Care First BlueCross BlueShield

CareFirst is trying to contact the member Customer Service has left a voice message and sent an email trying to open a discussion with the member To date the member has not responded We are researching the member's conversations with our Customer Service representatives to see what information she was given regarding the lab tests

CareFirst has been in contact with [redacted] *** Due to issues with the enrollment and initial premium payment, CareFirst had to set [redacted] with a new membership id number [redacted] ***'s initial premium payment was transferred to the new membership and ID cards were sent CareFirst is providing a time premium credit that will be applied to the month of December

CareFirst has attempted to contact [redacted] A message was left with a direct contact name and phone number CareFirst had to set up [redacted] under a new membership ID due to her policy being in a final bill status Her policy was updated to have an effective date of 8/1/The policy is active and [redacted] has had access to careHer policy is currently in the day grace period CareFirst is only showing payment being made along with the one time credit of $that CareFirst appliedWe do not see where a refund is due

CareFirst has been in contact with *** ***His refund of $has been processed. His check was mailed on 3/2/

CareFirst has been in contact with *** ***.Due to an online billing issue, an error message was displayed when a member made a payment even though the payment went through and processed.CareFirst did credit back $to *** ***'s credit card on 11/14/14. We have asked that he
verify this with his credit card company.*** ***'s premium for 9/1/14-12/31/was $1017.12. CareFirst received $but refunded $508.56, which left a balance due of $254.28.*** *** has notified CareFirst that he was attempting to pay the balance due online but was not seeing his current invoice, only an invoice for an older policy. This issue has now been resolved and *** *** should only see the invoice for his current policy. This should allow him to make his payment without delay or confusion

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

To Whom It May Concern:After reserching the issue at hand we will respond directly to the complainant
Sincerely,
Brian *K***, PAHM
Senior
Regulatory Analyst
CareFirst BlueCross BlueShield

To Whom It May Concern:We have recevied an identicle complaint from the Maryland Insurance Administration (MIA). We will reply to the MIA who will inturn respond to the complainant.Sincerely, Brian CK***Senior Regulatory AnalystCareFirst BlueCross
BlueShield***

To Whom It May Concern:Once the MIA case is complate we will have a Service Representative contact the complainant directly.Brian CK***, PAHMSenior Regulatory AnalystExecutive InquiryCareFirst BlueCross
BlueShield** *** ***Baltimore, MD 21224Mail Stop CT10-

CareFirst has contacted the member and advised that an error occurred with billing as her daughter was removed from the policy on 9/24/15 (with retro termination date 6/30/15). The billing has been corrected and was updated on 12/01/2015.  The member was
credited a total of...

$1471.35 (294.27x5=$1471.35) which was the difference
between the old rate of $1807.68 and the new rate of $1513.41 for the coverage
months of July -Nov (1807.68-1513.41=294.27).  The member currently has a
balance due for the coverage month of December for $42.06.  Billing
invoice attached.

CareFirst is trying to contact the member.  Customer Service has left a voice message and sent an email trying to open a discussion with the member.  To date the member has not responded.
We are researching the member's conversations with our Customer Service representatives to see what...

information she was given regarding the lab tests.

CareFirst has attempted to contact [redacted].
A message was left with a direct contact name and phone number.
CareFirst had to set up [redacted] under a new membership ID due to her policy being in a final bill status.
Her policy was updated to have an effective date of 8/1/14. The...

policy is active and [redacted] has had access to care. Her policy is currently in the 60 day grace period.
CareFirst is only showing 1 payment being made along with the one time credit of $140 that CareFirst applied. We do not see where a refund is due.

As requested, contact was made to [redacted] to discuss the Group’s inquiry to your office and past billing problems.  It was confirmed that there were at least two (2) instances in the past 6 months where payments submitted by the Group were improperly applied. In both cases the payments...

were located and posted after the group contacted us. To mitigate the potential risk of future issues, these examples were sent to the appropriate departments for possible process improvements and technical solutions. Arrangements were made with the Group to forward all future payments to one designated contact person for special handling. Once the issues with payment posting have been corrected and the Group’s confidence has been restored we will work to reintroduce the normal payment submission process with them accordingly.

A termination request, effective 01/01/16, was received from the Exchange on 12/21/15 and that request for termination was processed on the same day, 12/21/15.
A refund of $214.53 was processed on 01/04/16.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Regards,
[redacted]

CareFirst has been in contact with [redacted].
Due to issues with the enrollment and initial premium payment, CareFirst had to set [redacted] with a new membership id number. [redacted]'s initial premium payment was transferred to the new membership and ID cards were sent.
CareFirst is providing a 1...

time premium credit that will be applied to the month of December.

[redacted] submitted a ‘Notice About Medical Assistance' to CareFirst as proof of other insurance effective 4/1/2016. The member's policy with CareFirst terminated for non-payment of March's premium; the policy has a 3/31/2016 termination date.[redacted]s eligible for reinstatement but in...

order to bring the policy current and be paid in full thru 7/31/2016, he will need to pay $1,449.19 ($773.59 for the month of March + 4 x $168.90 for the months of April-July) since the effective date to remove the dependents is after the 3/31/2016 termination date.If payment is made and the policy is reinstated, the dependents can be removed effective 3/31/2016 and the policy will become a Self Only policy.CareFirst spoke with [redacted] on today, 6/29/2016, and he advised that he will make the payment of $1,449.19 on Friday, 7/1/2016.[redacted] asked if all of his will be reimbursed and CareFirst advised that we are unable to guarantee any payment of claims; however, we will consider them through processing according to his contractedbenefits,[redacted] agreed that he feels we are headed in the right direction for resolving his concern and there is nothing further he needs assistance with at this time.

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Better Business...

Bureau:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

Review: On June 2, 2014, I mailed an application for Blue Dental Preferred for my mother. I enclosed a check in the amount of $348 for the one year fee. The check was cashed on June 13, 2014. When I had not received any information on the application status by June 25. I called the company. They have no record of my mother's application and cannot tell me what happened to the money. Since June 25, I've called no less than 15 times. Each time I'm rerouted to someone else/another department and eventually I'm hung on. On July 15 I spoke with a "Leslie P" in the applications department - or so I was told. She said to fax a copy of the check to her at ###-###-#### and she would contact me after 3:30 to let me know she received it. No such phone call was made. I refaxed the check on July 18 at 7:55 a.m. and requested a call back. Today is July 21 and no call. I've made three calls today to see what is happening and naturally I've been on hold, disconnected, and put on hold again. I cannot believe that a company can just "cash a check" without applying it to an account. If it's not a scam, then there's something very broken in their organization.Desired Settlement: I want a refund and interest...or refund and an apology!

Business

Response:

CareFirst contacted [redacted].

When contacted she advised the issue has been resolved - a refund was received and this is now a closed issue.

She declined to provide any member information.

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Review: I purchased health insurance with CareFirst via the DC Health Exchange effective January 1, 2014 but subsequently moved to California, obtained coverage there and tried to cancel my DC coverage. After approximately 15 phone calls, 5 emails and now letters, this change has not been processed. My complaint is based around the fact that (1) several CareFirst representatives provided misleading information stating that I was responsible for premiums until my cancellation would be processed, though they could not tell me when that would be, and (2) the ridiculous administrative hoops one has to go through to make such a minor change as this and processing my change of address. Regarding #1, I believe this is standard practice by which they hope to scare customers into paying them for coverage they neither want nor need as long as possible. Regarding #2, this is simply incompetence and, as a business whose customers rely on efficient service for their physical and financial well-being, they are obliged to simplify things. I sent several emails through their online system without ever receiving a response. I called several times and always had a one-hour hold time. It is simply unacceptable.Desired Settlement: I expect an apology, cancellation of my policy effective May 1, 2014 and confirmation of a zero balance due and that there will be no collections activity.

Business

Response:

CareFirst has been in contact with [redacted] regarding her inquiry.

[redacted]'s policy originated with the DC Health Link. Cancellation of her policy needed to be initiated throught the Exchange in order to follow the established protocol. The policy has been terminated and there is a zero balance due.

[redacted] has been sent a letter of Credible Coverage which has her termination date as 4/30/2014 and a final invoice showing the zero balance.

CareFirst is addressing the long wait times customers have been experiencing. We hope that the additional staff that will be assisting on the phone lines will improve the response time for members.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. However, the process to reach this resolution is not satisfactory in the least. I believe that CareFirst staff are trained to frighten customers into paying money they do not actually owe because the statistics show that many people will pay without questioning it. It is a truly rotten company with horrible business practices. Unfortunately, its practices are standard for the insurance industry in the United States and are largely responsible for the appallingly corrupt nature of the health care industry in America. All Americans should be ashamed of this.

Regards,