ComplaintsforBlue Cross & Blue Shield of R.I.
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Complaint Details
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Initial Complaint
06/04/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
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 medBusiness response
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
02/01/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
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
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
01/05/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
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 claimBusiness response
01/26/2024
We have received this complaint, and we will review and respond directly to the member. Thank you.Customer response
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
12/31/2023
- Complaint Type:
- Order Issues
- Status:
- Answered
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
01/04/2024
The plan has received this compliant, and we will respond to the member directly.Initial Complaint
04/13/2023
- Complaint Type:
- Order Issues
- Status:
- Unresolved
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
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 youCustomer response
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 response
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!
~*****
******************************************************
************************************************************
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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.Initial Complaint
09/13/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Submitted numerous claims back in June. Contacted customer service several times and the agent was clueless about the situation.Business response
09/16/2022
Blue Cross & Blue Shield of Rhode Island has received this complaint and we will respond directly to the member. Thank youCustomer response
09/16/2022
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
09/01/2022
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
I have chronic intractable migraines and have a neurologist at Brown ********** They are recommending that I do IV infusion of the drug Vyepti as a treatment options as all other treatment options have failed. My neurologist faxed in the information to get this drug infusion covered, which was initially denied due to a lack of information on if I have tried and failed Emgality. This information was in the packet, so we appealed the decision and resubmitted the paperwork, highlighting where the information is, which was then denied on the same grounds. We have gone through this process, highlighted the information on page 2 and page 8, put it on the cover page and they continue to claim that they did not receive this information. We then requested a doc to doc to solve the problem, and they are refusing to speak with providers. I have been on the phone with Blue Cross Blue Shield weekly, for hours, highlighting this information and requesting direct communications, which Prime Therapeutics have refused. Last time I called, they told me I would need to retry old treatments that we know don't work. They also said that if the record is not part of their system originally, that they only look there, and won't review the medical records, but rather just look at what they have covered in the past. I clearly meet criteria for this treatment, but they continue to say they haven't received the information when I know for sure they have. This has been going on for MONTHS.My dob is 12/17/1985 My neurologist is ************** The case number is PSI_V8ELG My Member ID number is ***************Business response
09/01/2022
Hello,
This complaint has been forwarded to the plan Blue Cross & Blue Shield of Rhode Island (BCBSRI) for review and resolution.
Response from BCBSRI:
GAU has received the members complaint and currently reviewing the concerns. We will provide a written reply to the member directly as soon as possible.
Thank you,
Business response
09/03/2022
Blue Cross & Blue Shield of Rhode Island has received this complaint and we will respond to the member directly. Thank you.
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Contact Information
Customer Complaints Summary
8 total complaints in the last 3 years.
5 complaints closed in the last 12 months.