Business Profile
Health Insurance
Blue Cross and Blue Shield of North CarolinaHeadquarters
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Complaint Details
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Initial Complaint
02/11/2025
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I've been having this problem since October 2024, and it continues to leave me without health insurance. I've made six phone calls at this point, but they keep denying my claims due to supposed coverage by another insurance provider. They keep asking for the same details that were already submitted through the online portal and faxed to them. I even had an agent submit the information over the phone. I have multiple case numbers9197651920 and ************yet they still continue to deny my claims. If this issue is not resolved immediately, I will be involving the insurance board, as I have been without coverage since September, despite informing them that I no longer have the other insurance.Business response
02/11/2025
BlueCross NC will contact the complainant directly regarding their concerns.Initial Complaint
02/03/2025
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
1. BCBS NC is giving the runaround.2. Messages sent to BCBS NC in their web portal and app, but insurance carrier takes no action and does not reply to messages we took the time to send them 3. Section 5 of the member guide states that dental work resulting from accidental falls are covered under the medical plan and not the dental plan. Insurance carrier for the medical plan bounces the claim to the wrong department and the claim is in limbo.4. Multiple calls made to insurance carrier navigating through some ***** different IVR prompts just to reach a person. Excessive number of IVR prompts to reach a person.5. Phone **** open cases but fail to follow up as they promised to do. This results in delays in getting the claim processed correctly 6. The dental plan is also bcbs nc but as stated this accidental fall triggers coverage for dental work under the medical plan not the dental plan. 7. There are upcoming visits to other oral surgeon and this claim nightmare appears will continue for subsequent claims even though case notes from the provider was sent to confirm an accidental fall.Customer response
02/06/2025
Please note the business left us a voicemail on 2.3.25 at 11:26am.
On 2.4.25 at 125p I called the business and the *** ***** answer so I left a voicemail.
I tried again on 2.4.25 at 429p and did not leave another message when the *** again ***** answer.
I tried again today at 351p and left a message when they ***** answer. And again at 406p but ***** leave a message.
Please add these times to my case notesBusiness response
02/10/2025
BlueCross NC will contact the complainant directly regarding their concernsInitial Complaint
02/03/2025
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
BCBS is the provider my employer uses and this year we were offered a *** BENEFIT. When I essentially called on 1/22/2025 I was told that my coverage did not include the benefit until I explained to the agent that this year my employer includes the benefit in our coverage. The agent was able to locate the benefit, however when my provider called they were told my IVF procedure was not covered. Leading to a series of calls from myself and my provider. I have been told that my benefit will be updated and the issue has been resolved as ALL MECKLENBURG COUNTY EMPLOYEES ARE EXPERIENCING THIS SAME ISSUE**** I even advised my employers HR department because it is now 1/31/2025 and I still can not use my benefit. Every time *** are verified by my provider they now comeback as billable but not covered even with verbiage updated. I have now been told I have to wait for another system called BLUE E to be updated and my first appt is 4 days awayNO ONE CAN GIVE ME EXACT ANSWERS OR TURNAROUND TIMES ITS SAD I HAVE TO ADVOCATE FOR MYSELF AT THIS EXTREME. THEY ARE NOT RESOLVING THE ISSUE WITH URGENCY BECAUSE IT IS NOT PERSONALLY AFFECTING THEM!!! This has been going on for two weeks and I have lowered my expectations of a resolution at this time. I FEEL STUCK BECAUSE THIS PROVIDER IS THE ONLY ONE MY EMPLOYER OFFERS. NEXT YEAR i will purchase private insurance outside of my employer because this has been a complete nightmare. The only thing myself and my provider have been receiving is conflicting information with no uniformed method or usage of reading proper notes. They have not even uploaded my employers benefit booklet and continue to use the 2024 booklet as a referenceUNACCEPTABLE and I dont want another agent to apologize to me until I see and get results not only for myself but all the employees at my job not able to use their promised benefit. THIS COMPANY IS HINDERING MY FUTURE OF BECOMING A PARENT AS WELL AS ,ANY OTHERS AND THIS IS NOT FAIR.Business response
02/03/2025
BlueCross NC will contact the complainant directly regarding their concerns.Initial Complaint
01/16/2025
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Several BCBS employees misled and misinformed me about my insurance benefit coverage. When I was pregnant, I reached out to my insurer to confirm if a Labor Doula was covered. I provided them with the necessary procedure codes and was assured that this service was indeed covered under my plan. Based on their information, I hired a doula to support me through my prenatal care and eventual labor and delivery.I began the process of filing my claim in July 2023 for reimbursement. However, upon calling to check the status of my claim, I was told that since the services hadn't been rendered yet, they couldn't process my claim at that time. I was instructed to wait until after my child was born in ************ and refile the claim then.After delivering my child, I promptly prepared all the required documents and refiled my claim. To my shock and dismay, I was informed that my claim was now outside the statute of limitations for review. Heartbroken and furious, I appealed their decision and explained that I had followed the "proper protocol" as advised by their employees. Despite this, my appeal was denied.BCBS promotes itself as a company dedicated to supporting a healthy lifestyle and caring for its customers, but my experience tells a different story. Insurers beware: think twice before choosing this company to handle your medical coverage needs. I am extremely disappointed and angry at how I was treated during such a vulnerable time in my life.Business response
01/17/2025
BlueCross NC will contact the complainant directly regarding their concerns.Customer response
01/20/2025
Complaint: 22816500
I am rejecting this response because: BCBS is still reviewing my claim and conducting their internal investigation. No further resolution has been provided.
Sincerely,
Daemesha *******Initial Complaint
01/16/2025
- Complaint Type:
- Product Issues
- Status:
- Answered
In 2024, I enrolled in Experience Health NC ******** Advantage HMO, managed by Blue Cross Blue Shield. An allowance of $500 was available for dental preventive care. I visited the dentist in January '24, charged $342, paid. I then sent in a request for reimbursement and received a check for $342. This left $158 of the $500 to be requested for reimbursement. July 16, '24, I visited the dentist again for a cleaning and an exam. I was charged $167, paid. I then sent in a request for the remaining $158. I called customer service in September, "...be patient...", October, "behind in processing", November, I filed a grievance. December, I receive a letter that another 90 days is needed to evaluate my request. It has been SEVEN(7) MONTHS, and I have not been reimbursed. The letter was sent by a ******** *********** appeals analyst) ************, Experience Health, Claims Depart, ****************************. I have called several times and left messages, but there has been no response. I know of no reason the request for reimbursement should be denied. If so, what is the reason?Business response
01/16/2025
BlueCross NC will contact the complainant directly regarding their concerns.Customer response
01/16/2025
Complaint: 22819471
I am rejecting this response because: There has been no action to reimburse me for the dentist visit when there was money still remaining in the amount to be used for preventive care. There has been no action that I have experienced other than to tell me to be patient, wait, etc...
Sincerely,
****** ****Initial Complaint
01/14/2025
- Complaint Type:
- Billing Issues
- Status:
- Answered
Promised me a gym membership when I signed up for this health insurance through ********. I've yet to get my free gym membership. I have called several times trying to resolve the issue and nobody cares to resolve the issue. I had to cancel my gym membership at the planet fitness because the card they give me and told me to pay for my gym membership with this card it declines. I was with another insurance provider and I told them before I signed up. I don't want to lose my planet fitness fitness gym membership. I wasn't sure that I would not lose my gym membership and I can use this card that they sent me to pay for said gym membership. This is sadly not the case. I just want the gym membership I was promised along with the other benefits of the insurance program I was promised.Business response
01/14/2025
BlueCross NC will contact the complainant directly regarding their concerns.Initial Complaint
01/09/2025
- Complaint Type:
- Order Issues
- Status:
- Resolved
*************** was my primary ********* that ended on December 31, 2024 . On, and after Thursday, January 2, 2025. I decided to have the pharmacist fill Wegovy, Promethezine, ********** and Heslthy Blue refuse to cover any medicine but not until ***** ********* was over. I had to call Healthy Blue to make sure that they knew that my primary ********* was not my primary anymore and Healthy Blue was my primary ********* and so Healthy Blue . I sent in a termination letter to Heslthy Blue from ***** as well as ***** faxing the termination letter to the fax number ********** and my doctor also sent the prior authorization for Wegovy discussing why I needed it . I have not been able to get my meds as I am sick wihtout. Paying with my food money since I do not have money. I need the $24.04 for the ********** and ************ refunded to me. I am attaching the receipt. I also want ***** taken off as my primary and healthy blue actually paying for my meds and services. I need Wegovy approved.Business response
01/09/2025
Thank you for the referral. We will reach out to our member and address any questions or concerns.Customer response
01/09/2025
Complaint: 22786359
I am rejecting this response because: I was contacted by BCBS and left a message that I am not an insurance member even though I am an NC BCBS ********************** member and gave them my Member ID. ********************** *** then hung up on me and threatened not to pay for any meds. I am not sure what is happening. No one should be mistreated this way. I cant afford my meds and my insurance is behaving fraudulently.
Sincerely,
****** B. *******Business response
01/10/2025
Thank you for the referral. We will reach out to our member and address any questions or concerns.Customer response
01/10/2025
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,
****** B. *******Initial Complaint
10/17/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
My father suffered a stroke in 2023. My mother and I have filed claims with BCBS and were clearly told these would be covered. Over the last 8 months the process has been going in circles processing and re-processing, one claim approved, others not sure what is happening. When speaking with customer service we were told these already should have been approved and paid. Somebody needs to look into these and finalize these claims properly because we are wasting months and hours speaking to customer service. My father is ********* ************. Subscriber ID ************.Business response
10/17/2024
Thank you for the referral. We will reach out to our member and address any questions or concerns.Initial Complaint
10/02/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
My mother passed away on March 29, 2024. I called BCBS to stop bank drafts April 16th and to request a refund for the premium collected in April. Two premiums were collected on 4/5/2024: $****** and $291.00. They said they would stop all bank drafts and refund money. Check received from BCBS for ****** in mom's name. 5/7/2024 BCBS withdrew $291.00 premium. Called BCBS in *** and they apologized and said they would refund money and stop automatic bank draft. I asked them to issue checks in my name. Put Letter of Testamentary in mail per their request. 6/5/2024 BCBS withdrew $299.00 premium. I called BCBS and they said they did not receive letter of Testamentary in mail. They said I could fax it over. I faxed the letter to them. They also advised that I stop payment to them through my bank. 6/21/24 I paid a fee of $31.00 to stop payment to BCBS to my bank. 7/8/2024 Called BCBS. They said they received the Letter of Testamentary. They said I should be receiving a refund for part of March, all of ****** *** and June. Case number ******** was opened. 8/1/2024 Called BCBS to check the status of refund. I was on phone for 2.5 hours after being transferred multiple times and hung up on 2 times with no resolution. 8/7/2024 I called BCBS. They state that 2 checks have been issued in the amounts of $650.60 and $249.16 that day. 9/5/2024 I called BCBS to check the status of checks. They said they should have been expedited. I was put on hold and then disconnected while on hold. I called back. BCBS said it should take 30 days from 8/8/2024. I should wait until Monday and call back if I did not receive checks. 10/1/2024 Called BCBS to check status of checks. They said they could not tell me anything because their system was updating. They would call me back tomorrow.Business response
10/02/2024
BlueCross NC will contact the complainant directly regarding their concerns.Customer response
10/02/2024
Complaint: 22366408
I am rejecting this response because: My complaint is against BCBS not this company.
Sincerely,
******* ****Initial Complaint
09/18/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
Blue Cross Blue Shield has approved payment directly to me, for an ambulance ride that occurred 03/22/2024 in ****************. Since April, when they approved the claim and payment for the claim. I have been waiting for the check in the mail. i have called a total of 4 different times since April in regards to this issue. They have said that they have "voided and reissued" the check twice, but do not know why it is not getting to me. it is now September 18th... nearly 6 months later.. no payment has been received. And when asked if there can be an investigation into why i am not receiving these checks, they answer was no. We can only keep voiding and reissuing the check. At this point there seems to be issues within the company with regards to sending reimbursement to clients. I asked if there were alternative ways to submitting the money , ie. digital or to my bank. The answer is no. just a check. When asked what will happen if i still do receive a check in 30 days, the answer was we will void and reissue. How can this be escalated for investigation? or can there be alternative modes of delivery when clearly one is failing?Business response
09/18/2024
BlueCross NC will contact the complainant directly regarding their concerns.
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Customer Complaints Summary
103 total complaints in the last 3 years.
24 complaints closed in the last 12 months.
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