ComplaintsforHorizon Blue Cross & Blue Shield of New Jersey

• Initial Complaint

  07/17/2024

  Complaint Type:

  Delivery Issues

  Status:

  Unanswered

  More info

  Online Order # **************** On June 26, 2024, I ordered a ****** ***** * from my available Flex Benefit of $275.00. The order went through fine and I received the above confirmation order # and $200 was deducted from my benefit. As of July 11, 2024, I had not received the ****** so I called ****** ****** ** ***** ******** to ask where my order was. After much time, the rep finally told me that the item was out of stock and unavailable. She said the computer dropped my order. I asked her to reinstate my $200 and she told me that wasn't possible. I then asked to file a complaint. I was assigned Grievance # ******** and told I would have this issue escalated. Well, here I am 6 days later, no phone call, nothing from Braven. I am very disappointed as there is a very long wait time when calling and I do not have the $200 available to my account as of today, so I cannot buy anything.

• Initial Complaint

  05/22/2024

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  I do not subscribe to ****** ****** for insurance and I never did. I am not interested in a Medicare Advantage plan. I have phoned the company to request "no more solicitous email ads" and I am told the Marketing Department will be notified. Nothing stops the. outrageous number of ads I receive. I phoned Medicare 800 and was told to change my email address. I have adjusted and readjusted my Privacy choices on me cellphone, but ****** ****** finds its way to bombard me with the solicitous ads. I should have some rights to privacy against email box invasion and their overuse-abuse of advertising. Thank you in advance for your attempt to assist me **** ******* ***********************

• Initial Complaint

  04/18/2024

  Complaint Type:

  Order Issues

  Status:

  Unanswered

  More info

  Good afternoon, we have been trying to get paid correctly for the surgery of **** **** , *****************, d/o/s 11/3/22 billed 193,500 We have reached out to the local b/c plan and the reimbursement is no where near the patients 90% UCR benefit , this was a scheduled elective surgery , Please process per patients benefits plan, You are reimbursing us a medicare fee schedule rate Thanks

  Customer response

  04/24/2024

  Good afternoon:
  Please see signed HIPPA form, thanks

• Initial Complaint

  05/09/2023

  Complaint Type:

  Order Issues

  Status:

  Unanswered

  More info

  1/12/22 I spoke with ****************, Horizon Medical Director, to appeal ******************* denial for a single case agreement; the appeal was successful, the denial was overturned. **************** authorized a single case agreement for 1/3/2022 7/20/2022 for my patient, Single Case Agreement # ***-282-7029. The agreement outlined the terms: CPT code ***** (26 units), CPT code *********** (26/26 units each), and CPT code ***** (26 units), 100% no responsibility from patient, and deductible waved as well.1/21/22 I spoke with ******************* again, the Behavioral Health clinician who initially denied the single case agreement. We followed up regarding financial negotiations. **** stated someone should be reaching out to discuss a contract.2/18/22 I followed up with provider services regarding not having received a call regarding negotiations. I was transferred to the clinical department authorization line. Reference number for this call: ********** 3/9/22 I called to report I had still not received a call regarding negotiations, I also learned from Horizon ********** that the single case agreement erroneously transferred to the local (************) for payment. Several issues with this: (1) The local started paying as though I was an in-network provider which was a violation of how a single case agreement works. (2) The local stopped paying after 2/1/22 claiming I was not in network (obviously) so they cant pay. I spoke with Horizon Behavioral Health Provider Services in **, they stated they cannot resubmit the claims because it was turned over to the local Highmark. I later learned ******************* was responsible for this error. Reference # for this call: LVP-******* I have 14 more documented calls with Horizon **** through July 2022 with reference numbers that outline details of my case being escalated, I was promised they will correct the error and pay my $175 per session fee, I can provide the details. They stopped responding, payment for 28 sessions is pending. Total owed: $4,900

• Initial Complaint

  10/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have Medical and dental coverage for family through Horizon Blue Cross blue Shield. Recently about a month ago both my kids got their own medical coverage. When it was for 4 members, Horizon charges me $1976.23 per month. I had automatic payment from my credit card setup for monthly payment.Last month I called and asked them to remove my kids from benefits plan ****************************************** Horizon outsource calls to some other countries and after waiting for 40 minute I was able to talk to someone. They said they removed the kids from account. But in September I see they charged me again $1976.23. I called again and some other girl from another country picked the call. She asked me to fill a form and send it back. I did that for both my kids. When i called to verify they said some entry in the form is incorrect so they didnt do anything with application. I corrected and resent and they said everything is good.When my wife went to dentist they said she is no more in the insurance. I never requested to remove my wife from insurance. I called them, and waited for 20 mts and asked the person to add me my wife. They said they did it.Now I am seeing my credit card charged again the full amount $1976.23 (Charge for 4 people) and after waiting for 20 mts someone else picked the call and said I am the only one in the account.I am so frustrated Horizon being so irresponsible and doing all fraud activities of charging consumers wrong fees when clearly changes are made. Also they outsource calls to all other places and and whoever attend the calls has no knowledge to resolve the issue. I want BBB to take strong actions against Horizon so they dont do this again to any other consumers. I also want Horizon to correct my policy and return extra charges they did on my policy.

  Business response

  10/05/2022

  Please note that no HIPAA form was attached to the complaint. Therefore, this will be resolved with the member directly. 

• Initial Complaint

  07/11/2022

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  Horizon Behavioral Health made a mistake when processing my claim. Instead of simply fixing their own mistake they sent a request to a third party to negotiate the issue. The third party has been unresponsive. I got a call on June 6th that stated I was able to review those (Drs ***** claims and get those adjusted back up to the correct allowed amount and re-processed to have a check resent to you. I did want you to know that I was able to speak with behavioral health and get the check reissued for the (Dr ***** claims. That statement was untrue and when I asked the representative about that on July 1 they never responded. I cannot get Horizon to let me speak with an upper level in management to address this issue and they have no complaint department. They told me their only complaints are against providers, not against them. I just want to speak to someone who can actually resolve the issue as this has been gong on for 12 weeks.

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