Complaints

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:01/13/2025

  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.

  I had dental work done in october 2024 i paid 8000 dollars out of pocket and filed a claim to the insurance company they told me i will get 2000 dollars for the claim the first check they sent to the provider which the dentist does not except insurance and specifically on the claim noted the payment should be made to me but they still sent to them so i called and told them they made me reclaim it fill out new papers and sent a new check which i did not recieve after ten days so i called again and told them i did not recieve the check again and i have bought a house and moved i gave them my new address the lady said she will try to issue me another check by dec 31 2024 i should get it in 10 to 12 days i got a check today 1/08/2024 for 125.00 dollars i called and explained my situation that the check shoul have been for 2000 dollars and the lady told me she does not know what the 125.00 was for and then said these thing take time i should be patient i said i think i have been patient for two and a half months that this was no fault of mine and they hung up on me so i do not it seems i cannot get no satisfaction from them on where this check is and when im getting it

  Business Response

  Date: 01/13/2025

   

  Good morning, we were unable to locate the member which filed the complaint within the National Enrollment Data Base for Federal Employees.  To research further we will require the member's identification number which begins with an "R". 

   

  Regards, 

  Cynthia L*******

  Customer Answer

  Date: 01/13/2025

  There is all my info also in a attachment

  Customer Answer

  Date: 01/13/2025

  In case you didnt get it my member number is **************** and its for dental and i work for ******** ****** in case they ask 

  Customer Answer

  Date: 01/13/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because: In case you didn't get it my member number is **************** and its for dental and i work for ******** ****** in case they ask 
  
  
  
  Sincerely,
  
  
  
  ******* *****

  Business Response

  Date: 01/13/2025

  Good afternoon, I was able to contact the member and determined he had dental coverage with our company.  Based on my conversation with the representative in the dental department, and additional information I was able to determine the member didn't receive payment for services rendered last year because the address was incorrect.  I have since verified the correct mailing address and was assured the check would be reissued however it will take approximately two weeks before payment will be received.

  I also spoke with the member and confirmed what will be taking place and also provided a point of contact in the dental unit for further assistance.

  He was very appreciative of the steps taken to resolve his concern.

• Initial Complaint

  Date:01/12/2025

  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.

  ****** SUPER MAR 12/31/2024
  $ -99.11 Purchase of Goods or Services
  Expand ****** SUPER MAR 12/31/2024 details
  **** * **** ** SPARTANBURG, South Carolina
  Card Number: **** **** **** ****
  
  Please understand and respect that the pharmacy at ****** did try to assist me with the cost of these medicines but there must be a way for me to reduce the cost of these medicines that are either with the Blue Savings Card that was supposed to be on the way to my home. I am supposed to be able to spend the balance on the card toward medical related items, such as over the counter and prescription medications. In addition there was no disclosure of retail pricing of the medicine. I was schocked to see one of the medicines was very costly. I would like to either appeal this, submit the receipts for reimbursement or know what my options are at this point please. I tried to contact the insurance company prior to contacting BBB but I work during the day and the company is not open at times where middle class people can call, and apparently work on their website on the weekends.

  Business Response

  Date: 01/16/2025

  We have received confirmation that our member services team has successfully contacted Mr. ****, addressed his inquiries, and provided him with an explanation of their benefits. Mr. **** expressed his satisfaction with the outcome, and we have closed this matter on our end. Thank you. 

• Initial Complaint

  Date:01/09/2025

  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.

  On 06/27/2023, I had an outpatient procedure at ********* Medical Center for a medical necessity. I started a financial plan with ********* Medical Center shortly after two other medically necessary procedures in November and December. Any charges that were related to any outstanding bills were to be applied to this payment plan. I then called last November 2024 and told ********* Medical Center's billing department to give me my balance of all charges associated with ********* Medical Center. They gave me the total. I then paid off my balance (or so I thought) and then I received a bill on January 07th, 2025 for the date of service of 06/27/23, which was not included in the balance that I paid off. I have been in touch with ********* Medical Center and they state that I am just now getting billed for a date of service of 06/27/23 because BCBS just paid them for the services rendered. However, all my other dates of service INCLUDING two outpatient procedures after 06/27/23 received payments from BCBS. BCBS customer service department has yet to explain why it took them almost TWO years to send money to my provider. I have made an appeal request as well as requested an itemized statement from ********* Medical Center.

  Business Response

  Date: 01/10/2025

  Good afternoon, I have reviewed the information and determined the member is not a federal employee but a state employee.  I have forwarded the information to our Point of Contact within the State Unit for resolution, however if you require further assistance, please do not hesitate to contact me at ###-###-####.

  Customer Answer

  Date: 01/13/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:
  
  
  
  Sincerely,
  
  
  
  ******* *********

  Customer Answer

  Date: 01/13/2025

  A resolution has not been made. 

  Business Response

  Date: 01/21/2025

  Good morning, my apologizes as I thought I had updated the response last week.

  The concern was initially routed to the incorrect department as the member is not a Federal but a State Employee.  I hand carried the information to a POC in the State Unit for resolution and confirmed this morning that outreach was made to the member on January 14, confirming the claim resolved accurately.  If the member has any additional questions, she may call Ms. W***** at ###-###-####.   

  Customer Answer

  Date: 01/21/2025

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because: this is still in the appeals process with Blue Cross Blue Shield of South Carolina and after speaking with the appeals department, it still wasn't communicated with me from Blue Cross Blue Shield of SC nor ********* Medical Center that there was a pending claim out there from the date of service of 06/27/23. Like I told the representative from Blue Cross Blue Shield of SC, if someone had told me there was a pending claim, I would have researched or reached out to see why it was pending and if any additional documentation was needed. 
  
  
  
  Sincerely,
  
  
  
  ******* *********

  Customer Answer

  Date: 01/21/2025

  I have attached a bill from DOS 06-27-2023, where it shows insurance payments were made of $373.30. My question is, why would an insurance company pay a little bit for the services, but then back track and adjust the payment again. Also, this date of service was included in the payment plan that I paid off on November 15, 2024 in the total amount of $1879.44. 

  Business Response

  Date: 01/28/2025

  Both the member and the provider have been contacted. Both are satisfied with the response and the resolution.

  Customer Answer

  Date: 01/28/2025

  
  
  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.
  
  
  
  
  Sincerely,
  
  
  
  ******* *********

• Initial Complaint

  Date:12/09/2024

  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 was diagnosed with recurrent breast cancer in November of 2023 and was assigned to have 4 weeks of radiation as part of my treatment. We had paid our maximum deductible and out-of-pocket and the treatment should have been paid at 100%. My provider, MUSC Hospital, contacted Carelon (responsible for approving pre-certification) and was told that pre-certification was not necessary, so I began my treatments. Soon after, MUSC began sending me bills for 20% of the total costs, stating that my insurance was only covering 80%, because we had not received pre-certification despite Carelon's assertion. The hospital filed an appeal, which was approved, but they did not backdate it to the start of the radiation. After we pointed out the issue, they filed another appeal, which was also approved (I have documentation of both of these approvals). Despite that fact, BCBS, still refused to pay for several of the treatments, which amounted to a total of just over $850. We contacted BSBS on at least 10 separate occasions, and were told a new reason for why the claims were not being paid each time -- the wrong code had been used, the wrong department was contacted, Carelon had lost the letter, etc. Each time we were told to wait 30 days and it would be cleared up. After months had passed with no resolution, MUSC finally referred our bill to a collector, and we were forced to pay the balance. We even got our company's representative involved, and she diligently contacted BCBS once a week for months, and received the same runaround. We appealed the judgement several times, and were denied every time, the last several times because we had "not appealed in a timely manner" despite the fact that we were continously told to "wait". All we are asking for is to receive the coverage we have paid for. There is absolutely no excuse for this -- going through breast cancer is difficult enough without an insurer would could care less about fulfilling their obligations.

  Business Response

  Date: 12/10/2024

  Good afternoon, I do
  apologize for the problems you have experienced with the processing and payment
  of your claims. Unfortunately, I was not able to find any information regarding
  your concern since I only had your name to use to search with. If you would
  please provide me with your identification number found on your card, claim
  numbers and/or dates of service I will be happy to research further to decide
  next steps.

  Please note, that I did call the
  phone number provided and left a message should you wish to discuss this over
  the phone. My number is ************ or 800-288-2227, extension *****.
  

  Regards,
  Cynthia
  L*******

  Customer Answer

  Date: 12/11/2024

  I did speak with Ms. L*******, but unfortunately, she works for a different division of BCBS than the one handling my claims.  She has promised to find out more and get the right people involved, but that remains to be seen.  Given the utter nightmare we have experienced over the last nine months of attempting to get this claim resolved, I am skeptical.

• Initial Complaint

  Date:11/25/2024

  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.

  The plan is delaying processing for my claim for reimbusment with Dr. ******** ***** on8/15/24. I have reached out to Mrs T*****, Mrs. L******* and Mrs. D*** about this issue and continue to get the run around and no response. I have out of network benefits related to this claim.

  Business Response

  Date: 11/26/2024

  We are responding to your concerns regarding the delay in
  processing your claim.
  Upon review of your claim and notes from previous
  discussions with you, it was determined that we needed additional information
  from the provider to process your claim.
  The provider in question has been contacted and given
  instructions as to what is needed and given a direct contact should they run
  into any problems.
  Per our conversation yesterday, I explained the process and
  that it may take time to update the records depending on when the information
  is received.
  Our goal is to provide our members with outstanding service
  and support. We apologize for any inconvenience this may have caused and
  welcome you to contact me directly for any further questions or concerns you may
  have.

  Customer Answer

  Date: 11/26/2024

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:
  
  Business has had ample time to correct this issue.  I was under the impression one employee was handling the matter then told another employee was handling the matter.  I need assurance that the proper employee with Dr. *****’s office is contacted and the issue is resolved.  I request  reimbusment for this claim
  
  Sincerely,
  
  
  
  ******* ******

  Business Response

  Date: 11/26/2024

  Per our conversation on yesterday ******* with Dr. *****'s office was contacted and informed about the information needed to have the claim processed. We will follow up with ******* on Monday to see if the needed information has been submitted. 

• Initial Complaint

  Date:10/28/2024

  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.

  Blue Cross Blue Shield is not processing my daughter's speech therapy claims. I had the same issue earlier this year with her occupational therapy claims. I have been in touch with Jessica F******* and she said I had to stop contacting her. She told me I should continue submitting claims as I had been before, and she said she was sure my claims would be accepted this time. Blue Cross Blue Shield keeps denying my claims and saying they're "Missing Paid Receipt" even though I'm submitting paid receipts. Please just process my claims, because that's what I pay premiums for. I'm attaching a copy of the claim I uploaded which was most recently denied. I have since uploaded more claims, but it looks like they haven't finished processing them yet. If those are denied, I will need a resolution for those as well.

  Business Response

  Date: 11/05/2024

  Our member services team has been researching the issue and has an update to share. We are reaching out to member this morning (11/5/24) to give the update and answer any questions they may have. 

• Initial Complaint

  Date:10/20/2024

  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 have repeatedly been in contact with Blue Cross Blue shield about paying the benefits due to ******** **** ****** ****. Some of these charges are from the previous year. I last spoke with a representative from Blue Cross Blue shield approximately a month ago and was assured that ******** **** ****** **** is on my provider list and that the bills were being escalated to another department to be sure they are paid quickly after having received a letter from them stating that another provider was not covered when I specifically wrote to them about these bills from ******** **** ****** **** that we're going to be billed to my credit card if they did not pay them soon. Also, the provider they mentioned in their reply letter is indeed on my authorized providers and I can show you that they provider they inserted instead of Carolina urgent Care is also in network. I am now stuck with 657 in bills that they have had more than ample time to pay. They still haven't paid my neurologist for a procedure that they pre-authorized years ago. We even had a conference call with the doctor's office and the insurance company confirming the proper codes to submit to be sure they would match the pre-authorization for the procedure. They have yet to pay for that procedure. Additionally they have continued to deny several of my medications leaving me without access to those medications and in other cases I've had no choice but to pay for those medications out of pocket because they were intentionally dragging their feet knowing that I had to have those medications

  Business Response

  Date: 10/25/2024

  After further review, we found that ******** **** ****** **** is not part of the BlueEssentials network. The initial claims were incorrectly filed as internal medicine services, leading to their denial. These claims have now been reprocessed as urgent care services according to the member's benefits

• Initial Complaint

  Date:09/30/2024

  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 insurance company has not paid any of my medical bills from my Urologist since April. Although they get their monthly premium paid to them by my Federal Employer. They say they neglected to pay on my claims because I did not return a survey to them to let them know if I have Medicare. This is Fraud and Abuse! To not pay my benefits because of a survey. I am not 65 and they have my DOB and therefore cannot collect Medicare. They have not paid my medical provider since April and now I am being sent to collections and dealing with cancer. This is WRONG!!! I want my claims PAID, and I want them to contact my Urology office and let them know they will be reviewing and sending payment out immediately. This is CORRUPTION at its finest!

  Business Response

  Date: 10/03/2024

  We are
  responding to your concerns regarding the delay in processing your claims.
  Our goal is
  to provide our members with outstanding service and support.  One of the requirements for processing claims
  accurately is to determine on an annual basis if the member or patient has
  other coverage or if age appropriate, Medicare which would potentially pay
  primary benefits. And until that is determined claims are pended which is what
  happened in this situation. 
  After
  reviewing your records and speaking with your provider, we have confirmed there
  is no other coverage, and the information has been added to your file.  All outstanding claims in question have been
  resolved and new Explanation of Benefits generated.  The provider has been informed as well to
  expect payment for the outstanding dates of services.   
  We apologize
  for any inconvenience this may have caused and welcome you to contact us
  directly for any further questions or concerns. I can be reached at
  1-800-444-0025.

• Initial Complaint

  Date:08/18/2024

  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 have health insurance with BCBS SC. My daughter was born 5/31/24 and was added to my policy early June 2024. Due to the birthing process being so expensive, I had previously met my full deductible and out of pocket expense. My daughter had met her deductible as well. I reviewed my benefits 7/29/24 after receiving a new medical bill, and my balances had been reset back to $0.00. I sent a message on the app and called on this day. The customer service rep, Tashana, told me that there was a “change” in my policy that went into effect 7/1/24, but the only change made was adding a dependent. She told me she would return my call with a resolution by 8/2/24. After no returned call, I reached back out on 8/6/24 and spoke with the same representative. She said she had escalated my problem to management but nothing had come from it. She said she would resubmit and I would hear back by the end of that week. After no response (again), I sent a very demanding message via the online portal on 8/12/24 asking a member of management to contact me to figure out a resolution for my account. Their system says you will receive a response in 1 business day. Instead of receiving a response, my message is now unavailable for me to view and says “waiting on a response”.
  
  I am getting billed for new medical appointments at the rate as if I had not even met my deductible. I am afraid to not pay the bills because they are due, but I know they are being billed incorrectly because of BCBS error with my account.

  Business Response

  Date: 08/23/2024

  Our Member Services team has reached out directly to the member but was unsuccessful in making contact. We have left a voicemail with the appropriate contact information so the member can return our call. We will continue our efforts to reach the member to ensure that all questions are answered and provide direction on the next steps.

  Customer Answer

  Date: 08/26/2024

  
  
  Complaint: 22159655
  
  
  
  I am rejecting this response because:

  I received a call on Friday 8/23/24 from an unknown number.  I did get a voicemail, but unfortunately did not hear it until after business hours on that day.  I returned the call on Monday 8/26/24, and got a voicemail.  I left a message and will be waiting on a return call.  Situation with my account has not yet been resolved nor have I received information on how/when it will be resolved at this time. 

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

  Business Response

  Date: 08/28/2024

  Our Member Services team has reached out to the member and addressed all their questions. We will continue to follow up to ensure the issue is fully resolved.

• Initial Complaint

  Date:08/12/2024

  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.

  This is for Blue Blue-shield of SC. I was told in July that my coverage wouldn’t start on 7/01/24 and was offered a refund as I made a payment of $135.37. I was issued a refund and told my coverage would start on 8/01/24 and confirmed I would make the payment for 8/01/24. I logged into the account online before the start date and it showed no bill was due and that I couldn’t make a payment since there was no active bill. I put my card on file and set up automatic payments so it would charge the card on the start date. I received all my coverage information and confirmation that my insurance was active. I used the insurance to get bloodwork done on 8/02/2024. There was no issue or notification that the insurance wasn’t active. On 8/11/24 I reached out to BCBS as when I tried to login online on 8/10/24 it said my account was no longer active. I never received confirmation that there was a bill due or that the automatic payment didn’t go through, there was also no pending charges from BCBS for the month of August, so they never tried to charge the card for the payment even though I had automatic payments set up. I spoke to a representative on 8/12/24 confirming that for the first payment it needs to be manually paid and that it won’t draft even if you have automatic payments set up, which I was never told. She transferred me to a representative from the marketplace who said they could submit a claim for a retroactive date but it could take up to 30 days and I would have no insurance in the meantime. This means for August because I had switched to BCBS from another insurance (******) that I now have no insurance for August even though I tried to make payments and was never notified of a failure of payment and my insurance was wrongly terminated. I was told by the marketplace agent on 8/12/24 that I would need to pay out of pocket for any appointments since the insurance wouldn’t be active. I have a chronic illness (lupus) and I need to see my rheumatologist this month.

  Customer Answer

  Date: 08/13/2024

  This has been resolved