Complaints

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

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  Blue Cross & Blue Shield of R.I.

  500 Exchange Street Providence, RI 02903-2630

• 

  Blue Cross & Blue Shield of R.I.

  15 La Salle Sq Ste 2 Providence, RI 02903

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

• Initial Complaint

  Date:04/05/2025

  Type:Order 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 called to request proof of coverage to send to the *** and the agent confirmed my email and placed me on a extended hold and mailed my personal information to the address on file where I no longer reside. I informed the agent that I no longer lived there and I was assured Ill receive a email with 48 hours. No email was received after allowing 5 business days. I called again today and was on hold literally 30 minutes, the agent stated my personal information was mailed and not emailed. Also, that I could expect a email end of business today 04/04/2025. I have yet to receive even though I expressed the urgency. I will be filing a civil complaint for a breach of my information being sent incorrectly.

  Business Response

  Date: 04/08/2025

  ****** has received this complaint and will respond to the member directly. Thank you

• Initial Complaint

  Date:04/02/2025

  Type:Billing 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.

  I pay for RI BlueCross Direct. The new website is far behind in uploading my ****. Also, I have not been receiving copies by mail. I have called & messaged and several times since I cannot be sure what I am being charged by my Providers is correct without the EOB.The Providers get the **** and are quick to bill me, but I am still waiting For **** since February. I am told by ****** that I met my deductible but I would like to see it itemized on my patient portal. The numbers don't add up and I cannot determine if what I am paying for out of pocket is correct without the ****. For example, the pie chart online doesnt jive with out- of -pocket amount I have spent. (Unlike Delta DENTAL OF RI that claims are up on portal quickly and I found I was overcharged by my previous dentist practice by almost $700. I would not have known except for the EOB).RI BlueCare Connect Website has a lot of bells and whistles relating to keeping healthy and earning rewards points, but I am interested in updated claims. And it has been well over 30 days since the date of service and the claims are still not updated. I am retired and am trying to meep track of my expenses and healthcare is my most expensive one.Thank You.

  Business Response

  Date: 04/02/2025

  Complaint received. ****** will respond directly to the member.

  Customer Answer

  Date: 04/02/2025

  Better Business Bureau:
  I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. I did not received in mail nor do I see the **** on the patient portal for the three bottom claims that are in the chat session. I was unable to attach file here. if it was not for the chat session with a ****** representative, I would have not had this information and the fact that I met my deductible. All I received were notices of bills from the providers with a link to pay them online with no information (e.g. what the amount billed, amount paid by ******), only amount I owed.
  I hope you can appreciate my concern.  I need to know that I am being billed correctly and without the **** I have no way of knowing.Regards, ****** ********

• Initial Complaint

  Date:10/28/2024

  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.

  We have **** of FL coverage. I have been told that the protocol is for providers to submit claims through the local **** who is then supposed to forward the claim on to the appropriate **** company. Unfortunately, in the past 7 months, when providers submit their claims in **, ********** is instructing the providers that there is no coverage. ********** has attempted contact with the local, but they cannot figure out what the local is doing or why they are telling providers there is no coverage. Approximately 6-10 claims have been repeatedly submitted and repeatedly rejected in the last 6 months.

  Customer Answer

  Date: 11/12/2024

  I have heard from the business, however the issue is not yet resolved.

• Initial Complaint

  Date:09/22/2024

  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.

  I would like to report **** of RI for mismanaging and denying me a benefit offered to ALL members *** have ****** ******** Advantage plans Rewards Program. The company pays members various amounts for taking part in a suite of health initiatives. I submitted several claims for this benefit. However, they have only paid half the amount for getting a colonoscopy, $25. I am actually eligible for $50. Most recently, they kept me on the phone for over two hours, giving me various excuses why my account has not been credited the remaining $25. I worked with ***** and then *** *. They admitted that I should have received $50 credit to my Flex Benefit account but cannot seem to get me the reward that other members received after meeting the same exact requirements. When I complained that my ears actually began to physically hurt because of the unusually long time spent on the phone, *** C said she would call me back (9-18-24) with the resolution. As of 9-22-24 no one has contacted me from **** and Flex account still not credited. Original claim for Colonoscopy reward was submitted 8-17-24. I told them I have a letter from the doctor *** performed procedure but they made no effort to inform me where to send it. First, I want the outstanding $25 credited to my ****** OTC Flex account debit card, just as other eligible members received theirs. Clearly, this is an administrative error. Second, I am lodging complaint about their customer services tired old delay and deny tactics they use to dispatch with members they deal with on the phone. They switched me around and put me on hold for over two hours-at one point holding me for over 15 minutes while they updated my phone number after I informed them that after requesting that three times it still wasnt done. I want them sanctioned for terrible customer service and I simply want what THEY promised me and which others have received. If they DONT credit me the remaining $25 I will accuse the company of FALSE ADVERTISING.

  Business Response

  Date: 09/23/2024

  Blue Cross & Blue Shield of Rhode Island has received this complaint, and we will respond to the member directly. Thank you. 

• Initial Complaint

  Date:07/16/2024

  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.

  I purchased this dental coverage thru RI health source, it is the Elite BCBS dental plan, i pay a monthly charge , purchased in March of this year. I broke a molar and it needs a crown, when my dentist called it in they said i had a year waiting period and they cannot approve it at this time. ***** was broken end of june, so I called in and asked why, they said we have no proof of you having insurance before us (like im scamming them) if you send us in proof they will wave waiting period, On july 11th I faxed the proof over that i had insurance with Delta dental for the past two years and im expecting it waved as stated. They sell this policy on RI Health source stating there is no waiting period! I call BCBS and ask if fax was received and they said no , then i ask why it was received it says , then the woman who was very angry , states why are you calling? I told her the story and she says , we cannot wave your waiting period you didn't send us proof within 60 days of you purchasing new policy, I said no one told me that , how was i supposed to know that? she said that's all i can do for you , i said let me speak to a supervisor, she said there are no supervisores available but i will leave a message for them to call you back, this was 5 days ago and no call back. why do I pay for insurance if they will not pay , its ok for them to take our money but when something happens they turn there back, this is bull. I have a broken tooth no it was not planned it happened

  Business Response

  Date: 07/20/2024

  Blue Cross & Blue Shield of Rhode Island has received this complaint, and we will respond directly to the member. Thank you

• Initial Complaint

  Date:06/04/2024

  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.

  BCBS approved a left total knee replacement which was done yesterday 6.3.2024. In my prescriptions was Tramadol to pick up yesterday and I was unable to because ofThey did not approve or reach back out to Ortho RI for the approval. Ive had ZERO pain meds. Imagine you two leg bones sawed off at the ends with new titanium pieces in your body and no pain med. its only 50mg of ********. Im allergic to morphine, oxy etc so Im never going to have anything stronger than the Tramadol. BCBS is literally torturing me as Im in pain with no pain med

  Business Response

  Date: 06/04/2024

  Blue Cross & Blue Shield of Rhode Island has received this compliant, and we respond directly to the member. Thank you. 

• Initial Complaint

  Date:02/01/2024

  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 husband had a colonoscopy and I was told that it was covered 100% from Blue Cross of **.Then I got a bill from the hospital. When I addressed it with Blue Cross they said it should be covered and they would look into it. I must have called about a half a dozen times. I was told that on their end the additional charges didn't reflect the original procedure. Yesterday a claim agent from Blue Cross said they paid for the colonoscopy and I owed the result of the procedure. I feel that they should pay the balance remaining to the hospital of $883.78. The charges from the hospital are things used in the procedure. Attached are the papers from BCBS and *************************

  Business Response

  Date: 02/02/2024

  Blue Cross & Blue Shield of Rhode Island has received this complaint. We will review and respond to the member directly. Thank you. 

• Initial Complaint

  Date:01/05/2024

  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.

  1) coded my account information incorrectly 2) never reviewed the information on my account each time I called starting 2/23 thru 11/23 3) requested more information on each claim 3 to 4 times and then said it was denied 4) secondary dental insurance thru Blue Cross Blue Shield -RI 65 with dental dental (Delta Dental dual coverage)5) ****************** thru AAA ** paid all claims however delta thru bcbs ri denied all claims as well as starting wrong *****************. DD of ** accepted all billing codes and paid claim

  Business Response

  Date: 01/26/2024

  We have received this complaint, and we will review and respond directly to the member. Thank you.

  Customer Answer

  Date: 02/02/2024

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered. 

  [You must provide details of why you are not satisfied with this resolution.  If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
  
  Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
  
  FAQ
  
  Regards,

  ****

   

   

• Initial Complaint

  Date:12/31/2023

  Type:Order 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 mother changed her health insurance in August 2022. As a result, her dental insurance was canceled unbeknownst to us. When my mother went to the dentist in August 2023 we realize that she did not have any dental insurance. I contacted Blue Cross Blue Shield about this and they sent me information on new dental coverage. My mother and I were trying to figure out what dental insurance she should take Blue Cross Blue Shield took it upon themselves and signed her up for the dental insurance that she had in August 2022. They then retroactively charged her for her premiums back to August 2022 and hit her with a bill just over $1000. On December 1 I contacted Blue Cross Blue Shield and told him that we had never signed up for a dental insurance, and that they had just drafted the money out of my mothers account with no authorization. It has taken several phone calls to try and reimburse my mother and I have been working on this for four weeks now and no one can tell me when this will be resolved. I feel that this is predatory on an 83 year old woman, and if she didnt have a son to help her, she would be out $1000. I feel like this is wrong and this is the reason why Im contacting you.

  Business Response

  Date: 01/04/2024

  The plan has received this compliant, and we will respond to the member directly. 

• Initial Complaint

  Date:04/13/2023

  Type:Order 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.

  If I could give zero stars I would. This insurance company is borderline criminal. Customer service is beyond incompetent, they give misinformation about coverage and use third party services to make getting prescriptions nearly impossible for the patient. When they decide they dont want to pay for a script, they send it out to their third party entity, Prime Therapeutics, a billion dollar corporation that makes the patients life more challenging to obtain certain medications. Funny enough the president of Blue Cross Blue Shield of Rhode Island also holds a board position for prime therapeutics. Theres no supervisor ever available to assist, they have exuberant wait times etc More people need to speak up and report this insurance company and others to prevent this sort of treatment to others. Please reach out to your local government, reps. *** ********** to evoke true change and hold these corporations accountable for their actions.

  Business Response

  Date: 04/14/2023

  Blue Cross and Blue Shield of Rhode Island has received this complaint. We will review and respond directly to the member. Thank you

  Customer Answer

  Date: 04/14/2023

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered. 

  [You must provide details of why you are not satisfied with this resolution.  If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
  
  Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
  
  FAQ
  
  Regards,

  *****

   

   

  Customer Answer

  Date: 04/23/2023

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered. 

  Blue Cross Blue Shield of Rhode Island, is not taking accountability for their actions. 
  Basically whats transpiring, they are submitting medications that they do not want to pay for, that are not on their preferred med lists, that they have back end deals with the pharmaceutical companies. They are making it nearly impossible for clients to gain safe access to their medications and they are using a third-party to deter the patient from obtaining their medications. Prime therapeutics is the third party entity which comically enough the president of Blue Cross Blue Shield of Rhode Island also holds a board position of this referring company.
  Here is my complaint and attached you will see some of the rejections from prime therapeutics to support this claim. I have also included links below to show that prime therapeutics is being sued by **** and supporting documentation about the president being connected from Blue Cross Blue Shield and prime therapeutics
  I am looking for assistance from the Better Business Bureau to have this complaint impact their rating and if at all possible for an investigation to transpire on the company and their actions. Thank you again for all your time and assistance with this matter I greatly appreciate you and please let me know if theres anything else you need from me to help support this claim. 
  I truly appreciate all your help and thank you again for your service!
  ~*****
  
  ******************************************************
  
  
  ************************************************************
  
  
  *********************************************************************************************************************************
  
  
  
  If I could give zero stars I would. This insurance company is borderline criminal. Customer service is beyond incompetent, they give misinformation about coverage and use third party services to make getting prescriptions nearly impossible for the patient. When they decide they dont want to pay for a script, they send it out to their third party entity, Prime Therapeutics, a billion dollar corporation that makes the patients life more challenging to obtain certain medications. Funny enough the president of Blue Cross Blue Shield of Rhode Island also holds a board position for prime therapeutics. Theres no supervisor ever available to assist, they have exuberant wait times etc More people need to speak up and report this insurance company and others to prevent this sort of treatment to others. Please reach out to your local government, reps. *** office etc to evoke true change and hold these corporations accountable for their actions.