Carefirst claims not processing

[Anonymous]

We have Carefirst through FCPS. There is something on FCPS’ page about how they had claims on hold at the start of the year through mid February for audits. They also changed everyone’s ID on January 1. Our in network claims are processing normally now but I have 11 out of network claims that are just still showing as in process. I call weekly but it doesn’t seem like anyone can do anything. It’s really frustrating.

[Anonymous]

Just tell providers it's in process.

[Anonymous]

Anonymous wrote:Just tell providers it's in process.

I don’t think most of us are concerned about providers - we’re concerned about the money WE’RE owed because we’ve filed claims for out of network providers that we’ve already paid in full.

[Anonymous]

SO frustrating. If you were Kate laying your premiums, they would just drop you.

Perhaps complain to your employer (ie, whoever is the purchaser of the institutional plan).

It is sickening but they always show up around open season pretending that they are there for you.

(They could solve this problem overnight by just hiring more staff, but that would lower their profits!)

[Anonymous]

I’m reviving this thread. Is anybody having any luck? It is now 3/12 and we still haven’t had a single claim processed in 2026. Some exceed 60 days. We are sadly heavy users of healthcare and I’m worried what we are on the hook for if some of these end up being denials or require a deductible instead of copay (like labs/procedures) since our portal also doesn’t show our coverage details.

[Anonymous]

I checked yesterday and mine are all still “in process.” It’s maddening. You would think they’d release a statement explaining the delay. But it’s not like anyone can quit them mid year, so they have no incentive to provide customer service. And to be fair, we have had a lot of very expensive healthcare in past years and Carefirst was great with all of that. So I’m trying to be patient, but this is ridiculous.

[Anonymous]

Our hr people sent out a note about what is causing it. I forget the details but it is not just you - they are changing their systems

[Anonymous]

Anonymous wrote:Our hr people sent out a note about what is causing it. I forget the details but it is not just you - they are changing their systems

I’ve been afraid to complain to HR because this is our first year with Carefirst and I worry they will make us go back to the awful insurance we had last year if they think we’re unhappy. I hate waiting for the claims to process but I’d rather wait 6 months than deal with what we had last year.

[Anonymous]

Anonymous wrote:I’m reviving this thread. Is anybody having any luck? It is now 3/12 and we still haven’t had a single claim processed in 2026. Some exceed 60 days. We are sadly heavy users of healthcare and I’m worried what we are on the hook for if some of these end up being denials or require a deductible instead of copay (like labs/procedures) since our portal also doesn’t show our coverage details.

I have Anthem bcbs and 2 separate claims were denied and the reason code placed the onus on the providers. The billing manager at one provider was informed that there was a glitch between 2/2 and 2/25 where claims were denied, etc. They said all claims will be processed and it will take 45 days.

[Anonymous]

Yes 5 months still waiting. I keep getting the run around. Its a decent amount of money I need back this is rediculous now. They keep lying to me saying they will call back no one has. Its been extremely frustrating to chase this down. I'm so sick of the general lack or customer service these days and given the amount of money we're paying to BCBS this is unacceptable.

[Anonymous]

We pay over $3800 a month.
This is ridiculous!!!

We just joined this year because United was so awful.

I’ve only interacted with their pharmacy services but they were very helpful.
Although they approved an expensive and rarely covered prescription, they then denied one that’s $65 that seems more necessary.

[Anonymous]

Anonymous wrote:Yes 5 months still waiting. I keep getting the run around. Its a decent amount of money I need back this is rediculous now. They keep lying to me saying they will call back no one has. Its been extremely frustrating to chase this down. I'm so sick of the general lack or customer service these days and given the amount of money we're paying to BCBS this is unacceptable.

Contact your HR department about this. If they can't solve it contact your state's health insurance consumer support office (in MD it is the HEAU)

CareFirst and the entire insurance industry is full of grift. They make money by denying claims improperly, lying and keeping people on hold, hoping people will just give up. Our elected officials have utterly failed at developing meaningful consumer protections.

[Anonymous]

Anonymous wrote:Yes 5 months still waiting. I keep getting the run around. Its a decent amount of money I need back this is rediculous now. They keep lying to me saying they will call back no one has. Its been extremely frustrating to chase this down. I'm so sick of the general lack or customer service these days and given the amount of money we're paying to BCBS this is unacceptable.

That is completely unacceptable!

[Anonymous]

Anonymous wrote: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.

There has been no change with respect to the above claims. I'm considering filing a complaint with the DC AG.

[Anonymous]

I’m one of the PPs and most of mine changed status to processed yesterday! I was so excited. And so far none have been denied which I feared.

Unfortunately, at the same time I learned that my OON therapy claims for my DC are only being processed for less than 50% of the fee which is crazy low compared to when we had Cigna. At this rate, we will never hit the OON deductible. Oh well! Can’t win them all.