Complaints

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:09/17/2024

  Type:Order 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 was seen on 8/7 and 8/21 by an out of network physical therapist at ****** ***. Blue Cross Blue Shield of Kansas City has not processed these claims so that the cost of these visits apply to my out of network out of pocket maximum or out of network deductible. Additionally, BCBS of Kansas City is insisting that I fill out an accident questionnaire for an ER visit that occurred on 9/5/2024. They still have not supplied me with an accident questionnaire and this injury does not involve another party. This is just BCBS of Kansas City trying to find a way around paying the bill.

  

  Business Response

  Date: 09/18/2024

  Good Morning, 

  I was unable to local this member in our system. Can you please request a copy of the member's insurance card so that we can identify her policy and assist with the issue outlined. 

   

  Thank you, 

• Initial Complaint

  Date:03/07/2024

  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 January 25, I visited a ******* ********** to receive preventative services--a breast exam (not official mammogram) and discussed requirements for a PAP that I thought I was overdue for, but learned that the years between exams had been increased in recent years. On Blue Cross Blue Shield's website, ******* ********** is listed as in my network and covered. I received a bill from ******* ********** for 100% of the cost of services. I called ******* ********** and found out that BCBS had rejected coverage. Upon calling BCBS, I found out that ******* ********** is in my network, but the specific doctor who provided my services is out of network! Not only is the information on their website misleading, but I was denied coverage of preventative services for women! I believe that not only should this be considered in network, but that the services should be covered at 100% by BCBS. The statement date from ******* ********** is 2/26/2024 and the total amount due is $349.00. I request that BCBS cover this service 100% as preventative, in-network treatment.

  

  Business Response

  Date: 03/13/2024

  Good Afternoon,

  We have been unable to identify this consumer as a Blue Cross Blue Shield Kansas City member. Can you please obtain a copy of the member's insurance card to confirm correct Blue plan coverage. Thanks 

  Customer Answer

  Date: 03/13/2024

   
  Complaint: ********
  
  I am rejecting this response because I am a member and the pictures of my insurance card are attached.
  
  Sincerely,
  
  ******* ******

  

  Business Response

  Date: 03/28/2024

  Good Morning, 

  This member's insurance is administered through Blue Cross Blue Shield of South Carolina. I reached out to the South Carolina plan for assistance. I was advised they have made multiple attempts to contact the member and resolve her issue. However, they have received no response to their calls or messages. Representatives with the South Carolina plan is ready and able to assist the member with her concerns. I was provided the following contact information for the member to make outreach:

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

  We will me happy to address the member's concerns once she has contacted the number above. 

  Thank you, 

• Initial Complaint

  Date:03/19/2023

  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.

  We have a **** ******** ********* **** & have for several years. The start of 1/1/23, they changed how to access the different plan benefits: ********** for over the counter items, (sign up on a different site); find a Provider,(go to a different site); use their main site (sign up); sign-up for their meetings explaining coverage-over an hour away requiring someone to drive there. They are selling seniors with their plan but are making it impossible to access the benefits without internet or being computer savvy. I tried the 3rd time today to set-up the ********** benefits that we have not been able to use since January 2023 & tried speaking with a person. She was nice but had extremely limited use of English. The issue was not resolved! BlueCrossBlueShield KC must live up to their commitments to seniors. They are not. If I can find a way to get away from them now I will. Our complaint is not being able to access our insurance benefits.

  

  Business Response

  Date: 04/04/2023

  The complaint was forwarded to our ******** ********* team for handling. On 03/29/2023 I received the following response:

  “Thank you for reaching out regarding our **** ******** ********* ****. We respect all of our members’ concerns. We have connected with this member to resolve her concerns.”

   

  Thank you, 

• Initial Complaint

  Date:12/16/2022

  Type:Billing 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.

  I became eligible for Medicare November 1 signed up with Medicare advantage. Plan has a nations OTC over the counter, benefit card and card that also has vision and dental that you pay for with the card. To access the OTC benefit you have to be able to login online to order with them. We have not been able to login ever since November 1 when I was first eligible. My wife has made 12-13 calls to them at least an hour each time trying to get the issue resolved. We can use the card at Walgreens or CVS but we don’t know which items are available for purchase under the OTC plan. Every time I call they say they have escalated an IT ticket giving me the ticket number ***** and that within a few hours or a couple of days the issue will be resolved. Here we are a month and a half into that nothing has been resolved. They have said I can order items over the phone so I called today to try to do that because the end of the year I will lose the benefits they will not roll over into next year so today when I called to order an item they said the plan is not showing any benefits available!! Argh. I asked to speak to the supervisor they put me on hold for a while and suddenly I was disconnected. Supposedly. Called back to speak to the supervisor they put me on hold. Got disconnected called back, put on hold and disconnected again. Hmmm great customer service. One supervisor that I spoke with on November 28 at 3:23 PM said that I’m not the only one having issues I said well that doesn’t really fill me with confidence but she assured me they were working on the system to get it working for everyone. I did reach out to BCBS Medicare advantage on December 7 on my behalf, and BCBS called to let me know they had forwarded more information about my account to them. So after that I checked with the OTC number again and they said within a couple of days everything would be uploaded and good still nothing has been done and this is December 16.

  Customer Answer

  Date: 01/19/2023

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

  This complaint has been resolved. They finally fixed it to where we were able to access their website.
  Thanks so much for your help!!

• Initial Complaint

  Date:07/02/2022

  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.

  My wife, *** ******** was admitted to ******* ******* ****** ** ************ ** on 4/28/22. I contacted BCBS at 5:08 pm that day at customer service and advised them that she was admitted and that we would need to add our son to her policy once he was born. We were advised that this would be done automatically and there was nothing else needed. At 11:07 on 5/23, I again contacted BCBS customer service and spoke with *******. She informed me our son was not yet added, but that she would add him and resubmit our claims that were denied or pending for him. Her reason that he was not added was because they didn’t know if my wife had a vaginal or c section birth (vaginal.) I was again told there was nothing else that needed to be done and that he would be covered for the first 31 days after birth. On 6/27, our claims were still being denied. I spoke with ******* from BCBS at 1:28pm and was told that he was in their system, but not on the plan. It appears he had been added, but we were informed that because it was not added through my wife’s group coordinator, that none of the claims would be covered. Later that day, we contacted the group coordinator and a request for exemption was submitted and we are still waiting for answers. At 2:30 pm that day, I contacted BCBS and requested transcripts of previous calls where I was told our son would be covered and there was nothing necessary for us to do. They informed me that those transcripts could only be released with a court order. Blue Cross of KC is not acting in good faith to honor the claims that they are obligated to pay. They clearly had knowledge that our son was born and was to be added onto my wife’s plan. Because the method he was added was not through a broker, they are trying to deny payment in the ballpark of $3,000. I am requesting that they add him to my wife’s plan for the first 31 days like I have requested twice before now, so that the bills are covered by BCBS.

  

  Business Response

  Date: 07/22/2022

  Good Afternoon,

  Our records show Blue KC received a call from ******** ******** on May 13, 2022, asking to add a newborn to the policy. Unfortunately, at that time we were needing additional information from the provider and was unable to complete the enrollment.  It appears as of July 18, 2022, Blue KC received everything needed to update ****** ********’s enrollment and he now has active/eligible insurance coverage from April 30, 2022, through May 31, 2022.

  
  I reviewed all claims submitted, to date, for ****** ** ********, and found six claims have been submitted to Blue KC for services rendered April 30, 2022, through May 11, 2022. Please note, all claims have been processed or reprocessed for benefit coverage as of July 18, 2022. Mr. and Mrs. ******** have access to the original explanation of benefits and the adjusted explanation of benefits, via the online Blue KC member portal at **************.  The explanation of benefits will outline the total billed, Blue KC payment, patient liability and any provider write off.
  Please feel free to contact me if you need any additional information of have any additional questions.

  
  Sincerely,

  ****** *****
  Manager, Appeals
  Blue Cross Blue Shield Kansas City