Horizon Blue Cross & Blue Shield of New Jersey

It is January 7th and their pharmacy system/link is still not working. I have written several times and cannot receive any information other than "be patient." I do not know which pharmacies I can use to have a doctor call in medicine that is about to run out. Emails to the company do nothing.

The same exact plan through the marketplace. The same experience happened to me!!! They miss applied funds and corrected their mistake on 4/9/15, cashed my check in May 2015, promising that the plan would be reinstated due to their mistakes. Today, I call to check up on that and was very snippily informed that my insurance was canceled on March 31, 2015 due to non payment !!! I give up !! Asked when I could expect a refund on April an May's payments. [redacted] the supervisor s response?? In about 30 days. Oh, and this was my 5th call to them trying to get their issues resolved in 2 month. Once I was even told my $458. Premium was now $916 a month due to loosing my government credit. I Never received a government credit. When I informed that agent of such and asked to speak to a supervisor, they hung up on me. How frustrating

I am a 57 year old heart patient who has spent countless time and energy on the phone with their member service that always seems to be impossible to work with. I am going out of the country for three weeks and need to have enough medication for that time. I needed an extra week approved and they were so difficult to work with. I even had my pharmacist sent copies of my airline ticket as proof to get the approval. After a lot of back and forth I was finally granted the approval the day before my trip however the emotional distress that this process has caused me is inexplicable. I have stents in my heart and I can't go on a day without certain medications. This process was truly painful and I dread the day where I have to reach out to them again for something.

It is not surprising that Horizon Blue Cross Blue Shield of New Jersey garners a lot of negative reviews. This is a criminal organization, that under normal circumstances, all parties would have been given lengthy prison sentences. Unfortunately the CEO's, and their corporations, purchased most members of congress, and the senate. The laws are actually written by the lobbyists for the corporations, then given to the politicians to turn into law. I have had a great deal of trouble with this insurance company, because they are able to get away with just about anything they want. I have been battling them for years now. My strongest suggestion to all you need health insurance, STAY AWAY FROM HBCBS of NJ. If enough people would take their business elsewhere, we may be able to shut them down, once and for all.

Review: On or about 6/26/13 I filed papers with Horizon seeking reimbursement for services provided for my spouse on 3/18/13. Horizon is his secondary insurance the primary is[redacted] was billed and made payment. The provider stated they do not bill secondary insurance, so I made payment of $197.21. I received notice from Horizon 7/12/13 they needed more information they needed diagnosis code missing/invalid (which was on the form submitted), name/address (name of firm was on the form submitted)and Drs. IRS# which was submitted 8/2/13 by fax. 8/28/13 received another letter requesting the same information. I contacted them by phone and told them I already sent the information,they stated they needed copies of the EOB from the primary I sent that to them on 9/11/13 by fax. January 2014 I contacted them about the status they stated again they needed the EOB I sent them another fax1/23/14 including the EOB. I called Horizon 3/3/14, 3/13/14 both times they sated I should hear from them within 10-14 days. I called Horizon again 3/26/14 they told me my claim was denied because they needed my EOB from the primary insurance. I told her I sent it in twice already she said she will send the case to the board to review.I have been trying since 6/26/13 to get reimbursed unsuccessfully.One of the Reference # is [redacted].Please help!!!!Desired Settlement: Seeking reimbursement of $197.21 for services provided for[redacted] on 3/18/13. Which Horizon was not billed for.

Business

Response:

Horizon Blue Cross Blue Shield of New Jersey has received your request for protected health information for the above member. This request seeks medical payment record for March 18, 2013.

Enclosed is a Statement Of Payment for medical claims received and processed by Horizon BCBSNJ for date of service March 18, 2013. The enclosed summary data represents all information that is currently on file as of April 28, 2014.

We trust this information is responsive to your inquiry and thank you for the opportunity to be of service.

Review: FAX: [redacted]

ATTN: [redacted]

Ref: [redacted]

Dear **. [redacted],

At we talked via phone last Friday, the fax records regarding the result of my biometrics screening (fulfilled on Sept 28, and faxed Sep 30 from my doctor’s office, Oct 12 and 29 myself) were attached, which would lead to 100 points in the NJWELL program towards total 450 points.

Please feel free to contact me should you have any question. Thank you very much for your attention and help in the process.

Sincerely,

To **. [redacted]

NJ Direct ID from Horizon: [redacted]

Ref: [redacted]

FAX: [redacted]

ATTN: **. [redacted]

Ref: [redacted]

December 18, 2015

Dear **. [redacted],

I send this Fax because I did not your direct number to get connected. As a follow-up communication of our previous ones, I tried to login my account via horizonblue.com but did not see the 100 points (biometric screening) being credited so far, not sure if I looked at the right place. I should have 450 points in total which should lead to a 150 gift card.

Would you please call me at your convenient [redacted]e and walk me through the links to trigger the 100 points? Thank you again for your attention.

Sincerely,

Cell: [redacted]Contact with Quest -Summit Health) which handled the Biomatrics Screening records [redacted]

Case Number: [redacted], Date of Inquiry: 1/12/2016

Dear [redacted],

Thank you for contacting Quest Diagnostics Health and Wellness Services.

We uploaded your information 3 [redacted]es; twice on 10/21 and then again on 11/20.

Please do not respond to this email.

If you require additional information regarding this inquiry, please reference the listed case number.

The Quest Diagnostics Health and Wellness Service Center Support TeamDesired Settlement: Credit 100 points (biomatrics screening) to total earned 450 points to my 2016 NJ Well program: then qualify the $150 gift card which was due at the end of 2015.

Every time I call the customer service line the representative I speak to is terrible. I had a claim that took over a year to resolve, because every time I would call the staff member on the phone would tell me they were filing a report to be reviewed. EVERY TIME I would call back to check on the status of that report, it had never been filed.
I am now 6 months pregnant. I called today to get a further explanation of my maternity benefits. The person I spoke to had to put me on hold for an extended period of time in order to answer each question. I asked if there was a packet that had a summary of my maternity benefits, of course no such thing exists. This company has terrible customer service. On top of that every time I look at what is actually paid to my doctor after a visit, it is appalling. $2.97 for a prenatal visit. NO WONDER the doctors have to overbook and cannot spend enough time with you, they're getting paid nothing from the insurance company!

Review: I recently worked for [redacted] and through [redacted] my health insurance was with Horizon Blue Cross Blue Shield. The Insurance card I was given clearly shows that a specialist co-pay is $20. I was told that a specialist is anything but a primary care physician. I went to a few specialists while employed with [redacted]; a dermatologist, gastrointerologist, cardiologist and neurologist. All of them charged me the $20 copay the card indicated. Soon after I received a bill from all of them for an additional $5 for the copay stating that the copay was $25 not $20. That is NOT what I was told. Horizon changes their mind just like that? I would have given it a second thought 'going to the doctor' had I known they were going to screw me. This isn't right. The insurance card they sent me I received for the year 2014. Please let me know where I can send a scanned copy of the card if needed.Desired Settlement: This settlement is two fold. I want them to adjust the billing and pay the doctors their $5 and I want an apology for the undue stress and additional doctor visits I had to go to because of this. I should have them pay for my medical costs due to this hell.

Business

Response:

Morning, a response letter was sent to you on November 3, 2014. I have attached a copy of the letter for your records. Please note, that since a HIPAA form was not inlcuded with the complaint, we have responded directly to Ms. [redacted]. If you have any further questions regarding this issue, please contact me at ###-###-####.