Anonymous
Post 05/02/2026 15:34     Subject: Carefirst claims not processing
Or if PP is someone from Carefirst trying to justify why it's okay for CareFirst to simply stop reimbursing OON claims for months, kindly go F yourself
Anonymous
Post 05/02/2026 15:32     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:This thread had me very worried, since our first OON reimbursement claim was submitted on 4/20. They processed it on 4/24 and I received a check in the mail today.


From our experience it seems that as of mid April Carefirst is back to processing newly submitted OON claims efficiently, but still severely delayed on processing backlogged OON claims filed January through March 2026. With those earlier claims, there seems to be no pattern on how Carefirst is addressing them (chronologically, by family member, by provider, etc.). This seems in line with reports of Carefirst having a claim processing platform transition integration malfunction that is being addressed with manual entry.


Who are all these fancy rich people seeing doctors Out Of Network? I don't get it. How much money do you have?


I only have a $750 OON deductible. The calculation of the allowed amount is more generous than I thought. My out-of-pocket for my OON psychiatrist is only $55 vs $40 in network. I’m not rich, but I can swing the $15 difference.


+1 it really depends on your specific plan and health needs. Our plan reimburses OON pretty well (80% of the full cost) and we have a neurodivergent child. At one point there were actually zero providers that took insurance that were qualified to treat the specific issue our child had. Don't judge PP. You never know what people's situations are.
Anonymous
Post 05/02/2026 14:44     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:This thread had me very worried, since our first OON reimbursement claim was submitted on 4/20. They processed it on 4/24 and I received a check in the mail today.


From our experience it seems that as of mid April Carefirst is back to processing newly submitted OON claims efficiently, but still severely delayed on processing backlogged OON claims filed January through March 2026. With those earlier claims, there seems to be no pattern on how Carefirst is addressing them (chronologically, by family member, by provider, etc.). This seems in line with reports of Carefirst having a claim processing platform transition integration malfunction that is being addressed with manual entry.


Who are all these fancy rich people seeing doctors Out Of Network? I don't get it. How much money do you have?


I only have a $750 OON deductible. The calculation of the allowed amount is more generous than I thought. My out-of-pocket for my OON psychiatrist is only $55 vs $40 in network. I’m not rich, but I can swing the $15 difference.
Anonymous
Post 05/02/2026 14:23     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:This thread had me very worried, since our first OON reimbursement claim was submitted on 4/20. They processed it on 4/24 and I received a check in the mail today.


From our experience it seems that as of mid April Carefirst is back to processing newly submitted OON claims efficiently, but still severely delayed on processing backlogged OON claims filed January through March 2026. With those earlier claims, there seems to be no pattern on how Carefirst is addressing them (chronologically, by family member, by provider, etc.). This seems in line with reports of Carefirst having a claim processing platform transition integration malfunction that is being addressed with manual entry.


Who are all these fancy rich people seeing doctors Out Of Network? I don't get it. How much money do you have?


I will take your comment as made out of frustration with the overall healthcare environment, which I get. So I’ll give you the benefit of a doubt.

For many carriers, in network provider options are too limited - especially for those addressing chronic conditions. There is no other choice than take on the financial burden of paying for treatment out of pocket with OON providers. The current problems with Carefirst OON claim processing makes an already difficult situation much worse.
Anonymous
Post 05/02/2026 12:29     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:This thread had me very worried, since our first OON reimbursement claim was submitted on 4/20. They processed it on 4/24 and I received a check in the mail today.


From our experience it seems that as of mid April Carefirst is back to processing newly submitted OON claims efficiently, but still severely delayed on processing backlogged OON claims filed January through March 2026. With those earlier claims, there seems to be no pattern on how Carefirst is addressing them (chronologically, by family member, by provider, etc.). This seems in line with reports of Carefirst having a claim processing platform transition integration malfunction that is being addressed with manual entry.


Who are all these fancy rich people seeing doctors Out Of Network? I don't get it. How much money do you have?
Anonymous
Post 05/02/2026 10:45     Subject: Carefirst claims not processing
Anonymous wrote:This thread had me very worried, since our first OON reimbursement claim was submitted on 4/20. They processed it on 4/24 and I received a check in the mail today.


From our experience it seems that as of mid April Carefirst is back to processing newly submitted OON claims efficiently, but still severely delayed on processing backlogged OON claims filed January through March 2026. With those earlier claims, there seems to be no pattern on how Carefirst is addressing them (chronologically, by family member, by provider, etc.). This seems in line with reports of Carefirst having a claim processing platform transition integration malfunction that is being addressed with manual entry.
Anonymous
Post 05/01/2026 20:20     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:CAN someone please help?! PP here they have still not payed my claim and its gone to collections what am I supposed to do now? I have great credit I do not want to ruin but PP posters said DO NOT PAY the doctors office. So then what am I supposed to do?


Is this OON or In network? If the latter, submit a claim with the MD AG https://oag.maryland.gov/our-office/Pages/heau.aspx. Notify the organizations billing office that you have submitted a claim to the AG.


I work for the Maryland AG. We all have Carefirst and are experiencing the same issue.


Is this being reported and investigated? Clearly they're breaking contacts left and right.


+1 imagine if another type of business stopped paying invoices for months


Right? WTF. I don't get how this isn't some huge news story yet. A little public shame never hurt anyone.


+1 I wonder if any news producers read this site.
Anonymous
Post 05/01/2026 19:41     Subject: Carefirst claims not processing
This thread had me very worried, since our first OON reimbursement claim was submitted on 4/20. They processed it on 4/24 and I received a check in the mail today.
Anonymous
Post 05/01/2026 15:59     Subject: Carefirst claims not processing
New poster -they do this to us too - the claim is submitted irght, they don't prcoess or they process and say a code is missing when it is not.
Anonymous
Post 05/01/2026 10:34     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:CAN someone please help?! PP here they have still not payed my claim and its gone to collections what am I supposed to do now? I have great credit I do not want to ruin but PP posters said DO NOT PAY the doctors office. So then what am I supposed to do?


Is this OON or In network? If the latter, submit a claim with the MD AG https://oag.maryland.gov/our-office/Pages/heau.aspx. Notify the organizations billing office that you have submitted a claim to the AG.


I work for the Maryland AG. We all have Carefirst and are experiencing the same issue.


Is this being reported and investigated? Clearly they're breaking contacts left and right.


+1 imagine if another type of business stopped paying invoices for months


Right? WTF. I don't get how this isn't some huge news story yet. A little public shame never hurt anyone.
Anonymous
Post 05/01/2026 10:33     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:CAN someone please help?! PP here they have still not payed my claim and its gone to collections what am I supposed to do now? I have great credit I do not want to ruin but PP posters said DO NOT PAY the doctors office. So then what am I supposed to do?


Is this OON or In network? If the latter, submit a claim with the MD AG https://oag.maryland.gov/our-office/Pages/heau.aspx. Notify the organizations billing office that you have submitted a claim to the AG.


I work for the Maryland AG. We all have Carefirst and are experiencing the same issue.


Is this being reported and investigated? Clearly they're breaking contacts left and right.



+1 AG can you post back. Is this being investigated? I'm hoping for a class action suit. This is crazy.
Anonymous
Post 05/01/2026 08:33     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:CAN someone please help?! PP here they have still not payed my claim and its gone to collections what am I supposed to do now? I have great credit I do not want to ruin but PP posters said DO NOT PAY the doctors office. So then what am I supposed to do?


Is this OON or In network? If the latter, submit a claim with the MD AG https://oag.maryland.gov/our-office/Pages/heau.aspx. Notify the organizations billing office that you have submitted a claim to the AG.


I work for the Maryland AG. We all have Carefirst and are experiencing the same issue.


Is this being reported and investigated? Clearly they're breaking contacts left and right.


+1 imagine if another type of business stopped paying invoices for months
Anonymous
Post 04/30/2026 20:00     Subject: Carefirst claims not processing
I have some claims out and not paid four months out.

What are we supposed to do?
Anonymous
Post 04/30/2026 19:49     Subject: Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:CAN someone please help?! PP here they have still not payed my claim and its gone to collections what am I supposed to do now? I have great credit I do not want to ruin but PP posters said DO NOT PAY the doctors office. So then what am I supposed to do?


Is this OON or In network? If the latter, submit a claim with the MD AG https://oag.maryland.gov/our-office/Pages/heau.aspx. Notify the organizations billing office that you have submitted a claim to the AG.


I work for the Maryland AG. We all have Carefirst and are experiencing the same issue.


Is this being reported and investigated? Clearly they're breaking contacts left and right.
Anonymous
Post 04/30/2026 19:47     Subject: Re:Carefirst claims not processing
Anonymous wrote:
Anonymous wrote:Anyone who voted MAGA deserves to be denied. When will purple wake up. The GOP MAGAs don’t give a hoot about you or healthcare. All they care about are corporate profits.


Because Obamacare fixed health care?!

🙄


+1,000
BCBS literally told me that's why everything got so expensive. They didn't hide it or sugar coat it.