Complaints

This profile includes complaints for Highmark Blue Cross Blue Shield's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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• 

  Highmark Blue Cross Blue Shield

  120 5th Ave Pittsburgh, PA 15222-3000

• 

  Highmark Blue Shield, Inc.

  1800 Center St Camp Hill, PA 17011-1702

• 

  Highmark Blue Cross Blue Shield

  PO Box 890173 Camp Hill, PA 17089-0173

• 

  Highmark Blue Cross Blue Shield

  218 Summit Park Drive Pittsburgh, PA 15275

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:07/04/2025

  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.

  I am formally requesting help from the Better Business Bureau regarding self submitted claims mailed via certified delivery to Highmark BCBS. I have paid my out of network provider and facility in full and mailed the required itemized receipts with my Highmark BCBS member claim forms to indicate this is a self submitted claim. At this time, Highmark is rejecting my claims and asking the provider to submit the claims to the local BCBS of Oklahoma (where services were rendered). The issue is my provider does not accept insurance and I have paid my claims in FULL. I have formally submitted my own claims for direct reimbursement and do expect my insurance provider to process my claims ethically and timely. Please help make my insurance company accountable for the claims submitted for my reimbursement.
  
  I appreciate your help and attention to this time sensitive matter.

  Business Response

  Date: 07/25/2025

  We are in receipt of your letter dated July 4, 2025, regarding the above referenced 
  complaint. 

  
  Please be assured that we have reviewed the record thoroughly in responding to this 
  Complaint. However, we are limited in our ability to provide the Better Business Bureau 
  (BBB) with specific details relating to the claims in question due to protections detailed in 
  privacy standards established under the Health Insurance Portability and Accountability 
  Act (HIPAA).

  
  Even so, we can confirm that the claims were received. They have been sent back to be 
  reprocessed. The complainant will need to allow four (4) to six (6) weeks for the claims to 
  finalize and receive update Explanations of Benefits (EOB). If she is unhappy with the way 
  the claims process she can file an appeal by calling the phone number on the EOB or 
  writing to the address on the EOB. 

  
  Should the complainant have any questions concerning this matter, please have her contact 
  the phone number on the back of her ID card. If you have any questions, please feel free to 
  contact me directly,

  
  Sincerely,
  ***** **
  Highmark Inc.
  Regulatory and Executive Inquiries

• Initial Complaint

  Date:07/01/2025

  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.

  Case # HMK03-25-252388 Insured/Claimant: ****** P. ********* (ID *********** As part of my recent yearly checkup, my physician requests a Prostate Specific AG test. This is because of my family's history of prostate cancer--three of four family members have passed due to this disease. I completed the test on February 21, 2025 and later received a bill from Quest Diagnostics, the service provider, in the amount of $169.86. I've had no issues with the previous insurance company covering this test and have been doing this as part of my yearly screening since I turned 50.After considerable time and effort, I feel, HM's process to review claims is designed to stall, confuse, and deny coverage, despite one's good faith effort in trying to meet their demands.Dates of interactions w/HighMark--17 in total -March 11, I received the invoice from Quest Diagnostics, contacted HighMark via their Support Portal explaining that I had received this bill by mistake. -March 14, Spoke with HM agent and was told to contact *************** and have them code it correctly. Doctor correctly coded test and checked with Quest to be sure. Filed an Appeal as advised by ** representative.-March 20, Provided Doctor's contact info to HM so they could resolve payment -March 21, Spoke with HM agent and filed another appeal MAT36341 -April 9, Sent email via Support Portal requesting expedited service APPEAL LV1-7072771 HMK3-25-2523088 -April 21, Contacted Quest to place bill on 45day hold -April 22, Received Letter of Denial from 1st Appeal, but told to file 2nd Appeal in writing with supporting documents -April 27, Sent email via Support Portal 2nd Appeal with documents -May 1, Received response stating to mail 2nd Appeal in writing -May 6, Mailed 2nd Appeal-told it would be 45 days for response -June 3, Requested Status update -July 1, Spoke with HM agent, told letter was received May 12 and have to file with an independent review and resubmit info.

  Business Response

  Date: 07/11/2025

  We are in receipt of your letter dated July 1, 2025, regarding the above referenced 
  complaint.

  
  Please be assured that we have reviewed the record thoroughly in responding to this 
  Complaint. Unfortunately, we are limited in our ability to provide the Better Business 
  Bureau (BBB) with details of the claim in question due to protections detailed in privacy 
  standards established under the Health Insurance Portability and Accountability Act 
  (HIPAA).

  
  However, we can confirm that the claim processed correctly because the procedure 
  questioned is not part of the complainants preventive schedule. If the complaint feels that 
  the test was submitted incorrectly, he might want to contact his provider to have the claim 
  reviewed. If they feel it was submitted incorrectly, they can reach out to the laboratory and 
  have them submit a revised claim with the correct procedure and/or diagnosis codes.
  Should you have any further questions regarding the Complaint, please do not hesitate to 
  contact me.

  
  Sincerely,

  
  ***** *.
  Highmark Inc.
  Regulatory and Executive Inquiries

  Customer Answer

  Date: 07/15/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  They stated that if I disagreed with their decision that I could request a resubmittal of the bill with the correct billing code, which I had confirmed was done on March 14 after speaking with the physician's office assistant, Maya.  On March17th, ************************ contacted me and requested my physician's information so they could assist with the coding to help with billing. On March 20, I submitted contact information. On March 21, received confirmation from High ****** support portal that everything was coded correctly, but now had file an  Appeal. 

  Unfortunatey, having to jump through hoops only to be subject to more obstacles seems to be par for the course when dealing with High ****.  

  
  Regards,
  
  ****** ********* Jr

• Initial Complaint

  Date:06/26/2025

  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 attempted to use my benefits card to purchase vitamins on 6/18/2025. I was unsuccessful, the card was declined. I left the store spoke with three different people in customer **********************. Who did not help at all. The third ****** I spoke to I asked for a manager. I spoke to ****** *. Explained everything to him. ****** informed me I can make purchases and I can submit the receipts for reimbursement. I informed ****** I returned the items I purchased with my debit card; attempted to use the benefits card and it declined again. Thats why he informed me I can submit and get reimbursed. ****** reached out to the store on 6/19/2025 and spoke with ***** *. Who informed him there was an issue with the third party card reader. On 6/23/2025 I sent an email to ******************************************* Asking for information on how to submit receipts to be reimbursed. ******** not ****** responded. Ive called and absolutely no one has been helpful. I have several receipts with purchases that I should have been able to use my benefits card, but it was declined.

  Business Response

  Date: 07/07/2025

  Please be assured that we have reviewed the record thoroughly in responding to this Complaint. Unfortunately, we are limited in our ability to provide the Better Business Bureau (BBB) with details of the customer ********************** interactions due to protections detailed in privacy standards established under the Health Insurance Portability and Accountability Act(HIPAA).
  
  Nevertheless,we can confirm that our Customer ********************** Department has been working on the members issue regarding her benefit card being declined since June 18, 2025,with regular updates being provided at appropriate intervals.  It appears the issues lie with the merchants,and not the members card. The merchants were provided with information on how to resolve the issue by a Customer ********************** Supervisor. Additionally, a Customer ********************** Supervisor has confirmed they received her email requesting reimbursement on June 24, 2025 and ***** responded to her inquiry with instructions to complete a reimbursement form and to provide an itemized receipt with the submission.
  
  Should you have any further questions regarding the Complaint, please do not hesitate to contact me.
  Sincerely,
  ******* ****
  Grievance and Appeals Analyst Highmark ****

  Customer Answer

  Date: 07/07/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  What is going on? I cannot even see the company's response. When I click the link to read Im  being asked if I want to open it in TurboTax. Why was the response sent in a way that is not visible to me? Can the company reply to and on the BBB complaint? I want to get this issue resolved and reimbursed for the medicine I had to pay out of pocket for because the card sent to me by Highmark will NOT work when I attempt to use it for its purpose. It has been over two weeks of no communication or response to my email from Highmark. 
  Regards,
  
  ***** *****

  Customer Answer

  Date: 07/08/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

  ******* ****,

  With all do respect this has nothing to do with HIPPA ( Health Insurance Portability and Accountability Act ). As per my initial communication for filing this complaint  the entire problem has to do with ***** and or ******** not being professional and returning a call and or responding to my email; in regards to how I can submit receipts to be reimbursed. All of which have absolutely nothing to do with HIPPA. 
  
  
  However, it does have everything to do with the representatives at Highmark not being courteous and professional. So, please do not deflect or dismiss what Im explaining by bringing up *****. Nothing I said has anything to do with what ***** actually stands for. Its solely the lack of professionalism and communication from the people representing Highmark. I attempted to use the card at Food Lion for vitamins. It declined. 
  
  
  ***** communicated the next day that  he spoke to and confirmed there was an issue with the card reader at Food Lion. I attempted to use the card at Rite Aid. Yet again, the card declined. ***** called me later on that day and said he spoke with someone at Rite Aid who informed him the store is closing and some features at the store are unavailable. I spoke with the store manager at ********* who stated he would reach out to see what the issue is and get it resolved. 
  
  
  There was no need to communicate with anyone from Rite Aid because they were closing. I attempted to use the card yet AGAIN for medication at the pharmacy at ********* ( ******, ** )  and to my surprise, the card declined again. I also attempted to use the card at a CVS ( Dover, ** ) to purchase vitamins. The card declined again. Also, on 6/27/2025 I made yet another attempt to use the card at **** in the pharmacy. ( ******, DE ) The card was declined AGAIN. 
  
  
  There should be no reason why the card keeps declining when Im attempting to purchase items that literally should be covered if the card was functioning correctly. Food Lion was one thing. However, Im a customer who holds the card through my employer, I have too much sense to continue to attempt to use the card it keeps declining; and to not think theres an actual issue with the card! and not the stores. 
  
  
  Based off your response to the complaint I think youre thinking there is something wrong with each and every stores equipment and there is absolutely no way anything could be wrong with the card. That is absurd. Ive just given you a list of stores Ive been to make purchases, and the card keeps declining; yet youre saying and thinking its a problem at all the stores/ pharmacies? Please understand that if *****, Samantha  or any other representative I attempted to communicate with and gain knowledge on how to submit receipts for reimbursement. I would not  have taken the time to file a complaint, or send this long email because I would already have the information I needed and receipts would be submitted!
  
  
  Im baffled by your reply.  The whole point and purpose of me sending the email to *****, as you can see because I included screenshots of the communication; was to know how I can submit for reimbursement. Yet, you  reply with HIPPA? Please issue me a new card. 
  
  
  Please assist me with resolving the issues Im having. Please be a little more professional than the previous people Ive communicated with; as to youre on a corporate level representing Highmark. I welcome the opportunity for you to assist me by issuing me another card, and giving me the information I need to be reimbursed. Ive not mention anything via email, filing the complaint or now about anything that falls under HIPPA.

  
  Regards,
  
  ***** *****

  Business Response

  Date: 07/16/2025

  Dear Ms. ***************** are in receipt of your letter dated July 11, 2025, regarding the above referenced complaint.
  
  Please be assured that we have reviewed the record thoroughly in responding to this Complaint. Unfortunately, we are limited in our ability to provide the Better Business Bureau (BBB) with details of the customer ********************** interactions due to protections detailed in privacy standards established under the Health Insurance Portability and Accountability Act(HIPAA).
  
  Additionally,please understand that our response is addressed to the BBB, and the preceding statement is generically used for many complaints to explain that we cannot divulge certain information to the BBB in our response due to ***** standards and to protect our members protected health information (PHI).
  
    Our Wellness Benefit cards are typically used for the following products/services:
  Gym memberships, fitness classes, and personal training sessions.
  Health food stores and nutritional supplements (including GNC, Feel Rite, and ******************************* such as WW (Weight Watchers) and Noom.
  Online fitness subscriptions, including Peloton and Beach Body.
  Personal gym equipment from specialty fitness stores or specialty online retailers like Nordic Track and Peloton.
  Fitness wearables.
  Sports programs, camps, and lessons.
  Races and fun walks.
  
  The following merchants typically do not participate with our Wellness benefit card:
  Pharmacies.
  Sporting goods stores.
  Grocery stores.
  Doctors offices.
  Optometrists.
  Salons.
  
  
  
  
  However, should a non-participating store-type provide wellness items to our members, the member can request reimbursement by mailing us a reimbursement form with their itemized receipt.These locations normally do not have the merchant code types necessary to use the card.
  
  Our Customer ********************** Department states, <We> contacted Food Lion and spoke with ***** *., who confirmed they will reach out to their payment center to update their vendor card machine. I also called ***************** and spoke with Sri *** who informed me that the location will be closing permanently. I advised the member she can purchase vitamins at any other pharmacy, and I specifically suggested Feel Rite or GNC.
  
  Lastly, when viewing the members card in our internal systems, no transactions were found. There were no purchases, nor were there any declined transactions. This information would be consistent with a store not having the capability to run the card.
  If our member is unable to utilize the card at a health food store or nutritional supplement store, they are encouraged to contact our Customer ********************** Department again for assistance and possible reissuance of a new card.
  
  Should you have any further questions regarding the Complaint, please do not hesitate to contact me.
  Sincerely,
  ******* ****
  Grievance and Appeals Analyst Highmark ****

  Customer Answer

  Date: 07/22/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  Ive attempted to call customer ********************** to get another card issued. How is a health benefits card not able to be used on said items, but able to be used for a gym membership? Why want that stated in the initial response if that statement is in fact true. It appears ******* **** is literally making up lies to dismiss and deflect based off of her response. ******* said I can submit a form for reimbursement. How? Where is the form? How to do get the form? ******* said a bunch of nothing. How does a customer complaint get to this level and ******* **** representing Highmark still will not assist a customer? The fact that the situation has been going on for over a month and still no resolution is extremely disturbing. Why did ******* say in the second reply the card cannot be used at a pharmacy or grocery store? If true why was that not stated when she replied the first time? ******* dismissed and deflected on every concern Ive had. ***** state the same thing about not being able to see said declined transactions. However, if you look at the receipts I submitted you can see the attempted purchases were declined, look at the receipts thats why I submitted them. After ***** said he does not see the declined transactions, the receipts were emailed. On 6/18 and 6/19 when I spoke with him he mentioned he got the receipts. I asked how can they see declined transactions if the store doesnt even print out something stating it was declined ***** said Im not sure every interaction with people representing Highmark has been unpleasant, distasteful and clear that no one is knowledgable on how to do their job and exhibit 100% good customer **********************. Should I have more problems when I attempt to reach out to customer ********************** AGAIN to request a new card and yet again inquire about how to submit receipts for reimbursement I'll reach out to ******* for assistance. 

  Regards,
  
  ***** *****

  Customer Answer

  Date: 07/22/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  Ive attempted to call customer ********************** to get another card issued. How is a health benefits card not able to be used on said items, but able to be used for a gym membership? Why want that stated in the initial response if that statement is in fact true. It appears ******* **** is literally making up lies to dismiss and deflect based off of her response. ******* said I can submit a form for reimbursement. How? Where is the form? How to do get the form? ******* said a bunch of nothing. How does a customer complaint get to this level and ******* **** representing Highmark still will not assist a customer? The fact that the situation has been going on for over a month and still no resolution is extremely disturbing. Why did ******* say in the second reply the card cannot be used at a pharmacy or grocery store? If true why was that not stated when she replied the first time? ******* dismissed and deflected on every concern Ive had. ***** state the same thing about not being able to see said declined transactions. However, if you look at the receipts I submitted you can see the attempted purchases were declined, look at the receipts thats why I submitted them. After ***** said he does not see the declined transactions, the receipts were emailed. On 6/18 and 6/19 when I spoke with him he mentioned he got the receipts. I asked how can they see declined transactions if the store doesnt even print out something stating it was declined ***** said Im not sure every interaction with people representing Highmark has been unpleasant, distasteful and clear that no one is knowledgable on how to do their job and exhibit 100% good customer **********************. Should I have more problems when I attempt to reach out to customer ********************** AGAIN to request a new card and yet again inquire about how to submit receipts for reimbursement I'll reach out to ******* for assistance. 

  Regards,
  
  ***** *****

• Initial Complaint

  Date:06/15/2025

  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.

  To whom it may concern,I am writing because I dont know where else to turn. My husband and I are self-employed with two children and have had insurance through the Marketplace and Highmark BCBS of Delaware for over 10 years. Ive always paid my premiums on time. In January, I renewed our policy as usual, even though the monthly premium increased drastically from $468.96 to $1,750. I paid the first bill, which showed $686 due, after calling and being told I likely had a credit. I continued to pay over $1,700 monthly and even made a $2,400 payment in *********** the following months, I noticed a small balance of about $300 on my account and was told by a representative theyd look into it. I explained I had paid everything owed and was assured that was fineno mention of cancellation. I kept receiving monthly bills, with no notice or warning of ************** May, my son was injured and required scans and ER visits, all of which received prior authorization. We only learned our policy had been canceled (back in March!) when my husband tried to refill his medications last week and the pharmacy said we had no coverage. I called Highmark and after speaking to several people with no answers, a supervisor said if I paid the $350 balance, hed expedite reinstatement. I paid immediately. The next day, I followed up and was told reinstatement was denied. Another supervisor then said the department was "looking into it" and it could take 35 days. I explained my husband was out of critical medication and had recently been hospitalized, but they showed no urgency.Weve paid over $10,000 in premiums since January and are now uninsured without warning. I have documentation of payments, authorizations, and no record of cancellation. Please help or direct me to someone who can.Thank you.

  Business Response

  Date: 06/25/2025

  Re: Complaint ID: ********

  Dear Ms. **************** are in receipt of your letter dated June 15, 2025, regarding the above referenced
  complaint.

  Please be assured that we have reviewed the record thoroughly in responding to this
  complaint. However, we are limited in our ability to provide the Better Business Bureau
  (BBB) with details of customer ********************** interactions due to protections detailed in privacy
  standards established under the Health Insurance Portability and Accountability Act
  (HIPAA).

  Nevertheless, we can confirm that the complainants policy has been reinstated and is
  currently active. However, it is important for the complainant to understand the *****
  ****** associated with the policy. There is a 90-day ***** ****** associated with the policy.
  The ***** ****** is non-revolving and once it is entered, the member has 90 days to pay
  the full amount that is due on the policy to avoid termination. Highmark has evidence that
  delinquency letters were sent to the complainant, along with a termination letter following
  the policy termination. The complainants benefit book has the ***** ****** and
  reinstatement guidelines for the policy on pages 162 and 163.
  

  Should you have any further questions regarding the Complaint, please do not hesitate to
  contact me.
  

  Sincerely,
  

  ***** *.
  Highmark Inc.
  Executive and Regulatory Inquiries

• Initial Complaint

  Date:06/05/2025

  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.

  On March ******* I was admitted into the local ER with a blood sugar of 1056 I am type 1 diabetic. I was treated until I was stable to move and was transferred by helicopter to a different hospital that could provide better care. My insurance denied my flight said it wasnt medically necessary even though I was in kidney failure and hooked up to heart monitor as well as being in ***. I have gone through the appeal process was belied the first time and sent stuff in a second time per the insurance request and followed all the instructions they had given me questing them several times as to why my paper work showed a different address then what they were giving me? Come to find out just today that high **** had given me self and my mother incorrect information 5 times, I have had to make a payment or get turned over to collections they acted like it was my mistake by sending the stuff to he wrong address they provided me I have kept notes to every time I have called and talked to . I am going to get stuck with a $37,708 bill due to the. Mis guidance please help me. I have a strong case and I would like input from you for the next steps. I have got nothing but he run around for the last year, I am 21 now and going to have to file for financial assistance if they dont do thing. I have mailed all my medical records and all the documents they requested and this has been in review for a while and was told just today it was sent to wrong place due to them telling me wrong info and now have to wait 45 more day. I have spent $ on making copies sending packets of documents and had to take time off work to fight issue. This is wrong and they know it. Please advise myself and my mother ******* ******** how to proceed. I have documents if needed but to many to upload.Thank you ****** ****************** ******** ************

  Business Response

  Date: 06/16/2025

  June 16, 2025
  ******** ******
  The Better Business Bureau
  *****************************
  ******************
  Re: Complaint ID ********
  Dear Ms. ************* are in receipt of your letter dated June 6, 2025, regarding the above referenced
  complaint.
  Please be assured that we have reviewed the record thoroughly in responding to this
  Complaint. Unfortunately, we are limited in our ability to provide the Better Business
  Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
  in privacy standards established under the Health Insurance Portability and Accountability
  Act (HIPAA).
  Nevertheless, we can confirm that the claim was processed correctly as it was received
  from the provider based on the complainants benefits. An appeal was completed, and
  Highmark is not able to adjust the claim based on the outcome of the appeal. A request for
  an external review as received that is currently being reviewed. Highmark does not review
  those types of appeals and will not be responding to the complainant, he will receive the
  outcome directly from the Independent Review Organization.
  Should you have any further questions regarding the Complaint, please do not hesitate to
  contact me.
  Sincerely,

  ***** *.
  Highmark Inc.
  Regulatory and Executive Inquiries

   

  Customer Answer

  Date: 06/18/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  
  Regards,
  
  ****** ********

• Initial Complaint

  Date:06/03/2025

  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.

  This complaint with the Better Business Bureau is regarding three maternity claims that have been submitted through member services for direct reimbursement.I am formally appealing the three maternity claims (attached to this complaint) as the home plan has denied my claims requesting they be submitted through BCBS of Texas where services were rendered. I have explained countless times the attending provider has been paid in full and does not accept insurance. These claims are member submissions for direct reimbursement-This is something I am entitled to request.Lastly, I would like to include my in-network exception request is on hold pending the processing of my claims. Please reach out to Highmark BCBS to make them accountable for the claims they have received as a member submission.Please find my claim notes:Fri, May 23, 2:04PM (11 days ago)I spoke to ***** *. in the claims department, after several hours of going back and forth with his team lead he said they could not help me since this was a member submission for direct reimbursement.However, I argued the claims are a member submission for direct reimbursement and has to be processed by the home plan. Wed, Mar 12, 10:06AM I just spoke with **** *. under reference number LVI6906167. I was able to send the $4,400.00 claim and $2,500.00 facility claim back for reprocess with notes the claim is a member submission for direct reimbursement (**** of Texas should never touch the claim).Reference to call is LVI790711.

  Business Response

  Date: 06/11/2025

  Dear Ms. **************** are in receipt of your letter dated June 3, 2025, regarding the above referenced
  complaint.

  Please be assured that we have reviewed the record thoroughly in responding to this
  complaint. However, we are limited in our ability to provide the Better Business Bureau
  (BBB) with specific claim and customer ********************** interactions due to protections detailed in
  privacy standard established under the Health Insurance Portability and Accountability Act
  (HIPAA).

  We can advise that we have been working with the complainant to have her claims adjusted.
  When the claims finalize, she will receive an updated Explanation of Benefits. If there is
  additional information needed, we will reach back to advised and obtain so the claims can
  finalize.

  If you have any questions, please do not hesitate to contact me.
  

  Sincerely,
  

  ***** *.
  Highmark Inc.
  Regulatory and Executive Inquiries

• Initial Complaint

  Date:05/27/2025

  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.

  I signed into my **** portal on their website to find an acupuncture provider. Within my portal several acupuncturists were listed. I called one and asked if they took Highmark to double check even though they were listed in my health portal as a provider covered by Highmark. They said yes. I went to three appointments and was curious as to how many my insurance would cover. It was not listed on the website or in my portal so I called. The customer ********************** person at ******************** told me that acupuncture was not covered by my insurance even though it was an option within my health portal, and hat I should call and check first. They said that they just list ALL providers through Highmark on everyone's portal even if their level of insurance will not cover it. It does not state anywhere in my portal that I have to also call to confirm information they have listed in my portal. I now owe the acupuncturist $230.00 as Highmark is refusing to pay. How hard is it to tailor the algorithm to each person's level of insurance so you can use the portal affectively?

  Business Response

  Date: 06/03/2025

  June 3, 2025
  Better Business Bureau
  *******************************
  ******************
  Attn: ******** ******
  

  RE: Complaint ID: ********
  

  Dear Ms. ******************** are in receipt of your letter dated May 27, 2025, regarding the above referenced complaint.
  Please be assured that we have reviewed the complaint thoroughly before responding to this Complaint.
  Unfortunately, we are limited in our ability to provide the Better Business Bureau (BBB) with details of
  the customer ********************** interactions due to protections detailed in privacy standards established under the
  Health Insurance Portability and Accountability Act (HIPAA).
  We understand the member verified that the participation status of a provider via the member portal;
  however, this does not take the place of verifying benefits under the benefit plan. It is the members
  responsibility to verify benefits prior to receiving services. The member may do this by referring to the
  benefit book which can be found on the member portal. If the member is unable to determine the benefit
  via the member portal, the member can always contact Customer ********************** at the number listed on the back
  of their identification card.
  Should you have any further questions regarding the complaint, please do not hesitate to contact me.
  Sincerely,
  *********** ******-Suivan
  Executive Regulatory Inquiries

• Initial Complaint

  Date:05/16/2025

  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 outstanding issues with Highmark that continue to be ignored and not resolved. I have made numerous calls and ticket numbers with both Highmark personnel at a Call Representative level and Supervisor level. Highmark refuses to resolve an error on both my billing statement and medical ******* was acknowledged that my bill contained an error and the phone number on my ID card was incorrect. The billing double charged a dependent credit and refused family plan pricing. On my member ID card there was a marketplace or ****** contact number. I do not have a ****** or marketplace plan, I have a Highmark direct plan.I was promised that my billing issue would be resolved. I was promised that my ID card would be corrected and sent to my mailing address. I was promised that the online cost reflected the true cost of billing. A Family of three at my income level for PPO Gold 1700 HSA without marketplace assistance would be $519.12. That same pricing is reflected via the online portal today. I am currently billed in error of $4075.79 still pending investigation. Those promises were not honored, followed up on or treated with integrity or respect. Call Reference #:#LVI- 7520048 04/24 #LVI- 7568156 04/29 #LVI- 7585477 04/30 #LVI- 7640688 05/05 #LVI- 7793352 05/15 My resolution that Im seeking is to correct my recent 05/2025 bill resolving any outstanding payment. To have the contact information corrected on my member ID card. To have my dependents added to the family insurance plan.

  Business Response

  Date: 05/22/2025

  ******** ******
  The Better Business Bureau
  ****************************
  ******************
  Re: 23342787
  Dear Ms. ************* are in receipt of your letter dated May 17, 2025, regarding the above referenced
  complaint.
  Please be assured that we have thoroughly reviewed the record in responding to this
  Complaint. Unfortunately, we are limited in our ability to provide the Better Business
  Bureau (BBB) with details of the customer ********************** interactions due to protections detailed
  in privacy standards established under the Health Insurance Portability and Accountability
  Act (HIPAA).
  However, we can advise that the complainants billing is correct, as each member on a
  direct pay policy is charged a premium. The rate would be the same for both children on
  the plan since they are under 15 years old, but each child has an individual rate, it is not
  one rate for all children. Therefore, the amount the complainant is billed is the correct
  amount for the subscriber and each dependent. Additionally, the contact information on the
  members ID card is correct.
  Should you have any further questions regarding the Complaint, please do not hesitate to
  contact me.
  Sincerely,
  ***** *.
  Highmark Inc.
  Regulatory and Executive Inquiries

• Initial Complaint

  Date:05/14/2025

  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.

  Very difficult to cancel Highmark Blue shields insurance policy.3 different agents told me to hold and speak to someone else,I just found it impossible to cancel the policy ,still not canceled.

  Business Response

  Date: 05/22/2025

  Re: Complaint ID ********

  We are in receipt of your letter dated May 14, 2025, regarding the above referenced
  complaint.
  

  Please know that we have thoroughly reviewed the record in responding to this complaint.
  However, due to protections detailed in privacy standards established under the Health
  Insurance Portability and Accountability Act (HIPAA), we are limited in our ability to
  provide the Better Business Bureau (BBB) with details of the customer ********************** interactions.
  

  Nevertheless, we can advise that when a member enrolls in a policy through the
  Pennsylvania State Based Insurance Exchange (******), they must cancel their policy with
  them, as Highmark does not have the ability to disenroll a member who is enrolled in a
  policy with ******. We have contacted the complainant and explained this.
  

  Should you have any additional questions regarding this complaint, please do not hesitate
  to contact me.
  

  Sincerely,
  

  ***** *.
  Highmark Inc.
  Regulatory and Executive Inquiries

• Initial Complaint

  Date:05/07/2025

  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.

  See Attachment

  Customer Answer

  Date: 05/07/2025

  Highmark sold me a plan that included the wellness benefit ************ with a gym
  membership included. This was honored with payment through a Flex digital card for the months of
  January & February. In March, ***** changed payment procedure to a third-party payment system
  through Healthy Contributions. Anytime Fitness refused this payment system since the reimbursement
  amount was drastically reduced. It is stated on Highmark's site and Fiton's introduction letter I received
  in January 2025, that a gym membership is available for purchase with credits on the digital card, which
  was accepted by my facility. The card allows 32 monthly credits, the gym membership uses 18 credits.
  Fiton offers nothing else of value and the Anytime Fitness gym location is the only facility available to me
  without extensive travel. Highmark should be held accountable for falsely providing this benefit with an
  inferior company. Previous years Highmark used Silver Sneakers with absolutely no problems. I would
  not have signed on with Highmark if I knew I was not getting the benefit of a gym membership. I
  strongly feel I was cheated with a deceptive product.
  I have contacted Highmark and Fiton with NO RESULTS. They simply say they are working on a solution.
  This is going on now for 2-3 months. Highmark and Fiton have also been contacted by my insurance
  agent and the Anytime Gym manager and they get the same answers. NO RESULTS.
  
  

  Business Response

  Date: 05/29/2025

  Dear Ms. ****************** letter is in response to your inquiry that was received at Highmark Blue Shield on
  05/08/2025 on behalf of ******* ******.
  

  This member is presently enrolled in a ******** Advantage plan with Highmark. As such,
  the ******************** and ******** Services (CMS) require that we handle any
  expression of dissatisfaction as a grievance. We have initiated the grievance process and
  will reach out to the member with the outcome within 30 days in accordance with CMS
  requirements.
  

  We are working directly with the member to resolve her concerns
  

  If Ms. ****** has any questions concerning this coverage, please have her contact our
  Customer ********************** Department at **************. If you have additional questions, please
  contact me directly.
  

  Sincerely,
  

  ***** ******
  Executive Legislative Inquiries