Complaints

This profile includes complaints for Blue Cross and Blue Shield of Illinois's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Blue Cross and Blue Shield of Illinois

  300 E Randolph St Chicago, IL 60601-5099

• 

  Blue Cross and Blue Shield of Illinois

  PO Box 1364 Chicago, IL 60690-1364

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:08/31/2022

  Type:Service or Repair Issues
  Status:

  UnansweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I receive my health insurance from BCBS through the Healthcare Marketplace. This yr I signed up for the blue focuscare silver 210 plan. I went to see my Dr (I made sure was Included in plan, along with my hospital, South suburban *** 600) on Jan 18, and was told I was not covered by the policy shown on my insurance card, which did not have a lot of info on it. It did show the *** as 334 Progress Health on it. This meant nothing to me. Turns out, it was totally different hospital nowhere near me. It was MLK Day and BCBS closed for the holiday. I called the next day and spoke with a rep from BCBS, not knowing I should have called the Marketplace to settle this, and not being told this by the rep either. What I was told was that I could purchase a new plan which would cost over $150 more a month if I wanted to have my Dr and hospital included. I felt I had no choice but to do what he said and signed up for it. A few weeks later I came across my original paperwork, and realized someone had changed what I had applied for. Didnt know how this couldve happened. I called the marketplace, and they agreed that I had signed up for the 600 ***. They went through the steps, and up the ladder, eventually having a Supervisor have my case Escalated. We spoke with BCBS, and they said they would correct it right now. I cant tell you how many times this happened. EACH TIME I WAS TOLD IT WOULD BE CORRECTED, AND NO ONE NOTICED THAT IT WASNT! I complained every month, asked for a supervisor which I never got. The marketplace had this case escalated at least 3 times to correct as well. I continued to see my Dr and visit my chosen *** group. Oddly enough, someone called me from BCBS to do a survey about my 2021 policy. I told her a little about this yr, and a rep from the ***************** called me. She corrected, but made it effective 7/01. All previous agreed to 1/01. Have bills not being paid. calledInquiry **** and she wouldnt try to help. I give up on them. Please help.

• Initial Complaint

  Date:08/29/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Claim Number 0202222323158730C. My son who is 11, has been trying to get a CPAP machine since June of 2021, however BCBS is refusing to help. We have received multiple sleep studies for him that all say he needs the machine. We have received doctor prescriptions, letter of medical Necessity and pre certifications that have all been sent to BCBS however two claims have now been denied for not having a pre cert. Now on 8/29 i have been notified that BCBS has had a pre cert waiver for one year and knowingly still denied the claim. BCBS is actively committing insurance bad faith and will be reported to the ************** for their wrong doings.

  Business Response

  Date: 09/15/2022

  Please see attached response.  A complete response letter will be sent to the inquirer.

  Customer Answer

  Date: 09/16/2022

   
  Complaint: 17791899
  
  I am rejecting this response because: I still have not received reimbursement for my cpap by which I was promised.  Again I was told by BCBS and accolade we could buy that unit out right and get reimbursed.  I demand full reimbursement plus interest due to the delays. 
  
  Sincerely,
  
  *********************

  Business Response

  Date: 09/20/2022

  Response sent to member on  9-20-2022.  In order to release PHI a BCBSIL issued Standard Authorization Form (SAF) must be filled out.17791899

  Customer Answer

  Date: 09/21/2022

   
  Complaint: 17791899
  
  I am rejecting this response because: We still have not received the *** form.   You also have my phone number and can call me to confirm that information over the phone.  BCBS needs to handle this matter quicker. 
  
  Sincerely,
  
  *********************

• Initial Complaint

  Date:08/21/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I had applied for a *** waiver to obtain portable oxygen equipment which is covered by our insurance..They are allowed ************************************************************ to have testing redone staying out of town to do so and still by the time they finally approved it, my prescription was again no longer good qnd I could not go and rest at that time. I had been able to borrow some equipment while I waited for my own. This got me through last winter but not without impacts to myhealth. Now this spring I started the process again.. I went through the retesting and my prescription was renewed . That was good until July 23rd.. But no waiver from BCBS of IL. Nothing but the run around. We have been at the **** clinic since June 12th and will be going home Labor day weekend. Due to knee issues and other issues I will not be able to walk to do another o2 titration and repeat this test due to BCBS not getting the *** waiver done. I have had use of **************************************************************** over 2 year my health has improved and myocarditis resolving. When we leave here that wont be the case without that *** Waiver for portable oxygen equipment and a stationary one for home. THere is no reasonable explanation or excuse for these delays or refusal to provide coverage within our plan. I did find a fax from someone in June in response to my concerns but any mailings were not seen as we have not been home since June and the fax was in junk mail. I was never notified of the communication so this was not known until recently. It should not be difficult to re approve a waiver that was already approved previously. I did try to reach the person who sent the fax *********************** and her message says she is out of the office indefinitely.

  Business Response

  Date: 08/29/2022

  Please see attachment. Thank you. 

  Customer Answer

  Date: 08/29/2022

   
  Complaint: 17748288
  
  I am rejecting this response because:
  
  A release was signed to allow access to the protected information.  I am not currently at home to receive regular mail and will not see any written communication.   I am at the Mayo Clinic  getting care.  In part due to the refusal to provide coverage for needed DME and equipment by BCBS and the delay in recovery it has contributed to. 
  
  Regardless,   no health information has to be released  to provide contact numbers and names for people who are handling the  latest PPO waiver request or to provide answers as to why this is simply being ignored from what I can tell.
  
  I reject this response as it seems to be just another way to stall this off and pass the buck.
  
  Any written communication can be provided to me via fax or email 
  
  FAX  ************ 
  EMAIL  ***********************  
  
  Otherwise  you have access to  phone numbers on  our account already.
  
  Ive been beyond understanding and patient but  the time for that has gone and now its time to get this taken care of and hopefully with your help.
  
  Thanks
  
  Sincerely,
  
  ***************************

  Business Response

  Date: 09/01/2022

  This member does not have a signed Standard Authorization Form (SAF) on this inquiry in the attachments; therefore, a response will be submitted directly to the member. 

  Customer Answer

  Date: 09/01/2022

   
  Complaint: 17748288
  
  I am rejecting this response because:  I have asked for contact information  to help resolve this complaint and avoid filing a complaint with OCR  to resolve this matter.  No one at BSBCIL seems to feel this has any urgency or represents a problem.
  
  Ive not been provided with this information and I have called repeatedly and emailed to request another PPO waiver and  No one seems to know what is going on.
  
  I feel this is  just a tactic to keep from having to pay the cost of the equipment.
  
  
  I cant accept this response because its not a response, it provides  nothing other than call the number on your card which has gotten me nowhere.
  
  Also please note we are at the **** clinic and not at home and unable to  get **** mailing so please use email or this portal for communications  or contact me via phone and leave a message.
  
  
  
  Sincerely,
  
  ***************************

• Initial Complaint

  Date:08/17/2022

  Type:Order Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My husband, ************************* was admitted to the **************************** for covid Oct. 26 through October 29, 2020. I was employed at ************************** which BCBS was the company insurance, had for years. First ************ bought Champion and was changing insurance Companies beginning November 1, 2020. Therefore when my husband's **** was submitted, insurance was no longer active but when the services rendered, he was covered. I spoke with insurance representatives for BCBS and all stated he was insured at the time of services. For some reason, they are refusing to pay this hospital **** and it just recently surfaced after 2 years. We have been turned in to a collection agency because of this. Each time I called, the ladies I spoke with would say I will resubmit it. Letter I received last week in response to my latest call on 7-12-22 was the claim cannot be reprocessed now the policy has been canceled. Don't care about all this, my husband had insurance coverage when he was hospitalized. *************** premiums for "YEARS" and expect them to pay for the services.

  Business Response

  Date: 08/19/2022

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

  Customer Answer

  Date: 08/20/2022

   
  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.
  
  Sincerely,
  ***********************
  ***********************

• Initial Complaint

  Date:08/17/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My father, ****************************, passed away in November 2021. When I canceled his supplemental health insurance provider - Blue Cross Blue Shield of IL, they issued me a refund of $1000+ dollars. When I received the refund check, it was issued in the wrong name and I contacted them to reissue the check in the correct name. They requested a copy of the trust which was sent by mail to them with a cover letter stating what they told me needed to be stated with my contact information. Months go by - still not refund check. I called BCBSIL and they said that they have been trying to contact me because they needed more documentation. When I asked who they have been trying to contact they stated that they were trying to call my deceased father by his disconnected phone number. They were trying to contact a dead man! I told them that the whole reason they were issuing me the check was because my father was dead, why would they try to contact him? Didn't they read the letter with my contact information? Once again, they requested to send more copies of the trust and contact information - a month goes by and still no contact. I called again and the same story, they have been trying to contact my dead father. AGAIN I send the documents with a cover letter, a month goes by - NOTHING. I called this last time ad they told me that because they could not get ahold of me (via my dead fathers phone number) they sent my check to unclaimed property and that I needed to send the documents again. I have sent the documents for the 4th time and still not response or update from BCBSIL.

  Business Response

  Date: 08/30/2022

  August 30, 2022
  
  
  ******************
  205 ************
  ******, ** 60143
  
  RE:      Record ID: *********
  Inquirer: *************************
  File #: 17727740
  
  
  To Whom It May ******************** letter is in response to ******************* inquiry, submitted to your office and received by Blue Cross and Blue Shield of Illinois,a ******** of ******************************** a ******************** Company,an Independent Licensee of the Blue Cross and Blue Shield Association,on August 17, 2022. 
  
  Due to the Protected Health Information involved in the response of this inquiry a letter will be sent directly to Ms. ************
  
  We strive to deliver excellent service and appreciate being made aware of instances in which improvement is possible.  If you require additional information,please do not hesitate to contact us in the future.
  
  
  Sincerely,
  
  ****************** U312666
  Executive Inquiry Specialist
  Blue Cross and Blue Shield of Illinois

  Customer Answer

  Date: 09/05/2022

   
  Complaint: 17727740
  
  I am rejecting this response because: This issue has still not been resolved. I have never received the letter they said they sent. I spoke to a gentleman over a week or so ago, he said he would follow up the next day. He didnt, I called him back and he said he would follow up with me within 24 hours, never did. I attempted to call him back last Thursday and never got through. Still have not received the refund check or and timeline of issue being resolved. 
  
  Sincerely,
  
  ****** Moist

  Business Response

  Date: 09/08/2022

  Please see the attached response letter that was sent to Ms. ***** via US mail on September 7, 2022.

   

  Additionally, I have provided Ms. ***** with my direct contact number while we await receipt of the required documentation.

   

  Customer Answer

  Date: 09/09/2022

   
  Complaint: 17727740
  
  I am rejecting this response because: I spoke to ****************** (U312666) prior to him submitting this letter to you. As I have stated in the previous response as well as to Jernard, we have summited (3) copies of the trust to his office, which he stated had "tracked down". The first trust that was sent to him was the most recent and current trust, which should supersede any trust that came before. Nothing in the trust has changed regarding the name of the trust or who is in charge of his trust, regardless of original or amended. Yesterday when I spoke to him, around 2:00pm, he told me that he needs to speak to another manager regarding this and that the BBB had contacted him again - of course they contacted you again because this issue has not been resolved. When we canceled his original insurance, they sent a check immediately, no questions asked. Now its hassle to myself and my family, go back and forth. It is also still concerning that no on has addressed why BCBS was trying to contact my dead father multiple times anytime we have submitted paperwork.

  
  

  This issue is NOT resolved. I am still waiting on a call back from ******* regarding a resolution once he speaks to another manager. 
  
  Sincerely,
  
  ******************

• Initial Complaint

  Date:08/12/2022

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  In Feb 22 my son ****** received anesthesia at his dentists office to fill six cavities. I paid the full amount and submitted to my health insurance for reimbursement. In Apr 22 I received a letter from BCBS that they had denied my request for coverage and reimbursement. According to them, it was based on "Anesthesia administered for dental care treatment rendered in a Hospital or Ambulatory Surgical Facility if a child is age 6 and under, you have a chronic disability, or you have a medical condition requiring hospitalization or general anesthesia for dental care. The dentist strictly stated in the letter Options for treatment were presented and due to anxiety, extent of treatment, patient age and tendency to grab during the exam, it is determined that performing the necessary treatment in our office, under general anesthesia, is the best way to proceed. ****** has had a cavity in the past, was treated at the same office and did not do well. Therefore, based on the above, as well as previous experience, the dentist recommended that anesthesia was medically necessary. Additionally, due to having six cavities in all four quadrants of Hunters mouth in addition to Hunters previous reaction and response to filling a cavity, anesthesia was not only medically necessary but also the most effective, efficient and least problematic method for the child (Hunter). In May 22 I appealed. I filed everything and sent it certified mail. It was received I believe on May 27, 2022. It has been over 60 days. I never received any indication that they even received/was reviewing my appeal. The only communication that I have received was that the appeal was received and that is because I sent it via Certified Mail. This company has poor communication with their clients and is avoiding paying for coverage that doctors and dentists are recommending. I do not understand why an insurance company gets to override an educated, experienced doctor/dentist with respect to what is the best.

  Business Response

  Date: 08/15/2022

  BCBSIL has made outreach to **************** and will respond directly to her.

  Customer Answer

  Date: 08/15/2022

   
  Complaint: 17708384
  
  I am rejecting this response because:

  
  

  I do not want to close this complaint. They have reached out to me and have formally started the appeals process because, according to them, they never received my certified letter. Therefore, communication has started but that does not mean that the problem has been resolved.
  
  Sincerely,
  
  *************************

  Business Response

  Date: 08/23/2022

  Appeal has been completed and member notified of determination.

  Customer Answer

  Date: 08/23/2022

   
  Complaint: 17708384
  
  I am rejecting this response because now BCBS of IL is giving me the following reason for rejection: Charge exceeds the priced amount for this service. Services provided by a non-participating provider. Patient is responsible for charges over the priced amount. Prior to this appeal, they did not deny the claim because the services were provided by a non-participating provide. They gave the reasons of  "Anesthesia administered for dental care treatment rendered in a Hospital or Ambulatory Surgical Facility if (a) a child is age 6 and under, (b) you have a chronic disability, or (c) you have a medical condition requiring hospitalization or general anesthesia for dental care.  At the same time, I did not have any choice regarding who provided the services. The anesthesiology services were contracted out by the dental office. The dental office said that due to my son's history, the procedure required anesthesia. Because of the anesthesia, the dental office contracted that out to a physician. I was never given the choice. And why would I argue or go against the recommendation of the doctor/dentist? 

  
  

  They denied my first claim. I appealed the decision and they stated that they never received it (although it was sent certified mail and said it was received - I have documentation), so then they speed through my appeal, where I receive a letter that they will be reviewing it on Aug 15 and then a letter on Aug 16 that it was denied. One day. And this is for ******* PPO through my employer. I have had this insurance for over 10 years. I have had multiple surgeries where anesthesia was required and covered and now, *******, have been targeting me and my claims to where I have to fight to receive coverage. I will be filing an external review appeal.    
  
  Sincerely,
  
  ***********;******

• Initial Complaint

  Date:08/10/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  BCBC of Illinois is the worst company that exists. Every time I call I am transferred to another ***** who cannot help. I signed up for medical insurance that is in network with the health plan I chose, and the card has BCE on it so I cannot get treatments from my doctor at the hospital I wish to. When I enrolled I called and asked to change my plan (before it went into effect) and I was told I had to wait until the plan went into effect before I could change it, and that I had 30 days to change it. I called back a week after it went into effect and I was told I am stuck with it and I asked which plan doesn't have BCE on the card and the licensed agent does not know anything about BCE and cannot help. The company is useless, it is a scam, and they are unwilling to help. They never give accurate information, they are there to take thousands of dollars from families every month and lie to them by the phone. Last month I made about 15 different calls into the company, I was hung up on, disconnected, lied to, and given misinformation. Total scam, worst company there is. BEWARE!! If you ask to speak to a manager they will be either in a meeting or too busy so you cannot even escalate your concerns. BEWARE OF THIS COMPANY! THEY ARE HEARTLESS THEIVES!

  Business Response

  Date: 08/15/2022

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution. 

• Initial Complaint

  Date:08/08/2022

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Due to serious anxiety, stress, and depression based on family unexpected medical conditions, I needed to seek professional advice from a mental therapist. I contacted my PCP at the time in July 2021 because it was almost impossible to get a therapist available anytime soon on the network. She replied stating that I did not need a referral to an out of network provider (screenshot attached "Referral_Therapist_********"). I began my therapies in August 2021, and my insurance HMO Blue Advantage paid for that until February 2022 (see pdf document attached for the last payment they did). Around May 2022, my therapist told me that my insurance has been lately ignoring their invoices, and that's when I realized that the last payment the insurance did in February 2022 was for December ************************************************************************************* to don't worry because they would contact my medical group (NorthShore Physicians #***) to request their referral and to give them between 10 - 30 days to see that correction reflected. I waited and nothing changed. I contacted them via their ************** and received the answers uploaded (from July 14, 15, and suggesting Appeal). I called NorthShore **************** Services, and agent named ******* told me to contact my group #*** and request a backtracked referral to my PCP starting January 2022. I contacted them via NorthShore Connect site and received a referral from now on for 10 visits but not backtracked (see uploaded documents). Now, my group wants the therapist to send them a written appeal to their headquarter in ********* explaining my medical need to see if they approve backtracking the referral. So far, I decided to stop my weekly therapies on July 13 until this gets resolved, as there is an unpaid bill of approx. $2,000. Of course, this is exacerbating my anxiety and depression. I decided to make this claim due to lack of notice about this change to me by HMO Blue Advantage.

  Business Response

  Date: 08/22/2022

  August 22, 2022
  Better Business Bureau
  121 **************,
  Suite 2000
  ******* ** 60601
  RE: Record ID: *********
  Member: ********************************************
  File #: 17690011
  To Whom It May **************** letter is in response to *****************************-Inojosas inquiry, submitted to your office
  and received by Blue Cross and Blue Shield of Illinois, a Division of **********************************, a ***************************** an Independent Licensee of the Blue
  Cross and Blue Shield Association, on August 9, 2022.
  Due to the Protected Health Information involved in the response of this inquiry a letter
  will be sent directly to *********************************.
  We strive to deliver excellent service and appreciate being made aware of instances in
  which improvement is possible. If you require additional information, please do not
  hesitate to contact us in the future.
  Sincerely,
  ************** U312279
  Senior Executive Inquiry Specialist
  Blue Cross and Blue Shield of Illinois

  Customer Answer

  Date: 08/26/2022

   
  

  Complaint: 17690011

  I am rejecting this response because the letter response sent by post mail practically states the same reason why I had to fill out this complaint (See attachment). I explained the reasons behind the fact that I needed to have mental therapy starting in 2021 with an out-of-network provider,as there was no one available under my group provider at that time. There was no referral needed per my former PCP provider and no one received (my mental therapist or myself) about any changes in January 2022, while BCBSIL continued paying my mental health provider around February 2022. This not only added to the confusion but came as a surprise to me when I contacted HMO Blue Access customer service initially and the person on the line told me that this could be easily solved by them contacting my PCP medical group (NorthShore #***) and requesting the referral. I waiting a month to have this reflected per the customer service person I spoke to and found no difference, but when I contacted HMO Blue Access customer service again to know what happened, the response I received on the phone by a different person was the one to made me do this complaint. This is the same response I received again on the mailed letter.

   

  Also, I have opened my HIPAA rights to BBB by making this complaint, as I need this to be solved ASAP. I am holding my mental health provider appointments already for over a month due to that, and my anxiety/stress is getting worse. While trying to solve this directly with my PCP medical group (NorthShore #***) at the end of July, they requested an emergency appeal sent to them by my mental health therapist to consider backtracking the referral, and at the same time allowed me to make an appointment with a psychiatrist in the network who had nothing available until October 6. It seems that the insurance and this group provider want patients to go to the emergency rooms and get the deductible, which is sad because I really like my current PCP. I had to change the previous one because there were no annual preventive appointments until almost a year or so after requesting it.Now, I am facing the same with my current PCP, as my annual physical requested at the beginning of July cannot happen until Oct. 17. I really dont know what else to do at this time, but I consider that it is extremely abusive to put patients dealing with anxiety/stress/depression under this kind of circumstances that definitely impacts more our mental health conditions. As we know, pandemic has taken a major toll to all of us.

   

  I hope this can be resolved soon and my referral can be backtracked to January 2022, while I appreciate HMO Blue Access working better in their policy changes communications.

  
  

  Sincerely,

  
  

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

  Business Response

  Date: 01/27/2023

  Responded to member twice and they rejected our response

• Initial Complaint

  Date:07/20/2022

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  In January of 2022, I had a ********* collection performed, as ordered by my physician ******************************* at Advocate Health care.I have been notified by Exact Sciences that Blue Cross Blue Shield has not responded to their request to pay for this treatment despite my being in good standing on the state of Illinois employees health insurance at the time.

  Business Response

  Date: 07/28/2022

  Please see attached. We will respond directly to the member. 

  Customer Answer

  Date: 07/29/2022

   
  Complaint: 17597411
  
  I am rejecting this response because:  "Sending a letter" is nowhere near enough.  It's clear that no further solution will be forthcoming within your seven day response time.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  Date:07/20/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My husband works for ****** Airlines ******* since 2016, and they contracted with Blue Cross and Blue Shield of Illinois for ***************** My doctors and health care facilities are In Network- that is, there is a contract between them and BC/BS too. It is impossible to reach Blue Cross and Blue Shield of Illinois directly for assistance because the automated system redirects the member to Accolade, a 3rd party liaison between member and BC/BS. Accolade representatives have limited access to things; and most of the time the information they DO provide is INACCURATE. BC/BS has contracts with our health care facilities as well as UAL; yet ****************** Staff has no idea how to properly submit claims. Pre-authorization is required for an MRI, yet that wasn't done in December 2019. I just learned July 2022 that the claim had gone unpaid. Accolade representative **** put me on hold July 18, while calling ********* Regional Health billing department, where **** says BC/BS requested additional info for claim and Proof of Medical Necessity. She says HRH sent it and they refuse to do anything further. I contacted BC/BS, was transferred to ******** **************** and they have nothing in their records for me on that date, no fees, no additional info from HRH. I asked to initiate an Appeal of my own to get this paid, with supporting documentation they need to pay this claim. ******** told me I cannot file an Appeal, because a CASE NUMBER is required. The Case Number would have been given to HRH billing Staff to provide with the requested documentation. HRH must file an Appeal first. My hands are tied. My husband pays premiums via payroll deduction; yet Blue Cross and Blue Shield of Illinois and ********* Regional Health are committing possible Insurance Fraud. BC/BS is not providing the benefits ****** Airline Employees are paying for; and they are not educating/ training In Network Billing Staff how to file the claims.

  Business Response

  Date: 07/21/2022

  Company Response.

  Customer Answer

  Date: 07/21/2022

   
  Complaint: 17593440
  
  I am rejecting this response because:  the letter they have submitted acknowledges my complaint only.  It is not resolving the problem.
  
  Sincerely,
  
  *********************