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BBB Accreditation

A BBB Accredited Business since

BBB has determined that Regence Blue Cross And Blue Shield Of Utah meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses pay a fee for accreditation review/monitoring and for support of BBB services to the public.

BBB accreditation does not mean that the business' products or services have been evaluated or endorsed by BBB, or that BBB has made a determination as to the business' product quality or competency in performing services.


Reason for Rating

BBB rating is based on 13 factors. Get the details about the factors considered.

Factors that lowered the rating for Regence Blue Cross And Blue Shield Of Utah include:

  • 6 complaint(s) filed against business

Factors that raised the rating for Regence Blue Cross And Blue Shield Of Utah include:

  • Length of time business has been operating
  • Response to 6 complaint(s) filed against business
  • Resolution of complaint(s) filed against business


Customer Complaints Summary Read complaint details

6 complaints closed with BBB in last 3 years | 3 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 0
Billing/Collection Issues 4
Delivery Issues 0
Guarantee/Warranty Issues 0
Problems with Product/Service 2
Total Closed Complaints 6

Customer Reviews Summary Read customer reviews

0 Customer Reviews on Regence Blue Cross And Blue Shield Of Utah
Customer Experience Total Customer Reviews
Positive Experience 0
Neutral Experience 0
Negative Experience 0
Total Customer Reviews 0

Additional Information

BBB file opened: November 01, 1984 Business started: 01/01/1942 Business started locally: 01/01/1942
Business Management
Ms. Susan Gardner, Company Contact Ms. Wendy Cowley, Company Contact Jennifer Danielson, President Ms. Shauna Eldredge, Company Contact John Ruch, CEO
Contact Information
Principal: Ms. Susan Gardner, Company Contact
Business Category

Insurance Companies Insurance - Health

Alternate Business Names
Blue Cross And Blue Shield Healthwise Regence Blue Cross & Blue Shld Regence BlueCross BlueShield Federal Employee Prog Value Care

Additional Locations

  • 2475 Washington Blvd

    Ogden, UT 84401

  • 2890 East Cottonwood Pkwy

    Salt Lake City, UT 84121 (801) 333-2000 (801) 375-2090 (801) 481-6179 (801) 481-6177 (801) 399-3731 (801) 333-5290 (801) 333-2470 (801) 333-2100

  • 5255 Edgewood Dr Ste 150

    Provo, UT 84604

  • PO Box 30270

    Salt Lake City, UT 84130

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BBB Customer Review Rating plus BBB Rating Overview


BBB Customer Reviews Rating represents the customers opinions of the business. The Customer Review Rating is based on the number of positive, neutral and negative customer reviews posted that are calculated to produce a score.

Customer Review Experience Value
Positive Review 5 points per review
Neutral Review 3 points per review
Negative Review 1 point per review

BBB letter grades represent the BBB's opinion of the business. The BBB grade is based on BBB file information about the business. In some cases, a business' grade may be lowered if the BBB does not have sufficient information about the business despite BBB requests for that information from the business.
Details

BBB Letter Grade Scale

BBB Rating Value
A+ 5
A 4.66
A- 4.33
B+ 4
B 3.66
B- 3.33
C+ 3
C 2.66
C- 2.33
D+ 2
D 1.66
D- 1.33
F 1
NR -----
Star Rating scale

  Average Score
5 stars 5.00
4.5 stars 4.50-4.99
4 stars 4.00-4.49
3.5 stars 3.50-3.99
3 stars 3.00-3.49
2.5 stars 2.50-2.99
2 stars 2.00-2.49
1.5 stars 1.50-1.99
1 star 0-1.49

BBB Customer Review Rating plus BBB Rating is not a guarantee of a business' reliability or performance, and BBB recommends that consumers consider a business' BBB Rating and Customer Review Rating in addition to all other available information about the business. If the BBB Rating is NR then only Customer Reviews are used for the Star Rating.

Complaint Detail(s)

10/30/2015 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: We had our first baby on March 1, 2014 at UCSD hospital in San Diego. Our baby was born with high jaundice levels and we were moved to an aftercare room for a few days before discharge. Afterwards we received a bill from UCSD that did not cover the entirety of the stay based on the insurance policy with Blue cross saying that they only cover semi-private room and that we were put in a private room and it was not a medically required. Couple things 1) We were never given any option of room, the doctors told us we were going into a room. When we talked with UCSD, they indicated that this was decided by the doctors and they tried to convey to insurance who kept denying the claim and not covering. 2) we later found out after months of back and forth that the cost of the semi-private room was the same as the private room. UCSD again said they will submit this new information to Blue cross but we now received a collection letter last week along with interest. This has been a really frustrating experience with bad behavior from Blue Cross and also to some extent UCSD.

Desired Settlement: Fix the billing and not charge us for something that we did not control.

Business Response: A first and second level appeal was submitted to Regence regarding ********* ***'s concerns associated with her inpatient stay at UC San Diego Medical Center. Per her group's contract, room and board is limited to the Hospital's average semiprivate room rate, except where a private room is determined to be necessary. Based on the medical documentation received with ********* ***'s first and second level appeal, a Medical Director reviewed this information, and determined that the use of a private room was not medically necessary. The clinical documentation did not confirm a private room was medically necessary for monitoring, isolation, extra providers, or for unusual procedures. Therefore,these services were denied as a contract exclusion. It is important to note that the first and second level appeal was reviewed by two separate Medical Directors. Following the second level appeal determination on November 24, 2014, a request for an external review was submitted to an Independent Review Organization (IRO). An IRO has no association with Regence, and by choosing an external appeal, this is the members final appeal rights as the decision is binding. The Medical Review Institute of America conducted the external review. They performed an independent review of the proposed/rendered care to determine if the adverse benefit determination was appropriate. Medical records were reviewed as well as the documentation provided by the involved parties. On March 25, 2015 a decision was made to uphold the denial. A copy of this IRO was sent to the claimant and Regence on March 25, 2015. Regence regrets that we are unable to grant ********* ***'s request in paying for the charges that were billed above the standard room rate. As previously shared with ********* ***, the external review decision that was conducted by the Medical Review Institute of America is binding. Sincerely, Teresa *. P**** Legal Department Regence BlueShield of Idaho ************@regence.com ###-###-#### FAX ###-###-####

Consumer Response:
Complaint: ********

I am rejecting this response because:

UCSD does not differentiate between the private and semi-private rooms and they are billed at the same rate. Patients are assigned to private rooms if they are available, otherwise to semi-private rooms. If you call UCSD billing they will confirm this. As mentioned in the original complaint, we were never asked to choose. Rejection to cover asking for proof of medical necessity in spite of the fact that they are treated the same by the hospital seems like a practice to deny genuine claims, something I am finding based on my investigation has been done with others by this insurance as well. 
I don't need any further help from BBB as I have legal counsel advising me on next steps. Thanks BBB as always for representing the consumer.  

Sincerely,

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

10/9/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: They sent letter saying they are no longer paying for testosterone because the FDA says its dangerous. They provided no other information. They have no way to deal with the men trying to come off of it. Stopping this treatment is very dangerous and includes depression, thoughts of and or suicide, very low energy, muscle and joint pain and a lot of other serious side effects. This act they are doing is to save money and not help their clients and is very dangerous to me and others. They need to implement a protocol for this and not just send a letter out saying they are no longer paying for it after October. My company pays them a lot of money for my insurance and they are neglecting us.

Desired Settlement: They come out with a protocol they are going to pay for each male subject that they reject from testosterone treatment. Or they do what is right and continue to pay for treatment for men already on it.

Business Response:

Mr. **** is on a Regence BlueShield of Washington policy. In September Regence mailed letters to all members currently taking Testosterone. This letter was to advise that preauthorization would be required in order to continue use of Testosterone, not to advise that we would no longer be covering Testosterone for all members. Regence received a preauthorization request for Mr. **** on September 18, 2015. A letter granting approval from September 18, 2015 through September 18, 2016 was mailed to him on September 29, 2015.

3/28/2015 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: In the short time I used Blues Cross Blue Shield of Utah as an insurance provider the company proved to be unable to process any claims correctly the first time around. It has been constant mistakes with them. The errors leading up to my two year struggle with BCBS of Utah have to do with the fact that they incorrectly processed several of my medical claims as 'out of network' even after approving service with the providers. When things are billed as 'out of network' the insurance company sends the check to the patient so the patient can then give that money to the hospital. BCBS took several months to acknowledge and attempt to fix the mistake by which time I had already given the insurance company's portion of the payment to the medical provider and almost paid off my portion of what was owed for the medical services. After receiving a letter from BCBS informing me of a substantial 'overpayment' on their part, because of the 'out of network' billing mistake, and requiring that I give that money back I contacted them and informed them that the entirety of the check they sent to me went to the hospital and I haven't received any overpayment from the hospital to send back to BCBS. I suggested that they contact the hospital for their money. Several months later I receive a check from the hospital and when I call questioning it the hospital informs me that they sent their portion to the insurance company and this check represents a refund of my overpayment. Of course I gladly deposited the check in to my bank account. Then, several months later I receive another letter from BCBS, still saying that I owe them the money that they had mistakenly overpayed for 'out of network' charges. I contacted BCBS again and explained what the hospital told me, that their portion of any overpayment should have already been sent to them by the hospital. After a number of customer service calls, both to the hospital and to BCBS (neither of which appear to have communicated with the other and neither of which appear to have any information in their records that help solve the dispute), BCBS tells me that even though, I believe, their dispute should be with the hospital, the problem remains mine to deal with. The customer service representative from BCBS recommend that I send in a check for any amount along with a letter to the billing department explaining the situation and requesting to be put on a payment plan. So, I do that very thing, I send in a check for $25 along with a letter and requested to be put on a payment plan and then I wait for a response. A short time later the $25 check gets cashed and, naturally, I assume that the payment plan request is being processed so I continue to wait. Two months later I get a call from a collections agency regarding the disputed amount with BCBS! I immediately call BCBS to try to figure out what is going on and the woman on the other end tells me that they're not sure what happened, she helped me to request a payment plan right then and explained that they'll look into the $25 check and in the meantime I should expect a letter about the payment plan. The next day I tried to call the customer service representative that suggested I send the check and the letter in the first place to get assurance that BCBS will retract my information from the collections agency and ensure that it will not have a negative effect on my credit score - I've called several times and left two messages but still haven't gotten a response. What is going on with this incompetent company? BCBS appears to have paid the hospital twice for the same service and has turned around to get their overpayment from me instead of the people they gave it to in the first place.I would like for Blue Cross Blue Shield of Utah to do their jobs correctly the first time and not create this ridiculous situation that they've conveniently placed me in the middle of and expect me, their customer, to fix for them!

Desired Settlement: I would like Blue Cross Blue Shield of Utah fix the situation with the hospital and to give me their guarantee that their mistakes won't affect my credit score.

Business Response:

This is in response to ******* ********'s concerns, which Regence received on March 16, 2014.  We wish to assure Ms. ******** that her $25.00 payment has been received.  Per Ms. ********' phone conversation with Regence on March 11, 2015, a confirmation letter was mailed to her the same day.  The letter outlined the payment plan agreement for reimbursement of overpaid benefits.

With regards to Ms. ********' concerns that this may negatively impact her credit, we wish to assure her that GB Collect is a 'soft' collection agency who conducts business on our behalf.  However, this does not get reported to the credit bureaus.

In reference to the overpayment, Ms. ********' hospital claims were originally processed at the out-of-network benefit level leaving a total patient liability of $********.  Through ongoing negotiations with the hospital, an agreement was made to reprocess services received at the in-network rate.  This resulted in a better benefit to our members, and payments were sent directly to the provider.  Understanding that the initial payments were mailed to members due to the facility being out-of-network, it then required Regence to request those funds back, since we reissued a new check/payment to the provider.  In Ms. ********' case, the reprocessing of these claims reduced her patient liability from $******* to $******.  Additionally, the hospital mailed Ms. ******** a refund check for the overpaid amount on April 9, 2014 in the amount of $********.

Recovery notices to collect the overpaid funds were mailed to Ms. ******** on March 20, 2014, and again on December 18, 2014.

 

Regence apologises for the confusion this has caused Ms. ********, and hope this information has addressed her concerns.

****** *****

Regence Legal Department

************@regence.com

PH ***** ********

FAX ***** ********

 

1/30/2015 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: My name is ***** ***********. My father's name is ********* ***********. I, ***** have been paying Regence Blue Cross Blue Shield of Utah monthly checks of $87.00 for my father, *********s health insurance premium. In late November 2014, I received two seperate paper bill statements from Regence Blue Cross for my father's December Premium. I did not realize that the statements were for the same month (December) and that Regence was double billing my father. I mistakenly mailed two seperate checks to Regence Blue Cross. Each check was in the amount of $87.00 The check numbers *** and ***. I called Regence Blue Cross a few days after I mailed the checks and explained to them what happened. The representative stated that they will return the second check. She also stated that if they deposit both checks, they will send me a refund check. On Saturday, December 27th 2014, I received a check from Regence Blue Cross Blue Shield of Utah in the amount of $87.00 (check #**********). However the check was made out to the order of: ********* *********** not ***** ***********. On Monday, December 29th, 2014; I called Regence Blue Cross at phone # *************. I was on hold for approximatly 20 minutes. I was then transfered to another person who identified herself as "*****". I explained all of the above information to ***** and told her that Regence Blue Cross needed to send me another check for $87.00 made out to the order of ***** ***********. ***** told me that Regence Blue Cross does not do that and that they only send refund checks to the members, not to the person actually making the payment. ***** then told me that she would need to research the matter and that she could call me back. ***** never called me back that day. On the following day, Tuesday December 30th 2014, I called Regence Blue Cross back at *************. I spoke to another lady who told me that she would have ***** call me back. ***** called me back at 9:55am from call back number *************. ***** stated that she was busy yesterday and could not call me back. ***** further stated that Regence Blue Cross does not "track" were they receive payments from and that Regence will not issue me a refund check in my name. End of statement.

Desired Settlement: Send me a refund check in my name.

Business Response:

Regence has reviewed the concerns addressed in **** ***********'s inquiry regarding the refund payment being issued to his father.  In working with our Finance department, we were able to obtain a copy of the actual check received, which we show did come from **** ***********.    Therefore, Regence is issuing a stop-payment on the original refund check mailed to the subscriber, ********* ***********, and issuing a new refund check to **** ***********. 

Regence apologizes for the inconvenience this has caused, and wish to assure **** *********** that he will be receiving a new refund check issued in his name within the next 7 business days.

Sincerely,

****** *****

Regence Legal Department

************@regence.com

PH ***** ********

FAX ***** ********

 

1/27/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: We signed up for there bronze plan and end up paying more money to health care providers than if we would not have had the plan. The price for the premium in outrageous. The billing system is confusing and messed up. Why do people pay for this kind of health insurance. It's cheaper to go with out. I guess if I had a terminal illness it mugh be worth it but I doubt it. Cash pay for health insurance is way way cheaper. I get billed more for having this insurance.

Desired Settlement: Refund my money.

Business Response:

In reviewing Mr. *****’s account, we show that he initially applied for Regence’s individual Direct Bronze plan effective 11/01/14.  However, Mr. ***** requested a recent policy change effective 01/01/15 to a richer benefit plan, which is our Direct Gold policy. 

Understanding that Mr. ***** is not happy with the plan options currently available through Regence, Mr. ***** can work with his agent to determine what alternatives would better meet his needs both medically and financially.

In Mr. *****’s inquiry to the Better Business Bureau he states that his desired settlement is to have a refund.  While Regence can authorize a retroactive cancellation; this is only if the member has other active coverage.  In this case, the member must provide proof of other coverage in order for the policy to be retro-cancelled, and therefore resulting in a refund.

If Mr. ***** does not have other active coverage, and is simply wishing to cancel his current policy with Regence, he can contact our Customer Service department directly at ***** ********.  If Mr. ***** notifies Regence by January 31, 2015, Regence can cancel his medical policy effective February 1, 2015.

 

Sincerely,

 

****** *****

Regence Legal Department

 

Consumer Response:  
Better Business Bureau:

Yes, I did dumped the Bronze plan and select there GOLD Plus.  I did not expect to get a refund for my time on the Bronze plan. Even through it actually COST me more money to have it. I mostly wanted to go on record to compliant about a very broken health care system that companies like Regeance are taking advantage of. President Obama is not the only one to blame here. Regeance should stop offering there Bronze plan or at least rework it to be competitive with the new health care environment. Most clinic and hospital offer better discount to CASH pay customers. It's still cheaper to most people to not have insurance. We waited for the new 2015 plans, hoping for a workable one. We were sorely mistaken. They where the same crappy plans from 2014. The gaps between the Bronze and the Gold Plans are massive.  

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

Sincerely,

***** *****

12/4/2013 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: I cancelled my insurance with Blue Cross Blue Shield. They still billed me and insisted that they could not refund me for over a month if at all. I had been insured through Blue Cross Blue Shield of Utah for health insurance. My husband recently got a job that provided our family health insurance. I cancelled my insurance with Blue Cross. Several days later they still billed me for another month. When I called their office they informed me that they could not stop billing me for at least a month and a half because their customer service was backed up. They said they will refund me when they get around to it, but I have no guarantee if that will happen. I think it is absolutely ridiculous and unprofessional to not have the ability to stop billing someone. I would understand if they were backed up a day or two or even a week. But a month and a half is blatant corruption. I would maybe expect this from some 2 star health coverage plan, but I would expect a large company like Blue Cross to be more honest. I'm not sure what the fine print says and whether what they are doing is technically illegal, but it is certainly at least incompetence and at most gross criminal behavior. I hope this complaint helps as I'm sure other customers have faced similar situations.

Desired Settlement: I would like a full refund of the $192 monthly charge and to not be charged ever again.

Business Response: Initial Business Response /* (1000, 5, 2013/11/18) */ Thank you for your e-mail regarding a complaint submitted to your office on November 7. We are contacting Ms. ******* directly to review the issue of a refund and will arrange a prompt resolution. We appreoiatetne opportunity to be assistance. If you have any questions, please cali Customer Service at l (XXX) XXX-XXXX. Sincerely, ***** ******* Customer Service