they contacted me to see if I needed assistance with making treatment decisions AFTER my cancer treatment was over. I'm absolutely disgusted by them. And, they doubled our rates last year - my husband gets insurance through the company where he is employed. THE WORST!!!
Every time you call, you have to give your life information over and over and over. If you call 3 times in the same day, you have to give the information again, THEY claim it's to verify who you are. NO OTHER co. does that. Other companies ask for name and ID or phone number and your info jumps up. When you're not feeling well to begin with, then you know you have to call and get trained like a dog to give the info. How redundant! With all the money Horizon makes, come up with an easier way to identify us. OR just say "Has anything changed in the last hour when you called before?" It's so annoying. Then they get annoyed if you mention it or if you talk too fast because YOU'RE in a hurry too. Use the internet? Not working either, then you also have to call to verify because perhaps that Dr. or place canceled and Horizon forgot to remove or add their name!!! Really? What a waste of Customer time.
As a provider of services for Horizon BC/BS of NJ, if I could have given them a rating of less than zero, I would have. Since becoming a provider, I have experienced non payment of claims, getting multiple excuses for why, and then finding a more reasonable Provider Services person who agreed that they claim form was "clean" and "accurately filled out" who said that she would forward it to a supervisor so that the problem could be address and corrected. I actually felt hope for the first time as this was a rare, helpful and human response from the insurance co., only to be denied again later. This happened to the point where I had to hire a professional biller because I was going broke from non payment and needed to focus on my work, not the constant frustration of not being reimbursed for months of services.
A few months later, my payments were cut by 50%, with no warning, no explanation and no change in my clients' insurance plans nor in my credentialing. I spent 5 months trying to find out why, to no avail. I was given multiple numbers to call, hung up on, and made to feel confused... Spending tens of hours calling, trying to speak with someone who could explain what was happening and why. To no avail. I agree with those who wrote previous reviews who suggested that the insurance co. did this on purpose with the hope that members and providers would finally "give up". Well that is not going to happen with this provider and I can see that I am in good company.
Though I have worked with insurance companies for 30 years, I have never been treated more poorly or dismissively than I have with Horizon BC/BS of NJ. While they pay their CEO's millions of dollars, they nickel and dime and mistreat their members as well as their providers. I've seen a number of people who've previously posted suggest joining together to see this resolved legally. I would be happy to join.
BC/BS has been billing me for several years for "late enrollment". In fact I enrolled 80+ days before 65th BD as allowed. Several CS Reps confirmed I was NOT late, BUT said this is a lifetime penalty. Have tried to email but their NJ site is impossible to log in. I estimate if all billing is paid, which I refuse to do, $40 million a month (minimum) is being stolen from US Public. Given some phony 3rd party to appeal. Government appeal non-existent. This is message I'm trying to get to NJ BC/BS.
"I am going to try to be as gentlemanly as humanly possible. I demand you stop the Medicare Fraud you are harassing me with each month. Your own CS confirms I had NO late enrollment. In actuality I took advantage of the early period and enrolled nearly 90 days before age 65. If you or a supervisor cannot or will not rectify this farce, the airline's recent bad publicity will pale in comparison to the bad PR. I know you are on par with cable because you are a virtual monopoly and don’t care. One of your Reps told me this harassment is a life sentence. Ergo I will make it my life’s work to fight this injustice.
If you do not cease and desist this scam/theft billing and maintain the false claim of late enrollment, consider this demand for refund of misapplied premium. I PAID BC/BS $5657.28 between age 64 & 65. You can issue a check for the entire amount or I will accept 12 monthly payment of $471.28. I will waive the prior $30,000 with no claims paid to BC/BS since age 60. If you do not wish to reimburse me or cease this fraudulent billing, consider this a legal demand for the pertinent information (name, address & particularly State) where the initial authorization for above referenced illegal billing originated, so I can file criminal charges."
I have the Omnia plan, went to a Tier-1 hospital in an emergency, right? The hospital ordered a test that required anesthesia and guess what? GOT-YA. The people that the HOSPITAL hired to administer anesthesia ARE NOT part of my plan, so I pay $1,776.00 for anesthesia, are you kidding me? What choice did I have? Do I lay on the gurney and research anesthesia providers to see if the one the hospital selected is on my plan?
NJ Direct approved my surgery (skin removal from weight loss) the first time. But I couldn't do it at that moment. I had a low blood count. Had to see an oncologist to get it fixed. I informed nj direct and they said I be fine to still get my surgery. I came back and was denied. I want my health care to explain to me why would they denied me from a surgery that was already approved! Regardless I'm going to keep fighting... meanwhile find me a new health care provider since they rather see you die than to get your health back on track.
I called three times for getting registered online and none of those representatives were able to help me. I had to make a payment and they were saying that they don't know if I have an account or not even though I paid first two installments before. Very unprofessional and unorganized.
I filed a complaint with BCBSNJ due to my podiatrist charging me $460 for a pneumatic boot anyone can purchase for only $40 on Amazon. I called twice, sent evidence etc. They responded by telling me that $460 is a fair price to pay. Ridiculous! Clowns like this are why part of the problem! It's not Obamacare it's doctors being allowed to overcharge for items, big insurance paying only what they want to and passing the rest via write-off (increasing our premiums) or payment due by us the already overpaying consumer! Totally disgusting! There's a special place for these kind of criminals that allow this to go on!
I have been a member since 09/16. Since that time I have made my payments FAITHFULLY every month and ahead of time but I keep getting notices that my payment has not been received. Today I received a ridiculous letter telling me that my payment for 03/31/17 is past due and I am facing termination. I called customer service WHICH IS OUTSIDE OF THE U.S. and was told to ignore the letter. I have gotten two e-mails and now this letter saying that I'm past due. When I call, they tell me that I'm up-to-date. This is RIDICULOUS! Every month I go through this. I wish they would get it together and fix the problem!
I've been with HBCBS for 20+yrs. I am the only person on the policy, and I am paying $1000.00 per month for insurance with a $3000.00 deductible. I see a doctor once a year for a physical, which I did about 6 months ago and had to pay for the blood test ordered by the doctor. I am a pretty healthy person, don't smoke, drink 2 beers a week, good weight, sleep great... Soon I will go onto Medicare, and it can't be a day too soon. This company is draining the blood out of me, financially speaking.
Sadly I have had this insurance since January 2016 through my employer. It is the only option provided to me. This is by far the worst insurance ever. It covers nothing. Blue Cross does not have a fee schedule for any of the services they cover. They refer you to Castlight which is a Third Party company who is supposed to have these fees however when you call them they have no knowledge of any medical procedures even when you give them the CPT and diagnosis codes. They use Google to look up the definition of the codes given he is based off the definition it falls into a category in which it could possibly be a covered benefit and there is still no amount of what your cost would be. Their estimate range is very wide and does not provide any specific fee.
This is what the representative told me they were doing. I was told by a representative that in order for me to obtain the fees it would be once the claim is submitted to the insurance company. They then speak to the provider and come to an agreement as to what the fee should be. At that point the service has already been rendered and it could be anything amount they desire since it has already been performed which is unfair to the patient / customer.
I asked if there is any other way that we can obtain this information prior to having the procedure done even though it is stressed by the provider and Blue Cross that no pre authorization or predetermination is needed for the procedure and I was told that I would need to contact the grievance department by mail since there is no direct phone number for me the customer to reach out to them to obtain any sort of fee prior to since they do not speak to customers they only speak to the providers. But yet the provider also does not know what the contracted rate is between Blue Cross Blue Shield after contacting them. I am always told by all three parties provider Blue Cross and Castlight that once the claim is submitted I will find out what my fees are.
The reason I don't want to wait until I have the service done is because I want to make sure that I am financially prepared to pay before having the procedure done instead of being stuck to pay it after the procedures already performed. Another reason I asked is because I know I have a high deductible that needs to be satisfied before they cover anything. So therefore everything would be for me out of pocket based on their contracted rate which no one can figure out. until my deductible is met and never will because I barely go to the doctors the only fortunate part of this all. If it wasn't for the tax penalty I would rather be uninsured and pay out of pocket.
My son received a radiology test with dye on his elbow. My insurance policy has no co-pay for radiology tests in office or out-patient services. Horizon claims that because the dye was injected to perform the test that is outpatient surgery with a $300 deductible. Since when is an injection considered surgery. The insurance companies are a disgrace, trying to frustrate you until you give up. I have spent countless hours dealing with a call center in the Philippines. Horizon Blue Cross is a disgrace, we need competition across state lines. Worst customer service of any company that I have ever had to deal with. Call center personnel pretend they are a supervisor with a different name, same person though. What a disgusting situation.
Blue Cross of New Jersey Company Information
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- Blue Cross of New Jersey