ComplaintsforCareFirst, Inc.

• Initial Complaint

  01/16/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I am a mental health provider in Pennsylvania. I see a client who has Care First. I have been waiting for payment for 11 months. Both I and the member have made numerous calls to various entities (including **** ***** **** ******) to resolve the issue. Care First representative contend they call and leave messages (which they haven't). I have been redirected to different phone numbers and different addresses to send claims. Care First/BC/BS owes me in excess of 2500.00.

  Business response

  01/31/2024

  Good Morning-

  We will need the patient's name, DOB and CareFirst BCBS ID number in order to proceed.

  Thank you.

  Brian ** ***** ****
  Pronouns: he/him/his
  Senior Analyst | Executive Inquiry | Corporate Office of Civil Rights
  CareFirst BlueCross BlueShield
  1501 S. Clinton Street
  Baltimore, MD 21224

  Customer response

  01/31/2024

  Hello

  Care First is requesting more information.  Since this is a HIPAA sensitive issue, I would need them to contact me directly.  I see the response. I need them to contact me directly, which is part of my complaint.  They do not return calls.  

  If there is a way to provide my contact information that would be most appropriate. 

  Thank you.

   

  Business response

  02/08/2024

  Dear Heather ******:
  
  CareFirst ********* ********** and CareFirst  (CareFirst) cannot respond to this inquiry using a public forum due to privacy regulations. CareFirst will contact the complainant within 24 business hours of this response and work directly with that party to resolve the issue at hand. Thank you.

  I added an attachment, then deleted the attachment as it has the incorrect member's name. I sent the correct attachment for Dolores Mihalich. If you received an incorrect attachment, can you please call me at ***** ********?

   

  Sincerely,
  
  
  Donna ***************
  
  
  Donna ***************
  Senior Analyst, Executive Inquiry
  CareFirst BlueCross BlueShield
  carefirst.com  

   

• Initial Complaint

  01/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  On 11/21/23 ******** ******** sent to care first a letter stating we receive a $17 tax credit. Then on 11/24/23 they sent Care first an updated, corrected letter stating we receive a $628 tax credit. On the last week of 2023 I contacted the exchange to let them know care first was only showing a $17 credit. They said wait until the 1st of new year for info to update. I was also advised to make my premium payment of $621.93 which I did. I waited until 1/2/24 and it showed the policy was canceled. I called the exchange and they said the correct tax credit of $628 was sent and there was nothing more they could do and to contact care first. I called care first and the rep advised she would escalate my case but there was no time frame for this to be corrected. She said to keep checking the site and call back to check status. I called on 1/3/24 to check back and spoke to Kimberly. She would hardly allow me to speak and had me on hold repeatedly to try to get the pharmacy dept to make the policy effective so we can pick up our prescriptions using our insurance. She said it takes at least 72 hours for the case to be reviewed and at least 24 regarding the pharmacy. She assured she would call us back in 24 hours. No call back ever. I called again on 1/8/24 and spoke to Rikki * who said the case was escalated and she would check with the enrollment dept. I was on hold for a bit and she came back and said there was some issue with the application payment information and she would have to call me back. I did not receive a call back. I paid my premium and the government paid my tax credit but Care First refuses to give me coverage for the plan I was approved for through the ******** ********. I am unable to get my prescriptions or even visit a doctor because of this. My husband is a diabetic in need of urgent medical care and medication as well.

  Business response

  01/17/2024

  Hello *******, please see response for *********** ******* ***** attached. If you have any questions, please feel free to reach out to me at *************@carefirst.com. 

  Customer response

  01/18/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  
  BBB is giving me 5 days to say if I’m satisfied with Care First’s response but the email states they will respond after 10 days.  I am rejecting the response because 1) I was never given the opportunity to complete the authorization form required 2) the response time is outside of the BBB timeline given to me to determine if I’m satisfied or not.

   

  
  Sincerely,
  
  ******* *****

  Customer response

  01/22/2024

  I’ve attached the completed authorization form.  Thank you.

  Business response

  01/30/2024

  On January 16, 2024, CareFirst received an inquiry from the Maryland Insurance Administration regarding this case.  As such, we will respond to the regulatory agency and not to the BBB or the complainant.  The complainant will be notified of the outcome by the MIA upon completion of their investigation. Thank you!

  Customer response

  01/30/2024

  
  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.
  
  

  I had to escalate this matter and contact the Maryland Insurance Administration.  This matter is now being handled by the Maryland Insurance Administration and no longer through BBB.  This is the resolution to my BBB complaint. I advise others with similar problems to go directly to the MIA and file a complaint. 
  
  Sincerely,
  
  ******* *****

• Initial Complaint

  01/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 11/14/23 I changed my healthcare plans through ** ****** ******** during open enrollment. It is supposed to take 7-10 business days for this change to become effective. However for both the December health coverage and January multiple phone calls have been made to get the plan to be manually updated or changed to the correct plan. As of today, 6 weeks after changing it online I still have the incorrect plan because CareFirst refuses to change it claiming the health exchange owes them completed forms when the exchange says CareFirst has those forms. There’s also little consistency between answers to questions during calls. I would like them to change my plan to the one I picked out once and for all.

  Business response

  01/18/2024

  
  

  Good morning Ms. Pigott,

  I hope this communication finds you well.

  This is in response to your inquiry under case BBB-2108113, for ******** ********

  The authorization form included in the case has been submitted to the dedicated business area, and additional time will be needed for approval of the form. In the meantime, I will work to formulate a response to your inquiry. Please allow until January 26, 2024, for a response.

  Thank you.

   

   

   

  

   

  Angie *******

  
  

• Initial Complaint

  01/04/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  We need BBB’s help to have CareFirst (1) refund us for premium payments that we made for Nov and Dec 2023 and (2) terminate our CareFirst coverage for 2024. (1) My wife and I terminated our joint CareFirst account on 10/30/23 by contacting both the Marketplace (HealthCare.gov) and CareFirst. Since I had moved to Medicare, Marketplace created a separate account just for my wife, and we were advised by CareFirst to pay the November premium for the joint coverage as it would take a few days to process the changes. However, the changes were not made, and we received bills for both the joint account and the new individual account for my wife. We contacted CareFirst on 11/20/23 and were advised to pay the December premium for the joint coverage while they resolve the errors. A couple of weeks later, we found out that CareFirst had terminated my wife's individual account due to non-payment. Then on 12/08/23, CareFirst posted a message, indicating that our joint account is now termed effective 10/30/23. In sum, while we made a payment of $1182.94/month for November and December, we did not receive coverage from CareFirst, but we have yet to receive a refund. (2) Starting in 2024, Virginia residents are required to use Virginia's Insurance Marketplace instead of the Marketplace (HealthCare.gov). We found out that we had been automatically re-enrolled with CareFirst for 2024, so we canceled this and my wife enrolled with a different insurer on 12/07/23 during the open enrollment period. However, CareFirst continues to bill us for the January 2024 premium and shows that my wife and I have a new joint coverage for 1/1/24-12/31/24. The Virginia Insurance Marketplace representative confirmed that we are not enrolled with CareFirst for 2024, and that CareFirst has been notified. However, CareFirst continues to assert that they did not receive a notification from the marketplace and therefore cannot terminate our 2024 coverage. We have attached a detailed summary of these issues.

  Customer response

  01/04/2024

  Hello,

  As requested, please find attached our completed authorization form for information release. Please let us know if any further information is needed. Thank you,

  ***** ****

  Business response

  01/13/2024

  Good afternoon Heather ******,

  Please be advised that the member's 2024 coverage was voided on December 15, 2023. Also, a refund for the requested payments was processed electronically on January 3, 2024, to the account that was originally charged. The member may contact their financial institution to confirm that the payment was received.

  Regards.

  Danielle *******
  

  Business response

  01/16/2024

  More Information...Good morning Heather ******,
  
  Please be advised that the original complaint was received on January 5, 2024, with a due date for January 15, 2024.
  
  The authorization form that was included with the complaint was forwarded to our Privacy Office for review. Once approval was received advising the form was valid and that it was ok to reply to the BBB directly, the following response was uploaded into the portal on January 13, 2024, which was within the timeframe that was allotted. 
  
  "Please be advised that the member's 2024 coverage was voided on December 15, 2023. Also, a refund for the requested payments was processed electronically on January 3, 2024, to the account that was originally charged. The member may contact their financial institution to confirm that the payment was received."
  
  Let me know if you have questions or concerns.
  
  Regards.
  
  Danielle *******

  Customer response

  01/20/2024

  
  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

  01/03/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have been trying to pay my CareFirst bill that is due on January 1, however my invoice reads the incorrect amount and CareFirst is aware of this, but they have not updated my invoice so I can pay it. My member ID is XIB *********. My invoice currently reads $390.96, but it does not include my tax credits from the Maryland Health Connection, which would make my bill $59.64. I contacted CareFirst by email on their site and I was told they received this information from the Maryland Health Connection on November 30, so they are aware of the correct price, and it would be updated by December 24 by the end of the day. It is now December 27 at the end of the day, and it still has not been updated and I cannot even get through by phone as I received a message that their system is down. I need to pay my bill asap as January 1 is fast approaching. Via email, it was suggested that I pay the full 390 dollar bill as it is and I will receive credits for future months, but that is not possible right now. I need CareFirst to update my bill to the correct amount asap.

  Business response

  01/05/2024

  From: Donna ***************
  To: BBB of Greater Maryland
  Subject: Respond to Complaint
  Date: 1/5/24
  
  RE: BBB File Number: 21063024
  Consumer: **** ******
  
  Dear: Ms. Pigott,
  
  This letter is to acknowledge the receipt of your correspondence.
  
  CareFirst does not have a valid authorization on file from the complainant to provide a response to the Better Business Bureau. We will reply directly to the complainant.
  
  Please be assured that we are working as quickly as possible to provide an equitable resolution.

• Initial Complaint

  12/20/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  .On 12/14/23 I paid $373.90 to initiate a policy with CareFirst. The representative sent me a link after inquiring about if I could go through the company directly to start a policy. The representative stated that I could. I had been having a very difficult time with Maryland Health Connection. After I completed my application and the company took my $373.90 a message populated stating that my application was under review. This was very concerning because my money should have not been taken if the insurance was not going to be guaranteed. This increased my frustrations because the representative told me that if I was not receiving a subsidy from Maryland Health Connections than the prices would be the same and I can just go through the company directly online and start a policy instantly. Since then, I have been severely mistreated from customer service representatives who have hung up on me, gave me the runaround, lacked competency, did not listen to my peculiar circumstance, and gave me robotic responses, and now I have been told to make a fraud claim. My account that I used to pay for this is **** *** and they can't do anything to refund my money because the transaction is showing up as pending. We are now on 12/20/23 and after numerous calls I still have no update on my insurance and my money is tied up. I have sent the initial sales rep several emails in which she has not responded except only to the first one. On 12/14/23 she sent me an automated message that my application was received due to me saying I never got a confirmation email or anything after my application was complete. I would like my money back. I have never experienced such rudeness and overt disrespect. $373.90 of my hard-earned money is missing and I still have no insurance.

  Customer response

  12/20/2023

  Sales rep- Leslie *******
  Date problem occurred: 12/14/23
  Date I (Marrakesh Spann) paid for policy:12/14/23
  Plan- Blue Choice HMO Value Gold $1,000
  Payment: $373.90

  Nature of Complain: refund for nonactive policy/ no policy update after payment.

  Business response

  12/27/2023

  Hello Heather, please see my response attached. Feel free to reach out to me directly should you have any questions.

• Initial Complaint

  12/19/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to the urgent care on 2/8/2023 and received care. Prior to going to the urgent care I checked CareFirst BCBC provider directory (screenshot attached showing they are in-network), and called to double check and confirm what my charges would be. I was told there would be a $40 copayment, which I was good with. However on 8/1/2023, CareFirst took 6 months to complete a claim and I was sent a bill of $277.23. See the screenshot attached directly from CareFirst directory showing this is an IN-NETWORK facility, my network is ********** ********* PPO. Since August, Careerist and the urgent care center MDNow have been blaming each other and putting me in circles. It is NOT MY RESPONSIBILITY to ensure a claim was filed correctly in their own back-end systems. And I should not have any further bills from the $40 already paid (screenshot attached of the bill).

  Business response

  01/02/2024

  January 2, 2024
  
  Heather ******
  Dispute Resolution Specialist
  Better Business Bureau
  502 S Sharp Street
  Baltimore, MD 21201-2445
  
  RE: Reshika Mahase
  BBB Complaint ID: 21029371     
  
  Dear Heather ******:
  
  This letter is to acknowledge the receipt of your correspondence.  Thank you for allowing us the opportunity to further review the concerns presented in the complaint.
  
  Your letter has been forwarded to a CareFirst staff member to investigate and we will be in contact with the complainant directly.  Please be assured that we are working as quickly as possible to provide an equitable resolution.
  
  Sincerely,
  
  ******* ******
  
  ******* ******
  Senior Analyst, Executive Inquiry
  *******.******@carefirst.com
  Phone: ###-###-####
  Fax:  ###-###-####

  Customer response

  01/08/2024

  To note, I have received a voicemail from CareFirst stating the claim has been adjusted but not confirm the amount.

  They stated in the voicemail that I will receive a notice/explanation of the benefits in the mail soon. 

  Until I receive the mail, I am not able to confirm If i am satisfied with the results from CareFirst. Thank you. 

• Initial Complaint

  12/18/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Upon starting private insurance with Carefirst in MD, I was charged for three months' of premiums totaling just under $2100 in October of this year. I was charged twice to start the account, then a third time for the following month's premium. At this point, in the beginning of November, I contacted the business because I was charged in error. The business replied that I needed to supply proof of the over charge. I replied with a copy/paste from my account because a statement would not be produced for 30 days. When the statement was produced by my bank, I promptly sent it in. It was noted by Carefirst that I was overcharged. I asked for a refund as I was cancelling my policy due to starting a new job. Submitted cancellation paperwork a couple of days later (now the beginning of December). The response from Carefirst was that my cancellation takes effect at the end of December and therefore the overcharge would be applied to my account. The only reason the proof of overcharge came in December was because the form of proof required by Carefirst took that long to materialize from another company (my bank). So now I've been trying to get my money back but Carefirst's internal policies put me in a no-win situation and now I'm out the last month's premium due to no fault of my own. This is completely unacceptable from customer service standpoint, but also just a human standpoint. The only reason I couldn't get them the proof that they required is because the bank takes time to create monthly statements - Carefirst should have a way to verify an overcharge internally (I'm sure they do, its a big complex multi-billion dollar company), but instead, I'm the one holding the bag. Its just bad business.

  Business response

  12/19/2023

  Good afternoon,
  Within the complaint submitted by your company, it indicated that an authorization to release information form was submitted on 12/18/23. After carefully reviewing all the documentation submitted, we were not able to locate the required authorization form. Can you please submit the appropriate authorization form so that we may move forward with addressing the member’s concern? 

  Please also verify if January4, 2024. Is an appropriate due date as I see that you will be closed until 1/2/24. 

  Thank you. 
  

   

• Initial Complaint

  11/17/2023

  Complaint Type:

  Delivery Issues

  Status:

  Resolved

  More info

  In October 2023 I signed up for COBRA health insurance through my former employer's COBRA administrator (Paylocity) and paid the premium (see proof attached). Coverage was to switch to COBRA on November 1st without interruption in coverage. It didn't. For the past 16 days, Carefirst has been denying claims because they haven't updated their system to show that my COBRA policy started on November 1st. Paylocity has contacted Carefirst to confirm that my coverage should have started. My attorney has contacted Carefirst twice. All I've received from Carefirst is repeated emails saying "we're looking into the matter." This has been going on for two weeks. In the meantime, I have had to pay more than $1,000 out-of-pocket for Rx refills as a consequence of Carefirst's failure to correct their error.

  Customer response

  11/21/2023

  The matter has been resolved and you can close the case.

  Bureau response

  11/21/2023

  Kim *******
  CareFirst, Inc. 
  ***** **** *** *** ****** ****** ** *****
  
  
  Dear Kim *******:
  
  This message is in regard to a complaint submitted to BBB about your business on 11/16/2023 by Matthew ******. This complaint was assigned ID *********
  
  BBB would like to thank you for your cooperation and response to the above-referenced consumer's complaint. After forwarding the consumer your response, the consumer notified our office the matter is resolved. Therefore we have closed this case accordingly.
  
  If you have any questions, however, we are happy to assist you. Thank you for your cooperation in this matter and for your support of our self-regulatory goal.
   
  Each year, millions of consumers contact BBB for pre-purchase information, and your response to this dispute will assist your future customers with making valuable purchasing decisions.
  
  Sincerely,
  
  Heather ******
  Dispute Resolution Specialist
  *************************
  Phone: ###-###-####
  
  MESSAGE:
  
  The matter has been resolved and you can close the case.

• Initial Complaint

  11/01/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I’ve been seeing Blue Cross Blue Shield Mental Health patients since July 12th of 2023. I went through all of the required channels to get credentialed as a BCBS in network provider and have been formally accepted in-network as a behavioral health therapist. I’ve advertised on Psychology Today and gotten quite a few Carefirst clients. At this point, I’ve submitted hundreds of billable hours for my services performed. However, every single claim has been rejected, and I’ve gotten absolutely no reimbursement whatsoever, along with zero support or follow-up. Availity, which is the billing clearinghouse which works with them, has advised me that they can’t pay claims because BCBS claims it doesn’t recognize my NPI billing number. BCBS is completely unavailable for any kind of support in resolving this no-payment problem. Both myself and my billing person Lauren have called hundreds of times, spending many, many hours on hold, getting switched from one department to another, frequently getting disconnected, writing emails, etc. Ultimately, we never get any response, let alone actual resolution. I realize that BCBS is a huge corporation, but I’m a solo practitioner who provides BCBS services which continue to go un-reimbursed. I’m trying to be patient, but at this point, my business is seriously at risk of collapse, not to mention the personal hardship this has caused. I have saved BCBS tens of thousands of dollars, not to mention saving lives by staying on telehealth visits with members in crisis, accepting phone calls at all hours. My services as a mental health therapist often prevent costly hospitalizations. With all of their billions of earnings, BCBS surely can afford to have a competent employee provide the support necessary to get me paid.

  Business response

  11/07/2023

  Dear Heather *******
  This letter is to acknowledge the receipt of your correspondence.  Thank you for allowing us the opportunity to further review your concerns.
  
  Your letter has been forwarded to a CareFirst staff member to investigate and we will be in contact with the complainant directly.  Please be assured that we are working as quickly as possible to provide an equitable resolution. 

  Bureau response

  11/08/2023

  Melissa *********
  *** * ***** ** ************ **********
  
  
  Dear Melissa *********:
  
  This message is in regard to your complaint submitted on 10/31/2023 against CareFirst, Inc..  Your complaint was assigned ID ********* 

   

  BBB has received a formal response from CareFirst, Inc.. We ask that you review the response and understand that BBB is here to assist both parties in reaching a fair and reasonable resolution.

  Please review their response to your complaint and advise us of your position in the matter within 5 calendar days. If we do not hear back from you, BBB will assume you are satisfied and will close your complaint as answered.

  Please be sure to indicate whether the business' response is satisfactory or not and how you would like to proceed in this matter.

  If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.
  To access/respond to this complaint online:
  Go to: ****************
  Enter the following code: **************

  Sincerely,

  Heather ****** 
  Dispute Resolution Specialist
  *************************
  Phone: ###-###-####

  
  MESSAGE FROM BUSINESS:
  
  Dear Heather *******
  
  This letter is to acknowledge the receipt of your correspondence.  Thank you for allowing us the opportunity to further review your concerns.
  
  Your letter has been forwarded to a CareFirst staff member to investigate and we will be in contact with the complainant directly.  Please be assured that we are working as quickly as possible to provide an equitable resolution. 

  Bureau response

  11/13/2023

  Kim *******
  CareFirst, Inc. ***** **** *** *** ****** ***** ** *****
  
  
  Re: ID * ******** - Melissa *********
  
  Dear Kim *******:
  
  Thank you for your recent response to Melissa *********. We have not yet heard from the consumer and are closing this case as answered.
  
  Following our usual procedure, BBB notified the consumer of your response and requested notification of whether or not a satisfactory resolution had been reached.  Unfortunately, the consumer has not notified our office if they are satisfied. BBB has determined that your company has addressed the issues within the complaint; therefore we have closed this case in our files. This matter will appear in your BBB Business Profile as: "Answered - The Business addressed the issues within the complaint, but the consumer did not accept the response, OR BBB has not heard back from the consumer as to their satisfaction."
  
  The text of your response may be publicly posted on BBB's website. BBB reserves the right to not post in accordance with BBB policy, and we may edit your response to protect privacy rights and to remove inappropriate language. 

   

  In the event the consumer contacts BBB again regarding this issue, we may reach out to you to review any new or additional information we've received from the consumer. 
  
  Sincerely,
  
  Heather ******
  Dispute Resolution Specialist
  *************************
  Phone: ###-###-####

  Bureau response

  11/13/2023

  Melissa *********
  *** * ***** ** ********* ** **********   
  
  Re: ID * ********* CareFirst, Inc.
  
  Dear Melissa *********,
  
  We have not received your response to confirm this complaint has been resolved. Therefore, this complaint has been closed and will appear in the company's BBB Business Profile as: “Answered- BBB has not heard back from the consumer as to their satisfaction with the business's response.” 
  
  Please know that BBB is always available to discuss your case and review additional information. Thank you for using BBB's Marketplace Services.
  
  Sincerely,
  
  Heather ******
  Dispute Resolution Specialist
  *************************
  Phone: ###-###-####
  

  Customer response

  11/14/2023

  Unfortunately, the complaint is still unresolved.

*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. ↩