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Consumer Stories

I went to the hospital a few times for a routine treatment and everything was fine, until I got the bills. The hospital said I didn't have insurance, even though I did. When I called Blue Cross, they told me they would "take care of it." The next thing I know, the bills for those visits were sent to collections.

Now, to add insult to injury, Blue Cross refuses to pay for my daughter's bills. They claim that she does not exist on my policy. I have been trying to fight this for years now, but I've gotten nowhere with them. Blue Cross refuses to pay for the bills, and they claim the "window frame" of responsibility for them has now passed. So now not only is my credit ruined, but so is my daughter's and she's only a minor.   

I thought Blue Cross was supposed to protect me when things went wrong, not make things worse.

-- Kristina, San Jose


RobyneMy sister battled cancer for 18 long months. We thought she had good insurance through Blue Cross and that they would cover the costs, We were wrong.

She incurred $125,000 in debt because Blue Cross said all her treatments were "experimental."

My sister was forced to work the whole time she was in chemo.  When she finished chemo, the hospital sued her and she had to take a second job.

I work in a hospital lab; I know my sister's treatments were NOT experimental. Does Blue Cross put profits before people? In my opinion, yes.

-- Robyne, Santa Clara


I had insurance through Blue Cross when I delivered my first child, but it didn't cover my $10,000 bill. Neither Blue Cross or the hospital offered me any financial options other than taking me to collections and then to court. I had to hire a lawyer, which cost me hundreds of dollars. My only solution was to charge the $10,000 on my credit card.  With the 18% interest, I know that my family will never be able to get out of debt.

-- Anna, San Francisco


I've had Blue Cross insurance for years.  It doesn't seem to be helping much these days, but if I lose it, I know I'll probably never get insurance again.
I'm disabled and have a medical condition that is treated with a variety of medications. Blue Cross keeps changing what they are willing to pay for. Right now, I'm paying about $400 a month for drugs and about $600 a month in Blue Cross premiums.

I owe thousands of dollars to the pharmacy for medicines my Blue Cross wouldn't pay for. Plus, I'm currently in collections because of lab work that Blue Cross wouldn't cover either.  Because of all these bills, my credit has been ruined.

It's hard enough being disabled, but my pathetic insurance coverage is destroying my life.
 
-- Jan, Anaheim 

"When Steve and Leslie Shaeffer's daughter, Selah, was diagnosed at age 4 with a potentially fatal tumor in her jaw, they figured their health insurance would cover the bulk of her treatment costs.
Instead, almost two years later, the Murrieta, Calif., couple face more than $60,000 in medical bills and fear the loss of their dream home. They struggle to stave off creditors as they try to figure out how Selah can keep seeing the physician they credit with saving her life.

"'We're in big trouble,' Leslie said.
 
"Shortly after Selah's medical bills hit $20,000, Blue Cross stopped covering them and eventually canceled her coverage retroactively, refusing to pay for treatment, including surgery the insurer had authorized in advance.
 
"The company accused the Shaeffers of failing to disclose in their coverage application an undiagnosed bump on Selah's chin and physician visits for croup. Had that been disclosed, the company said in a letter, it would not have insured Selah.
 
"The Shaeffers say they weren't trying to hide anything. When they applied for coverage, Selah did not have a tumor, at least as far as they -- or any physician -- knew. The doctor visits occurred after Leslie filled out the paperwork, and they seemed routine, the Shaeffers say. They believe Blue Cross was looking for any excuse to dump their daughter and dodge her bills."
 
-- Steve and Leslie Shaeffer, Murrieta
Los Angeles Times: September 17, 2006

"Dawn and Steve Foiles were left with $100,000 in bills when Blue Cross terminated Dawn's coverage after authorizing back and neck operations. It accused her of failing to disclose a 1997 back surgery and refused to reconsider after the Foileses told the company that it had made a mistake.

"A copy of her application supports her contention that she disclosed the operation, including the date and name, location and telephone number of the hospital where it was performed.
 
"But the company's apparent error didn't stop physicians from demanding payment. The couple used almost all of an $8,000 home equity credit line to pay some of them.
 
"But, when one physician's collection agent threatened to file a report with credit agencies over a $7,000 bill, the Riverside couple thought they had to sell their home and move in with Steve's mother in Idaho.
 
"'I've never been that stressed out in all my life,' Dawn said."
 
-- Dawn and Steve Foiles, Riverside
Los Angeles Times: September 17, 2006

"One California woman profiled in the (Michael Moore movie SiCKO), Tarsha Harris, said she was denied coverage because she once had a yeast infection on her navel.

"Ms. Harris said she noticed redness around her bellybutton after completing the Los Angeles Marathon. She saw a doctor and was diagnosed with a common yeast infection; she then used a cream the doctor prescribed to clear it up.

"Then, since she didn't have a job or employee coverage, Ms. Harris decided to buy an individual policy with Blue Cross of California.
 
"She said she completed the application, was approved and began paying premiums.
 
"But soon afterward, Ms. Harris started bleeding from her navel. Her doctors ordered surgery and Blue Cross approved the procedure.
 
"Only after the surgery were doctors able to diagnose her with a rare disease: spontaneous endometriosis of the umbilicus, she said.
 
"Blue Cross rescinded her policy, pulling back the money it had already paid to the doctors and hospital that treated her, she said in the movie. That left Ms. Harris -- sick and unemployed -- responsible for thousands of dollars of medical bills.
 
"Blue Cross claimed Ms. Harris made a material misrepresentation on her application, saying she should have disclosed her yeast infection.
 
"A spokesman for the insurance company also said Ms. Harris' case has been settled, adding that he thinks she is satisfied with the outcome, although he declined to give details.
 
"'Many of the Americans featured in Sicko were not as lucky as Tarsha,' said her attorney, Lourdes DeArmas, of the Quisenberry Law Firm in Los Angeles. 'They didn't receive the care they needed before the insurance company pulled the financial rug out from under them.'"
 
-- Tarsha Harris, Los Angeles
Dallas Morning News: June 30, 2007

When I tried to get health insurance through Blue Cross, I was turned down because, like a lot of other people, I had high blood pressure and high cholesterol. I remember hearing somewhere that 9 out of 10 people will eventually get high blood pressure! Blue Cross also said that I suffered from a heart condition, but my current doctor has examined me several times and says I'm fine.

People keep talking about fixing healthcare through "shared responsibility." I tried to be responsible, but it seems insurance companies don’t want to take ANY responsibility.

-- Linda, Apple Valley


I have been going to an eye specialist in Fresno for over 10 years because of my prosthetic eye. Blue Cross has been paying for this service for several years, but all that has changed now.

A while back, I had to have my prosthesis serviced. Afterwards, Blue Cross informed me that they would not be paying for the service any longer.

When I called to ask why, they told me I would have to go to Los Angeles for service. Blue Cross also said they would not continue to pay for any more custom prosthetics. Instead, they will only pay for "off the shelf" prosthetics.

I appealed and the State Appeals Board heard my case. They reversed the decision and Blue Cross had to pay for the service.

But if Blue Cross has their way in the future, I will have to take off work, find someone to drive me to LA, pay for the gas, food, and lodging. In addition, I would have a prosthetic eye that would look unnatural and weird. I know this would affect my social and mental well being.

-- Claudette, Fresno


I had an extremely hard time finding good health insurance for me and my family. I felt that a little insurance is better than none, so I looked around to find a plan we could afford.

Our Blue Cross plan has an $8,000 deductible, so we don’t go to the doctor unless it’s an absolute emergency. I don’t know what we will do if we ever have to pay that amount, it’s a scary thought.

Since I have high blood pressure, I really should be going to the doctor to get regular checkups, but I don’t. I know the visits will cost me hundreds of dollars and I just can’t afford it. I purchase my medications from a discount store so I don’t have to pay huge prescription drug costs.

-- Alex, Campbell


I needed to have surgery on my legs. The procedure is considered pretty routine, but because I have a Blue Cross high deductible plan, I knew I would have to pay the $2,500 for it. My doctors told me I had to have sonograms on each leg, twice before the surgery and once after to watch for blood clots. The scans were $1,500 per scan, per leg.

I thought the Blue Cross would cover most of those, but I ended up paying about 50% of the costs. In fact, they ended up charging me for more scans than I actually had done. My surgery ended up costing me about $4,000.

When I called to ask if there was an error, Blue Cross said they don’t make errors. I asked them not to approve the hospital’s bill until I could get an audit, but they wouldn’t.

I don't understand why I was charged $8,000 for all of this when the Blue Cross is supposed to be covering everything after my deductible.

-- Elizabeth, Berkeley


When our son David was born, he appeared to be a healthy little baby. It wasn't until four months later that he was diagnosed with a rare disease.

David is now 11 years old and can’t walk, talk, sit up, or eat by himself. David also suffers from seizures. David's life has largely depended on receiving critical nursing care at home. Blue Cross agreed that this care was medically necessary and paid for it for eight years.

But about a year ago, Blue Cross refused to pay for David’s care anymore, saying that we had exceeded the maximum coverage for the year. When we protested, Blue Cross changed their story and said David’s condition "wasn't medically necessary." They made this decision without ever consulting David’ medical records. Even after all of David’s doctors agreed that he needed a professional nurse at home, Blue Cross still wouldn’t cover it – even though they had in the past!

I thought insurance was supposed to protect you when you got sick -- how can they do this to David?

-- Gerald, Torrance


A couple of years ago, I underwent surgery, chemo and radiation therapy to battle colon cancer. Last year, my doctors told me the cancer had spread to my liver and I had another course of chemo, which didn’t get the cancer.

My doctors said perhaps my only chance to beat the cancer was to undergo Selective Internal Radiation Therapy (SIRT), which has helped hundreds of people with liver cancer (CHK).

Blue Cross denied me treatment, saying SIRT was an experimental procedure, even after my doctors provided them with overwhelming evidence to the contrary. I appealed the Blue Cross’ denial. Given my urgent need to undergo this potentially lifesaving treatment, Blue Cross was supposed to respond to my appeal within 72 hours. FOUR WEEKS later, they still refused to review my request.

I couldn’t wait any longer and I was able to get the procedure by raiding my retirement savings.

I have no doubt that I’m here today because of my doctors and this treatment – despite the efforts (or lack thereof) Blue Cross.

-- Eugene, La Canada


Blue Cross covers part of my prescription medication costs, but it's not enough to cover all of my needs. One of my medications is $1,900, which means I have to pay at least $500 out of pocket each month.

To make matters worse, the cost of the medication can go up each month, so I might be paying even more for the next dose. I called Blue Cross to see if there was an out of pocket cap on this drug, but they told me there wasn't.

Since I have Multiple Sclerosis, I can't go without my prescription if I want to stay healthy and manage my disease. But I don't know how much longer I can keep paying these sky-high costs each month.

This is really hard on me, but I know that I am luckier than some of the others out there, and that's a scary thought.

-- Gina, North Hollywood


I used to have health insurance through Blue Cross, but then I realized that I was paying for a worthless plan. When I renewed my policy with them, they raised my premium by 30%. I assumed that I was paying for the same coverage that I signed up for, but they also dropped some of my benefits.

When I got sick, I found out that Blue Cross wouldn't be covering ANY of my treatments. I couldn’t believe I had been paying $350 every month for nothing.

I finally cancelled Blue Cross, but when I tried to find another insurance policy I was denied for my 'pre-existing' condition. I couldn’t find anyone to insure me and it felt like I had been blacklisted.

Eventually I managed to find insurance through my work, but that was after going a few years without any coverage. I just hope that I can keep the coverage I have now.

-- Thomas, Los Angeles


A few months ago, I started to have problems with my neck from working at a computer all day. I decided to see a chiropractor that a friend recommended. The chiropractor fixed the problem in a few short visits.

Then the bills came.

Blue Cross told me they wouldn't pay for the visits. I made a of lot phone calls to Blue Cross, only to be told the same thing, over and over – they wouldn’t help me.

Finally a nurse with Blue Cross said she was reviewing my case and that I would have to PROVE that I hadn't had any neck issues for the past five years. I consider myself a pretty smart person, but how do you prove something DIDN'T happen five years ago?

After three months of phone calls, paperwork and stress, I was finally able to get Blue Cross to pay.

I thought my insurance company was supposed to work with me, not against me.

-- Zara, Santa Monica


When I first joined my Blue Cross PPO, it cost me $96 a month for my health insurance. Since then, that amount has skyrocketed. It jumped up to over $329 in 2005 and now, less than 2 years later it is up to $430 a month.

I've never been given any notice by Blue Cross that my health insurance premium is about to go up. I always find out after they have taken the money out of my paycheck.

My co-pays for my prescription medications went up too. They are costing me another $200 on top of my rising premium. These costs are ridiculous – something needs to change.

-- Cathie, Sacramento


When I was diagnosed with leukemia, I had Blue Cross insurance and they were constantly pulling a fast one on me.

My doctors would request treatments for my leukemia, and Blue Cross would approve them – until the bill came. Then they would suddenly decide to "deny" my claim, and leave me with the bill.

As a result, my credit went on a downward spiral.

The "power of blue" never really worked for me that well.

-- Peri, Tarzana


I have Blue Cross health insurance through my work. When I had my routine colonoscopy done, Blue Cross sent me a letter a few days later to tell me that they were not going to pay for the anesthesia on colonoscopies anymore.

According to the letter, anesthesia is "not medically necessary" for a colonoscopy.

I'd like to see the CEO and executives of Blue Cross have a colonoscopy done without anesthesia. Then maybe they wouldn't make such ridiculous claims.

-- Bob, Pasadena


My husband's co-pays on his insurance have gotten so expensive, that now he doesn’t go to the doctor anymore. We can't afford to spend $40 for every doctor's visit or for each prescription medication – it just adds up too quickly.

Because of the costs, my husband goes without any routine visits, exams, tests, or prescriptions.

-- Heidi, Ceres


When Blue Cross raised my premium again this year, I knew I had to find another insurance plan. My premium went from $450 a month to nearly $600. I just can't afford that. I tried to switch to a cheaper plan with Blue Cross but I was denied. I have a minor medical condition that I take a prescription for. I've had it for 25 years without a problem, but Blue Cross still refused to switch my plan because they said it was a "pre-existing" condition.

This past month, I decided to drop my Blue Cross coverage. I found an insurance company that was willing to work with me to lower my premium, but the policy doesn't take effect until next month. I just hope that nothing happens to me while I wait for this new policy to start.

-- Lattefa, Lockeford


I tried to apply for an individual health insurance plan thorough Blue Cross, but I was denied. They said that they wouldn't cover me because I have a 'pre-existing' condition, even though I am currently in very good health.

Blue Cross then told me that if I could go 5 years without any symptoms of my 'pre-existing' condition that I could reapply for an individual plan. I'm in the process of doing that right now, but I don't have high expectations for it.

There's a problem when healthy people like me are willing to pay for insurance, but still can't receive it. I know there are plenty of others out there in situations that are far worse than mine. We all need to work together to solve this problem.

-- Marika, San Francisco


My family and I didn't have health insurance so we decided to purchase our own. We applied to Blue Cross and were given a major medical plan – it was the only thing we could afford.

Each person had a $2,000 deductible. To make things worse, Blue Cross decided not to cover one of my daughters and my son. My daughter had a benign heart murmur that her doctors said would go away as she got older and my son has a learning disability. I wrote letters to Blue Cross and made phone calls asking them to reconsider, without any luck.

It wasn't until I got my kids' pediatrician involved that things changed. He wrote letters and contacted Blue Cross. Finally, they caved and added my kids to our health insurance. I can't believe it took so much time and effort to get my children on our plan.

Great healthcare should be a right for all of us.

-- Solveig, Oakland


I had Blue Cross health insurance through work, but then I got sick. Now I have COBRA, but it's expensive. Last month, they raised the rates again!

After paying for my health insurance premium and my rent each month, I've got nothing left. I'm going to have to take in a roommate to help pay for the rent, and my mom, who is retired, is cashing in some of her assets to help cover the premiums so that I have enough to buy food.

I've worked my whole life. I should be able to have affordable health insurance.

-- Barbara, rural Santa Cruz County


I can't afford my healthcare because Blue Cross says cancer isn't a "catastrophic illness."

When I was younger, healthy and rarely needed medical care, I purchased a Blue Cross Basic PPO policy so I would at least be covered for catastrophic conditions. The plan had a $3,500 deductible, but I thought it would be better to at least some insurance, rather than nothing at all.

Then I was diagnosed with stage 2 breast cancer.

I thought Blue Cross would be paying 80% of the remaining costs of my cancer treatment because I had already met my deductible for that year.

I was informed that breast cancer was not covered under my policy because it wasn't a "catastrophic illness." Blue Cross would not be paying for any exams, lab tests, prescriptions or treatments.

Silly, SILLY me to think cancer would be considered a catastrophic illness.

Fortunately, a friend of mine referred me to a state program through Medi-Cal that treated women with breast and cervical cancer. If she hadn't, I would be penniless.

Since the program ended, I'm back on my own trying to pay for my medical costs. Right now I've got $12,000 bill and mounting credit card debt.

I've asked Blue Cross if I can upgrade my plan to cover the more routine things so I don't have to pay so much out of pocket, but they turned me down. They told me that I would have to wait 5 years after I finished my post-cancer treatments before I could apply.

Those treatments take 5 years to complete, and if I have to wait 5 years on top of that, I'm looking at 10 years before I can change my policy. I'm already putting off treatments because of the cost and I just hope my cancer doesn’t come back.

-- Susan, Altadena


Blue Cross recently sent out a letter to their customers. It starts by stating they support "affordable coverage for all Californians." But at the end of the letter, they warn that "we can't rush" healthcare reform or we might "break what is working."

This reminds me of another letter I routinely get from Blue Cross.

You see, every month Blue Cross sends me a letter that starts off by thanking me for "choosing Blue Cross." But at the end of the letter, they warn me that my payments are due by a certain date and if I don't pay on time, my policy will be "canceled immediately."

Because I have a pre-existing health condition, I know (and Blue Cross knows) that if my policy is canceled, the only way I can get insured again is by paying increased premiums and co-pays – if they choose to insure me at all.

If California passed a law on guaranteed issue (meaning insurers can't deny you coverage), this would no longer be the case. Of course, in the third paragraph of that Blue Cross letter, they warn me that guaranteed issue isn't good for consumers.

Blue Cross raised my insurance 16% last year – I know they're not in any hurry to reform the system. In the meantime, you can bet I'll be doing two things: working for healthcare reform this year and making sure my insurance payments are on time.

-- Susan, Oak Park

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