Blue Cross And Blue Shield Of Tennessee
Reviews and Complaints
Very very bad
Seniors beware
Preferred solution: Provide service as doctor requested.
Refusal to cover services I pay premiums for!!
Worst insurance I've ever had !!!
Short Review on March&nbs-04:00;15,&nbs-04:00;2017
BCBS-Tennessee refuses to pay for vital PT--will result in permanent disability
My daughter, Savannah, my wife Lori, and I wanted to thank so many of you who donated to help Savannah recently so we could purchase a wheelchair lift to get her in an out of the new house we’re renting. It’s been such a blessing and was a difficult process to go through, one of many over the past year.
We also wanted to ask your help in spreading the word about another stumbling block to Savannah’s recovery—our Blue Cross Blue Shield of Tennessee health plan (through my employer) has a limit of covered outpatient physical and occupational therapy visits per year—twenty. Because of the unique nature of Savannah’s disease, her only hope of achieving a complete or even a useful recovery, is for her to have regular PT/OT for the next year to two years. But BCBS-TN has denied our requests for additional rehab visits not once, not twice, but THREE times, this time after I showed up in person at their Grievance Committee meeting to plead Savannah’s case.
For those of you who are new to her predicament and our circumstances, let me give a little summary and bring you up to speed on the current issue.
Eleven months ago Savannah began waking up early in the morning with headaches and nausea, this persisted for more than a week, and then became accompanied by numbness in her feet/toes. After a week of this not getting better, but steadily worse, she had an eye exam that revealed swelling of both optic nerves. This prompted an MRI of the brain, which revealed a very large cyst pressing on and wrapping around the most vital parts of her brain. Within a week she had a craniotomy, brain surgery, and she was blessed to have a wonderful surgeon; the mass was nearly entirely removed and she wasn't expected to have any lasting problems.
However, a month into my recovery, though, her toes began getting numb again, it became harder and harder to climb the stairs to get to her bedroom and her vision started to worsen. After slowly getting worse over a few weeks and after numerous doctor's visits, she was diagnosed with CIDP, a chronic form of Guillain-Barre syndrome which causes paralysis starting in the toes and fingers and works its way up your limbs. She’s been confined to a wheelchair for the past seven months and hasn’t been able to do the most basics things for herself such as get dressed, shower, or use the toilet. She became wheelchair bound and therefore was unable to sleep in her own bedroom because she couldn’t climb the stairs to her room. Sadly, she had to spend the better part of six months sleeping in the dining room.
A couple of months ago we were preparing to leave the house we were renting to move to a different rental house where Savannah could have a bedroom downstairs, the city of Brentwood, Tennessee forbade us from building a wooden wheelchair ramp in the front of the house, leaving us with only two very expensive options: a metal (and very large) wheelchair ramp or a wheelchair lift, both of which would cost thousands of dollars. After using all the money we had saved on medical bills, we knew that this was going to be impossible to fund by ourselves.
That's where you stepped in so graciously and generously with your time and donations--we were able to buy and have a talented friend install a wheelchair lift so we could Savannah in and out of the house.
A little background on CIDP may help you better understand what Savannah's been going through and why our plea for help is so crucial. Our bodies are supported by and are able to move and do so many things because we have muscles, ligaments, tendons, and skin attached to a framework, our bones. But without the "wires" from our brain and spinal cord--our nerves--sending necessary signals to our limbs, our arms and legs would be lifeless appendages. We wouldn't be able to walk, pick up objects, blink or even see or talk. Our nerves are an indispensable part of our body's ability to function in the most basic of ways. If someone has an accident and the nerves in one arm are damaged, for example, eventually that arm, the hand and fingers will start to freeze up--the joints of the fingers and hand will become immobile and the muscles in the arm and hand will whither away.
Chronic Immune Demyelinating Polyneuropathy, or CIDP, is an auto-immune disease where the nerves all over the body become stripped of their conductive coating and become damaged. The nerves that are mainly affected are the ones controlling the fingers, hands, arms, toes, feet, and legs. Without these nerves functioning, you can't feel your hands and feet, the muscles in the legs and feet don't work and so walking becomes impossible, the fingers and hands become useless appendages and in Savannah’s case, she even had damage to her vision and her voice for a while. In the case of CIDP, there is a blaze of damage inflicted on the nerves by the immune system. It takes days of antibody injections, or IVIG, and in Savannah's case, weeks to months of regular steroid infusions to finally put out the fire of her immune system attacking her nerves. Until the immune system attack on her nerves was controlled and stopped, she continued to get worse on a daily basis, which happened for the first four months of her disease. In fact, her pediatric neurologist, an expert in CIDP told her that she was one of the worst cases he had ever seen.
Now that the immune system fire has finally been put out and she is slowly being weaned off of steroid injections, we can only wait for the body to heal itself and the nerves to regenerate. It is an agonizingly slow process because the nerves regenerate at about a millimeter a day--when you think of how long the nerves are that leave your spine and travel all the way to your toes, you begin to understand why her recovery is measured in months to years.
Now, returning to the scenario of the arm with the damaged nerves, without functioning nerves the arm would eventually become a frozen, withered stump. This is because there is no direction from the nerves to keep the limb moving and the muscles active and healthy. Normally, when an injury like this happens, physical and occupational therapy are done to keep the joints in the arm flexible and mobile while healing is occurring, to prevent the muscles from wasting away from disuse.
Our health insurance policy that I have through my work is a plan offered by Blue Cross Blue Shield of Tennessee. Our plan limits the number of outpatient physical therapy, or PT, and occupational therapy (OT) visits that Savannah can have over a single year's time to twenty visits of each. If Savannah had reconstructive knee surgery or broke a leg and needed some rehab visits, twenty visits would likely be enough to aid in her recovery. However, CIDP is a very different beast. Because it's going to be a year at least and maybe up to two years before all of her nerves are expected to heal, Savannah will need at least two PT visits and one OT visit per week for that entire time to make sure that her joints, muscles, and bones don't freeze up and become permanently dysfunctional.
Utilizing the regular therapy that she has needed so far this year, her allotment of outpatient therapy visits expired in April. After that time, her doctors petitioned for additional visits and we were mailed a denial letter. The reason? Our plan doesn't allow more visits. Most of us know that health insurance companies make a profit by denying more services than they approve, but I figured that once a second, detailed appeal was made on Savannah's behalf, the medical facts would clearly demonstrate the need for more therapy and our appeal would be approved. After making this second appeal and waiting for a couple of months for a response, it came with a resoundingly impersonal but technical denial. The reason? AGAIN it was because our plan says we can't have more visits.
We were offered the chance to make one FINAL appeal, advised to make any and all medical records available to the Level II grievance committee who would hear this third appeal and to have any and all statements by us and her doctors available for them to review. I was given the option to call in to participate in the meeting or I could even go to Chattanooga to be at the meeting in person--I took the day off of work because there was no WAY I was going to miss this chance to appeal to Blue Cross in person. I mailed in EVERY page of documented medical records from all of her hospitalizations, tests, clinic visits and rehab appointments, which amounted to about one and a half reams of paper. I gave an impassioned plea to the eight-member committee over about ten minutes, including having her pediatric neurologist call in during the meeting to provide a very specific and concrete testimony of the vital need for her to have continued therapy visits. After I nearly broke down in tears in front of this committee, part of me thought there was no way they could deny our request. Unfortunately, the part of me grounded in reality knew such an approval would be too good to be true. As expected, I was informed a few days ago that our third appeal was denied. Again, we were denied because Blue Cross Blue Shield of Tennessee didn't WANT to pay for more therapy visits and had their butts legally covered by our policy limitations.
After all of the trials she has gone through so far, and for the long and difficult road ahead, the only way she is going to recover fully is the passage of time needed for the nerves to heal and for her limbs to be functional when the nerves finally start working again. While we can do some PT and OT exercises and therapies with her at home, we have neither the necessary equipment nor the training to provide her with the functional equivalent of skilled PT and OT therapists. Even at a cash discount, each of these visits cost at least $100, meaning the monthly bills would be prohibitively large. After watching all of our savings vanish in a puff of hospital-debt smoke, we don't have any hope of affording this continued therapy.
We recognize that we have been blessed to have insurance at all, because we would’ve been destitute from medical debt without it. However, as many of you with employer-sponsored health insurance plans know, the choice of three insurance plans to choose from when we signed up was really just one plan with three levels of deductibles, co-pays, and premiums. All of the benefits are the same--there wasn't a particular plan we could choose that would allow her more rehab therapy visits.
We understand that Blue Cross Blue Shield of Tennessee was legally within their right to deny us according to the limitations of our health insurance plan. While repugnant, they are effectively legally shielded from having to pay even a dime more than their policy allows. However, ethically we think Blue Cross Blue Shield of Tennessee is playing the role of bottom-feeder quite effectively--do just enough to satisfy the law and deny any and all other requests to maximize profits.
Logically and from a business standpoint, it makes perfect sense. Why pay for something that can potentially affect their bottom line. After all, we, the insured signed the contract and they're just honoring it (if you can call it that). However, their argument falls apart through logic as well. Why would they spend thousands of dollars in her care, through multiple hospitalizations, procedures/surgeries and doctors visits to restore her health, and then refuse to pay for the therapy on which her ultimate and complete recovery hinges on? Because in the end, these health plans have been carefully constructed to produce the maximum profit--even if they have to pay for hospitalizations, durable medical equipment and numerous doctors visits, if they deny enough critical, but EXPENSIVE benefits, their bottom-lines will be boldly black and no one will have to see the crimson stain of blood on their hands.
If you have experience battling the big health insurance companies and have some pearls of wisdom that we could use in our fight, I would welcome and appreciate your advice. If you have a bright idea that we have not thought of or know of an avenue that may be able to help us, your thoughts would be greatly appreciated. Having already looked into many possible sources for help, I came across numerous programs, both private and government, that are available to help patients and families in our situation--unfortunately we do not qualify for a single one of them because my salary as a physician disqualifies us. I could write volumes on how society's image of the average physician from decades ago--the Porsche-driving, jet-setting doctor living in a million-dollar home—has become an apparition years after the suffocating grip of managed care and government-driven health care took effect. But suffice it to say, a cross-country move, starting a brand-new medical practice from scratch, combined with a student-loan debt that would make most third-world nations blush and the thin-air of the tax bracket I reside in are not a recipe for being able to privately fund on-going rehab therapy out-of-pocket.
Savannah has one of the most genuinely happy dispositions that I've ever seen--she's always been a vibrant, active, and intelligent but precocious girl. But as she starts her senior year of high school, instead of taking part in new clubs, swimming on the swim team or acting in the school's theatre production, she'll be dropping her pencil every few minutes while trying to scribble answers to homework that are legible enough for her teachers to read and learning how to dress and bathe herself. While we once dreamed of seeing her walk across the stage at graduation, we are just hoping she has the stamina and perseverance to finish her graduation requirements on-time, only attending school for half of the day this year. We still expect her to be on that stage at the end of the year receiving her diploma, but we will be hoping that she doesn't get her fingers caught in the spokes of her wheelchair just before her big moment. Our faith in God and in her eventual healing and recovery are strong and so we know that one way or another, God will help heal her. But the thought of her possibly not recovering her function completely breaks my heart and makes me sick at the same time. The fact that a multi-billion-dollar industry giant like Blue Cross and Blue Shield of Tennessee builds the showcases displaying the golden parachutes of their executives on the stacks of our premium money while denying her the services she so desperately needs is even more sickening.
We could so VERY much use your help in getting the word out about Blue Cross Blue Shield of Tennessee because their business-driven, ethically bankrupt stance is preventing my sweet daughter from healing and may permanently disable her. We need Blue Cross Blue Shield of Tennessee to get the message loud and clear that we need them to do the right thing and not the financially expedient thing.
- Refused to pay for necessary rehab visits
Preferred solution: Pay for two outpatient PT visits and one outpatient OT visit per week for at least 18 months
Discrimination to Chiropractic Profession
Preferred solution: Full refund
*** Payment Policy
- Paying for services
Preferred solution: Full refund
BCBST cancelled my son's policy without notice due to their error
Blue Cross Blue Shield of Tennessee terminated my policy based on their mistake!!!
I signed a contract to receive health coverage with Blue Cross Blue Shield Tennessee through the marketplace in January 2015. I paid my premium immediately for the first month's coverage. Soon after, I requested through the marketplace to put my daughters on TennCare, which slightly altered the premium for my policy and left a difference of one dollar. I received a letter from BCBSTN dated February 11th, 2015 that requested that I pay the difference of the one-dollar within 30 days. On May 10th, 2015, which was 27 days from the date of the letter, I called to pay the difference. To my surprise, I was told that my policy had already been cancelled due to negligence to pay the difference. When I pointed out that I was within the required 30-day time limit, the call center told me that I was supposed to pay the difference before the 1st of March, the date that the policy should have gone into effect. I pointed out that the letter indeed told me that the change would go into effect on the 1st of March but nevertheless, allotted me 30 days to call and make my payment. Nowhere did this letter tell me that I had to make the payment by the 1st of March. The only other correspondence that I ever received from them was from March 5th stating that my policy had not gone into effect due to non-payment.
The Call Center operator pulled up the letters that had been sent to me and agreed with my point. She put an order in for my case to be reviewed by a board so that my policy could be reinstated. I was happy with this course of action. I called back a few times to see if they had reached a decision yet because I needed to get an annual reservist physical done for the military and was told that the board had not yet reached a decision and that it would take up to 72 hours to reach a decision. I was called back by the same lady I initially spoke to and was told that the board had rejected my request, my policy would not be reinstated, and directed me to the Healthcare portal to look for insurance. I complained that this was not right and that the eligibility period for insurance was over and that I could not get insurance at this point through the portal. She agreed and said that she would send my case up for a second review. I also asked what would happen to my initial premium payment and was told that it would be refunded to me.
At this point I am concerned. I called back 20 March 15 at the 72 hour mark and was told that it would take a week. I called after a week was up on 25 March 15 and was told to call back on Monday, the 30th. I called back on the 30th and was told that according to records, the case had been closed without resolution or notification to me. I explained my situation to the gentlemen, who was very helpful, and he once again agreed that I had done everything that BCBSTN had asked me to do. Without prompting he reopened the case for review and sent it to his supervisor. On the 2nd of April I received a voicemail notifying me that my request was once again denied.
I called back the same day, the 2nd of April, and was told that the company was not at fault for the errors in correspondence and neither was I but they still could not reinstate the policy. I asked to speak to a supervisor because I needed someone to be able to explain to me why my policy had been cancelled despite having done everything the company had asked me to do. I was told that a supervisor was unavailable but a call back could be scheduled to speak to one. As of the 5th of April, I have not received a call back from neither a supervisor or anyone from BCBSTN.
In my view, this company has dishonored itself by not honoring its word, which was printed in black and white, "within 30 days to pay." I met the mark that they set for me. BCBSTN is NOT meeting the mark and NOT honoring its own word. I watched a few advertisements to see how the company portrays itself and one line stuck out at me, "We've always been there and will continue to be there...for you." I don't really feel like my health insurance company is there for me. Also, 33 days after my policy was canceled, I still have not received a refund for my initial premium on a policy that never went into effect. I guess they'll get around to it when they can.
- Not returning all monies
- Communication
- Seeing a problem but overlooked it
Preferred solution: Deliver product or service ordered
BCBST Unfairly Cancelled My insurance
Here is what I have now been dealt. I renewed my Coverage through the health insurance market place on 12/09/2014 and was approved.
I kept the exact same plan for my husband and myself as what we had in 2014. I contacted BCBST on January 6th because I had not received any billing and they had not updated my info in order to pay online. Long story short I continued to contact BCBST and health Insurance market place and kept being told by BCBST not to make a payment until I received my bill. I told them in February I was nervous about not paying so I made a payment through my bank website.
BCBST told me not to do that because they could not guarantee it would be posted correctly. I continued calling and they finally did post my payment the middle of March, a month after I paid. They once again would not accept a payment via phone and told me I would receive a bill within the next few weeks. On April 10th I finally got something from BCBST, I thought it would be my billing finally but NO it was a cancellation notice.
I have spent many many hours on the phone with BCBST and the health insurance market place. I kept being told by the market place they would get it straightened out. Today I was finally told that the Health Insurance market place will not allow me to have insurance because Blue Cross says I did not pay. So BCBST uses the health insurance market place as an excuse and the health insurance market place use BCBST as the excuse.
I hav esent a letter to President Obama and I also called and spoke to a White House operator today. She listened to my story and said she would let President Obama know what is being done to me. I asked her if she would like my contact info and she then hung up on me! I am so disappointed with what is happening in this Country, I can not even put into words.
Basically the insurance companies have found a loop hole not to insure people and the market place is letting them get by with it. I had insurance with BCBST prior to the Obama Care and I was a supporter for everyone to be able to get insurance and now I feel as if I have just been BETRAYED
Preferred solution: I want my insurance re-instated
Blue Cross And Blue Shield Of Tennessee - Cirrhosis Medication Review from Knoxville, Tennessee
Disorganized service: confusing website, 36 minute phone wait
- Customer service
- Confusing website
Blue Cross Blue Shield of Tennessee: Most Annoying Hold Audio Ever/Website is Confusing
Blue cross blue shield memphis tn
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My dentist stopped taking any kind of dental insurance a few years ago after they got tired of frustrations as you describe. I actually have dental insurance included as part of my health insurance coverage, but have never used it as I like and trust(the main reason) the dentist I have been with for 25 years.