Highmark Reviews

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.

My problem is I try to talk to you a representative because I've been having issues. All I wanted was a case worker and the representative hang up on me. I contacted a supervisor after been dealing with issues for a month dealing with people hanging up on me. I just want the whole gateway health plan to know we are humans. To not have my bad day but I don't put my bad energy on everyone else I did talk to someone but the end of day I don't want to be disrespect. When that lady hung up on me I had a bad day already like I said I don't put my bad energy on no one.

So Highmark in its infinite wisdom has dropped weight loss meds from coverage. Why? Cost. Plain and simple. They chose a blanket answer to a problem that is dealt with individually every month when you have to contact your physician to get it refilled. They document your weight, BP and side effects. I am sure there are people who aren't using it as prescribed but that falls back on the individual case to deny not block everyone. I hope someone sues the daylights out of them and it's a class action one that costs them millions.

I am dealing with retiree benefits. The segment of the company I deal with has no email or website. I have to call or mail everything. They are waiting for this small group of customers to die-they simply do not care AT ALL if you get any help or ever get paid. I hate this company with every ounce of my being. DO NOT use this insurance if you EVER want even a mediocre experience. ABSOLUTELY AWFUL. 0/10. When the class action lawsuit gets filed, I hope I get a call from an attorney.

Husband's work switched from UPMC which never had a problem with, never ever had to call customer service all around no worries. Well they switched to this insurance and all I got to say is I and others are demanding we go back to UPMC for we are the ones paying!

If I could give Highmark negative stars, I would. Their handling of weight loss medication coverage is not only disheartening but downright unethical. I was approved for weight loss medication when I was considered “morbidly obese,” and with the help of that medication, dedication, and support from my doctor, I was able to drop into the “obese” category. You’d think this would be a success story. But instead of supporting continued progress, Highmark decided I wasn’t “fat enough” to keep the medication covered. Yes, you read that right—still obese, still at-risk, still under medical care—but not fat enough anymore.

Had two calls this morning from two different Matrix reps trying to schedule in home appointment and saying that Sunday May 11th which is Mother’s Day was their only available time. They were quite pushy! Of course we said no. As an aside, I just lost my mother. Not impressed with this group!

I am in a financial bind because of information that multiple representatives at Highmark Medicare and or Express Scripts regarding my medications. Before I committed to an additional recommended drug in January, I contacted Express Scripts (mail order co. for Highmark) who handles the pharmacy claims etc. to discuss the new $2000. out of pocket for Medicare members in 2025. I repeatedly called and spoke to reps or supervisors confirming each time what I had been told. Based upon what one supervisor told me in January that the total included what I paid for a covered drug and what my part D plan paid. He directed me to

In my 23 years of adult life, I have never had such horrifically bad service from ANY company. Their website works randomly or not at all, and when I can actually get to their login screen my login creds never work. I try to reset the password using the info they request, member ID #, first name and birthdate and the site tells me it's wrong. I spend 45 minutes on the phone with someone who gives me a temp password, which works, then I create a new one, which then doesn't work. Rinse and repeat this scenario over and over again. I can access my claims, benefit info or search for covered doctors or services. I can't wait until next year when I can switch from this god-awful insurance company.

They "accidentally" dropped our renewal in Jan 2024 despite being active on Jan 1 and COBRA being paid. They had to reinstate. Then in Feb of 2025 while COBRA was still active, they somehow expired both myself and husband. Then after being denied an MRI on Mar 2 due to "coverage expired", I spent over 6 hours March 3 on on the phone getting it reinstated only to find out they forgot to reinstate Rx as well. Had to call back.

Absolutely terrible! I was on Wegovy for 5 months, lost 20 lbs and my high blood pressure was under control and then they changed the criteria. Denied for Wegovy and Zepbound by a pediatric doctor that reviewed my case and I'm a disabled adult limited on how I can exercise. Why do they go against my doctor's advice on drugs that ARE covered? The premiums that I pay are absurd, but if I had Medicaid it wouldn't be an issue. They don't even deserve one star. I was on Wegovy for almost 6 months and they covered it but because I lost 20 lbs but I wasn't anorexic looking they won't cover it and my blood pressure is all messed up and they don't care.

Took 6 months and 5 or more phone calls and sitting on hold for 40 mins at a time to finally get refunded for health insurance payments I paid and then was told my insurance was cancelled. They refunded me $177 after I paid $290 that they need to fully refund. Now I try to login and I can’t access my login. Of course.

A sad excuse of a disaster for an insurance company. Worst insurance company. I had in 35 years and they just don’t seem to care. More denial more confusing answers. Even when they deny something, they just tell you to reach out to your doctor cause they don’t have a clue. Wish the government would investigate them or they would get sued. Unfortunately, I am stuck with them.

I have been a type 1, juvenile onset diabetic since I was seven years old. Within the last year Highmark Blue Shield has started refusing my insulin prescription every time I try to fill it stating they need the dosage information even though the dosage has never changed under my current physician. This has forced me to ration insulin for months, to which Highmark has zero concern. Their customer service seems to exclusively be based outside the US and they have zero information about your plan when you call.

WORST HEALTH INSURANCE I HAVE EVER HAD. Their website NEVER LOADS. How can I find coverage if I CAN NEVER ACCESS THE WEBSITE. Their phone tree is also complete trash. Utter trash. TRASH. TRASH. TRASH.

Very frustrating website that is not customer friendly. Can tell it was designed by programmers FOR programmers, and not for consumers. Some of the problems I ran into: a) no easy way to print a temporary ID card for people who buy individual coverage; b) if I lived across the road (in another county) my premium would drop by a lot and I would have access to a much better plan; and c) my doctor listed as “not covered” even though his claims go through every time I see him. Exchange plan members seem to be second class citizens to Highmark, and they make no bones about it. They act like we’re pariahs. No other choices here though.

I have engaged with the Highmark customer service staff on 5 occasions in the last 3 weeks. Each call promised a follow up within 1 to 5 business days. No follow up occurred. Each call was handled by a polite well-intentioned person that was not capable of clear communications in English. I do not fault the people. They seem to be trying their best. But when my effort is to confirm that we actually have coverage in place this is very frustrating. When I log into to the web site, and it says we do not have coverage and yet the calls to the service center say that we do have coverage this is not very reassuring.

The worst health insurance provider I have had in my fifty years of life. They have denied services requested by my primary care provider, as if they know what is better for my health than my doctor does. I can't wait to get out of their service at the beginning of the new year. Money hungry insurance providers have ruined our healthcare system, and these fools are at the heart of everything wrong with it.

Highmark now decided routine diagnostic blood work was preventative care and not covered. Same for removal of inflamed skin tags. Denials come frequently while I was just notified of a $200 monthly rate increase. Upon appeal, they have not responded to the appeal. Highmark has made it clear that they don't care about health of their customers. It's a numbers game for them. The more they deny, the more they keep. Try to call customer service and someone from offshore answers after a long wait period and repeats the same sentence over and over. And they won't allow you to talk to someone in the US. And you get disconnected at least once every time you try to reach someone. Highmark is awful and I would find another company who cares.

EVERY year I have a physical Highmark denies payment for part of my lab work. I have to contact a patient advocate and jump through hoops to get them to pay. This year has been HORRIBLE. Every time I call a patient advocate the story changes: It was coded incorrectly, Medical history supporting it must be submitted, it requires a letter of Medical Necessity... My doctor's office has done everything they've asked of them at this point and still... denied. I dread my physical each year knowing I will have to deal with them. I've called for help 5 times now. I HATE dealing with this. Get your act together Highmark BCBS!