CareFirst Blue Cross Blue Shield

I have been a member of CareFirst Community Health Plan Maryland for a few years now. My experience the first two years was fine. My experience the last 6 months (from January 2026 to present) has been atrocious. CareFirst Community Health Plan issued new cards to members in January 2026 and got a new client portal (and possibly a new system for processing claims) soon after. From January 2026 to present, many of my claims have been denied for covered services including: annual exams (with primary care provider, eye doctor, and gynecologist), urgent care visits, medical nutrition therapy, an MRI, and durable medical equipment and supplies (including CPAP machine and supplies, custom made orthotics, and urinary Incontinence pads). It also looks like my claims for routine blood work and physical therapy will be denied in the near future. Also, when I log into the client portal, all of my claims have "CareFirst Medicare Advantage" listed on the letterhead (instead of "CareFirst Community Health Plan.") I am very careful to make sure that all of my providers accept CareFirst Community Health Plan and I believe that all of these claims should be covered (as they were in 2024 and 2025). I have been in regular contact with the Member Services Department since late March 2026 and my case was escalated to a supervisor in late April 2026. I feel like the staff at CareFirst are quick to say that the providers are the ones that are making mistakes when submitting claims and are quick to defend CareFirst's system for processing claims. While I am sure that providers do occasionally make mistakes when submitting claims, the errors are widespread and I think that CareFirst's system for processing claims is causing most of these errors to happen. As I have asked on multiple occasions, I am hoping that a staff member (or team of staff members) at CareFirst will be doing a deep dive into my profile (account) to see why so many of these claims are being denied in error instead of simply asking all of my providers to call Provider Services to try to remedy the problem. I hope to see all of these denied claims covered at some point in the near future. CareFirst, I have been a satisfied customer in the past and I know that you can do better. Your members deserve better.

0 Stars. CareFirst should be called CareLast. They would rather see you in a body bag, so they can steal your monthly premiums to pay their FAT bonuses- - I'm not joking! They don't want to pay for meds that my doctor prescribed that works and my last insurer paid for. Haven't been taking my meds going on 3 weeks now because my health insurer CareLast refuses to pay.

I guess zero stars isn't an option. This company is the worst insurance provider I've ever dealt with. They spent most of last year charging me double every month and when I tried to pay for just 1 of the plans they'd cut my policy off until both were paid. They eventually gave me half of the money back and I just lost the rest of it. This went on from January to July and I got credit until The beginning of November. I just took it after spending 60+ hours on the phone getting nothing done and frequently hung up on.

The Pharmacy isn't any better as they refuse to help you with anything ever. They also like to just hang up on you when you ask them too many questions. Then if you actually get someone to talk to you they just lie to you. They also change the costs of your meds by the month to whatever they want. They almost always go over your supposed "co-pay".

If you have any other option aside from them, you should try that because they're going to screw you over in anyway they can. The reps you talk to are all useless, and just want you off the phone. They make it plain they don't care if you have the care or meds you need to live or if you drop dead on the phone with them as long as you pay them. If you did die on the phone with them they would continue to charge your account as long as possible. If you are in a position to run you should. Like all the other monopolies in America, they don't care about anyone, just the money you give them. I'm sorry if you are also stuck having to deal with this joke of a health-care plan.

I have a CareFirst dental policy and have found the customer service to tbe the worst I have ever experienced by any company in any industry. To reach a dental customer service representative I have found that a 20-40 minute hold time to be a best case scenario. Often, I have spent well over an hour on hold and then at times, my call is disconnected. There was a three week period when it was literally impossible to reach anyone in customer service at all. I tried calling first thing in the morning and throughout the day, for several days in a row, spendiing hours and hours on hold, never being able to reach a representation. On a sporatic basis, the answering system will provide the caller the option to have CareFitrst call you back when it is your turn in the call que. I elected the option probably 6 or 7 times and not once did I get a callback. CareFirst also provides enrollies the option to ask questions via email (once logged into the Carefirst network), however it takes at least 5-6 weeks to receive a response and those responses are usually pretty useless. Often the response is to call customer service. But for those who persevere and are willing to make the investment in time, it is possibe to finally reach a representative. But reaching a representative is only half the battle. The question then becomes: does the representative have the experience and training to properly answer the question and provide the appropriate guidance. I have found that about half the time, the answer to that is no. That likely results in the need to make additional to calls customer service which means more hours spent on hold. The positive aspect of the CareFirst dental customer service is that the reps are almost always very kind and respectful and seem genuinely interested in addressing any issue one might have. Indeed, they seem to try very hard. That is something I truely appreciate and I recognize its not their fault the company lacks the staff to handle the volumde of calls or that they were not provided adequate training to be effective. They are just a cog in an company that I have come to view as the poster child of a poorly managed, highly bureacratic, massively disfunctional and inefficient organization. Other than thay, its probably a pretty good company.