Blue Cross of New Jersey
ConsumerAffairs Unaccredited Brand
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."
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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.
My daughter is a ** addict and wanted treatment. After 10 days of inpatient rehab Horizon would not approve any more treatment. So my daughter asked me if she could arrange for the rehab to bill her and set up a payment plan. But they said she could not because Horizon will not allow this because she is a subscriber. I don't understand how this could be. The rehab said their legal team is working on this matter but it could take months of litigation. This is my daughter's, and Horizon will not allow me to pay. How can this be? Next I am writing to my Congressman. Hope someone can help us before it is too late.
I have been juggling between Horizon and ADB-COBRA service centers for the past 1 month plus, just to ensure that my newborn daughter is enrolled in my health benefits. All payments have been made to ADP starting the date she was born in April, but she is still not listed in my coverage. The Service centers always point finger as the other company and for every call, they initiate new ticket closing out the prior ticket incident without informing/updating. Both ADP and Horizon - reputed business missed to do their due diligence while proving these service centers they customer/client services. Audit them!! Make sure your clients are treated right. This is a total Customer ripoff where the business shows one thing, obtain price from client for it, and then give nothing. I have even started to think of suing these companies!
My son reached out to get help for his drug addiction. He went into rehab only to find out that the insurance denied coverage. His coverage was denied because they stated he had a loving and supportive family environment and his blood pressure was not elevated and no signs of withdrawals. My son is addicted to heroine. Insurance would not speak to me because he was over 18 and they explained they would email his counselor the release form. They never did after countless attempts to get them to send it. He was released and did an appeal and they denied his appeal. He relapsed once again and has gotten himself in trouble with the law also.
I would really like to know how a doctor or whomever sits behind a desk and has never meet my son or has no idea what my son's family has been thru with his addiction, make the decision that he does not need inpatient therapy and is capable of living at home doing meetings only. Do they not understand this addiction? I don't understand why I need insurance if nothing is going to be covered to protect and help my family. What a waste of my money.
When you call Horizon now for anything, you get a call center somewhere out of the US! When asked, I was told, '"we are in the Philippines"!! WHAT?? Some third world country has ALL of my information at their fingertips!! And can sell it, or do whatever they want anywhere in the world and Horizon BC/BS has no real control over what is going on. Foreign access to our personal private information in an instant should be stopped immediately and returned to US.
Have had continual problems thought resolved but not. Have outstanding bill for payment from last year as Home marketplace said not eligible for rebate - thought cleared up in May via conference call was cleared up for 2 months. BC/BS continue to charge full amount again, refuse to cover any bills for 2016 due to outstanding balance of $3,900. Recent conference call about 1 week ago with supervisor and insurance marketplace shows letter sent to BC/BS letter sent on 8/2015 was eligible for rebate! I should not owe extra as had been paying quoted rate. Insurance had been cancelled in October due to non-payment. Amazingly enough no one knows who cancelled. Received no letter. Now nothing in 2016 is being paid for.
Also note if have OMNIA ask if institution accepts Tier I. As found out hospital only accepted Tier2. Was told by BCBS considered out of network would be respond for full bill. Running a scam here BCBS pays nothing, hospital gets money. At no time was told by hospital only accepted Tier2. BEWARE. Will NEVER use BSBC again.
While my problem is not as bad as other folks it just proves that Blue Cross of New Jersey is very careless. It all started for me back in 2013 Blue Cross claims that I signed up for Obama care. While I did look at it I had opted to change my mind. According to the morons at Blue Cross that the bills should have been stopped in September of 2015. And now we are going into march still getting them. Lucky for me once I get my home sold having my mail stopped.
I have now spoken to 6 different reps, each one telling me something different re the need for prior authorization for a procedure for my son. The reps say "yes, you need prior authorization. Tell your provider to call this number..." The provider has called 3 different numbers and has been told, "no prior authorization is needed". Meanwhile, if I just went ahead, there's no assurance procedure will be covered. I'm waiting to hear back from them. Seems like a strategy on their part - give the runaround, delay service = no reimbursement necessary! They save, I pay. Stuck in limbo with no treatment and no one to talk to.
DOESN'T Even deserve a star! STAY AWAY!!! The most inept, rude and incompetent insurance company I have ever dealt with in my life and I have worked in both a doctor's office for years and now an insurance brokerage so I have dealt with a lot of companies! Horizon BCBS is a complete nightmare! They make simple things like enrolling on a plan, IMPOSSIBLE! Every "Licensed and professional agent" is so rude and incompetent. I have been disconnected and transferred innumerous times. For weeks not one person has been helpful, just to check the status of an enrollment and payment! It's the most ridiculous thing. STAY FAR AWAY!!!
I have had nothing but problems with this company. From January 1st of this year though approximately May, they told every provider we saw that we were not covered, thought we fixed this several times, took till end of June to get corrected. Now they are pretending not to see codes on bills that are covered items. Even did a conference call with one med biller who kept saying "the code is right there"! It says emergency room visit yet they keep looking for reasons to deny. Never in my adult life have I experienced this before. They search for reasons not to pay hoping the people who have their policy will just give up and pay the bills themselves while collecting our payments. This company should be investigated, something stinks very badly there.
On May 1, 2015, my husband went for a covered visit to Penta Hearing Care. Mei **, the audiologist is part of Penta Hearing Care which is covered by our husband/wife Horizon Advanced Silver plan. On the same day, when Penta's receptionist called Horizon (Debbie, receptionist's name?) regarding payment, Bryson of Horizon said that John's policy has expired. Absolutely not. His visit is covered and we started our husband/wife Horizon Advance Silver Coverage of the policy in April 2015.
It was futile to talk to them that day since we were at Penta clinic and I was talking on a cell phone AND THEY KEPT INSISTING THAT HIS POLICY EXPIRED. I was on the phone with them for 45 minutes and they kept transferring me and insisting that they were right. They even transferred me to the manager or someone higher than the representatives.
I called again. I SPOKE WITH Arin (Erin? ), reference number ** and she said that she will call Penta to tell them that it's covered. Penta's phone was busy at that time. She left me a message saying that she will call them again and let me know. In the meantime, I took the reference number of my conversation with Erin (**) and told Debbie that Erin will call. I gave her the reference number.
On May 5, 2015, Erin called me to say that she spoke with Debbie to tell her that Horizon Blue Cross Blue Shields will send them the money, which is $180.00. As far as I know, Erin is very good. Seven months have passed and Penta told us that Horizon refused to pay the $180.00 with the excuse that John's coverage expired -- which is a lie.
Today, Nov. 30, 2015, I spoke to Bruce of Horizon regarding the same matter. He said that there was no record of Penta submitting the bill. I do not know what is going on but we called Penta to ask them to kindly submit the bill again. I will update you as to what Horizon will do. In the meantime, if you have any problems with them, please email **. We could forward all our complaints to the NJ Attorney General in one package or we could get a lawyer to sue them class-action. This is the only way to make sure that no one there is cheating the consumers by erasing computer information, especially if they are people in need of medical assistance.
My doctor has prescribed me with several medication. But I find it that my insurance company keeps taking my money every paycheck and denying my medication. Why should I even bother paying for insurance if they continue to deny my prescriptions. This insurance company totally gives me the runaround and isn't worth having. Total waste of money. First they deny me testosterone and now they only want to cover 4 pills of ** for a month. It supposed to be 1 a day REALLY!!!
They seem to keep messing my acct up or information up. I want to pay my bills - the very same bills that they send me in the mail. I want to send a payment over the phone. First it's impossible to get a live person, then when I call the number that they provide which is 1-888-778-2005 to pay my bill, it does not recognize my acct or gives me the acct of my dental plan which I want to pay my health part of the bill. Then when I pick (0) hoping that the phone system will direct me to a live person so I can pay my bills, it still did not work. I tried this 5 to 6 times so I gave up. In addition, when I went to the doctor the office said that I was not covered. I called the Horizon and luckily got someone to ask why they said that I am covered from their end. I am so confused. I have never experience anything like this which I feel like I am in a twilight zone when I try to call them. Pls. help if anyone have any answers to my problems.
I've had problems with my insurance ever since I got it and I could never understand why. I always just paid out of pocket because I didn't want any problems with my doctor's offices. My policy is under my stepfather so him, my mom and my brothers all have a different last name than me. Well they decided to, despite my enrollment paperwork saying my correct legal last name, they put my information in wrong so technically I have no insurance because the person my stepfather is covering doesn't exist!
And then when I call them they get nasty on the phone with me and tell me there is nothing I can do to change it but have the policyholder call and request paperwork and then they'll mail it to him then we have to fill it out then have it mailed back. I have to get physical therapy and I can't do that if I don't have insurance because I'm done paying out of pocket. WORST INSURANCE COMPANY EVER. The people at human resources are nasty and don't care about anything. I should sue them for all the money I've had to pay out because of them.
Found out my docs were 'out-of-network' after 6 months of visits & now on the hook for 2K. Cancelled policy and then CHARGED the next month!! Still not sorted out. Arrogant & incompetent. Bad experience from the start.
I had a small group policy with Horizon BCBS of New Jersey. My premium was about $1226/month for an HSA with a 5k deductible. I faxed a cancellation letter in February 2015 to Horizon requesting the policy cancel effective 1-31-15. I was trying to get coverage thru ObamaCare and submitted an application in January 2015. I was approved and qualified for a subsidy which made my premium about $250/month but the start date was 3-1-15. So no one in my family went to any health care providers in February 2015 and no claims were submitted.
Now Horizon has has sent my case to a collection agency looking for the February premium of approximately $1226. My current policy is with Health Republic and their cancellation policy states coverage ends as of the paid up premium date. I had to make a decision to not get health coverage for 1 month to make sure I paid my employees. Aren't all insurance policies cancelled as of the paid up premium date?
I signed up for insurance in January 2015. I went to see my PCP for a routine checkup that same month. Horizon claimed I had no insurance with them and refunded my premium payment. After many complaints and fighting, they still have not resolved this and are taking $800 from me for no reason at all. I am at a loss. I don't know what to do!!! This is the worst insurance company I've ever dealt with!!!
After going through all of the documentation, pre-certs, etc. to get authorization to provide services for an autistic/special needs child - ALL CLAIMS DENIED for over 3 MONTHS and still NO PAYMENT to-date. All codes and units were authorized and documented by Horizon BCBSNJ. Now the parent is at a loss because all of the charges are their responsibility even though coverage was verified multiple times. I have more than 5 documented calls on just this one patient alone. HORIZON BCBSNJ needs to quit posting what they are doing and FIX what actually matters! Authorizing, confirming, and sending documentation of coverage for autistic children and then no payment for three months. HELP ME UNDERSTAND HOW THIS IS OK?? THESE CHILDREN MATTER TOO HORIZON!!!
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