Complaints

This profile includes complaints for Premera Blue Cross's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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• 

  Premera Blue Cross

  PO Box 91102 Seattle, WA 98111

• 

  Premera Blue Cross

  PO Box 91102 Seattle, WA 98111-9202

• 

  Premera Blue Cross

  7001 220th St SW Bldg 1 Mountlake Terrace, WA 98043-2160

• 

  Premera Blue Cross

  PO Box 327 Seattle, WA 98111-0327

• 

  Premera Blue Cross

  7001 220th St SW Mountlake Terrace, WA 98043-2160

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:04/11/2025

  Type:Order Issues
  Status:

  UnansweredMore 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 am filing a complaint against Premera Blue Cross for misrepresenting the reimbursement process related to an approved in-network exception for maternity ******* 2024, I paid my licensed midwife $8,500 out of pocket for a home birth. Prior to receiving care, I obtained and submitted a written in-network exemption approval from Premera, confirming that my midwife would be treated as an in-network provider.When the claim was processed, Premera reimbursed me only $3,336.82. They stated they had applied a Premera Network Discount of $5,133.18, claiming this discount was negotiated with the provider. However, my midwife and her billing representative have confirmed they never agreed to any such discount or contract with Premera.Premeras actions significantly reduced my reimbursement without transparency or a legitimate basis, resulting in thousands of dollars in unexpected out-of-pocket expenses despite following their approval process. I am seeking a full and fair reimbursement in accordance with the terms laid out in the approved exception.

• Initial Complaint

  Date:02/06/2025

  Type:Service or Repair Issues
  Status:

  UnansweredMore 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.

  Reference #*****C1096 10-24-24 I contacted Blue Cross of Idaho regarding coverage for a Cologuard test. Since I was referred by my PCP as a part of my Preventative benefit, Blue Cross stated it would be covered at 100%. I then called ************************** which is the provider of the test kit. They checked *** & confirmed 100% payment. In November received an *** saying it wasn't covered it because they were out of network. *** gave me 2 addresses for In-network, one being ***************************************************************** I called Exact Sciences and they confirmed that is their physical location. I filed the first appeal on 12-2-24 with all of the above information. It took almost 60 days and numerous emails and calls, I just received another denial. When I called ******** on 2-5-25, I was told that the address was still wrong. I spoke again with Exact Sciences on 2-5. They said that Blue Cross of Idaho should be processing the claim based on the ***, not the address. I have filed a grievance with the Blue Cross of *****. In the meantime, I am being billed $681 for a test that is covered under my insurance plan of 2024. Now they are sending me emails saying they can't find information on me, nor coverage.

• Initial Complaint

  Date:12/11/2024

  Type:Service or Repair Issues
  Status:

  UnansweredMore 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.

  This is Premera Administrating healthcare for a Microsoft Employee Patient followed recommendations of her surgeon, had intraoperative diagnostics done during her surgical case After billing, insurer denies intraoperative diagnostics for medical necessity,Our practice helps patient fill our medical necessity denial,Insurer upholds decision, but refuses to send denial letter to either the member or the provider, which they are supposed to immeidately per ERISA,Our practice requested this denial letter on four separate calls 11/12/24 , call w ****** Ref # ************ 11/19/2024 call with *** "Bubbles" Ref #************ 12/3/24, Call with *** ****** *. Ref: ************ 12/11/24: Call with *** ****** Ref#************ All four have said they are speaking with a supervisor, who will escalate the issue and send a denial letter with further steps.I don't know what else they expect the patient or us to do, we're specifically following the details of their ***. it's just being ignored.

• Initial Complaint

  Date:11/20/2024

  Type:Service or Repair Issues
  Status:

  UnansweredMore 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.

  Turned in all receipts required and requested by Premera for eye glasses and a doctors appointment. $951.40 Premera has not reimbursed me but tells me one check of $80 was sent last week. No check has been ************ can I escalate this matter to force their hand into paying me what is owed? Thank you, ******* ********

• Initial Complaint

  Date:10/22/2024

  Type:Delivery Issues
  Status:

  UnansweredMore 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.

  A delivery medical claim #************ of $4,495.60 at the hospital admitted on 7/23/2024 and dismissed on 7/29/2024 was showing up incorrectly as it did not contribute to the deductibles. As result, I did not receive a payment of about $3,183.91 as I have $957.92 deductible remaining outside of this claim. I have engaged Premera on since 8/27/2024 and they acknowledged they are working on addressing this error but this has not been resolved till date (10/22/2024).

• Initial Complaint

  Date:07/30/2024

  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.

  My PCP referred me for a Vitamin D test which Premera denied as un-necessary. However after 3 years of ******** and 5 rounds of strong antibiotics, this is a necessary test which I clearly outlined in my request for appeal. The appeal was denied and I formally request intervention and a second level appeal. I am happy to work with the BBB to refer this to the media for further investigation.

  Business Response

  Date: 09/24/2024

  Please see attached 

  Customer Answer

  Date: 09/24/2024

   
  Complaint: 22067485
  
  I am rejecting this response because:  they have not fully or completely reviewed my request for review and have made a decision based upon incomplete information. 
  
  Sincerely,
  
  ****** ********

• Initial Complaint

  Date:05/19/2024

  Type:Product Issues
  Status:

  UnansweredMore 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 misled about the legislation and timing regarding My health reimbursement account (HRA) funds after I was laid off from my employer. I was informed by Premera Blue Cross that It was IRS federal regulation which requires my unused HRA funds to be returned to my employer. I was told this was not a ******** policy. This was not unique to me. Therefore all funds would be returned to ******** in my policy regardless of if I returned to ********. If I were to return that would be considered a new policy and b my HRA funds would NOT carry over. I was told that because this is a federal policy and not one decided by Premera nor ******** there was nothing no could do to avoid losing my funds except spend them. Therefore, Premera helped me find services to utilize my funds. I began spending under the impression there was no way at all possible to avoid these funds being lost except spending them. Months later, I was told that ******** had changed their policy and that I could keep my HRA funds. I had been explicitly told previously this was not a ******** decision and now I had been told it was ******** who reversed course to allow me to remaining funds. If this was a ******** policy from the start, I would have pursued ******** to pressure the changing of this policy sooner rather than spending down my funds. I feel I was mislead in regards to the ownership of this policy and the likelihood it would change resulting in me unnecessarily spending my HRA funds for several months.

• Initial Complaint

  Date:01/24/2024

  Type:Sales and Advertising 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.

  Premera Blue Cross is denying claims they already paid out on my behalf to my healthcare providers because they are claiming I had coverage through another provider, Cigna. Cigna is the insurance I had through a former employer, Grape Expecations. My last day at Grape was 7/29/2022. My insurance through my new employer American Northwest is with Premera Blue Cross. Unbeknownst to me, my former employer Grape Expectations had continued to pay my Cigna health insurance premium for another 9 months with that coverage ending on 4/30/2023. I didnt know anything about this until today when I opened my mail to discover a package of Explanation of Benefits forms from Premera denying 5 different claims dating 11/22/2022 through 1/24/2023 because of the Grape Ex Cigna coverage. Again, these are visits that were already paid for by Premera and Premera recently took the money back and denied my claims. I assume more of these denials from Premera will be coming for every service I had through 4/30/2023. You would think at this point I could simply tell all of my healthcare providers to resubmit claims to Cigna, which would be hugely time consuming, but doable. However, ***** only accepts claim submissions filed within 90 days of the date of service. Meanwhile, both of these companies, Premera and Cigna, were paid premiums by me and/or these employers for coverage, but neither of them are paying my medical costs, all of which are in network and covered, and neither company is helping me to get this resolved.

  Business Response

  Date: 03/07/2024

  Please see attached. 

• Initial Complaint

  Date:09/01/2023

  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.

  Nature of Dispute: Premera Failure to adjust claims Premera High PPO Heritage Prime Member *************************** ID # ********* Group: ******* Claims Dates and Amounts for Dr. *********************** (****** visits)5-15-2023 $400.46 4-20-2023 $203.56 4-13-2023 $400.46 Total: $1004.48 I have insurance through the *** with Blue Cross Blue Shield and have a dispute that I am unable to resolve for claims I should not be responsible for in the amount of about $1004.48 for 3 doctor ****** visits. My copay is $25, which I paid during each appointment. Premera shows that I owe this amount because my doctor did not respond to their credential renewal with them (apparently this happens every 3 years). The doctor said they did and there was a letter from Premera that shows my claims should have been covered. After numerous phone calls and the resurrance they were working on the adjustment, I heard nothing back and the amounts have not been adjusted. Now, my doctor is billing me for the amount (adjusted but still way above my already paid co-pay). I made another call to Premera yesterday and the clerk had me on the phone for over an hour and finally said that the first week of January 2023, they sent a letter to me indicating that my doctor was out of network (which would not have covered these 3 visits), she then backtracked when I asked for a copy of the letter. The clerk admitted that no letter was sent because they don't have to send one if I didn't have a doctor's visit within a certain amount of time, which conveniently fell before the 3 appointments. During the 3 ****** visits, I never received any notification that there was a problem that would make the doctor's status change to out-of-network. This doctor has been my doctor for years and my insurance has always covered him as in- network. Whatever issues Premera has with the doctor should not fall on my shoulders or they should notify me if the doctor changes to out-of-network.

  Business Response

  Date: 10/02/2023

  Please see attached 

• Initial Complaint

  Date:06/06/2023

  Type:Order Issues
  Status:

  UnresolvedMore 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.

  This is in response to several attempts to renegotiate my 10 year contract with Premera Insurance. I have been met with over the years (most recently the last two) with: "We have not received and email." "You have to fill out the forms and submit...""We will have a representative get back o you."All while trying to run a practice and not being able to keep up with the salary demands. *************************************************************************** annual inflation rate for ***************** was 4.9% for the 12 months ended April, according to U.S. ********************* published on May 10, 2023. This follows a rise of 5.0% in the previous period. The next update on inflation is scheduled for release on June 13 at 8:30 a.m. ET.Below is a chart and table displaying annual US inflation rates for calendar years from **** and 2013 to 2023. For inflation rates in prior years, please refer to historical inflation rates. If you would like to calculate the accumulated rates between two different dates, you can use the US Inflation Calculator.*The latest inflation data (12-month based) is always displayed in the charts final column.Premera paid ***** $30.71 per unit in 2013 Premera is paying ***** $32.57 per unit in 2023 This is a $1.86 per unit increase or $7.44 per hour increase in 10 years This is a ****% increase in 10 years or a rate of .6% increase over 10 years Cost of living nationally is up by 40% per research n one year for goods and services Table: Annual Inflation Rates To find annual inflation rates for a calendar year, look to the December column. For instance, the inflation rate in 2022 was 6.5%. Meanwhile, the "Ave" column shows the average inflation rate for each year using CPI data. In 2022, the average inflation rate was 8.0%. These average rates are published by the *** but are rarely discussed in the news media, taking a back seat to the actual rate of inflation for a given calendar year.

  Business Response

  Date: 07/13/2023

  July 6, 2023 

  BETTER BUSINESS BUREAU 

  PO BOX 191279 
  ***** ** ***** 

  Regarding: BBB Case Number 20150641 

  Dear Resolutions Specialist: 

  Thank you for your inquiry received in our office on June 6, 2023. You have forwarded a complaint for our review an response. 

  We are unable to provide any information about any person who is or may have been our member without proper authorization. We responded directly to the person who submitted the complaint to your office. 
  Please note health benefit plans are not subject to review or oversight by the Better Business Bureau. We respectfully request that this complaint be removed against Premera Blue Cross of Washington. 

  If you have any questions, please contact **************** at ************. 

  Sincerely, 

  ****************

  Complaint and Appeals Department

  Customer Answer

  Date: 07/13/2023

   
  Complaint: 20150641
  
  I am rejecting this response because: I am not a member. And, complaints against business practices do not have to be from a member but anyone who may have concerns or complaints. This is not the only complaint Premera has received.  
  
  Sincerely,
  
  *****************************