ComplaintsforExcellus Blue Cross Blue Shield

• Initial Complaint

  05/08/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  My mom ***** ******* passed away 3/18/23 she had Blue cross blue shield insurance they received a copy of her death’s certificate on 4/24/23 they were also called prior to inform them to cease the insurance as she passed away, they billed her after being informed fir aApril and again attempted ti withdraw mi at from her account in May the bc/bs policy is ************ My moms SS is *** ** ****

  Business response

  05/23/2023

  An email was sent to BBB yesterday, May 22, 2023 (attached) to advise that the complaint was received and acknowledgement letter sent to ***** ****** (Daughter), as appointed through the small estate death certificate, small estate form and HIPAA paperwork.  

  ** Today, I received a response from our membership team:

  The death certificate and small estate were not received until 4/27/23, information was entered to the account on 5/3/23 and term (back-date) effective 3/18/23.. 

  We received non-sufficient funds prior to that; then on 5/1/23 the eft was pulled but was returned as not sufficient funds on 5/4/23.

  The only payment that actually cleared past the date of death (DOD) was on 4/1/23 and that was prior to the receipt of death certificate. 

  EFT removed once the death certificate and small estate were received and entered on 5/3/23.

  The refund has been issued to small estate holder on 5/12/23 in the amount of $ 529.63. The refund was prorated based on DOD 3/18/2023.

  Please advise if any additional information is needed.

  Customer response

  05/26/2023

  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.  Based on my Most recent conversation with Representative Anthony who corrected the error of prior representative. Anthony’s stated a check would be mailed to ***** ****** we have this conversation on May 25, 2023, he agreed the prior representative made errors and was in the wrong 
  Regards,
  **** *******
  

• Initial Complaint

  01/25/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I was told by an agent I could submit secondary claims. Upon trying to do so, my Member ID had expired ( 1 year) then I was told they only except claims on a year basis. Most providers never even ask for secondary coverage information because they don't want to deal with submitting to two companies. Once we found out that my wife did indeed have secondary coverage through her ******** insurance, it was too late, according to Excellus Blue Cross Dental. I expect this happens often with couples where one is still working and the other has retired and is on ******** for insurance. The primary coverage is submitted through the medical/dental office and the office never checks about secondary coverage. The customer gets screwed out of their secondary coverage payments... The time frame for insurance companies to allow secondary coverage to be submitted should be extended to at least a 3 year period.

  Business response

  02/09/2023

  Regarding BBB Upstate New York complaint #******** - Our Advocacy team has received this information and is working on it. Also, there have been a few staff/contact changes, so please ensure that emails are going to [email protected], plus to *************************** *** ************************** and keep me copied if that helps. Thank you. Kevin K***, Corporate Communications ***********************  

• Initial Complaint

  02/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  Hello, I am currently on the liver and kidney transplant list at ****** ******** in Rochester New York. I also am a kidney dialysis patient that treats three times a week. Last year I had Excellus Blue Cross Blue Shield PPO plan. That left me with a large outstanding balance so this year for 2022 I picked a Medigap plan C coverage during the open enrollment period. During the beginning weeks of January I received my new insurance cards but they were labeled PPO plan. I called BC/BS and told them this is last years plan not the one I picked out. BC/BS said It wasn’t activated and they would activate it and make sure it went to Plan C. One week later I Received another set of insurance card this time marked Medigap part C. So I brought the new card to the hospital and when it was entered the account was inactive. So I called a second time she said oh we have your application here they just found it and it was never put through we will do that now and get back to you in three or four days. Just like the first time there is no response. So this morning I called them for a third time now they say I have been terminated due to lack of payment. I just received my first bill at the beginning of February it stated I was overdue for the January bill and the total is now $618. I asked the Representative how they could charge $309 a month for a service that was never activated to begin with. I would just like help getting insurance coverage. I can’t keep incurring these kind of medical bills I need coverage immediately.

• Initial Complaint

  12/23/2021

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Excellus plan (subscriber id *********) with a premium amount of $1,389.31. I received my first bill dated 6/16/21 with a payment due of $350.31 with both ***** ***** and ******* ***** as covered members stated on the back of the bill, which was paid on time. I attempted to make a medical appt. using that subscriber ID and was denied, upon a phone call to excellus they informed me my plan had been rolled into a basset preferred gold plan with the NEW subscriber ID *********, which clearly states on the back of the billing statement received 7/12/21 the covered members are now solely ***** *****. ******* ***** was removed from the back of the bill under the "covered members" section. It is from that day on that we were under the assumption ******* ***** had no coverage and made no claims from the months of July 2021 to present. I received a Bill dated 7/12/21 stating a premium amount of $694.65 with a tax credit of $1,039.00, leaving an amount due of - $344.35. Clearly showing that this payment also covered July premium, which was double paid as ***** ***** had paid a amount of $350.31 also for the month of July. Another bill was received dated 7/12/21 for a premium amount of $694.65 with a tax credit of $1,039 leaving a balance on the account of negative $1,039.01, with the only covered members on the back ***** *****. Throughout the remainder of the year the Billing statements have continued to state the only covered members were ***** *****, ******* ***** has made no claims for medical or dental from July 2021 to present. Most recent bill that was received December 8th is stating that there is a past due balance of $1,751.55 for a member who was not on the billing statements shown by my previous billing statements. Upon conversation with representative Shelly at excellus, they stated and admitted that it was a billing mistake. It clearly states ******* ***** was not a covered member on the policy and therefore we are disputing the past due amount.

  Business response

  01/31/2022

  Description: Premium billing Dear ***** *****:SUBJECT: Level One Grievance Determination We recently received a request from the Better Business Bureau, on your behalf for a Level One Grievance. We have completed our grievance review and have the following information toshare with you based on our investigation of your grievance.You reported that you received your first bill dated June 16, 2021, indicated payment due$350.31, which including both ***** ***** and ******* ***** as covered members; you indicated that you paid the bill on time. While attempting to make a medical appointment, youfound there was no coverage available under subscriber ID# *********. You telephone Excellus and were informed that your plan had been rolled into a Basset Preferred Gold Plan with the new subscriber ID# *********. The billing statement received on July 12, 2021clearly states on the back of the billing statement, covered members are now solely **********. ******* ***** was removed from the back of the bill under the "covered members"section. You were then under the assumption that ******* ***** had no coverage and submitted no claims from the months of July 2021 through December 2021. You received a bill dated July 12, 2021 which indicated a premium amount of $694.65 with a tax credit of$1,039.00, leaving an amount due of - $344.35. Clearly showing that this payment also covered July premium, which was double paid as ***** ***** had paid a amount of $350.31also for the month of July 2021. Another bill was received dated July 12, 2021 for a premium of$694.65 with a tax credit of $1,039, leaving a balance on the account a negative $1,039.01,with the only covered members on the back ***** *****. Throughout the remainder of theyear the billing statements have continued to indicate the only covered members were **********, ******* ***** has made no claims for medical or dental from July 2021 to present. Most recent bill that was received December 8,2021 is stating that there is a past due balance of$1,751.55 for a member who was not on the previous billing statements. Upon conversation with representative Shelly on December 22, 2021, she advised that there was billing error. Itclearly states ******* ***** was not a covered member on the policy and therefore we are disputing the past due amount.Upon receipt of your complaint we requested and received input from our Membership and Billing Enrollment Team. We were advised that when your new add was received on June 9,2021, the information was fed to the member's old ID# ********* in error. When this was discovered, the member was added to a new ID# ********* to be put on hold for initial payment. When this was moved in error, ******* was loaded as spouse rather than husband and this caused him to not be included on the policy. The first bill was manually sent and included both the subscriber and spouse. Due to the miss coding of the spouse, the member was billing with a credit due to the APTC amount for both subscriber and spouse in the amount of $1039.00. This was not discovered until member's term transaction was received on November 24,2021, which corrected the dependent from spouse to husband and billed the premium amount.Our Enrollment Operations Specialist worked together with the NYSOH (New York State of Health) for options to correct the policy. The Plan Manager provided two options for correction. Ms. ***** was contacted on January 25, 2022 by our Customer CareRepresentative, Mary Ellen. She provided available options and you chose Basset Preferred Silver. This option will reduce all cost sharing obligations, and monthly premium obligation forcouple's enrollment would be $85 after APTC.We appreciate the time you have taken to communicate your concerns to us and apologize forthe inconvenience your have experienced. By presenting your concerns to us, we have been able to work with the NYSOH and provide an agreeable resolution to the billing concerns. We trust the information provided responds to your inquiry.I f this grievance relates to a benefit determination, you may request a copy of the following documents that were used to make this determination, at no cost to you:reasonable access to, and copies of, all documents, records and other information relevant to your case.a copy of the benefit provision, clinical criteria, guideline or protocol on which our determination was based.Your request must be in writing and submitted to the address listed below.1 Complaint to the New York State Department of Financial Services If you disagree with this determination, you have options available to you.You may file a complaint with the New York State Department of Financial Services by caliing###-###-#### (within New York State) or ###-###-#### (outside New York State). You may also write to the Department at:New York State Department of Financial Services Consumer Services Bureau One Commerce Plaza Albany, New York 122572. If your employer is covered under ERISA, you have the right to bring a civil suit under Section 502A of that Act.I f you have any questions, please call the number on the back of your identification card or contact us at the following address and telephone number:Advocacy DepartmentP.O. Box 4717Syracuse, New York 1322###-###-#######-###-#### (Fax)Sincerely,Lr&k a Valerie G Advocacy Associate Copy: Better Business Bureau Excellus * @? 165 Court StreetRochester, NY 14647 A nonprofit independent licensee of the Blue Cross Blue Shield Association

  Customer response

  01/31/2022

  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. 
  
  Regards,
  
  ***** *****
  
  
  
  
  

• Initial Complaint

  06/22/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  March 29, 2021. I received a letter/form from them indicating that a check that was issued to me in the amount of $60 was never cashed. I filled out the form and emailed it back to the *********************. They claim that as of today, they have re-issued this check twice to me. I have verified my address multiple times with them. The latest check that was re-issued was on 6/11. According to them. They will not tell me when it was mailed. I firmly believe that this check is never gping to be mailed to me. This has been going on for over 4 months. I have spoken to 5 different customer care reps. No one can help me. I believe what they are doing at this point in time is bordering on being illegal. The law states that they are supposed to be reimburse me. I have multiple emails ftom the *********************. Check #, bank information. I will provide this as needed. My email is *******************  Thank You

  Business response

  08/10/2021

  Dear ******** *****:
  SUBJECT: Level One Grievance Determination
  You recently requested, verbally or in writing, a Level One Grievance. We have completed our
  grievance review and have the following information to share with you based on our
  investigation of your grievance.
  You reported to the Better Business Bureau on June 22, 2021 that you received notification
  from Excellus on March 29, 2021, that a check in the amount of $60.00 was issued to you but
  never cashed. You advised that you completed the required form and emailed it to
  *********************, as directed. You advised that the check was re-issued to you twice;
  however, you have not received it. You verified your address on multiple occasions, spoke
  with several Customer Service Representatives over the past 4 months and still unable to
  resolve.
  Upon receipt of your complaint, our research identified that check #******* has since been
  issued to you on June 28,2021 in the amount of $60.00 and cashed on July 7,2021. The
  payment was for services rendered on October 2,2020 under subscriber ID #********* for
  an ophthalmological medical exam.
  Additional research found that you contacted Customer Service on June 8, 2021 to inquire
  about the status of the unclaimed check # ******* in the amount of $60.00. You advised
  that you completed the form as directed and emailed it to *********************. You were
  advised that an explanation of benefits with a new check #******* was sent on April 1, 2021;
  however, you did not receive it. According to our records, the payment was still outstanding
  and a new check was being reissued. On June 14, 2021 you called again to inquire; you were
  advised that a check was reissued on June 11,2021. You later called on June 17,2021 to
  advise that a check still had not been received; the representative advised that it could take up
  to 10 business days. On June 21, 2021 you called Customer Service to report that the check
  was still not received, and you were filing a complaint with the Attorney General. On June 24,
  2021, you called Customer Service and advised that you had been dealing with this issue since
  March 2021 and expressed your frustration. You were assured that a check was reissued;
  however, if not received by June 25,2021 please reach out and our Customer Service
  Supervisor will work with our Finance Department to have the check send certified and have
  you sign for it.
  We truly appreciate the time you have taken to express your concerns and apologize for the
  frustration you have experienced. We are always accepting feedback as ways to improve our
  processes and appreciate when members like you take the time to let us know when we are
  not meeting your expectations. We trust the information provided responds to your inquiry.
  If this grievance relates to a benefit determination, you may request a copy of the following
  documents that were used to make this determination, at no cost to you:
  reasonable access to, and copies of, all documents, records, and other information
  relevant to your case.
  a copy of the benefit provision, clinical criteria, guideline, or protocol on which our
  determination was based.
  Your request must be in writing and submitted to the address listed below.
  1 Complaint to the New York State Department of Financial Services
  If you disagree with this determination, you have options available to you.
  You may file a complaint with the New York State Department of Financial Services by calling
  ###-###-#### (within New York State) or ###-###-#### (outside New York State). You
  may also write to the Department at:
  New York State Department of Financial Services
  Consumer Services Bureau
  One Commerce Plaza
  Albany, New York 12257
  2. If your employer is covered under ERISA, you have the right to bring a civil suit under
  Section 502A of that Act.
  If you have any questions, please call the number on the back of your identification card, or
  contact us at the following address and telephone number:
  Sincerely,
  
  Valerie G** ******
  Advocacy Associate
  Advocacy Department
  P.O. Box 4717
  Syracuse, New York 13221
  

*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. ↩