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I pay for my insurance out of pocket. I was with BCBS WNY for three years and everything was great. Last year Highmark took over. Premiums increased, deductibles were increased, coverages eliminated and customer service is virtually nonexistent. Their accounting department has lost my payment twice (this is an EFT from my checking acct). I had to call to straighten it out. Was on hold for over 3 hours the first time and 1 1/2 hours the second time. Do not get insurance from this company. You will end up being disappointed and frustrated!
No no, like ACTUALLY the worst insurance possible. Let me give you a general run down:
- $15 PER appointment (Doctor)
- $25 PER appointment (Therapist)
- $75 per script of basic medications
- $150+ for LIFE SAVING medications, MINIMUM
- $250 to literally SET FOOT in a hospital waiting room (Family Practice or otherwise)
- $500+ for this random thing that never happened
Highmark takes full advantage of you if you're living just above the poverty line. Like absolute FULL advantage. The amount of random charges I have for things that never happened is disgusting, let alone the fact that they will tell you something is covered, but it actually isn't. My appointments with my therapist are supposed to be $15 even, but they charge me anywhere from $25 - $70 per session. I went to the hospital a few months ago for some serious issues with my stomach, needed some testing done. Per my member pamphlet AND Highmark CS themselves, my testing was to be covered. Well, it wasn't, and I got smacked with a $500 charge.
I literally have to cancel every single appointment I make and have cut myself off from 4 different medications because they want me to pay anywhere from $75 - $200 for EACH 30 day script. They take full advantage of you, and then send you a bunch of spam about how ''great'' they are. Never again will I deal with Highmark.
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This is the best insurance plan my company offers. Until this plan year I had not had any issues that were not easily resolved. My problems started in July of 2021 when my chiropractor closed his office and joined a group practice. Highmark started sending flexible spending account checks to a chiropractor in my home town that I had never been to. I was given details about how to get the new office to send in the W-9. Highmark sent checks directly to me for my copay amounts in that plan year until the W-9 issue could be resolved. The office sent the W-9 in May of 2022.
Fast forward to July of 2022, new plan year. The W-9 was never updated with the Health Savings Account department or the Flexible Spending Account department. I was informed in May that checks could not legally go directly to me for HSA money. Checks were still being sent to the chiropractor that I had never seen and I can no longer get this checks at all from Highmark. Direct to patient checks is no longer an option with the new plan year. I have now discovered that none of the HSA checks or FSA checks have been sent to multiple doctor's offices. I am paying into this insurance that is suppose to cover the first $3650 toward any deductibles or medical expenses the only expenses that I have not had to pay out of pocket are those that I am able to put on the debit card, eye doctor and pharmacy expenses.
Highmark denied payment for a 1-day inpatient hospital stay via correspondence. I followed the instructions in the letter to file an appeal via phone by calling the Member Services number. I spoke to no less than (5) Member Service Reps (MSRs). They just kept transferring me over and over. One rep I couldn't understand, as he had his microphone turned down. Offshore MSRs give customers fake names, as well. The final rep transferred me to a number in Erie, from which I was disconnected, as it does not accept calls. Two hours, and I was never able to start an appeal. Highmark customer no more.
My husband has had the same insurance for over 20 plus years never could get him to go to the doctor. Finally he has to see a urologist a few months ago and urologist said you need to get a primary care physician so after 25 years finally gets a doctor goes to see him and Highmark Blue Cross denied claim because of wrong codes being used. I don't understand medical coding but how is it we are supposed to fix everyone not doing their jobs correct. So now after not using my insurance for 20 plus years my husband's first doctor appointment has been denied and we have to pay 200 dollars for it.
I have been waiting on approval for an MRI for over a week (last Friday). Now going into the holiday weekend (it's Friday before Memorial Day now) I still have nothing. The best anyone can tell me is it is pending a medical director's review. I am walking around on a possible fully torn ACL!!! This is absolutely unacceptable! I have called every single day since Tuesday, sometimes even twice a day! So now I won't get the approval until the earliest Tuesday of next week and then I still have to get on the schedule to have the MRI! WE HAVE TO DO BETTER THAN THIS! For what I pay for this insurance, I shouldn't need to wait on someone else's opinion. My MEDICAL DOCTOR'S OPINION IS THE ONLY ONE THAT SHOULD MATTER!
Unfortunately, since Blue Cross Blue Shield of WNY has become Highmark BCBS of WNY, the service across the board has become downright awful. They've cut a ton of medications from their dispensary, shifted a number of them to tiers 2 and 3 (higher copays), removed the cap on total out-of-pocket expenses, fail to cover basic bloodwork panels claiming they are out of network (I got them done locally at Quest Diagnostics), cut all out of network coverage (even partial coverage) and make it near impossible to reach their customer support. When I did reach their customer support (on my 3rd half-hour phone call) they told me nothing could or would be done about my issue. Run from this health insurance company as quickly as you can.
The company has changed ID cards and accounts; nothing works. Change was effective 1/1/2021; it is now 1/27, Cannot use wellness card or get scripts that were previously covered. We are being told to pay out of pocket and submit forms and that they are having issues because of the changeover. Have contacted customer service numerous times. Holds are from 45 minutes to an hour or more. When you finally connect to a person, they transfer you to somebody else and the wait time starts all over again. Sent emails, no response. We were not told the company was changing during open enrollment during November and December and that there would be coverage changes with the name change. We would have left the company. We want the service we are paying for.
We Highmark BCBS in PA & I've only had to call customer service twice, with an average of one call per year. This is due to their well laid out, easy to use webpage & app. Most info I am able to easily find online. Some company web pages are messy and answers hard to find. Highmark has done an outstanding job making the interface easy for anyone. It is well laid out, non confusing and pleasing to look at. I didn't feel overwhelmed with the immense amount of information I was able to find online to fully answer all of my questions.
As a health insurance company, they do their job. I am not left to do their jobs for them. When I have questions and call them, I am not left ending the call with more calls to make. They are great at doing the legwork that's needs done to answer all my questions. Claims are processed quickly and the wide range of in network facilities and doctors makes it very easy to always have many options when choosing your care. The rates we pay for a married couple is so affordable and after we meet our small deductible, everything is covered 100%, including prescriptions.
Highmark has been awful to work with. There is no communication between representatives. When you call you always reach someone different. I put a call into my care navigator on Dec. 22 and still have no resolution. I am in need of IV home infusion services for a kidney disability and so far they have denied care. No one returns phone calls. We have spoken to at least six different people and all have inaccurate information. Some of their medical coverage may be good but their representatives either do not document or read records. There is no communication. It is extremely frustrating. It has been many days since the original call and no resolution. Continuing to deny care can be life-threatening.
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