Complaints

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

close

Find a Location

CareFirst, Inc. has 3 locations, listed below.

*This company may be headquartered in or have additional locations in another country. Please click on the country abbreviation in the search box below to change to a different country location.

BBB accredited

Near

Country

USUnited States

Please enter a valid location.

Filter

• 

  CareFirst, Inc.

  PO Box 8894 Baltimore, MD 21224-0894

• 

  CareFirst, Inc.

  10455 Mill Run Cir Owings Mills, MD 21117-4208

• 

  CareFirst, Inc.

  PO Box 14114 Lexington, KY 40512-4114

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:08/31/2022

  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.

  My son's doctors and therapists recently recommended getting him ABA therapy in order to help him to learn social and life skills at home and in the school setting. Fortunately, his school provides ABA therapists as part of their therapy clinic which would allow him to have continuity with his school program. At the end of June 2022, my son's therapy clinic applied to Blue Cross Blue Shield Federal (Carefirst) Health insurance for a basic option exemption so that the insurance would cover his ABA therapy as an in-network service. We required this basic option exemption because my son's therapy provider was not yet in-network with Carefirst even though their application for in-network status had been in process for months already.In July, the basic option exemption finally came through which would allow us to engage my son's therapy clinic to provide ABA services to him. Around the same time, the therapy clinic received their approval to be in-network with Carefirst. This required us to change our approach and request a pre-certification for him to be allowed to receive ABA therapy. Unfortunately, after several attempts to make an application by fax and online, we have still not heard back about the status of the pre-certification. This delay is threatening to seriously hinder my son's progress and I am extremely upset that there is no one to either call, email or otherwise.
  Our two pending authorization numbers: ********* and *********

  Business Response

  Date: 10/24/2022

  Business Response /* (1000, 8, 2022/09/07) */
  Good evening. CareFirst will respond directly to the complainant. Thank you.
  
  
  Consumer Response /* (2000, 10, 2022/09/06) */
  Our pre-authorization was just received this morning. I appreciate the prompt response to our complaint and am dismayed by the fact that I was forced to go to such extremes to receive proper service.
  Thank you BBB for providing a forum to resolve issues such as these.

• Initial Complaint

  Date:08/29/2022

  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.

  This year in April 2022 I received a letter informing me that my Carefirst Medplus premium would be increasing. I cannot afford the increase so my daughter called the customer service and was advised that I can change my plan to a lower premium. We were advised to submit a paper application instead of online because the online application would have to go through medical underwriting. It was sent in on June 9, 2022. Ten business days later my daughter called to check on the status and was told that they could not find the application. The application was sent again on June 21, 2022 by fax. On June 31, 2022 we called again to get the status of the application and it still had not been processed and now both applications were on file. I usually pay for my policy a year at a time but in the new application I indicated that I would be switching to monthly and the new policy should begin July 1, 2022 at the expiration of the previous years payment. As of July 2, 2022 the new application was not processed and of upcoming medical appointments, a customer service rep took payment for one month of the previous policy premium as we wait on the application processing. In July I had not had any update, so my daughter called again and the application still had not been processed. At this point we asked to speak with a supervisor and we were advised to fax the application directly to her and she will send it into enrollment herself. July 22,22 another application was faxed into for the third time. As of August 1, 22 and the policy had been changed but the premium amount was still reflecting the old policy cost. I was informed that it would be escalated and I would be contacted in 5 business days. Since Aug 1 my daughter has called 2 times every week and has been told the same thing. My policy was canceled July 24 while waiting for the correction. I have been told that there is nothing that can be done and they would escalate it. Since then I have had to cancel appt with no info.

  Business Response

  Date: 10/24/2022

  Business Response /* (1000, 5, 2022/09/01) */
  September 1, 2022
  
  
  Heather ******
  Dispute Resolution & Trade Specialist
  BBB of Greater Maryland
  502 S. Sharp St., Suite 1200
  Baltimore, MD XXXXX
  *******@greatermd.bbb.org
  
  RE: Case Number: XXXXXXXX
  Complainant: ****** ********
  
  
  Dear Heather *******
  
  This is in response to your inquiry dated August 30, 2022, to CareFirst regarding the above-mentioned case file number.
  
  CareFirst BlueCross BlueShield has no record of an authorization from ****** ******** 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 ***** (Miki)
  CareFirst BlueCross BlueShield
  Senior Analyst Executive Inquiry
  ************@carefirst.com

• Initial Complaint

  Date:08/17/2022

  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.

  I have submitted both the receipts for my COVID purchased at home tests and the attestation forms multiple times to my insurance provider. I received confirmation they received the missing info but no refund since January 2022. I am hoping you can send these attachments to show and ask why they do not want to pay me?. I escalated through their rep who continues to say they need the forms - so after resubmitting both forms 3 times, I am asking if BBB can help with my refund - since it is Aug and this was a USA law put into place in January when I purchased COVID tests Thanks
  
  
  

  Business Response

  Date: 10/25/2022

  Consumer Response /* (4200, 10, 2022/08/31) */
  No update from my insurance company on the refund for COVID tests per the US government law.
  
  "The claim has been escalated to management. They are working on processing the claim but it's still being worked on." was the response from the insurance company - I guess it takes management to examine a simple refund????????
  
  Why do insurance companies get to do this with no fine or extra customer service?
  
  
  Business Response /* (4000, 21, 2022/10/19) */
  Please see the attached document. Thank you.
  
  
  Consumer Response /* (2000, 23, 2022/10/20) */
  (The consumer indicated he/she ACCEPTED the response from the business.)
  the INSURANCE COMPANY paid me as they are REQUIRED BY LAW - it is a SHAME that the USA insurance companies do not follow the law unless each and every person in the USA files a complaint and follows up constantly and still wait 8 months for them to do what they MUST DO PER THE LAW! INSURANCE COMPANIES ARE RIPPING EVERYONE OFF

• Initial Complaint

  Date:08/15/2022

  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 been trying to get in touch with someone regarding pre-authorization for my son. The provider has called several times and we have both waited on hold for over an hour to get no where. As I'm typing this I have been on hold and have not yet talked to a single person for an hour. Their lack of customer support is preventing my son from receiving the care he needs.
  

  Business Response

  Date: 09/15/2022

  Business Response /* (1000, 5, 2022/08/19) */
  We will contact and respond to the member directly.
  
  B.****
  CareFirst BlueCross BlueShield

• Initial Complaint

  Date:08/11/2022

  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.

  I am a mental health services provider. Claims are rejected every time I submit on behalf of my clients. I have contacted Carefirst by phone and attempted numerous times to contact Carefirst's NPI support email in order to have Carefirst recognise my NPI so that claims will be accepted into adjudication system for processing. The representative I spoke to was rude and unhelpful. I have mailed and faxed my NPI submission form to Carefirst BCBS Provider Information and Credentialing Department. I haven't received any correspondence or reply. I also spoke with a representative at CAQH, who advised me that Carefirst is able to access my profile through CAQH in order to verify my NPI. Carefirst is the only insurance company that presents this obstacle for providers and members which is deeply troubling. I have been hesitant to file this complaint but I see no other option as I am consistently ignored.
  

  Business Response

  Date: 08/31/2022

  Business Response /* (1000, 5, 2022/08/17) */
  CareFirst will respond directly to the Complainant. Thank you.
  
  
  Consumer Response /* (2000, 7, 2022/08/17) */
  (The consumer indicated he/she ACCEPTED the response from the business.)
  I look forward to a timely response. Thank you.

• Initial Complaint

  Date:07/27/2022

  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 was told on 4/29/22 a service did not require a pre-authorization. I had the service. Now I'm getting an explanation of benefits from CareFirst stating the claim was denied because there's no pre-auth on file. I have spent 3 days along with my provider's office making phone calls & being bounced around from CareFirst, to AIM (pre-authorization 3rd party company), Florida Blue, Maryland Blue Cross Blue Shield, etc. This is a waste of multiple hours of my time & my provider's time trying to get the pre-auth backdated. Nobody can help me and they are so quick to transfer me to various departments to get me off of their phone line. On 7/25/22 Anna at CareFirst said my provider needs to send documentation to AIM - phone # 844-***-****. Reference # ************. ********* *. at AIM states the CPT code that was billed (*****) is not in their system so they're not able to do a pre-authorization and that it needs to go through CareFirst. My provider's office called CareFirst (I live in Florida, my doctor's office is in Florida, my insurance is based out of Maryland because it's through my husband's job which is based in Maryland). On 7/26/22 Amanda at CareFirst gave me the phone number 866-***-**** for BCBS pre-authorization department, reference # ************. My doctor's office called this number and they said it needs to go through the local BCBS. My doctor's office was transferred to another line and then hung up on. On 7/27/22 I called the local Florida BCBS 1-800-***-**** and spoke with the claim status department who wouldn't let me finish speaking - I had to raise my voice and insist that they let me fully explain my situation before they transferred me off of their line. They transferred me to the Florida Blue Pre-Auth department at 800-955-5692, option 2, option 4, and option 8. They were closed for training. 7/27/22 called the pre-auth back after they reopened, and was told it needs to go through the local in Maryland. I keep getting bounced back and forth.
  

  Business Response

  Date: 08/31/2022

  Business Response /* (1000, 5, 2022/08/01) */
  Hi Ms. ******,
  
  This is a response to your inquiry received on 7/29/21 regarding **** ******.
  
  CareFirst BlueCross BlueShield has no record of an authorization from Mrs. ****** to provide the Better Business Bureau with information regarding the inquiry; therefore, a response will be sent to the member.
  
  I hope this information is helpful.
  
  Sincerely,
  
  Donna *********-*****
  Analyst,******************* **
  
  
  Consumer Response /* (3000, 7, 2022/08/03) */
  (The consumer indicated he/she DID NOT accept the response from the business.)
  This is not accepted. I am giving authorization to CareFirst to release a response to the Better Business Bureau. I would have thought that the fact that I sent this to the BBB would have made that obvious. Please send this back to CareFirst showing them they must provide information to both the BBB and me. Thank you.
  
  
  Business Response /* (1000, 11, 2022/08/11) */
  
  Hi Ms. ******,
  
  This is a response to your inquiry received on 8/4/21 regarding **** ******.
  
  Mrs. Porter authorized CareFirst to provide the BBB with information concerning her claims inquiry for date of service 6/3/22.
  
  ***. ****** requested to obtain a backdated pre-authorization.
  
  On 6/13/22, CareFirst received claim ************ for date of service 6/3/22 from provider, Quest Diagnostic Clinical Laboratory in the amount of $361.09.
  
  On 7/7/22 CareFirst processed the claim, the allowed benefit was $25.48, CareFirst paid $25.48, and the amount of $169.85 was denied 3SP - Claim denied because required pre-authorization is not on file. The member liability was $169.85.
  
  Upon receipt of the inquiry, CareFirst reviewed the claim and overturned the denial of Current Procedure Terminology (CPT) code *****.
  It has been determined for future reference that CPT code ***** does require a pre-authorization.
  
  On 8/8/22, CareFirst adjusted claim ***********1 in the amount of $169.85 that was previously denied. The allowed benefit was $31.59, CareFirst paid $31.59, and the member has a $0.00 liability.
  
  If you have any additional questions, feel free to contact me at (410) ***-****.
  
  
  
  
  
  
  
  
  
  
  
  
  I hope this information is helpful.
  
  Sincerely,
  
  Donna Blackwell-Brown
  Analyst, Inquiry Management Sr

• Initial Complaint

  Date:07/25/2022

  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 work for an orthopedic practice and as a precertification coordinator. I have been trying to reach a representative at Care First since 6/29. Every time I call, I am on hold for 2 hours then get disconnected or no one EVER picks up. I have also faxed the pre cert requests to care first at the fax # listed on the pre cert request form and received successful transactions yet no response. This is absolutely absurd and patients who have this insurance are going to have delays in care because your insurance company doesn't respond or answer any provider calls regarding authorizations or just to see if auth is even required!

  Business Response

  Date: 10/31/2022

  Business Response /* (1000, 17, 2022/10/04) */
  ** See attached**

• Initial Complaint

  Date:07/23/2022

  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 been protesting an adverse decision on my insurance reimbursement for Focal Laser Ablation of Adenocarcinoma of the Prostate. I requested that CareFirst Re-evaluate their position that this procedure is investigational, since it has been done thousands of times in the last 30 years with excellent results and very minimal side effects, especially when compared to surgical procedures such as Prostatectomy. Instead, they sent the case for review by MCMC who recommended denial of the claim based on supposed "evidence" in references which mostly dealt with HIFU (High Intensity Focused Ultrasound) which is an entirely different procedure mostly used for partial gland ultrasound ablation. In their denial letter dated June 1, 2022, which I received on June 3, 2022, they demanded that I supply them with any additional information regarding my claim by June 6, or they would make a final decision. Since June 5 and 6 were a weekend, and I was away I did not read this letter until I returned late on June 5. I faxed them a request for more time, but on June 6, they send a Notice of Grievance decision. I believe that giving me zero business days to reply is and unreasonable business practice and frankly disrespectful as well. I have since sent them several letters complaining about this situation and have contacted the Maryland Insurance Administration regarding this situation and they are currently processing my complaint.

  Business Response

  Date: 10/27/2022

  Business Response /* (1000, 8, 2022/08/25) */
  ***Document Attached***
  
  
  Business Response /* (1000, 9, 2022/08/25) */
  CareFirst will respond via letter which will be forwarded to the Dispute Resolution Leader in an email. Thank you.
  
  
  Consumer Response /* (3000, 11, 2022/08/25) */
  (The consumer indicated he/she DID NOT accept the response from the business.)
  CareFirst never contacted me for permission to share its response with the BBB. Had it done so I would gladly have given it. This is just another attempt at hiding their poor business practices behind a privacy curtain when it has nothing to do with healthcare, only poor customer service.
  
  
  Business Response /* (4000, 15, 2022/09/09) */
  Member was contacted on 9/1/22 via email and advised that the complaint was being reviewed and he would be contacted directly.
  
  Member was contacted via email on 9/6/22 and was advised of CareFirst's actions regarding the complaint.
  
  
  Consumer Response /* (4200, 17, 2022/09/11) */
  (The consumer indicated he/she DID NOT accept the response from the business.)
  I received an email saying that they were preparing a response but I have not as yet received any communication from them.
  
  
  Business Response /* (4000, 19, 2022/09/12) */
  Please see attached. Will resend response to customer via email.
  
  
  Consumer Response /* (4200, 21, 2022/09/13) */
  (The consumer indicated he/she DID NOT accept the response from the business.)
  I have already authorized CareFirst on two separate occasions to share any and all information relative to this complaint.
  
  I hereby authorize CareFirst to share any and all information necessary to resolve this complaint.
  
  Don ******. 9/13/2022
  
  
  Business Response /* (1000, 25, 2022/09/22) */
  CareFirst is validating the authorization submitted by the customer with our privacy office and has responded via email directly to him with this advisement. An additional response will be sent to the customer as two responses have been sent with the information pertaining to the complaint to the email on file.
  
  
  Consumer Response /* (3000, 27, 2022/09/22) */
  (The consumer indicated he/she DID NOT accept the response from the business.)
  I have not reverted any correspondence from CareFirst regarding this complaint and have sent them an email authorizing them to access any data necessary to respond to this matter and resolve my complaint.
  
  
  Business Response /* (4000, 29, 2022/09/27) */
  Email was sent to the customer to the email address on file with CareFirst. Member has responded to this email prior. Privacy authorization form and all complaint related documents were attached in this email which was sent on 9/23/2022 3:33 PM. Additional advisement regarding CareFirst's current actions are contained within referenced email.

• Initial Complaint

  Date:07/21/2022

  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.

  January 1, 2022 a new company took over processing authorization for BC/BS on patients that require it. Prior to January authorizations would be back within 5 days. Now it is taking 8-12 weeks, which is effecting our patients and our business. I have spoken to several representatives and have sent a certified letter of the issues in hand with no response.
  

  Business Response

  Date: 08/25/2022

  Business Response /* (1000, 5, 2022/07/25) */
  July 25, 2022
  
  
  ******* ******
  Dispute Resolution & Trade Specialist
  BBB of Greater Maryland
  502 S. Sharp St., Suite 1200
  Baltimore, MD 21201
  [email protected]
  
  RE: Case Number: ********
  Complainant: ****** ********
  
  
  Dear ******* ******:
  
  This is in response to your inquiry dated February 7/22/2022, to CareFirst regarding the above-mentioned case file number.
  
  CareFirst BlueCross BlueShield has no record of an authorization from ****** ******** to release information to your organization. Therefore, a response will be sent directly to the complainant.
  
  I hope this information has been helpful in formulating a response to the complainant.
  
  
  Sincerely,
  
  Damiki *****
  
  Damiki ***** (****)
  Senior ******* ********* *******
  CareFirst BlueCross BlueShield
  ************@carefirst.com