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My hip replacement surgery was denied as not medically necessary, and my surgery was cancelled, last minute. I have severe arthritis. My doctor was baffled and appealed, and the appeal was denied. I also sent an expedited appeal, and did not receive a response. My family has had the same Empire Blue Cross Blue Shield policy since 1992 through my husband’s union, Metal Trades Local 638. I believe BCBS has not followed their contract.
My mother, who is a cancer patient, has this horrible insurance. She pays sky high premiums every month, while they approve the services the doctor bills to them and then don't pay, pay different amounts of money for the same approved service (ex.: $400 one month, $1000 another month, $0 another month). They have no explanation for doing this. They also sent a letter that states all these services have been approved. It has now been over a year of phone calls and emails back and forth. They have pre-approved multiple services, just to claim later that the approval was never given. Now they are telling me the approval numbers they have sent to me are not in their records. This company is basically extorting money from clients with their premiums, and then refusing to pay for services they are supposed to cover.
Blue Cross of New York is not a good health insurance. It do not cover much and the cost to families and when you call to get help with anything not very helpful. I wish my company would find another Health Insurance because this keeps going up and less services and poor customer service.
I’ve had multiple communications with Empire Blue Cross Blue Shield over the course of a year, mainly to correct my address. The first thing that they always ask for is a callback number in case I get disconnected. I have been disconnected many times, was told to wait for a callback while they look into the issues that I called about, and I have yet to receive a single callback from them. I have spent over a year now trying to correct my mailing address, as Empire’s system keeps changing my mailing address and all of my EOB’s end up getting lost in the mail.
Upon calling Empire, they told me so many different reasons for the address error which ranged from my employer having to change the address on their end; to Empire having limited characters space on their internal system, which ends up cutting off the complete address; to the fact that their internal system has glitches, which ends up switching the address in their system, and this is an issue that their supervisors are aware and are “working on.”
My employer has communicated with Empire about five times now and has sent multiple requests to Empire to have the address corrected. When I call Empire’s customer service, some days they tell me that my address has been corrected on their end, other days they say that it remains unchanged. I’ve asked for them to add notes to my account noting the address correction, which they claim to do, until I callback next time, time after time again only to find out that the address was never corrected.
My employer has informed me that when I call Empire, Empire needs to check their internal system called Teleview, which shows the correct address information that my employer supplied to Empire, which is what Empire uses to update their other system that is used to mail out EOB’s. After asking the representative if she looked at Teleview, her response was “Oh, no.” I asked her if the information in Teleview contained the correct address and she said that it did. She informed me that the problem was on their end, that the amount of characters that their system allowed was limited, hence the reason for my address being cut off and incorrect.
She assured me that she will go ahead and talk to her supervisor about updating my mailing address correctly, and will submit the relevant information to their NY & NJ teams in order for the change to go into effect. I insisted that I wanted to remain on the phone while this was done. It took her over an hour to complete all the necessary steps. Once she was done, she assured me that the address was finally corrected and that she added a note to my account stating that this was done. I finally received an EOB mailed to the correct address in August. However, I called this week to check on a different claim that has now been pending with Empire for over a year (due to incorrect codes/missing information, but mainly due to the fact that I had to have the rejected EOB’s re-printed and re-sent to me multiple times) and once again was told that the claim was sent to a different address.
Today, after so much frustration, Empire informed me that they have reached out to my employer and corrected my address on their end. I called back five minutes later to check and make sure that this was in fact true, and was told by another rep that it’s impossible for their employee to reach out to my employer and have the address corrected.
I’ve spoken to over two dozen people at Empire, and a year later, my address remains incorrect on their system. The level of incompetence that this company possesses is very frustrating, and their procedures are unethical. Every time I call, they tell me a different story. I’ve asked multiple times to speak to a supervisor about this issue, they simply put me on hold for over half an hour, and later tell me that no supervisor is available. They have never called me back to follow up like they said they would, yet when I ask them for a callback number so that I may call them in order to follow-up on prior issues, they simply say to call the general number. A year later, and they have offered no assistance in resolving this issue.
High co-pay for x-rays. Doesn't always cover the entire cost of a procedure. Has very old listings of dentists on their dental plan; these dentists have long ago left Empire. Most egregious, doesn't cover medical massage for 65+ insureds. Very discriminatory!!! Medical massage can be a very effective part of PT. Why are we less important than those under 65 who ARE entitled to medical massage.
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In the current era of healthcare, we are all used to some glitches. Two years ago I had insurance with a company that went out of business during the year. That was bad. Last year I had insurance with a company that wouldn't cover everything I wanted them to. Didn't love that either. But Empire Blue Cross is without a doubt THE WORST insurance I have ever had or in fact, can imagine. In addition to the fact that it covers incrementally less than other companies I have dealt with, there is in effect NO CUSTOMER SERVICE.
If you call the customer service number you will, guaranteed, be on hold for at least an hour and a half. I have twice had to give up at the two hour mark, so I can't say how long it can go. And the two times I tried contacting them through their online customer service it took a MONTH (and in one case, more) for them to get back to me. Stop and ask yourself how this would have worked if the issue I needed to reach them about was not something administrative but medical. Their social media pages are thronged with deeply unhappy customers. I cannot strongly enough recommend this -- DON'T GET BLUE CROSS BLUE SHIELD.
They refuse to help me change back to my previous plan. I have submitted an appeal letter and copies of my pay stub. I use to come home with 600.00 every two weeks. Now with the new plan that was picked by mistake I come home with 300.00. How am I suppose to live off 300 every two weeks. Even the benefits department at my job is refusing to help. Lost my appetite and losing sleep over this. I'm not asking to cancel my plan. Just change it back to what it was.
This is the worst health insurance. Everytime I call, the wait is usually 1 to 2 hours - yes, 1 to 2 hours. Why don't they hire more people to work and answer the phones. I mean, they charge $$$ for coverage that really doesn't even pay for your dr. visits. Also, if they know they are going to be extra busy in January - then prepare and hire more people to work the phones. We need socialized medicine in this country big time. Putting healthcare into the hands of corporations is just wrong. Healthcare is a basic right for all Americans - not just the rich.
Am unable to reach any of numbers listed on card. When finally able to get rep they passed me from dept to dept and disconnected. Now for 5 days I am trying to cancel. I had to stop payment as I prepaid 2 months. I had to pay bank to stop payment as no one could help with this either. Now I have no med ins as I need proof of cancellation.
Couldn't sign on. Called tech support. Waited on hold an hour and 15 minutes. Couldn't find me in the system. Called Membership Department. Waited on hold for 2 hours. The rep couldn't find my records. Said she was going to put me on hold. Sent me back to the main menu. After 15 minutes was cut off. Was just trying to get my customer i.d. number.
I don't know how this company stays in business - 2 hour long phone wait times, premiums that are supposed to autopay that don't - and you are left without coverage even after spending a total of 14 hours on hold and talking to 4 different sales people on 4 different days to make sure the premium would be taken out of my bank - all to no avail. I don't understand why the government doesn't step in and control the health insurance companies - it's not socialist, it's a basic human need. Or at least have a government agency watchdog these morons. Sick people need better help. I mean, the outrageous cost of health insurance, why don't they hire more people to answer phones???
I would like to make a complaint about the rudeness of the supervisor of customer service representative name Mathew ** and his unreachable supervisor Britney. And Mr. Mathew states she does not speak with people, and he was unwilling to help me and my questions in any form. My mother is fighting pancreatic cancer and she is weak, tired, and near end of life. All was needed was 2 questions answered so she can receive her chemotherapy medication. The lack of empathy and rudeness that was given to me and my mother is unacceptable.
Customer service is to my knowledge is to help the customer. I received no help, from Angela ** that was very rude. I requested to speak with her superior after many attempt of telling me he is not available to speak with customers. Mr. Mathew ** continued with the rudeness and lack of help. I requested to speak to Mr. Mathew superior, I was rudely told that Britney (no last name was given) will not and is not able to speak with customers. I am very disappointed in the customer service department of Empire BlueCross BlueShield. I hope in time the department will take on the name of customer service and actually help a customer in need.
Expect nothing from Empire's 24/7 Nurseline. After my child drank fetid water in the backyard, I called my pediatrician to ask if there was anything I should do. Because they were closed, I then called my insurer's 24/7 Nurseline to ask the same question. I was connected to a nurse who asked me about 30 questions in order to confirm that I was a paying customer entitled to the service, and to cover themselves legally in case my child was harmed. Once I asked all their questions, I was told to call Poison Control. I asked why all the questions, and I was told it was policy. I asked why there was no advice, and I was told that they don't provide that advice. When I said that the 10 minutes answering all the questions could have exacerbated my child's problems, and I was told that I was being argumentative and was hung up on. Service was a total waste of time.
We pay an exorbitant amount a month (which is not even including the hike as of next year), and yet I am unable to get through to the right person to discuss any simple issues. It's beyond a joke. I spent nearly an hour on the phone being passed from one person to the next. I have given up, and here I am spending more time going out of my way to complain about them. On top of this, receiving a letter saying we have to pay ridiculous amounts for my children's dentistry which are quite clearly included in the policy!! What a joke. We'll be leaving as soon as the policy is up.
It's difficult if not impossible to get a human being on the phone. When I have been transferred to a supervisor, the supervisor has turned out to be voicemail and my call has not been returned. My experience today typifies the level of dysfunction at Blue Cross Blue Shield. I called the number for customer service on the back of my Empire Blue Cross Blue Shield insurance card at 10:50 AM to find out if a surgical procedure had been approved. Upon selecting the Pre-certification option from a "phone tree" I received an outgoing message stating that Pre-certification will "not able to assist [me] with benefit or claim related questions." I held the line anyway.
A second outgoing message then picked up, stating that "due to circumstances beyond our control we are not available", and that I should call back to talk to a service representative "during our regular business hours." I tried selecting an option other than Pre-certification to see if I could possibly reach a human being. I selected "Benefits" and was told in an automated message only the name of my primary care physician and that I was enrolled in this Blue Cross Blue Shield Pathway HMO. I tried a different number for Blue Cross Blue Shield and again selected "Pre-certification" and got the same outgoing messages saying that no one would be able to assist me with benefit or claim related questions and that "due to circumstances beyond our control we are not available" and that I should call back "during our regular business hours." This was at 11 AM on Monday, July 25, 2016.
I am recovering from a stroke and need physical therapy. Blue Cross only authorized a minimum amount out of the sixty allowed. I need further therapy and they are making me wait until they authorize more. Would they like it if I wait to pay my $300 per month premium for the poor service?
I applied for coverage through the exchanges at the end of August to begin September 1st for coverage. I paid for the first month of coverage when I applied (for September). I received my cards for insurance the first week of September. Then I started getting notices in the mail that I was overdue for payment for my September premium. When I called to inquire, they informed me my start date was August 1st. Which was an error on their part and that the first payment I made was for August. How am I supposed to use insurance for time that I didn't even apply for? Time in the past that I didn't have a card for?
I called multiple times to get the date fixed, and even told them not to take money out of my automatic withdrawal for Sept until we had the issue resolved. Well, they took the money out anyway, and wouldn't let me speak to a supervisor to even talk about the problem. Just told me it was denied through the customer service rep. They even told me the way to fix it was to cancel the insurance if I wanted during the enrollment process. But yet they get to keep my money. This is just out and out fraud. THE WORST. If you are looking for insurance, I suggest you try someone else if you can.
We have been trying for over 6 months to submit a claim to Empire Blue Cross Blue Shield for treatment for my son. We paid at the time of service. We have currently submitted the claim 3 times, to no avail. Each time we submit, we eventually (weeks later) receive denial of the claim for a different reason. The first time (after 8 weeks,) we were told that our claim was denied because we did not use the correct submission form. We resubmitted using the correct form. After 4+ weeks, the second claim was denied because the therapist used the wrong billing code.
When I called, the Empire representative said they could not give me or the therapist the correct code, but we could try googling it. They said if I did find the correct code and resubmit the claim, they would in all likelihood reimburse us for the claim. The therapist suggested adding a decimal point and two 0's to the code as that had worked in the past. We resubmitted the forms with this code, and now, 4 weeks later received another denial because the code is not specific "to the 4th or 5th decimal point." Neither the therapist or I can discover the correct code. This ridiculous back and forth (it has now been over 6 months!) is what gives insurance companies a bad name.
I have had BCBS insurance since 2010. When the Obama Care Act came into play I was notified that my insurance is no longer valid. They sent me a letter telling me they put me on a plan and gave me a website to read about the plan. So I go to the website. The website gives you an error. This page is not available. I contact BCBS. They tell me they are aware of the problem. I should just accept the policy and go ahead and pay the bill for the new insurance. I told them I want to know what I'm paying for and what is in this plan. Well this went on for a few weeks. I finally got a plan and information.
After all that, I get a notice a month later in the mail. "You failed to pay your bill. If you do not pay your insurance will be cancelled." I call BCBS. I tell them I never received a bill. They tell me they will send it out again. One week later I called back. I still did not receive the bill. They tell me they mailed it wait a few more days. I wait a week. I call them again. I still have not received a bill. They tell me ok. "We will take your credit card and you can pay the bill." I said, "Would you pay a bill that you have no idea what you are paying for? I want a copy of my bill." They tell me they are going to mail it out again.
So I get a letter again stating I am past due and still have not received my bill. So finally I had them fax it to me. Well, they are sending me a past due notice to my address and a bill to a different address. DUH. Wonder why I'm not getting my bills??? Ok. So it only took me 13 months to get them to correct my billing. I made complaints to the NYS Insurance board. I contacted anyone I could. I never received a correct bill for over a year. I only received late notices.
So now this year I get a letter telling me my insurance was canceled because the plan no longer exists. They put me on a new plan, which costs $95.00 per month more than my last one. I said are you kidding me? So I found a different plan and enrolled. So, last week they sent out a letter telling me they are canceling my insurance again due to lack of payment. I guess I have to do this all over again. How can a company this large have such incompetent people! I hope I never get sick. I have paid them all the monthly payments via a credit card just so I have a receipt.
I am a member of empire blue cross and up til Dec 2014 I had coverage for my dental and then without notice they canceled it on me. I called, the dental customer service was put on hold and talked to twenty different people who gave so many different answers I do not know what to believe.
My friend, Jacob **, is a retiree, who currently subscribes to Empire Blue Cross Blue Shield for the medicare prescription program. He is currently in the hospital since Wednesday December 17, 2014 for numerous issues. I will leave it to the medical professionals to give details as to his condition. But there is one major condition that has caused his stay in the hospital for close to two weeks: stress. Imagine you are a retiree who worked your entire life to then need medication to cope with arthritis, lower back pain, breathing issues et cetera. There was a major advertisement campaign a number of years ago, and of course ongoing, that this company used to lure individuals such as my uncle.
However, after securing the business, he is left to suffer. You may ask what suffering? Complete denial of all medication he needs to live. Now of course despite the all his doctors' orders, the insurance company still does not yield to what is medically professional. They deny, then need an appeal, only to deny again. Why? Because they feel that every human being is built the same. They believe that the human hand has the same finger size. Simply not the case. The way one person reacts to medication is not the same of another. A pair of $40 gloves to help my uncle cope with excruciating pain in his hands overnight was denied. Then various people call, and the answer is "We need lots of support from the medical community..." It goes on and on and on. Then they give the Affordable Care Act as the excuse.
While there is significant debate regarding the Affordable Care Act, I am sure somewhere in this large legislation there is something relating to the patients' needs; it is the belief in the US that was the whole reason for the legislation. I am writing today on this online forum because writing letters to individual members of Congress helps, but your platform appears to be the forum of choice. Americans need to be made aware of the plight of the elderly, especially those who've worked their entire lives in this country. I implore your forum to make known that the insurance companies need to live up to certain standard. On a personal note, Empire Blue Cross Blue Shield needs to alleviate the pain of elderly who suffer and need their assistance in obtaining much needed life saving medication. Thanks in advance for listening and please spread the word.
I am a physician and requested a procedure. The procedure was denied and we asked for an appeal. We have been unable to contact anyone for an appeal. We keep being referred to one number after another with no success. After one week of trying, my medical staff has given up. I have been trying for the past 2 hours with no success. I guess that is their strategy: prevent any appeal by preventing access! The most horrible experience I have ever had in dealing with a health insurance plan.
First I must say that I have been a member of blue cross for over 10 years. When healthcare policies changed this year in January my husband and I were given a new policy in which we were separate holders. This had meant separate deductibles. I have called numerous times and spent countless hours on the phone trying to be set up as holder of policy E. McGovern and spouse. I was told to fill out a Member Termination Worksheet by Wyetta and my husband to fill out a new enrollment form so that I could be added to his plan. I was NEVER added back onto his plan and my payment was put towards my husband's account. I have spent HOURS on the phone with incompetent people trying to have this straightened out. I went to the doctor and was DENIED to be seen because my insurance card was not valid. I went to pharmacies to pick up prescription medication and had to pay out of pocket.
In order to get through to blue cross blue shield I had to use my HUSBAND'S social security number because my card was not valid. FINALLY when I got through to someone who had the slightest comprehension of what I was going through, she told me I had insurance, and that I would be back charged for January and February because she claimed I "had it the whole time". If I had it the whole time, why would I be denied by both my doctor and pharmacy? As if this were not bad enough, I STILL DO NOT HAVE A VALID INSURANCE CARD!!!!!! OR A COPY OF WHAT MY NEW POLICY ACTUALLY COVERS!!!
This whole experience has been very frustrating and stressful. On top of all of the aggravation the customer service representatives are very rude, harsh and unsympathetic to my situation. They have even disconnected me several times. I am writing a letter to the CEO of the company because maybe he is actually competent and can do something because clearly the representatives are USELESS. I would really like to sleep again at night so I hope this situation gets resolved soon, since we all know I can't go to the doctor to get sleeping medication! If you are considering BCBS, consider no more, RUN!!!!
After an incessantly long process to enroll in the plan, I've had many of the same experiences as other customers - long wait times to talk to someone, being assigned a different PCP, etc. The payment process, though, is really burning me up. Two months in a row, I was able to make a payment online or over the phone. This time, neither system is recognizing my ID number. I called Member Services, which forwarded me to Tech Support. That rep sent me to another dedicated line. That person told me exchange policies weren't being recognized by the system, which shouldn't affect me because I'm not in the exchange, and then sent me back to Member Services. They literally sent me in a circle. Now, my only choice is to pay by check, and other members are being told their checks were lost in the mail (something that happened to me with another provider a few years ago). The lack of answers is inexcusable, and the reps need to do more than just send me to another division. This was my first time dealing with Empire. Based on these first impressions, I can't get out soon enough.
Signed up via NY State of Health through The Affordable Care Act on the recommendation of my doctor. I have been trying for two days to get a human voice to change my primary care physician. I was assigned one without my consent by Blue Cross! On hold for an hour one day, sent a message via the website that was never answered two days ago and am now on hold 75 minutes and counting right now. I have never been on hold for anything this long in my 62 years of living. Can't wait for Medicare and will never choose this company again.
Today I was denied a much needed preventive procedure because of dysfunction and incompetence of customer service. All I needed was for Empire Blue Cross to grant a one-time referral for the procedure. This should have taken 15 minutes maximum including hold time. Instead myself and multiple office assistants at the clinic and at the physician's office spent five non-stop hours on the phone on separate lines getting the wrong information, constantly transferred to the wrong department, confused by a terrible automated system, and hung up on repeatedly and simply unable to get an answer from Blue Cross.
We finally gave up exasperated. I lost two days of work in preparation for the procedure, fasted, bought over the counter drugs, traveled for hours, and left untreated, sick to my stomach literally and emotionally. This is unconscionable and has no place in the world of medical care.
I had secured referrals from all parties, but Empire Blue decides the referral I got from my general physician in 2013 was invalid since he is no longer in the network of the new plan for 2014. Why doesn't Empire Blue have the decency to honor the referrals and procedure established by THEIR in network physicians despite THEIR change in my plans? To make matters worse, I lose coverage for a good general physician of 20 years.
So in the end, Empire Blue Cross has taken my money, not provided basic customer service to enable critical medical procedures, potentially seriously compromising my health, and lowering quality of access to health care in 2014. They are quick to blame the Affordable Health Care for their burdened customer service but to be clear they had terrible customer service long before 2014. They stand to benefit from AHC and with their billions of dollars certainly can make customer service at least functional. The overnight doubling of my deductible is another atrocity that this company does with impunity or accountability. There is simply no place for the profit motive when it comes to getting equal access to health care.
I’m writing to you because my health insurance is giving me problems. They had cut me off in 2008 without informing me, I was still in school. In 2010, I wasn’t feeling good; I knew it was just any cold so I scheduled an appointment in March. So I attended my doctor’s office, did blood work and went home. After a few months, I started getting bills at home from the lab, which I couldn’t pay. I was attending school and not working. I called up my insurance that’s when they informed me I was taken off by my father’s union. I had called the union, that’s when they told me I’ve been kicked off, and that my insurance was suppose to notify me but no one had. My bills cost about $3,000-4,000 and I can’t afford to pay it, I’m currently unemployed. My union said that I have insurance as of July 2011 but didn’t want to add me a few months earlier when I was charged for the lab work March, 20011. Now debt collection. Please help me, I’m very much stressed. Please contact me back as soon as possible. I appreciate it. My phone number is **. Thank you.
I purchased a traditional plus health insurance plan from this company approx. 8-9 months ago. I am unemployed and receiving unemployment benefits, but felt it was in my best interest to at least have emergency medical insurance. Sure enough I went to the emergency room about 7 months ago, thinking I have coverage. After months have passed, I receive a bill from the doctor who apparently wrote up my chart, (who I never saw) for $1762.00 and Empire says they do not cover this fee, Only facility fees. I am unemployed and was paying out of pocket for what?? Now i have to come up with $1762.00 and both the doctor and insurance company were no help. I am very upset about this issue, and wish someone would of contacting me earlier and told me they were not covering these fees!!!
Daughter had hurt nose playing soccer. She needed a protective sports mask for her to continue playing soccer. Went to prosthetic place and said we needed for insurance dr's note stating she needed this and prescription. Got all that information gave to prosthetic place. Got letter in mail from BCBS saying that total responsibility to provider $0. dated 9/29/09. Rec'd call from prosthetic place beg on Jan 2010 saying insurance did not pay or authorize and we have to pay bill. I have paid $150 towards the $500 bill. I need to pay the rest they are asking for payment. Why did this not get approved? we went back and forth several times on phone with insurance company. I have times/dates documented with who I spoke with, what they said was going on. I put in a appeal to the insurance company on 2/17/10. And still nothing. Very frustrated keep getting different answers from Empire blue cross blue shield.
Under Empire's Direct Share policy, they claim to pay 90% of a physician's bill, with the insured paying 10%. If an insured had Medicare only, with no secondary insurance, the insured is liable for the entire 20% difference between what Medicare pays the physician and what the physician bills. As I understand it, Empire defrauds its insured in three ways. I will cite an example of a $200.00 physician's bill, for which he is reimbursed $160.00 by Medicare and there is a balance of $40.00.
1. Empire, instead of paying 90% of the $40.00, considers its obligation to be 90% of the entire bill, less what Medicare has already paid. In other words, Empire considers the Medicare $160.00 payment as if Empire---not Medicare---paid this amount of 80%---leaving a balance of only 10% as Empire's obligation to the insured. Instead of paying 90% of $40.00, Empire pays only 10% of $40.00, or only $4.00. As most physician's bills are under $200.00, Empire is taking premiums of about $5,000 per year for which it virtually pays no coinsurance, rendering this policy almost worthless.
2. Under this policy, there is a $40.00 copay for a specialist. This copay is as much as the difference between what the doctor bills and what Medicare pays. Therefore, there is effectively no secondary insurance. 3. If Empire deems the Medicare payment---as small as it is---to be in excess of Empire's reasonable and customary charges, Empire pays nothing, once again, rendering its policy worthless.
Damages to me, personally, about $2,000 to $3,000 over almost three years. I am less interested in recovering the damages than making sure that Empire does not perpetrate this fraud on the public. I have switched to AARP secondary insurance where I pay a far lower premium and have no out-of-pocket costs.
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