Business Profile

Health Insurance

Blue Cross and Blue Shield of North Carolina

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Complaints

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

Customer Complaints Summary

91 total complaints in the last 3 years.
23 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:07/21/2025
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.
Dear Better Business Bureau,I am filing a complaint regarding a recurring unauthorized charge submitted by *********** on March 26, 2025.I was billed $16.25 for a behavioral assessment (CPT *****) that I did not authorize, consent to, or complete during the visit. I previously raised this issue with *********** and Blue Cross NC, and the charge was supposed to be removed.However, despite the resolution, the same charge has reappeared on a subsequent Explanation of Benefits from my insurance provider. This suggests a possible administrative or billing error that is causing repeated unauthorized claims.I am requesting that Duke Health:Immediately remove the charge Ensure no further billing of this nature occurs Clarify how this error happened after the initial correction I appreciate your support in helping me resolve this matter promptly and ensure my insurance is not misused.Sincerely,**** ***** do ****** Durham, ** Subscriber ID: **************
Business Response
Date: 07/21/2025
Thank you for the referral. BlueCross NC will contact the complainant directly regarding their concerns.
Customer Answer
Date: 07/22/2025

Complaint: 23631540

I am rejecting this response because: No one called my or email to explain what is happening.

Sincerely,

**** ***** Do ******
Initial Complaint
Date:07/21/2025
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.
BCBSNC is purposely making it difficult for healthcare providers to submit claims that are covered by law by enacting processes that require non standard diagnosis codes for preventative screenings. The same codes that other insurance companies accept are rejected by ****** and ****** purposefully refuses to provide the correct codes to resolve the issue. They are actively working to not pay *** mandated coverage for preventative services.
Business Response
Date: 07/21/2025
BlueCross NC will contact the complainant directly regarding their concerns.
Customer Answer
Date: 07/23/2025

Complaint: 23629596

I am rejecting this response because:

Sincerely,

***** *********
Initial Complaint
Date:07/17/2025
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 have a claim from March 17th. it is a maternity claim with ********. ******** has not filed the claim correctly. The labs were maternity related. I am having issues with ****** and ***** with BCBS helping me. My ID number is *********
Business Response
Date: 07/18/2025
BlueCross NC will contact the complainant directly regarding their concerns
Customer Answer
Date: 07/21/2025

Complaint: 23616140

I am rejecting this response because:
I have not heard back and the issue remains unsolved. Thanks
Sincerely,

******* ******
Business Response
Date: 07/22/2025
BlueCross NC has made contact the complainant directly regarding their concerns and will continue to provide complainant with updates.

Customer Answer
Date: 07/23/2025

Complaint: 23616140

I am rejecting this response because:
My issue is unresolved. I spoke with ***** earlier this week and asked him to keep me updated. ******** resubmitted the claim to BCBS. They should have it to reprocess correctly. I ask that ***** contact me with an update. He did not provide a direct dial to reach him.
Sincerely,

******* ******
Initial Complaint
Date:05/02/2025
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.
BCBS of North Carolina denied claims filed with their agency and there were two policies covering my children from August of 2023 to March of 2025. Attached are claims and history compiled by the *****************. There are other outstanding claims that I am unsure about as my ex wife keeps those records.
Business Response
Date: 05/05/2025
BlueCross NC will contact the complainant directly regarding their concerns.
Initial Complaint
Date:04/30/2025
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 have paid for my minor son to be covered under Blue Cross Blue Shield of NC for over 14 years. Recently, I changed employers and while maintaining an account with Blue ********************** I had to cancel his former account having just paid a Premium. When I called to do so the *** assured me I would receive a prompt refund for over payment. I have just received the check which was made out to my 14 year old son who has never made a payment. I called to request this be corrected as I do not want my son to have to be pulled out of school nor I to miss work to fix this. I have always made direct payment from my account and should be reimbursed as such. I have asked to speak with account and was refused told a P2 supervisor is the highest I could talk to and it was my issue to sort out by ****** *. Can't imagine billing couldn't quickly fix this problem if aware
Business Response
Date: 04/30/2025
BlueCross NC will contact the complainant directly regarding their concerns.
Initial Complaint
Date:03/11/2025
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.
I am filing a formal complaint regarding the denial of additional treatment for my diagnosed Neurogenic Thoracic Outlet Syndrome (nTOS) despite documented medical necessity from my healthcare provider.Neurogenic Thoracic Outlet Syndrome is a complex condition caused by compression of the brachial plexus nerves, leading to chronic pain, numbness, tingling, weakness, and loss normal function in my upper extremities. These symptoms significantly impact my daily life and ability to work as a general dentist, making continued physical therapy essential to maintaining my function and quality of life to avoid more invasive and more expensive treatment options (i.e. surgery). My physical therapist's office submitted a request for continued physical therapy, which was denied even after a second request using a peer-to-peer review. The denial was cited as not medically necessary, even after a letter from my specialist stating otherwise. The refusal to approve medically necessary treatment contradicts standard medical guidelines for managing nTOS and disregards the recommendations of my treating physician. This denial has led to increased pain, weakness, and in my arms and hands as well as muscle tension.
Customer Answer
Date: 03/14/2025
Yes, my health insurance is through BCBC of North Carolina, my partner who is the subscriber works from home, the offices' head quarters is in North Carolina. Thank you.
Business Response
Date: 03/14/2025
BlueCross
NC will contact the complainant directly regarding their concerns
Initial Complaint
Date:02/20/2025
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.
The BCBS ******** plan for 2025 stated that preventive care from a dentist in-network would be covered 100%. I searched through the in-network dentist listed by BCBS and chose ***** P. ********, in-network. I understand the BCBS "farms out" its clients to **************. Therefore, the in-network dentist for BCBS should also be in-network for **************. I have learned that is not the case. ***** P. ******** is in-network for BCBS but not Liberty Dental who BCBS is using to manage their clients. I paid $331 for preventive care at ********' office, the office filed the claim, I received a reimbursement check of $206. A difference of $125. Which is not the 100% stated in BCBS's reference guide for 2025. I would like to be reimbursed the full amount since that was what was stated in BCBS's material for dental care, that it would be covered 100%. For an in-network dentist that is in-network for BCBS. Before I received the partial reimbursement check, I had another appointment with ***** ********. That claim should also be covered 100%. $305. The first appointment was for x-rays and examine. The second was for a cleaning and a filling.
Business Response
Date: 02/24/2025
BlueCross NC will contact the complainant directly regarding their concerns.
Customer Answer
Date: 02/24/2025

Complaint: 22966360

I am rejecting this response because: *********** plan is with BCBS, I chose an in-network dentist on the list belonging to BCBS. Even with clients being "farmed out" to Liberty Dental, the dentist should still be in-network rather than there being another group of dentist to select from. Especially when there was no indication that there was another in-network group relating to *************** It is misleading to have another list. People are led to believe in-network is in-network when it is not.

Sincerely,

****** ****
Initial Complaint
Date:02/11/2025
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've been having this problem since October 2024, and it continues to leave me without health insurance. I've made six phone calls at this point, but they keep denying my claims due to supposed coverage by another insurance provider. They keep asking for the same details that were already submitted through the online portal and faxed to them. I even had an agent submit the information over the phone. I have multiple case numbers9197651920 and ************yet they still continue to deny my claims. If this issue is not resolved immediately, I will be involving the insurance board, as I have been without coverage since September, despite informing them that I no longer have the other insurance.
Business Response
Date: 02/11/2025
BlueCross NC will contact the complainant directly regarding their concerns.
Initial Complaint
Date:02/03/2025
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.
1. BCBS NC is giving the runaround.2. Messages sent to BCBS NC in their web portal and app, but insurance carrier takes no action and does not reply to messages we took the time to send them 3. Section 5 of the member guide states that dental work resulting from accidental falls are covered under the medical plan and not the dental plan. Insurance carrier for the medical plan bounces the claim to the wrong department and the claim is in limbo.4. Multiple calls made to insurance carrier navigating through some ***** different IVR prompts just to reach a person. Excessive number of IVR prompts to reach a person.5. Phone **** open cases but fail to follow up as they promised to do. This results in delays in getting the claim processed correctly 6. The dental plan is also bcbs nc but as stated this accidental fall triggers coverage for dental work under the medical plan not the dental plan. 7. There are upcoming visits to other oral surgeon and this claim nightmare appears will continue for subsequent claims even though case notes from the provider was sent to confirm an accidental fall.
Customer Answer
Date: 02/06/2025
Please note the business left us a voicemail on 2.3.25 at 11:26am.

On 2.4.25 at 125p I called the business and the *** ***** answer so I left a voicemail.

I tried again on 2.4.25 at 429p and did not leave another message when the *** again ***** answer.

I tried again today at 351p and left a message when they ***** answer. And again at 406p but ***** leave a message.

Please add these times to my case notes
Business Response
Date: 02/10/2025
BlueCross NC will contact the complainant directly regarding their concerns
Initial Complaint
Date:02/03/2025
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.
BCBS is the provider my employer uses and this year we were offered a *** BENEFIT. When I essentially called on 1/22/2025 I was told that my coverage did not include the benefit until I explained to the agent that this year my employer includes the benefit in our coverage. The agent was able to locate the benefit, however when my provider called they were told my IVF procedure was not covered. Leading to a series of calls from myself and my provider. I have been told that my benefit will be updated and the issue has been resolved as ALL MECKLENBURG COUNTY EMPLOYEES ARE EXPERIENCING THIS SAME ISSUE**** I even advised my employers HR department because it is now 1/31/2025 and I still can not use my benefit. Every time *** are verified by my provider they now comeback as billable but not covered even with verbiage updated. I have now been told I have to wait for another system called BLUE E to be updated and my first appt is 4 days awayNO ONE CAN GIVE ME EXACT ANSWERS OR TURNAROUND TIMES ITS SAD I HAVE TO ADVOCATE FOR MYSELF AT THIS EXTREME. THEY ARE NOT RESOLVING THE ISSUE WITH URGENCY BECAUSE IT IS NOT PERSONALLY AFFECTING THEM!!! This has been going on for two weeks and I have lowered my expectations of a resolution at this time. I FEEL STUCK BECAUSE THIS PROVIDER IS THE ONLY ONE MY EMPLOYER OFFERS. NEXT YEAR i will purchase private insurance outside of my employer because this has been a complete nightmare. The only thing myself and my provider have been receiving is conflicting information with no uniformed method or usage of reading proper notes. They have not even uploaded my employers benefit booklet and continue to use the 2024 booklet as a referenceUNACCEPTABLE and I dont want another agent to apologize to me until I see and get results not only for myself but all the employees at my job not able to use their promised benefit. THIS COMPANY IS HINDERING MY FUTURE OF BECOMING A PARENT AS WELL AS ,ANY OTHERS AND THIS IS NOT FAIR.
Business Response
Date: 02/03/2025
BlueCross NC will contact the complainant directly regarding their concerns.

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