BCBS Coordination of Benefits provision Concerns


I guess you all know that all/most major insurance carriers have a coordination of benefits admin/manager. That is your particular contract, whether is be via your employer or personally selected, contains a Coordination of Benefits provision.

Now this really sounds good using the term provision. Makes it look like insurance company is looking out for the best interests of its loyal customers right?  I know that BlueCross BlueShield of New Mexico did not explain what the Coordination of Benefits provision actually means. Take a look at the form below and see if you can figure out what their motive for sending it might be.

The first question is Are you or any member of your family covered by any other health or dental plan?  If not, you are supposed to sign the form and return to BCBS. If yes, then you have to provide all the wearisome details over  coverages you or you family has with other insurance carriers.

They state that if you do not promptly fill out their nosy request, that any claims you submit might be delayed or not processed. Does anybody know if this is legal? Let’s say you honestly fill out the form detailing your dental, eye, etc. policies from other companies. Does BCBS lower their payouts on your claims or maybe not even process your claim? Why do they need to know if you have other health insurance polices from other carriers? If it was to benefit the customer, I am sure they would profusely list those benefits in letter you see, but there is no such language, ONLY a demand for you tell them if you use anybody but them!



1 comment on “BCBS Coordination of Benefits provision ConcernsAdd yours →

  1. A Rolling Meadows, Illinois epileptic had an egregiously stressful experience with blue cross insurance.

    She had BCBS for a long time after switching from CIGNA. She received a notice from her doctor saying that She was no longer insured despite faithfully paying her premiums on time for last 4 years. Customer service said she was late on a payment. She sent both BCBS and BCBS Marketplace/Silver her bank statements to prove there was NO billing issue corroborating all premiiums had been paid on time. In the mean time she was paying out of pocket for her $850 per bottle epilepsy medication!!

    By all appearances BCBS dropped coverage on her because it was not profitable for them to continue coverage on this seizure prone customer. They fabricated the lapse in her payments so they would have a reason to discontinue or terminate her life sustaining policy.

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