Tired of BCBS not paying for routine screenings? (insurance, buyers)

[goat1of2]

I've about had it with the various scams BCBS North Carolina has used over the years to avoid paying for routine screenings (e.g. mammograms, paps, etc.) My policy states that I will get one free screening of each type per year. In practice, however, this has rarely been the case.

Has anyone else experienced these problems? I'm looking for anecdotes as I'm preparing a complaint for the state insurance commissioner. Even if we can't get BCBS to change their ways, at least they need to be more upfront to prospective buyers of their product: "free" screenings require extensive legwork on the part of the patient to make certain they will indeed be free.

[RuthL]

I've been told they routinely deny to see if you'll take the time to appeal on average 2 times before they will pay those claims that they should.

It's a numbers game they play to make more money.

It stinks, but may be worth your time to appeal at least twice.

[sowk09]

Wow, I didn't know this was an issue. I only get one routine screening per year, but haven't had a problem with it. I hope you get it resolved!

[rabbitsong]

I've never had a problem. We had BlueOptions for the past few years. Routine screenings were covered. I never had a problem with them approving MRIs, CTs or my hysterectomy.

The only issue I had was the colonoscopy, but I think that was more the GI than the insurance. It was done at a free-standing clinic so it was "only" going to be a $30 specialist copy as opposed to the hospital outpatient charges. Ended up costing over $500 because of the numerous biopsies he did. He handed me a sheet listing the prices ahead of time, which didn't look so bad, but seriously.... $500 worth? Maybe I should have said, "okay, but can you only do 2-3?"

[sowk09]

Ohhh maybe that's the reason... I have BlueOptions as well.

[Silence Goodall]

With BCBS my premiums go up and my benefits go down each year. I drive an hour and forty-five minutes for a colonoscopy at a free standing facility, and drive the same about of time for stress test and any type of scan. I have a family history of heart trouble yet they deny my doctor's request for tests until numerous phone calls and appeals. I have a history of pulmonary embolisms and they deny a follow up scan a year later. In November a spot was found on my left lung. So far they have denied to pay for the scan.

If my premiums continue to increase at the same rate they have the past ten years by the time I am eligible for Medicare I will have been paying over $10,000 a month for my BCBS policy.

[TXsurburbanmom]

Nope I have BlueOptions and they have yet to pay a claim without sending me a denial stating my child has other coverage. This is after we had just filled out the applications in July stating coverage with the previous carrier would end prior to coverage with their company starting. I then sent a copy of the previous Certificate of Coverage showing coverage ended before the BCBS NC started. After the next denial I called spoke to a rep who found a copy of the certificate on file, faxed it to her attention again, received a follow-up call that it was received, processed and the denials would stop. Of course when I took my other son to the doctor I immediately received a denial stating he had other coverage despite the fact he was included on the twice provided Cert of Insurance. I just wrote a letter concerning that denial asking them to provide ME the proof that my 4 year old, who I had repeatedly provided info concerning the fact that his coverage ended prior to our starting and paying for coverage with them, had somewho obtained coverage from another carrier. A few days ago I received a letter stating they had decided to forward my letter to customer service. Perhaps they have a file of letters from fed-up customers they use for training--as in, please drive our customers to the point that they write us disgusted and sarcastic letters. On the other hand, I was up last night worrying that I would still need to write another letter about the denial since it was not addressed and my letter was sent to a dept that probably can't approve the claim. Every BCBS I have dealt with has sent sporadic denial letters but BCBS NC has denied EVERY claim immediately despite all the info we've provided. Amazing that is was ANTHEM that drove Pelosi to push the Health Care Reform through because we had Anthem and BCBS NC is much worse so far! Oh, and it's twice the cost of any coverage we've ever had.

[bosoxfan1]

The only problem we've had with BCBS not paying for a screening has been when the provider coded something as diagnostic instead of preventative. We had the provider resubmit it correctly, and there was no problem.

[lamishra]

That's weird, we had BCBS for 10 years up until this year and never had a single issue with them denying anything! OP, are you sure you're doing everything within the parameters they set? Such as free yearly mamograms after a certain age? Or that your provider is submitting the information correctly? They always covered all of our preventative medicine as long as we were following the standard procedures.

[Usedtobe VaNC]

We have BCBS too and have never had issues with coverage for routine screenings or anything else. They are strict about their "once a year" or whatever their requirements are, but as long as we are within that, they have paid without a problem.