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Initial Complaint
09/26/2024
Complaint Type:
Billing Issues
Status:
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.
Multiple visit to 3 doctors to get a UTI. Change my primary doctor and sent all records prior to change primary due to small town and not getting me treatment. 1 st denial was Dr not on list ( PPO) error sent thr list yo bc of Al, next was not referral. I was told a primary/ internist can not refer to another primary internist. Now Bc of Al shows new Dr as primary but after 2 visit. Records again transfer and changed primary prior to appointment. For 21 years I have also been treated for skin pre cancer and cancer. Again ******* couldn't refer FL dermatologist but my 21 year history of mammograms get paid? This " insurance" cost me $13,296 a year and excuse after excuse to not pay claims. This is not having medical insurance. Please help, currently evacuating do to hurricane, I can be reached after 10/2 by phone. Email is good option. Thanks for any and all help.
Business response
10/02/2024
October 2, 2024
*** *******
XXX
XXX

Name of Patient: *** *******
Contract Number: ***********
Complaint Number: ********

Dear *** *******:
We are responding to your complaint that none of your claims are being paid.
According to our records, you are covered under the Blue Saver Silver plan. Under this plan, there is an in-network deductible of $3,600 per calendar year and an out-of-network deductible of $7, 200 per calendar year, depending on if you use an in-network or out-of-network provider. This plan also requires members to designate a Select Provider and all care must be coordinated through this provider. Referrals are required when utilizing providers other than the designated Select Provider. We reviewed your claims for 2024 and found that the majority of them applied the allowed amounts to your calendar year deductible and that is why no payments were made. We did find claims for the service dates of July 24, 2024, August 9, 2024, and August 21, 2024, that were denied because a referral was not obtained as required under the terms of the contract you have chosen.
We hope this information is helpful.

Sincerely,
Customer Service
Customer response
10/02/2024

Complaint: ********

I am rejecting this response because:
I changed my primary Dr prior to being seen. I wasn't getting necessary care and fwd all medical records to new primary. These are just excuses for valid care and not being hospitalized by the primary care that I changed from. Re considered please. Your people gave bad info as not in network, you have phone records and then again that a referral was not needed. You need to take responsibility here!
Sincerely,

****** *******
Business response
10/09/2024
*** *******
xxx
xxx

Name of Patient: *** *******
Contract Number:         ************
Claim Number(s):         ***********
Date(s) of Service:        August 9, 2024

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

We are responding to your rebuttal regarding your Primary Care Select Physician (PCSP).

Under the guidelines of your contract, you are required to designate a Select Provider and all care must be coordinated through this provider. You may call our Customer Service Department and request to change your PCSP, or you can change it yourself online through your myBlueCross account at ***************. We have reviewed your emails that were sent to our Customer Service Department and based on the information that was submitted to us on August 19, 2024, and August 21, 2024, you stated that you got *** ********* name off a Blue Cross and Blue Shield of Alabama in-network list and had your medical records sent to *** ********* office. This does not change your PCSP with Blue Cross and Blue Shield of Alabama. Our representative explained that you must either contact us or go online and change it. On August 21, 2024, our representative advised you that they could change your PCSP but it would not go into effect until that day. *** ******* was updated as your PCSP with an effective date of August 21, 2024. However, we are granting you a one-time exception and we have backdated the effective date to August 9, 2024, with *** ******* listed as your PCSP. This will allow us to reprocess claim number *********** for date of service August 9, 2024, for services rendered by *** *******. For future reference, you are allowed to change your PCSP up to three times each calendar year. Please make sure that you verify that the doctor is accepting new patients before you make any changes. Please note that you will still be required to get a referral from your new PCSP prior to seeing another provider or no benefits will be available. In addition, any referrals that you already had with your previous PCSP are no longer valid, and you will be required to obtain new referrals once a new PCSP is designated. Additional information regarding designating a PCSP is also located in your benefit booklet.

We hope this information has been helpful and addresses your concerns.

Sincerely,

Customer Service
Initial Complaint
08/21/2024
Complaint Type:
Customer Service Issues
Status:
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.
I have reached out to the subrogation department a total of 7 times by phone. I have asked for a return call on all 7 calls. I have also reached out to customer service, and they have sent 2 emails to that department to have them call me back. dates I have placed a call are the following Aug 2nd, 6th, 9th, 14th, 16th, 19th and 21st. There is no other way to speak with them and they do not return phone calls.
Business response
08/22/2024
August 22, 2024

****************
XXX
XXX

Name of Subscriber: ****************
Contract Number: PPA888888888
Complaint Number: 22173620

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

We are responding to your complaint from the Better Business Bureau concerning our Subrogation Department.

We deeply apologize that you had this issue. We are looking into where the breakdown in communication happened and correct it. A subrogation representative called you this morning and addressed your concerns.

Please let us know if we may be of further assistance.

Sincerely,

Customer Service
Initial Complaint
04/22/2024
Complaint Type:
Customer Service Issues
Status:
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.
I have acupuncture benefits with my plan and they refuse to pay the bills from August of last year until now. They have paid some but not all claiming there was no proof other pain management failed before this. I have submitted this information multiple times and so has the provider. My provider submits it with each claim now and they still have every thing in a pending status for months and refuse to give me updates and pay them. This held up my care for months leaving me in agonizing pain. This is inhumane. Any other provider they pay within days but have tried to find any way to not pay this when it is a covered service. I'm tired of getting the run around and people refusing to respond. This mistreatment needs to be addressed by upper management immediately and the provider paid. This is stressing me out even more as a cancer patient which is affecting my health in a negative way. If it isn't paid immediately I will take legal action for the additional pain and suffering I have had to endure the last year during this ordeal. I shouldn't suffer because you are not paying out for benefits I'm entitled to for the insurance I'm paying monthly for.
Business response
05/01/2024
April 30, 2024

**************
XXX
XXX

Name of Patient:   ********************************
Contract Number(s): GEC809035470 and GER809222049
Claim Number(s): 884-3331937, 885-3331988, 885-3355231
Date(s) of Service: September 30, 2023, through November 29, 2023
Complaint Number: 21602381

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

We are responding to your complaint from the Better Business Bureau concerning acupuncture claims for services provided from August 2023, to present.

Acupuncture is a covered benefit under your employer's contract. However, under the guidelines of the contract, each visit must meet medical criteria in order to be eligible for coverage. A review of your medical records determines if a service meets criteria for coverage. Based on our research, three claims for dates of service from September 30, 2023,through November 29, 2023, were denied. We have reprocessed and paid these claims based on additional information that was sent with an appeal. Also, all claims for acupuncture services for 2024 have processed and paid.

We hope this information addresses your concerns.
Sincerely,
Customer Service
Initial Complaint
04/19/2024
Complaint Type:
Customer Service Issues
Status:
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.
I have uncontrolled asthma and blue cross & blue shield has refused to cover ANY steroid inhaler even though I have prior authorization and my physician is adamant that I use this medication consistently to prevent complications. I have gone through just about every name and combination of treatments listed on the bcbs formulary, but bcbs has refused to consistently cover any form of treatment prescribed. When asked what their preferred medication is they refuse to work with me. Currently, I am on tier 1 drug, which is a preferred medication that should be covered without prior authorization, but I have found out that it will not longer be covered. Not only is this drug not covered, but I have found it less effective than others in controlling my asthma. Now it is pollen season and my asthma is currently uncontrolled. Not only could this kill me, but I am at an extremely high risk of developing future, debilitating co-morbidities such as COPD. I have been hesitant to reach out because bcbs has a long history of retaliation in Alabama, but my lack of treatment is putting my life and health at risk.
Business response
04/19/2024
April 19, 2024
**********************
XXX
XXX, AL 36XX
Name of Member: **********************
Contract Number: XAC88888888
Complaint ID Number: ********
Dear **********************:
We are responding to your complaint concerning your coverage for a steroid inhaler. We are not finding an active contract with Blue Cross and Blue Shield of Alabama. Your last contract shows cancelled effective May 1, 2022. If you have an active Blue Cross and Blue Shield of Alabama policy, please call the **************** phone on the back of your ID card and we will be happy to assist you.
Sincerely,
****************
Initial Complaint
03/29/2024
Complaint Type:
Billing Issues
Status:
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.
Member ************************************************************* Flexcard program was rolled out before it was ready. It now orders very very limited options. I placed an order in early January 2024 when the catalog included hundreds of items. It now offers ONLY 4 items. Since each item is $90 I can not spend my $46 balance. I have contacted BCBS 4 or 5 times. They did not return my call as promised. They did mail a meaningless letter that did not address the issue. A classic example of a huge organization failing to be responsive to customers. I want to be able to use my $46 balance.
Business response
04/09/2024
April 9, 2024

********************
XXX
XXX

Name of Member: ********************
Contract Number: MBG*****2824

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

We are responding to a member complaint to the Alabama Better Business Bureau concerning the Blue Advantage fitness benefit.

For a brief period at the beginning of 2024, the at-home fitness kit section of the Flexcard website displayed additional at-home product options that were not authorized by Blue Cross Blue Shield of Alabama (BCBSAL). We have addressed the issues that prevented the at-home options from displaying correctly. We apologize for any frustration that this error has caused for the member. A BCBSAL representative will contact you to assist in the selection of an approved at-home fitness kit valued at $90.

The contract benefits provide a $90 allowance every three months and is available via a flexcard. The $90 quarterly fitness allowance can be used in-person at a gym or towards approved at-home fitness kits. The allowance is available at the beginning of each quarter of the plan year (January, April, July, and October).Plan benefits do not allow unused quarterly allowance amounts to carry over to the next quarter.

We hope this information is helpful in understanding your plan.

Sincerely,

Customer Service
Initial Complaint
01/24/2024
Complaint Type:
Customer Service Issues
Status:
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.
After having answered all security question to enable BCBS-AL to confirm that it was authorized to speak with me, the BCBS representative insisted that I had to provide the name of a current medication my mother was receiving before the BCBS representative could answer my questions concerning a co-pay for proposed medication to be administered to my mother due to COVID. I told her that I didn't have any such information and the BCBS representative refused to assist me and had the audacity to tell me that federal law - HIPPA - required that I provide the name of a medication my mother was taking before she could answer my co-pay question. I informed the BCBS representative that I was a lawyer and her statement was not true - that federal law- specifically HIPPA - contained no such requirement. The BCBS representative started talking over me and became most uncooperative and refused to provide the information I was seeking - so I terminated the call.I also want to note that it took me 35 minutes (I timed it on my phone) for me to get to a live person at BCBS-AL - their telephone program is a disaster - anti-customer service.
Business response
01/29/2024
January 29, 2024

**************
XXX
XXX

Complaint ID:              17331466

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

We have received your complaint from the Better Business Bureau concerning the experience you had when calling on your mothers contract.

Since no information was given concerning your mothers name or contract number, we cannot
address what actually happened. We can however advise that it is our policy that if you were calling to obtain benefits,we would need the name of the drug in order to properly quote accurate benefit information. Based on the **************** Portability and Accountability Act (HIPAA) privacy, we would advise you of the copayment but not the name of the drug as that would be the members protected health information (PHI).

As far as the wait time, we are extremely busy during the first and last quarters of the year. We apologize for your inconvenience.

We hope this information addresses your concerns.

Sincerely,
Customer Service
Customer response
01/30/2024

Complaint: 21192593

I am rejecting this response because: My mother's name is ******************* *******. Her BCBS-AL # starts with XAR 05 and ends with 5927. Her group number is 53534. My mother had contracted COVID. Her pharmacist had advised that the co-pay was $497 per dosage. I was seeking to find out why co-pay was so high and whether or not there was an alternative medication available through her insurance plan that had less of a co-pay. I had successfully identified myself as my mother's guardian and agent in fact pursuant to a durable power of atty ********** and health care proxy (which BCBS has on file incidentally) to TWO different BCBS representatives. The first BCBS representative was cooperative and apologized for me having to wait on the phone 27 minutes to speak to her. The second BCBS representative was uncooperative and obviously did not know federal HIPPA law.  I tried to provide the second BCBS representative with the name of the prescribed medication with the high co-pay. Such was not satisfactory to her. She wanted me to identify other medications my mother was taking. The second BCBS representative insisted that federal law REQUIRED to me furnish the name of a medication my mother was taking. That is nonsense. Federal law does NOT require a person to state a medication someone is taking as an identifier. Further, I was only seeking co-pay information - NOT any confidential information concerning my mother.

Sincerely,

*************************
Business response
02/01/2024
February 1, 2024

*******************
XXX
XXX

Complaint ID: ********

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

Thank you for providing your Mother's information for our review.

Your Mother is covered under the Federal Employee Program thru the federal government. Members
covered under the Federal Employee **************** Prescription Drug Program (MPDP) have a
separate pharmacy drug program, which is not handled by Blue Cross and Blue Shield of Alabama. The
Federal ******** Prescription Drug Program can be contacted by mail at: P.O. Box **** ********, **
18505 and their phone number is **************. Based on our files, there have been no calls under her
contract thru Blue Cross and Blue Shield of Alabama since April 11, 2023.

We hope this information has been helpful.

Sincerely,

FEP Customer Service
Customer response
02/01/2024

Complaint: 21192593

I am rejecting this response because it is not truthful - I did call and speak to 2 different BCBS reps and the number I called was the number on my mother's BCBS card.

Sincerely,

*************************
Initial Complaint
12/26/2023
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I was prescribed a medical regimen for a chronic illness. They took a week to set up a peer to peer with my doctor, because BCBS of Alabama canceled the meeting twice. Then they denied me because the dosage was too high. They never contacted me once. Then when my doctor changed the dosage to a lower level that would be acceptable to BCBS, they held onto it for another week siting low staff near to Christmas. I have waited over 3 weeks without resolution to a simple approval for a life saving medication.
Business response
01/09/2024
January 9, ****

****************
XXX
XXX

Name of Patient: Mr. Forbes
Contract Number: PPA888888888
Date of Service: September 8, 2023, October 18, 2023, and December 28, 2023
Claim Numbers: 265-2542235, 895-2969280, 895-0019266,
Complaint ID: 21053915

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

We are responding to your complaint to the Better Business Bureau regarding the above referenced dates of service.

Our records indicate that your claims for the dates of September 8, 2023, October 18, 2023, and December 28, 2023, have all completed for payment to the provider. Claim numbers 265-2542235 and 895-2969280 completed in our system on January 9, ****,and claim number 895-0019266 completed January 8, ****. These claims will be paid to the provider of service by the local Blue Cross and Blue Shield Plan.We apologize for the delay in the review for this approval. Based on our research, there was a delay in our vendor reviewing your case which resulted in a denial due to it not meeting the policy criteria. Additional information was received and an approval has been granted.

We regret any hardship this matter has caused.

Sincerely,

Customer Service
Customer response
01/10/2024

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,

*****************************
Initial Complaint
11/29/2023
Complaint Type:
Billing Issues
Status:
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.
On 9/15/23, I had an outpatient procedure. *** hospital was told that I had a $500.00 deductible, that would have to be met for this procedure, and thus the hospital billed me $500.00. I later received a statement of benefits from BCBS of Alabama and noticed that they had not paid the doctor who performed the procedure any of his fees. I contacted them and was told that his fees were applied to my deductible and that those fees had satisfied my deductible. When I asked why I was being billed the $500.00, I was told that it was my co-pay. After much discussion, I was told the claim would be resubmitted, reviewed and resolved. *** **************** Rep. told me that there shouldn't be a co-pay for that procedure once my deductible had been met. I started receiving bills from the hospital past the time that I had been told the issue would be resolved so I contacted the insurance again. This Rep. once again agreed that the claim had not been processed correctly and said that she would resubmit it. About two weeks later I received a call from an insurance Rep. telling me that she had been told that my claim had been processed correctly and that per my Maternity Benefits, it was subject to a $500.00 co-pay plus the remainder of my deductible for that outpatient procedure. Number one: I AM 59 YEARS OLD!!! I DO NOT have any Maternity Benefits!!! Number two: *** hospital WAS NOT told that I had a $500.00 deductible plus a $500.00 co-pay for the procedure!!! If I did have a co-pay, I am sure the hospital would have been told that when they were told about the deductible.
Business response
12/08/2023
December 8, 2023

********************
XXX
XXX

Name of Patient: ********************
Contract Number: PPA888888888
Claim Number(s): 350-2642982 and 895-2727966
Date(s) of Service: September 15, 2023

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

We reviewed your complaint to the Better Business Bureau concerning date of service September 15,2023.

Based on the guidelines of your employer's plan, a colonoscopy falls under "special diagnostic services."
Benefits for the facilitys charge are subject to a $500 copayment and the physician's charge are considered at 80 percent of the allowed amount subject to the $500 in-network deductible. When a provider calls our *************************** for benefit information, they are only given the benefit for their location. A facility would not be given physician benefits and vise verse. Our records indicate that the physician called on September 5,2023, and only wanted to know if a precertification would be required. They did not request benefits. Based on the groups contract benefits, both claims were processed correctly.

We hope this information is helpful.

Sincerely,

Customer Service
Customer response
12/09/2023

Complaint: 20934132

I am rejecting this response because:
The hospital WAS told that I had a $500 deductible when they contacted your company. If they had ONLY called to find out about precertification, how did they find out about the $500 deductible? Obviously, they were given this information by your company! If there was also a $500 co-pay, why weren't they given this information at the same time? Also, when I contacted your company, twice & by two different representatives, I was told that after my deductible had been met, with the doctor's ***** the procedure should have been covered at 100%.

Sincerely,

*******************************
Initial Complaint
11/13/2023
Complaint Type:
Billing Issues
Status:
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.
Blue cross blue shield took $714.00 out of my checking account without my permission. They told me they made a mistake but it would be 21 days at least before they would refund. Another employer told me to call on the 21st because sometimes they still dont send out. This is their mistake and they are holding me hostage on my account. I need them to refund my check immediately, and I hope you can stop them from doing this anymore to me and other people. Thank you *********************** - Contract # for Blue Cross IBU880228703. My address ***************************************************************************************************************************
Business response
11/15/2023
November 15, 2023

***********************
XXX
XXX

Name of Subscriber: **************
Contract Number: IBU888888888

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

We are responding to your complaint to the Alabama Better Business Bureau concerning your refund.

We have researched the complaint and based on our review, you authorized permission for Blue Cross
and Blue Shield of Alabama to withdraw automatically your monthly premium from your account. According to our records, your account has been on automatic draft every month since January of 2013. The premiums are deducted on the first of each month for that month's premium. Our records indicate
that we automatically drafted the Novembers premium on November 1, 2023. Our records further show that you contacted us on November 2, 2023, requesting cancellation of the policy due to you having other insurance. The automatic draft had already taken place prior to you contacting us. We asked you to wait until November 21, 2023, because it is our policy to wait for the report from the bank to make sure that the payment clears before we issue a refund. An e-check was requested on November 14, 2023, for $714, which will be deposited into the account on file. Depending on your bank, please allow 2-5 business days for the funds to show.

We hope this information is helpful.

Sincerely,
Customer Service
Initial Complaint
10/10/2023
Complaint Type:
Billing Issues
Status:
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.
This insurance company does not let you know when certain health issues are addressed with your family doctor and you find out whe they send you a statement showing they are not paying for a service provided by your family doctor or when there is a simple document that is beyond your knowledge at the time and basically they find any loophole they can so they don't have to pay ??
Customer response
10/10/2023
Blue Cross And Blue Shield Of Alabama
Health Insurance

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

******, ** 35244-2858

Business response
10/11/2023
October 11, 2023

************************
XXX
XXX

Name of Patient: **********
Contract Number: BEG88888888
Complaint Case Number:20683616

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

We are responding to your complaint to the Alabama Better Business Bureau that your insurance company does not let you know of issues until you receive a bill from the provider.

Under the guidelines of the plan you chose though the Marketplace Exchange, in Alabama, members are required to designate a ************ Select Physician (PCSP) and all care must be coordinated through this provider. Referrals are required when utilizing providers other than the designated PCSP. If you fail to obtain a referral, then there are no benefits. This information is listed several times in your online benefit booklet beginning on page two.

When a claim completes in our system, a Claim Statement is available to you by signing into your myBlueCross account at AlabamaBlue.com. This way you will know prior to receiving a bill how the claim completed. If you need assistance in locating your benefit booklet or if you need assistance with claim information, you may call our *************************** at the number on the back of your Blue Cross and Blue Shield of Alabama identification card.

We hope this information is helpful.

Sincerely,
Customer

Customer response
10/12/2023

Complaint: 20683616

I am rejecting this response because:

Sincerely,

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

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