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Allen's complaint:
December 23, 2014

Insurance Company: Blue Cross and Blue Shield Association
Coverage Type: Health Insurance

  • PolicyHolder Service - Inadequate Service
  • PolicyHolder Service - Incompetent Employees
  • PolicyHolder Service - Delays/No Response
  • PolicyHolder Service - Denied Access to Services
  • PolicyHolder Service - Unfair Negotiation
  • Claim Handling - Delays upon Delays
  • Claim Handling - Unsatisfactory Settlement/Offer
  • Claim Handling - Fraud
  • Claim Handling - Denial of Claim
  • Claim Handling - Unjustified Accusations
  • Marketing & Sales - Misleading Advertising
  • Marketing & Sales - Misrepresentation
  • General - I feel abused by this company

My wife had cervical fusion back in September of 2014. At that time the doctor also told her that her lower back would also need fusion as well. On Dec 9th the doctor sent in "urgent and necessary paperwork" to allow for additional needed surgery. The website from Blue Cross/Blue Shield states that if the request is "urgent" then the decision would be decided within 5 days. (the marketing/website department of this company lied when it implies on it's website that you will hear from someone within the 5 days) This was not the case and the decision was not decided until 10 days later (a total lack of concern, empathy and abuse from this company)When I asked who was handling the case I was given no information (deception and delays, elements of bad faith). The customer service representatives that screen the calls were no help and totally incompetent to answer any of my questions.

I lost my job earlier in the month of December so it was urgent that this surgery be completed by the end of the month. This was disclosed to blue cross/blue shield and they took no steps to expedite the situation. "We" (myself, my wife and the doctor) called the 23rd day of December because they would not otherwise contact us and "we" were told the claim was denied. When we asked why they refused to acknowledge stating that we have "30 days to appeal". My insurance runs out the end of the month. This was a personal, well-crafted execution to deny benefits that my wife so desperately needs. I feel that this company did this under unfair intensions, was deceptive and breached my rights as well as my wife's as a person under their contract and should be held liable for intentional wrong-doing and bad faith.... my wife now has excruciating pain for the Christmas holiday... Merry Christmas Blue Cross/Blue Shield!!! ..Hope your loved ones feel the same!!!!

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