Complaints

This profile includes complaints for Highmark Blue Cross Blue Shield Delaware'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 Delaware

  800 Delaware Ave Ste 900 Wilmington, DE 19801-1368

• 

  Highmark Blue Cross Blue Shield Delaware

  PO Box 1991 Wilmington, DE 19899-1991

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:12/12/2024

  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.

  Highmark BCBS Delaware has wrongfully denied payment for my children's lead and anemia screening blood tests by misclassifying them as "diagnostic" rather than "preventive" care.
  
  These blood tests were:
  1. Explicitly covered at 100% pre-deductible in our plan documents
  2. Performed at an in-network facility (Children's Hospital of Philadelphia)
  3. Recommended by our physician as routine screenings
  4. Mandated to be covered under ACA § 2713(a)(3)
  
  I filed an appeal on 11/1/2024, which Highmark denied on purely administrative grounds, claiming the ICD-10 coding classification exempts them from payment. This appears to violate both our plan terms and Federal Law. This also appears to meet the definition of insurance fraud under Delaware Administrative Code Title 18, § 2407(c).
  
  I request immediate investigation into this practice, which effectively denies families access to legally mandated preventive care through administrative technicalities.

  Business Response

  Date: 12/17/2024

  Response attached

  Customer Answer

  Date: 12/21/2024

  Better Business Bureau:
  
  
  I have reviewed the response made by the business in reference to my complaint and have determined that this does not resolve my  issue.  For your reference, details of the offer I reviewed appear below.
  I have confirmed with both our provider and the billing department at CHOP that the tests were coded appropriately. The preventative screening tests my children underwent on 7/9/2024 are covered per my policy.The Affordable Care Act mandates that health insurers pay for children's preventative healthcare, including the tests that my kids underwent (lead and anemia screening).The presence of an ICD-10-CM code in the billing submission from CHOP does not intrinsically make a test "diagnostic." Anyone who is appropriately trained in coding and billing would know this. Furthermore, page 81 of our member benefits guide specifically states that "diagnostic" tests are covered as well, as long as they are done for the purpose of prevention.Please read my appeal.
  
  Regards,
  Complaint ID: 22678534
   
  
  
  
   

  Business Response

  Date: 01/10/2025

  Response attached

• Initial Complaint

  Date:11/07/2024

  Type:Product 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.

  9/1/2024 I contacted HIGHMARK BCBS OF DELAWARE to get medical, vision, and dental insurance coverage. I was on Medicare and a new job so I had to get my own insurance. I was told coverage would start immediately once paid ($1,086.43). I cannot get covoerage ofr my kids through my employer. I was also told if I cancelled the plan within a few days I would receive a refund. The next day I contacted Medicare and they informed me my kids and I were still covered. So, I cancelled the plan the next day 9/2/2024. The customer service rep said it may take a couple weeks to get my refund. The plan and/or services was never used. However, it has been several months and I would like my full refund.

  Business Response

  Date: 11/13/2024

  Please see attached response.

  Customer Answer

  Date: 11/14/2024

  Better Business Bureau:

  
  

  I have reviewed the response made by the business in reference to my complaint and I will give another month for my resolution. I want to be made whole. That's all. If I do not receive the refund by December 1st 2024, I will reach out to the BBB once again. That will made the refund timeline over 90 days. Thank you for the status update BBB? BCBS.

  
  

  
  

  
  

  
  Regards,
  

  
  

  
  

  Complaint ID: 22526049
  
  

  
  

  
  

  
  

   

  
  

   

  
  

   

• Initial Complaint

  Date:08/05/2024

  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’m covered by Medicare as primary insurer. I purchase BCBSDE Suplemental as secondary that carries a deductible amount. I’m also covered by a 3rd BCBSDE State of DE plan with zero deductible. Lately, BCBSDE has sometimes failed to apply the SDE zero deductible plan to some of the provider bills which leaves me getting billed from providers for amounts that should be coved by the State of DE plan. I cannot get BCBSDE to explain why this occurs or how to prevent it from occurring going forward. It’s been taking much time trying to resolve the issues when they occur. I want this problem resolved once and for all going forward.

  Business Response

  Date: 08/23/2024

  Please find attached response.

• Initial Complaint

  Date:06/15/2023

  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.

  My wife, *** ******, had a stroke in Maui, Hawaii. She was admitted on July 9, 2022. The hospital required a medical transport service (serviced by MM Transport on July 15, 2022) to take her back to Delaware.
  
  I submitted a claim on July 31st 2022. BCBS repeatedly asked for information and I promptly provided all information they need. The claim is almost one year old and BCBS still doesn't resolve it. They don't even acknowledge the claim on their website.
  
  It appears to me BCBS purposely drags on the investigation so I will get frustrated and give up the claim. I called today (June 15, 2023), the operator told me she can't find my claim and won't let me talk to her supervisor.
  
  Please help me resolve the problem with BCBS. I want BCBS to reimburse for the charge by MM Transport to transport my wife from Hawaii. If BCBS rejects the claim, I want them to provide me the reasons.
  
  I also attached a file with details about the case. You can contact me at 3*********** ** **********************om.
  
  Thank you,

  Business Response

  Date: 08/07/2023

  See attached response that was initially sent last month via email.  I apologize for the inconvenience.

  Customer Answer

  Date: 08/08/2023

  Better Business Bureau:
  
  
  I have reviewed the response made by the business in reference to my complaint and have determined that this does not resolve my  issue.  For your reference, details of the offer I reviewed appear below.
  **In order for the bureau to continue to assist you, you MUST provide your view on the matter or your complaint will be closed as answered.
  Hello,HighMark's letter is an acknowledgement of the complaint, not a resolution.  I received at least 5 earlier acknowledgements, but no resolution before.Regards,
  
  Regards,
  Complaint ID: 20192099
   
  
  
  
   

• Initial Complaint

  Date:01/30/2023

  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 used to attend Pivot physical therapy following a long stay in the hospital. I would have to call weekly to make appointments as Pivot would say they needed to call my health insurance (Highmark BCBS) to get authorization before they could book my appointments. The last appointment I had in October 2021 I was told it was my last appointment because my health insurance would no longer cover future appointments. I am now receiving bills in the mail trying to bill me for the dates of 8/23/21 and 10/6/21 saying I didn't have coverage on those dates. That is not possible because Pivot always called Highmark to get approval BEFORE scheduling my next appointments. I called Highmark to tell them how silly this was, how could I be covered on days past 8/23/21 but somehow not covered on August 23rd? Same thing with my 10/6/21 appointment. I know Pivot would always call before making my appointments because it took longer to book an appointment but it made sense. Highmark is still denying the claims so now I need more help because highmark told pivot at the time of service that those dates were covered, now months later they've gone back on that.

  Business Response

  Date: 02/03/2023

  See attachment

  Customer Answer

  Date: 02/11/2023

  Better Business Bureau:
  
  
  I have reviewed the response made by the business in reference to my complaint and have determined that this does not resolve my  issue.  For your reference, details of the offer I reviewed appear below.
  It literally makes 0 sense.. that you denied the claim on 8/23/21 saying there were no more therapy sessions, but then covered the claims from 8/30/21--10/4/21. And then you denied the claim on 10/6/21 saying there were no more therapy sessions but approved the session on 10/8/21. How can you say you won't cover those two dates because I ran out of sessions but then you continued to cover more sessions after those two dates? 
  
  
  
  
  Regards,
  Complaint ID: 18953091
   
  
  
  
   

  Business Response

  Date: 03/01/2023

  Please see attachment for response