Horizon Blue Cross Blue Shield of New Jersey
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Horizon Blue Cross Blue Shield of New Jersey Reviews
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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!!!
Had a legitimate Sleep Study done, they, HBCBS of NJ, denied the claim. Said it wasn't medically necessary. All the doctors had told me that this procedure has always been covered by insurance. The doctors said "We have never seen anything like this before". I have been battling the insurance co. for nearly a year and a half. I have been hounded by collection agencies for the last year, and my credit is now bad. Thanks HBCBS of NJ.
Signed up for a policy and without contacting me or broker, they ignored my choice and signed me up for a more expensive policy. No one takes responsibility, no one calls back and no one at this company follows up. Can't even register online as the website is not working. Want to pay my bill and Philippines call center cannot process payment as they are having computer issues. Avoid this company.
Avoid like the plague. They have all their rules and regulation written to perfection in their favor for all claims. They'll take you to the cleaners and back again. Would probably be cheaper to pay out of pocket. Terrible customer service that is uninformed and mostly useless, often taking 1/2 an hour or more to look up basic information.
BCBSNJ has refused to pay claims and keeps me on the probation list as new subscribers and would only pay half of the claim. They constantly refuse to pay for full prescriptions and piece out my medicines. Then when I call them today because I have new insurance, they tell me I was cancelled in October!!! Yet they never sent a letter and they took the payments each month AND authorized procedures. They also said it was cancelled because I did not pick a primary care which I did the first month I had the coverage. Can we start a class action law suit???
I have a complaint going in US District Court - Idaho (Case **) about the Blue Cross use of "outpatient" categorization of medical care, so they can put a greater portion of the "plan allowance" amount onto the patient in the form of increased co-payment. I would be interested in hearing from anyone who has been victimized by BCBS in said manner. Thank you.
Wife's medical insurer, Horizon BC/BS via ACA, advised no pre-approval required for implantation of neurological stimulator to relieve chronic migraine pain, as the procedure required only "same-day" surgery. Procedure performed at Beth Israel Hospital, Newark, N.J. intended to remove previous implantation incorrectly performed (several times) at North Shore LIJ Hospital. Implantation failed in several aspects: device provided no relief at proscribed site, battery/controller subcutaneous implant site continues to be red, sore and inflamed and provides continuous discomfort. Implant does not work, and causes pain itself. Horizon BC/BS now refuses to cover removal of device stating it is an "experimental" procedure. No such determination was made upon initial surgery. Wife is now being forced to retain a damaging, painful device that offers her no benefit. Numerous calls have resulted in no action being taken by Horizon BC/BS.
They are supposed to cover all ER with A HUNDRED $ CO-PAY. THAT HAS ENDED. THEY ARE SAYING UNLESS YOU'RE ADMITTED OVERNIGHT you are responsible for over half the bill because now they are saying you only get $500 for an entire year - they will cover towards diagnostics like blood work and x-rays. So now they are calling ER outpatient. They are out of control. I can't write all I've uncovered but please contact me.
On numerous occasions I have taken my prescription into multiple pharmacies a few days early due to a busy schedule that week, but Horizon BCBS of NJ will not allow my refill early. It's absurd that they aren't willing to be flexible in the least with a longstanding customer like myself. On other occasions, they have demanded a "Prior Authorization" for my medication before covering the fees, in addition to not reimbursing me for paying full price before the authorization takes place. They should treat high-paying customers like myself (and all of their customers for that matter) with gratitude, and flexibility as opposed to treating them like books on a shelf.
I have been using the same Chiropractor for 15 years. My Doctor has had issues with HBCBS and has stopped using them for the last 2 years. I have been paying out-of-pocket and submitting the bills for reimbursement. Once I meet my deductible ($100.00 individual) they are suppose to reimburse at 70%. All was well until around May/June of 2014. All of a sudden, they are not reimbursing me. They are sending the check to the doctor and listing the doctor as accepting a "Multi-Plan Discount Rate". Multi-Plan is another company that my Doctor deals with; however, he still doesn't deal with Blue Cross. Blue Cross claims to have joined on with "Multi-Plan" and insists that they pay based on the rate set by Multi-Plan. Every single visit has the same service/codes on them, and every visit pays out at a different dollar amount.
I had gotten the doctor's office and HSBCBS of NJ on a 3-way call and Blue Cross could not provide a contact number/address/email/name of/for Multi-Plan for us to confirm that they are now participating members with Multi-Plan. Up to today, Horizon Blue Cross Blue Shield of New Jersey lists my Chiropractor as "Out-Of-Network" and refuses to pay out-of-network rates. Every time I call BCBSNJ, I get a different person, different story, different explanation. I only today found out that they had settled a Class Action Suit for not paying out-of-network benefits as required. I still have to fight Horizon Blue Cross Blue Shield of New Jersey to get reimbursed for my bills. I am ready and willing to join anyone who is looking to file a new suit against Horizon....
There is endless claims that have to be completed before they pay. They lose claims. They tell you forms were not completed correctly, but takes a month to let you know this and they tell you in a letter. You have to resubmit a brand new claim. They come up with a new problem, but again don't tell you until a month later through. If I get my coverage, it is after months and months of paperwork and an endless battle. Their strategy is to wear you down so they never have to pay out. The WORST health care coverage we have ever had and there are some bad ones out there. I feel bad for the customer service reps. They are polite and try to do their best, but are unable to help you in any way because the system is set up to stall on payments. You do better to not have insurance than have this one.
We followed their guidelines and my husband met their comorbid conditions for Sleep Lab test for Apnea. Now Blue Cross PPO of New Jersey refuses to pay, leaving a Disabled War Veteran with the bill for almost $3,000.00. We have appealed. We have sent pages and pages of records showing the exact comorbid conditions that Blue Cross' own policies require. We meet everything and they still refuse to pay. Now Blue Cross is saying they will randomly call and will "try 3 times" to reach "The Doctor" (they refuse to tell us which doctor they are calling or when) and "If we can't reach the Doctor after 3 tries, the decision stands". So get this, they can call God knows which Doctor (my husband has seen over 20 Specialists) and they can call at 3AM or Midnight and no one is there, then say they could not get a hold of anyone. This is CRIMINAL!!!!! I do not understand why there is not a Class Action Lawsuit Against Blue Cross.
Dealing with Horizon BCBS of NJ is a nightmare at best. Members are treated as disposable commodities. I just spent 45 minutes trying to change my primary care physician and it was like stabbing my eyes with knives it was so painful! I wasn't even trying to get Horizon to pay out on a claim. All I wanted to do was change my doctor. That's it. Simple. Easy. Nothing difficult. 45 minutes and 4 calls later (each time I was connected with someone), I lost it. I was done! I asked to speak with customer service and the associate on the line told me there wasn't a department for that. Figures. What do they care! I asked to speak with a supervisor and it was a joke. She came on the line and it was a total waste of my time. I had to repeatedly ask her if she would like to be treated as a customer the way I was (hung up on, transferred to an automated survey, told I should do it online, etc. all to no avail, I still couldn't get what I wanted done, to change my primary care physician). I had to survey her, asking her along the way each time if what I experienced was acceptable. Look, I get it. It's a big business and as customer, I'm a commodity. My employer has selected Horizon based on a cost effective analysis. With that said, it really does stink to be treated as if they honestly do not care, which they clearly don't.
It has been brought to my attention that they are illegally denying my claim and using a doctor that is unlicensed as a peer reviewer named Dr. Waqas **whose license was arrested on July 3, 2013 and charged in federal court for fraudulent prescriptions. He is a Peoria doctor facing 32 years in federal prison for illegally obtaining hydrocodone prescription over a 2 year period. He was also arrested on who was arrested for to have read my 1,200 pages of medical records and clearly did not because his rationale contained discrepancies such as it stated that chronic Lyme disease patients have elevated protein levels which has been noted on the blood work. I have attached copies of his arrest records.
When they discovered I found out they utilized this unlicensed doctor who was using drugs when he had a peer conference with my Attending Physician and attended my appeal panel meeting in Newark, NJ via teleconference when he had already lost his license. They then switched up the name of the Dr. to Craig ** from Alabama who I spoke on speaker phone with witnesses present who stated he never spoke to my doctor and knew nothing about my case. Both reports were identical and they even stated he spoke to my Dr. on the phone which my dr. stated never happened. Dr. ** also denied participating in the in person panel that Horizon fraudulently stated he did. In addition, HIPPA laws were violated and they have inadvertently sent me appeals of other patients with all of their personal medical information enclosed. I had a positive western blot lyme test and has been prescribed medication since September by three different doctors that they refuse to pay for. I am awaiting a panel with the Division of Pension and Benefits who provides the insurance.
I had possessed a Horizon BCBS of NJ Traditional B Plan for over 20 years due to severe vaccine related injuries & damages. When I was lying in the Hospital of the University of Pennsylvania with systemic vasculitis of the colon, where my colon had perforated, Horizon reps contacted my elderly, severely infirm & mentally compromised mother (dementia from multiple strokes) to fill out forms to actually downgrade my insurance status from a Traditional B Plan to a Traditional D Plan, thereby causing the annual premium to rise to $28,500 and the quarterly deductible to rise to $1,500 from $500.
As a consequence, all of my medical treatments were terminated. When I was briefly enrolled in a nonviable Horizon HMO plan, I utilized the ER at HUP and was admitted for 4 days as an inpatient for treatment of my colon to prevent another perforation. I have a severe & rare form of SLE. For two weeks after I was released, the Horizon reps kept telephoning my brother's residence in Moorestown, NJ. When they could not speak with me by phone (due to the very fact I do not reside in NJ on a full-time basis), the Horizon sent one of their representatives to my brother's home in an attempt to intimidate and coerce me into not going to the ER for emergency intervention, nor should I receive inpatient life-saving inpatient hospitalization. As a consequence of the actions of Horizon downgrading my health insurance status, I am now uninsurable. My family now pays out-of-pocket for all of my care. I now have a $50 thousand-plus bill to pay - and that's just one of many bills. The Horizon BCBS of NJ actually had my father paying for two separate plans - one plan covering 4 persons (only 3 persons used this plan) & the single plan for me.
I had HBCBS of NJ in 2013 with a $500 maximum diagnostic test allowance for the year! I went for a test in January 2013 at a hospital. Horizon paid the bill for a
test, and exam. Now, in February, 2014, they recalled the payment that they made to the hospital, 13 months after the visit. I had send an appeal to Horizon on Feb. 5, 2014 regarding another matter. All of a sudden, the hospital billed me for the January visit in the amount of $650. This is definitely a vendetta by Horizon against me for appealing another claim. Can they do this, over a year later. The hospital advised me that I am responsible for the bill. I would NEVER buy Horizon insurance. They are unreliable. I had authorization to get this test on the day of the test.
Signed up for automatic billing via credit card in December. Got past due notice in February, called and was told BCBS is behind in setting up autopay till probably June, can continue paying with card until then. Tried to pay March premium today, was told no credit card payments allowed. How an annual plan can be changed without written notice (at least or) at all in midstream? Bait and switch?
Don't depend on printed 2013 BC provider directory. 9/1/213 Sunday - Doctor's office denied BC insurance coverage for urgent treatment on a painful blister/boil rising on my neck. I checked directory before going to Dr. **, M.D (pg. 147) MT/Lakes Medical Center, NJ to confirm that he is participant in Blue Cross HMO plan. His office attendant refused to accept to Medicare Advantage Blue Value (HMO) insurance. I'll take a sharp instrument and pierce the blister to reduce swelling for pain relief.
I am my sister's advocate Michele **. To the day of 3/17/2011, my sister suffered a stroke at the age of 50. With the grace of God, she beat the odds of what was told to me by the first doctors. Monique would be a vegetable, she is not. HBCBS did not give Monique a chance to rehabilitate. When she entered into a rehab facility, the first week she was sick. The second week, feeding tube came out, surgery to replace. I appealed for more rehab to no avail, sent to nursing facility with all intentions to have her cared for at home. Upon entering the nursing facility, there were staff who fought for her to receive speech therapy, made gains and began to speak. She also had swallow test to which she was getting ready to start on puree and thicken liquids (but not thick like bananas). The time allotted for the feeding was ended because within this time, she had been admitted and discharged to the area hospital too many times to count.
I asked the social worker to expedite getting Monique home. Her spirits were low when visiting and she asked when am I going home, calling HBCBS twice asking about her home nursing care benefits. I was told whatever is medically necessary, Monique is a high risk patient. At this point, feeding tube, diabetic with a wound (on behind), continuous spike potassium but denied no nursing care. As I type in, 15 hours we are waiting for the authorization release of medical equipment, working with the social worker (who received the scripts from the doctor, passed them to the medical supplier who faxed them days ago with conformation receipt and was speaking to HBCBS case management). When I called the case management, the worker told me there was no fax nor a call from the provider, but she told me who was the medical supplier. How? If there was no fax or call from medical supplier? Also, the reference number for the calls were the same as when I called and when the provider called. Monique has earned and paid into her insurance for benefits and is entitled to them. Monique has been victimized twice!
I had health insurance with Horizon Blue Cross Blue Shield of New Jersey (Horizon). In network outpatient lab work was provided by Laboratory Corporation of America Holdings (Labcorp). Due to the limitations of the policy, there was a limit of $500.00 per year for this benefit. During October 2010, I visited my primary doctor. Blood was drawn and sent to Labcorp. Horizon was billed for four (4) tests - two (2) were paid in full, one was paid partially and the last was not paid. The explanation of benefits sent to me did not show the remaining balance for outpatient testing. For the partially paid test, Horizon was billed at $104.00, allowed amount $20.21, and paid $1.85. The last test was billed at $66.00, allowed amount $11.68, not paid.
When this first started, I offered to pay the unpaid contract amounts of $30.04. It was not accepted. I see no reason why I should pay more than five times the contract amount for a test. Also, I have not worked since January 2008 and can't afford to pay $66.00. If you have Horizon for health insurance or any other health insurance that uses Labcorp as the exclusive outpatient testing service, then you should look for new insurance. Or, if employer provided, ask for new insurance. If enough of us stop using Labcorp and the insurance companies that cater to this company, we could put them out of business. Provide feedback to government agencies: Federal Trade Commission, FBI, US Postal Inspection Service, etc. For other states, find the state website or check the phone book for government listings. If you have already posted here, contact the agencies listed above.
Horizon Blue Cross had "loaded" my benefits information wrong into their computer system and gave out the wrong benefit information to my acupuncturist (in the chiropractor’s office). Now I owe my chiropractor nearly $2,600 for acupuncture services. They told me on the phone they were responsible. After numerous calls and complaints, they rejected paying for their mistakes.
Dr. Rogena Cain, NP ENT ordered RAST test, which BCBSNJ says was medically unnecessary, so I am responsible to pay the $663 bill to Twin Lakes Regional Medical Center for the test.
I was admitted on August 13, 2010 at Brook Haven Hospital in Long Island and was discharged on August 14, 2010. It was an emergency. I had severe pain at my brother's funeral. I was rushed to the emergency room and stayed overnight. BCBS refused to pay my medical expenses. I have been with BCBS since 1972. I avoid any unnecessary medical expenses as my record can show that I am in good health. There seems to be a pattern with BCBS not paying insured expenses. Since I am a nurse, I know how to take care of myself not to incur overhead expenses. My subscriber ID is **. Please look into this matter.
My health insurance company has been playing games, giving me the run around for the last four months and now I have bills piling up to almost $1,000 and can't get the medications prescribed to me. I don't know what to do.
My employer rolled our insurance over from Aetna to Horizon Blue Cross back in August. We were told by a representative that our deductible for Aetna would pertain to Horizon. We were told that everything is "being taken care of" and that we wouldn't have issues. In September, when I went to the doctors, I was billed and told I didn't meet my deductible. I talked to other NAFA employees and they were being told the same thing.
My boss, Phil **, wrote this to me regarding the situation: By law, your deductible amount must carry over from one carrier to the next. You may have to get your last Explanation of Benefits (EOB) statement from Aetna, which shows your total deductible amount met to that point, and send a copy to Horizon. Jayne just went through this as well, so you can ask her for how to details.
I called Aetna and Horizon on November 3. I told Aetna the deductible didn't roll over to Horizon and they said they would send me a letter stating I met my deductible as of August 2010. I spoke with Horizon and told them my employer switched from Aetna to Horizon but my deductible was not carried as it should be. I told them Aetna was sending proof that I met my deductible. The reference # for this conversation/claim with Horizon is: **. Aetna sent the letter to me on November 11 and I mailed it out the same day to Horizon. I contacted Horizon as soon as I mailed this letter to let them know that they weren't covering me and let them know that someone messed up when rolling over the deductible.
They receive the letter till November 16. I called and was told it would take 20-30 business days to process this letter and "key it into the system". That in 20-30 business days it would show "in the system" that I met my deductible and all doctors visits and medications would be covered. I called Horizon on November 18 as well as wrote the help desk a letter stating the situation. I called several more times since mailing the letter and talked to a manager named Stephanie (on November 22) who put an emergency rush to key it into the system. I was told keying it into the system was done by another department, who cannot be contacted by phone - only email.
I called again on December 6 (reference number **) and spoke to Stephanie, as well as another manager, and was told that another emergency request would be put in. During this phone conversation the manager told me that it would take only 9 more days till the "deadline" was up and in 9 days I could walk into my pharmacy, pick up my medications, and be covered. That in 9 days my bills (doctor's claims from August till now) would be paid. I called again today and spoke to Megan McCormick, an escalator specialist. She told me that in 24-48 business hours the letter (which is called a conversion claim) would be entered into the system. But, once it's keyed into the system it could take up to 14 days for it to show - meaning it could take another 14 days till I could be covered for medications....another 14 days till the doctors claims are paid.
My health insurance with this group runs out on January 1. The deductible starts over again on January 1. Which means if something isn't done then ASAP medications sitting at the pharmacy won't be covered at all - by the time Horizon shows I'm covered in the system my deductible would have started all over again. I am more than fed up with the insurance company and they're going to get away with not covering needed prescriptions. Right now I have doctor's bills and claims totaling over $800 and pharmacy medications totaling over $300. I can't pick up medications and my doctors are threatening to go to a collection agency.
It really is a matter of someone just typing information into a computer and I'm getting the run around. Having it take over 4 months to roll over my deductible and waiting till the last minute when my insurance runs out can't be legal.
We have had several problems getting BCBS to pay our claims in a timely manner. CSRs all tell you different things and supervisors aren't much better. We were always promised a call back and only received one out of about 20 promises. I am still waiting for a claim from 2007 to be paid and supervisors admit there is no reason it should be held up but no one can seem to actually process it. Now they are repeatedly denying charges that are covered. You basically just have to appeal everything to get a full payment. It is just plain frustrating and I am about to involve a lawyer. Stay away from this group if possible!
I called regarding no payment of an anesthesia submission that was made as part of a colonoscopy which Horizon pre-approved. Their reason for non-payment was based upon the fact that my $1,000 deductible wasn't met until the day of the procedure. By background, I changed carriers in Sept./Oct. of 08 and in fact had no deductible payments before that day. However, the entire procedure which they pre-approved cost $3,875 - so my $1,000 deductible was met that day. Horizon said that their rules state that the deductible needs to be met before the bill is submitted or they refuse payment. Why does it matter when I meet the deductible - I can't understand at all how they can separate work pre-approved??? Kinda chicken or the egg scenario but a lot more money. Another clear example in my mind of the major problems that exist in our healthcare system - it is a disgrace that companies aren't held responsible. We need massive changes in the system.
I have medical insuranace through my employer. On December 9th I had a vist to the hospital for a heart attack.
In April of 2007 I went in for a five bypass surgey.
All of the service providers have submitted my bills to my insurance and they were denied due to the number not being known as an active number and the number is correct.It is now December 2007 and some of the bills have still not been paid and some have been sent for collection.
The collection notices are now on my perrsonal credit and this is totally unfair.
The doctors want me not to have any stress and this situaion is very stressfull and has gone on far too long.
Horizon Blue Cross Blue Shield of New Jersey Company Information
- Company Name:
- Horizon Blue Cross Blue Shield of New Jersey
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