ComplaintsforBlue Cross Blue Shield Federal Employee Program

• Initial Complaint

  09/07/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My husband needed surgery for a torn ligament in his toe, it was not caused by an accident.My insurance company BlueCross BlueShield Federal Employee Program sent me a form asking his accident. I immediately returned to form, in the mail the next day. Now they say they have not received the form back and are refusing to pay the claim. They never called me, or contacted me. I have not been able to contact them, they havent answered their phone. This is a large bill, and Im not sure what to do. Please help me. I filled out the required form immediately. Its very frustrating.

• Initial Complaint

  08/29/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  FEP Blue erroneously applied a claim to my account from 2 Dec 2022 and paid me a total of $659.02 for this claim. Services rendered were not for anyone on my plan; this was completely a mistake of FEP Blue. I immediately contacted FEP Blue thinking this may be fraud. I was told of the mistake and that a payment was issued to me and that I would have to pay it back. I received a letter requesting to pay back the $659.02 which I did in Feb 2023. Unfortunately, due to another error by FEP Blue, my check was cashed but deposited into the wrong account. My account was never updated with this payment and a balance of $659.02 remained on my account (unbeknownst to me). Now that I am overseas again, all of my claims are not being paid me and instead are being applied to this balance that shouldn't even exist. I've written many messages and no one seems to even understand what I am talking about. Why do I have to pay for the incomptency of multiple people in FEP Blue?

• Initial Complaint

  07/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I was approved by my medical insurance on 02/1/2024 in writing that my insurance plan approved an exception for an out of network provider for an oral appliance. I was informed of the pre-service estimate and what my copay would be. I submitted the paperwork to my insurance company for reimbursement on 04/30/2024. I then called to follow up on this claim and was told I needed to submit the Health Benefits Claim form along with the paperwork (which I was not informed of initially). I submitted this paperwork back to my insurance on 06/06/2024. I then called back to follow-up and was told it hadnt been routed to the correct department. I received another explanation of benefits for July and still does not seem this is being processed by the insurance correctly. I have submitted all required documents and requesting reimbursement in a timely manner.

• Initial Complaint

  07/15/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Unanswered

  More info

  I brought my two daughters to Munchkins Pediatrics for wellness visits in February 2022. The office confirmed my insurance courier was in network. The office took my insurance card, driver's license and copay. Several follow up visits were made where additional copays were made for ongoing health issues for one of my daughters. After several visits and no progress with the medical issue, we no longer considered going to this office and had to seek a specialist to correct what the nurse practitioner had done. These visits occurred between the dates of February 2022 and March 2022. In December of 2023, I received a text alert from Munchkins Pediatrics saying I had an outstanidng balance for one of my daughters. This was the first I had learned of any balance due. I called the office to learn that I also had an outstanding balance for my other daughter as well. I have contacted BCBS of FEP and they have stated that all claims by that office were denied because the provider did not join their network until several months later. However, they would reconsider if I submitted a letter of reconsideration to the address they provided me. I have mailed 2 letters to the provided address. The second of which was mailed certified with a tracking number and signature required because the first letter was never received. The tracking states that the letter is being returned to sender because it was never retrieved from the ** Box. When I call, the representatives do not provide any additional information or help. They simply want to research the claims and tell me why the claims were denied again and again. I am at a point where I just keep getting turned in circles instead of reaching a resolution.The outstanding medical bills that I am now responsible for are a result of the insurance and providers lack of communication and efforts in doing their jobs.

• Initial Complaint

  07/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  Since Jan 2024 BCBSFEP has been "delaying" not denying the payment of my overseas claims. Prior to these claims were paid. Two changes took place this year. Medical and pharmacy claims are submitted through a portal and a new company Geo Blue was placed in charge of initial processing of claims. Geo Blue is a subsidiary of BCBS. I am spending hours trying to send claims through the portal--I fill out all the documents and press submit, and nothing happens--I must redo all the information. This is an ongoing problem, and I am spending hours just trying to submit. Many claims are blocked at the Geo Blue level. Those claims that made it to Care First are just sitting in process. CF told me the backlog will clear up at the end of June. Geo Blue and Care First are unable/unwilling to answer questions in a meaningful manner. They are all TOO BUSY, is what I am frequently told. Hours spent on the phone. The processing of pharmacy claims has also been challenging since the use of the portal. The claims that are submitted through the portal are unreadable. It is my understanding that pharmacy claims initially go to Geo Bleu and Geo Blue forwards them to Care ****.I get many returned pharmacy claims that cannot be read and need to resend the documentation. BCBS FEP is aware of the problems. The Tech supervisor did not even know there were portal issues with Care ****. Oh, and he did chuckle at our situation.The *** OIG referred me to another office of ***. I have reached out to the *** office that manages health insurance. I left messages that were not returned. I then tried calling again and used a different extension. I was transferred to a supervisor who at least appeared interested. I then submitted an 8-pg. memo with numerous attachments and follow up and have heard nothing from the supervisor. Ongoing calls with ************** First, and Care **** have been unproductive. And I do NOT find my situation AMUSING. I can send the memo , etc. if you want it.

• Initial Complaint

  07/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I am a retired annuitant who has subscribed to Blue Cross Blue Shield. Because my daughter's providers are out of network, I have the Standard Plan.Every single time I submit a claim for an out of provider network, they deny it saying there is information missing, though they don't say what. When I call, they check and realize the information was indeed on the claim form and invoice and say they will resubmit it and I have to wait 60 more days. When I call a month later, they tell me the agent forgot to resubmit it and I'd have to wait another 60 days. When I checked a month later, they said it was closed and would have to be resubmitted as a Manager's Special, and again I'd have to wait an additional 60 days. On top of that, they added the charges wrong and had an incorrect amount on the claim, even though the correct total was on the invoice and on my claim form.This has happened several times over the past year, and I have to spend 45 minutes to an hour on the phone each time I call, assuming I can get through to them. I've spoken with supervisors who understand my frustration but acknowledge they're incapable of processing these claims. One supervisor suggested I try mailing them to her in the portal, but said she's not sure if she would actually get it and the claim may just be deleted.I pay a lot of money in extra premiums for this plan, and will most likely change plans during open season. If they can't process my current claims ($2700), I'm considering legal action. This isn't about me not qualifying for reimbursement; it's about their total incompetence and inability to process simple claims. It's been five months for my last claim and I still have nothing.

• Initial Complaint

  06/19/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  I am covered by the Federal Blue Cross Blue Shield program as a disabled former employee. My monthly payments are deducted automatically from my pay. I live in the country of ****** and I am supposed to be covered worldwide. In December of ************************************************************************************ with my recovery. I am still waiting for a nurse case manager to be assigned. I have many medical issues that need to be addressed and the insurance company has sent me a response from someone who is pretending to be a nurse case manager. In this response the writer only gives me a first name and does not include a last name, direct contact information nor credentials. I am paying for coverage and I need healthcare assistance.

• Initial Complaint

  05/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I have extensive genetic issues. This neck surgery is a new procedure done by 1 surgeon in the **. The muscles in my neck are deformed causing chronic pain/lack of mobility. The hope is this surgery would improve my quality of life/mobility in multiple ways. I'd been working with a BCBS agent since 2021 to get the surgery preauthorized. He didn't do his job properly, which his supervisor at **** was notified of & should be able to verify. Because of this, I have spent 3 years fighting to get reimbursed for this surgery that insurance should have & WOULD have covered (as I was told by a BCBS agent) had he done his job properly from the beginning. When I tried getting information from ************** he refused to respond to me until I stated I would be filing complaints that he finally responded.I have been shuffled between ****************** offices for ********** claim continues to be dismissed & denied because one man failed to do his job at the very beginning & now no one knows what to do with my claim because it is all happening AFTER the fact &, as several employees have stated, "it wouldn't have been an issue if we had talked to you BEFORE your surgery, but since it's already happened we don't know how to help you."When my claim was denied I tried to appeal it & yet another BCBS staff member failed to do their job. *********************************** was assigned my case. She sent me an initial email requesting documentation. I responded expeditiously with the requested items, but never heard back. I followed up multiple times, but still never heard back. Once again, I stated that if she failed to respond I would be forced to file complaints for her failure to properly do her job. Still she failed to respond to me directly, but instead chose to pretend to process the claim, but did so without even bothering to read the file. She started requesting information from the doctors office for a procedure that I wasnt even requesting reimbursement for.

• Initial Complaint

  05/08/2024

  Complaint Type:

  Order Issues

  Status:

  Unanswered

  More info

  Before an appt, I called FEP BCBS and spoke to ********************************, BSN, CCM, Office: ************| Fax: ************ to request an in-network physician. ******************** provided ********** as in-network doctor. The appt was 9-23-2023. Since then, BCBS has not paid for the insurance portion. At first, BCBS sent me a check for $51.73 and when they determined it was an in-network doctor, they requested the payment back. I include copy of my check. It took me all this time to get the other two transactions on my bill fixed. ********** is an in-network doctor and as such, the insurance needs to pay it's part and has been having the doctor's ****** and me wait for them to process the insurance claims and continues to not pay its portion.

  Customer response

  05/08/2024

  This was provided by BCBS to show ********** was an in-network physician.

• Initial Complaint

  05/02/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  I am a U.S. *************** Officer and was a client of Blue Cross Blue Shield Federal Employee Program from 2006 to January 1, 2024. On July 30, 2023 I was hiking in ****** (where I am stationed). I fell and broke my leg. I had a spiral fracture that required surgery. On July 30, I was rescued by helicopter and flown to the nearest hospital in a city called *****. Since my injury was so severe, the doctor stabilized me and my leg and I was transported via an airplane ambulance to **** (where I live). I was admitted to a hospital called *******************************************. I was admitted from August 1-7. I had surgery for internal fixation on August 2. I submitted all of my medical bills and proof of payment for the stay in *****, my PT, and my surgery in ***********************.BCBS issued an EOB for my stay in ***** within the expected time frame, less than 30 days and reimbursed me. They also covered all of the follow up appointments and PT. However, as of May 2, ***************************************** completed processing my claim for the surgery in ***********************. BCBS Number: R59379927 Amount Requested for Reimbursement: $10,218.72.I've received several requests for information which I've promptly responded to. This includes all available information from the hospital and my discharge papers. I submitted everything through the portal on the website and more recently by email. I no longer have access to the fepblue.org website. This means I can not use the chat feature to communicate with customer service or have access to my EOBs. (I have downloaded them previously). When I call, I am usually transferred from person to person multiple times. I have communicated with two employees in the ******************** and GeoBlue via email. GeoBlue employees, who process overseas claims, have explained that my request was previously handled by GMMI, another company which no longer works with BCBS. Tha past few times I've called or emailed, they don't answer, or just say that it is being processed.

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