Daniel M Nrg
map-marker Austin, Texas

Ridiculous

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In May 11 2019 i called about a claim that had not been properly completed by blue cross blue shield of Texas, so I called and was on the phone for 1 hour and the person I was on the phone to said how about this goodbye and hung up the phone. The best part is he won’t have no recourse from treating a policy holder that pays $1300.00 a month like trash
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1 comment
Machele Imf

Blue Cross is licensed to sell and provide health insurance within the state of Texas and is thus subject to the scrutiny of the Texas insurance regulatory agency----I don't know what they call it in Texas, but each state has an agency that can help you with problems with insurance agencies. Go to the Texas main website and find the proper agency.

You may be able to file a complaint, etc. online.

You can also appeal Blue Cross's denial of payment, etc. Take a look at the brochure you should have received from them when you signed up and look under "appeals" or similar for the procedure(s) to take if you disagree with their decisions.

Matt M Kwj

The worst health insurance company

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I have been denied on my claim which is no small amount ($9400) after it was pre-approved and pre-authorized. The doctor, anesthesiologist and hospital are all in network as "participating providers" which BCBS readily admits. They are all on their own website as participating providers. The loophole that they are using to deny and not pay the claim is that the are a participating provider in network but it is an institutional claim. Which doesn't make sense to me and I am a licensed Health and Life insurance sales person and have been for 6 years. We checked all the boxes and made sure ahead of time that the procedure would be covered only to find that Blue Cross Blue Shield of Texas will not pay the claim and they do not care. Unfortunately they don't care about negative reviews either and they don't respond or seem to bother with the claims side of their business. They just say, we have 32 divisions of BCBS and we are too big to deal with a small insignificant problem like this. It may seem small and insignificant to a large corporation like Blue Cross Blue Shield but $9400 is a significant amount to me. At this point I hope the government gets their way and takes over the health care industry and puts companies like this out of business for good. You get what you deserve.
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Loss:
$9400
Cons:
  • Bait and switch
Reason of review:
Problems with payment

Preferred solution: Deliver product or service ordered

2 comments
Genny G Vpm

This post serves as more proof of what a disgraceful company BCBS/TX is. I am grateful that I no longer am a part of their 'coverage,' but feel for this poster and others who have also suffered losses as a result of this sort of corporate madness.

Guest
reply icon Replying to comment of Genny G Vpm

You would most likely have to appeal the claim all the way to court. It sounds like only a judge would be able to reverse the decision and make them pay

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Annmarie J Glk

Mental Health Claim

I have had nothing but trouble trying to make a complaint. First they told me the wrong place to file a claim. Then they told me I needed additional information without telling me what I needed. I had to be on hold for an hour to get the information about what additional information I needed. Then I found out my service provider doesn't even have the additional information. And, I have to resubmit the claim rather than being amend my previous claim. It feels like an attempt to avoid paying a complaint.
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Loss:
$960
Reason of review:
Problem with delivery
Michael J Bzb

Watch your appeals!

In 2017 after having a ct scan it was found I had several new kidney cancer lobes in my abdominal area. My oncologist ordered a pets test to see if the cancer was anywhere else on my body. The Blue Cross Blue Shield of Texas stated this test was not necessary and the claim was denied. After several documented appeals from myself, clinic and Doctor Blue Cross Blue Shield of Texas refused to pay for pets. The last reason for payment was past due to time has run out for appeals. My guess is I was approaching my 65th birthday and they would be done with me being Medicare would start. I'm stuck with the $5000 bill.
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Loss:
$5000
Reason of review:
Poor customer service

Preferred solution: Let the company propose a solution

David S Nsh
map-marker Broomfield, Colorado

Denied Coverage for PET/CT Scan at Mayo Clinic

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Blue Cross Blue Shield of Texas has denied coverage for at PET/CT scan that I undertook per doctor instruction at the Rochester Mayo Clinic in March 2017. The PET/CT scan was recommended for the initial evaluation and follow-up for non-Hodgkins lymphoma. Blue Cross Blue Shield took significant time to respond to my numerous calls and then after five months determined that it would refuse to cover the costs of $6783 claiming the PET/CT scan was not medically necessary. I was diagnosed and treated for both lymphoma and AL amyloidosis in 2013 which involved both chemotherapy and a bone marrow transplant. These costs were covered by a previous medical insurance company without issue so I was not prepared to be told that a further test involving lymphoma a few years later would be deemed medically unnecessary. When my doctor ordered the additional PET/CT scan in 2017 I also never questioned the medical necessity of the test since he was a highly regarded doctor at the Mayo Clinic that I had been referred to due to the complexity involved with dealing with AL amyloidosis. I was formally denied coverage for the PET/CT scan by Blue Cross Blue Shield in October 2017 after significant time, stress and communications over a five month period. Dealing with two fatal diseases is extremely daunting. If I had been aware that I would have to question the medical necessity of the PET/CT scan before taking it I would have done so. Having to pay $6783 for a test that it took Blue Cross Blue Shield five months to determine was not medically necessary is sad and very frustrating. Who am I to trust the next time I am instructed to take a major test for lymphoma or amyloidosis - the Mayo Clinic or Blue Cross Blue Shield? Will I have to wait five months again to determine if the test is medically necessary? David Snyder 612-240-****
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Loss:
$6783
Reason of review:
Problems with payment

Preferred solution: Let the company propose a solution

Brenda P Lqt
map-marker Orange, Texas

Representatives have false information on the insurance and what it offers.

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When w moved to Texas I had to change my Medicare. The representatives told me ask falsehoods about the benefits. I was told numerous times that I have dental that covered dentures and was told where to go for service just to find out I have NO dental coverage. I was told where to go for eye exam and glasses I went and that was a lie also NO eye coverage...why was I lied to??
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N.Williams
map-marker Lufkin, Texas

Over 3.5 HOURS on hold

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My dental office has been ON HOLD for more than 3.5 HOURS trying to ask a question about benefits
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Loss:
$100
Cons:
  • Tooooo long on hold
  • Customer service
Reason of review:
Poor customer service

Preferred solution: Let the company propose a solution

Anonymous

Not paying for medications

My husband is a type 1 diabetic, he was using lantus pain,was controling his blood sugar. Blue cross sent him a letter saying they no longer would cover lantus due to price. My husband switched to another brand took several months to control his sugars. This week he was sent another letter saying bluecross stopped covering colchicine for his gout. He needs that medication. Bcbs of tx. Is slowly not covering medications, due to pricing. These are LIFE. SAVING MEDICATIONS OR MEDS. NEEDED TO CONTROL PAIN. Pharmacist told us that bcbs is doing what medicare does. Is it your intention to slowly decreasing the population, especially the ill ones. Im sure all board members or PRESIDENT OF bcbs get a hefty paycheck, even heftier BONUSES. Its so OUTRAGEOUS. MEAN, HORRIBLE way to treat people who need these medications. Whats the use of having BCBS OF TEXAS if you eventually will stop paying for anything#! Your to busy counting the money in your bank accounts, and killing off the sick population just like medicare..
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Zara E Bwr
map-marker Nashville, Tennessee

Very disappointed never use them again

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Its the worst. I could not sign up online, or using the app and after waiting for almost an hour in the pharmacy they said that my plan does not cover my medication. And i got the most expensive plan just for that purpose, and I asked them before i signed up. I just really have a bad and annoying experiment. I wish if I kept my United health care plan. Defenatly will not use them next yeas.
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Reason of review:
Bad quality
Anonymous
map-marker Wichita Falls, Texas

Not a good place to work

This place will rabdomly fire you with no warning. Also wil not inform you of what you need to improve on to help improve before termination or at least my supervisor did not care enough and was barely around. Also instead of informing me that I no longer worked there WHILE I WAS THERE they set me up to leave on break just to inform me that I could not go back to get MY STUFF including my purse until THEY said I can. The way I was treated was unacceptable and should have handled things more differently and show more effort when it comes to helping others improve.
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Reason of review:
Work Experience or Job Application
Anonymous
map-marker Richardson, Texas

Suck face csr in call center

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I’ll just say this BCBS sucks!!!! Sorry United Heathcare you lost the bid to this sorry agency
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Reason of review:
Poor customer service
Paola O

They dont care about people!!!

These guys are denying my husbands chemo treatments over and over again thus signing his death certificate! We are both physicians and have been helping serve and treat people for decades! These guys do NOT value life and God forbid any of their family members have to go through this! If my husbands cancer spreads i am personally holding them accountable! The depth of this diagnosis calls for action last week! Not when the bureaucrats decide that its time to take his precious life Seriously! This is a call to action!
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2 comments
Genny G Vpm

This is not just 'disgraceful,' but downright evil on the part of BCBS/TX. Absolutely disgusting!

Guest

Agreed

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Phyllis B Snz

BCBS is insane

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BCBS denied my claim and I've been dealing with this for over a year. I even had proof how many times I've called and they even gave my doctor the wrong fax number. I even call before going with a procedure and provided code numbers and they said it was proved. I get a letter saying, they are staying with their decision because my reconsideration needed it to be reviewed within the six months of their decision. No $_&$ Sherlock, BCBS kept saying they never received my paperwork even when we did a 3-way call with my doctor and BCBS. Bottom line is, they don't know their heads from their @$$#$$ and they don't give a damm.
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Reason of review:
Poor customer service
Anonymous

Not paying providers and lying

BCBSTX is systematically NOT paying out-of-network providers and misinforming the public to: 1. eliminate competition by forcing people in-network where they can force underpayment to hospitals, clinics and providers 2. eliminate patient choice by forcing them into overcrowded clinics, hospitals and emergency rooms 3. decrease number of claims by promoting frustration and barriers to access 4. increase company profits by not paying claims but instead distributing member premiums to administrators or share-holders.... all on the back of not paying claims BCBSTX is NOT concerned about Texans, only profits. As an administrator, I hear first hand from providers, patients and business owners about the lawlessness that is allowed by BCBSTX. The TX legislators need to get serious about policing this giant or it will forever ruin people.
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Reason of review:
Problems with payment
REBECCA C Xcj

Confusing EOB

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This is what the bill looks like for a patient who's company covers him 100%: Amount billed $137.00 Disc, reduct, payments $0.00 You may have to pay provider $137.00 AMOUNT COVERED $137.00 AMOUNT NOT COVERED $0.00 You may have to pay provider $137.00 In other words, BCBS of TX covered everything, but the patient might have to pay everything. It sounds like they don't know what they are doing or who is supposed to pay, if the patient pays the doctor, fine, if he doesn't, that's fine, too. If he pays, the insurance won't have to and the doctor gets some extra money that they shouldn't have gotten.
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Reason of review:
Not as described/ advertised