Business Profile

Health Insurance

Highmark Blue Cross Blue Shield

Headquarters

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Complaints

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

Customer Complaints Summary

118 total complaints in the last 3 years.
35 complaints closed in the last 12 months.

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Submit a Complaint

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:04/29/2025
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.
In December 2024, I enrolled in my employer's health plan administered by ********************. I filled a medically necessary, name-brand contraceptive prescription through Express Scripts (the required vendor) with $0 cost-sharing, consistent with ACA requirements. I have used this medication for years with Highmark and have always followed their medical necessity approval process. It has always been covered at $0, regardless of plan design or formulary coding.When I attempted to refill the same prescription in February 2025, I was told I would owe $278. On 2/19/25, I contacted Express Scripts. On 2/20/25, 3/7/25, and 3/21/25, I contacted Highmark and was repeatedly told the medication would not be covered without cost-sharing due to plan designspecifically because it was a brand-name drug. I explained this violated ACA protections, which require zero cost-sharing when a provider deems the medication medically necessary.I had to push multiple times just to obtain the exception form. My doctor completed and submitted it. Highmark later confirmed verbally that the exception had been approved, recognizing the medical necessity. Despite this, Express Scripts continued to show the $278 charge.When I contacted Highmark again, I was told that even though the exception had been granted, I would still have to pay the full cost because it was a brand-name medication. This directly violates the **** which prohibits cost-sharing once medical necessity has been establishedregardless of branding or formulary tier.I submitted a formal appeal on 3/27/25. Highmarks 4/7/25 response upheld their decision but did not acknowledge the *** requirement for zero-dollar cost-sharing for medically necessary contraceptives. It failed to correct the issue or explain how their position complies with federal law. Ive spent hours contacting Highmark, Express Scripts, my provider, and my employer with no resolution.
Business Response
Date: 05/07/2025
May 7, 2025
******** ******
The Better Business Bureau
**************************
******************
Re: 23263186

We are in receipt of your letter dated April 29, 2025, regarding the above referenced
complaint.
Please be assured that we have reviewed the record completely in responding to this
complaint. However, we are limited in our ability to provide specific medical, pharmacy,
and customer ********************** interactions due to protections detailed in privacy standards
established under the Health Insurance Portability and Accountability Act (HIPAA).
Because the complainant enrolled in a new policy in December 2024, the original approved
authorization did not transfer to the new group. It is recommended that her physician
submit a new authorization for the complainants current group coverage. An approved
authorization for her current group coverage should resolve the issue she is having.
Sincerely,
***** *.
Highmark Inc.
Regulatory and Executive Inquiries
Initial Complaint
Date:04/28/2025
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.
Was using Highmark BlueCross BlueShield for years. I had my premiums coming off my credit card automatically every month. For some reason, Highmark took me off auto payments and did not tell me. Premiums went unpaid because of this. I was not notified why this happened. When I brought it to their attention, I got no answers and was kicked off my plan. I changed addresses well over a year ago and told them but they still have not corrected it. Zero answes as to why I was kicked off of automatic payments and now I have no health insurance because of it. ******** ****** told me I couldnt be reinstated but couldnt tell me why.
Business Response
Date: 05/06/2025
May 6, 2025
******** ******
The Better Business Bureau
**************************
******************
Re: Complaint ID ********
Dear Ms. ************* are in receipt of your letter dated April 28, 2025, regarding the above referenced complaint.
Please be assured that we have reviewed the record thoroughly in responding to this complaint.
Unfortunately, we are limited in our ability to provide the Better Business Bureau (BBB) with
certain details surrounding the members billing and customer ********************** interactions due to
protections detailed in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).
However, we can confirm that the complainants policy terminated in accordance with the
guidelines set forth by the *************** Act. Highmark did not remove the complainant from
automatic payment because he set his account up for recurring payments and noted a date that he
wanted the recurring payments to end. The complainant also stated that his address changed, and
Highmark did not change it in their system. Highmark is not able to change or update the addresses
for members who enroll through the Marketplace. These members must contact the Marketplace
and update any address change.
Should you have any further questions regarding this complaint, please do not hesitate to contact
me.
Sincerely,
***** *.
Highmark Inc.
Regulatory and Executive Inquiries
Customer Answer
Date: 05/12/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Regards,

***** *********
Initial Complaint
Date:04/17/2025
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 have been contacting Highmark since 12/30/24 was my first phone call to them. I ask that they remove my husband from my account. They stated they would send me a change from within ***** hours. I never received the form. I then called back 2 weeks later and the same thing was told to me i would receive the form in ***** hours. It is now 4/17/25 and they are still taking $183 out of my account for my husband insurance who is no longer on my Insurance.
Business Response
Date: 04/27/2025
Dear Ms. ***************** are in receipt of your letter dated April 17, 2025, regarding the above referenced complaint.

Please be assured that we have reviewed the complaint thoroughly before responding to this Complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

Our records indicate the members spouse was removed from the plan retroactively to January 1, 2025, thus changing the plan to an individual account. Please recognize that updates to our membership files and billing accounts are managed in two separate departments. I have confirmed that the members billing was also updated to an individual account.

However, due to the timing of the approval and the subsequent update to the billing account, there is now a credit balance on the members account which will automatically be applied towards future premiums unless a refund is requested. If the member chooses to request a refund, the member will need to contact Customer ********************** to request.

Should you have any further questions regarding the complaint, please do not hesitate to contact me.

Sincerely,

*********** ******-********
Executive Regulatory Inquiries
Customer Answer
Date: 04/28/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I receive premium payment from my work. They pay my premium, so no I do not want my refund to go to my premium. I work with Take Command for them to handle my premium. I want a refund for any and all of the money that Highmark has taken from my paycheck.

******** ********
Business Response
Date: 05/08/2025
May 8, 2025

Better Business Bureau
******************************************************************************************************
Attn: ******** ******

RE: Complaint ID: ********
Dear Ms. ***************** are in receipt of your letter dated April 28, 2025, regarding the above referenced complaint.

Please be assured that we have reviewed the complaint thoroughly before responding to this Complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

As noted in my original response, the member needs to contact Customer ********************** if she is requesting a refund.

Should you have any further questions regarding the complaint, please do not hesitate to contact me.

Sincerely,

*********** ******-********
Executive Regulatory Inquiries
Initial Complaint
Date:04/12/2025
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.
My work changed to this health insurance in January 2025 and I have been denied a medication Ive been on for over 8 years. My doctor sent in all the required paperwork 3 times explaining how I meet the criteria. My HR at work finally received a letter stating that it has been approved and then I began receiving a 30 day supply instead of the 90 day she requested. Now I have received a phone call from them to call them so I did and now its been denied again! They are making this so difficult and going back and forth with this its not right. Every thing that they have asked for my doctor has given them.
Business Response
Date: 04/22/2025
April 22, 2025
Better Business Bureau
*******************************
******************
Attn: ******** ******
RE: Complaint ID: ********
Dear Ms. ***************** are in receipt of your letter dated April 13, 2025, regarding the above referenced complaint.

Please be assured that we have reviewed the complaint thoroughly before responding to this Complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

Our records indicate this plan administered by HealthNow Administrative Services. While we do not have access to their files, I was able to confirm that the members prescription benefits are administered by another carrier.

Should you have any further questions regarding the complaint, please do not hesitate to contact me.

Sincerely,

*********** ******-********
Executive Regulatory Inquiries
Initial Complaint
Date:03/26/2025
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.
For the office visits on 01/12/2023 and 01/16/2023, these were regular office visits. They were initially classified as regular office visits and Highmark Blue Cross Blue Shield made the appropriate claim payment. I also paid my office co-pay of $20.00 per visit. Highmark Blue Cross Blue Shield revoked payment for these two visits and now the provider is sending me a bill. Please send back the payments for these claims to the provider.
Business Response
Date: 04/03/2025
We are in receipt of your letter dated March 27, 2025, regarding the above referenced
complaint.

Please be advised that we have reviewed the record thoroughly in responding to this
complaint. However, we are limited in our ability to provide the Better Business Bureau
(BBB) with details of the claims in question due to protections detailed in the privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

Nevertheless, we can confirm that the claims were originally submitted by the provider and
the provider submitted corrected claims, which changed the benefit under which they
processed. The provider was paid the correct amount based on the way the corrected claims
were submitted and processed. The most recent Explanations of Benefits (EOB) explain
how the claims processed. Unfortunately, the appeal time frame to file an appeal has
exhausted for both claims, as members have 180 days to submit an appeal from the date of
the adverse determination. This information was listed on the EOB.

If the complainant has any questions regarding the manner in which the claim processed,
please have him contact Highmarks Customer ********************** Department at **************.

Sincerely,

***** *.
Highmark Inc.
Executive and Regulatory Inquiries
Customer Answer
Date: 04/03/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I never received the updated EOB and I was only made aware of the balance owed when the provider sent me a bill. The bill shows that Highmark Blue Cross Blue Shield on 11/27/2024 changed the claim payment amount. I am still within the 180 day period for an appeal.
Business Response
Date: 04/15/2025
We are in receipt of your letter dated April 8, 2025, regarding the above referenced
complaint.
Please be advised that we have reviewed the record thoroughly in responding to this
complaint. However, we are limited in our ability to provide the Better Business Bureau
(BBB) with details of the claims in question due to protections detailed in the privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).
Unfortunately, the appeal time has exhausted. The change to the claims was based on
updated information received from the provider. Highmark is unable to pay any more on
the claims. The complainant might want to reach out to the provider to discuss payment
options.
If the complainant has any questions regarding the manner in which the claim processed,
please have him contact Highmarks Customer ********************** Department at **************.
Customer Answer
Date: 04/15/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Highmark Blue Cross Blue Shield violated my appeal rights, incorrectly processed my claim, and took money back from the provider without notice leaving me stuck with the bill. They took the money back from the provider after the claim appeal deadline to purposely leave subscribers with inflated bills to pocket more profits. This is nothing but a scam company with horrible service!
Initial Complaint
Date:03/08/2025
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 am formally lodging a complaint against Highmark for a series of egregious errors and failures that have left my fiance and me without health coverage despite our diligent efforts to enroll and pay for a policy. This experience has not only caused undue stress but also placed us in a precarious position without access to essential ************* December 2024, I contacted Highmark to enroll in a health insurance policy for 2025. I clearly communicated the specific plan I wanted to a customer ********************** representative. However, due to an apparent administrative error, I was enrolled in the wrong plan. Upon realizing this mistake, the representative assured me that she had corrected it, but in hindsight, it appears no action was ever takenor if it was, it was not executed properly.Despite making the timely payment, neither my fiance nor I ever received Member ID cards. Instead, we received a letter stating that our policy had been canceled before we had even received any proof of enrollment or benefits.I immediately contacted Highmark and spent hours being transferred between representatives, with no one providing clear answers or solutions. After much persistence, I finally reached an associate who seemed to understand the severity of the situation. She assured me that she would personally investigate the issue and correct our enrollment. She also promised to keep me updated.However, her follow-through was woefully inadequate. She called once after a week to ask additional questions but then disappeared entirely. Then I received another letter from Highmark stating that we were enrolled and that Member ID cards were forthcomingbut, once again, they never arrived. After weeks of waiting and hearing nothing, it became clear that Highmark had failed to resolve the issue.Because of Highmarks negligence, my fiance and I have been left without health coverage despite our good-faith efforts to enroll and pay for a policy. This situation is wholly unacceptable.
Business Response
Date: 03/18/2025
We are in receipt of your letter dated March 8, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and Accountability
Act (HIPAA).

Nonetheless, we can confirm that the complainants account has been reinstated due to the
confusion surrounding the enrollment process the complainant experienced.

Should you have any questions regarding this complaint, please do not hesitate to contact
me.

Sincerely,

*. *****
Highmark Inc.
Regulatory and Executive Inquiries
Initial Complaint
Date:03/07/2025
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.
A patient with highmark insurance in ********* lives in Pennsylvania, and claims must be submitted to highmark in Pennsylvania. When I call *********, they can see the patient exists but not the claims. When I call Pennsylvania, they won't even connect me to a person because the system doesn't recognize the member id. Consequently they are refusing to provide health insurance and access to care to a paying member. I've spent hours on the phone with them. The last *** who i just got off the phone with hung up on me, refusing to connect me with a supervisor to discuss my concern about the patients access to care and my ability to access a competent human to resolve this. The claim review process is 30 days for a patient who needs weekly psychotherapy, so they would rack up another $800 in bills on that time, on top of the current $720, waiting to hear of highmark will honor the insurance coverage. I have confirmed the patient is eligible for coverage of your treatment. I'd like additional $200/hour reimbursement from highmark for my time calling them to get them to do their job, totalling $800 thus far
Customer Answer
Date: 03/07/2025
I cannot disclose the patient's name because of confidentiality. For highmarks ability to respond, ID is **************. I am the owner of the practice and supervisor of the patient's therapist who works under my license.
Business Response
Date: 03/17/2025
We are in receipt of your letter dated March 7, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. However, we are limited in our ability to provide the Better Business Bureau
with details of the provider service interactions due to protections detailed in privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

Nonetheless, we can advise the complainant that Highmark has implemented a new
provider service model. There is no longer a direct point of contact for providers, and they
are to utilize the self-service tools that are available such as Availity and Highmarks
Provider **************** ******** is the resource for providers to use for getting
assistance with claim denials. The following web address with assist the complainant with
issues he might have concerning his claim issue:
*****************************************************************************************************************************.

Should you have any further questions regarding this complaint, please do not hesitate to
contact me.

Sincerely

C *****
Highmark, Inc.
Regulatory and Executive Inquiries
Customer Answer
Date: 03/17/2025
Highmark says they have a new provider process that involves using self-help, electronic tools. This means they are not helping providers. The entire issues is that I utilized and exhausted these resources and they did not work. Basically their policy is that they won't help providers beyond this point. *** had to hire a third party company that charges 6% per claim even though I already pay for claims processing on my electronic health record. If Highmark doesn't want to pay for their member's health services, requiring I need a third party company, then they need to reimbursement for this.

I wanted to add some details. This complaint is only in part about the individual client and payment for services, but more-so about the customer care and inability for me, as a private practice provider, or members to resolve the issue.

I'm having the same issue again with Highmark, this time the person's insurance is in Washinton state, ID **************. I've followed all the guidelines: I asked the patient to call their benefits number prior to starting services to confirm eligibility, my EHR checks eligibility but it takes longer to confirm than the amount of time to start care, there is no reason she should not be eligible, but like the other patient, I cannot find her info on Highmark / BCBS provider portal (through Availity), and I cannot get through to a human on the phone either calling the PA highmark line or the number on the back of her card.
Business Response
Date: 03/28/2025
We are in receipt of your letter dated March 18, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. However, we are limited in our ability to provide the Better Business Bureau
with details of the provider service interactions due to protections detailed in privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

We understand the complainants concerns regarding obtaining patient information.
However, if the patient is not a Highmark member, calling Highmarks Provider Service
Department will not assist, as we do not have member information on non-members.

Additionally, the only way Availity would have the information was if the patients home
plan also uses Availity. It is important to remember when doing a claim investigation via
Availity, there are three levels of investigation, doing the same level multiple times will
not result in a more concise answer, providers must use the system as it was designed, and
that information is available on Highmarks ************************ as previously stated.

Should you have any further questions regarding this complaint, please do not hesitate to
contact me.

Sincerely
C *****
Highmark, Inc.
Regulatory and Executive Inquiries
Customer Answer
Date: 03/28/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
The members in question are highmark BCBS members. I have images of their member ID. The member benefits number acknowledges them as members, but cannot see the claims from another state. But PA highmark does not recognize the member ID numbers and the robot on the phone hangs up, refusing to connect to a human. This is a glitch in highmark's system.

Regards,

*** **********
Business Response
Date: 04/06/2025
We are in receipt of your letter dated March 28, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. However, we are limited in our ability to provide the Better Business Bureau
with details of the provider service interactions due to protections detailed in privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

We understand the complainants concerns regarding obtaining patient information. As
previously stated in the initial response on March 7, 2025, there is no longer a direct point
of contact for providers, and they are to utilize the self-service tools that are available such
as Availity and Highmarks ************************* Availity is the resource for
providers to use for getting assistance with obtaining benefits and eligibility and claim
denials. The following web address with assist the complainant with issues he might have
in obtaining member benefit and/or claim issues:
*****************************************************************************************************************************.
Highmark members as well as other Blue Cross Blue Shield members whose carriers utilize
Availity will be available through the site. Our records indicate that the complainant is
Availity enabled. Therefore, it is strongly recommended that he utilize the provider portal
to obtain the necessary information. If he has is unable to find the necessary information,
he can submit messages through Availity.

I apologize for the inconvenience this may cause the complainant, but I am unable to
change the solution. While it may take some time to because acclimated with the system,
we believe it will become an asset once it is learned.

Sincerely

C *****
Highmark, Inc.
Regulatory and Executive Inquiries
Initial Complaint
Date:02/27/2025
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 have been trying to get an in network exception for my daughters therapist since January 2nd, 2025 for her eating disorder. I only get the run around as I call almost every other day for an update. I asked for return calls and I never get one. I am also working with a supervisor, who never calls me back, makes constant excuses, example she dialed my number wrong. My daughter is not getting the treatment she needs. Now they are saying 4-6 weeks.
Business Response
Date: 03/08/2025
We are in receipt of your letter dated February 27, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the complaint thoroughly before responding to
this Complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

While we understand the members concern about the length of time her request for a
network exception is taking, please consider all requests of this nature must be reviewed
by our Medical Review team. In addition to reviewing for medical necessity, the team must
also rule out that the service is unable to be performed by an in-network provider.

If it is determined that in-network providers are available who can provide the services, the
names/practice would be provided to the member in the determination letter in addition to
appeal rights.

If the member has any question, please have the member contact their Customer **********************
Department at **************. If you have any questions, please contact me directly.

Sincerely,

*********** ******-Sullivan
Executive Regulatory Inquiries
Initial Complaint
Date:02/05/2025
Type:Product 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 made two payments on 1/31 for health insurance for the month of february through ******. both plans were cancelled but yet the company cannot locate these payments to refund me. i have payment confirmation, proof the plans were cancelled and proof the charges were made on my bank account and on my credit card. I want a refund since these plans were cancelled and i want to know why you can't find my payment information.
Business Response
Date: 02/12/2025
We are in receipt of your letter dated February 5, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with specific policy details due to protections detailed in privacy standards
established under the Health Insurance Portability and Accountability Act (HIPAA).

Nevertheless, we can confirm that the complainants payments have been removed from
the unapplied cash account and are in the process of being refunded to her. She should
allow two to three weeks for receipt of the payment.

Should you have any further questions regarding the complaint, please do not hesitate to
contact me.

Sincerely,

***** *.
Highmark Inc.
Regulatory and Executive complaints
Initial Complaint
Date:02/02/2025
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.
About May, 2024 I submitted a claim for durable medical equipment for reimbursement under my contract along with a copy of the insurance form, copy of the prescription and copy of the invoice showing my address where the equipment was delivered. The claim was denied stating it did not show my address which was clearly shown on the invoice. I have called several times and the claim has been assigned ref. LVI5506845 end of 2024 but still has not been resolved. I've been calling **************, spoke with ****** on 9/Dec/2024 at 10:00 AM EST, again with ****** on 12/Dec/2024 at 01:24 PM EST and was informed my claim "is still pending". It has been almost 8 months and this issue has not been resolved. Note the amount claimed for process was $499 and coverage should be 70% or $350 which is substantially less than the cost had I rented the equipment. I had to replace a CPAP machine which had reached end of life. For reference my member ID was ************ and my employer was (now retired) ******.
Business Response
Date: 02/21/2025
We are in receipt of your letter dated February 3, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with claim and customer ********************** interaction details due to protections
detailed in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

However, we can confirm that we have the sent the claim for adjustment. Unfortunately,
we have run into some delays that are not related to previous delays. We are continuing
to work to have the issue resolved so the claim can be adjusted. Should there be any
additional issues, we will reach out to the complainant to advise.

Should you have any further questions regarding the complaint, please do not hesitate to
contact me.

Sincerely,

***** *.
Highmark Inc
Regulatory and Executive Inquiries
Customer Answer
Date: 03/03/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I received the following letter (copy attached) from Highmark BCBS requesting additional information on my claim. They also requested I include a copy of their letter in my response. I sent a copy of their letter, my letter I composed (also attached), a copy of the receipt from DirectHome Medical and a copy of the prescription with the information requested highlighted. Let's hope this results in a final resolution of my complaint. Thank you for your time and consideration.

Regards,

******* *******
Business Response
Date: 03/10/2025
We are in receipt of your letter dated March 3, 2025, regarding the above referenced
complaint.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. Unfortunately, we are limited in our ability to provide the Better Business
Bureau (BBB) with claim and customer service interaction details due to protections
detailed in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

We can confirm that the complainant’s claim has been adjusted. He will need to allow three
to four weeks for the claim to finalize. If he is not satisfied with the adjustment, he has the
right to file an appeal. The appeal information will be included on the Explanation of
Benefits he will receive once the claim has finalized.

Should you have any further questions regarding the complaint, please do not hesitate to
contact me.

Sincerely,

Cassy L.
Highmark Inc
Regulatory and Executive Inquiries

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