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Business Profile

Medical Plans

CareFirst, Inc.

This business is NOT BBB Accredited.

Find BBB Accredited Businesses in Medical Plans.

Complaints

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

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CareFirst, Inc. has 3 locations, listed below.

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    Customer Complaints Summary

    • 135 total complaints in the last 3 years.
    • 41 complaints closed in the last 12 months.

    If you've experienced an issue

    Submit a Complaint

    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.

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    Complaint status

    Complaint type

    • Initial Complaint

      Date:11/15/2022

      Type:Billing Issues
      Status:
      Answered
      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 a credentialed provider. They have not paid any insurance claims I have filed. They are not answering claims or credentialing line. I have called as soon as they open and literally 2 minutes later theres a recording that says leave a voicemail and they are busy with other customers.

      Business Response

      Date: 12/26/2022

      Business Response /* (1000, 52, 2022/12/06) */
      ** see attached **

    • Initial Complaint

      Date:10/09/2022

      Type:Customer Service Issues
      Status:
      Answered
      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.
      Filing a compliant for Carefirst Credentialing.

      I have called your credentialing line 10 times over the last month and been led to voice mail each time. I have yet to receive a call back. I cannot find any fax or emails online to contact someone. I need to add providers to my group practice and have no idea how to do this.

      Thank you,
      Gargi
      XXX-XXX-XXXX

      Business Response

      Date: 10/25/2022

      Business Response /* (1000, 5, 2022/10/13) */
      Please see attached.

    • Initial Complaint

      Date:10/06/2022

      Type:Customer Service Issues
      Status:
      Answered
      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 a Dental policy with CareFirst and since 8/29/22 I have been trying to correct the mistake for my date of birth. I have spoken to several representatives after being on a outrageous hold time and still the date of birth is not corrected. However CareFirst wants me to pay the bill but I can not go to the dentist without it being a billing problem. I have sent in all the documents that CareFirst has requested and still no correction has been made. I can't reach a supervisor and I always have to wait for someone to call me back which I have not received the call back yet!!!

      Business Response

      Date: 11/02/2022

      Business Response /* (1000, 5, 2022/10/10) */
      Please see attached

    • Initial Complaint

      Date:09/20/2022

      Type:Delivery Issues
      Status:
      Answered
      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 take a certain prescription medicine as prescribed by my doctor. Suffice it to say that this particular prescription is potentially dangerous to stop suddenly, and in any case, I do not wish to do so as it has been a lifesaver for me. My doctor prescribes me a 90-day supply.

      The issues are that CareFirst BCBS will not, despite my calls, give me more than a 30-day supply. I travel frequently for work, usually for at least a month at a time (and indeed this has become an issue since I will be out of the country for October and November). This is dangerous and unacceptable.

      Worse, CareFirst has told me repeatedly that it is Express Scripts which limits the full but having made many calls to both and having the Express Scripts representative read me the fine print, it does appear that the issue is with CareFirst.

      Business Response

      Date: 11/02/2022

      Business Response /* (1000, 8, 2022/10/04) */
      Please be advised CareFirst is not the Administrator for the Complainant's prescription coverage. As such, the complaint is not against CareFirst. The Complainant should refer to their prescription drug card to determine the Administrator of the prescription coverage.


      Consumer Response /* (3000, 10, 2022/10/05) */
      (The consumer indicated he/she DID NOT accept the response from the business.)
      My original complaint specifically addressed the issue of who is responsible for my prescriptions, it is almost as if they didn't read it. While it is express scripts. Indeed, I contact express scripts and they read me the fine print which clearly states that it is my health insurance which is forcing 30-day supplies instead of the 90 days supply my doctor prescribed. I discovered this after spending hours on the phone with both CareFirst and express scripts. I realize already that their response to this will be to deny that they have any day over the prescription fills but after considerable research into this I believe that the issue does indeed lie with CareFirst (or my specific employer health care which care first administers), and not express scripts.

    • Initial Complaint

      Date:09/19/2022

      Type:Billing Issues
      Status:
      Answered
      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 the CareFirst Blue Dental Preferred plan. I went for a dental cleaning on September 2. The dentist submitted his expenses to CareFirst - which has not paid for any of the charges despite the deductible having been met. I have since tried calling CareFirst Dental 5 times - and have had to spend 6+ hours on hold. I have spoken with two representatives who had no idea how to resolve my issue and put me on another hold during which the connection cut out. I have emailed the customer service team to ask for their inputs on the resolution - but to no avail. I would like to know why the service charges were not paid - there might be a valid explanation, but I have not been provided any thus far. I would like someone from CareFirst to call me / email me with an explanation.

      Business Response

      Date: 10/27/2022

      Business Response /* (1000, 5, 2022/09/22) */
      Please see attached.


      Business Response /* (1000, 7, 2022/09/22) */
      ***Document Attached***

    • Initial Complaint

      Date:09/07/2022

      Type:Billing Issues
      Status:
      Resolved
      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 was told by a blue cross blue shield representative that I would be covered for my phycologist visit completely other than for a 40-dollar copay. I call today to get the process for submitting my claims for reimbursement for the services my psychologist provided and I'm told that I have to meet an annual deductible now that wasn't mentioned at all before. Now I've been charged 725 dollars for services that i won't get any refund for. that's disgusting

      Business Response

      Date: 11/08/2022

      Business Response /* (1000, 60, 2022/11/02) */
      **See attached**

    • Initial Complaint

      Date:09/07/2022

      Type:Product Issues
      Status:
      Resolved
      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.
      Under my Carefirst EPO plan, vision coverage allows an annual payment of $45 towards frames and $52 towards single vision lenses (see 1st attachment for vision coverage details). On 7/25/2022 I paid Physicians Eye Care directly for the frames and lenses (see 2nd and 3rd attachments - receipts) and then filed a claim with Carefirst for reimbursement of the entitled benefit. I received a denial of benefits dated 8/8/2022, indicating the provider was out of network (see 4th attachment). This is incorrect, as this provider is part of the network.

      After several back and forth phone discussions with Carefirst and the vision service they contract with (Davis Vision), I was told I was ineligible because the provider did not file the claim on my behalf with Davis Vision on the actual date of service. They stated it is their policy; however, there is nothing in the coverage details (1st attachment) or on my member card stating this must be done on the ACTUAL date of service (see 5th and 6th attachments - member card). I contacted Physicians Eye Care about filing a claim on my behalf. I was told they are part of the Davis Vision network, but can only file patient claims on the actual date of service. They added that Davis Vision does not allow retroactive claim filing.

      After all this back and forth, the fact remains that I am entitled to the benefits described in the 1st attachment. How does it matter when or how a claim was filed, even if I erred in the manner in which I tried to get the annual $97 reimbursement? I request that Care first resolve my issue in good faith. It's not like $97 is going to break their bank.

      Business Response

      Date: 10/24/2022

      Business Response /* (1000, 5, 2022/09/12) */
      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.


      Consumer Response /* (3000, 7, 2022/09/13) */
      (The consumer indicated he/she DID NOT accept the response from the business.)
      I will not "accept" anything at this point except the requested remedy to my complaint. However, I have responded directly to the Carefirst representative (see attachments) to ask for instructions on how to provide a "valid authorization". Why they need an "authorization" from me to respond to my complaint here is puzzling. I have yet to hear from her.


      Consumer Response /* (2000, 10, 2022/09/13) */
      Update: The Care first rep has since reached out and said I will receive a $97 reimbursement check within the next week or so. Therefore, I "accept" their response.

    • Initial Complaint

      Date:09/05/2022

      Type:Product Issues
      Status:
      Answered
      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 made a claim (Claim # DXXXXXXXXXXX) for reimbursement of COVID tests. I purchased 16 tests and submitted for insurance. I was only reimbursed for half with them saying only 8 reimbursed per month. But it is 8 per individual on the plan, and there are 3 people on my plan (I could have up to 24 covered per month). I disputed this many months ago and have not heard back

      Business Response

      Date: 10/27/2022

      Business Response /* (1000, 7, 2022/09/12) */
      ***Document Attached***
      Please review attached response.


      Consumer Response /* (3000, 9, 2022/09/12) */
      (The consumer indicated he/she DID NOT accept the response from the business.)
      Response unacceptable


      Business Response /* (4000, 11, 2022/09/14) */
      CareFirst is working to review the complaint and will respond directly to the member.


      Consumer Response /* (4200, 13, 2022/09/18) */
      (The consumer indicated he/she DID NOT accept the response from the business.)
      not resolved


      Business Response /* (1000, 17, 2022/09/27) */
      CareFirst is sending a response directly to the customer today via customer's secure email on file regarding the complaint, we are not authorized to discuss or disclose Protected Health Information through the BBB Portal's public site.

    • Initial Complaint

      Date:09/01/2022

      Type:Billing Issues
      Status:
      Answered
      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 dental coverage including orthodontic care with care first. My lifetime max was $1500. I contacted them you make sure the dentist I chose was in their network and they confirmed he was. They only made 2 payments of $996.64 as per what their rep told me. He added that payments are made quarterly and what is left is $503.36. I was later informed but my dentist that they have not paid and what us left to be paid is 850.06 ($503.36 for ortho and $347.24 for recare cleanings on March 3-25-22 and 8-26-22. Note that I did not have any dental work in June and July. I contacted Care first multiple times with no avail. They are refusing to pay even though my premiums were covered. They refused to pay what for services that was rendered when this plan was active. This is cheating! I need Care first to pay what they refused to pay $850.06.

      Business Response

      Date: 10/24/2022

      Business Response /* (1000, 5, 2022/09/02) */
      September 2, 2022


      Heather ******
      Dispute Resolution & Trade Specialist
      *** of ******* ********
      *** S. Sharp **** Suite ****
      ********** ** XXXXX
      *******@greatermd.bbb.org

      RE: Case Number: XXXXXXXX
      Complainant: Vanessa *****


      Dear Heather *******

      This is in response to your inquiry dated September 2, 2022, to CareFirst regarding the above-mentioned case file number.

      CareFirst BlueCross BlueShield has no record of an authorization from Vanessa ***** to release information to your organization. Therefore, a response will be sent directly to the member.

      I hope this information has been helpful in formulating a response to the complainant.


      Sincerely,

      Damiki *****

      Damiki ***** (Miki)
      CareFirst ********* **********
      Senior Analyst Executive Inquiry
      ************@carefirst.com

    • Initial Complaint

      Date:09/01/2022

      Type:Billing Issues
      Status:
      Answered
      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 health insurance through the exchange and and set up through auto pay with my credit card. I received a letter on Aug 15, 2022 stating that my credit card expired and that my health insurance is terminated as of July 31, 2022. My credit card has not expired - nor has it changed. I've called CareFirst and the Exchange multiple times and keep getting the run around. If there was a problem with my credit card, I should have been notified and called in an attempt to pay the outstanding bill. I have the money to pay for health insurance. Carefirst cancelled my health insurance without adequate correspondence to me due to an error on their behalf. They are now reluctant to let me get back into my health insurance plan because it is not open enrollment. I have tried many times to resolve this issue with them, but I am getting nowhere. Please help.

      Thank you

      Mark T *********

      Business Response

      Date: 10/24/2022

      Business Response /* (1000, 7, 2022/09/12) */
      ***Document Attached***
      Please see attached response.

    CareFirst, Inc. is NOT a BBB Accredited Business.

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