February 05, 2013
Insurance Company: Blue Cross and Blue Shield Association
Coverage Type: Health Insurance
- Marketing & Sales - Misrepresentation
My company changed insurance plans on January 1st 2013. They went with Blue Cross Blue Shield of IL. They started telling us about the plans several months out without any written material. They finally released a guide on line that stated a third party company called Accuview would be handling the plans and information. They gave you a choice of four plans with the best one costing over 750.00 a month. I went with the lesser plan so I could pay my bills and buy food for the family.
The problem is this. They put these plans out with individual and family enrollment listed as individual ded/family ded
No where in the information does it state that if you take the family coverage that your deductible will be the total family deductible whether its one family member or ten family members. I have had insurance health coverage all of my working career and I have not seen a policy or contract written like this. If this is the case they had an obligation to make sure that everyone understood this. I believe its misrepresentation by omission. I talked to BCBC IL and all they would say was this is the way the contract was written. That's not the question, the question is, or statement is they have an obligation to disclose this information so everyone understands this and maybe tries to budget for a different plan with lesser deductibles and out of pocket expenses. I know of two others in my work place that have found out the hard way when they had a claim that they owed the total deductible and didn't find out until then.
I was licensed for health insurance for years and I can tell you if I didn't have enough information to understand this there will be thousands out there that work for this company that will have the same surprise I did when they need to use their coverage. Again, this is not right.
The way I found out was my wife was diagnosed with breast cancer and the cancer centers financial center printed out a sheet that stated the deductible for my wife was 5,500 with an out of pocket of 11,900. I told them that was wrong and that was for the family of two or more. They said no, you have to pay the family rate whether its one or ten.
Again, this information was not disclosed and I believe this is wrong. As of this date they still have not mailed out a summary of benefits booklet or changed it online. It still has the old plan from 2012.
The time to know and understand this is not when you are facing a grave family ordeal such as Cancer but when they are offering the plans that you base your life decisions on.
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