Complaints

This profile includes complaints for CareFirst, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  CareFirst, Inc.

  PO Box 8894 Baltimore, MD 21224-0894

• 

  CareFirst, Inc.

  PO Box 14114 Lexington, KY 40512-4114

• 

  CareFirst, Inc.

  10455 Mill Run Cir 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:01/23/2023

  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 had simply sought to transfer my dental coverage from yearly to quarterly. There was no obvious way to do this online, to my surprise. I called, and they gave me a form to fill out, from an obscure location. I filled out form, and faxed it to them. The form made it obvious and clear, that the one and only change, was to change from yearly to quarterly. Since then, I have received virtually no proper response. I called up because I hadn't received the new quarterly bill, and they said concerns would be escalated. In meantime, I paid the quarterly amount. I DM'ed Carefirst directly, on topic, as well. As of now, they claim the Dental was "terminated" even though I had paid the quarterly, and doing this is a ready option, despite it not being an "online" option for no obvious reason. I therefore cannot schedule a dental appointment, despite apparently doing everything correctly, and certainly not receiving any proper response otherwise.

  Business Response

  Date: 03/09/2023

  March 9, 2023
  
  Reference: Consumer Info: 18935825
  
  Dear Dispute Resolution Team:
  
  Our apologies for the delayed response.
  
  This letter is to acknowledge the receipt of your correspondence regarding the above referenced file.
  
  CareFirst requires a valid "Authorization Form" in order for us to release specific details regarding customers' complaints. 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,
  
  ***** ********
  
  ***** ********
  Executive Inquiry Manager
  

• Initial Complaint

  Date:01/13/2023

  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 have been trying to collect from CareFirst Blue Cross Blue Shield on a medical claim for services provided on August 9, 2022. I have called Care First five times (once a month) and the company has not resolved my issues. The claim of $879 for lab tests is still pending. The claim for the Doctor's office visit of $581 still does not even appear to be entered into the system. I have submitted the documentation to show that my provider does not participate in Medicare so CareFirst as my secondary should reimburse a portion of these bills. This has been the practice in prior years. I have filed two complaints with CareFirst and have received no response.

  Business Response

  Date: 02/24/2023

  Hello, please see attached response regarding BBB ********.

• Initial Complaint

  Date:01/13/2023

  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.

  Carefirst BlueCross Blueshield's incompetence has made me unable to change my dentist since he retired. I've tried so many times to use what they call "self service" on their website to change to another dentist in my network. The self-service doesn't work, and their IT department admitted it. Their message portal doesn't work, and just gives error messages, so I can't get in contact with anyone that way. Also, nobody picks up the phone on the customer service line. It will literally just play music for hours. The lack of competence is mind-boggling, particularly when you take into the fact that this involves a medical issue. I'll have no other choice than to contact a lawyer for services not provided if they do not solve my issue promptly. Thank you
  
  *********** ****

  Business Response

  Date: 02/24/2023

  Please see attached response.

• Initial Complaint

  Date:12/30/2022

  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 not received a bill for January 2023 coverage, and no bill is showing on my account. I want to make sure I maintain my coverage.

  Business Response

  Date: 01/11/2023

  January 11, 2023
  
  
  Name:BBB of Greater Maryland
  Address:502 *************************., Suite 1200
  *********, ** 21201
  
  
  RE: BBB File Number:36197913 - *****************************
  
  Dear:Better Business Bureau,
  
  This letter is to acknowledge the receipt of your correspondence.
  
  CareFirst does not have a valid authorization on file from the complainant to provide a response to the Better Business Bureau. We will reply directly to the complainant.
  
  Please be assured that we are working as quickly as possible to provide an equitable resolution.
  
  Sincerely,
  
  
  ****************************************
  
  
  CareFirst BlueCross BlueShield
  Senior Analyst, Executive Inquiry
  

• Initial Complaint

  Date:12/30/2022

  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.

  I have CareFirst dental insurance under an individual policy, CareFirst has not paid a claim for me for the past 2 years because they keep saying I have other dental insurance which needs to pay first. I do NOT have any other insurance. The other policy that I have through my husband's company expired on July 3, 2020. I have provided proof of this to CareFirst many times over. I have tried the customer service phone number and have sent numerous emails through their portal but no luck at all. I have sent a long letter with supporting documents to the office in ******** that handles claims and have received no resolution. All I get are emails back asking me to "complete the attached coordination of benefit form" which I have done and submitted NUMEROUS times!! In my letters and emails I have asked for the situation to be corrected and an audit done of all my claims since July of 2020.I have attached the letter and supporting documents that I sent to CareFirst.I would appreciate any assistance that you can give me in resolving this matter.*************************.

  Business Response

  Date: 01/09/2023

  January 9, 2023
  
  
  ***************************
  Dispute ****************** Practices Specialist
  BBB of Greater Maryland
  502 *****************************, Suite ****
  *********, Maryland *****
  
  Re: Member Name: ***************************
  Identification Number: 903556267
  Complaint Case #: BBB-36197947
  
  Dear ****************:
  
  This letter responds to your inquiry concerning the member and case number cited above.
  
  **************** is enrolled in a fully insured BlueDental Preferred policy. The **** number is *****, and the policy is not grandfathered.
  
  We are committed to protecting the confidentiality of members and their information. In accordance with Privacy Regulations, Personal Health Information (PHI) can be released only upon receipt of written authorization from the member or designated representative.
  
  We will work diligently to resolve the matter and reply directly to the Complainant.
  
  If further assistance is needed, please contact me at **************************************
  
  
  Sincerely,
  
  
  *******************
  ************************ Analyst
  CareFirst Executive Inquiry Department
  
  

• Initial Complaint

  Date:12/28/2022

  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.

  Service Date: October 27, 2021 Service Provider: ***************************** Address: ************************************************ I was quoted by a CareFirst representative that 3 pairs of orthotics was covered under my insurance. So my doctor ordered the 3 pairs. After the bill was submitted to CareFirst I find out that I was misquoted. I explained to the representative that the liable should not fall on me as a patient. I have been going back and forth with CareFirst for over a year. All of EBO (Explanation of Benefits) state that I do not have a patients responsible.The total amount was $1020 and only $260.52 has been paid to date. I would like CareFirst to pay the remaining balance. I have been paying on the bill because I don't want the balance to go to collections and harm my credit. I have not filed a claim before now because CareFirst kept telling me that everything has been taken care of. Attached is a copy of my EBO and a bill from my chiropractor.

  Business Response

  Date: 02/06/2023

  February 6, 2023 
  
  
  Better Business Bureau of Greater Maryland   
  Attention: ***************************;
  Dispute Resolution Team Leader 
  502 *************************., Suite 1200 
  *********, ** 21201 
  
  
  RE: BBB File Number: 18935724 
   
  
  Dear *****************************: 
  
  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, 
  
  ***************************;
  
  ********************************************;
  CareFirst Executive Inquiry Department 

  Customer Answer

  Date: 02/07/2023

   
  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:12/15/2022

  Type:Customer Service 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.

  12/15/22 Care First made a typo in my birth year resulting in it being listed as 1988 instead of 1998 in their systems. This error on their part led to me being denied care by my dentist because they could not verify my insurance. When I attempted to contact Care First to correct the mistake they made it very difficult to contact a real person and when I finally did get ahold of an agent they insisted there was nothing that they could do to fix it. The result is that I had to cancel my appointment and likely won't be able to see my dentist until next year. At this point they have still refused to correct my birth year in their systems and none of the representatives I spoke to offered a solution or a workaround. I am requesting an apology from Care First for their mistake which resulted in me being denied care. I am also requesting a refund of all payments made from October 1st, 2022 onwards, as the data was incorrect in their system this entire time, which resulted in me being denied care and the plan I paid for being completely inaccessible and useless during this time.

  Business Response

  Date: 12/27/2022

  Case #: ********
  
  
  
  Dear Dispute Resolution Team:
  
  
  
  Our apologies for the delayed response.
  
  
  
  This letter is to acknowledge the receipt of your correspondence regarding the above referenced file.
  
  
  
  CareFirst requires a valid "Authorization Form" for us to release specific details, regarding our customer's complaints. 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,
  
  
  
  Terea M*******
  
  Executive Inquiry Manager
  

  Customer Answer

  Date: 01/03/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  
  CareFirst has made no attempt whatsoever to resolve my complaint and my plan is still effectively useless. They said "we will reply directly to the complainant." This is not true as I have received no correspondence from CareFirst whatsoever, emails and phone calls go unanswered. We are seeking a full refund of all payments submitted to CareFirst and will be cancelling our plan as soon as possible.

• Initial Complaint

  Date:12/15/2022

  Type:Product 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 provided CF BCBS with written proof that reimbursements totaling $189.93 were due me from prescription check reimbursements during a time period I was moving, and therefore unfortunately not cashed. I was initially told to write to Carefirst, with a cover letter and copies of the uncashed checks. They later claimed to have difficulty locating this, but eventually located it in their system. I was also told to fax them, after they had more difficulties following up. About a year ago, I was told the check reimbursements were in process of being sent. (Something about it going through their Kentucky HQ) They never were received from CF BCBS. Given the lateness of Carefirst's actions, and varied inability to address the clear requests made for over a year (which I followed their agents' specific requests for this), I request the reimbursement/reissuance of said checks, plus approximate interest charges of $50 over the time period (which I was willing to waive, had they responded correctly), for a total of $239.93.
  

  Business Response

  Date: 01/16/2023

  Business Response /* (1000, 7, 2022/12/27) */
  ***Document Attached***

• Initial Complaint

  Date:12/13/2022

  Type:Product 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.

  Several times this year (as early as February) I have been to several different doctor's offices and had an experience where I hand my carefirst insurance card to the receptionist and am told that my insurance is not active. I then insist that my insurance is active, and the receptionist is usually kind enough to personally reach out to carefirst by phone to confirm that it is indeed active. I've called carefirst in August to confirm if everything is okay on their end, and I think we even had a new insurance card mailed to me. I'm still experiencing the same issue. Today, I went to another doctor's office (new one) and again, my card was declined and needed a follow up phone call to carefirst directly. I also called carefirst today to confirm if my insurance is active, but I've been led on enough in life to know that I need to escalate this to BBB since I feel like carefirst will not do anything to correct this without some action from BBB. Please help me to make sure I never experience this again. Like I said, several different doctor's offices have had the same problem, so I do not believe that it's possible this is a problem on the doctor office end. This is clearly a carefirst problem. Please help me. My only other option that I can think of is to cancel my insurance, and then restart it as a new case file.

  Business Response

  Date: 01/03/2023

  Business Response /* (1000, 5, 2022/12/16) */
  Contact Name and Title: L ****,Sr Inquiry Analyst
  Good afternoon, Heather,
  Please see attached response.

• Initial Complaint

  Date:12/01/2022

  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.

  CareFirst is not covering my claims even though it approved a special case agreement under which they agreed to pay the claims. I see a mental health therapist who is out of network, and CareFirst approved the special case agreement so my biweekly appointments with him would be covered. However, CareFirst has repeatedly denied my therapist's claims. I have called multiple times and each time after very long waits and unhelpful customer service agents have been told each time that the special case agreement is not being included when the claims are being submitted, and that it must be attached and sent along for readjustment. Though they know this is the problem, they have done absolutely nothing to address it, and I am left to pay some 900 dollars in bills when I am supposed to only be paying a 30 dollar copay, which I have continued to pay directly to my therapist.

  Business Response

  Date: 01/19/2023

  Dear ******* ******-
  
  
  
  This complaint has also been received from the Maryland Insurance Administration (MIA). We responded directly to the MIA with our findings. THe case was resolved and the MIA closed the case on 1/18/2023.
  
  
  
  Respectfully,
  
  
  
  Brian C. K**** ****