Blue Cross Blue Shield Association [BCBSA]
Reviews and Complaints

We triple checked our insurance coverage booklets we received, found an in network provider, and had them verify that we would have our specialist visit covered by speaking to a representative from BCBS Florida themselves. She misquoted them. None of the services that we received were processed like she said they would be leaving us to pay hundreds of dollars out of pocket for a service we wouldn't even done if she wouldn't have confirmed it would be covered. We called several times after we received the incorrect coverage and each person we talked to was very rude and just kept insisting they were right and that everything processed correctly. Months later, we finally get them to review what happened and see how they messed up. Its now past the appeal date and "they can't do anything about it." The worst customer service I have ever dealt with. Avoid them at all costs.

My doctor order a prescription for blood monitor because I am on warfarin, after a month they don't process my prescription and I am without blood monitor testing and control, putting my life in risk. I call more than 50 times and spoke with several people and they redirect me to talk with there provider (alere) to deal direct with them (that is not suppose to be ) and that company is a mess. Nobody know about my case and lie about my status and different facts.

I began coverage in 02/2014 with BCBSFL. Used their website to locate a Dr. who told me, after several visits, that he did not take my insurance, leaving me with several thousand dollars of bills. I made payments for February, March & April and discovered in April, when I went to refill my insulin prescription that my insurance had been cancelled on March 31. I contacted BCBSFL to discover that yes, my policy had been cancelled for non payment in April. I explained that sent April's payment and they discovered that I had so, they stated that they would send me a refund for that payment. Several weeks went by and I received no payment, no calls from BCBSFL, still no letter stating that I had been cancelled. I contacted the marketplace and was advised that I had been terminated wrongly by BCBSFL so they did a review and I was told my insurance would be reinstated. I spoke again to BCBSFL, who was not contacting me mind you, and was advised that yes, my insurance was reinstated. So, back to the website to find a doctor. The address of the office was incorrect on the website and then, when I did locate it, across town from where it was listed, I was advised that my insurance card was inactive. I contacted BCBSFL and they verified that yes, my insurance was inactive due to bills I owed for the months that they had cancelled my insurance. WHAT? I was cancelled and had no coverage at all, how can you possibly charge me for a service that you were not providing? Terrible, bad, horrible experience. I will never deal with them again and would strongly recommend others not do business with them either.

I moved to another state and needed to change my insurance provider. I went to Highmark Blue Cross Blue Shield. I spoke with the representative and he told me that they would help me. I told her all required info and told what the previous insurance covered. But it turned out that the new insurance didn’t cover lab and xray costs. But no one informed me about it before. I was shocked, because they needed to tell me about it. Suspicious and worst company ever. Post your comments.

I am writing to inform you of the ongoing difficulty I've encountered with Horizon BCBC of NJ. After ten months of numerous written correspondence and phone calls and promises to call me back, I find myself in a position where nothing has been accomplished regarding several claims from various medical providers submitted to my Horizon policy. Depending on which phone call I make to them or letters I receive from them I'm told something different. Supervisors tell me they will call me back on a predetermined day or that they will send me specific forms and I don't receive either the forms or the phone call. I've been told that Horizon requires additional documentation and questionaires from providers, and then I'm told they have received all of the necessary documents. When I call to inquire on the status of my claims I am told once again that they haven't received the documents that they told me they had previously received. Horizon has informed me that two of the questionaires they received from two different providers were returned "blank'. T've been told that the documents went to the wrong department within Horizon and sat there for thirty-four days until I called again. Each explanation requires additional time and more requests for duplicate documents. I've lost all confidence in Horizon and I don't believe that they have made a genuine effort regarding my claims. The only thing that has not been lost or sent to the wrong department is my monthly premium which is $399.49, just for me. If I took as long as Horizon, to pay my premium, they would terminate my policy. Just as they expect to be paid in a timely manner I also expect my claims to be handled ethically and fairly. I've adhered to all of Horizon's policies and specific instructions regarding only seeking medical treatment from "in-network" providers, submitting all the preadmission authorization forms and paying all of the co-pays as required in my policy. I've never encountered such delays, miscommunications, and mishandling of important documents as I have with Horizon. I believe that they are purposefully delaying their different "review" processes to intentionally stall so that I'm beyond my appeal time limit. I don't believe that horizon has diligently tried to do anything to resolve this issue. Currently, I'm receiving billing statements from different providers and they want to be paid. I've been advised by these providers that I have incurred thousands of dollars in medical expense liability due to Horizon's unwillingness to complete their "review" process. Horizon tells me to give them their provider's service phone number, evidently this doesn't accomplish anything because I still receive their statements. I'm at atotal disadvantage and have never dealt with a "reputable" company with as much difficulty as I have experienced with Horizon. I've curtailed all of my medical treatment and also the most basic annual medical tests for fear of being put through this same ordeal. For $399.49 per month I am not able to seek any type of medical treatment without fear of delays, denials, and additional medical expenses. I don't believe that Horizon has acted properly or made any effort to remedy this matter. I don't want to pay them another penny for healthcare and am looking for a "legitimate" health care insurance company because I certainly have not found this with Horizon Blue Cross Blue Shield of New Jersey.

I have account with my health provider Mercy with account number:[protected] and my
Insurance provider is Bluecross Blueshield the member-id of the same is WMW-12900337W.
I have 2 dependents that Iconsult at Mercy.
Mercy has been billing the insurance company Bluecross Blueshield for the
insurance amount from all the medical visits from 2012.Bluecross Blueshield have been rejecting all the claims from June 2012.
I have done multiple calls during this year and last year tom Mercy and Bluecross Blueshield and the
insurance team is rejecting all claims that Mercy files with them.

I work for Walmart and I have provided my name and my dependent names correct while applying insurance.
There is a inherent problem in the Bluecross Blueshield system that can hold only 15 characters for the dependents last name.
My both dependents last names are more than 15 characters long and Bluecross Blueshield keeps
Rejecting the claims mentioning the name is wrong.

Mercy has been trying the claims multiple times and Bluecross Blueshield representatives keeps on saying we never recieved the bills.

Once in the call Bluecross Blueshield associates even asked me to change the name while claiming from Mercy, but Mercy mentioned that that is illegal and refused the claim with a change in name.

After multiple call back and forth, I asked Mercy to file the claims not electronically but in the form
of hard mails and/or FAX. Mercy mentioned that they tried that option too but still the Bluecross
Blueshield is rejecting all the claims made since.

I have been paying all my health insurance bills accurately and never did fault on a single bill.

From last 2 years the Bluecross Blueshield insurance company keeps rejecting all my dependents claims
and keep on saying to me that it’s not their problem but their system problem.

As a customer I really don’t care if their system cannot hold more than 15 characters in the last
name, but I should get all my insurance amounts paid on the bills that I sent to Bluecross
Blueshield. I have provided my accurate details as per records to my company and my company mentioned that they
have my name and my dependents name correct in the system and the forms submitted to Bluecross Blueshield.

Please help me with this complain as I am tired calling the two, the health provider and the
Bluecross Blueshield to get my claims paid. All the claims are rejected for my both kids.

An investigation on behalf of all individuals who, from May 17, 2008 to the present have paid health insurance premiums for individual or small group full-service commercialhealth insurance by Blue Cross and Blue Shield was announced.

If you paid health insurance premiums from May 17, 2008 to the present for individual or small group full-service commercial health insurance by Blue Cross and Blue Shield of any of the below listed states, you have certain options and you should contact us at [protected]@healthinsuranceprobe.com or call +[protected] – 6157.

The investigation by a law firm seeks to determine whether Blue Cross and Blue Shield in the above listed states have driven up health care costs by conspiring to carve up the insurance market. More specifically, the investigation concerns whether that several state Blue Cross and Blue Shield plans through their national trade group – the Blue Cross and Blue Shield Association - have potentially agreed not to compete.
The states that could be affected include the following:
1. Alaska
2. Mississippi
3. Western Pennsylvania
4. Iowa
5. Michigan
6. Rhode Island
7. Arkansas
8. Montana
9. New Hampshire
10. Southwestern Virginia
11. Nebraska
12. Delaware
13. Hawaii
14. North Dakota
15. Illinois
16. Indiana
17. Kansas
18. Maine
19. Tennessee
20. Washington, D.C. District of Columbia
21. Maryland

Recently a purchaser who paid health insurance premiums to Blue Cross and Blue Shield of Alabama filed a lawsuit against Blue Cross and Blue Shield of Alabama and the Blue Cross and Blue Shield Association over an alleged ongoing conspiracy in violation of the Sherman Act. The plaintiff alleges that the defendants have charged inflated premiums as a result of the alleged illegal conspiracy and as a result of anticompetitive conduct it has taken in its illegal efforts to establish and maintain monopoly power throughout Alabama.

The plaintiff claims that Blue Cross and Blue Shield of Alabama is the direct result of an illegal conspiracy in which thirty-seven of the nation’s largest health insurance companies have agreed that they will not compete with Blue Cross and Blue Shield of Alabama in Alabama

According to the complaint the Defendants’ alleged illegal conspiracy has perpetuated monopoly power of Blue Cross and Blue Shield of Alabama in Alabama, which has resulted in skyrocketing premiums for enrollees in the Blue Cross and Blue Shield of Alabama for over a decade.
The U.S. Justice Department has been investigating whether a contract provisions, commonly known as “most favored nation” clauses, which ensured that Blue Cross received the best prices for health care services, in North Carolina and other states violate antitrust laws.

Those who paid health insurance premiums from May 17, 2008 to the present for individual or small group full-service commercialhealth insurance by Blue Cross and Blue Shield in the above listed states, have certain options and should contact us at [protected]@healthinsuranceprobe.com or call +[protected].

I was looking for an individual health policy for my wife, my current policy through work cost over $10, 000 per year. This is the response I got from Blue Cross Blue Shield :

From: Marc Dwiel
Sent: 09/12/12 04:46 PM
To: [protected]@.com
Subject: RE: RE: Marc with Blue Cross and Blue Shield — your Florida Blue HEALTH QUOTE-adv

Can't get individual coverage due her health. The rules will change on 1/1/2014 if Obamacare goes into effect. I suggest you keep her on your group till then.

Marc Dwiel

Florida Blue
Blue Cross Blue Shield of Florida
Toll Free: [protected]
[protected]@florida-insurance.com
to learn more about me:
http://www.ezvideobizcards.com/fl_insurance/marcdwiel/

It makes it clear that the only thing these # insurance companies care about is money, money, money!
If your not 100% healthy they want nothing to do with you, they might actually have to pay a claim!

My name is Donald Deschene [protected]) I am a small General Contractor in Little Falls NY. I currently have health insurance coverage through Blue Cross/Blue Shield. The policy costs $1371 per month. With the business climate as it is, I can no longer afford this policy. I asked BCBS to change my current policy to a similar policy offered at $800 per month. I was told that their "Senior Management" does not allow such changes at this time, but may allow such changes in the near future. I was required to provide a formal letter of request, on my letterhead, signed by me. Such a change is of no effort to them, only a little paperwork. They wouldn't even take the time to give me a formal response signed by someone in "Senior Management". I find this totally arbitrary, and obviously profit driven. These people know where I would stand on my own in the current open market, and have basically told me to pay up or do without. This is not only unfair, but outrageous to think this "Senior Management" can place such a burden on my family with no repercussions at all. All I am asking for is a cheaper policy. Please help me change their minds.

Bc/bd took 3 months to correct records that I did not have medicare and doctors complained that they were not paid.
First doctor's claim they charged me more that copay because I was 65yr old. Instead charged me copay plus 15% of plan allowance. (standard option).
Second doctor's claim they did not pay 75% as required by basic option plan. (page 22 of contract). Instead they found a way to make me pay full amout finding terms on page 53. Biopsy procedures are not covered.
Bc/bs is sneeky with 60 page exemption and conditon that get them out of paying for service even though patient has to pay high premiums.

I had health insurance with horizon blue cross blue shield of new jersey (horizon).

In network outpatient lab work was provided by laboratory corporation of america holdings (labcorp).

Due to the limitations of the policy, there was a limit of $500.00 per year for this benefit.

During october 2010, I visited my primary doctor, blood was drawn and sent to labcorp. Horizon was billed for four (4) tests - two (2) were paid in full, one was paid partially and the last was not paid. The explanation of benefits sent to me did not show the remaining balance for out patient testing.

For the partially paid test, horizon was billed at $104.00, allowed amount $20.21, paid $1.85. The last test was billed at $66.00, allowed amount $11.68, not paid.

When this first started, I offered to pay the unpaid contract amounts of $30.04 - not accepted.

I see no reason why I should pay more than five times the contract amount for a test. Also, I have not worked since january 2008 and can't afford to pay $66.00.

If you have horizon for health insurance or any other health insurance that uses labcorp as the exclusive out patient testing service, then you should look for new insurance or if employer provided ask for new insurance.

If enough of us stop using labcorp and the insurance companies that cater to this company we could put them out of business.

Provide feedback to government agencies;

Federal trade commission http://www.ftc.gov/index.shtml
Call [protected] or visit https://www.ftccomplaintassistant.gov/FTC_Wizard.aspx?Lang=en to file a complaint online.

Fbi http://www.fbi.gov/
To find a local field office http://www.fbi.gov/contact-us/field and drill down to the division to find the local office closest to you or use the online form https://tips.fbi.gov/.

Us postal inspection service https://postalinspectors.uspis.gov/forms/MailFraudComplaint.aspx or call [protected].

For nj start at http://www.state.nj.us/
In new jersey contact njdobi at
https://www16.state.nj.us/DOBI_UIC/servlet/Servlet.idxServlet?div=%27INS%27 (insurance form)

For consumer affairs download the form at http://www.nj.gov/oag/ca/ocp/ocpform.htm and mail.

For other states find the state web site or check the phone book for government listings.

If you have already posted here, contact the agencies listed above.

We filed two applications in early may 2011, one for me, the other for my wife and kids (2 year old and newborn). Bcbs of fl approved me.in late may 2011, they denied coverage for my wife because she hadn't gotten her postpartum check up. Since my wife was denied, so were my two children under her application. The insurance agent told me children wouldn’t be denied, they just had to go underwriting process, but this was not the case. They were not approved and bcbs never explained why. I tried to get the kids switched over to my application. Bcbs of fl said that all we needed was a signed letter faxed to our agent requesting for the kids to be under my policy. I signed and faxed immediately. However, after more than 2 weeks bcbs of fl told me they had given me the wrong information and a formal application and underwriting process for my two children was necessary. Consequently, we applied for my two children to be under my policy on 06/01/11. Bcbs of fl approved my 2-year old daughter after 4 weeks of following up with the insurance agent and underwriters.

My newborn isn’t approved yet (as of 07/25/11). They are still reviewing his case. They asked for his medical records and we provided them on a timely manner. Bcbs of fl needed a maximum of 15 business days for underwriting, but they have exceeded this. My son has gotten sick and we have had to come out of pocket for vaccination and doctor visits. We follow up every day but no answer.

The bad business practices of bcbs of fl are: they denied my wife and kids coverage because of no postpartum checkup but they never told us she needed one. Because she was denied, my kids were automatically denied without reason. They have taken almost 2 months to underwrite my newborn’s coverage, even though their quality control timeline has been exceeded. We have tried to get the underwriters to move our case along, and the estimated wait time has been exceeded. We would have left bcbs of fl a long time ago, but we are all under them except for my newborn.

I have a condition called lymphedema and a letter of medical necessity was written via dr. Ellen tedaldi one of temple university hospital top doctor in this city of brotherly love for a medical appliance. The letter was sent to blue cross and blue shield of center city philadelphia. The initial contact started? 2008, two years in the process. I have been seen by a physical therapist as well as a lymph therapist trying to control my condition. My leg is getting bigger and more painful, especially when I walk. I am seeking your much needed help regarding this matter as blue cross and blue shield have shut the door in my face for a product that will keep me from becoming a cripple. I have been denied my appeals for the leg appliance by the people / panel who works for blue cross and blue shield. The insurance company admits that I have lympheda but they denied my claim because my lymphedema is a different lymphedema which is ridiculous, lymphedema is lymphedema if you get burned by fire from the stove or fire from a match youare stilled burned. Legitimate denial of a medical claim is one thing but to be denied a claim by a panel of people who is paid by blue cross and blue shield (from whom I am seeking the appliance) to deny the claim is very criminal. The panel seems only exist to deny claims, I now that this is not an academic explanation but this is the cheating behavior of the insurance company I paid faithfully for the last 15 years or more, I feel cheated and raped by thir decision of denial, would you and your team of investigative reporters go to blue cross / shield and see why their denial rate of medical equiptment is so high. I am becoming a cripple fast without the appliance, my leg is painful and is slowly growing as I sit to type this email. I need some help in fighting this big insurance company. The insurance comp said that their appeal decision of denial was final, ineede three on my side please help me mr donovan

I recently visited my doctor’s office for a routine physical. The doctor took a blood sample that day. It all seemed like a very routine check and never was I informed that any out of the ordinary tests would be conducted.

Sure enough, two weeks later I get a bill from quest diagnostics charging me $215 for a vitamin d-3 test.

Why is blue cross blue shield not paying if this is a routine physical?
Why did the doctor not warn me? Why is quest charging so much? I called all of them, and everyone blames everyone else. The bottom line is, this is a huge rip-off. Beware before you take any blood test and make sure your doctor does not order any tests that will result in such outrageous fees.

I took my dog to the blue cross vet cause she was having trouble breathing the vet examined her but took no blood or x. Rays said she had a bit of chest infection so gave me antibiotics and sent her home 4 days later she was worse so we returned her to the same vet they kept her in doing tests to work out what was put down on 16th of march 2011 my complaint is if the vet had done xrays or blood work when I first briught her in would it of made a difference wouldnt she still be alive today

I should have known better, than to trust this crummy, lying, sack of a company! Before I go to see any physician, other than my primary care doc, I call this company. I don't care if it's something like a hospital procedure, or an office visit, I call to make sure that they are indeed participating providers. This time, the doc was going to be reinstated as being on his own, after he and the other docs had a falling out. So, he was going to be on his own by 10-01-10. My appt. Was on 09-23-10, so they probably had him on file, under his old practice. They told me that he was ok to see, then I get a huge bill, to me anyway, of 250.00, so I call them. The person that I have the pleasure of speaking to, listens, and says there is nothing to do, but to file an appeal, through bc/bs, and then to opm. I don't have time for this. This is just bad consumer relations. The person I talked to lied, just like they told me that a doc was participating, and was on their books. When I called to make anappt., they told me they hated the company, and do not take it.

Bc/bs have no idea what they're doing, and they have a bunch of eejits who answer phones, and those same eejits don't give a crap about what they tell people!

I hate bc/bs, and now wish i'd gone with another company. What good does it do to pay for insurance, when they lie, and get away with it. Leaving their customers holding the s — t bag?

On 2/9 bill fandrich and his challenged henchman ted marsh presided over yet another layoff in it. The purpose: structural re-alignment. The truth is that nothing has aligned since he arrived there with ol' ted at his side and nothing will align after he leaves. Bill wants for much, including image. He is a destiny man through and through, but he's empty as a baggar. The problem is that he believes his own press and has had a messiah complex since arrival. Ted simply follows him around breathing his unused oxygen. Bill=bully. Ted=bully in training. The two combined don't have an iq of 50, but they do have matching goatees! Bill, ted stop making foolsof yourselves. Everyone knew why you brough mello in and why she left abruptly. You read a deloitte report, made some changes requiring no creative thinking on your part, hired ibm, and now you're attempting to right size, but bill, please be candid with folks. You didn't leave cigna, and were that even were that not known, your value potential has reached obviousness at blue. Go home to portsmouth. Get a heart. Stop your messiah complex

Unethical practice from a not-for-profit organization

On 6/24/2010 I and the entire group of developers I work with at horizon blue cross-blue shield of new jersey were laid off from. So my 18 month contract with this large insurance company located in newark nj was cut short by about a year. They claim it was a decision made by upper management to outsource all of our work and they blam... E it on the economy. This has left us all without a job in very tough time again, when work is scarce and job are very hard to come by.

While the outsourcing will be provided by ibm, it will be done off-shore. Which means my job is going over-seas (india). And we all wonder why the "economy" is doing so bad. If we don't have jobs or the money to buy your products, we won't. And even though you take my job over-seas and pay them my salary, guess what, they won't buy your products either. Because they are over-seas and want nothing to do with your insurance and your products. So any cost savings will worthless in the long run because we are without jobs and cannot afford to buy anything from you.

This was very unfair of horizon blue-cross blue shield and ibm to do. This is the sort of work ethics that is destroying the us economy. Companies are outsourcing work to over-seas operations, which is reducing the available work from the unemployed labor force in the united states.

Hbcbs is a not-for-profit organization, which is getting tax brakes in nj for their standings. These are very unfair practices, to send work, and pay, to overseas operation instead of hiring from the unemployed labor force in the us at a time where jobs are scarce at is it.

I also blame ibm for providing this cheap labor at the cost of us citizens not being hired at a time where jobs are scarce as it is. All for cutting costs.

Especially when 3.5+ million was paid out this year to the hbcbs ceo. (articles below)

Obscene bonus for blue cross ceo | gather
http://www.gather.com/viewArticle.action?articleId=281474977179843

Blue cross ceo's pay rose 26% - the boston globe
http://www.boston.com/business/healthcare/articles/2009/02/28/blue_cross_ceos_pay_rose_26/

So again I am out of work. This is the 3rd time this has happened to me in 2 years of being back from florida. I moved back to the ne because of the bad job market in florida at the time, only to find that the job market in the ne is just as bad.

Empire bluecross blueshield is the worst insurance provider I have ever had. My employer (a very large health care organization) reports that they pay over $ 13, 000 on insurance coverage for each employee every year. For this amount, I would assume that I would be provided with comprehensive health insurance. That is not the case. The empire bluecross blueshield plan recently became a pos - I have had intense pain in my lower back and lt leg for the past 4 months. The pain is disabling and has sent me to the emergency room three different times. My doctor has been trying to order a mri of my spine. Empire bluecross blueshield has denied covering the mri three times now. I'm not sure what they expect me to do. [protected]@#! Them. I will now go to the urgent care center every day until they agree to pay for my mri. Let them be billed for that.

I have had bluecross blueshield for over 2 years. I had my wife on the policy and they never paid a claim on her by saying everything was preexisting after a year I had her taken off because why pay for something that don't work. Last year I had a surgery and they wouldn't pay for that I had it to end up on my credit report and this has runt my credit, I had to get legal with a lot of money to get them to pay it. So after 7 months they paid part of it and it is still on my credit.in fact there is 7 things on my credit now that is blue cross blue shield but my company still pulls their money out of my check every week. So when people have to file bankruptcy on medical bills this is the reason for it. I hope they will read this and feel ashamed for their actions, but my luck they would set up there and see what I wrote and think well I shafted another one.