ComplaintsforBlue Cross and Blue Shield of Kansas City

• Initial Complaint

  03/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On January 25, I visited a ******* ********** to receive preventative services--a breast exam (not official mammogram) and discussed requirements for a PAP that I thought I was overdue for, but learned that the years between exams had been increased in recent years. On Blue Cross Blue Shield's website, ******* ********** is listed as in my network and covered. I received a bill from ******* ********** for 100% of the cost of services. I called ******* ********** and found out that BCBS had rejected coverage. Upon calling BCBS, I found out that ******* ********** is in my network, but the specific doctor who provided my services is out of network! Not only is the information on their website misleading, but I was denied coverage of preventative services for women! I believe that not only should this be considered in network, but that the services should be covered at 100% by BCBS. The statement date from ******* ********** is 2/26/2024 and the total amount due is $349.00. I request that BCBS cover this service 100% as preventative, in-network treatment.

  Business response

  03/13/2024

  Good Afternoon,

  We have been unable to identify this consumer as a Blue Cross Blue Shield Kansas City member. Can you please obtain a copy of the member's insurance card to confirm correct Blue plan coverage. Thanks 

  Customer response

  03/13/2024

   
  Complaint: ********
  
  I am rejecting this response because I am a member and the pictures of my insurance card are attached.
  
  Sincerely,
  
  ******* ******

  Business response

  03/28/2024

  Good Morning, 

  This member's insurance is administered through Blue Cross Blue Shield of South Carolina. I reached out to the South Carolina plan for assistance. I was advised they have made multiple attempts to contact the member and resolve her issue. However, they have received no response to their calls or messages. Representatives with the South Carolina plan is ready and able to assist the member with her concerns. I was provided the following contact information for the member to make outreach:

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

  We will me happy to address the member's concerns once she has contacted the number above. 

  Thank you, 

• Initial Complaint

  03/19/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  We have a **** ******** ********* **** & have for several years. The start of 1/1/23, they changed how to access the different plan benefits: ********** for over the counter items, (sign up on a different site); find a Provider,(go to a different site); use their main site (sign up); sign-up for their meetings explaining coverage-over an hour away requiring someone to drive there. They are selling seniors with their plan but are making it impossible to access the benefits without internet or being computer savvy. I tried the 3rd time today to set-up the ********** benefits that we have not been able to use since January 2023 & tried speaking with a person. She was nice but had extremely limited use of English. The issue was not resolved! BlueCrossBlueShield KC must live up to their commitments to seniors. They are not. If I can find a way to get away from them now I will. Our complaint is not being able to access our insurance benefits.

  Business response

  04/04/2023

  The complaint was forwarded to our ******** ********* team for handling. On 03/29/2023 I received the following response:

  “Thank you for reaching out regarding our **** ******** ********* ****. We respect all of our members’ concerns. We have connected with this member to resolve her concerns.”

   

  Thank you, 

• Initial Complaint

  12/16/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I became eligible for Medicare November 1 signed up with Medicare advantage. Plan has a nations OTC over the counter, benefit card and card that also has vision and dental that you pay for with the card. To access the OTC benefit you have to be able to login online to order with them. We have not been able to login ever since November 1 when I was first eligible. My wife has made 12-13 calls to them at least an hour each time trying to get the issue resolved. We can use the card at Walgreens or CVS but we don’t know which items are available for purchase under the OTC plan. Every time I call they say they have escalated an IT ticket giving me the ticket number ***** and that within a few hours or a couple of days the issue will be resolved. Here we are a month and a half into that nothing has been resolved. They have said I can order items over the phone so I called today to try to do that because the end of the year I will lose the benefits they will not roll over into next year so today when I called to order an item they said the plan is not showing any benefits available!! Argh. I asked to speak to the supervisor they put me on hold for a while and suddenly I was disconnected. Supposedly. Called back to speak to the supervisor they put me on hold. Got disconnected called back, put on hold and disconnected again. Hmmm great customer service. One supervisor that I spoke with on November 28 at 3:23 PM said that I’m not the only one having issues I said well that doesn’t really fill me with confidence but she assured me they were working on the system to get it working for everyone. I did reach out to BCBS Medicare advantage on December 7 on my behalf, and BCBS called to let me know they had forwarded more information about my account to them. So after that I checked with the OTC number again and they said within a couple of days everything would be uploaded and good still nothing has been done and this is December 16.

  Customer response

  01/19/2023

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

  This complaint has been resolved. They finally fixed it to where we were able to access their website.
  Thanks so much for your help!!

• Initial Complaint

  09/12/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have called BCBS multiple times to get information on them honoring a program benefit for my plan. BCBS has not been able to provide me with any providers in my area or within my coverage area that will apply their advertised program benefit of $250 coverage for Prescription eyewear. "Eyewear & Vision Services WHAT IS MY BENEFIT? You can receive a $0 routine eye exam (up to one visit every year). You plan also provides a $250 eyewear benefit each year. You can use your benefit to help purchase eye glasses (lenses and/or frames) or contact lenses. HOW CAN I ACCESS MY BENEFIT? You may choose any provider or find a Blue KC participating provider at medicarebluekc.com/ find-a-doctor.

  Business response

  09/26/2022

  Thank you for the opportunity to respond to this complaint. Mr. ***** has filed a complaint indicating he is struggling with getting assistance from Blue KC regarding a vision benefit for eyewear. I reviewed Mr. ******* complaint and the member’s benefit contract terms.  After careful review, I found Mr. ***** is enrolled in a Medicare Supplement policy and does have an Eyewear benefit.
  The member’s covered services include an annual refraction exam to determine changes in vision and/or the need for eyeglasses or contact lenses. The plan pays up to $250 every year for eyewear (Contact Lenses or Eyeglasses – frames and lenses). The member is responsible for charges over the Eyewear Benefit Maximum. The member may choose any provider or find a Blue KC participating provider at medicarebluekc.com/find-a-doctor.

  
  I was able to locate several providers within 5 miles of Mr. ******* address that are participating with Blue KC and accepting new patients. I have contacted the closest provider, Dr. ****** ***** with ************ ****** *** ***** who is willing to provide services to Mr. ***** and submit a claim on his behalf if he elects to purchase eyeglasses from their office.  Please note, if Mr. *****, decides to seek services from Dr. ****, I’ve advised the provider to file the claim directly to me to ensure proper handling.
  
  The following is the contact information for Dr. ****:
  

  Name: ****** * **** ********** *********** **** ********** ******** ***** * **** ** ** ************* ** ***** ****** ************

  Please feel free to contact me if you have any questions regarding my response. 

   

  Sincerely, 

   

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

• Initial Complaint

  07/02/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My wife, *** ******** was admitted to ******* ******* ****** ** ************ ** on 4/28/22. I contacted BCBS at 5:08 pm that day at customer service and advised them that she was admitted and that we would need to add our son to her policy once he was born. We were advised that this would be done automatically and there was nothing else needed. At 11:07 on 5/23, I again contacted BCBS customer service and spoke with *******. She informed me our son was not yet added, but that she would add him and resubmit our claims that were denied or pending for him. Her reason that he was not added was because they didn’t know if my wife had a vaginal or c section birth (vaginal.) I was again told there was nothing else that needed to be done and that he would be covered for the first 31 days after birth. On 6/27, our claims were still being denied. I spoke with ******* from BCBS at 1:28pm and was told that he was in their system, but not on the plan. It appears he had been added, but we were informed that because it was not added through my wife’s group coordinator, that none of the claims would be covered. Later that day, we contacted the group coordinator and a request for exemption was submitted and we are still waiting for answers. At 2:30 pm that day, I contacted BCBS and requested transcripts of previous calls where I was told our son would be covered and there was nothing necessary for us to do. They informed me that those transcripts could only be released with a court order. Blue Cross of KC is not acting in good faith to honor the claims that they are obligated to pay. They clearly had knowledge that our son was born and was to be added onto my wife’s plan. Because the method he was added was not through a broker, they are trying to deny payment in the ballpark of $3,000. I am requesting that they add him to my wife’s plan for the first 31 days like I have requested twice before now, so that the bills are covered by BCBS.

  Business response

  07/22/2022

  Good Afternoon,

  Our records show Blue KC received a call from ******** ******** on May 13, 2022, asking to add a newborn to the policy. Unfortunately, at that time we were needing additional information from the provider and was unable to complete the enrollment.  It appears as of July 18, 2022, Blue KC received everything needed to update ****** ********’s enrollment and he now has active/eligible insurance coverage from April 30, 2022, through May 31, 2022.

  
  I reviewed all claims submitted, to date, for ****** ** ********, and found six claims have been submitted to Blue KC for services rendered April 30, 2022, through May 11, 2022. Please note, all claims have been processed or reprocessed for benefit coverage as of July 18, 2022. Mr. and Mrs. ******** have access to the original explanation of benefits and the adjusted explanation of benefits, via the online Blue KC member portal at **************.  The explanation of benefits will outline the total billed, Blue KC payment, patient liability and any provider write off.
  Please feel free to contact me if you need any additional information of have any additional questions.

  
  Sincerely,

  ****** *****
  Manager, Appeals
  Blue Cross Blue Shield Kansas City

• Initial Complaint

  02/14/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was able to get health insurance through the *** *********** last July because of the expansion of benefits under Covid funding. I was told when I applied that the only way I could have a contract with BCBS ********* was if I allowed BCBS to take the money directly from my bank account. This is the same thing they insisted on when I last had health insurance from them in 2016. They were authorized to take the premium which I believe was $42.23/mo. I don't have a bill for the premium and the bill does not show up under the billing tab on the S**** **** portal. The first correspondence I have from them is at the beginning of December. I have 2 letters that arrived on the same day. One says it's the beginning of December and I don't owe anything and the other says that my coverage is terminated for non-payment. I called BCBS and was told I had been terminated October 1st for non-payment. I told the person on the phone that BCBS was taking it out of my bank account automatically and I was told they didn't take the money and I was terminated for non-payment. When I asked to speak to a supervisor I was transferred to the *** ***********. The person at the Marketplace told me I was terminated for non-payment. I told her that I wasn't allowed to sign up for the insurance without agreeing to have the money taken automatically. She looked at the contract and agreed there was an issue there and sent me on to the next higher person at the Marketplace. That person took the information and filed an appeal with BCBS. I was told it would take up to 30 days for BCBS to respond. I mentioned that I didn't know if I would qualify for the same insurance after December 31st and they told me it wasn't a problem. Next, I took the 2 letters to ***** **** where a nurse tried to help me figure out what was going on. She was very kind and made a number of calls to straighten it out. I offered to pay the back premiums that BCBS had failed to take from my account. Now I'm out of space on here.

  Business response

  03/02/2022

  Thank you for the opportunity to respond to this complaint. I reviewed Ms. ******** complaint and the member’s eligibility. After careful review, I found Ms. ******** eligibility was terminated on September 30, 2021, for non-payment of the premium.
  
  The policy became effective August 1, 2021, and one payment was received as a one-time electronic payment for $40.24 on July 7, 2021. This amount was sufficient to effectuate the policy.
  
  Billing invoices were processed for mailing on August 9, 2021, September 9, 2021, and October 11, 2021, for September, October, and November premium, respectively. Delinquency warning letters were processed for mailing on September 16, 2021, October 16, 2021, and November 16, 2021. After 90 days of delinquency, the policy was terminated for non-payment retroactively to September 30, 2021, leaving a balance of $40.24 remaining for September coverage. A termination letter was processed for mailing on December 1, 2021.
  
  Our records show the first contact Blue KC received from the consumer regarding payment was on December 9, 2021, advising she received the termination letter. The consumer indicated her account was supposed to be on autopay. Issuer has no record of an autopay set up for this consumer.
  
  A case was forwarded to healthcare.gov on December 10, 2021, requesting a review for reinstatement. A review was completed, and no evidence of autopay was found. Since multiple billing invoices and delinquency warnings letter were provided to the member, the request for reinstatement was denied and mailed to Ms. ****** on December 16, 2021. 
  
  Based on the above, Ms. ******** request for reinstatement has been denied. We encourage Ms. ****** to reach out to the Healthcare Exchange Marketplace to see if she has any options for enrolling into a new policy through the Marketplace.

• Initial Complaint

  01/27/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Beginning July 22, 2021, I sought psychotherapy for a diagnosed adjustment disorder with an out of network provider who specialized in the type of therapy that I need (EMDR). Bi-weekly, from that point, I received care from my provider, totaling 18 visits and paying $2,190 out of pocket. I routinely submitted these visits to the BlueKC online portal for reimbursement. Multiple times, they sent a request for yellow forms to my provider, which she provided - multiple times. Multiple times, we were informed that the yellow form was no longer the issue. In early December of 2021, I had to discontinue care because of the large amount of financial impact that a lack of reimbursement had taken on my family. At that time, one ***** ******* canceled my previous claims and submitted one large claim (Case #************) , with all 18 dates for reimbursement. On December 10th, she informed me that the case was being processed and I would see the payment in 30 days. On January 20th, 2022, I still had not received reimbursement and called BCBSKC to understand why. I was told that the case # had yet to be assigned as a claim, and therefore would be a minimum of 37 days for payment. When they followed up with me today, I was told that the case was waiting for yellow forms from my provider. Blue Cross Blue Shield of Kansas City is running me in circles, refusing to reimburse my money per my plan, and acting in bad faith.

  Business response

  02/11/2022

  Thank you for the opportunity to respond to this complaint. I reviewed Ms. ******** complaint and the claims in question. After careful review, I found Ms. ****** received services from a provider who is not in the Preferred Care Blue network and not participating with Blue KC in any of our networks.  Unfortunately, this means at the time the first claim was submitted, in August 2021, we had no information on file for this provider. Therefore, we sent a request to the provider, **** ******, requesting she complete paperwork so that we can create an 8-digit provider ID number that will allow us to process any claims submitted for services rendered by **** ******. Additionally, we requested a copy of her W9 form and state license.

  
  On November 4, 2021, Ms. ****** was advised all of the information had been received from Ms. ****** and her claims would be processed. December 6, 2021, Ms. ****** contacted Blue KC to check on the status of her claims for Ms. ******. At that time, Ms. ****** was advised the documentation was received and claims were waiting to be processed. Ms. ****** was informed on January 20, 2022, that her claims had not been processed as information was missing from the forms Ms. ****** submitted, specifically we were missing her tax ID number and a copy of her W9 form.
  On February 4, 2022, we reached out to Ms. ****** and obtained the additional information needed to process all of Ms. ******** claims. Ms. ****** provided all the necessary information on February 7, 2022, and all of Ms. ******** claims were reprocessed on February 10, 2022.

  
  In reviewing the adjusted claims, I found all claims were reprocessed and benefit coverage applied based on Ms. ******** contract terms. Specifically, outpatient mental health services received from an out of network provider are submitted to her deductible and then 40% coinsurance and out of pocket maximum. Additionally benefit coverage is based on an allowable charge and the difference between what Ms. ****** billed and the allowable charge will also be Ms. ******** responsibility.

  
  If Ms. ****** has any questions regarding this response she may contact me at ************* For questions regarding her benefit coverage, she can contact the customer service number listed on the front of her insurance card. Additionally, revised explanation of benefits will be issued in the next 5 to 7 business days.

   

   

   

• Initial Complaint

  07/12/2021

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Blue Cross Blue Shield of Kansas City (Blue KC) will not pay the amount they owe my eye doctor for cataract evaluation on July 12, 2019. On the date of service, I paid the portion that was not fully covered by my insurance. However, during my April 14, 2021 eye doctor visit, I was told that charges had not been fully paid. So, that is when I began to investigate why charges were not fully paid. I learned that Blue KC was late in making the appropriated arrangements with Medicare, so this claim was not forwarded from Medicare to Blue KC. Although Blue KC accepted my policy on May 28, 2019, they didn't have the arrangements in place when my coverage began on July 1, 2019. Medicare tells me "It was never sent because your supplemental did not have their information on file with Medicare at the time. They created a record on 7/30/2019." So, I filed Blue KC claim ************. The information needed to process the claim was attached. But, Blue KC still won't pay what they owe.

  Business response

  07/28/2021

  Good Evening, 

  Thank you for the opportunity to research and respond to this member’s complaint. 
  

  Our member, Mr. **** *******,  has submitted a complaint indicating Blue KC has not processed the remaining member responsibility for a claim for service rendered on 07/12/2019. During my investigation of this case, I reviewed Mr. ********* medical claim history and found Blue KC received the member submitted claim on July 2, 2021. At that time, the claim was closed because no diagnosis was submitted on the claim, without all of the information we could not proceed with processing. On July 7, 2021, Blue KC issued a letter to Mr. ******* and the provider of service, advising what information was needed. A copy of the July letter is attached to our response. 

  Upon further review, I discovered Blue KC a new claim submitted by Dr. ******** with the primary medical diagnosis. The claim was submitted on July 19, 2021, and processed on July 26, 2021. Unfortunately no benefit payment was issued in this case. 

  Mr. ******* is enrolled in a Medicare Supplemental plan which does not provide benefit coverage for any amounts applied to the Medicare Part B deductible and any amount denied by Medicare. According to the documents Mr. ******* submitted The Medicare claim was submitted with total billed charges of $285.00, of which Medicare allowed $184.25, paid $147.16, $40.00 non-covered refraction (code 92015) and $36.89 was applied to the Medicare deductible (see attached). 

  Mr. ******* will be issued a new Blue KC Explanation of Benefits documenting our denial of service. He should also reference his Medicare Explanation of Benefits for a better understanding of their denied charges. 
  
  I hope this response is helpful in understanding why no benefit coverage was issued. Please feel free to contact me if you have any further questions regarding my response. 

   

  Sincerely, 

   

  ****** ***** 

  Manager, Appeals Department 

  Blue Cross Blue Shield of Kansas City 

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

  Customer response

  07/30/2021

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

  The response from Blue KC falsely states that "$36.89 was applied to the Medicare deductible."
  
  Medicare Claim Details MedicareClaimDetails.pdf shows "Total Applied to Deductible: $0.00."
  
  Other claims fully account for the year's Medicare deductible.  Medicare Claim Details show the deductible being applied to the claims in **************.pdf, **************.pdf and **************.pdf.  ($68.10 + $4.24 + $112.66 = $185.00)  Medicare Summary Notice MedicareSummaryNotice.pdf attached to original complaint explains "You have now met $185.00 of your $185.00 Part B deductible for 2019."
  
  The Blue KC policy fully covers all Medicare copays.  Blue KC is responsible for the $36.89 copay amount.
  
  Regards,
  
  **** *******

  Business response

  08/09/2021

  Thank you for the follow up inquiry. After speaking with our Claim's department again, we discovered the claim examiner did incorrectly process Mr. ******* claim indicating Medicare applied deductible. The claim was reprocess again on August 2, 2021, with a payment of $36.85 issued to ******** *** ******, via electronic bank transfer. I've attached a copy of the revised Explanation of Benefits for your records and for Mr. *****. 

   

  Please let me know if you need anything further or have any additional questions. 

  Have a good day! 

  Customer response

  08/09/2021

  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.
  

  
  

  Thank you for helping to resolve the issue.
  

  
  Best Regards,
  
  **** *******

*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. ↩