ComplaintsforBlue Cross Blue Shield of Texas

• Initial Complaint

  10/07/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  As of 8/5/2024 I have attempted to contact the billing department at Blue Cross Blue Shield of Texas regarding my ***** payments at ************. Each representative states that billing will only speak to ***** representative and cannot do anything. I have paid 8/5/2024 $1181.40 = (2 payments of ******) and 9/12/24 $1772.10 (3 payments of ******). Each payment was $570.24 for medical and $20.46 for dental. However the dental payments have never posted. I have called the ***** 3rd party at WEX health at ************ and have been told repeatedly BCBS has been sent billing notices and multiple messages to correct this. Yet my dental coverage is not paid and showing inactive.

  Business response

  10/09/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

  Customer response

  10/10/2024

  I have reviewed the business response and accept this resolution.  The plan suddenly shows dental insurance now active as of 10-10-2024.

• Initial Complaint

  09/26/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I'm writing to notifying you regarding my experience during a call with one of your customer ********************** representatives who identified herself as "Kenzie" this morning on September 26, 2024 at approximately 10am CT. On this call, "Kenzie" was very hostile and unprofessional and even told me that she wasn't even supposed to be helping me since it wasn't urgent. She also refused to answer certain questions and instead attempted to transfer the call to someone else so that she could end the call. There were times when "Kenzie" expressed annoyance, impatience, and irritation and also accused me of not wanting the information that I agreed to receive from her. This was inexcusable behavior on her part and I'm requesting that someone review this recorded call as customer ********************** representatives should not be treating customers in this manner. I requested the reference number for the call and was given LVI11067798. I'm also requesting that someone from corporate reach out to me for further discussion.

  Business response

  09/30/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

• Initial Complaint

  09/17/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Detail of complaint:Requesting the status of my application for adding six providers to my roster, and requesting a timely turnaround time to process this request.Given the long delay in **** request to add providers I am concerned, there is an error on my application but I am unable to get in contact with anyone outside of the automated "status or case check" ********** business took 3.5 months to be credentialed and we it has now been another month and we are still waiting for six providers to be credentialed and there is no effective way to communicate with **** for a status update.A fair resolution to my complaint:1-Add six providers (dietitian) to my contract (roster) in a timely fashion. Requiring 90 business days is impossible for small businesses to operate with a 3-month to expected start time. 2-Have a working and accurate system to check the status of credentialing and contracting. The current website checks are ineffective, email is an automated response to the website checks, and phone numbers *********** either reroute you indefinitely or disconnect you.3-Allow providers to talk to an agent and receive accurate status updates and the ability to correct application errors. in a timely fashion.

  Business response

  09/26/2024

  Please see the attached response. 

  Customer response

  09/26/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  09/17/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I got a elite membership for my family through Tivity's Well on Target program. When you sign up they advise you that you must set your home gym and that membership would be active immediately. They advised that you would simply need to print the membership card and then take it to the location to activate it. The gym that I chose as my home membership was Lifetime Fitness ******** ** location. I called the gym before paying to verify that I would be eligible for the signature membership if I chose this package and was advised I would. I went to the gym location that same day after signing up and followed all instructions and was advised by the gym that I was not active in Tivity's system and that I could not be allowed to activate my membership with them AND that I could only access the classic membership not the signature. I offered to show them my portal which showed I was active and that the gym was my home location and was advised that until it showed in Tivity's system I could not access the gym and was refused entry. I was advised that a email would be sent to the manager to reach out to me about the issue and the name I was given was *******. To date I have yet to be contacted by the gym and still am unable to access my membership which is already paid for. Other Lifetime Fitness locations under Tivity's membership (such as City Center and Sugarland) which only offer the signature membership are also covered under this plan. My concerns are the lack of concern for the business following up with members unable to access their paid membership and the discrepancy in information provided to potential members when considering this location.

  Business response

  09/24/2024

  ****** will respond to the member directly, no ***

• Initial Complaint

  09/04/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  My company has two advertised deductible amounts - $1500 and $1600. I would like the difference sent to me. Of course, BCBSTX is referring to the Summary Plan Description for the deductible amount but I am asking why my company's site states (and still states) my deductible is $1500.This, to me, is false advertising. I have contacted BCBSTX, my HR department, and our Benefits Solution line and nobody is able to help me.

  Business response

  09/10/2024

  Response letter to BBB

  Customer response

  09/18/2024

  I would like to find out what my next steps are.  Blue Cross and Blue Shield cannot do anything about an error of the deductible posting on our company's website.  Who else can I turn to?  ********** and insurance company will not help me.  Thank you!

• Initial Complaint

  08/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  ****** through my employer operates a program (HealthSelectShopERS) that rewards members with a deposit to their *** account when they comparison shop for cheaper service providers using a tool on their website and have a procedure done with the cheaper providers. I comparison shopped for a site to perform a head MRI on 7/31/23, and their website shows my shopping history and corresponding claim number. The service was performed at the cheaper provider on 8/14/23, for which I was supposed to have $100 deposited into my ***. This deposit never occurred and both BCBSTX and the *** have been unhelpful in resolving this issue despite admitting that they can see my ShopERS shopping history. I want $100 deposited into my *** as was agreed.

  Business response

  09/18/2024

  Due to the Protected Health Information involved in the response of this inquiry a letter will be sent directly tothe member

• Initial Complaint

  08/22/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  On 8/22/2024 I called BCBS to make a change to my policy. I needed to remove myself off of the policy but my husband and our son was to stay on the policy. The ***resentative (instead of doing what I asked) completely cancelled the entire policy and attempted to put another policy into place. I told her that is not what I wanted to do and that I specifically told her I was just removing myself off of the policy. I specifically told her that our deductible had been met and my husband was under the care of a specific doctor. She went against my requests and cancelled the policy anyway. I asked for her employee ID number so I could file a formal complaint.. I was then placed on hold for over 10 minutes and then transferred over to another ***resenative who was unable to help. She placed me on hold while she submitted an escalation ticket to "un do what the previous *** did." and in her words "she really messed up your entire policy and I dont know what she did but I cant fix it." and I was placed on hold- told she would return and then I was transferred to a third *** who says that the previous *** did not transfer over ANY of my infomation and I had to re identify my self and explain again what had happened. She says she placed an escalation ticket and someone should be contacting me within ***** hours. However, I'm afraid to wait that long and lose coverage.

  Business response

  09/10/2024

  To Whom It May Concern:

  This letter is in response to *********************************** inquiry, submitted to your office and received by Blue Cross and Blue Shield of Texas (BCBSTX), a Division of Health Care Service Corporation, a ***************************** an Independent Licensee of the Blue Cross and Blue Shield Association, on August 23, 2024.
  
  Due to the Protected Health Information involved in the response of this inquiry a letter will be sent directly to ****************.
  
  We strive to deliver excellent service and appreciate being made aware of instances in which improvement is possible. If you require additional information, please do not hesitate to contact us in the future.
  
  
  Sincerely,
  
  *********************** U312688
  
  Sr. Inquiry Specialist
  Blue Cross and Blue Shield of Texas

• Initial Complaint

  08/02/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have tried now 11 times over 10 hours of my time to get this company to correctly bill the right person under my plan. They hang up on me, disrespect me, say they will personally handle the situation but never do. I'm in extreme pain and the one physical therapist that has worked in the past 20 years is under my plan but they keep denying my primary doctor to submit a refferal to the covered correct doctor. I just had a supervisor hang up on me telling me to make it 11 calls then hangs up on me again when I call back because he can't spell canary. This is such a common occurance, I have very little time to handle this and to be ***** it shouldn't be up to the account holder to spend an hour each time calling and waiting on hold with either false promises or just being hung up on waiting for a supervisor (6) times. They need to stop pushing me to a useless tech that can't solve the problem. It is not ok to treat someone who has the correct coverage and keep blocking their claim. I need someone who isnt a cog in the wheel to address this. 7 times I've followed what was told to me and have nothing get fixed or resolved.

  Business response

  08/05/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.
  

  Customer response

  08/05/2024

  I am rejecting this response because: They didn't resolve the issue so I can have the correct doctor billed and see my physical therapist. 

  Business response

  08/06/2024

  Good afternoon,

  Please see the attached response letter. We will respond directly to ******************** regarding his referral.

  Business response

  08/07/2024

  Good morning,

  Please see the attached response letter, BCBSTX will respond directly to ******************** when the research is complete.

• Initial Complaint

  07/26/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I called Member customer ********************** for more information and the phone number is a non working number. Then I called the pre-authorization hotline, the agent confirmed my name, dob, and address. I then informed the agent that I would like information about my benefits and was told that I dialed the wrong department and instructed to call the member customer ********************** line. I informed him I've done that and am only calling because that number was non working. He advised me to call back and confirm if I dialed the correct number after I stated that I had not called more than once to ensure that it was a working / correct phone number.

  Business response

  08/15/2024

  Please see attached letter.

• Initial Complaint

  07/17/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  On or around 6/3/2024 My provider reached out to ***************** to request prior authorization for treatment. My ********* company provided me with the attached approvals that are completely misleading. Prior Authorization Status Explanations Approved The health service you requested has been approved. You can talk to your provider to schedule the service.Denied The health service you requested is not medically necessary and has been denied. If you do not agree with this decision, call the phone number on your member ID card.Pending The health service or procedure you requested is being reviewed. Please wait to schedule the service with your provider.The definitions above are directly from BCBSTX website. After being told my drs were approved by BCBS TX on multiple phone calls and via mail, i started planning travel to ************************. A second request for approval for an additional DR at the same practice was submitted and the same approvals were received. This solidifed my plans to travel. Prior to all of this I spoke with a Member Service rep and verified ************** . I was informed no copay and no out of pocket expenses should be expected due to both in Network and Out of Network deductibles being met. Today, i received a call from the dr ********* coordinator stating my request were denied. I called the ********* company and sat on the phone being bounced aroound for 3+ hours being told it the services were in fact denied. I finally speak with **** who shares - BCBSTX ran my request based on incorrect address seeing that i reside in Texas. She said the claims were completely overlooked and that they would need to be reprocessed but would be denied because i do not reside in **********. She then discovers an appeal that i completed on 7/11/2024 that had not been decisioned. This by far is a horrible experience. They have no real resources

  Business response

  07/18/2024

  Due to the Protected Health Information involved in the response of this inquiry a letter will be sent directly to our member.
  
  We strive to deliver excellent service and appreciate being made aware of instances in which improvement is possible.If you require additional information, please do not hesitate to contact us in the future. 

*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. ↩