Blue Cross

Blue Cross ( )

15 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!!!!!!!!!!!
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.

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