Carefirst claims not processing

[Anonymous]

Is anyone else having problems with Carefirst not processing claims? At first we had both in and out of network claims that were pending. Now the in network ones have gone through, but the out of network (therapy) claims have been pending for over 2 months. I have sent messages, but no response.

[Anonymous]

Call

[Anonymous]

Anonymous wrote:Call

I did. An hour on hold and no human. They have always recommended messaging and I normally have very fast answers that way.

[Anonymous]

We are having this issue for more than 2 months I believe. So frustrating. They know some people will just give up. I really am livid at the lack of consumer protections in health insurance regulation

[Anonymous]

If you have a fully insured plan, contact the insurance commissioner in the state where your plan was underwritten.

[Anonymous]

Their claims department is very backed up. We received a letter about this ~ 2 months ago. We recently got EOB’s about doctor's visits one year ago!!!

[Anonymous]

Reddit has a thread about it with some theorizing it’s due to the implementation of new AI systems; no idea if that’s true.

[Anonymous]

Anonymous wrote:We are having this issue for more than 2 months I believe. So frustrating. They know some people will just give up. I really am livid at the lack of consumer protections in health insurance regulation

It's got to be a tactic.

[Anonymous]

We have 20+ in-network claims so far for 2026 with some going back to early January. Not one has been processed. It’s stressing me out. We also have an OON claim for therapy that I assume will take even longer. I’m getting ready to submit last month’s OON claim on top of it. At this rate, I expect we won’t see any reimbursement soon.

[Anonymous]

Even messages as in "contact us about this claim " take weeks not days lately.

[Anonymous]

I'm having the same issue. I've been submitting monthly claims for speech therapy since December of last year. The December claim has been "In Process" for 60+ days; the other claims show as submitted, but haven't appeared as "In Process" yet. I spoke with customer service, but that has had no apparent effect.

[Anonymous]

Yep. Same here. It's ridiculous. For those who have spoken with customer service, what are they saying about what the hold up is?

[Anonymous]

It is maddening!

[Anonymous]

Anonymous wrote:

Anonymous wrote:We are having this issue for more than 2 months I believe. So frustrating. They know some people will just give up. I really am livid at the lack of consumer protections in health insurance regulation

It's got to be a tactic.

This is a well known, deliberate tactic that has been covered many, many times in the media (esp The Washington Post, do a search). The average person does not appeal. I always go on reddit for suggestions on how to appeal as there always seems to be another person who has had the same thing happen in the past and I have found it super helpful.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We are having this issue for more than 2 months I believe. So frustrating. They know some people will just give up. I really am livid at the lack of consumer protections in health insurance regulation

It's got to be a tactic.

This is a well known, deliberate tactic that has been covered many, many times in the media (esp The Washington Post, do a search). The average person does not appeal. I always go on reddit for suggestions on how to appeal as there always seems to be another person who has had the same thing happen in the past and I have found it super helpful.

There has to be a denial, in order to appeal. What people are saying in this thread is that claims are simply not being processed, period.