Carefirst claims not processing

[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.

[Anonymous]

We have insurance with the federal government - CareFirst BCBS.

I got this email from one of my doctor's offices:

"We want to inform you of a current issue affecting our complimentary insurance claim submission service for patients with Carefirst/BCBS. All Carefirst/BCBS plans require claim submission to the local BCBS where services are rendered, which is Carefirst BCBS of Maryland.

Although our office has submitted all claims as usual, we are experiencing technical submission errors with CareFirst Maryland. Because of this, your insurance portal may or may not display recent claims from our office at this time.

Our team is actively working to resolve the issue with the insurer, and we hope to have an update soon. We sincerely apologize for any inconvenience this may cause and appreciate your patience while we address the matter."

[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.

You should be able to get the Summary Plan Description (or the entire plan) from your employer, if the insurance is employment-linked—either will have this info.

[Anonymous]

Anonymous wrote:

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.

You should be able to get the Summary Plan Description (or the entire plan) from your employer, if the insurance is employment-linked—either will have this info.

Thank you. We let them know we couldn’t access it and their response was to call carefirst which got us nowhere. I will ask again.

[Anonymous]

I’m the OP - still no movement. We may have to pause my DC’s out of network care without having received any reimbursement since November. It’s really squeezing our budget. My HR has not been helpful and I’ve tried every means available to contact Carefirst with no response.

[Anonymous]

There is nothing going through with my claims. It's crazy, nothing is being paid and I'm getting bills constantly now.

[Anonymous]

Unfortunately, you are not alone in having Carefirst claims sitting as pending since 1/1/26. We stared receiving Explanation of Benefit statements for in network claims filed since 1/1/26 starting mid March, but OON claims all remain in limbo - so frustrating…

If anyone has proven strategies known to effect a change - or if you are noticing your claims from 1/1/26 and later being processed (and paid), please let the rest of us know. Thanks!

[Anonymous]

dental office here - carefirst has become the most dreaded insurance company. most of us have adjusted by not accepting them. consumer needs to grow up and stand up for their rights, they pin the doctors against the patients since they dont pay on time and fail at processing claims so its easier for us to not be at the receiving end of all the complaining and anger since its not even our fault.

[Anonymous]

We had some OON claims paid out from last year a couple of weeks ago. But claims from December onwards are in process. Such a grift. My employer is self-insured meaning Carefirst is just the administrator for the funds that my employer provides. Carefirst is simply not doing their job.

[Anonymous]

Update to anyone dealing with this.

I am on the phone with a Carefirst rep now (it was a 30-minute wait). He has explained, clearly reading a script that he has read many times already, that on January 1, Carefirst changed systems and this added 2-3 minutes to every single transaction they perform. Allegedly the system change was needed because they are so frequently the victims of cyberattacks.

According to this CSR, OON claims are massively backed up because the providers have to be re-entered into the system one by one before any claims pertaining to them can be adjusted.

He is unaware of any process via which that can be expedited, and has no ETA to completion.

The script said to expect 45-60 days instead of 30-60. My claims are already three months old.

[Anonymous]

Anonymous wrote:

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.

Same here for out of network BCBS claims with dates of service in January and February. I had the first claim readjusted successfully. Then 2 subsequent claims were denied with the same nonsensical reason code.