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:01/24/2024

  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.

  Re: FEP vision benefits 2024 Dear Mr. ****** I am having issues with receiving my entitled 2024 benefits for my contacts. I have contacted the supervisor Keira S**** for assistance. The issue remains unresolved and affects my vision health. I have been working on this issue for the entire month of January. I ask that the matter is escalated. Thank you, ***** ******

  Business Response

  Date: 02/03/2024

  Member ****** was advised that there was some technical difficulties with member utilizing their benefit for the 2024 year. Since member was notified of the technical difficulties, the issue was escalated to our Tech Support team to research and resolve this internal issue.  We have remained in communication with member ****** by providing updates to the resolution to this issue. 
  As of 2/2/2024, all issues have been resolved. The member was contacted on 2/2/2024 to inform them that all issues surrounding their complaint has been fully resolved. Member has confirmed that they were successful at utilizing their 2024 benefit with no issues.
  We greatly apologize for the inconvenience in the delay in use of the 2024 Benefit as this was an one off and isolated incident. We appreciate Member ******'s patience and understanding as we worked to remedy this issue. 

• Initial Complaint

  Date:01/10/2024

  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.

  I am insured with **** ***** *** **** ****** *** **** Vision I needed specialty contact lenses that are medically necessary, and the provider of the lenses is not a participating provider. I contacted FEP Blue Vision to see if these lenses are covered. They told me that they would be partially covered. I have filled out the claim form, had my Doctor fill out the claim form, had my doctor send over every form they have asked for. I have called them several times and every time I get a different answer as to what they need. I have provided FEB Blu Vision with the receipt that I had paid in full. I cannot get them to process the claim or tell me what is missing or what they need. I have asked to speak to a manager every time I have called, at least 6 times and a manager is never able to speak with me. I am always told there is no one available to help me. My vision provider is frustrated as they have also called FEB Blue Vision. I would just like my claim processed. If they want more information, they need to tell me or my doctor. I feel like I am getting the run around and that this is a game for them hoping I will just go away so they don't have to process the claim.

  Business Response

  Date: 01/17/2024

  Thank you for your inquiry. We have received all the documents needed from your eye care provider as of 12/21/2023. It appears that on 12/29/2024, your request for Medically Necessary Contact Lenses was reviewed and resolved. On 1/9/2024, you advised customer service via phone, that you received a response to your request via letter. We apologize for the delay in processing your request as additional details were needed from the provider to assist our Utilization Management Department in making a decision on your request. A manager from our Member Services department will contact you directly to discuss any additional concerns.

  Customer Answer

  Date: 01/19/2024

  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  Blue Vision has told me nothing in their response other than they sent something to me in December of 2024, which is 12 months away in the future.  I have asked to speak with a manager no less than 6 times and a manager has never been available or returned my request for a call back. I doubt very seriously that a manager will call to address my concerns. When I spoke with customer service, they indicated that they have nothing from the Dr that says these lenses are medically necessary, however, the Dr indicates several times on the paperwork that they are medically necessary. No one from Blue vision will tell me what the issue is. That is why I filed the complaint.   Regards,  ****** ******

  Business Response

  Date: 02/01/2024

  This is regarding BBB Complaint # ******** for ****** ******. I would like to advise that ****** ******’s Out-of-Network Medically Necessary Contact Lens Denial has been sent to our medical review department for a First-Level Appeal. The appeal will be reviewed with the supporting documentation provided and based on the criteria listed in the **** FEP Vision Brochure on page 19:  “Medically Necessary Contact Lenses: Contact lenses may be determined to be medically necessary and appropriate in the treatment of patients affected by certain conditions. Clinical documentation may be requested from your doctor to support the medically necessary contact lenses. Contact lenses may be determined to be medically necessary for the treatment of specific eye conditions such as Keratoconus, High Ametropia, Anisometropia, Aphakia, Aniridia, Moderate to Severe Dry Eye Disease, or Irregular Astigmatism. Having the diagnosis of a particular eye condition does not guarantee that the contact lenses would be determined to be medically necessary per the criteria outlined in the clinical guidelines.” Sincerely, Sarah B****BCBS FEP Vision

  Customer Answer

  Date: 02/02/2024

  B I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  I had an appointment with my eye Dr today and they have assured me that these are medically necessary, and I could not drive at night without them. I am waiting to hear back from the manager assigned to the case. She is expected to call me sometime this coming week. I can follow up with BBB after I speak with the manager. Kind regards, ****** ******  

  Customer Answer

  Date: 02/05/2024

  I am waiting for the business to contact me. I was told that the manager will contact me on Wednesday.  I have also contacted my Dr's office and asked them to provide a detailed letter explaining why this was medically necessary. It seems that the insurance company is under the impression that these were not medically necessary. 

  Customer Answer

  Date: 02/11/2024

  A manager from BC&BS ***** ****** was supposed to call me by Friday the 9th of February.  I did not hear from the manager. I have asked my Dr's office to provide me with a letter explaining why glasses will not work for my vision problem. Several of the documents that the Dr has provided to BC&BS indicate that these scleral contact lenses are medically necessary and that there is no alternative for me. I feel like I am caught in the middle. I have had to pay out of pocket for these lenses because the Dr has told me this is my only choice to see clearly. I will send you the letter in the next few days.  

  Business Response

  Date: 02/28/2024

  A 1st Level Appeal was sent on the member's behalf on 1/26/2024 that was denied on 1/31/2024 because the provider was unable to provide clinical notes needed to approve the member's claim. Specifically, the provider must submit the manifest refraction with BCVA clinical notes to determine if there is visual function that eyeglasses can not improve.  This testing/information was not available from the provider.  Based on the information provided, there is no medical necessity, only preference for monovision contacts. On 1/31/2024, the member was contacted and advised of the 1st Level Appeal Denial reason. On the same day, Manager of BCBS FEP Vision contacted the provider's office to inform them of the member's appeal denial and reason "The provider must submit the manifest refraction with BCVA clinical notes to determine if there is visual function that eyeglasses can not improve.". Office agent, ********* stated she would consult with the provider and see if a letter explaining why the member is in need of the Medically necessary contacts. ********* stated that the letter would be generated and sent to BCBS FEP Vision manger that following Monday, 2/5/2024.  Member ****** received a call from BCBS FEP Vision manager on 2/2/2024 explaining that the provider will send a letter to explain reason for Medical necessity of contacts and that the document is expected to be received on 2/5/2024.  The letter from the provider's office was not sent / received on 2/5/2024. Member ****** received a call on 2/5/2024 to advise that the letter was not received.  On 2/9/2024, Manager of BCBS FEP Vision contacted the provider's office to seek status of the letter from the provider.  The Office manager stated that they were out of office and that the letter will be sent.  On 2/15/2024 at approximately 12:34pm est, a call was made to Member ****** was made, but no answer from the member. Manager left a voice mail to the member advising that the letter from the provider's office was not yet received.  On 2/15/2024 at approximately 3:06pm est, the provider's office faxed the letter needed.  On 2/19/2024 a 2nd Level Appeal was submitted on the member's behalf with the original clinical information and a letter explaining patient's need for  Medically Necessary Contacts.  On 2/21/2024, the provider was contacted by BCBS FEP Vision Manager to inform them that the letter was not enough to make a determination on the member's request as the clinical notes for the manifest refraction with BCVA clinical notes to determine if there is visual function that eyeglasses can not improve are not present. ********* from the providers office stated that they did not have such clinical notes and that they may need to have the member come back in to have that particular test done. Once those clinical notes are available, she will fax them to BCBS FEP Vision manager to assist with making a decision for the 2nd Level Appeal.  On 2/28/2024, ********* sent a fax with updated clinical notes. BCBS FEP Vision manager submitted the new fax with updated clinical notes to pair with 2nd level appeal for additional review. As of 2/28/2024 12:54pm est, the 2nd Level Appeal is still being reviewed.  An appeal review take up to 30 days for determination. Once a determination is made, the member will be notified via letter and phone.  

  Customer Answer

  Date: 02/28/2024

  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  I received an E-Mail from ****** ****** on 2-15-2024 with the attached document. The manager from **** ***** *** **** ****** is very nice but I have not talked to her until today when I called to inquire the status of the case. The last message I have on my phone from Blue Cross is from 2-05-2024 when the manager told me she was waiting for more information from ****** ******. The documentation clearly explains why I require special contact lenses and why glasses will not work for my situation. It seems a letter from the doctor is not good enough and they want more clinical documentation to process the claim. I understand that the Dr's office has also provided more proof that this is a correct diagnosis. I am not sure why they do not believe the doctor and why I am getting the run around for such a small claim. I feel like Blue Cross has me caught in the middle and I feel like they just want me to go away. I also feel like they want so much documentation and additional proof of the issue, but they are not willing to have one of their doctors talk with my doctor. This is actually becoming comical.   Regards, ****** ******

• Initial Complaint

  Date:12/08/2023

  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.

  On December 1, 2023, I had an eye exam and purchased lenses through my **** ***** FEP Vision Benefits at ***** ****** (**). Prior to making my appointment, I did my due diligence and confirmed ** was one of the accepted providers. They are and in fact, they are a preferred provider. As an extra measure of precaution, I confirmed the Doctor of Optometry, Dr. Kristy W***** at ** was also an in-network provider. When I arrived at my appointment, I was advised by ** they could process my lenses under my insurance however I would have to directly submit a claim to **** ***** directly for the exam. My benefits cover a yearly exam, so I was not worried about getting reimbursement. However, once I contacted **** *****, I was told that I needed to seek reimbursement from **, and they needed to file the claim. I went back to **, and they advised that they could not process reimbursement because Dr. W***** is not credentialed with **** **** Again, I called **** ***** and they disagreed with **** assessment and again told me that if I wanted reimbursement, it would need to come from **. This back and forth went on a couple times (emails attached) and **** ***** finally landed on Dr. W***** needing to be removed from the website, but I was still out of luck for the cost of my exam. I was also told that if I wanted to file a claim with **** *****, it would have to be an out of network claim and I would only get a fraction of the exam cost. I’m at a loss for words. I did everything that I was supposed to do for **** *****, and I still was punished. I sought out the in-network provider; I sought out the in-network doctor and I’m still out of pocket because now to **** ***** says the doctor is out of network. While I will say that the representatives, I spoke with at **** ***** were incredibly kind, their hands were tied and couldn’t offer me anything more than an apology. I’m seeking a rightful reimbursement of $160 for an eye exam that is covered through my annual insurance.

  Business Response

  Date: 01/23/2024

  We have carefully reviewed the member’s complaint. We found that the provider mentioned, Kristy W*****, OD, is a participating provider with **** ***** **** ****** FEP Vision. Accordingly, we have determined his benefits should have been applied at the time of service. Because of this determination, a check for $160 has been processed and was mailed to the address we have on file for the member on 1/22/2024. 

  Customer Answer

  Date: 01/29/2024

  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.   Regards, ******* *******

• Initial Complaint

  Date:07/20/2023

  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 signed up with FEP vision in January and I checked to make sure my eye doctor was in network. I took my son to his appointment on July 11 and was told they were not in network. I paid for the visit and glasses. I went on the FEP website and it still showed my doctors office as in network. I called FEP and was told they hadn't been removed from the website. I asked if I had any recourse because I had done my due diligence in ensuring my eye doctor was in network by using their website and I was told I had no recourse. I have to pay out of pocket for my son's appointment and eyeglasses along with keeping an Insurance for the rest of the year that isn't any good for me to use with my doctor even though I did everything that I should have done before signing up.

  Business Response

  Date: 07/28/2023

  This is in response to ******* ****’s complaint regarding the provider she took her son ****** to on July 11th, 2023. I will respond to the member’s points one by one:
  •The call that took place between member ******* **** and a BCBS FEP Vision representative on 7/20/23 was reviewed.
  •The member stated on the call, that she took her son ***** ****, to a provider that was listed on the BCBS FEP Vision in-network provider listing. 
  •The member stated on the call that the provider did inform her that their office is no longer in-network with BCBS FEP Vision.
  •Despite the provider confirming that they were not In-Network with BCBS FEP Vision, the member proceeded with the appointment. The member paid out-of-pocket and submitted an out-of-network claim to BCBS FEP Vision for reimbursement of *****’s eye exam. The member received the maximum $30 reimbursement for out-of-network eye exams.
  •Further research was performed to verify that the provider termed with BCBS FEP Vision as of 7/4/23 which was before ***** ****’s exam on 7/11/23. Please make note that when the member signed up for the BCBS FEP vision plan, the provider was In-Network.
  •A request to have the provider removed from the in-network listing has been submitted to the appropriate department. 
  •Currently, any further reimbursement for the remaining cost of ***** ****’s eye exam is denied.
  •The member may follow the appeal process if deemed necessary. 
  Thank you for your inquiry.
  Sincerely,
  Sarah B****
  
  

• Initial Complaint

  Date:01/09/2023

  Type:Sales and Advertising 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 a federal employee and customer of ***** Vision under FEP BlueVision PPO standard (FEDVIP). During open season for benefits (Nov 14-Dec 12, 22) I reviewed my current plan including the approved providers list via the BENEFEDS portal. Once I confirmed my optometrist was still listed as in-network, I decided to keep FEP BlueVision/***** Vision standard as my elected vision insurance as I have been satisfied with their coverage to this point. On 3 Jan 23, I contacted my optometrist' office (***** *** ****, Chardon, OH) to schedule an eye exam for my wife and I at which time the provider advised they were no longer in network with *****, they knew they were still showing up on the approved provider list and I was one of multiple customers they have had to advise of this erroneous listing. NOTE: as a standard plan customer there is zero out of network coverage. If I want to see my preferred optometrist any longer I must either change my plan or pay 100% out of pocket. I called BENEFEDS and was told there is no exception (OPM policy) to allow an out of open season switch for such an issue. Furthermore, the BENEFEDS rep advised they publish the provider list exactly as furnished to them by ***** Vision. If a provider was no longer covered, ***** should have updated the listing. This brings the following questions to mind: Why has ***** Vision not provided an updated listing to BENEFEDS? When did ***** *** **** cease to be a newtork provider? How long does it take for ***** Vision to update their provder list? Some lag in processing such an update is understandable, but given the timing of the year, this delay has now locked me in to a plan I do not want and forced me to find another optometrist which I have no desire to do, otherwise spend quite a bit out of pocket while still paying for insurance I will not utilize for the entire year. Effectively, ***** VIsion has fraudulently represented themselves to lock in guaranteed revenue for the next year

  Business Response

  Date: 01/27/2023

  Dear ******* ********,This is regarding your recent inquiry to the Better Business Bureau (BBB). Since **** ***** **** ****** FEP Vision is not the organization responsible for receiving premium payments for **** ***** **** ****** FEP Vision members, we are not able to offer any reimbursement of the premiums you have paid thus far. However, due to the circumstances surrounding your inquiry, we would like to offer you a reimbursement of your next visit at the in-network rate for services received at a visit to ***** * ******* Eye Care LLC this benefit year. When you visit this provider, please have them prepare an itemized receipt and email this receipt to *****************************. Please include your name and **** FEP Vision ID number in the subject line as well as “ATTENTION: Barbara A****”. When I receive this documentation, I will have it processed so that your out-of-pocket amount is equal to that of a member receiving the same services at an in-network provider.I have also contacted our Provider Relations team to further investigate the Provider’s In-Network termination. We apologize for the inconvenience that this matter has caused and are willing to do whatever in our power to make this right.  Please contact me directly at ###-###-#### if you have any questions. I am typically available between 8:00 AM and 4:30 PM Eastern Time on weekdays.Sincerely,Barbara A****, FEP PCSA###-###-####8** ******** ******* ***** ***** ************* ** *****