Business Profile

Insurance Companies

Blue Cross and Blue Shield of Massachusetts

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Complaints

This profile includes complaints for Blue Cross and Blue Shield of Massachusetts's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

65 total complaints in the last 3 years.
27 complaints closed in the last 12 months.

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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:07/03/2025
Type:Service or Repair 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 received a hospital bill of ****** from giving birth. Yes I am aware insurance covers some of that as well. On my account it displays a char that tells me if I pay ****** I have reached my max out of pocket. I paid the ****** and have a remaining balance of ******. I went back and forth with umass and blue cross about this and then they finally found someone who told me that doesnt apply to my out of pocket because theyve already factored in me paying ******, even though I didnt pay it. That is deceitful and unfair, and can be considered a lie. The amount of money I pay for insurance as it is pretty insane. I have paid my max out of pocket and my remaining balance should be paid by the insurance I pay on a monthly basis.
Business Response
Date: 07/09/2025
To whom it may concern,
For privacy reasons, we are responding directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.
Regards,
Member Appeals & Grievances Program
Initial Complaint
Date:06/29/2025
Type:Service or Repair 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.
Blue Cross and Blue Shield of MA and its selected manager ********** engaged in unfair and deceptive acts, failed to provide candor and fairness and to act in good faith when marketing its product. I claim that their conduct violated the MA licensing requirements and ********'s regulations in connection with the marketing and implementation of supplemental ******** health insurance, (Part D). This included making false, deceptive and misleading oral statements, policy illustrations and related documents that its policy would provide insurance coverage explicitly for my all my prescription medications --which it did not -- and then failing to comply with ********'s rules in denying my claim for drugs on procedural grounds that wrongly applied the time limits set by ********. It further failed to identify that all customer ********************** was provided by **********, which repeatedly created obstacles to comply with its own appeal process. They repeatedly failed to provide relief. All of which should require the state to pull its license to sell health insurance.
Customer Answer
Date: 07/13/2025
I have not heard from the business in response to my complaint.
Business Response
Date: 07/20/2025
To whom it may concern,

For privacy reasons, we will respond directly to our member regarding this complaint. The member will receive a written response to their complaint shortly.

Regards,
Blue MedicareRx
Initial Complaint
Date:05/08/2025
Type:Service or Repair 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 am turning 65 in June this year. Per ******** guideline, the window for me to sign up for ******** is between March and September this year. My plan is to sign up in September and have it being effective on Oct 1st, after consulting with ******** office. My employer agreed that I can stay in my current plan until then. However, ****, my current medical insurance company refuse to cover me between June and September, arguing my employer has fewer than 20 employees. I seriously doubt that they have the right to overrude the ******** guidelnes, so I should be covered until Sept 30th.
Business Response
Date: 05/16/2025
To whom it may concern,
For privacy reasons, we are responding directly to our member regarding this complaint. The member will receive a written response to their complaint dated today, in the mail shortly.
Regards,
Member Appeals & Grievances Program
Initial Complaint
Date:05/07/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My claim was denied unfairly as it was medically necessary and is a covered benefit under *** student PPO with BCBS MA
Business Response
Date: 05/22/2025
To whom it may concern,
For privacy reasons, we have responded directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.
Regards,
Member Appeals & Grievances Program
Initial Complaint
Date:05/02/2025
Type:Sales and Advertising Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
**** has changed coverage on prescription drug Wegovy during the plan year. I signed up for the more expensive Standard plan during open season ($200+ more per month) so I could get a 12-week supply of Wegovy for $125. I was able to do that in January. In April, I requested a refill and now it will cost me over $1858.81. For the rest of the plan year this adds up to $5,201.43 (3 refills). I called **** and asked them to change my enrollment back to the Basic (cheaper) plan if they weren't going to honor the costs and they refused. They said I had to go through my employer. My employer will only allow me to change coverage during open season or with a QLE.
Business Response
Date: 05/05/2025
BCBSMA is unable to locate the member in question based upon the limited information available on the complaint. Please have the member provide their Member ID# and/or date of birth so we may research further to if this is in fact a BCBSMA member.
Thank you
Customer Answer
Date: 05/05/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
This was not a resolution but a request for information. Here is the requested information: My BCBS FEP ID is: *********. Thank you,

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*********

Business Response
Date: 05/07/2025
To Whom it may concern,

For privacy reasons, we have responded directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.

Regards,
Member Appeals & Grievances Program
Customer Answer
Date: 05/14/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
BCBS has responded by saying that I would need to make my complaint and request resolution from the ****************************** (***). I do not agree. *** did not publish the drug prices for 2025 on the **** website or change the cost to their members after only 3 months. *** did not make it look like switching from the cheaper Basic option to the more expensive Standard option needed to be done to get the prescription at a reasonable price. I also don't believe that the cost from the manufacturer has risen since open season when **** published costs for 2025. This is causing extreme hardship on me because I will no longer be able to get the needed prescription, but will continue to pay much more for the coverage. I do not accept their response.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*********
Initial Complaint
Date:04/29/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My dentist put in a crown on one tooth. Blue Cross denied the claim because they said the dentist should have done a root canal first because they claimed the tooth has inflamation before he put in the ******** dentist would not have put in a crown if the tooth was inflamed , he decided to give me some antibiotics and after a few weeks he took another xray and resubmitted the claim with the new xray. My dentist has disputed their findings and I feel he knows more about my tooth than the insurance reviewer does.
Business Response
Date: 05/09/2025
To whom it may concern,
For privacy reasons, we are responding directly to our member regarding this complaint. The member will receive a written response to their complaint dated May 9, 2024, in the mail shortly.
Regards,
Member Appeals & Grievances Program
Customer Answer
Date: 05/16/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*******
Initial Complaint
Date:04/02/2025
Type:Product 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.
Blue cross blue shield of Massachusetts denied medical necessary and preventative care. Claim *************** must be covered under coverage policy
Business Response
Date: 04/07/2025
To whom it may concern,
For privacy reasons, we have responded directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.
Regards,
Member Appeals & Grievances Program
Customer Answer
Date: 04/07/2025
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved.

Regards,

***** ******
Initial Complaint
Date:03/27/2025
Type:Service or Repair 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.
In November Auburn sleep med got a benefits quote for me to get a dental appliance from the dentist Dr. ******** for snoring. I was told I only need to pay the remainder of my deductable which was $48. I went to Dr. ******** paid $500 deposit and had the impressions taken. I called BC/BS to confirm coverage again 12/29 and device code ***** was covered. ******************* called and said they were having a problem with my insurance. Called BC/BS again 1/10/2025 ref # ***** was instructed to file an exception for reimbursement. Called again referance # ***** instructed to submit reimbursement form. I went to pick up the appliance at which time I paid another $500 to get the device and I was to reimburse the dental office if I recieved any money from BC/BS. Recieved $1260 check from BC/BS with explanation of benefits. Called BC/BS ref#**** was told the TOTAL due provider is $1800.$540 is patients responsibility and $1800 was owed to provider.I mailed $800 to make Dr. ******** whole as I had previously paid $1000. Dr. ******** then sent me a bill for $2060 more.I did my due dillagence and called BC/BS with my member number multiple times to make sure the mouth guard was to be covered. I went from being told that I would only pay $48 to $3060. I would never have gone through with getting a plastic mouth guard if I knew I was going to be liable for that amount. I live pay check to pay check and cannot afford even medically necessary items that strain my budget. BC/BS representitives should be held responsible for their misinformation and pateints should not have to call NUMEROUS times for an accurate quote.
Business Response
Date: 03/31/2025
To Whom it may concern,
For Privacy reasons, we have responded directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.

Regards,
Member Appeals & Grievances Program
Initial Complaint
Date:03/20/2025
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.
My husband began a new job on September 16, 2025. We were fortunate enough to start our insurance coverage with **** of Massachusetts on the same day. Since then, however, I have had four claims denied by them, even though we have had consistent coverage. One of those claims was related to a hospitalization that started on 9/10/24 and lasted until 9/20/24. **** was our secondary insurance from September 16 thru September 30. After multiple calls between **** and the hospital, **** decided that they are not responsible for the portion of the bill that overlapped with our coverage. The bill I received was for $4344. Given that **** was the secondary insurance at the time, their portion would be significantly lower than if they were primary, despite that, they have continued to refuse to pay. This is a lot of money. The other three of those claims were related to blood work and the incorrect diagnostic codes used by my providers. These resulted in bills ranging from $50 to over $800. In two of these cases, after multiple calls to ****, my providers and the lab (*****************), where I was not able to coordinate between three separate entities to get the bill paid, **** agreed to an adjustment and reprocessed the claims. The most recent claim for $69, they are refusing to do so and I was also told, they wouldn't do that again moving forward. I am exhausted by all these calls where I have to be the go-between and nothing gets resolved because the people who need to be speaking to one another (my providers and ****) are not doing so, nor do I have the power to make that happen. Regarding this most recent denial for $69, they sent me an appeal form, but at this point, I'm too worn down to take that step. I believe this is a part of how insurance companies make their money, deny claims and make the process to get them paid impossible. I want the coverage that we are and have been paying for and are entitled to. Each medical procedure was for medically necessary reasons.
Business Response
Date: 03/27/2025
To whom it may concern,
For privacy reasons, we have responded directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.
Regards,
Member Appeals & Grievances Program
Customer Answer
Date: 04/03/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
I received a letter from BCBS of Massachusetts in the mail as they indicated. The letter was a written version of my complaint and the same responses I have received over the phone. They agreed that there was overlap of coverage during my hospital stay on 9/16/24-9/20/24, however, they continue to say that the hospital will need to submit a modified claim. They are again not taking the initiative to make that happen and are putting it in my hands after I already stated that I've have done everything I can do to make that happen. Again, both the hospital and BCBSMA are saying the other needs to do something differently, but no one is taking on the responsibility to make that happen. Each party is putting that on me when I am clearly without any ability to make anything happen, hence this complaint in the first place. I am not satisfied with a response that just regurgitates the details we have already covered but is now in writing.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
Heather

Business Response
Date: 04/16/2025
To whom it may concern,
BCBSMA contacted Horizon Blue Cross Blue Shield NJ who advised that the provider submitted a corrected claim to them on April 7, 2025 and Horizon Blue Cross Blue Shield NJ is in the process of entering the claim in their system.
Regards,
Member Appeals & Grievances Program
Customer Answer
Date: 04/24/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.
I have checked to see if the claim status is available for me to view online and it is not. Other than the response on 4/16/25, there have been no further updates, so I reject this response to keep the complaint open. Once I know the claim status, that will determine next steps.
Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
Heather
Initial Complaint
Date:02/21/2025
Type:Service or Repair 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.
Hello,I have been disputing a lab bill for 2 years now with no resolution. The date of service was 2/16/2023 with a patient balance of $98.64 and the issue has not been resolved despite countless attempts from the doctor, the lab - Quest diagnostics, and member services team from ****. I have spoken to the doctors office and the they have told me that the request was submitted to quest with all preventative billing codes. As per the policy at the time of the service, all preventative labwork is covered at 100% with no requirements for the deductible or coinsurance being met. I have been told by **** after over a year of back and forth that they will be manually issuing a payment to Quest diagnostics on my behalf as a courtesy to resolve the issue. This has never happened, and no matter who I speak to, they point the finger at another party and claim that they are the ones who are at fault for not processing the claim or paperwork correctly. I am requesting that blue cross blue shield step in and resolve this issue as this has dragged on so long that it has been sent to collections and we are now being harassed for payment. It is not my responsibility to bear the burden of cost for these tests as far as I understand, and I am not willing to just pay the bill because the various parties cannot provide an explanation as to what went wrong here. You may review my internal correspondence with Shaolin ***** from BCBSMA, who has been very helpful throughout the process Patient: ***** ******* - BCBS account holder - ***** ******* - Member ID ************
Business Response
Date: 02/27/2025
To whom it may concern,
For privacy reasons, we have responded directly to our member regarding this complaint. The member will receive a written response to their complaint in the mail shortly.
Regards,
Member Appeals & Grievances Program

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Blue Cross and Blue Shield of Massachusetts is NOT a BBB Accredited Business.