• Report: #964005

Complaint Review: Blue Cross Blue Shield Florida

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  • Submitted: Fri, November 02, 2012
  • Updated: Fri, November 16, 2012

  • Reported By: Dave — Fort Myers Florida United States of America
Blue Cross Blue Shield Florida
jacksonville, FL Jacksonville, Florida United States of America

Blue Cross Blue Shield Florida BCBSFL labyrinth of poor customer service leads to denial of service Jacksonville , Florida

*Author of original report: What happens to people who complain?

*UPDATE Employee: Prescription Drug Issues

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I am a new customer to Blue Cross Blue Shield Florida. I was a customer of A***A for the last 10 years. I lost this when an employer cancelled my policy. I am now part of a family plan with BCBSFL and paying about $385 extra per month.

I have a condition which requires a specific med. I've been taking this for 3 years and if helps me live my life without pain. With my previous insurer they listed the med as a "non-preferred" brand name, as there were other similar generics on the market, I had tried all of them and only the brand name worked. It has a time release mechansim that works I think, I had the physician contact my previous insurer and they added an exception based on my medical need. Simple as that. Took about 2 days.

When I switch to BCBS FL, I assumed I could go through this process again, with the doctor's office contacting the insurer about this. How Completely wrong I was, as I learned in the next 60 days. Luckily my doctor has provided samples to help offset the cost.

BCBS again listed this med as "non-preferred" (not non covered) on the "formulary list" of my policy which I have a copy of. They also had a form called "step therapy, pre-authorization form" which listed all the generic meds I had tried. I had the doctor fill this in and submitted it. I called BCBS FL about 4-5 times in the coming 4 weeks. I emailed through the customer portal. I never received any reply via email response. When I called, each time I was told a completely different story: that I had called the wrong department, that my doctor had faxed the incorrect forms, that they were simply the pharmacy branch and my med was not covered period. Finally I spoke to someone who informed me I needed to complete a formal "appeal of denial of coverage" as I had spent about $300 on paying for this med myself. (This rep, Vanessa was the only kind person I encountered)

I completed this appeal, and sent about 5-6 pages of supporting documentation of why I needed them to offer me an exception and cover this brand name, as the alternative generics did not help me.  After several weeks, including me sending them an email which was never answered, I received two letters denying my appeal. No call, no human touch or compassion. Simply, you're plan does not cover this med as of the date of the appeal. Use a generic. They offered me a form for a "third party review". Obviously they had not read any of the material I had submitted which explained in detail why the generics they suggested did not work.

I have never dealt with a more in-human, less compassionate customer service system. The reason I think it's a rip off, is 1. Every time I called I got a completely different answer. Not even close to the previous answer. 2. My physicians fax forms and calls were ignored by BCBS and Prime based on them telling me they had submitted the wrong forms, Prime assumed no responsibility for any prescription orders that were not on the approved formulary list, even though they are a subsidiary of BCBS. 3. The insurance plan I have includes a formulary list, which I have and shows the med as being "non-preffered", yet now they tell me that it's "non-covered" as of the date of my appeal. I am paying over $350 per month for health and prescription medicine insurance and yet, I have to pay full retail for my medicine myself so I am not in pain. Oh, to go back to A***A insurance where at least they have a mechanism in place to help patients who actually need a particular brand name medicine, when the generic version which is "similar" does not work.

If you have a choice, do not choose BCBS Florida.

This report was posted on Ripoff Report on 11/02/2012 07:28 PM and is a permanent record located here: http://www.ripoffreport.com/r/Blue-Cross-Blue-Shield-Florida/Jacksonville-Florida-/Blue-Cross-Blue-Shield-Florida-BCBSFL-labyrinth-of-poor-customer-service-leads-to-denial-o-964005. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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Updates & Rebuttals

#1 Author of original report

What happens to people who complain?

AUTHOR: dbeaty - (United States of America)

While I appreciate the offer, I have learned over the course of 40 years that complaining about a company in public isn't the best way to get in the good graces of that company. But, since the service and help I got in exchange for the premiums I pay through a large group policy was so poor, I don't ever expect anything different from anyone in your organization. But letting people know about this passing the buck within the customer service system, and automatic rubber stamp denials of coverage in public is a good way to sway other consumers away from your company. I will make a concerted effort to also sway the company insurance administrator away as well when the annual contract review comes around.

While insurance-company-employed pharmacy specialists can make broad determinations about drug molecular formulations and similarities within groups of drugs, it may seem logical to deny a very similar brand name when generic alternatives exist. But everyone needs to know, sometimes those minute difference make all the differences in the world and I would say that a patient like me would be the perfect example that SHOULD receive a formulary exception EVEN before a formal appeal.

That and my experience with my previous insurer, it took my doctor 2 calls to get this exception and it was the exact same "non-preffered or non-covered brand name" within the formulary.

I have no hope that talking to anyone at BCBSFL will help. Sorry.
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#2 UPDATE Employee

Prescription Drug Issues

AUTHOR: BCBSF - (United States of America)

Hi, my name is Tommy and I am on the Social Media Team at Florida Blue. I apologize about the frustrations you have experienced in trying to obtain an authorization for your prescription.  If you would like me to take a look at this for you, please forward your contact info. to socialmedia@floridablue.com and I will be happy to contact you directly.
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