Business Profile

Medical Plans

CareFirst, Inc.

This business is NOT BBB Accredited.

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Complaints

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

Customer Complaints Summary

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

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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.

Initial Complaint
Date:01/03/2024
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 trying to pay my CareFirst bill that is due on January 1, however my invoice reads the incorrect amount and CareFirst is aware of this, but they have not updated my invoice so I can pay it. My member ID is XIB *********. My invoice currently reads $390.96, but it does not include my tax credits from the Maryland Health Connection, which would make my bill $59.64. I contacted CareFirst by email on their site and I was told they received this information from the Maryland Health Connection on November 30, so they are aware of the correct price, and it would be updated by December 24 by the end of the day. It is now December 27 at the end of the day, and it still has not been updated and I cannot even get through by phone as I received a message that their system is down. I need to pay my bill asap as January 1 is fast approaching. Via email, it was suggested that I pay the full 390 dollar bill as it is and I will receive credits for future months, but that is not possible right now. I need CareFirst to update my bill to the correct amount asap.
Business Response
Date: 01/05/2024
From: Donna ***************
To: BBB of Greater Maryland
Subject: Respond to Complaint
Date: 1/5/24

RE: BBB File Number: 21063024
Consumer: **** ******

Dear: Ms. Pigott,

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.
Initial Complaint
Date:12/20/2023
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.
.On 12/14/23 I paid $373.90 to initiate a policy with CareFirst. The representative sent me a link after inquiring about if I could go through the company directly to start a policy. The representative stated that I could. I had been having a very difficult time with Maryland Health Connection. After I completed my application and the company took my $373.90 a message populated stating that my application was under review. This was very concerning because my money should have not been taken if the insurance was not going to be guaranteed. This increased my frustrations because the representative told me that if I was not receiving a subsidy from Maryland Health Connections than the prices would be the same and I can just go through the company directly online and start a policy instantly. Since then, I have been severely mistreated from customer service representatives who have hung up on me, gave me the runaround, lacked competency, did not listen to my peculiar circumstance, and gave me robotic responses, and now I have been told to make a fraud claim. My account that I used to pay for this is **** *** and they can't do anything to refund my money because the transaction is showing up as pending. We are now on 12/20/23 and after numerous calls I still have no update on my insurance and my money is tied up. I have sent the initial sales rep several emails in which she has not responded except only to the first one. On 12/14/23 she sent me an automated message that my application was received due to me saying I never got a confirmation email or anything after my application was complete. I would like my money back. I have never experienced such rudeness and overt disrespect. $373.90 of my hard-earned money is missing and I still have no insurance.
Customer Answer
Date: 12/20/2023
Sales rep- Leslie *******
Date problem occurred: 12/14/23
Date I (Marrakesh Spann) paid for policy:12/14/23
Plan- Blue Choice HMO Value Gold $1,000
Payment: $373.90
Nature of Complain: refund for nonactive policy/ no policy update after payment.
Business Response
Date: 12/27/2023
Hello Heather, please see my response attached. Feel free to reach out to me directly should you have any questions.
Initial Complaint
Date:12/19/2023
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 went to the urgent care on 2/8/2023 and received care. Prior to going to the urgent care I checked CareFirst BCBC provider directory (screenshot attached showing they are in-network), and called to double check and confirm what my charges would be. I was told there would be a $40 copayment, which I was good with. However on 8/1/2023, CareFirst took 6 months to complete a claim and I was sent a bill of $277.23.
See the screenshot attached directly from CareFirst directory showing this is an IN-NETWORK facility, my network is ********** ********* PPO.
Since August, Careerist and the urgent care center MDNow have been blaming each other and putting me in circles. It is NOT MY RESPONSIBILITY to ensure a claim was filed correctly in their own back-end systems. And I should not have any further bills from the $40 already paid (screenshot attached of the bill).
Business Response
Date: 01/02/2024
January 2, 2024

*******
******
Dispute
Resolution Specialist
Better
Business Bureau
502 S
Sharp Street
Baltimore,
MD 21201-2445

RE: ******* ******
BBB Complaint ID: 21029371

Dear *******
******:

This
letter is to acknowledge the receipt of your correspondence. Thank you for allowing us the opportunity to
further review the concerns presented in the complaint.

Your
letter has been forwarded to a CareFirst staff member to investigate and we will
be in contact with the complainant directly.
Please be assured that we are working as quickly as possible to provide
an equitable resolution.

Sincerely,

*******
******

******* ******
Senior Analyst, Executive Inquiry
*******.******@carefirst.com
Phone: ###-###-####
Fax: ###-###-####
Customer Answer
Date: 01/08/2024
To note, I have received a voicemail from CareFirst stating the claim has been adjusted but not confirm the amount.
They stated in the voicemail that I will receive a notice/explanation of the benefits in the mail soon.
Until I receive the mail, I am not able to confirm If i am satisfied with the results from CareFirst. Thank you.
Initial Complaint
Date:12/18/2023
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.
Upon starting private insurance with Carefirst in MD, I was charged for three months' of premiums totaling just under $2100 in October of this year. I was charged twice to start the account, then a third time for the following month's premium. At this point, in the beginning of November, I contacted the business because I was charged in error. The business replied that I needed to supply proof of the over charge. I replied with a copy/paste from my account because a statement would not be produced for 30 days. When the statement was produced by my bank, I promptly sent it in. It was noted by Carefirst that I was overcharged. I asked for a refund as I was cancelling my policy due to starting a new job. Submitted cancellation paperwork a couple of days later (now the beginning of December). The response from Carefirst was that my cancellation takes effect at the end of December and therefore the overcharge would be applied to my account. The only reason the proof of overcharge came in December was because the form of proof required by Carefirst took that long to materialize from another company (my bank). So now I've been trying to get my money back but Carefirst's internal policies put me in a no-win situation and now I'm out the last month's premium due to no fault of my own. This is completely unacceptable from customer service standpoint, but also just a human standpoint. The only reason I couldn't get them the proof that they required is because the bank takes time to create monthly statements - Carefirst should have a way to verify an overcharge internally (I'm sure they do, its a big complex multi-billion dollar company), but instead, I'm the one holding the bag. Its just bad business.
Business Response
Date: 12/19/2023
Good afternoon,
Within the complaint submitted by your company, it indicated that an authorization to release information form was submitted on 12/18/23. After carefully reviewing all the documentation submitted, we were not able to locate the required authorization form. Can you please submit the appropriate authorization form so that we may move forward with addressing the member’s concern?
Please also verify if January4, 2024. Is an appropriate due date as I see that you will be closed until 1/2/24.
Thank you.
Initial Complaint
Date:12/07/2023
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My name is **** Pappanal, Subscribed to health insurance through ***************** ( ***** R ****), Member ID number *********. Claim number ************** with carefirst.I have received care from Chesapeake Urology for Cystoscopy on an outpatient basis. My account number with Chesapeake Urology is ********** am receiving multiple payment slips for the amount of $3720, $******, and $72 for the ** procedure. My out-of-pocket Maximum is 1500 per year. I have verified with the providers office and with Care First Insurance before my Appointment. Both the providers office and Carefirst acknowledged that its in-network and recommended no prior authorization needed for this procedure from the insurance company. However, after the procedure, I received multiple payments from the Chesapeake Urology at different amounts of $ ******, $ *******, and $72.00. When contacted the **************** they said insurance denied the claim. When contacted Carefirst, they said the provider is out of network and could not approve the claim. I spoke to the **************** advocate ****** ****, who states that Chesapeake Urology is in the network, but they billed under another providers name **************, which is not in the network. I have visited the ************************* associated with ***************** and has seen the provider for the ** visit and procedure in the same office building. I was never told that there would be a different group involved in my care and billing. I am still receiving the payment bills from Chesapeake Urology.This action makes me hesitant to seek medical assistance in the future for me and my family due to the financial hardships that arise from the bogus billing. I hereby request to request to provide me with my right to get the appropriate billing for this service. Expecting the Needful
Business Response
Date: 12/12/2023
December 12, 2023

Better Business Bureau of Greater Maryland Attention: ******* Pigott
Dispute Resolution & Trade Practices Specialist
***************************************;
*********, MD 21201

RE: BBB File Number: ******** **** Pappanal

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,

***** *********-*****

***** *********-*****, ***************************************************** Inquiry Department
**CONFIDENTIAL COMMUNICATION NOT TO BE RELEASED TO THE PUBLIC **

Customer Answer
Date: 12/18/2023
Did not receive any correspondence from care first. Not sure if its resolved
Business Response
Date: 12/19/2023
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.

On 12/19/23, I called you ************** and shared a response was emailed to the member at ********************************.
Initial Complaint
Date:11/17/2023
Type:Delivery 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.
In October 2023 I signed up for COBRA health insurance through my former employer's COBRA administrator (Paylocity) and paid the premium (see proof attached). Coverage was to switch to COBRA on November 1st without interruption in coverage. It didn't. For the past 16 days, Carefirst has been denying claims because they haven't updated their system to show that my COBRA policy started on November 1st. Paylocity has contacted Carefirst to confirm that my coverage should have started. My attorney has contacted Carefirst twice. All I've received from Carefirst is repeated emails saying "we're looking into the matter." This has been going on for two weeks. In the meantime, I have had to pay more than $1,000 out-of-pocket for Rx refills as a consequence of Carefirst's failure to correct their error.
Customer Answer
Date: 11/21/2023
The matter has been resolved and you can close the case.
Bureau Response
Date: 11/21/2023
Kim *******
CareFirst, Inc.

***** **** *** ***
****** ****** ** *****

Dear Kim *******:

This message is in regard to a complaint submitted to BBB about your business on 11/16/2023 by Matthew ******. This complaint was assigned ID *********

BBB would like to thank you for your cooperation and response to the above-referenced consumer's complaint. After forwarding the consumer your response, the consumer notified our office the matter is resolved. Therefore we have closed this case accordingly.

If you have any questions, however, we are happy to assist you. Thank you for your cooperation in this matter and for your support of our self-regulatory goal.

Each year, millions of consumers contact BBB for pre-purchase information, and your response to this dispute will assist your future customers with making valuable purchasing decisions.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

MESSAGE:

The matter has been resolved and you can close the case.
Initial Complaint
Date:11/01/2023
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’ve been seeing Blue Cross Blue Shield Mental Health patients since July 12th of 2023. I went through all of the required channels to get credentialed as a BCBS in network provider and have been formally accepted in-network as a behavioral health therapist. I’ve advertised on Psychology Today and gotten quite a few Carefirst clients. At this point, I’ve submitted hundreds of billable hours for my services performed. However, every single claim has been rejected, and I’ve gotten absolutely no reimbursement whatsoever, along with zero support or follow-up. Availity, which is the billing clearinghouse which works with them, has advised me that they can’t pay claims because BCBS claims it doesn’t recognize my NPI billing number. BCBS is completely unavailable for any kind of support in resolving this no-payment problem. Both myself and my billing person Lauren have called hundreds of times, spending many, many hours on hold, getting switched from one department to another, frequently getting disconnected, writing emails, etc. Ultimately, we never get any response, let alone actual resolution. I realize that BCBS is a huge corporation, but I’m a solo practitioner who provides BCBS services which continue to go un-reimbursed. I’m trying to be patient, but at this point, my business is seriously at risk of collapse, not to mention the personal hardship this has caused. I have saved BCBS tens of thousands of dollars, not to mention saving lives by staying on telehealth visits with members in crisis, accepting phone calls at all hours. My services as a mental health therapist often prevent costly hospitalizations. With all of their billions of earnings, BCBS surely can afford to have a competent employee provide the support necessary to get me paid.
Business Response
Date: 11/07/2023
Dear Heather
*******

This
letter is to acknowledge the receipt of your correspondence. Thank you for allowing us the opportunity to
further review your concerns.

Your
letter has been forwarded to a CareFirst staff member to investigate and we will
be in contact with the complainant directly.
Please be assured that we are working as quickly as possible to provide
an equitable resolution.
Bureau Response
Date: 11/08/2023
Melissa *********

*** * ***** **
************ **********

Dear Melissa *********:

This message is in regard to your complaint submitted on 10/31/2023 against CareFirst, Inc.. Your complaint was assigned ID *********

BBB has received a formal response
from CareFirst, Inc.. We ask that you review the response and understand that BBB
is here to assist both parties in reaching a fair and reasonable resolution.

Please review their response to your complaint and advise us of your position in the matter within 5 calendar days. If we do not hear back from you, BBB will assume you are satisfied and will close your complaint as answered.

Please be sure to indicate whether the business' response is satisfactory or not and how you would like to proceed in this matter.

If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.

To access/respond to this complaint online:

Go to: ****************
Enter the following code: **************

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

MESSAGE FROM BUSINESS:

Dear Heather *******

This
letter is to acknowledge the receipt of your correspondence. Thank you for allowing us the opportunity to
further review your concerns.

Your
letter has been forwarded to a CareFirst staff member to investigate and we will
be in contact with the complainant directly.
Please be assured that we are working as quickly as possible to provide
an equitable resolution.
Bureau Response
Date: 11/13/2023
Kim *******
CareFirst, Inc. ***** **** *** ***
****** ***** ** *****

Re: ID * ******** - Melissa *********

Dear Kim *******:

Thank you for your recent response to Melissa *********. We have not yet heard from the consumer and are closing this case as answered.

Following our usual procedure, BBB notified the consumer of your response and requested notification of whether or not a satisfactory resolution had been reached. Unfortunately, the consumer has not notified our office if they are satisfied. BBB has determined that your company has addressed the issues within the complaint; therefore we have closed this case in our files. This matter will appear in your BBB Business Profile as: "Answered - The Business addressed the issues within the complaint, but the consumer did not accept the response, OR BBB has not heard back from the consumer as to their satisfaction."

The text of your response may be publicly posted on BBB's website. BBB reserves the right to not post in accordance with BBB policy, and we may edit your response to protect privacy rights and to remove inappropriate language.

In the event the consumer contacts BBB again regarding this issue, we may reach out to you to review any new or additional information we've received from the consumer.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####
Bureau Response
Date: 11/13/2023
Melissa *********

*** * ***** **
********* ** **********

Re: ID * ********* CareFirst, Inc.

Dear Melissa *********,

We have not received your response to confirm this complaint has been resolved. Therefore, this complaint has been closed and will appear in the company's BBB Business Profile as: “Answered- BBB has not heard back from the consumer as to their satisfaction with the business's response.”

Please know that BBB is always available to discuss your case and review additional information. Thank you for using BBB's Marketplace Services.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####
Customer Answer
Date: 11/14/2023
Unfortunately, the complaint is still unresolved.
Initial Complaint
Date:10/30/2023
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.
My health insurance provider continues to tell me they have not received my requests to cancel my account. This has been going on since September. I called them on the phone and received verbal confirmation that my account would be closed within two weeks. It wasn't closed and my messages to customer service indicate there was no request to cancel my account. So I submitted a request online on October 11, with a request to cancel the following day since I was already well over the time I wanted the plan to end. This was recorded in their system with a confirmation number. I messaged them on October 18 because I hadn't received an update, and got a message saying no cancellation request had been received. I forwarded them a copy of the submitted termination form. But they keep ignoring my requests.
Bureau Response
Date: 11/06/2023
Kim *******
CareFirst, Inc.
***** **** *** ***
****** ****** ** *****

Dear Kim *******:

This is our second attempt regarding this complaint. For your reference, the complaint was submitted on 10/29/2023 and was assigned an ID of *********

BBB forwarded you a complaint filed by Sarah ****. We have not received your response in the time frame allotted. If you have responded directly to your consumer and reached a resolution, let us know so our records are current. If this was a simple oversight, please provide your response at this time. BBB understands that there are two sides to every story is interested in your perspective.

In the interest of time and good customer relations, please provide BBB with written verification of your position in this matter within 7 calendar days.

We encourage you to use our ONLINE COMPLAINT system to respond to this complaint. If you received this complaint via email, the fastest and easiest way to view and respond is to the simply click on the “Respond to this Complaint”, link located on the left, when you are ready to answer.



If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.

To access/respond to this complaint online:

Go to: ****************
Enter the following code* **************

Please understand that the consumer's complaint and your response may be posted on the BBB Website (BBB reserves the right to not post in accordance with BBB policy). Please do not include any information that personally identifies your customer. By submitting your response, you are representing that it is a truthful account of your experience with this consumer. BBB may edit the complaint or your response to protect privacy rights and to remove inappropriate language.

We look forward to your prompt attention to this matter.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

CUSTOMER EXPERIENCE INFORMATION

Customer Information:

Sarah ****

**** ****** **
*** ********** ** *****

Daytime Phone: ###-###-####
E-mail: ******************

The details of this matter are as follows:

Complaint Involves:
Customer Services Issues

Customer’s Statement of the Problem:

My health insurance provider continues to tell me they have not received my requests to cancel my account. This has been going on since September. I called them on the phone and received verbal confirmation that my account would be closed within two weeks. It wasn't closed and my messages to customer service indicate there was no request to cancel my account. So I submitted a request online on October 11, with a request to cancel the following day since I was already well over the time I wanted the plan to end. This was recorded in their system with a confirmation number. I messaged them on October 18 because I hadn't received an update, and got a message saying no cancellation request had been received. I forwarded them a copy of the submitted termination form. But they keep ignoring my requests.

Desired Settlement:
Other (requires explanation)

Cease billing me; Terminate my health insurance

HIPAA: HIPAA Release was offered and accepted on 10/29/2023.

Additional Comments from Consumer:

Business Response
Date: 11/07/2023
Good morning Heather,

Please note that an email was sent to you on November 2, 2023, to ************************* with the attached document.
Also, the issue was resolved, and the member was contacted to advise on November 3, 2023.

Regards
Danielle
Bureau Response
Date: 11/07/2023
Sarah ****

**** ****** ** ********* *
*** ************ *****

Dear Sarah ****:

This message is in regard to your complaint submitted on 10/29/2023 against CareFirst, Inc.. Your complaint was assigned ID *********

BBB has received a formal response
from CareFirst, Inc.. We ask that you review the response and understand that BBB
is here to assist both parties in reaching a fair and reasonable resolution.

Please review their response to your complaint and advise us of your position in the matter within 5 calendar days. If we do not hear back from you, BBB will assume you are satisfied and will close your complaint as answered.

Please be sure to indicate whether the business' response is satisfactory or not and how you would like to proceed in this matter.

If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.

To access/respond to this complaint online:

Go to: ****************
Enter the following code: **************

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

MESSAGE FROM BUSINESS:

Good morning Heather,

Please note that an email was sent to you on November 2, 2023, to ************************* with the attached document.
Also, the issue was resolved, and the member was contacted to advise on November 3, 2023.

Regards
Danielle
Bureau Response
Date: 11/12/2023
Kim *******
CareFirst, Inc.
***** **** *** ***
****** ***** ** *****

Re: ID * ******** - Sarah ****

Dear Kim *******:

Thank you for your recent response to Sarah ****. We have not yet heard from the consumer and are closing this case as answered.

Following our usual procedure, BBB notified the consumer of your response and requested notification of whether or not a satisfactory resolution had been reached. Unfortunately, the consumer has not notified our office if they are satisfied. BBB has determined that your company has addressed the issues within the complaint; therefore we have closed this case in our files. This matter will appear in your BBB Business Profile as: "Answered - The Business addressed the issues within the complaint, but the consumer did not accept the response, OR BBB has not heard back from the consumer as to their satisfaction."

The text of your response may be publicly posted on BBB's website. BBB reserves the right to not post in accordance with BBB policy, and we may edit your response to protect privacy rights and to remove inappropriate language.

In the event the consumer contacts BBB again regarding this issue, we may reach out to you to review any new or additional information we've received from the consumer.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####
Bureau Response
Date: 11/12/2023
Sarah ****

**** ****** ** ********* *
*** ********* ** *****

Re: ID # ********- CareFirst, Inc.

Dear Sarah ****,

We have not received your response to confirm this complaint has been resolved. Therefore, this complaint has been closed and will appear in the company's BBB Business Profile as: “Answered- BBB has not heard back from the consumer as to their satisfaction with the business's response.”

Please know that BBB is always available to discuss your case and review additional information. Thank you for using BBB's Marketplace Services.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####
Initial Complaint
Date:10/30/2023
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I called my insurance plan to ask if a certain procedure was covered and I gave them the diagnosis codes, primary and secondary codes, they said yes to it being covered. I reiterated what they said to confirm what I heard and understood. They again confirmed it was covered. Then CareFirst denied the claims after my procedure was completed. I had to pay $3,455 out of pocket and now I dont trust my insurance company, they are deceitful. This should be illegal.
Business Response
Date: 11/27/2023
November 27, 2023

Reference Number: 20796812

Dear Dispute Resolution Team:

We notice that this case may still be open on your end.

This is an acknowledgement of receipt for the above-mentioned reference file number.

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
Customer Answer
Date: 12/03/2023

Complaint: 20796812

I am rejecting this response because:

There is no solution. I will call to see how to move forward with authorization form
Sincerely,

**** ********
Business Response
Date: 12/04/2023
To Whom It May Concern:
The complainant advised she would move forward with the authorization form. The authorizaton form can be obtained at **************************. Since there is no rebuttal we will wait to receive a completed authorization form.
Regards,

***** C. ****, ****
Pronouns:he/him/his
Senior Analyst | Executive Inquiry | Corporate **********************
CareFirst BlueCross BlueShield
***********************************************************************************************
Initial Complaint
Date:10/25/2023
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 treating Carefirst patients in our medical practice. I wrote a prescription for a life and limb medication for a patient and the patient was unable to get the medication. I personally spent 4 hours on the phone to multiple representatives from this company and their behavior is awful. I was hung up on twice. The matter was subsequently resolved by one of the 14 reps that touched this case because she called back to the specialty pharmacy and the reason medication was being denied and I wasted 4 hours on the phone is because clerically the insurance was entered incorrectly on the pharmacy side of the same carefirst company. Why would anyone not recognize this issue from the beginning, is beyond me. The policy was read so many times, I have the patient's ID memorized at this point. They were provided all the information. This is more so for the reps who hung up on me and did not do their due diligence to support this patient in their treatment. It is disgusting that this took so much effort and that Carefirst is lying, cheating and stealing time from providers and care from their patients. They need to be held responsible for ridiculously long hold times and lack of initiative. This is the bare basics and this is not acceptable behavior on their behalf. I don't write complaint letters until I am so mad there is no other recourse. They need to be exposed. I recommended the patient contact 7 on your side so I feel they are getting off easy reading my complaint here.
Bureau Response
Date: 11/01/2023
Kim *******
CareFirst, Inc.
***** **** *** ***
****** ****** ** *****

Dear Kim *******:

This is our second attempt regarding this complaint. For your reference, the complaint was submitted on 10/24/2023 and was assigned an ID of *********

BBB forwarded you a complaint filed by Nancye ******. We have not received your response in the time frame allotted. If you have responded directly to your consumer and reached a resolution, let us know so our records are current. If this was a simple oversight, please provide your response at this time. BBB understands that there are two sides to every story is interested in your perspective.

In the interest of time and good customer relations, please provide BBB with written verification of your position in this matter within 7 calendar days.

We encourage you to use our ONLINE COMPLAINT system to respond to this complaint. If you received this complaint via email, the fastest and easiest way to view and respond is to the simply click on the “Respond to this Complaint”, link located on the left, when you are ready to answer.



If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.

To access/respond to this complaint online:

Go to: ****************
Enter the following code: **************

Please understand that the consumer's complaint and your response may be posted on the BBB Website (BBB reserves the right to not post in accordance with BBB policy). Please do not include any information that personally identifies your customer. By submitting your response, you are representing that it is a truthful account of your experience with this consumer. BBB may edit the complaint or your response to protect privacy rights and to remove inappropriate language.

We look forward to your prompt attention to this matter.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

CUSTOMER EXPERIENCE INFORMATION

Customer Information:

Nancye ******

**** ****** **
********* ** *****

Daytime Phone: ###-###-####
E-mail: ************************************

The details of this matter are as follows:

Complaint Involves:
Customer Services Issues

Customer’s Statement of the Problem:

I am treating Carefirst patients in our medical practice. I wrote a prescription for a life and limb medication for a patient and the patient was unable to get the medication. I personally spent 4 hours on the phone to multiple representatives from this company and their behavior is awful. I was hung up on twice. The matter was subsequently resolved by one of the 14 reps that touched this case because she called back to the specialty pharmacy and the reason medication was being denied and I wasted 4 hours on the phone is because clerically the insurance was entered incorrectly on the pharmacy side of the same carefirst company. Why would anyone not recognize this issue from the beginning, is beyond me. The policy was read so many times, I have the patient's ID memorized at this point. They were provided all the information. This is more so for the reps who hung up on me and did not do their due diligence to support this patient in their treatment. It is disgusting that this took so much effort and that Carefirst is lying, cheating and stealing time from providers and care from their patients. They need to be held responsible for ridiculously long hold times and lack of initiative. This is the bare basics and this is not acceptable behavior on their behalf. I don't write complaint letters until I am so mad there is no other recourse. They need to be exposed. I recommended the patient contact 7 on your side so I feel they are getting off easy reading my complaint here.

Desired Settlement:
Other (requires explanation)

It would be nice if Carefirst reimbursed me for my 4 hours of time I spent on the phone trying to get their employees to do their job. I won't hold my breath but that is what it will take for me to retract my complaint.

Additional Comments from Consumer:

Business Response
Date: 11/02/2023
Good Morning Heather:
On 10/27/23 CareFirst telephoned the provider's office to discuss their concerns. Unfortunately, the provider was not in the office. Therefore, a message was left requesting they contact Rhonda Evans, Customer Service Advocate at ###-###-####. Ms. Evans attempted again, this morning, to contact the provider. She was advised theyt provider only comes in the office when they have appointments scheduled. Ms. Evans was instructed to try again tomorrow.
If you have any questions, please don't hesitate to contact me at either ************************ or ###-###-####
Bureau Response
Date: 11/02/2023
Nancye ******

**** ****** ** *** ***
*********** *****

Dear Nancye ******:

This message is in regard to your complaint submitted on 10/24/2023 against CareFirst, Inc.. Your complaint was assigned ID *********

BBB has received a formal response
from CareFirst, Inc.. We ask that you review the response and understand that BBB
is here to assist both parties in reaching a fair and reasonable resolution.

Please review their response to your complaint and advise us of your position in the matter within 5 calendar days. If we do not hear back from you, BBB will assume you are satisfied and will close your complaint as answered.

Please be sure to indicate whether the business' response is satisfactory or not and how you would like to proceed in this matter.

If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.

To access/respond to this complaint online:

Go to: ****************
Enter the following code: **************

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

MESSAGE FROM BUSINESS:

Good Morning Heather:
On 10/27/23 CareFirst telephoned the provider's office to discuss their concerns. Unfortunately, the provider was not in the office. Therefore, a message was left requesting they contact Rhonda Evans, Customer Service Advocate at ###-###-####. Ms. Evans attempted again, this morning, to contact the provider. She was advised theyt provider only comes in the office when they have appointments scheduled. Ms. Evans was instructed to try again tomorrow.
If you have any questions, please don't hesitate to contact me at either [email protected] or ###-###-####
Bureau Response
Date: 11/07/2023
Kim *******
CareFirst, Inc.
***** **** *** ***
****** ***** ** *****

Re: ID * ******** * Nancye ******

Dear Kim *******:

Thank you for your recent response to Nancye ******. We have not yet heard from the consumer and are closing this case as answered.

Following our usual procedure, BBB notified the consumer of your response and requested notification of whether or not a satisfactory resolution had been reached. Unfortunately, the consumer has not notified our office if they are satisfied. BBB has determined that your company has addressed the issues within the complaint; therefore we have closed this case in our files. This matter will appear in your BBB Business Profile as: "Answered - The Business addressed the issues within the complaint, but the consumer did not accept the response, OR BBB has not heard back from the consumer as to their satisfaction."

The text of your response may be publicly posted on BBB's website. BBB reserves the right to not post in accordance with BBB policy, and we may edit your response to protect privacy rights and to remove inappropriate language.

In the event the consumer contacts BBB again regarding this issue, we may reach out to you to review any new or additional information we've received from the consumer.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####
Bureau Response
Date: 11/07/2023
Nancye ******

**** ****** ** *** ***
******** ** *****

Re: ID * ********- CareFirst, Inc.

Dear Nancye ******,

We have not received your response to confirm this complaint has been resolved. Therefore, this complaint has been closed and will appear in the company's BBB Business Profile as: “Answered- BBB has not heard back from the consumer as to their satisfaction with the business's response.”

Please know that BBB is always available to discuss your case and review additional information. Thank you for using BBB's Marketplace Services.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####
Customer Answer
Date: 11/07/2023
I was out of town last week. My staff has no recorded message from any of the people listed above. I specifically asked them if they spoke to either Rhonda ***** or Dee ****** and they responded no. I am not sure why you would close my complaint when I clearly listed what happened, just because you documented 2 days of attempted calls does not mean this should be closed. You are doing a horrible disservice to the community by closing this case. I will continue to go public about how BBB is not appropriately addressing my complaint also, not a good position for your company. I am in town. My cell phone number is ###-###-####. Feel free to call that anytime, I answer the phone myself so there is absolutely no excuse for you to say you can not reach me.
Business Response
Date: 11/27/2023
.
Good Afternoon:
Since there was no authorization from the provider attached to the inquiry, CareFirst has responded directly to the provider.
Sincerely,
Dee ******
Bureau Response
Date: 11/27/2023
Nancye ******

**** ****** ** *** ***
*********** *****

Dear Nancye ******:

This message is in regard to your complaint submitted on 10/24/2023 against CareFirst, Inc.. Your complaint was assigned ID *********

BBB has received a formal response
from CareFirst, Inc.. We ask that you review the response and understand that BBB
is here to assist both parties in reaching a fair and reasonable resolution.

Please review their response to your complaint and advise us of your position in the matter within 5 calendar days. If we do not hear back from you, BBB will assume you are satisfied and will close your complaint as answered.

Please be sure to indicate whether the business' response is satisfactory or not and how you would like to proceed in this matter.

If you received this complaint via Postal Mail, you may respond online using the link below or respond by mail using the address above.

To access/respond to this complaint online:

Go to: ****************
Enter the following code: **************

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

MESSAGE FROM BUSINESS:

.
Good Afternoon:
Since there was no authorization from the provider attached to the inquiry, CareFirst has responded directly to the provider.
Sincerely,
Dee ******
Customer Answer
Date: 11/27/2023

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********* and I received an apology. I don't know if that will prevent this from happening again but I guess its a good start and I find that this resolution is satisfactory to me.

Sincerely,

Nancye ******
Bureau Response
Date: 11/27/2023
Kim *******
CareFirst, Inc.

***** **** *** ***
****** ****** ** *****

Dear Kim *******:

This message is in regard to a complaint submitted to BBB about your business on 10/24/2023 by Nancye ******. This complaint was assigned ID *********

BBB would like to thank you for your cooperation and response to the above-referenced consumer's complaint. After forwarding the consumer your response, the consumer notified our office the matter is resolved. Therefore we have closed this case accordingly.

If you have any questions, however, we are happy to assist you. Thank you for your cooperation in this matter and for your support of our self-regulatory goal.

Each year, millions of consumers contact BBB for pre-purchase information, and your response to this dispute will assist your future customers with making valuable purchasing decisions.

Sincerely,

Heather ******
Dispute Resolution Specialist
*************************

Phone: ###-###-####

MESSAGE:

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********* and I received an apology. I don't know if that will prevent this from happening again but I guess its a good start and I find that this resolution is satisfactory to me.

Sincerely,

Nancye ******

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