Complaint Review: BlueCrossBlueSheildof Texas

On December 31,2013,  I called BCBSTX to find out about their insurance plans. Our old policy(Tricare)ended Dec 22,2013. They asked me a few questions about our income and said we may qualify for some tax credits to help pay for our plan so they did a 3rd party call to The Market Place. Come to find out, I did not qualify for any deductions and was told to pick a plan off the marketplace. I picked one out and was asked for my credit card information, my login and password for BCBSTX. The plan I picked was PPO Silver 004. It gave me a 3,000 det, a 6,000 out of pocket and my premium was 317.00 a month. I gave her my credit card information and she said I would have a welcome packet in a few days and my insurance would start Febuary 1, 2014.  They said I could not use my husbands income as mine since he was not on the plan (he uses the VA)and my kids could not be on my insurance plan and had to be on medicad. That phone call took 5 hours and 23 minutes to finish.

I called the Market place to ask a question about 4-5 days later about Medicad and why I had to put my children on it and why could I not use my husbands income AND why could we only use his taxable income (he is an injured vet and we both attend college. They said there was no "other" option to add other income. We both each get a housing allowence while going to college full time , he gets money from the VA that he will get forever , and he works a small part time job. We are by no means rich but we have a great savings and get by just fine and once were done with college,we will be great)  He told me that none of that was true and he did another application over the phone. I used all the income and added my husband(I didnt know the VA only sees him for reasons why he could not stay in the military ) to the plan. (kids still had to have Chip)  We ended up with about 450.00 in a tax credit and able to have a cost sharing plan ( I dont know the exact name of it because I am not very familiar with terms like these. My husband was in the military for 12 years and we had Tricare Prime and never saw a bill or anything so please bare with me)

SO.. I kept the same plan (PPO Silver 004) and now our premium(monthly payment)is 195.00 (total for both) we have a 0 deductable and 500 out of pocket expense. Much better right?? I recieved a welcome packet but it was the first one so I called BCBSTX(on hold for 1 hour 43 min)to explain what happened and they said they already knew because the Marketplace sent over that information. They apologized and said the new one will be sent out soon and do not worry about making a payment until I got my new welcome packet. Said they were so far behind, they were still running January 1 benefits,payments.

At this time I was not too concerned because it was only Jan 12 and our benefits do not start until Feb 1.(2014) I (think) finally got the welcome packet in the mail. Once again, its the wrong one. SO.. I call them back (on hold for over 2 hours) and explain it AGAIN. She said I see the problem, you have 2 applications on file. One is not active and the one with you and your spouse is . I said right... that is the one I am needing. She said she would send it to her supervisor to expidite it. Now this time I was worried because it was about January27. Febuary 1 came and went. No card,call and get the exact same thing told to me.."I will send this to my supervisor to have it looked at and be expidited". Febuary 3 I call(of course on hold for over an hour)because my husband has got to go to the doctor. He is literally completely deaf in his left ear. Got them on the phone and said I cannot wait any longer,is there an temporary card or something so he can go. She saw that I had 2 plans( blah blah blah)but took my payment of 196.00 for my premium and said for my husband to take the old card to the drs office(because its still the same ID number,just wrong group number)and told me it would be fixed in about 30 minutes.

He went to the dr the NEXT day(way passed 30 minutes,more like a day and 30 minutes)He explained to our dr what the lady had said and he saw my husband(we have had this dr for awhile now so he knew us very well)He then goes to walgreens and what do you know..."your insurance company is saying you dont have a plan with them and here is an 800 number for you to call and you will have to pay cash for our meds. If you get it fixed within 5 days,we can reimburse you" His meds were 199.86. SO he gets home and I call. Get same story.

By this time I am steaming mad because I needed to get my ADHD meds filled on the 7th. Hoping it was fixed when I went..NO..Those meds were 149.99. Same thing ,same story. Itll get fixed asap. Have a Pain management appt that I can not miss(plus just had a full hysterectomy in Dec)they took the cards info and just charged me the 55.00 co pay. Go to Pharmacy..What do you know...it doesnt work AGAIN. Those meds were 259.99. Once I get home, I call the pharmacy number,not the usual 800 number. Some very sweet woman answers right away. SHe then tries to help and says she is not getting off the phone with me until it is fixed. SHe understood my frustration because she doesnt have insurance. She said she sees my payment, she sees the days I called in and the times when those people said they were sending it to their supervisor to be expidited. But...they were never sent to the management. They were all left open,every single one. She said she had no idea how this happened but under my name I had 3 group numbers and we could only figure out one that was wrong(the one on my card)She said she promised she would get it taken care of and shed call me back on Feb 14. She did call me back, left a message saying she is so sorry and its still not fixed yet. The pharmacy only will wait 5 days to give your money back.

As of today..every last one is past 5 days. That was 460.00 out of our pocket,because they cant fix it or honestly not even touching it and maybe hoping I will go away. SHe said it can take more than 90 days to get that money back. Sad thing is..these meds are all FREE with my plan I chose. Noone gives me an answer, they just blame the last person, say they will get it fixed asap and there is absolutely NOTHING I can do. They sure had no problem taking my premium payment. This is the best plan out of all of them because I need to see the same drs I was before due to the diseases I have and the surgeries I have had with these doctors. I have no one to call because they do not allow you to speak to higher ups. I honestly feel like this is a scam.

If you use the marketplace..they dont help you. They had NO problems at all sending me my welcome packet,card,ect when I picked a plan off the market place but now that I am using it...I am treated HORRIBLE. I am lied to, I am told they will call me right back, I am told it will be fixed in 30 minutes. Look..just because we cant afford a "real" plan that isnt reduced, doesnt mean we should get treated like CRAP. My husband served 12 years in the army and deployed 4 times. (Iraq and Afganistan) He was the first to go right after 9/11(he joined before then)BUT..he got injured,protected ALL of those phony and fake employees/management there. Its not like we are sitting on our butts,collecting welfare and not doing anything to fix our situation(not that anyone deserves this treatment)We are both full time college students. I am going for my RN and he is going for IT(computer forensics)We both cannot work because we have 2 young children. We get no help paying our rent, bills,phone..nothing except medicad but they told me we had no choice but to chose that or they would be on this plan as well. Its like they are trying to push me aside to see if any rules change and keep telling me CRAP to me off the phone and hopeful that its finally fixed.

I have MAJOR health problems(but do not count as pre-existing because there has only been a month and a week between insurances)and my husband does too.  It has been stressing me out so badly that its all I can think about. I worry more about my husbands medical needs then my own and he is worried about my medical needs. This place is SICK. How dare you judge us and lie to us. We paid our monthy premium and we paid about 460.00 in a week for our medications. We paid our copays(33.00 and 55.00)just like everyone else. If you can..stay FAR away from them if you are getting a tax deduction. Its not a real plan. The Marketplace isnt real. They make you think you are getting this great deal on health insurance but this company wont touch you if you do. Theyll take your money but wont give you anything else.