North Carolina State Health Plan

AG99

In the past year, I have experienced several issues with the NC SHP. Prior to this, my rating would have been much higher. 1.) NC SHP refuses to advocate for their consumers when copays are charged for preventative health services that are to be covered at 100%. Doctor's offices are making quite a bit of additional money by charging copays when they are not supposed to, and they know they can get away with it from most people. (Read your benefits information and question charges!) 2.) One can not get a definitive answer on whether or not services will be covered under copay and deductible, or if it will be an out of pocket expense. I have called with the billing codes from the physician's office, and still receive different answers from different representatives. If the specific billing code is provided, there should be no reason why this information could not be given to the consumer. 3.) The "find a procedure cost" tool on their website is a great idea, in theory. But again, even when you have the specific codes you can't get a cost. When all of the doctor's offices nearby give the same range of cost for the procedure, how are we expected to choose the lowest cost? 4.) CVS Caremark is required for mail order specialty prescriptions. At first, things were great and they were a 100% improvement over Express Scripts. Over the past year, there has been a drastic change in their level of service. NC SHP needs to demand they do better for their consumers, or the PBM needs to change. 5.). Why do our insurance cards say "provided by NC tax payers"? While that is partially true, it is not the whole truth. State employees have lower salaries in exchange for benefits. Tax money also provides Medicaid services, and the same statement doesn't appear on Medicaid cards, but it should.

McKenzie Jordan

It is extremally frustrating how complicated the process is to change your Primary Care Physician. One star is very friendly. I have been on the phone for over an hour speaking with at least 8 different reps. I have been transferred to multiple departments only for them to continue to tell me "this is the wrong department, let me transfer you to the right department". The moment I am transferred, it is either the wrong department AGAIN or they hang up. They even ask for a callback number and NEVER call back. Let's also add that it takes over 5 minutes to get through the recorded message just to talk to a human. On top of the issue with the phone calls/ customer service, it isn't until the final call that I am informed I cannot even change my PCP because I am not the primary account holder. Customer service couldn't inform me of this on the FIRST phone call? Not to mention, there is NO WHERE to file a complaint on BCBS NC website. I started a chat online to express my complaint only for them confirm that I cannot change my account. Lol, I know that now... So, in conclusion, if you want to experience over an hour of phone calls, speaking with 8 different reps, starting an online chat session all to update your PCP then BCBS NC State Health Plan is the number to call! Thank you google reviews, as I am sure BCBS will never see or address this issue.

Rachel rosenbaum

Mailed in a claim, they said they never received it. Asked if I could submit by email or digitally somehow for a paper trail. They said no. They asked me to fax it so I did, called back and asked for confirmation of receipt and they said they were unable to confirm fax arrived. They need an electronic submission system with a paper trail. This is ridiculous, even my pets insurance has online submission and tracking.

Melissa Jones Martin

Continually being overcharged for copays . Numerous calls and 6months later the charges are supposed to be processed correctly I guess I'll wait another 30 45 days to see.