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 Find Local Branches.

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  Blue Cross and Blue Shield of Massachusetts

  101 Huntington Ave Ste 1300 Boston, MA 02199-7611

• 

  Blue Cross and Blue Shield of Massachusetts

  200 High St Canton, MA 02021-3654

• 

  Blue Cross and Blue Shield of Massachusetts

  Route 128 Peabody, MA 01960

• 

  Blue Cross and Blue Shield of Massachusetts

  34 Saint Martin Dr Marlborough, MA 01752-3021

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:03/14/2023

  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.

  This bill was paid to *********************************** (we paid the balance) however it was processed incorrectly. We have spoken to multiple people at ******* and BCBS about this claim and we have been unable to get this resolved after nearly a year of phone calls and follow up.The services billed were from Dec. 29, 2021 to Feb. 1, 2022. BCBS processed all these charges on the 2021 plan and applied a significant co-insurance on that basis. However, in 2022, we had many other medical bills associated with the birth of our daughter that meant that we met the out of pocket maximum. So if this claim is processed on the correct dates, there is a portion of $4,913.32 corresponding to the coinsurance that is not the patient's responsibility as the out of pocket maximum has been met otherwise. Several representatives from both companies have seen this and worked to get it corrected. however, it's very dependent upon who we speak to how far we get. On today's call we were told completely different information. So we are at a loss of how to actually get a resolution.

  Business Response

  Date: 03/22/2023

  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:02/14/2023

  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.

  My doctor visit cost is denied against our contract and the no surprise medical bill act. Details see attachment

  Customer Answer

  Date: 02/25/2023

  I have not heard from the business in response to my complaint.

  Business Response

  Date: 02/28/2023

  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:02/13/2023

  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.

  With our PPO plan with BCBSMA, the claim of **** **** **** 702 should be fully covered with our benefits. Our insurance reclined to pay for this routine baby discharge as stated in the attachment by the provider. Instead, they insisted that it is medical diagnostic charge. However, we have never came to the hopitical for such a diagnostic charge. The insurance continued to reject paying for this routine services. We asked and appealed and they dont want to help. We asked the provider, and they said they did submit ***** as the routine new born discharge services. Please help us !!!

  Business Response

  Date: 02/24/2023

  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:02/08/2023

  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.

  I refilled my prescription at the pharmacy to find out it now costs twice as much as it did last year. BCBS of MA switched pharmacy providers to CVS Caremark claiming that it will save on prescription costs and it is not true. It was a financial decision that is going to make important medications MORE expensive to their clients. BCBS of MA lied in the statement they sent out saying that the change would make things more affordable.

  Business Response

  Date: 02/14/2023

  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:01/12/2023

  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.

  I am filing this complaint regarding the High Performance Network Plan for Blue Cross Blue Shield **********. I have been on this plan for over a year and I have had multiple issues regarding in-network providers clearly showing that they are in network with Blue *** which is an employer plan offered through BCBS Mass and this insurance company when going to pay the bill from the provider states they are not paying it due to the provider not being in the network. I have screenshots proving that my doctor is in the network with this plan and this company has stated otherwise on multiple occasions. The issue here is that this company has violated a federal law US code title 18 pt.1 chapter 47 code ****, which has been attached below and has refused to pay for services as I am still in the middle of my treatment. They have advised me that they will not cover any further bills and this is illegal as they falsely provided documentation on their website stating that the provider is in network. (a)Whoever, in any matter involving a health care benefit program, knowingly and willfully(1)falsifies, conceals, or covers up by any trick, scheme, or device a material fact; or (2)makes any materially false, fictitious, or fraudulent statements or representations, or makes or uses any materially false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry,in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 5 years, or both.I would like someone to contact me as soon as possible regarding this as I am being billed for a treatment in which this insurance clearly shows this provider being in the network and is stating other wise. This has happened on more than one occasion with my primary care doctor as well as now my dermatologist. This company violated part 2 of the Federal law and this needs to be remediated as soon as possible as I will be disputing this due to the violation of federal law as well as the No Surprises Act.

  Customer Answer

  Date: 01/22/2023

  I have not heard from the business in response to my complaint.

  Business Response

  Date: 01/23/2023

  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: 01/25/2023

  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 am rejecting this reply until complaint has been handled with a resolution. 
  
  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: 01/31/2023

  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: 01/31/2023

  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. 
  
  the entity contacted me via email and I do not agree or accept the response provided I will be keeping this complaint file in place. 
  

  
  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:01/10/2023

  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 was attempting to file a claim on the website as I had done previously, however, it was proven impossible to do so. Upon contacting customer ********************** they are informing me that the ONLY way to file a claim now is via mail of fax ** they decided to remove this feature. This is an undue burden on customers and seems like a way to avoid responsibility for claims - many people do not have access to printing or faxing facilities, not to mention postage costs and time. Many people need to file claims on a weekly basis. BCBS should at a bare minimum be required to reimburse customers for the cost of sending in claims. When I called customer ********************** they told me they have taken this ability offline and do not have plans to bring in back online.

  Business Response

  Date: 01/12/2023

  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:12/27/2022

  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.

  I had a periodontic procedure to get 2 bone grafts on my lower jaw. The surgery was medically necessary or my lower jaw would cave in over time. My plan covers periodontics, but this got rejected. My dentist, like ****% of dentists, accept dental insurace, but don't have a license to accept medical coverage. My rejection came back with no explanation and everyone I talk to at Blue Cross says to file with medical and don't listen when I explain. No one has been sure how to file an appeal. I just want my $1,000 benefit.

  Business Response

  Date: 01/06/2023

  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: 01/11/2023

  This is in response to the claim I submitted about bone grafts. I'd like you to explain and put in the open to the BBB and not just say, "we've sent you something", which is just a "no" because you created your own procedural code to avoid paying claims. The type of graft I had is called "socket preservation" and is considered periodontics all over the country. Why is Blue Cross rejecting the fundamental idea in dentistry that this is a periodontics procedure?

  Business Response

  Date: 01/23/2023

  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. A letter has been mailed to member regarding a follow up the BBB received from the member for their initial recent grievance.
  
  Regards,
  Member Appeals & Grievances Program

• Initial Complaint

  Date:11/19/2022

  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.

  Called **** at Horizon blue shield said she will call me to do application over phone never called me.Called her 4days in a row never returned my calls l get mpression that she is avoiding **** need neck surgeryand if I don't get surgery eventuality I will be crippled surgeon told me that to.So my time is limited.Need SSI disability to pay medical bills,6months behind rent,been sleeping on couch.Need bed for after surgery.

  Business Response

  Date: 11/21/2022

  BBB,

  This is not a BCBSMA member, his information does not appear in our systems and there is no BCBSMA ID# for this member. It appears the member is trying to complain BCBS ** - not MA.

  Sincerely,

  BCBSMA

• Initial Complaint

  Date:10/28/2022

  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.

  My employer's BCBSMA high-deductible health plan has a nasty undocumented "feature": if you reduce your level of coverage from family to individual during the plan year, you will have to pay a new individual deductible, even if you have already paid the full family deductible. This is not explained in any of the plan documents available to me. I reduced my level of coverage in the month my wife started ********* I had a procedure the next month that I thought would be affordable, having paid the full $3,000 family deductible. When the bills arrived, I was shocked to be charged an additional $1,500 deductible. My appeal was denied, saying they had to follow the plan rules, but they gave no coherent explanation of the rules. My employer's HR benefits specialist had never heard of this either until he called BCBSMA for an explanation.There was no reasonable way I could have known they would charge this extra deductible. Had I known, I could have easily rescheduled the procedure to avoid the charge. Charging a fee like this without forenotice is an unfair and deceptive practice that I believe is illegal under Massachusetts law. I want BCBSMA to refund my $1,500. They should also either change their rules or document them clearly. I hope the BBB can prompt BCBSMA to resolve this matter without my having to initiate a legal action.I will attach personal information in a separate document.

  Business Response

  Date: 11/02/2022

  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: 11/08/2022

  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. 

  BCBSMA has not addressed my complaint. They simply reiterated their denial of my appeal, saying, in essence, "We followed our rules." My complaint is not whether they followed their rules. My complaint is that they failed to disclose their rules up front. It is unfair and deceptive to take my money first and explain later. The information they are giving me now was not available to me before. There is no reasonable way I could have known about this fee in advance, when I could easily have taken action to avoid the fee.
  

   

  
  
  FAQ
  
  Regards,

  *******

   

   

  Business Response

  Date: 11/16/2022

  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: 11/26/2022

  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 # ********.

  BCBSMA has not yet even acknowledged the core of my complaint:
  
      BCBSMA acted unfairly and deceptively when they charged me a large fee without disclosing it in advance. Unfair and deceptive business practices are illegal in Massachusetts.
  
  BCBSMA has not addressed my complaint:
  
      BCBSMA said they processed my claims correctly according to the plan. But this does not answer or excuse unfair and deceptive practices. BCBSMA has a legal obligation in Massachusetts to conduct business in a fair and honest manner.
  
      BCBSMA also said that, in a phone call, "our Member Services Department advised you that the deductible applies for a colonoscopy." This language, as used in the plan documents I have seen, merely indicates that colonoscopies fall in the category of services for which a deductible applies. It did not in any way disclose that BCBSMA had subjected me to a new deductible, or that I would be charged an unexpected $1500 deductible for that specific colonoscopy.
  
  Please send to me a copy of the full terms of my plan, which have never been made available to me, so that I can verify that my claims were processed correctly.
  
  Please also send to me a copy of whatever records BCBSMA has of the phone call on December 14, 2020, including any audio recordings of it.

  
  Regards,

  *******

   

   

• Initial Complaint

  Date:10/11/2022

  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 wife and I submitted routine dental claims for services on 8/18/2022 that included x-rays, cleaning and exam for an out of network dentist located in ********* where we live. For the past three years, BCBS of MA has fought and resisted re-imbursing our dental claims as our dentist is not in their network. We pay the dentist directly and seek re-imbursement. The claims filed for 8-18-2022 services were altered by BCBS claims department to add an additional x-ray line item not shown on either claim form submitted just so they could deny all x-rays taken. I have called two different times (9/13/22 and 9/27/22) and been lied too and given complete run around about our claims. In the meantime, BCBS has paid $64 of a combined $752 submitted for these routine services because they don't want to pay the claims. I feel I have repeatedly experienced insurance manipulation and now fraud as they added line items only to claim denial to drag out paying the claim. I need the claims re-examined and processed so I can receive an honest payment for these routine services. BCBS of MA has all claims, dental statements showing payments, EOB's and details of this situation as I have had to email copies of each to the customer ********************** reps in trying to get this resolved.

  Business Response

  Date: 10/18/2022

  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