Complaints

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:01/21/2025

  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.

  BCBS of TN networks S has refused to pay for my husband’s, ****** * ******, stage 4 metastasized prostate cancer radiation treatments. They approved 20 treatments, and we have paid $9.000 for 13 more, and will have to pay for an additional eleven treatments. It’s heart breaking, he’s only 60 yrs old. I have paid for this commercial insurance for 30 yrs., never realized how bad it was until I needed to use it to save my husband’s life. Their reasoning is of course number one, they don’t want to pay for it. Number 2, they say it will not help him. If he had Medicare or Medicaid or another insurance they would approve the treatments. We’ve had 2 appeals, both denied. If we don’t find the money, he will not get to “ring the bell” of recovery. These people are playing GOD, deciding how long a person is allowed to live. No, it will not cure my husband. However, it will prolong his life. I’m only asking them to be descent human beings instant of saving BCBS money. I can’t believe a life has come to this cruelty and this insurance company is allowed to make this type of judgement call.

  Business Response

  Date: 02/04/2025

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on
  behalf of Ms. ****** ****** regarding her spouse. In summary, the member expressed concerns a
  prior authorization denial by Evolent for Radiation Therapy and request reconsideration review.
  After review of all available information to include coordinating efforts with our business department,
  it has been determined the provider, on behalf of the member, filed an Expedited Level 1 Grievance
  (********-E) for this, and a physician consultant outside of BCBST specializing in radiation
  oncology upheld the denial because it was determined this service does not meet medical
  appropriateness criteria. We sent the decision letter to the provider on 1/3/2025 letting them know it
  was upheld, and it provided the member’s Level II Grievance option.
  As a courtesy, we have attached a copy of the decision letter; as well as included a Level II grievance
  form in the event the member wishes to avail himself of this right. BCBST is committed to ensuring
  our members receive the highest level of quality customer service and we appreciate the opportunity
  to provide peace of mind to our community. If you have immediate questions, please contact me.
  
  Sincerely,
  ****** ******* 

• Initial Complaint

  Date:01/15/2025

  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.

  I received correspondence on 9/16/2024 stating that I had been overpaid in the amount of $3867.89 for a date of service of 2/20/2024 related to a Tremfya injection medication 100MG/ML that was covered by ******** ********* ******** per a letter I received on 2/10/2024. I was misled in believing that the particular plan I chose would include my Specialist in Murfreesboro as a covered provider as well as providing coverage for my Tremfya injections that I am required to have every 8 weeks. I had an appointment with my Specialist and discovered that he did not accept my insurance despite it being listed on Marketplace and according to the representatives that I spoke with from BCBS. I contacted BCBS of TN again to pay my next premium installment. I was shocked when I was told that they would not accept my credit card payment when that is all I had, and I had used it to pay the first premium. I called back multiple times and tried to pay the premium. Because of my medical issues, I had to leave my healthcare position after being there for 22 years. I received a letter on 3/4/2024 from BCBS of TN stating that they received the request from ************** to cancel my Marketplace plan and that my coverage would end on 2/29/2024. I was under the impression that 2/29/2024 was when my coverage was canceled according to that letter. I received a letter on 9/9/2024 stating that I owed them money for my Tremfya injection. I filled out a grievance form & mailed all my documentation/letters that they had sent me to BCBS on 9/30/2024. I received a letter on 11/22/2024 from BCBS stating that their Grievance Committee decided to uphold the request for $3867.89, because the “termination date of coverage” was prior to 2/20/2024 despite the letter BSBC had sent me stating coverage ended on 2/29/2024 and despite their negligence in processing the Tremfya prescription in a timely manner which caused severe pain and suffering on my part. I have documents/letters to support this complaint.

  Business Response

  Date: 02/23/2025

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on
  behalf of the above-named Ms. ***** ****. Accordingly, the member states in part: “I received
  correspondence on 9/16/2024 stating that I had been overpaid in the amount of $3867.89 for a date of
  service of 2/20/2024 related to a Tremfya injection medication 100MG/ML that was covered by
  ******** ********* ******** per a letter I received on 2/10/2024. I was misled in believing that the
  particular plan I chose would include my Specialist in Murfreesboro as a covered provider as well as
  providing coverage for my Tremfya injections that I am required to have every 8 weeks. I had an
  appointment with my Specialist and discovered that he did not accept my insurance despite it being
  listed on Marketplace and according to the representatives that I spoke with from BCBS. I contacted
  BCBS of TN again to pay my next premium installment.
  I was shocked when I was told that they would not accept my credit card payment when that is all I
  had, and I had used it to pay the first premium. I called back multiple times and tried to pay the
  premium. Because of my medical issues, I had to leave my healthcare position after being there for 22
  years. I received a letter on 3/4/2024 from BCBS of TN stating that they received the request from
  ************** to cancel my Marketplace plan and that my coverage would end on 2/29/2024. I was
  under the impression that 2/29/2024 was when my coverage was canceled according to that letter. I
  received a letter on 9/9/2024 stating that I owed them money for my Tremfya injection. I filled out a
  grievance form & mailed all my documentation/letters that they had sent me to BCBS on 9/30/2024. I
  received a letter on 11/22/2024 from BCBS stating that their Grievance Committee decided to uphold
  the request for $3867.89, because the “termination date of coverage” was prior to 2/20/2024 despite
  the letter BSBC had sent me stating coverage ended on 2/29/2024 and despite their negligence in
  processing the Tremfya prescription in a timely manner which caused severe pain and suffering on
  my part. I have documents/letters to support this complaint.”
  After review of all available information to include coordinating effort with our business department,
  it has been determined this is related to a refund request in the amount of $3,867.89 for the purchase
  of prescription drug Tremfya on 2/20/24, which is after the 1/31/24 termination of the member’s
  Marketplace policy. The member filed a Level I Grievance regarding this issue that was upheld
  because the termination date of coverage was prior to the purchase of this medication on 2/20/24. The
  member’s Marketplace plan was effective from 1/1/24 – 1/31/24 and terminated effective 2/1/24 due
  to non-payment of premiums.
  We sent the decision letter to the member on 11/22/24 letting them know it was upheld, and it
  provided their Level 2 Grievance option. See attached decision letter. Also, we are not showing a
  Level II Grievance has been filed at this time. In light of the above noted findings, we take the
  position all concerns have been appropriately addressed. We appreciate the opportunity to provide
  peace of mind to our community and advise you of our handling of this matter. If you have
  immediate questions, please contact me.
  
  Sincerely,
  ****** *******

  Customer Answer

  Date: 02/24/2025

  
  Complaint: ********
  
  I am rejecting this response, because I have filed a Level II Grievance. They refuse to acknowledge their own negligence in the untimely delivery of my medication that could have been delivered within 24 hours but it took 7 weeks. Also, I participate in the ******** Savings Program that guarantees payment of any amount not covered by insurance with little to no copay. They had all this information in January & refused to assist me! They refused my payment of the premium more than once also. They sent a letter in the mail stating my coverage would not end until the end of February 2024 & that my Tremfya injection was covered! Their negligence caused pain & suffering on my part, & they need to make this right!
  
  Sincerely,
  
  ***** ****

  Customer Answer

  Date: 02/25/2025

  The amount of $3867.89 that BCBS of TN now says that I owe them for a date of service of 2/20/2024 related to a Tremfya injection medication 100MG/ML that was sent to me via mail to my address that was covered by ******** ********* ******** per a letter from BCBS of TN received on 2/10/2024. The medication was supposed to be sent in January 2024 not February 2024.

  Business Response

  Date: 03/26/2025

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your rebuttal inquiry
  submitted on behalf of the above-named. Currently, our records show that we have a pending Level II
  grievance on file awaiting review by the Level 2 Grievance Committee (Case #********-*). This
  case has a due date of 4/15/2025. In this setting, we will not have a definitive response on this matter
  until the grievance decision has been completed.
  Given the update outlined above, we take the position all concerns have been appropriately addressed.
  Once the grievance review has been finalized, the member will be notified in a separate
  communication. We appreciate the opportunity to provide peace of mind to our community and
  advise you of our handling of this matter. If you have immediate questions, please contact me.
  
  Sincerely,
  ****** ******* 

  Customer Answer

  Date: 03/26/2025

  
  Complaint: ********
  
  I am rejecting this response because the matter has not been resolved. BCBS of TN continues to deny their neglect of processing & delivering my medication in a timely manner when I clearly reached out to them multiple times beginning the first week of January 2024; misrepresenting the particular plan I was placed on by stating my Rheumatologist was covered under the plan when that was not the case; refusing my attempts at payment of the premium by credit card when they accepted the first payment previously with the same credit card; & sending fraudulent letters stating that my coverage did not end until the end of February 2024 & that the medication was indeed covered by BCBS of TN.

  Sincerely,
  
  ***** ****

• Initial Complaint

  Date:12/10/2024

  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 was approved through Prior authorization a power wheelchair that was supposed to have functions specific to my handicaps. I got a generic bariatric wheelchair which rated for 800 pounds ( I was not half that much) . So I called the delivery/ salesman. He hung up and I could not get back in touch. I took the chair back the next day and called Blue care to recoup their money because the chair did not work. They said they'd paid $26,000 for it yet they did not have a blue care rep verify that it functioned before delivery.. blue care has been sending me list of other companies (maybe 5 or 6 times) in their network and none said they had the particular chair. I would not expect anyone to have this as they said it should be CUSTOM MADE for each patient. I have been being gaslighted for 2 years. I have talked, had injuries for trying to walk, and layed ROTTING IN BED because I have no mobility. I am depressed. This is discrimination against 1) handicapped 2) obese people ( as they seem to put all obese people in a 1 size fits all supersize after a particular weight)3) and the impoverished, but I would care less as.inam the person sufferring. I worked 2 and 3 jobs at a me and i paid into the system. In June 2024 they say my prior approval ran out. It wasn't run out when I turned in the chair! Then I don't work for them to be looking for chairs 5 or 6 separate times over periods of time in their network. I found an out of network chair for $5600 including shipping and warranty. I want them to pay it out of their pockets, I want them to pay a fair amount for my injuries and is my life not worth anything? I've been lying in bed loosing days of my life because of this mobility issue. Let them get it out of their " petty cash" or something! They had the chance to supply me with another chair now they gaighting me and saying I'm not cooperating because they want to keep sending me list via email of referrals that don't have what they promised to provide.

  Business Response

  Date: 01/16/2025

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on
  behalf of the above- named member. In summary, the member expressed concerns relative to the
  delay of obtaining a replacement wheelchair. Ms. ***** also notes after the receipt of her initial DME
  equipment, she contacted BlueCare and returned the chair advising it does not meet the needs for her
  condition and request assistance with mitigating.
  After review of all available information to include coordinating efforts with our business department,
  it has been determined this is a member that Special Needs Unit with BlueCare has been responding
  to Oversight regarding the wheelchair complaint made to Tennessee Department of Commerce and
  Insurance, ******** Oversight Division. Accordingly, the last response was sent on 11/27/24,
  explaining that the member needs to go back to her physician to be assessed for a new wheelchair
  order, but the member refused stating she was in too much pain to travel to the office.
  To accommodate the member, our Case Manager offered the member telehealth options and she still
  refused. The Case Manager also outreached to member on 12/09/24 and member continued to refuse
  to follow up with her provider and stated it was the principle of that matter. Because the member
  refused to comply, the Case Manager then closed her file as the member did not have any other needs
  at that time.
  Lastly, we also wanted to mention our records show did not transition over to BlueCare Plus on
  12/01/2024. The member is showing eligibility with BlueCare ******** Medicaid effective
  01/10/2025. Under the terms of the member s policy, the CMS guideline and ******** rules as
  follows:
  • The BC/TCS Durable Medical Equipment (DME) Supervisor advised that BC/TCS follows
  Centers for Medicare and Medicaid Services (CMS) guidelines related to authorizations
  requests. The guidelines as stated below requires a member to have seen the prescribing
  physician within six months of the order request.
  o Per CMS-1713-F-Standard Written Orders, “for power mobility devices, the treating
  practitioner that conducted the face-to-face encounter must complete the standard
  written order (SWO). The treating practitioner that conducted the face-to-face
  encounter does not need to be the prescriber for the durable medical equipment,
  prosthetics, orthotics, and supplies (DMEPOS) item; however, to demonstrate
  compliance with the regulation, the prescriber must:
  o Verify that a qualifying face-to-face encounter occurred within the 6-months prior to
  the date of their prescription; and,
  o Have documentation of the qualifying face-to-face encounter that was conducted.
  • Per ******** rule 1200-13-16-.01 DEFINITIONS. (1) ADEQUATE when applied to a
  medical item or service shall mean that the item or service, considered as part of a course of
  diagnosis or treatment, is sufficient, but not in excess of what is needed, for diagnosis or
  treatment of the particular medical condition. In order for a medical item or service to be
  determined adequate, such item or service must also satisfy the requirements at rule 1200-13-
  16-.05(5) regarding “safe and effective” and the requirements at rule 1200-13-16-.05(6)
  regarding “not experimental or investigational.”
  o Rule 1200-13-16-.05 MEDICAL NECESSITY CRITERIA. (1) To be medically
  necessary, a medical item or service must satisfy each of the following criteria: (a) It
  must be recommended by a licensed physician who is treating the enrollee or other
  licensed healthcare provider practicing within the scope of his or her license who is
  treating the enrollee; (b) It must be required in order to diagnose or treat an enrollee’s
  medical condition; MEDICAL NECESSITY CHAPTER 1200-13-16 (Rule 1200-13-
  16-.05, continued) November, 2011 (Revised) 8 (c) It must be safe and effective; (d)
  It must not be experimental or investigational; and (e) It must be the least costly
  alternative course of diagnosis or treatment that is adequate for the enrollee’s medical
  condition. (2) The convenience of an enrollee, the enrollee's family, the enrollee’s
  caregiver, or a provider, shall not be a factor or justification in determining that a
  medical item or service is medically necessary.
  Given the above noted findings, we take the position all concerns have been addressed. We appreciate
  the opportunity to provide peace of mind to our community and advise you of our handling of this
  matter. If you have immediate questions, please contact me.
  
  Sincerely,
  ****** ******* 

  Customer Answer

  Date: 01/16/2025

  Complaint: ********

  
  

  I am rejecting this response because:

  
  

  I responded to the blue cares refusal to provide the appropriate vehicle because I returned the chair within  the same day it was given to me. They issue that they state that **** **** that this and that has no relativity to the fact and was not necessary for me to go to the doctor. The chair was already approved. The delay that they themselves caused to provide a replacement is the issue NOT the doctor visit. I'd already been provided an approval. They could have gone out of network for a chair and gotten the chair somewhere else for 1/6th of the cost. But they want to continue with their legal jargon and try to make the issue .ore than what it is supposed to be.

  
  

  
  

  it is not a matter of me taking more trips to the dr or anything. It is a matter of their lack of action to replace the chair which caused the delay of providing the service to me, which has resulted in physical harm from injury from me not having the vehicle! 

  
  

  do you understand? They need to just send me money from petty cash k can buy the chair myself..they are ******

  
  

   they are ******** trying to use nickle and dime psychology in my already proven case. I had the chair returned to them in 24 hours they owed me another. They did not provide it. My condition has not changed since i was provided a chair that they paid for years previous. I should not have even had to go for a prior approval when i had been in a chair for 10 years prior to the request.

  if they chose to use companies that cant provide services or vehicles in a timely way, that should not, not is my problem.or concern. But by them failing to provide me a transportational vehicle in a timely way it has got to be a crime when i gave the non functioning one back to them.

  
  

  Sincerely,

  
  

  ***** *****

  
  

   

• Initial Complaint

  Date:10/16/2024

  Type:Order 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.

  When the policy for our plan was purchased, we specifically asked the agent **** ***** about whether or not the policy covered bariatric surgery. Mr. ***** replied that while that procedure is listed under an exclusion, it can be approved with a form (he sent us the form) under medical necessity. I have all correspondence confirming that we specifically told him we did not want the policy if that surgery could not be approved. He assured us that with a recommendation of medical necessity (which I got) it would be covered "most of the time." I have been denied by BCBS TN both initially and on appeal for this citing that it is an exclusion. The agent **** ***** and his supervisor **** *** ****** were both complicit in asserting that this procedure could be covered and sold us this policy at $546.00 per month knowing they misrepresented themselves. They have all medical records and documents in their possession.

  Business Response

  Date: 11/20/2024

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on
  behalf of the above- named member. In summary, the member indicates a discrepancy has occurred
  with her prior coverage and request assist to mitigate so that her current BlueCare/******** coverage
  will pay.
  After review of all available information to include coordinating efforts with our business department,
  it has been determined this member is covered under a fully insured. They recently filed a grievance
  on this and the Level I Member Grievance Committee upheld the denial of benefits on 10/9/24. As a
  courtesy, we have attached the decision letter which gave them their Level II rights.
  This plan specifically excludes the following:
  1. Services or supplies, including bariatric Surgery, for weight loss or to treat obesity, even if
  You have other health conditions that might be helped by weight loss or reduction of obesity.
  This exclusion applies whether You are of normal weight, overweight, obese or morbidly
  obese.
  Considering the above noted findings, we take the position all concerns have been appropriately
  addressed. We appreciate the opportunity to provide peace of mind to our community and advise you
  of our handling of this matter. If you have immediate questions, please contact me.
  
  Sincerely,
  ****** ******* 

  Customer Answer

  Date: 11/20/2024

  
  Complaint: ********
  
  I am rejecting this response and attaching the email correspondence from the BCBS agent and ******* ******, the supervisor who represented that with the attached form, we did not require any additional provisions or ryders to have the procedure covered under "medical necessity." This is representation in bad faith in order to sell a policy. I feel that BCBS has continuously skimmed over the fact that the agent of their company was asked outright if this was a covered feature when we noticed the "exclusion" language and he assured us it could be covered under the medical necessity with the BCBS form.

  It is very disheartening that a company as large as BCBS would operate in such bad faith and not honor their commitment to an insured person who put their faith in them to provide what was promised in writing. In court, these emails are legally biding contracts of promise to provide a service. We clearly stated to Mr. ***** and Ms. ****** that if the policy would not cover it, we would look elsewhere. 

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

  Business Response

  Date: 01/07/2025

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your rebuttal inquiry submitted on behalf of Ms. ******* ******. As previously indicated in our initial response letter, Ms. ****** expressed concerns specific to a discrepancy occurring with her prior coverage and request assist with resolution so that her current BlueCare/******** coverage will pay. To ensure a thorough and comprehensive review of this matter has been completed, we continue await a definitive disposition from both our business department and Senior Leadership team. Once we have final update, I will advise you accordingly. We appreciate the opportunity to provide peace of mind to our community and advise you of our handling of this matter. If you have immediate questions, please contact me.

  Customer Answer

  Date: 01/07/2025

  
  Complaint: ********
  
  I am rejecting this response because it is still vague and truly unresponsive to the direct issue. The agent and the agent's superior both confirmed that the procedure could be covered under medical necessity, specifically with the form they sent us in an email. There is a paper trail on this issue. Moreover; there is email correspondence that was sent to the appeals department wherein the agent was specifically told that if there was a chance it could not be covered under the policy, then we would look elsewhere. This is a direct misrepresentation of coverage and benefits by the agent who was the BCBS representative speaking on their behalf. I feel this was a gross mishandling of the matter and that even though the agent made the misrepresentation, if I buy a car online and am told in an email that the car comes with a warranty and it will cover the engine and computer then when I see the warranty, I say, well it does not say that it covers the computer. The sales rep sends me an email and confirms it is covered when a mechanic says it is factory failure. Then a month later, my computer has issues and then as I send it in, it is denied for claim because it is an exclusion on the policy. I guarantee that the dealership owner, manager, etc. will honor their employee's error to rectify the situation. 

  I am at this point very frustrated that a company with such a good reputation in the healthcare industry would ignore their agent's clear representation and tarnish their name and reputation in doing so. I hope this can be rectified and that BCBS will reconsider their position. I could understand if the agent was clear that it was an exclusion and we proceeded anyway, but that is not the case. We advised in writing we would switch policies and providers if the procedure was not able to be covered and we were specifically told in writing it would be with the form they provided and with the word that if it is medically necessary it would be. 

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

  Business Response

  Date: 01/21/2025

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division has completed its final review of
  your rebuttal inquiry submitted on behalf of Ms. ******* ******. After careful review of this matter,
  it has been determined a one-time administrative decision has been reached for an approval exception
  contingent upon the member providing an estimated surgery date to include confirmation of the
  provider performing the services before we can provide a definitive approval.
  Additionally, our business department sent the member the attached letter detailing our position. For
  us to finalize the approval, the onus is on Ms. ****** to provide the required information. We
  appreciate the opportunity to provide peace of mind to our community and advise you of our handling
  of this matter. If you have immediate questions, please contact me.
  
  Sincerely,
  ****** *******

  Customer Answer

  Date: 01/21/2025

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. I am.meeting with the surgeon today and am proceeding accordingly. Thank you. 
  
  Sincerely,
  
  ******* ******

• Initial Complaint

  Date:03/22/2024

  Type:Product 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 was suppose to receive a $50 gift card for getting my yearly physical last November. I spoke to a person back then that I had gotten the physical and I had my primary doctor send over the paperwork multiple times since then. I was finally forced to file a trouble ticket. I was contacted today and told that I no longer qualify for the gift card, because it's now 2024. I have spent months trying to get this worked out but the staff over at BlueCross lied and mislead me. I want the $50 gift card that I was promised. I did everything right! I did exactly what was asked if me but the staff have just lied and lied. Even today, they lie and say they never received the paperwork from my primary doctor. Which is a total lie! You have everything that was needed and if you don't, that is YOUR FAULT! I shouldn't be cheated, just because your staff doesn't know what they are doing!

  Business Response

  Date: 04/22/2024

  see attached

  BlueCross BlueShield of Tennessee (“BCBST”) received your letter submitted on behalf of Mr. *******
  ********. In summary, the member states in part: “I was supposed to receive a $50 gift card for getting
  my yearly physical last November. I spoke to a person back then that I had gotten the physical and I
  had my primary doctor send over the paperwork multiple times since then. I was finally forced to file
  a trouble ticket. I was contacted today and told that I no longer qualify for the gift card, because it's
  now 2024.
  I have spent months trying to get this worked out but the staff over at BlueCross lied and mislead me.
  I want the $50 gift card that I was promised. I did everything right! I did exactly what was asked if me
  but the staff have just lied and lied. Even today, they lie and say they never received the paperwork
  from my primary doctor. Which is a total lie! You have everything that was needed and if you don't,
  that is YOUR FAULT! I shouldn't be cheated, just because your staff doesn't know what they are
  doing!”
  After review of all available information to include coordinating efforts with our business department,
  it has been determined the gift card was mailed out on 3/27/2024, less than 4 weeks from the paid
  date of the claim. If Mr. ******** still has not received it, we are happy to have the same gift card
  resent. In an effort to prevent any future communication discrepancies from our representatives, we
  have implemented coaching opportunities to ensure correct information regarding gift card eligibility
  to prevent this from happening again.
  We appreciate the opportunity to provide peace of mind to our community and advise you of our
  handling of this matter. If you have immediate questions, please contact me.

  Customer Answer

  Date: 04/22/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ******* ********

• Initial Complaint

  Date:03/18/2024

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  BCBST's payment service ******** said they were refunding payments made to providers refusing payment from them. What I understand is ******** pays using depit type cards. One provider I spoke with explained that many issues have been occurring with ********. Patients calling for the same reason I was. To follow up to see if ********/BCBST had submitted payments to them. One priovider said they did not receive any payment on my behalf as ******** had claimed. I was also given by BCBST follow up phone numbers to providers which were , in one case, no working phone numbers saying it was disconnected. By ******** withholding funds for so long it puts patients in jeopardy of default or late payment. Which in turn could affect their credit rating. It has been 14 days since ******** stated they would refund money, but it is yet to appear in my bank account wasting more time for paying providers

  Business Response

  Date: 03/27/2024

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on
  behalf of the above- named member. In summary, the member expressed concerns relative to a
  discrepancy that occurred with an ******** pay card. As a result of the issue, the member states
  ******** aggressed to reimburse funds, but he’s yet to receive money.
  
  After review of all available information to include coordinating efforts with our business department,
  it has been determined the inquiry lacks pertinent information necessary to conduct a thorough and
  comprehensive investigation. In order for BCBST to comply with your request for coverage/claims
  information, etc., we ask that you provide us with additional demographics to include the member(s)
  Subscriber Identification number and D.O.B.
  
  Once the requested information has been received, we will provide the requested information and
  assist you fully in your inquiry. Given the above noted findings, we take the position all concerns
  have been addressed. We appreciate the opportunity to provide peace of mind to our community and
  advise you of our handling of this matter. If you have immediate questions, please contact me.
  

  
  

  
  

  Business Response

  Date: 04/23/2024

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division has completed the review of the
  additional information supplied on behalf of Mr. Campbell. As previously indicated, the member
  expressed concerns relative to a discrepancy that occurred with an ******** pay card. As a result of
  the issue, the member states ******** aggressed to reimburse funds, but he’s yet to receive money.
  After additional review of this matter, we coordinated efforts with ******** to provide high level key
  points related to this case. Below is a timeline for the claims.
  Claim # Provider Deductible
  Amt
  Date of
  Service
  Date of
  Payment
  via
  ********
  Expiration
  of Virtual
  Card
  Date of
  Refund
  ************ ********** ****** *** ****** ******** ******** ******** ******** ************ ****** *** ** ***** ******** ******** ******** ******** ************ ****** ******** ***** ******** ******** ******** ********
  Further, it has been determined none of the providers have opted-out of receiving virtual cards and
  have settled them in the past. Until they opt-out they will continue to receive this type of payment.
  The refunds were processed not because the providers returned the virtual cards, but because they had
  expired, i.e., they had not been settled in a specific timeframe.
  Also, ******** has a record of the member contacting them on 3/14/24 to inquire about the status of
  the refund. This is the only record of contact from the member. As it relates to the reimbursement,
  ******** indicated that the member should have received the refund into their account by now.
  Additionally, ******** notes the member should have received the refund within 5 to 10 business
  days from the expiration of the virtual card. The member would have received emails related to the
  original payment, notification of the providers lack of settlement and notification of the payment
  expiration.
  Given the above noted findings, we take the position all concerns have been addressed. We appreciate
  the opportunity to provide peace of mind to our community and advise you of our handling of this
  matter. If you have immediate questions, please contact me.

• Initial Complaint

  Date:02/21/2024

  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.

  I had to take my son to the emergency room back in April of 2023. I received a bill in July/August time frame for $143 that I paid. Just yesterday I received a text message from the hospital saying I owed $300 plus MORE dollars for this visit. After calling BCBS of TN I quickly learned that this claim was ran (by BCBC) as an OUT OF NETWORK bill. Meaning the hospital adjusted my bill accordingly leaving me owing $143. It was an error that BCBS made that this hospital was actually IN NETWORK, meaning the adjusted it AGAIN making me owe $300 more. Because they made an error, I am now having to pay MORE money on top of what I already paid. Again, this visit was back in APRIL.

  Business Response

  Date: 02/26/2024

  Good morning, *****. Please find attached our response letter for your Case#********.  Of note, I attempt to send this response via email, but it returned with an error message. 

  Kindest, 

  ****** ******* 

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on
  behalf of the above-named member. In summary, the member takes issue with member liability
  associated with her dependent son emergency room visit April of 2023. In particular, the member
  states she received a bill in July/August time frame for $143, but once it was paid, she received a text
  message from the hospital indicating she owed $300 plus because the provider was deemed out of
  network.
  
  After review of all available information to include coordinating efforts with our business department,
  it has been determined this provider’s contract was retro back to 10/1/22, so claims had to be
  reprocessed to apply the correct rate/benefit level, which in turn can change the member’s liability. If
  the member continues to disagree with the claims processing after the correct benefit level was
  applied, she has the option to file a member can file a grievance.
  
  In the event she wishes to avail herself of the grievance right, we have included a grievance form.
  Given the noted findings, we take the position all concerns have been addressed and appreciate the
  opportunity to provide peace of mind to our community. If you have immediate questions, please
  contact me.
  
  Sincerely,
  
  
  ****** *******
  
  
  
  

  Customer Answer

  Date: 02/26/2024

   
  Complaint: ********
  
  I am rejecting this response because:

  I do not feel the remainder of this balance should be put on me. I have already paid the sum that I was billed for. This hospital visit is almost a YEAR old and now you are saying that I owe MORE money on top of what I already paid? How is this fair to the consumer??, 
  
  Sincerely,
  
  ******** ******

• Initial Complaint

  Date:10/11/2023

  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 harassing marketing calls from BCBS of TN for some time now. Most recently one while I was at home with a nurse getting my treatment, under circumstances that any additional stress could have made life threatening! A few minutes another call just came from an unknown number but a reverse search indicates it is another marketing call from BCBS. This is a cease and desist order intended for BCBS's legal team. Under no circumstances is BCBS or any of its affiiliates, "partners" to contact me for any offers, events, surveys or anything else via any means whatsoever including but not limited to ****, telelphone or e-mail. The only acceptable contact from this company should be regular business correspondence relating to my treatment, claims, approvals and the payment thereof along with regular monthly statements. Failure to abide by my demands will result in legal actions for harassment, undue stress and resulting health issues from above, tresspass to chattels and anything else applicable by statute or common law.

  Customer Answer

  Date: 10/30/2023

  All I got from them were a couple of forms in the mail.   This is not acceptable!  I am not jumping through their hoops, running all over town to get stamps to mail back a form. 
  
  
  It's clear they got my complaint, so now I have hard evidence to take to court should they do it again as I will sue them for violations of state laws regarding harassment, Federal TCPA violations, just to name a couple items.
  

  
  

  Business Response

  Date: 11/03/2023

  see attached

  BlueCross BlueShield of Tennessee (“BCBST”) received your inquiry submitted on behalf of Ms.
  ****** *******. In summary, the member expressed concerns specific to Marketing fatigue and request
  all contact from BCBST ceased.
  After review of all available information to include coordinating efforts with our business department,
  it has been determined Ms. ****** was successfully added our Do Not Contact lists for all campaigns.
  Also, a letter was sent to the member advising of the option to opt out of these calls next year, for
  applicable campaigns.
  We appreciate the opportunity to provide peace of mind to our community

• Initial Complaint

  Date:09/26/2023

  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.

  BCBS of TN has denied my daughter a drug that is needed for her to remain healthy! They have denied appeals and do not seem to care about an eight-year-old with Down Syndrome with two autoimmune diseases and her health. They are approving an infusion which is only done at the hospital twice a month! How is this better than me giving my child a 2-second injection? I work full time and she is in school plus there are times we will be out of town when she needs her medication... then what? Having Down Syndrome this will flat out be torture for her.. she does not understand. They are making the situation worse, way worse! They will not give my doctor a chance to talk to the medical professional who denied it! They do not care about children or their health! Her disease is not one that you can just change drugs and everything will be ok.. when you find one that works you have to stick to it. That is how it is! Her medication needs to be approved.. this is my child.. my baby! And they are basically saying "we don't care!" let her get sick, let her suffer and get PTSD from infusions every other week. Get it together and help your customers! Listen to them.. have compassion.. and fight for them! My child.. every child deserves the chance to be health and live a healthy life.. you are taking that away from my daugther!

  Business Response

  Date: 11/22/2023

  see attached

  BlueCross BlueShield of Tennessee (“BCBST”) Legal Division received your inquiry submitted on behalf of the above-named member. In summary, the member take issue with the denial of medication for her dependent daughter and request reconsideration review. After review of all available information to include coordinating efforts with our business department, it has been determined they recently filed a Level I grievance under case ******** for ******* ****** **** *** ********* and Pharmacy approved the medication from 9/8/2023 to 9/27/2024. As a courtesy, we have attached a copy of the Level I decision letter. Given the above noted findings, we take the position all concerns have been addressed. We appreciate the opportunity to provide peace of mind to our community and advise you of our handling of this matter. If you have immediate questions, please contact me.

• Initial Complaint

  Date:11/08/2022

  Type:Service or Repair 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 have been on testosterone therapy for the last year or so due to low levels. The therapy has resolved the issue, but I need to stay on it to maintain normal levels. I was informed yesterday via a call from the provider that Blu Cross Blue Shield of Tennessee that they will no longer cover this treatment for men 65 years or older. I am 66. I view this as unfair and an unlawful denial of medical coverage. My birthday is *********. BCBS ID #: *************** Group: ******** BCBS Plan: ******* RxGrp: ******* RxBIN: ******

  Business Response

  Date: 12/06/2022

  Please see attached letter.

  Customer Answer

  Date: 01/02/2023

  Please be advised that this matter has been favorably resolved and can be closed by your office.