Complaints

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

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• 

  Highmark Blue Cross Blue Shield

  120 5th Ave Pittsburgh, PA 15222-3000

• 

  Highmark Blue Shield, Inc.

  1800 Center St Camp Hill, PA 17011-1702

• 

  Highmark Blue Shield, Inc.

  1800 Center St Camp Hill, PA 17011-1702

• 

  Highmark Blue Shield, Inc.

  1800 Center St Camp Hill, PA 17011-1702

• 

  Highmark Blue Cross Blue Shield

  218 Summit Park Drive Pittsburgh, PA 15275

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:12/15/2022

  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.

  Highmark Blue Cross Blue Shield gives blue cross a bad name. This subsidiary is incompetent and inept. I have had multiple instances of improper billing. Received apologies, yet improper billing keeps happening. Also their customer service lines are inefficient and ineffective with unacceptable wait times. They ask for call back numbers and yet don’t call back. Or you get connected to a department that does not even apply to your case. Received an approval for a medication. No further assistance. They do not sent it to the pharmacy or the script that they have from the MD. They do nothing for the client. God forbid if I was elderly and unable to manage these things. Blue cross has never been like this in my past experiences. Highmark is unfortunately the only choice I have given to me. Would not choose if had a choice.

  Business Response

  Date: 12/22/2022

  Based on our review, Complainant currently has active coverage as of January 1, 2022. Our documentation does not reflect any calls with Complainant within the last year. Highmark BCBSWNY cannot confirm the length of time that Complainant may have been on hold while trying to reach us. However, Highmark BCBSWNY is converting a large membership to a new eligibility and claims processing platform, contributing to a larger call volume than usual. Unfortunately, without more information we are not able to confirm that Complainant has claim issues. 
  
  Highmark BCBSWNY does not forward prior authorization approvals or scripts to pharmacies because the prescribing physician and member receive an approval/denial notice. However, once a prior authorization is approved and loaded into the Express Scripts processing system, the medication claim will attach to the prior authorization approved allowing the pharmacy to fill the prescription.
  
  We encourage Complainant to contact the number listed on the back of her ID card for further assistance. 

• Initial Complaint

  Date:12/13/2022

  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.

  Today is 12/13/2022 and I am currently on hold with Highmark BCBS trying to get a PA and it is now 2 hours and 43 minutes and I am STILL ON HOLD. This is highly unacceptable and how are any providers even able to work like this. Highmark requires prior auth for everything but the clearly do not have the adequate or equipped to even take on auth if wait times are this long! How about get rid of auth until a certain amount of visits so providers aren't spending the whole work day on hold. I have to run mu duties but can not fully because of this HORRIBLE process! Something needs to be done about this! And looking at previous complaints this is always a problem!

  Business Response

  Date: 12/21/2022

  
  
  Good morning,
  
   
  
  Can you please tell me if this is a provider and if so who are they?  I would like to respond, but I need more than a first name and the first initial of their last name.  I appreciate it.
  
   
  
  Thank you!

  Customer Answer

  Date: 12/21/2022

  Hello Full name is ******** ******, I am a manager at a providers office for therapy services for ********  ** **** ***** *******

  Business Response

  Date: 01/03/2023

  We are in receipt of your letter dated December 13, 2022, regarding the above referenced complaint. 

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

  
  Nevertheless, we can confirm that certain procedures do require authorization and to obtain that, providers need to reach out to Highmark or one of the third-party utilization management companies Highmark utilizes to obtain the necessary authorization. Highmark also has Provider Resource Centers for providers which houses a great deal of provider information. Because we do not know the Highmark region the provider is speaking of, I am unable to give the exact web address for the Highmark location in question. However, https:/******************.com is the site for western Pennsylvania groups. There is a link on the site for authorizations, which may be especially helpful for this provider. 

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

  
  Sincerely, 
  Cassy M***** 
  Regulatory and Executive Inquiries 
  

  
  

  Customer Answer

  Date: 01/04/2023

  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.
  

  
  

  Clearly my complaint was not addressed properly. Of course I now autorization is required the number I called is where I was trying to get authorization in the first place. The complaine is the WAIT TIME! Why am I on hold for over 2 hours at a time with still no rep picking up. This is bad for patients who need services! Please address you very long wait times! 
  
  Regards,
  
  ******** ******

  Business Response

  Date: 01/10/2023

  We are in receipt of your letter dated December 13, 2022, regarding the above referenced
  complaint.

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

  
  Nevertheless, we can confirm that certain procedures do require authorization and to
  obtain that, providers need to reach out to Highmark or one of the third-party utilization
  management companies Highmark utilizes to obtain the necessary authorization.

  
  Highmark also has Provider Resource Centers for providers which houses a great deal of
  provider information. Because we do not know the Highmark region the provider is
  speaking of, I am unable to give the exact web address for the Highmark location in
  question. However, https********************.com is the site for western
  Pennsylvania groups. There is a link on the site for authorizations, which may be
  especially helpful for this provider.

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

  
  Sincerely,
  Cassy M*****
  Regulatory and Executive Inquiries
  Highmark Inc.

  Business Response

  Date: 02/13/2023

  We are in receipt of your letter dated January 6, 2023, regarding the above referenced
  complaint.

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

  
  Highmark’s Provider Escalation Department has reached out to the complainant to offer
  assistance. The complainant seemed appreciative of the outreach.

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

  
  Sincerely,

  
  Cassy M*****
  Regulatory and Executive Inquiries
  Highmark Inc

• Initial Complaint

  Date:12/01/2022

  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.

  After a year of taking a prescribed medication with authorization from medical doctor and Highmark coverage was rejected. Attempts to remedy and get authorization again by medical doctor for weeks of November 14th and 21st were denied on 11/22/22 for unknown “criteria.” Third call to Highmark on 12/1/22 is still unresolved. I filed a grievance (appeal) on 12/1/22 with Highmark and was told that it would take 30 days. I am now 3 weeks overdue for my medication. Medication is testosterone cypionate (200 mg) which I understand I will need to take for the rest of my life. Apparently I will need to “jump through hoops” annually to get this authorization. Highmark has no supervisors or managers available to escalate this to and won’t transfer me to “authorization” department to resolve.

  Business Response

  Date: 12/09/2022

  This is in response to your inquiry sent on behalf of the member identified by case ID
  ******** concerning the denial of a prescribed medication.

  
  Certain medications require a Prior Authorization and specific medical criteria must be
  met before an approval is granted. Once approved, an authorization will be placed on file
  with a start and end date. Please recognize that once an approval is granted, it is not open
  ended, as we do verify that members continue to meet medical criteria to continue with
  the medication.

  
  Our records indicate that while this member had previously been approved for the
  medication in question, the approval had expired after a year. Current clinical information
  was requested from his physician. Our records show the information was received and a
  new approval has been noted in his files. As with the prior approval, the current approval
  will be good for a year from the date of approval.

  
  If the member has any questions concerning his coverage, please have him contact our
  Customer Service Department at ###-###-####. If you have additional questions, please
  contact me directly.

  
  Sincerely,
  Margueritte M**************
  Executive Legislative Inquiries

  Customer Answer

  Date: 12/16/2022

  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.
  
  Although the prescription was finally approved, this does not remedy the month-long delay in getting this drug filled. This seems to be a pattern, as I had this happen earlier this year after I had total knee replacement surgery and urgently needed to fill my refills for hydrocodone. I ended up paying full price to get the prescription filled in a timely matter. Waiting a month was not an option. This second denial (May 2022) was with a different doctor and different medicine.

  We have four entities involved: patient (me), pharmacist, doctor, and insurance company (Highmark). The details of requirements imposed by Highmark are unknown to me (such as yearly approval, or drug monitoring program/PDMP). I am at a loss on ho=w to fix the root cause because I am not in the medical field.

  If re-approval is required, then that should be initiation BEFORE the prescription is needed. If I, the pharmacist, and the prescribing doctor do not know of the approval requirements prior to the next prescription request, as happened in the two denials cited, then Highmark should be initiating those approval requests before they are urgently needed. I would pose that it should be initiated when the last eligible prescription is filled and before the request for the next refill.

  Additionally, the requirements should be obvious, even detailed in a request form by the insurance company so that the doctor or pharmacist does not have to guess what the insurance company needs before it is denied for lack of "criteria." 

  This incident is corrected, but the systemic (root) problem is not.

  Kind regards,
  

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

• Initial Complaint

  Date:11/21/2022

  Type:Customer Service 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 a mental health provider in upstate nee york and am required to send bills for out of state Blue Cross patients through the local Bc/BS Plan which was BC/BS of NENY and is now Highmar. I have been told z since September 1,2022 that , due to a system error, claims cannot be paid. 3 months later this is dtill the case. That is if you can even get someone onn the line. Thr average wait time is 45 minutes! This is I nbelievable. Thats all the info i can get,.supervisors dont call back and providrr services says"not my department. Ive never seen anything like this in v 50 years.. Filing a complaint with the NYS Department of finance. Help.

  Business Response

  Date: 12/09/2022

  This is in response to your inquiry sent on behalf of the provider identified by case ID
  ******** concerning the processing of claims and contact to Provider Services.
  Our records indicate that this provider practices in New York, and as an in-network
  provider he would need to contact the local Blue Cross Blue Shield Plan in which he
  provides services.

  
  However, I understand that he is advising he has been dissatisfied with his contact to his
  local Provider Service Department. Therefore, upon receipt of your inquiry, I did forward
  his concerns to our contacts at Highmark Western and Northeastern New York. I have
  been advised that they have attempted to contact him to assist him with questions
  pertaining to his claim submissions.

  
  If you have additional questions, please contact me directly.

  
  Sincerely,
  Margueritte M**************
  Executive Legislative Inquiries

  Customer Answer

  Date: 12/12/2022

  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 have discussed the situation numerous times with both provider services and blue card department. No one can tell me when this will be resolved if ever.

  Also, the parent company is telling me in their rrply that i contact and go through the local insurance provider which i have donne. I'm being yold there is a systproblem SINCE AUGUST!  This is outrageous  ,causing customers/clients to drop out of treatment and consider alternative insurance providers.

  I'm filing a formal complaint with the NYS department of finance and considering going to the local media..

  The fact that the parent company provides no effective solution nor help is unconscionable. 

  Thats why i am not accepti n g the explanatio 
  
  

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

• Initial Complaint

  Date:11/11/2022

  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.

  I am trying to reach the health plan Highmark bcbs out of PA. I need to get an prior authorization for a patient to have a procedure. I have set on hold for 4 hours and still no one has answered the phone. This is unacceptable for any business. An insurance company could jeopardize a patients life by delaying diagnosis for care.

  Business Response

  Date: 11/14/2022

  This is in response to your inquiry sent on behalf of ***** ****** of a provider’s office
  concerning being unable to contact Highmark to request an authorization for a patient.

  
  Since no identifying information was provided for the patient, I attempted to contact Ms.
  ****** on November 11, 2022 due to the urgency of her request. However, I received a
  voice message that indicated that the office was closed for the day. Therefore, I contacted
  the office today and was able to confirm patient information. I advised Ms. ****** that I
  would relay the request to the appropriate area.

  
  Please recognize that the patient’s employer plan has opted to utilize Third-Party
  Administrator, Quantum Health to manage Provider Service inquiries as well as Care
  Management for their employees. Once Quantum Health was notified that the provider
  was contacting Highmark in error, they contacted the provider to offer assistance. It
  should be noted that this information is listed on the back of the patient’s identification
  card.

  
  If Ms. ****** has additional questions concerning this patient’s coverage, please have her
  contact Quantum Health at ###-###-####.

  
  Sincerely,
  Margueritte M**************
  Executive Legislative Inquiries

• Initial Complaint

  Date:10/17/2022

  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.

  Highmark's medicare supplement marketing department will not update their contact information. They have my father-in-law **** * *****, who died in 2012, confused with my husband (**** * ***** **). Despite repeated requests to correct this information, during medicare enrollment periods we continue to recieve marketing materials.

  Business Response

  Date: 11/07/2022

  This letter is in response to the correspondence received by Highmark Blue Cross Blue Shield on October 17,2022 regarding a complaint concerning the above named. Ms. ***** states that she, her husband, and her deceased father-in-law are receiving unwanted mailings from the plan. 

  
  Please be advised we have informed the appropriate contacts to remove these individuals from our market mailing list. 

  
  If you have any further questions, you may contact me directly at ###-###-#### Monday through Friday from 8:00 a.m. - 4:30 p.m. 

  
  Sincerely, 
  Jo L. 
  Executive Inquiry Resolution Highmark, Inc.

  Business Response

  Date: 11/11/2022

  
  This is in response to your inquiry sent on behalf of the member identified by Case ID
  ********.

  
  We reviewed our internal system account and there is no active contract. A request was sent to
  stop all mailings to complainant immediately.

  
  If the member has any questions concerning this coverage, please have her contact our
  Customer Service Department at ###-###-####. If you have additional questions, please
  contact me directly.

  
  Sincerely,
  Morgan * Y****
  Executive Legislative Inquiries

• Initial Complaint

  Date:09/13/2022

  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 elected to have HighMark BCBS via my employer in July of 2022. On August 24th, 2022 I was prescribed a medication by my doctor. The medication required pre-authorization. My doctor has sent in the requested information multiple times, yet I have been unable to fill my much-needed prescription. Whenever I contact customer service, I am placed on hold for at least 40mins. When the call is finally connected, I am re-routed to another area requiring an additional wait of 40mins or more. I have contacted HighMark nearly every day since August 24th and to date I still am without my medication. I have requested to file a grievance with customer service staff and the agent spent a half hour telling me why "I need to wait" or there are "other options", yet not providing me with any. I have requested a reference number for the call and grievance I was assured was filed but I am never provided with one. The call will be transferred without response of "becomes disconnected." I would like to receive a response regarding my preauthorization. This is the worst insurance company out there. They are consistent with taking monies to cover the costs for services they consciously not providing. Instead of being a proponent of wellness this insurance companies acts in contradiction of it. As soon as open enrollment becomes an option I will no longer deal with this company. In my option this insurance company requires investigation an ongoing monitoring.

  Business Response

  Date: 10/11/2022

  Good afternoon,
  
   
  
  First please let me apologize that an email or response wasn’t sent to you timely.  We did complete this investigation back on 9/19/22.
  
   
  
  We were able to get her authorization approved.  We also contacted the pharmacy to have the prescription processed and then contacted the member. The customer service representative left a voice mail message to let her know it was all set.
  
   
  
  Have a great day
  
  Becky
  
   
  
  Rebecca * S*******
  
  Manager | Member & Pharmacy Customer Service
  
  Highmark Western and Northeastern New York
  
  

• Initial Complaint

  Date:09/06/2022

  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.

  I recently received an Explanation of Benefits (EOB) that said you have denied coverage for my Cologuard® colorectal cancer screening test. My physician prescribed this test so that I can be appropriately screened for colorectal cancer. I am appealing your claims decision regarding my Cologuard test. 

  
  You denied payment for my claim based on a finding that this service is not a covered service under my plan. I believe this finding is inappropriately blocking my access to a preventive service mandated under the Affordable Care Act (ACA). 

  
  Cologuard is a non-invasive colorectal cancer sDNA screening test. Cologuard is intended for adults of either sex, 45 years or older, who are typical average-risk candidates for colorectal cancer (CRC) screening. It is not a diagnostic test. I can attest that I meet these requirements. I am over 45. My healthcare provider has indicated that I am at average risk for colorectal cancer. I am due for screening. I have not had another Cologuard test in the last three years. If you need a copy of medical records to substantiate my medical history, please advise. However, I do not understand why medical records are needed to show I am an average candidate for a screening test. 

  
  Under federal law, most health plans must now cover the Cologuard test without cost-sharing for average risk patients. Specifically, Section 2713 of the Public Health Service Act (the Affordable Care Act) requires non-grandfathered health plans to cover, without cost-sharing, items or services that receive a rating of "A" or "B" in a USPSTF recommendation, beginning with plan years starting one year after the recommendation. The U.S. Preventive Services Task Force (USPSTF) updated its recommendations on May 18, 2021 and the sDNA-FIT test continues to be one of the included screening strategies for patients at average risk for developing colon cancer. 2 Therefore, under federal law, most health plans are now required to cover Cologuard (the only currently available sDNA-FIT test). 

   
  Under federal law, plans may only use "reasonable medical management techniques to determine the frequency, method, treatment, or setting for [a recommended preventive service] to the extent not specified in the recommendation or guideline." 3 Under the terms of the regulation, plans may not use medical management techniques that exclude from coverage any method of CRC screening specified in the guideline. A health plan may use reasonable medical management techniques only within each method of CRC screening. While there are multiple test options within some of the identified screening methods (e.g., there are multiple fecal immunochemical test options), Cologuard is the only test option within the sDNA-FIT screening method identified in the USPSTF recommendation. Therefore, medical management cannot be used to block my access to the Cologuard test. 

  
  Additionally, under federal law, if a plan does not have an in-network provider who can provide the service described in the USPSTF regulation, the plan must cover the service when performed by an out-of-network provider and may not impose cost-sharing. Cologuard is a sole source test and is only available from Exact Sciences Laboratories. Under the ACA, if you do not have a network agreement with Exact Sciences, you have an insufficient network and are depriving me of access to this ACA-mandated preventive service test. When you have an insufficient network, you are required to treat my claim under my in-network benefits. 

  
  Based on my medical history and federal law, I believe your denial is incorrect and in violation of the law. If you insist on maintaining this denial, please provide me with an explanation as to why you believe the ACA does not apply to my claim and the plan language and medical policy upon which you are relying. Otherwise, I may refer my concerns to my state insurance commissioner. 

  
  Thank you in advance for your consideration.

  
  Sincerely, 
  ******* ********* 
  

  
  

  Business Response

  Date: 09/20/2022

  We are in receipt of your letter dated September 7, 2022, 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 service interactions due to protection detailed
  in privacy standards established under the Health Insurance Portability and
  Accountability Act (HIPAA).

  
  Nevertheless, we can confirm that we have forwarded the member’s appeal request to
  Highmark’s Appeal Department. Going forward when the member wants to file an
  appeal, he can file it with our Member Grievance and Appeals Department at the address
  on the EOB or by calling the phone number on the back of the member identification
  card. As part of that process, the member can seek relevant documents during the appeal
  and obtain relevant documents upon which the claim denial was based.

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

  
  Sincerely,
  Cassy M*****
  Highmark, Inc.
  Executive and Regulatory Inquiries

  Customer Answer

  Date: 09/20/2022

  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.
  
  Their fails to address any of my concerns.

  
  

  Cologuard is covered by my policy and Highmark avoids paying without any options other than to file a formal appeal.

  
  

  Their out of the country customer service fails to have the tools and knowledge to address customers concerns.

  
  

  Highmark hides behind behind a wall and their are zero options to have a simple discussion with a person who speaks english and has product knowledge.

  
  

  Highmark needs to step up and pay valid charges instead making their customers give up and pay legit out of pocket.
  
  Regards,
  
  ******* *********

• Initial Complaint

  Date:09/02/2022

  Type:Customer Service 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.

  Have been trying to contact Highmark BCBS Pa for the past few days for an authorization for surgery. On 08/29/22 I waited on hold for 3 hours no one ever answered. On 08/30/22 I attemped to call again, on hold for 45 minutes, no one answered. Attempted to call again today and was on hold 3 hours and 31 minutes and again no one answered. Patient's surgery is 09/06/22 and will not have to be cancelled due to not being able to obtain authorization. I 've also tried to fax authorization request and they still will not answer. At this point I'm not sure what to do. All we're trying to do is take care of our patients. this is so sad.

  Business Response

  Date: 09/20/2022

  We are in receipt of your letter dated September 2, 2022, 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 provider service interactions due to protections detailed
  in privacy standards established under the Health Insurance Portability and
  Accountability Act (HIPAA).

  
  Nevertheless, we can confirm that we correctly informed the provider regarding coverage
  under the relevant group health plan. We also contacted the provider upon receipt of the
  complaint and confirmed what they had previously been advised.

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

  
  Sincerely,
  Cassy M*****
  Grievance and Appeals Analyst
  Highmark Inc

  Customer Answer

  Date: 09/22/2022

  
  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:08/29/2022

  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.

  This unpaid claim is for Shingrix (Shingles Vaccine). I called BCBS 3x confirming that it will be covered. The reps give multiple excuses for why it wasn't paid. They commit to getting back to me and don't. There is no contact phone number for BCBS in the USA. They force you to speak with reps in the Philippines who can't speak or understand English. I asked to speak to a supervisor or a USA representative. They say there is none. This vaccine is covered by my plan. I should not be harassed or ignored in getting this taken care of. Please take care of this immediately or I will open a complaint with State of PA.

  Business Response

  Date: 09/20/2022

  We are in receipt of your letter dated August 29, 2022, 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 service interactions due to protection detailed
  in privacy standards established under the Health Insurance Portability and
  Accountability Act (HIPAA).

  
  Nevertheless, we can confirm that we correctly informed the member, but because of a
  coding issue, the claim denied. We are having it adjusted as an exception. Going
  forward when the member has a concern about the way a claim processed, he can file an
  appeal to our Member Grievance and Appeals Department at the address on EOB or by
  calling the phone number on the back of the member identification card. As part of that
  process, the member can seek relevant documents during the appeal and obtain relevant
  documents upon which the claim denial was based.

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

  
  Sincerely,
  Cassy M*****
  Highmark, Inc.
  Executive and Regulatory Inquiries