M Rif

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Primary Care Provider unable to reach a representative in authorizations

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Contacted this company to follow up on a denied claim for a wheelchair. Medical documentation proves beyond a doubt the patient requires a wheelchair. Unable to get through on the provider line as the system did not recognize the patient's insurance member number. Was able to get through to a representative after 35 minutes and several automated messages that required a response. Eventually, after providing the same information for verification purposes TWICE, the unpleasant/unhappy representatives stated they would transfer the call to the authorizations department. Both times the call was disconnected. Was never able to get through. In addition, the DME vendor had submitted an appeal, but it was denied because it "exceeded the time limit allowed for a claim". They are being required to submit an entirely new request for authorization. No doubt so that this company can do exactly the same thing. The primary care provider's office has advised the patient to change their insurance carrier.
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Preferred solution: To inform patient's that this is not a good insurance carrier.

User's recommendation: As a primary care provider's office we advise patients to select a different insurance carrier.

Phyllis Jean R
map-marker Syracuse, New York

Need insurance

Please help me I need health insurance Im willing to pay for Empire, Blue Cross and Blue Shield. I have UnitedHealthcare right now but doesnt participate with Mount Sinai or some of the hospitals that I use. I am not eligible for Medicare until 65. I am 64 years old now I will be 65 in November.
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Preferred solution: I would like to have Empire, Blue Cross and Blue Shield as my insurance health insurance

Danica A Fch

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Verified Reviewer

Poor service and product quality.

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Mammogram denied 24 mile RT drive to nearest pharmacy Outsourced customer service with poor English Wont cover 100% annual checkup (I pay nearly $1,200/mo) Sydney app appears to have been written by middle-school student programmers And the list goes on and on. F rating at BBB Average satisfaction rating on most sites is slightly higher than 1/5
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Loss:
$750
Pros:
  • Sounds prestigous
Cons:
  • Fails to deliver

Preferred solution: Chapter 11 filed by BC/BS

User's recommendation: Stay away

Sung sil K

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Verified Reviewer

My insurance plan cancel

I has been moved to LA. In 2020... that time l already cancel to Blue Cross insurance. But still working.
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Preferred solution: I don't have my ID card in blue cross insurance So.. i can't contact insurance company by phone.

Kay R Luu

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Verified Reviewer

The OVC Reps for Empire that I talked to are liars, scarcastic and cold blooded.

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This complaint is not against Empire, but the company that runs the OTC service for them. Friday, January 13, 2023. I ordered some necessary OTC items online. The website app for OTC said 2-day delivery service. After placing your order online, they do not give you a tracking number, nor do they send you anything stating they received your order like other insurance companies. The only way that you know you placed an order is the amount that they deduct from your Flex card they provide you with. I had not received the items by Jan 16th. It was MLK holiday. So I didn't call until Jan 17th. When I had mentioned that I did not receive my items that I really, really needed. The rep said, "because of the MLK holiday, the delivery people are backed up". She then says it will take 7 to 10 business days. She assured me that I would be receiving the items on Thursday, Jan 26th. Ok, on Jan 26 at 4:00 pm I still had not received my items as the rep assured me I would. I called back and spoke with Miriah after 4pm on Jan 26. Miriah assured me once again that my items would be there before the end of that day. At 9pm the same day, I had still not received the items. She refused to tell me the tracking number and didn't even bother to look it up. So the next day on Jan 27th I call back and spoke to another rep. I was upset and didn't get her name. This rep was very sarcastic and not at all helpful. She didn't even look up the information. She didn't even ask if I had a tracking number, so she could check if it was delivered or not. Instead, her only response was sucking her teeth, she said"TSK TSK, isn't that a shame you didn't get your package. Then she said, "Well, I don't know when you will be getting it. I just hung up. . Furthermore, I'm disabled, I needed those items to function properly. I don't like dealing with unprofessional, unsympathetic liars. I'm filing a complaint with Empire. If they keep this current company. Then I'm cancelling my insurance with them.
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Loss:
$1

Preferred solution: Deliver product or service ordered

User's recommendation: I wish Empire would get another OTC company. they are liars and are not helpful at all.

Erica E Qxy

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Verified Reviewer

Benefits

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I am new to the Empire healtplus gatekeeper. No specialists take this. I was denied a removal of a growth on my scalp. They do not fill my asthma medication and will only use generic now they are telling me I have to fill through CVS discount program. For $900 a month this is terrible insurance!!!
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Loss:
$900
Pros:
  • No pros only cons
Cons:
  • Most doctors decline to take it
  • Frequenty deny simple procedue
  • No specialists take it

Preferred solution: Let the company propose a solution

User's recommendation: NO dont get it

Anonymous
map-marker Brooklyn, New York

I was denied of emergency care

I had an accident, I broke my ankle and was denied the care from the Insurance company, I was just told by the hospital. What kind of "care" is this when I pay for my health care and was denied an EMERGENCY?!?!
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User's recommendation: Dont trust the system!!!!

Darlene E Ttv

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Verified Reviewer
| map-marker New York, New York

Received insurance I'd later told I'm not covered

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I received my insurance I'd card I had to visit my doctor to find out my card is not valid. Called empire was told they needed additional information no explanation and end of conversation. I am scheduled for surgery with no insurance
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User's recommendation: Blue cross blue shield is not what it use to be look for another company

Anonymous
map-marker New York, New York

Insurance Problem

I signed up for Blue Cross Blue shield as a secondary insurance for myself. I received the welcome kit with my insurance card included. I visited my doctor and was told I do not have a secondary insurance. Why would a company send a confirmation of a product when its aka, not valid. I am a senior going into surgery and cannot afford to pay the bill
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User's recommendation: Use Another Compan

Anonymous
map-marker New York, New York

Worst. Company. Ever.

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Terrible customer service. Long wait times, too many phone numbers, each for different things and when you finally get off hold and speak to a human being, more often than not, they can't help! That is, if you're not disconnected I've seen more complaints about Blue Cross/Empire Blue on the internet than any other insurance company. WHEN will someone in the executive office start caring? I'm convinced that the only reason they're doing well as a company is because thanks to the Affordable Care Act, they have been anointed! I HATE that I have to carry this insurance! If Aetna and Oxford/United weren't so expensive, I'd bail on Empire in a flash. If you're reading this and can swing it, I'd recommend Aetna and Oxford/United over Blue, and also, OSCAR is worth checking out. I really hope that my doctors start taking OSCAR next year.
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Cons:
  • Policies
  • Customer service
Reason of review:
Poor customer service
1 comment
Guest

Terrible Customer Service. Wait time more than 1 hours.

Anonymous
map-marker New York, New York

Jump in premiums

I pay for my daughter to have health insurance. In December 2013 we were told her rate would increase from $154.00 to $172.00. The withdrawal from my account was $366.90 on Jan 23, 2014. I called and was told she received a cancellation notice from BCBS stating her policy was no longer offered and she was offered a new policy with Healthkeepers for the larger amount. Really? Don't remember receiving this cancellation letter, only the letter stating the increase to $172.00. She is a student and cannot afford the $366.90 and neither can I.
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1 comment
Guest

Welcome to Obamacare. Cancelling good policies and boosting premiums because the government said so.

It's not over yet.

The young and healthy aren't signing up, so the rest of us are going to have to foot the bill.

Anonymous
map-marker New York, New York

No ID card, several unanswered e-mails =NIGHTMARE

On 12/27/13 $456 was deducted from my ckng. acct.I did not receive an ID card until 1/25/14. Almost 4 weeks. Being without a card physically on me (and the ID# they gave me did NOT have the 3 letter prefix before it, as it does on the card itself, so my Drs. could not find me in the computer, having had to cancel important tests as result.As a breast cancer survivor, I have found this process to be a travesty and next to being told I had cancer, this has been the next worse thing to deal with. This entire process is making people sick, not better. People should be arrested for this
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Loss:
$456
2 comments
Guest

My job changed to this company and it took over a month to get our cards. You are not alone. This company is corrupt.

Guest

At least you recieved your I D Cards.It is now 02/09/14 and I still have not recieved my I D Cards from signing up back in Dec.2013.I hate i even signed on with BlueCrossBlueShield this is bad business on their end.They have my money for the months of Jan.and Feb.But in return i have nothing to show that i even have health insurance with them.This really should be against the law.BlueCross BlueShield i hate you all you Suck Big Time.

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Anonymous
map-marker Yonkers, New York

Refused to cancel my insurance

I cancelled my insurance over the phone several weeks ago, they confirmed it with me. Yesterday I was charged for a new plan that I had declined weeks ago. After being on hold for hours they finally answered, the woman on the phone was polite and said she was going to transfer me to the correct dept. she transferred me back to the main menu. I had to go through the whole process again only for the *** computer voice to inform me that the phone lines were now closed. I'm so angry and frustrated. Don't trust this company.
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3 comments
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John N Mzy

Just don't pay the premium for the new plan. Why are you so intent on calling them to cancel something they arbitrarily signed you up for? When you don't pay an insurance premium, they automatically cancel you out after a certain length of time.

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Lauren v Ozi
map-marker New York, New York

Blue Cross Blue Shield

BCBS wrote me a check for $67 to reimburse me for a $43,300 dollar surgery. They are complete scam artists. They claim the usual and customary cost for my surgery is $2067 and since I have a $2000 deductable they are only paying me $67. I don't know any surgery that you can get for only $2067. They are complete scam artists who just decide out of the blue what they are willing to pay. I have a supposedly good insurance plan, a PPO where I pay $480/month. Do not use them. Is there anybody that regulates these insurance companies?
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Loss:
$43000
3 comments
Guest

Insurance companies r a ripoff regardless if your in or out of network

Everyone siding for any of them is probably employed by one

Sarahmarie Gco

It sounds like you went out of network. If you went in network you would have only been on the hook for your deductible and 20% of the remaining contracted rate bill up to your out of pocket max.

However since you went out of network there's no pricing agreement between your provider and BCBS, thus you are on the hook for any amount above what BCBS determines is usual for the service. BTW Most insurance companies calculate usual and customary not based on their contracts with providers, but based on what Medicaid pays doctors in the region. Most doctors don't take Medicaid because of the fact it offers **** for payment. Thus BCBS basically is basing the bill on the lowest amount a provider can charge (by law a provider can't charge a person/insurance company less then what they charge Medicaid, which is also why health providers can't waive charges except in very limited situations)

Bottom line even though you have choice to go in or out of network, going in network is always the better choice.

If for no reason other then the provider has to waive the amount billed above the contracted rate and can't charge the patient for it.

Guest

They are not paying YOU the $67. That $67 is for your medical bill.

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Anonymous
map-marker New York, New York

BCBS NJ - worst track record for handling claims!!!

It is necessary to fight for every single dental claim with this company. My husband has always had a clear filling used for a cavity. We have been with the same dentist for 17 years. When my school district switched to BC/BS dental we were told we would have the same coverage. Low and behold his clear filling was not covered. Their explanation was ridiculous. I went to our employer who went to the NJEA (I am a teacher) with my claim and after we all fought it, it was finally paid. Shame on you BC/BS dental. Now I am fighting to receive the covered amount of my twins' orthodontic care. It is ridiculous. I should be paid by BC/BS for my time fighting these claims.
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Anonymous
map-marker Rochester, New York

Blue cross blueshield of rochester ny drugs

My doctor sent in the necessary forms so I could take a name brand drug. Bluecross blueshield pharmacy board denied the request. I called bluecross blueshield and they said I would have to try the no name drug for four weeks If it did not work they would review to see if I could switch back to my original drug. I tried the drug before for ten days and the results were unacceptable. I feel this is just a prelude to what will happen when Obmacare has a 15 member panel not even made up of doctors deciding if your doctor's requested form of treatment will be approved before he can proceed.
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3 comments
Sarahmarie Gco

There's no such things a Obamacare health panels. In fact the choices will be made by the insurance company just as they are now.

The government is not involved in the actual paying of benefits like they are for Medicare/Medicaid.

Guest

Ken Sin, I agree with you, just like insurance companies can tell a person what doctors to see.

Ken Mdn

I have some news for you, ObamaCare has nothing to do with the panels decision to switch your drugs to generic, they've been doing that for at least 20 years that I know of. *** at the drug companies who spend pennies on the dollar to produce drugs & then charge the consumer hundreds of dollars for the same medication.

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