ComplaintsforBlue Cross and Blue Shield of Illinois

February 8th, 2024 I submitted a Predetermination form and have not gotten any answer if it will be covered. I have Lyme disease which is a medical condition that causes my teeth to become infected and need to be replaced with implants. The cost is about $28,000 and I cannot afford it. I have my doctor who filled out the form with all the codes, but I have not gotten any response despite calling 10 times and being on the phone for over an hour without any resolution.

On March 22, 2024 I went into a BCBSIL in network hospital for a preventative colonoscopy, a service that is to be covered 100% per my benefit booklet. The doctor, hospital, and lab were indeed paid at 100% by BCBSIL. But it appears that anesthesiologist, unknown to me, was not in network. Since I went into an in network hospital for the procedure, however, according to the federal *************************************************************************** network hospital should be paid at in network benefit levels. After four calls to BCBSIL and determining no one I spoke with understood the No Surprises Act, I then chose to file with the BBB.

I called to request information about my benefits. The representative refused to answer my questions about benefits for hospital stay after a c-section or allow me to speak with another representative. I asked multiple times to speak with someone else and he refused stating there was no one else. He talked over me and wouldnt listen to my concerns. He said he couldnt help me but also wouldnt transfer me to someone who could. I asked for his name and he provided two different names. He refused to give me his supervisor name. I began recording the call with his knowledge and again asked to speak with someone else who is knowledgeable about my insurance package. He refused to transfer me or look up my insurance benefits. While being recorded he changed his story and then hung up on me. I can share the recording as evidence. Employee said his name was *****************************. I would like this specific employee to provide an apology for this unprofessional behavior. I called back and immediately got an answer from a different representative.

THIS IS MY INSURANCE THROUGH MY EMPLOYER. I HAVE A MEDICAL CONDITION THAT I GET A PROCEDURE EVERY 4MTHS. THIS WAS PRE-APPROVED IN NOV 2023, DOS 1/19/24, THEY DENIED A PORTION OF *** STATING NEED MORE INFO. I CONTACT THEM MULTIPLE TIMES, AND OVERALL THEY AGREED IT WAS AN ERROR, BUT SPENT A MTH WAITING TO PROCESS THE **** IN THE MEANTIME, I NEED MEDICATION, THAT I PD 200,00+. THE *** WAS EVENTUALLY PROCESSED, HOWEVER, IF IT WAS ORG PROCESSED AS IT SHOULD HAVE THE *** WOULD HAVE BEEN MY RESPONSIBLITY, WHICH I HAD FINANCIAL ASSISTANCE THROUGH THE PROVIDER AND WOULD HAVE PD 0. BUT NO, THE INSURANCE COMPANY MADE ME PAY FOR MEDICATION OUT OF MY HSA AND OWN POCKET, THEN REPROCESSED **** AFTER I MET MY OOP, AND THEY PD THE PROVIDER LEAVING ME ******+ IN THE ***** BASICALLY COMMITING FRAUD AND DOUBLE DIPPING IN A SENSE. THEY BELIEVE THEY DID NOTHING WRONG

I was misled to believe that my HMO plan would allow me to see primary care doctors in ******* (********) where I live.After suffering a herniated disc, I went to see a doctor in the Northwestern medical group 475. My plan says my group is 475. I am allowed to see specialists in 475/******* but NOT primary care in 475/*******. It's the most bizarre thing I've ever heard and Northwestern reps told me it causes a lot of confusion and trouble for patients who sign up for my **** HMO plan.Northwestern admitted on a previously recorded line with a **** supervisor also on the 3 way call that they mistakenly listed the doctor I saw as being in the ******************************** the 475 group.I have continued to receive bills for services rendered by that doctor on Feb 1 2024 and for referrals that she made on that visit.I also have had countless (dozens and dozens) of phone calls with both **** and Northwestern reps including one today, May 6, 2024, a 3 way call with reps for both companies. The **** rep today was incredibly rude, dismissive, disrespectful and WRONG about my being able to see primary care physcians in the 475 group. He repeatedly said he had "limited resources" to help me and that I was wrong and allowed to see doctors in 475. I repeat, Northwestern has TWO groups of doctors and it only allows HMO patients to see primary care doctors in the far western suburbs of *******. I can see specialists in ******* but NOT primary care doctors in ********The rep today refused to help me. He said he could not change my group to 489 (he misunderstood the entire situation) but I asked him to print out a list of primary care doctors in 489 and he refused. He refused repeatedly and angrily.The Northwestern rep on the 3 way call finally confirmed that my plan allows ONLY specialist care in ******* and only primary care OUTSIDE ******* but he also insisted the regional doctors group (489 in the far suburbs) was in fact part of 475. He was mistaken. He didn't even understand his own company's medical groups.The whole experience has left me paying hundreds and hundreds of dollars in premiums for NO CARE while suffering an extremely painful debilitating injury for more than a year now. My referrals for PT and other doctors were canceled due to my primary being out of network, even though she was identified as in network on Northwestern's own site! Northwestern admitted on the 3 way recorded call that they were at fault and she appeared online as if she were in 489.I'm done. I called the healthcare.gov people today and requested a case be opened to decide in my favor and refund all my premiums paid to **** for taking my money and not providing care and not providing effective customer service and subjecting me today to what was, really, an abusive customer service rep. I want him held responsible. He would not provide his name.

This complaint is related to complaint # ******** filed against BASIC and another complaint (complaint # TBD) filed against *****. I have been under COBRA Coverage since 11/1/2023. On 3/1/2024, my previous employer switched insurance policies from Humana over to Blue Cross Blue Shield of Illinois. For some reason, the insurance broker (Gusto) and COBRA Administrator (BASIC), failed to get me switched over to BCBS at that time as they should have. After 6 weeks of back and forth with broker/administrator, a reinstatement notice was sent to BCBS of Illinois on 4/13/2024. My enrollment has completely stalled as BCBS continues to delay the enrollment (that should be set retroactive to March 1st, 2024) process, even though I continue to make all of my monthly payments. Meanwhile, my daughter was born on 3/18/2024 and the hospital and various providers are after me for tens of thousands of dollars. My daughter was born with a hip issue requiring multiple imaging studies to be done and she will also be needing surgery. I also need surgery for a serious respiratory issue. All of this care is having to be delayed while we wait for BCBS of Illinois *************** to process my family's reinstatement notice and turn on coverage for myself, my wife, and my newborn daughter. My have made BCBS aware of urgent access to care needs and yet, there is limited to no progress.