Care First BlueCross Blue Choice

State of Maryland CareFirst BlueCross BlueShield health insurance provider (located in Baltimore,MD)

I am writing regarding a situation that Maryland state employee health insurance provider CareFirst BlueCross BlueShield appears unwilling to address. In early January 2006, I submitted my first set of vision plan claim forms for a contact lens purchase from December 2005. My understanding is that this claim should be processed within 30 business days. When six weeks had passed without a reimbursement check, I called and spoke with customer service, who informed me that there was no record of my claim on file.

After confirming the address to send the form, I once again gathered up all my paperwork and sent the claim forms to the appropriate address. I called within two weeks to follow-up and was told AGAIN that my form was not found on file. Once more, I made copies of my paperwork and sent it off to the address listed on the State of Maryland Employee Health/Vision Plan Claim Form. Unbelievably, I called once again and was told by a Ms. Jacobs that my third set of claim forms had not made it to the Operations Center. Not wanting to make a fourth futile attempt at sending paperwork, I asked Ms. Jacobs if there was another option. She advised me to fax the paperwork to her at and she would submit the form. I did so that day.

Ten days later I attempted to call Ms. Jacobs to insure that my paperwork had indeed been received. Ms. Jacobs was not in the office and I instead spoke to a rather unprofessional customer service representative named Stephanie. Stephanie did let me know that my paperwork was not showing up in the system and that she would leave a message for Ms. Jacobs with my information. When I hadn’t heard back from Ms. Jacobs towards the end of the day, I called again and spoke with a quite personable customer service representative named Renee. Renee sits in the same vicinity as Ms. Jacobs and informed me that Ms. Jacobs was out of the office that day and she would leave another message with my concern and contact information. At this point I asked to speak with a supervisor, but was told that none were available. How can no managers be available to speak with a distressed customer? That is very poor service.

At this point, over 72 hours have passed and I have not received a return phone call. I no longer care to waste my own time calling this company and am trying a new tactic in the hopes that I will get a response. I sent an email through my CareFirst BlueCross BlueShield member account, but do not expect that I will receive an actual reply. I am also sending a snail mail letter to the State of Maryland CareFirst BlueCross Blue Shield Operations Center.

The service I have received is completely unacceptable. I am a State of Maryland employee and it is my understanding that CareFirst BlueCross BlueShield has a team of workers entirely dedicated to the needs of Maryland state employees. I would expect that Maryland state employees would receive much better customer service.

The amount of time and energy I have devoted to this one small claim is mind-numbing. A little bit of competency and customer service could have saved hours of both my time and the time of the customer service representatives I have been forced to call repeatedly. Perhaps others can avoid the situation I now find myself facing.

Regards,

Allison

P.S. I would have copied CareFirst on this email, but you can't email them directly. You have to fill out a form through your account. That's convenient for CareFirst as now I can't keep a record of my correspondence in my email account to prove that I emailed them.

Comment On This

Comment On This

I too have been a victim of CareFirst. My husband and I have been self-employed and we've had the CareFirst BlueChoice plan since August 2005. We didn't have any problems with them until last year when I got pregnant. We previously had individual plans last year (September 2007) as we figured we could save money doing that instead of a family plan.

I called up them up to ask what to do if we need to change our plan from individual to family. I was told to submit a Membership Change Form, which we did last November of 2007. I was told that it will only take 30 days for it to be processed. I followed it up 30 days after and I was told that they did receive the change form, but it's still a work in progress. I was asked to call back a couple of weeks after. So, I waited for Christmas to pass. Then came January 2008, I called up again and nothing was still happening to our request. They said, if there is something wrong with the application that I would receive a notification in the mail. A couple weeks later, I received a letter from them together with an application form. It stated that the change that we're requesting requires a new application. It didn't make any sense because we've already been through the tedious application process and have been approved already. I don't know why we needed to apply for it again when all we needed was to be in one plan--FAMILY. I called them up and another representative told me another version of the story. I could not remember how many times I have called them...I'm sure, my name was all over their call documentation. We filled out the new application that they asked us to fill out in the mail and sent it back to them in a timely manner.

Days turned to weeks, and weeks turned to months, nothing was still happening to the change that we've requested, nor have we heard anything about the application that they asked us to fill out. I called them up again for the Nth time and asked for the status of it. This time, they have a different alibi. They said, the papers were sent to the wrong department and that they're processing it now. UGH!! Was I mad?? --YES!! FUMING MAD!! I asked for a supervisor, but was told that no one was available too. Oh come on! I also worked as a call center agent before, and there is NO WAY that there is no supervisor on the floor!!

April 2008 came, I was starting to panic because I was a month away from giving birth. I knew that if the change in our plans will not be done before our baby was born, that we will be having another problem. Our unborn child back then was not in the change form nor in the application. If CareFirst would wait until the newborn arrives, we would be bumping in another problem--submitting another form with our newborn in it. I was more forceful and did not take NO for an answer. I begged the agent to connect me to the enrolment department. Good thing this agent had a heart to give me the number for the enrolment department. The other agents I spoke with before told me they are not allowed to give out the enrolment hotline. I was connected to Mr. Cris Banks. After talking to Mr. Banks, he saw the application in their file and promised to escalate the case to his supervisor and get everything moving. He even asked me to call him back the day after. I thought my problem with this issue has ended...NOPE! I called him back the next day, he was not answering. I left him messages in his machine, but he NEVER called me back--HOW UNPROFESSIONAL!! I was panicing once again! I was 9 months pregnant and getting ready to go on labor anytime, and I was still dealing with this stupid problem!!

May 22nd, I delivered our baby girl...but still, no signs of Mr. Banks. He still hasn't answered any of my calls. Two to three weeks after I delivered, I called again and spoke with an agent asking why Mr. Banks has not answered any of my calls and that he knows how important this matter is. The agent would always say--"Mr. Banks is currently on the other line, would you like me to take a message? I'll hand the message out to him personally." I did that 4 times, still NO CALL BACK. I was desperate! Our baby has already arrived, still no development with our change form. Finally, I was connected to a man named Derek. He was able to get everything moving fast. However, he had to ask me to add my daughter to my husband's account first before we could proceed to do the whole family change plan. I was so desperate that I just followed what he asked me to do. He did finish the change, but another issue came up...

We received our very first bill for the family plan. We had retroactivity and will pay $141 more. I examined the bill and this is due to having our newborn added to my husband's account. Our newborn was going to be covered for 30 days after birth under my policy. My policy was going to be cancelled June 31st, but what they did, FOR THEIR CONVENIENCE, they would add our newborn to my husband's policy (even when our newborn was covered through me) so the transition from individual to family will be a lot easier. Now, we're paying for that!!

This has been a verrrryyy stressful experience with CareFirst. I agree with the previous complainant, Allison. They are very incompetent. If they have processed the change form that we submitted November of 2007, we didn't need to add our newborn to my husand's before adding her to the family plan. Because of their inefficiency, we have to pay a bigger amount. There is no use fighting this issue with them as I know I am not going to win.

By the way, the email feature from their website is USELESS! I got a response from them a month or so after I sent my email.