Blue Cross of Illinois

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jim of woodridge, IL June 29, 2009

BCBSIL is unfairly profiting from"post claim underwriting in this state now. My wife's coverage was rescinded (cancelled all the way back to it's original effective date, as if it never existed). Some insurance companies that do not conduct a thorough health history investigation at the time of application attempt, after the fact, to underwrite your insurance policy only after you file a claim.

This is done by the insurance company to try to avoid the consequences of its deliberate marketing decision to forego initial underwriting in order to increase sales and profits. This recission took place 9 months after the policy was issued based on a claim for services at her annual check up. A minor side note in the doctor's record of the visit was highlited out of context and redefined as a major condition which the BCBS claims was pre=existing and undisclosed on the applicatio. The doctor has stated in follow-up that no condition exists and there has never been a diagnosis of it previously, and that the pre-approved tests were consistant with routine maintanence check-ups.

After 2 dozen + contacts to BCBSIL there is continued disregard for their contractual responsibility to pay the claims they approved in advance. They have not honored their obligations by deceitfully doing what is illegal in so many other states. In California, Huge class action suites and even the doctors are joining in because Blue Cross has rescinded policies on unethical grounds and still approved tests and operations for which they refuse to pay, leaving the patients, doctors and hospitals holding the bag ... many horror stories in that state alone. My case is identical to hundred of the CA. cases and my contacts are all documented. Beware folks ... you are not secure if you have BCBS,IL insurance due to this pattern of post claim underwriting and rescission to improve their bottom line profits .

Insurance consumers, and particularly those who have purchased individual health policies from Blue Cross, need to be vigilant as to this practice which seeks to deprive us, the health insurance policyholders of valuable insurance coverage at a time when it is most needed: after they become seriously ill and submit claims for promised and approved benefits.

susan of chicago, IL June 25, 2009

Bottom line----BCBS of IL sucks! They "bait and switch" their customers, which seems highly illegal to me. Long story short, we applied for individual insurance from BCBS of IL for my 55 year old husband in Nov. of 2008. It took until Jan. 2009 until they accepted him into the plan. He signed an Amendatory Endorsement stating he had back problems, but they were resolved at the time of the application. BCBS never sent a exclusionary rider or called his back pre-existing. So it was our dumb luck that his back went out as soon as we got the insurance. We carried Unicare for two months simutaneously to BCBS, just to make sure BCBS paid the claims. They did pay, so we cancelled Unicare thinking everything was "kosher" with BCBS.

Well 6 months after accepting the insurance, BCBS sent a permanent rider on his back. We either sign it or the insurance gets rescinded. They had ample opportunity during the application process to figure this out. WE don't know what is or isn't acceptable to their underwriters. They should have done their due diligence and examined everything before we accepted the insurance, cuz we never would have accepted it with a rider. My husband would still have insurance with UNicare if they did their homework before hand. We never lied on the application. My husband talked with 4 nurses about his back on a recorded line. They knew everything before they wrote the policy.

Doris of Warren, MI February 8, 2009

My company insurance was terminated on nov 1 2009. Owner of company didnt tell the employees at all. The money was still taken out of paycheck. Its a horrible mess and I know the company I work for is at fault. Blue Cross really did the unthinkable to me also. I had a doctor appointment on jan 26th. I called blue cross to make sure I was using the right doctor in network. I also wanted to make sure I was covered before I went into the doctor. I called four times as the doctor kept adding test to my visit. BLUE CROSS told me I was covered. If my boss stopped paying on nov 1th and here it is jan 26 almost 3 months after the fact! Why would they tell me I was covered. After fining out what my boss did to us.

I recalled Blue cross and they then tell me it was terminated in their records on nov 1 but it didnt show it on there system till feb 3 rd. It took them 3 months and two days to catch up. I cant understand why just a few days before when I called them directly why they didnt tell me it was terminated. Blue cross shuldnt take 3 months when they know it was terminated they should tell people. So thinking I was covered I went to the doctor. I have a huge doctor bill now along with medication I thouht was covered. My company is totally wrong to take money for my paycheck for insurance and not pay the bill! Blue cross is just as wrong for not telling me!

Three months not being paid. dont tell me blue cross didnt show it immediately on there system it wasnt paid for. My medical now is 2 grand since the blue lied to me. If a policy is terminated on nov 1 dont tell me blue cross had the right to wait till feb 3 to tell a customer. Especially when I called them. It should be illegal on blue crosses part also. People get bad credit scores from medical bills. I work in a credit field. Ive seen it happen. Now I know why it happens. Bad blue cross. They totally lied to me. Three months to catch up on a termination. Dont tell me it takes that long.

Owing a doctor bill of 2 grand for a mamagram. pap ect, full blood work, treatment for acute lung infection, x rays and 5 medications. Not to mention the full day of work I took off without pay to have these things done. Which I wouldnt of done or did if blue cross told me the truth. They jsut told me to call my company about it. I asked blue cross why it tokk them three months to let me know and why only a few days after I went to the doctor.

Barbara of Chicago, IL October 8, 2008

Before Zyrtec-D became an OTC drug, Blue Cross of Illinois covered my use of this medicine. Now, Zyrtec-D is a hybrid OTC medication -- a controlled substance dispensed under law by a pharmacist with limited supply available without a prescription AND a BCBS non-covered medication because it is STILL classified as an OTC, despite the D. By law, now, it is illegal for me to purchase my monthly supply without a prescription.

I purchased the generic brand of the Rx that BlueCross of Illinois said they would no longer cover -- despite it being handled as a regulated substance -- and within a week I began to suffer from debilitating sinus headaches as I had for a decade... as I had until I found Zyrtec D. By the month's end, I was dealing with the crushing headaches that had sent me to the doctor. I could not get relief from the generic brand and I could barely afford that, out-of-pocket, let alone my Zyrtec-D without Rx coverage.

I'm now in month two of making the transition back to Zyrtec-D, and am starting to feel better. I can't believe that the current regulation of decongestants enables the entire Blue Cross of IL to squeeze me both ways. By the way, my yearly premium is in the range of 8000. The 80% effectiveness of generics is made me 20% sick. The three-times-the-price name brand is making me poor. The face-less legislation enacted to curtail illicit drug-makers from melting down pills only to re-sell them as street drugs is keeping me running in circles.

Donelle of Chicago, IL May 9, 2008

My husband has BCBS of Illinois PPO. Encompass Health Management Systems is contracted to work with my husband's place of employment to pre certify occupational and speech therapy. When I went on the website for my husband's medical insurance in the Dept. of Human Resources, the speech therapy and occupational therapy is listed as paying at 90% in network coverage as long as it is pre certified by Encompass Health Management Systems.

Our 4 year old son has sensory modulation issues, auditory processing, vestibular, oral sensitivity, tactile, inattention issues all with his sensory processing disorder. He has some coordination difficulties as well-that can occur with sensory processing disorder. We went to our pediatrician whom gave us the referral we needed to get an evaluation from an occupational therapist to help with the sensory issues in question. This is needed to get the evaluation itself as well as for the insurance company for coverage. We obtained that from our pediatrician and went to Children's Memorial occupational therapy dept. on April 22, 2008. We found out our 4 year old son needs occupational therapy once a week for one hour. Our insurance information was sent in and Encompass was notified that our son would be needing this therapy one time a week.

We received a letter from Encompass Health Management Systems around May 4th or so dated April 29th, 2008. Encompass is denying any and all precertification necessary for BCBS to pay for our son's therapy he needs. Their reason is, Encompass has been uanble to certify the Occupational Therapy service because services are for acquisition of function normally expected for your child's developmental age. If our son was completely up to developmentally what he should be then we would not need the occupational therapy once a week for an hour a day. We are not looking for a hand out. We are just looking for the occupational therapy service once a week for our son. My husband pays into his plan. The money is deducted from his paycheck and we are not trying to take advantage. We just want help for our son.

On May 8th 2008 I called Encompass to tell them I was going to be filing complaints with the BBB and anyone else that would listen about the unfair practice of denying needed coverage for children. I talked to a woman named Penny after waiting for around 25 minutes for the receptionist or person answering the main calls to find a supervisor. I could hear someone pick up the phone and place me back on hold as if to see if I was still on hold. Anyway, I stated my case to Penny and wanted to know the name specifically of the person Encompass was claiming was telling them from my husband's place of employment to deny precertification for our son's therapy. She could not come up with a name but stated in our benefits handbook it would probably be why our insurance pre cert was being denied. I told her I was on the main website that stated 90% coverage for in network as long as Encompass Health Management pre certified the therapy.

I wanted to at least know what page this denial is supposedly under in the benefit book and the name of an actual person in charge of the denial of pre certification. Penny told me the supervisor in charge of that information was out and would not be back for a few days.-This was 5/08/2008 that I spoke to Encompass. Shetold me she could resubmit it for review. We have the letter from Encompass giving us the ridiculous reason for not precertifying our 4 year old's coverage is because services are for acquisition of function normally expected for your child's developmental age-as previously mentioned. The whole reason for the occupational therapy is to help our son acquire function normally expected for his developmental age. It is only for one hour a week once a week-nothing extra or fancy.

I am upset that the precertification may be denied again for therapy my child really needs from insurance we pay into. We are a middle class family that does not qualify for low income special state funded programs. We rely on our insurance coverage to help us for reasonable expenses. We think that therapy for our son once a week is a reasonable expense. I am sending info. about this off to the Tribune editorial section, state legislators and anyone who will listen to try to be an advocate for my son and other families who are being abused by health management systems and health insurance companies. I just wanted to get the word out through your website as well.

These companies are hoping when we receive the denial of coverage letters that we as the ins. consumer will accept this and not file a complaint or follow up on the denial. We are our children's best advocate and we have to fight for them against unfair insurance policies and the health management system companies they use for pre certification like Encompass. Please just help me get the word out about unfair denial of ins. coverage for our kids.

We have brought our son to 2 sessions so far at Children's Memorial Hospital and have paid over 500.00 so far for 2 hours. This is our rebate check money. After that is gone we will have to use money that would have gone to bills. I discussed filing bankruptcywith my husband. We have looked into Easter Seals but it still would be around 600.00 a month. I am not able to take a job at this time or I would. We have a mortgage and other bills but would forego having our condo if it meant we could pay for our son's therapy. We aren't asking for the moon so to speak just for 1 hour of occupational therapy once a week to help our son. Our last hope is for Encompass to pre certify treatment for our son's o.t. therapy. We are at their mercy with this.

Maryann of Sioux City, IA April 16, 2008

I have had several medical bills denied due to a lack of information that was sent several times. The fact of the matter is that there have been too many incidents to keep track of. I do have information, but it would take forever to find all of it. One incident in particular, is an incident that involved services rendered on 1-17-07 from CNOS (Center for Neurosciences, orthopaedics, and Spine)PO Box 1430 Dakota Dunes, SD 57049. My primary contact at CNOS is Sue. It has taken us over 15 months to get this paid. BCBS kept telling me different things, then kept telling her different things. The last instances they were telling her they needed me to send the dates that I was under United Health Care. They kept telling me that they needed her to send the EOB (Explanation of Benefits) from United Healthcare--United Plan # and BCBS # available upon request (I don't like over the internet information transfer) BCBS Address Via National Automatic Sprinker Industry is 8000 Corporate Dr Landover, MD 20785 - 800-638-2603 or 301-577-1700---United Healthcare PO Box 740800 Atlanta, GA 3037 40800 Ph#800-357-0978.

Today we spoke with Sadequa Via 3 Way Calling. Her Ext at BCBS is 4789. She stated that she needed the EOB from United and that she had a wrong address for CNOS. The address she had was a physical address and would have still reached the same place. CNOS did receive the denials so this is not an issue. Just in case though, Sue @ CNOS faxed a new W9 and the EOB while keeping her on the line. At first, she stated that nothing was received then after persistance, we tried again and to 2 different fax #'s. Eventually, she stated that she received the information. If it is not taken care of this time, what should I do. ALSO, this is not the first time that a 3 Way call had to be used to get things taken care of. The last time, they also said they did not receive the faxed info the first time and we had to fax it again. Needless to say, I have not been happy about this.

My husband works for a Union though. They choose who our healthcare is through and we don't even have a choice that allows us to opt out and just receive the money they take per hour for this. If we did we would have taken the money and paid for a different provider years ago. This would not be as frustrating if we didn't get a different story every time we called on the same issue. The first 4 or 5 times, they told me a different story on what they needed everytime. Call me if you need more info. Sue also said she would help in any way possible. P.S. I don't want to put BCBS out of business. I just want them to do things correctly. Preferrably the first time the claim is sent, then I don't even have to get on the phone and waist hours of valuable time!

Several hours of lost time. Possibly a dent in my credit history. If you want to split hairs, increased stress which leads to increased headaches and pains. Which leads to increased cost for pain medication. Which leads to financial troubles. Etc.

Carolyn of Antioch, IL June 24, 2003

In July, 1999 I had been working for Pepsi Cola General Bottlers, Rolling Meadows for about 3 months. Was new to the insurance and new to the company, in fact I hadn't received an insurance card yet. I was at a company sponsored event at a water park, I received a head injury when I smashed into a cement wall. I was taken away in an ambulance.

The next morning I called the primary care doctor I had chosen, in fact I contacted every primary care physician in the Antioch area to make sure I alerted them to the incident. When HMO received their paperwork on me, they claim they never received the form which lists out my doctors name. So they arbitrarily assigned me to a doctor in another town. Of course according to their records I didn't call and receive a referral from my primary care physician. So they have been denied the charges.

In January of 2002 it was brought to my attention that the charges were outstanding still. I contacted HMO and talked with a Sarah Morgan who assured me that this would be taken care of. She was in contact with the collection companies and they were going to send her whatever statements were needed to clear this up. I never heard from anyone after that and the charges were dropped from my credit report.

In April 10th this year my credit was pulled and it was not listed, the bank I'm attempting to refinance with pulled a subsequent report and the charges were brought back up again. To find out that the charges still have not been paid. I contacted HMO and spoke with consumer affairs who is now disputing that the incident was indeed an emergency.

The economic damage is that this incident has been on my credit off and on for over 4 years now. I was fully insurred at the time and these bill should have been paid. I'm at this time unable to take full advantage of the low interest rates because now I won't be able to refinance for at least another 60 - 90 days which is what I was told was suppose to be the soonest timeframe.

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