- Report: #907714
Complaint Review: Blue Cross Blue Shield of North Carolina - Durham North Carolina
Reported By:
Hot under the collar in AZ. -
Sun Lakes, Arizona, United States of America
Submitted:
Updated:
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Author Confirmed
Why?
Blue Cross Blue Shield of North Carolina
PO Box 35 Durham NC Durham, 27702 North Carolina, United States of America
Phone:
1-888-722-7441
Web:
bcbsnc.com
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Blue Cross Blue Shield of North Carolina Will not respond to a valid claim Durham, North Carolina
In 2011 while working outside I experienced dizziness, disorientation and was light headed. I went in the house and after resting for a bit took my blood pressure (BP). The upper was over 190.
I called the BCBSNC 24 hr nurse help line and after talking with me the nurse insisted I go directly to the emergency room. However, being an individual that detests hospitals, and feeling better I elected to wait until the following morning and contact my primary care physician.
On explaining the events of the previous day and what my BP currently was, I was directed to go directly to the emergency room.
I did, all the tests for stroke, etc., were negative, and I was referred to a cardiologist who subscribed BP medication and subsequently brought my BP down.
Everything is good, right? Not!
Now I start getting bills from the emergency room doctors billing group for $1000 plus change. Since I had a EOB from BCBSNC say although the doctor was out of net work, the visit was covered due to emergency, I didn't pay any attention to the bill assuming sooner or later the insurance would pay.
Six months later the doctors billing group sent notification that they were sending it to collections. I then called them to find out they had not received payment. I called BCBSNC and was told they had initiated a payment voucher and sent it to me so it was my responsibility.
Guess what, no voucher! I called back and asked for a copy of the check voucher. The customer service representative for BCBSNC came back on the phone and admitted she could not locate a copy, or a record of my having been paid. She then transferred me to the BCBSNC finance group. I again asked for a copy or a record of the voucher. I was told it would take time as they would need to search the hard copies (isn't it the digital age?).
Weeks went by still no response, no copy and no record. So, I drafted a letter requesting BCBSNC to provide me with a copy or record, or initiate a payment voucher so I could pay the doctor and sent it registered mail. They got it. I've got the receipt. Still no payment voucher or documents that they paid the claim.
So, I'm now paying the $1K bill and another $25K+ that they denied on other claims. Swell. Great insurance. With BCBSNC I really hope I don't get diagnosed with something serious. These guys will bankrupt me.
Get everything in writing folks, and even then read those EOB like a legal form.
This company is slippery.
I called the BCBSNC 24 hr nurse help line and after talking with me the nurse insisted I go directly to the emergency room. However, being an individual that detests hospitals, and feeling better I elected to wait until the following morning and contact my primary care physician.
On explaining the events of the previous day and what my BP currently was, I was directed to go directly to the emergency room.
I did, all the tests for stroke, etc., were negative, and I was referred to a cardiologist who subscribed BP medication and subsequently brought my BP down.
Everything is good, right? Not!
Now I start getting bills from the emergency room doctors billing group for $1000 plus change. Since I had a EOB from BCBSNC say although the doctor was out of net work, the visit was covered due to emergency, I didn't pay any attention to the bill assuming sooner or later the insurance would pay.
Six months later the doctors billing group sent notification that they were sending it to collections. I then called them to find out they had not received payment. I called BCBSNC and was told they had initiated a payment voucher and sent it to me so it was my responsibility.
Guess what, no voucher! I called back and asked for a copy of the check voucher. The customer service representative for BCBSNC came back on the phone and admitted she could not locate a copy, or a record of my having been paid. She then transferred me to the BCBSNC finance group. I again asked for a copy or a record of the voucher. I was told it would take time as they would need to search the hard copies (isn't it the digital age?).
Weeks went by still no response, no copy and no record. So, I drafted a letter requesting BCBSNC to provide me with a copy or record, or initiate a payment voucher so I could pay the doctor and sent it registered mail. They got it. I've got the receipt. Still no payment voucher or documents that they paid the claim.
So, I'm now paying the $1K bill and another $25K+ that they denied on other claims. Swell. Great insurance. With BCBSNC I really hope I don't get diagnosed with something serious. These guys will bankrupt me.
Get everything in writing folks, and even then read those EOB like a legal form.
This company is slippery.
2 Updates & Rebuttals
The Outlaw Josey Wales
Golden Meadow,United States of America
Resty
Waunakee,Wisconsin,
United States of America
Why
#3Consumer Comment
Sat, July 07, 2012
You're a fool if you pay this. WHY are you paying something you dont owe? BCBS is generally not bad coverage all things considered.
It shouldnt take them more than 5 minutes MAX to find the check copy that they claim they sent. At best they can pull the claim up on the system and tell you EXACTLY what was billed, what was allowed and what was paid, they can tell you the procedure code, the diagnosis code, and what your responsibility is.
The facility charge should be paid with the exception of your cost share, copay or deductible at probably 80-85%. As far as the doctor being out of network, it was an ER visit, that should also be paid though maybe a bit discounted.
If you've got money to throw away....throw some at a homeless shelter or a food pantry....buy someone suffering in the heat an AC unit. But dont pay something you dont owe.
