Complaints

This profile includes complaints for Excellus Blue Cross Blue Shield's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Excellus Blue Cross Blue Shield

  165 Court St Rochester, NY 14647-0001

• 

  Excellus Blue Cross Blue Shield

  12 Rhoads Drive Utica, NY 13502

• 

  Excellus Blue Cross Blue Shield

  344 S Warren St Syracuse, NY 13202-2008

• 

  Excellus Blue Cross Blue Shield

  171 Main Street New Paltz, NY 12561-1119

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:08/22/2024

  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.

  Since Feb 2024, we have been submitting claims monthly to be reimbursed for ****** ****' mental health medical needs from the previous month. Almost every month there has been a problem being reimbursed correctly. January claim was underpaid because the wrong NPI was used from the superbill. February claim was not paid until 7/31/24 and the allowed amount equals the provider charge amount. March was paid and the allowed amount is about 55.6% of the provider charge amount. April claim was not paid until 8/5/24 and the allowed amount equals the provider charge amount. May claim was paid at $344.25 and an overpayment recovery amount of $568.24 was deducted from the total because **** sent a check to both us and the provider. June claim was paid at 55.8% of the provider charge amount. Another check was sent for Jan on 8/19 equal to the provider charge amount but an overpayment recovery amount of $568.24 was deducted again for presumably the same reason as May. We received a notice sent 8/15 that a claims overpayment exists for May's claim of $912.49 even though we only received a check for $344.25. We have called at least monthly since March because of these problems. **** representatives have tried to help resolve the problems. Some have offered to call me back until the issues are resolved but normally we get one call back and that is it even though there are outstanding problems. We are tired of calling and the issues persisting. At this point, we do not know what amount we should be reimbursed for each claim. We should not have had an "overpayment recovery amount" deducted at all for **** error sending a check to the provider and instead it has been deducted 2x. We request that **** immediately correct the claim processing issue, advise the amount we should be reimbursed, and immediately send out revised checks for the correct amount plus interest for the applicable claims.

  Business Response

  Date: 10/04/2024

  I have attached the letter that is being mailed today at 3 pm to the Parent or Guardian of ****** ****.   Upon receipt of your complaint, we issued and received information from our Claims Process Analyst of National Programs and our Manager of Customer Operations. It was founded that all claims should be submitted directly to Excellus, even though the provider is an out of area provider. However, Excellus is in the mist of completing an internal update so that claims that are submitted for providers out of our current area, be held and processed in a timely manner. Please keep the over payment check that was mailed to you in our error for the inconvenience and frustration this has caused. While the updates are continuing to be completed, please send all claims to [email protected] as we will have them processed correctly and in a timely manner for you to receive your payment back for medical services for Meghan. Also,once this update has been completed, and confirmed we will contact you so that you may continue to either submit your paper claims via the Excellus App or by mailing the paper claimto Excellus BlueCross BlueShield P.O. Box 21146 Eagan, MN 55121.Also, due to the provider is out of network and does not contact with Empire, approximately75% of the out of network allowed amount would pay per date of service. Please remember,this price can change depending on current medical services provided or if an allowable amount changes. Please allow approximately up to 45 days to review the claim, upload to the correct department, load, process, pay and mail and receive your check. We would like to apologize for the inconvenience you have experienced. We continue to seek ways to improve our processes and the quality of service that we provide to our members and appreciate you bringing this matter to our attention. We take measures to ensure that quality service is given. If you need to reach me directly, my direct number is ###-###-#### and my general business hours are Monday through Friday 7:30 AM to 4 PM, I would be happy to answer any questions or offer my assistance.

  Customer Answer

  Date: 10/10/2024

  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. 
  
  Regards,
  
  ******* & *********** ****
  
  
  
  
  

• Initial Complaint

  Date:05/08/2023

  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.

  My mom ***** ******* passed away 3/18/23 she had Blue cross blue shield insurance they received a copy of her death’s certificate on 4/24/23 they were also called prior to inform them to cease the insurance as she passed away, they billed her after being informed fir aApril and again attempted ti withdraw mi at from her account in May the bc/bs policy is ************ My moms SS is *** ** ****

  Business Response

  Date: 05/23/2023

  An email was sent to BBB yesterday, May 22, 2023 (attached) to advise that the complaint was received and acknowledgement letter sent to ***** ****** (Daughter), as appointed through the small estate death certificate, small estate form and HIPAA paperwork.  

  ** Today, I received a response from our membership team:

  The death certificate and small estate were not received until 4/27/23, information was entered to the account on 5/3/23 and term (back-date) effective 3/18/23.. 

  We received non-sufficient funds prior to that; then on 5/1/23 the eft was pulled but was returned as not sufficient funds on 5/4/23.

  The only payment that actually cleared past the date of death (DOD) was on 4/1/23 and that was prior to the receipt of death certificate. 

  EFT removed once the death certificate and small estate were received and entered on 5/3/23.

  The refund has been issued to small estate holder on 5/12/23 in the amount of $ 529.63. The refund was prorated based on DOD 3/18/2023.

  Please advise if any additional information is needed.

  Customer Answer

  Date: 05/26/2023

  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.  Based on my Most recent conversation with Representative Anthony who corrected the error of prior representative. Anthony’s stated a check would be mailed to ***** ****** we have this conversation on May 25, 2023, he agreed the prior representative made errors and was in the wrong 
  Regards,
  **** *******
  

• Initial Complaint

  Date:01/25/2023

  Type:Customer Service 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 told by an agent I could submit secondary claims. Upon trying to do so, my Member ID had expired ( 1 year) then I was told they only except claims on a year basis. Most providers never even ask for secondary coverage information because they don't want to deal with submitting to two companies. Once we found out that my wife did indeed have secondary coverage through her ******** insurance, it was too late, according to Excellus Blue Cross Dental. I expect this happens often with couples where one is still working and the other has retired and is on ******** for insurance. The primary coverage is submitted through the medical/dental office and the office never checks about secondary coverage. The customer gets screwed out of their secondary coverage payments... The time frame for insurance companies to allow secondary coverage to be submitted should be extended to at least a 3 year period.

  Business Response

  Date: 02/09/2023

  Regarding BBB Upstate New York complaint #******** - Our Advocacy team has received this information and is working on it. Also, there have been a few staff/contact changes, so please ensure that emails are going to [email protected], plus to *************************** *** ************************** and keep me copied if that helps. Thank you. Kevin K***, Corporate Communications ***********************