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HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY IS A SCAM
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Oct 23, 2008 BLUE CROSS BLUE SHIELD complaint by Drhewitt |
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I have a PPO plan with Horizon BCBSNJ - This is my first health insurance coverage and I was aware of the pre-existing condition. I am reasonably healthy and have not seen a doctor since 2004.
Last month, I discovered I had a tick on me which I had for four days. It was on my head but under my hair and I did not notice it. I had symptoms the third day and went to MedCare for diagnosis.
The doctor said I would be treated for possible Lyme disease.
As far as I’m concerned, this is not a pre-existing condition.
Horizon sent me a letter saying this claim would have to be reviewed for pre-exisiting conditions and they would send my doctor a questionnaire which would need to be sent back within 45 days or the claim would be denied.
A week later I call Horizon to see if they sent the form out to the doctor - no we didn’t they say. I said how can my doctor be expected to know to send a form back if she didn’t get one?
I checked with my doctor to see if she got the claim and they haven’t.
I called Horizon again and they said they would sent a form out - so we shall see - I suspect they will give me the runaround for 45 days and then deny the claim.
If they do, I will go through their appeals process. We shall see.
I called Horizon on 7/22 they told me they received the information from the Dr on 6/11 and that I would have to wait SIXTY business days for a decision as to whether or not the tick bite I received was a PREEXISTING CONDITION.
This puts the date for the decision at Aug 28, 2008.
I waited and waited and nothing until last week when my doctor calls me and tells me that unless Horizon pay the claim they will be billing me.
Such contrast to what Horizon say “until a determination is made you are not responsible” for the bill.
I sent a letter to Horizon BCBSNJ requesting information by the end of this month. It has been four months since I was seen by this doctor and Horizon BCBSNJ refuse to look at my claim and communicate with me.
The funny thing is they paid my lab fees, yet they won’t pay me doctor’s bill.
I call again on Oct 23, 2008 and the rep said that I have a preexisiting condition clause. I said, "so, basically, Horizon only cover emergencies for the first year" which she more or less confirmed.
DO NOT BUY HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY INSURANCE
THEY ARE A RIP-OFF, A SCAM
THEY WILL DENY PAYMENT, DELAY PAYMENT AND EXPECT YOU TO KEEP PAYING THEIR PREMIUMS WHICH OFFER LITTLE OR NO BENEFITS
HORIZON IS THIEVING SCUM
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BLUE CROSS BLUE SHIELD Complaints
1. Written by MellowCat, on 18-11-2008 21:47
They are under investigation by the governor of your state, I believe. You are right. They are criminals. Par for the course for insurance companies.
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2. Written by I. M. Disgruntled, on 24-10-2008 16:32
I feel for you, Horizon will f**k you every chance they get. My Surgeon in Philadelphia said they, Horizon NJ, is the worse insurance to have.
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Consumer Forum is another great place to discuss consumer concerns NOT RELATED to this article. |
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