Complaint Review: Blue Cross Blue Shield Florida - Jacksonville Florida

I am a new customer to Blue Cross Blue Shield Florida. I was a customer of A***A for the last 10 years. I lost this when an employer cancelled my policy. I am now part of a family plan with BCBSFL and paying about $385 extra per month.

I have a condition which requires a specific med. I've been taking this for 3 years and if helps me live my life without pain. With my previous insurer they listed the med as a "non-preferred" brand name, as there were other similar generics on the market, I had tried all of them and only the brand name worked. It has a time release mechansim that works I think, I had the physician contact my previous insurer and they added an exception based on my medical need. Simple as that. Took about 2 days.

When I switch to BCBS FL, I assumed I could go through this process again, with the doctor's office contacting the insurer about this. How Completely wrong I was, as I learned in the next 60 days. Luckily my doctor has provided samples to help offset the cost.

BCBS again listed this med as "non-preferred" (not non covered) on the "formulary list" of my policy which I have a copy of. They also had a form called "step therapy, pre-authorization form" which listed all the generic meds I had tried. I had the doctor fill this in and submitted it. I called BCBS FL about 4-5 times in the coming 4 weeks. I emailed through the customer portal. I never received any reply via email response. When I called, each time I was told a completely different story: that I had called the wrong department, that my doctor had faxed the incorrect forms, that they were simply the pharmacy branch and my med was not covered period. Finally I spoke to someone who informed me I needed to complete a formal "appeal of denial of coverage" as I had spent about $300 on paying for this med myself. (This rep, Vanessa was the only kind person I encountered)

I completed this appeal, and sent about 5-6 pages of supporting documentation of why I needed them to offer me an exception and cover this brand name, as the alternative generics did not help me.  After several weeks, including me sending them an email which was never answered, I received two letters denying my appeal. No call, no human touch or compassion. Simply, you're plan does not cover this med as of the date of the appeal. Use a generic. They offered me a form for a "third party review". Obviously they had not read any of the material I had submitted which explained in detail why the generics they suggested did not work.

I have never dealt with a more in-human, less compassionate customer service system. The reason I think it's a rip off, is 1. Every time I called I got a completely different answer. Not even close to the previous answer. 2. My physicians fax forms and calls were ignored by BCBS and Prime based on them telling me they had submitted the wrong forms, Prime assumed no responsibility for any prescription orders that were not on the approved formulary list, even though they are a subsidiary of BCBS. 3. The insurance plan I have includes a formulary list, which I have and shows the med as being "non-preffered", yet now they tell me that it's "non-covered" as of the date of my appeal. I am paying over $350 per month for health and prescription medicine insurance and yet, I have to pay full retail for my medicine myself so I am not in pain. Oh, to go back to A***A insurance where at least they have a mechanism in place to help patients who actually need a particular brand name medicine, when the generic version which is "similar" does not work.

If you have a choice, do not choose BCBS Florida.