SiCKO - The Official Site - In Theaters June 29th

Blue Cross ( )

94 Comments

Rob Says:
May 27th, 2007 at 4:04 pm
All health insurance companies are greedy. They do not value human life and dignity, only money. People who works in the health care insurance industry and health care services sold out their humanity.
B Buckmann, MD Says:
May 27th, 2007 at 10:37 pm
I work in a hospital…as a doctor. One day, I developed stroke-like symptoms which, thankfully, turned out to be nothing. I went directly to the emergency room and received a complete medical work-up including a CT scan.
When the claim was submitted to Blue Cross, it was denied because I did not call for pre-approval and (since the work-up was negative) it was not an emergency.
The claims representative was telling me, the doctor, that it was not an emergency….STROKE-LIKE symptoms.
They also told me that I should have gone to the ER across town as it was in-network. Do not seek immediate medical attention….GO TO THE ER ACROSS TOWN.
They never paid….and this is precisely what they bank on: there’s a certain percentage of people that will not sue, will not follow-up and file complaints but will go away. If one does get a lawyer and press the matter, its no big loss to them, they just pay what they should have only much, much later and theit money at least got to collect interest for them a while longer. Not a lot of interest….but when you multiply that interest by all the thousands of claims they deny, it’s a lot of money and, besides, you’ll probably just give up and pay the bill yourself anyway.
Mr. Moore has it exaclty right: It’s a racket.
Pandora King Says:
May 28th, 2007 at 10:57 am
Hopefully, in 2008, when we get a Deomocrat in, we’ll see a big change.
Brian Kortmeyer Says:
May 29th, 2007 at 3:51 am
Howdy all. I am a huge M. Moore fan, and love all (and have seen!) of his past works. However, my experience with Health Insurance has been mostly positive. However, without that insurance I would most likely be dead by now. Overall in my life, I have had more operations and health issues than most common people over 100! And I’m not kidding. I am only 32!

I have had the following:

30+ Sinus Infections including each case of Anti-Biotics to go with it
1 Spinctorodomy (Not for the weak minded)
1 Tonsilectomy (Killer painful!)
Asthema Since a young child
1 Broken Nose
1 Nose Surgery and Punch Through with Sinus Palup Removal
Constant Steroids for the Asthema and also Eye conditions which have now caused extreme Far Sightedness with Acute Astigmastism.
Dislexia (Which Health Insurance won’t cover!)

Ah yes. Life on Earth. Thank Goodness the 4th Pole Shift is on its way. Only 5 years to go folks. I am looking forward to Heaven, and that enough said for me.

Peace be with you all and love you Mike, You Rule.

Brian Kortmeyer
Palm Springs, CA
Watts Says:
May 30th, 2007 at 3:19 pm
I recently rode out the end of a COBRA plan from when a previous employer had been bought. When applying for a new policy with Blue Cross, the underwriters categorized me as “high risk, uninsurable” because of the following found in my medical records:

Allergies treated by Rhinocort
Indigestion treated by Famotadine
Patient admitted to marijuana use

The Rhinocort had not been prescribed or used for years as shown on my records, the marijuana was one of those profile things that I circled when I started with the doctor 10 years ago and Famotidine is just Pepcid, but the doctor thought that he would save me a few dollars by prescribing it instead of having me buy it over the counter.

So, instead of the PPO plan that I had submitted my application for, Blue Cross has entered me into a different program with a monthly cost of almost $500 for crappy coverage! I am a 42 year old, self employed male, in perfect health. No history of severe illness and the doctors always say that my numbers and vitals are that of someone half of my age. Yet the United State’s largest insurance company rates me as “uninsurable” through a basic plan.

When I submitted that application, it never even crossed my mind that there was going to be a problem. I just expected my coverage package and first bill in the mail. Most people are insured through their employers and do not go through the personal plan application process, but if you ever find yourself in that position, then you realize just how screwed Americans are by these insurance companies. The “Uninsurable American” was always a person that I felt that I was fighting for. I pictured somebody of unfortunate circumstance and bad health who we let slip through the cracks of our society. I now wake up each morning and see in the mirror that the “Uninsurable American” is me.
Doug M. Says:
June 1st, 2007 at 1:16 pm
I’ve had a nightmare dealing with Empire Blue Cross. I received services from an out-of-network provider believing that Empire would cover a portion of my 3k bill only to have them deny coverage in its entirety. This is completely outrageous — I told them that all I wanted in return was whatever sum they would have provided the in-network provider whether it is $20 or $100. The response I got from the representative was almost gleeful: “nope, no can do.” I am now faced with the decision to continue these services at my financial peril or discontinue them at the risk of endangering my health.
Dean Moriarty Says:
June 2nd, 2007 at 2:00 am
Wife has a strong family history of breast cancer. That is, both grandmothers and one great-grandmother DIED of it, and her mother had a mastectomy in her 30s. She was 28, and had a mammogram. Denied by insurance. Despite the fact that her doctor prescribed it, the BCBS assholios said “not medically necessary.” I called them and asked them if they would rather have paid for the entire cancer treatment in a few years, and if course they demurred. Thank God she’s ok, but we’re out a few thousand dollars at this point. Money well spent, but it woud have been better spent in our kids’ college fund.

Fark the insurance companies. Lord knows I hope we catch and kill OSama bin Laden, but if not, we can only hope he catches as many fatcat insurance execs as possible in the next 9-11
Itchy N'scratchy Says:
June 3rd, 2007 at 9:49 am
When my doctor prescribed me new alergy medication the phamacy would not fill it because it required approval form Bluecros (Bluecross wanted proofthat over the counter meds would not work). In the meantime I went golfing and broke out in hives. Good thing I paid my premium that month.
MIA Says:
June 3rd, 2007 at 5:01 pm
Anthem BC/BS….
Denied medically necessary treatment for my daughter. Backlash caused me into a BK 7. losing everything, including our home! Also, the lack of child psychiatrists in the Cleveland area was at fault here. They had very few to non-existant contracts…many that were listed had 6m to 1 year wait lists or just not even taking new patients.
My beautiful daughter has mental illness which required treatment…DUH!
Would only cover 30 days a year in a hospital. If she had cancer, unlimited days in a hospital.
Had a long history of suicide attempts, yet the insurance company admitted by letter that hospitalization was medically necessary, but this letter is no guarantee of payment. WTF???
I as a single parent did everything humanly possible to save my daughter. I lost everything in the process.
The government had to take my daughter and place her in a hospital at their expense as I had no money to do so as she was and still is ill. Yes, I pay child support to the government for that.
I still pay insurance thru my paycheck for Anthem BC/BS yet my daughter receives no care from them.
On the flip side, if my daughter had a “physical” illness she would have all the treatment necessary.
Insurance companies treat people with mental illness as something lower than pond scum. They get away with it. The Ohio Dept of Insurance did NOTHING to help my daughter.
I would have given up my life to save my daughter, what parent wouldn’t?
So in the meanwhile, we have no home, (living in crappy apartment, because my credit was destroyed) no savings, (treatment took everything) and no credit. Yea, right, who will trust me?
I would have done anything to save my daughter. And, BTW, guess who made out like a bandit at the expense of my beautiful daughter..you guessed it. Anthem BC/BS.
So after reading this TRUE story, go hug your kids and thank the almighty that they are well!
Nick Says:
June 3rd, 2007 at 10:52 pm
blue devil

greetings from a muggy & overcast boston, ma.

this is day 8 of my 12 day vacation from berkeley. during the last two days i’ve been in boston, and i haven’t done too much since i’ve been here….just spending quality time with my friend matt and his wife bonnie.

unfortunately, while allegedly on vacation, i spent approximately 5.5 hours of my day trying to sort out a mess that blue cross…um, i mean blue devil…eventually conceded was their fault.

today, i attempted to purchase refills of my insulin and diabetic test strips. however, as i was unloading items from my shopping cart, my friend matt, who also happens to be an internal medicine doctor, noticed that the checkout register read $450.00+. i was shocked. the pharmacy clerk then stated that my prescriptions weren’t paid by my insurance.

so, try to follow this….

i have two insurances from my work: (1) blue cross and (2) ben-elect

blue cross will cover my prescriptions and medical visits once I’ve accumlated $2,000.00 in medical expenses within a calendar year.

ben-elect will cover my medical expenses until i’ve met my $2,000 blue devil deductible. once this deductible has been satisfied, ben-elect will reject any further claims.

so, according to ben-elect, they have actually overpaid my medical claims this year….they’ve paid out $2,300.00.

this afternoon, interestingly, blue devil stated that i had only accumulated $1,700.00 of medical expenses this year.

why is there a $300.00 discrepancy?

ben-elect told me that i met my deductible on march 7, 2007; as of may 31, blue cross still thinks i haven’t met my deductible.

with the help of folks from ben-elect, i obtained the claim number of the actual bill that brought me over the $2,000 deductible threshold. i informed blue devil of this claim, and they conceded that they hadn’t gotten around to updating my claims record.

if my claims records had been updated in a timely manner (say, like three months ago!!!), this drama wouldn’t have unfolded while attempting to enjoy a vacation.

opps! (i wonder why blue devil took so long to acknowledge i met their high deductible of $2,000?)

after a 5.5 hour back and forth, cross-country exchange between the a pharmacy in boston, my primary pharmacy in berkeley, blue devil, ben-elect, the benefits adminstrator at my work, and myself, i was finally able to pick-up my medicine at 8:30pm EST.

here’s the best part of this frustrating day….

while i was finally picking up my meds, my doctor friend matt felt compelled to give blue devil a peice of his mind.

he pretended that he was me while talking to a blue devil represenative over the phone. he stated that because i was unable to get my insulin in a timely manner, i was having symptoms of hyperglycemia and ketoacidosis.

posing as me, my friend asked if i could get a pre-authorization to visit an emergency room and (since i was apparently too sick to drive) an ambulance. blue cross said yes, even though this would cost at least $1,600 for an ER visit (and an ambulance drive would add significantly more costs).

finally, matt drove home his main point, and said to blue devil “you’re able to pay for an ambulance and ER visit that would cost a few thousand dollars without any question or hesitation, yet you’re unable to allow me to prompty obtain medicine that costs $300.00?”the representative again said yes.

what a crazy world we live in….
Matt Says:
June 4th, 2007 at 3:19 pm
B Buckman MD is exactly right. Many insurers will simply deny claims because they know that enough people won’t follow up or fight back, which increases their bottom line.

Here’s the amazing thing about pre-certification: even if you are in a position to put a call in to the insurer requesting pre-certification of a medical procedure, you might get approval for the procedure and then the insurer WILL STILL DENY COVERAGE! The reason given for this? The insurer was only certifying or authorizing that the procedure was “medically necessary,” not that coverage would be provided or that there would be benefits. So, for the insurers, it’s “heads they win, tails you lose.” If you don’t get pre-certified, your claim is denied, but even if you do get pre-certified, your claim can still be denied.

So, whenever you call to get pre-certified, make sure you verify coverage for the procedure. You can bet the insurers are doing this from the moment they get your call.
Patrice Says:
June 4th, 2007 at 3:48 pm
When my wife was pregnant (5 months) I called my insurance to find out how much it would cost us. I’m from France so I guess I’m not used to asking doctors how much their treatment will cost. Anyway, we have a PPO and we pay about 30% of what’s left to pay. I called the insurance company that couldn’t tell me anything until they get the tax ID from the hospital. I called the hostpital and got the tax ID eventhough the billing department was reluctant to give it to me. I called back my insurance with the tax ID number but they needed a procedure ID. I called the hospital who told me that it would depend on the procedure (of course - I totally understand - so I asked her to give me a regular procedure ID code for a vaginal delivery without any problem and with epidural). She said that she could not give me any code. Called back the insurance who could not give me any detail without a procedure code. So I finally asked the insurance person to hold the line and I did a conference call with the billing department at the hospital and the insurance company. They could not give me a better range for the cost than between $4000 to $60K.
The only thing that was clear is that I had a premium and that it could go up to that premium.
my premium is $6K. So I tried to find out if it would be close to $0 or close to $6K and no one could tell me anything.
I then explained (joked) that I had to plan to save money in one case and not in the other case if they wanted to get paid. That didn’t help.
Julie Says:
June 4th, 2007 at 8:27 pm
I got a toenail infection and was informed by my PCP that BlueCross BlueShield does not cover any medication for it (not even a generic). The generic my PCP wanted to prescribe, Diflucan, is only covered for people having recurrent vaginal infections. Not even Lamisil (all over the TV and is recommended to have liver testing when taken) is covered. The generic cost me $30 a pill. Thanks BCBS!
Jen Says:
June 4th, 2007 at 8:40 pm
Hi.

I understand the dillemma of health insurance these days, but I would not say that just because someone is a health insurance agent that they are “selling their souls” as a previous person wrote. I am an insurance agent for Blue Cross Blue Shield. I always tell people to please read the policy before they sign and anyone with diabetes, heart attacks, and cancer would not be covered. It is unfortunate, but these people need to seek other health coverage.

THIS DILEMMA IS DUE TO NON_GOVERNMENT INTERVENTION TO HELP THE RATES NOT THE INSURANCE COMPANY!!!! So next time you want to throw stones, you better not live in a glass house. You have a job just like me to do and most people are very thankful when they buy coverage and they have something happen CATASTROPHIC. Think about it, if you had no coverage, then what? Lose your house?? and cars and assets?? Now that would be smart.

I am not agreeing that the rates are not high, but since the government offers no other plans, this is what we must do, pay higher rates if we have pre -existing conditions or lapse in coverage.

That’s AMERICA. GOD BLESS THE USA!!!!!!!!!!!
Jen Says:
June 4th, 2007 at 8:41 pm
julie try CANADAPHARMACY.COM.
Jonathan Says:
June 6th, 2007 at 10:40 pm
I turned 21 and was dropped from my parents insurance plan (on which I rarely made a claim more than once every couple of years) and was in the process of getting insurance under my own name. This process took one month, but during that time I had paid my local emergency room a visit with a case of appendicitis. I was not covered and paid for this out of my pocket, no insurance was awarded. I had the hardest time getting the insurance company to issue me a policy after that because apparently I was now a “high risk for re-injury.” It took letters from my family doctor, the surgeon who operated on me and my insurance representative for the last 21 years of my life to convince them that I only had one appendix. The sad truth is that the letter from my insurance contact probably carried more clout at Blue Cross than the letters from my doctors. Things need to change. God Bless You All!!
Victor Says:
June 6th, 2007 at 11:03 pm
We no longer have health care ,we have health inc.
There is no care,just greed.I to suffer from these greedy bums milking our health system.Sb 840 is the best chance we have in California to cut Enron jr. from screwing us too.Please pass the word,
onecarenow.org
Join the fight to get our care back in the health system
Marsha V. Hammond, PhD: Licensed Psychologist, NC Says:
June 6th, 2007 at 11:58 pm
Marsha V. Hammond, PhD: Licensed Psychologist, NC

My family has BCBS. For $600.00 + dollars/ month, I mostly get catostrophic coverage, some cheaper meds, office visits which I mostly do not neet, and a $2500.00/ yr deductible for any surgeries needed/ family member.

I figure BCBS is making $5500.00 off of me and my family. With millions of dollars in assets, it would be nice to see ANY other ‘non-profit’ giving them some competition.
Angela Says:
June 7th, 2007 at 10:28 am
I am a married woman, whos husband is self employed. Which mean our insurance SUCKS!

Dec 2006 I found out I was pregnant (a welcomed surprize), I called my doc (as normal procedure), after the first appointment & much paper work later I come to find out that my pregnancy is NOT COVERED!!! According to BC/BS you MUST plan your conception, apply for the maternity rider plan, THEN get pregnant — all the while you are trying to concieve you are paying the insurance company per month as if you are pregnant.

I suppose I am one of the lucky woman, sneeze on me & I’m knocked up What about those women that it takes months/years to get pregnant? … as if trying to get pregnant itsnt stress enough (so I hear).

Long story short we paid for my docs visit, hopsital procdures & every prenatal vitamin OUT OF POCKET! $8000 & 10 months later we finally paid it off!

Not to forget my sinus infection last month…. $225 dollars for my meds. Only $25 covered by my insurance company!!

BLUE CROSS/BLUE SHIELD KISS MY A$$
Angela Says:
June 7th, 2007 at 10:47 am
Let me also add…..

Baby #1 - not married & 20 years old - the government paid for this child through medicaid.

Baby #2 - planned pregnancy, had BC/BS through my employer. Child only cost us $200.

Baby #3 - unplanned pregnancy, insurance with BC/BS self employed. Child costs us $8000
Michelle Says:
June 7th, 2007 at 1:38 pm
I had COBRA for six months after I got out of college and was looking for a job. It ended up costing me 6000 dollars!!!! While in school I had to go to the OBGYN because I was having my period for thirty-forty days at a time. At no point was a diagnosis ever given, and instead they just took me off birth control in the hopes that it would resolve. Well, shortly after getting out of school, i had the OPPOSITE thing happen and I wasn’t getting my period at all. I went back to the doctor (this time under COBRA) and again, no diagnosis was given, but they performed an ultrasound as well as a saline infusion sonogram. Well, a month later I get a STACK of bills in the mail in total of 6000 dollars. I contacted COBRA and they stated that because I had gone to the doctor for the same set of symptoms within the past five years they were considering it a pre-existing condition. Same set of symptoms?!?!?!? One time I had my period for forty days, the next I don’t get my period at all for three months. Sounds like the complete opposite thing to me? Well, I later found out that they considered it the “same condition” because both were undiagnosed menstrual problems. So does that mean that if I had done even more tests and tehy had figured out what was wrong they would have paid for it??? Anyways, this was two years ago, and I am still trying to pay off the debt….
Kristi Says:
June 7th, 2007 at 9:54 pm
I especially tuned in to what the ER doc wrote about his experience. Yes - the insurance companies hope you will not complain, sue, or otherwise try to get a fair deal. I have had BCBS on and off most of my life, but after an experience with them last year - NEVER AGAIN. I’d rather be uninsured. I had a routine female exam with pap smear, all results normal. Imagine my shock when I received the FULL BILL from my doc - after insurance had allegedly paid! I am a nerd (as well as an English professor), so I do read ALL of the materials sent to me by insurance. Thus, I knew they owed me. I offered to send BCBS a copy of my policy (which they claimed did not cover “special exams” like paps). I told them it wasn’t my policy I was looking at - it was the FOURTEEN PAGE rider attached, and which clearly stated “one free gynecological exam per year” (along with a litany of other supposed benefits). My name and policy number were clearly indicated all over said rider. Guess what BCBS told me? That the rider had been sent to me in error. Fourteen pages sent to me “by mistake”? Not a chance. I held their feet to the fire. They eventually paid my doc, whom I then had to hold to the fire. Nine months later, I received my reimbursement and promptly canceled my policy. Health care, my foot. It’s more like “wealth care” - their own, that is.
Kim Symonds Says:
June 8th, 2007 at 6:58 pm
My son was born in January with a congenital heart defect called Hypoplastic left heart syndrome. Unlike most of the stories here, BCBS of NC has treated us wonderfully! They even assigned a health coach to follow my baby and make sure that he gets the services, equipment, medication, etc that he needs…. However, this IS a private insurance policy that we pay a substantial amount for and not some random group policy through an employer. My baby was born on 1-3-07 and we had met out maximum out of pocket for the year on 1-8-07. Nonetheless, we would financially bankrupt if not for this company.
Another citizen Says:
June 9th, 2007 at 12:23 am
BTW folks.

Have you seen the numbers these companies are posting in PROFIT…. not income…. Pure PROFIT??

Then look at their CEO salaries and Board of Director perks. They managed to get John Q Public to believe that “those greedy doctors” are robbing the healthcare system… when all along it’s been them with their hand in the cookie jar.

As more and more smaller hospitals close because they can’t afford to stay open — and more and more docs bail out of medicine to less stressful and more lucrative work elsewhere. Good Luck Getting ANY decent care ANYWHERE.

Our government has put the wolf in charge of the henhouse.
Jan Brown, II Says:
June 9th, 2007 at 12:13 pm
I am a BCBS member and a third-year medical student. I am at risk for a heritable condition called “hypertrophic cardiomyopathy”, and was scheduled to receive an echocardiogram as a screening test. The hospital called BCBS ahead of time (as is it’s policy) to get approval before scheduling the procedure. I was approved and the procedure was scheduled. I then later got a bill for the full costs, and was told that the procedure wasn’t covered by my policy. What BCBS forgot was this; THE HOSPITAL WON’T EVEN SCHEDULE A PROCEDURE WITHOUT PRIOR APPROVAL FROM THE INSURANCE COMPANY. They’re just not too bright when it comes to out-and-out theft.
Matt Says:
June 9th, 2007 at 8:26 pm
I had appendicitis and subsequently an abdominal infection. There was no problem in them paying their part, and we only got saddled with about one thousand out of the ten thousand dollar bill.

I’m pleased with blue cross in all my experiences.
Richie Taylor Says:
June 10th, 2007 at 3:08 am
My brother went to drug rehab last year, it has saved his life. However our Blue Cross PPO is still refusing to pay even a percentage of the costs because it wasn’t billed with the correct code by the treatment facility. The facility rebilled Blue Cross with the requested codes and they found something else to nitpick in order to refuse payment. Why have insurance if they won’t pay their promised portion? Would I be allowed to tell them that I wasn’t going to pay my required portion? No, they would send me to a collection agency and maybe sue me.
AR Says:
June 10th, 2007 at 10:07 pm
I can’t really say that my insurer has jerked me around as far as meeting their terms, but in 7 years my insurance rates have gone from 83 dollars a month to 211. As a healthy person still in their 30’s, there is no otehr reason for this than pure profit. I don’t get more, I just pay far more.

The reality is, we have a huge healthcre system becuase of the tax dollars that we as taxpayers pay. Not private insurance companies. All health insurance companies are is gatekeepers. They provide NOTHING, but access to the very health care system we have already built with our tax dollars. The only people who have instant access are the millions of illegal aliens who complain they have nothing, and their employers profit off of it.

Its time all Americans have equal access to the socialized health care system they have, without private gate keepers taking a cut for…nothing.
Wes Smith Says:
June 11th, 2007 at 12:45 pm
I don’t get twisted about much. I can ditto a couple of these comments. I was at the Seattle airport around midnight getting ready to fly back to NYC when I realized I had an alergic reaction to something. My lips and face began to tighten and swell. I opted not to fly and instead take a taxi to Northeastern ER. Good thing, by the time I got there i looked like hitch. The ER was great, took my insurance card, rushed me in, etc… so I give those workers all the credit. They juiced me up with some anti inflamatory and grounded me for two days at a hotel taking a prescription.

Several months later, battling the $500 with BCBS over not having pre-approval for the ER visit, they finally relented when I got to speak with a manager and threatened to pull my entire payroll off their service. Even still, I was required to provide them with all my correspondence with NW trying to clear the matter over the previous months. I probably spent 20 to 30 hrs getting this straight. I talked to some of the attendants so much I’m sure they were tired of it. How can this be efficient or profitable for anyone….?

I have had several other problems not to mention high costs to SMB’s, and we are now moving our employees plan off of BCBS, at our staffs request. The worst part is i realized the other day I have come to think it’s better to postpone regular checkups, dental, etc…knowing I might have to pay out of pocket…because I am more put off by the red tape and potential cost liability than the health issues…Clearly not the best idea, I hope the next one works better.
SuperJ Says:
June 11th, 2007 at 10:28 pm
Though it is easy to blame the doctors, insurance companys and government for the condition of our healthcare system today, we must take the challenge to look at our own contributions. Everytime you puff a cigarette, eat a dougnut, watch tv, stress out at work, snowboard down the mountain, speed while driving, bake in the sun, … the list goes on, you are in effect taking down the healthcare organization. As a community we need to take charge of our own health before we see transformation. So, if you are looking for the true answer of transforming healthcare, take a look at your choices, practice healthly living, be informed about your healthcare, and spread the word!
Carole Says:
June 12th, 2007 at 12:15 pm
Everytime I submit a claim to BC/BS I have to call to see if it is being processed. They say it takes about 3 weeks but I usually call after waiting 6 weeks. One occasion a I waited 9 months for a claim to be settled then the check was sent to the wrong address not once but 3 times. All kinds of excuses were given. I think insurances companies want paid but they don’t want to pay. They float money as long as they can and pay as little as possible.
Jake Says:
June 12th, 2007 at 2:06 pm
GEHA

My 15 month old daughter has been in and out of the hospital 3 times over her short life. The most recent trip was for a battery of tests to investigate a chronic cough. I received a bill for the entire procedure, when I should only pay 30%. This certainly isn’t the first time it has happened either. I had to call them and explain to them what their benefits should cover. After receiving a “we thought it was a duplicate billing” explanation, I received my benefits. No call to me or the hospital to clarify the possible duplicate bill. Their first and only policy is to DENY!, DENY! DENY! They assume most folks won’t take the time to actually mess with the problem and pay them.
julie Says:
June 12th, 2007 at 3:29 pm
I have nver had a problem with Blue Cross. They have always covered 100% of evertything & have never tried to weisel their way out of paying anything. I also think it depends on your plan, but I really cant complain.
Dean Farley Says:
June 13th, 2007 at 10:21 am
One day, I had stroke-like symptoms which, thankfully, turned out to be nothing. I went directly to the urget care in my northern michigan town and they started treatment, but they need to transfer me to the hospital across town. Later this year I received a bill for $800 from the ambulance company for the transfer. It was stated in the a letter, that the transfer was not covered by the BC/BS.
Denise N Says:
June 13th, 2007 at 12:26 pm
BCBSMA basically denies every single claim. Then you call, talk to a claims rep and it gets approved. Meanwhile the doctor has to wait another 90 days for the payment. SO from claim submission to actual payment can be right around 180 days. I have unlimited chiropractic care that has been “limited”. According to BCBSMA its unlimited treatments but the doctor has to provide a starting date and end date (at the beginning of the treatment) otherwise they deny all the claims. How is that unlimited chiropractic care?
Brodie Says:
June 13th, 2007 at 1:04 pm
Looking at the American health care industry (so weird that it should be called an industry) I feel really lucky to be Canadian and it makes me appreciate our health care. I truely believe that being the riches country in the world, the US should try to adopt a similar health care system. Health care should be a basic right that every individual should have. Focusing on keeping the American people healthy and alive should probably be the top priority rather than putting all the countries resources and effort into fighting “Terror” and securing oil. I feel bad that your administration doesn’t seem to value human life as it should. I know it is a harsh statement to make, but reality is harsh sometimes. I do hope the best for the American people, I just think they need to wake up to what is going on around them. You keep doing what you’re Mr. Moore and help wake the people up.
Joanna Says:
June 13th, 2007 at 4:11 pm
I am a Canadian citizen but permanent resident of the US living in San Diego pregnant with my first child. Although I work for a large company and have a premium PPO, I am truly disgusted by the medical system here. I just don’t understand why people don’t get why the Canadian health care system works. Good medical care shouldn’t only be for the rich.
smitty Says:
June 14th, 2007 at 1:04 pm
Blue Cross stinks. They insist on assigning a “primary care provider” or “PCP” (huh huh) and then can’t get it right. They mail me three and four duplicates of my insurance card, each one with a PCP that’s, like, 40 miles away and in another state. Doesn’t exactly inspire confidence, does it?
Marilyn Says:
June 14th, 2007 at 6:16 pm
After ten year working in a surgeon’s office as a patient advocate, I learned the business of every insurance company is to grow the business. It has nothing to do with health, it’s about WEALTH!

I battled each day on behalf of patients, to obtain the benefits they were clearly entitled to and keep the doctor working. What a joy it was for the patient when we obtained permission for a procedure and how devistating, when denied. If insurance did pay, it wasn’t enough. Patients spent thousands out of their own pockets and those who couldn’t afford their share, went without care.

The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance.

With two common pre-existing conditions, I can’t afford U.S. healthcare. To protect my health and my wealth, I’m moving to Mexico, where in general, health care is very good, and in many places, excellent. Most doctors and dentists in Mexico receive at least part of their training in the U.S. (And many U.S. doctors have trained in Mexico, notably in Guadalajara.) Many Drs. continue to go to the U.S. or Europe for ongoing training.

Costs on average, a doctor -specialists included-will cost 250 to 300 pesos (about $25). A house call is about the same. Lab tests cost about a third of what they cost in the U.S., and a CAT scan often costs about 25% less . An overnight stay in a private hospital room costs about 350 pesos ($35). A visit to a dentist for cleaning costs about 200 pesos ($20).
Adios Amigos!
Will Says:
June 14th, 2007 at 7:15 pm
We have had Empire Blue Cross for Health Insurance for 6 years. Nearly every claim is denied routinely for one reason or another. My son had bilateral hip surgery, they reduced the surgeons fees from $17,000 to $2000. CEO makes $20M plus. The system is SICKO, the cutthroat way they treat their policyholders is nothing short of criminal. I would love to be one of the 50 M uninsured, because my premiums are not going to my family’s health care., It is going into the pockets of these creepy MBA’s
TC Says:
June 15th, 2007 at 6:38 pm
BCBSSC brags about sitting on over 1 billion dollars of cash reserves for their non-profit sector. The company makes huge proffits off of U.S. tax payers by providing the computing and data storage for Medicare/Medicaid and TRICARE. They keep their costs low by hiring contractors who are not even eligable for the the BCBSSC private health insurance. They force their workers to work in ghetto offices. They teach classes on how to deny claims.
Patty P Says:
June 15th, 2007 at 11:21 pm
I work in the healthcare field and am quite familiar with BC and health insurance in general. I have good reason to believe that the minute the insurer receives a claim, they begin to find a reason not to pay it! A previous poster said “nitpick” and that is a good description. They have many employees dedicated to nitpicking until the insured gives up.
Beau Says:
June 16th, 2007 at 2:21 am
As a practice admistrator of a large oncology practice in Southern California, we are realing from the continued cuts in reimbursment, or flat out denials of chemotherapy treatments for our patients, even with prior approvals. What few patients understand is that physicians routinely engage in insurance contracts with payors so that they may treat their patients. What a physician charges for a procedure is NEVeR what they are paid, in fact they are paid as little as 33% of charges which do not usually meet their expenses.

In Oncology, the drugs are the biggest expense and with the most recent Blue Cross cuts in reimbursment, it does not cover the cost of the drug the physician pays for. The insurance will also not pay for all the other services provided such as infusion, hydration, medication for anemia,nasea etc. as they bundle it into the initial payment.

With the saturation of Blue Cross/Blue Shield as the primary insurance in our area, they have now taken to extortive tactics in imposing a blanket reductions of nearly 17% below what Medicare pays. When contacting BC to express that we aren’t able to meet our expenses with these cuts, their response is ” take it or leave it. there are other physicians who will be happy to take your patients!!” At present the practice sits on over 1.5 million dollors in drug costs.( that we have already paid for) for Blue Cross patients that have been denied and very little recourse for reimbursment.

When I entered healthcare nearly 10 years ago, I too believed that physicians and hospitals where the reason healthcare expenses where out of control. However, what I have discovered is that hospital routinely loose money because they must(required by law EMTALA laws) treat the uninsured, underinsured, accept healthcare contracts from the insurance companies that barely cover their expenses. Physicians earn less than a mortgage banker, real estate agent or insurance broker. After nearly 12 additional years of education and extensive debt, astronomical malpractice expenses, they are lucky to get their heads above water before they are 40. All the while, the true bloodsuckers of healthcare are the pharmacueticals, suppliers to healthcare and the insurance companies.

I can only hope that Sicko will begin to truley unravel how we are all hostages of the insurance industry. They are feeding on our health fears and selling our souls to the investers. Parent company of Blue Cross is Wellpoint, look them up on the stock exchange!!
henry bless Says:
June 16th, 2007 at 5:27 pm
blue cross made me singing the blues….raising my premium in the llast five years ten times….cause i reached half century old…had been with them since 25years ago…
i cut my coverage from full covered, to 500deductible, to 1000deductible, to 2500 deductible to plain basis hospitalization only.
henry bless Says:
June 16th, 2007 at 5:30 pm
anyone think of COOPERATIVE HEALTH INSURANCE SYSTEM -own by insurers and doctors and hospital, like in farming, or in credit union?
Evil Aunt Mel Says:
June 17th, 2007 at 1:56 am
I hope our Guvenator in Kalifornia gets us to have mandatory health insurance. God bless him for his pilot program he is doing for universal healthcare across the state.

I don’t agree with Michael Moore on everything he says/writes/produces.

But I have to say from what I have seen of this movie, he is winning me over to the dark side.

I am a born-again Christian who voted for Bush 2 times. And a registered Republican.

And I am so sad at the state of our healthcare system.

I rejoice my Guvenator is doing something about it.

Dang it, this country needs a change!

I have an HMO from Blue Cross Blue Shield that only now is a pretty good deal since I go through a brokerage (my company is one of many companies this well-known brokerage for Human Resources uses). I have PCOS, a condition that costs money. Already, I am on diabetec medication to prevent diabetes. I pay 30.00USD for avandamet for my copay. My valium for my dental procedure was $10.00 for 4 pills I think. But I find it interesting the prescription mouthwash I was given to prevent infection was not covered, I payed the full $20.00 for that. Go figure.

Michael, this film was needed. Thank you for this in advance before it comes out.
Julie W. Says:
June 18th, 2007 at 9:20 am
My husband has been a type one diabetic for six years. He was let go from his job but luckily was able to find another job right away but like most employers, we had to wait 90 days for insurance. We the insurance finally became active, we were sent a letter that his medical condition (diabetes)is a pre-existing condition and that any claims filed with them in regards to his diabetes would not be covered for 13 months. My husband pays $300 a week for our insurance & for them to not cover his claims is absolutely insane! We have a hard enough time with all of our other medical bills, we cannot afford to pay a $200 office visit and $500 worth of labs every two months. Luckily, he has a primary care physician that understands that insurance companies are unfair and refills his medications without seeing him, which we both know is not healthy, but we cannot afford that kind of expense out of our pockets.
Torbin Says:
June 18th, 2007 at 10:29 am
I don’t like having to pay 3-4 different co-pays for just one problem. Case in point I have an abnormal growth on the base of my neck which I guessed was a cyst so I went to my doctor(1) co-pay. He examined me (I was correct) and sent me to get x-ray (2nd co-pay) Then I has to go back (3rd co-pay) just so he could send me to a surgen (4th co-pay). Let’s just say I couldn’t take off work that many times and I’m yet to get the bump removed that is near my spine on my neck.
What a racket!! Just to go thru a simple procedure.
RD Says:
June 18th, 2007 at 10:34 am
I have Health Options, a BC/BS HMO in Florida. Although the group coverage I have is expensive (to me), they have been great about covering all expenses. My husband was diagnosed with MS a few years ago and they have not denied one thing the doctor has recommended or prescribed. Do I wish the coverage was cheaper? yes.. but how can I complain when the medication he takes is more than twice what I pay for coverage?
Sharon Says:
June 18th, 2007 at 2:16 pm
The stories I’ve read on this website have shocked me. I’n glad things are arranged differently in The Netherlands.
I can’t wait to see Sicko. It’s a pitty that I’ll have to wait untill oktober. That’s when it will be shown in The Netherlands.
Loved the other Michael Moore films!

Good luck everybody!
Grtz Sharon
Heather Trahan Says:
June 18th, 2007 at 2:47 pm
In December 2005, my daughter had tubes placed in her ears to cease her chronic ear infections. Her father had Blue Cross insurance, and she was also covered under my insurance, so her surgery should have been completely taken care of. There was no deductable for her father’s Blue Cross policy. Neither of the insurance companies wanted to pay for my daughter’s surgery, and to this day I am being harrassed by the hospital for the entire cost of the surgery.
Nancy Roback Says:
June 18th, 2007 at 10:58 pm
I broke my leg in a car accident, a friend took me to a doctor who diagnosed it as broken and set the leg. Blue Cross deemed the doctor’s visit on the day of the accident “not medically neccesary” As soon as a lawyer called them they reversed their decision.

In another accident I broke my jaw and had it wired shut. Blue cross paid for it to be wired shut but would not pay for the metal hardware to be removed. They said it was “not medically necessary.” It had gone through their highest review board, which they stressed included doctors. I was told there was no appeal process. After contacting the state insurance board I filed a greivance with Blue Cross. Under the section asking me to explain my dispute I wrote - any idiot can tell that once your jaw is wired shut someone need to remove the wires… they are not intended as a permanent fixture. The decision was quickly reversed and BC paid the claim.
LCW Says:
June 19th, 2007 at 12:45 am
I am an information technology consultant who has worked for numerous insurance companies, including several Blue Cross organizations.

These companies waste money at a scale that would make your head spin. Doomed projects, unchecked vendors, endless reorganizations, poor planning, and outright incompetance. It adds up to millions of dollars.

At one Blue Cross/Blue Shield company, I was told that since they were “non-profit” and would be fined if they made too much, they had to spend down their profits.

I don’t support socialized medicine, but I do believe that health care profit margins should be regulated much more carefully.
WK Says:
June 22nd, 2007 at 12:20 pm
My 5 month old son’s medication was denied because he spat a couple of doeses out before we could get him to swallow it. I hate having to deal with these problems, but it is part of life. I am an insurance broker, myself. If you will talk with your agent or HR person, they can give you an outline of benefits, so some of these problems can be avoided. However, there will always be problems. I did not sell my humanity, rather, I have saved my clients millions. Nothing in this world is perfect, especially health insurance in our country, but will a political party fix it? You must stay behind the companies. If you will get off your ass and stay behind the doctor bills and EOB, you will save yourself a ton of headaches, and probably some money. As for those who are uninsruable, I would love to come up with a way to insure you without it costing a fortune. I just had to come here and read what the left was saying, since they have all the answers to fixing every problem, but they never do anything but BITCH!!!
Samantha Says:
June 25th, 2007 at 11:26 am
I am 21 and recently diagnosed with MS. For the most part I’ve had a positive experience with BCBS which I receive under my mother’s policy. I’ve only had a few fights with them (the most infuriating being the ambulance ride they said I didn’t need.They said I should have driven myself since the ambulance had been preapproved. I was ACTIVELY seizing when paramedics arrived! Sorry I can’t plan my seizures ahead of time.) but at other times they’ve been extremely helpful. I was able to get several in-home steroid treatments for a recent MS exacerbation rather than having to go to the hospital and they readily cover all of my dozen or so prescription medications each month. The way I see it is that anytime you have bureacracy (private or public) you’re going to get some amount of red tape. Yes current private insurance has some deep deep flaws that should be remedied (for example, the reason your premiums keep increasing despite good health is that health insurers are not just health insurers. The companies also insure a lot of other ventures and when there is a catastrophe in one area, like 9/11 or Katrina, they pass the cost of what they lost paying for it onto us) but public systems have their fair share of red tape and flaws too.

My biggest fear right now, since I recently graduated, is future coverage. I will soon lose my mother’s coverage and with MS I can’t go without some coverage for very long. And I especially worry that whatever insurance I end up with will consider this a “pre-existing condition.”
Rachel Says:
June 25th, 2007 at 12:58 pm
I am an insurance agent and let me tell you a few things. The fact that you are not happy with your plan coverage through your employer is not the carriers fault, your employer has many different plan to choose from and they pick the one that makes the most financial sense, so not to burden the employee more than necessary. For the self-employed, deal with it, health insurance is necessary, other carriers offer other plans and different rates, SHOP AROUND! It’s not the carriers fault that your plan “stinks” take it to your employer, ask more questions, take your health into your own hands. No one looks out for you except you so take responsibility. Get the facts before you complain and try to fix things. America is full of people who expect everything for nothing and you are no exception! You work for a reason, the government shouldn’t take care of you.
FYI Says:
June 25th, 2007 at 8:08 pm
Some of you have said some interesting things. An insurance policy is a legal contract. If the legal contract is not set up to cover certain things (ie drug use/rehab), that means you have not been paying for that coverage on a monthly basis. It is like car insurance. If you are buying liability only, and have an accident they will not pay out like you have had full coverage! It is a legal contract. An insurance company is that, a company. It is not welfare.

If your doctor submits your claim as something your insurance company does not cover. How is your insurance company supposed to know? They get a claim with a number on it (such as 12345). How are they to know if the doctor’s office put the wrong code? Should the doctor’s staff take some responsibility in doing their job correctly?

Also, someone mentioned not paying their part of the bill if hospitalized. You don’t owe that to your insurance company! You owe that to the provider (doctor/hospital etc.) It is between you and that provider when/if you pay it. They would be the ones sending you to collections, not your insurance company.

I have never had any dealings with this company, but thought some facts (actual facts) should be mentioned here also. I do not claim that the system does not need reform either.
Sean Says:
June 25th, 2007 at 11:47 pm
My Grandmother has Michigan Blue Cross through her pension with as a retired teacher. Her care has been excellent: because of her union. Whenever Blue Cross tried to pull something on a teacher, the union threatened to go eleswhere, and the company backed down.

With unions, there is power. That is why it is the American people must demand universal health care, or take their business (votes) elsewhere.
CH Says:
June 26th, 2007 at 10:34 am
I have what is supposedly touted as ‘the best insurance plan’ in the city of new york but when I began experiencing pain while training for the new york marathon I sought advice from my sister, a physical therapist, who explained that (along with several other leg and hip disorders) my flat feet were negatively impacting my stride and without arch support long regular runs could do permanent damage to my knees and hips.

As a generally healthy young fellow I had not used my insurance once in the over two years I had it but when I spoke with them regarding seeing a podiatrist and acquiring orthotics I was told I wouldn’t be covered for anything preventative. When I explained to them that permanent damage could be done — damage that would require surgery and years of rehabilitation that they (the insurers) would eventually have to pay for they suggested I ‘go that route’ that it would be the ‘best way to assist me.’

Though I know some have far more horrifying stories than I this shook me and angered me for days. I was being directed with a smile and a ‘thank you’ to injure myself and to put myself on the table because they weren’t in the business of keeping me healthy — they were in another business entirely.
Rob M. Says:
June 26th, 2007 at 11:51 am
One very important piece of information that nobody, including Michael Moore, is pointing out is that each Blue Cross plan is INDEPENDENT. What happens at Empire Blue Cross in New York is totally different from what might happen at Blue Cross of, say, Utah. When you say “Blue Cross is greedy” or “Blue Cross denied my claim,” you’re tarring several dozen independent companies with the same brush.

Also, many Blue Cross plans are not for profit. Blue Cross of Louisiana is one example. It is a mutually held company. Look it up. They have no shareholders to “maximize profits” for.

I personally have had Blue Cross plans in both Georgia and Louisiana and have had 90% positive experiences. It’s pretty unfair to say that all people who work for an insurance company have sold their souls.

I am a fan of much of Michael Moore’s work, but he has an agenda, and he is going to use information to push his side of the story. People who want to be fully informed need to get ALL the information they can. If you’re not sure, call your insurance company and ask them if they are a publicly traded company, ask for a copy of their latest annual report, etc.
Robin Says:
June 26th, 2007 at 12:11 pm
Blue Cross and Blue Shield of Louisiana has paid more than $85,000 in benefits on my behalf in the four years I’ve had coverage with them. They’ve paid for two total hip replacements as well as other surgeries, rehab, doctor visits and many, many other aspects of my complex medical care. Only one time in four years, I have had one thing denied that my doctor requested. I am completely satisfied.

I have to admit that you have to be knowledgeable and well-informed in dealing with an insurance company. Before you sign up, read the coverage benefits and ask the agent a lot of questions about your specific case. When you get your policy and benefit documents, read them again so you know what is and is not going to be covered. People don’t like to hear this, but it really isn’t the insurance company’s fault if you go get a procedure that is explicitly not covered by your policy. It doesn’t mean that you can’t have the procedure done; it just means that you have to pay for it yourself.

Look, there are definitely problems with healthcare in America. There are terrible problems! But I think just about everyone shares a part of the blame, and that includes the government, doctors/hospitals, trial lawyers, and consumers, too.
susann dempsey Says:
June 26th, 2007 at 6:01 pm
I have been a nurse for over 20 years and have worked in various hospitals. If you want to scare the insurance reviewers in the hospital, tell the nurse you are a malpractice lawyer, a radio personality or a newspaper editor. They will keep a low profile. If this doesn’t work say you have hired a lawyer to protest. You will win. Don’t ever agree with the insurance coverage, they are usually trying to screw you to increase their profits!
Stewart Urist Says:
June 26th, 2007 at 9:04 pm
I’ve had the Federal BCBS policy for many years and an quite pleased with it. I also work in the health care field and have to talk to insurance companies every day. I found the the Federal plan is one of the best. I think that, if we can’t have a health plan that is medicare for all, having a plan like the one I have available for all is a good second choice.
Linda Says:
June 26th, 2007 at 11:42 pm
BCBS insurance sucks!!!! I have worked in a hospital
for almost 10 yrs. We just changed to this. We had
Accordia & Carelink(which was great). We only had
a $10 co-pay for a doctors visit. Now it is $10 for
your HMO & $20 for a specialist(obgyn). Then about
2 weeks after each visit to the doctor you have a bill
in the mail for the rest of the visit or blood work or
whatever. They failed to tell us there was a deductable for everything and I mean everything you have done. I had a stroke last year and it didn’t cost me as much seeing all the doctors, being in the hospital for a week and seeing 2 different neuro-logists and also having tests done at 2 different
hospitals. This has been since we have changed to BCBS in the past 3 months I have spent more of my hard earned $$$ on this sucky insurance. It hardly pays for anything.
Barry Graham Says:
June 27th, 2007 at 12:32 pm
I never even used my insurance with Blue Cross and they Increased my premium!
Gale Says:
June 27th, 2007 at 1:11 pm
My daughter, aged 14, broke her hand a year ago. Took her to the local docs who x-rayed it and on we went to the specialist ortho. First doctor put a splint on it and claimed it would heal itself in time. Our cost, 800 dollars BSBC paid 85.00 bucks.
Hand out of splint and a month later it’s shown broken again. Went to another Ortho who did surgery.
This time our cost 1,500.00 and BCBS 115.00.
This is with private insurance, not paid through any employer, that I paid monthly.
I still don’t understand this breakdown but what are you going to do? Not pay?
Jan Says:
June 27th, 2007 at 3:52 pm
I have a friend who works for Wellpoint which is owned or owns Blue Cross. He’s been there less than 3 years and received a $10,000 bonus at the end of their fiscal year. Everyone gets a bonus, the longer you’ve been there and the more they make the more the bonus is to the employee. So if you have a loved one who is sick and a large medical bill they are denying, you should call an employee there and ask them to pay your bills!
SHAME ON THESE INSURANCE COMPANIES!!!!!!
Connie Framberger Says:
June 27th, 2007 at 5:46 pm
I am insured with Blue Cross of CA on an HSA compatible plan. I couldn’t be happier. After I reach my deductible, they pay at 100% and I also have the savings account part of it. I really think this is the solution to the problem. It encourages saving, at a tax free basis, and yet, the insurance is there if you need it. I have had no claims denied and I have lots of claims, with a chronic back problem. It’s hard for me to believe so many people have such a hard time with their insurance. I’m happy.
Janet Says:
June 28th, 2007 at 12:46 am
Does anyone else think it is odd that none of these national insurance companies got more than 3 stars on the rating scale? There must be one insurance company that actually cares and pays the bills they say they will…..SIGH….
Rob Says:
June 28th, 2007 at 12:50 am
They cut off my meds prescribed by my doctor for Lyme Disease. When I called to complain about the situation, I had some glib customer service rep tell me “look..you already got your moneys worth, the prescriptions you got this month exceed your monthly insurance payment”. ISN’T THAT WHY I HAVE INSURANCE???
Kim Says:
June 28th, 2007 at 7:56 am
I guess my husband and i are a few of the lucky ones. He has been battling cancer for 6 months and our BC of Illinois has paid exactly what is laid out in the plan. No questions asked. I am a Michael Moore fan, though, and plan to see Sicko.
chris Says:
June 28th, 2007 at 1:45 pm
my husband is a doctor.
he HATES (i mean REALLY HATES) the insurance companies… he goes into a rant/rage if you even mention them.
he says paying for insurance is basically gambling…
you are gambling on whether or not you’ll be sick or hurt… throwing hundreds of dollars away a month… for what ? not even the security to know your illness and/or accidents will be covered ???
(so i suppose it’s a gamble either way- whether you have insurance or not)
fortunately (knock on wood) i am relatively healthy, yet the 2 prescription drugs i take are not covered by blue cross- nor are there generics available (that’s a WHOLE other issue about the EVIL pharmecutical comapines)
why should anyone have to decide whether or not to buy medicine that will keep them alive… or to buy food ??? (or pay the electric bill, or car payment, etc)

it’s a total SCAM !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
and it SUCKS !!!!!!!!!!!!!!!!
Sarah Says:
June 28th, 2007 at 11:17 pm
Contrary to what most people are writing, my experiences with BC/BS have been wonderful. My parents are both teachers in Michigan and I had MESSA for as long as I can remember (until this past January when I could’ve been covered by COBRA, meaning they provided full coverage until I was almost 27). The only things that have not been covered were extended residential mental health care and extended drug rehab stays, and even then, they covered a reasonable time period. Another major benefit was prescription coverage. Our prescriptions were–ok, you’re going to choke–$2! All name brand and generic were covered, and medications that could be bought otc, like the nicotine patch, were also covered. As an adult, $2 seems a bit socially irresponsible, but I’m not complaining too much. I have been without MESSA for about 7 months now and it is terrifying. I haven’t been to the doctor, dentist, or opthomologist in that time, even though I’ve really needed to go at times. Fortunately, I myself will begin teaching in September and will be covered by MESSA once again. For many teachers (especially in Michigan), insurance is the most valuable benefit offered (better than summers off) and many teachers have been willing to take pay cuts as long as they can keep their excellent insurance plans.
PTPenny Says:
June 29th, 2007 at 5:20 am
I am a physical therapist in New York State working in an outpatient office.
In our state, many Empire Blue Cross and Oxford Health plan rehab providers must submit their requests for PT services through a company called “Orthonet”, in White Plains, NY. Orthonet is a privately held and (I have not checked public records) rumored to be owned by a physical therapist.

Generally, Orthonet tends to cut off physical therapy after around 18 visits. They often dole out visits in small parcels of 6, then 5, 4, and then maybe 2 or 3 more and then patients are essentially sent packing.
Therapy visits are authorized based on the written request from the therapist. This keeps the therapist mired in an ongoing stream of requests.

Doctors often prescribe therapy for 8-12 weeks, 2 to 3 times per week, but rehab professionals are lucky if even half of this recommended time is paid for by insurers. Keep in mind, a post-surgical patient, say for a torn rotator cuff [a shoulder problem], often requires months of therapy to regain full function. With Orthonet, 80% better is now the new 100%. Forget returning to sports activities, or more challenging physical labor–Orthonet cuts patients off when they can dress, eat, and perform simple activities. We can thank Orthonet and their buddies Empire Blue Cross, and Oxford for the progressive dismantling of physical therapy in New York State.
Mel Says:
June 29th, 2007 at 9:11 am
Blue Cross is one of the worst providers I know. I had to join a civil lawsuit agains them in order to get the care I needed.
Summer Says:
June 29th, 2007 at 9:14 am
I work for an osteopathic association that offers BCBS to us as employees as well as our members, the D.O. docs. I’ve had my fair share of run-ins with services billed and not paid but I think my biggest beef with BCBS is the cost of having it. It’s absolutely evil. I was looking at a premium statement that was sent to one of our members. It’s just he and his wife, both under 63. Their monthly premium was over $1600. That is a PPO coverage and pharmacy. He will be turning 63 shortly and eligible for Medicare as his primary coverage, which he has to take, so his premium will reduce to slightly over $1200 each month. $1200 to pick up 20% of the bill??!!?? And that’s of course if he and his wife have any claims at all. So for BCBS to not pay for claims submitted is outrageous. No wonder so many people are without health care coverage. If I had to pay $1600 for my husband and I, consider what it would cost to add my two children. I think I’d be better off taking my chances, paying for an office visit or two and if something catestrophic did happen, file bankruptcy!!!
Steve Says:
June 29th, 2007 at 9:26 am
I am a retiree from General Motors Corporation, currently on Medicare, my secondary insurance of which I pay about $90.00 per month has denied all claims submitted to them. I was also able to get into the VA System prior to the US Government stopped future enrollments, the VA has been fairly decent. I guess that I am one of the few lucky ones.
Heather Says:
June 29th, 2007 at 5:06 pm
Are people really buying this lie, that it is all the health insurance companies fault? At least at this point when the insurance carrier screws up you can change insurance carriers. Just wait until the government gives us even worse health care and everyone will be stuck with it… Don’t believe the oversimplified soluions that are only addressing a small percent of the issue…
Melissa M Says:
June 30th, 2007 at 1:29 pm
I am a huge Moore fan and am arranging to see Sicko despite the fact that I have been unable to see a movie at the theater for over a year due to my health; I will be lying on my reclining wheelchair in the back of the theater to do so. I say all this to voice the extent of my support of the film & the overall message it is trying to spead. That is that the health care system in America is in need of MAJOR change.

But with that said, I will say that with rare exception my experience with my insurer, Blue Cross Blue Shield of Minnesota (PPO), has been near excellent. I have a very complex medical situation involving home care, months of hospital stays, ambulance transportation, intravenous nutrition, surgeries, expensive equipment, and more. And the only real problem I’ve had was being in a hospital that was in-network yet had none of a particular specialty that was covered under BCBS. There have been a few other things that were paperwork errors (not always on the side of the insurer) but I stay on top of things and they were easily corrected.

But I am well aware that this is not always the situation. And if I did not have my insurance through my former employer I would truly be uninsurable due to the complexity & cost of my medical situation (over half a million last year alone), and I only have my insurance for two more years. At that time I will hopefully have medicare but the uncertainty of my situation gives me a great appreciation for those without insurance. So despite my good experiences I am the first one to assert that change is needed. Because health care should be a right, not a privilege.
David Says:
July 1st, 2007 at 10:25 am
I’m not overly thrilled nor overly displeased with Blue Cross. My company covers my insurance costs but I’m responsible for co-pays and drug fees. My co-pays have been creeping up and I’m at the point when I have to think twice before I make an appointment with a doctor. I should add that besides paying a significant co-pay the doctor spends about 6 minutes with me. It’s an unpleasant experience.
Ronald Pridgeon Says:
July 1st, 2007 at 10:57 am
My wife and I had Blue Cross Blue Shield of FLorida Blue Cares for 4 years and we never had an issue and our claims were always taken care of without any problems.I even had a total knee replacement and required additional hospital stay and BCBS never denied or delayed payment to any of my claims. We had a very positive experience. Like every other insurance the rates seemed expensive but well worth the cost.
Garret Stamm Says:
July 1st, 2007 at 2:02 pm
I was born with a club foot as an infant. Having several surguries done as an infant, child, and young teen was required to keep me walking, and a possibility of more surgeries that might be needed. Well there was a need for one, a pretty major one in fact, and that was right before i turned 22. I was dropped off the family plan one month after the surgury and picked up BCBS in NC. Since i had to go to the ER because of a susupected blood clot, i bought insurance through them (a 90-day insurance) only to find out that i wasted the money and there was a deductable on EVERYTHING 500$ Doctor visits, 200$ ER, zero coverage for RX, and a whole crap load more. To make it short, i was stuck for 90 days with bad insurance, and since the operation was a failure im worse off than i was in the past. I cant get another one approved to fix it, pain meds that i take regurarly are not covered and neither are the name-brand anti-biotics i need to keep the infection down because of what? Have you ever head of pre-existing illness? when u dont have insurance for more than a month, I guess they assume your ‘alright’ and now this lifelong battle with my now, handicap, wont be covered for years to come….bye bye bonus
Dave Says:
July 1st, 2007 at 3:30 pm
In contracting my individual family insurance policy at a Blue Cross regional headquarters, I wasnt offered a real Blue Cross employee to work with, but instead had to deal with a third party insurance broker in a special room set up next to the lobby adjacent the main office suites. This gave me the sense of a company that distances itself from its clients even as its making new business. As it turns out, in the past year we’ve had over $3500 in medical expenses related to exploratory work for diagnosis of a serious digestive tract condition. The plan not only didnt cover any of these expenses, but also did not count a single penny spent towards the deductible.
Michaeleen Says:
July 1st, 2007 at 11:26 pm
My sister got sick when she was a freshman in high school about 13 years ago. My parents had health insurance but it wouldn’t cover her condition (depression). She was hospitalized several times d/t attempting suicide. My parent’s had to take out a second mortgage to pay the hospital bills. In order for my sister to get the medical care she needed to save her life, MY PARENTS HAD TO GIVE UP THEIR PARENTAL RIGHTS AND SIGN MY SISTER OVER TO THE STATE, SO THAT SHE COULD RECEIVE CARE. THIS CAUSED SO MUCH PAIN. NO ONE SHOULD EVER HAVE TO DO THIS, IN ORDER TO PROTECT THEIR CHILDREN!
Steve Mellenthin Says:
July 2nd, 2007 at 10:05 am
Several years ago I ran a small manufacturing company in Wisconsin, and unfortunately our health insurance premiums were so high that the only option left was high deductible plans with MSA’s. So we decided to drop health insurance coverage all together. Knowing that both of my parents had diabetes and heart issues it was scary for me to go uninsured as I near 50 years old.

Shortly after that I started showing some symptoms of diabetes; almost insatiable thirst at times after meals and excessive urination. I refused to seek treatment for almost 2 years for fear that a new insurance company would refuse to cover a preexisting condition.

I got a new job in February of this year, and my employer offers Blue Cross. When I was a kid BC/BS was the gold standard in health Insurance. Still, I didn’t want to rush to get a diagnosis right after my employment so I waited.

In Late may I developed some new and different symptoms, which included loss of balance. I couldn’t stand without holding something to steady me, and was afraid to drive. I hoped it would go away but after a day or so I became concerned that it might be related to diabetes, so I called Blue Cross to find out where to go.

I wanted to go to an urgent care center a few blocks away because I thought I might be too dizzy to drive on the beltline, but they said that it wasn’t an approved facility. So they sent me to an approved urgent care clinic about 10 miles away in Fitchburg, Wisconsin. So I drove there only to find that the clinic was out of business, and closed down. I called them again and they sent me to the University if Wisconsin Clinic on the East Side of Madison.

I talked to the doctor about the dizziness, which turned out to be an inner ear infection. While I was at it I mentioned my excessive thirstiness and urination and he ordered blood glucose level, which came back very high. So he diagnosed me as a type 2 diabetic, and I began treatment.

Several weeks later, I got a letter from BC/BS saying that they would not cover the bill because it was for a pre-existing condition. I called and explained that it was a new diagnosis, and they gave me the run around. They essentially said that I would have to do the legwork with UW Clinic to prove this was not pre-existing. I have done all they asked of me, and still have not heard back from them.

It is shameful that any company would put their profit ahead of a clients well-being. Though I believed I had great insurance in this instance, I guess you never really know until you seek treatment - because you can’t believe what they say in the paperwork.

Over the years I have had some crappy insurance, like John Alden that only paid 50% of anything, but at least they paid that 50%. BC/BS should be ashamed, and I will encourage my employer to find something better in the future.
Vanessa Says:
July 2nd, 2007 at 12:45 pm
I AM ON BCBS and they will not cover my daughter. She had 1 seizure and the doctors have said her chances of having it again are 80%. She had the seizure while I was in the military/airforce. Now that the military has force shaped me (yes, the military/airforce has forced me to leave because they have too many officers and do not need us, AND I JOINED DURING THE TIME OF WAR KNOWING FIRST HAND I WOULD BE SENT TO IRAQ, I ACCEPTED THIS FATE), for no reason other than they have to many officers and must downsize. I am left unemployed by the govt with a daughter who is uninsurable.

I am now trying to become a nurse, so for the next 2 years I have to have my own plan. But without being able to cover my daughter!

SOMETHING IS NOT RIGHT!!!
Meg Says:
July 2nd, 2007 at 4:02 pm
I was three months pregnant and suddenly started bleeding. Very quickly I realized I was losing the baby. I called my doctor who told me to go to the hospital. She met me there, and performed an emergency d&c in the obstetrics ward. I lost a lot of blood, and was very weak and sad. On my husband’s policy, any emergency treatment should have been covered at 100%. They refused the claim. They told me that if I had been treated in the emergency room, it would have been covered. Then - and this is the really hard part - the agent told me on the phone that she saw in my paperwork that I’d had an abortion. I calmly explained that “spontaneous abortion” is the medical term for losing a baby, but she didn’t care. My doctor wrote a letter explaining that my treatment was an emergency, but they still did not pay the claim.
Tom Says:
July 2nd, 2007 at 6:17 pm
My wife has been going to the doctors and specialist for the past 7 years to find the reason for her alments. They came up with arthritis now they want to give her a type med that is injectable. Insurance is willing to pay $54,000 for a 90 day supply 1 shot every 2 weeks. Insurance WILL NOT pay $60.00 for stop smoking patch, nor will the pay in full my kids school phyicals. THIS IS A NO BRAINER
Katie Agren Says:
July 3rd, 2007 at 3:00 am
One of the biggest problems with blue cross is the limited amount of doctors you can see and get covered. I recently needed a physical in order to get a job working as a teacher in South Korea. The only doctors in my area that blue cross would cover were booked out two months or more on physicals. I couldn’t get an appointment in time to get my work visa. I ended up having to go to a walk in clinic, shelling out almost $200.00 for a routine physical exam.

I am curious to see how the Republic of Korea manages their health care system.
Lisa Says:
July 3rd, 2007 at 10:27 am
I am currently trying, for the 6th time, to quit smoking. I’ve been told it’s the biggest cause of preventable death, it’s unhealthy, and that I should stop. I believe all of this which is one reason why I am quitting. I’ve tried the patch, the gum, cold turkey and all to no avail. I went to the doctor 2 weeks ago and he wrote me a prescription for Chantix, the smoking cessation pill. Unfortunately, this and every other smoking cessation aid, IS NOT COVERED by insurance. Isn’t BCBS supposed to have “a greater hand in my health”. Don’t they realize they will save money in the long run (i.e. lung surgery, oxygen tanks) if they cover cessation aids now. CHANTIX is working (I feel great about this) but it is costing me $100/month for it. Luckily, I can afford it but I know many people who cannot and are still killing themselves with cigarette smoke. QUITTING SMOKING IS NOT EASY - and the insurance companies are one big farce.
B Patterson Says:
July 3rd, 2007 at 12:06 pm
So my issue is not with BCBS, but with the incompetent hospital billing staff. A freak accident involving my eye took me to Hospital ER. Didn’t have my ins card with me at the time, Hospital told me to call in within 72 hours after discharge. After 10 calls to the billing department to ‘Clarify’ my insurance information, they said they could no longer find me in the BCBS system. I called BCBS to ensure that I did exist as a policy holder in their system, then I conferenced in the hospital billing department. With both parties on the phone, and on recorded lines with BCBS and the hospital, I gave my information, updated my name, confirmed my visit to the hospital, and was PROMISED that hospital would bill insurance and that insurance would process claim. two weeks later? the 12th bill from the hospital, saying BCBS Insurance wouldn’t pay; they couldn’t find me as a policy holder in the BCBS system. BCBS has YET to see a claim from the hospital. A little digging around led me to the information: Hospitals gain more profit from billing patients with a “No Insurance Applied” billing discount rate, than they do from accepting payment from an Insurance company. So, rather than have BCBS pay $120 of whatever the pre-negotiated rate would be, Hospital found it MUCH easier to try and get me to pay $360. 12 months later, I still won’t pay and BCBS has been nothing but kind and considerate towards this aggravation and the incompetence of the Hospital Billing department.
Marie Lutters Says:
July 4th, 2007 at 12:40 pm
Great film! I am so glad I am healthy.
I have been with Blue Cross for 25 years, by employers choice. During most of that time I had been to the doctors office only for mandated physicals.
Then last year after rafting down a river my ears got all plugged up (infection) — so I go to my primary care physican and he gave me the latest and greatest antibiotic — I had an allergic reaction to that — so I wait for a week to see the doctor again (first available appt) then he says well I can’t do anything more for you until the rash is gone, then I will give you another antibiotic. I asked to be referred to ear-nose-throat doc, he said no — not proper protocol, so I go back in another week after the rash is gone to get another antibiotic, which I was also allergic to– repeat again — so after 2 months of this nonsense I get my referral to ear-nose-throat doc, and they vacuum out the junk, squirt in a little bit of topical antibiotic and within a few days I am good as new.

So for a minor thing which they had a simple solution for — they danced around for 2 months — my employer sure appreciated the 2 month drop in productivity since I couldn’t hear squat and had balance problems.

I hope to heck I never have a serious illness!!!!
Theresa Says:
July 4th, 2007 at 7:21 pm
I have been on the same medications for a thyroid disease for 8 years. During this timeframe I have had 2 different insurance plans through my work. I NEED these medications to fuction normally. Upon becoming covered under Blue Cross, I was suddenly denied my thyroid medication because it was “not pre-authorized” by my physician. WHAH?? I just put in the prescription from my endocrinologist (aka- my physician!!!). When I asked them if I could have my dr. call them to “pre-approve” it, they said they could not talk to my doctor…that I had to get the “faxed” pre-approval from the Dr. from a form I had to download off of BC/BS website. I then was to fax this to Blue Cross. I asked them if they could fax the form directly to my doctor and they said no, I had to do that. I had a few choice words with the representative on the phone and then immediately downloaded and faxed the form. I asked the dr. to fax it back to me when they filled it out. They did about 20 minutes later. I then faxed the form back to BC and got the confirmation. I hadn’t heard anything in 3 days, so I called them back. They said they never got the fax, so I resent it. I waited another couple of days and when I called back I was told that sometimes “faxes take up to 5 days to be received”. Long story short…3 WEEKS later, my medication was approved. Thank goodness my dr. supplied me with enough samples to get me through.
Beth Says:
July 4th, 2007 at 8:58 pm
California Blue Cross has been very good to our family. Over a two year period our individual coverage PPO plan has covered over a million dollars worth of hospital, doctor, in home care, medication, physical therapy and tests for our child who was diagnosed with pediatric cancer. We are self employed and have a $2500 deductible per person for our family of 4. Our goal was to maintain health insurance for catastrophic coverage. We have had a few debates over bills with Blue Cross but overall I give them high rankings. While our children were in their last year of high school we obtained individual policies for them and pay them automatically so that they will never lack coverage.

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