About Empire Blue Cross Blue Shield of New York
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Like most health insurance plans they require you to see in-network providers but, they will make it impossible to reliably find and see covered providers. 1. The "Find Care" tool provided to identify in-network providers is full of incorrect information. It will tell you a provider is in-network but, then the claim will be denied and you will be liable for 100% of the cost. You have no recourse unless you call the morning of your appointment and record the agent on the phone telling you the provider is in-network.
2. Providers will leave and enter the network arbitrarily. So if you choose a specialist that's in-network then in the two weeks you wait for your appointment they can leave the network. Or, you will get tests done and go back the next week for treatment and the treatment claim will be denied because the provider dropped out of network.
Then many claims will be denied "just because" and you will have to go through a very lengthy and time consuming process to appeal the claim, then file a grievance on the claim, then file for a review with your state's regulatory agency to finally get the claim covered according to plan documents. I have wasted untold hours of my life and paid thousands of dollars in uncovered claims all while doing exactly what the plan says you should to avoid any problems. I personally think it is intentional and I feel scammed out of my health insurance premiums.
As of August 3rd, 2022 (08/03/2022) Blue Cross and Blue Shield Association of New York's dental care provider list (on their website and Sydney app, and anywhere accessible to its members) is being falsely enhanced to populate a bigger in-network list than is actually provided by your current membership (specifically the ones for your PAID member ID when typed into their search). They’re doing this with the knowledge of it happening and aren’t doing anything to stop it.
This means if you are signing up for dental insurance you will get a FALSE LIST of actual providers for your initial search, and once your insurance starts, you will not have the accurate dental information and have to re assign your primary care dentist to one that isn’t on any list accessible to its members. I've spoken with multiple supervisors that have agreed that this is not right to false advertise a wider in-network provider list than is actually supplied by your specific membership - and it seems this isn't the first time or last, and it will not be fixed considering no one gave me any answers and I have now chosen to cancel my coverage with them. Beside the fact that this all started when their associate told me 30 days ago they would change my primary dentist and, "forgot to submit the paperwork."
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I change my PCP by calling EMPIRE BSBC customer service and they confirmed the change. Later, after 5-6 doctor office visits I noticed that BSBC denied my visit to a specialist "Because my PCP on file didn't render that service". I called them and explain that I have the referral and that I changed my PCP and that I did everything by the book... Customer service people are useless... They can tell you only "what says in the file"... I tried to explain the whole process again and again... like you are talking with a wall... I will change my Medical Insurance and never again BSBC...
First time with Empire Blue and every time I have to do anything with them it's SO PAINFUL. I cannot wait until the year is up and I can try a different Health Insurance Company. Crazy for $650/month. Looking for a PCP within their website is so confusing, the algorithm kept trying to make me see Doctors far away and when I google the offices they are Gas Station parking lots!! Don't trust anything about that. Several doctors refused to see me because there's a code from Empire Blue that makes it look like I am on Medicare, but I'm not. Am paying out of pocket full price. So many days of my life calling and calling the doctors on the list, and they are all really weird rundown offices. Something seems so wrong
Several phone people I spoke to gave inaccurate information, for example saying I had to pay for included Preventative Services, or that I needed a referral for Preventative Services. I read the small print of the contract and this is not correct. But wow if English was not your first language, it would be so confusing. Also wary because if they give inaccurate info about the basics, then what else are they going to get wrong. Website is very confusing, you can't even download a billing statement. But there's a help bot asking you questions every few minutes. Everything is more painful than it needs to be, I'm not sick, I dread to think what they would be like to deal with then, I cannot wait to change. Stay away folks.
I am an Out of Network Provider in NJ and sent claims for patient with policy in NY (Empire BCBS of NY). When I called to verify coverage, they said the plan has out of network coverage for the services I render. After sending the claims, I received letters from Empire BCBS stating that the claim cannot be processed due to missing provider info, which is not true since I sent the claim form with the information. The service representative I've talked to said I need to call the local BCBS plan, but they don't have the contact info. I searched on the web, but Empire does not have NJ plan, so there is nobody to contact.
When I asked if the plan covers services rendered in NJ out of state provider, they confirmed it does. I spent over 1.5 hours on the phone to figure this out but they still don't give me any resolution. They do not have any phone number, nor FAX number nor any specific information pertaining to it. I still don't know if the service is even covered. I will not recommend any out of network provider in NJ to accept the plan.
This company *knows* the Biden administration mandated the full reimbursement of expenses regarding Covid testing, including RT-PCR tests. Yet, they keep pulling old tactics to get away with their shameless scam: pay in only in part, and ignore the customer in hopes that we will eventually give up and stop complaining. I am insured with Empire BlueCross BlueShield through my employer, not directly. However, I just contacted HR and let them know of this irregular activity. I will also seek alternatives in the near future, as I expect my insurance company to be minimally honest, among other things. Stay away from this company.
They keep processing claim from an in network doctor as out of network. They did it in 2021 first time. They are still trying to fix it and reprocessed the claim 5 times. No one has got any money yet. For the same doctor they made the same mistake in 2022. Processed his claim as out of network again. There is a huge disconnect between departments and BCBC in different states. Every time I call I get conflicting information. Same is true for emails. I think they do it deliberately to rip innocent subscribers off their hard earned money. Pathetic company. Wonder how they became so big. Bribed their way up.
Don't use Empire Blue Cross...They didn't come to my aid at a time when I desperately needed it. After corrective jaw (orthognathic) surgery to address facial deformity, I was left with some severe sequelae: difficulty eating/chewing, swallowing, breathing, sleeping, and severe asymmetry of the back of the jaw (on one side, the ramus of the jaw was terribly flared out). My occlusal plane angle was severely out of the range of normal, causing my biting difficulty. My airway was still severely narrow and obstructed, leading to sleep apnea and breathing problems. Both of my jaws were still retruded (too far back) and vertically underdeveloped. I also had a prognathic chin.
I chose a world-renowned surgeon for revisionary corrective jaw surgery, and he wrote a clear letter to Empire Blue Cross explaining why this procedure was medically necessary. However, Empire Blue Cross refused to cover the hospital fees, and I had to pay Baylor Medical Center $30,000. After having had this surgery, my condition is now significantly improved. Not to mention...after appealing the initial denial, the subsequent denial letter left blank the entire area where the explanation for the denial was supposed to be shown. After I contacted Empire Blue Cross (over several attempts) to try to get this resolved so I could access the explanation for the denial, it took an unreasonably long time for a revised letter to be sent to me. I was in bad shape and needed the surgery. My family had to assist me and I took out loans.
Accepted in most places, and coverage is very good, also their customer service is very friendly, I have them for a while now and have absolutely nothing to complain about it and other people I know are very satisfied as well.
My partner signed up for this insurance during open enrollment last year because it looked like it had sufficient scope in terms of coverage and doctors. Unfortunately he was then diagnosed with cancer. Then, thankfully we thought, the insurance had an oncologist nearby. After a few sessions, we started to get large bills and the doctor's office stated that the insurance was claiming they were out of network. As it turns out, many of the listed doctors on their site, and the ones their agents tell you are in network, are actually out of network. Now we are without an oncologist. With a deadly disease. They cannot seem to be able to join a call to resolve the issue, and now after reading the other comments here, it appears that this is some sort of very large and deadly scam. We pay over $1,300 a month for this. And there is no doctor that he can use that is in network.
How do we create a claim to have this insurance reviewed and either cleaned up or shut down? Who should we contact? At this point we are going to have to figure out how to pay hundreds of thousands of dollars out of pocket, just to stay alive. What other insurance will take us now? With a preexisting condition? No one please ever use this insurance. Save your money, your time and your life. Because they will take it all otherwise.
Empire Blue Cross Blue Shield of New York Company Information
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- Empire Blue Cross Blue Shield of New York
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