ComplaintsforHighmark Blue Cross Blue Shield Delaware

• Initial Complaint

  06/15/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My wife, *** ******, had a stroke in Maui, Hawaii. She was admitted on July 9, 2022. The hospital required a medical transport service (serviced by MM Transport on July 15, 2022) to take her back to Delaware. I submitted a claim on July 31st 2022. BCBS repeatedly asked for information and I promptly provided all information they need. The claim is almost one year old and BCBS still doesn't resolve it. They don't even acknowledge the claim on their website. It appears to me BCBS purposely drags on the investigation so I will get frustrated and give up the claim. I called today (June 15, 2023), the operator told me she can't find my claim and won't let me talk to her supervisor. Please help me resolve the problem with BCBS. I want BCBS to reimburse for the charge by MM Transport to transport my wife from Hawaii. If BCBS rejects the claim, I want them to provide me the reasons. I also attached a file with details about the case. You can contact me at 3*********** ** **********************om. Thank you,

  Business response

  08/07/2023

  See attached response that was initially sent last month via email.  I apologize for the inconvenience.

  Customer response

  08/08/2023

  Better Business Bureau: I have reviewed the response made by the business in reference to my complaint and have determined that this does not resolve my  issue.  For your reference, details of the offer I reviewed appear below. **In order for the bureau to continue to assist you, you MUST provide your view on the matter or your complaint will be closed as answered. Hello,HighMark's letter is an acknowledgement of the complaint, not a resolution.  I received at least 5 earlier acknowledgements, but no resolution before.Regards, Regards, Complaint ID: 20192099    

• Initial Complaint

  01/30/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I used to attend Pivot physical therapy following a long stay in the hospital. I would have to call weekly to make appointments as Pivot would say they needed to call my health insurance (Highmark BCBS) to get authorization before they could book my appointments. The last appointment I had in October 2021 I was told it was my last appointment because my health insurance would no longer cover future appointments. I am now receiving bills in the mail trying to bill me for the dates of 8/23/21 and 10/6/21 saying I didn't have coverage on those dates. That is not possible because Pivot always called Highmark to get approval BEFORE scheduling my next appointments. I called Highmark to tell them how silly this was, how could I be covered on days past 8/23/21 but somehow not covered on August 23rd? Same thing with my 10/6/21 appointment. I know Pivot would always call before making my appointments because it took longer to book an appointment but it made sense. Highmark is still denying the claims so now I need more help because highmark told pivot at the time of service that those dates were covered, now months later they've gone back on that.

  Business response

  02/03/2023

  See attachment

  Customer response

  02/11/2023

  Better Business Bureau: I have reviewed the response made by the business in reference to my complaint and have determined that this does not resolve my  issue.  For your reference, details of the offer I reviewed appear below. It literally makes 0 sense.. that you denied the claim on 8/23/21 saying there were no more therapy sessions, but then covered the claims from 8/30/21--10/4/21. And then you denied the claim on 10/6/21 saying there were no more therapy sessions but approved the session on 10/8/21. How can you say you won't cover those two dates because I ran out of sessions but then you continued to cover more sessions after those two dates?  Regards, Complaint ID: 18953091    

  Business response

  03/01/2023

  Please see attachment for response

*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. ↩