ComplaintsforCare First BlueCross BlueShield

• Initial Complaint

  01/24/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Every time I talk to a Carefirst Representative I get a different answer. My initial claim for my DXA (Bone Density Screening) exam was declined, the representative I spoke with on December 19, 2022 agreed that it should be covered by the insurance and told me that I was absolutely right but she told me that the provider, ************************* Imaging (***), had filed the claim under Medical instead of under preventive care. I contacted *** and they resubmitted the claim, to no avail. I called CareFirst again on January 6th, I was told that it was hard to label DXA as preventive care even though it appears on this website as such, *************************************************. The representative told me to write a claim to this address in *********, **, **************. I did on January 9th, 2023. This morning I called because I have not heard from them (of course *** keeps sending me the bill), and I was told that I had sent the documents to the wrong address!!! So, now I have to send all the documents again to a KY PO box and wait 45 days to resolve the issue. I find unbelievable that such a big company as Carefirst can get way with such horrible service to its clients and were are left powerless faced with such lack of competency/lies.

  Business response

  02/17/2023

  RE: BBB File Number: ********* *** ********
  
  Dear Better Business Bureau:
  
  This letter is to acknowledge the receipt of your correspondence regarding the above
  referenced file.
  
  CareFirst requires a valid Authorization Form for Information Release to provide your office with
  specific details regarding the complaint. Because we do not have that authorization on file, we
  will reply directly to the complainant.
  
  Please be assured that we are working as quickly as possible to provide an equitable
  resolution.
  
  
  Sincerely,
  
  **** ****
  
  **** ****, Sr. Analyst
  CareFirst Executive Inquiry Department

• Initial Complaint

  12/24/2022

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  I am an out of network mental health professional with over 4 decades of experience. My clients routinely submit their bills to and are the recipient of the reimbursement checks issued by their insurance companyI. Periodically, the insurer send such payment directly to me. My policy upon my clients' request is to deposit such payments and deduct the amount from what they ow, otherwise it might take sometimes months for my clients to receive the payment. I had never had a problem until recently when I received a letter from Care First claiming that they had overpaid me due to an error and demanded the payment of $ ******. They threatened that if I do not send them a check they would refer this case to a collection agency.I wrote them a letter and explained that I only received two checks in 2022 and all the other payments were cashed by my client/their member. One check in the amount of $ ****** dated 02/11/2022 and the second one in the amount of $ ****** dated 07/22/2022/both were deducted from what my client owed me. I also called and had a conversation with one of the representatives/ ****** on December 8th,(ref #**************) who interestingly enough did not seem to have any knowledge of direct payments to me. She said she would get back to me.On December 23rd on my day off while I was feeling very sick due to the side effect of covid shot, I received a call from them using my ************ number, once again harassing me abut the payment. This time, the representative I spoke with kept on repeating the information I provided them with, claiming that they had sent my client the duplicate checks that they sent me, demanding the payment of over a thousand dollars. When I asked for proof, they declined. My client denies the receipt of such payments. I also spoke with a supervisor who insisted that I had cashed a $ ****** check . I asked her to email me the copy .She put me on hold and then changed her story and refused to send me the proof of over-payment.

  Business response

  01/13/2023

  Thank you for forwarding the inquiry. CareFirst will respond directly to the Complainant. 

  Customer response

  01/17/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because: I had a bad experience with them. They are dishonest and unwilling to back their claim by presenting solid evidence. I highly doubt they would provide me with the necessary documents that I need to report them to *********************************. 
  
  
  Regards,
  
  *******************
  
  
  
  
  
  
  
  
  

• Initial Complaint

  07/12/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I joined CareFirst BluleCross/BlueShield in 1989. At the same time, my son, ************************** also became a member. My Group ID: #****; Subscriber ID: ***********. Over the intervening years I routinely paid the annual invoices for both of us. I did not receive an invoice for the 2019-2020 policy year but received/paid my son's invoice. I sent them a letter with a check for estimated payment explaining that I had not received an invoice and informing them of my correct address. No reply was received, the check was cashed and I assumed the policy had been continued. A similar situation occurred for the 2020 policy year. It happened again in 2021, my letter and check were sent in Nov 2021. The check was cashed on Dec 1, 2021. By fortuitous circumstances, in June 2022 I was given a check from BC/BS dated May 19, 2022 that had been misaddressed. It was in the same amount as the check I sent them in November 2021. There was no letter or any information with the check. I have not cashed that check. I called their Customer Service and after three hours on the phone was essentially told my policy had been cancelled in 2019 for nonpayment and could not be reinstated nor could I obtain a new policy. I have never received any notice of impending termination nor termination for nonpayment. I wrote to the President of CareFirst BlueCrossBlueShield on June 25, 2022, included copies of the appropriate correspondence and requested reinstatement. To date, I have not received any reply. I do not have available electronic copies of the correspondence referenced, however, if needed, I can photograph them and make electronic copies to send to you or I can make paper copies and mail them to you. by U.S. Mail. Because of character limitations in this explanation, I have had to summarize my attempts to have them send me an invoice. I believe that I have made repeated good faith efforts to make payments even though I have not received invoices.

  Business response

  08/11/2022

  Regarding this complaint, because there is no authorization to release information to the BBB on file from the member, we will respond to the complainant directly.

   

  Thank you

   

  *********************

  Customer response

  08/11/2022

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me providing the business does contact me direcdtly
  
  Regards,
  
  ***********************
  

• Initial Complaint

  06/03/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  They dropped my wife from the insurance without any reason or documentation. According his benefits department I am still paying employee and spouse rates for insurance. The benefits department at my job still have me listed hve having employee as spouse benefits. They said they received a document saying to drop my wife but care first can’t find it in their system. They have been giving me the run around about reinstating her insurance even though I didn’t not request for her to be dropped or my benefits department not request it either. This is an issue that needs to be resolved as soon as possible. Care first refuses to take responsibility for their mistake and correct for my wife to continue getting the treatment she needs. I have not heard anything back from anyone. They only person that was supposed to to be dropped off was daughter who turned 26. I have tried to talk to some one else and I am still getting the same thing. They didn’t notify me let alone did I send or request for this. As I said the benefits department at my job still has me listed under employee spouse benefits. I am very frustrated and so is my wife about this this is not the first time I have had an issue with care first doing their job. I am not pleased with their service or their works ethic to correct their mistake. I am trying to be patient with them but my wife’s heath is important and she has important appointments coming up that she needs. I would like for them to reinstate her insurance as well as pay any bills that come from them dropping her off without my request. They still have no idea of who and what sent this request which means they are not professional, they don’t pay attention and they are not a company of honesty or integrity. We have been trying to get this resolved since last week. Everytime I talk to someone they say it’s is being processed and looked into when their shouldn’t be anything to look into. They should just reinstate her insurance. They need to fix this.

  Business response

  06/21/2022

  Good Morning-

  We have responded directly to the complainant. The issue has been resolved.

  Sincerely,

  Brian ** K*******, ****
  CareFirst BlueCross BlueShield
  Senior Analyst | Executive Inquiry
  ***************@carefirst.com

• Initial Complaint

  02/22/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  I had $1,126.26 taken out my checking account for a policy I did nit authorize. Member ID ********* , I canceled the account but they took my money anyway. I am a senior citizen in SS and I need my refund ASAP. Thank you for your help.*********

  Business response

  03/02/2022

  To Whom It May Concern:
  The termination date of the policy has been updated and a refund will be issued.

  Regards,

  Brian *. K*******, ****
  Senior Analyst
  CareFirst BlueCross BlueShield
  Executive Inquiry | Corporate Office of Civil Rights PO Box **** Baltimore, MD *****
  Pronouns: he/him/his
  Working Remotely: M-F, 8am-4pm

  Customer response

  03/05/2022

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  
  Regards,
  
  *******************
  

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩