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It is a HDHP HMO with PPO out of area. You can't beat the BCBC provider network and predictability of costs with co-payments instead of coinsurance. CareFirst has a great network where I live in the Washington, DC metro area. The only downside is their customer service is below average.
I recently submitted a claim and after submitting, received the popup with the reference number and also received email. Now, being the first time I split the claim in case something went wrong, didn't want to put all the eggs in one basket to so speak. When I logged back in to create another claim I notice there were no submissions shown that I had entered. I contacted tech support and while nice enough were not able to recover it ... fine, I'll do it again.
The second time I may have entered the wrong address, home address instead of clinic address. I emailed to see if they could check. While waiting for email I created a second claim. When I eventually received email I was told once submitted no corrections could be made, not even the address. They then said it appears I already resubmitted the claim. I wrote back and explained no I didn't resubmit the claim, they are two different claims. I then received an email back stating that there is no way to cancel a claims submission and the claim will be processed twice, one will deny as a duplicate. First time using CareFirst support - not remotely impressed! -Rick
I'm someone who's never been fired from any customer service job or any job for that matter who is just astounded by how incompetent CareFirst clerical workers tend to be. While moving once my card was misplaced so I needed to order a new one. It took about 7 calls before they finally got it right. Later I had some bloodwork done to determine whether I have one genetic condition. There were clerical issues yet again until that was worked out. Finally and most recently a woman on the phone said I could renew my membership quite a while before the Jan 31 deadline. I went ahead and worked with her. She said it was all recorded on the phone. My phone records indicate clearly that I called. Well what do you know? My insurance status isn't listed as active, and after 2 phone calls later I've had no one effectively help me once.
One male said I'd renewed on Dec 24 and that I needed to do more? I renewed nothing on the 24th because at that point I was still working on sorting out the clerical error involving the blood lab which wasn't done until the 28th as an email shows me still reaching out to the blood lab then which by the way was worked out. I told him that, too. Worse yet? I'd almost gotten a surgery this February that CareFirst said they covered - a tubal ligation because I have bad genes and have never wanted to procreate. Well I was approved and scheduled for the procedure. Thank goodness I cancelled or they wouldn't have even covered it like I'd gotten a letter stating they would because the recorded phone call renewal of my membership was apparently never entered into the system! I only cancelled because of the post tubal ligation symptoms
I read other women had experienced - thank goodness I listened to them and thank goodness for everyone on the site telling the truth! I once must have waited about 40 minutes only for my phone call to be forwarded to Nobody at all! It's shameful! Even if someone does fix this latest issue I don't want to work with them ever again! I am beyond tired of this bs and appreciate that I don't actually need anything right now. This insurance only seemed really necessary for if I were injured in a car accident, but honestly after reading what a lot of people have written I doubt they'd even help me there because they can barely help any of us with a simple phone call! Avoid them like the plague if you can and just beware of their bs in general.
I had private health coverage with care first and auto payment was set up for that for years, end of 2018 I had to make changes to my insurance through Maryland health connection but I selected the same plan with care first, the only difference is my daughter was removed from the plan. I received welcome letter from them and another letter notifying me that my policy has changed from the first one to the second one and they are stating the new amount due. I was shocked when I checked my bank account online to see four transactions by care first, two for medical and two for dental for both the old policy and the new policy. I called them to fix this mistake and to find out why all these double charges. They were so rude and informed it's too late to fix this issue and they can't refund me the old policy payment that was charged by mistake. I'm looking for new provider now and I don't recommend this scam company to anyone.
Individual deductible is 16% of my annual income and combined family deductible is 32%. No benefits are realized until annual deductible is met, which amounts to having to pay provider's full rate (minus insurance "discount"), so the stated $50 office call runs anywhere from $75-$100, until deductible is met, which at the rate set, it won't. Further, premiums don't count toward deductible (contrary to my experience with other legitimate insurance). Further yet, the so-called prescription drug benefit is non-existent.
According to the carrier's own literature, prescriptions are supposed to be covered at $10/45/60. Yet my FORMULARY asthma medication costs me over $200 retail. When asked why my prescription isn't $10 per fill, I'm told that coverage doesn't go into effect until I meet my individual deductible. So, in effect, I pay around $780/month for a discount plan. Run as far as you can from this plan. You're probably better off going to an exchange under the UN-affordable Care Act (Obamacare). Looking to start/join a class-action lawsuit against BC/BS CareFirst for insurance fraud and file criminal complaint with my state's insurance regulator.
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We paid thousands of dollars for nothing until we got smart. They don't even offer dental or vision. They keep changing their plans and keep raising the premiums for less coverage. They even are trying to rip off my mother after she has died. They owe us a refund and I am waiting for them to figure that one out.
VERY SHADY business practices. After 6 months of good coverage, CareFirst decided to change how they processed my kids' necessary specialty asthma medications, without ANY notice. We went from having a monthly $30 copay to owing around $7000 in the last 6 months. After months of calls, where I did got a different answer every time as to what was happening, I was finally informed that these prescription medicines were no longer processed under our drug benefits, but were now considered medical equipment claims.
The medicine still showed up in our drug benefits as a covered prescription with a $30 copay, but only if it was filled at a regular pharmacy. It was always and continues to be a specialty medication that has to be shipped directly to our doctor. Picking it up at a pharmacy was NEVER an option. They claim that our benefits coverage didn't change, just how they define this product, which makes little difference to me. After months of appeals, they did not make any changes and we are out a ridiculous amount of money. This is exactly why people despise insurance companies!
I have been in contact with CareFirst since December of 2017 trying to get claims paid. Every time I call I get a different answer as to why they are not processing. They say call back in 14 days - I do and then they tell me to do something differently. I have over 10,000 dollars in claims pending that are covered underneath my plan. I have been reimbursed a total of 600.00 totals YTD. I am disgusted with everyone I have spoken to at CareFirst. They are not helpful. It is a covered expense which they tell me on every call but then say it isn't processing correctly. I can't do anything about that. The services I am receiving are medically required - again acknowledged by CareFirst. However, they will not pay me back in a timely manner. I have submitted and resubmitted paperwork a total of 10x to them the local plan and the appeals.
So I’m going on vacation for two months and I got authorizations for all of my prescriptions but I have two pain medicines that are very fragile. I guess you would put it these days because they are **. So that means I’m a drug addict because the government says I am LOL. So anyways I go to get my vacation fill on all of my medicine but since I am leaving out of town actually out of the country for two months the day after tomorrow I am filling my medication two days too soon. So they won’t!!! Idiots!
I cancelled the application process on 3/2/18 and received a cancellation statement in my email and was told I would not be charged for the insurance. Yet YESTERDAY they charged me $186.24 for insurance I don't have!!! Not once, but 3 times!!! That's over $550.00!!! I want my money back!!
It takes them 1 week to reply to an email. And when they reply to the email, they make silly mistakes, or don’t do proper homework. It’s been 4 weeks since I sent a basic inquiry, but the people on the other side of the system don’t seem to have any common sense.
After many years with Aetna, which kept dropping previously covered medications and cut my migraine medication to a ridiculous low amount per month, we decided to switch to CareFirst and are very happy; a much better value and service! I'm now also covered for acupuncture.
For the second time in as many invoice periods, I NEVER received my DENTAL invoice by mail or email, but did get a dunning notice (no it didn't go to my spam folder). And yes I went online to pay them. I spent 1/2 hour of my dwindling life trying to get someone to hear me. If this affects my credit in any way, lawyers will be involved! It's open enrollment and there is no chance I use them again. Oh, I do get my MEDICAL invoices from them just fine! CareFirst, just doesn't care...
Do not pay anything if you are Medical Medicare patients. It is to be written off. If you are paying for this insurance get off. Go to another insurance you want and have them get you away from these crooks. Do not allow to pay then be taken for your monies. It defeats the purpose of having coverage here in USA. You need a better insurance if they are billing you and not submitting the proper Authorization form to be seen by a true network provider. Read your manuals. Contact your insurance provider within network dr's.
Do not go to any facility they send you to. I took my mom to a facility thinking they were contracted with her CareFirst and they were not. They only seen SeaSide Adult patients. Go figure. I never heard of this one and I have my experience with billing. These Dr's break off cause of poor monies being funded by the state/government. Dr's are greedy and want, want, want monies daily. IPA's are not good. Find one facility/group that pays well and dr's are there for the patient not your money. Pay for a Dr that truly diagnosis you and truly cares. Pay what you can afford not what dr's are overcharging and billing depts are falsely lying to you about what you are resp for.
This is an HMO Advantage plan, which makes the entire process very simple. Most doctors are in the directory. There are no claims to be submitted. Referrals are necessary, but they are processed quickly, and can be processed even faster in case of an emergency. Vision and dental plans are automatically included.
I recently tried to cancel my health insurance through Blue Cross Blue Shield. As I am writing this, it was 3 months ago when I sent them the necessary paperwork to cancel my insurance. Not only did they not cancel my insurance, they continue to bill me and claim that I owe them money, when I do not. They have made it as humanly difficult as possible to cancel an insurance policy, and even then once you know how to, you have to fax them the necessary paperwork -- and only fax or mail. Despite doing both of these things, one cannot rest assured that they actually received it as in my case, despite faxing them the necessary forms twice, and receiving confirmation that the fax went through to the right number, they have not cancelled my insurance policy. They now claim I owe them nearly $2000, when I should owe them absolutely nothing. I am currently seeking what recourse I have with the Maryland Insurance Administration.
If I were to recommend a health insurance company to anyone, it would not be Blue Cross Blue Shield. They are currently more than happy to play the system and bill me, knowing that I don't have the necessary means to hire an attorney, all the while they cause me financial chaos to the tune of nearly $500/month that I should not be paying at all. I just wanted my health insurance cancelled.
I am an honest, stand up citizen, and I always pay my bills. 780 FICO. I have never been late on any payment, on anything, in my entire lifetime. That all changed with Blue Cross Blue Shield. They will continue to take your money and NEVER let you cancel your policy. They are worse than a scam, because most scammers aren't in the pockets of the government and don't have the means to hire a thousand attorneys to stand on the front lines. I would be VERY cautious of getting health insurance through Blue Cross Blue Shield, unless it is paid for via public funding, which then you can't possibly get it for any cheaper. That is the only benefit they serve.
They didn't pay 100% of a routine physical. Didn't pay another claim for preventative service. I've had to pay out of pocket twice as they claim the Dr didn't code it right. They are just ripping off customers... I would not recommend them and will file a complaint with the organization that I work. I hope they will look for a better service as I pay quite a bit of $$ for insurance and then have to take time off of work to try to get claims covered by being on the phone with the Dr. and insurance company getting the run around. What a lousy experience for a hard working, healthy, and paying customer. CareFirst is a JOKE!!!
In April I called CareFirst more than once, in total more than 4 times to ask the same question with different representative. All told me the same answer. I asked if my insurance cover psychologist visits and they told me only in-network once. I also asked them if there is a max. number of visits per year and they said no. I can visit my psychologist as often as I like. After several weeks of search I found a few that is not too far from me and they are in network. I am the type that don't trust just one person giving me information so I called numerous time asking the same question.
Only recently I found out that CareFirst refuse to pay because they stated that I am not cover... I wouldn't have seen one if it isn't cover... They give out wrong information consistently more than 3 times by all different representatives... Now I am stuck with a super huge bill??? This sound like I am not the first person they done this to. After reading some of their reviews, other insured say the same thing...
I was covered by CareFirst as an employee of TEKsystems, a subsidiary of the Allegis Group. The insurance policy stated 100% coverage for urgent care. However, CareFirst denied payment for a urgent care visit. I contacted a health insurance advocate that stated I was indeed covered and they tried for 3 months to get a payment from CareFirst. However, CareFirst continued to deny payment. The stated reason was that they only cover urgent care from a doctor's office (which was never stated in their website or insurance agreement).
I need regular blood draws once per month to check my medicine levels. If the levels are too low or too high, I will die. BCBS has refused to cover any blood draws because I have an out-of-state specialist who writes the order, even though I get the blood drawn and processed by a lab that is in network. Who writes the order has NO bearing on the blood draw cost, but BCBS is using it as an excuse to not cover regular blood labs. My doctor has reached out over a dozen times to submit prior authorizations but BCBS continues to deny them without explanation, even though they have accepted them before. BCBS does not care about customers with high needs; the insurance company is better off if I die. That is very clear.
Dealing with CareFirst insurance has been incredibly frustrating. I used their email service to ask how to cancel my plan because I was moving out of the country. It took 8 days for a response. Before their email response, I called and was told I need to mail or fax the cancellation form. No problem. I filled out the form and sent it in. Now overseas, I have called and emailed several times to follow up on the cancellation form. They don't know where it is. The only help they can give me is to give me instructions on how to send the cancellation form. Thanks, Carefirst!
My experience is never email them. It takes days to get a response. I emailed them again asking if they received my cancellation form only to receive another email telling me how to cancel. I'm not entirely sure anyone even reads those emails. I sent another emailing expressing that and finally got a response that in fact they do not have my form and instructions on how to fill out the form I already sent a month previous. They're really good at providing cancellation instructions. That's why they get 1 star.
If you need to cancel your plan, by god, find yourself a fax machine because mailing it is apparently ineffective. It takes 10 business days for them to even tell you if they have received your letter. Make sure when you send in the cancellation form that you also add your proof of new coverage. The woman I spoke to on the phone said that may be the reason that my form was not processed. But who really knows? It's a pretty archaic system. I used Blue Shield while living in California and when I moved to Maryland I was able to cancel with no problems.
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.
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.
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