Blue Cross Blue Shield Association [BCBSA]
Reviews and Complaints

I have had Blue Cross of Alabama for over 20 years. I have had an issue several years ago with getting Nexium filled in the past and my Doctor sent in an exception and I have been getting Nexium since then, I called to get a refill in September and Blue Cross denied it saying they no longer covered Nexium. I have tried the generics and they do not work. So I called Blue Cross and three overrides have been sent in and denied. So, I have been taking the over the counter Nexium since and my stomach has hurt continuously. I do not take Nexium for acid reflux. I take it because my stomach produces ulcers. Since they denied the Nexium I requested the generic. They denied it too. I still do not have any medicine and they say my doctor must fax a Drug Formulary Exception for the generic. Obviously, they do not want to cover any medicine for me. I will believe Blue Cross will cover when I see it.

On June 30, 2023 Dr. Al Covington called in an eye drop named Restasis. The prescription was rejected at CVS because it needs prior authorization. I called my provider which in turn sent in the prior authorization. I phoned BCBS for the second time and was told that everything was ok to pick up the eye drops. When I went to pick up the eye drop I was told that it still needed prior authorization. I have been on the phone for the 4th. time today with BCBS being told that they never received the prior authorization from my provider. I phoned the provider again and was informed that BCBS just denied to prior authorization and gave me the reference number of BRWJED6U. Now, BCBS is attempting to talk to prior authorization team and I am being told that the eye drop is denied. My provider is currently trying to assist me. I have requested a supervisor but they will not put me through. I have severe dry eye and macular degeneration in my right eye. i need help.

I called Health Care Sept 2022 to find Health Care in Alabama I could use as the previous option no one took (I believe it was United) the CS rep switched me to BCBS AL because the Dr I needed to see for hormones was “in network”. I explained to her at the time I only needed to get balanced and Dr Corbett was in network. I told her I was making the appointment with Corbett the day my coverage started.

There was NO mention of going on line and establishing “Primary” prior to any appointments.

I went to the appointment confident with my new insurance plan. Dr Corbett sent me for mammogram as well.

Then I get a bill that none of it was covered because of a SIMPLE 30 second on line submission for a Primary. Truly I WOULD have done so had I known. I CAN NOT afford to pay these bills over a simple miscommunication. Please help!

Mary C Nielson

[protected]

BEG0847437478 &

XAD817882429

I have a rare disorder and requested assistance to find a physician who specializes. I was sent a general list of 250+ physicians who I called for weeks and could not find anyone to take me as a patient. I called BCBS and asked for case management help. I was assigned a case manager who helped me find a physician, have gone through testing and was scheduled for surgery on 08/25/2022. I was informed on 08/22/2022 that the physician doesn't have privileges at any facility that BCBS will cover in network.

I can either pay $11000.00 extra or they can refer me to a new surgeon, who requires new MRI before he will even schedule a consultation (again extra $).

I had to stop other treatments to get the surgery, so now I wait in excruciating pain and no answers.

I put in a Reimbursement Request on April 5, 2022. I am still waiting for it (July 8, 2022). On the website it says it is finalized, but the details say:

WE CANNOT PAY FOR THIS SERVICE UNTIL WE RECEIVE THE PROVIDER'S MEDICARE AND MICHIGAN IDENTIFICATION NUMBERS. WE HAVE ASKED YOUR PROVIDER TO SUPPLY THIS INFORMATION. THEREFORE, NO ACTION ON YOUR PART IS REQUIRED. (X001)

I don't have Medicare.

What happened is that from the electronically submitted Superbill, they made a Typo. So they of course didn't find the provider anywhere, and now they need the provider to verify details.

But what is even worse, this is the fifth time I submitted for the same Provider a reimbursement request, and all the other times it was approved and paid out.

And even I put another reimbursement request on May 9, and that was paid on end of June. For the same provider. How come a claim is paid out earlier, even though it is submitted later.

This is so frustating.

I was issued a debit prepaid Mastercard by Blue Cross Blue Shield Federal Employees Program after answering a survey or requested procedure response. This was back in the fall of 2021. I have tried using it in listed stores (on the website) such as Bath and Body Works (2x) and TJMaxx (2x, last try today) and payments all failed to go through all 4x. It is very embarrassing and so I ended up paying cash on all of my purchases. My card still says I have $50 balance but it won't even accept on Old Navy online today (also a listed store). Is this something that I should take up with Better Business Bureau? I feel that I answered the Blue Cross Blue Shield survey and was never really given $50 as promised because the card would never, ever go through in all 5 attempts. Please give me a valid list of stores that I can use this card with.

I was pre authorized for Skyrizi in Nov after months of doctors working to change me from Stelara after it stopped working… I finally got the pre authorization and the first shot in dec…. The maintenance shot would start 4 weeks later the end of dec…. I was away and called for that shot on the 1st… I have been on hold had been hung up on and delayed numerous times… I have spent hours on the phone each time they keep mentioning the pre authorizations … I now dont know how to get this fixed… I think They are delaying because I will be moving to Medicare in April… not fair and with my psoriasis and the arthritis I am having a tough time moving… can I please get so help! Please I don't know what to do… they are to hard to get to and even harder trying to keep on the phone.. all this and I have patient assistance from Skyrizi…help

My wife and I have used BCBS for many years with Plan F with no problem until 11/7/2021 when there over billing by wife's monthly payment. It used to be 48.25 per month. They took out our bank account on 11/5/2021 $463.75 and 12/6/2021 $270.75 and 1/5/2022
$270.75. I tried calling them - no way to get person, they had too many calls about billing. I finally found a way to complain in an email after the December payment. I called them many days later and said that they were looking at my email and can't talk about it. After the 1/5/2022 I tried calling again - no rep available! I can not afford more over billing.

I work at a physician's office and I have to call to verify insurances for bcbs of nc. The wait time is ridiculous. You are on hold for over an hour regardless of what time you call. I cannot hang up, because I have to verify a patients' insurance so they can be seen at the office. The longest wait time is 2-3 hours. Unacceptable! How can we provide customer service for our patients to be seen in our facility if we cannot verify their benefits and eligibility. This is the worst insurance company hold time. No other insurance company from aetna, uhc, aarp, humana has you on hold this long for customer service. Yes you have a web site, but I need to speak to a live person each time. Worst hold time ever

Hello,
I hope you can help me. I was scheduled for surgery on Wednesday November 7 th for a fusion of the L5S1. My vertebrae is collapsed on my right side and is pinching my nerve causing me excruciating pain, my life is reduced to laying on the couch and taking pain killers, opiates, gabapentin. I am only 52 years old, in good shape otherwise and I can barely walk anymore or sit or stand in any one position for any amount of time.
On November 6 th at 3 pm my spinal surgeon of 28 years had a peer to peer consult with an OBGYN dr! The OBGYN denied my surgery at the last minute. An OBGYN is not a spinal surgeon nor a correct peer to peer for a spinal surgeon.
I am ANGRY, and in a state of shock that BCBS would treat a patient who is in dire need, pain and taking opiates and pain killers and wants to get better and not risk my life to opiate addiction and deny me needed surgery for my crushed nerve! My physicians office has filed an expedited appeal and I am awaiting a better decision. If you care and if you are able to help, please HELP me!

Michelle L. Boylan

Carrier: BCBS Illinois
BMB838248851
Group:959581
Covered under Brian Boylan

After calling and finding out I could not get info on my brother his web page was taken down. since then all the papers have been filed with bcbs. I cannot seem to log in. Changed password too. I keep trying to log in . I really would like to log in and see who is billing his account. I really like to keep track of his claims. The web site was taken down sometime in September. I was taking the eob's. They are keeping information. I have tried several other times since then and it still does not work. The following is my brothers i.d. number XYW893652013, and group number is [protected]. I hope this information will help.

I had a reverse shoulder replacement on 7-18-17. Finely took off my
my huge shoulder brace on 8-31-17 which was my first physical therapy
session. PT for the first month is very minor because you can't start weight strengthening till week 11 after surgery. today 10-4-17 I was told I was cut down to once a week. The reason I was told was I was improving so I don't need it. Yes I can barely get dressed, scratch my nose, wipe my self but I can't bring a cup of coffee to my mouth, cut a piece of chicken or hold anything over 2 pounds with my new shoulder. They are right, a week after
surgery I couldn't brush my teeth, get dressed at all. hold a cup or scratch my nose at all. I sat inside while my shredded rotator cuff and shoulder replacement was healing. There is no PT for the first 6 weeks. Now I am getting better and I am cut down to once a week. My surgery was Munson Medical Center in Traverse City, MI, my PT was through Great Lakes Orthopedic Center and my surgeon was Dr John Reineck through same center. I was told I have 32 visits but only 4 a month.
I had a total knee replacement 3 years ago, same blue cross and great PT. If it wasn't for 2 o 3 times a week PT I would not be pain free as I am now.
This is as I see it just another way to cut their costs and not care at all about people who need it. I am 71 years old and working full time because I have to. The pain in my arm is still pretty bad for daily use. I need to eventually able to shovel snow, cut grass, vacuum etc since I live alone.
I was told a Physical Therapist can do a review at the end of the month, stating I am improving and bcbs cuts me down. Not happy

$357 was never refunded to my mother who was left with no choice but to pay out of pocket for her prescription. At the time she was unemployed due to disability & was waiting for an answer from SS; she just happened to have cash in her pocket that she had borrowed to pay rent. When she spoke to bcbs CS; she was assured that the money would be refunded, told a check had been sent in the mail & otherwise stonewalled, misled & straight lied to. $357 to a huge "non-profit" corporation such as the blue cross blue shield, (organization with written statements that claim to truly care about their clients), is chump change with their CEOS giving themselves million dollar bonuses every year, but to a hardworking, upright citizen such as my mother, it was her rent money which in turn put undue emotional stress on her. The last thing she needed on top of already dealing with an illness that became chronic & is painful in nature! This is an abhorrent disrespect & lack of concern for another's life & can not be allowed to continue!
If all you rich folks are so smart, then how can you think you'll just continue ripping your fellow humans off when anyone with any intelligence knows that we are all connected? You may as well rip your arm out of socket & slap your own faces with it! Time has come for change, and I am not afraid to encourage it, I am energy & I will make a difference!
Thank you for your understanding & cooperation in resolving this matter!
Respectfully,
Autumn Anne Saaxon

Ha. The local paper just reported that 2 executives at NC Blue Cross/Blue Shield got over one million dollar bonuses. These are the same people who just sent me a revised 'Explanation of Benefits' for a procedure I had done 10 months ago and had paid in full. They pretty much lied to me and said that the company that provided my service had refiled a claim with them for the service from 10 months ago(May, 2016). After multiple phone calls to the company who did the service, I felt certain they had not refiled anything. I also now believe this same issue is happening with thousands of people. Finally, after a whole lot of hassle and my request that they contact the other company, BCBS admitted that they had 'fixed an error' and that I am pretty much on the hook for something that happened 10 months ago. I filed an email claim with NC Insurance asking if that's even legal and what prevents them from coming back again, and again. Horrible thing to do while the few at the top rake in millions. I could not sleep at night if I stole from the little people. Horrible ethics and a dishonest company.

http://www.newsobserver.com/news/business/article135752543.html

Absolutely worst experience of my adult life! Long and short of it, I have my 8 years old son and myself on an HMO plan. Without notice it went from $525 to $758 without warning and of course its automatic payment so I'm calling day after day to cancel and what do you know, not one of the 12 reps I got tossed around to could help! I'm so furious I could scream! Worst company ever! Steer clear...Awful..as bad as it gets😬😠😣😯

Initially I was happy with Florida Blue. Early on I wound up having to under go a major procedure.
It was all handled well. Everything got done. I was impressed. It was during this time in Feb 2016
that I met my out of pocket max as well. Also good because now my coverage is 100% according to the policy. In one year I am on my 3rd Doctor. they all quit Flea. Blue and as a result me too. As I progress along things seem ok. One health issue down one to go. I went to a specialist I could not get any coverage for the procedures that she was considering and Florida Blue would not cover any of the medications she reccommended. As my PCP stated "Everything you need you can't get". I also find that clerical staff at the 2 PCP's stonewalls and just does not get these referrals processed in a reasonable time and too often they are not correct. Trouble with this is it destroys your 100% coverage time frame. It has mine. Staff appears to dislike the BCBS procedure. In Oct. 2016 I start receiving bills from past visits to Healthcare pros. The specialist I went to see is now billing me for copays I do not owe. This stuff is from months ago. I contacted BCBS a few times. Their lip service is great. I am now sending through their system so the info is in text form. What they did was destroy my max out of pocket numbers. And now previous transactions are finding there way to me. I don't owe this but the facilities can't see that. After many repeated efforts to get BCBS to deal with their issues all I ever heard from them was something different with every communication. NOTHING ever got fixed. I received today a letter stating that I had 30 DAYS TO PAY UP. Pay up what I do not owe. I stopped being cordial with them 2 months ago. It looked as though in DEC. 2016 it was going to be fixed. Contacted Marketplace. Agreed to renew 1 more year until Medicare next year(hopefully) this is the best I can afford. Here it is Jan 2017. I'm getting those bills again. BCBS increased the price and now my premium is doubled as they hold me accountable for paying their 2016 bills. These people are pathetic including those in customer dis-service.

[protected]
reference number: 1-[protected]
agent: joedie m. In florida
2 years it took after over a dozens phone calls to get reimbursed for eyeglasses.
2 pertinent pieces of information were missing without which the check could not be send out.
After asking representatives for the right way to fill out the forms and confirming the forms and the faxes sent - still nobody until today was able to
1. Identify the problem
2. Address the problem
3. Resolve the problem.
I do wonder how this company works and is in existence?
lets say there are 10, 000 representatives employed, sitting their cubicles in florida.
My representative joedie and her supervisor were are 2 people out of 100 who were able to help.
So i am not a mathematician but 200 representatives out of 10, 000 are able to do their job and keep this company afloat?
amazing. Close to a miracle
seriously, this company is a disgrace to florida, to the united states and to our health system.
How can that be that it takes 2 years and 100 reps to figure out a minus issue that have been confirmed by that same company in the first place?
i called and spoke with quinton and i asked him pertinent questions about the company. He as a supervisor had no idea about his company.
I also told him that has he ever considered the fact that if the company is so careless about their customers doesn't he think they also are as careless about their employees?
food for thought
now next week i have to get new glasses and this whole process that should take up to 30 days may take...?
i will keep you updated
thank you for you time

On April 13, I paid almost $500 using my bank debit card for Blue Cross Blue Shield (BCBS) of GA COBRA because the US Government requires insurance coverage. Normally, I would use a credit card in case something happens, however, it required that my payment was in the form of debit card. Now, I know why! On April 19, I had dental surgery. The dentist put me on antibiotic and gave me something for pain. When I got to the pharmacy, my insurance was declined. I called COBRA administrator and BCBS and had them on the phone. I was told that it takes 10 days. So, I had to pay for the meds. On April 28, I called the vision company to order contacts. I was told that I was terminated. I called both COBRA and BCBS because I was not going to pay for May insurance and I could not get service in April. Then, my dentist called me this week and informed me that BCBS rejected my dental claim that was submitted on April 28 (more than 10 days). I had to pay them on Friday almost $400 because I don't want my credit ruin by BCBS. I would just like my money back. I am going to contact GA Insurance Commissioner and Health Care. Gov because I don't want to be penalized for not having insurance coverage when I did. BCBS/COBRA please refund my money immediately!

In November 2015 I went to my family doctor and complained of left shoulder soreness. Because I had a shoulder manipulation in 2012 my doctor referred me to the orthopedic surgeon. I saw him around the beginning of December. He quickly evaluated my issue as scar tissue forming from the shoulder manipulation which was causing irritation and nerve pressure causing the tingling that had now started in my left hand. He gave me a cortisone shot in the shoulder and said take it easy and call back in a month.
I changed jobs at the end of December. The pain now getting worse and rather than being a come and go thing it is now almost always sore and I am losing feeling in my index and middle finger.
I go to a UnityPoint Clinic in West Des Moines where a doctor evaluates me and says that there was a mis-diagnosis and what I had was a neck problem. He put me on prednisone for five days and asked me to contact him if it didn't get better. After a week it was getting worse and affecting my ability to work. He said he would schedule an MRI but needed pre-approval. My insurance changed Feb. 1 but just from one Wellmark account to another. I had to give my new information before they called it in but did so. On Feb. 3 Wellmark mailed me a notice of denial. I was told to seek physical therapy. I saw the PT and after 10 minutes he told me there was a big problem and I needed an MRI to figure out what was wrong. Two days later I went to an urgent care, was evaluated, told that I needed an MRI, was give a shot for pain and told to contact my family doctor. On Monday morning I went to work but the pain was excruciating. I went across the street to another urgent care where I saw another doctor who evaluated me and said I needed an MRI. I called my Wellmark and they advised me to have my family doctor submit again. On this past Monday they resubmitted. I called Wellmark on Thursday to see what part of me had to go completely numb before they would approve the MRI. I was told it was in review and that she would contact me on Friday to give me an update.
It's now Saturday. I have heard nothing, and of course, there is no way to contact anyone at Wellmark. I am in constant pain, and because I recently changed jobs I have very little medical leave and I'm saving it for the potential surgery I may have to have, if Wellmark approves that.
Why are we paying insurance if the company can just pick and choose denial of a doctor's recommendation. In this case, three doctors and a licensed PT. I can't continue to live this way.

Blue Cross Blue Shield terminated health insurance for hundreds, possibly thousands of patients. They terminated the PPO through the Affordable Care Act. I have a patient on dialysis, who received a letter stating he terminated the insurance and the date it was terminated. He never received a letter that clearly states they terminated the insurance and the date of termination. Without that letter, we cannot place him on a supplement. He has a total of 63 days to get a supplement, and that time is almost up. He has phoned several times. His name is Raul Nunez, and his member ID was [protected]. He needs the insurance company to send a letter correctly stating that the company terminated the insurance, and the date it was terminated. If this is not possible, I would like you to look into a law suit against Blue Cross Blue Shield for terminating insurance when some people are unable to obtain insurance any other way. I have also been informed by a nurse that many doctors refuse to take insurance received through the Affordable Care Act. They say it is difficult to receive payments. I think the insurance through the Affordable Care Act should reimburse doctors as any health insurance. This is something the federal government needs to look at and resolve with the insurance companies. Thank you for your time. My name is Brenda Pardue. I am a social worker with U. S. Renal Care in Laredo, TX. My work number is [protected], and my cell phone number is [protected]. My work address is 4602 Ben-Cha Dr. Laredo, TX 78043. Sincerely, Brenda Pardue