CareFirst

CareFirst Reviews

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CareFirst Reviews

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    Page 3 Reviews 40 - 240
    Coverage

    Reviewed Aug. 22, 2016

    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.

    Reviewed Aug. 16, 2016

    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.

    Customer ServiceStaff

    Reviewed May 3, 2016

    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.

    Customer ServiceStaff

    Reviewed March 13, 2016

    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???

    Coverage

    Reviewed March 10, 2016

    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.

    Customer Service

    Reviewed Feb. 10, 2016

    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!

    Verified purchase
    Customer ServiceStaff

    Reviewed Jan. 27, 2016

    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!!!

    Customer ServiceCoverage

    Reviewed Jan. 20, 2016

    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.

    Customer ServiceContract & TermsCoverageStaff

    Reviewed Jan. 7, 2016

    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.

    Customer ServiceCoveragePunctuality & Speed

    Reviewed Nov. 23, 2015

    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.

    Customer Service

    Reviewed Nov. 9, 2015

    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.

    Customer ServiceCoveragePriceStaff

    Reviewed Nov. 9, 2015

    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.

    Verified purchase
    Customer ServiceCoveragePricePunctuality & SpeedStaffProcess

    Reviewed Sept. 2, 2015

    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.

    Customer ServiceCoverageStaff

    Reviewed Aug. 21, 2015

    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?

    Customer Service

    Reviewed Aug. 18, 2015

    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.

    Customer ServiceContract & TermsOnline & App

    Reviewed July 18, 2015

    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!

    Verified purchase
    Customer ServiceStaff

    Reviewed May 29, 2015

    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.

    Customer ServiceCoveragePrice

    Reviewed May 28, 2015

    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.

    Reviewed May 5, 2015

    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.

    Verified purchase
    Customer ServiceCoverage

    Reviewed April 16, 2015

    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.

    Verified purchase
    Customer Service

    Reviewed Feb. 25, 2015

    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.

    Verified purchase
    Customer ServiceStaff

    Reviewed Feb. 10, 2015

    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.

    Verified purchase
    Customer ServiceReliability

    Reviewed Feb. 3, 2015

    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.

    Verified purchase

    Reviewed Jan. 14, 2015

    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?

    Customer ServiceContract & TermsCoveragePriceStaff

    Reviewed Dec. 31, 2014

    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.

    Verified purchase
    PriceStaff

    Reviewed Dec. 28, 2014

    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.

    Customer ServiceCoveragePriceStaff

    Reviewed Dec. 10, 2014

    I'm going to start studying what my options are legally. These people (CareFirst) should be jailed and they should throw away the key. Modern day mafia tactics are not what I was willing to give my life in defense of in service. Now I have been turned down for VA Health care (Seemingly not much better on tactics but maybe cost) because I make too much money. I have a newborn and a sick wife and all I get from CareFirst is the continued Grift. I wasn't going to peruse fixing a huge issue with billing because of how painful it is to resolve and the lies and games CareFirst has played. I started a new dental policy, attempted to cancel CareFirst, and they refuse to cancel from my attempted date with all the games about a fax or non-proof of new dental insurance.

    Spent hours faxing and fixing things because of their shady protocol. I gave up thinking time value of money, billable rate of 120 an hour, just pay it. Now I'm fed up! There is no excuse that I and Quantum Health should have to spend this much time and resources to get CareFirst to do what's legal and appropriate.

    They can't get dates correct. They can't get paperwork correct. They can't manage their communication center. They can't keep up with their employees and policies. Employees lie to get you off the phone and don’t record conversations then because you can't prove that you called them.

    That’s money out of your pocket. I use their online billing system and funds aren't applied/mysteriously lost. I have put in over 20 hours trying to fix the headache called insurance because CareFirst employees are incompetent and it is my believe are told to follow less than ethical practices to get more money out of their members. When I think of CareFirst, I think of the most underhanded organization I have ever had to deal with. Billing and Customer care are fowl, unethical and my options are? Sounds like a monopolistic organization to me.

    Verified purchase
    Customer ServiceStaff

    Reviewed Nov. 10, 2014

    This is an ongoing complaint with CareFirst. Payment been made, not posting payment and terminating policy without the consumer knowing. Back in January 2014 I made a payment to CareFirst and they cashed the checked as always but not see the money or post the money to the account. The consumer have to be calling them and they are so quick to cancel the policy for nonpayment meanwhile they have cash your check, and then don't posting the payment. Three times with CareFirst and they have the nerve to call and ask how is their service. I have nothing but pain from CareFirst with this new service they are providing, with some employee that have no common sense at all. I know God gave us common sense but one employee in particular did not use hers at all. Just sit on her ass and providing trash information on the phone. But it took just one person who is using her common sense to find what was missing which was the money I was calling for about in a different account, that CareFirst refuse to remove from the account that is causing confusion all time. I will like CareFirst to get a big fine from the government for misconduct and bad practice of service. Someone need to listen to the consumer.

    Customer ServiceCoverage

    Reviewed Nov. 3, 2014

    Worst company to deal with EVER! I just switched from my companies CareFirst Health Insurance to a private health insurance plan within CareFirst. This switch should have been easy as it was entirely within the same network. Being 6 months pregnant and switching out of open enrollment the MD Health Connection gave me a pass and I filed in September for an October 1 start date. My bill was due By October 7. Their payment system was down October 1-6 and could not take any payments. On October 7 they called me saying their system was up and they could take a payment. They took my money, it came out of my account on October 7 and the online bill shows that I paid on October 7.

    Needless to say it is November 3 AND THEY HAVE NOT ACTIVATED MY ACCOUNT! I have called at least 2-3 times a week and every time I call they say they are "escalating my account to be activated" or "we are doing an emergency escalation to fix your problem." I paid for the month of October and have received no Insurance. The past two weeks they will activate the same day apologizing profusely and then immediately deactivate my account the next day!

    Did I mention I am 6 months pregnant and to make matters even worse as of last week I have pretty serious bronchitis and can not see a doctor because I don't have an active insurance plan. I can't pay for November because they haven't given me a bill. Needless to say, I am pissed, they are horrible and I'm going to switch BUT NOT BEFORE I GET MY MONEY BACK!

    Customer ServicePunctuality & SpeedStaff

    Reviewed July 1, 2014

    They don't have consequences. I have worked with the same incompetent people (some even supervisors) for years and years over there. They are equivalent to working for the gov't; you would basically have to murder someone for them to fire you and even then, I doubt it. I had a supervisor mess a claim up so bad once, then he disappeared. Some lady helped me and then when I complained to the supervisor that he was incompetent, he blamed it on the worker that solved my problem?? Of course, was not fired at all, and he's still 100% incompetent AND running the dept!!! They are a non-profit organization that brought in one billion revenue last year???? WOW a NON-PROFIT ORG?

    That's Maryland, DC, VA & DE National Capital Area of CareFirst!!! On top of paying their president about $10Million a year (if you really want a good one, look at previous presidents retirement fund payouts!!!!). They average an 80% profit margin, meaning only 20% of your premiums actually go towards your healthcare. They have fake people sending letters that no one knows who they are and the letters mysteriously disappear in their database, but yet when you send them a copy of their letter. The problem seems to get fixed rather fast with no explanations. Sometimes you can call them and actually get an answering machine stating, "They are not taking calls at this moment." What huge corporation would run a company like that and get away with it... Besides our gov't?

    They will give an entire department a vacation, oh I'm sorry, a "learning class," on a nice island somewhere (that's how they stay non profit, I guess). Literally the dept has one person answering phones but cant tell you one piece of information. If you really want to laugh, go to Owings Mills and take a look at their 5 building compound parking lots. There is not one car in there under $50,000. It's a disgrace to see where our premium money is going towards. Sitting in their parking lot will make you want to vomit!! They have security guards at their front doors and you can not get past them for nothing, that should tell you A LOT!!!! They conveniently keep their received paper mail in a secret locked box for two weeks before they open it, then YOU are late!

    Wow, it really took the US postal system to 23 days for only 30 miles, wow? They deny and reject claims without any reasons, no denial codes, nothing. That's illegal and they get away with it all the time. If you have denied claim and you call in for help, you will then get it denied for another reason and then if you keep coming at them, you may even get a 3rd reason its denied. Meanwhile ALL of them are incorrect, but have you exhausted your sanity trying to deal with this by then? Of course!!!

    I have appealed claims to them for 18 years and they have almost NEVER even responded to any of them!!! I had a 5 hr surgery that cost $51,000 and CareFirst paid my surgeon and surgeon's asst $2777 for the entire surgery!!!!

    No wonder no doctor wants to work for them. As a broker, I have one thing to say to ALL OF YOU. It's called the Maryland Insurance Commissioner!!!! That's the 3 magic words!!! You don't even have to say it, just submit a simple paper complaint to the Maryland Insurance Administration. Don't play CareFirst's game, don't give them one second to delay or stress you out. Go immediately to the Insurance Commissioner!!! It works like a charm and really fast too, its almost amazing how fast they can fix something when the Commissioner comes after them.

    Customer Service

    Reviewed March 10, 2014

    I have a Medicare supplemental plan for my wife and getting them to auto draft the payments correctly has become a real joke. Since the middle of 2013, I have made 8-10 calls to get them to auto draft the premiums. Every time I call them, they say it will be taken out the next month. I have them take the payment while I am on the phone with them (after an hour on hold) and they have no problem. The next month rolls around and still no auto draft taken. I go through the same thing over and over. Then they got it working for two months. Now it is back to the same problem and I got a letter saying there was an account update at my bank and I should call the bank for information. I called the bank and CareFirst had inverted the first 3 numbers of my account.

    Here I go again I call and wait to talk to CareFirst just to be told the computers had lost some of the account information and I would have to re-enter it which I did and double checked it and was told to wait till the 9th of Mar. to see if it is taken out. Well, here it is the 10th and nothing has been taken out once again and was told they would monitor it and send me an email. Still Nothing!!!! OH by the way, they know how to send you cancellation notice even though it is their fault!!!!

    Verified purchase
    Customer Service

    Reviewed March 4, 2014

    Every month we submit a check for my policy and my husband’s policy. EVERY MONTH we receive a notice that they did not receive the money. EVERY MONTH we have to call them and stay on hold for half a day waiting for someone to answer. EVERY MONTH they see the funds but have misapplied them. When you get upset they tell you that they cannot help you since you are upset and they put you on hold for the rest of the day and or disconnect you. WHAT OTHER BUSINESS IS MANDATORY (healthcare or ObamaCare) where nobody has to answer and nobody has to get it right EVER but you HAVE to pay? What country do we live in?

    Customer ServiceStaff

    Reviewed Jan. 30, 2014

    We started credentialing our new office in late October. After several glitches, we were told we'd be able to start billing 1/4/14 (we opened 1/2/2014). Our claims have all been rejected. Nobody at CareFirst can tell us what's wrong. I've contacted our billing clearinghouse, and after investigating, they said it was almost certainly CareFirst issue. I have talked to my CareDirst Provider Representative and a contracting specialist, who both told that our information should have all been filed, and told me to call the Help desk. Every time I've called (7 times now), I am on hold for 45 minutes before I give up in disgust.

    We have $18,000 worth of claims sitting around, not getting paid. All our other insurers are online. It's impossible to get any answers. There is no "supervisor" that can help us; I can't find anybody online to help me. We are a small, two-provider office, and we cannot afford not to get paid while CareFirst puts me on hold. CareFirst is without a doubt the worst insurer that I have to deal with, and that includes the Medicaids that we have. Their phone system is positively Byzantine, customer reps are often rude, and it's never clear whether you've selected the right option on the phone tree. Also - their fee schedule is terrible; even most of the Maryland Medicaids pay better than they do. This is a travesty, because they have a real grip on the Maryland area - they are our biggest insurer next to Medicare.

    Customer Service

    Reviewed Nov. 1, 2013

    I submitted a claim for reimbursement three times via the BCBS web site. I called to confirm their receipt and was told that they could not confirm receipt until the claims had been processed. I then resubmitted my claim via fax directly to a BCBS manager who told me that it would be sent to the correct department for processing. Well, how difficult can this be? Apparently, quite difficult as it took at least three weeks just to be received. It seems that they could not make up their minds as to who it should be processed by. I call nearly everyday and never get the same story. I've requested a single point of contact in an attempt to get them to be more responsible. I guess this isn't possible as they never complied with my request. It has now been two months since I first filed my claim and I still haven't been paid. My claim had about thirty line items but was for the same two medications and same diagnosis yet it appears to be far too complicated for them to process. They have now requested additional information as a delay tactic. Why it has taken two months to do so I have no idea.

    Customer ServiceCoveragePriceStaff

    Reviewed Jan. 8, 2013

    The insurance was decent enough and relatively cheap, but cancelling was a nightmare. It took an entire two months and calls to no less than four separate people in order to get my cancellation processed. While they did eventually refund me, I got a call weeks later from one of the people I spoke to months prior - just now telling me how to start the cancellation process. This company obviously has no internal structure or management, and it's bloody amazing the entire management staff hasn't somehow starved to death due to incompetency. Avoid at all costs unless you absolutely cannot afford anything else.

    Customer ServiceStaff

    Reviewed Jan. 4, 2013

    I am an office manager for a family practice office. Carefirst is our largest payor, and they are our worst. From their totally unwieldy phone system (Which of my 3 provider numbers does it want? Which prefix does my patient have? What is the relationship to the subscriber? Blah, blah, blah), to their oft-repeated non-answer of "We'll have to call the home plan." They are so bad it makes my head spin. As a provider trying to get answers, we don't even know whom to call half the time. I needed to get a duplicate Remittance Advice (the sheet that shows which patients the payments are for) that was about 4 months old. I was told (after being transferred at least twice, and being placed on hold for 45 minutes) that I couldn't get it unless I wrote a letter! Any other insurer allows one to go online and download these - they are like a bank statement or similar financial document.

    For as much money as people are paying for the "privilege" of subscribing, you'd think they'd be able to afford some real state-of-the art website at least, but no. It's pitiful. I can't look up claim status if a patient is out of network, although they administer these payments. On the other hand, Medicare, a government-administered program, has a high-quality phone tree where I can get real answers, and if my answer can't be found there, customer service reps are knowledgeable and able to help. This is one example of private enterprise doing a wholly sloppy job because they think they have a monopoly.

    Staff

    Reviewed Dec. 4, 2012

    To follow up on my comment from 12/02/2012 - The manager Steve ** contacted me over the phone. He was extremely helpful and polite. Steve was the only person who was listening to my concerns and he took his time to fix the computer problem (which was not my problem to begin with). I am dissatisfied with the company service overall. I cannot complain about Mr. ** as he was helpful unlike Heather and other people who had no human touch and kept telling me “the computer says...” Thank you, Steve.

    Customer ServiceStaff

    Reviewed Dec. 3, 2012

    I have a family medical coverage from my employer. The insurance company is Care First (Blue Cross. Blue Shield). The company did not seem to hire professional people to attend to the needs of the consumers. Around 10/16 or 10/17/2012, I was told by the company representative that my family deductible has been met. The same information was presented online in the summer and my chiropractor's office member confirmed that the deductible has been met. On 11/26 and 12/03, I was informed that the deductible has not been met and I was responsible for the deductible portion of my medical bill. It is still the same calendar year. The supervisor Heather informed me that there was a system error and the bills from my chiropractor (from June and July) have not been applied towards my deductible. My understanding was that they were applied before and someone overwrote the system. Again, this was a system error and not my fault.

    Can anyone explain to me how the deductible was met and not met later in the matter of 1.5 month in the same calendar year? The supervisor was less than friendly. When I asked for her supervisor, she refused to connect me to him/her. It took a few screaming matches on my end to get Heather to tell me the name of the person above her. She said that she does not have a supervisor; she has a manager. Isn't it the same thing? The manager Steve has not answered the phone and did not call me back. Heather refused to provide me with phone numbers of managers/supervisors. As a result of the computer error, I ended up with $441 bill from the hospital and over $1,000 bill from the chiropractor. I do not know where else to turn. Please help.

    Customer ServiceCoverage

    Reviewed March 8, 2012

    This is one of dozens of problems I have had with CareFirst BlueCross of Maryland Federal Employee Plan. I wanted to go to a local urgent care facility about a persistent cough (because I was out sick and PPP is closer to work, this was closer to home). I called facility and asked if they took my plan. Yes, $30 co-pays.

    Three weeks later (after I had returned to the same facility for a follow-up visit), I received a bill in the mail for $100. Turns out FEP Blue has changed their plan and no longer covers urgent care. This is their game. You literally need to scan and memorize your policy every year, then call them ahead of time to make absolutely sure. At this point, FEP Blue is a discount program, not an insurance plan.

    Reviewed Nov. 22, 2011

    My monthly rates for my PPO health insurance policy just increased by almost $100 per month.

    Reviewed March 28, 2011

    I found myself without health insurance in January 2011 due to my ex-husband losing his job. I applied for health care with Care First Blue Choice in March and was informed that I had to have continuous coverage, therefore, had to pay for February as well. The person responsible for submitting the information sent it, it was complete with a physician chosen. I did not receive a card until March 28 and the insurance will be canceled on April 1 due to my loss of job, thereby, giving me no time whatsoever to use any of the insurance. I was also turned down twice for prescription refills. I requested my $1000 to be returned as they did absolutely nothing.

    Reviewed Jan. 14, 2011

    We had a baby son in October of 2010, and three weeks later we called to add him to my wife's insurance policy. When she spoke to the representative, she was told the insurance would be $356/month. Now it is January 1 and the bill arrived and it is retroactive to October for our son, and comes to $2226.71. Needless to say, we are overwhelmed with the bill, it is due by the 1st of February.

    How are we expected to come up with that much money and still pay our monthly expenses? Why would we not have gotten any documentation stating the cost hike to $733/month? So after getting the statement we called and spoke to a representative again, and they stated there was no way we were told it would be $356/month. When we reaffirmed that we were told that, they said we could file a complaint with the state commission if we wanted to.

    Why do we continue to allow this insurance company to fleece us, and nothing is done? Why are we passing health care bills when the lobbyists are allowed to buy politicians votes, and dilute the bills to nothing again? How do I make the insurance company accountable for their actions?

    Reviewed March 24, 2010

    I have been paying on my son's health insurance with Blue Cross/Blue Shield and in August 2009, it was cancelled because they said a payment was not sent in in July 2009. However, I did not know of the cancellation and continued to pay on his policy. I paid $404.00 every month even in August, the month they cancelled the policy, on up until March when my son went to get a prescription filled and was told he had no insurance. CareFirst advisor told me the money stays until I call concerning what I want done with it. If my son had not had a prescription to be filled, he would not have known he had no insurance and I would have continued to pay on a policy that was cancelled. I was told if I wanted to have him reinstated I would have to pay $1120 plus the money I have already paid since August 2009 over $1550.00 to get him reinstated.

    I asked them if he had gotten sick, they would not have paid for his claim so why should I have to pay for the time he was not covered by them August 2009-March 2010, that the money they were holding on to and collecting interest on it until they heard from me should least go toward future premiums. I was told that they would not do that and I can cancel the policy and they would refund the $1550 that they had and I would not have to send the $1120 which would have gone toward the two missed premiums July, September and for the present one in March. I wanted my son to have insurance without having a long waiting period to get one so I paid the $1120 along with them keeping the $1550. It seem that that is insurance fraud to keep people's money knowing that their insurance has been cancelled.

    They should have contacted me regarding cancellation. If I had known his insurance was cancelled, surely, I would not have been still paying on his premium. I wonder how many other clients they see have they done this same thing to. I'm sure a lot of money has been collected because of their policy of not letting people know their policy is cancelled and still holding and collecting money on the policy along with interest accrued on the money they are collecting. I am asking for restitution by returning the money they held when he was not being insured and to continue his benefits with the $1120 that has been sent in to cover his premiums until April 2009.

    Reviewed Jan. 21, 2010

    Multiple attempts to speak with a representative blocked by the automated system. It needed an address to send a cancelled policy due to the death of the applicant. The policy was never used. This wasted time and caused aggravation since my request is unusual and should be handled by a representative, not an automated system.

    Reviewed Jan. 14, 2008

    I became unconscious due to acute hypoglycemia in Cancun, Mexico (there for a wedding). After the doctor at the Hilton revived me, I was transported by ambulance to the hospital emergency room. The ER doctor advised me to be admitted for overnight observation. I contacted Carefirst for authorization to be admitted, but they told me nobody was available to help me (this was on July 4, 2007.) I have a $10,000 deductible individual policy, so based on my experience (I am 46) and the advice of the ER doctor, I admitted myself to the hospital. My estimate was that I would be responsible for about $600 of the actual charges. The next day I was discharged, and Carefirst refused to help me or pay any part of the bill. They insisted I file with them for reimbursement which I promptly did upon returning home on July 7. After a lengthy wait, Carefirst initially imposed a 20% penalty for failing to obtain preauthorization and still refused to pay any part of the bill. Furthermore, they never provided me with information on the negotiated rate I was to receive (the Cancun Hospital is one of their approved providers.)

    Ultimately, they removed the penalty only to apply it to my deductible. They were not able to explain how they could impose a penalty, remove it and then give it a new name and still charge me for the 20% that they agreed was erroneously applied. I paid the hospital $1,800 US upon discharge. Had Carefirst been responsible, they would have likely allowed about 1/3 of $1,800 charge and I would have paid the hospital $600 upon discharge as I had estimated prior to admission. I am now trying to recoup the difference between the actual charge and the billed amount. Carefirst has yet to discuss this with me, and I have submitted my second and final appeal to them as of the last week in November. No, I have not heard anything from Carefirst about this second appeal. They responded to my first appeal by saying the claim was properly processed. They continue to stress to me that I have a $10,000 deductible. I am well aware of my $10,000 dedutible, but I know that the $10,000 is reached by applying successive allowed amounts and not billed amounts. They have not explained why they have denied my claim.

    I am almost certain that they have violated laws for not explaining this denial to me in a timely manner. Furthermore, to not even have a polite conversation with me about why nobody was available to assist me when I was in an emergency room 1,500 miles from home is beyond belief. Lastly, I think that they know they have made a serious misjudgment and are now hoping I just go away.

    I would like to give you another example of how this firm operates. In August, my doctor suggested I get an MRI on my sore left shoulder. Because of my $10,000 deductible, I wanted to get an estimate of my out-of-pocket expense. I made two calls to the MRI provider and one call to the radiologist after Carefirst instructed me to do so. I reported the procedure code to Carefirst, and Carefirst told me the allowable charge was $419. As my budget was $450, I had the MRI done. After the procedure was done, Carefirst sent me an Explanation of Benefits that now showed my out-of-pocket expense was $793. I called Carefirst and asked them what happened to their estimate of $419? They explained to me that it must have been a mistake. I told them that that was not my fault ,and I wanted them to correct the estimate to $419. They told me they would not do it and I would have to ... you guessed it...file an appeal. By now, I doubt it would surprise you to let you know that they denied that appeal, too. This company needs to be stopped.

    Once I tried to uncover and set a market for these fees, the providers and insurers treated me disrespectfully and kept fee information well guarded. The MRI provider and the radiologist will now likely submit my accounts to collection. I have excellent credit and have decided to accept a blemished credit record to make my case. It is worth noting that I contacted the two providers and explained that their contractual business partner Carefirst caused this problem. The MRI provider has tried to contact Carefirst, but has not heard from them in two months. The radiologist refused to speak with Carefirst and indicated that only I had the problem with Carefirst, not them. I would like to think this is merely an aberration, but I somehow suspect that I am being mistreated because I was able to obtain my non-medically underwitten health policy because I was HIPAA-eligible. Althought I manage my hypertension and diabetes very well, perhaps Carefirst loses money on my policy and would like to see me cancel. In any event, they have treated me poorly. I have been trying to get coverage elsewhere, but other companies are slow to respond to my insurance needs. I could sure use your help to correct they way Carefirst has treated me. Thank You.

    I'm mis-charged a total of $1,574. Also, I spent about 30 hours of uncompensated time trying to recover these expenses.

    Reviewed Nov. 28, 2006

    A claim for $1136 for emergency medical services on a cruise ship was filed in September 2006. Despite 10 phone calls over that last 3 months,resends of information and the promise that the claim takes 2 weeks to process, NO ONE can give me any status of the claim or an estimate of when it will be processed. A supervisor, Ms. Stewart, supposedly has this claim for "manual Handling" since early November, but will not speak to me or call me to explain any issues related to the claim. I feel this is horrible customer service and until resolved I am unable to move forward with any trip insurance claims. Please help me find the responsible correct person for escalation and help.

    Reviewed April 18, 2006

    In Oct 2005 I recieved testing for ADHD after consulting my insurance, to make sure it would be covered. After recieving a go ahead from Carefirst, I paid out $1575 toward the testing and my psychologist sumbited the claim, only to have it first lost and then rejected. When I inquired about why it had been rejected they said because there was not enough information to determine if it was a pre-existing condition. I then had my primary doctor send all of my records, and still that was not enough information for them. It seems to be logical that if there is not any prior information about a perticular problem that should be proof enough that it is not pre-exsisting.

    After countless phone calls and faxing of my medical information still to date (Apr 2006) I have had no feedback from Carefirst, and when I call, I am always told that they haven't recieved my information. I am then given a direct fax number and reassured that this is not typical and that it will be gathered by, the person I am speaking with, and taking personally to the review board. I have had this same conversation with over ten people at Carefirst, all stating they will call and keep me updated, including supervisors and customer care speacialists, and still no response.

    Finally, yesterday, I spoke witha customer service rep and was then trasfered to a supervisor, who never returned my call, even after stating that I will not call Carefirst again, instead my next calls will be to the Insurance Commissioner and a lawyer. It is now the next day and still no phone call. I have had insurance through BC/BS since I was born, always through a employer, and never had a problem. Now that I am an individual member it seems that Carefirst could care less if I am a very dissatisfied.

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    CareFirst Company Information

    Company Name:
    Carefirst
    Website:
    individual.carefirst.com