Topics:Buying health insurance health care Open Enrollment health insurance guides Health and wellness Medicare research
May 7th, 2021
May 7th, 2021
2020 brought the importance of health insurance and health care access into sharp relief as we followed implications of the COVID-19 pandemic. It also heightened the importance of the customer experience in client retention as companies adjusted operations along COVID-19 guidelines. Regardless of industry, customer reviews play an important role in understanding what clients want. We analyzed health insurance customer reviews received in 2020 to understand more about what matters to health insurance plan members. Key Takeaway: Health insurers can improve the customer experience in 2021 by focusing on the areas listed below. Customer service Coverage options Provider networks Claims processing Affordability 2020 Customer Review Breakdown Best Company received 905 total reviews for the health insurance industry in 2020, slightly below 2019's 1066 total reviews. (Read the full 2019 report.) Here's how 2020's review star ratings came out: 44 percent 5-star (compared to 28 percent in 2019) 21 percent 4-star (compared to 18 percent in 2019) 6 percent 3-star (compared to 8 percent in 2019) 5 percent 2-star (compared to 5 percent in 2019) 24 percent 1-star (compared to 41 percent in 2019) The biggest difference between 2019 and 2020 reviews is the increase in 5-star reviews and the decrease in 1-star reviews. This change in review data makes the health insurance industry more hopeful than last year: 65 percent 4-star and 5-star reviews in 2020 versus 46 percent 4-star and 5-star reviews in 2019. These differences in review percentages may indicate that health insurers are doing a better job when providing services. However, we only have two years of similar analyses. Until we have more data, whether health insurers responded to 2019's complaints is uncertain. It's also unlikely considering the more pressing issues of responding to COVID-19. 5-star review analysis Since the largest proportion of 2020's reviews are 5 stars, we dug deeper to understand what plan members value about their experience: 47 percent mentioned good customer service 28 percent discussed coverage satisfaction 20 percent talked about provider networks positively 15 percent mentioned positive user experience with the insurer's platforms 14 percent of reviewers were happy with claims 14 percent of reviewers discussed cost satisfaction 7 percent of reviewers mentioned affordable out-of-pocket costs (counted separately from general cost satisfaction) Interestingly, 9 percent of 5-star reviewers mentioned being on a health plan through an employer. Customer service When you have a question or need to resolve something with a company, good customer service makes a big difference. Our data analysis found that praise for customer service included short wait times, quick response times, and knowledgeable representatives. Health insurers can continue to deliver high quality customer service by focusing on these aspects. Coverage You buy health insurance for the coverage, so good coverage is important. With health insurance, it's key to balance cost and coverage. Health insurers can make it easier to find good coverage that fits your price point by offering a variety of health plans. In customer reviews, reviewers liked having a variety of coverage options. Adjectives describing coverage also included "excellent" and "great." Customer Review: Nathan from Broomfield, Colorado "I have always been impressed with the quality and quantity of coverage I have gotten from Blue Cross Blue Shield. They have helped me get through some very trying times and pay for my medication!" Provider network The third most frequent praise was about provider networks. Reviewers mentioned either their plan's wide acceptance or praised the quality of their care providers and facilities. Finding a doctor you trust that provides good care matters. Large provider networks make it easier to find a good in-network, which helps you keep your out-of-pocket costs down. Platforms Reviewers also appreciated how easy their insurer's platforms were to use. These included the company's website, online member portal for tracking claims, tools for finding providers, and the mobile app. Customer Review: Rahim Sabadia from Yorba Linda, California "Excellent overall care. Very responsive and their online platform and tools make it very easy to keep track of appointments, lab results and communications with health care providers." Telemedicine is also included in this category because it can be accessed through platforms connected with an insurer. Platform interfaces and ease-of-use mattered even more in 2020 as we did more things remotely. Cost The cost satisfaction category included general statements about cost and affordability. In some reviews, it seems like these references were about monthly premiums. However, some reviewers may combine premiums and out-of-pocket costs when commenting on cost generally. Seven percent of reviewers specifically mentioned satisfaction with out-of-pocket costs. These were counted separately. Claims Claims satisfaction was just as common as cost satisfaction in 2020 5-star reviews. Reviewers mention never experiencing a denial or timely processing and payouts. Customer Review: Patti Miller "I had BC&BS for 27 years through my work place. Never had a claim denied. Not alot of time past before payments were made. Customer service was always available to answer questions." 2019's complaints and 2020's praises It's not hard to imagine that 1-star reviewers and 5-star reviewers have very different experiences with a company and an industry. Considering 2019's high number of complaints alongside 2020's high number of praises reveals a helpful parallel. 2019 Complaints Poor customer service (42 percent) Coverage difficulty or denial (32 percent) Claims process or payment difficulty (23 percent) Provider network concerns (22 percent) Cost vs value of plan (21 percent) 2020 Praises Good customer service (47 percent) Satisfaction with coverage levels and options (28 percent) Happy with provider networks (20 percent) Smooth claims processing (14 percent) Affordable cost (14 percent) Top complaints in 2019 strike similar notes as 2020's top praises. This congruity highlights the importance of each of these factors to the overall customer experience. Health insurers should pay attention to these areas as they train employees and serve plan members. Methodology These results are based on a total of 905 health insurance reviews left on Best Company in 2020. Of those reviews, 401 had 5-star ratings. A random sample of 163 5-star reviews is the basis for the praise analysis. Results of the 5-star review analysis have a 90 percent confidence level with a 5 percent margin of error.
Updated October 26, 2020 2020 Open Enrollment is just around the corner. With health care concerns from the pandemic and increased health care access concerns resulting from shutdown layoffs, health insurance's role in removing barriers to health care access is much clearer. Since health insurance companies can change their offerings and even your current plan, you should shop around each year to make sure that you have health insurance that fits your budget and meets your needs. For helpful information on choosing a health plan, read "4 Things to Look For in a Health Plan [Video]". In addition to finding a good health plan, it's important to choose a trusted and reliable insurer. To help you identify the best health insurance companies to work with, we'll review what this year's customer reviews say about nine companies. While Best Company lists more than nine health insurance companies, only these had a worthwhile number of reviews to analyze. These nine are listed from most 2020 reviews to fewest 2020 reviews. (In other words, we're the most confident about our findings for BlueCross BlueShield because there were more reviews. We're the least confident about our findings for Molina Healthcare because there were fewer reviews to analyze.) BlueCross BlueShield UnitedHealthcare Oscar Kaiser Permanente SelectHealth Ambetter Cigna Aetna Molina Healthcare 1. BlueCross BlueShield Best Company Rank: #12020 Best Company User Rating: 4.10/52020 Review Breakdown: 54% 5-Star 24% 4-Star 7% 3-Star 7% 2-Star 8% 1-Star 2020 Reviews by State: 12% from Utah 8% from Texas 7% from Mississippi 6% from California 6% from Florida 2020 Most Common Complaint: Cost (10%)2020 Most Common Praise: Customer Service (30%) Coverage dissatisfaction (8%) and concerns with red tape (6%) both followed cost dissatisfaction. Praise was much more common in BlueCross BlueSheild's 2020 reviews than complaints were. Other common praise included coverage satisfaction (22%), cost satisfaction (21%), general satisfaction (17%), network satisfaction (17%), and claims satisfaction (15%). Note: Qualitative analysis based on a random sample of 114 out of 194 reviews left on Best Company for BlueCross BlueShield as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 reviews by state, 2020 geography breakdown) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Vantresa Scott from Annapolis, Maryland "I've been with BCBS for most of my life. They have been great. I started when I was 26 years old and I am now 57. Their physician network is terrific and plans are great and I have never had a problem with them covering my expenses. NEVER EVER. I started my own company 5 years ago and we only offer BCBS plans because of the exceptional quality. Their national and international coverage is top notch." Our Advice With 78 percent of this year's reviews hitting 4 or 5 stars, BlueCross BlueShield is a great company to work with. Before enrolling in a plan, be sure you understand what's covered and what requires prior authorization. Having this understanding will help you be prepared for prior authorization and can prevent coverage concerns. While the most common concern was cost (10%), 21 percent of reviews were happy with the cost. As you look at plans consider whether the monthly premiums fit into your budget and do your best to estimate what your out-of-pocket costs may be next year. After evaluating BlueCross BlueShield plans, you can be confident in your insurance company choice since reviewers had more positive comments regarding customer service, provider network, coverage, and claims than negative ones. Keep in mind that BlueCross BlueShield is a national company and works through many subsidiaries. For more specific information on the BlueCross BlueShield subsidiary in your area, look for reviews for it by name. Subsidiaries include Regence, Anthem, Florida Blue, Independence BlueCross, and others. BlueCross BlueShield Health Insurance Learn more about BlueCross BlueShield by reading customer reviews and our expert analysis. Learn More Back to Company List 2. UnitedHealthcare Best Company Rank: #62020 Best Company User Rating: 3.61/52020 Review Breakdown: 51% 5-Star 16% 4-Star 2% 3-Star 7% 2-Star 25% 1-Star 2020 Reviews by State: 15% from Utah 10% from Florida 7% from California 7% from Texas 5% from Arizona 4% from New York 2020 Most Common Complaint: Customer Service (21%)2020 Most Common Praise: Customer Service (25%) The two other most common complaints were about claims (14%) and coverage (14%). Network satisfaction (14%) and general satisfaction (12%) followed praise for customer serivce. Note: Qualitative analysis based on a random sample of 85 out of 122 reviews left on Best Company for UnitedHealthcare as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Dorothy from Omaha, Nebraska "I have been a UnitedHealthcare customer for 2 years and highly recommend this reputable company. I was enrolled in their student health insurance plan and the plan's details were easy to understand, the plan was accepted at all of my providers, and customer service was always helpful!" Our Advice Based on this year's customer reviews, it's harder to give a clear recommendation of UnitedHealthcare. It's promising that a majority of its reviews (67%) are 4 or 5 stars. However, 25 percent of this year's reviews are 1 star. It's also concerning that reviewers offered more specific complaints than praise. As with most health insurance companies, your coverage, network, and cost vary depending on the plan you choose. Health plan offerings can also vary by location. Because of this variation, you need to review any health plan you consider carefully to ensure it covers the medical services you need. You also need to ensure that the monthly premiums fit your budget and that the health plan will help you control your out-of-pocket expenses. Since a majority of UnitedHealthcare members reported a good experience this year, UnitedHealthcare is worth considering. However, carefully review the coverage offered in each plan you consider before you enroll. You'll want to avoid issues with claims and coverage. Double-checking that the services you need are covered will increase the odds that you'll have a good experience with UnitedHealthcare. UnitedHealthcare Health Insurance Learn more about UnitedHealthcare by reading customer reviews and our expert analysis. Learn More Back to Company List 3. Oscar Best Company Rank: #32020 Best Company User Rating: 3.54/52020 Review Breakdown: 42% 5-Star 22% 4-Star 7% 3-Star 6% 2-Star 23% 1-Star 2020 Reviews by State: 33% from Texas 22% from California 12% from Florida 12% from New York 2020 Most Common Complaint: Provider Network (21%)2020 Most Common Praise: Customer Service (41%) Poor customer service was the next most common complaint at 16 percent. Praise was more common in Oscar reviews and included satisfaction with the app (20%), satisfaction with perks and incentives (18%), general satisfaction (14%), network satisfaction (14%), and cost satisfaction (14%). Note: Qualitative analysis based on a random sample of 56 out of 69 reviews left on Best Company for Oscar as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Brock Williams from Los Angeles, California "Oscar has been the best health insurance company I've ever had. I've been self-employed my entire adult life, so I've paid for my own health insurance and I've had a lot of different policies with different companies, in multiple states. Oscar has been the most affordable, easiest to navigate and best coverage I've ever had." Our Advice While 64 percent of Oscar's reviews are 4 or 5 stars, 23 percent are 1 star. As you consider Oscar health plans, pay attention to the provider network in your area. Make sure that the doctors you need are reasonably close. Fortunately, Oscar reviewers had more positive things to say than negative ones. If you're looking for a good app, nice perks and incentives, and good cost, Oscar is worth investigating further. Again, be sure to review each plan's network, coverage, and cost to ensure that you find an affordable health plan that meets your needs. Oscar Health Insurance Learn more about Oscar by reading customer reviews and our expert analysis. Learn More Back to Company List 4. Kaiser Permanente Best Company Rank: #42020 Best Company User Rating: 3.97/52020 Review Breakdown: 57% 5-Star 15% 4-Star 10% 3-Star 3% 2-Star 15% 1-Star 2020 Reviews by State: 41% from California 15% from Utah 7% from Colorado 7% from Georgia 5% from Oregon 2020 Most Common Complaint: Doctors and Staff (17%)2020 Most Common Praise: Doctors and Staff (42%) Other complaints included issues with member services or red tape (13%) and concerns that Kaiser Permanente was expensive (10%). Other common praise included general satisfaction (17%) and convenience (12%). Note: Qualitative analysis based on a random sample of 52 out of 61 reviews left on Best Company for Kaiser Permanente as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Luna from Rockville, Maryland "The doctors and nurses there are very nice. They have clean and high technology equipment. I think it worth the money." Our Advice A majority of Kaiser Permanete's reviews this year were 4 or 5 stars (72%), it still received a fair number of 1-star reviews (15%). Considering other years, Kthe proportion of 5-star and 1-star reviews are similar. It's tricky to make a clear recommendation. Kaiser Permanente stands out from other health insures because it employes doctors and runs hospitals instead of negotiating and contracting with doctors and hospitals to build a provider network. When you enroll in a Kaiser Permanente plan, you'll be limited to its doctors, clinics, and hospitals. Since both the most common complaint and most common praise this year were about Kaiser Permanete's doctors, you'll want to know how many Kaiser Permanente facilities and doctors are in your area and how good they are to gauge how well a Kaiser Permanente plan might work for you. You'll also want to pay attention to how your plan's coverage works and whether any services require prior authorization. Doing so will help you use your health plan better and be prepared for the prior authorization process. Kaiser Permanente Health Insurance Learn more about Kaiser Permanente by reading customer reviews and our expert analysis. Learn More Back to Company List 5. SelectHealth Best Company Rank: #22020 Best Company User Rating: 4.41/52020 Review Breakdown: 57% 5-Star 33% 4-Star 6% 3-Star 2% 2-Star 2% 1-Star 2020 Reviews by State: 78% from Utah 8% from Minnesota 4% from California 2020 Most Common Complaint: Cost (8%)2020 Most Common Praise: Customer Service and General Satisfaction (tied at 35%) Praise was far more frequent in SelectHealth reviews than complaints. Other common praise included provider network satisfaction (29%), coverage satisfaction (27%), and clarity regarding coverage (12%). Note: Qualitative and quantitative analysis based on 51 reviews left on Bes tCompany for SelectHealth as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Aidan Keogh from Ogden, Utah "We have like Select Health Insurance. The coverage is great and the number of available facilities and providers is large. They are quick to pay out benefits and to inform us what they plan on paying." Our Advice SelectHealth offers health plans in Utah and Idaho. With 90 percent of this year's reviews earning 4 or 5 stars, SelectHealth is a recommended health insurer. Even though SelectHealth received only 51 customer reviews on Best Company this year, it has consistently received a high proportion of 4 and 5 star reviews. Based on this year's reviews, you're likely to find good customer service, good provider networks, coverage, and be generally satisfied. While 2020 SelectHealth's reviews were full of general satisfaction and praise, cost was the most common complaint. You'll want to review your health plan's costs before enrolling. Your costs include monthly premiums and out-of-pocket expenses. Review the copays or coinsurance for the health services you think you'll need next year. Since most of this year's reviews come from Utah, it's difficult to say whether SelectHealth is as good in Idaho as it is in Utah. If you're in Idaho, review SelectHealth plans for the provider network, coverage, and cost. Compare these three aspects to plans offered by other insurers in your area to see which best meet your coverage and financial needs. SelectHealth Health Insurance Learn more about SelectHealth by reading customer reviews and our expert analysis. Learn More Back to Company List 6. Ambetter Best Company Rank: #72020 Best Company User Rating: 1.98/52020 Review Breakdown: 18% 5-Star 7% 4-Star 2% 3-Star 2% 2-Star 71% 1-Star 2020 Reviews by State: 31% from Texas 14% from Georgia 11% from Arizona 11% from Florida 2020 Most Common Complaint: Coverage (36%)2020 Most Common Praise: Customer Service (13%) Complaints were quite common in Ambetter's reviews. Other common complaints included network dissatisfaction (27%), claims issues (24%), and poor customer service (24%). Note: Qualitative and quantitative analysis based on 45 reviews left on Best Company for Ambetter as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Even though Ambetter received only 45 reviews this year, 71 percent of them are 1 star. Ambetter has also consistently earned a high proportion of 1-star reviews on Best Company, which means that Ambetter is not a recommended insurance company. If you don't have another option in your area, ask questions about the provider network, the claims process, and be sure to throughoughly understand what coverage your plan offers. Learn more about Ambetter by reading customer reviews and our expert analysis. Back to Company List 7. Cigna Best Company Rank: #52020 Best Company User Rating: 3.33/52020 Review Breakdown: 36% 5-Star 15% 4-Star 18% 3-Star 8% 2-Star 23% 1-Star 2020 Reviews by State: 27% from Utah 13% from Texas 2020 Most Common Complaint: Coverage (18%)2020 Most Common Praise: Customer Service (21%) Other complaints included network dissatisfaction (15%), cost dissatisfaction (10%), and claims dissatisfaction (10%). Praise also included coverage satisfaction (15%) and claims satisfaction (13%). Note: Qualitative and quantitative analysis based on 39 reviews left on Best Company for Cigna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Kevin Liu from Sandy, Utah "Cigna has good coverage options for my primary care doctors. Their web ports is very transparent and easy to use to find physicians and see what I’ve paid towards my deductible." Our Advice A clear recommendation is also difficult to make for Cigna. The insurer only received 39 reviews this year. While 51 percent of these reviews are 4-stars or 5-stars, a good chunk (23%) were 1 star. Considering all of the reviews left on Best Company regardless of year, Cigna has received a majority of 1-star reviews (40%). 4-star and 5-star reviews account for 43 percent of Cigna's overall reviews, 20 percent and 23 percent respectively. While it's promising that Cigna received a lower proportion of negative reviews in 2020, be careful as you look at plans from this company. Pay attention to the coverage offered, provider network, and cost to be sure you find a plan that meets your needs. Learn more about Cigna by reading customer reviews and our expert analysis. Back to Company List 8. Aetna Best Company Rank: #82020 Best Company User Rating: 3.53/52020 Review Breakdown: 41% 5-Star 22% 4-Star 6% 3-Star 6% 2-Star 24% 1-Star 2020 Reviews by State: 15% from Florida 15% from Utah 12% from California 2020 Most Common Complaint: Claims and Customer Service (tied at 18%)2020 Most Common Praise: Coverage (35%) Complaints were less common. Other complaints included network dissatisfaction (6%) and general dissatisfaction (6%). Praise also included good customer service (21%), cost satisfaction (18%), network satisfaction (18%), and plan choice (18%). Note: Qualitative and quantitative analysis based on 34 reviews left on Best Company for Aetna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Phil Carriere from Cambridge, Iowa "Looked at several other plans from various other companies , but felt like the Aetna plan was best for my wife and I. Low cost,covered everything we needed covered, and includes a dental rebate program. When i needed an answer to a question they have always been there for me and are always concerned about improving my well being." Our Advice Although Aetna received 63 percent 4-star and 5-star reviews this year, it also received a good chunck of 1-star reviews (24%). If you opt for Aetna, be prepared for potential issues with claims and customer service. Keep in mind that Aetna doesn't offer individual and family plans. It offers Medicare and Medicaid. If you qualify for those plans and find one that meets your needs, Aetna can be a good option. Learn more about Aetna by reading customer reviews and our expert analysis. For specific information about Medicare, read Aetna's Medicare profile. Back to Company List 9. Molina Healthcare Best Company Rank: #152020 Best Company User Rating: 3.56/52020 Review Breakdown: 4% 5-star 13% 4-star 8% 3 star 0% 2-star 75% 1-star 2020 Reviews by State: 17% from Utah 17% from Washington 13% from South Carolina 13% from Texas 8% from Wisconsin 2020 Most Common Complaint: Coverage (38%)2020 Most Common Praise: General Satisfaction (8%) Other common complaints included poor customer service (33%), dissatisfaction with network (33%), issues with red tape (25%), and premium or billing difficulties (21%). Note: Qualitative and quantitative analysis based on 24 reviews left on Best Company for Molina Healthcare as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Since the number of reviews is so small and this year's reviews are almost half of the reviews on Best Company for Molina Healthcare, it's hard to make a certain recommendation. It's concerning that 75 percent of this year's Molina Healthcare's reviews were 1 star while only 17 percent were 4 or 5 stars. If you're considering Molina Healthcare, call your current doctors — and even doctors you may need to visit — to ask if they accept Molina Healthcare insurance plans. You'll also want to carefully review the coverage Molina's plans offer so that you know how to use your plan and how to approach prior authorization when needed. You should also review your plan's costs, including the premium, deductible, copays, coinsurance, and out-of-pocket maximum. Keep an eye out for billing issues as well. Learn more about Molina Healthcare by reading customer reviews and our expert analysis. Back to Company List
BlueCross BlueShield has earned the top spot in health insurance on Best Company. It has earned a 3.6 user star rating, and 66 percent of its reviews are 4 or 5 stars. If these numbers seem just average or a little low, consider that 41 percent of health insurance reviews were 1-star in 2019. Since complaints are common for the health insurance industry, what look like average ratings are actually quite good. BlueCross BlueShield has also earned a 5.35 out of 10 net promoter score. This score indicates how likely reviewers are to recommend the company to a friend. A score of 5.35 may seem low, but the average for the health insurance industry is 4.14 out of 10. BlueCross BlueShield's net promoter score is above average. So, what is BlueCross BlueShield doing right? I looked at 4- and 5- star reviews to find out. The most significant areas of success were customer service, coverage, and reliability and quality. Customer service The most commonly mentioned positive experience with BlueCross BlueShield was customer service. Roughly 44 percent of reviews had praise for BlueCross BlueShield's customer service. Customer Review: Linda Hill "The best part of Blue Cross is their customer service. They are very patient and willing to take the time to explain your benefits." Customers appreciate BlueCross BlueShield's commitment to clarity and making sure they understand their benefits and claims. Customer Review: Thomas Hullinger from Pleasant Grove, Utah "BlueCross BlueShield has made it easy for me to take care of my health and the health of my family. They give you the information up front to make an informed decision and help you every step of the way. Top notch care from top notch doctors and nurses." Clarity isn't the only thing that BlueCross BlueShield customer service gets right. Members also appreciate how responsive BlueCross BlueShield is when they have questions or concerns. Customer Review: AJ and Maria Ferguson from Riverton, Utah "We have had BlueCross Blue Shield for many years. They have always been great in paying claims quickly. Their customer service has always been quick to respond and find the answers to my questions or help empower me with knowledge that I have needed when there has been a discrepancy with a provider." Another satisfied BlueCross BlueShield member was impressed by the care shown by company representatives. Customer Review: Brandy Rudy from West Jordan, Utah "I have had BlueCross BlueShield insurance coverage off and on since I was in college. The coverage and customer service remain impeccable and I highly recommend them. They send monthly updates on my coverage along with my usage and any concerns. They are truly concerned with me and my family receiving the best medical available." If you purchase a health plan from BlueCross BlueShield, these reviews show that you can expect clarity, caring, and quick responses from customer service. These traits of BlueCross BlueShield customer service are especially important because health insurance is where your health and finances meet. Coverage Positive reviews also frequently mentioned satisfaction with coverage offered by the plans. You're buying health insurance for coverage, so knowing that BlueCross BlueShield members are happy with coverage is reassuring. Roughly 36 percent of 4- and 5-star reviews mentioned satisfaction with coverage. Coverage and provider network satisfaction were often mentioned together. Roughly 19 percent of reviewers were satisfied with the network coverage. Customer Review: Jake from American Fork, Utah "Our favorite insurance we have had is Blue Cross Blue Shield. Their coverage of different things was very good. We also really liked their network of doctors and hospitals and urgent care facilities. It was very nice to know that they had such a wide range of coverage that was covered in network." Covered services and network size are both important because you don't want to buy a health plan from an insurer that doesn't have a good selection of providers in your area. If your area has many providers that accept your plan, it's easier to save money on care. Reliability and quality BlueCross BlueShield's general reliability and quality were mentioned by about 33 percent of reviews. Customer Review: Jerry and Janette Jack "Overall, they are excellent. I have had them on/off since the 1980's and they have improved vastly in that time." Improvement over the years shows that BlueCross BlueShield is committed to offering its plan members top notch services and plans. General reliability Health challenges are stressful enough without the added stress of an unreliable health plan or difficulties with insurance. Customer Review: Teagan Hickman from Salt Lake City, Utah "We have always had reliable insurance with bcbs they process their claims quickly" Knowing that reliability is one of BlueCross BlueShield's strengths offers peace of mind. General quality Quality is challenging to pin down because it encompasses many aspects of a health insurance company. Quality shows up in coverage, customer service, and more, but it can be articulated in vague terms. While these statements of how much people like having BlueCross BlueShield don't offer much in terms of specifics, they are indicators of general satisfaction. Other positive traits Customer service, coverage, and reliability and quality aren't the only things BlueCross BlueShield is getting right. These other aspects were not as commonly mentioned in reviews, but are still worth highlighting. Reviewers on Best Company were happy with the cost (17 percent), claims and paperwork (15 percent), value (9 percent), plan options (3 percent), and plan perks, meaning health incentive programs like Blue365®, (1 percent). Cost and value Generally, 4- and 5-star reviewers thought the rates were fair and were happy with the service and coverage they received in exchange. It's challenging to find an affordable health plan that offers the coverage you need. When customers mention reasonable rates and are happy with out-of-pocket costs, that's good news. Steven Davis also recognized the value offered by BlueCross BlueShield, even if the rates were a little higher. Customer Review: Steven Davis from Maineville, Ohio "Retired federal employee this is the best I have ever delt with and have delt with many. You get what you pay for, excemptional customer service and year-end tax info returns. Hospitals and Doctors love this insurance because of the service they provide (just ask, I did), no questions. Have never had a collections issue or billing. Customer oriented company. I will pay more for better service and thatâ€™s what I get." If you can afford to pay a little higher costs, the value and service offered by BlueCross BlueShield is worth it. Claims and paperwork Claims processing and getting the paperwork right are important for you and your doctors. Doctors need to be paid for their work, and you need to understand how your plan covered those costs and what you owe your provider. Plan options and perks If you're looking for an insurer, it's essential that it offers a health plan that meets your coverage and financial needs. You're more likely to find a plan that works for you when your health insurance provider offers a wide selection of options. Many health insurance companies are offering perks and incentives programs to encourage wellness among their members. While these certainly aren't a dealbreaker when choosing an insurance company, these programs are a nice feature and add value. Customer Review: Kristie Pierocich from Long Beach, Mississippi "Weâ€™ve had BCBS federal for many many years and the coverage and incentives are the best around." If you're looking for a health plan with a robust provider network and good value from an insurer that manages its claims and paperwork well and offers clarity, BlueCross BlueShield is an excellent insurance company to work with. Negative experiences Unfortunately, roughly a quarter of customers (26 percent) rating BlueCross BlueShield so highly also mentioned negative aspects and experiences. The most common concerns related to cost, coverage, claims, customer service, and network difficulties. It's important to understand that despite these concerns, these reviewers still gave BlueCross BlueShield high ratings and had good things to say about the company. In other words, even with the occasional difficulty, reviewers were still largely satisfied with their insurance. Cost The most common concern (32 percent) expressed by these customers had to do with cost. Some expressed regret for needing to switch companies because plans became too expensive to keep. Another reviewer felt that it was worth paying higher costs: Customer Review: Richard "Blue Cross has been the best provider I have had for 30+ years. We had switched providers many times, but have always returned Blue Cross. The extra monthly payments have been worth the coverage and services." It's hard to find a good health plan that fits your budget. However, if a BlueCross BlueShield plan does fit into your budget, you can know that you're buying a quality plan. Coverage The second most common concern was coverage (18 percent). Customer Review: Karen Nelson from Alpine, Utah "They occasionally are a hassle for us and don't cover things that we think they should. We have had to write a few letter to them to try to get them to cover different medicines and treatment, but other than that they have been pretty good at taking care of us." Be sure to understand how a plan works and check the Summary of Benefits before enrolling, so you have a better idea what to expect and know what's covered. Claims and customer service Issues with claims and customer service tied for third (16 percent of reviews with negative experiences). No one wants to deal with claims difficulties, but they do happen from time to time. Customers who rated BlueCross BlueShield highly were no exception. Be aware that issues with claims can arise, and be prepared to handle them whether you choose BlueCross BlueShield or another company. Customer service complaints tended to focus on trouble getting ahold of representatives. Provider network Concerns with provider networks were mentioned by 13 percent of reviewers who mentioned negative experiences. If doctors in your area don't accept your plan, it offers limited value, especially if it only covers in-network care. Some reviewers had trouble finding network doctors in their area. Before enrolling in a health plan, check the provider network online to see how big it is and if your current doctor accepts your plan. The most hopeful part of these reviews is that they mention positive responses from the company and the comparative ease of resolving issues and concerns. Methodology Data based on a random sample of 149 out of 241 BlueCross BlueShield's 4- and 5-star reviews from October 2017 to April 2020 on BlueCross BlueShield's profile. Roughly 37 percent of these reviews were from Utah, 11 percent from Arizona, and 22 percent did not have a location. Reviews from other states were between 0 and 5 percent. The confidence level is 95 percent with a 5 percent margin of error. The net promoter score data is based on review data from November 2017 to May 2020. BlueCross BlueShield has many subsidiaries that operate in specific states and regions. Many of these subsidiaries have their own profile on Best Company, like Anthem and Regence. Subsidiary profiles were not part of this analysis. BlueCross BlueShield Frequently Asked Questions How much is BlueCross BlueShield per month? It is difficult to give a good, blanket estimate on health insurance premiums because several factors affect the cost. Premiums for Affordable Care Act (ACA) plans are based on your age, location, and tobacco use. The kind of plan you choose and the number of people enrolled on the plan with you (e.g., spouse, children) also affect your rate. If you want to learn more about BlueCross BlueShield's monthly costs, you'll want to work directly with BlueCross BlueShield to compare coverage, out-of-pocket costs, and monthly premiums on different plans. What does BlueCross BlueSheild cover for dental? BlueCross BlueShield dental insurance coverage varies by dental plan. Some of BlueCross BlueShield's subsidiaries may not offer dental insurance. You'll need to work with the insurer directly to get more information. Learn more by reading BlueCross BlueShield dental insurance reviews. What vaccines are covered by BlueCross BlueShield? You'll need to check specific plans for vaccine coverage information. Many vaccines are considered preventive care, so plans that meet the Affordable Care Act guidelines should cover them. Call a BlueCross BlueShield representative or review your plan's Summary of Benefits and Coverage or the more detailed coverage agreement to understand vaccine coverage specifics. What does BlueCross BlueShield cover? Again, you'll need to check your plan documents or talk to a company representative to learn about what your plan covers. If you're buying an Affordable Care Act (ACA) plan, it will cover the Essential Health Benefits. These include outpatient and emergency care, prescriptions, preventive care, mental health services, and pediatrics. What type of insurance is BlueCross BlueShield? BlueCross BlueShield offers several types of insurance. It offers health insurance (including Medicare Advantage, Medigap, and Prescription Drug Plans), dental insurance, and vision insurance. Availability of specific kinds of insurance, plans, and network structures vary by BlueCross BlueShield subsidiary. How to read a BlueCross BlueShield insurance card? Your insurance card will have information on the kind of plan you have, its network structure, identifying numbers, and helpful phone numbers. The types of phone numbers may vary by plan and region, but possible phone numbers include customer service, pharmacy, and precertification. Your card will have all the information you and your providers need to access information on your health plan including the plan holder's name, member identity number, and its effective date. All the information is clearly labeled, but if you have trouble understanding the information on your card, you can reach out to customer service or check out this guide from BlueCross BlueShield Texas. How do I submit my insurance reimbursement to BlueCross BlueShield? In most cases, your health care provider or pharmacy will submit a claim on your behalf. However, you may need to file a claim yourself. Each BlueCross BlueShield subsidiary may have some variation in their processes. However, you'll have to complete a claims form and submit it within the deadlines. For more information on the process, reach out to customer service or do a quick Google search. How can you manage your Blue Cross coverage online? You can use your BlueCross BlueShield subsidiary's member portal to file a claim, estimate costs, request a member ID card, view Explanations of Benefits for care received, and check your deductible's balance.
Read our customer review report for 2020: "What Health Insurers Are Doing Right: 2020's Customer Reviews" Your health matters. It directly affects your quality of life, ability to work, and longevity. Health insurance is key to many people’s ability to access the health care they need, but accessing health care isn’t always easy even with insurance. Because health is so central to our lives, it isn’t surprising that government policy around health care will be one of many important issues on voters’ minds in November. Whether you’re a health insurance shopper, U.S. voter, or part of the health insurance industry, paying attention to what customers are saying will help you understand the state of the health insurance industry in the United States and identify ways it can be improved. Want to skip to the review data? Jump to the Reviews Analysis Why health insurance matters A recent Freedom Debt Relief study found that affordable health care was the top concern when people ranked current issues in order of importance. Health insurance and health care costs are at the forefront of many Americans’ minds. There is a strong correlation between having health insurance and accessing health care. According to a Kaiser Family Foundation brief on uninsured Americans found that “(43 percent) of uninsured people said they had problems paying household medical bills in the past year and are more likely to have medical debt than people with insurance.” No one should have to make sacrifices in their health to maintain their financial security and avoid debt. But, medical care is expensive, and people are making health sacrifices because of it. Freedom Debt Relief’s study found that only 28 percent of people hadn't skipped doctor or dentist appointment, delayed receiving a procedure, or rationed, found alternatives to, or didn't buy prescriptions. While having health insurance usually increases access to health care, health insurance itself isn’t cheap. The uninsured rate in the United States rose slightly in 2018. Recent changes to health care policy may have had an effect according to a New York Times article. There was less advertising and education due to budget cuts. Subsidies available under the Affordable Care Act were also eliminated. Medicaid enrollment has also been affected by other changes. Moves to request proof of eligibility more frequently and limiting access for those applying for green cards or citizenship likely caused the lower enrollment rates. While the uninsured rate is still low compared to pre-Affordable Care Act levels, limited access to health insurance affects millions of people in the United States. The Kaiser Family Foundation brief found that cost was the main reason adults had for being uninsured. Forty-five percent of uninsured adults reported that cost was a barrier according to the brief. Other barriers to access included no employer-coverage, no Medicaid expansion, and ineligibility for subsidies or lack of knowledge of subsidies. While some of these studies focus on access for U.S. citizens and documented immigrants, undocumented immigrants are not eligible for these programs, so they experience even more barriers when trying to access medical care. Some of these barriers are related to government policy. However, the largest barrier was cost, which begs the question: What are the costs of health insurance that could be lowered to increase access? The Freedom Debt Relief study sheds some light on this question and on what consumers would like to see in their health plans: Lower deductible (54%) Lower monthly payment (44%) Expanded coverage (31%) Coverage for whole family (27%) These consumer insights combined with other studies offer valuable insight into current issues in health care and health insurance. Customer reviews add another dimension to these conversations because they document the challenges people face when dealing with insurance companies. Why customer reviews matter Unfortunately, as valuable as health insurance is, the pasture isn’t necessarily green once you have it. We looked at health insurance customer reviews left on Best Company during 2019 to learn more about the biggest issues people have with health insurance companies. Reviews offer excellent insight into the customer experience because you find stories of how the company treated a customer and the value the customer gives the service rendered. Reviews can help shoppers avoid bad companies and choose good ones. Given that "82 percent of buyers consider user-generated reviews to be extremely valuable," you probably looked at reviews the last time you made a purchase. Reviews can also help companies understand what they’re doing well and how to improve to attract more clients in the future. From an industry-level, reviews also show us the problems within the industry. Identifying the problems is the first step to finding innovative solutions. Health care is a major issue in the United States, and health insurance plays an important role in health care access. Customer reviews are becoming more and more important for consumers and businesses. More customers are reading reviews before making purchases, which helps them understand the quality, value, and what to expect from their purchase. Bad reviews are bad news for businesses, so it’s tempting to pay for good reviews or repress bad ones. Companies sometimes pay for fake reviews. Companies also incentivize customers to leave reviews. While these reviews may not be fake, incentives increase motivation for fake reviews and even the real reviews may not genuinely reflect the customer experience. In some cases, companies may be able to work with a review website to stop publishing bad reviews. Even if it’s tempting to pay for good reviews or to repress bad reviews, businesses can use better methods like responding to them. Because review guidelines are not standardized across the industry and there are unethical practices in use, consumers need to understand a review site’s policies and practices regarding review publication. While this review analysis is limited to Best Company reviews, it contributes valuable information to the broader discussion of health care access and health insurance. Best Company vets each review submission before publication to ensure that the review is genuine, not fake. It also publishes all genuine reviews — good and bad. While analyzing reviews from Best Company yields a more accurate representation of the customer experience, there are a few limitations when analyzing 1-star reviews in aggregate. Best Company has 62 health insurance companies listed. Reviews (including 1-star reviews) are not evenly distributed between the companies. Some companies even have no reviews. Companies also have different splits among 5-star, 4-star, 3-star, 2-star, and 1-star reviews. Companies with a higher proportion of 1-star reviews may skew the broader analysis. However, even though some companies may have fewer 1-star reviews, understanding the difficulties people experience with health insurance regardless of the company is valuable information for anyone trying to make health insurance better and anyone shopping for health insurance. While there are some limitations related to sample size and scope, because Best Company verifies the reviews that come in and publishes all genuine reviews this analysis gives a good picture of how customers experienced the health insurance industry in 2019. Health insurance reviews analysis Overall, the review breakdown of the total 1066 reviews was 28 percent 5-star reviews, 18 percent 4-star reviews, 8 percent 3-star reviews, 5 percent 2-star reviews, and 41 percent 1-star reviews. The combined total of 5-star and 4-star reviews helps paint a more hopeful picture of the industry. However, using these ratios to calculate a weighted score gives health insurance companies a 2.9 user star-rating on Best Company. In other words, there’s room for improvement. 1-star review analysis When we analyzed the 1-star reviews, complaints fell into the following categories: 42 percent of reviewers mentioned poor customer service 32 percent of reviewers mentioned coverage approval difficulty or denial 23 percent of reviewers mentioned claims process and payment difficulty 22 percent mentioned provider network satisfaction 21 percent talked about the cost vs value of the insurance plan 13 percent of reviewers mentioned company errors 7 percent referenced coverage misrepresentation 5 percent said they would have given a lower rating 4 percent sought additional help by filing formal complaints, getting an attorney, etc. Reviewers mentioned as many as four of the above issues. Some mentioned fewer. The average length of a 1-star review was 117 words, while the average word count for a 5-star review was 42 words. When people had bad experiences, they had on average more than twice as much to say and typically mentioned more than one problem. Poor customer service If you’ve ever had an unfruitful or difficult interaction with a customer service representative, it’s no surprise that this complaint tops the list. Reviewers that complained about customer service mentioned poorly trained representatives, getting the runaround, not getting the help they needed for finding a provider or enrolling, and getting conflicting information. While you can find similar customer service complaints in almost any industry, poor customer service in health insurance can affect people’s finances and health in important ways. Coverage approval difficulty or denial Reviewers who had difficulty getting prescribed medicine and treatment approved talked about how the delays with the process and denials affected their health. These reviews were the hardest to read. Unfortunately, these difficulties aren’t surprising. Health insurance adjusters will look for cheaper treatment alternatives and may not always consider the unique circumstances, like allergies or negative side-effects associated with some drugs. Some treatments, procedures, and surgeries are considered experimental, and insurance companies don’t always cover those because they have not yet become a widely accepted treatment. It’s also important for insurance shoppers to realize that health plans have different rules regarding coverage and cost-sharing. You’ll want to carefully evaluate health plans with a trusted insurance agent to be sure that you understand the caveats and what the plan may not cover. Claims process and payment difficulty Some reviewers had difficulty using making premium payments either online, via phone, or with a check. While these payment difficulties are troublesome and can lead to loss of coverage, they are easier to fix and were mentioned less frequently in comparison to difficulties with the claims process. Reviewers who had difficulty with the claims process were frustrated as they had to go back and forth between their provider and the insurance company. In some cases, claims weren’t paid or were denied because of a company error or an error in coding the health service received. Resolving these issues was not easy for most people. No one enjoys dealing with a difficult claims process, especially when they’re recovering from treatment or caring for a recovering family member. An insurance company’s failure to pay claims also resulted in doctors stopping acceptance of the company’s insurance plans. Provider network satisfaction Health plans typically come with specific provider networks. Seeing in-network care providers tends to be cheaper for you and the insurer. Some plans offer coverage for out-of-network care. Although typically more expensive for you, having flexibility when choosing providers is nice. Complaints about the provider network included a doctor’s bedside manner and interactions with patients and the difficulty of finding a network doctor nearby. Some complaints mentioned the insurance company’s failure to update its provider lists, which made it harder for plan members to find network doctors to get the treatment they needed while getting the most value from their plan. Cost vs. value While many factors affect the value of a health plan and a customer’s experience of value, not all reviewers explicitly referenced a disproportionate relationship between the cost of a plan and its value. Cost usually referenced the monthly premiums. Value represents the coverage and cost-sharing customers received. Reviewers felt that the premiums were higher than the coverage and cost-sharing offered. Company errors Company errors fell into several categories: there were coverage errors, inaccurate billing, policy cancelations that took reviewers by surprise, poor record keeping by the company, incorrect network provider lists, and incorrect information given by company representatives. One reviewer even had difficulty with the prescription delivery service. Some of these errors had an effect on the reviewer’s health. Others mostly affected the reviewer’s finances. What’s most concerning about these complaints is that reviewers noted difficulty working with the company to resolve the errors. It took a lot of effort and consistent communication over time to get errors fixed. In some cases, the errors were not fixed. Coverage misrepresentation Coverage misrepresentation usually resulted from working with a third party or receiving bad information from a company representative. Most of this seems like it could have been unintentional, a result of poor training, or even miscommunication. While the reasons for the disparity between expectations and reality may be relatively benign, the effects on customers were serious because they affected their finances and access to health care in unexpected ways. Lower rating Some reviewers noted that they would have given a lower rating than 1-star if they could have. This came up frequently enough to track it. These comments reflect the deep dissatisfaction that consumers feel compared to what was expressed by other reviewers. Sought additional help A few reviewers felt they had been treated so unfairly that they were considering filing a formal complaint with a government agency or meeting with a lawyer. Several already had taken one of those steps. Where we go from here There are two ways to approach these results: from a company level and from a consumer level. We’ll go over action items for both. Health insurers 1. Provide better training for customer service representatives You can do a better job training their representatives. Training should involve professionalism on the phone and providing reliable information to customers. Well-trained representatives go a long way in improving the customer experience when asking questions and resolving issues. 2. Create a smoother prior authorization process You can evaluate your prior authorization processes to help members achieve better health outcomes. Finding ways to be more efficient with this process will make it easier for members and doctors to work with companies while delivering or receiving the care they need. 3. Revisit your claims process You can review the claims process. First, you need to be reliable in making payments to health care providers. When insurance companies are not consistently reliable, doctors stop accepting plans. Second, find ways to make the claims process easier. What are your protocols for when claims issues arise? Are there processes you can change to make processing claims and dealing with disputes easier? 4. Make it easier to resolve issues and fix errors You can make it easier to catch and correct errors in general. Most importantly, you need to evaluate your processes for resolving errors when they happen. If errors are faster and easier to resolve, they will not be as big of an issue for members who deal with them. 5. Offer robust provider networks You can increase the value their plans offer by maintaining robust provider networks. Plans that make it easier to find in-network providers will help keep members with the company. Part of maintaining a good network includes making timely payments to doctors and hospitals when they make a claim. Consumers 1. Be wary of companies with too many 1-star reviews You should avoid companies with high percentages of 1-star reviews, especially if the reviews are recent and come from people in your area. Reading customer reviews from your area will give you a good sense of how a company treats its clients. If your options are limited to a poorly rated company, you’ll be prepared because you’ll know what difficulties to expect. 2. Check provider networks When shopping for insurance, you should ask your provider if they accept any of the plans you’re considering. If you don’t already have providers, you should look at the network of doctors listed by the health insurer and in-network. Call a few to see if they still plan on participating in the plan’s network. This is extra work on your part, but it will help you know how accurate the provider lists are and give you an idea of how easy it would be to find an in-network doctor. 3. Keep your own records You can also keep your own records of conversations with representatives and enrollment. This documentation can help you resolve errors if they arise, even if the resolution process may be difficult. And, if your challenges need to be escalated to legal action or filing a formal complaint, you’ll already have the documentation to support your case ready. Methodology These results are based on a total of 1,066 health insurance reviews left on Best Company in 2019. Of those reviews, 439 had 1-star ratings. A random sample of 202 1-star reviews is the basis for the complaint analysis. Results of the 1-star review analysis have a 95 percent confidence level with a 5 percent margin of error.