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Blue Cross And Blue Shield Of FloridaHeadquarters
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Complaint Details
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Initial Complaint
12/02/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Blue Cross mishandled my claim processing and will not expedite the correction. The fix is an easy one, and their lack of addressing it is causing me financial hardship. Their reps refuse to elevate it to management or just work the claim properly. I submitted a claim and all required paperwork to BC via certified mail, and they received it on 9/24/24. The claim should have been denied because it's not a covered service, which would then allow me to move on and submit the claim to my dental insurance for reimbursement. BC did deny it, BUT they denied it for the wrong reason; which means I cannot begin the process with my dental insurance. They told me to resubmit the paperwork, which I've done 3 times now, but the claim remains unprocessed. Their reps keep telling me to wait 60 days. I should not have to wait normal processing times for them to correct the ERROR THEY MADE. This is causing me financial hardship. Please immediately deny the claim with the appropriate reason code, such as 165- non-covered service. The provider's NPI number is ********** and the TIN is *********.Business response
12/10/2024
Please see attached letter.Initial Complaint
11/19/2024
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
For the past 3 years i have complained to BC/BS OF FL about my PCP charging me for what should be an annual physical. Each time they have called my PCP and been advised that I order refills for my regular medications. Blue cross has advised me they can not force the provider to give me back my money but it should not be happening for any reason except if I went in for a problem. I’m out of at least $80.00 and no one wants to help enforce the rules unless I make them. I’m a 58 year old women that has been on health insurance for a while, I know this should not be happening and so does blue cross. They do not document the information they have collected and no one above customer service even looks at it. When I send in a complaint on their website I get a copy and paste answer. They still don’t take the time to investigate. The providers will holding back any medications you need because they are told patients need to be proactive and participate in their own wellness. Then why do I have to pay for a physical I don’t think I need. If the provider doesn’t have rules then why don’t we have a free for all. I don’t care who give me back my money I have been fighting for. I want it and I want you to educate your provider you employed and tell me to trust. I am told your provider knows where to send you if needed and your provider know the rules the govern my insurance but that is a bold face lie. If you provider can not follow your rules like you enforce them on the patient then you should not allow them to practice under your umbrella. Who protects patients rights? Who speaks for the patient? Isn’t member service supposed to give the rules to patient and provider the same. I’m out of more money than the $80.00. My labs are supposed to be covered also. I had to pay my labs fees to make sure my credit was tarnished by you only following the rules to your patients. This is a lot of money and no one seems to care about the patient.Business response
12/11/2024
See Attached ResponseInitial Complaint
11/14/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
On January 18, 2024 I visited Gentle Gynecology. They do not participate in Blue Cross Blue Shield. Medicare paid for a portion of the services I received. I paid $124.69. Blue Cross Blue Shield informed me that I would be reimbursed for the $ 124.69. BCBS apparently had the wrong address for Gentle Gynecology. I was told that they could not mail the check to me, but had to send it to the provider. I had to wait for over two months for BCBS to stop the check and for the provider to give BCBS the correct address. I told BCBS I could provide the correct address. I was told that they could not accept the address from me, but only from the provider. Apparently, BCBS now has the correct address in their system. I keep getting the run-around and cannot get information on when the new check will be sent to the provider who then will reimburse me. I beieve I have been more than patient.Business response
12/02/2024
Please see attached response.Customer response
12/03/2024
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
Complaint: ********
I am rejecting this response because:I have not been informed of the options for getting the
check reissued as of December 2, 2024 at 4:06 PMRegards,
***** ******
Business response
12/06/2024
Please see attached response.Customer response
12/06/2024
Good progress. I will inform you if the promised action does not occur.Initial Complaint
10/01/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
BCBS through company *******; benefit for hearing aid is up to $5000 a year with 90% paid by BCBS after deductible is met; I have found out that there are no providers or at least none that BCBS can provide me that will provide my full benefit; I have found out that all the providers have individual contracts with BCBS that limit the benefit to $2000; providing a benefit that they know that it can not be provided is fraudulent, criminal, false advertising on behave of BCBS. I have asked repeatedly over the last week for BCBS to provide me a provider that will honor the benefit and they can notBusiness response
10/16/2024
Please see attached response.Initial Complaint
09/24/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I have very high Cholesterol, however I am unable to take statins or any other normal cholesterol medications, as it causes severe muscle pain or gastrointestinal issues. It has been monitored and going up for years. I have tried all the meds, including red yeast rice, statins, zetia, cholestyramine. I have modified both lifestyle and diet. I am not overweight. I exercise - a lot. My cardiologist (after a lengthy visit and a calcium score test (which was 6, too high for a 58 year old), recommended that I try Repatha, an injectable cholesterol med. Florida Blue denied the request, even after a prior approval was provided, stating that I needed to already have a heart attack in order to get the medication. We are trying to PREVENT a heart attack. My doctor is appealing but we have had no response. I would like to get this medication approved. It is $666 a month without insurance assistance. Thank you.Business response
09/27/2024
Please see attached.Initial Complaint
09/17/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
I was advised I needed a D&C for my miscarriage on 02/22/2024. Called Florida Blue on 02/24/2024 with the CPT codes for the surgery to obtain an estimate of the portion that I would need to pay for this surgery. I was told by the representative that my portion would be NO MORE than $900. All calls are recorded so pull up this call. During this call - I confirmed that if I was advised to pay more than the $900 at the time of surgery - that Florida Blue would be able to reimburse the remaining amount. I was scheduled for surgery on 02/26/2024 and was advised by the hospital (Orlando Health) that I would need to pay my surgery in FULL or it could not proceed as scheduled. This is absolutely ridiculous and when has this become hospital policy?!? Given that I had no choice but to pay for the surgery in full so that it could proceed as scheduled and having reassurance from Florida Blue that they would reimburse me for any amount over $900 - I reluctantly paid approximately $4000 to have the DNC which lasted 34 MINUTES TOTAL. I then called Florida Blue multiple times to see how/when I could be reimburse for the additional amount over the originally quoted $900 and was advised that there was nothing that they could do as the representative who provided me with the initial information was incorrect. This is impossible as I provided this rep with not only the CPT codes for the surgery, but also all the information regarding my coverage with Blue Cross. Every time I called back - I was advised that I was basically s*** out of luck. This is absolutely ridiculous as I was reassured and told by e rep of Blue Cross that my portion would be NO MORE than $900. This is clearly their attempt to confuse and misinform their customers to pay large sums for medical treatment knowing full well that we will not be reimbursed on the backend. This is fraudulent behavior and must be stopped. It is clear that Blue Cross took advantage of my emotional state due to my miscarriage.Business response
09/26/2024
sentInitial Complaint
09/06/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
Florida Blue has failed to resolve two errors after multiple hour-plus phone calls with their customer support over the past month. Firstly, they charged me a premium for the first 30 days of my newborn son's life, which directly contradicts pg 95 Schedule of Benefits stating that if a newborn dependent is added within the first 30 days of his life, no premium is charged for the first 30 days (his care is included in my individual monthly premium). He was born on 07/11 and I contacted FB to add him to my policy on 08/01. I clearly explained to the agent (***** ***** *******) that my intent was to add him ONLY for the first month, as the new monthly premium she quoted for a policy to cover me and my son after that period was completely unaffordable ($1,078.44). Despite receiving all needed documents on 8/1 and multiple follow-up emails, Agent ************* failed to file the application to add my son. When I called back on 8/11 agent **** ********* filed his application and told me I just had to call back the next week to cancel his policy after the app was processed and I wouldn't be charged a premium. However, after calling on 8/13 and receiving confirmation from Agent Breya (and also receiving a secure message in FB's portal stating that my son's coverage was cancelled 8/13) Florida Blue now claims that the effective date on my son's cancellation is 8/31 and they are still attempting to charge me premiums for the entire month of August. All I want is for Florida Blue to abide by their own policies as stated in my Schedule of Benefits (regarding not charging a newborn premium for first 30 days) and to abide by the words of their own agents regarding cancellation effective dates. I have agreed to pay the rate for 2 prorated days ($26.25) of the quoted premium for 8/12-13 (even though the delay in processing my son's app was entirely their fault, which they admit, and thus I had to call in to cancel his policy 2 days after the 30 day newborn period had ended.)Business response
09/19/2024
Please see the attached documentInitial Complaint
09/03/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
Formal Complaint Against Florida Blue - Refund Processing Delays (+90 Days) SUMMARY OF COMPLAINT: I canceled my BlueOptions ********* plan with Florida Blue on 04/11/24, and due a refund on part of the full monthly premium payment on 04/01/24. A refund of $1,173.18 was processed on 04/22/24, and I was informed it would arrive via US mail in 7-14 business days. As of 08/29/24, I have yet to receive a refund check. REQUEST FOR ACTION: I respectfully request the Better Business Bureau to intervene to ensure Florida Blue promptly processes my refund. Attached are all relevant payment records, proof of coverage, and confirmation of my policy cancellation. INSURANCE INFO: Insurance Company: Florida Blue Policy Number: ********* Claim/Reference #: ***************** Policy Owner: ***** ******* (Self) Group Plan: BlueOptions ********* Policy Effective Date: 02/01/24 Policy Termination Date: 04/11/24 Thank you for your assistance with this matter. Sincerely yours, ***** ******* ****************** *** ***** ********* *** *** *** *** *** **** *****, ** *****Business response
09/09/2024
Please view letter attached.Customer response
09/10/2024
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
Complaint: ********
I am rejecting this response because: As of Tuesday, September 10, 2024, I have not received the funds due to me, indication a new check has been released, or tracking information to confirm shipping.
Regards,
***** *******
Business response
09/13/2024
Please view the letter attached.Customer response
09/16/2024
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
Complaint: ********
I am rejecting this response because: As of Monday, September 16, 2024, I have not received the funds due to me, indication a new check has been released, or tracking information to confirm shipping.
Regards,
***** *******
Business response
09/25/2024
Please view the attached letter.Initial Complaint
08/02/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
This is the worst company I have ever been with Blue Cross Blue Shield of Florida every medication that my doctor prescribe I have to have problem with them with my health because of them. I have to change my HIV medication two times now I am close to diabetes and my doctor prescribe a medication call wegovy to lower my levels from catching type, one type two diabetes and they are refusing to cover it. They said my plan does not accept that medication, but I can file for coverage exception but still yet they are working around the nine my health because of them. My health is worse than where it is right now. No I am looking to see court and Attorney to file a class action lawsuit against them if the situation is not resolved peacefully.Business response
08/15/2024
sentInitial Complaint
07/15/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
On April 1st I was switched back to an Florida Blue Options plan from a Florida Blue select one, through an escalation within the company. They erroneously backdated my insurance plan and charged me over $750 which they shouldn't have done. After wasting hours on the phone, they figured out the issue and told me it would be taken care of, only to say they were refusing to fix the issue and that I'd have to pay more or they would drop me from my insurance. They are highly disorganized thieves.Business response
07/30/2024
sent
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Customer Complaints Summary
139 total complaints in the last 3 years.
42 complaints closed in the last 12 months.
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