Who else has had problems with Blue Cross?

Question

When we joined Blue Cross we got a call from a rep to "thank us" for choosing them and to explain some of the benefits of our policy. One of them was a preventive care program that allowed each family member up to $500 worth of preventative care paid at 100% and NOT applied toward our deductible. So, I go ahead and make my daughter appointments for their yearly physical.

Two weeks later Blue Cross send me a statement telling me I am responsible for the costs. I call and find out that the Rep told me the wrong info. The preventive care only kicks in AFTER we fulfill our deductible. They even have notes in our account from the Rep showing that she told us the wrong info. Too bad so sad, is basically the answer. Now we are have to figure out how to pay these bills. I would not have even made the Dr. appointment if the Blue Cross Rep had explained the benefit correctly. I HATE BLUE CROSS!

Answer 1

I suggest appealing this, in writing.  Stay cool, and be patient.  They may offer a small credit, (but I doubt it). Appeal at least twice.    

If that does not work, file a report with the state DOI, BBB, and Ripoffreport.com, and anywhere else on-line you can.  

Also, have a NEW agent move you to a new carrier. Your agent should have caught this or at least helped you. They did you a disservice in not explaining this to begin with.

If Cross has notes in their files, be sure the state DOI/Dept of Managed Care (DMC is for HMO plans only in CA)  is aware, so that they know to request copies of their documentation. It will take months, but they may be able to help.

Answer 2

are you sure that it was billed as a yearly physical?  

If it was billed as a physical for school or sports it would not be covered.  I have seen this happen, a lot as people will need a physical for a job or school and the doctors office will code it as a job physical or school physical which is not covered by insurance.  But, if it is billed as a yearly physical it is covered.  I don't know if this will help, but it would be worth the try.

Answer 3

Unfortunately you are the one responsible to read the fine print.