Highmark Reviews

Twice I've been denied an MRI until I do a few weeks of physical therapy. One MRI referral was by my orthopedic surgeon who wanted to know if I tore my meniscus because if that's the case the feels surgery would be better before therapy. Second time an MRI was denied was was when my neurologist wanted to know if I have pinched nerve in my back causing numbness in my legs. But no High Mark won't approve because they feel more conservative means should be used and say I have to go to Physical therapy for my back. Even my doctor feels an MRI is more appropriate. Also I can't start therapy for my back until I finish with my knee. And Highmark will only approve about half the amount of therapy sessions my doctors recommended.

Used to love them. Had them over 30 years. Now premiums go up while benefits go down with only one month warning. You don't speak to a rep but an Ai bot. The website which used to be usable is now rendered useless with glitches and error messages. 😕 Looking around sorry to say as don't have the time to work through the poor system now nor do I have time to wait for a live rep who really can't answer my questions. I can't update my own info at all now.

Horrible insurance company. While they continue to cut costs, support, and coverage for their clients and cut staff, the corporate company continues to experience record profits (so their strategy is working, but at a cost to the client!). Meanwhile, there is ZERO service anymore - you can’t even get help via the online chat, let alone ask a person a question anymore; the website continues to fail - it’s cumbersome, is often down, and has too many disconnected sites. Wait times for a live online rep are 30 minutes and the CUSTOMER has to reach back out (ever hear of Jira?) and 6+ hour wait times for phone calls. But hey - as long as the execs and board are happy, who cares, right? I’m self employed, so forced to get my coverage through this provider. It’s shameful I don’t have more choices. Competition would be an asset to this industry to improve things for the people who are actually paying for the products.

Highmark by Blue Cross Blue Shield is great if you prefer the most limited choice of providers and hospitals? Rush Orthopedics - No, Advocate - No, Duly Health and Care - No. If you want to drive the maximum distance in an emergency so you are covered. 15 miles/ 20 min no traffic. Employers choose the High performance network instead of giving you a pay cut the give you a healthcare cut. This plan is the absolute worst and should be illegal in Illinois. Thank you, RENTOKIL! formally Terminex. You really know how to mistreat your employees.

I have been attempting to have a claim that was incorrectly processed corrected for months. The MD office is now threatening collections when the error is on the part of Highmark. I have called 3 times now and am waiting for a call for the 4th time. I pay an absurd amount yearly for the best plan my company offers. I refuse to pay another cent because of incompetence. So far I have been told it was an error in Highmark's end processing the claim and it would be repossessed, then I was sent a check and told not to cash it as this was sent in error to me instead of the MD, the third time I was told it was being reprocessed again. I have a difficult time understanding the representatives and now I believe they are not understanding me. This is beyond absurd and extremely frustrating. They have no problem calling me multiple times to schedule their unwanted in home visit despite my requests to stop calling as we aren't interested. Highmark do better.

My experience with Blue Cross Blue Shield’s claims review process perfectly illustrates what is wrong with the American health insurance system. My provider ordered lab work to meet their requirement that testosterone levels be drawn before 11:00 AM. The labs were drawn at 07:35 and 07:58. These times are clearly documented on the report. Blue Cross Blue Shield denied the claim because the lab report used 24-hour (military) time and did not explicitly say “AM.” Let that sink in. The insurer responsible for reviewing medical documentation apparently cannot interpret the most basic time format used across healthcare, hospitals, laboratories, and the military. Anyone who has ever worked in healthcare knows 07:35 and 07:58 are morning times.

Needs shut down. I’ve never had such a horrible plan. They are completely full of lies.🚩 I’m filing a complaint with the state. I advise others to do so we can come together to put a stop to this horrible mismanagement #. Us the people need to put a stop how people health are being mismanaged!!

Healthcare coverage is just getting worst and worst every year. I have Highmark Blue Shield and standard coverage on a routine checkup for bloodwork that was usually covered. Now was not. I called to ask why and the person on the phone only could say, "It's not covered". I asked why and again "It's not covered". "Why was it covered last year, exact same annual visit and bloodwork?", response: "It's not covered". Had the doctor re-issue with another more standard code thinking that this might be the cause... Doctor acknowledged that another code was used last year, then reissued with new code. Month goes by, "claim denied with new code".

I have Highmark BCBS for my medicare Advantage provider... Called in about buying a CPAP machine. Was told they paid 60%, I pay 40%... I said fine... Paid the full price, submitted the claim.... 45 days later they rejected it. Called CS... Asked them why, they said I had to rent it? Asked them to look at the transcript of my call and rep told me that they did quote me exactly what I said... Now they have 60 days to look at the "grievance" over $300??? A multibillion dollar company can just say "yeah, we screwed up" and eat $300??? I can see why only 50% recommend this to family or friends.

Pay $1000 a month and can’t even get a knee replaced that won’t allow me to walk. Had surgery scheduled in 24 hours and they just denied my surgery. I guess they’d rather me be addicted to pain pills. Will be getting my insurance else where what a joke. Laugh will be on you when your kid or loved one is in the same spot. Greedy greedy insurance company will take your money but not help. 12,000 for a year to get denied what a joke. Wish someone was face to face so I could spit on them.

Highmark Wholecare is the worst..! I changed from Aetna Advantage to these liars, after one of their representatives called me and told me that they match Aetna Advantage Care card, item for item. Well, that's a total lie..! They will only pay for certain foods, OTC birth control, (I'm 65, that time has been long gone) and OTC meds that I'm not allowed to use.

I had Highmark over 20 years ago and they were great. I went to a new job and had UPMC insurance and they were great. My job changed two years ago and I have Highmark again. They refuse to use my current information provided by my new employer. They have my cell phone number, my address, my social security number but will not change my email address from 25 years ago from my old employer. I have made an attempt to change my email address 5 times and once again, I call today and they say they cannot validate my information because I cannot firm by email that goes to my old employer. However, I have been through this process before 4 other times, and the change has still not been made so I cannot access my Highmark Account to get the information that I need.

Aetna Advantage plan was hell-on-earth. I'd heard Highmark Wholecare was "a great plan" by an insurance agent. Sure, their ADS look great but NONE of their propaganda is true. 1st went through a long list of 'in network providers' in my area. 99% had retired, or moved years ago. Spent 2 hours on phone with Highmark & was assigned the ONLY dr that accepted their plan & gave Highmark 2 weeks notice for transportation. Ride NEVER showed up or bothered to call, to cancel. Highmark promised OTC benefits but refuses to send the card, you need to use those so-called-benefits. I've called repeatedly. They say, "Oh, it's just been shipped out".

Nothing short of MADDENING!!! I did learn that Medicare Advantage plan holders are indeed the "red headed step-children" and their policies, web portals and apps are held in a different regard that any of their normal customers. What I don't understand is that when accessing Highmark on the web or app store that they don't seem to have a special site/app for us unimportant Medicare customers. I only see one choice when I go online or to the app store. I am confused by this because I am assured by Highmark reps that because I have Medicare it is a totally different site than what the normal people get and therefore they are unable to help with a web issue, even though they are the web services dept. Unfortunately, 1 star is the lowest choice that you allow me to choose.

Absolutely horrendous. Provider covered one visit, not the next visit. Out of pocket expenses for a routine wellness exam exceeds $350 with zero coverage from Highmark. Trying to find a new provider in my area that accepts new patients is impossible.

This insurance company is a joke! They told me my premium would be one price and they ended up charging me a higher rate. This has been going on since July 2025. They absolutely refuse to refund the difference that is owed to me. Highmark doesn’t care about their customers and their employees have absolutely no clue what is going on. I will never be a Highmark customer again and if I could give a negative star on this review I would!

High premium cost, worst customer services in the planet. Even the information they put on your card is wrong. You hold several hours for the member service phone, you can’t reach a representative. Can’t describe how bad the experience it is with this insurance company.

The customer service is horrible. Endless automated responses, almost impossible to reach an actual person, and if you do that person is just a flunkie who cannot resolve the issue. Don't waste your money on this plan; so many other better options.

This is the worst health insurance provider on the planet. Agents are rude and cannot resolve anything over the phone. Records are stale and not updated for over a year resulting in denial of benefits. The company also use a tactic to deny claim by claiming you already have primary insurance with another provider and therefore will not pay for any services received until you contact the previous insurance company that you have a relationship 2-3 years ago and tell them to send in proof of insurance cancellation.

I work for a billion dollar company and this is the insurance they give us. Absolutely ridiculous. ANSWER THE PHONES!! PEOPLE NEED HELP!!! I have never been more frustrated with an insurance company in my life.