Highmark Reviews

Highmark has just decided to deny the coverage of my remicade infusions that I have been getting for my Colitis for 15 years. They denied the medicine with less than a month to my next infusion and didn't respond to my doctor's appeal until 2 days before my appointment. Highmark claims my infusions are medically unnecessary. My gut since missing my infusion would say otherwise. They want me to switch drugs to see if their "preferred" drug works. But my drug is working great, I shouldn't have to switch to something else and hopes it works without side effects.

My husband has been a client of Highmark since his retirement 6 years ago. They consistently take the automatic payment EARLY (prior to the 1st) and cause our acct to be overdrawn (we, unfortunately, are a family that lives month to month). So the end of June, I called and asked to have the automatic payment date moved to the 3rd so our SS money will be in the acct to cover the bill. I was told it was all set up and I'd have to make the August payment myself, which I did.

I have had Highmark for 2 years now. I found out that I need another back surgery which is my 3rd and it is a major surgery. My Dr. sent all the necessary paperwork on July 22nd of this year and my surgery was supposed to be on August 12th. Well they drag their feet and when the Dr.'s office called to see what the hold up was, they were told it is still under medical review. They said they would expedite the review, (Which they didn't do).

Takes 14 business days to receive a replacements HSA card and 21 business days to receive a reimbursement checks. They self identify as a healthcare company yet are not available on the weekend. In their “About Us” section on their website they post their Mission, Vision, Core Values, and Behaviors and fail to live up to them.

Horrible insurance. Overpriced garbage that constantly kicks my claims off on my HRA card my employer supplies for lame shit like my daughter's dentist needed the payment in advance before doing a procedure, so they refused to let me use the card. Or just now when Rochester Regional sent a bill that was from last year and refused to pay it with my HRA even though I had 2k roll over from last year on it. Was I supposed to pay a bill I was unaware of until June of this year?

They suddenly stopped covering my youngest daughter (18). They claim they were notified she has another insurance. When I asked they were unable to provide me with either the names of this other company or who told them this information. I was bounced from chat bot to chat agent to phone agent. None of whom could or even had any interest in solving the issue. Still waiting with the medical bills piling up and an otherwise excellent credit profile in danger.... They just don't care. They are the epitome of why the general public despise medical insurance companies!!!

I work for a very reputable hospital and having to do appeals almost on a daily for stroke patients is absoultuely ridicuous. Not only that but filing a expedited appeal which is suppose to render determination within 72 hours it has been 12 days and still no response. I have been calling numerous times leaving messages and finally got a response from a rep that has been out of the office for a week. Was told I would get determination within 24 hours and here we are 2 days later and still nothing. The patients who pay for this insurance deserve better than this!!!!

Wife recently suffered a traumatic burst fracture of a lumbar vertebrae with a piece of bone pushed back into her spinal canal. Local ER transferred her to a regional trauma center where a trauma surgeon and a neurosurgeon admitted her for 2 days to stabilize her spine and treat other problems. A month later Highmark's retrospective reviewer denied coverage of the entire hospital stay as "medically unnecessary," second guessing the opinions of board certified specialists. (All this for a 2250 monthly premium that went up 20% this year.) The hospital told us they have to deal with their denials all the time. So this is what the greedy corporate take over of health care delivery in this country has brought us.

Companies like Highmark is what makes it so hard for people to take care of themselves. Every female in my family has had an aortic aneurysm, so my PCP submits a prior auth for a chest CT for me and Highmark denies it. So disgusted with healthcare in general, but when you try to take care of yourself insurance companies like this make it impossible.

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.

Fully agree with many of the comments before this. Their focus appears to be denying claims or processing them in a manner to put the burden on consumer and making the resolution process so onerous that their hope is that you will eventually just give up. I eventually had to file a formal complaint with the PA Insurance Dept.

There was no in-network doctor qualified to perform my skin cancer surgery, yet they penalized me by charging me the tier two fee for my coverage. I filed a formal appeal to have tier 1 coverage because I had no choice. They denied my appeal. Communication was terrible and I received no up-front warning that would have to pay 500% more in out-of-pocket expenses.

They canceled my coverage for owing less than $10 and did not send me a single notification through email the app or any other means of communication. They claim that they sent me several notices in the mail that I had never received and canceled my insurance dating back several months After the notice date on the termination paper costing me thousands of dollars all over a less than $10 payment. Thanks Highmark.

The most part they're helpful. However they like to make things difficult for seniors and keep it tricky so if you're not into that get some other insurance, you know I've used the over counter store for.. oh my now for three or four years, it was saying that I'm putting in the wrong numbers for my member ID, putting the same numbers in I was putting in for 3 years not recognizing it, I call member services and they say, "Well you don't got to put the first number in." Well how am I supposed to know that and then when you try to contact you over the counter store I could have contacted because it wasn't recognizing my number that I wasn't supposed to be using that I didn't know but now if you can figure that out go ahead and get the insurance. Otherwise don't bother.

I'm extremely dissatisfied with Highmark insurance. They excel at collecting premiums, but when it comes to providing the coverage I need, they fall short. Recently, Highmark changed its policy on obesity, now considering a BMI of 40 or higher as the threshold for coverage. This change has had a significant impact on me and many others who rely on medication to manage our health.

Highmark is the ABSOLUTE worst company I've had to deal with. Our family switched to COBRA on Sept 12, 2025. We decided to take my husband off (who was the main member under his employer, I was beneficiary) because we're only keeping this so I can give birth in October 2025. The lady we spoke with ensured us everything would still remain the same and the coverage would be retroactive starting Sept 13, 2025. What she didn't explain was that by taking my husband off the plan, it would start a whole new plan with a whole new ID number. Mind you I've already spent over $1k in out-of-pocket expenses and met by $750 deductible for the year. By triggering a whole new plan with a whole new ID number... it restarted my out of pocket and deductible expenses at $0 and I'm giving birth in a few days!!!!

I pay nearly 5000$ a year to insure myself and my two daughters. Out of the 28 claims I made this year, only 2 were covered. They have paid doctors a grand total of 460$ while I have paid them over 2000$ in addition to the monthly cost of this insurance. These people are evil. They are taking advantage of the poor and powerless to make profit. They do not care about you or your family, they only care about your money. These people are the absolute scum of the earth. You would save money not paying for this insurance at all and just negotiate with Doctors yourself. These people are only in the business of taking your money and refusing to give you anything in return. Complete scam of a company, and I hate my employer switched to this.

I have been working and carrying the health insurance for my family for over 30 years and Highmark is the worst company I have ever dealt with. The one star was generous, I would give a negative if allowed. EVERY SINGLE claim has been denied or only partially covered with everything being applied to my deductible. Every time I called to inquire about why, I have to speak to someone that is very hard to understand and most likely not even in America as well as being rude and condescending. Their favorite line of BS is that it was coded wrong and not covered. Or the doctor, hospital or medical practice is out of network. I will be cancelling during open enrollment. I'd probably spend less paying out of pocket with the discounted uninsured rates.

I would give 0 star if there is an option. As a cancer patient, my primary care provider ordered lab test and ultrasound after my surgery. Both of them get magaically denied as "the PCP is out of network!" I contacted the agent on May 2024 and discovered that exact PCP was on the website for in-network! The agent said this was due to a mistake of their system, which they would resolve soon. Fast tracking to May 2025, I still have the same claims denied. Tried to contact Highmark again. Surprisingly, they gave me the same reason for denying service and said the previous agent did nothing!!?? Seriously??? Doing this repeatedly to a cancer patient, your company's behavior is so disgusting!!! Shame on you, wish your family go through the same thing as I went through!

Had Highmark through work. The absolute worst company I have ever had. They send you a detailed letter for all of your visits. However, they will send you letters periodically asking you to mail them a copy of the bill, or they won't pay it. They already have the information. I've never heard of anything like this with any other insurance company. Get hurt at work, You have to call a number and go through a bunch of hoops. After 15 minutes, the call dropped. I skipped it and just went to the ER, I never did call them back. I pay you plenty, I shouldn't have to beg you to use my insurance. I will never use them again and would 100% not recommend them to anyone.

This medical insurance company will make you sick. Call them and you have to go through a 3-minute automated message before you can speak to a person. At the 2 minute mark some ** who designed this informs you that if you don't have certain info you need to call back (they put that at the 2 minute mark). During this long message, Highmark will brag about its extensive network all over the world. The reality is that getting anything reimbursed by this company will be mishandled, not followed up, incorrectly coded, and host of other problems. Highmark outsources its intentional insurance to Global Core, but the two companies hardly can talk to each other except through cryptic electronic messages. Highmark itself has to sit and wait for when global core will respond. In the last three years I have submitted claims for three procedures and none of them has been reimbursed because of errors at Highmark's end.