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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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:01/31/2025
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 was contacted by ******* at Creative Health and Spine (chiropractor) who does the billing with insurance for that company. I was informed by ******* that my wife's services were denied due to not having a prior pre authorization. I contacted customer ********************** at the number provided on the back of my insurance card and was told that a pre authorization form needed to be submitted in order for these claims to be paid. I worked with the customer ********************** *** who said the form that needed to be submitted in order for the claims to be paid. I coordinated with ******* and he stated he would submit the prior authorization. A few weeks later I was contacted by ******* who told me that the pre authorization form was canceled for some reason and the claims were denied. I contacted Highmark again and the customer ********************** *** told me that the reason it was cancelled was that the services **** received did not need authorization. So I was told something that completely conflicted what I initially was told when this issue was first addressed. I also had an overpayment on the account and was told that was taken care of and that I was ok as the last claim for meds covered the overpayment and that I would start getting reimbursed again for my meds that I purchase. I had another purchase and never received a check for that amount. It is just one problem after another with Highmark and you can't get anywhere with customer **********************.
Business Response
Date: 02/06/2025
We are in receipt of your letter dated January 13, 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 ********************** e interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and Accountability
Act (HIPAA).

However, we can confirm that the complainant was correctly advised that authorization is
required for chiropractic services. The provider has the option of submitting the
authorization request on the provider portal, Availity, or by calling Highmarks ****************************************** at ************. Providers may request authorizations
retroactively. I apologize for any information that was received incorrectly. Rest assured
that we have addressed the issue with the advocates management team to facilitate
education.

Whenever incorrect information is received by a member from Highmark, it is important
that it is brought to our attention so that we may address it with the advocate to prevent it
from recurring. On behalf of Highmark, I apologize for any frustration and inconvenience
these issues may have caused.

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: 02/07/2025
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 authorization was submitted and it was cancelled by the insurance company when I was told to have the provider submit it to pay the claims. I expect these claims from last year to be paid. The response issued did not solve my issue. I have now filed a complaint with the attorney general and I will also be filing with the PA insurance ***** Right now its considered theft due to not receiving the benefits I am entitled to. If I dont get resolution soon my next step will be to file a lawsuit.

Regards,

****** ********
Business Response
Date: 02/12/2025
We are in receipt of your letter dated February 7, 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 ********************** e interactions due to protections detailed
in privacy standards established under the Health Insurance Portability and Accountability
Act (HIPAA).

We apologize for the providers authorization being cancelled, but it is necessary that the
providers authorization requests be submitted to the third-party utilization management
company as previously advised. Should the requests not be received, the complainant also
has the right to file an appeal for each denied claim. Additionally, according to our records,
the second issue the complainant spoke of has been resolved.

On behalf of Highmark, I apologize for any frustrations or inconveniences these issues may
have caused the complainant. 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: 02/12/2025
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:
The incompetency of this company is astounding to me. I will now file a complaint with the PA **** of insurance for fraud as I was deceived and not received the benefits that are included in my plan and they want to find a loop hole to get out of paying these claims. Thank you BBB for your help in this matter even though you werent able to get it resolved.

Regards,

****** ********
Initial Complaint
Date:01/16/2025
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.
1. I have had to contact Highmark related to questions about some new bills I have received, and they continue to delay, point fingers, and employ bad-faith tactics to avoid communication with their members. For example, they offer an online chat tool. However, the website seems to boot you off after an hour - so you lose the full transcript and start back at square one. This has happened to me several times and I have been blamed, but it seems clear to me that the website has a timeout that boots you off after a period of time. The chat representatives seem to know this as they delay more when they are confronted with questions that they do not want to answer or need to do some digging to find an answer. I asked for an email address to be able to continue a single thread conversation, but they will not offer it. Therefore, I feel that I have no way to dispute or even dig into the details surrounding new bills that I am getting for service that occurred over 11 months ago. 2. These are surprise bills for us, and it is very convenient that we allow the insurance company to take as long as they want to figure out what they need to bill, but insurance-members are given 30 days to pay. Insurance companies need to be given a time limit. 30 days to figure it out or else they do not get paid. 3. Very recently we had 8 claims (related to service from 11 months ago) adjusted - and they were all adjusted upwards. The odds that this is a neutral review process and all 8 claims would happen to have a higher cost for us after the review is frankly an easily provable lie. The odds of a coinflip falling on heads 8 times in a row is < 1%. We still don't understand why there are so many upwards adjustments, but if the insurance company is really making so many mistakes - who is reviewing these claims on OUR behalf and finding the 8 that need to be adjusted down? Is this my responsibility as the consumer? Is every American supposed to become an expert on hospital billing codes?
Business Response
Date: 02/04/2025
We are in receipt of your letter dated, 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).

I can confirm that claim adjustments were made to claims under this members plan.
Unfortunately, with system corrections, there could be instances where the claim
adjustments could affect member liability. Please recognize that these corrections would
not fall under the No Suprises Act. On behalf of Highmark, please extend my apology to
the member for any inconveniences experienced as a result of the adjustments.

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
Customer Answer
Date: 02/05/2025
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.
Highmark uses HIPPA as a shield to protect themselves from explaining what happened. They could have said that they would be responding to one of my several unanswered messages in their portal. They have not explained the reasons why 8 separate adjustments were made that all resulted in increases to my payments. This is not simply "errors" as Highmark explains, because the amount due is always going up. Additionally, if Highmark has made an error - hold them responsible. Does no one see the imbalance of expectations when Highmark is given unlimited time to work out the details of what is owed, but the consumer is given 30 days to pay and no method of communication to dispute any errors. If Highmark is so error prone, I think they need to send me every single bit of information they receive on all of my claims so that I can double check their work.
And I would like just 1 reasonable method to contact Highmark. Currently it seems like the BBB is the best method, but I do not want to use your resources.

Regards,

******* *****
Business Response
Date: 02/18/2025
We are in receipt of your follow up inquiry dated February 5, 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).

After further research, it was determined that the type of adjustments being performed
should not have changed the members liability. Please know that any claims that retracted
a refund and changed member liability were adjusted back to the original processing of the
claim. Updated Explanation of Benefits statements have been issued to the member with
the corrections. Once again, please extend my apology to the member.

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:01/04/2025
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.
Unable to obtain a policy to explain coverages, website shows nothing. I have contacted them at least 4 times to no avail.
Business Response
Date: 01/10/2025
This is in response to your inquiry sent on behalf of the member identified by Case ID
********.

******* **** is enrolled in Freedom Blue PPO Prestige, a ******** Advantage plan with an
effective date of January 1, 2025, and no current end date.

The member is presently enrolled in a ******** Advantage plan with Highmark. As such, the
******************** and ******** Services (CMS) require that we handle any expression of
dissatisfaction as a grievance. We have initiated the grievance process and will reach out to the
member with the outcome within 30 days in accordance with CMS requirements.

If Ms. **** has any questions concerning this coverage, please have her contact our ********************************************* at **************. If you have additional questions, please contact me
directly.

Sincerely,

****** *****
Executive Legislative Inquiries
Initial Complaint
Date:12/19/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My son, **** ***** (insured on this policy) was taken to the ** via ambulance on 8/04/2024. He was taken via Lancaster *** (******************************************) to ************* (*********, **). The dispute in question is the *** bill I had received. This is a cost that my health insurance was covering in full. The full amount of the bill is $1,432. The insurance company was not willing to pay the provider directly and sent us a check. The check was sent to my prior residence as we had closed on our new home about a week before this incident occurred. I notified the insurance company and was told that they would have a new check sent to our home in 4-6 weeks. The check was not received and we were told that it would be sent in another 2 weeks. After the check still hadn't arrived we were told that it would be there in another 5-10 days. When we had received the check, our credit union stated that they were not able to cash the check as I was told that the account number on the check was invalid as it had too few digits. I placed another call with the insurance carrier and was told that there was nothing wrong with the check number and we would received a new check in 30 ******* has been over 4 months since the service with no valid payment and the *** bill has since gone to collections. An appropriate solution, given the length of time, is to have a new check overnighted to us or give me and electronic funds transfer for the missing funds we are owed.
Business Response
Date: 12/30/2024
We are in receipt of your letter dated December 19, 2024, regarding the above referenced
compliant.

Please be assured that we have reviewed the record thoroughly in responding to this
complaint. Unfortunately, we are limited to what information we can provide the ******************************* (BBB) due to protections detailed in privacy standards established under
the Health Insurance Portability and Accountability Act (HIPAA).

However, we can confirm that the check that the complainant requested be reissued has
been stopped. In order for a check to be reissued, the claim has to be reprocessed again.
Therefore, complainant will need to allow approximately four to six weeks for the claim to
be adjusted and the check reissued and sent to the complainant.

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

Sincerely,

***** *.
Highmark, Inc.
Regulatory and Executive Inquiries
Initial Complaint
Date:12/08/2024
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.
Since February 2024, I have been working with Highmark Insurance to secure a reimbursement for 9800 I paid for my mother, **** ****** in Sept 2023 when she was covered under their insurance. Since that time, Highmark has given us the run around. I sent them the bills, doctor letter, services that they requested. Next we go the retro active reauthorization they requested. All of this material was submitted in August 2024. Since that time, Highmark has lied to use stating they didn't have the correct materials. When we call, we are left on hold for hours while they claim once they received something, then next they deny what they told us in the previous call. I worked with the Somerset County Ombuds who confirmed that all information was in and that Highmark was working on this. That was in October. We are asking BBB to contact Highmark so they finally review all materials and process the reimbursement that we are due.
Business Response
Date: 12/13/2024
This letter is in response to the correspondence received by Highmark on behalf of **** ******
regarding claim reimbursement.

**** ****** was enrolled in the Freedom Blue PPO, a ******** Advantage plan, from 03/01/2001
until 02/01/2024.

This member is presently enrolled in a ******** Advantage plan with Highmark. As such, the
******************** and ******** Services (CMS) require that we handle any expression of
dissatisfaction as a grievance. We have initiated the grievance process and will reach out to the
complainant with the outcome within 30 days in accordance with CMS requirements.

If Ms. **** ****** has any additional questions or concerns, we ask that she please contact a
Highmark Customer ********************** Representative at ************** Monday through Sunday 8:00 a.m.
to 5:00 p.m. If you have additional questions, please contact me directly.

Sincerely,

****** *.
Executive/Congressional Inquiry Unit
Highmark******
Customer Answer
Date: 12/14/2024
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 personally spent over 15 business hours on hold, calling the business asking for explanations. My mother, **** ******, was on hold for three hours last week. Calling customer ********************** means getting the run around. If it were as simple as calling customer **********************, the problem would be solved. I am asking Highmark to update us on the their process. They have sent the letter of necessity, bills, services, and the retroactive preauthorization from ********. I have been working with them since February 2024, and sent in my materials in August 2024 (after being on hold for four hours from my desk at work). They told us they needed the retroactive preauthorization from ********. I contacted the Somerset County Ombuds and discussed that Somerset has submitted this twice.
I request they they update me through the BBB process because their customer ********************** process does not work and ineffective with a series of excuses for months. We are requesting the reimbursement of 9800 that we paid when in fact my mother was covered at the date of service and we submitted a letter of necessity to justify the service.

Regards,

**** ******
Business Response
Date: 01/13/2025
This letter is in response to the correspondence received by Highmark on behalf of **** ******
regarding claim reimbursement.

**** ****** was enrolled in the Freedom Blue PPO, a ******** Advantage plan, from 03/01/2001
until 02/01/2024.

As previously indicated in our response to you dated December 13, 2024 this member is presently
enrolled in a ******** Advantage plan with Highmark. As such, the ******************** and
Medicaid Services (CMS) require that we handle any expression of dissatisfaction as a grievance.
We have initiated the grievance process and will reach out to the complainant with the outcome
within 30 days in accordance with CMS requirements.

If Ms. **** ****** has any additional questions or concerns, we ask that she please contact a
Highmark Customer ********************** Representative at ************** Monday through Sunday 8:00 a.m.
to 5:00 p.m. If you have additional questions, please contact me directly.

Sincerely,

****** *.
Executive/Congressional Inquiry Unit
Highmark******
Customer Answer
Date: 01/13/2025
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 response is emblematic of the problem. Thirty days ago- they said they needed thirty days. Now after I wait 30 days- they say ANOTHER 30 days. I believe these delays are meant to defraud me and my family. Highmark has had this information for over three months now and still not working swiftly to resolve the matter.
The delays from June 2024 til now are unacceptable especially since Highmark misled my family stating the retroactive pre authorization from ******** was not submitted when in fact it was submitted twice.
Highmark does not allow clients to close to a year to resolve issue when money is owed them- but then expects us to keep waiting with endless delays. The matter is not resolved.

Regards,

**** ******
Business Response
Date: 01/31/2025
This letter is in response to the correspondence received by Highmark on behalf of **** ******
regarding claim reimbursement.

**** ****** was enrolled in the Freedom Blue PPO, a ******** Advantage plan, from 03/01/2001
until 02/01/2024.

This member is presently enrolled in a ******** Advantage plan with Highmark. As such, the
******************** and ******** Services (CMS) require that we handle any expression of
dissatisfaction as a grievance. We have sent a grievance response letter to the Power of Attorney
on 01/08/2025 regarding the request that was submitted.

If Ms. **** ****** has any additional questions or concerns, we ask that she please contact a
Highmark Customer ********************** Representative at ************** Monday through Sunday 8:00 a.m.
to 5:00 p.m. If you have additional questions, please contact me directly.

Sincerely,

****** *.
Executive/Congressional Inquiry Unit
Highmark******
Customer Answer
Date: 02/03/2025
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.

All this is - more of the run around.
It doesn't take from Aug 2024 until now to review the files.
I will pursue other authorities to look into this.
A shame- I should not have to beg for Highmark to do what it's contracted to do.

BBB- please just post the complaint on the website to see. It has been more than 30 days I with these delays- I believe Highmark is acting in bad faith.

This is not resolved
Regards,

Dr. **** P. ******
Initial Complaint
Date:11/13/2024
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.
My husband and children have health insurance through Highmark Blue Cross Blue Shield Of Pennsylvania. All claims from December 2023-May2024 were paid by this company. In August of 2024, I received *** stating that all money had been retracted from providers because there is another insurance carrier for my children. THERE IS NO OTHER INSURANCE COVERAGE FOR MY CHILDREN. I began calling Highmark in August to resolve this issue. It was determined that the policy number for my insurance (Blue Cross Blue Shield of Nebraska) was somehow linked to my children's accounts. Through many phone calls with both insurance carriers, it was proven that my children only have insurance through Highmark of Pennsylvania. I was assured on multiple occasions that this has been solved and that the money would be returned to the providers. Some of the claims have been paid and the retracted money returned. But there are 3 claims that still remain unpaid. Each time I call Highmark and give them the Inquiry number for the problem, the agent states they figured out the problem and will guarantee that it is taken care of. This has been going on since August. We are now receiving calls and letters from **** collection agencies. This has been a completely frustrating situation. I have been told when asking to speak to a supervisor, that they would not speak to me. I have also been told that I need to prove to them that there is no other insurance. I have proved to them that there is no other insurance coverage and they still will not resolve the issue. No one will take responsibility for their job, each time we call we get a different person and they say that it will have to be passed on to the "correct" department- which may take another ***** days. I am writing this complaint upon the urging of the debt collection agency. When this situation was explained to them, they felt that we are being mistreated with their incompetence.
Business Response
Date: 11/14/2024
We are in receipt of your letter dated November 13, 2024, 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).

It has been determined that other insurance information was entered into a common
Coordination of Benefits portal used by multiple insurance carriers that led Highmark to
adjust claims to request other insurance Explanation of Benefits statements for the
dependents claims. Please recognize that other insurance can become effective at any time,
and we rely must on the portal as well as the members to notify us of any changes.

However, in this instance the information on the portal was incorrect. Once the complainant
notified Highmark that the information was incorrect, we adjusted the claims accordingly.

On behalf of Highmark, please extend my apology to the complainant for any
inconvenience experienced.

Should you have any further questions regarding the complaint, please do not hesitate to
contact me. The member may contact Customer ********************** with any questions.

Sincerely,

*********** ******-Sullivan
Executive Regulatory Inquiries
Initial Complaint
Date:10/30/2024
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 over 6 months, I have called, emailed, sent letters, submitted claims to the Better Business Bureau, left voice mail messages, spoken with over 20 representatives, to no avail 99% of the calls have been disconnected mid-call by **** with NO callback. **** has yet to follow the instructions provided by myself nor the providers and has continued to send me bills that I am not liable for. We have advised over 30 times that there is only ONE insurance company, BCBS to be billed. Despite this information repeatedly being expressed to ****, the *** states: In order to process the claim, additional information is required. Please resubmit the claim with the Other Carrier's Explanation of Benefits (Notice of Payment/Denial), so we may calculate our secondary payment. Electronically enabled providers should resubmit electronically. Reason code: R5095 All providers have resubmitted the claims directly to **** as required, but **** continues to ask for secondary payment. There is NO secondary insurance, nor payment. **** is the primary and sole insurance company for this ******** this point, we are unsure what the issue is and why BCBS is not taking this case into action as required and that has been requested for over 6 months....and THOUSANDS of dollars of unwarranted billing.
Business Response
Date: 11/07/2024
We are in receipt of your letter dated October 30, 2024, 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 the information we can share with the ************************* (BBB) concerning the claim in question due to protections detailed in
privacy standards established under the Health Insurance Portability and Accountability
Act (HIPAA).

Nevertheless, we can confirm that Highmark is aware of the claim issue and are working
to have it corrected. Due to the type of claim that it is, Highmark is not able to make the
adjustment without authorization from the providers local Blue Cross Blue Shield plan.
As soon as the adjustment is complete, the complainant will receive an updated
Explanation of Benefits.

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

Sincerely,

***** *.
Highmark Inc.
Executive and Regulatory Inquiries
Initial Complaint
Date:10/16/2024
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 represent Best Practices BHOM, a New Jersey-based medical billing service known to Highmark BCBS of West Virginia. Despite multiple attempts to directly engage with a representative, Highmark continues demand interaction via email. To date we have complied with this directive, however this process has not produced the required result. We need to be able to submit claims on behalf of our clients (licensed behavioral health practitioners) to this insurer. Our recent claim submission yielded an unintelligible denial message. This confusing outcome necessitates a conversation with a representative knowledgeable in the relationship between insurer and provider but it seems no one is available to discuss the matter. We have direct access to provider support resources of many other insurers so this lack of access is both unusual and frustrating. We ask that BBB facilitate either a teleconference call (Zoom or Teams) or a telephone call between us and a Highmark representative capable of resolving our issues.
Business Response
Date: 10/18/2024
We are in receipt of your letter dated October 16, 2024, regarding the above referenced
complaint.

As the complainant may be aware, Highmark has implemented a new provider service
model that resulted in the reduction of staff in the ****************************** The
remaining resources are being restructured into different teams with different focuses.
There is no longer a direct point of contract, and providers are to utilize the self-service
tools that are available such as Availity, the Highmark ************************ and
Provider Services.

In addition, the link below can be used for procedures on claims resolutions. Availity is
the resource for providers to use for getting assistance with claim denials.

****************************************************************************************************************************
If the provider has any questions, please have them call our Provider Service Department
at **************. If you have any questions, please contact me directly.

Sincerely,

***** *.
Highmark Inc.
Executive and Regulatory Inquiries
Customer Answer
Date: 10/21/2024
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 response provided by Highmark includes a phone number to call for direct assistance. The phone number does not belong to Highmark Provider Service Department. The writer, ***** *****, might be able to assist but we still have no way of contacting her. Again, we seek a teleconference (preferred) or, minimally, a phone conversation. Thank you for your ongoing assistance.

Regards,

***** ****
Business Response
Date: 10/30/2024
We are in receipt of your letter dated October 22, 2024, regarding the above referenced
complaint.

As the complainant may be aware, Highmark has implemented a new provider service
model that resulted in the reduction of staff in the ****************************** The
remaining resources are being restructured into different teams with different focuses.
There is no longer a direct point of contract, and providers are to utilize the self-service
tools that are available such as Availity, the Highmark ************************ and
Provider Services.

In addition, the link below can be used for procedures on claims resolutions. Availity is
the resource for providers to use for getting assistance with claim denials.

****************************************************************************************************************************
If the provider has any questions, please have them call our Provider Service Department
at ************** or reach out to them using Availity. If you have any questions, please
contact me directly.

Sincerely,

***** *.
Highmark Inc.
Executive and Regulatory Inquiries
Customer Answer
Date: 10/31/2024
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.

Yet again, Highmark has provided a telephone number which purports to enable us speaking with a Provider Service Department representative. It does not. Calling this number reaches to Highmark's Member Services Customer ********************** Center. Navigating the phone tree does not produce any clear way to reach a resource adequate to our need. Again, one brief conversation with a knowledgable Provider Services representative would likely clear all confusion and allow both parties to reach resolution.
Thank you for your continued involvement.
Regards,

***** ****
Business Response
Date: 11/14/2024
We are in receipt of your letter dated November 4, 2024, regarding the above referenced
complaint.

As the complainant may be aware, Highmark has implemented a new provider service
model that resulted in the reduction of staff in the ****************************** The
remaining resources are being restructured into different teams with different focuses.
There is no longer a direct point of contract, and providers are to utilize the self-service
tools that are available such as Availity, the Highmark ************************ and
Provider Services.

In addition, the link below can be used for procedures on claims resolutions. Availity is
the resource for providers to use for getting assistance with claim denials.

****************************************************************************************************************************
The previous phone number given is the phone number available for provider services in
the region the complaint is associated. However, providers no longer have a direct point
of contact and are advised to utilize Availity to obtain the information requested. There
are webinars and tutorials available on the ************************ for navigating and
using Availity.

If you have any questions, please contact me directly.

Sincerely,

***** *.
Highmark Inc.
Executive and Regulatory Inquiries
Customer Answer
Date: 11/15/2024
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.

Yet again, Highmark BCBS has refused to put me in direct contact with a representative. This is wholly unacceptable. Is there recourse available to me through the BBB?

Regards,

***** ****
Initial Complaint
Date:10/10/2024
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.
This time I was trying to report probable/possible fraud, for more than 2 months, yes 2 months. I have been calling ************ every day of the business week several times a day (at least 1 call per hour), I am retired and have the time. The phones are ALWAYS BUSY! Other departments I have been able to reach via (800) numbers, but, they say they can't help me so they either transfer me to ************ or tell me to call that number, but, to no avail. So I am now done with them. I am going to get health insurance for another yet, competent insurance company. I want them to send me the proper paperwork to end my /our relationships with BC & BS of WNY/Highmark? through the ******** addressed thusly: *** and Mrs. ***** C. *** ************************* Ransomville NY *****
Business Response
Date: 10/21/2024
We are in receipt of your letter dated October 18, 2024, 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 details of the consumers complaint due to protections detailed in privacy standards
established under the Health Insurance Portability and Accountability Act (HIPAA).

Based on the complainants comments, Highmarks **************** can be reached Monday
through Friday 8:00 am to 4:00 pm at ************.

Should the complainant still wish to terminate her coverage with Highmark, she would need to
reach out to her employer group because of the type of plan the complainant is enrolled. Changes
to the policy type must come from the group.

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

Sincerely,

***** *.
Highmark Inc.
Regulatory and Executive Inquiries
Initial Complaint
Date:10/07/2024
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 husband and I were receiving benefits through Highmark ACA plan. My husband returned to work on August 19 and was eligible for an employer sponsored plan as of September 1. On or around August 19 I called and canceled our ACA plan as of August 31. I received a bill in the mail on or around September 1. On September 3 I went online and it was not canceled. I called to verify it was canceled as of August 31 and again was ensured there were no issues. Today I receive a large bill for deductible from *** plan. I call and they essentially tell me I am lying and never canceled. She states there are no notes or entries on my account to which I reply obviously someone did not do their job. I ask her to speak to a manager and she not only refuses to send me to a manager but asks "if someone at your place of work wanted to speak to a manager would you let them to which I reply...um, of course". It speaks volumes to how they do business that they will not allow consumers to speak to a manager when there is an issue. This is 100% fraudulent to not cancel a service upon request. I have looked online and there are a multitude of consumers saying this has ocurred to them as well. I told her I would be contacting BBB, attorney general and Highmark directly to which she rudely replied...go right ahead. I only want this insurance to be deactivated. I have another Highmark plan which they can clearly see...
Business Response
Date: 10/14/2024
We are in receipt of your letter dated October 7, 2024, 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 disclose Protected Health Information
(PHI) to the Better Business Bureau (BBB) due to protections detailed in privacy standards
established under the Health Insurance Portability and Accountability Act (HIPAA).

Nevertheless, we can advise that when a member enrolls in a policy through the
Pennsylvania State Based Insurance Exchange (Pennie), all enrollment activity must be
completed with them. Highmark is not able to update any enrollment or disenrollment
information. All such activity must be completed by Pennie. Therefore, should the
complainant wish to change the termination date, contact would have to be made with
Pennie. They can be reached at 1-844-844-8040.

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
Customer Answer
Date: 10/15/2024
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 22391385, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

This letter is not addressed to me but to a Jennifer Muzzie! Seems like a HIPAA violation and does nothing to address my concerns!

Regards,

Shelby Williams

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