Complaints

This profile includes complaints for Blue Cross Blue Shield of Texas'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 Texas

  1001 E. Lookout Drive Richardson, TX 75082

• 

  Blue Cross Blue Shield of Texas

  PO Box 660044 Dallas, TX 75266-0044

• 

  Blue Cross Blue Shield of Texas

  2215 Southwest Pkwy Wichita Falls, TX 76308-5007

• 

  Blue Cross and Blue Shield of Texas

  1800 West Loop S Ste 600 Houston, TX 77027

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:04/03/2024

  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 went to ******** Eye on October 11, 2022. I received a letter from Blue Cross Blue Shield stating that they were recouping the money back for the visit. I had United Healthcare as a secondary insurance at the time. ******** Eye billing department sent me a bill for $331.91 the money BLue Cross paid on the claim. The billing department informed me that they just filed the claim with BLue Cross not the other insurance company. I don't have that job anymore and its almost 2 years now and they wanting me to pay this. I paid my portion at the time of service, I shouldn't be held liable due to how the coordination of benefits was presented.

  Business Response

  Date: 04/25/2024

  Please see the attached response letter.

• Initial Complaint

  Date:03/26/2024

  Type:Delivery 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.

  Blue cross blue shield has a specialty pharmacy vendor named Accredo (also under Express Scripts or Evernorth) that has been denying my prescription for over a month now due to inability to verify insurance. Blue cross has been unable to resolve the issue with their vendor despite calling daily, but will not let me fill my prescription anywhere else. I am stuck in the middle unable to get my medication because they are improperly making their underperforming vendor.

  Business Response

  Date: 04/12/2024

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

  Customer Answer

  Date: 04/12/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  Date:03/26/2024

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been a BCBSTX provider for 25 years. My contact information is as follows:*************************, Psy.D. ******************************************* ************** Email: *********************** NPI: ********** Tax ID: ********** I am writing to file a complaint on a claims representative, *******, who was rude to me today after I spent an hour on the phone and politely requested claim status. Recently I have had unexplained difficulty with payment from BCBS for claims properly filed through Availity. I have not received payment for claim# *********Q30X00 or 403550481G90X00. Availity indicated that claims had made an error in my address and directed me to contact claims. ******* told me, in an annoyed tone of voice, that is what Availity is for. I do not intend to do my job before hanging up the phone without saying goodbye or offering to transfer me to a supervisor.Several emails and phone calls to my provider representative have not been returned. I am unsure why BCBS has been unresponsive toward clients and providers lately and neglecting to pay claims, but I have attempted to contact them and hope to get a call from a representative who cares enough to listen to legitimate concerns about non-payment of provider claims.

  Business Response

  Date: 04/16/2024

  Please see the attached company response. 

  Customer Answer

  Date: 04/22/2024

  I am a 30+ year BCBSTX provider, NPI 120-585-1995. I need your assistance in resolving payment issues with several unpaid BCBSTX claims. I have emailed and called my BCBS provider ***** **************************** several times. Both ****************** and the BCBSTX claims ***** have acknowledged that claims sent my payments to the wrong address (or that the payments were returned to them). However, They will not agree to reprocess and have told me that after 3 months the claims will be denied because they are late in processing (due to the claim's department error). The claims information is as follows: 406350660Q20X00 DOS 2/20/24 2/29/24, ck # ********, "paid amount $255.62, issued 3/5/24, payment status OUTSTANDING." Payee address ***************************************. I was told by a customer ********************** rep. in claims that they needed to re-issue because they had sent this check to the wrong address, and not the address on file. I need to know what to do to get them to re-issue. 401550150B30X00 - DOS 1/15/24, ck # ********, paid amount $104.64, issued 1/16/24, payment status RTRNMAIL. Payee address *************************************** I was told by a BCBSTX claims rep. this check was returned to them but she did not know what action I could take to have them reissue to my address, although she admitted they were in error. I have called customer ********************** twice on these claims but have documented responses indicating there is no action I can take to correct their errors, and if they do not process these claims in a timely they will be denied as late. Please let me know what action I can take to resolve my complaint in a fair manner according to our contractual obligations. Should I resubmit? The claims representatives have been rude and unwilling to do their job. I'm at a complete loss and need assistance in resolving my grievance.

  Billing Adjustment

• Initial Complaint

  Date:03/19/2024

  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.

  On 2/16/2024 I paid a premium amount of $660.93 for coverage to begin on a new policy I signed up for, to begin effective date 3/01/2024. BCBS then back applied my money to a different policy beginning on 2/01/2024 that I never started with them. I paid for all of my and my families medical bills out of pocket for February since we did not have insurance. The way I found out they applied my policy payment to one I never started was while trying to checkout at the doctor's ****** in March. BCBS claimed I never paid my premium in order for coverage to begin and wanted another $660.93 for them to accept my doctors claim. I spoke to the customer ********************** representative and explained I never had another policy nor paid for another policy at least 20 times. I over and over again asked to speak to a supervisor. In the end I was hung up on and asked to complete a satisfaction survey. I was sold a policy beginning 03/01/2024. They refused to pay my doctors claims because they claimed the money given was for a different policy on a different effective date. They did not offer a solution nor an explanation. Claimed it was all the marketplaces doing (even though I paid BCBS directly through my online account with them) and to contact the marketplace for a solution then I was hung up on.

  Business Response

  Date: 03/22/2024

  To Whom It May ******************** letter is in response to ********************* inquiry, submitted to your office and received by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a ***************************** an Independent Licensee of the Blue Cross and Blue Shield Association, on March 19, 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
  
  Executive Inquiry Specialist
  Blue Cross and Blue Shield of Texas

• Initial Complaint

  Date:03/19/2024

  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.

  In December 2023, I called Blue Cross Blue Shield of Texas to make sure that my 2023 insurance premium would end on December 31st and my new selected premium would start January 1st, 2024. Customer ********************** cancelled both insurance plans, leaving me without insurance. I called in February and they notified me that haven't had insurance, and stated they would listen to previous calls to identity the mix up. They called me days later with no explanation and said my insurance policy was reinstated. I get a bill in the mail that includes charges for the 2 months of did not have insurance, because of their error. I called customer ********************** and they threatened to cancel my policy if I do not pay, they will cancel my payment for non payment.

  Customer Answer

  Date: 03/19/2024

  - I spoke with Blue Cross Blue Shield on 3/19/24 and they stated that because it reinstated, I would be responsible for the 2 months I did not have insurance because of their error. I stated that I did not agree on that nor was I told this when they suggested this solution in February. 

  - They then stated that they never received an application for my 2024 policy, which is not true because the new policy was on my Blue Cross Blue Shield Portal back in December. The representative during my December call saw my new policy. 

  -My application was sent directly to Blue Cross Blue Shield by Take Command on November 14, 2023. Application ID is ********

  Business Response

  Date: 04/04/2024

  This letter is in response to ***************** inquiry, submitted to your office and received by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a ***************************** an Independent Licensee of the Blue Cross and Blue Shield Association, on March 19, 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

  
  Executive Inquiry Specialist
  Blue Cross and Blue Shield of Texas

  Customer Answer

  Date: 04/04/2024

  I have reviewed the business response and accept this resolution. I highly suggest that proper training is provided to all customer ********************** representatives due to the inconsistent and inaccurate information I received each time I called. I also received unsatisfactory and disrespectful service from some of the reps. 

• Initial Complaint

  Date:03/17/2024

  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.

  I lost my job in June of 2022 then did a chapter 7 bankruptcy and it was finalized in October 2022. I included all my medical bills in this bankruptcy. Almost 2 years later my personal injury case settled and my personal injury attorney not knowing bankruptcy laws settled with BCBSTX to pay them back from my medical bills but I do not owe them since I did chapter 7 bankruptcy in October 2022 liberty mutual needs to give me back my $1600 because they are not entitled to that, my bankruptcy cleared me of any medical debit and bankruptcy court can sanction a violation of the automatic stay and find the BCBSTX in contempt. Please see attached my bankruptcy case, filings, and discharge.

  Business Response

  Date: 04/08/2024

  Company Response

• Initial Complaint

  Date:03/14/2024

  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.

  Day January 2024 ongoing Subject: Complaint Against Blue Cross Blue Shield for Refusal to Cover Medically Necessary Surgery I am writing to express my deep dissatisfaction with Blue Cross Blue Shield's handling of my insurance claim for face feminization surgery. Despite the fact that this procedure falls within the scope of services they cover, Blue Cross Blue Shield has repeatedly refused to provide coverage, causing significant emotional anguish and distress.My doctors and I have made multiple attempts to submit the necessary documentation through various fax numbers provided by Blue Cross Blue Shield. However, we have encountered a frustrating pattern of misinformation and miscommunication. On no less than six occasions, we were given different fax numbers to use, only to be informed upon follow-up calls that the last number provided was incorrect.This bureaucratic runaround has not only delayed my access to medically necessary treatment but has also added to the already considerable stress and anxiety associated with navigating the healthcare system as a transgender individual. Face feminization surgery is not a cosmetic procedure for me; it is an essential aspect of my gender-affirming care and directly impacts my mental and emotional well-being.Blue Cross Blue Shield's refusal to promptly and efficiently process my insurance claim is unacceptable. Their failure to provide accurate information and their repeated denials of coverage for a medically necessary procedure are a clear violation of their contractual obligations to their policyholders.I urge the Better Business Bureau to investigate this matter thoroughly and take appropriate action to ensure that Blue Cross Blue Shield fulfills its obligations to provide coverage for medically necessary treatments, including face feminization surgery, without further delay.

  Business Response

  Date: 04/03/2024

  We have received the inquiry from the Better Business Bureau. Please be advised due to Protected Health Information, we will not be responding to the BBB directly, but to the inquirer only. Thank you

• Initial Complaint

  Date:03/12/2024

  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.

  Group / Subscriber: ****** / ************ Claim #: 32375259Q960H Summary: **** representative confirmed full coverage of service with no exclusions during benefit verification call with my provider. But claim was later denied citing coverage excluded certain provider type. Appeal was also denied. We were misled by **** representative ****************** before proceeding with the service, citing no exclusion. **** representative **** admitted to ****'s apparent mistake. We request **** to correct this mistake by paying for this claim. Detail: Per my call with **** representative **** ( call ref# *********), the service was covered but not the provider type. **** admitted that there was an apparent lapse on ****'s part, as no exclusions were mentioned, provided, or discussed during the benefit verification quoted by **** representative during the benefit verification (call ref # *********).Below is a record from my provider of the benefit verification:Following is the summary of the call to the **** local plan, Regence for the benefit verification quote by ****************:Called Regence for Psych (*****, ***** &*****) benefit check.All the above codes are covered under member's plan.No auth required.Plan running per calendar year.As per the rep there are no exclusions for the codes.Telehealth has same benefits as office.Rep name: ******, Ref no: ********* Also of note, codes ***** and ***** are permitted for a speech therapist to use.Here are some resource my provider found online regarding CPT codes ***** and ***** codes that are acceptable for a speech therapist to bill for testing services.******************************************************************************** My provider and I have done all that we could before the service to verify it was fully covered by my plan. I only proceeded with the service knowing it was covered by my plan with no exclusions as verified by **** representative ******************

  Business Response

  Date: 03/26/2024

  Please find attached our response to the complaint.  We will follow-up directly with the complainant.

• 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.

  In September of 2023, I submitted claims for reimbursement. Some of the dates of service overlapped with a previous claim I had submitted in May 2023, which has caused some mix-*** in the reimbursement checks I have received. In October I received a check that was much too high, and included reimbursement for claims I had already received reimbursement for (it was a duplicate reimbursement). I called BCBSTX at that time to say that the check I received was too high, and asked for the correct-sized check to be issued. The customer ********************** rep at that time was extremely knowledgeable and helpful, and issued the correct check immediately. She instructed me to tear up the incorrect check and dispose of it. I received the correct check, cashed that, and the issue was resolved. In December 2023 and January 2024, I received two separate letters from BCBSTX stating that I had been overpaid that that I needed to submit a payment of ~$3000 to correct the issue. These billing requests were issued because the system detected that it had sent duplicated reimbursements and was trying to correct that. I called and tried to explain that I never cashed the check that was incorrect last year, and that these requests for payment to BCBSTX were generated in error. The customer care staff said they needed to work with a specialist to resolve the issue and after 3-4 weeks of receiving weekly updates saying they were still resolving the issue, they determined that I needed to pay the $3000 payment and then the correct payment would be made back to me. I attempted several times to call back to discuss this but the customer care representatives were unable to assist, and said I needed to make the requested payment. This requested payment was generated in error and I will not be paying it without further explanation and reassurance that the correct amount will be paid back to me.

  Business Response

  Date: 02/22/2024

  Please see attached document

  Customer Answer

  Date: 03/01/2024

  The message below is my response to BCBX's offer to send me a letter in response to my complain.

  Dear BCBSTX,

  
  I hope this message finds you well. I appreciate your prompt response to my previous inquiry regarding the billing matter. However, I find the complexity of the issue requires a more detailed discussion than can be effectively conveyed through written correspondence.

  
  In order to gain a comprehensive understanding of the situation and to address my concerns adequately, I kindly request a telephone conversation with a representative who is well-acquainted with the specifics of my case. It is imperative that the individual possesses a deep understanding of the intricacies surrounding the overpayment from BCBSTX and can provide a thorough breakdown of the reasons behind the outstanding balance.

  
  I am confident that a direct conversation will enable us to reach a resolution more efficiently. To ensure a productive discussion, I would appreciate it if the designated specialist could have a prior review of my case, allowing them to be well-prepared to address the concerns I have raised.

  
  Your attention to this matter is highly valued, and I believe that a collaborative effort through a telephone discussion will lead to a satisfactory resolution. I am available at your earliest convenience and look forward to arranging a suitable time for this discussion.

  
  Thank you for your understanding and cooperation.

  
  Best regards,
  *************************

• Initial Complaint

  Date:02/15/2024

  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 minor children are on policy through there father; however, there is a court order in place where he provides medical insurance and I am custodial parent as the mother. I was told to turn in the divorcee to show this since I need the last 5 years of medical history with claims facility and amount out of pocket. However, I keep getting the run around. The father is not in there the children's lives physically nor does he actually pay any of the out of pocket amounts, I personally do and now need to show this in court in a few weeks and keep getting the run around. My daughters is unable to set up online access since they are minors. Your assistance would be greatly appreciated in this matter since I keep getting the run around. ID ************ *********************** 01/03/2007 ***************** 06/20/2008 Thank you, ***********************

  Business Response

  Date: 02/19/2024

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

  Business Response

  Date: 02/22/2024

  Please see attached additional response letter for other case/dependent ****** along with the *** form.