ComplaintsforBlue Cross Blue Shield Federal Employee Program

• 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.

• Initial Complaint

  04/30/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  On April 6, **************************************** that I had no health insurance. I called Fepblue to see what was going on and they said my ex husband took me off the insurance because I got divorced. I said ok but can you please send me a letter stating that I am no longer insured they said yes of course and that it would take 7/ 10 days. I waited and call them back because I havent received the letter which I need to pick up health insurance through me employer they gave me 30 days and I am running out of time. My member number is R59323519 please help me. I also have a written court agreement where that he was going to keep my health insurance.

• Initial Complaint

  04/26/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  I am a Veteran,use to be a federal employee for more than 20 years,have to retire but keep Blue Croos Blue Shield for federal employee in my pension or OPM more because my wife got rheumatoid arthritis.In 2024 my wife get ******************************************** September 2023 to know what I have to do to cancel the health insurance,because I was paying like 500 a month only receiving net 200 and something here we are a couple living of social security and little of a pension .They told me I have to write a letter and when they receive a letter the end of that month they don't going to cover no more,mean they receive it in october 2023,November and December 2023 don't going to be cover,I let my wife know because ******** going to kick in January 2024.In October my wife get a message medication was ready,she went to pharmacy to let them know is no more insurance but they told her was aprove,pharmacy insist was ok,she pay deductible that was October 17,2024.In April around 24 I got a letter from BCBS that I owe 934.76,I call BCBS they told me that is what they pay a pharmacy,that was approve because took till December to let pharmacy know,my wife went to the pharmacy with a letter,the medication was 3 pack of eye drops and she have 2 unopened, the pharmacist try to discard the 2 she bring to him,but say was to late computer don't let him go that far on time was 5 month and more that took BCBS to let me know.Right now my wife use same medication and pay 40 for 2 pack with ********.Is no fair I have to pay big money for medication could be unapprove or let pharmacy on time.I send a check to BCBS only give 30 days I have excellent credit,was afraid late payment.

• Initial Complaint

  04/03/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  I am a retired military officer and a Federal civil service retiree insured under the Blue Cross/Blue Shield Federal Employee Program. In addition to paying Blue Cross/Blue Shield health insurance premiums for me and my wife, I also pay ******** premiums for me and my wife as well. Because we pay both premiums, my wife and I are *********** claim a ******** Reimbursement of $800 for both myself and my wife totalling $1600 each year. Blue Cross/Blue Shield hired HealthEquity and wageworks as 3rd party administrators to manage the ******** Reimbursement claim program on behalf of Blue Cross/Blue Shield.I filed the necessary ******** Reimbursement claim forms for my wife and I on February 21, 2024 to HealthEquity (P.O. Box *****, *********, ** *****). I have received several emails claiming the amounts due have been paid, buy neither my wife nor I have received any ******** reimbursements at this date. I have contacted HealthEquity at its ************ customer service on March 18 and March 25, 2024 to no avail, after numerous dropped calls and a 40 minute wait time. On March 25th, I was given case no. ******** and case no. ********, and to call back after 10 business days to see "if the case numbers were being processed". I was then told by the HealthEquity call center operator to wait an additional 10 business days to see if I had received any reimbursements. I tried contacting Blue Cross/Blue Shield at its ************ call center, but was told to contact HealthEquity about reimbursement problems.I find this charade to be negligent mismanagement by the 3rd party administrators with Blue Cross/Blue Shield acting as an accomplice in purposely delaying and stalling reimbursement payments rightfully due Federal retirees. These delays have created an annual financial hardship for my wife and I. In 2023, after constant phone calls, it took Health Equity from January 19, 2023 to July 2023 to make the mandatory reimbursement payments.

• Initial Complaint

  03/22/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  BCBS FEP has incorrectly processed my claim for dental care received on 11/30/23 and owes me a reimbursement for covered services that I paid for out-of-pocket. BCBS continues to incorrectly process the claim as if I had an FEHB medical policy at the time, which would have been the primary payer. But I did NOT have an FEHB medical policy on 11/30/23, which makes BCBS is the primary payer.I have communicated this to BCBS customer service over the phone and chat on multiple occasions. Most recently, BCBS assured me that they would resubmit the claim and correct the error. However, instead of correcting the error, BCBS rejected the resubmitted claim as a duplicate. I have received NO reimbursement for the $265 I paid out-of-pocket.I have been waiting for reimbursement for 4 months and this claim has been processed incorrectly multiple times. I need BCBS to call me and resolve this situation ASAP.

• Initial Complaint

  02/16/2024

  Complaint Type:

  Order Issues

  Status:

  Unanswered

  More info

  I have a prior authorization that is pending with Dr. ************************ *** is denying the prior authorization saying there is no diagnostic work up for infertility. However, all of my clinical noting this have been sent over to *** from my doctor. Also, on the *** portal, *** has infertility as one of my diagnosis. I am getting then run around and need for the prior authorization to be approved so I can have my treatment. *** is delaying the process. Also, there are two claims for Coopergeonomic that I am waiting to be processed. My doctor sent over all necessary documents required by ***. My doctor has a fax confirmation noting this from 2/9. However, *** is saying they did not receive. My doctor sent the required notes a second time. I need for the prior authorization to be approved and for my claims to be processed.

  Customer response

  02/22/2024

  
  ***************************
  219 ********************
  *******, ** 29662
  Mobile ************
  
  Re: R59801949
  Case Number 2403123112513
  
  Dear ***,
  
  I am writing to dispute the denial and request reconsideration for prior authorization for infertility treatment, which I am entitled to under the Standard *** plan.
  
  I note that a board certified ophthalmology reviewed my case for preauthorization and that this doctor is NOT an expert in infertility treatment. He is not a fertility specialist. I have had a well documented diagnosis of infertility for over 10 years. Dr. ************************ my treating physician, has sent medical records supporting this to ***.  It is confirmed by history. Further, the *** portal even notes my diagnosis of infertility. The denial decision is not consistent with the Service Benefit plan brochure. I ask that my prior authorization be approved without delay as my treatment is time sensitive.
  
  Thank you,
  
  *******************;
  
  cc: *** and BBB

• Initial Complaint

  02/08/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  Bcbs employees do not give the same answers. They lie. They give out miss information and delay the approval of much needed medication. They do not want to approve zepbound for weight loss and are trying everything possible to deny requests. They go around and around on the forms needed and I truly think they want people to give up and say forgot it. I have experienced stress and anxiety trying to get to the bottom of what I need. They say they will call back then say they cant make outbound calls. Very hard to get a hold of them. Employees need training and should know their job

• Initial Complaint

  01/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  FEP BLUE SHIELD BLUE CROSS changed my secondary insurance prescription coverage without my knowledge or permission to **** FEP ******** Prescription Drug Program. When I went to pick up my prescription under this new coverage I was told by the pharmacy I could only get 30 days (I used to get 90 days) and it tripled in price. I did not pick up the prescription because I wanted to talk to BCBS, ********, and my medical provider to see what was going on. Now I am currently out of my thyroid which you aren't supposed to do. I had to disenroll to return to the original coverage I had with FEP BCBS and they said it would not be effective until January 31, ****. When I retired in 2018 I was assigned ******** as my primary and I chose FEP BCBS as my secondary. How dare BCBS enroll me in this prescription program without my knowledge.This is WRONG and fraudulent in my opinion.

• Initial Complaint

  01/22/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  I have been diagnosed with Myalgic Encephalomyelitis as well as multiple other conditions since 2018, and I see multiple neurologists.Unfortunately there are no specialists in my area, so multiple doctors help manage my symptoms and work together.And since there are no *** approved treatments or medications for my disorder, so this causes many issues for me. Every year I have to get prior authorization on the same 2 medications I have been prescribed since 2019, and every year I go through a battle with BCBS federal.The clinical call center will not let you talk to anyone who is involved in the authorization process nor can they give me any information about what is needed.There is no cure for my illness, so my medications are essential to me.So every year, twice a year, I have to play the game with BCBS federal and the pre authorizations.If my doctor is prescribing something that clearly improves my quality of life, why is this such a big issue????I feel that BCBS Federal truly lacks any sympathy, understanding or emotional intelligence on this issue.Nor do they take the time to assist their customers with any issues.I have even written a letter that explains my condition and how my prescribed medications help my quality of life, that fell

• Initial Complaint

  01/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  During Oct 2023 I received a letter that mentioned that I am being signed up for a ******** part D prescription plan and if I don't want the plan to call and opt out or I will be automatically enrolled. I called and opted out. Then I received another letter again telling I am being signed up for a plan that I did not ask for. I called again and opted out. I just received have a new benefit card that shows a ******** prestation part D plan and I received a booklet telling me welcome to the new ******** prescription plan. I called the 800 number for FEP BCBS and was told they do not have any record of my opting out and now I cannot opt out unless I write a letter explaining why I want to opt out. I would like to know how a health insurance company can force a customer into a ******** part D plan without their permission. I feel that this would be something that I would have to ask for. Now I have to pay a monthly premium for something that I did not ask for. Isnt this a violation of the consumer protection act? I feel this is unfair being forced into a plan and being charged a monthly premium.

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