ComplaintsforWellmark/Blue Cross Blue Shield of Iowa

• Initial Complaint

  05/30/2024

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  In January of this year, I signed up for affordable insurance through Heathcare.gov and was paired up with a plan through Wellmark. In order to activate my account I had to first make a payment of $62.84, which I did on January 23, 2024. I even received a confirmation email with my name, email, account number and payment from **********************. However, when I attempted to log into my account in February it would not let me log in. I tried repeatedly over two dozen times over the next 2 and half months to log in and pay my bill or just find information on how to use my insurance, only to be told it didn't recognize my account number. I even tried to do an account reset only to be informed that my name and email are not in their system. During this time I have received numerous letters in the mail, under account number *********, about making payments (including instruction for paying online) but never receiving anymore emails. In April I received a letter in the mail stating that not only were they canceling my account but also baring me from being able to sign up for any other insurance. They are still sending me letters demanding I pay them $251.36, by "check or money order". Which, at this point, is incredibly suspicious. They want me to pay them, on top of the money I have already paid them, for insurance I never got and was never able to use while not even being able to access my account in any way. None of this makes sense and I can't tell if this is some elaborate scam or complete incompetence on the part of Wellmark. Now that I have been laid off of my job I no longer even have the money to pay for insurance, even if they were to actually let me have an account. I'd like to be refunded my money, but at the very least I would like them to stop sending me bills for insurance I never got.

  

  Business response

  06/03/2024

  Multiple unsuccessful attempts were made to reach the member to further discuss their request. A letter was sent to the member on 06/03/2024 to address their concerns and the outcome of their request for a refund. 

• Initial Complaint

  08/11/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I made the payment on 7/31/2023 and on 8/2/2023 I got two emails, one showing a balance of $427 then a second one showing a balance of $0 and finally on 8/10/2023 I got a bill for a whoopingly ridiculous $855.32. When I called in to inquire as to what was going on I was told that it is for August and September, that the bill is actually due on the 1st of the month and that I paid July but not August. Even though I wasn't provided anything stated they were actively covered until weeks into July. I kept being told information will be sent to you and then I would be contacted but no one ever did so I called on 7/31/2023 and made the payment. To say I am ****** would be a heavy understatement.I initially got the quote from the marketplace back in June but without any information I couldn't make any payments and as father not one who is covered I kept being told to be patient. I was suppose to be contacted to set up the guardian account and still no one has contacted me. It was once again forwarded to the privacy department as of 8/11/2023.I was told when I initially told I had until 7/31/2023 to make the initial payment yet not once was I told that I would have to make a double payment nor was anything explained so that I could understand.Their account is: *********

  

  Business response

  08/16/2023

  Successful outreach was made to the member by telephone on 08/16/2023, in which the member was informed of having authorization on the account to discuss information regarding their dependent's coverage as well as explained billing notices received and amount due. 

  Customer response

  08/16/2023

   
  Complaint: 20455835
  
  I am rejecting this response because of a complete lack of customer support. As the person solely responsible for providing health care for my children that arrogant discussion performed by the employee has made it clear that as soon as open enrollment begins I need to take my money elsewhere. The incompetence shown by that employee is completely without merit. Refusing to allow for any discussion or compromise is a very pathetic tactic when an employee has zero proper answers. There is a reason Wellmark is hated so much in the Midwest.
  

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

  

  Business response

  08/17/2023

  Per attached, a billing notice was sent to the member on 07/03/2023 and again on 07/17/2023 advising July's premium is due by 07/31/2023 to have active coverage. Payment was received on 07/31/2023 and Wellmark sent a billing statement reflecting $0.00 due for the month of July. An additional billing statement was sent for August premium which was due by 08/01/2023. All billing statements were sent out appropriately by Wellmark and it is Wellmark's process to send out statements as sent asking for payment to be received prior to having active coverage. It is also Wellmark's process to require payment to be paid by the first of the month each month. During my conversation with the member on 08/16/2023, I tried to explain this to the member to which the member did not want to talk and ultimately disconnected the call. There is no Wellmark error which occurred and all correspondences per attached were sent out appropriately and accurately. 

• Initial Complaint

  05/16/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been trying to work with my insurance company for a secondary referral for out of network coverage after being referred by my primary care doctor as well as a neurologist. The referrals have been denied as well as appeal letters.On the most recent denial, one of their care nurses left me a voicemail to call back to talk about options and how to move forward. I have called this person back several times and have left messages but have never received a call back. So, I am sitting in limbo with my insurance company not honoring the referral requests and also not communicating back and forth with me as stated. I feel like I have exhausted all options to resolve this.

  

  Business response

  05/17/2023

  Please review the attached letter for Wellmark's response to this member's complaint.  Thank You.

  Customer response

  05/25/2023

   
  Complaint: 20065149
  
  I am rejecting this response because: The business has failed to resolve my initial complaint, has not provided additional information on how I can resolve the matter, and has not returned phone calls after stating that they would. They only replied back that they could not deal with this issue because of ***** but I am sure I signed the ***** release for health information when submitting this complaint.

  Again, my expectation for this to be resolved is for the insurance to approve my referral for out of network healthcare based upon the litany of reasons and evidence that I have already supplied them.
  
  Sincerely,
  
  ***************************

  

  Business response

  05/30/2023

  Here is our response to ******************** complaint. We have sent him a letter, as well, detailing our response to this issue.

• Initial Complaint

  12/15/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Wellmark has denied medical charges do to them stating i have a primary insurance. Which at one time I did. I called and let them know that I no longer had a ****************** That Wellmark is now primary. For over two years now they have denied all claims.. I have emailed and called numerous times. I have given them all the information they have asked for and to no avail have they changed the information and covered any insurance claims. The only ones that have been fixed are from my chiropractor being on top of it doing their job for them. There was an email sent with all the information on it and they keep saying we will run every claim again and get them taken care of and nothing has still been done. Re-enrollment was not done we are done with this company!! Im sick and go to the doctors today for medical care and was denied treatment because the bill has been denied! I have been on hold for over an hour trying to reach out to wellmark.

  

  Business response

  12/22/2022

  Wellmark is working directly with the member to address her concerns.

  Customer response

  12/28/2022

   
  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

  12/01/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  Wellmark has repeatedly provided inaccurate Explanation of Benefits for a routine eye examit doesn't include documentation for the co-pay. The last time this happened they reissued the inaccurate form four times before an accurate one was issues. I have received another inaccurate explanation of benefits form and called Wellmark repeatedly. Each time they have assured me that the one I received is inaccurate and that a correct one would be generated. Each customer service person has said they would follow ** in seven days, but then I never receive any follow up and have to call again. It has been nearly two months since the initial appointment and I have yet to receive correct documentation despite three separate phone calls. Without accurate documentation, I cannot get reimbursed by my employer.

  

  Business response

  12/08/2022

  This member's concerns regarding the incorrect processing of a vision claim have been reviewed and corrections for future processing are being made. The claim has been reprocessed and the member will be issued an updated EOB reflecting the appropriate processing with applicable copayment. Successful outreach was completed on 12/08/2022 notifying the member of this status update and progress in reprocessing of the claim. 

  Thank you,

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

   

  Customer response

  12/09/2022

   
  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,
  
  ***********************

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