Care First BlueCross BlueShield

Review: I underwent shoulder surgery December 28, 2012 in Vienna, Austria. I submitted all necessary for** and receipts on January 24, 2013. Through a series of negligence and neglect, I have still not received the full reimbursement for my surgery. The U.S. Department of State has sent us an official notice that we are to be taken to collections because we have not paid them the reimbursement we should have received from Blue Cross Blue Shield. Please refer to the following timeline for details:

16 September 2013

[redacted] and husband, **. [redacted] is a Political Officer for the Department of State, US Embassy Vienna, Austria [redacted] ; [redacted]

RECORD OF BLUE CROSS CLAI** ISSUES

FOR 28 DECEMBER 2013 SHOULDER SURGERY FOR **. [redacted]

24 Jan 2013: **. [redacted] submitted initial claim report, itemized summary of charges, and receipts of service. Claim was submitted via email to: [redacted]

15 Mar 2013: A letter dated this day (15 Mar) received by mail requesting an itemized bill. Unsure of date received in the mail, likely between 24 March and 04 April.

04 Apr 2013: **. [redacted] called BlueCross/BlueShield (BXBS) to request clarification. The representative reviewed the submitted claim and stated that everything appeared to have been submitted correctly. Representative took **. [redacted]’s email address and phone number and stated that she would re-submit the claim as-is and contact him if there were any proble**. No email from the Representative was received after this phone call.

10 Apr 2013: Received a Department of State Notice of Dunning dated 10 Apr 2013. The Notice states the payment to the Department of State is 30 days overdue. Likely received the Notice via mail 17 Apr and 10 May.

10 May 2013: **. [redacted] followed up with BXBS via telephone. The representative stated that the itemized receipt was missing. **. [redacted] informed her that he had attached the necessary receipts to the initial claim submission e-mail. She said that she could not see the receipts. While still on the phone, **. [redacted] forwarded the initial e-mail to her, to which she responded that she could now see the receipts, and that this was the first time she had seen them. The representative again took **. [redacted]’s contact information so that she could contact him if there were any proble** with the submission. No email from the Representative was received after this phone call.

17 May 2013: **. [redacted] followed up with BXBS via telephone. The representative said the clai** had been submitted, and that she would request the clai** to be expedited.

29 May 2013: **. [redacted] followed up with BXBS via telephone. The representative stated that the first claim ([redacted]) had been processed, and was received by the adjudicator. A 3-way call was made to the adjudicating department CareFirst. The CareFirst representative said that the first claim was currently being handled by another representative. When **. [redacted] asked for a possible timeframe, she stated that they should be finished with the claim by the end of the working day (29 May), and that the check should be submitted within a week. The CareFirst representative also stated that the second claim ([redacted]) had not yet been received by CareFirst. The BXBS representative stated that the claim had been sent but that it needs to pass through electronic checks before arrival at CareFirst, and that she did not know where it was in the process. **. [redacted] informed the representatives that he would follow up again the following week.

07 Jun 2013: Received a Department of State Notice of Dunning (i.e. being sent to Collections). The Dunning Notice is dated 13 May 2013. It is a 60 day notice. 60 Days from 13 May is 12 July.

07 Jun 2013: **. [redacted] called BXBS. The representative stated that the first claim was still with the adjudicator. She then connected him with manager [redacted], who made another 3-way call with CareFirst. CareFirst representative [redacted] stated that the adjudication process can take between 4 and 6 weeks, and apologized for the misinformation given by the other representative. **. [redacted] also said that CareFirst had still not yet received the second claim. **. [redacted] once again explained the electronic submission process, and that she still did not know where it was in the process, only that it had been sent to CareFirst.

11 Jun 2013: **. [redacted] and [redacted] called BXBS. Spoke with [redacted] as [redacted] was unavailable. [redacted] stated the two claims were sent to CareFirst for final adjudication. [redacted] transferred the call to CareFirst and stayed on the line. [redacted] at CareFirst states the following:

FIRST CLAIM:

• Claim [redacted] is for $5,290.04 USD. The claim is in the final paying process and was sent to Nurses Review on 04 Jun 2013.

• “Nurses Review” approves or rejects the claim. Then it goes to the Claims Department for payment so they can release the claim for payment. This may take approximately three additional weeks.

SECOND CLAIM

? Claim [redacted] is for $7,002.64 USD. [redacted] stated the claim was sent to CareFirst on 20 May. It was sent again on 10 June. It is unclear why it had to be sent twice to CareFirst.

? [redacted] stated this claim has not yet be process by the Claims Department at CareFirst.

[redacted] stated she will send an email to her supervisor asking about the possibility of expediting Claim [redacted] and Claim [redacted] states she will send [redacted] an email at cn[email protected] on Thursday 13 June 2013 with an update on the claims. [redacted] asked if she could cc someone as DOS on the email. She is asked to cc [email protected]. We request CareFirst and BXBS note for the record that we will be sent to collections in July should we not receive payment for the claims.

13 Jun 2013: Dated of reimbursement from Blue Cross for claim # [redacted] for EUR 3,886.61.

23 Jul 2013: Wrote personal check to Embassy for $ 5,402.00 USD for claim # [redacted].

05 Sep 2013: **. [redacted] called Blue Cross in AM. The BCBS manager said she was not sure why the check for claim # [redacted] has not cleared adjudication. She speculated that it was marked as a duplicate, since it involved the same paperwork as claim # [redacted]. The BCBS manager told **. [redacted] that they needed to speak with CareFirst, who would not open until 9 am CT, and that a BCBS representative would call him later with more information. He told her he would call back when CARE First was open. **. [redacted] called BCBS at 9:15 CT, but the BCBS representative could not reach CareFirst or a BCBS manager. She also said the BCBS agents that handle cases were not currently available, and that she would have somebody call him as soon as one was available. **. [redacted] stated that he would wait on hold until an either an agent or manager was available. After holding 15 minutes, the BCBS representative returned to the line and said nobody was available, and that she would have somebody call **. [redacted] as soon as possible. Nobody called him.

06 Sept 2013: Called BCBS and spoke with manager [redacted]. She stated that Care First will not accept the second claim because it was for the same procedure, and that they needed to process all charges for the surgery as one single claim. A conference call was made with Care First. CF representative [redacted] requested that BCBS resubmit all surgery-involved paperwork as one claim. She stated that CareFirst would not process claim # [redacted], because it comes up as a duplicate claim, even though charges for both claims are different. She said that once BCBS re-submits the two claims as one combined claim, they would re-process the claim to include the additional 5295 Euros that was initially denied. CareFirst Representative [redacted] then said that it would take approximately 21 days for 1) Carefirst to submit a request to BCBS for re-submission, 2) BCBS to re-submit the claim to CareFirst, 3) CareFirst to approve funding and send back to BCBS, and 4) BCBS to submit the wire transfer. The CareFirst and BCBS representatives again claimed that the process would be expedited. **. [redacted] will call BCBS again in 21 days to check on the progress.

CareFirst Reference # for claims [redacted]

** Oct 2013: Called BCBS to check on status of claim # [redacted]. Conference call with CareFirst. [redacted] (BXBS) and [redacted] (CareFirst). Sept 18, payment of $7,002.64 sent to overseas assistance center (BXBS) to be bank-wired to me. [redacted] from [redacted] assistance said nobody from accounting is available right now. Will call back in one hour. Confirmed funding was received from CareFirst. Signed up to receive bank check by mail in Euros (not a bank wire). Should be mailed by end of business day October 11 according to [redacted]. Will call back next week.

16 Oct 2013: Called BCBS for status update. Spoke with [redacted], who stated that the claim has been approved for payment as of October 16. He claimed that a check should be cut within 24-48 hours. [redacted] was advised by BCBS supervisor [redacted]. to request that we check back in that timeframe to see if a check has been mailed.

It has be shown that we, as consumers, have done our due diligence in attempting to retrieve the reimbursement owed to us from BlueCross/BlueShield. It has been 9 months since we first submitted for reimbursement, and to this date, we still do not have the funds that BCBS is required to pay us as reimbursement for services rendered.Desired Settlement: We require the reimbursement for claim number [redacted] in the amount of $7,002.64 USD.

Business

Response:

October 23, 2013

Dear **. [redacted]:

This letter is in response to an inquiry received by our office on October 18,2013.

Effective April 14, 2003, procedures for handling member concerns changed due to the Health Portability Act (HIPAA), specifically the Privacy Rule. If you request an update from CareFirst BlueCross BlueShield or a request is forwarded to us, the member will need to submit an authorization allowing us to respond directly to you, or your stall Authorizations may be obtained on the Federal Employee Program section of forms under the Members and Visitors tab of www.CareFirst.com. Our records do not indicate we received a valid authorization from the

member; therefore, we must direct our response to them,

Sincerely,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: The matter is still not solved. We still have not received our bank transfer as of Tuesday, October 29, 2013 @ 12:26 pm EDT.

Regards,

Consumer

Response:

Hello **. [redacted],

This email is to inform you that the complaint ([redacted]) has been resolved. Thank you for your assistance.

Kind regards,

Review: My problem is being told the wrong information, misinformation, and conflicting information by CareFirst and DC Health Link but this complaint is regarding CareFirst. On January 7th I applied for a CareFirst BlueChoice HSA Bronze health insurance plan through DC Health Link. DC Health Link sent me a letter in the mail dated January 8th that states " I will start getting health insurance benefits through BlueChoice HSA Bronze $6,000 on February 1st as long as I make the first premium payment by January 15th." Now I did not receive the letter in the mail until January 16th. I called DC Health Link to let them know I didn't get the letter in the mail until the 16th which is last minute. They told me that CareFirst extended the first month's premium being due not until February 15th so I thought I had until then to pay the premium but that was the wrong information. When I called CareFirst they told me that they had terminated my coverage on February 4th. I explained to them that I spoke with a customer service representative at DC Health Link and they told me that CareFirst extended the first month's premium being due until February 15th so I thought I had until then. CareFirst reinstated my coverage and told me I needed to pay the first month's premium by February 15th. I was going to pay my first month's premium on the CareFirst web site but I was not able to access my online account that I had set up, so on February 15th I called CareFirst to pay for the first month's premium by phone. The payment did go through and was deducted from my bank account. When I tried to call CareFirst on February 27th to speak with someone in member services I was not able to speak to anyone after calling multiple times just to get a message and then it would hang up. When the message asked me to put in my member ID and birthdate the message said that it did not have my member ID in their records. I called again multiple times on February 28th to get the same message and kept calling and after finally getting through and waiting on the phone for 51 minutes a member services representative finally answered my call. On February 28th I called CareFirst and spoke to a member services representative to have my health insurance plan canceled because of recurrent problems with not being able to access my account online and other problems with CareFirst. I told the member services representative that I wanted a full refund of the first month's premium of $158.17 that I paid by phone. On March 3rd I faxed a letter to CareFirst stating that “I requested on February 28th that my health care insurance plan through CareFirst be canceled and that I wanted a full refund of the first month's premium. I didn't hear anything by phone or mail about the cancellation letter that I faxed to CareFirst on March 3rd so I resent the letter to CareFirst on March 24th. On April 7th I called CareFirst and spoke with someone in billing and they told me that I would receive my refund in 3 to 5 business days. I asked them if they received the cancellation letter that I faxed on March 3rd and 24th and they told me that they didn’t receive any documents from me. I called CareFirst again on April 23rd about my refund for the first month’s premium because I did not receive a refund in 3 to 5 days. Now CareFirst tells me that I need to contact DC Health Link and that my health insurance plan has to be canceled through them since I got the health plan through DC Health Link. I should have been told that in the first place by CareFirst. So on April 23rd I called DC Health Link to have my health insurance plan canceled. DC Health Link told me that all refunds are done through the carrier which would be CareFirst. DC Health Link did a process request to have the health insurance plan canceled. After not hearing anything about my refund I called CareFirst again on May 16th they told me that they haven’t received the application and determination request from DC Health Link. They also told me that they now have the cancellation letter that I faxed to CareFirst on March 3rd and 24th. On May 16th I called DC Health Link to let them know that CareFirst said they didn’t receive the application and determination request from them. DC Health Link told me that the request was submitted and still in progress to CareFirst. When I called DC Health Link on June 9th they told me that the plan is canceled. After that on June 12th I called CareFirst and they told me that the money was suspended in a CareFirst account. On June 23rd I called CareFirst to check on the status of my refund and they told me that they received a cancellation request from me on June 3rd which is not correct at all. I requested that my health insurance coverage be canceled on February 28th by phone to CareFirst and also by letter, faxed to CareFirst on March 3rd and 24th. They also told me that I supposedly faxed the cancellation letter to the wrong fax number but when I called on May 16th they told me they received my cancellation letter. So that is confusing to me. My health care coverage is supposed to be canceled but CareFirst keeps sending letters in the mail and premium statements in the mail. The only thing I want to receive from CareFirst is a full refund of my first month’s premium of $158.17. On January 7th after applying for health care coverage with CareFirst through DC Health Link I never received an information packet, booklet, or ID cards in the mail until a few months later in April after I had canceled my plan on February 28th by phone and March 3rd and 24th by faxed letter. Furthermore, on July 22nd I called CareFirst to make sure my health insurance is canceled because I am still receiving things from them in the mail. They informed me that DC Health Link just submitted a request to have my health insurance plan canceled last month on June 3rd. My health insurance was suppose to be canceled effective February 28th. I feel like CareFirst has been giving me the run-around about my refund and this whole process dealing with CareFirst and DC Health Link has been very frustrating.Desired Settlement: I want and have been trying to get a full refund of the first month's premium for February of $158.17. That is the only thing I want to receive from CareFirst in the mail.

Business

Response:

CareFirst is trying to contact [redacted]. An email and voice message has been left for her regarding her issue. [redacted] can contact the Customer Service representative at the number provided in the voice message.

He policy was effective 2/1/2014; invoice sent 2/6/2014. CareFirst recieved a termination notice on 3/4/2014 with a 2/28/2014 termination date. A second termination request was received on 3/25/2014 requesting a 2/28/2014 termination date - both notices requested a full refund. A third termination notice was received on 6/4/2014 for 2/28/2014 termination date.

CareFirst cannot change the term date unless a new file is received from the Exchange with a corrected termination date.

[redacted] has a claim that applied $2.75 toward the deductible for date of service 4/5/2014. This claim will be retracted and the member will be liable for the full payment to the provider once the policy is voided.

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

All I want is a full refund of the first month's premium for February, 2014. CareFirst's services were not used and should not have been used because I requested that the health care plan be canceled on February 28th by phone to the customer service rep at CareFirst and also by faxed letter on March 3rd and 24th. The facility that submitted the claim in April did not get the CareFirst health care plan information from me because I have not been using their services because the plan was suppose to be canceled on February 28th. I never did use their services.

Regards,

Business

Response:

CareFirst cannot provide a refund at this time.

[redacted]'s policy is through the DC Health Link. CareFirst cannot change the termination date without receiving an updated file from the Exchange. At this time CareFirst has not received any update, therefore the termination date will stay as 2/28/14.

Review: After paying my monthly premiums for over 6 months, I went to see my in-network PCP and was shocked to discover that I was charged $164.49 for 2 doctor visits because Care first failed to update my account with the PCP information!!!

Now, they refuse to retroactive assign this PCP under my name and require me to pay the full amount I was billed for.

This is absolutely disgrace and shameful customer service any company could offer. Literally stealing from your customers!!!Desired Settlement: I am only asking what I paid for, which is to retroactive assign my PCP under my name and adjust the billing for the two doctor visits I had.

Business

Response:

[redacted] has been contacted by our Customer Service department regarding his claims.

Adjustments are being completed and [redacted] will be contacted when the adjustments are finished. [redacted] was provided a direct contact person in Customer Service for his inquiry.

Review: I have called Blue Cross Blue Shield and I have been on hold for over an hour, only to have them hang up on me (I can hear talking in the background). I applied for health insurance and never received documentation and now it is past the first of the year and I still do not have a membership card or payment information.I keep trying to contact but I can't get through. I can't email them because I no longer have an account (they deactivated it).I really need help because I cannot obtain any other insurance here.Desired Settlement: I need them to contact me and get me my paperwork.

Business

Response:

CareFirst Customer Service contacted [redacted] regarding her ID cards. [redacted] had not selected a PCP, therefore her cards could not be released. [redacted] provided the name of her PCP and her policy was updated accordingly. Her ID cards have been released and should arrive within 7-10 business days. [redacted] was instructed the same. She was advised she may obtain a termporary ID card from the MY ACCOUNT site, which she will be able to now access now that her policy is effectuated.

Review: Blue Cross Blue Shield was my Insurance Provider until my company changed vendors Jan 1st 2013. In the past 3 years we have had several claims that were not processed correctly. Most of the time it was BCBS's fault and not the health care provider. If BCBS were audited, one would find that most of the claims were reversed in our favor, and one would see how many times we had to call them. If we had not pursued each one strenuously, we would have been paying money for things we shouldn't have. After switching insurance companies, BCBS still haunts us. There are two claims that weren't covered 100% from end of 2012. Wife and I are just very tired of calling and waiting, calling and waiting, talking to my benefits office, finally after weeks...a claim is reversed. Hopefully, I have the correct BCBS.Desired Settlement: For once...BCBS should call us...explain to us why they weren't covered, if it's their mistake...they should fix it and apologize. We are just tired of the whole thing

Business

Response:

You r email of 5/22/13 to [redacted] was referred to me to research the inquiry. Unfortunately, the information provided by [redacted] was not very specific or was he sure which BCBS Plan he should be addressing?

In order to research and respond to this inquiry we will need more specifc information to investigate [redacted]'s issues. Please request he be sure which BCBS plan he requires the information from and then provide the specific name of the patient, date of service, and/or provider name to research.

Also, in order to respond to the Revdex.com we would need a signed authorization from the member. Thank you

Review: This is inreference to Carefirst Blue Cross Blue Shield Member ID # [redacted] Group # [redacted], in the name of [redacted] and family. Services for [redacted] through an out-of-network provider called [redacted]) have been going on for years now. I have numerous and multiple complaints about all services for [redacted] through the [redacted] from January 2013 through July of 2013. I have called at least 15 times and never get a call back or any resolution to my concerns, after 30 minutes of "please hold while I research that" . I believe I have been underpaid for some of these claims as well as outright denied for other claims in which I should be reimbursed.Desired Settlement: I want a point of contact person who actually knows whats going on and is going to sift through these claims piece by piece to resolve this issue. I have an autistic kid and am sick and tired of dealing with customer service representatives who don't know anything about my plan and just drop the ball when they see how many claims are involved. I have a mortgage to pay and other bills, when I tell them that my billion dollar health insurance company is incompetent and/or intentionally holding my money which I am contractually entitled to they don't seem to care. I am ready to consult a lawyer and contact the local media.

Review: I have tried since January of 2014 to cancel my policy with them. I have spent HOURS on the phone trying to contact customer service, I've faxed my cancellation request and emailed their support team via their online email system. I'm still getting billed and can not seem to have this cancelled. I've actually lost hours of my life trying to deal with this. They get an A+ for the worst customer service.Desired Settlement: I want confirmation that I no longer owe them anything and that my policy has been cancelled. Its really that simple. Notice of Cancellation and a Zero Balance Due!

Thanks so much for your help. I'm at a loss of what to do at this point. [redacted]

Business

Response:

[redacted], Customer Service Specialist reviewed and Per the complaint, the member wanted proof that policy was cancelled and that he had a zero balance. Upon review, the policy was cancelled effective 02/01/2014. A HIPAA cert was sent on 04/18/2014. There is no balance due for group 9901, but member owes $70.00 under group [redacted]. A letter was prepared for **. [redacted] and will be sent to him on 4/30/14 advising him of balance that is due for group [redacted].

Review: I have been trying to reach the membership provider on phone but they are taking a really long time to answer the phone. this is the 4th day I am trying to reach CaseFirst member service provides customer care. every day I was put on hold for around 2 hours and every time I get a different answer or phone number to call for the Maternity option I am trying to add to my policy.

Today I had called in and was on wait for 45 minutes, and the representative gave me a non working number to call for the option, I could hear her typing but she never responded back to me when I was talking to her and telling her that she gave me a wrong number.Desired Settlement: Get a resolution for my problem and an explanation of this will not happen again with me or others.

Business

Response:

CareFirst Customer Service spoke with **. [redacted]. He stated that he has already spoken with another Customer Service Representative to address the maternity issue.

He did state he has another concern regarding their Health Savings Account - procedures and wanting more information. The CSR advised **. [redacted] he should contact the HSA vendor, [redacted], and provided the toll free phone number.

Review: A person claiming to be from CareFirst called me today (7 August 2014) asking for my credit card information. He said I needed to make the payment if I wanted my health insurance to be activated as of 1 August 2014. Why is CareFIrst calling me one week after my health insurance is supposed to be activated?

Background:

My old health insurance policy was cancelled and I was sent a letter stating that I could sign up for a new health insurance policy using DC Healthlink. I did sign up for Blue Choice HSA Bronze on 28 June 2014.

DC Healthlink sent me a letter stating that I would receive my new insurance card "shortly from your health plan if you have not received it already." I am quoting corresponding from DC HealthLink from 28 June 28. However, no insurance card was sent to me, and the company elects to call me asking for my premium a week AFTER my policy was supposed to be activated. Why?

Also, on 29 July I received an email , with a link attached, rom CareFirst asking me to confirm my email address. When I clicked on the link, I got an error message stating that " Information keyed does not match information on file. Try again." I got the same error message over and over again. When I replied on 30 July to the email from CareFirst stating that I could not confirm my email address because of the error message, but I never got a response back from the company.

Also troubling is the call I received from CareFirst today (7 Aug) asking for my credit card information. The person claimed to be from CareFirst and was asking me to confirm my name, address, and last four of my SSN. However, that person never gave me information proving that he was from CareFirst. Further, why didn't CareFirst send me a bill in the mail? Had they done so, I would have been able to ascertain whether or not it was CareFirst from the return address. However, there is no way of me knowing that a random caller is not a criminal asking for my credit card information. Additionally, why would CareFirst call me a week after my bill was supposedly due?Desired Settlement: On 28 June, DC HealthLink wrote me stating that I would receive an invoice from CareFirst "with 3-10 business days." That did not happen.

Also, DC HealthLink stated in the same letter that I "will get your new insurance card and other information about your benefit card shortly from your health plan(s) if you have not received it already." Again, that did not happen.

Finally, a person purporting to be from CareFirst calls me on 7 Aug-- a full week after my health insurance is supposed to be activated--asking me to give him my credit card information if I wanted my health insurance to be activated as of 1 Aug.

Business

Response:

CareFirst is trying to contact [redacted] regarding his inquiry. A voice message has been left on 8/15/14 with a direct phone number for him to contact a Customer Service representative.

CareFirst received [redacted]'s information from the Exchange on 7/29/14. His invoice was generated on 7/29/14 with an 8/13/14 due date. CareFirst does make outbound calls to members who have not paid their premium payments in hopes of stopping policy cancellations.

The initial premium payment was received 8/14/14 but the due date was past and the policy was terminated.

The message left for [redacted] advised him that 8/15 was the cut off date to receive a 9/1/2014 effective date. He would need to contact the Exchange that day in order to get that change made, otherwise a 10/1/2014 date would be given.

The payment CareFirst received will be refunded.

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: CareFirst states that they generated my invoice on 7/29/2014 with an 8/13/2014 due date for policy due to commence 9/1/2014. What they fail to mention is that the invoice arrived at my address on 8/11/2014--a full 13 days AFTER the invoice was generated. I sent my check to CareFirst for $193.53 on 11/8/2014 (see attachment with the date on my check). CareFIrst claims that my check arrived at their offices on 8/14/2014, a day after the invoice was due, thereby leading to my policy's cancellation; however, it arrived late because they sent me the bill almost two weeks late!Please note that my original complaint against CareFirst was filed 8/7/2014--which is the day a customer service person from that company called me asking for my credit card number to pay my bill. As I stated in my original complaint with the Revdex.com, I refused to give them my credit card information over the phone because I had no way of knowing whether this was a fraudster trying to steal my credit card information. I also told CareFirst that the proper way to conduct business was for them to sent me a bill in the mail. That bill arrived 8/11/2014--a full FOUR days after my call with the person alleging to be from CareFirst who asked for my credit card information.

Review: Since July, I had been calling about my policy being held up due to the company applying my initial payment incorrectly. Finally, I got fed up and wrote the Revdex.com about the issues I was having. The business responded at the end of August to say my problem would be fixed. They were to make my effective date August 1st since I was unable to use my insurance for the month of July and use the initial payment that I provided for the month of September. I have the emails from their agent for validation if they need to be presented. I accepted their resolution and closed the complaint. Well, it is now the middle of November and nothing has been done. I am still being billed as if no payment was ever applied. I have called Carefirst several times once again and they have done nothing to solve an issue that they created. I write down each time I call so I can keep track and, since the start of the issue, I have called 37 times, contacted them on fb twice, exchanged emails with their agent, and now filed 2 Revdex.com complaints with no actual resolution. This service has been abhorrent at best, which is quite disappointing and completely unacceptable.Desired Settlement: At this point, I am requesting a refund of the money I paid. I think it is a reasonable request as they have not corrected anything that they promised to correct both via email and Revdex.com message. The card I used initially is no longer active, which is why I am requesting the refund in the form of a check.

Business

Response:

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.

Review: I called Carefirst Blue Cross Blue Shield to ask if it would be covered if I received a pap-smear and STD tests, my main reason for calling was the STD part however. I hadn't had an STD test in awhile and like to stay up to date on such things. I was told it would be fully covered under my insurance, without any caveats mentioned. I looked up providers within my network, and the only one that was available on a Saturday (the only day I could go) was an Urgent Care facility. I called them and they didn't provide pap smears, but could do the STD test. I figured since they were in network, and I was told that pap smears AND STD tests were covered that this wouldn't be an issue. I could get the pap smear later. I went to the facility and had the whole STD gambit run, including having blood drawn. A few weeks later I receive 2 bills from [redacted] and a 3rd bill from the doctor, all of which totaled almost $400. I called Carefirst to see what the issue was, since I was informed that this would be covered. I spoke to a woman, that was very polite and told me that she would have a supervisor pull the call, where I was told it would be covered, and she would get back to me in 48 hours. Three weeks later I had heard nothing. Normally, I would have called back earlier, but with my work hours and the hours that CareFirst's customer service line is open, its difficult for me to call. I called again, and again spoke to a very polite woman that told me she was trying to get in touch with the last person I had spoken to to see if the call was ever pulled. Our call got disconnected, and though she presumable tried to call me back, when I answered the phone no one was on the other line. Again, I had to wait a little while before I could call again due to my work hours, but when I did I spoke with a Supervisor. She informed me that the recent it wasn't covered was because it was billed at X code instead of Y code. I don't understand medical coding, so I had to ask her multiple times to explain what she was saying in a different manner and she kept basically repeating the same medical jargon in a rude tone. Fed up, I eventually said "Ma'am I don't understand what you are saying, I don't understand medical codes. Please explain what I need to do, do I need to talk to the doctor?" She then, again rudely, explained that I was billed for a "non-medically necessary" code and need to be billed at a "medically necessary code" for it to be covered and my doctor would have to change that. At my previous call, I was not explained that there were "if & buts" to whether or not I was covered. I called my doctor, and understandably, she was not able to change the codes. I again called Carefirst back and was told by yet another person, that they would have the original phone called pulled and would contact me. After 3-4 days, I called back again and was told AGAIN that someone would have the call pulled and someone would get back to me. This woman however, did inform me that it would take 3-5 business days and to please give her that allotted time to get back to me. A week and a half later, I hadn't heard anything back, so I called again. I was informed by this woman, that the call hadn't been pulled (after 3 different people told me they would do so and get back to me) but she did have it pulled while I was on the phone, waiting on hold for a decent 30 minutes of the conversation while it was being pulled and listened to. I was then transferred to a Supervisor who had listened to the call. She informed me that I never mentioned STD tests and only asked about a Pap smear and that therefore they cannot cover the expenses. I told her that that didn't make ANY sense, because my main reason for calling was to check on STD tests, why would I not mention them at all? I then asked if I could have a copy of the phone call, to which I was informed I could not,

All in all, though Carefirst does have very friendly customer representatives, it was still the worst customer service I have ever experienced. I was incorrectly informed that my services would be covered, and then had to spend months trying to get an answer and call back a total of at least 5 times to finally get an answer. If I were to be incorrect (which I highly doubt), and I in fact I did not mention the STD I was calling about, then I would gladly pay the money. However, I'm supposed to trust that what they say is correct and they refuse to provide proof that I didn't mention STD testing.Desired Settlement: I would like Carefirst to either pay the expenses of the STD tests, or refund me for June, July and August as I did not use their services.

Business

Response:

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.

Review: Have tried for days and hours to pay for my health insurance. Have been on hold for approximately three hours over the course of three separate attempts to speak with a representative. Only when one finds the "call-back" option, was I able to make contact. And even then I am on hold again. And again I have been told that that person cannot take a payment. And again another number has been given to me to try again to pay. I have been trying to pay for my health insurance since December 20, 2013.Desired Settlement: I want the system fixed! And if they cannot serve their customers, then they should stop being able to do business.

Business

Response:

Our member was able to contact CareFirst on January 7, 2014 and made her payment at that time.

Her policy is active. Her welcome packet and ID cards will arrive within 7-10 business days.

Our Service area tried to contact the member yesterday, January 14. A message was left regarding her inquiry and a direct phone number was provided for the member to contact a Service specialist if she had any additional questions/concerns.

Review: Numerous attempts to collect on a claim have been passed around and no resolution appears to be forthcoming. Calls to one part of BCBS resulted in referring to another office, and it has been going on for 2 years. We are being told the claim is "being processed" but nothing has happened to resolve this. I have documentation I can provide. Attempts by the patient has resulted in similar results.Desired Settlement: We are only trying to get resolution on an ongoing claim from 2012. Payment is owed in the amount of $1863.60 or whatever is allowed under the policy. Patient has been advised full coverage is available but no payment had been made.

Business

Response:

July 22, 2014Dear [redacted]:This letter is to acknowledge the receipt of your correspondence. Thank you for allowing us the opportunity to further review your concerns.CareFirst contacted the provider office to obtain specific claim information on Wednesday, July 16, 2014. The office was closed for vacation. A message was left to contact [redacted] in Dental Provider Relations upon their return. A follow up message has been sent to [redacted] to contact the provider a second time to try to obtain the claim information.Once this information is obtained from the provider, we can begin our investigation of the status of the claim in question.Thank you for your patience while we continue to work on the abovementioned file.Sincerely,

Review: I have made numerous requests to cancel my health insurance policy, starting on March 5th. Every time I call I get a different person telling me they'll take care of it and nothing ever happens. I have repeatedly asked that a manager contact me, but no one ever does. It always ends up with me having to call back and talk to yet another person who has no idea why my policy hasn't been cancelled. I have faxed, scanned and emailed official requests to cancel my policy at least a dozen times. They have these requests on file and a running history of how many times i've contacted them about this yet they have the nerve to tell me that unless I can provide them with an effective date on my current health insurance, I will be billed up to the most recent billing date, despite that they have a record showing my numerous requests to cancel the policy. My current health insurance effective date has absolutely no bearing on the cancellation of the Carefirst policy. I have spent hours out of my time away from work during the week speaking to agents and faxing and re-faxing their requests to them with no resolution. I feel as if i'm being held hostage against my will and the bills keep stacking up for an insurance policy I don't need or want and have been calling every week for the past three months to be cancelled. I am not responsible for the incompetence of management and staff at Carefirst not being able to perform a task as simple as cancelling a policy and therefore have no obligation for the monthly premiums that have been accumulating each month.Desired Settlement: I would like to cancel my Carefirst policy. I would like a MANAGER from Carefirst to contact me and apologize for the grief and HOURS out of each and every week I have spent dealing with this issue. And most importantly I would like my account credited for the accumulated monthly premiums that have been charged to me against my will starting March 5th, 2013.

Business

Response:

Member was contacted by [redacted] and left several messages to advise that policy was canceled as he requested effective 3/31/13. Member was satisfied with outcome *. [redacted]..............Please see below comments from [redacted]

"**. [redacted] called me back today 7/8/13. I advised him of his termination date & that premium is paid through that date. I explained to him if we receive claims, after his policy is inactive, for claims for dates of service prior to the termination date, he will still receive those EOHB’s. He was happy that we were able to get his issue resolved.

Review: For the entire year of 2014 I have been trying to resolve an issue with carefirst over dental coverage. When my husband received his summary of benefits dental was not on it plus he never received a separate dental card for the policy he renewed from 2013 which had a separate dental card from the medical card. I then called and the assured me that he had dental coverage. He has tried on several occasions to schedule a appointment with a dentist including the denist carefirst has on file for him to use with no luck. Everytime he scheduled appointments he received a phone call back that there was an insurance issue and they could not see him. He has called to request dental cards on several occasions as I have as well and everytime we received the same medical card. I called carefirst everytime this has happen. After the sixth time carefirst told us that his dental was embedded in his medical and that is why we only receive the medical card. Which is obviously not the case since he hasnt been able to see a dentist due to the card not having the correct information which carefirst has no answer for and says that is not true. We have paid $20 extra a month for his dental which we were reimbursed for and the reasoning is because our dental was embedded we shouldnt have been charged that amount. We have been told it has been embedded all year. At that point I didnt care anymore we were given our money back for this service that my husband has not been able to use on their fault even though we still had this ongoing issue over the coverage. Now carefirst is demanding the money back saying that our plan did not have an embedded dental plan and that there is no record in their notes that we were ever told that. I was told on the 8th of this month that he did not have an aca plan which is why he should have been charged the $20 a month and was told today that he did in fact have an aca plan which is why we should have been charged. Everytime I speak with a representative it is something different. Ive spoken with several supervisors with the same luck. I sit on hold for hours to be told I am a liar and that I was never told all year he had a plan that he actually did or did not have. Whether he should have been charged the $20 a month or not is not the issue at this point. Whether carefirst issued a credit wrongfully is not the issue at this point. We were still calling to resolve this issue and have gotten nowhere. I do not feel we should have to pay for coverage that was not able to be used because of carefirsts fault. My husband and I have tried to resolve this issue from the beginning and carefirst couldnt figure it out. There were times that representatives werent sure if he even had coverage because they couldnt find it in their system. But they still said they were rightfully charging us for it. Now all of the sudden none of these conversations are in the notes at all but have been there for other representatives earlier in the year.Desired Settlement: I would like for carefirst blue cross blue shield to waive this bill for the $240 for my husbands dental coverage that he was unable to use due to carefirst not knowing what plan he actually had, not sending correct dental card, and giving false information to my husband and I all year.

Review: I obtained a health insurance policy numbered [redacted] through Carefirst Healthyblue Bluecross Bluesheild, with start date December 1, 2011. Carefirst never billed me and subsequently, sent me a letter informing me my policy was cancelled as of February 29, 2012, because of unpaid bills. I paid off my bill in full for the months between Dec. 1st, 2011 till Feb. 29 of 2012. I replied in writing, conceding to their decision to cancel my policy as of February 29, 2012, but till this date, Carefirst continues to bill me in larger and larger amounts. Carefirst is treating me as if I am still their customer under policy number [redacted], even though I am not. I have called, faxed and written numerous letters regarding this issue, but to no avail. I really need your help.Desired Settlement: I wish for Carefirst to cease billing me. I wish for Carefirst to send me a written letter in which they concede that I owe them nothing (Zero dollars), and that my policy with them; numbered [redacted], is and was cancelled permanently as of February 29 of 2012. I also wish for a sincere apology for the headache they are causing me.

Review: I have a history of ovarian cancer in my family and my doctor had discussed getting genetic testing to rule out this hereditary gene for me and my daughters.

She gave my the procedure code and I sent a communication to Carefirst via my account on their website, asking if this procedure was covered. The response was "100% coverage after a $100 deductible.

My doctor sent a copy of this communication to [redacted] Genetic Laboratories with my DNA sample.

About a month later I began getting online communications from Carefirst, in the form of Explanation of Benefits, stating that this is NOT a covered service.

Fortunately [redacted] makes a promise, that it will not charge more than $375 if your insurance company will not cooperate.

They billed me only $375 for the testing.

MY COMPLAINT IS THAT I WAS TOLD THAT I WOULD HAVE TO PAY $100, AND [redacted] SHOULD GET AN ALLOWED BENEFIT.

THEY STATE IT IS NOT INCLUDED IN MY CONTRACT. I HAVE MY INSURANCE THROUGH MY EMPLOYER, SO I DON'T HAVE A CONTRACT.

I STATED, IN WRITING. THE PROCEDURE THAT I WAS HAVING AND I WAS TOLD THAT IT WAS COVERED.

I HAVE PAID THE $375 IN ORDER DAMAGING MY EXCELLENT CREDIT.Desired Settlement: I FEEL THAT [redacted] SHOULD GET PAID AN APPROPRIATE AMOUNT FOR THEIR SERVICE, AND THAT I SHOUDL BE REFUNDED THE MONIES I PAID FROM CAREFIRST LESS THE $100 DEDUCTIBLE

WHICH EQUALS 275.

Business

Response:

August 2, 2013

Dear [redacted]:

This is in response to your July 22, 2013 email regarding the abovementioned file.

Our NAIC number is [redacted] (CareFirst of Maryland, Inc.).

[redacted] is enrolled under the self-insured employer group, [redacted] County Public Schools with the situs of Maryland. This grievance does not fall under the jurisdiction of state or local government regulators. The complainant will be notified directly once the issue at hand has been thoroughly reviewed.

[redacted]plans are plans offered by employers who directly assume the major cost of health insurance for their employees. CareFirst BlueCross BlueShield only provides claims processing and administrative services for self-insured contracts and does not assume any financial risk or obligation with respect to health care claims.

Sincerely,

Consumer

Response:

[redacted]

Review: I am a current customer of CareFirst Blue Cross Blue Shield, but I need to cancel my policy, effective February 1st. For the last two weeks, I have been trying to reach them in order to cancel. I have called more than 10 times and have not been put through to a representative. When I call, I am told that 'due to high call volume, they are unable to take my call' and that I should call back at another time. I have called on many different days of the week, during business hours. I have also sent 3 messages through their online Communication Center and an email to their billing team.Desired Settlement: I would like my policy to be canceled, effective February 1st.

Business

Response:

CareFirst Customer Service has tried to contact the member.

A message was left for the member advising that her policy was terminated, effective 2/1/2014.

The Customer Service Representative left their direct phone # for the member to call if she has any questions or concerns.

Review: I just ended a long term contract with a company called [redacted] and my insurance was with Carefirst Blue Cross Blue Shield. Under the ter** of my insurance, my family deductable was $600; in which, I had the opportunity to share and fill in personal health information to receive credits for myself and my wife. I did so, but my wife did not so I was only issued one healthy blue reward in the amount of a $300 deductable reduction. I before my insurance ended, I asked customer service many times how and when I would receive a refund for my out of pocket expenses since I had already paid $561.36 of my own money for medical services. Customer service stated that I would receive a refund check for anything paid over $300 since I had received the healthy blue rewards deductable reduction. So, I am still waiting for a check in the amount of $261.36. It has been about 2 months since I have not had Carefirst Blue Cross Blue Shield insurance, but know that I reached the $561.36 payment mark months prior to ending my insurance with Carefirsts and had asked about my refund at least twice on calls to their support when confirming benefits and out of pocket expenses for specific ite**. What I find odd and what brings me to open this case, is that when I log on now to their site they no longer have it as I have received the $300 healthy blue reward. So not only do I want to get my refund but i'm a little concerned about the information and practice of them collecting insurance information.Desired Settlement: I am owed a refund check in the amount of $261.36. No other outcome is acceptable. I paid my insurance premiu** and qualified for a deductable reduction of $300, so i'm due a refund for my over payment.

Business

Response:

November 11, 2013

Dear **. [redacted]:

This is in response to your inquiry of October 9, 2013, in which you requested an investigation of allegations raised by the aforementioned complainant.

We are committed to protecting the confidentiality of members and their information. In accordance with Privacy Regulations, Personal Health Information can be released Only upon receipt of written authorization from the member or designated representative. The Authorization for Release of Information form may be obtained on our weblsite, www.carefirst.com. We will be happy to reply further to your inquiry upon receipt of a valid authorization. In the interim, we will work diligently to resolve the matter and reply to the complainant directly.

Thank you for the opportunity to address your inquiry. If you have questions or concerns regarding the information provided in this letter, you may contact me at ###-###-####.

Sincerely,

Review: I paid for my health insurance on September 1st, 2014. BCBS did not mail me my insurance cards until October 24th, 2014. I had a doctors appointment for September 29th and was not able to keep that appointment because I did not have my insurance cards. I've asked BCBS to use the funds I had paid for September to cover my monthly premium for October because it was their fault for not mailing me my insurance cards so I could visit my doctor. It is now October 30th, and they have refused to issue me this credit of $199 and its' simply highway robbery. I was forced to pay for something that they did not provide to me.

I now have to make another payment for my October Insurance coverage and I haven't been able to use my insurance for both September and October.Desired Settlement: I would like a refund for the month of September.

Business

Response:

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.