ComplaintsforBlue Cross Blue Shield of Oklahoma

• Initial Complaint

  08/29/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I signed my daughter up for insurance through BCBS. Before the policy went into place I had cancelled the policy. I waited over 30 days before they would issue a refund check. The check was issued in the name of my 22 month old daughter. Over 5 hours on the phone they refuse to refund the money to anyone other than her. After 3 hours on the phone I was told that I wasn't on the account and they could no longer talk to me. This company just like the product they offer is completely worthless.

  Business response

  09/11/2024

  Please see the attached company's response.

  Customer response

  09/11/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  05/13/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In 2023, I was placed on Ozempic for an unhealthy weight. the drug was working great until Jan. of 2024, Blue Cross Blue Shield of Oklahoma denied the medication based I was not diabetic, which runs in my family. My health care provider requested ****** which is for weight loss and was denied by Prime Therapeutics a third party for Blue Cross Blue Shield of Oklahoma. The reason was for my health care provider placing me on an oral appetite suppressant. I stopped taking the oral medication and the Wegovy was requested again and was denied for the second time stating same reason as before. I had stopped the oral medication so that decision should not be valid. I filed an appeal and called to check on the appeal and spoke with a customer service rep by the name of ****, on 05-07-2024. **** stated from what the ***** care provider sent it showed the oral medication and with me not taking it, the Wegovy should be approved. On 05-08-2024 I again received a denial letter from Prime and Blue Cross> ***** said denied based on last decisions. It seems like the third party works for the insurance company and denies everything. Pretty sad when the insurance company makes decisions for your health care and not the physician.

  Business response

  05/15/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

  Business response

  05/21/2024

  Please see the attached response letter.

  Customer response

  06/17/2024

  Blue Cross Blue Shields has failed to contact me as they stated in their response. Guess its just the insurance company doing what they want to do with no accountability. 

  Business response

  06/25/2024

  Please see the attached letter.

  Customer response

  07/05/2024

  I am rejecting this response because:   I am being punished and made to file my own appeal because the health care provider did not send in the proper documentation. I was told by BCBS the health care provider only had one appeal and since they did not send in the proper documents, I am now the one that has to file the appeal, when BCBS knows this. I am covered for this medication the health care provider prescribed. When I file this appeal, it can take up to 45 days meanwhile, I am paying $300 a month out of my own pocket for a medication that should be covered by insurance. Doesnt seem like a very good way of doing business or trying to get out of paying for prescriptions. 

• Initial Complaint

  04/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  After several attemps to resolve my name that has been the same since 2019, and from no where starting 2024, it has been switched back to what it was before 2019. It was ***************, and it is ************************* since late 2019. I Cancelled Medical on Jan 28, 2024 through the healthcare market place, but they still took out another payments. Although I kept my dental, they stopped auto-pay on dental refunded 1 payment to my checking account.I spoke to someone on 3/18/24 who said "Don't worry, they will take march and april payment out in April. I asked her to reassure me as I was ready to make the payment. Then April came, they processed the autopay and then refunded it to me, and said I'm terminated! After speaking them on 4/8/24, I was told I could pay again and given a phone # to contact to make the payment and I would reinstated, and a few days later they refunded that too, and said, I'm terminated. They sent a check this timeto *************** (Wrong name) . I have spoken to them (9) times trying to get this straightened out and these are the dates I called. 1/31/24, 2/6/24, 2/27/24, 3/6/24, 3/18/24, 4/8/24, 4/11/24, 4/16/24, 4/17/24. And on 4/17/24 I picked the option for payments, and after stating I wanted to see where we are at and wanted to make the payment, the rep in the *********** said, "In order to get you a 1099" and I stopped her and said, and kindly said, I didn't say anything about a 1099 and since I have made so many previous calls, I don't feel comfortable speaking with you and I will call back later. Each call taking about 40 mins to 1 hour of my time. I am completely stressed over this at this point and I don't believe what I'm go through in every single phone call. They all reassure me they will get it all cleared up. "Please, please, Help."

  Customer response

  04/23/2024

  Pleaes let me know if you need anything else from me. Thank you, *************************. 

  Business response

  04/26/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

  Business response

  05/03/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

  Business response

  05/07/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

• Initial Complaint

  02/13/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  This payment was made on 12/15/23 on my credit card in error. The policy was closed and a new policy was being created that required no payment.I have been calling on this payment ever since, requesting a refund. I was even once sent an email stating my refund was being processed. Nonetheless, I still have a credit on my account and have not received the refund back to my credit card. Im told to allow time for research or so many business days for the refund to be processed only to call back and be told the same.I escalated my call to a supervisor today, *******. And she said there was nothing more that could be done. There is surely some limit to the number of calls I must make, and months that I should be required to wait for my money to be returned.Thank you,*************************

  Business response

  02/16/2024

  Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

  Business response

  02/19/2024

  Company Response to Inquiry 

  Customer response

  02/19/2024

  I am rejecting this response because:  
  There is no response included in the letter provided. A statement that the issue will be investigated and I will be contacted later, is even more vague than the promises that my credit will be processed at some future date. That expectation that I should continue to wait 24 - 48 hours for another research response, or a certain number of additional business days to process my refund is not helpful after so many failures. This response is even less than that I received from the call center. And, I would like to stress that despite being promised contact after more research in the past, it has never occurred. It always falls to me to call back and follow up.

  It Is not too much to ask that my funds simply be refunded after 3 months of repeated calling and requesting it and 3 months of being told it will be no problem. Its all done. Just wait 10 more business days for it to show up.

  I Would like the $214.91 refund that I have requested repeatedly since it was made in error in December 2023.

  thank you,

  Business response

  02/26/2024

  Please know we are working working to resolve this inquiry. If the member would prefer the response be handled by the BBB , please send a signed SAF so we have permission to share his PHI. 

   

  Thank you, 

  Customer response

  02/26/2024

  I have reviewed the business response and  I do not need to sign an additional release or communicate any further. 
  

  My refund was posted and I am satisfied with my refund.

   

  thank you,

• Initial Complaint

  02/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  It's been a constant battle with getting prescriptions covered. My son has been on the same insurance and medication since last year in 2023. We tried to fill his regular ADHD medication prescription on Monday, January 29, ****. It was not filled because we are waiting for a prior authorization. This showed as covered when looking at prescriptions on the Market Place. Now it's not covered and my son is not able to get his medicine. I have been paying a ridiculous amount. I called Blue Cross and they said there is nothing that they can do. Blue Cross shows this medication as covered it's the same prescription we have been using and the same insurance. No changes have been made. I have to been given any notification changes from the insurance about this change. Blue Cross has changed how the prescription is covered even with penalties without letting the insured know what is happening.

  Business response

  02/07/2024

  Due to the Protected Health Information involved in the response of this inquiry a letter will be sent directly to *********************************** Please allow **** business days for the member to receive the letter as mail typically takes that long to process.

• Initial Complaint

  01/31/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a medical bill from the date of service of 12/5/2020. By this date in 2020, I had met not only my deductible but also my out-of-pocket maximum. As a result, my payment responsibility for this date of service should be $0.00. I have spoken with Blue Cross Blue Shield of Oklahoma several times and they have agreed to pay the entire amount. The medical provider on this date of service was ******************************. Blue Cross has paid ********************* three times and then retracted the payment three times. Most recently, Blue Cross retracted the payment in October of 2023. I did not initially realize that my bill with ********************* was associated with this date of service. As a result, I have been making payments on this bill on my credit card and incurring interest on these charges. I am seeking the resolution that Blue Cross pay ********************* the full $4, ****** that is owed and that Blue Cross re-imburse me for the interest paid on my credit card, due to my making payments related to this date of service.

  Business response

  02/13/2024

  Please see the attached

• Initial Complaint

  12/09/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I receive Blue Cross coverage through my employer as a state of Oklahoma employee. A professional therapist has been difficult to find because most of those who are in network and specialize in the areas I need help in are not accepting new patients. I've contacted at least 10. I'm interest in a provider who sounds suitable for my needs but she is not in network. Her services without insurance are $85 and I can't afford that. I'm wanting to set up a single case agreement where my insurance can cover this one provider. I contacted Blue Cross via message and it took nearly a week to get a reply. The reply was vague and just said I needed to get a referral with no other details about the process. I don't know if they are saying if I get a referral from my Primary Care Provider, Blue Cross will make an exception and cover this out of network mental health care provider? I called the company's behavioral health and they said HMO's don't get out of network benefits or exceptions whatsoever. So there is too much confusion on this issue.

  Business response

  02/27/2023

  Business Response /* (1000, 5, 2022/12/13) */ BCBSOK has received the complaint filed by ******* ******. Please be advised, the request is currently under review and a response should be provided to the consumer by January 2, 2023.

• Initial Complaint

  12/01/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Details Of Complaint: On 11/3 I contacted BC/BS regarding the out of pocket expenses they had listed on their website for my policy. I had a surgery scheduled for 12/6 and I needed a confirmed # for the out of pocket expense to plan payment appropriately. The rep I spoke to said they normally resolved tickets within a couple days but they always gave a 2 week target date. In 2 weeks I hadn't heard anything so I contacted them again ... roughly around 11/16. The rep told me that the ticket had been closed with no notes and no action. She stated she would reopen the ticket and assign it to herself to resolve and that she would contact me on the 18th just to touch base but probably wouldn't have a resolution that quickly and she would follow up again the week of 11/21. Never received any communications or updates. Contacted them again today and the rep stated that, apparently, the ticket still has not been worked and I would be contacted once it was. I had to cancel the surgery as the out of pocket amounts are significant to someone who lives on a fixed income. According to BC I still owe $4,800 which would have to be paid up front. My healthcare provider tells me that BC states I still owe $6,800 that would need to be paid up front ... and the claims with the amount I was responsible for on the BC website indicates I should only owe $3,800. The differences are significant and since I wouldn't be able to get refunds for any overpayments, I can't afford to move forward with the surgery. The surgery is for an aortic aneurism so it's fairly important I get this resolved but I am receiving no cooperation from Blue Cross/Blue Shield

  Business response

  02/28/2023

  Business Response /* (1000, 5, 2022/12/09) */ Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution. Consumer Response /* (3000, 7, 2022/12/12) */ (The consumer indicated he/she DID NOT accept the response from the business.) This is basically hogwash. There is nothing they could disclose that would violate any confidentiality rules. However, by setting a response date of December 22, 2022 they do ensure that no action can be taken on my part to schedule the required surgery until January when, as everyone knows, the deductibles and out of pocket expenses go back to 0. What I asked of them is quite simple - explain/specify why the out of pocket expenses listed on their own website do not match the claims listed on that same website. Hardly confidential. I think it's obvious that Blue Cross Blue Shield has learned an excellent way to prevent patients from having procedures that will be expensive for them to cover, because many of us cannot cover the entirety of out of pocket expenses all at once. However we could cover them at the end of a fiscal year as we've paid out of pocket expenses throughout that year. If the out of pocket expense that I would have to cover remains high, there's less chance I will move forward with a procedure. Basically this means they'll be able to avoid my scheduling my surgery until I can qualify for Medicare. It saves helps their bottom line since there will be claim they would have to pay.

• Initial Complaint

  11/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  BCBS of Oklahoma has caused a living nightmare to our family. My husband moved to my family plan under UHC after the birth of our twins. (Qualifying event/change in coverage). His place of work stopped deducting Insurance BUT BCBS continued to show he had coverage which has caused every claim thereafter to be denied by our new insurance under UHC. He did not have coverage with them any longer. The biggest issue of all is that BCBS added our twins to my husbands old closed policy as well so we have $180,000 in NICU preemie hospital bills that are in limbo when they should have ZERO to do with BCBS. We never instructed them to be added to BCBS because we had already determined everyone would go on my medical insurance. They also added my twin daughter twice and not son. Like what?? We had two babies with the same name? So this is Now affecting bills as far back as 4/25/2021. Our twins are 18 months old now. 18 months... This is affecting FSA reimbursements and our out of pocket thresholds for 2021 and 2022. When my husband's HR department contacts BCBS of OK to remove them - they were not instructed to be added and alter the coverage date they just say we have to research it. Zero accountability. They removed one of the twins (bc of the duplicate name) but refused to remove the other.... We are entirely at a loss and at this point are in fear of catastrophic impact to our credit scores if we miss a statement. We spend no less than 5 hours per week on the phone with carriers, agencies to resolve - I have even had to use time off to tackle - and then... then cycle continues bc we do literally discuss the same statements every week. How is this even legal?? They should be out of business or in a class action suit at this point. Utterly shameful. This is the most impactful personal moment of our lives and has been entirely tarnished by this insurance negligence. Surely someone over there can step in????

  Business response

  02/01/2023

  Business Response /* (1000, 5, 2022/11/15) */ Thank you for your inquiry. We are reviewing the case and will reach out to the member directly with a resolution.

• Initial Complaint

  09/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  In approximately May of 2022, I received snail mail from the Unclaimed Property department of Blue Cross Blue Shield- my previous health insurance provider. This mail was a notice letting me know I had unclaimed property to the tune of over $200 that BCBS owed to me. It directed me of information I needed to add to their form and instructed me to send it back. I did this promptly, then never heard anything back. In approximately June of 2022, I called BCBS to inquire about this and they let me know that I needed to send another letter with the same information. I did this promptly and I never heard back. In approximately late July/early August of 2022, I called BCBS again to inquire about this once more and they let me know I would receive a check in the mail by September 2, 2022. I confirmed my mailing address with them at this time. This date came and went and I received nothing. I called early last week and was told I would receive a call back from a supervisor in 24-48 hours regarding the matter. That time frame has come and passed. At this point, external intervention is needed to insure I receive the money I am owed, that they provided me confirmation of both in writing and over the phone multiple times.

  Business response

  12/22/2022

  Business Response /* (1000, 8, 2022/09/21) */ Good Morning, BCBSOK mailed a response to Mr. Boyce on September 20, 2022, regarding BBB XXXXXXXX.

*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. ↩