Consumer Complaints and Reviews
I have been taking care of my mom since these past 3 years, my mom 67 had care1st for about over 5 years. They want to charge her more money but wait here's the thing. My mom was diagnosed with stage 4 lung cancer 2 years ago and Care1st couldn't cover the cancer dr that my mom was seeing in the hospital so my mom ask the dr if they can find her one, we went and the people said "you're not in our database" and they don't even know who or why they told my mom she was approved. We get home and call the insurance, I'm on hold for an hour. She hangs up and doesn't even think to call back!
I call again and then my mom gets schedule for a blood test so I take my mom for her blood test and we call to let them know she took her blood test. That way they can schedule the cancer dr. Well guess what, the other people were confused asking who told us to come, who did we speak to etc. So we call again! They finally get back to us 6 months later and say my mom needs to do another blood test because it's been a while and finally tomorrow we are going to see the cancer dr but I'm not sure because they might say the same thing. This is not right. My mom looks so depressed and I don't know a good health insurance for her, they want her to pay more money but yet do a ** job! Like please don't put your family in this. I'm only 24 and I have to watch my mom die because we can't get help.
My family had a medical policy with Care First last year, which was cancelled in December. We signed up for a new policy for this year. Care first nonetheless billed my credit card for 2017 for the monthly premium. After speaking with five customer representatives, I cannot get the overcharge that was billed to my credit card, and I am still billed for the canceled account. So, even though we switched to a new Policy with Care First, they illegally bill us for both policies. We do not intend to use this company again. Based on my experience, it is either engaged in fraud or is simply grossly negligent.
My daughter is under 19 and she is supposed to be covered under her medical policy for dental. I have only every had 1 claim done correctly. CareFirst dropped her from coverage and no one could explain why. I finally was able to get her back under dental but since then the problem is I have to send the claim forms via certified mail (costing me more money) to some PO box which then takes them over six months to do anything with. By then I have already been back for the next 6mth check up. Why does it take so long to process a claim? They just raised my daughter's health insurance premium to almost $300 per month unless I want a plan that pays for nothing until you reach your 2500 deductible.
Why have health insurance if you have to pay the premium and pay the total doctor bill every time you might have to go to the doctor. Obamacare has done nothing but raise the cost of premiums for everyone and the out of pocket. I see why people take the tax penalty. I will now be paying close to $600 per month for my daughter and myself. Guess it is time to time to find another job just so I can pay that or get a lower premium and come up with 200 dollars every time my child gets sick and I have to take her to the doctor. Rip off artists... All insurance companies.
The CareFirst insurance was going to cancel my insurance because I was past due for only 0.03 cents. I am very upset and depressed. How can a insurance do this to people that is so sad? No wonder people commit suicide because of the health insurance. Please do something about. Where can I sent a copy of the letter that CareFirst insurance send me? I want consumer report to take this matter seriously. Thank you.
My elderly mother was served a civil action by Carefirst. Due to a fall resulting in a fractured spine compounded by dementia it took several months to find out what insurance mother has. By the time we found out from her local pharmacy a massive bill accumulated and payment was to have been made to settle the debt. Looks like only a part of the bill was settled since Carefirst would not cover her pharmacy expenses from the onset of the accident. Was told they have a policy of only going back a limited time to honor back claims. Carefirst does not communicate, takes little notice of the difficulty in trying to manage an aging parent's affairs during a confusing and delicate time and it's time the regulators put them out of business. I have no claim number to reference only a docket number from the civil action against my Mother.
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In my experience, CareFirst is not in the Health Care business. They are in the business of collecting premiums. At over $400 per month, I do expect my prescription to be covered... which is not the case.
I can't express the amount of ignorance the call center has. Do they know how to listen? And they speak to me like I'm an animal. Not only were they rude they hung up on me twice while being on hold for longer than forty-five minutes! These people need to get it together! I can't even get a complaint taken care of because no one cares. Some management they have! I'll call every day if I have to get something taken care of. They need to learn some manners.
Signed up with CareFirst when my COBRA ended. As a Senior, but too young for Medicare, I joined in order to keep renewing the few prescriptions that I'd been taking for years (Wellbutrin, Evista, QVar, Xalatan, Requip, & Flonase. This was before it was OTC.) I chose a Primary, (who I will name if asked,) & began to TRY getting an appointment. During those 6 mos, I got thru to the office twice & left messages each time. Never had a call returned. 1st time they finally answered, they took all my info & said they'd get back to me. 2nd time, the clerk, who took more extensive info, PROMISED that as soon as they'd reviewed it for legitimacy, they would call me & book an appointment. I NEVER heard back from them. I then canceled CareFirst' & got 'Covered Calif.' But a year later, CareFirst STILL thinks I'm a customer of theirs!
Can't really tell you how MANY times they've been informed of this, but 1 time, when I'd complained that they really SHOULD figure out that I'm NOT WITH THEM ANYMORE, I was told that I should really report my quitting CareFirst to my "CASEWORKER!" I don't have a caseworker! Why should I have a caseworker? HOW DO I GET ONE WHEN I DON'T QUALIFY FOR WELFARE??? I now have "OBAMACARE" (Truly more like "ROMNEYCARE"!!) -- does that mean I'm "on welfare"? Do I now have to apply for welfare, to get a caseworker, to quit CareFirst? REALLY???
This HMO is deceptive. They do not have providers for covered conditions. If they require you to use a provider in network and they do not have a provider for a covered condition this means that the medical condition is effectively not covered. I live in the Washington DC metro area. When looking for a specialist they have NO providers in a 30 mile radius. NO providers = NO COVERAGE. Period! If they do not have providers in the Nation's Capital I am sure this is an issue elsewhere as well. There is no excuse for them to not have several choices for providers in every single category of their coverage in a densely populated urban area like this. They should be required to publish every specialist or area that they do not have providers for because there is no provision to go out of network. Something like "Since we do not have in network doctors for these conditions you will not be covered if you get/have the following..."
If a plan has no out of network options, then it cannot claim to provide coverage for items that it does not have an in network provider for. In order to truly know what your coverage is you need to research the providers' list for each and every POTENTIAL condition to see if they have a specialist for that. If there is no provider in their network THERE IS NO COVERAGE FOR THAT ITEM.
I pay my bills using automated Bill Pays services. Jan. 2016 a shortage of nearly $1000 missing from checking account. A review, found the culprit: CareFirst ACH $942.45 on 12/30 siphoned from my account while on Holiday. HAPPY NEW YEAR Care-Less-First! Customer service went to 3 different supervisors who said "Highly irregular. Appears to be fraud, they never take money out like this. First time. We need to investigate." After 5 hrs of phone work the final word from "Ernest" - "Look your bank allowed us to take the money out so we did." How many subscribers to CareFirst would like an extra $1000 pulled during Holidays? Compounding matters were my voluntary payments of $330 on 12/17, $300 on 12/23 and $300 on 1/8. So much for pay it ahead! Caution: If you have an automated bill pays set up with CareFirst think of a Hoover Vacuum on the receiving end of your Electronic Payments!
After 2 3/4 hours on hold and having been dropped 3 times, have given up. Explained my situation over 3 times to a Vanessa (Reference#**), and she was still unable to comprehend. All I can say is if I am now paying almost $200 more a month, and with this type of customer care, I can shop for a different health carrier. Also, after waiting to be transferred to supervisor 3 times, the call was dropped and no return call even though they ask for a callback number in case of a disconnection. GOOD LUCK WITH THIS INSURANCE CARRIER!!!
I have done everything as I was supposed to do it, by deadlines and according to everyone's rules and here I am paying $489 a month and no health plan and I need a doctor's appointment before I have irreparable damage to my foot. It's been over 30 days of emails and calls and emails and calls to both CareFirst and Maryland Health Exchange with no resolution. I applied on the Maryland Health Exchange for the silver plan under CareFirst, yet CareFirst denies receiving the plan. Well, I posted the copy of the plan acceptance on the email to CareFirst (I had a plan of theirs outside the Maryland plan so I was able to email through that account and upload documents).
So - they have my payment and documentation of the plan I chose and they won't give it to me. Can someone help me with this? I need to see a doctor and can't afford to pay both for care and the exorbitant insurance costs! They have been making money from me for many years with very few appointments and now that I need to see the doctor, they can't seem to acknowledge the plan I have. H-E-L-P.
I have been a member of CareFirst's Medicare advantage program since 2013. Prior to signing up, I had straight medicare and loved the freedom I had in choosing providers, no referral requirements, etc. However, in 2012 I received a phone call from my primary care doctor's office, telling me that this new Medicare Advantage program being offered through CareFirst provided benefits not otherwise available through Medicare, such as dental benefits. I really was not interested in switching to a HMO, but looked into it for the dental benefits, which I sorely needed. Based on the promise of dental coverage, FREE gym membership (through the "Silver Sneakers" program), and other coverage such as acupuncture treatment and chiropractic, I decided to try CareFirst.
Well guess what? Aside from all the hassles inherent in a HMO (limited to their network of providers, referrals for everything, etc, incorrect billing), after 2 years, without notice, they have terminated the dental coverage, the gym membership, the acupuncture and more. But the worst part is they provided NO NOTICE. I have been automatically reenrolled the past two years AFTER receiving notice of change in benefits, for which the prior two years were negligible.
This year, for 2016 enrollment, I received NO notice of any change in benefits. SO I reasonably assumed there were no material changes. Imagine my surprise when, the first week of January 2016, I call to find out why Delta Dental (CareFirst's contracted dental provider) has no record of my coverage, and the CareFirst rep says it's no longer a benefit! What? When did that happen? He didn't know. Why does it state on CareFirst's website that dental is included? He didn't know.
I filed a grievance and am told that I SHOULD have received a notice of change in benefits. So why didn't I? Hmm, maybe because they don't want to lose members? In any event, this is fraud. They have cut numerous benefits without notice, and the only way I found out was when I called AFTER they had already auto enrolled me. Their supervisor in the grievance department, Terri, told me that I'm now covered by state dental program and to call them! Yes, that's CareFirst's response to the effects of their fraud. So after an hour of calling state offices, I find out that because CareFirst previously provided dental coverage, I have to jump through hoops for state eligibility. In other words, due to CareFirst's fraudulently omission regarding termination of benefits, I am now forced to spend hours of my time and energy fixing a problem not of my own making.
As for the change in benefits? After 30 minutes of using google and searching CareFirst's website I FINALLY found a notice of the change in terms of coverage for 2016. I am a professional with a job that entails a great deal of research, so 30 minutes to find a document like this, one that should be sent to the consumer in the first place, certainly doesn't seem like a minor oversight by CareFirst but rather an intentional attempt to conceal material terms from members. I hope Medicare investigates this company. They really need to go out of business. I'm going back to straight Medicare and look forward to the demise of CareFirst. Awful, deceptive, and clearly taking advantage of those who are unlikely or unable to protect themselves from CareFirst predatory practices.
I have paid my premiums on time for 9 months through my HSA. In August they cashed my check and cancelled my account due to "not paying my premium". Three months later and after sending them my cancelled check, continuing to pay my premium, and calling them 18 times, they still have not resolved the issue and all of my claims come back saying I have no insurance. They assured me it will be reinstated and retroactive, but that was 6 weeks ago and still nothing. I am paying out of pocket for all prescriptions and doctors visits that cannot wait until CareFirst fixes their mistake. They said at the latest it would be resolved 8 days ago and they would call. I have received no such resolution or call. Get to call them now and waste yet another 1-2 hours getting the run around.
Not only they credited back my dental to my primary medical account but we keep trying to contact them but we wait literally hours on the phone. I put my phone next to my laptop and work. Who has time to spend hours on the phone to correct their errors? It is at best a mediocre service, I do not recommend this provider.
I've had CareFirst for years and had no problems until after the changes due to Obamacare came into effect. 2 years ago my health insurance doubled in price. Now doubled again topping out at $400 a month. They failed to update it last year which caused a lapse in coverage. Now I have to pay for directly despite having a hard copy letter stating that my insurance was active at that date. They have been completely incompetent.
I had problems with billing online and called them specifically requesting to pay the exact amount that was due. And later I got a letter stating my coverage had lapsed again despite I trying to communicate to him directly. It is clear they are abusing the new laws set forth and robbing people with their rates that have increased 4 fold but covers less. This has happened to everyone I know with their coverage. They should be charge for criminal extortion. $400 a month for a 30 year old healthy male. At that rate I can pay for my medical bills myself.
I have health coverage through CareFirst and prior to getting dental coverage I was pretty unhappy with all aspects of their business so I'm not sure why I thought it would be a good idea to get dental coverage through them. First off they refuse to let you fill any forms out online. Whether you are waiting for an approval of coverage or they need to you fill out forms you must do all communication via USPS. So let's say you need insurance ASAP. Too bad. You must download the pdf, print it out, then mail it to them. Then once they receive it, you must wait anywhere from 14 to 28 days to get a response from them. It took me 9 phone calls and 2 months of waiting to get coverage. They actually told me on the phone that they "don't have email" so that is why I couldn't just email the completed form to them.
Next, I got medical coverage in October as I was eligible to enroll because of loss of benefits from a prior employer. In January I got a letter saying that the rate I was approved for was only good for 2014 so my monthly rate would be increasing from $129 a month to $159 a month. If I wanted to change my plan so that I could get a better rate I had to print out a cancellation form, fill it out and mail it to them and wait several weeks for it to go through them and only then could I RE-ENROLL with CareFirst again.
Even though they had all of my information and I still had a plan with them I had to start the entire process over just so I could get coverage and it ultimately left me without coverage for another two months. I couldn't enroll for an online profile until I called in and had them manually delete my old profile that I could no longer access because I had applied for a cancellation. All just because they never told me that my rate would increase significantly after only 3 months.
Next I got dental coverage and once again it was a crazy long process. I had to print out forms, mail them in and wait once again for a response. When I did finally get a response I was actually shocked to see how low the cost was for coverage. $75 for three months of coverage. "Great!" I thought. So I paid three months ahead and thought it would be perfect. On July 28th I logged on to the website to pay my medical coverage premium before I left town for three weeks. I paid my medical bill and then I noticed on the bill tab there was a new amount for the dental plan for $20.32. It didn't say what it was for but I assumed it was an amount owed for a service or something. The strange thing was that I couldn't make a payment towards the amount. Usually there is a "PAY NOW" button underneath the bill that allows you to make a payment but in this instance there was nothing.
So I figured it was an upcoming payment for the next month that it was too early to pay. Nope, when I came back in town on the 21st of August I got an email from CareFirst that same day saying that they had given me 25 days to pay my new "premium increase of $20.32" and since I didn't make my payment that my dental coverage had been terminated effective immediately. I called them and they told me there was nothing I could do to get my coverage reinstated and that in order to get coverage again I could "RE-ENROLL IN 12 MONTHS." I explained to them that I couldn't pay the amount online and that I still couldn't pay the amount because the option was not available. I asked if I could just pay the amount over the phone with them but that wasn't a possibility because "their system wasn't set up for that" and I would "have to wait 7-21 days to receive a final bill in the mail" for $20.32. Then I could mail them a check.
I have yet to receive a bill and I'm sure when I do they will have added some sort of late fee on there too even though I have never even had the option to pay it. Even now when I get on the Carefirst website it still gives me no option to pay this. It's crazy and makes no sense. I did a little research and found out just how terrible they are. I wish I had done that before I got involved with them. I called a few dentist offices and asked them which insurances they had the best experience with. They recommended Delta Dental and Metlife.
I called Delta and it was pretty obvious right away that they were a different type of company. I called and they picked up the phone immediately. They helped me with exactly what I wanted and connected me with a client broker directly who gave me her direct line to talk. She sent me an email within a few minutes of talking to her with a link to all the plans she recommended for me. I picked a plan, filled everything out online, paid for the coverage and she called me back to confirm everything. The whole process took less than 20 minutes and I only had to dial one phone number. I will never ever recommend CareFirst to anyone and I can't wait to cancel my medical coverage with them and get it through a worthy provider. What a waste of time they have been. Good riddance to bad rubbish.
My poor experiences started with my daughter being born in July 2014. It took them 3 months to add her to my policy and then back charged me for the time period without a warning. Next, in open enrollment in January I wanted to add my wife. I was told they needed to mail me an application and to expect it in 2-4 weeks. I have yet to receive it. The final straw however, has come with my soon to be stepson. My wife and I received notice that "B" would be losing his state-assisted health care due to my income being added in. Since he is my stepson by marriage I was told he could be on my plan. I started applying in May and had the application sent back twice, each time asking for more information. Both times the entire application was faxed back with the additional information within 24-48 hours. This was not something I let linger.
In mid June I still had not gotten any answers and I called in to CareFirst. I was told that it didn't seem like he had coverage but yes, they did have all the faxes and information. The very next day I got an insurance card in the mail when I got home. Of course, it was too late to call since they only have M-F until 5pm hours but, I called the next business day and was told he had coverage. When I got my bill on July 3rd I did not see charges for him and sent an email July 7th stating my concerns. I also called in a few days later when I did not get a response and was told not to worry. On August 1 we went to get prescriptions refilled and found "B" health care to be denied. Of course CareFirst is closed and I can't get any information. On August 3, I finally got an email back to my email sent on July 7 which stated that they wanted his adoption certificate which is not complete yet.
After calling back in while on vacation on August 5 I recounted that he is being added using the qualifying event of losing coverage, not the adoption, to which the person on the phone stated she could not find the information sent. On August 13, when I returned to MD, I talked to another rep who was able to find the information I was told was "lost" and sent it back up for review. When it was sent back I was then told that the application I sent in was the wrong one and would need a different one. When I called back in they now are telling me that he would need his own plan until adoption and even if I wait until adoption I need another form since my plan is a grandfathered plan. I asked for the forms to be faxed to me and was told I would have them in 24-48 hours and would receive a phone call to make sure I got them within 2 days. It has now been 4 and I have gotten neither.
On top of that, I constantly have asked for any billing considerations for the hardship, being a young family a little bit can go a long way. I have gotten no such consideration. Due to the extreme length of time, I lost any ability to get other coverage for my son since it is 60 days past the date he lost healthcare. My questions are: If the application was indeed wrong why wasn't this the first thing sent back? If the documentation couldn't be done, why did he get a card? Why does it take 24-48 hours to send a fax? Why does it take 1 month to send an email that could have avoided the whole situation?
Two months ago I was rushed to the ER. Turns out I have 9 cm mass on my side... Treatment??? I would not know. It took CareFirst a month or so to start on my referral (it took me calling them 4 times in one week to get answer about my referral - My Health). Weeks later I am able to get an appointment, two weeks down the line. 08/18, two days before my appointment I get a call to cancel my appointment. I was not given a solution. I was told "WE DO NOT THE SEPT SCHEDULE. I CAN CALL YOU IN A COUPLE OF DAYS WITH A TIME."
After waiting months for CareFirst to handle my paperwork, my appointment is being cancelled. Meanwhile the ER doctor tells me to take it easy because my mass can burst at anytime. I am sick & in a lot of pain. I've lost 13 pounds in two months. My side hurts time to time and I have yet to see a doctor. There has to be some type of customer training.
Today I looked into my mailbox to see a small envelope with my name (first and middle, not my last name which struck odd for me) and in the most horrible, almost childlike, handwriting. No return address except for a stamp and "Capital District 200, 208" and underneath the date - "14 Jul 2015 FMSL" either stamped or typed on. I opened it up and a folded up check is inside for an amount of $3,050.00 Correctly written out is my full name (last name included as well) and the signature is exactly similar to the handwriting on the envelope yet unable to read the name. Both my boyfriend and research the company for red flags of scams or anything negative and nothing particularly strange popped up. I do have Blue Cross Blue Shield but because I'm not 26, I'm still under the insurance of my parents. I don't do anything in terms of dealing with it except for carrying my cards around and giving them to health providers when asked for them.
I've called numbers provided on the website to talk to someone yet, not successful. I've asked my local bank to look over the check and confirm that this is a legitimate check and they said it was. However they were not able to call and check to make sure it was not fraudulent or of sorts due to their terms of being a local bank dealing with local and customer only situations. I live in Auburn, AL and only have a Columbus, Georgia bank that I make a monthly trip to which also happens to be a local only bank. The check is Wells Fargo and I haven't been there to get inquiry from them yet but I'm seeking out any reviews through here if anyone knows or gone through my same experience. I'm frightened to deposit or do anything with the check in case of it being a scam or fraud. Any help would be great!
I am writing to state that I am disgusted with the treatment that I have received from CareFirst DC BCBS/FEP customer service staff. The staff are arrogant, they provide incorrect information, and they are very rude. I have been trying to get the above subject claim resolved for going on three months. I just want someone in management to help me resolve this claim. I don't want to have to contact OPM to help me. I am exasperated.
Begin in November 2014, I signed up for a family plan with Blue Cross. It was 3 people, me, my husband, and my daughter. My husband and daughter got their cards, I didn't. I call them every month about my case and to ask them if I am on the plan. They said yes, still no card or ID number for 3 months. On April 18th, I got a card and then they told me I need January, Feb, March prorate. They gave me a price and I paid it Jan, Feb, March. They even said I had a credit because we over paid them after April 18. We got a bill for $1198.00. It jumped from a credit to being behind in my payment. Because they charge me now for the 3 months I was not covered, I have called and asked them can I make payment? They now say I have insurance but they will not paid for our meds.
I have been paying them every month the price they gave me. And I will pay them for the three months I was not covered. But I am on a budget and I can pay it all at one time. I told them if they would have given me the price at first, I would have worked it into my budget like now. They get paid every month but because of the 3 months I was not covered, they say I am behind a payment.
I been calling for the past few days to schedule my appointments. On the first day I waited an hour and still no one picked up. I had to cancel my next day appointment. On the second day I waited for 45 minutes. I'm handicapped.
My daughter cancelled her coverage with CareFirst and is now out of the country on a humanitarian mission. CareFirst mistakenly sent a bill for additional coverage which I paid erroneously. Now, this complaint site appears to be the only recourse for me. The 'contact phone' asks me to call a number on the reverse side of her statement, but there is no number listed. The website gives an optional phone number for people with coverage, but the answering machine says it is for new customers only, and then hangs up.
Removed my mother from auto pay and cancelled her policy. Refuse to reinstate. I talked to 5 people in ascending positions. I was told to leave a message for a 6th person after 2 hours and 50 minutes. I have found their website confirmation of the auto pay. Called back and spoke to two more people. They have told me to leave a message for the next up supervisor. I have spent 3 hours and 40 minutes on the phone with them today to no avail.
I took Carefirst insurance Bronze plan and the policy ends by Dec 31st, 2014. For 2015 I applied for new Carefirst Platinum insurance. On Dec 31st, 2014 I called the Carefirst to cancel my old Bronze plan because I took the Platinum plan, they said give me in writing and fax it to their office. I did & I have proof for that. I called on Jan 21st to know the status, they said they did't receive the fax. They asked me to send it again not in writing, fill the cancellation form. I did and sent them fax. Called couple of days later they said they received it, but to process it will take time and asked me to call after a week. Called after a week, they said to cancel my policy it will take 30 days and I am responsible for it. I felt she don't know how to cancel my insurance she just given some random number.
Immediately I called another representative asking to cancel my policy, she replied I have to fill up cancellation form and send their office to cancel, I told her I did couple of times and requested through online email after logging into my account, she said she didn't see any document to cancel my policy. I asked her to check my previous call note details, then she said yeah I am seeing now. She repeated previous call notes again. What you will do if you are in my place? Every month money deducting from my account. I appreciate if any body give me some advice. Thanks in advance.
I just given up after a 35 minute-wait on the phone - trying to reach directly a representative to explain that I believe I have already paid my bill for year 2015. I also wanted to ask why, if the fee listed online at the time was $441.96 for 2014, I was actually charged $512.94, a 16% excess fee. Trying to reach you via your site, after putting it ONCE my password, I find that: "Your account is now locked due to multiple unsuccessful attempts to log in" i.e., a poor online service.
From all the above, one question: IS THIS COMPANY A SERIOUS OPERATION OR RATHER A DODO-BIRD OR FLIGHT-BY NIGHT OPERATION? I found out the answer (a clue: it is not the former). So I am glad you did not receive my payment, because obviously you do not deserve any. I will also take this complaint to the appropriate places. PLEASE, COUNT ME OUT OF YOUR SILLY OPERATION AND CANCEL MY ACCOUNT.
CFBCBS has not been helpful in resolving the issue of claims already paid for which they are now requesting payment. I was told that 30 claims have been reviewed and that copies of the claims in addition to the explanation as to why the insurance company isn't paying the claims would be sent to me over 2 months ago and I have received nothing to date and was told the claims went to the wrong address. However, providers are already contacting me concerning monies I owe for 2-year old claims. Why wasn't I given notice?
I was going to Holy Cross Pain Management at Holy Cross Hospital for several years. Our Health insurance has been through my wife's private sector job which was with Care First Blue Choice the whole time and when she accepted a job with the Federal Government, we also stayed with Care First. The lab the clinic used was Alere which is not in network with Care First but at first, Care First had been sending me a check for the lab which I paid Alere with. They told me they were paying it because I had no way of knowing where the clinic sent my test.
Wanda ** @ Care First told me Lab Corp is their only in network provider who they should be using. In March 2014 our policy changed. Because of health cost rising, so we then had a $6000.00 deductible for out of network services. The lab cost was about $400.00 per visit, which is what Care First had been paying. In November 2013, I received a letter stating, because of regulations, the Lab has to move to their own location. Which I had no idea they were sharing the clinics space until then. I knew then if I went to their new location and knowing they were out of network, I would be responsible for paying the lab bill. I called Member Services and asked them what to do and they told me to call or file a complaint with the corporate office, which I did. I first spoke to Sandy ** and she had Wanda ** call me to explain the problem. She said she would look into it and told me she will have someone inform Holy Cross Pain management they must send Care First HMO clients to Lab Corp. I spoke to the Doctor at Holy Cross and he said, he is only a contract doctor there and he has tried to get this changed, but said they will not change it no matter what Care First says.
I informed Wanda ** and she first said she would override the lab bill but then I informed her that my wife is taking a job with the Federal Government. She said their guidelines were more strict and she will have to see if she can override theirs. She said it will take her a week or less and get back to me. Weeks had gone by and Wanda ** had not called me back or fixed anything so if I continued going to this lab, I would be responsible for the lab bill up to 6000.00 and once we changed to the Federal Government's plan, that had no out of network benefits.
I called Care First every week to see what, if anything, they were doing. I called Member Services, the presidents office of Care First and was never allowed to speak to Chester Burrell (their President). Anytime I called, they directed me back to Wanda ** in the executive office. At first she told me she has had someone inform Holy Cross that they must send me to Lab Corp. Nothing changed over weeks or months, so I tried to call Chester Burrell, the president of Care First, again, but his secretary Sandy ** would not let me speak to him and directed me back to Wanda **. I told Wanda that the clinic refused to send me to Lab Corp but she said they were advised. I told her I advised them but they won’t listen, and since Care First has a contract with the clinic, Holy Cross Hospital and the Doctors, since they are all in network, they are supposed to send CareFirst members too in network providers or labs.
In August 2014 our policy changed as I told Wanda ** it would because my wife accepted a job with the Federal Government and again we chose a high option Care First policy. Now we have no out of network benefits, and if I went to this new lab location, I would be responsible for the lab bills. Holy Cross Hospital Pain Management refused to let me go to Lab Corp even though my Doctor there asked me to find out if Lab Corp could do the same tests. I had to get the test panel from Alere and send it to Lab Corp to see and yes they said it was not a problem. In the meantime Holy Cross Pain Management sent me a certified letter dismissing me as a patient. I continued to call Care First and called their main corporate office Blue Cross Blue Shield but again said my complaint will be sent to Chester Burrell.
Now what Wanda has done is sent out a memo flagging only my account, so now, no matter who I call or contact at Care First, they are told not to talk to me and to write via USPS, email or go through their web mail with any questions I have about my benefits, billing or anything. My contract states that if I have any questions or concerns to call the Member Services number on the back of my card just like anyone and that this cannot be changed verbally. I found this out the other day when I called Member Services phone number on my card to find out my benefit information about a new problem I have to have surgery on. My left shoulder is now in pain with a SLAP Tear, which is a new issue. I need to have surgery on it soon. Since they flagged my account to call Member Services and forcing me to write everything, it is impeding my access to my health insurance benefits, which can put my health at risk. It takes them anywhere from 1 day to answer a question to two weeks and some they do not answer at all. (I am a Senior) So if I had no computer or never knew how to use one like my parents, I would be forced to write a letter via USPS.
How Wanda ** can single me out of all members with Care First is a breach of their contract, it’s discrimination and she is doing it in retaliation because I filed a claim which I am supposed to do according to our contract. I was able to speak to a supervisor in customer service. I asked him why this flag was put on my account and he could not tell. I asked if any notes he can see when I had called in show that I ever said anything derogatory, etc. and he replied no.
I was told by Dr ** at Pain Management at Holy Cross that others have complained about the same issue. I was also told that Holy Cross is in network and that their contract with Care First states they are only to send people to in network providers. Care First should enforce them to do this or take them out of network. They should fire Wanda ** for getting paid and doing nothing as well as retaliating against clients and arbitrarily altering the contract we have with them, which is a breach of contract. This is highly prejudicial and fraudulent, we pay the same as others and it clearly states in my policy, on my membership card and everywhere you read on line that if I have any questions or concerns to call the Member Services number or I can send in a web mail which is my choice. It also states in the contract that this wording cannot be changed verbally which is the parole evidence rule. She has caused me days if not weeks of time from work. She should be responsible for compensating me personally unless she was instructed by Chester Burrell to do this to me and if he was, he should also pay for my loss of work.
This has gone on for months and I have not heard one thing from Mr. Burrell personally and I know for a fact that he is aware of this. If you have a problem with Care First, you can call Wanda ** direct number is ** . Sandy ** direct number is ** who is supposed to be Chester Burrell’s secretary, but she will not allow you to speak to Mr. Burrell or even send a message to him. The only thing I have done is called in a complaint for not using Lab Corp. Care First's position is they know they can afford to fight anyone in court and most private attorneys if you call them, tell you for them to handle this case could run you 10K, 30K or some have said $60,000.00 and none of this has any guarantee of winning. If you make too much money, you can’t get a pro Bono attorney, forget calling the Bar Association or any attorney referral service. If you have any money, you won’t if you hire an attorney and Care First knows it. They also know most people do not know how to file in District Court Pro Se. For an issue like this, you yourself can do it if you follow the steps. This can be filed as a breach of contract, or sue for Specific Performance and probably Bad Faith Contract.
I recently sent Care First a web mail stating this was done in bad faith which they could be ordered to pay punitive damages. Because I mentioned this, Care First then replied for the first time with reasons they flagged my account. They only gave me a vague response, by stating they did not like my tone, substance or nature of my calls, etc. They did not say I used profanity or disrespected them in any way, which gives them the option of later making up any lies if I have to file in court. If you are having issues with Care First contact Wanda ** by writing her at ** or contact Sandy ** if she does not allow you to speak to Chester Burrell, CareFirsts President @ ** .
If you have insurance through the Federal Government and need to file a complaint with the OPM Office, you can call Arlean ** or her supervisor William** at **, but do not expect any help. I also after a week received a reply from the director of OPM Health Care, John O'Brien but through the regular OPM people who did nothing anyway. I also wrote the White House and my Congressman. I must have called 100 different phone numbers at OPM, and they either do not answer, or return a call or if they do pick up say they have nothing to do with the Health Care. OPM should be the poster picture of Government waste.
I was a previous employee with this company. I came onto this company thinking it would be innovative and dynamic. This proved the opposite. They are so behind the modern times. Everything is paper and manual data input. They expect you to learn 6 to 8 systems that are all dinosaurs and pit bandages in all this problems that make it worse. The senior management team are more concerned about how it will impact them personally than their customers. It's ridiculous. Then they have meetings about things they have been working on for over a year. Nothing gets accomplished except how to place blame on others. The Sr. management team there are so back stabbing of one another then it displays their distention among the team. Not a good leadership style.
No wonder they are losing their client base in Arizona. I worked there as a manager and used to get the complaints of their customers and sadly my team. They are tired of it. No wonder we they can't keep them. They do pay pretty well but with all the issues it's not worth it. My director and folks complained about the COO all the time but my director was just like her. My predecessors all warned me about the company but I didn't listen. I am sorry I didn't listen. My warning to others are don't take their services or work there.
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