Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:04/04/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On April 3rd 2025 the doctor prescribed my baby **** the medication ****** for *******************. Blue Cross Blue shield for which we pay nearly $1,000 for the family every month deny the $13 medication, citing it was too early for a refill. The last prescription was over a month ago on March 2nd 2025 for three tablets. This significantly delayed care in a timely manner as we went through all the trouble to go to the doctor only to have this medication denied by insurance. Baby was left continuing to vomit throughout the day . This is basically medical malpractice by the insurance for $13 medication. First of all it has been over a month. Second it was for less than 10 tablets. Third, how does insurance company decide when it is too early for refill? Absolutely insane. Medical malpractice by the *****************. These issues continue to happen through the year for other services for Blue Cross Blue shield. This causes me to a significant time on the phone to call both the provider and the insurance company, waiting for a long time on both sides speaking to different individuals every time and we're explaining my situation and hoping that somebody knows what they're doing.I would like to refund check for my payment for my months premium for my frustrations dealing with these unexplainable insurance denials.

  

  Business Response

  Date: 04/21/2025

  April 21, 2025

  
  *. **

  XXX
  XXX

  
  Name of Subscriber:             *. **
  Complaint ID:                      23159724
  Image Control Number:        20259801110334

  
  Dear Ms. ********* received a copy of your complaint to the Better Business Bureau concerning medication for Skye.
  We would be happy to research this issue. However, we are unable to locate your contract number. Please provide your contract number to the Better Business Bureau or call our *************************** at the number listed on the back of your identification card for assistance.

  
  We appreciate the opportunity to be of assistance.

  
  Sincerely,
  Customer Service

• Initial Complaint

  Date:04/01/2025

  Type:Customer Service Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been living with type 2 diabetes for a few years now. There's no cure and the medication that manages my diabetes is being denied by BCBS. They are not doctors and can not cure me of diabetes. So they need to provide coverage of my medication or stop selling insurance.

  

  Business Response

  Date: 04/02/2025

  April 2, 2025

  Mr. *******

  XXX

  XXX 78260

   

  Name of Patient:  **************************************** CSA88888888

   

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

  We have researched your complaint concerning the denial for Mounjaro. Based on our review, the drug denied appropriately since our policy requires that the patient's diagnosis by confirmed by lab test results. The A1C must be greater than or equal to 6.5% and the highest A1C provided in your medical records is 6.3%.

  However, we are going to grant an exception and approve the drug since it appears you may have recently changed providers making it hard to get yearly lab results from the initial diagnosis years ago. You will receive a letter advising you of the approval and may order your medication.

  We hope this information address your concerns.

  Sincerely,

  Customer Service

  Customer Answer

  Date: 04/02/2025

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

  My initial lab work was 8.x% mid to the high side of 8%.

  Thank you for all your help. 

  Sincerely,
  
  ****** *******

• Initial Complaint

  Date:03/31/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Charges for PREVENTIVE flu and covid shots at *********************** that had been used in previous years at no charge. NO communication, written or verbal, stating fees due for services that ****** requirements for insurance or mention of charges at check in / out by staff on duty.Address, insurance and primary doctor info given (******************************* acquired by ***) numerous times without remittance to on file BlueCross Blueshield of Alabama Account:******* ******** Contract# NDJ876566203 Group# ***** Blue Standardized Silver EPO Continuing to charge AN EXTREMELY HIGH AMOUNT as SELF-PAY ADJUSTMENT AUTOMATED ******* - (******) = ******

  

  Business Response

  Date: 04/02/2025

  April 2, 2025
  
  Mr. ********
  xxx
  xxx
  
  
  Name of Subscriber:     Mr. ********
  Contract Number:          NDJ888888888
  Consumer Complaint Number:23135965
  Claim Number(s):          700-3397580
  Date(s) of Service:         September 17, 2024
  
  
  Dear Mr. ******************* are responding to your complaint to the Alabama Better Business Bureau concerning your claim for
  the above date(s) of service.
  
  Under the guidelines of your policy, members must designate a ************ Select Physician (PCSP) within the Blue High Performance Network (BlueHPN) or there are no benefits available unless in the
  case of a medical emergency or accidental injury. Under this plan there are only in-network benefits when services are rendered by a ******* network provider within the ************************ (metropolitan service area). There are no benefits available when services are rendered out-of-network (non-BlueHPN provider) or out-of-state, except for medical emergency and accidental injury. This information is located in your benefit booklet. Your benefit booklet can be found online through your myBlueCross account at ******************************. Based on our review, claim number 700-3397580 and *********** denied correctly
  as the rendering provider is not a ******* provider.
  
  We hope this information is helpful.
  
  Sincerely,
  
  Customer Service

• Initial Complaint

  Date:02/24/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 7/26/2024, my wife ******, visited her primary care physician for an annual physical. Because she has been ********* deficient in the past, her doctor ordered a ********* test along with her other lab tests. On 8/21/2024, my wife went to ******** to provide blood samples. Within a few weeks, the claim was processed. All was covered except for the ********* test. After calling BC/BS, she was told it was denied because it was not medically necessary. It clearly is. A simple ****** search shows all the problems low ********* can cause. What followed was my wife spending countless hours on the phone with her doctor's office, ********, and BC/BS trying to get this claim paid. She was told the doctor used the wrong code. The doctor corrected the claim, but it was again rejected. Someone from **/BS called the doctor's office to provide instructions, but the claim was rejected yet again. Because of this denial, ******** is billing us $306.60 for a test we can get from an independent lab for about $40. BC/BS's negotiated rate would most likely be less than that. But yet BC/BS apparently would rather waste hours of everyone's involved time, than to pay such a small amount. I demand that BC/****** this claim as required by their contract.

  

  Business Response

  Date: 03/04/2025

  March 4, 2025
  
  
  Mr. *****
  XXX
  XXX
  
  
  Name of Patient:           Mrs. *****
  Contract Number:         QNF888888888
  Claim Number(s):         275-2393835
  Date(s) of Service:       August 21, 2024
  Complaint Number:      22984000
  
  
  
  Dear Mr. **************** have researched your complaint from the Better Business Bureau concerning the ********* test on August 21, 2024.
  
  Claims are processed based on the primary diagnosis code submitted. In this case, the diagnosis filed   was routine, which caused the ********* test to deny correctly. The claim was refiled with a primary medical diagnosis that was not covered. In reviewing, that claim also include a secondary diagnosis code that was eligible for the ********* test. The claim has been reprocessed for payment and was completed in our system on March 3, 2025. The payment will be made to the provider by the ***********.
  
  We hope this addresses your concerns and we regret any hardship this matter has caused.
  
  Sincerely,
  
  Customer Service
  

• Initial Complaint

  Date:02/06/2025

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  With the change in doughnut hole regulations, Blue Cross charges a $150.00 co-pay for drugs in the 4 and higher levels to compensate for their loss of revenue. My prescription for ******* .25mg weekly comes in a 3 mg pen and up to this year was dispensed as 3 pens for 3 months. This carries a copay of $80.00 (regular copay for 2 pens with the 3rd pen as free for buying 90 days. Blue Cross policy. My weekly dosage will allow more supply beyond 30 days but not 60 or 90 days. A prior approval is required of the provider because of the off label use of this drug. My provider using the ordinary paperwork supplied this approval to the **************** in ******** Al. Today I requested the refill and paid **************** $230.00 for 1 (one)Pen that will last me approximately 6weeks. The only opportunity to right the issue was to get a different prior approval from my provider which takes about 4 to 6 weeks. Since I need my weekly dose in 3 days, I elected to pay the ant and seek to right the wrong that has occurred .

  

  Business Response

  Date: 02/07/2025

  February 7, 2025
  
  
  Ms. ****
  XXX
  XXX
  
  Name of Member:       Ms. ****
  Contract Number:       MBG*****9185
  
  
  Dear Ms. *****
  
  We are responding to your complaint concerning your copay for *******. The prescription was written by the doctor for 0.25mg a week with a 2mg pen being the lowest dose available, the pharmacy would have to run it for 56 days (2 mg / 0.25 mg weekly = 8 doses or weeks).They cannot fill two or more pens at this time because of the directions would exceed a 90100-day supply. After the 8 weeks this pen should last, the doctor may increase the dose to 0.5 mg which would last you 4 weeks and therefore you could fill three pens or 3 months worth. Also, the pharmacy cannot run this prescription for less than 56 days with the directions saying that and therefore you would be subject to a copay related to a greater than 30-day supply. The good news is after this deductible phase and if you go up in dose, you will only have to pay $80 for a 3-month supply going forward.
  
  We have requested a customer service representative to call and explain this information and answer any questions you may have concerning this prescription.
  
  We appreciate your comments and the opportunity to address your concerns.
  
  Sincerely,
  
  
  Customer Service

  Customer Answer

  Date: 02/08/2025

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

• Initial Complaint

  Date:01/16/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have a rotator cuff injury. I have had an X-ray by my primary provide, went through six weeks of physical therapy, and was referred to an orthopedic Dr. ****** **********. Dr ********** utilized and ultrasound to give me an **********************, and followed-up four weeks later with an injection outside the joint. He determined I need and MRI to see exactly what's going on and suggested to me that targeted physical therapy may resolve issue, once the exact issue it determined.BCBS denied the claim saying it was "medically unnecessary". I went through all the steps they require, and see no reason for the procedure being denied. Order ID: *********

  

  Business Response

  Date: 01/24/2025

  January 23, 2025
  
  
  Mr. ******
  XXX
  XXX
  
  
  Name of Patient:   Mr. ******
  Contract Number:  BEG888888888
  
  
  Dear Mr. *******       
  
  We are responding to your complaint concerning an ****
  
  We have researched this issue and found that the provider failed to submit the results of any ultrasounds or x-rays that may have been done.The provider needs to submit any and all available information along with the request for the **** Please contact the provider and ask that they resubmit with the additional information.
  
  We hope this information is helpful and regret any hardship this matter has caused you.
  
  Sincerely,
  
  Customer Service

• Initial Complaint

  Date:12/11/2024

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  There has been several attempts to get an authorization approval for a surgery that is needed. The authorization has been denied twice. The information that they are requesting is being sent and then they requesting something else. This has been going on since August of 2024. There was an appeal done back in August, they denied the appeal stating some code was wrong but never contacting my provider. Surgery was reschedule after what the requested was complete, that information was sent in in November the new scheduled surgery date and the was denied. Between me and the provider we made numerous call to them and still got no where. And the authorization was still denied upon appealing it again.

  

  Business Response

  Date: 12/12/2024

  December 12, 2024

  *** ******

  XXX

  XXX  *****

  Name of Patient:    *** ******

  Contract Number:   RGN888888888

  Complaint ID:        22668997

   

  Dear *** *******   

   We are responding to your complaint concerning the denial for surgery. Based on the medical records submitted for review, there is nothing that defines the ** joint as the pain generator. There is presence of chronic pain and reports by other practitioners to consider a spinal cord stimulator for the radiculopathy. The medical records also show long-term narcotic use and only 50 percent relief from the original surgery. However, the most important factor is that there is no imaging study showing failure of the previous surgery. The pain is not below l5 vertebra, consistent with ** joint pain. Based on this, the medical necessity criteria have not been met. We submitted the records for an outside review by an Orthopedic Surgeon and the decision was upheld.

  We hope this info is helpful and addresses your concerns.

  Sincerely,

  Customer Service

  Customer Answer

  Date: 12/13/2024

   
  Complaint: 22668997
  
  I am rejecting this response because: There was imagining provided, and also 2 more injections were done to prove this was the cause of the problem. This is the information that was requested by the insurance company after the first rejection. There was more than 50% relief from those injection. This company is just not willing to do what is best for me. I am suffering from this chronic pain and it affects my day to day life. This surgery was recommended by my orthopedic **************** is just trying to keep from doing what is right for the customer. You requested more information,  you got it and now you still find a problem. 
  
  Sincerely,
  
  ******** ******

• Initial Complaint

  Date:12/09/2024

  Type:Customer Service Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  ******* from, blue cross blue shield called my phone today and was told that, I wasn't availed and to call back. ******* continue to talk about my personal information and my policy and was then told that he shouldn't talk about my personal information with her because told him that I wasn't availed. He continue until my daughter hung up the phone on his face. The called was received on, December 9, 2024 at 12:35p.m.He first told me that he had canceled my insurance policy as I requested and gave me a confirmation number #************ and then he called back with who knows what. These people are giving out my personal information even when he was told he wasn't speaking with me. He is very unprofessional and doesn't know his job and should receive better training. He's a risk to all customer's because these people/company has all our personal information and can do as they please with it and this is very unacceptable! I called eight differnt time trying to speak with a supervisor with no avail..

  

  Business Response

  Date: 12/16/2024

  December 16, 2024                   
  
  
  *** *******
  XXX
  XXX 36301
  
  
  Name of Member:      *** *******
  Contract Number:       MBG*****0815
  
  Dear *** **************
  
  We are responding to your complaint concerning our representative.
  
  We strive to provide excellent customer service each and every time that we are contacted.Protecting your protected health information (PHI) is extremely important to us and each representative goes through extensive training. We reviewed the calls and have gotten with the representative so that this does not happen again.
  
  We apologize and appreciate you bringing this to our attention.
  
  Sincerely,
  
  Customer Service

  Customer Answer

  Date: 12/16/2024

   
  Better Business Bureau:

  This isn't the first time this has happened and. I filed a complaint againt BlueCross BlueShield before concerning this same matter. I only pray this will be the last time!!

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

• Initial Complaint

  Date:09/26/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Multiple visit to 3 doctors to get a UTI. Change my primary doctor and sent all records prior to change primary due to small town and not getting me treatment. 1 st denial was Dr not on list ( PPO) error sent thr list yo bc of Al, next was not referral. I was told a primary/ internist can not refer to another primary internist. Now Bc of Al shows new Dr as primary but after 2 visit. Records again transfer and changed primary prior to appointment. For 21 years I have also been treated for skin pre cancer and cancer. Again ******* couldn't refer FL dermatologist but my 21 year history of mammograms get paid? This " insurance" cost me $13,296 a year and excuse after excuse to not pay claims. This is not having medical insurance. Please help, currently evacuating do to hurricane, I can be reached after 10/2 by phone. Email is good option. Thanks for any and all help.

  

  Business Response

  Date: 10/02/2024

  October 2, 2024

  *** *******

  XXX 

  XXX

   

  Name of Patient:        *** *******

  Contract Number:       ***********  

  Complaint Number:     ********

   

  Dear *** *******:

  We are responding to your complaint that none of your claims are being paid.

  According to our records, you are covered under the Blue Saver Silver plan. Under this plan, there is an in-network deductible of $3,600 per calendar year and an out-of-network deductible of $7, 200 per calendar year, depending on if you use an in-network or out-of-network provider. This plan also requires members to designate a Select Provider and all care must be coordinated through this provider. Referrals are required when utilizing providers other than the designated Select Provider. We reviewed your claims for 2024 and found that the majority of them applied the allowed amounts to your calendar year deductible and that is why no payments were made. We did find claims for the service dates of July 24, 2024, August 9, 2024, and August 21, 2024, that were denied because a referral was not obtained as required under the terms of the contract you have chosen.

  We hope this information is helpful.

   

  Sincerely,

  Customer Service

  Customer Answer

  Date: 10/02/2024

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:
  
  I changed my primary Dr prior to being seen. I wasn't getting necessary care and fwd all medical records to new primary. These are just excuses for valid care and not being hospitalized by the primary care that I changed from. Re considered please. Your people gave bad info as not in network, you have phone records and then again that a referral was not needed. You need to take responsibility here!
  
  Sincerely,
  
  
  
  ****** *******

  

  Business Response

  Date: 10/09/2024

  *** *******
  xxx
  xxx
  
  
  Name of Patient:         *** *******
  Contract Number:         ************
  Claim Number(s):         ***********
  Date(s) of
  Service:        August 9, 2024
  
  
  Dear *** *******:
  
  We are responding
  to your rebuttal regarding your Primary Care Select Physician (PCSP).
  
  Under the
  guidelines of your contract, you are required to designate a Select Provider
  and all care must be coordinated through this provider. You may call our
  Customer Service Department and request to change your PCSP, or you can change
  it yourself online through your myBlueCross account at ***************. We have
  reviewed your emails that were sent to our Customer Service Department and
  based on the information that was submitted to us on August 19, 2024, and
  August 21, 2024, you stated that you got ***  ********* name off a Blue
  Cross and Blue Shield of Alabama in-network list and had your medical records
  sent to *** ********* office. This does not change your PCSP with Blue Cross
  and Blue Shield of Alabama. Our representative explained that you must either
  contact us or go online and change it. On August 21, 2024, our representative
  advised you that they could change your PCSP but it would not go into effect
  until that day. *** ******* was updated as your PCSP with an effective date of
  August 21, 2024. However, we are granting you a one-time exception and we have
  backdated the effective date to August 9, 2024, with *** ******* listed as your
  PCSP. This will allow us to reprocess claim number *********** for date of
  service August 9, 2024, for services rendered by *** *******. For future
  reference, you are allowed to change your PCSP up to three times each calendar
  year. Please make sure that you verify that the doctor is accepting new
  patients before you make any changes. Please note that you will still be
  required to get a referral from your new PCSP prior to seeing another provider
  or no benefits will be available. In addition, any referrals that you already
  had with your previous PCSP are no longer valid, and you will be required to
  obtain new referrals once a new PCSP is designated. Additional information
  regarding designating a PCSP is also located in your benefit booklet.
  
  We hope this
  information has been helpful and addresses your concerns.
  
  Sincerely,
  
  Customer Service
  

• Initial Complaint

  Date:08/21/2024

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have reached out to the subrogation department a total of 7 times by phone. I have asked for a return call on all 7 calls. I have also reached out to customer service, and they have sent 2 emails to that department to have them call me back. dates I have placed a call are the following Aug 2nd, 6th, 9th, 14th, 16th, 19th and 21st. There is no other way to speak with them and they do not return phone calls.

  

  Business Response

  Date: 08/22/2024

  August 22, 2024
  
  
  ****************
  XXX
  XXX
  
  Name of Subscriber:     ****************
  Contract Number:         PPA888888888
  Complaint Number:     22173620
  
  Dear ****************:
  
  We are responding to your complaint from the Better Business Bureau concerning our Subrogation Department.
  
  We deeply apologize that you had this issue. We are looking into where the breakdown in communication happened and correct it. A subrogation representative called you this morning and addressed your concerns.
  
  Please let us know if we may be of further assistance.
  
  Sincerely,
  
  Customer Service