ComplaintsforCareFirst, Inc.

• Initial Complaint

  03/20/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I signed up with CareFirst BlueChoice as an employer based offer health insurance in August, t that time I selected Medical & Dental coverage, I pay 400.00 biweekly with a monthly contribution from my employer bringing the total cost of my medical insurance & Dental insurance to 1,000 a month. In August shortly after signing up with Carefirst, I received my medical card & dental card in the mail., The dental Card is marked CareFirst: BlueDental Preferred, the member ID on it is *********, the group is ***** I recently made a dental appointment with ******* ****** and gave them my dental insurance information. The medical assistant called me backed shortly after and informed me that I didnt have dental insurance with Carefirst, only medical and prescription. I dont take medication and have never had a prescription plan, as I dont need it but do need medical and dental. I have for months thought I was covered for dental insurance> even called called Carefirst and spoke to a rep. who confirmed that I didnt have dental insurance but could not answer why ws I sent a dental insurance card. I feel as if i have been duped, instead of dental insurance, which I had to pay 400.00 out of my pocket today, to see a dentist, they put in place a prescription plan that I will never use. In my opinion this is a very deceptive practice and needs to be investigated. I was ok paying 1000.00 a month when I thought I was covered for health & dental but paying 1000.00 month for medical and a prescription plan, no way. Why would Carefirst send me a dental card if I am not covered for dental insurance? this seems very wrong and deceptive.

  Business response

  03/21/2024

  Good morning ******* ******,

  Please see the attached document.

  Regards,

  Danielle *******

  Customer response

  03/27/2024

  Good Morning,

  I submitted to Carefirst the Dental Card I received and since then have not had any communication with the company, I m not aware how this dispute was reported as settled, as I don't see any off from CareFirst.

   

  Business response

  04/13/2024

  Hi *******,

   

  CareFirst resolved the concern and contacted the member to advise on April 4, 2024.

   

  Regards,

  Danielle

• Initial Complaint

  03/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Brand new policy with **** through ** ****** ******** became active on 01/01/2024. I am seeking reimbursement for the money spent on mediction because I didn't have access to my prescription benefits. ******** denied my submitted claims. One was denied incorrectly, the other denied payment but only wanted to reimburse me for the allowable. **** should reimburse me the difference between what I had to pay and they medication allowance since it's their fault that I didn't have access to my full benefits. I have spent countless hours wasted trying to reach a competent human who can actually provide me the assistance I need. I got very sick on 01/08 and needed an antibiotic prescription filled. The short of this horrid experience is I was denied access to my prescription benefits because "I didn't exist". I couldn't pay retail price to fill it. The reality is **** did an entire system update which screwed a lot of people. Desperate & exhausted with worthless phone calls in 36 hrs to ******** my PCP gave me a medication discount card so I could get the antibiotic I needed. Thanks to their mistake my infection spread to my eyes. Could speak, couldn't hear & now couldn't see. On 01/09 late pm I had a prescription filled at another pharmacy for a steroid. On 01/11 my PCP gave me a discount code for an additional medication to expedite the clearing of infection. ******** is denying this medication too. I lost the medicine, it fell out of my car. On 01/12 my PCP office called in another prescription This claim is denied due to frequency, but asked for an appeal under the circumstance. ******** says they denied the second ** because *** submitted a claim. However, after the initially debacle I never filled, paid or picked up ANY medicine frm ***. ONLY *******. I submitted all required documents w/ my claims & still rejected. This is stressful & disgusting that there is no apology, correction or reimbursement of what I had to pay unnecessarily.

  Business response

  03/22/2024

  Please be advised that communication has been sent to the member directly.

  Regards,

  Brian ** ***** ****
  Pronouns: he/him/his
  ****** *******
  Executive Inquiry | Corporate Office of Civil Rights
  CareFirst BlueCross BlueShield
  **** ** ******* ******
  Baltimore, MD 21224

  Customer response

  03/29/2024

  Hello *******,
  I am writing back in response to a message I just received that the case against **** is closed.
  
  I apologize as I did not see any previous communication from you.
  
  I have not received the full requested refund from **** so I would say that I am not fully satisfied. I received a communication from ******** that I would be receiving 2 refund checks. That was 2 weeks ago. I received only the lesser of 2 reimbursements last week.
  
  Frankly I pay my premium on time each month and they can’t efficiently refund me what I’m due. I am still waiting for the final reimbursement. I dread contacting their customer service which is unhelpful in any resolution and I spend hours on the phone.
  
  Sincerely
  ****** *****

  Business response

  04/13/2024

  Please refer to the attached document.   Thank you. 

• Initial Complaint

  02/20/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  The CareFirst BlueCross and Marketplace representative falsely told me that I was not eligible for ******** Medicaid and he registered me for the CareFirst BlueCross ObamaCare plan. Unbeknownst to me, I actually did have ******** Medicaid coverage since July 2022 (see 1095B and address of insurance), which I later transferred to Maryland Medicaid in Jan 2023. I had used ******** Medicaid as the primary insurance provider during the two months (Nov and Dec 2022, see 1095A). As a result, I was double billed for visits that should've been billed to and covered by Medicaid but were charged from a Marketplace plan I did not want to nor need to sign up due to my income and other factors at the time. Because of this mishap by CareFirst and Marketplace, not only was I billed $852.06 for an insurance I shouldn't have been, since I was covered that whole time by ******** Medicaid, I also lost the premium tax credit too, also because the CareFirst representative misunderstood my situation at the time, and did not discontinue the CareFirst plan in Nov before the billing were incurred

  Business response

  02/26/2024

  Please refer to the attached response. Thank you. 

• Initial Complaint

  02/14/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  As a provider that services hundreds clients with CareFirst, there is a certain amount of support from Blue Cross Blue Shield needed in order for our operations to run smoothly. In order to provide our therapy services, we are required to obtain an authorization for services from CareFirst. CareFirst claims that we must always use the online portal to retrieve client data and authorization information. However, aside from the fact that the portal glitches almost daily, we will often be told through the portal that authorizations are not required when we know for a fact that they are. As a second resort, we fax necessary documents to the authorization department to request authorizations that way, but oftentimes the fax is returned with a message stating that authorizations cannot be obtained through fax and that portal must be used. When trying to use the portal, the portal will either glitch again or will tell us no authorization is required again. Times that we had discontinued attempts to obtain authorization because the portal said one is not required, claims have been returned as denied because authorization was not obtained. When we call provider services, we are almost always left on hold waiting for a representative for hours. We have left countless messages on authorization help lines, on the provider support line, and on individual contact lines. There is nobody to speak with. Any time we are finally connected with a representative at provider support, we are told we have to call another line to speak with someone else to help us. We simply want to be connected with a contact at CareFirst who can serve as an established representative for our agency and be contacted directly to assist us with authorization issues when they occur. These issues do not arise frequently - the hours upon hours spent waiting to connect with someone is absolutely wasted when all we need if a few minutes of attention. Thank you

  Business response

  02/20/2024

  Good afternoon,

  CareFirst BlueCross BlueShield and CareFirst BlueChoice (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. 

  Latasha *. *******
  Manager|Executive Inquiry & Corporate Office of Civil Rights
  
  
  
  

• Initial Complaint

  02/05/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I purchased a denatl policy for December 1, 2022 to December 31,2022. Policy number ********* Group ****. The application ID is ***********. This policy was for Myself ******* ****** DOB ****/1975 and my husband ******* ****** DOB ****/1973. For some reason who ever input the information they had my husband as the subscriber and the wife with both DOB with ********* name so it looked like I was not covered when in fact I was. I have spoken to sevral people over the last year trying to get this fixed. I can not goto my dentist because they are stating I have an outstanding bill of $1000 something. This was supposed to be paid by Carefirst but because they have my husband with my DOB the clamis were denied stating I did not have coverage. I spoke to supervisor Vanessa on 1/29/2024 and she saw the issue and told me it would be resolved by Wednesday 1/31/2024. She said she was waiting to hear back from the department that handles the changes and she would call me back. Well she did not. So I called every day the week of 1/29/2024 tryimg to get this straight. I spoke to Stan A on Thursday 2/1/2024 and he stated he would handle it and call mr Friday 2/2/2024. Needless to say he did not call me. So meanwhile I am having a tooth issue and can not been seen due to this bill not being paid. This was supposed to be resolved a year ago. This need to get fixed ASAP and have the payment for the 3 claim for 12/12/2022 and 12/30/2022 paid now so I can go to the dentist. This should not take this long to fixed and hours and hours on the phine trying to get resolved.

  Business response

  02/10/2024

  Please refer to the attached response. Thank you!

• Initial Complaint

  02/01/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On December 30, 2023 we spoke with Julie ***** from Carefirst to find a new health insurance plan because Carefirst was increasing our rate over $700 per month. She helped find a plan and advised that we could start the new plan January 1, 2024. After checking with her manager she advised not to cancel the old plan until the new one was accepted since it was so close to the new year. The call was recorded and can be checked for verification. Carefirst has always billed us monthly (see screen shot) but billed us for January and February at the new rate $4574 (see screen shot) on original plan Jan 6. They also billed us for $1668.65 on January 6 for new plan (see screen shot) We are requesting a refund for Jan and Feb 2024 for the old plan. We have spent hours on the phone with Carefirst trying to resolve the issue.

  Business response

  02/05/2024

  Please see the attached letter. Thank you. 

• Initial Complaint

  01/26/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Over the course of multiple months, I have had repeated issues being able to access my CareFirst account. From the start of service, I was unable to access my account for several weeks. I had to repeatedly call in to Technical Support and open multiple tickets. They would try calling me once then close the ticket, they would just decide to close the ticket for no reason, or they would try something and not communicate with me that they were no longer trying to resolve the issue. I had to waste hours of my time calling, cajoling, and arguing with people. I've been hung up on many times. I've been transferred to the wrong department multiples. CareFirst has been unprofessional, rude, and ineffective in resolving this issue. I have attempted to file a complaint with them but no one will take the complaint. I am paying for access to my account information, and I am tired of them not doing their job repeatedly.

  Customer response

  01/26/2024

  Attaching completed form to provide any customer service notes related to two months of website access issues.

  Business response

  01/27/2024

  Hello.  CareFirst BlueCross BlueShield is not able to respond to this complaint as we do not have an authorization on file to release protected health information to the BBB.  CareFirst will respond directly to the complainant under separate cover. Thank you. 

  Business response

  01/27/2024

  To clarify the authorization submitted is not valid to release information to the BBB in Maryland.  Thank you. 

  Customer response

  01/30/2024

   
  Complaint: ********
  
  I am rejecting this response because it provides no resolution. I don't understand why they would provide no option to address this either by email (I have received email from CareFirst in response to this complaint) or this platform.  If CareFirst needs proper forms for release of information, please define or ask for the BBB to facilitate the resolution.

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

  Business response

  01/31/2024

  CareFirst is unable to provide any form of protected health information in a public forum due to HIPAA regulations.  CareFirst spoke with the complainant via telephone on 01/30/2024.  We will continue to work directly with the complainant until resolved.  No additional information will be provided to the BBB regarding this complaint.  Thank you.  

  Customer response

  01/31/2024

   
  Complaint: 21192298
  
  I am rejecting this response because it has not resolved my issue. I have not been able to access my account for 10 days.  This is after I wasn't able to access my account for three weeks in December.
  
  Sincerely,
  
  Michael Slattery

• Initial Complaint

  01/22/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  My name is ***** ** with member ID: *********. I earned $250 blue rewards form the CareFirst wellbeing program with $150 on November 2nd, 2023, $30 on December 12, 2023, and the rest $70 on January 19th, 2024. But CareFirst did not deposit the fund into the reward card. I called the customer service many times but it is obviously no one can help me out. The card managing program asked me to call Carefirst member service with the reference number ************. I did it but still no luck to get the money back.

  Business response

  02/22/2024

  Dear Heather ******-

  The member was responded to directly via email on 2/06/2024.

  Sincerely,

  Brian ** ***** PAHM
  Pronouns: he/him/his
  Senior Analyst | Executive Inquiry | Corporate Office of Civil Rights
  CareFirst BlueCross BlueShield
  1501 S. Clinton Street
  Baltimore, MD 21224
  carefirst.com
  Working Remotely: M-F, 8am-4pm
  We work flexibly at CareFirst. I am sending this email
  now because it works for me, but I don't expect that
  you will read, respond to, or act on it outside of your
  regular business hours.
  

• Initial Complaint

  01/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I applied for an Individual Health Insurance policy from CareFirst BCBS in Maryland in November 2023. I finally received a letter from CareFirst in December confirming receipt of my application and notifying that I would be issued a policy soon. On December 7, I paid CareFirst the full policy premium of $793.51 online via ACH bank transfer. I also enrolled in automatic payments using my bank account. Two weeks later, my CareFirst account online says my policy is null because they haven't received my binder payment. The online account still shows that I have a credit of $882.88 (which includes a separate payment for my dental policy) on my account and the money was withdrawn by CareFirst from my bank account correctly on 12/7. I have spent over 12 hours on the phone with CareFirst Member Services, across multiple days in December and January, attempting to rectify the issue. I have a CareFirst member ID and temporary ID cards, but CareFirst is not able to verify my insurance coverage. To be clear, they have withdrawn the premium payments from my bank account. Each time I speak to a CareFirst representative, they have to involve their supervisor, then tell me to call back again in 4-5 business days. The last time I called on January 9th, the representative confirmed that this issue was "marked as high priority on my account", but no progress had been made by the billing department. I took my children to the doctor on January 2nd to have their virus symptoms evaluated and CareFirst would not verify my coverage, despite my having a Member and Group ID, and, AGAIN, proof that I had paid CareFirst my health insurance premium. I need to take my two children, both under the age of 7, to the doctor and the dentist. This is absolutely unacceptable and I am at a complete loss as to how to resolve the issue because it appears there is no other way to contact someone at CareFirst that can help.

  Customer response

  01/22/2024

  Thank you *******,

  I have completed the Authorization form for CareFirst and attached it to this message. I look forward to your response. Thanks again.
  

  *** *******
  

  Business response

  01/30/2024

  *******, please see my response attached. A valid authorization must be on file with the Privacy office. 

  Business response

  01/31/2024

  Hello *******, I submitted the authorization form to the Privacy Office for review on January 30, 2023. Please allow additional time for the process and in the meantime, I will continue to work towards a resolution for the member.  Please allow until February 6, 2024, for a resolution. If the Privacy office does not approve the authorization, we will respond directly to the member. Thank you. 

  Business response

  02/02/2024

  Please refer to the attached response. Thank you.  

  Customer response

  02/07/2024

  
  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

  01/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Signed up for medical insurance during open enrollment 12/20/2023. Payment was processed through my bank account. Did receive my ID card in mail. Used at local pharmacy and was active. However, to date, when checking my CareFirst on-line account the medical card and payment is not listed on the website. Since 1/2/2024 have talked to numerous customer representatives. Have been constantly re-directed, promised call-backs, and assurances that they will send my concerns to the correct party for resolution. Have been given three ticket numbers ************, ************, and most recently on 1/17/2024 by customer rep Sherry INC5382946. Need to have this situation resolved ASAP so that I can access my account information on-line. Lastly, have not yet received my member information packet in the mail.

  Customer response

  01/22/2024

  HIPPA release

  Customer response

  01/29/2024

  1/29/2024:

  Wanted to update status of complaint ID ********. 

  On 1/22/2024 received an e-mail from CD social Media inquiries from CareFirst:

  Dear ***** ** *******

  Thank you for your inquiry concerning help desk ticket number **********. We apologize for any inconvenience this matter may have caused. Our technical team is diligently working on your concern. Please allow 3-5 business days for a resolution. 

  There was no person or phone number listed to respond to in the message. 

  On 1/31/2024, noticed that the payment information was posted to my on-line account, but not the actual copy of the membership card.

  This information disappeared later that day with a message on the server that they were having technical difficulties updating account information. That message disappeared later that evening.

  Checked account this morning and issue still not fixed.

  Thank you for your assistance with my concern,

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

   

  Business response

  01/31/2024

  Tell us why here...

   

  Please refer to the attached response. Thank you. 

  Customer response

  02/04/2024

  
  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,
  
  ***** ******

  As of 2/4/2024, my CareFirst on-line portal does show that the requested corrections have been enacted. I do want the original post to remain as I did need to spend a month trying to correct this issue with numerous CareFirst customer representatives. The issue was resolved only  after I escalated my concerns to filing a claim 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. ↩