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Blue Cross Blue Shield Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Nov 30, 2018

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The Blue Cross Blue Shield Association is made up of almost 40 different insurance organizations throughout the United States. It operates as a federation, and insurance companies are licensed to operate under the Blue Cross Blue Shield Banner.

The organization itself is a not-for-profit outfit that has come together from a collection of previous non-profit healthcare federations, including the original Blue Cross, and the original Blue Shield. The history of the organization dates back to 1929, when the original Blue Cross was established.

Since the organization is a network of insurance companies rather than one large business, consumers may find different levels of care and customer service depending on what underlying company they are working with. This review will cover Blue Cross Blue Shield as a whole, where possible, based on consumer data readily available.

BCBS Products

Blue Cross Blue Shield offers insurance products for individuals, families and businesses. As one of the largest health care provider networks in the United States, their product offerings reflect the large scale at which they operate. Some of their most popular products include:

  • Individual Health Insurance
  • High-Deductible Health Insurance
  • Health Savings Accounts
  • Dental Insurance
  • Small Business Health Insurance
  • Corporate Health Insurance

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BCBS Consumer Complaints

Since Blue Cross Blue Shield operates independently throughout the United States, there are dozens of Better Business Bureau entries for the company, most by state. Since they are headquartered in Chicago, Illinois, this review will use the Illinois BBB rating.

Blue Cross Blue Shield is not accredited with the Better Business Bureau and currently has an F rating. The first complaint was filed with the BBB in 1941. In the previous three years there have been 173 complaints lodged against Blue Cross Blue Shield, 71 of which have been closed in the past 12 months.

The number one complaint according to the BBB website surrounds problems with the products and services, with billing and collection coming in a close second. The BBB states the the poor rating given to Blue Cross Blue Shield is because the company has failed to respond to 15 complaints filed against them. In addition the the lack of response, there have been eight complaints that were not resolved.

BCBS Consumer Research Reports

According to J.D. Power’s 2017 US Member Health Plan Study, Blue Cross Blue Shield scored just above average when factoring together the three largest population centers. California and Texas came in the lowest with an overall rating of 2 out of 5 and New York received a 3 out of 5.

 

Financial Ratings

Rating Company Grade Financial Outlook
AM Best A Stable
Fitch A- Stable
S&P A+ Stable

 

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Bottom Line

Blue Cross Blue Shield is a very large organization that operates in some capacity within every state in the United States. They offer individual, family and business plans to fit just about every need available. The underlying organization is not-for-profit, which at least in theory is a good thing. Since the organization is broke up into smaller groups that are state specific, care can range wildly depending on what state you are in. The ratings range from below average to best depending on what state is being examined.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

22 Comments

  1. I am represented by blue cross federal.

    My insurance company has denied my claim and is asking to see the medical records to determine if the procedure I had done is medically necessary.

    I verified that the procedure is covered and was done by an in-network provider and did not require prior authorization.

    The hospital sent over 80 pages of medical records.

    I asked blue cross to send me what they sent the hospital to ask for the medical records.

    I wanted to make sure the 80 pages addressed the medical necessity concern that caused blue cross to deny the claim.

    Over the phone, they said that a letter usually is sent with the EOB denial.

    However, when I requested a copy over the customer service portal, I received some vague non-response.

    Is it normal for Blue Cross to request medical records?

    My impression is they are just looking for a way to deny the claim.

    I’m receiving care at one of the top hospitals in the United States for my condition.

    I’m not sure why/how Blue Cross can deny the claim based on medical necessity.

    Reply
  2. On 2/20/2019 I had an eye exam at JCPenney Optical and got eyeglasses that I can”t use, they are out of focus.

    I am using me two years old glasses and I have a vision problem.

    I filed out a grievance and still is going on.

    For six month Blue Shield HMO can’t authorize me to go to another optometrist to get a new prescription and lenses.

    This is the reality to have Blue Shield HMO insurance.

    Reply
  3. My husband is currently on the phone already for 40 minutes (long-distance) just trying to get a phone call transferred to the BCBS extension we have been given.

    So this is customer service at it’s best?

    This isn’t the first time we have been put on hold and transferred from place to place incorrectly.

    So frustrating!

    Reply
  4. Fep blue of Florida is worse than Obama care.

    They advertised $350 yearly deductible but actually do not cover 100% until $5000 is met.

    Stay away!

    Reply
  5. I am a retired CSRS. I need a tooth implant to replace an unsavable molar.

    BCBS has stated they will not cover the cost of an implant for 2 reasons.

    First, BCBS states there is no ‘limited access” for “in-network” pricing in Rehoboth Beach, DE because they list 100 “in-network” dentists withing 35 miles of my home.

    This determination is facetious because: a) 60/100 are in NJ, which actually is within 35 miles, it entails driving across the water of Delaware Bay (no bridges) or driving 362 miles;

    b) Dentists listed do not exist;

    c) Dentists listed are specialists who do not do general dentistry (e.g. orthodontics);

    d) 35/100 are well over 35 miles driving, though maybe within that limit as a direct line (e.g. Salisbury, MD is over 1 hour & 16 minute’s drive on Delaware roads);

    e) Dentists listed state they are not taking new patients.

    Second, though BCBS lists implants on their coverage, they state they will never do them because there is always something cheaper, suggesting having all of teeth pulled, because dentures are cheaper than implants.

    This company is clearly in the scam business, refusing coverage for “in-network” pricing when no functional dentists exist and refusing coverage even though services are listed. Federal employees be warned.

    The BBB has given them an “F” rating.

    Reply
    • With further respect to my earlier comment, I have just found that Anthem BCBS was fined several $ millions for doing in California exactly what they are doing to me in Delaware.

      As soon as the year of coverage has ended, I will file the same lawsuit here based on the precedence in California.

      Perhaps their realization of the extensive eventual costs from lawsuits will change their attitudes & coverage.

      I look forward to recouping my out of pocket costs & nailing them for attorney’s fees in the process.

      Reply
  6. I am VERY disappointed in Blue Cross vision, why they ever selected [Redacted] vision I will never know. What a horrible company. I have been trying to talk to whoever selected them. Nothing but problems with them.

    Reply
  7. I had to go to the ER because of chest pain and low blood pressure with high pulse, I thought I was having a heart attack! The hospital contacted me saying BCBS of Tennessee had refused to pay the bills due to out of service network services! In an emergency such as this who is going to ask if the hospital, doctors or services is in the network ? I wonder if BCBS would have been happier if I would have died! They don’t mind getting their chunk of my paycheck every week and after seeing all these bad reports I’m scared to go back to the doctor if needed! Out of a $20,000 dollar visit they paid $ 700! They’ve taken way more than that from me! Hopefully, I’ll get this settled and will be leaving BCBS (worse than Obama Care)! You people should be ashamed of yourselves for ripping so many people off!

    Reply
    • What can I say but all of my dealings with BCBS I have had was nothing but trouble. They are one scam company stay away from them if you can.

      Reply
  8. I have BCBS FEP.
    I have been getting my reoccurring medication for the last 30 years. In December my doctor tried to get my albuterol tablets reordered through the mail order prescription program. That was on December 4, 2017. The pharmacist said they had none and they were on back order. Over 6 weeks? Why can Publix get the drug, but mail order can’t get it. If I get it at Publix it will cost me $100 for a 90 day supply. Get it through my mail order it would cost me $15. This is just crazy!!

    Reply
  9. blur cross blue shield cancelled my insurance with no letter or phone call at the end of april. then contuined to bill me for my health coverage. i found out that is was cancelled when i went to the er and was told it was inactive. when i called and waas told why it was cancelled it was over a dollar the ws not paid due to them messing up on a payment amount for my coverage. they continued to bill me and took my money for the coverge knowing that it was canceled for two months. when i asked for that money back i was told basically no without saying it so i said i will call every day demanding my money back. they said it will take awhile to get it back due to the steps of refunding. they were good enough to take my money right away but i have to jump through hurdles to get it back. so everyone keep track of everything they are happy to take your money right away but will make you go through hell to get it back from them. f*** the insurance company and the way the government f***** it up

    Reply
  10. My son has Blue Cross Blue Shield of North Carolina. He was prescribed strips of Suboxen for pain in his back when a drunk driver hit him doing 90 miles an hour flipping my sons vehicle nearly killing him. H e can not take pain meds so we thought this would work.

    Blue Cross is putting this pour kid through the coals though and will not cover, explain why and wants him to do a 3 way call with a already annoyed doctor who has contacted blue cross 3 times. This is just a way to try to get out of paying for the strips which is $900.00 for 90. Insurance companies in this country are like organized crime.

    We will file a complaint with the NC DOI and see what they have to say. Shame on you Blue Cross Blue Shield.
    A upset Parent

    Reply
  11. I have BCBS through my employer. BCBS requires that Prime Specialty be used for my prescription for Humira (it is shipped via FedEx overnight because it is temperature sensitive). I have an option to obtain this prescription through Fairview here in Minnesota which is very close to my home, but instead I must work through Prime. Prime received my prescription on 2/24/17, and at that time I told them that I was going out of town and needed it by 3/3/17. It is 3/2/17, and due to “back log” the prescription has not yet been processed so that I can get shipped before I head out of town. It is concerning the BCBS doesn’t monitor the capacity of a vendor when they contract with them. Interestingly enough, Prime changed its process, at the expense of the patient, and I was told that there were others who have been waiting longer than I – so comforting.

    Reply
  12. My wife had a baby in Baguio City, Philippines on 20 July 2016 and they denied the claim for the baby stating: Your claim cannot be processed at this time The patient on the invoice is not on file. All follow-up medical claims have been denied. The whole hospital stay for mom and baby was a little over $1000.00 and if in the USA it would be probably $20,000! They go through every claim like it was coming out of their own pocket!

    Reply
  13. how do I file a complaint against an Insurance representative who was very rude on the phone when I was trying to obtain eligibility and benefits on a patient. She was talking so fast she got mad when I asked her repeat it. I asked her another question and she stated ” I can not go back and forth with you all day.” I was so frustrated that I ended the call and still didn’t get the information I needed. I also asked her if this patient had a limit of certain visits / year with a chiropractor. She stated well my computer isn’t loading so I guess they have unlimited visits. (the automated system said 12) Um I guess not is not an answer when I’m explaining the price of his/her care in our office I’m very upset.

    Reply
  14. I had Blue Cross Dental and of course I paid the quarterly payment bc there are only to option of payment “Quarterly and yearly” when I went to pay my quarterly payment BLue Cross told me I didn’t have insurance! How is that possible? the Rep told me I only paid for one month, that’s impossible bc that’s not even an option. So for 2 months I didn’t have insurance when I paid 3 months in advice in full, sounds like fraud to me! Also I had to cancel dental appointment that were already schedule. Most importantly where did my money go? and how come I cant have my dental insurance??????

    Reply
  15. On April 30, 2014 I called blue cross blue shield to cancel my health insurance. I called at 9:30am to make a long story short I was bounced around to 5 people the 5th person that I finally talked to was at 11:45am. I have yet to receive back into my checking account $579,29 and by the way the 5th person was very understanding of my frustration and very helpful . She told me she had taken care of the cancellation.

    Reply
  16. I am a federal goverment employee and I have Blue Cross and Blue Shield of Arizona under the Federal Employees Benefit Program. My heart doctor ordered a CT scan for me to take. I took the exam. All indication it came out negative for any coronary problems. Now BCBS of Arizona is refusing to pay the bill in accordance to the payment schedule. Of which I’m responsible for only the copay. BCBS of Arizona has determined that the the procedure was unnecessary and have indicated that I’m responsible for the entire amount.
    Of my 30 plus years of service, I have never experienced this with any of the health insurance plans I have signed up for and pain into.
    I plan to appeal this decision. Also to make the necessary complaints etc..
    Very dissappointed in the health insurance industry.

    Reply
    • Hello Toby,

      I am sorry to hear about the situation you are finding yourself in.

      You are right to file an appeal. That should be the first course of action. It gives them a chance to review and see if it was a mistake. Why my first child was born, nearly 50% of the medical bills we received had some error attached to it.

      If the appeal does not work, it may make sense to get a lawyer that specializes in these types of cases involved. You can also file a complaint with the insurance commissioner in Arizona.

      Arizona Insurance Commissioner Complaints

      They can not always do something about it, but it is worth a shot.

      Finally, if you are part of a union as a federal employee, try notifying your representative. They can have a lot more sway than an individual policyholder.

      Good luck.

      Eric Stauffer

      Reply
    • I am a federal employee with BCBS (FL) I have had ongoing checkups since I was diagnosed with ovarian cancer in 2011. The doctor has ordered an MRI every 6 months (as reoccurence of the disease is most likely 2-3 years after chemo). I had MRIs performed in 2012 and 2013 and then I last one in Jan 2014 was denied as medically unnecessary. I am appealing.

      Reply
  17. I had Blue Cross Blue Shield of Illinois through my employment at WalMart . During that time I was injured 11/19/2009 and had to use diablility. The case was closed the following year. I now have the problem that Medicare says there is still an open case from that time and as a result is not paying bills submitted to them. Would you please close that case and sent me written confirmation.
    Thank you,
    RoseMarie Smith

    Reply
    • Hello RoseMarie,

      We are not actually affiliated with Blue Cross Blue Shield, so you will want to contact them directly for any issues related to a past account. I imagine you already have their contact information, but here it is again just in case:

      http://www.bcbsil.com/contact_us/

      Reply

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