Florida Blue
Reviews and Complaints

Florida Blue cut my Primary Care Physician last September, while I was in the middle of scheduling major surgery. My PCP had been my doctor for more than 40 years. They then assigned me to some doctor in Palm Beach County, who knew nothing about me, and when I tried to schedule a visit, could only allow my first visit in February of 2025, which was unacceptable, and I told an agent in FB that. They then gave me a list of allowable PCP's in my county, I found one 1/2 mile from my house,
Clare Medica, and scheduled a visit with them. They gave me a basic physical. After the visit I called FB and told them I wanted ClareMedica for my PCP, and some agent (who, as I found out, was seriously uniformed) told me that ClareMedica was NOT in my plan, so I was forced to select another PCP, My Care Medical, and I selected them. I subsequently found out that ClareMedica WAS on my plan, and for some bizarre reason, when ClareMedica attempted to bill FB, they denied it, stating that I had selected the doctor in Palm Beach as my primary, which was a lie. ClareMedica has billed me numerous times, in spite of my complaining to my former agent in Florida Blue. I demanded that Florida Blue pay this invoice, since the mixup was totally their fault. This is unaccepted behavior, bordering on fraud, and I must demand they accept responsibility for their numerous bad decisions in my case (and others, as I have found out.)

FloridaBlue needs to do an audit of the contract for service and replace NationsHearing as the support company for its members. The entire experience in using this company is filled with a myriad of frustration. This mandated 3rd party service provider, who is clearly just a basic level medical billing Company has oversold their ability to understand the needs and to be able to service FloridaBlue members with hearing impaired issues. Lack of knowledge in the impaired hearing industry is clearly documented from the CEO to his family member just of college and appointed as the COO, who do not have the hearing industry knowledge to be effective in supporting the hearing impaired members of FloridaBlue. Ask anyone member who has recently dealt with NationsHearing and they will attest to the lack of skill their request is met with or how frustrated their in-network support professionals have become when they have to use the NationsHearing network. A change is needed to another provider who has the skill set to provide the professional hearing support members pay and are promised to receive. Issues include, delayed answers to questions, payment for deductibles system is a callback from NationsHearing which puts a member at risk of knowing who they are giving information to over phone line, input of forms and delayed followup to allow network providers to fulfill service to clients. Inability of front call center employees to access information online. HEPA concerns that team uses chat messaging to internally talk to supervisors.

I told Florida blue to keep my insurance. I am working on medicare. Don't cancel my insurance. They did finally got a semi competent rep. In reinsted it and a month later thet cancelled it. I was transfrred put on hold. I asked for a supervisior. She put me on hold twice. I'm heart patient can't the stress of these incompetents! No knows anything, do what they want no matter what you say. Its take multiple to get someone competent. Pray supervisor calls back. Let a heart patient without hospitalization. My policy info is constanrtly messed up.

On October 4, 2023 I was let go from the company Lukos LLC I was working for. However I was still on payroll till the end of the month and paid for all my benefits till the end of October. Florida Blue stopped paying any of my drs visit which was still using till October 31, 2023. Anytime someone loses a job whether laid off etc. You have your benefits because you pay for them till the end of the pay period since I was paying 200 bi weekly for my benefits to Florida Blue I am entitled to use the insurance. I went for blood work with Quest on October 17, 2023 The insurance was supposed to pay 473.87 Claim number Q100001097803482 Member number H40798451. Next I had nose pillows and things for my Cpap machine 173.60 Claim number Q1000001101340761. Then Caring foot and ankle specialist my podirast 253. 65 also was all used before the end of October. So since I am entitled to use my insurance to the end o the month Florida Blue needs to pay al these bills that where used prior to 10/31/2023. I have used Bue cross blue shield for years and have been led go of other employment jobs and I was covered till the end of the month because I paid for the benefits as I did now. So unless Blue cross does there job I will ask to go to a hearing because what they are doing is illegal not right and they are going to be reported as well to the state department of insurance.

I made 4 phone calls and each time i was on hold for over 35 minutes with no answer. Due to other appointments and things going on, I couldn't wait any longer. This is supposed to be a reflection of the type of service I'm going to get ? I just signed up with Florida Blue and it's been nothing short of a nightmare !

The website is garbage. I can log on, but thats it.. Nothing.. just a big circle going around then a white screen with an error messages saying that they are a little "under the weather".. Can't do anything or view my coverages.. It's totally worthless..

God ! I hope that this isn't how my coverages are going to be. Hopefully, I didn't make a mistake and leave my other insurance for Florida Blue...

Florida Blue is leaving me BLUE !

I called about my 2024 policy. I could not get through automated system. Won't take my information. 4 calls can't get it can't get it. Finally got a rep, repeated and repeated info, she hung up. Had to thorough phon maze again. Same bs can't get I can't get it. Got a rep took forever to find out what my new policy would cost. Very incompetent reps, put yo no hold a lot. No one knows any5hing. Most of the info is incorrect. Send you all over the place. Bad company poor trained reps, don't understand english. Repeat and repeat and repeat! Than hung up on. Took me over an hr, with the phone maze and incompetent reps.

I had access to my son's account for a long time. He's underage. Suddenly, I can't access his information any more even if I'm his legal and financial representant. According to Florida Blue, I need to demonstrate our relationship no matter I registered him. I'm the policy holder, and the account financial responsible. According to the support department, I have to mail them documents and when they receive them it could take 3 or 4 weeks to approve it!

I called oct 19 and 0th to get a new agent.
First the system is deplorable! Can't get your information.
When you finally get a rep. It s a non english speaking riued rep. They put you on hold very quick as they can. Never come back.
They find find your account, so they transfer you.
I'm a heart patient. Don't need this stress.
No one know what number to give you, or answer any question. Just out sourced untrained help.
They are dealing with people's health!
Very incompetent company, just rips patients off.
I can't a usa rep!
This company needs to be made responsible, for lack of customer service when dealing with people's health.

If I could give customer service a MINUS 10 that wouldn't be low enough. Been trying for OVER TWO MONTHS to get a med I've been on for several years. Advised since the correct documentation wasn't submitted originally and it was denied it would have to go to FL BLUE APPEAL. Trying to get to that department - one could die before that would happen. CUSTOMER SERVICE not only INCOMPETENT, INEFFECTIVE, INSUFFICIENT & OUTSOURCED. It would have been CHEAPTER, less stressful and more efficient time efficient to pay the $1,200/month for Cobra. Med at $450/month PLUS the nearly $800/month for FL Blue = $1,250. Not a mathematician but my calculation reflects $50 LESS with COBRA insurance than FL BLUE. PLUS, DID I ALREADY SAY WHAT HORRIBLE, INEFFECTIVE CUSTOMER SERVICE FL BLUE HAS!

A few months ago I have received a letter from Florida Blue Medicare dated 06/24/23 informing me about my new primary care doctor, which was assigned for me and which change I never requested (and by the way, this new doctor is 300 miles away from my home). This letter was followed by new membership card with new provider. I could not believe my eyes. Everything was done without my knowledge and request and is ridiculous. I called Customer Service and they blamed on their computer system and promised to fix it right away. I stayed assured this problem was gone. Today 09/14/ 2023 I received a phone call from my provider telling me they received the letter from Florida Blue telling them I switched my primary care provider. I called Florida Blue Customer Service today and they promised again to fix it. I was kind of happy with Florida Blue but now with screw ups like this (accidental or intentional) I will be looking for a different insurance company at the end of the year. I am very disappointed with Florida Blue Medicare. Thank you, Stan

Florida Blue provides an appeal process that borders on unethical disallowing any direct contact between the patient and the Florida Blue Appeal reviewers requiring the provider of the services to directly contact the insurance company for details. In theory, this process may actually be effective some of the time, except when laboratory services are administered by a third party (AKA, the provider) as required. Case in point, Florida Blue healthcare insurance when associated with affordable care act mandates the use of quest diagnostics to perform laboratory work in Florida. Certain procedures are covered under unique circumstances but considered investigational under other circumstances. Florida Blue routinely denies the claim and it is up to the patient to coordinate between the physician who ordered the service (yet has no direct financial stake) and the provider (laboratory) who actually gets more money when the service is denied to provide the unique language and background needed for claim coverage. The third party (Quest Diagnostics) has no incentive to get it right and Florida Blue has no incentive to get it right and the physician has no direct financial benefit to get it right and Florida Blue provides no direct access between the patient and the Florida Blue appeal process. Hence, months go by and no one gets it right until Florida Blue passes the amount of time where they have to pay the claim and the patient is then required to pay the denied claim. Whether this is unethical is certainly up for discussion, but it is certainly unfair. For my particular case, a scan was performed 5 times over an 18 month period, denied each time and eventually covered through appeal after months and numerous calls, chats, and back and forth conversations between the physician, Florida Blue, and me. The sixth time, Florida Blue denied the claim, the appeal, external review and provided no capability for me to speak to someone who could explain what was needed. Keep in mind, this was the same procedure they covered 5 times previously through their appeal process. The cost was only $165, but it is the principle of the matter that is important. Three of the five times, Quest Diagnostics sent the bill to collections before it was eventually covered. The last time where Florida Blue never covered the exact procedure it was sent to collections and I paid the $165 because I was convinced the insurance company was never going to fairly handle the claim. Thankfully, I aged out of the ACA insurance and had other insurance options besides Florida Blue through Medicare and will never have to deal with their unfair / unethical claims process again.

Approximately two weeks ago, I called Florida Blue for an explanation of a billing statement. The gentleman agent reviewed the statement and said there was a billing mix-up, and I would see approx. $500 removed from the bill within a few days. After a week, I received a past due bill from Florida Blue but no changes. I called again and spoke to a different female agent. After explaining to her what the previous agent stated, the female agent advised her mouse was not working properly and she would have someone else call me back that was higher up in their Billing department. I waited several days and no returned phone call from Florida Blue. I called a third time because I still have a past due bill. This time I was advised there was no error and I needed to pay the bill in full. I never had a problem paying my bill but the second I have to start working for my health insurance coverage is completely unacceptable. Why am I have to call you so many times to get the run around because you are not training your agents? Why no call back? Why tell a customer you had billing mix-up and not to worry? Of course, we have to worry because large companies like Florida Blue do not hold their employees accountable for their mistakes but will quickly threaten their customers with sending them to collections. I want to know if the customer service calls are recorded. And since I am being held accountable for my bill, who is being held accountable for telling me it originally was Florida Blue's $500 mistake?

I had a child on 12/27/22 and called the second week of January to add my child on my insurance so the birth would be covered AND I wanted to switch plans because I needed to add my husband as well. The customer service rep confirmed that she added my son and started the new plan for 2023. Fast forward to February and my husband was in a severe accident and admitted to the hospital. We found out we had no insurance due to the lady who supposably helped us did not submit anything. I found out as well she screwed my sons insurance up as well. I have submitted appeals and had someone from escalations department after I called the commissioner reach out and said Isaiah was added (April). I then had all the hospitals and peds office resubmit all the claims then come to find out in June he STILL was not on the insurance. I have called Florida blue over 50 times I’ve spent countless hours and time trying to get this fixed and it is still not resolved after 8 months. So I reached back out to the same woman and took several emails and another call to the commissioner for her to respond. She replied 3 days ago and said Isaiah was now added and should show up in the system. I called Florida blue again today and confirmed he was NOT added. I reached out again and she is now stating that since he was “allowed to be put on the plan after 30 days the system is not accepting it and may be my responsibility for the bills” NO! I’m not responsible. Florida blue is which I told her. I am not the one that didn’t do their job. I’m beyond frustrated.

My name is Marlin Mena

My insurance ID VMYH17827112

My address is:

166 SE JENESE WAY

Lake City, FL 32025

Mobile Phone:

[protected]

(Voice & Text messages OK)

Email Address: [protected]@gmail.com

I have a diagnosis of Cancer and Florida Blue cancelled my insurance and it is not accepting my payments. I have been able and willing to pay but they cancelled. When I called in February 1 they did not accept my payment. Later in April they cancelled my insurance however, the pharmacy is giving me my medications. But the hospital (my chemo treatment) and my counseling providers are not receiving payment. Since April I have been experiencing problems, still is not being resolved.

I need my insurance, and Florida Blue is cancelling me (maybe because they do not want to pay for my cancer treatment?). The information is not correct, and Florida Blue is violating my rights to have insurance.

Hello. I have a wonderful caseworker named Andreina who unfortunately has to rely on a nurse named Candy to provide me with transportation to my Dr visits. I sent a message on April 27 for my May 2 appt.

Candy did not call me until 1 hour before my appointment, despite my messages and Andreina messages. Candy claims to have attempted to call me once on the 28 but my phone shows no missed calls nor messages from her. One hour before the appt she tells me my only option is to set up a Lyft account with a verified payment method then she will send me a code. I am homeless and not yet receiving disability and unable to provide a verified payment method on such short notice. Why didn't she leave me a message on the 28? Why didn't she call me again on the 1st? If my health is so unimportant to my nurse then why am I assigned to her? With a fractured tailbone and paralyzed hand I took two trolleys and one train each way. Standing room only.

Zoe Sparrow
Member Number
VMAH40746855
BC 090 BS 590
Rx Bin 012833
PCN FLBC
Group Number 99999
Plan Number
1410C
Plan Number
1410C

On 10-18-2022 I went to Broward hospital Account number [protected] the balance I have to pay back is to Hight I call Florida Bleu the argent say they can't help me reduce the bill but it's too high and I can't pay it. Please I am looking for someone who can help me reduce the bill please.

I spoke to Anderson Y, he stated that he can't help me.

Please I am looking for someone who can help me please. ________________________________________________

Case Num (C202303101241127)

My name is Clarence Bynes Jr

i am filing a complaint on Florida Blue about my PPO Service i am trying to

get authorization for my prostate MRI.my insurance you said that we did not need no authorization to see our Doctors. every where we go we have to have authorization for all apointments. we were told when we purchased the insurance it would need no authourization for anything. the people on the phone are rude and talk down to your customers i will be contacting an attorney about these matters. my life is in danger because of your action. i need the MRI for my prostate .

The only lab that Florida Blue covers @ 100% is Quest.

My physician ordered lab work today (2/23/23) to be done on a specific day (2/27/23)

None of the Quest Labs in my area have appointments available on 2/27/23.

There is a Sarasota Memorial Hospital Lab facility across the street from my employer but since Florida Blue considers this an “Out patient” facility I will be responsible for a $150 co-pay.

It is NOT an urgent care, or walk in clinic. All they do is labs.

My screening mammogram and DEXA were covered with zero copay.

Why should I have to pay $150 copay for labs ordered by my physician just because Florida Blue restricts where I can go for those services to a lab that has no appointments available and will not see patients without appointments?

I need someone to explain this stupidity to me.

First my plans were suppose to be on auto pay and for some reason they didn't do that and my plans canceled. Then they said theyve never had auto pay on my account but theyve been taking it out my checking acct for years. I was able to use my plans at drs and pharmacies. Didn't know until I needed them at the pharmacy this time that is was canceled. Second and the worst part is customer service. They keep transferring you to different reps, you have to keep repeating your info, and you cant understand a word they say to even take care of your problem. Blue cross and blue shield needs to quit out sourcing our companies in America and hire people from here so we can understand the dialogue. This is ridiculous. I've had blue cross and blue shield for 25 years and it's never been this bad.

Claim hasn't been paid after the appeal approval from May and other one is still pending and filed wrong from Florida Blue a year later. I filed a complaint with the Florida Insurance Commissioners office and the person replying on behalf of Florida Blue doesn't know anything about the claims and he avoids calls and emails. After telling me that he would help. I even supplied documentation obtained from Florida Blue and the customer rep can't seem to understand the problem let alone fix it. They need to hire someone who does. Pay the claims already. And I hope that the Insurance Commissioners Office fines them for their total incompetence.