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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.
Blue Cross of New Jersey Company Information
- Company Name:
- Blue Cross of New Jersey