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    Medicare Supplement Center

    5.0 (2 reviews)
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    Blue Cross Blue Shield

    Blue Cross Blue Shield

    1.0(4 reviews)
    0.9 mi

    I have an HMO Blue Cross Blue Shield. In the hospital emergency room it is wonderful however, my…read morepain manager wrote prescription for me to have water therapy for my herniated disc and they will not approve it because they want my primary care for this. This is a pain management problem not a cold or flu problem. None of my doctors are in network none of them. They tell me that it was in me a list of doctors yeah that's just great. They did and I'm not about to go to any of those doctors. I do believe that we crossly shield would rather see you dead so they won't have to worry about paying for anything anymore. It is disgusting. I would not recommend this to anyone that care quality is horrible. I am leaving a one star because that is the only way I can leave a review that really this requires half a star

    Chapter 541 and Chapter 542 Violations…read more I am writing regarding the improper denial of a medical claim submitted under my Fiance's health insurance policy with Blue Cross Blue Shield. The medical services at issue were provided by an in-network physician, and all required documentation was properly submitted by the provider. In addition, the deductible and applicable plan requirements had already been satisfied at the time the claim was processed. Despite this, the claim was denied without what appears to be a reasonable basis or adequate investigation. Throughout this process, we have experienced significant issues with claim handling, including but not limited to: Failure to properly investigate the claim; Denial of a medically necessary service despite supporting documentation; Failure to reasonably evaluate evidence submitted by the provider; Delays and avoidance in responding to communications; Repeated difficulty obtaining meaningful claim status information; Conduct that appears inconsistent with the obligations of good faith and fair dealing under Texas law. Based on the facts currently available, we believe these actions constitute violations of Chapter 541 of the Texas Insurance Code involving unfair claim settlement practices and bad-faith insurance conduct. We are also evaluating potential violations under Chapter 542 regarding prompt payment and timely claim handling requirements. Formal complaints have already been filed with the Texas Department of Insurance and the Office of the Texas Attorney General. In addition, legal counsel is being retained to pursue all available remedies related to this matter. We request the following immediately: -A complete written explanation of the denial, including all policy provisions relied upon; -Copies of all internal claim notes, reviews, and determinations related to this claim; -Confirmation of whether all submitted medical records and supporting documentation were reviewed; -Immediate reconsideration and reprocessing of the claim in good faith. Preserve all records, communications, recordings, electronic files, and documentation related to this claim, as they may become relevant in pending or anticipated legal proceedings. We expect a prompt response and resolution of this matter.

    Medicare Supplement Center - healthinsurance - Updated September 2026

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