Blue Cross & Blue Shield

Software issue NOT allowing me to receive mailings on EOBs for 2 months. Reset daughters deductible incorrectly.7/16/13 Spoke with [redacted]@bdbs.com. Definite software issue. BCBS site could not link correctly with hcbo site. I was not receiving claims (the Dr. statements seemed to be correct.) Per a legal site this can be a lawsute under ERISA. 7/24/13 Spoke and emailed [redacted] Software corrections took longer than expected. She promised a mailing of certain EOBs I never received. 7/31/13 Received an actual EOB in the mail. However I pretty much had a heart attack since the explanation for daughters chirpractic visit said I owed WAY more than normal. SOMEONE IN SOFTWARE reset the deductible. Normal year deductibles reset every April 1st. [redacted] met her deductible by may 10th. Asked [redacted] at BCBS to send me to a [redacted] immediate.y. A [redacted] said the problem/issue "would easily be taken care of by Friday Aug 2nd" and that he would call. 8/2/13 No phone call. I went on Twitter to leave a request. Also sent emails. [redacted] on vacation or a week. 8/4 [redacted] responded saying he was OUT last Friday. He could have darn well contacted me since he had my cell phone/email with any status. Nope.8/5/13 [redacted] emailed saying he "apologized for the inconvenience" yeah, sure. Said he is also working on it.I do need a definite response since I no longer trust BCBSMA any more. I have CANCELLED ALL CHIROPRACTIC TREATMENTS FOR MY DAUGHTER UNTIL IT IS BILLED CORRECTLY. HER NAME IS [redacted] aS OF TODAY I cannot contact them successfully. I have contacted the insurance person at the chiropractice place, All I get IS FALSE CLAIMS OF BEING ABLE TO GET EOBS. As of today I AM LOCKED OUT OF THERE WEBSITE. NEITHER MY HUSBAND (THE CARDHOLDER) OR I CAN INQUIRE.This can be a legal issue since I am by law supposed to be able to get an EOB .Desired SettlementWISH TO HAVE ALL EOBS FROM JUNE 2013 ON. WISH TO HAVE MY LOGON RESET FOR BCBSMA.COM FOR BOTH MYSELF ([redacted]) AND HUSBAND[redacted] MEMBER XXXXXXXXX. WISH TO HAVE CORRECTED 7/16/13 EOB SHOWING 15 DOLLAR COPAY SINCE DEDUCTIBLE ALREADY MET. NO FURTHER DIFFICULTIES LINKING FROM BCBSMA SITE TO HCBO SITE (THIS CAUSED THE ORIGINAL PROBLEM. )NO FURTHER ISSUES FROM THIS !!!

Blue Cross Blue Shield advised me via a telephone conversation that they would deny claims because I did not have [redacted] They approved therapy for me on 3 occasions and said because my company had less than 20 employees that I needed [redacted]. When I applied for [redacted] I inquired to three representatives that I was still working and could I keep my own insurance and was told yes. I was never informed of the employee number until today. How can you approve treatment and then deny it. The rep from BC/BS told me they would resubmit my bills but they would be denied because I did not have [redacted].I could submit an appeal and request that they cover me until I get[redacted]. I have accrued a lot of medical expense due to arm surgery and had I been informed of same, I would have applied for [redacted]. I informed BC/BS on 2 separate occasions that I only had[redacted] and was working so I kept my insurance and they never told me then either. I spoke to 2 reps in the last week and they did not inform me and told me they were resubmitting a bill and not to worry about it, I was covered.Also they have accepted insurance payments from my employer and did not inform them of the issue either. I was just making progress with my therapy and canceled my next 6 appointments due to this. I will have to cancel injections from the pain clinic (to which I had one recently) and doctor appointments. This is unfair and detrimental to my health.Desired SettlementI want them to cover all medical expenses I have incurred since I turned 65 and until I receive [redacted]. I want confirmation to continue my treatments and doctor visits without waiting for them to submit claims again so that they can deny them. It seems a waste of time and effort especially when I was making progress.Business Response Contact Name and Title: [redacted]Contact Phone: (XXX) XXX-XXXXContact Email: [redacted]@bcbsma.comMs. [redacted]'s employer-sponsored health insurance policy states "When you are eligible for [redacted] and [redacted] is allowed by federal law to be the primary payor, the coverage provided by this health plan will be reduced by the amount of benefits allowed under [redacted] for the same covered services. This reduction will be made whether or not you actually receive the benefits from [redacted]." Federal Law states if you are insured in a group with under 20 employees, [redacted] is primary payor. However, at this time, BCBSMA is processing Ms. [redacted]'s claim as primary payor and will continue to do so for a short period of time. Ms. [redacted]'s has a 7 month window after turning 65 to sign up for [redacted]. Ms. [redacted] should contact her employer, and request her employer to contact the Inside Service Team at BCBSMA to request an exception until her[redacted] is effective.Consumer Response (The consumer indicated he/she ACCEPTED the response from the business.)I did apply and my employer is processing the required information as requested by BC/BS. Thank you all so much for all of your assistance. Your response was prompt and I am extremely grateful for your assistance.

I went to see a new doctor for the first time under a new carrier [redacted] on [redacted] 2014. Initially I was seen by a Dr. [redacted] who was a specialist I neither requested nor had a referral for. According to [redacted] rules, one cannot be a patient for a specialist without the need and a Dr. referral. She spent about 10-15 minutes talking with me and checking general breathing and left the room. A different Dr., Dr. [redacted] then came in spending the same amount of time being interrupted at least several times, and doing the same procedure. When I was billed for this visit, I was billed for a specialist at a [redacted] co-pay which which was not authorized.On that first review of the 1st statement, I complained and spent at least 45 minutes explaining the facts. I also contacted [redacted] who said then they would review the matter and thought the second Dr. didn't yet have authority to bill patients. Since then, I get at least one call a month where I go thru the same lengthy discussion where they say they will look into it. I called [redacted] on this a second time who also replied they will again look into it. There is never a resolution nor admittance to the error, just bad business as usual where [redacted] should share some of the guilt and shame.I immediately call when I receive a statement and reply to every phoned request for payment. I have exhausted literally hours getting no where in the last 6-7 months. I have informed them the moment they fix their shameful over-billing, I will immediately pay everything in-full, but nothing before. Thanks to this endured process, I have both dropped [redacted] - [redacted] and have dropped the doctors and [redacted] family [redacted] as well.Desired SettlementDo the right thing and bill for a routine office visit of [redacted] not for a specialist. Their total billing should be updated to show all the visits due less this overcharge.Business Response Mr [redacted] was seen in our medical office on [redacted] for a new patient visit. The visit was billed accordingly to his insurance company. His insurance company then billed him for whatever copay they deemed appropriate. We did not bill this as a specialist visit as we are a primary care office. We subsequently saw Mr [redacted] on 2 additional visits and billed them as return office visits. Again, his insurance company determined the amount that he would be charged for a copay. We do not determine the amount to bill a patient for a copay, that is done by the insurance company, in this case [redacted] Since Mr [redacted] has demonstrated to us that his first visit was billed to him with a [redacted] copay and subsequent visits at [redacted] we requested a review of the first visit copay charge with [redacted] We are still awaiting a response from [redacted] on this matter. Until we hear otherwise from [redacted] we will not be able to resolve this question for Mr. [redacted] as it is not within our authority to determine his individual insurance benefits. We hope that this matter gets resolved between the patient and his insurance carrier soon and will cooperate in any way that we can. [redacted] ManagerConsumer Response (The consumer indicated he/she DID NOT accept the response from the business.)Since there are no other options, I will clarify here. I accept their information. It is true that [redacted] was supposed to look into the matter as I have also initially mentioned. We're now talking 8 months ago. [redacted] said the same to me on 2 occasions.However, BCBS indicated that [redacted] who was one of 2 doctors on the 1st visit, is a specialist by [redacted] then [redacted] had to use her as the co-pay since apparently the other doctor was not able to bill under his name (UMass confirmed this). That being said, I would expect that UMass would make the proper correction and all this would then go away. Since they are unwilling to fix what should not have been initially, and BCBS has to pay by the [redacted]'s name (here a specialist) we are in essence a "dog chasing his tail"! The simple fix is to replace Dr. [redacted] with the actual Doctor responsible for the 1st visit and subsequent follow-ups, and [redacted] me, and UMass should be happy with [redacted] charging only for the regular MD.Final Business Response Dr. [redacted] is credentialed with BCBSMA Medicare Advantage Plan as a specialist, therefore it is appropriate to have a [redacted] specialist copayment. However, due to miscommunication and misinformation, [redacted] will pay this claim as an exception without any co-payment from the member. Mr. [redacted] has been informed of this decision. BCBSMA also gave Mr. [redacted] a person to contact at [redacted] if he needs further assistance with this matter. [redacted]Blue Cross Blue Shield of Massachusetts, Inc.[redacted] Department(XXX) XXX-XXXXFinal Consumer Response (The consumer indicated he/she ACCEPTED the response from the business.)I don't believe this would have even been escalated if it were not for the Revdex.com. Actually, [redacted] said over the months they did escalate it, a couple of times, and never did a thing and never had a courtesy to call. The hospital was the initial problem but [redacted] ended up the scape-goat.The matter has been resolved better than expected as the slate was wiped clean. The shame of it all is the fact it was a simple matter to fix, but too many chiefs.Thanks for the work!