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Business Profile

Medical Plans

Highmark Blue Cross Blue Shield of Western New York

This business is NOT BBB Accredited.

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Complaints

This profile includes complaints for Highmark Blue Cross Blue Shield of Western New York's headquarters and its corporate-owned locations. To view all corporate locations, see

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Highmark Blue Cross Blue Shield of Western New York has 2 locations, listed below.

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    Customer Complaints Summary

    • 15 total complaints in the last 3 years.
    • 0 complaints closed in the last 12 months.

    If you've experienced an issue

    Submit a Complaint

    The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

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    Complaint status

    Complaint type

    • Initial Complaint

      Date:03/27/2024

      Type:Service or Repair Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Credentialing issue for over a year.

      Business Response

      Date: 05/07/2024

      The Provider Information Management team reached out via phone and email on April 24, 2024.  They received your response April 30, 2024 and are working to resolve your credentialing concern.

      Customer Answer

      Date: 05/07/2024

      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. 

      Regards,

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








    • Initial Complaint

      Date:01/01/2024

      Type:Service or Repair Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      We were covered through my husbands place of employment with a Highmark BC BS Western New York plan. This plan was canceled on 12-1-23, we now both have ******** advantage plans. This old plan still shows up as in effect as of 12-1-23, as “additional insurance” on my ******** account, it does not show up on my husbands ******** account. I spoke with ******** and was told HIGHMARK has to “CANCEL AUTOMATIC CROSSOVER” for this plan on my ******** account, it can cause problems in the future for me as it’s listed as “in effect” as “other insurance.”No one can do it but them. I’ve spent an entire week and 1 day the following week for at least 2 hours a day on the phone trying to have it removed, I have been on hold, transferred, given other numbers to call etc and it’s still there. The last person I spoke with told me it was taken care, that was over 2 weeks ago. I checked today and it’s still there. I do not know what else to do but contact you and see if you can help. I’ve done all I possibly could with Highmark, I’ve asked to talk to managers, supervisors, anyone who could “Cancel the Automatic Crossover” no one has done it. I do not need issues down the road with this showing up on my ******** as in effect and someone trying to collect from them. I was told by ******** that they could go to them first as it shows up as other insurance. I would appreciate any help at all you could give me with resolving this matter. Old plan number *************** for **** *** *****

      Business Response

      Date: 01/26/2024

      We have contacted our member by phone and this issue is now resolved.  The information on ********.gov was not current when it was originally viewed.  We verified with the member that this was updated as of our call yesterday. Our member is satisfied and had no further questions or issues. 

      Customer Answer

      Date: 01/26/2024

      Highmark called me back today and I spoke with an Elsa. The matter has been taken care of and Highmark BC/BS of Western New York no longer shows up on my ******** account as “Other Insurance”. Thank You very much for your help in getting me to someone who could actually help. **** *** *****

    • Initial Complaint

      Date:11/08/2023

      Type:Billing Issues
      Status:
      Answered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Over 15 years ago another insurance was our primary. After that it was Blue Cross and Blue Shield of Western New York and no issues were ever experienced that is until Highmark purchased Blue Cross and Blue Shield of Western New York. I went for my yearly health visit, covered under insurance, and the claim was denied because 15 years ago my primary was another insurance carrier. Highmark is grossly incompetent in handling basic health care billing issues.

      Business Response

      Date: 11/09/2023

      Our Other Party Liability team addressed your coordination of benefits issue on November 8, 2023 and your claim was adjusted.

    • Initial Complaint

      Date:11/07/2023

      Type:Billing Issues
      Status:
      Unanswered
      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.
      Date of service 4/1/23 Greenfield Health & Rehabilitation
      Highmark claim #***********
      I have exceeded my yearly individual out of pocket limit of $6700. (Highmarks own website shows $7856.60). I have repeatedly received bills from *********** stating that I owe them $1176.00. I have repeatedly contacted Highmark regarding this, and they say they will revisit the claim and contact me, yet nothing is resolved. I called them last week, and again said that I had exceeded my yearly out of pocket limit. The rep said she s=could not see that on her screen. I told her I was looking at their own website and could see it from my end. She them "refreshed" her screen and could see the information. She said the would pass the claim on to have it looked at again, even though this has supposedly happened several times. I checked today, and there are no messages to me or any information on recent claims to indicate that anything has happened. I spoke with *********** again, and they understand the situation, but also want their money. Highmark needs to pay *********** directly.

    • Initial Complaint

      Date:10/18/2023

      Type:Service or Repair Issues
      Status:
      Answered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      My daughter was seen at a FREE, college clinic at Rochester Institute of Technology on September 11th, 2023. The clinic sent her lab work to an IN-NETWORK provider, Quest Diagnostic and provided her health insurance member ID ************. I got a bill for $509.34 from the lab with claim number ***********. When I called BC/BS they stated they would not cover the bill as the FREE clinic was not an in-network provider. How would a FREE clinic ever be in-network? And the fact that Quest Diagnostics is in-network, why wouldn’t it paid?

      Business Response

      Date: 11/02/2023

      We attempted to contact you by phone on October 30th and October 31st, 2023.  Unfortunately, were unable to reach you.  The claim in question has been reviewed and is processing correctly.  You have the right to file a grievance.  This can be done verbally by calling 1-************ or by completing the form on page 3 of the explanation of benefits and returning it via postal mail to: Grievance & Appeals Department, PO Box 15068, Albany, NY 12212. 

      Customer Answer

      Date: 11/03/2023

      Better Business Bureau:



      I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

      I have filed a grievance with Highmark Blue Cross Blue Shield. They stated the free clinic is out of network and although the lab testing network is in network, it is being processed correctly and I’m responsible for the in network bill of $509.34. The grievance takes up to 45 days to be processed. 



      Regards,



      ****** ****








    • Initial Complaint

      Date:07/14/2023

      Type:Service or Repair Issues
      Status:
      Answered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Highmark is our health insurance coverage, provided through my husbands employer, the Town of West Seneca. In January, our plan switched from BC/BS of WNY to “Highmark”BC/BS. Some of our coverages were changed and updated guidelines were apparently put into place, without any notification to the members by Highmark. It was only after claims were denied and calls were placed to them were we informed changes were made.
      We have been asking for an updated copy of our plan benefits since March 2023 and we still have not received an explanation of our coverage. They direct everyone to their new and improved website and inside our personal member portals, when we try and access our plans benefit summary, it simply pops up a message that it’s coming soon. It’s nearly 7 months into the plan year and we still have no information. Our providers are calling us prior to appointments and requiring us to verify our coverage before seeking treatment to avoid visits and treatments from being denied.
      We, as members have to call before every appointment and get codes to give to their customer service department to see if we will be covered to avoid costly bills.
      When calling customer service, several times, we have been told the the request has been placed and we should see the benefits books within 7-10 days.
      I’ve requested this 3 times, everyone nothing is received and have even been told when following up that the books are on back order.
      This deceit is unacceptable. They are putting people’s health in jeopardy by not being up front about what our coverages are.

      Business Response

      Date: 07/20/2023

      We apologize for the delay in loading your benefit booklet to the member portal.  We are still working on resolution for that issue.  In the meanwhile, the requested document has been sent to the email provided.

    • Initial Complaint

      Date:02/06/2023

      Type:Billing Issues
      Status:
      Answered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      The plan I was under was covering me till the end of October, at that point my new insurance would pick up and I would not have a lapse in coverage. I went for my annual check up on 10-31-22 and they rejected the payment saying that since the last day of coverage was 10-31-22 the last day I could get something covered would be the day before. On the bill they state that coverage was cancelled prior to the date of service. That is not true. Coverage was paid for to the end of the month.

      Business Response

      Date: 02/24/2023

      Your eligibility inquiry and claim issue are being researched. Once this research is complete, we will be able to provide an update.  Thank you for your patience.

      Customer Answer

      Date: 02/24/2023

      Better Business Bureau:

      I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

       They say they are researching it.  It is as simple as looking up an end date.  All that is, is a stall tactic.  

      Regards,

      ******* ****

      Business Response

      Date: 02/27/2023

      Thank you for your patience while we researched your issue.  As of this morning, the eligibility and claims issues have been resolved and Mr. **** was notified by phone.

    • Initial Complaint

      Date:01/23/2023

      Type:Order Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Under my company health care plan, Highmark Blue Cross and Blue Shield of WNY, that began on July 1, 2022 and runs through June 30, 2023, I received a wellness card that allowed purchase of groceries from specific stores as part of my plan. In December 2022, Highmark sent a letter informing me that as of January 1, 2023, I could only use my wellness card for a gym or fitness membership. I went to one of the grocery stores (********* ****00) January 14, 2023 and bought $75.00 worth of groceries and when I tried to use my card, it was declined. The person working there gave me a reimbursement form and suggested I try to get reimbursed. He said "Some people have been able to and others not." I called Highmark Customer Service and asked why I received the letter and why I was not able to use my card for groceries when I assumed I would be able to use the card under the terms of the original contract until the contract period expired. She simply said the policy changed and even if I sent in a reimbursement claim, I would be denied. I then called our company's plan manager and explained the situation to him. He said he would call another person in the organization to see if he could get them to allow my grocery purchase. He called back to say he was unsuccessful. However, he did tell me that the new restrictions only applied to "small" plans like my company (less than 10 employees), but that larger companies still had that option. I cannot imagine this is entirely legal because the contract signed by our company and Highmark states in 3 separate places that the plan cannot be changed by anyone until the end of the coverage period, which in this case would be June 30, 2023. I have over $125.00 left to spend before June 30, 2023, and I believe I am legally entitled to that amount. If not on my card, then Highmark should send me a check for the balance of unspent funds provided to me by that contract, including the $75.00 I spent already.

    • Initial Complaint

      Date:01/13/2023

      Type:Order Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I decided to switch medicare supplemental insurance in early Nov. 2022, my decision was to cancel my policy with Highmark BC/BS and switch to a ****** policy effective in Jan 1, 2023. since early Nov I have tried numerous time to contact Highmark BC/BS to cancel my policy on Dec 31, 2022. after finally getting thru to a customer service rep I was told I needed to send a signed letter in order to cancel my policy, which I did in early Dec. in this cancelation letter I also asked for a confirmation email confirming the cancelation. after a couple weeks and no communication from them I called again, after getting thru again to a customer service rep I was informed that the cancelation had not showed a going thru yet. the customer service rep then informed me she could do the cancelation at that time over the phone, after giving her my information she canceled my policy, last day of coverage to be Dec 31, 2022, she also gave me a confirmation number, which I have. my problem is I never received a cancelation email or letter and Highmark BC/BS has continued to send me invoices for premium payments for Jan 2023 and now for Feb 2023, which has caused me much anxiety. I'd like to get resolved before it causes me health issues!
      Thanks Much for any help! **** **

      Business Response

      Date: 01/17/2023

      We
      received the termination request via email on 12/03/2022. We have processed
      this termination with an effective date of 01/01/2023. A phone call was made today
      01/17/2023 to verbally confirm the termination of the plan and an email was
      sent to the member to confirm the termination as requested.  

      Customer Answer

      Date: 01/18/2023

      Better Business Bureau:
       
      I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.  

      Regards, 

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

    • Initial Complaint

      Date:01/12/2023

      Type:Billing Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      BCBS declined payment on claim #****** for reimbursement of funds from my wellness card for $198.37 date of service 12/31/22. I spent 4 hours on the phone with Various BCBS Reps on 12/30/22 until one showed me the approved list of uses that includes Health Food Stores and Supplements this list is attached. She also said that it could be a local store even though the company I am employed by is based in NY. I was instructed to only upload the receipt after purchase to the website for reimbursement the receipt is also attached. BCBS then denied the claim. I emailed them last week to refute the denial and got a message saying a rep would be in contact and I have not heard from them at all. My BCBS Subscriber ID is **************, covered is Myself and two children, ****** and ******

      Business Response

      Date: 02/21/2023

      Please accept our apologies for the delay in responding to your inquiry.  The reimbursement check you inquired about was cut on February 11, 2023.  If you have not received this payment, please contact the phone number on the rear of the ID card.

      Customer Answer

      Date: 02/22/2023

      Better Business Bureau:



      I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 



      Regards,


      ***** ******








    Highmark Blue Cross Blue Shield of Western New York is NOT a BBB Accredited Business.

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