Jason F Ztt

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Claim denial

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Blue Cross Of Northeastern Pennsylvania - Claim denial
Blue Cross Of Northeastern Pennsylvania - Claim denial - Image 2
I understand insurance companies try to deny everything, however this instance and denial is absurd. My 7 month was suffering from a severe stomach virus with all the associated issues that come with it (going to the bathroom uncontrollably). He was taken to a doctor who sent him to get a stool test in order to ensure there was not anything else that needed to be addressed. The insurance company, specifically the claims person without a medical degree, stated that my pediatrician was wrong and this test was not medically necessary. A stool test for a child with severe diarrhea, a novel idea apparently. They then went on to state in the denial this test was not warranted in people who had immune systems that were not weakened. So not only was my pediatrician wrong, apparently babies have immune systems that are comparable to those of adults and they should not be considered to be more at risk. I find it very enlightening that a young 7 month is now considered fully developed and their immune system is fully functional. Even worse, we were not notified our appeal was received and subsequently denied. When I called and asked to speak to someone with claims, I was told they were busy and would return my call. Not surprisingly, I never received a call from anyone. Would give 0 stars if possible
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Loss:
$1300
Cons:
  • Awful customer service

Preferred solution: Claim to be readdressed and paid in full

User's recommendation: Do not use them

KATRINA Gdl
map-marker Boca Raton, Florida

FILE MEDICAL CLAIM

I NEED AN ADDRESS TO FILE MEDICAL CLAIMS. OUR DR IS LOCATED IN THE MONROE COUNTY
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Anonymous
map-marker Belmopan, Cayo

Blue Cross of North Eastern P.A.

In April Blue Cross changed their policy and made my life a complete misery. What happened was that I have a doctor in New York, a specialist and researcher of Multiple Sclerosis, and have been seeing him for 15years.. I also get a very expensive treatment which Blue Cross has paid 80%. Without this treatment I will be in a wheelchair and in pain. The treatment is 80grams of gamma globulin once a month. I also get stem cells as a research program and both work together. It is really helping me. My doctor is out of state and out of network and that was not a problem. I paid a $500US deductible and 20%.. Now I am an Independent wildlife fimmaker and the business has been bad and not getting much work. So income is nil.. NOW Blue Cross new policy is they do not pay for out of network at all and out of state the doctor must be a member. BUT with a deductible of $3000 out of state and $1200 in state with a blue cross member--this is like a HMO.. I have a PPO. Individual. ANyway I complained and they will pay 60 percent out of network with an over all deduable of $4200 plu $250 co-pay. I can not pay the 40% or the deducibles.. I am really in bad shape and now no one cares what happens to me.. I need the treatment and can not get help anywhere.
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Anonymous
map-marker Scranton, Pennsylvania

Blue Cross/Blue Shield NE Pennsylvania Run Around

BC/BS of Northeastern PA is the worst! My wife has advanced cancer and needs time-release pain patches and medicine to control the nausea from chemo and radiation. They paid for the chemo and radiation but only allow three days a month of medicine for the nausea - idiots. So she is supposed to just vomit the pills that they paid for the other 27 days? They covered the pain med for the first month, and now will only cover 20 days of the same exact med this month, claiming that they have changed their policy, even though the formulary on their website doesn't say any thing about a change. When I called them they told me that its my doctor's problem. Take my advice, save your money, don't go with BCBS NEPA, just order the pills you need from India, you'll be better off. You'll actually stand less of a chance of being ripped-off by India in my opinion.
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