Complaints

This profile includes complaints for CareFirst, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  CareFirst, Inc.

  PO Box 8894 Baltimore, MD 21224-0894

• 

  CareFirst, Inc.

  10455 Mill Run Cir Owings Mills, MD 21117-4208

• 

  CareFirst, Inc.

  PO Box 14114 Lexington, KY 40512-4114

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:04/29/2025

  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.

  On 12/21/23 I had a medical emergency while in ******. Hospital fees were nearly $5000 all of which had to be paid at the time of the services. We phoned Carefirst letting them know we paid ******. Carefirst apparently also paid someone (although not me) for the services. Despite being told multiple times a check would be coming (for only a partial amount owing) as of 4/26/25 Carefirst has not reimbursed for any hospital expenses. In fact today they said we actually owed an $85 co-pay and once I said they were acting in bad faith and unfairly processing the claim I was hung up on. They made a mistake and likely paid Mexico (they keep talking about trying to void the check), a mistake that should not be to our detriment. They have delayed payment for a year and a half of a valid claim, they are not paying the full claim amount, and have failed to fairly investigate (never once have they reached out to me). While they have one claim of $2169 there was also another claim they indicate they dont have. Thank you for any assistance you can provide.

  Business Response

  Date: 05/07/2025

  As stated in my response on May 2, 2025, CareFirst BlueCross BlueShield and CareFirst BlueChoice (CareFirst) cannot respond to this inquiry using a public forum due to privacy regulations. CareFirst will work directly with that party to resolve the issue at hand. Thank you. 

  Business Response

  Date: 05/08/2025

  Please review the attached response. Thank you. 

• Initial Complaint

  Date:04/25/2025

  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 have been following CareFirst approval process for EverSense 365CGM device for nearly a year.This requires medical surgical insertion. Currently ****** is covered by my *********************** Your policy limits the use of any CGM that helps with substantial prevention of health issues and Dexcom CGM is failed expirement that is almost inaccurate. How do I get this policy revised for approval for my medical health and well being.

  Business Response

  Date: 04/28/2025

  Please refer to the attached response. Thank you.

• Initial Complaint

  Date:04/09/2025

  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.

  I had an employer policy through July 31 2024 and started an individual policy Aug 1 2024. Unknown to me, my previous employer didnt cancel my policy so I had two active policies when I had surgery in August 2024. There were five claims on Aug 9 2024 and two went to one policy and three went to the other. So Im being charged for two separate deductibles on two separate policies, one of which should not have been active. I have called CareFirst over and over again. Every time I call I get a different answer. Initially agents told me they would re-submit the claim and to wait 30 days. After ***************************************************************** it couldnt be done. After months of this, an agent told me it wasnt the fault of CareFirst and I had to go through the hospital. Then CareFirst said it was my former employers fault and CareFirst cant help until the employer policy was cancelled. Every time I ask for a supervisor they tell me everyone is busy and no one ever returns my calls. Both policies are through CareFirst with the same ID number, just different group numbers. Seems like a simple fix to me but no one will help me. The issue is Im being charged an extra 1800 for a deductible on a policy that should have cancelled July 2024.

  Business Response

  Date: 04/11/2025

  Hi *******,

  I have attached a response to this case.

  Regards,

  ********

  Customer Answer

  Date: 04/19/2025

  Hi, this message says carefirst responded and closed the case. They did reach out with an email saying they are investigating but that was it. No follow up at all yet. 

  Business Response

  Date: 04/23/2025

  Hi *******,

   

  Please see the attached document.

   

  Thank you

• Initial Complaint

  Date:04/03/2025

  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 am writing to formally express my dissatisfaction with the recent handling of my prescription medication coverage. I underwent a prior authorization process for my medication, only to find that it is not covered under my plan due to my deductible not being met. This situation has left me feeling frustrated and ************** a policyholder, I expect my insurance to assist me in managing my healthcare costs, especially when it comes to necessary medications. The out-of-pocket expense for my prescription is excessively high, and it is disheartening to know that I am paying premiums without receiving the coverage I need.I urge you to review my case and consider the impact this lack of coverage has on my health and well-being. I would appreciate a prompt response regarding any potential solutions or alternatives that may be available to me.

  Customer Answer

  Date: 04/03/2025

  Here is my form

  Business Response

  Date: 04/08/2025

  Please see attached letter of response for #********.

  Customer Answer

  Date: 04/09/2025

  The company said they would reach out within 7 business days which is not within the 5 day window you gave me to respond. ***** **** also retracted the message and this is all I have from them. (****, **** would like to recall the message, "SECURE COMM: BBB ********".) Once they send me a message to resolve it I will let you know.

  Customer Answer

  Date: 04/14/2025

  This has not been resolved. The only thing they did was send me cheaper options which I have already went through to get Prior Authorization. They have done NOTHING to help cover or get coverage for this Rx. I have jumped through every hoop possible trying other meds to satisfy them. 

   

• Initial Complaint

  Date:03/26/2025

  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.

  Routinely, CareFirst denies claims in error citing false NCCI edit information, refuses to ***rocess claims upon appeal even after requesting loads of medical records which are provided, then silence from their office. It's impossible to reach someone via the phone as they have limited office hours and the wait time is over 1 hour. Even then, when the calls goes through it's disconnected and there's no attempt to call us back even though the # number registers in their database. We have no *** to handle issues and our office spends countless hours trying to get claims paid.

  Business Response

  Date: 03/28/2025

  Please review the attached response. 

  Business Response

  Date: 03/28/2025

  2nd attempt to attach file. Please contact me directly at **************************************** or ************ if not attached.

  Customer Answer

  Date: 04/11/2025

  We have many more issues with claims not being processed correctly by CareFirst.  I reached out to *******, who previously promised to work with me on a resolution and she now refuses to speak with me regarding these claims - see her email attached.  I am legally contracted by Dr. **** to handle all billing issues and have been for 20+ years. At no point in time has any insurance company refused to speak with us, this is baffling. To my knowledge, there is no legal justification for anyone at CareFirst to refuse to speak to Shore Billing regarding billing matters related to Dr. ****** claims. 

  The claim problems we reported to you have not been resolved/paid as promised, and we have many more.  Expecting an office to wait on hold for over an hour to speak to a human about a mistake made by CareFirst is overly burdensome. I have inquiries filed on 2/6/25 that remain "in process" -- for 2 months.  Nothing has been done.

  We're considering our options and will move forward as appropriate.  
  
  
  

  Business Response

  Date: 04/14/2025

  CareFirst explained we will respond directly to the provider of services with the outcome of the complaint and remain committed to doing so. 

  Thank you. 

   

   

  Customer Answer

  Date: 04/15/2025

   
  Complaint: 23119726
  
  I am rejecting this response as it fails to provide any legitimate justification under HIPAA for the refusal to engage with the duly authorized agent of this office. It appears to be retaliation since we've filed this complaint and one with OPM.  Further, before they decided it was a privacy violation - their initial response/resolution was promised to be in hand over a week ago. This remains unresolved and more claims are denying for the same reason, incorrectly. We have no reason to believe CareFirst is taking the appropriate steps to correct their payment processing system to so these claims on first pass. Incorrect denials only benefit CareFirst - not the member or the provider. 

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

  Customer Answer

  Date: 05/02/2025

  On 4/21, Dr. **** finally received a reply to this complaint however it fails to address all of the claims / patients listed in our complaint.  Further, it ignores the proof we sent regarding two CPT codes - one of which was denied in error.  CareFirst is incorrectly applying the **** rules for CPT codes ***** and refusing to fix their system. Providers are losing $ while CareFirst continues to withhold payment.  
  
  Dr. **** would appreciate a full response to each of our concerns. 

• Initial Complaint

  Date:03/13/2025

  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 have COBRA Coverage with Carefirst and my premium has been paid, however my have coverage is still listed INACTIVE. They have had this j formation for about two weeks and still failed to pay claims and activate coverage.

  Business Response

  Date: 03/17/2025

  Please see response for Consumer Complaint # ********. Thank you. 

• Initial Complaint

  Date:03/11/2025

  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.

  I have health insurance through CareFirst. This includes medical, dental, and vision. In January of 2024 I received dental services that are covered under my insurance. However, the provider was out of network so they had to submit reimbursement forms for me. CareFirst received these forms and reimbursed what was due with the exception of $1,800. The $1,800 check took a while to get to me. When I did receive the check in October of 2024 and deposited it into my account, the bank labelled it as stale and did not allow any funds to be deposited. Consequently, I reach out to CareFirst via phone explaining the matter. CareFirst said they reissued another $1,800 check during our call and I should receive it in ***** business days at most. Well, those days went by and no check. I call them again and they told me to wait another ***** days. Another ***** days past and no check. I called again and they promised me a check would be sent out, just give them another ***** days because they are busy. Well, I called more times and kept getting the same story after being on hold for hours each time. It has been since October and I have not gotten my check yet. It is March 10th of 2025 and I am on hold with them as I type. I have been on hold for over three hours and counting. I feel like I have to take legal action. Please provide assistance. Thanks

  Business Response

  Date: 03/18/2025

  Please review the attached. 

  Business Response

  Date: 03/24/2025

  Please be advised this is the second attempt to send a response in the BBB portal on this complaint. I have also emailed the BBB contact directly to let them know that the portal is not showing my original response sent on 3/18/25. 

• Initial Complaint

  Date:03/07/2025

  Type:Customer Service 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 office was provided a provider relations representative from carefirst and this representative does not answer her phone calls and her email stopped working. I tried contacting general number for provider relations found on the internet and their website and the phone numbers are not in service. I need assistance **** and would like Carefirst to contact me and provide another representative that answers phone message/emails promptly.

  Business Response

  Date: 03/14/2025

  Please review the attached response. 

  Customer Answer

  Date: 03/24/2025

  Thank you for helping me with this matter.  Carefirst's provider relations person finally reached out to me and I asked to speak to her supervisor, who offered her services and contact information in case we have difficulty reaching provider relations in the future.

• Initial Complaint

  Date:03/03/2025

  Type:Service or Repair Issues
  Status:

  UnresolvedMore 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.

  Our company's claims for one of our therapists keep being rejected as OON, because the incorrect coverage termination date was entered. We called CareFirst on November 1, 2024 to file a termination date of February 4, 2025. Whoever did this incorrectly listed the termination date as November 1, 2024, and thus all of those therapist's claims for the next four months have been wrongly rejected. This incorrect listing also violated CareFirst's own policy, which states that termination of coverage requires 90 days' notice.We have called CareFirst multiple times about this over the past few months, and each time we have been assured that it would be resolved promptly, only for the payments to continually be rejected. Most notably, we spoke with **** (case #********), who told us that she escalated the reinstatement up the chain and it should be resolved within 5-6 business days. That was at the beginning of this month; we have not heard anything since, and this continues to be an ongoing issue.The last time we called about this, we waited on hold for hours until we were finally given the phone number for the credentialing team; we were told we were being transferred there, only for the call to fail. When we called back, there was no option to speak to a person, only an offer to leave a voicemail after another hour on hold. This has been a complete waste of time and an incredibly frustrating experience. CareFirst's treatment of the people it relies on to do business is abhorrent.

  Business Response

  Date: 03/06/2025

  Please see response. Thank you. 

  Customer Answer

  Date: 03/12/2025

  You marked this as resolved. It is not. I have still not heard anything from the company itself. They promised to contact me "within 24 business hours" of their response and they haven't. Why would you mark it as resolved if I have not indicated that it is? Just another useless thing for CareFirst to hide behind while it continues its path of destruction. Thanks for absolutely nothing.

• Initial Complaint

  Date:02/28/2025

  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.

  i applied for a tier exception but the insurance company denied this request without providing any reason why. i've been without my medicine for weeks! as of 2025, the co-pay went from $60 to over $600 for 1 month's supply of my zepbound. i don't ever recall being informed this was going to happen! the tier exception would take my co-pay down to $75 per month. i explained the hardship of not being able to afford the huge price increase, but the insurance company never provided any explaination or assistance.please call or email me and explain exactly what i need to do to be approved for the tier exception please!

  Business Response

  Date: 03/04/2025

  3/4/25

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

  Dispute Resolution Specialist
  ********************************************************************************
  Phone: **************
  
  Complaint ID: ********
  
  Dear Dispute Resolution Team:
  
  This letter responds to your inquiry of 2/28/25, in which you requested an investigation of allegations raised by the complainant, ******** Dattoli ********.
  
  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 for the opportunity to address your inquiry. If you have questions or concerns regarding the information provided in this letter, you may contact me at **************.

  Customer Answer

  Date: 03/26/2025

  I have been trying to reach **** again. I re-filed my tier exception request and spent a great deal of time as well as my doctor's time to submit this paperwork.  **** again denied the paperwork, even after I did exactly as they had instructed me to do.  They also failed to provide a reason why this happened. I was told the ******** was not eligible for a tier exception as of 3-1-25, however **** failed to inform me of this rule before I jumped through all the hoops they told me to do.  this is greatly unfair and unethical for this company to cause ongoing problems for a patient as well as the doctor and staff. Please ask **** to call me so I can learn more information about how to handle this.  Thank you.

  Customer Answer

  Date: 03/27/2025

  Im still waiting to hear from Bcbs 

  Business Response

  Date: 04/01/2025

  BBB RESPONSE:
  
  4/1/25
  
  ******* ******
  
  Dispute Resolution Specialist
  ********************************************************************************
  Phone: **************
  
  Complaint ID: ********
  
  Dear Dispute Resolution Team:
  
  This letter responds to your follow-up inquiry of 3/28/25, in which you requested an investigation of allegations raised by the complainant, ******** Dattoli ********.
  
  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 for the opportunity to address your inquiry. If you have questions or concerns regarding the information provided in this letter, you may contact me at **************.

  Customer Answer

  Date: 04/06/2025

  I have not received a phone call back from the business, can you please ask someone to call me ASAP? Or if they can send an email. Im not able to reach anyone to help me at ****. Please !

  Business Response

  Date: 04/08/2025

  4/8/25
  
  ******* ******
  
  Dispute Resolution Specialist
  ********************************************************************************
  Phone: **************
  
  Complaint ID: ********
  
  Dear Dispute Resolution Team:
  
  This letter responds to your follow-up inquiry of 4/7/25, in which you requested an investigation of allegations raised by the complainant, ******** Dattoli ********.
  
  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 for the opportunity to address your inquiry. If you have questions or concerns regarding the information provided in this letter, you may contact me at **************.