Highmark Blue Cross and Blue Shield
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Written by
Jeffrey Johnson
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UPDATED: Aug 20, 2020
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Company Overview:
Company History: Highmark’s predecessors, Pennsylvania Blue Shield and the Blue Cross plan in Western Pennsylvania, were founded in the 1930’s. In 1996, they were consolidated to create one of the largest health insurance companies in the U.S.Highmark Inc. (which in 2007 announced plans to merge with Independence) offers Blue Cross and Blue Shield coverages to about 4 million people in central and western Pennsylvania as well as in the Lehigh valley. It also operates in other areas of Pennsylvania through partnerships with other insurers and provides administrative and network access services nationally. In all it serves 50 of Pennsylvania’s 67 counties. In 1996, Highmark purchased West Virginia’s largest health insurer (Mountain State Blue Cross Blue shield). In West Virginia, Highmark sells Medicare supplement and prescription drug plans to seniors. Highmark has other subsidiaries not operating under Blue Cross or Blue Shield licenses that provide dental insurance, vision care and other products and services nationwide. Highmark utilizes multiple distribution channels to sell its products. These include an internal sales force, independent agents and brokers, and partnerships with other insurance carriers.Highmark Inc. resulted from the 1996 merger of Blue Cross of Western Pennsylvania with Pennsylvania Blue Shield. Highmark’s West Virginia operation offers Blue Cross and Blue Shield services to all 55 counties of West Virginia and one county in Ohio. In addition to its not-for-profit operations, Highmark has a downstream holding company, HM Insurance Group, that is licensed in all 50 states and the District of Columbia and that provides various life insurance, property-casualty insurance, dental insurance, vision and eye care and other products and services including some for-profit ventures.Independence Blue Cross is a nonprofit corporation in the Commonwealth of Pennsylvania. It provides coverages to individuals in the Philadelphia area (Bucks, Chester, Delaware, Montgomery and Philadelphia counties). It also provides coverage through group plans. Independence and its subsidiaries cover more than 3.6 million people. Independence health benefits are offered under contracts with members through hospitals, skilled nursing facilities and other organizations. Independence contracts with providers of health care to provide health services to members and also performs administrative services such as billing, collection, and marketing for Highmark Blue Shield and processes claims for other Blue Cross plans’ members and for programs such as the Federal Employee Health Benefits Program and the BlueCard Program. Independence participates in various arrangements to provide Major Medical and Comprehensive Major Medical benefits. The Company offers its Preferred Provider Organization and Point-of-Service programs in Pennsylvania through its wholly owned subsidiary, QCC Insurance Company. The Company provides health insurance to New Jersey residents through AmeriHealth Insurance Company of New Jersey and to Delaware residents through AmeriHealth Insurance Company. Health insurance is provided by the Company for Puerto Rico residents through its 83.6% owned subsidiary, La Cruz Azul de Puerto Rico, Inc. Independence provides workers’ compensation claims management services and third-party administrative services through CompServices, Inc. and AmeriHealth Administrators, Inc., respectively. In addition, the Company provides HMO coverage through its wholly owned subsidiaries, AmeriHealth HMO, Inc. and Keystone Health Plan East. The Company participates in providing hospitalization and medical/surgical coverages through Inter-County Hospitalization Plan, Inc. and Inter-County Health Plan, Inc., which are jointly owned subsidiaries. Through its 93% owned subsidiary, NewSeasons Assisted Living Communities, Inc., the Company acquires, constructs, owns, and operates assisted living facilities. A low cost student health plan is also available from Independence.
Principle Sales Methods: Career and independent agents and brokers.Also partnerships with other insurance carriers.
Special Business: Through its non-Blue branded subsidiaries, Highmark offers a variety of specialty products nationwide, including dental, vision, life and casualty insurance.
if you’re employed and the employer pays part of it it’s great, but when you leave, it’s very expensive to keep, and there are very few options to choose from!
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Because of a pre-exising condition I am forced to purchase the only hippa policy available in PA. Highmark takes advantage of the situation, eventhough I have made no claims related to the condition. They charge me over $550 per month for $42 worth of insurance coverage – based on the competition. B.S.
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It has been impossible to obtain a defnitive statement of benefits from this company. The Members Information booklet is vague and misleading. I believe this is intentional, so that they can make their own determinations concerning specific benefits. Even upon appeal of a decision, you can not obtain specific information, other than their denial of payment, which is always specific…. “NO, we we will not pay”
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Highmark will do anything to get out of paying a claim. Their representatives will give you misleading information about the status of your claims and try to run out the clock on your time to appeal. I have to stay with this company because it is the only one provided by my employer, but if there were any other options, I would choose any health plan over Highmark.
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Very unhappy with Highmark. They try to charge us for EVERYTHING they can even though we pay quite a bit per month. Just raised rates and never told me. I had to call to ask why my invoice went up $40 a month.
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The customer service is the worst! They tell me it will take 7 business days to answer one question! I have never been so frustated with one company. Will be switching in January
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Had PPO thru Century Link -My long time doctor had Achilles tendon surgery and was unable to work for 2 months. This outfit decided to drop the doctor and told me nothing. After many attempts to find out what i was to do,was basically told to mind my own business.
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Will nickel and dime you at every level of coverage and will never pay. Customer service requests go unawnswered for months at a time. For a little more money, go with UPMC
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They are making me pay for insurance they told me I did not have. If I dont pay it I am cancelled.
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Nickle and dime customers re-bill without explainations representatives are rude and unhelpful. Seem purposely ellusive with information.
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Absolute nightmare to work with. Customer service is useless. Dealing with this company was more stressful than the medical condition I was trying to get help for. Had to stop seeking treatment. It is my belief that they make it as difficult as possible so customers will get discouraged and not file claims.
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Satisfaction has gone downhill over the last year. They have outsourced much of their business to India. Claims are not paid correctly wait times on line are very long over 10 – 15 minutes on holdcustomer service difficult to understand. Very bad place.
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After having both my annual physical and blood work classified preexisting conditions I realized Highmark would do anything not to pay out any money. I have paid 590 per month for ten months to get nothing covered. What a letdown after having UPMC at work for years.
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SCAM Artists – NOT a real insurance companyIn pre-medical visit calls they claim to cover everything but after the visits or procedures they deny everything.
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Customer service is rude and unwilling to help waiting weeks for surgery approvals claim they cover things until the bill comes in then told it was not necessary. Extremely unsatisfied.
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As of present date website is confusing. Under "Your Spending" it shows HRA with an amount but no way to see for which year that amount applies. Clicking on links such as "Deposits" will yield an error that does not describe the problem. I had to take 15 minutes out of my day to speak with HBCBS Cust. Service to figure out the above problem. The medical insurance itself is wonderful but the website needs a lot of improvement to be effective at saving end-users from having to call customer service.
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They deny preventative services. I am afraid to go to the doctor… it is like I have no coverage at all and I pay 650/month for single coverage… horrible
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There are two drugs that will help the condition I have. Highmark refuses to cover either of them and instead tells my Dr. to prescribe me a different drug that I have tried and does not help me at all. They tell you to appeal over and over again but in they end they just reject you.
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They deny all claims I have had including physicals which should be covered by law.
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denied cancer therapy when i was told they wouldhalf way through therapy started getting claims denied
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I get this insurance through my company and physicals are covered 100%. Well not according to Highmark who has left me with nearly 1000 in bills to pay. Why bother with preventative care if it sucks up your entire paycheck? I would NOT recommend them. I plan to file a claim but am not hopeful about the resolution.
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Awful
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They deny everything and don’t even count what they kick back towards your deductible. When you call customer service they deliberately try to confuse you. I was asked to give them THEIR code number for my particular service then told "Sorry Ma’am…if you don’t have the correct code number then we can’t help you." They were rude dismissive and condescending. We are actively looking for an alternate insurance company.
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I have had claims from very basic bloodwork and well visits to surgery and not one claim has been processed correctly. Is this a tactic to not pay claims and increase cash flow? I am sure some people get tired of the fight and just pay out of pocket.
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Please don’t sign into this scam. I had to tell Highmark 5 times to close my account with them then today I get a letter in the mail asking if I would like to close my account. HIGHMARK IS RUN BY COMPLETE IDIOTS. Please do not let these idiots run your health care You will be very frustrated
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They denied everything. They dont want to pay out and have a terrible customer service.
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Run from this company. They pretend to be considerate and helpful but after literally hundreds of hours and days with customer service you get nowhere cannot talk to supervisor and they lie. Find another company who really cares about you rather than billions in their pockets.
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They lie and never pay claim’s. Everything is always out of there network. One operator says they’ll pay the next operator says NO. I hate them and don’t trust them
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Twice we have had to call and resolve this on line both times they finally agreed they blamer the provider for coding incoreectly.I do not trust them.
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Insurance companies speak of consumer health fraud – what about Highmark corporate fraud when they look for ridiculous reasons not to pay claims. Never treated and never diagnosed with sleep apnea but was declined coverage due to pre-existing condition. Companies like Highmark are the reason for ObamaCare. They can only blame themselves
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Highmark covered most of my emergency care however after the stroke and heart surgery I ended up with thousands of dollars of bills that were not covered for one reason or another. High deductibles and out of pocket expenses.When my doctor and I decided a hysterectomy was the best course of action for me Highmark pressured me every way they could to accept a high frequency ablation which my doctor did not think appropriate for me. They have denied every appeal for a hysterectomy in the most condescending tone.Never considering my points or at least brushing them off and focusing on their damned procedures. Bureaucrats can’t think outside the manual. And they are all bureaucrats at Highmark.
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I have to have this so called "insurance" because it is what my employer picked. They are expensive and deny coverage. Their strategy is to deny and wear you down. If you have a choice of which company to use run away from this one.
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If you like multiple deductibles that never seem to be met or asking customer service for claim forms that never get mailed not available on their web site or having payments denied for no particular reason then Highmark is the plan for you. Every time I have to deal with these bstrds I become more convinced that we need a single payer system and make health insurance companies a thing of the past. Also I get never ending pleasure out of hearing that if I attend an athletic event I can receive a hat shirt bobblehead or other trinket "compliments of Highmark". It’s nice to know where my premiums are going.
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I have been on a medication for years I went to have my prescription refilled and I was denied by High mark as not being eligible and I did not meet the criteria. When did they become DR’s??? I had my current dr and previous dr send my files and they stil would not apporove. I have been off my meds COLD TURKEY for a week with A LOT of side effects of stopping that way. They would not even ween me off of it and onto one that THEY thought would be suitable for me in THEIR opinion. I hold them liable to anything that happens and hishappening to me both physically and mentally due to them playing Dr and God I have to have thi sdue to being with my company but am currently looking into going to another company on my own. If you have a choice PLEASE look into another one and save yourself the trouble and money
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I paid my first premium on 4.28.14 and have a credit card receipt. As of 5.9.14 I do not have ID cards and the web site shows no payment and no details. Emails have gone unanswered and phone calls get no results. Their customer service is completely unresponsive and I can only pray I never need to use their insurance
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Highmark is the worst insurance company. They denied a medically necessary procedure for me to help my quality of life. After 2 Dr appeals and my own appeal being denied i filed a complaint with the Insurance Commissioner. Don’t you know the insurance commission overturned the denial from highmark and now I can have my medically necessary surgery the only way to be heard is to file with the insurance commissioner. Someone needs to investigate highmark. They don’t approve anything and are making all profit off of their members. The worst company ever
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Lost claim
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While doctors and services are covered for the most part I am currently having trouble with a misquote issue. I was told to order a breast pump through a particular company and given the number to call. 7 months later they tell me the company is out of network and they will not cover the cost. I am not sure why it took 7 months for them to deny coverage or why they told me to use this particular company. They never told me it was out of network in fact they told me the company was the one to go to for my breast pump because it would be 100% covered. The appeal process has been a nightmare and they keep mixing up information and "losing" paperwork. It seems this is a common issue. If Highmark were to become better organized I think a lot of the issues could be more easily resolved.
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You use deceptive advertising. Advertisement shows deductible conditions than the fine print shows. We are forced to buy a product and then you rip us off. I hate Highmark and I have at least 200 people insured with Highmark. I can’t say enough bad things about Highmark to my clients. Yes I am a licensed insurance agent in PA and you have screwed me with deceptive advertising
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High deductible plus out of pocket expenses which is mind blowing ….
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Luckily, I haven’t had the misfortune to have to actual use the insurance policy itself very much because based on how they are handling their monthly payment process, I can only imagine they can’t handle processing a claim. I sent a check in at the end of the year because their online system was “going through changes”. They lost the check although they did cash it and they have been taking months it was sent in the first week in January – it’s now mid-March for them to attach it to my account and give me credit for it. I have been on hold with them for hours, finally hung up several times and now working through emails to see if they can actual try to contact me That has been over a week ago of them saying twice “we’ll be in touch asap”. Terrible customer service
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This is the most incompetent company I have ever worked with. The majority of customer service reps will not go out of their way to find out information. They will give you erroneous information just to end the call. I have called this company numerous times for the last 4 days and haven’t gotten the same answer twice. At one time this was a good company but they no longer care about your healthcare only about taking your money. If you are shopping for an insurance company do not waste your time or money because getting good care is impossible.
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The first year with highmark was ok. The second year has been a nightmare. I have never missed a premium nor been late. In the last 3 months they have told providers I have no coverage because I have not paid my premium for 3 months. I needed a heart stress test at the hospital, my dr. had it preapproved. The day before the test Highmark told the hospital I had no coverage for non payment. After an hr. on the phone highmark called the hosp. and said I could have the test. I asked them where’s my money if they’re telling people I haven’t paid. They keep saying it’s their computer program. I say not my problem. I’m just trying to get through till the end of the year so I can hopefully get decent insurance. I am now making a list of every place in my state to register a complaint as well as the marketplace who suggested this horrible insurance. Hate highmark, worst insurance ever.
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Highmark Blue Cross denies basic coverage claims and you have to complain to state commissioners office to get they to pay. Took me one year to get them to pay for our child’s well child visit. Crooks
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In my opinion, this is the worst company ever. Three weeks ago I had every single symptom of a heart attack , severe chest pain, the feeling of a weight on my chest,pain in my shoulder and back, and shortness of breath etc so I went to the ER. This was the first time since I was a child I had ever been in a hospital ER since I was a child so iyou know I must have been scared. Well guess what claim denied and I’m left with a 6000 ER bill that I have to appeal. I read my policy manual while my husband drove and chest pain was one of the diagnosis that said go to the ER. I guess you either have to have a real heart attack or die before they will pay. I do not have Obamacare and pay 700 every month for this plan. I personally think they pick on individual plan owners since I have had blood tests declined also. I do not abuse the insurance and have only been to the doctors maybe twice in the three years since my employer dropped our health care coverage at work and I was pretty much forced to go with highmark . Several people had mentioned to stay away from highmark since they are known for declining claims.
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Dropped my insurance for no reason this month. I had to spend an hour on the phone with them in order to get a required medication refill. Prior to this, I have had issues with billing they still haven’t technically cancelled multiple old policies, so I still get mail regarding those. Read all of your bills and double check everything,they aren’t to be trusted
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they paid the hospital from the wrong account/told me incorrectly I had no more claims pending/told me I had 231 dollars left….and I did not/would not call back with 4 days notice/refused to provide transcripts of calls/they SUCK
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Their online system is crap and drafted money from the wrong account. I specified on account they took from another causing my personal account to go into the red. Their systems show no error occurred but they can’t even see the other account on their end. Terrible people, terrible company.
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Just signed up with this company and I’m already ready to scream I have been on the phone with them all day and they keep assuring me that I have prescription coverage and yet, when I go to my pharmacy, they cannot find me in the system. I call highmark back and AGAIN, they assure me that the problem is corrected and I am in the system, yet, no one can find me. I am beyond frustrated with this incompetent company. I get my insurance through my place of work, which is owned by my father and myself. I think we need to change insurance companies and we need to change quickly This company is atrocious
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Very poor customer service. My “plan” was ending 12/31/2015. I had to pick a new plan or default to the terrible plan they picked for me Previously $1000 deductible to $6000, etc. Chose a new plan, filled out application, payed sent in and received before deadline cashed check about a week before. On December 28th called to verify because website still showed wrong plan. Was informed first that no record of payment or plan change received. Then payment was found, application could not be located. Request that I contact broker and have them call Highmark. Broker had to resend faxapplication check they cashed was attached to it first time, would have resolved by January 2nd. Have called on the 4thfound application dated December 2nd and 6th, “still in process” and last representative, Michael, kept quoting that they are following government guidelines, I needed to pay first, etc…he obviously didn’t read the case file as was overall rude. So I have no coverage for January according to last discussion…
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the website is absolutely awful. can’t do anything. trying to pay a premium online, first off can’t log on. trying to get password or username company “has on record” to be sent to me. keep getting message my name or password is incorrect. What a waste of a website.
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I have had Highnsrk Blueshield Freedom Blue PPO since 01/01/2016. I made the decision to switch from Humana as my Part D provider based on information taken from the Highmark 2016 Drug Formulary. I am a kidney transplant recipient and take 2 different immunosuppressant drugs daily. Two weeks ago I placed an order for my first prescription refill since becoming a Highmark PPO member. I have been on the phone daily for hours the last 2 weeks and have spoken with many Highmark representatives that have promised to get the problems taken care of so I can get my life sustaining medications. I am being told that my drugs require Prior Authorization, which the Drug Formulary clearly states they do not. I am also being told by Highmark that my dropouts are not Tier 2 drugs as stated in the Formulary. Apparently, there is now a revised 2916 Formulary that Highmark is using. Today is 01/20/2016, the year is not even 3 weeks old and Highmark is rewriting the 2016 Formulary?????? I encourage anyone that gas had problems with Highmark to file a report with their State Insurance Commissioner. You can file the complaint online. Please take a few minutes to file a complaint. Highmark needs to be held accountable for the horrendous care being given to their members that have entrusted> them to take care of their medication needs. We have a responsibility to educate anyone considering Highmark for their medical needs to look elsewhere. DO NOT CHOSE HIGHMARK FREEDOM BLUE PPO.
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I have had Highmark on and off for years. Last year, after a lay off, I was on the exchange plan for Highmark. Not only did they fight my doc on getting meds filled, but they over charged me for my premiums, then created a bogus account and tried to double charge me, next they sent letters out to all my docs stating I didn’t pay my premiums so I would have to pay in full for my visits even though I had receipts showing I did pay the premiums, and finally they denied my life sustaining medication even though I had a medical necessity letter from my doc stating I needed it. I got a new job towards the end of the year last yr and they had a different ins company. Not only did they accept all the paperwork my doc sent in for my medication but had my medication to me within a day Unfortunately, in January, my employer switched carriers and went back to Highmark. Again, I had to fight them to get my meds and once I won that, I had to get the Attorney General involved, they lied to me several times on stating they sent my meds when they didn’t. I was told it was mailed on a Friday and I would receive it Sat. Then Sat at 2 I got a call stating they “didn’t get the meds in the mail so it wouldn’t be to me until Tuesday.” When I threw a fit on that because I needed it on Sunday to keep the level in my body a manager got on and told me the best they could do was get it to me on Monday in the afternoon. So I would have to miss a dose. She apologized but that didn’t help me any. She also tried to blame it on several things but when I called her bluff on the lies she just stopped trying. Monday morning I got a call stating it was coming, from a different manager, and would be there before I got off work. Then 30 mins later I get another call from a different manager again stating they didn’t get it on the delivery truck and I wouldn’t be receiving it. I lost it I told them I didn’t care if they personally drove the meds out, I better have it here before the end of the day or an attorney would be called. They found a way to get it to me but the stress of it all about put me in the hospital Horrible customers service The Attorney General found they over charged me, agreed with me on the set up of the bogus second account, and agreed with me on the fact Highmark wasn’t paying claims correctly. I got money back from Highmark but no letter of apology or one sent to my docs stating they messed up and I did in fact have ins.
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Worst Health Insurance Ever.
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These guys are overpriced thieves, they look for ways to avoid paying doctors.
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This company is awful I was very happy with first priority but this year I guess Highmark took them over. Ok my premiums went up to $400mo, I can deal with that. Well they have turned down over 3/4 of the meds I have been on without ever having an issue with them for over 4 years, I have already spent over $2,000 this year and so far $60 has gone to my 1500 deductible. I had a heart attack recently and upon discharge went to get my one med that I was told I must take every day or I will die, by multiple doctors that keeps my heart from rejecting what they installed. Guess what, almost had a heart attack when I got to the pharmacy and it was $350 bucks And I still do not know if it is because of my deductible or that they just refuse to cover it as they never tell you This company is a disgrace and needs to loose its license, please buy us back first priority STAY FAR AWAY FROM THIS COMPANY NEXT OPEN ENROLEMENT BUYER BEWARE ETC. ETC. I can not stress enough how horrible this insurance has been, I can not wait until I get my ambulance and hospital denial for having a heart attack because they do not believe the doctors or something, I am not exaggerating. I may actually have to declare bankruptcy for the first time in my life because of this supposed insurance company. HORRIBLE
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Horrible company with horrible people in management. Should go out of business.
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Dragged their feet and delayed approval for typical surgical procedure. Refused additonal testing unless patient returned to PA even though out of state provider was within their approved network. Website down and could not access info and update password. Rates are extremely high for a family of four on their bronze program. Prescription coverages are low. Staff for two medical providers commented on non-responsiveness of Highmark personnel. Standard procedure delay and deny.
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Highmark is horrible. They are denying a prevent coverages that are covered. It’s disgusting how they process claims. I am over 50 and they are trying to not pay for items that are covered.
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Highmark makes you actively call in and refuse mail order prescriptions
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This company should be named like a law firm….. Dewey, Screwum and How.
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Over priced. On the hook for everything. Trying to find out if someone is in network “they THINK they are” but I have to check with the doctor’s office. Doctor’s office says I have to check with BC/BS. I am NOT a ping pong ball. I truly loved United Health Care and would return to them in a heartbeat. They knew there stuff and coverage was awesome.
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They release your personal information to Trover Solutions in the hopes of getting out of paying claims. Trover Solutions in turns harasses high mark customers with threatening letters to reply to their inquiries into your private health status.
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If I could choose negative stars I would. I’m currently using a CPAP machine and was told that I have paid for the unit and I now own it, the next month here comes another Bill for the cost of the unit again. There explanation was that since I did not make my yearly checkup because I was out of town on buisiness, the time starts all over again like a new claim. I will not pay these crooks.
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My monthly premiums have been posted to someone else’s account since Jan 2016. This past Tuesday I finally found this out because my prescriptions were denied for payment. The CSR told me she would call the other person and he would have to state on a recorded phone call that he did not make the payments. Of course, he refused. I now have to provide bank statements showing the amounts I paid since Jan to his account number. I got the 20 pages of documentation from my bank and brought it to my local Highmark office. I explained the situation to the CSR there and he said what do you want me to do. I said fax this stack of papers to your main office. He then got a girl in the office to do it. Now I wait
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I submitted claims for reimbursement in February and still have not been reimbursed as of 61516 and keep getting the run around. I have escalated it and still get subpar service. They owe me thousands of dollars
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always need to resubmit claims,they deny payment,cause big hassle,always need to spend long time on phone trying to get them to pay for claims.terrible insurance company.
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This is the worst insurance company on the planet. I never write reviews on these sites, but I feel like I have to warn others and hopefully save them the grief they WILL experience with this company. I have had a few insurance companies in my day, but I have never had the horrendous time I have had with these people. I am currently pregnant, and every single time I have been to the doctor I have had to call them to get the bill straightened out. I am still trying to get them to process and straighten out my prenatal lab work bill from 4 months ago. It has been extremely frustrating, knowing every time I went to the doctor’s office I know I’m going to have an issue with the bill and have to call and correct something. And every time the issue has been on their end, not the doctor or lab. The lab work bill came and it said i owed this astronomical amount, so I checked my online profile which said I owed a different amount and that my provider was out of network which its not every time I call to get it straightened out the person says they don’t know why it’s out of network – that my provider is in network and the lab is in network so they aren’t sure…. but it never gets fixed. This has been 4 months of calling trying to get this sorted out and no one seems to have an answer or want to fix it in any way. I have switched insurances thankfully and I am with one I am very happy with and have never had to call. Please do yourself a favor and turn from this company and run like your life depended on it. THEY. ARE. THE. WORST.
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they try and pick apart your coverage and add things to your deductible.
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My husbands plan was to have the best health care at home. When it came to him getting the care the policy says he was entitled to he was denied a depth the minimum which is nothing My husband is a stroke victim, paralyzed on right side, does not speak or swallow, is in terrible pain, has a feeding tube, needs catherization and periodic enemas for his paralyzed bowel. Highmark said he doesn’t meet the criteria, he’s not sick enough When I questioned how sick does he have to be, they came back with, and I quote, does he have a colostomy bag Is he on a ventilator They cherry picked the only things he does not have You tell me if this isn’t fraud
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They don’t care about you, only your money
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So expensive, medications and procedures aren’t covered with no medically-sound rationale, and my premium and deductable are now unmanageable for my family.
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Highmark initially refused to pay a claim for a diagnostic test because some of the coding included screening test information. After correction of the coding and resubmission, the claim was still denied. Now the claim is in collections.
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I was at the point where I would over my deductible and the 8020 would kick in, and all of a sudden my doctor was out of network and the costs of all of my appointments were put toward the out of network deductible. They keep blaming a different BCBS provider and no one I talk to is authorized to fix the problem. This has been going on for months with no resolution. My doctor’s office has been in touch with them as well. In the past I’ve also been charged for preventive visits that had been covered in the past with no change to my coverage. Their website is awful, and don’t bother contacting them using the message application within your online account – they will never get back to you.
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I had cancer and I was denied medication not once but twice. Pfizer was good enough to donate the medication that was prescribed by my doctor. During my battle with cancer I had a bout of pain when my doctor prescribed a medication for pain which was again denied by highmark. He also prescribed a medication to increase my appetite since I was losing weight at a rapid rate. I was again denied by highmark. It is now the end of the year and I have now changed insurance companies. Thank goodness because I would be dead in a short time with highmark.
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My biggest complaint is their customer service. I was given wrong information 4 times by their customer service. It took me near a month to find out where and how to get test trips for blood sugar testing. Something so stupid maple. Finally, I got a manager who finally did straightened things out only after I spent hours on this issue.
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They decline to pay for prescriptions that have been working well for the patient for years – regardless of the doctors instructions or medical records.
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My Rx prices went from 80 last month to over 450 so I could not afford to get them. The ins costs is over 1,300 a month and I have to pay over 450 for just 3 prescriptions. Guess I will wind up in the emergency room and hospital soon due to no medication
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Deny diagnostic testing example MRI
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After paying 4000 so far in premiums I got statements showing that Highmark payed 94 dollars and my portion is 269. what is the point in having health coverage if I am paying the majority of the claim
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They are always available and helpful,when you need them.
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They claim I shorted them a payment for .48 cents and cancelled my policy without my knowledge. They also kept my premium payment for 1,020.22 for the month they cancelled. They are refusing to pay any December claims when I offered to pay them the whole .48 cents they said they can not take the payment, when asked why they did not refund my money they said we can cut a check today this is not March- 4 months after they cancelled. In my opinion they are scoundrels cancelling policies behind your back and had no intention of returning my money. Refusing to pay claims -BEWARE OF THIS COMPANY – I have filed a complaint with the state and will with consumer affairs.
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Highmark denies all claims that come through, even though the customer service reps tell you that the visitprocedure is in network. I have to fight them every time I go to see a doctor or have a procedure. knowing full well the claim will be denied. I am not sure who they have processing these claims, but they have no clue what they are doing. If anybody out there is looking for health insurance, you need to run far away from Highmark. They are the worst insurance company I ever had to deal with.
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Highmark is killing people
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You’re better off paying for medical care out of pocket. Coverage costs more. Ridiculous.
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They dont cover a single one of my medications anymore, with one of them being one of the most prescribed antidepressants in the United States. They stopped covering all psychiatry and therapy appointments. My medical costs per month are upwards of 1000. My doctor said she keeps getting an error message that says Im not insured, even though I have an insurance card through them with my name on it. I was on hold for a total of 8 hours one day, and it was the same two branches sending me back and forth. Each kept saying sorry I cant help with this, transferring you to pharmacy and before I could tell them that pharmacy was the one who transferred me to them, theyve already done it. I asked for a supervisor after a few hours and they just hung up on me. This insurance is a scam and Im not getting covered on top of paying for every medical expense.
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Keep looking.
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Company must be proud of 1 star review
Customer service is a joke. Called a couple days ago and was told I would get a call back in 2 days at 1:45 pm. Call never came. So I had to call them back…..First you have to navigate through the endless options to get to where you need to be. 2nd you finally get someone on the line in the correct department (BILLING DEPT) and they say “I’ll have to put you on hold” then you are disconnected. Now, YOU KNOW THEY HAVE YOUR PHONE NUMBER SITTING IN FRONT OF THEM, why not call the person back????????????????? Problem is no one wants to work or do the job they are tasked to do or go above and beyond. Very aggravated that I wasted 1/2 hour lunch and got no where. Will have to call this worthless Billing Dept back again when I have a day off. Very Frustrating.
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