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

115 total complaints in the last 3 years.
33 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:10/16/2023
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.
Date of Transaction: 6/16/23 Amount: 96.17 Business committed to provide you: My contracted rate for insurance is a $30 co-pay for specialist visits. (Attached is my insurance card and benefits) Nature of the dispute: Highmark BCBS is not honoring their contracted rate of $30 co-pay for specialist visit. Instead, they are charging me full price of the visit. Business tried to resolve problem: I have contacted them 6 times which they all have on file. They have recorded all our discussions as well. They specifically told me that my specialist visits should be at the contracted rate, yet they still have not adjusted the fee and issued a refund. This is the second time that I have had this issue. ( Please see attached, where they were required to adjust – visit 5/24/23) At this point, I am concerned for insurance fraud.
Business Response
Date: 10/25/2023
We are in receipt of your letter dated October 16, 2023, 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 protections detailed in privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

I understand the member is questioning how her benefits were applied to a claim and stating
that the service should have processed with a copayment being applied rather than applying
the in-network allowance toward her contract year deductible; however, a review of the
member’s benefits indicates that the service in question processed correctly. Please
recognize the member may want to verify her benefits online via her online member portal
as the plan’s Summary of Benefits can be found in her benefit book, or she may contact
her Customer Service Department at the number listed on the back of her identification
card.

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

Sincerely,

Margueritte M**************
Executive Legislative Inquiries
Customer Answer
Date: 11/01/2023
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.

I have reviewed the complaint in great detail and my policy in great detail. Psychology and Psychiatry are SPECIALIST SERVICES. Highmark is choosing to ignore this fact and say this is not true. This is not a matter of debate on whether "it is true or not". It is a well known / verified fact that Psychology and Psychiatry are SPECIALIST SERVICES. Highmark is trying to get out paying their portion and are making excuses on why they can not follow my specialist contracted rate. There is a legal binding contract that says any specialist service is $30. Now, for some reason, they will not provide me an answer on why they will not honor their contracted specialist rate. I have been in contact with customer service 6 times and no one at their company is able to give me a reason on why they will not honor my contracted rate. They are not allowed to pick and choose when they want to honor a contracted rate. They are legally bound to always honor the contracted rate.

Regards,
******* *****
Initial Complaint
Date:10/06/2023
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have insurance with this company. My employer pays a company named quantum to be a sort of go between. When I call, I get routed to quantum. Quantum and this company blame eachother for very outdated information on their provider lists. They tried to say I was out of network with Labcorp near me because there was no contract. They wanted to send me 80 miles away if I wanted to use a standalone test clinic. One clinic didn't even exist at that address. Their list is very outdated, and their reps are telling me incorrect information. I called Labcorp. Labcorp told me I could use any of them, including nearby ones, and that they were in network. They need to update their information, and stop telling people these things. I'm not sure why this is happening, hopefully just an oversight. I think they may be in danger of violating the new transparency act if they don't fix their data and training issues. I wasted a big part of my day on the phone.
Business Response
Date: 10/11/2023
This is in response to your inquiry sent on behalf of the member identified by Case ID
********.

Please know we can confirm that that the member’s employer group has opted to use a
third-party administrator to provide all member and provider services. If the member has
questions concerning this arrangement, she may direct them to her employer group.

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,

Margueritte M**************
Executive Legislative Inquiries
Customer Answer
Date: 10/11/2023
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.
The satellite third party organization is blaming highmark for the lack of information, they say their provider list comes from them. This type of back and forth is not providing efficient patient care. Please provide them with an updated list of sites for labcorp in the state of North Carolina, and inform the BBB that you have done so. This is not an outrageous request by any means. They can't provide me an updated list if they get an old list from you, because they said their list comes from you. As I stated, one of the addresses provided has not been a labcorp in many years.

Regards,

******** ******
Initial Complaint
Date:10/02/2023
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.
I have been receiving bills for lab work that was done at Quest Diagnostics, this lab work is routine, it is lab work for confirmation of pregnancy from March 14th, March 8th and March 17th in which the doctor had to do cereal blood work to confirm the success of my pregnancy. I have insurance with Highmark Blue Cross Blue Shield Insurance ID number PNM ************ group number ***** My doctor's office and myself have gone back and forth with Blue Cross Blue Shield providing them with the correct diagnosis codes so that they could pay the bills, however they still refuse to pay the lab fees due to the doctor's office initially submitting an infertility diagnosis code. My doctor's office has since then submitted the correct diagnosis codes and for reference the codes they recently resubmitted again are z32.01 as well as z13.29 for the services provided on March 8th and for the services provided on March 14th and 17th they provided the diagnosis codes of z32.01 as well as 002.81 and the Z34.9. The point of contention here is that Blue Shield Blue Cross is declining to pay for the lab work because they were under the impression that this is for infertility, however this is not infertility it is simply the confirmation of pregnancy which is definitely covered under my current insurance with Highmark Blue Cross Blue shield. If you can just help me to resolve this issue and get these claims paid it is for Bill number ************, ************** and ************ Thank you!!
Business Response
Date: 10/17/2023

We are in receipt of your letter dated October 2, 2023, 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 protections detailed in privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

Nevertheless, we can confirm that the claims have processed correctly based on the
submitted coding listed on the claims. Highmark is unable to change submitted coding on
claims without corrected claims being received. In the instances of laboratory charges, the
ordering physician needs to send corrections to the laboratory who will in turn, submit a
corrected claim.

As you may be aware, the member has the ability to pursue internal plan remedies with
Highmark simply by submitting a claim to our Member Grievance and Appeals
Department at **** *** ***** *********** ** ***********

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

Sincerely,

Margueritte M**************
Executive Legislative Inquiries
Customer Answer
Date: 10/18/2023
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.

[this response is not sufficient to address my issue because the doctors office already submitted the correct diagnosis codes to allow for payment of these routine lab tests. Pregnancy is covered under Highmark Blue Cross Blue Shield. The diagnosis codes that were re-submitted by the doctor’s office were Z32.01 as well as Z13.29 for the services provided on March 8. For the services provided on March 14 and 17th. The doctors office submitted diagnosis codes of Z32.01, 002.81 and Z34.9. Again these are diagnosis codes that are appropriate to test for the confirmation of pregnancy. There is no reason that these routine pregnancy tests should not be covered by Highmark Blue Cross Blue Shield.]
Regards,

***** *******
Initial Complaint
Date:09/14/2023
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.
On 9.11.23, I completed an over the phone urgent authorization for a client that was discharged from a hospital. He had a Kidney transplant and is in need of IV antibiotics and a dressing change. Multiple attempts have been made with the authorization department in which we keep getting 'they need more time' push back. We aren't allowed to talk with a RN case manager so we have to rely on a call back. I was told on 9.11.23 that my request was marked urgent and that it would take 24-48 hours at most. I called on 9.12.23 to follow up and was told that the case was not marked as urgent. BCBS then made it urgent and I was told I should have this by the end of the day or Wednesday at the latest. As of 9.14.23, the case is still pending and BCBS has not moved forward with reviewing his clinical documentation for approval. Not have approval means this client will have to transfer back to the hospital (3-4 hours away) to receive care. This is neglect on BCBS part. I need help getting authorization completed/approved so we can provide care to this patient.
Business Response
Date: 09/14/2023
Based on the information in the case listed above, there is no complainant information. Without any additional information, there is nothing we can do to offer any sort of response. It is obviously a provider, but they are apparently in IL and with no member information either. If you can provide us with additional info we can respond otherwise there is nothing we can do.
Initial Complaint
Date:08/14/2023
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On 4/27/23 I had partial knee replacement surgery. Part of the recovery was physical therapy and would require approximately 3 months of PT. My plan only allowed for 12 visits per calendar year. The PT office put in a request for additional days, which was approved, and an authorization letter was sent to both myself and my physical therapist. However, on 6/26/23 I received a bill from PT saying that the claims were denied. I connect the billing office with Highmark and on a conference call was told that the only thing I was responsible for was the $20 copay. I received a new bill saying that the claims were once again denied. I called Highmark and was told that the authorization is not a promise to pay, just that the services were medically necessary and that they do not check coverage before giving the authorization and that I should have called them first before getting any services under that authorization. Additionally, she said that the gentleman who gave the wrong information would receive an "educational notice" about giving wrong information. This practice is predatory and had I known the services would not be covered there were alternatives I could have taken advantage of that would have cost me a few hundred dollars verses upwards of $4,000. I am asking that Highmark stick to the information that was provided on 6/26/23, where the only payments I owe are my $20 copay.
Business Response
Date: 08/23/2023
This is in response to your inquiry sent on behalf of the member identified by Case ID
******** concerning benefit limitations.

I understand the member is questioning the authorization process as it pertains to claims
and benefit limitations. An authorization review for services is performed to determine
the medical necessity of a service. Authorization letters note this in their determination
letters and advise that the letter is not a guarantee of payment and directs the patient to
Customer Service to verify benefits under their plan.

This member’s benefit plan allows twelve (12) Physical Therapy visits per benefit period.
This member may want to review his benefit book which he should be able to obtain
from his employer.

Our records indicate the member submitted an appeal for reconsideration of denied
claims on August 14, 2023. The appeal process may take thirty (30) days. The member
should allow the appeal to finalize; he will receive a decision letter from the Appeals
Department.

If the member has any questions concerning this 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: 08/23/2023
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.
As stated in my original complaint, when someone is going through recovery from major surgery and they receive a notice from an insurance company that a requested service was authorized, they are going to follow through with the service and not read through the disclaimers at the bottom of a page. To expect them to then further jump through hoops to make sure that the authorization was actually authorized is simply unrealistic. When you are told that something is authorized, it means that it has been approved. The staff at Blue Cross admitted that the additional days were medically necessary when they authorized the additional 8 days. Also, the physical therapist office was informed that the days were approved, so they also had no reason to doubt payment for the services. If an authorization is not truly an authorization for services, then Highmark needs to change their practices to prevent this from happening.
Additionally, after an earlier conversation with their customer service department, both myself and my physical therapist were told that the only thing that I would owe is my $20 copay. This is has been noted in the billing office notes from the conversation as well as Highmark's notes as well. If the individual from Highmark told me the wrong information, that is on Highmark and they need to stand behind the information that their employee provided. During a subsequent call to their customer service department, I was initially told that to appeal the decision, I would have to collect information from my surgeon and physical therapist to prove that it was medically necessary to have the additional dates of therapy. Yet, that was done during the authorization process.
Instead of several hundred dollars in physical therapy bills, I am faced with several thousands of dollars due to the practices of Highmark. At the time of authorizing the additional days, had they simply said that no more days were available I would have had other options with the physical therapist that would have reduced the overall out-of-pocket expenses.
As noted in their response, I have appealed their decision. However, to date, I have yet to receive the written confirmation of the appeal as promised and as noted, their own customer service representative gave wrong information so I am not confident that they will approve the appeal. We have already paid the physical therapist for our copays, since they are valid charges. I find their suggestion to contact their customer service department with further questions comical and borderline insulting. When I did contact their customer service department, I was told I owed $20 per visit, then I get a bill for $1,300 (with another $2,000+ waiting). When I contacted them again, I was told the other agent was wrong and that I had to pay the extra amount and all they did was simply restate the company line. So, one can understand why I a reluctant to go through the same conversations over and over again.
So, to rectify this situation, I am saying that Highmark needs to stand behind the information that their customer service representative agent gave me and stand behind the meaning of the word authorize. I would also like Highmark to change their authorization process so that there is no question on if a service is approved or not.
Regards,

******* *****
Business Response
Date: 09/06/2023
This is in response to your inquiry sent on behalf of the member identified by Case ID
******** concerning benefit limitations.

We understand that the member feels that information provided on a telephone call to our
Customer Services Department questioning the claim denials should be grounds to allow
his claims to reconsidered as eligible as he states incorrect information was provided.
However, the services had already been provided to him and it is evident that the
information from the call did not affect whether or not he had the services.

Please consider if the member had called to verify his benefits prior to the services being
incurred and the information provided had led him to have services beyond his benefit
limit, only then could the denied claims have been reconsidered for adjustment. We have
no record that the member called for benefits prior to his receiving the physical therapy,
and it should be noted again that authorization letters do instruct members to verify their
benefits since they only address the medical necessity of services. While a service may be
medically necessary, Highmark must administer health insurance benefits in strict
accordance within the terms of the benefit program in which the member is enrolled.

The member’s appeal of the denied services is still in process and a decision letter will be
sent to the member.

If the member has any questions concerning this 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: 09/06/2023
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.

In reviewing the response from Highmark, and their stance that since the incorrect information was given after the physical therapy was provided allows for the continued denial of the claims, I find problematic. Based on the information that I, and my physical therapist, had in hand, the extra days were "approved". However, I had decided to hold two of these "approved" days for the future incase there were issues with the recovery upon my return to my job. Had I decided to use them, based on the information provided by their employee, I would be in this exact same position, even though I had "called to verify {my} benefits prior to the services being incurred." There are several underlying issues that need to be addressed.
First, I would challenge this entire practice by Highmark as being unethical and predatory in nature. A prime example of this was made evident within the last week when I had a medicine prescribed to me by my family doctor that required "prior approval". My family doctor and the pharmacy were told that the medicine had been approved. However, based on my most current experience with Highmark, should I have to call them to verify that it is actually being covered? Since Highmark has said that the word "approved" does not actually mean that it has been approved, should I be expecting a bill from CVS for the different medicine, or does "approved" only mean "approved" in certain circumstances? Highmark has yet to explain why there is a difference in how the term "approved" is applied within their company and in their policies.
Today, when attempting to get a copy of the June 2023 letter, I was utilizing the online chat feature that Highmark encourages members to use and the term "Approved" was used in regards to these 8 days. So, once again, if I had used the chat feature on their member site, I would have been given this same information that the services were "Approved". Their own representative just confirmed my understanding that these services were APPROVED and the 8 additional days are valid claims to be paid by Highmark. His exact words were, "They were approved to take place between 06/12/2023 - 12/09/2023." I asked if I had reached out in June to make sure, he said that "They were approved on 06/12/2023 at 09:32am. If you would have contacted us on that date and after 09:32am, then yes." Highmark is getting into a game of semantics with their members to get out of paying valid claims. When a member calls in, or chats, and asks if these sessions have been approved, they are going to go on the understanding that it is okay to receive the services. Yet, Highmark is expecting members to jump through additional hoops and use specific words to find out if a claim will actually be paid. Just like at the pharmacy, I was told I needed prior approval, not prior confirmation of coverage, hence when being told that something is approved, you trust that they mean that it has been approved, not "maybe approved".
Secondly, if my memory serves me, the EOB was received AFTER I had already received some of the denied services. Unfortunately, the only EOBs that are on the Highmark online portal is for the dates of 7/7/23, and 8/25/23, again denying the claims. Additionally, when I chatted with a member of the Highmark team today, they were unable to find the letter. However, based on the frequency of when the physical therapy sessions were to be provided, the EOB/Approval letter would have been received after some of the sessions had already occurred. So based on Highmark's statement, how should I call to verify coverage based on an EOB/approval letter that was received after the service was already given, based on the physical therapist being told by Highmark that the additional 8 days had been approved.
I have included a copy of the chat from 9-6-23, confirming that I would have been told that the 8 sessions were approved for your review. Regarding Highmark's statement regarding allowing the appeal process to continue. Unfortunately, their responses to this complaint and my previous conversation with a supervisor at Highmark, have shown that they are very unlikely to change their position. If Highmark does not do the right thing by making the necessary adjustments, I was advised by the Pennsylvania Insurance Department that I may seek assistance from the United States Department of Labor, Employee Benefits Security Administration and The United States Department of Labor, which I fully intend to do.
Regards,

******* *****
Business Response
Date: 09/15/2023
This is in response to your follow up inquiry sent on behalf of the member identified by
Case ID ********.

Before I continue, please recognize that Highmark does not administer the prescription
benefits for the member’s plan; therefore, I am unable to address his concerns regarding
his prescription plan.

Our records indicate the member’s appeal finalized September 12, 2023, and while a
decision letter was issued to him the same day, an amended letter is being issued today to
include additional information as the member has the option of a voluntary level appeal to
be submitted to his employer. The original letter indicated this but did not include the
employer’s address.

In the event the member wishes to file the voluntary level of appeal to his employer he
should follow the instructions provided on the letter dated September 14, 2023.

If the member has any questions concerning this 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
Initial Complaint
Date:07/17/2023
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.
When Highmark took over blue shield in July of 2022, they have been impossible to get in touch with to resolve anything .. claims go unpaid .. they say they don’t receive them even after multiple submissions and conversations with a rep and Amsure .. my sessions with my therapist are covered in full .. they claimed in July 2022 I was no longer covered (even though I was ) and I was paying out of pocket, they were reimbursing me partially (after 7 months of calls and requests and complaints ) .. come to find out, it was still covered the whole time.. now they are asking for money back they sent me .. This amt made me whole based on what I paid and what was owed to me .. I will not pay them this amt back
Business Response
Date: 07/23/2023
We are in receipt of your letter dated July 17, 2023, 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 (BBB) with details
of the customer and provider service interactions and details due to protections detailed in privacy
standards established under the Health Insurance Portability and Accountability Act (HIPAA).

Nevertheless, we can advise the complainant that payment for claims for providers who are in
network with Highmark is sent directly to the provider. If payment is erroneously sent to the
member as well, Highmark may ask for that payment to be returned. In cases such as these, the
member would need to return the payment to Highmark and the provider would need to refund the
member for any overpayment that may have paid.

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

Sincerely,

Cassy L****
Highmark Inc.
Regulatory and Executive Inquiries
Customer Answer
Date: 07/24/2023
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.

Regards,

****** ****
Initial Complaint
Date:05/26/2023
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.
All i want is someway to show the doctors office what insurance i have. they have flat out refused to let me access my online account, nor send me a link on were to go. wound up arguing with their representatives because they cannot understand simple english. I have been waiting WEEKS for my physicall cards and the refuse to send me new ones! I am literally paying for insurance that they are refusing me to be allowed to use!
Business Response
Date: 05/31/2023
We are in receipt of your letter dated May 26, 2023, 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 protections detailed
in privacy standards established under the Health Insurance Portability and
Accountability Act (HIPAA).

According to Highmark’s records, the member’s ID card was mailed to the address on
file the day following Highmark’s receipt of his enrollment information.

We can advise that the member was correctly notified of the ways he could obtain his ID
card. The member was also advised that he could create an account on Highmark’s
member portal at www.highmarkbcbs.com. With that account, he can access his personal
health insurance information which has access to an image of his ID card that the can
print and use. He can also request a copy of his ID card over the phone with the
Customer Service Department or via the member portal.

If the member has any additional questions, he can contact the Customer Service
Department at ###-###-####.

Sincerely,

Cassy L****
Highmark Inc.
Executive and Regulatory Inquirie
Customer Answer
Date: 06/07/2023
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.
They refused, and continue to do so, give me any access to my health care coverage. They need to provide us a way to go online and either show, or print out out insurance information.

Regards,
****** *****
Initial Complaint
Date:05/18/2023
Type:Delivery Issues
Status:
UnansweredMore 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 July 2022 I received a bill from the ambulance company. I was informed HIghmark should send a check to my residence for myself to forward to the ambulance corp. I was informed a check would be sent to our home address and it may take up to 45 days. I called Highmark again 11/1/22 and was informed a check would be redistributed within 10-15 days. No check was received. I called Highmark again, I was told I should call back after 12/9/22. I called again 12/27/22 and was told to call back again after 1/2 or 1/3, 45 days from the last request. I called Highmark again 1/4, gave them my parent's address to reissue the check. I was told one would be issued in 30-45 days and to this date of 5/18/23, no check has been issued and the ambulance company now put my account into collections. I am beyond frustrated with Highmark.
Initial Complaint
Date:05/13/2023
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.
I had a medical procedure in January. My claim was processed and I received a bill and paid for it months ago. In May, I received a letter in the mail stating that Blue cross blue shield is currently correcting an error in their system on how claims were processed/paid. This error is causing my bill to increase. I do not believe that it is ok for me to pay more for their system error. At the very least they could apologize and cover half if not all of their systems error. However, to simply send an EOB in the mail without any attempt to own their error does not feel right.
Business Response
Date: 05/16/2023
We are in receipt of your letter dated May 14, 2023, 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 claims associated with her account due to protections
detailed in privacy standard established under the Health Insurance Portability and
Accountability Act (HIPAA).

Nevertheless, we can confirm that the claim in question was updated due to the
provider’s agreement with their local Blue Cross Blue Shield plan. If the member has
any additional questions related to this issue, she should contact the phone number on the
back of her member ID card.

As you may be aware, the member has the ability to pursue internal plan remedies with
Highmark simply by submitting an appeal to our Member Grievance and Appeals
Department at **** *** ******* *********** ** *****. As a part of that process, the
member can seek relevant documents during an appeal and obtain relevant documents
upon which the claim was processed.

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

Sincerely,

Cassy L****
Highmark Inc
Executive and Regulatory Inquiries
Initial Complaint
Date:05/10/2023
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On April 12, 2023 - I called customer service to find out why a prescription cost was so high. I was informed by a customer service representative on my individual deductible (2,800), how much of that deductible I already met (2,111.44) and was reassured if I got the prescription in question (1,299.85) I would then not only reach my deductible, but exceed it and receive a reimbursement check for the overage. It was then explained to me that since my deductible was met from that point on the insurance company would shoulder 90% and I would be responsible for 10%. NONE OF THIS WAS TRUE. I called customer service back a month later when I went to pick up my new prescription and it was not covered as I was informed (May 9). I was on the phone for 2 hours and 18 minutes - spoke to two different individuals who both informed me that I had not met my deductible. One of them contacted a supervisor who extended their apologies through the agent I was speaking with. At this point I desperately needed to speak to a manager/supervisor myself to understand what was going on and how to fix it. I was told I would be connected to a supervisor and was placed on hold, for FOURTY minutes. At this point one of the agents told me she was going to end the call on her end but assured me (after I asked) that the other agent still was on the line and the call would not be dropped. THE CALL WAS IMMEDIATELY ENDED. 2 hours and 18 minutes, no manager/supervisor? Is this normal business practice? How is there not a manager/supervisor readily available?? I immediately called back (now the 3rd agent) who connected me to a prescription company?? Another 34 minutes with no help. At this point I ended the call. Highmark managers/supervisors, do you exist?
Business Response
Date: 05/12/2023
We are in receipt of your letter dated May 10, 2023, concerning the above referenced
complaint.

Please be assured that we 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 protections detailed in the privacy
standards established under the Health Insurance Portability and Accountability Act
(HIPAA).

Nevertheless, we can confirm that we correctly informed the member regarding the
prescription benefits associated with her policy prior to her obtaining the prescription.
The initial incorrect information she was given concerning her prescription benefit has
been forwarded to the advocate’s management team for education.

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

Sincerely,

Cassy L****
Highmark Inc
Executive and Regulatory Inquiries.

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