Complaints

This profile includes complaints for Care First BlueCross BlueShield's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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Care First BlueCross BlueShield has 4 locations, listed below.

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  Care First BlueCross BlueShield

  550 12th Street SW Washington, DC 20065-0001

• 

  Care First BlueCross BlueShield

  840 First Street NE N500 Washington, DC 20065-0001

• 

  Care First BlueCross BlueShield

  1310 G St NW Frnt 12 12th Floor Washington, DC 20005-3007

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  Care First BlueCross BlueShield

  10455 Mill Run Cir Stop OM1-918 Mail Stop OM1-918 Owings Mills, MD 21117-4208

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:12/01/2023

  Type:Order 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.

  Due to a qualifying life event I applied for health coverage with CareFirst BlueCross BlueShield (Group #****.) through my employer. My employer provided me with documentation stating that coverage with CareFirst for my wife and I was effective September 9, 2023. CareFirst is stating that my coverage was not effective until October 1, 2023. Unaware of this discrepancy, I visited the doctor for medical services and have been billed by the provider of those services for services rendered. When the bill for those services was submitted by the provider for payment, CareFirst declined to pay the bills claiming that my coverage didn't start until October 1, 2023 and since the services were provided prior to that date they would not pay. I reported the matter to my employer. My employer and those it deals with (e.g., ************* ****************** Inc. and *******************) have all attempted unsuccessfully to rectify the problem with CareFirst (via their Appeal process). My attempts to get CareFirst to correct the date of coverage discrepancy have also been ineffective. CareFirst position now is that the window for appealing has closed and that's that, their decision is final. They continue to refuse to correct the start date of my coverage from Oct 1 to Sep 9th. The way CareFirst is dealing with this matter is not reflective of a company interested in resolving an issue in which it alone is clearly (based upon the documentation and support provided by my company, ***  Inc. and *******************) the only one disputing the documented fact that my coverage started on September 9th and not October 1, 2023. Such a position by CareFirst does not appear to be a company interested in "Better Business", thus the reason for this complaint. BBB assistance in resolving this matter would be greatly appreciated so that provider bills can be paid. Thank you.

  Business Response

  Date: 12/26/2023

  Hello, please see the attached response for ************************* for File number ********. If you have further questions, please feel free to reach out to me directly ****************************************

  Business Response

  Date: 12/28/2023

  Hello, please see my previous response on 12/26/23, without a signed authorization form from the member, we cannot release information to you and therefore will be responding to the member directly. Thank you. 

  Business Response

  Date: 01/04/2024

  As CareFirst previously explained, we cannot release protected health information (PHI) regarding this complaint without a valid authorization to release information to the BBB from the complainant.  We also explained that we would work directly with the complainant to resolve the complaint, which is currently in process.  

  Thank you. 

  *********************, Director

  Executive Inquiry

  CareFirst BlueCross BlueShield

  Customer Answer

  Date: 01/11/2024

  Carefirst status on our claims at this time is that they are still being processed.  Only time will tell if Carefirst will honor or deny our claims.

  Customer Answer

  Date: 02/06/2024

  To whom it may concern:

  Please be advised that I have received receipts from our provider documenting the fact that we no longer own any money on bills for services they rendered prior to Oct 1st, 2023.  Also, please be advised that CareFirst has finally acknowledged that our coverage was valid/in effect prior to 1 Oct 2023.

  Your assistance in resolving this matter with CareFirst was instrumental in enabling a quick and satisfactory resolution to the complaint.

  Thank you very much.

  Sincerely,

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

• Initial Complaint

  Date:11/26/2023

  Type:Service or Repair 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.

  My health insurance - for me and my ten year old son, was improperly and abruptly terminated without notice, on October 01, 2023. I have appealed the decision directly through CareFirst, also through the Health Insurance Marketplace, and am now even seeking out the support of lawyers. We did not deserve to have our health care plan terminated, were improperly notified about the event, and handling of our situation since than has been disorderly, and marked by lack of information and incompetence by the Exchange, throughout in their guidance to me of how to handle the situation. All details of this complaint are described in detail in the attached letter which I have sent to the Health Insurance Marketplace . I have experienced zero accountability to paying customers by CareFirst, and so far in the actions of the Exchange and Health Insurance Marketplace.

  Business Response

  Date: 12/20/2023

  Your letter was forwarded to a CareFirst staff member to investigate, and we contacted the complainant directly.  The complainant advised CareFirst that the issue has been resolved. 

  Customer Answer

  Date: 12/29/2023

  [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

  Date:01/24/2023

  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.

  Every time I talk to a Carefirst Representative I get a different answer. My initial claim for my DXA (Bone Density Screening) exam was declined, the representative I spoke with on December 19, 2022 agreed that it should be covered by the insurance and told me that I was absolutely right but she told me that the provider, ************************* Imaging (***), had filed the claim under Medical instead of under preventive care. I contacted *** and they resubmitted the claim, to no avail. I called CareFirst again on January 6th, I was told that it was hard to label DXA as preventive care even though it appears on this website as such, *************************************************. The representative told me to write a claim to this address in *********, **, **************. I did on January 9th, 2023. This morning I called because I have not heard from them (of course *** keeps sending me the bill), and I was told that I had sent the documents to the wrong address!!! So, now I have to send all the documents again to a KY PO box and wait 45 days to resolve the issue. I find unbelievable that such a big company as Carefirst can get way with such horrible service to its clients and were are left powerless faced with such lack of competency/lies.

  Business Response

  Date: 02/17/2023

  RE: BBB File Number: ********* *** ********
  
  Dear Better Business Bureau:
  
  This letter is to acknowledge the receipt of your correspondence regarding the above
  referenced file.
  
  CareFirst requires a valid Authorization Form for Information Release to provide your office with
  specific details regarding the complaint. Because we do not have that authorization on file, we
  will reply directly to the complainant.
  
  Please be assured that we are working as quickly as possible to provide an equitable
  resolution.
  
  
  Sincerely,
  
  **** ****
  
  **** ****, Sr. Analyst
  CareFirst Executive Inquiry Department

• Initial Complaint

  Date:12/24/2022

  Type:Product Issues
  Status:

  UnansweredMore 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 an out of network mental health professional with over 4 decades of experience. My clients routinely submit their bills to and are the recipient of the reimbursement checks issued by their insurance companyI. Periodically, the insurer send such payment directly to me. My policy upon my clients' request is to deposit such payments and deduct the amount from what they ow, otherwise it might take sometimes months for my clients to receive the payment. I had never had a problem until recently when I received a letter from Care First claiming that they had overpaid me due to an error and demanded the payment of $ ******. They threatened that if I do not send them a check they would refer this case to a collection agency.I wrote them a letter and explained that I only received two checks in 2022 and all the other payments were cashed by my client/their member. One check in the amount of $ ****** dated 02/11/2022 and the second one in the amount of $ ****** dated 07/22/2022/both were deducted from what my client owed me. I also called and had a conversation with one of the representatives/ ****** on December 8th,(ref #**************) who interestingly enough did not seem to have any knowledge of direct payments to me. She said she would get back to me.On December 23rd on my day off while I was feeling very sick due to the side effect of covid shot, I received a call from them using my ************ number, once again harassing me abut the payment. This time, the representative I spoke with kept on repeating the information I provided them with, claiming that they had sent my client the duplicate checks that they sent me, demanding the payment of over a thousand dollars. When I asked for proof, they declined. My client denies the receipt of such payments. I also spoke with a supervisor who insisted that I had cashed a $ ****** check . I asked her to email me the copy .She put me on hold and then changed her story and refused to send me the proof of over-payment.

  Business Response

  Date: 01/13/2023

  Thank you for forwarding the inquiry. CareFirst will respond directly to the Complainant. 

  Customer Answer

  Date: 01/17/2023

  [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 as Answered]
  
   Complaint: ********
  
  I am rejecting this response because: I had a bad experience with them. They are dishonest and unwilling to back their claim by presenting solid evidence. I highly doubt they would provide me with the necessary documents that I need to report them to *********************************. 
  
  
  Regards,
  
  *******************