• Report: #138999

Complaint Review: Horizon Blue Cross Blue Shield Of New Jersey

  • Submitted: Fri, April 15, 2005
  • Updated: Fri, April 15, 2005

  • Reported By:Thorofare New Jersey
Horizon Blue Cross Blue Shield Of New Jersey
3 Penn Plaza, Newark, New Jersey U.S.A.

Horizon Blue Cross Blue Shield Of New Jersey refuses to fully reimburse my Pain Managment Doctor when he provides treatment, Ripoff! Newark New Jersey

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In November of 2002 I had an Intrathecal Morphine Pump implanted; due to the fact I have suffered from chronic pain for the past 10 years. Horizon Blue Cross Blue Shield of NJ, my health insurance company, approved the surgery and for the first year they paid my doctor a fair amount of his fees when I went in for him to refill my pump (something that needs to be done every 10 weeks.)

Beginning with my December of 2003 they cut back on what they paid my doctor. Out of $1034 they were paying over $300; that was cut to $135. They had stopped paying for the "procedure" in which the doctor fills my pump; in addition they stopped paying for the actual syringe he used.

A few months later they stopped paying for the actual medication that is injected into my pump. The last few visits my doctor billed them $604 and they paid him $37!!!!! My family doctor gets paid more for treating a sinus infection!

I received a letter in the mail the other day referencing one of the payments I had complained about. They wrote that my doctor had negotiated the amount he is paid (we are talking about the $130 not the $37 they pay him now - they are months behind answering complaints) and I do not have to worry because I am not responsible for the difference between what my doctor bills and how much they pay. So I need not worry.

Instead, when I went for my pump refill this past week the receptionist handed me a letter stating that my doctor will NO LONGER be accepting Horizon Blue Cross Blue Shield of NJ due to abnormally low reimbursements! It was like a slap in the face.

I am dependent upon having this pump filled with medication every 10 weeks. Had I known this would have happened down the road; I would have never agreed to have it put in. The Intrathecal Morphine Pump (which is placed in my abdominal area directly under the skin)pumps pain medication directly to the spinal fluid, through a catheter; which in turn takes the medicine to the pain receptors in the brain. The result is I no longer have to take oral pain medication and my body uses a lot less medication and I get better relief.

Before I had the pump implanted; my pain was so servere that 600 mgs. a day of MSContin did not work!! I was in so much pain. Since my condition is irreversable and cannot be "fixed" (nerve damage and degenerative disc disease in my lower back) and I was still in my 40's at the time; they doctor felt it would be easier on my digestive system and my liver to take medication through the pump.

I am still in a lot of pain and will never be pain free -- but this pump has at least helped!!! In addition when I was taking 600 mg. of MS Contin a day it was costing Horizon Blue Cross Blue Shield of NJ nearly $1000 a month! The amount of money I saved them by having this pump implanted is a lot; especially since I had been taking oral pain medication for 8 years before the pump.

I've written the CEO; the Commissioner of Insurance for the State of New Jersey and our Governor. I am more than willing to start a class action lawsuit against this insurance company because they are supposed to pay for their customers medical expenses according to the contract. Anyone who is having this same problem who wants to join me; please let me know.

Thorofare, New Jersey

This report was posted on Ripoff Report on 04/15/2005 04:11 PM and is a permanent record located here: http://www.ripoffreport.com/r/Horizon-Blue-Cross-Blue-Shield-Of-New-Jersey/Newark-New-Jersey/Horizon-Blue-Cross-Blue-Shield-Of-New-Jersey-refuses-to-fully-reimburse-my-Pain-Managment-138999. 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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