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.

  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:12/09/2024

  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 have been with Carefirst more than 10 years with the same insurance policy and coverage. All the blood tests I did were always covered in the past (12/19/2022 and 10/1/2021 etc). On 11/07/2024, I did my annual blood test again, same as the prior years (please see attachments). However, most of the items on this blood Lab test were denied this year. The current bill is $989.39.I have contacted Carefirst twice on 11/25/2024, appeal a claim and called agent ***** (Case#: Case# ************). ***** stated that my insurance policy now excludes lots of blood work items. However, I never received any notification from Carefirst that my policy was changed and excluded lots of blood work. This dishonest action caused me to have a tremendous medical bill of $989.39. ***** asked me to send appeal to *********************************************************************** for another review and I did it on 11/26/2024. No response from Carefirst so far. I already received the invoice from ******* and asked me to pay the bill. I need Carefirst to clarify the issue and change this claim statement as soon as possible.

  Business Response

  Date: 12/15/2024

  Hi *******,

   

  Please see the attached document.

   

  Kind Regards

  Customer Answer

  Date: 12/21/2024

  The issue is not resolved yet. ******** replied and stated they will review it within 60 days while ******* keep asking for the balance. I will reopen this compliant if the result is not satisfied. 

  Thanks BBB.

  Customer Answer

  Date: 01/13/2025

  To whom may concern,

  I am not satisfied the resolution from Carefirst. Please see the attachment for the updates.

  Regards,

  Chefang Mo

  Business Response

  Date: 01/14/2025

  Please see the attached response.

• Initial Complaint

  Date:12/05/2024

  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.

  To Whom It May Concern, I am writing to file a complaint against CareFirst BCBS of Maryland regarding their excessive delays in processing credentialing applications for healthcare ************ a business owner operating a mental health practice in Maryland, I rely on timely credentialing to provide services to clients who depend on CareFirst insurance coverage. I submitted two credentialing applications on 7/1/24 and provided all requested documentation promptly. These applications were "lost." We reapplied on 8/21/24, one application finally was processed after hours of calling and the other was never started. Despite following up multiple times and ensuring compliance with all requirements, the application has not even been started, this far exceeding industry standards, as ***** and ***** take 30 days or less.This delay is causing significant challenges for my practice, including financial strain on providers, frustration and confusion of clients who have CareFirst coverage and are not having claims filed. These delays disrupt the hiring and on-boarding process for new therapists, as credentialing is a critical step in doing their job and being paid.I have made numerous attempts to contact CareFirst to resolve this issue, including calls on 8/21, 9/19, 9/20, 10/8, 11/1, 11/15. Our providers have also made hours worth of calls. These calls have promised escalations to supervisors ****** ******* and ******* *****, neither have contacted us. The lack of efficiency in CareFirst's credentialing process is unacceptable. Directly impacting the quality and accessibility of care for their members. I respectfully request that CareFirst expedite our application and implement measures to improve their credentialing process to ensure timely and transparent handling of provider applications in the future.Thank you for your attention to this matter. Sincerely,***** ******, LCSW-C ******* Clinical Director Insight Wellness of Maryland, LLC.

  Business Response

  Date: 12/10/2024

  Dear ******* ******-

  We will have our Provider Information & Credentialing area contact ***** ****** to help resolve her credentialing concerns. All communications forward will be between CareFirst and ***** ******.

  Regards,

  ***** C. ****, ****
  Pronouns: he/him/his
  Senior Analyst
  Executive Inquiry | **************** of Civil Rights
  CareFirst BlueCross BlueShield
  ***********************************;
  *******************
  Working Remotely: M-F, 8am-5pm
  We work flexibly at CareFirst. I am sending this email
  now because it works for me, but I don't expect that 
  you will read, respond to, or act on it outside of your
  regular business hours.
  

  Customer Answer

  Date: 12/16/2024

  We have received ZERO communication from CareFirst, they have not called nor emailed. Please keep this open and can you reach back out to them. This is so unacceptable.

  Business Response

  Date: 01/20/2025

  Our records indicate that ****** ******* of our Provider Information & Credentialing area contacted ***** ****** on 12/17/2024 via email advising credentialing status. Any additional questions should be directed to ****** *******.

• Initial Complaint

  Date:12/04/2024

  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.

  Carefirst has not reimbursed nearly the entirety of prescriptions for the past 6 months (May through October 2024). This issue is something I have to get resolved through extraordinary methods every few years. These are supposed to be reimbursed at 80%. So approximately $275 X .8 =$220. This is part of my coverage, for reimbursing out of pocket medical related items. That's also why there's a prescription "maximum" per year. I spoke with Carefirst over the phone, after using the portal a few times, and explaining the same thing. The "portal" people are either done by AI, or by people, who are doing impressions of being AI. On the phone, I was assured that it would be resolved, and remedied. Then I get an DM from the portal, which says the same thing as before, which makes no sense. Getting paid what's already owed, is insufficient, since Carefirst Blue Shield is now doing this semi-regularly, and intentionally, even if incompetent, the incompetance is intentional. I also have sent the *********, ******** address, at the cost of a few dollars postage., making copies of everything. I am requesting no less than $500, or about twice the amount that's reimbursable, since this has been an ongoing and repeated issue with Carefirst, which I really should sent to the Md. **'s office of dispute as well. On the phone, everyone agrees it should be reimbursed, it's been reimbursed for over a decade, but every few years, Carefirst begins inexplicably refusing to provide the required reimbursements. They do it with me, they do it with quite a few other people.

  Business Response

  Date: 12/09/2024

  Hello *******, please see the response for BBB ******** ******* **** attached. Thank you. 

  Customer Answer

  Date: 12/09/2024

   
  Complaint: 22635735
  
  I am rejecting this response because:
  

  They have not contacted me yet today, after I made no less than 4 efforts for a legitimate response, none was forthcoming.  BBB also has deadlines, which a company will use to excuse themselves. These weren't nuanced responses/declinations before either.   They simply cited gibberish that was unrelated, then different gibberish, in the more recent declination for reimbursements (saying I don't have insurance, when I clearly do), without basis.  The telephone person assured that it would be fixed....the person on the portal, assuming it is a human person, simply hit "resend" on the previous gibberish. This is their business structure.

  I expect $500 due to the intentional actions of withholding the reimbursements.

   

  Sincerely,
  
  ******* ****

  Customer Answer

  Date: 12/10/2024

  The Response given by **** wasn't a response.  It was they would call me.   I don't think that's appropriate, and just meant to give the appearance they are responding.  Regardless, it has also been more than 24 hours, since the response, and they have not called me.  So they haven't complied with the matter, they indicated in the "Response."  They should have a supervisor, put a detailed written response, and give appropriate explanation for why they've not provided nearly 6 months of perscription reimbursements.   They have zero difficulties, sending excuses via their portal system, that have no basis with reality, and contradict each other.    They should take their duties more seriously, in my humble opinion.

  Business Response

  Date: 12/13/2024

  Hello, thank you for providing the additional feedback. The member response seems to be in regard to his case in ***************** We (Executive Inquiry Team) have made contact with the member and will be responding to him directly. 

  Customer Answer

  Date: 12/16/2024

   
  Complaint: 22635735
  
  I am rejecting this response because:

  They, BC-BS have not and do not respond to the Complaint.  They indicated they are in contact with me.  THat's not accurate or true.  They sent a single email, more than 24 hours after the deadline they said they would, saying they are "looking into it."  CFBS has supposedly "looked into it" 4 times, via portal messages and call,  none that were real, made sense, and frankly bad faith.  They have not contacted me in the past week, other than the short "robo-letter" of they are looking into it.   There is no resolution.  There has been no actual legitimate response, to my knowledge, certainly more than 5 second of shooting out a mostly blank e-mail, saying they are looking into it, and will get back to me within a week, which they have not done, to my knowledge, via emails or telephone calls.

  
  
  Sincerely,
  
  ******* ****

  Business Response

  Date: 01/03/2025

  Hello, Mr. **** had sent his complaint to multiple areas, I completed the review of this complaint on Tuesday, December 31, 2024. Mr. **** was sent a response including new Explanation of Benefits on December 31, 2024. This matter has been resolved, thank you. 

  Customer Answer

  Date: 01/03/2025

   
  Complaint: 22635735
  
  I am rejecting this response because:

  The full amount has not been provided, as explained to CF BCBS.  It's approximately $60 off.  (That's assuming additional payments should not be made for other damages)

  The total amount provided was $165.96.  Some of that includes interest.   The total amount sent in the attachments originally, for unpaid reimbursements, was $273.97, which at 80%, totals $219.15.  So there's a number of additional payments due, for non-reimbursed items, that have yet to be received, totaling at least $54.19.  That's NOT including interest.  With interest, it's approximately $60 still due

  Sincerely,

  
  ******* ****

  Business Response

  Date: 01/09/2025

  Hello, please see the response attached. I will follow up with Mr. **** again. Thank you.  

• Initial Complaint

  Date:11/15/2024

  Type:Customer Service 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 psychotherapist (LGPC) in the state of Maryland trying to get credentialed with Carefirst. Myself and my organization submitted for this credentialing July 1, 2024. From that date, we were told that we had to wait 120 days for me to be credentialed so we could submit claims for clients that I was seeing. Carefirst has allowed me to see clients that have their insurance and I can retroactively submit claims/bill with them as long as I am licensed (I have been licensed since June 2024). In August, they "lost my application" and claimed that the 120 days would have to start over despite the applications being completely virtual and not lost on our end. Since then the case has reportedly been "elevated to a supervisor" but I have not been able to get in touch with anyone at their office to be updated on the status. My original 120 days would have been complete as of November 1, 2024. At that time, we did not hear anything from them about me being credentialed. We do not know of the status of anything because we have been unable to get in contact with a person at the office. There has been next to nothing done to resolve the problem other than "elevating things to a supervisor." Carefirst owes myself and my organization (Insight Wellness of Maryland) over $5,000 for services rendered. I can provide exact numbers upon request. My desired resolution would be to become credentialed as soon as possible so that I can be paid for services rendered.

  Business Response

  Date: 11/25/2024

  We have forwarded this complaint over to our Provider Information & Credentialing area. We will follow-up with the complaint once the case has been thoroughly reviewed.

  Best Regards,
  
  ***** C. ****, ****
  Pronouns: he/him/his
  Senior Analyst
  Executive Inquiry | Corporate **********************
  CareFirst BlueCross BlueShield
  ***********************************************************************************************
  Working Remotely:M-F, 8am-5pm
  Off Site Meeting:Tuesday 12/03/24
  Off Site Meeting:Wednesday 12/04/24
  We work flexibly at CareFirst. I am sending this email
  now because it works for me, but I don't expect that
  you will read,respond to, or act on it outside of your
  regular business hours.
  

  Customer Answer

  Date: 11/25/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********. I did my own independent work to resolve the problem and it was resolved as of 11/25/24 through my efforts. There is no need to continue with my case, however, I think it is still important that Carefirst examine their credentialing practices and improve moving forward. This is many people's livelihood and the process was not clear nor was communication easy.  

  Sincerely,
  
  ***** ****

• Initial Complaint

  Date:10/31/2024

  Type:Customer Service 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.

  Carefirst runs a customer service portal to allow patients to view and download explanation of benefit documents (***s). The web page experiences frequent issues, including maintenance that lasts for several days, missing information regarding deductible and out-of-pocket costs, and ***s that are not viewable or downloadable. On October 21, 2024 I tried to download the *** for claim # ************** and received the message Due to the nature of certain documents, your image is not ready to be viewed at this timeplease try again later. Thank you for your patience. I submitted a request through the online message system to rectify this problem and received a reply the next day confirming that this is a technical glitch and would be corrected. I followed up on October 28 and was asked to try different web browsers, clear browser caches and submit session IDs identifying my login sessions. To this day I am not able to view the ***. Carefirst has had 10 days to look into and correct this problem. They are required to provide ***s and I think this delay is unacceptable. I would like them to provide an ***, online and in keeping with their advertised service. I would also like them to reduce the frequent service outages they announce on their web page and provide complete and accurate information on my familys insurance and coverage, 24 hours a day, seven days a week, as is customary for web services like this.

  Business Response

  Date: 11/06/2024

  Hello *******, please see my response attached. We appreciate the opportunity to address your inquiry. 

  Customer Answer

  Date: 11/11/2024

   
  Complaint: 22496591
  
  I am rejecting this response because:

  The EOB for claim # ************** is still not available. CareFirst is working on it but instead of sending me the correct EOB, they sent an EOB of a complete stranger to me, violating ***** regulations. Apparently, CareFirst gives out the same claim number to different claims, hence their confusion (and perhaps also the reason I cannot download my EOB). As of today, I am still waiting for a copy of my EOB for claim # **************.
  
  Sincerely,
  
  ******** **********

  Business Response

  Date: 11/20/2024

  Hello *******, please see my response attached, this issue has been resolved. 

  Business Response

  Date: 11/21/2024

  Hi *******. This issue is resolved as explained by the CareFirst analyst on 11/20/2024.  The member has been contacted. We are closing the file. Thank you!

• Initial Complaint

  Date:10/16/2024

  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 have multiple dental claims that have been paid/mailed checks to the wrong provider. CareFirst keeps paying the wrong location on the wrong tax ID number. The provider is OUT OF NETWORK and I (the subscriber) should be receiving the check for covered services. They keep paying the provider as if they are IN NETWORK the full amount! All the CareFirst **** promise to help but they hang up on me and/or the dental office. This has been dragging for months and both myself and the dental office are extremely frustrated with this service.

  Business Response

  Date: 10/21/2024

  Please see the attached response.

• Initial Complaint

  Date:10/07/2024

  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.

  On 25 June 2024, I received urgent care from *** ****************** I received treatment for giardia. On 28 ***** *** ***** charged me $235.00 for the urgent care visit. On 9 July 2024, I directly paid *** Lukes $235.00. Afterward, I reviewed my insurance coverage. My insurance provider is CareFirst. I realized that my financial obligation to *** ***** was only $75.00, with Carefirst to pay the difference, which is $160. I therefore submitted a claim to Carefirst requesting reimbursement on 15 July 2024. I included the bill from *** ***** *********** in my claim. On 19 July 2024, Carefirst communicated that I was solely responsible for the $235. This is obviously not correct, so I disputed the claim on 19 August 2024. On 23 August 2024, Carefirst communicated that they required further information in order to reconsider the claim. I therefore reached out to ********* for this additional information. ************** provided this information to me 16 September 2024. I submitted this information to Carefirst the same day. On 18 September 2024, Carefirst again refused my claim yet again, requiring the information I already provided them. This is not acceptable. I therefore request that you use your independent authority to help adjudicate this matter and attain $160 reimbursement from Carefirst.

  Business Response

  Date: 10/08/2024

  Please review the attached response. Thank you.

• Initial Complaint

  Date:09/17/2024

  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.

  Im a healcare ****** and Carefirst representatives simply are the most unprofessional people I have ever dealt with. I regret wasting so much of my time with them. 0/10

  Business Response

  Date: 09/23/2024

  Please see response. Thank you, ******* Banda 

• Initial Complaint

  Date:08/16/2024

  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.

  On March 15, 2024, I submitted a claim to CareFirst Administrators (CFA, LLC) for reimbursement of an out-of-network medical session that occurred on March 14, 2024. The session cost $300, of which $265 was paid out of pocket directly to the provider. Despite multiple follow-ups and communications, including confirmations of receipt and assurances that the claim was being expedited, the claim remains unprocessed. I also have two other claims from 5/8/24 & 5/22/24 with the same problem. I followed up on the claim multiple times, including resubmitting the necessary documentation on June 21, 2024. On July 25, 2024, a representative named ******* assured me that the claim had been expedited and would be processed within 7 days. However, as of today, I have not received any reimbursement or further communication regarding the claim.I have provided all necessary documentation, including the claim form, itemized bill, and correspondence with ***, yet the claim remains unresolved. This delay and lack of resolution have caused significant frustration and financial inconvenience.I am seeking assistance from the Better Business Bureau to ensure that CareFirst Administrators fulfills their obligation and processes the claim as promised.

  Business Response

  Date: 08/18/2024

  Good Morning-

  In order to move forward we will need the complainant's CareFirst Administrators ID number.

  Thank you,

  *.****

  Business Response

  Date: 08/18/2024

  Since our earlier message we have received an inquiry from the Maryland ************************ (File ********) concerning the member's issue. Since we have received the inquiry from a Regulator, we will be responding directly to the Regulator.

  Thank you,

  *.****

  Customer Answer

  Date: 08/19/2024

  I have also sent a complaint through the Maryland Insurance Administration.  CareFirst has stated that the *** does not have jurisdiction over them.  I find it spiteful that CareFirst has not chosen to rectify the situation, but to deny that the *** has "no jurisdiction" over the them.   I am still looking for a resolution to my problem, that CareFirst Administrators has yet to rectify.  CareFirst DOES NOT process claims in accordance with their own policies or in a timely manner.

• Initial Complaint

  Date:08/14/2024

  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 CareFirst's member ID: *************. I received a bill stating I owe $695.77 (Reference #: R1551458) for prescriptions filled after coverage ended. I used Online order and payment at pick-up time order with CareFirst coverage. The prescriptions were filled 5/13/24. Coverage ended 5/3/24. Online Order would have had to get approval from ***************************************** to fill PRIOR to filling the prescription. The fill dates are when the items were filled, when did **************** request approval to fill these? If **************** failed to get approval to fill, this is their fault not mine. **************** has a duty to get insurance providers approval and pricing PRIOR to filling the prescriptions. The demand for payment sent is conveniently vague with dates and threatening in nature for a first request. I want to see verification of **************** requesting approval to fill the prescriptions along with the date. Sending me an unacceptable and ridiculous bill is irresponsible billing, they have a fiduciary responsibility as a debt collector to verify all information prior to demanding payment. **************** in **********, IN had to get insurance approval prior to filling prescription. If they performed their responsibility as prescribed and requested and received approval prior to expiration and I showed up to pick up after expiration and then tell me the amount without coverage, I would rejected it at the pick-up time, this is ***************** fault. I placed an online refill request and it took 3 days for them to fill and get approve from CareFirst, they should have the Coverage end date from CareFirst and give me the full amount on my description. I paid for the amount but I would like a refund because it is not my Fault in the first place, **************** and CareFirst has enough time to give me the right total value of my prescription before they filled it and gave it to me.

  Business Response

  Date: 08/21/2024

  Please see the attached. 

  Customer Answer

  Date: 08/21/2024

   
  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,
  
  ***** Le