ComplaintsforCapital BlueCross

• Initial Complaint

  06/05/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 3/20/23 I had an appointment at *************************************************************************************** I paid the $30.00 co-pay that I am obligated to pay for a Tier 1 specialist with my health insurance.I have been continually getting bills stating I owe $45.00 more. This is incorrect. I have called and spoken to 5 different CSR at CBC and they have all said I DO NOT owe this amount, that they are coding it incorrectly and it will be taken care of. On April 18th I spoke to *******- who told me I do not owe that balance, don't pay it she will take care of it (she did not). On May 2 I spoke to ***** who at first told me to file an appeal- which I started to do. She then called me back about a half hour later and stated that her and her Supervisor did not want me to file an appeal--the fault was with Capital Blue Cross-they are not coding it correctly-they would take care of it---they did not. On 5/30 I called and spoke to *****-he told me I am correct I do not owe the extra $45.00 and he promised to call me back the next day to let me know what happened when he spoke to the physicians office. He never called me back so on 6/1 I called again and spoke to **** who told me I was correct--I did not owe that amount. She called the physicians office (with me on the phone as well) and asked them to put a 30 day hold on the bill until CBC corrects their mistake. Then on 6/5 ***** finally got around to calling me back and said I should file an appeal. This is ridiculous. I have spent so much time getting conflicting info. from CBC--no one there knows what they are doing.

  Business response

  06/28/2023

  June 27, 2023 
  

  Dear *** *******: 
  

  I am writing in response to your letter, which we received on June 26, 2023. Your inquiry is written on behalf of ****** ******. The issue is pertaining to the processing of a claim for services, which *** ****** states she was only to have a $30 copayment. 
  

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from *** ******, which permits us to release her information directly to you; therefore, Capital Blue Cross will send a response directly to *** ****** regarding this issue once our review has been completed. 
  

  If *** ****** would like Capital Blue Cross to send a response directly to you/The Better Business Bureau, we will need her to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release her PHI directly to your office. 
  

  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at ************. 
  

  Sincerely, 
  Senior Expedited Inquiries Analyst 

• Initial Complaint

  02/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On 12/27/22 I went to my healthcare provider for my quarterly **** shot for ********* prevention (***** ******* shot). I never get billed anything out of pocket for this service. In January 2023, I got a bill in the mail for $69.00 for claim ************ b/c the shot was billed as "medication" instead of "preventative." I noticed this immediately and first called ******** ****** the provider thinking they made a bill coding error. They informed me that all codes sent to insurance match all others done in 2022 for same service. I called Captial that day 1/12/23 and the rep submitted a claims adjustment. I called 1/27/23 to check on the status and I was told the claims adjustment was denied. At that time, I asked to speak to a manager. Manager ******* called me back and said the provider does not determine the "type of service" on a claim that a Capital Rep would have input that and she was escalating this issue to be corrected. She said it would take up to 2-weeks to show as being back open on my claim on their website for the correction to be made. I called back today 2/21/23 (25 days later) and the representative I spoke to (*******?) basically had no idea what I was talking about and kept trying to tell me about how this was marked as medication vs. preventative as type of service which is back to square one of what I've been dealing with, as if notes from all other conversations are no where to be found in the system. I've spent hours between speaking to Capital Blue Reps and the health care provider trying to resolve this issue and I keep getting no where. I want my claim corrected and I want my healthcare provider informed that I do not owe them any money for the service I received on 12/27/22.

  Business response

  03/06/2023

  February 28, 2023

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

  The Better Business Bureau

  1337 North Front Street
  Harrisburg PA  17120

  Re:  Complainant:  ********************************

          Member: ********************************

          Inquiry #*******

          Your Case #********

  Dear ******************:

  I am writing in response to your letter, which we received on February 27, 2023.  Your inquiry is written on behalf of *****************************. The issue is pertaining to the delay in reprocessing a claim, which ****************** states was to be adjusted as a preventive service with no member cost-share. 

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from Ms. Fortney, which permits us to release her information directly to you; therefore, Capital Blue Cross will send a response directly to *** ******* regarding this issue, once our review has been completed. 
  
  If *** ******* would like Capital Blue Cross to send a response directly to you/The Better Business Bureau, we will need her to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release her PHI directly to your office.
  
  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at 717.703.8209.
  
  Sincerely,
  
  Angela A********
  
  Angela A********
  Senior Expedited Inquiries Analyst
  
  Enclosure(s)

  Customer response

  03/06/2023

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  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. 
  
  I fully expect to be contacted directly by Capital Blue once their investigation is completed. 

  
  Regards,
  
  *****************************
  

• Initial Complaint

  02/02/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I’ve submitted, multiple times, several claims for reimbursement of health care paid out of pocket - from May 2022 - Dec 2022. (I also have three more i haven’t submitted yet bc of these constant issues). Total amount - out of pocket- for these claims is $5000+ They were initially submitted through service called Reimbursify - offered by the providers. All claims were verified as being transmitted, AND received by, the insurance company within 48 hours of submission (the first time was July 6, 2022). On August 9, 2022 I called to check progress of claims I was told by Capital BCBS they had no record of claims on file. I provided info to the service and they again submitted all of them electronically. In all, each of these claims was submitted electronically 12 times - w/ confirmed transmission & receipt by the insurance company each time. In Sept, claims were printed by service and sent USPS to them with certified delivery and signed confirmation - and were received on Sep 24 directly by the insurance company. On Oct 17 - representative at Capital BCBS told me once again, they had not received the claims & they were not in the system. She said she’d have to do an office to office request to get the information and would contact me with info on progress/any additional info. No phone call/email/text/letter has been received to date. In November - was told exact same thing but also was asked to provide detailed info for each claim, which I did - even though all info BCBS requested was clearly on EACH super bill (for each visit) that had been submitted no less than 18 times each at this point. Again - told I would be contacted w/ update - nothing. Same in Dec, Jan2023 again on February 2, 2023. Was told Supervisor would call within 24 hours. 28 hrs later & again - no contact at all. Not acceptable in any way. Pay outrageous premiums & they “won’t accept and process” claims beyond 6 mo, but 9+ months waiting to get my money reimbursed. Someone needs to do their job.

  Business response

  02/14/2023

  February 10, 2023 
  

  Dear *** *******: 
  

  I am writing in response to your letter, which we received on February 6, 2023. Your inquiry is written on behalf of ***** *****. The issue is pertaining to the delay in processing claim submissions, which *** ***** states were forwarded by using the service called Reimbursify. 
  

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from *** *****, which permits us to release his information directly to you; therefore, Capital Blue Cross will send a response directly to *** ***** regarding this issue, once our review has been completed. 

  If *** ***** would like Capital Blue Cross to send a response directly to you/The Better Business Bureau, we will need him to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release his PHI directly to your office. 

  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at 717.703.8209. 
  

  Sincerely, 
  Angela A. 
  Senior Expedited Inquiries Analyst 

• Initial Complaint

  12/12/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I've asked for a copy of an invoice twice and have been told it will take a month for them to email it to me. I am leaving Capital Blue Cross because of this. In my account, I can't view it, and an error comes up. That is why I have to request it from them. It should be a simple thing. I work for a business and if a customer asks me for an invoice I can get it for them in a day. Terrible customer service, if you can not do the small things right, how can you do the big ones?

  Business response

  12/15/2022

  December 15, 2022

  Dear *** *******:
  
  I am writing in response to your letter, which we received on December 15, 2022.  Your inquiry is written on behalf of ***** *******. The issue is pertaining to the need for billing invoices. 
  
  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from *** *******, which permits us to release his information directly to you; therefore, Capital Blue Cross will send a response directly to *** ******* regarding this issue, once our review has been completed. 
  
  If *** ******* would like Capital Blue Cross to send a response directly to you/The Better Business Bureau, we will need him to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release his PHI directly to your office.
  
  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at ************.
  
  Sincerely,
  Angela A********
  Senior Expedited Inquiries Analyst

• Initial Complaint

  03/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have been unsuccessful in getting a claim re-processed that took place on 9/1/21. I have faxed this claim to Blue Cross (in November 2021), physically mailed the claim to Blue Cross (in November 2021), faxed this claim to ****** Blue Cross (the local insurance company in CA that processes my claims and sends them to Capital Blue Cross), and emailed this claim to Blue Cross (on 12/30/21). I have called Blue Cross' member services line at LEAST 20 times, spoken to countless reps ********* ******* etc.) and no one has been able to get this claim processed. This is in reference to case #********. I want this claim to be re-processed and finalized once and for all.

  Business response

  04/04/2022

  April 1, 2022 
  

  Dear *** *******: 
  

  I am writing in response to your letter, which we received on March 28, 2022. Your inquiry is written on behalf of ******* ********. The issue is pertaining to the delay of reprocessing of *** ********'s claim (************) for services provided by **** ******* ****** on September 1, 2021. 
  

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from *** ********, which permits us to release her information directly to you; therefore, Capital Blue Cross will send a response directly to *** ******** regarding this issue, once our review has been completed. 

  If *** ******** would like Capital Blue Cross to send a response directly to you/The Better Business Bureau, we will need her to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release her PHI directly to your office. 

  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at ###-###-####. 
  

  Sincerely, 
  

  J'uan S.

  Expedited Inquiries Triage Coordinator 

• Initial Complaint

  01/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On November 18, 2019 I had a procedure done at ********* in Danville, PA, which was not covered by Capital Blue, after they stated that no prior authorization was needed to cover the surgery. After the procedure was done, they Capital Blue Cross claimed the procedure was not a covered service according to my plan, and that I was responsible for the ****. However, Capital Blue covered the same surgery a year prior in 2018, and then again in June 2020 and July 2020 without issue. When I questioned them as to why the one procedure was denied, they changed their reasoning and said insufficient evidence was provided, and no documentation that the surgery was needed was provided. However, ********* opened their own independent investigation, and found that Capital Blue Cross was provided with sufficient evidence, and in fact used the same evidence to justify the following two procedures in 2020. Since then, Capital Blue Cross has been hanging up on my phone calls, placing me on extensive holds, and using tactics to intimidate me into giving up. Multiple officials from ********* have tried calling on my behalf, and have been given the same hostile behavior, or have been hung up on. Because of this, my account has been referred to debt collection, which has been negatively impacting my credit and my ability to move on with my life, including buying a house or taking an auto loan. Therefore, I agreed to settle my account with *********, but believe I should be reimbursed by Capital Blue Cross for their negligence and error with handling my account. All documentation currently is at ********* Medical Center in Danville, under the care of **************, who has been reviewing my account. Her number is *************.

  Business response

  02/04/2022

  February 4, 2022

  Dear *** *******:
  
  I am writing in response to your letter, which we received on February 3, 2022.  Your inquiry is written on behalf of ****** ********. The issue is pertaining to the denial of payment for services provided by ********* Medical Center on November 18, 2019. 
  
  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member’s Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from *** ********, which permits us to release his information directly to you; therefore, Capital Blue Cross will send a response directly to *** ******** regarding this issue, once our review has been completed. 
  
  If *** ******** would like Capital Blue Cross to send a response directly to you/The Better Business Bureau, we will need him to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release his PHI directly to your office.
  
  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at ###-###-####.
  
  Sincerely,

  Angela A********
  Senior Expedited Inquiries Analyst

• Initial Complaint

  11/15/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I purchased a ******** supplement from Capital Blue with an effective date of 08/01/2020. Capital Blue was supposed to send crossover information to ******** with my new supplement policy number. Instead they sent the policy number that I was previously insured under my wife's employer which was cancelled 7/31/2020. I did not use the Insurance until September 2021 at which time I found out that Blue Cross was denying all of my claims. I have spoken to four customer service people, Michael on 09/27/21, Selina on 10/29/21, Scott on 11/02/21, and Mary K on 11/15/21. All of these people said they would get this corrected. What needs to happen is Blue Cross must send an update to ******** with my ******** number and my correct Blue Cross policy number. Although they say they did this a ******** Representative on 11/15/21 states that they only ever received the incorrect information from Blue Cross in August of 2020. ******** has no record of any updates being sent even though four people have worked on this problem. I have asked to speak to a supervisor but was told they would take care of it. Blue Cross assigned this situation case# ********. This is a very simple matter. ******** will not take the updated information from me. It must be submitted by Blue Cross as a crossover update. Blue Cross has verified my correct policy number and ******** number four times. As a result of this incompetence my claims are not being paid under a valid policy I have with Blue Cross which has been paid on time every month through automatic deduction.

  Business response

  11/23/2021

  November 23, 2021  
  Dear *** *******:  
  I am writing in response to your letter, which we received on November 22, 2021. Your inquiry is  written on behalf of **** *******. The issue is pertaining to his enrollment and Medicare crossover  information.  
  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a  Member’s Protected Health Information (PHI) may only be released to an authorized representative.  Capital Blue Cross has no authorization on file from *** *******, which permits us to release his  information directly to you; therefore, Capital Blue Cross will send a response directly to *** *******,  regarding this issue, once our review has been completed.  
  If *** ******* would like Capital Blue Cross to send a response directly to you/The Better Business  Bureau, we will need him to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising we are permitted to release his PHI directly to your office.  
  Thank you for your patience while your inquiry was under review. If you have any question regarding  this issue, you may contact me directly at ###-###-####.  
  Sincerely,  
  Angela A.  
  Senior Expedited Inquiries Analyst  
  

• Initial Complaint

  09/20/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Insurance only covered 66.00 for a procedure for teeth removal after referral from my sons orthodontist. The dentist quoted a larger amount should have been covered.

  Business response

  09/28/2021

  September 27, 2021 

  Dear *** *******:  
  I am writing in response to your letter, which we received on September 23, 2021. Your inquiry is  written on behalf of *** *****. The issue is pertaining to the processing of her son, ********  *****’s claim for dental services. Specifically, the covered amount for the removal of teeth.  

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a  Member’s Protected Health Information (PHI) may only be released to an authorized representative.  Capital Blue Cross has no authorization on file from *** *****, which permits us to release  ********’s information directly to you; therefore, Capital Blue Cross will send a response directly to  *** *****, regarding this issue, once our review has been completed.

  If *** ***** would like Capital Blue Cross to send a response directly to you/The Better Business  Bureau, we will need her to complete and return the enclosed Capital Blue Cross Member  Authorization Form (MAF) advising we are permitted to release ********’s PHI directly to your office.  

  Thank you for your patience while your inquiry was under review. If you have any question regarding  this issue, you may contact me directly at ************.  
  

  Sincerely,  
  
  Angela A.

  Senior Expedited Inquiries Analyst  
  

• Initial Complaint

  09/20/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was sent for a Preventative service due to a medical concern within my ******. Capital BlueCross has stated since I am not 40 years old, I have to pay the deductible for the service. Money I don't have. According to the insurance online the deductible only has $50.00 left to be paid to be met. According to Capital Blue it is still $400.00. No one can understand the information and then when it's explained, it is felt like the representatives make it up. I am apparently too young to have a preventative service, but it was medically necessary. The insurance is not understanding that. I now have to cancel upcoming preventative appointments because I cannot afford the cost. I am not eligible for any assistance from the government or any programs offered through the hospital or doctor's office. I spoke with **** at Capital Blue Cross. He was rude, disrespectful, and uncaring towards my feelings. When asked for a Supervisor, he refused and said I cannot speak to one today.

  Business response

  09/24/2021

  September 23, 2021  
  

  Dear *** *******:  

  I am writing in response to your letter, which we received on September 23, 2021. Your inquiry is  written on behalf of ****** ******************. The issue is pertaining to the processing of her claims  for mammography services she underwent on August 25, 2021.  

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a  Member’s Protected Health Information (PHI) may only be released to an authorized representative.  Capital BlueCross has no authorization on file from *** ******************, which permits us to release  any information directly to you; therefore, Capital BlueCross will send a response directly to ***  ******************, regarding this issue, once our review has been completed.  

  If *** ****************** would like Capital BlueCross to send a response directly to you/The Better Business Bureau, we will need her to complete and return the enclosed Capital BlueCross Member Authorization Form (MAF) advising we are permitted to release her PHI directly to your office.  

  Thank you for your patience while your inquiry was under review. If you have any question regarding this issue, you may contact me directly at ************.  
  

  Sincerely,  

  Angela A********  
  Senior Expedited Inquiries Analyst

• Initial Complaint

  09/01/2021

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  On 8-9-2021 while shopping health insurance, i happened upon a insurance company (Capital Blue Cross) to find rates for me and my spouse. I never completed the process (at least willingly i didnt) and wound up with a policy without consent. The policy takes effect today, and the monthly premium is 1,575$.I just called to cancel this policy today, and Capital Blue Cross states that there is a "process" that can take up to 3 weeks for cancellaton, and that I am responsible to pay said premium until they decide when to cancel it within the 3 week time period. I absolutely let them know that I would only be paying for the premium earned today, and they said i would be billed according to their policies. This is blatantly UNFAIR!!!

  Business response

  09/09/2021

  September 9, 2021 

  Dear ******* *******: 
  

  I'm writing in response to your letter, which we received on September 8, 2021. Your inquiry is written on behalf of **** * ******. The issue is pertaining to *** *****s' contract dispute and dissatisfaction with Capital Blue Cross process for policy cancellation requests. 

  In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a Member's Protected Health Information (PHI) may only be released to an authorized representative. Capital Blue Cross has no authorization on file from *** ******, which permits us to allow you to act as his representative and release any information directly to you; therefore, Capital Blue Cross will send a response directly to *** ****** regarding this issue once our review has been completed. 
  If *** ****** would like Capital Blue Cross to send a response directly to you at The Better Business Bureau, we will need him to complete and return the enclosed Capital Blue Cross Member Authorization Form (MAF) advising that you may act as his representative and that we are permitted to release his PHI directly to your office. 

  Thank you for your patience while your inquiry was under review. If you have any questions regarding this issue, you may contact me directly at ###-###-####. 
  

  Sincerely, 
  

  Victoria O.

  Expedited Inquiries Triage Coordinator

*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. ↩