Business Profile

Insurance Companies

Blue Cross And Blue Shield Of Florida

Headquarters

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Initial Complaint
01/26/2024
Complaint Type:
Product Issues
Status:
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.
I have b*** fighting with Florida Blue Cros* Blue Shield since October to get my refund that they processed. They keep holding out from reimbursing me ********** Like I said, I have b*** trying since October to get thi* amount. Each time that I call Florida ***S, each person that I speak to give* me a different answer a* to why I have not received my reimbursement. I have b*** told it i* because the doctor himself ha* to pay me back, which would not be the case a* **** would have to send him the money first (which I have b*** asking them to do), I wa* told I wa* missing information that I did in fact give because I have all the information that I gave them saved. What they said I wa* missing wa* the tax ID and provider NPI, which I have given to them originally in my insurance claim like they asked. I have also given it to them over the phone like they asked, and wa* then told that the doctor will receive the reimbursement in 15 day* since I have given all the information provided. I called three week* later and Florida **** said that they do not have that information but will go and get it themselves. Two week* later, it i* the same issue where they do not have that information and now telling me I need to send in a new claim. My issue with that i* I gave all the information provided, which i* reflected in the fact that my claim wa* processed and state* that the provider will be awaiting the payment. I need Florida **** to return the money that they owe to me. An incomplete insurance claim would not result in a claim being processed and ready to send the money. An incomplete insurance claim would have resulted me being notified by the insurance company that they did not receive all of my information, and would need me to send it again. I cannot play anymore game* with thi* company. The NPI i* ********** and the Tax ID i* ********** incase anyone ask* yet again. The claim Florida **** received had all the information they asked for and more with receipt* and letters
Customer response
02/06/2024
I have sent the HIPAA forms. I am not sure what other information i* to be looked for. Florida Blue Cros* Blue Shield processed my claim I sent with all the information. The first few time* that I had called to receive my refund they said it will go to the provider. When I had not heard back from them, I called again and it wa* because I wa* missing my provider NPI and tax ID. In the claim, both of those piece* of information can be found because they asked for it. In my last complaint, you can see I even typed out the NPI and Tax ID. Florida Blue said that they would be able to push through the claim since I provided the information and it would take two weeks. Two week* later they said they needed that information again, but thi* time that they would retrieve it. Two week* after that they said they have the information I just need to call my doctor for the money. I said you would need to send the money to him a* reimbursement so he can refund it to me. There i* no way I can just demand money from him without the insurance reimbursing him. The lady said no that i* not true. I called a few day* later to be told I need to resubmit my claim, even though my last claim wa* processed and stated that I am awaiting for Florida **** to reimburse my provider. They are not reimbursing my provider no matter how many circle* I go with them. They have all the information needed, I have provided them with the same information over and over with the same claim over and over, and they still refuse to reimburse me, even though it clearly say* my claim ha* b*** processed. If I did not have the information required of me, my claim would not have b*** processed AT ALL. They are refusing to reimburse me even though I have b*** providing them with the necessary information since I filed the claim September 1st.
Business response
02/15/2024
sent
Customer response
02/27/2024

[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:
Good afternoon,
I got into contact but I am getting a different answer from him that is very different from what I have been hearing variations of over the phone. I tried to follow up to get an explanation to his answer as no one has been consistent with me at BCBS. He will not respond to me when I ask for an explanation and as to why his answer is very different from others.

Regards,

********* ********

Business response
03/01/2024
sent
Initial Complaint
01/11/2024
Complaint Type:
Service or Repair Issues
Status:
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.
On November 21, 2023 I made a payment agreement for my plan with an agent by the name of *******. There was a significant language barrier on his end so I made sure I repeated and had him confirm what I said; he assured me he understood. That was not the case. I asked ******* for an email confirmation and he sent me an email, but it did not list any figures of what we’d talked about nor the payment agreement amount. The agreement on November 21, 2023 was supposed to be set for $107.80 and it was to be debited from my account on November 30, 2023. That was not the case; on November 30, 2023, actually $407.80 was debited from my account. After seeing this, I contacted my credit union and they informed me that I would need to dispute that transaction and retrieve a letter from Blue Cross Blue Shield of Florida stating the correct amount to be debited from my account which was the $107.80. Over the last week I spoke with a supervisor at Blue Cross Blue Shield of Florida by the name of ****** and informed her of what was going on. I talked with her again on today, January 8, 2023 and she informed me that she could not send a letter because of what *******’s note said, and I asked her more than once to go back and play the recording of our conversation because that is where the correct information and correct amount is; she did not give a response for that. She stated that she spoke with her supervisor but no further details of a solution were given. I still have an overcharge of $300 from Blue Cross Blue Shield of Florida and I am still awaiting the letter from them so that I can send it to my credit union.
Business response
01/19/2024
Please see attached
Initial Complaint
01/08/2024
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
The hospital sent me a bill for my newborn circumcision and routine daily care, but my insurance rejected to reimburse me. I filed a complaint with BBB before and the answer provided by my insurance is that hospital did not code the services correctly. I filed another complaint against the hospital and hospital did an investigation with my insurance and told me they have coded it correctly. The reference number for this investigation in the Florida Blue system is ******************. From there, it shows Florida blue knows my newborn had circumcision instead of minor surgery and routine daily care instead of non-routine daily care. Before we had the services, I called Florida twice to confirm it and I was told as long as the circumcision was done at hospital within 30 days after born, it would be covered 100% by my plan, so would be the routine daily care. I have also talked to Florida Blue agent several times when I tried to get this bill paid. EVERY SINGLE TIME, the agent told me I was right and reprocessed it every time, but it got denied every time because I was told my hospital did not send the code correctly. Now the hospital did an investigation after I filed a complaint with BBB and it turns out hospital sent the code correctly. The reference number is provided above.
Customer response
01/08/2024
Hi, I was trying to fax you this morning but the machine said it's either your fax was not turned on or too busy. I will try to fax again but I also attached the form here.
Thank you.
Business response
01/12/2024
attached
Customer response
01/16/2024

[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: I did not receive any contacts from Florida Blue. No email or phone calls.

Regards,

** ***

Business response
01/17/2024
sent
Customer response
01/18/2024

[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: Florida blue did not contact me after my submit this time. After filing the BBB complaint against the hospital, it turns out that the results are different from what Florida Blue gave me last time. I even included the ref number in the attachment provided by the hospital that records the most recent talk between the hospital and the Florida Blue. I don't understand why Florida Blue is still using the old information to communicate in this conversation hereby, rather than check this ref number in their system and give an up-to-date result.

Regards,

** ***

Business response
01/26/2024
sent
Customer response
01/29/2024

[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: In the letter, Florida Blue claimed that they have reviewed the reference number which includes the investigation done by the hospital. From the reference number, the hospital claimed that Florida Blue got correct codes which means Florida Blue has known that my kid had a circumcision within 30 days after the born and routine daily care services. Since Florida Blue did not provide further comments, can I assume that Florida Blue agree with the results from Hospital investigation? If so, this result from Hospital investigation is different from what Florida Blue told me. Because Florida Blue stated that the hospital did not send correct codes and they only knew my kid got a minor surgery and non routine daily care, and that's why Florida blue can not reimburse me. Right now, if they received the correct codes per the investigation done by the hospital, why are they still refusing to have a real talk? I can see how great the business is. The insurance claimed that the plan covers the circumcision and routine daily care to attract you to buy the plan. However, when we really received those services, the insurance refused to cover it.
Initial Complaint
01/02/2024
Complaint Type:
Customer Service Issues
Status:
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.
On October 4, 2023 I was let go from the company ***** *** I was working for. However I was still on payroll till the end of the month and paid for all my benefits till the end of October. Florida Blue stopped paying any of my drs visit which was still using till October 31, 2023 . Anytime someone loses a job whether laid off etc. You have your benefits because you pay for them till the end of the pay period since I was paying 200 bi weekly for my benefits to Florida Blue I am entitled to use the insurance. I went for blood work with Quest on October 17, 2023 The insurance was supposed to pay 473.87 Claim number **************** Member number *********. Next I had nose pillows and things for my Cpap machine 173.60 Claim number *****************. Then Caring foot and ankle specialist my podirast 253. 65 also was all used before the end of October. So since I am entitled to use my insurance to the end o the month Florida Blue needs to pay al these bills that where used prior to 10/31/2023. I have used Bue cross blue shield for years and have been led go of other employment jobs and I was covered till the end of the month because I paid for the benefits as I did now. So unless Blue cross does there job I will ask to go to a hearing because what they are doing is illegal not right and they are going to be reported as well to the state department of insurance.
Business response
01/11/2024
Please see the attachment.
Thanks
Initial Complaint
12/14/2023
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On November 21,2022, I filed a claim for a medical procedure performed by *** ******* ****** on 4/15/22 in the amount of $8000.00. I paid *** ****** out of pocket. On 2/24/23 I received an outline of claims processed showing a check for $586.44 paid to *** ******. I called Florida Blue and advised that check was supposed to be paid to me because the Doctor had already been paid by me. Julius, the rep I spoke to emailed the doctor’s office and left a voice mail advising check needed to be returned back to Florida Blue so they could reissue and send to me. Check #**** in the amount of $586.44 was returned by the doctor on 1/5/23. According to Florida Blue rep ***** that check cleared on 3/25/23. She sent an adjustment and advised I should receive the check within 30 days. Ref # ****************. I have been communicating with Fla. Blue since 1/24/23 and issue has not been resolved. I have sent a letter to Florida Office for Insurance regulation (8/21/23) no response. I sent another letter on 9/11/23 to Florida Blue Corporate Office in Jacksonville with a call log of all the representatives I have spoken to. I received a call from ****, from Medicare escalation department on 9/21/23. He was going to resubmit to claims to be paid to me. Advised me can take up to 90 days. I have called him 11/30/23-12/6/23 left messages and no call back of resolution. I’m hoping you will be able to help me resolve this issue. If you need any other information or receipts of the money I paid, please don’t hesitate to contact me. Thank you in advance These are all the dates I have spoken to someone at Fla. Blue calls initiated by me. 1/24/23; 2/24/23; 4/3/23; 4/5/23; 4/6/23; 5/2/23; 5/10/23; 5/18/23; 5/30/23; 7/17/23; 7/18/23; 7/28/23; 9/21/23; 11/30/23; 12/1/23; 12/4/23; 12/5/23; 12/6/23; 12/12/23
Business response
12/22/2023
*** **** contacted Florida Blue on 12/14/2023 about a refund that was due to her from Florida Blue. Member had procedure done and paid in full the amount of 8000.00. Claim **************** was filed on 04/15/2022 by the doctor and paid to the doctor in the amount of 586.44. Provider was contacted by Florida Blue requesting check be returned so that it could be reissued to the member. According to the Provider’s office the check #**** in the amount of 586.44 was returned to Florida Blue. A copy of cancelled check has been requested from our Bank Recon dept. If we have a copy of cancelled check showing it was returned to Florida Blue, a check will be reissued to member. I will continue to work with *** **** until resolution. I called *** **** on 12/22/2023 at 1:36 and advised her of the update and she agreed.
Customer response
01/02/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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.
However, if Florida Blue neglects to resolve this case, I will be filing another complaint

Regards,

*** ****
Initial Complaint
12/11/2023
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I recently got cajoled into obtaining health insurance with Florida Blue and while there has been several questionable recurring issues there seems to also be some sort of identity theft and unauthorized account tampering going on. On several occasions without my consent or authorization, they (Florida Blue) claim someone or something changed my email address and username on the account. How the hell does an email address or username change by itself or by "something"? They consequently would route all emails to said unknown email address and disable any log in to my account. Even when I can sign in to the account, nothing works that should. I am supposed to be able to log into website change selected doctor or provider or search for providers of specific services in certain areas or with certain specialization. None of this %$^#& works. Then when you spend several hours on the phone with a rep to query and email you specific information due to a totally jacked and f&^*&% website, they go in and change your email and username and email the information to a bogus fabricated email account. This has occurred on several occasions within the span of the last month and twice within the last week. I cannot tolerate or accept an explanation of "we dont know how or why this happened". There should be absolutely no f^&%$#@*( reason whatsoever for such a security breach where my account email address and username is changed repeatedly without my consent. This is also just deliberate blatant harassment and need to stop. They cannot continue to engage in the absurd pattern of changing account emails and logins without consent while enabling unauthorized access to my account and the frivolous use of sensitive personal information under these flimsy and idiotic childish schemes. This is a continuing unwarranted provocation which I have no intent to tolerate or condone.
Customer response
12/12/2023
Attached is the executed HIPAA form. FYI, nature of the complaint requires only providing information necessary to identity the customer/member. There is no need to request authorization to release health plan or benefit information or to release any past or future claims information. They only need to identity the customer/member to address the issue. Time is of the essence!
Business response
12/15/2023
Please attachment.
Customer response
12/21/2023

[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: What is stated in the response is by the BCBS representative is ABSOLUTELY FALSE. You should be ashamed of yourself! There has been NO discussion and NO resolution of this matter. NONE. Someone contacted me from BCBS told me on the phone that to address the matter I needed to verify my address... when I provided my address.. she started trying to have an argument with me like some knuckle head. Its always one excuse after another. They have sent several mailing to my address which I provided to her... yet she kept trying to get in some sort of an argument with me apparently as some sort of tactic instead of addressing the fu*#(*&^% issues in the complaint. This is why a formal complaint has also been filed with the office of insurance regulation and the FTC.... these idiots are doing all this mess on purpose.

Regards,

****** ******

Business response
01/08/2024
Please see attached response.
Customer response
01/09/2024

[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: These are utter lies... no one from Blue Cross Blue Shield has contacted me in regards this matter and most certainly have not discussed or resolved ANYTHING. You continue to repeat these utter despicable lies. You should be ashamed of yourself Mrs karol strickland or whatever your name is. The only person who contacted me from your company after filing this complaint attempted to get in a moot argument about my address... if you are confused what this complaint is about, read the gadamn complaint. YOU NEED TO STOP LYING. What Blue Cross and Blue Shield have actually done since this compliant was filed is they HAVE engaged in some sort of RETALIATION. The recently mailed me some bullshit about my premium being increased. They are utter assholes.

Regards,

****** ******

Business response
01/12/2024
please see attached.
Customer response
01/17/2024

[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: Again this is false. You did not and have not contacted me and most certainly there has been no resolution of this matter. Clearly you criminals continue to tell all these lies and fabricate all this nonsense. I will be forwarding this matter to an attorney and filing a formal complaint with whoever regulates insurance companies in the state of florida. You continue to also mail my personal information to an incorrect address trying to facilitate an identity theft in addition to the initial complaint. I have no intent to tolerate with this level of utter stupidity and incompetence. What a bunch of fucking idiots. Stop telling this lies.... ms stickland... you are an utter moron.

Regards,

****** ******
Initial Complaint
12/07/2023
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I have had a Medicare Advantage plan with Florida Blue since 2019. I also have a secondary health insurance plan with Cigna from my retirement from the City of Conyers Ga. Until May 2023 Florida Blue accepted the Cigna plan as a secondary policy. Now Florida Blue is denying all claims submitted to them even from my primary care physician. When I inquire about the denials, I have been given several different reasons. I was told by customer service representatives they did not understand why the claims were being denied. First I was told the Cigna plan was my primary insurance, which it is not. Second I was told the Cigna plan was a Medicare plan, which it isnt. Thirdly I was told the Cigna policy was for active employees and therefore should be my primary. I have explained to Florida Blue I have been retired since February 2009 and even had a Cigna Representative contact Florida Blue verifying the retirement. Claims have been denied from February 6, 2023, August 7, 2023, and September 7, 2023. Florida Blue has not cooperated with Cigna to pay these claims and as such I am looking to get billed for a minimum of $1300.00.
Business response
12/18/2023
Good afternoon,
I am writing in response to the issue with *** ***** ******, he has stated that Florida Blue has been denying his claims due to recognizing Cigna as his primary insurance. I have looked into this case and *** ******** status as Florida Blue Primary was changed on 07/01/2022 due to documents we received indicating Cigna was primary on his account. After review this was done in error as those document were for Cigna to pay as secondary insurance, at this time we have made the necessary changes to *** ******** account and we be reworking his claims so we are primary.
Business response
12/18/2023
Good afternoon,
I am writing in response to the issue with *** ***** ******, he has stated that Florida Blue has been denying his claims due to recognizing Cigna as his primary insurance. I have looked into this case and *** ******** status as Florida Blue Primary was changed on 07/01/2022 due to documents we received indicating Cigna was primary on his account. After review this was done in error as those document were for Cigna to pay as secondary insurance, at this time we have made the necessary changes to *** ******** account and we be reworking his claims so we are primary.
Customer response
12/19/2023
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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,

***** ******

Customer response
12/19/2023
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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
11/14/2023
Complaint Type:
Service or Repair Issues
Status:
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.
Oct. 2021. Please see attached letter. I had a BCBS policy for MANY years. I always paid my bill in a timely manner. When I turned 65, I should have been notified that I could and should change my plan to the "over 65 plan", which was FREE - NO charge. (I now have full coverage with AARP Medicare Advantage from United Health - NO COST). I was charged up to $1736.00 for 2 month by BCBS until I was 78 years old - 13 years. That equates to well over $100.000.00. I am now 80 years old. Again, please see attached letter. I tried for weeks to talk to someone, but never could get any answers. I have much more information, and recorded telephone conversations. Please contact me for any reason if I may be of assistance. **** ****** ************ Thank you in advance for you help and consideration.
Business response
12/12/2023
Please see attached
Customer response
12/13/2023

[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:

Regards,

**** ******

*** ******** called me at 5:00 PM on 12/11/23. She sail that she called to let me know that she has received the BBB letter. She had NOT read my complaint yet, so I gave her a quick explanation
as to the contents of the letter, and she said she would "follow up with you" after she reads the complaint.
Her letter to the BBB stated: "We reviewed with him the outcome of our investigation and the steps taken to resolve." THAT IS RIDICULOUS. SHE HAD NOT EVEN READ MY LETTER, AND
NOTHING WAS DISCUSSED OR REVIEWED. I spoke with Kim ONLY ONCE, when she called me at 5PM on 12/11/23.
**** ******

Business response
12/15/2023
Please see attached
Initial Complaint
11/08/2023
Complaint Type:
Sales and Advertising Issues
Status:
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.
Me and my family has had blue shield for years however my kids was in a car accident which we did not have pip insurance at the time my kids went to the hospital and to be told by the hospital that my kids hospital bills are being decline like how can they decline to cover the incident when by law if we had no insurance it should be covered by the insurance company and we had full coverage health insurance this is not right and should be a crime i pay my health insurance every 2 weeks with no Poblem and for them to not my pay my kids medical bills is and should be a violations. I need all my kids medical bills to be take care of Case Number ********* ******** ******* 8/6/1977 ******* ****** 12/23/1979 kids involve ********* ****** ******** ******* Jr ******** *******
Business response
11/17/2023
Please see attached response
Initial Complaint
10/02/2023
Complaint Type:
Product Issues
Status:
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.
The full explantion is on doc Ref. INSULIN docx.PDF brief: Blue Cross Blue Shield (BCBS) is destroying till disapear my initial coverage of $4660 (PHASE 2) per year setting prices for the Insulin above the law (35 or less per month per insulin) . BCBS set a kind of "over the counter price" instead // in august set astronomical values of $431.02 for the Humalog Kwik INJ 100/ML for 12 days and $889.98 for the Lantus SOLOS INJ 100/ML for 30 days. instead a maximun of 35 ea this values sum of $ 1321 that they discount from my initial coverage (PHASE 2 ) of $4660 instead what the Law 35 or less Plus today I receive an email from Walgreens that for pickup the Humalog for 12 days I have to pay $255.89 money that I do not have and becasue is weekend nobody answer phone on BCBS So I have to try to get the insulin (minimal 4 inj per day with ea meal from hospitals) Pay atention BCBS set $431.02 on their Ago spreadsheet for the Humalog Kwik INJ 100/ML for 12 days while Walgreens for the same quantity of 12 ask only 255.89 ???? This is one of the biggest issues that I have among others that affect all the ones that have daibete4s type1 and need this before get into diabetes coma Pay atention BCBS set $431.02 on their spreadsheet or the Humalog Kwik INJ 100/ML for 12 days while Walgreens for the same quantity of 12 ask only 255.89 ???? So at this moment I cannot take any more medicine unless I pay 25% money that I do not have due the initial coverage that they destroyed
Business response
10/10/2023
If I may be of further assistance, contact me directly at ************ **** *****. My office hours are Monday, Tuesday Wednesday, and Thursday from 8:00 a.m. to 6:30 p.m.

Business response
10/24/2023
Submitting Response Letter again in PDF format.
If I may be of further assistance, contact me directly at ************ **** *****. My office hours are Monday, Tuesday Wednesday, and Thursday from 8:00 a.m. to 6:30 p.m.
Customer response
10/24/2023

[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:
1) We do not call to a number that are not listed on our Member card (attached) and also was written on the answer that we gave before, (attached)

2) no PDF arrived to our email address *********************** from your "domain name" bcbsfl.com plus also we checked with our hosting services and they confirm no received from your domain name email
we attached an email received time ago for your knowledge from your domain tha we alow to receive
we receive email from *************************************** ... (here you can see + read that the domain name is no other than bcbsfl.com)

Regards,

******* ********

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