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 Cross Blue Shield

  218 Summit Park Drive Pittsburgh, PA 15275

• 

  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

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:10/17/2022

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Highmark's medicare supplement marketing department will not update their contact information. They have my father-in-law **** * *****, who died in 2012, confused with my husband (**** * ***** **). Despite repeated requests to correct this information, during medicare enrollment periods we continue to recieve marketing materials.

  Business Response

  Date: 11/07/2022

  This letter is in response to the correspondence received by Highmark Blue Cross Blue Shield on October 17,2022 regarding a complaint concerning the above named. Ms. ***** states that she, her husband, and her deceased father-in-law are receiving unwanted mailings from the plan. 

  
  Please be advised we have informed the appropriate contacts to remove these individuals from our market mailing list. 

  
  If you have any further questions, you may contact me directly at ###-###-#### Monday through Friday from 8:00 a.m. - 4:30 p.m. 

  
  Sincerely, 
  Jo L. 
  Executive Inquiry Resolution Highmark, Inc.

  Business Response

  Date: 11/11/2022

  
  This is in response to your inquiry sent on behalf of the member identified by Case ID
  ********.

  
  We reviewed our internal system account and there is no active contract. A request was sent to
  stop all mailings to complainant immediately.

  
  If the member has any questions concerning this coverage, please have her contact our
  Customer Service Department at ###-###-####. If you have additional questions, please
  contact me directly.

  
  Sincerely,
  Morgan * Y****
  Executive Legislative Inquiries

• Initial Complaint

  Date:09/13/2022

  Type:Product 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 elected to have HighMark BCBS via my employer in July of 2022. On August 24th, 2022 I was prescribed a medication by my doctor. The medication required pre-authorization. My doctor has sent in the requested information multiple times, yet I have been unable to fill my much-needed prescription. Whenever I contact customer service, I am placed on hold for at least 40mins. When the call is finally connected, I am re-routed to another area requiring an additional wait of 40mins or more. I have contacted HighMark nearly every day since August 24th and to date I still am without my medication. I have requested to file a grievance with customer service staff and the agent spent a half hour telling me why "I need to wait" or there are "other options", yet not providing me with any. I have requested a reference number for the call and grievance I was assured was filed but I am never provided with one. The call will be transferred without response of "becomes disconnected." I would like to receive a response regarding my preauthorization. This is the worst insurance company out there. They are consistent with taking monies to cover the costs for services they consciously not providing. Instead of being a proponent of wellness this insurance companies acts in contradiction of it. As soon as open enrollment becomes an option I will no longer deal with this company. In my option this insurance company requires investigation an ongoing monitoring.

  Business Response

  Date: 10/11/2022

  Good afternoon,
  
   
  
  First please let me apologize that an email or response wasn’t sent to you timely.  We did complete this investigation back on 9/19/22.
  
   
  
  We were able to get her authorization approved.  We also contacted the pharmacy to have the prescription processed and then contacted the member. The customer service representative left a voice mail message to let her know it was all set.
  
   
  
  Have a great day
  
  Becky
  
   
  
  Rebecca * S*******
  
  Manager | Member & Pharmacy Customer Service
  
  Highmark Western and Northeastern New York
  
  

• Initial Complaint

  Date:09/06/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I recently received an Explanation of Benefits (EOB) that said you have denied coverage for my Cologuard® colorectal cancer screening test. My physician prescribed this test so that I can be appropriately screened for colorectal cancer. I am appealing your claims decision regarding my Cologuard test. 

  
  You denied payment for my claim based on a finding that this service is not a covered service under my plan. I believe this finding is inappropriately blocking my access to a preventive service mandated under the Affordable Care Act (ACA). 

  
  Cologuard is a non-invasive colorectal cancer sDNA screening test. Cologuard is intended for adults of either sex, 45 years or older, who are typical average-risk candidates for colorectal cancer (CRC) screening. It is not a diagnostic test. I can attest that I meet these requirements. I am over 45. My healthcare provider has indicated that I am at average risk for colorectal cancer. I am due for screening. I have not had another Cologuard test in the last three years. If you need a copy of medical records to substantiate my medical history, please advise. However, I do not understand why medical records are needed to show I am an average candidate for a screening test. 

  
  Under federal law, most health plans must now cover the Cologuard test without cost-sharing for average risk patients. Specifically, Section 2713 of the Public Health Service Act (the Affordable Care Act) requires non-grandfathered health plans to cover, without cost-sharing, items or services that receive a rating of "A" or "B" in a USPSTF recommendation, beginning with plan years starting one year after the recommendation. The U.S. Preventive Services Task Force (USPSTF) updated its recommendations on May 18, 2021 and the sDNA-FIT test continues to be one of the included screening strategies for patients at average risk for developing colon cancer. 2 Therefore, under federal law, most health plans are now required to cover Cologuard (the only currently available sDNA-FIT test). 

   
  Under federal law, plans may only use "reasonable medical management techniques to determine the frequency, method, treatment, or setting for [a recommended preventive service] to the extent not specified in the recommendation or guideline." 3 Under the terms of the regulation, plans may not use medical management techniques that exclude from coverage any method of CRC screening specified in the guideline. A health plan may use reasonable medical management techniques only within each method of CRC screening. While there are multiple test options within some of the identified screening methods (e.g., there are multiple fecal immunochemical test options), Cologuard is the only test option within the sDNA-FIT screening method identified in the USPSTF recommendation. Therefore, medical management cannot be used to block my access to the Cologuard test. 

  
  Additionally, under federal law, if a plan does not have an in-network provider who can provide the service described in the USPSTF regulation, the plan must cover the service when performed by an out-of-network provider and may not impose cost-sharing. Cologuard is a sole source test and is only available from Exact Sciences Laboratories. Under the ACA, if you do not have a network agreement with Exact Sciences, you have an insufficient network and are depriving me of access to this ACA-mandated preventive service test. When you have an insufficient network, you are required to treat my claim under my in-network benefits. 

  
  Based on my medical history and federal law, I believe your denial is incorrect and in violation of the law. If you insist on maintaining this denial, please provide me with an explanation as to why you believe the ACA does not apply to my claim and the plan language and medical policy upon which you are relying. Otherwise, I may refer my concerns to my state insurance commissioner. 

  
  Thank you in advance for your consideration.

  
  Sincerely, 
  ******* ********* 
  

  
  

  Business Response

  Date: 09/20/2022

  We are in receipt of your letter dated September 7, 2022, 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 service interactions due to protection detailed
  in privacy standards established under the Health Insurance Portability and
  Accountability Act (HIPAA).

  
  Nevertheless, we can confirm that we have forwarded the member’s appeal request to
  Highmark’s Appeal Department. Going forward when the member wants to file an
  appeal, he can file it with our Member Grievance and Appeals Department at the address
  on the EOB or by calling the phone number on the back of the member identification
  card. As part of that process, the member can seek relevant documents during the appeal
  and obtain relevant documents upon which the claim denial was based.

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

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

  Customer Answer

  Date: 09/20/2022

  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.
  
  
  Their fails to address any of my concerns.

  
  

  Cologuard is covered by my policy and Highmark avoids paying without any options other than to file a formal appeal.

  
  

  Their out of the country customer service fails to have the tools and knowledge to address customers concerns.

  
  

  Highmark hides behind behind a wall and their are zero options to have a simple discussion with a person who speaks english and has product knowledge.

  
  

  Highmark needs to step up and pay valid charges instead making their customers give up and pay legit out of pocket.
  
  
  
  Regards,
  
  
  
  ******* *********

• Initial Complaint

  Date:09/02/2022

  Type:Customer Service Issues
  Status:

  ResolvedMore 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.

  Have been trying to contact Highmark BCBS Pa for the past few days for an authorization for surgery. On 08/29/22 I waited on hold for 3 hours no one ever answered. On 08/30/22 I attemped to call again, on hold for 45 minutes, no one answered. Attempted to call again today and was on hold 3 hours and 31 minutes and again no one answered. Patient's surgery is 09/06/22 and will not have to be cancelled due to not being able to obtain authorization. I 've also tried to fax authorization request and they still will not answer. At this point I'm not sure what to do. All we're trying to do is take care of our patients. this is so sad.

  Business Response

  Date: 09/20/2022

  We are in receipt of your letter dated September 2, 2022, 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 provider service interactions due to protections detailed
  in privacy standards established under the Health Insurance Portability and
  Accountability Act (HIPAA).

  
  Nevertheless, we can confirm that we correctly informed the provider regarding coverage
  under the relevant group health plan. We also contacted the provider upon receipt of the
  complaint and confirmed what they had previously been advised.

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

  
  Sincerely,
  Cassy M*****
  Grievance and Appeals Analyst
  Highmark Inc

  Customer Answer

  Date: 09/22/2022

  
  
  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

  Date:08/29/2022

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  This unpaid claim is for Shingrix (Shingles Vaccine).
  
  I called BCBS 3x confirming that it will be covered.
  
  The reps give multiple excuses for why it wasn't paid. They commit to getting back to me and don't.
  
  There is no contact phone number for BCBS in the USA. They force you to speak with reps in the Philippines who can't speak or understand English. I asked to speak to a supervisor or a USA representative. They say there is none.
  
  This vaccine is covered by my plan. I should not be harassed or ignored in getting this taken care of.
  
  Please take care of this immediately or I will open a complaint with State of PA.

  Business Response

  Date: 09/20/2022

  We are in receipt of your letter dated August 29, 2022, 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 service interactions due to protection detailed
  in privacy standards established under the Health Insurance Portability and
  Accountability Act (HIPAA).

  
  Nevertheless, we can confirm that we correctly informed the member, but because of a
  coding issue, the claim denied. We are having it adjusted as an exception. Going
  forward when the member has a concern about the way a claim processed, he can file an
  appeal to our Member Grievance and Appeals Department at the address on EOB or by
  calling the phone number on the back of the member identification card. As part of that
  process, the member can seek relevant documents during the appeal and obtain relevant
  documents upon which the claim denial was based.

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

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

• Initial Complaint

  Date:08/25/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I submitted a Highmark, Member Submitted Health Insurance Claim Form on 6/13/22 to be reimbursed for an Inogen Portable Oxygen Concentrator that my doctor advised that I purchase due to having COPD. I paid $2810.00 out of pocket for the Inogen. After waiting 6 weeks I contacted Highmark to be told that there was insufficient information and that I would have to contact my health provider for the requested information. I was to upload the information on the Highmark Portal. I obtained the information 7/29/22 and uploaded as directed. I waited another week and called again to be told that I still needed additional information from Inogen. I submitted that information as requested via the portal for claim #***********. I since then have made numerous calls and messages through the portal to Highmark. I was then told to resubmit all the paper work again via mail and the portal because the initial claim was denied and another claim was opened claim # *********** and an adjustment would be made this was on 8/17/22. Today, 8/25/22, I looked at my claims standing and Highmark paid Wellspan my provider for the Inogen. I contacted Highmark and again was told that the claim was being adjusted and yet another claim # was being opened. After being on the phone and put on hold (one hour) I got cut off. I have done my due diligence to provide all the requested information yet still I'm not being reimbursed for the Inogen, Wellspan has been paid $126.64 and I was told by the Highmark associate that they would have to get Wellspan to refund the money. I am so frustrated that I have done so much work and still no reimbursement for the Inogen.

  Business Response

  Date: 09/14/2022

  This is in response to your inquiry sent on behalf of the member identified in Case ID
  ******** concerning his request for reimbursement for a portable oxygen concentrator.
  Our records indicate that Highmark received the member’s original claim submission on
  June 16, 2022. The member contacted Highmark on July 11, 2022, to check the status of
  the claim, and our Customer Service replied that it could take four (4) to six (6) weeks for
  processing, in addition to a ten (10) mailing period to receive an Explanation of Benefits
  statement. However, when the member contacted Highmark again on July 25, 2022, it
  was found the submission had insufficient information to process the claim. Typically,
  itemized statements include Patient Name, Identification Number, Provider Name, Tax
  Identification Number, Procedure Code(s), Diagnosis Code(s), and charge per item.

  
  The member sent in additional information that included a letter from his physician. The
  claim was sent for an adjustment on August 18, 2018, but the adjustors entered the
  incorrect provider information. They listed the physician’s office at the billing provider,
  and the claim processed a payment to the physician’s office in error. Please note that a
  new claim has been entered and is currently in process. Since the durable medical
  equipment provider shows as an in-network provider, contractually Highmark is
  obligated to pay the provider our in net-work allowance. Once the provider received our
  payment with the provider statement, they should reimburse the member his payment that
  he paid directly to them. The member may also want to forward a copy of his
  Explanation of Benefits statement to them once he receives it.

  
  If the member has any questions concerning this coverage, please have him contact our
  Customer Service Department at ###-###-####. If you have additional questions,
  please contact me directly.

  
  Sincerely,
  Margueritte M**************
  Executive Legislative Inquiries

  Customer Answer

  Date: 09/19/2022

  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.
  

  
  

  Highmark has paid Wellspan and not me and I should not be the one that has to chase down my money.  Highmark should void the payment to Wellspan and reissue to me.  I have attached the copy of the invoice that clearly states I made full payment to purchase the equipment.  My provider only advised that I purchase the equipment they did not purchase for me.
  
  
  
  Regards,
  
  
  *** *********

• Initial Complaint

  Date:08/15/2022

  Type:Billing Issues
  Status:

  ResolvedMore 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 a Highmark Medicare Advantage customer. I always date stamp my incoming mail. I received my July 2022 statement for insurance June 16, 2022 in the amount of $25.00 due July 1, 2022, I always pay three months in advance or $75.00. I placed my $75.00 payment in the mail June 23, 2022. I received a past due notice July 13, 2022. **** ****** never receives a past due notice. Obviously, my payment has been lost in the mail. I am told by Highmark late payments can terminate my health insurance coverage. On July 25, 2022, I directed a letter (copy attached) to Mr. Daryl V****, Senior Vice President and Chief Financial Officer at the Highmark headquarters located at 5th Avenue Place * 120 5th Avenue * Pittsburgh, PA 15222 along with a new check number **** for $75.00. Stop payment checks for oldsters are expensive and I am not issuing another check. I have left messages for Mr. V*****'s office August 8, 2022; August 5, 2022; August 3, 2022 with a phone number 412 – 544-7711 and none of my calls are addressed. I reiterate I am not going to issue a third check. Where is check number ****? 
  Please promptly investigate. 
  
  

  Customer Answer

  Date: 09/01/2022

  Re ******** and this is an addendum to my August 24, 2022. 

  
  Morgan called August 24, 2022 from Highmark (Scranton, PA) as outlined in my August 24, 2022 correspondence and asked me a couple questions. She questioned where did I mail the check in question #****. I replied I used the coupon address that accompanies my statement. She continues to claim this has been paid. I spoke with my customer contact Sherry at Citizens/Main Office in Washington, PA and she reiterated that check #**** has not been paid and my account reads on 'HOLD' screen 'DO NOT PAY CHECK #**** TO HIGHMARK.' Morgan also asked me to obtain my checkbook and read to her my next check number which I concurred. How audacious! I do not think Morgan believes me when I mailed another check number **** to their corporate headquarters. I cannot begin to imagine what transpired to that letter and check; the check was stapled to the correspondence. 

  
  Sincerely, 
  

  **** ****** 
  

  
  

  Customer Answer

  Date: 09/07/2022

  Morgan from Highmark called August 19, 2022 for a grievance check. She is located near Scranton, Pa. Her phone number is ###-###-####. She stated my check number **** was cashed August 10, 2022 and was paid for in the amount of $75.00. However, that is not the check in question if you can refer to my correspondence addressed to the BBB dated August 11, 2022, (copy attached.) She indicated my account is paid in full to date. She is looking into the whereabouts of my letter and check number **** addressed to Mr. V**** (copy attached.) My big question at the moment in this dispute is where is check number #****? 

  
  ****** at Citizens Bank indicated the original check number **** was a "Stop Payment" check dated July 18, 2022 and no payment can be made. 
  

  Sincerely, 
  

  
  **** ****** 
  

  
  

  Business Response

  Date: 09/07/2022

  This is in response to your inquiry sent on behalf of the member identified by Case ID
  ********.

  
  The member is currently enrolled in a Complete Blue PPO plan with an effective date of June
  1, 2021 with no end date. Review of the plan internal system shows that a payment of $75.00
  for check number **** applied to the member’s account on August 10, 2022.

  
  Further review of the member account shows an invoice was issued to the member on June 6,
  2022 with the premium amount of $25.00 due on July 1, 2022. When a premium payment was
  not received, a delinquency letter was issued to the member on July 13, 2022. The letter advised
  that the premium was not received as of July 1, 2022 if the payment is not received by
  September 30, 2022 the member will be disenrolled effective October 1, 2022.

  
  We received the complaint on August 19, 2022 for review. The member became concerned
  when she received a past due notice of a premium not received. The first check number ****
  was dated June 23, 2022 and mailed on June 25, 2022. She did not know why she was receiving
  a past due notice in the mail on July 13, 2022 when she mailed her premium payment. It was
  then determined with the post office that her mail was lost at that time and other checks to
  different companies also did not get to the payment destination. Member went to the bank to
  stop pay on the first check issued, this was the result for the member to write another check.
  The member wrote another check, check number ****. Plan records reflect the receipt of check
  number **** applied to the member’s account on August 30, 2022.

  
  The member’s invoices advise to please submit payment to Complete Blue PPO P.O. Box
  382178 Pittsburgh, PA 15251-8178. The member researched Mr. Daryl V****, Senior Vice
  President and Chief Financial Officer at the Highmark headquarters to send her second
  premium check. With the member not sending to a corresponding address for premium
  payments it delayed the payment processing. The plan reports information that is reflected
  within in our internal systems as we do not have access to the banks record.
  
  The plan contacted Ms. ****** on August 24, 2022 to gather additional information to complete
  due diligence to address the member’s concerns. She was understanding and happy with the
  resolution. In conclusion, the member is actively enrolled and her account is paid in full with
  no past due balance.

  
  If the member has any questions concerning this coverage, please have her contact our
  Customer Service Department at ###-###-####. If you have additional questions, please
  contact me directly.
  
  Sincerely,
  
  Morgan * Y****
  Executive Legislative Inquiries

  Customer Answer

  Date: 09/08/2022

  
  
  
  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. 

  Morgan from Highmark contacted my August 30, 2022 and stated they honored the Stop Payment of Citizens check number **** (the original check in question.) The second check number **** directed to Mr. Daryl V**** was located and they are processing this for payment. My account is paid in full. I asked Morgan of the three phone calls I made to ###-###-#### why did someone not call me? She indicated that person was on an extended leave. I then stated someone should have been accepting these calls. She did not answer. 

  
  I had all the ammunition required to prove my point check number **** was a Stop Payment check and I would not have to file a complaint with BBB. 

  
  Highmark apparently had to prove their point. Sometimes it is best to listen to the individual issuing the complaint for verification! I can say this claim with BBB has been resolved, 
  Thank you for all your assistance in this Claim. 

  
  Sincerely,  
  
  
  
  **** ******