Will not cover a follow-up SCREENING Colonoscopy

I had a cologuard test and received a positive, as exact sciences recommends, I got a colonoscopy to verify the results nothing was found at all. I filled an appeal, and want a third party review, but I am told I am not eligible because they did cover it with cost sharing. My case rep was a jerk, and I want another, but they will not let another review. We all need to fight this, if they cover the cologuard test they need to follow the cologuard guide lines and cover a follow-up screening especially if it is a FALSE positive. BCBS MASS is benefiting significantly financially with this policy, and it is illegal. they are saying it is diagnostic based on a false result.

User's recommendation: keep fighting fighting fighting.

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ID
#2514928 Review #2514928 is a subjective opinion of poster.
Location
Manassas, Virginia

Monopilizing thier revenue and hindering good health

I'm a type 1 diabetic with excellent control. My current copay for each of my diabetic prescriptions are $150.00 each. The five scripts that I do fill would be cost $750.00 per month. I don't fill 2 other scripts that my Dr wants due to these high costs. After talking with BCBS, my employer and our rep I was told that the only way to cut these costs is to go to Express Scripts. Ugh!! Their are no generic or less expensive medications. I have tried Express Scripts before with much frustration due to poor customer service. They try to get paid upfront and want to send scripts automatically. BCBS has some type of relationship with Express Script which does not help the insured. Due to the slow processing time of Express Scripts I will be out of my bolus insulin before express scripts even ships. Due to their "banker hours" I couldn't contact anyone today. Until they had an automated call to have me prepay scripts they will be processing. They told me they will only "bill" up to $150.00, that's one script. So I will have to prepay going forward. I have already spent an hour and a half this morning trying to get insulin that I need. Right now I don't know if I will be able to get a vile of this insulin or if I will have to come up with my own dosing plan until it arrives. If I do this I may run out of that insulin before Express Scripts delivers. If that happens I guess I will just check into the hospital for my insulin, that surely wont save BCBS money. Just plain poor healthcare by BCBS and Express Scripts
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ID
#1254075 Review #1254075 is a subjective opinion of poster.
Location
Quincy, Massachusetts
Service
Blue Cross And Blue Shield Of Massachusetts Health Plan
Reason of review
Bad quality

BCBS Healthy Me is a "Big Brother" Marketing ploy which favors the young

The new feature, HEALTHY ME is recently added to my health plan at work. Who would not like a gift card of $300.00 in their pockets? But, it favors the young, who don't have as many annual check ups and required routine physical exams as older people do. The playing field is not the same. Not to mention good cholesterol counts and blood pressure counts differ per age group. And do all doctors use the same rating scales of counts? Do all doctors go by the same healthy weight averages for each age group and sex? What one doctor may say is healthy, another might not. This is a program is not inclusive and unfair.
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ID
#907534 Review #907534 is a subjective opinion of poster.
Location
North Haven, Connecticut
Service
Blue Cross And Blue Shield Of Massachusetts Health Plan
Reason of review
Bad quality
New Reviewer

Disappointed in Blue Cross's Groundless Denial of Coverage

We have been Blue Cross/Blue Shield customers for a long time, always paying our premiums conscientiously. This past spring, our son in college had a frightening health scare: he developed a rash that spread over his body and went into anaphylactic shock, with his throat closing up. He rushed to the health center at his college; they immediately sent him to the emergency center at the nearby hospital. But now Blue Cross/Blue Shield refuses to pay the hospital's bill because the hospital neglected to file the incident under "emergency care." The Blue Cross representative to whom my husband spoke on the phone said that, given that our son was triaged into the ER, Blue Cross would pay the bill. However, today, we were told it would not pay the bill but given no reason for this. Such a decision seems grossly unfair, unwarranted, and arbitrary. I urge Blue Cross to reconsider this decision and do the right thing.
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ID
#665865 Review #665865 is a subjective opinion of poster.
Location
Needham, Massachusetts
Cons
  • Arbitrary denial of coverage
Reason of review
an unwarranted denial of health insurance coverage
Loss
$4000
Preferred solution
Full refund

Not covering MRI's and prescription costs,and prescriptions

I am sick of hearing insurance companies claiming poverty. During the last contract year, they have denied prescriptions or increased their prices a hundred fold. They denied 3 Mri's out right and claimed it was the physicians fault. I get a weekly dose of methotrexate, a drug that has been around more than 50 years, costs pennies to make. The nurse gives them to me but I have to pay an office visit co pay, like I am seeing a doctor. They refuse to cover drugs I have been on for years. They get us to pay four thousand dollar deductible plus monthly though his company which chose an unaffordable plan, Anthem. I have used Mass Health to fill in some gaps, which was only temporary. I take 12-15 meds as I have severe arthritis, inflammatory, and other diagnoses, including the latest one of visual migraines. Due to not being able to cover costs after a large loss in 2008,we are close to losing our house. I need home care covered by Mass health currently. My husband works two jobs and we are paying off bills from way over a year ago. When they did cover MR I, they only covered 50%, they upped the generic medicines to. One hundred dollars, and deny other generics. They spend more time and paper denying valid claims. I have to deal with at least four people to get the bills paid. Then the three referrals for any procedure. I also need steroid injections in a torn rotator cuff which was fixed once, then tore again. Not Covered. I have two knees with no cartilage, procedure not covered. I have a slipped disc not covered until it destroys nerve completely. I don't think I will make it.
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ID
#568123 Review #568123 is a subjective opinion of poster.
Location
Marlborough, Massachusetts
Service
Blue Cross And Blue Shield Of Massachusetts Health Plan
Reason of review
Not as described/ advertised

Denied Maternity Claims after charging extra for specific Maternity Coverage for years!

I have been paying for a special "Maternity" health plan, for the event that I became pregnant. After 2 years of paying for the coverage, now BCBS is denying to pay for 100% of my baby's hospital coverage, after being promised by my agent, and the reps at BCBS for months over the phone (and literally many many hours wasted on the phone with them, that I should have been enjoying with my newborn!) that this would be covered. I keep receiving hospital bills and had met my high $6500 deductible months earlier for the year!!! BCBS is now telling me that I need to hire an attorney if I want them to review my case any further! This is sickening!!!
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1 comment
#822865

Contact your states insurance commissioner maybe they then can do something for you and you can save all that money you would spend on a lawyer.

ID
#485991 Review #485991 is a subjective opinion of poster.
Location
River Falls, Wisconsin
Service
Blue Cross And Blue Shield Of Massachusetts Health Plan
Loss
$2500

Trying to change plans for an elderly relation.

here in Mass I was asked by family to see why the plan cost 700 per month while other plans were cheaper with blue cross. I called mid November and was told all of the available plan details would be sent to me and our family member. It never arrived. Called blue cross again on Dec 3rd and got the package on Friday Dec 6th. Reviewed it the next couple days and called today Dec 9th. 1 hour and 20 minutes on the phone (& 6 transfers) and this is what I found out: we can switch the medical coverage from 700 to 200 a month BUT it does not cover medicines. Medicines are covered in Part D. Cut off for enrollment in Part D was Dec 7th and we have to wait another ~ 10 months. We have to stay on the current plan if we want drugs / medicines covered. IF blue c had sent us the paperwork from the November 7th call we would have made it on time. If blue c had notified me last week I would have been able to get part D in time BUT they didn't. Due to blue c not telling us we will be paying them an extra 400 per month for another year. 700 dollars per month for someone on a fixed income is a lot of money.
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1 comment
#759690

I feel for you, but the deadlines for Part D have been known for years. It's not something that just popped up.

Given that knowledge if you had not gotten paperwork you should have called again before the cutoff. It's not a date they set and it's not one they can override, plus it's know at least a year before when next years enrollment is open.

I do feel sorry, and agree it hurts, but this is a case of waiting to the last minute and it biting you in the ***. We've all had it happen.

ID
#462591 Review #462591 is a subjective opinion of poster.
Location
Boston, Massachusetts
New Reviewer

BCBS has Idiots running the company

My daughter was a pedestrian hit by a car. She sustained a head injury. We found the best doctor in the state (U-Mass Memorial) and he personally took over her care and prescribed a treatment plan. Blue Cross Blue Shield bureaucrats have run us ragged - they send us from one dept to another. They have a "peer group" where their doctor talks to the patients doctor but they refused to talk to our Dr. What is the point of a peer-to-peer review if they just sit behind a desk and deny help? - so my daughter is in daily pain and they are shuffling paperwork while she suffers. They are a private company - so there is no recourse. One dept. reviews another - so they are self monitoring - which is no monitoring at all. They can literally do whatever they want. I can't wait for Obamacare - it can't be worse than these idiots. Without treatment she won't be able to work and will have to go on disability - there is a solution for you.
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ID
#443594 Review #443594 is a subjective opinion of poster.
Location
Boston, Massachusetts
Service
Blue Cross And Blue Shield Of Massachusetts Health Plan
New Reviewer

SUBOXONE TREATMENT WITHELD

The insurance Bluecross Blueshield of massachusetts is taking away the right for patients to choose their own doctor and they are taking away the medication privileges that the patient has with the PPO and POS plan. I have been told as the physician of these patients who have had a treatment alliance with me for years, that the insurance is telling them that their treatemnt will not be covered and that even when the patient will be paying ahead of time my fees that the insurance will refuse to pay them back. A ppo and a POS plan offer the patient the ability to go to a physician of their choice and therefore to go out of network.
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ID
#385180 Review #385180 is a subjective opinion of poster.
Location
Boston, Massachusetts

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