Margaret's complaint:
November 12, 2013

Insurance Company: Horizon Blue Cross Blue Shield
Coverage Type: Health Insurance

• PolicyHolder Service - Inadequate Service
• PolicyHolder Service - Incompetent Employees
• PolicyHolder Service - Delays/No Response
• Claim Handling - Denial of Claim
• Claim Handling - Unjustified Accusations
• General - I feel abused by this company

Prior to my gaulbladder surgery last year I was given the usual tests (scopes etc).
I had the surgery. No problem.

Then the bills started to come in. Horizon denied all claims, stating that I have a pre-existing condition. (Which I don't).

Approx 3 years prior I had a hysterectomy. Prior to that surgery they did the same tests. They tested all my abdominal organs.

Because I had these "tests" before Horizon is claiming that I have a pre existing condition.

CSR are rude and even when prior insurance carriers spoke with them they admit that we are right but refuse to pay these bills.

I've heard from my doctors billing dept that Horizon is famous for doing this to their new customers. The first time they file a claim it is always denied, due to pre existing conditions. I've called so many times and I've even spoken to supervisors (who refuse to give their full names or their emp id #.

Everyone is waiting to get paid. My credit rating is very important to me and I'm still waiting.

They told me that I can appeal ALL these bills, but it is obvious that they are wrongfully denying a good claim.

Every month they take over $350.00 out of my bank account but they refuse to provide the services I'm paying for.

I anxiously await a response, as I'm not sure what to do at this point. These medical bills are piling up and the Drs, etc acknowledge that, in fact I have NO pre-existing condition for ANYTHING.
Thank you,
Margaret Donaldson

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