Consumer Complaints and Reviews
Being on hold 35 minutes after being transferred from one person to the next. Local BC told me we needed a HIPAA document. BC of SC told me client would have to do this. Horrible customer service. Would not help me or their client. BC of WNY told me it was not a problem to get this document and give it to client to complete - BC of SC would not. They wanted the client to call themselves be on hold for 30 minutes get passed from one person not knowing what they are doing to the next, getting hung up on then calling back. I cannot believe the difference between BC of WNY and BC of SC, you would think they were different companies. BC of WNY is far superior to their southern counterpart.
Under BSBSNC in Dec 2011, Medicare paid $52.49 for each of my sessions. BCBSNC supplement paid the remaining $13.24. I joined BCBSSC Medicare Blue (Advantage) in January 2012. BCBSSC continues to collect the $52.49 from Medicare, but refuses to pay the hospital for my 2012 cardiac visits - 18 YTD. BCBSSC 2012 Evidence of Coverage page 54 states that cardiac rehab is covered with $40 copay. This cost-sharing applies only when the rehab is obtained at a free standing facility. If service is provided in a doctor's office or other medical facility. Is a hospital not a medical facility? They now refuse to pay the hospital and are keeping my Medicare payments for profit. Now, I am being held responsible for the entire $1070 in cardiac rehab bills, which Medicare would have covered $944.82. Now I have to drop my rehab and I am only halfway through the 36-week program.
Our benefit year runs from January 1st through December 31st, so our deductible and out of pocket maximum should be for the benefit year. However, our renewal date is November 1st, and our plan changed for the coming benefit year, starting January 1st, 2012. BCBS of SC changed our deductible, and out of pocket maximum, as of November 1st 2011. My wife had met both deductible and out of pocket maximum for the benefit year 2011, because of a health issue earlier in the year. Due to this change, the two procedures recommended by her internist should have been paid for, 100%. We now owe the additional deductible and out of pocket maximum of $1,000, plus 20% of the bills, on top of the two increases.
In October 2009, I had a cholesterol test done as ordered by my cardiologist, BCBS rejected the claim 100% saying that the test is not approved. It is a relatively new test, but both labs I have blood drawn from say that this test is accepted everywhere else. I have contacted BCBS several times, they talk with you for awhile, then transfer you to a "supervisor" who is never available to speak. What you are left with is a chance to leave a recorded message that is never returned.
BCBS can basically use this tactic from now till eternity and their customers have no recourse. After doing some snooping the internet, it seems that this is their modus operandi. If they can get away with this with me, just think how many other thousands of subscribers they are doing the very same thing to. They are betting since it is just a "nickle-dime" bill [$120], the average Joe will not have the time or tenacity to fight it. I went ahead and paid the entire $120 to the lab. This test is the most comprehensive look at my blood and my cardiologist ordered this test for a very good reason.
For past 7 years, I maintained Blue Cross Blue Shield coverage through my employer; effective May 1, 2005 this coverage ended due to layoff. I applied for individual coverage in April 2005 (before coverage ended). BCBC requested my medical records from my Heath Care provider. I received a letter from BCBS stating that they could not offer me coverage based on following health history: elevated Sed Rate (56)in 2001 with no diagnosis/current information. Pee Dee Health Care, Darlington, SC had not updated their records and had sent BCBS obsolete data.
I've had blood work done several times since 2001 - most recent blood work was February 14, 2005. Pee Dee Health Care submitted claims for all blood work including Feb. 2005 to BCBS. BCBS sent me EOB and has paid on the February 2005 claim. I contacted Pee Dee Health Care; they said their files hadn't been updated and they would fax my current blood work (which showed my Sed Rate was in the 30's) to BCBS - the letter also stated that Pee Dee Health Care was unaware of me having any medical problems (and that Sed Rate is not an indicator of any specific disease) to BCBS. Pee Dee Health Care faxed the corrected infomation to BCBS.
Additionally, I sent them data which included, copy of letter from my Doctor, EOB (February 2005) BCBS sent me which included payment for Sed Rate test and recent bill received from Pee Dee Health Care which included the Sed Rate test.
Since sending this information (June 22, 2005) to BCBS, I received a letter stating that my Appeal was denied (no reason noted). I've phoned BCBS 3 times since then - initially, I was informed denial was based on the 56 Sed Rate (old data); later I was informed no reason was stated for the denial. I explained to each individual that the 56 Sed Rate was obsolete (2001) and that results of current Sed Rate had been submitted. The first individual told me to call back in a few days and the others said they would check and call me back. To date no one has called back.
Consequently, I've phone (Pee Dee Health Care (Medical Records) several times. I left messages informing them that BCBS was still denying me coverage based on the 2001 records they sent; I asked that they contact BCBS to correct the error. Pee Dee Health Care has not responded.
I've never been diagnosed with any health problems; my doctor has never discussed Sed Rate blood work with me; the rejection letter from BCBS was the first mention of Sed Rate. If I had/have a medical condition (Sed Rate), my doctor has never bought it to my attention, prescribe medication or followup.
I currently DO NOT have medical coverage. Because Pee Dee Health Care sent BCBS obsolete medical data, I've been denied coverage. Although, Pee Health sent updated blood work, BCBS is still denying me coverage.
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