29 Aug, 2018 → by ClaimboUser572414
BCBS Did Not Pay 100% for Routine Immunization as Specified in the SBP.

2

According to the BCBS’s Standard Benefit Plan (SBP) 2017, the Hepatitis A and B Vaccine should be covered under the Preventive Care Adult for 100%, and you don’t have to pay anything if you have it done at their preferred network providers or pharmacies. Well, this is not really true with BCBS because they only pay for part of it and not in full. I had the BCBS Standard Option Insurance for many years until 2018, and have not had any major claims with them. On December 2017 I went to Walmart and tried to get the Hepatitis A/B Vaccine injected, but they told me my insurance card was rejected and couldn’t be processed. So I tried Kroger Pharmacy and the same thing happened. I called BCBS to find out why, the representative said that the vaccine is covered but the injection fee is not. I told her that ALL the cost should be covered including any fee, since this immunization is recommend by CDC and is also stated in their SBP under the Preventive Care Adult for full coverage. She told me she had no idea. I had to call BCBS Account Manager, he told me to go ahead have the vaccine done and pay for it myself, then file a claim and BCBS will reimburse me for the full amount because the system cannot process my insurance card at the moment. So, I did as he told me and paid a total of $102 for it at Walmart Pharmacy, then filed a claim with BCBS. After waiting about 3-4 weeks, they processed my claim and only paid me $97. I called them back to find out why, and they said that’s all they can pay for this immunization service. I told them the Hepatitis A/B Vaccine should be covered in full as stated in their SBP since it was taken at their Preferred Network Pharmacy, and was also promised by their Account Manager. BCBS rep said that she doesn’t know what’s wrong and would have to review this issue with her management and let me know later. Until today they still have not pay me the $5 difference as they are supposed to. Five dollars is not much but I am very disappointed with the way BCBS is doing business. The Account manager told me to pay for the vaccine myself in advance and they will pay me back in full, but they didn’t keep their promise. They don’t abide by their SBP and not pay for the service correctly as stated in the SBP. Their customer service reps don’t seem to understand nor can they help the customers very well. It is not my fault that BCBS system or their network pharmacies cannot process the insurance ID card for their customers. I hope that BCBS will recognize their mistakes and try to improve their services better in the future. I have changed my insurance to a DIFFERENT COMPANY and have had the vaccines injected with no problem at all especially those recommended by CDC, and the new insurance company ID card works very well with any of their network pharmacies.
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