Blue Cross of New Jersey

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Kenneth of Loraine, IL October 9, 2009

We have had several problems getting BCBS to pay our claims in a timely manner. CSR's all tell you different things and supervisiors aren't much better. We were always promised a call back and only recieved one out of about 20 promises. I am still waiting for a claim from 2007 to be paid and supervisors admit there is no reason it should be held up but no one can seem to actually process it. Now they are repeatedly denying charges that are covered, you basically just have to appeal everything to get a full payment. It is just plain fustrating and I am about to involve a lawyer. Stay away from this group if possible!!!

Richard of Lambertville, NJ May 12, 2009

I have chronic back problems and have been taking several pain medications for years and never had a problem filling the scripts. This past week 2 out of 3 scripts were denied. I am insured through Keystone Blue Cross Blue Shield, who in turn uses Future Scripts to cover prescription benefits. Apparently, starting May 1st Future Scripts has implemented a new policy where any member can only fill one prescription for a controlled substance in a 30 day period. They failed to notify their members, the doctors, the pharmacists and the public of these changes. They failed to clearly communicate these changes to my pharmacy when my script was denied.

The end result is that I am now without the medications I need and must wait (in a barely tolerable level of pain) for the paperwork and procedures to be completed, if they are even approved. I have already filed a complaint with Keystone and Future Scripts and I will be posting, blogging and working to expose this unacceptable change and poorly managed implementation (along with the failure to notify) to as many media outlets and politicians as possible.

Based on what my pharmacist told me hundreds of thousands of people will be adversely affected by this change; I would urge all those effected to file complaints. I am shocked and dismayed by this irresponsible enactment; this is just another example of reforms or controls that are missing from our great country's terrible health care system.

I would urge Future Scripts to repeal this change and if they must re-instate it, then this should only follow proper notification of all effected. I believe Future Scripts is liable to anyone in a similar situation to myself, undue pain and suffering sounds about right. Once I have exposed the issue, I will consider hiring legal counsel. I can only hope that too many people are not suffering, waiting for approval to receive the medications they need.

Kevin of Cliffside Park, NJ February 18, 2009

Kevin of Cliffside Park NJ (02/18/09)
I called regarding no payment of an anesthesia submission that was made as part of a colonoscopy which Horizon pre-approved. Their reason for non-payment was based upon the fact that my 1,000 deductible wasn't met until the day of the procedure.

By background, I changed carriers in Sept./Oct. of 08 and in fact had no deductible payments before that day. However, the entire procedure which they pre-approved cost 3,875 - so my 1,000 deductible was met that day. Horizon said that their rules state that the deductible needs to be met before the bill is submitted or they refuse payment. Why does it matter when I meet the deductible - I can't understand at all how they can separate work pre-approved? Kinda a chicken or the egg scenario but a lot more money.

Another clear example in my mind of the major problems that exists in our healthcare system - it is a disgrace that companies aren't held responsible. we need massive changes in the system. It cost me 875 more because I met my deductible on the same day as the procedure - what was I suppose to do - have it over 2 days?

Sasha of Haddonfield, NJ October 17, 2008

I believe that my insurance premium was taken out of my paycheck, but my service was cancelled before it was taken out. I basically paid for insurance but am not insured. I have called but they will not return my calls to clear this up. I called the insurance carrier, and they agreed that the premium is taken out for the following month. So my service should have been valid for a month after my paid premium which was 10/3/08, but was cancelled on 9/30/08, the day I quit.

I also believe that another premium may have been taken out 10/17/08, but will not be sure until I receive my pay stub. I have a 2 year old son who was injured and taken to the doctor, and found out my insurance was cancelled. I must now pay out of pocket, as well as dental work that I had done that was extremely expensive.

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