RIVER GOLD
System Abuse System Abuse
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Health Insurance Corruption
Updates: Page started 2019/02/20 IN THIS SECTION:   Blue Cross-Blue Shield    Blue Shield COMMENTARY Pay attention to: Special Problems with Private Pay (Non-Employer Provided) Long phone waits; inadequate, conflicting, wrong or dishonest information Rapid Rate Increases within 1-3 years; SEAMLESS seamless hikes - if you miss a piece of correspondence advising up upcoming price change, it can look like one day you are paying one thing, the next twice that amount. Changing or Closing Out a Program Started Out With =within one to two years see SEAMLESS above Proprietary - Acting like people really don’t have a choice and have to “just take it” from the insurance companies - a tendency to think like the government, the tendency to act not just like a government bureaucracy in what is supposed to be a private corporate enterprise, but a monarchy - like “members” are peons, but also like communism or socialsim ie, party members Investigators need to be prepared to find out WHO makes the rate changes and WHY - what office, what department, what individual or group of individuals, what part of the country Cartel-like games being played across the medical world, not just insurance, but including insurance Embergency Room insurance related problems - not a clean and direct insurance experience for most people - too many gray zones and in-network/out of network designations; we need to nationalize emergency room uses so that an emergency room is an emergency room is an emrgency room and that fair, up front, easy to understand insurance practices apply. This holds for peope of any educational level, of any language dominaceand so on.  THere need to be clear connections between ER and the various doctors and labs used in connection with it so the whole thing goes under one insurable bill, not broken down into pieces that often go uninsured BLUE CROSS-BLUE SHIELD Blue Cross Blue Shield: Corruption, Lawsuits Against, Consumer Complaints, Cartels or Like Cartels Corrupt High Paid Executives Corrupt Authority: KillingsworthBlue Cross Blue Shield exec walks out with $11 million severance package March 2, 2011 | http://corruptauthority.com/blue-cross-blue-shield-clive-killingsworth-severance/ Cartel-like Alabama federal court Wall Street Journal: (2015/05/27)) Is Blue Cross Blue Shield an illegal cartel? By Anna Wilde Mathews http://pnhp.org/news/is-blue-cross-blue-shield-an-illegal-cartel/ Excerpt:  Blue Cross and Blue Shield health insurers cover about a third of Americans, through a national network that dates back decades. Now, antitrust lawsuits advancing in a federal court in Alabama allege that the 37 independently owned companies are functioning as an illegal cartel. http://pnhp.org/news/is-blue-cross-blue-shield-an-illegal-cartel/ Sfgate: Experts warn of medical industry cartels power https://www.sfgate.com/news/article/Experts-warn-of-medical-industry-cartels-power-3199384.php The planned spike in health insurance rates by Anthem Blue Cross in California is just the tip of a Titanic-size iceberg of exorbitant price increases, secret pricing and consolidation not only by insurers - but by the hospitals, doctors and medical devicemakers that send the bill… Individuals who buy their own insurance instead of getting it through their employer are at an especially steep disadvantage. They do not get the giant tax break Congress grants only to employers. Nor do they get the discounts that providers negotiate, often confidentially, for large insurers. What has received far less scrutiny is the collusion operating underneath this system. The regional "networks" that hospitals and their allied physicians form to negotiate with insurers often exclude competitors and lock in exorbitant prices that are passed on as premiums. https://www.sfgate.com/news/article/Experts-warn-of-medical-industry-cartels-power-3199384.php Healthcare Finance News: https://www.healthcarefinancenews.com/news/blue-cross-blue-shield-insurers-accused-cartel-control-over-market Becker Hospital Review: https://www.beckershospitalreview.com/legal-regulatory-issues/the-blue-cross-blue-shield-antitrust-case-13-key-points.html Blogs Blue Cross Blue Shield New Mexico https://www.google.com/search?q=New+Mexico+Blue+Cross+Blue+Shield+corrupt&rlz=1C1CHBF_enUS787US787&oq=New+Mexic o+Blue+Cross+Blue+Shield+corrupt&aqs=chrome..69i57.9670j1j9&sourceid=chrome&ie=UTF-8 Cathryn G. Albuquerque, NM  1.0 star rating 10/20/2015 I resent even giving them 1 star as they should get none. BCBS of NM may be worse than no healthcare at all. They have denied 5 of 7 drugs my doctor says I need, will give highly addictive and dangerous drugs for free but have major copays for nondrug approaches to many issues. What is worse is that because of them, "members" are locked out of choices otherwise available. It is clear to me this is a corrupt health plan designed to avoid paying for real healthy options in favor of big pharma treatments that are harmful in long run. Run do not walk from this plan! They use substandard subcontractors who perform below standards be it home health or transportation, and only pay for cheapest possible drugs. Paul G. and 6 others voted for this review    John M. 1.0 star rating 12/10/2017 *Update* I SUGGEST YOU NEVER BELIEVE EVEN ONE WORD THIS COMPANY HAS TO SAY; Not in Print, Not by Phone, Not in any way. 12-9-17, Filed with DOJ Civil rights for Violation of Patient rights by Health Care Service Corporation DBA Blue Cross Blue ShieldNM/TX/IL/OK/MT. This company has promised continually for 6 months my account would be repaired/fixed = all lies! I took this insurance by what they put out in print as covered only for HCSC to deny all promised covered. All I got were Justifications from the Ombudsman "All Companies have wrong information out there". **Update 12-1-2017** Just filed with Department of Justice for Civil Rights Violations by HCSC/BCBSNM/TX/OK/IL/MT !!! 3 people voted for this review    ow First S. 1.0 star rating 11/4/2017 My bad experiences with Blue Cross reveal the following: 1.  4 hours on the telephone trying to get them to understand their own systems and policies for one simple walk in clinic bill.  They tried to avoid paying anything, and only partially resolved after I contacted the NM Office of Insurance.  Blue Cross  had told me no coverage,  which was entirely untrue (and they finally acknowledged), and in every other instance under the same policy, we were covered after the co pay at walk in clinics. 2.  Another billing from a doctor who has offices with Christus Saint Vincent, but is not in the hospital.  Blue Cross paid very little on $3000 billing, applying all to the deductible, because they said it was considered in patient in the hospital, which it was not, it was a doctors office visit.  Brought all this to their attention and they still refused to pay.  Still working on that one 1 1/2 years later. 3.  Their web sight does not list all providers who are actually in their network.  We have learned to call to double check, you get more, but even then they do not know all who are covered in their own network.  Told of providers they said were not in their network, who we knew from past billings and payments were and after double checking  with the provider they were in fact in  their network.   They make it difficult to know accurately who is in network, increasing chances of your going out of network, which means they pay less. 4.  When they check simple bills in their system it takes them 10 minutes on hold to find it, and this can happen several times in one conversation. 5.  I have not found them to be rude as others have, but I have found they do not understand their own policies, systems,  procedures and information. All of the above have one thing in common, they pay less and you pay more.  As others have stated in reviews, it is hard to know if they are simply incompetent or are they trying to cheat customers out of paying what policies clearly say they should? Not sure myself but the more and more experiences of these and other non payments over time have me thinking the latter. Our insurance broker is assisting us with the above and he stated he has never seen in his 30 years of experience an organization as dysfunctional as Blue Cross. He attributes part of this to their IT system, which has many issues. Paul G. and 2 others voted for this review    Paul G. 1.0 star rating 11/29/2017 I resent giving these folks even one star! My wife took out Medicare Advantage with BCBS New Mexico. Turns out they are as bad as Christus and that is saying something. First as other reviewers have commented their customer service is second to all: it appears to based in the Philippines and the agents know nothing more than their scripts, and certainly less than is in the Proof of Coverage book. Both my wife and her dental provider have spent hours on the phone with their CS reps. Then we discovered what my wife needs is covered by their "Comprehensive" dental plan but not by her current plan. She was never given the option of the comprehensive plan. Now we hear that BCBS is pulling out of NM, which is probably a good thing. So beware of BCBS in NM. 1 person voted for this review    Django Z. 1.0 star rating 4/17/2014 I have never had customer service this bad or this consistently bad. I actually had to make a formal complaint to the New Mexico health insurance board just to get our insurance cards from BCBSNM and this was 4 months after we signed up for insurance with them. Just a few of the lowlights: - their website has been very buggy or missing functionality - consistently rude and unhelpful call center folks - never sent our insurance cards - unable to set up auto-pay for our bills until last month - after setting up auto-pay last month with someone on the phone and being reassured that everything was set for this month, i just got a notice in the mail from them today that the auto-pay did not go through...and no reason for it - very long wait times on the phone when trying to get help - been disconnected by their phone system twice, once after waiting 20 minutes, the other time after waiting over 50 minutes It's tempting to say this is all about the ACA and they're having trouble adapting to the change, except this is for Dental Insurance and we have our Medical Insurance with Presbyterian and have had nothing but great experiences with them even though that was through the ACA as well. In short: avoid BCBSNM at all costs for any kind of insurance. They treat customers like old-time insurance companies did: as if we have no choice. But now we do! 13 people voted for this review    David M. Santa Fe, NM  1.0 star rating 1/11/2016 I've had a BCBS-NM Medicare supplemental policy for a year+ and every time a claim has been filed, it's been denied claiming I have another policy. Not true. So with every denied claim, I spend 20-40 minutes on the phone with very nice customer service agents who apologize and resubmit the claim and tell me the problem is corrected. But thus far, there is not evidence that is the case. I don't know whether it is malevolence or incompetence, but it is very hard to stomach. I hope you have better luck. 4 people voted for this review Michelle I. Albuquerque, NM  1.0 star rating 1/12/2014 First to Review We are a few weeks into ACA which kinda forced me into switching to BCBS of NM and I'm ready to scream!  Our family policy was approved in early December, paid our first month's premium and yet to receive any type of proof of insurance.  Hubby needed to see a Dr. so I tried to login and call but they have no record of us or information.  Told me to call my agent, so I did and he's no help either.  I've spent a few hours on hold the last week just trying to get a policy # or something to work with.  No help whatsoever.  Thanks Pres. Obama- my new insurance is neither affordable or accessible. BLUE SHIELD CALIF. https://www.consumerwatchdog.org/newsrelease/blue-shield-california-sued-pushing-policyholders-bare-bones-coverage-and- hiking-premium Santa Monica, CA – Blue Shield has used enormous rate hikes, and the threat of rate increases, to force patients into lower- benefit and higher-deductible health coverage in violation of state law, according to a class action lawsuit filed today by Blue Shield policyholders and consumer advocates.   The lawsuit alleges that Blue Shield is illegally gaming the health insurance system by alternately closing older policies and opening new ones in order to push older, sicker consumers who are more expensive to insure into lower benefit, higher deductible coverage that requires consumers to pay more out of pocket.   The lawsuit seeks to stop Blue Shield from shoving its policyholders into what is known as a “Death Spiral”–the industry term for what happens when a health insurer “closes” certain insurance policies to new customers, and later raises rates to those remaining in the closed policy until those enrollees can no longer afford coverage. Since consumers with preexisting conditions cannot switch to a comparable or better policy, consumers trapped in the closed policies must either accept greatly inferior coverage or face bigger and bigger premium increases.   “Blue Shield closed my family’s policy and then threatened us with a 23% premium increase.  We had no choice but to switch to the only bare-bones policy Blue Shield offered us.  When Blue Shield canceled the original rate increase, the company refused to let us transfer back into our old, higher benefit policy.  Then, Blue Shield raised the rate of our bare bones policy by 14.8%!” said Robert Martin of Gilroy, California, one of the Blue Shield customers representing other consumers in the class-action lawsuit. “It’s just plain unfair.  Blue Shield is pushing families like mine with pre-existing health conditions out of their health plans – either into higher deductible coverage or into the ranks of the uninsured.”   Robert Martin and his family suffered triply as result of the Death Spiral: they were forced to switch to lesser coverage, were hit with a big rate increase for their new high deductible, lower-benefit policy, and were not allowed to switch back to their better coverage. Rob talked at a press conference in front of Blue Shield's headquarters in San Francisco, which can be viewed at: http://www.ustream.tv/channel/consumer-watchdog   “Death Spirals are the result of insurers behaving at their worst,” said Jerry Flanagan, staff attorney for Consumer Watchdog.  “Instead of providing coverage to loyal customers who have paid their premiums, Blue Shield pushes consumers into skimpier coverage or prices them out of care altogether when they are sick and need insurance the most.”   The lawsuit was filed in San Francisco Superior Court by the nonprofit consumer advocacy group Consumer Watchdog and the law firm of Whatley Kallas, LLC.  Click here to download the lawsuit.   According to legislative records, it was Blue Shield’s own past business practices, resulting in Death Spirals for consumers, that spurred the Legislature to adopt the same 1993 law that Consumer Watchdog and Whatley Kallas, LLC now allege the company has violated.   The violations are taking place among certain insurance plans in the individual market that Blue Shield is closing down. California law requires that when health insurers close a policy the insurer must either offer consumers new comparable coverage, or minimize rate increases on the closed policies. Two regulatory agencies – the California Department of Managed Health Care (“DMHC”) and the California Department of Insurance (“CDI”) – oversee different segments of Blue Shield’s insurance business.  In the lawsuit, Blue Shield is accused of illegally closing eight policies regulated by the DMHC, and announcing it will close 23 policies regulated by the CDI on July 2, 2012 without offering consumers comparable policies or limiting rate increases as required by law.   Considered together the closures of the Blue Shield policies at the DMHC, and the impending closures at the CDI, demonstrate a broader scheme to illegally manipulate blocks of health insurance business, according to the lawsuit. https://www.consumerwatchdog.org/newsrelease/blue-shield-california-sued-pushing-policyholders-bare-bones-coverage- and-hiking-premium