Blue Cross Blue Shield of New Jersey

According to an Explanation of Benefits for a date of service in 2006 Blue Cross Blue Shield informed me that I had to notify my co-insurer to pay for a doctor’s visit and lab work done on December 5th.

I had already written letters stating I was unemployed thus there was no co-insurance, so I called and had the dreadful misfortune of speaking to some creature named Josephine who informed me that I had an 80/20 policy. I tried to tell her I did not, but she persisted. It appeared that this woman felt that she should do all the talking, however since I signed her paycheck indirectly I felt otherwise, thus the conversation took longer than it should have because she refused to listen to me…

After reviewing the claim in question she realized that a mistake on the insurer part had been made, we were paying for a PPO policy which meant that we only had a $15.00 co-pay with 100% lab work.

This morning two days later she calls to say that insurance only pays for 80/20 lab work, I asked why would it pay for 100% office visit and not lab? She said that these were requirements that were stated in the handbook. How convenient THERE WAS NO HANDBOOK. This is a stratagem a maneuver done by Blue Cross they do not issue a handbook until there is a dispute with payment, as there is now…

Not only that I proved that they were supposed to pay more because I had EOB’s from the year previously that show the company paid 90/10 and should have disputed that but did not…

I have involved lawyers at this point because this really rips into my fabric of trying to have good day…

These people are adamant that I pay this bill, when I know deep down inside that these people are responsible for this, I am just furious.

Alise Williams Bamforth

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