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Highmark

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30 User Reviews

3.6

Overall Score

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LAST UPDATED: April 6th, 2024

Highmark BlueCross BlueShield was originally called Blue Cross of Western Pennsylvania. Founded in 1977, this company’s original name reflects the limited service area it has in parts of Pennsylvania, Delaware, and West Virginia. Backed by its parent company, BlueCross BlueShield, Highmark serves millions of members.

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The Good

  • Types of Plans Offered
  • Member Resources
  • Customer Service

Types of Plans Offered

There aren't many health plans that Highmark doesn't offer, which is great for shopping for a plan. Highmark offers Medicare and CHIP (Children's Health Insurance Plan). CHIP through Highmark is only available in some parts of Pennsylvannia.

In addition to differing in terms of provider networks, Highmark's health plans vary in terms of benefits for deductibles, copayments, referral requirements, and out-of-pocket costs. While shopping for a health plan here, you'll be asked to give your zip code because the location is an important factor in the types of plans you qualify for. Shopping for a plan is really easy with Highmark though. Highmark doesn't ask for very private information before telling you specific details about plans, and the company outlines the benefits of qualifying plans so that it's easy to compare them.

Member Resources

Becoming a member with Highmark entitles you to lots of tools for managing your account and saving money to get healthy. First, there's a tool you can use to find a provider, be it a doctor, pharmacy, dentist, or vision care provider.

Members can take a doctor match quiz to find a provider with a care style that works well with your needs and personality. You can also use RealAge® on ShareCare to see how old your body is based on its health condition. This tool can help you take action to be healthier. The tool also allows you to track yoru health habits.

Customer Service

Customer service isn't something Highmark treats lightly. In fact, several of the company's overall values are directly related to customer satisfaction and proper business conduct. These include integrity, for one, and the notion that people matter.

Like many other health insurance companies, Highmark wants to be a motivator for members' good health. Customers can contact Highmark through phone or via an online form.

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The Bad

  • Limited Service Area
  • No 24/7 Customer Service
  • Time in Business

Limited Service Area

Highmark health plans are primarily available in western Pennsylvania, as well as some coverage in Delaware and West Virginia. This is really a limited scope and makes the company available to a small portion of the country.

No 24/7 Customer Service

As helpful as the customer service options are with Highmark, none of these features are available 24/7. Their live chat and phone numbers are only available during certain business hours, which leaves members to rely on just their only accounts for help outside of business hours.

Time in Business

On a less crucial note, Highmark is a relatively new company, since it has only been around since 1977. While not new to the health insurance industry, some of its competitors have been in business much longer. Other health insurance carriers boast several decades and even more than a century of business experience, which leaves Highmark to be a smaller, newer name in the industry.

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The Bottom Line

For the right customer, Highmark is definitely a recommended company. But what makes a customer "right"? In this case, you're an excellent candidate for a Highmark health plan if you live in western Pennsylvania (or one of the covered areas in Delaware or West Virginia). The remaining factors that determine whether you'll be satisfied with Highmark are specific to the health plans you qualify for through them. The company has a great selection of plans, good member resources, and a great reputation all around. So as long as the logistics of location fall into place, Highmark is definitely in the running of quality health insurance companies.

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User Reviews

Star Rating

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1.2

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30 Reviews

Review Breakdown

5 grade

3%

4 grade

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3 grade

3%

2 grade

0%

1 grade

93%

Sentiment Criteria

Value

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Quality

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Service

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Hashem Sadeghiyeh

Despite the high cost, the plan often complicates covering even small prescriptions, like a $40 medication. If you pay out-of-pocket and file for reimbursement, the process is exceedingly inefficient and cumbersome, seemingly designed to dissuade people from pursuing reimbursements, considering the extensive time investment needed for multiple mailings and follow-ups. It appears that no action is taken on claims unless you repeatedly contact them to prompt a response.

1 week ago

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Justin Johnson

This is the worst medical insurance I’ve ever had. I will be calling my benefits department to see if I can opt out of this insurance and find my own, because the insurance premiums are high and this company doesn’t want to pay for anything. They take you through so much trouble to pay nothing. It’s like you have no insurance coverage. If my employer keeps this insurance next year, I will definitely waive my option and get my own.

2 months ago

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Chris Wonnacott Pittsburgh, PA

I was doing research for college on insurance companies. When I noticed the terrible reviews for Highmark Health Blue Cross Blue Shield Coverage (Highmark), I had to write a positive review. I live in Pittsburgh. Highmark has insured me for four years. I am insulin diabetic and have an autoimmune disorder, so these health issues make me a frequent user of Highmark insurance. The customer service people answering the phones are amazing and always willing to go the extra mile for my needs (a rare commodity in customer service these days). In the last three months, I have had a heart cath and two out-patient surgeries. As long as I stay within network, I cannot refer to my out-of-pocket expenses as extreme. There has to be some costs involved; nothing is free. How is the organization supposed to pay the people who provide a service to us if we expect everything to be free? I pay a monthly payment, but check your hospital bills and you will actually discover how much more Highmark pays. My out-of-pocket was high for my heart cath, but Highmark offered me a low cost, no interest, monthly payment plan (without me asking). I took it. Today, health insurance is about staying in-network. If you refuse in-network doctors, then the out-of-network costs run exceedingly high. As long as a person stays within Highmark's network, they have reasonable copayments (of course, this depends on your plan). The health care providers in the network, including my cardiac care doctors, my lung doctor, and my primary are amazing. I cannot accept all the bad reviews without giving Highmark Health a great recommendation. As a previous United Healthcare member, I was extremely dissastified with their coverage. I switched to Highmark. I picked a plan (there are multiple plans) with low copayments. I am a fan of Highmark and consistently recommend them to my friends..

3 years ago

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joheyv State College, PA

I was told by my doctor that I "may" have cancerous cells in my uterus and that I need a colposcopy. I called Highmark to get the price, because you KNOW that is going to be expensive, and the agent told me that it's company policy NOT to give out prices for procedures. So I'm not going to schedule something that may cost me hundreds of dollars I don't have and will spend the next year before I'm "allowed" to see my gyn again worrying. Shame on Penn State for forcing us to go with this awful corporation so they can save a few bucks. But, hey, I guess Highmark's shareholders are happy, and that's what counts, right?

4 months ago

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Displeased Darla Colorado Springs, CO

I have had fairly good experiences with my basic insurance PPO plan. However, I have signed up for the FSA, flexible spending account, two years in a row and both times they have attempted to bog me down in paperwork, shut down my account, close my debit card activation (without notification the second time), and block reimbursement submissions from being submitted through their website (literally the same one will not go through but 20 others will on the same day, so they have blocked ONE particular submission) to prevent me from using the money which is use it or lose it by the end of the year. I have accused them twice of intending to steal my money because they get to keep it if they bog me down long enough and have received no response in apology or saying that they aren't doing exactly that. DO NOT USE THEIR FSA OPTION.

5 years ago

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Jon Mesko Oakdale, PA

Just trying to get a Covid shot, won't cover it at certain pharmacies. First they tried to just openly lie and tell me there was a new law that you had to have a prescription, then told me I had to look online for a list of acceptable pharmacies. Surprise surprise, the website doesn't work either. If they spread across the country, we'd have a single payer system in weeks.

6 months ago

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Mark H West Branch, IA

I have to give Highmark the LOWEST of marks for accessibility and access to customer service thru online or telephone member services. I am a new member thru work, and they find it very difficult to mail info needed (the barest possible, likely what they first grabbed whether it fit the need or not) and after calling the member services 5 tries and providing the asked information 7-8 times the automated system simply ignores it and says to call back when I have the required information. There is NO speaking to a customer service representative when their system fails. It seems they don’t care to provide this service to members and this is the way to avoid it. The same runaround online. LOW MARK FOR LOW SERVICE!

9 months ago

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Julie Patton Gulfport, MS

Horrible company. I have had insurance and an FSA through my employer for 17 years. Last year they changed to HIGHMARK BCBS. This year my FSA card gets cut off not once, but twice for charges LAST YEAR that they are questioning. How does that even happen? I have NEVER had another insurance company do this for valid medical expenses. I have had to pay cash for a doctors appointment and meds while my own money is sitting in my FSA. Tried to talk to someone that I barely understood and he was no help. Come to find out, the same thing has happened to other coworkers. I will everything in my power to have my employer switch companies before benefit time rolls around.

10 months ago

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Anastasia Potapova Seattle, WA

I attempted to call them 4 times in a row. The automated system hangs up every time. It asks for ID and SSN, after I provide it, it starts all over and then says "call us back when you have this information". I am holding the card in my hands and provide numbers, but they hang up anyway and do not even attempt to connect with the real person.

7 months ago

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Martin Wakesberg Schenectady, NY

I am a mental health provider in upstate new york and c am required to submit out of state Blue Cross patients through the local Bc plan, which for lu c ky me z is Highmark of NENY. Never a problem prior to their merger. Since 9/1/22 i have not been paid o n any of these claims and have been told there iis a "system error" with n o anticipated date of resolution. This is if c you can speak to anyone as the average wait time is an hour!!!! This is unacceptable and I am filing a formal complaint with the NYS Insurance department. I have been providing therapy to patients for 50 years and have never seen anything like this. It is unbelievable!

1 year ago

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Shan Buffalo, NY

I was with BCBS before they switched over to Highmark. Without warning, my insurance premium went way up per month. I don't know if the notice of the increase was lost in the mail or what? Anyways, I pay the higher end of $300/month for health insurance through them. I don't have any co-pays and regular doctors/specialist that I need are low cost. However, due to a health condition I have, I've been in and out of emergency rooms. A few times taken by ambulance. Just last week, I was sent to the ER twice. Then just yesterday I received a letter saying my coverage was canceled back in June! This is September. Yet, they are still sending me my premium bills. This was the first I learned of my coverage being canceled! Which, this is not a good time. Considering the medical condition I have could potentially cost me my life if I don't keep seeing doctors on a regular basis for it. Oh also, they don't cover much of your emergency bills, unless you are 55 or older, which I'm not. I'm in my early 30s. SO they only coved 10% or less of my emergency room bills. Where is my hard earned money going to?!

1 year ago

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Lisa Dupere Exeter, NH

I had to switch insurance after 11 years with BCBS. I have had nothing but problems since I switched to Highmark. I am a type 1 diabetic and all of my claims have been denied. I called and asked if my doctor was covered under the network and was told he was. After paying out of pocket for my prescriptions and then being told to submit multiple claims for each prescription totaling approximately 2,000 dollars, they informed me he was not in the network. Their website is very confusing and no one can answer your questions when you call. I asked to speak to a supervisor and was told they were busy and would call me back. No one ever bothered to call me back. If you can avoid using this insurance company I would recommend you do so.

1 year ago

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John James

Force switched to Highmark when they took over Bluecross Blueshield of WNY. I’ve literally have never had such a lousy insurance company in my entire life. They are the absolute worst it’s unbearable. If you can do anything in your power to avoid this company, make sure you do so. Not only have they drastically reduced the list of covered medications, but they completely removed the limit on out of pocket expenses. In addition, they’ve removed Quest Diagnostic bloodwork as a covered service, saddling me with a $530 bill for a basic series of bloodwork. This is not to mention their new customer service, if you get lucky and stay on the phone for several hours to speak to a foreign call center agent, is unlikely they will assist you in any meaningful way.

2 years ago Edited April 6, 2022

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Carysa Middleton, WI

I am trying to get treatment for my mental health and I called to see if I need a prior authorization. The lady on the end literally asked if I was the insurance company, I told her no that she was the insurance company and I was the person who pays to have that insurance. She kept asking if the service codes I gave her for TMS were covered by the insurance, I told her that its her job to know that information and that why I was calling. I asked to speak to a manager and she put me on hold for 20 mins and then answered again asking how she could help me. These "customer service" people have no training, I have gotten 3 different answers about whether or not I can do TMS.

2 years ago

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J. Thomas Gough San Jose, CA

Highmark is great until you need them for anything. My work pays big bucks every quarter into the Highmark coffers and, as fortunately healthy adults, we rarely need medical services, but when we have needed them Highmark is right there - with limited hours, complicated contact procedures, extensive denial of service strategies, and heavily touted coupons for luxury items. But in the last couple of months, I have watched my wife trying to grapple with their impossibly complex "prescription drug" program. It is slick, I'll give them that. You can't get a prescription filled in person, of course, everything has to be mailed. So her doctor phones in her prescription and the fun begins. So far this has had to be done five times. Each time the doctor phones it in, my wife calls the "service" to follow up on shipping details, she talks to a different person who has no record of previous conversations but who appears to have a different rulebook and a complete set of new questions. It always ends up with my wife having to call the doctor again to tell them what all the new rules/changes/roadblocks/inconveniences might be so they can try and contact the prescription "service" again and talk to someone who knows nothing about the case but has a new set of rules...blah...blah...blah. I'll give them credit, Highmark makes it extremely easy to make your quarterly payments, but incredibly difficult to access care, so in that way, they are exemplars of the American Healthcare "System".

2 years ago

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David Lavin Dover, PA

I'm no math whiz and insurance tends to spin my head around. My company went with Highmark to save a buck and I went with the HDHP since I was a generally healthy person. Well last year I fell ill and ended up spending quite a bit of money at the doctors. Somehow I never met my plan deductible or out of pocket limit. Even though my total expenditures out of my HSA far exceeded both? So I ended up spending every penny I put into the HSA. Not to mention that the money I put in, even though it was "guaranteed" to be available after one business day would take days to be available in my account. Good luck trying to get a hold of anyone. You'll spend most of your time on hold, and most likely, like me, get frustrated and hang up. To employers, switching to this company may save you a few bucks but it's going to cause your employees stress, and frustration. If that matters to you at all.

4 years ago

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JT Dracut, MA

I have to be rushed by an ambulance. Highmark Blue Cross Blue Shield tells me that I will be paying the full amount of for the Ambulance service. Highmark did not pay their share being my insurance company because they keep insisting that the Ambulance was Out of Network well in fact in my Policy Page 13 under “Summary of Benefit” clearly states that under Ambulance service I will have the greatest amount of benefits that the program can provide. It is always tagged as “Same as network services even if it’s Out of Network and Page 21 under Emergency Care Services it was stated “you’re covered at the higher, network level of benefit for emergency care received in or outside the provider network. This flexibility helps accommodate your needs when you need care immediately”. In my two formal letter appeal to Blue Cross Blue Shield I keep insisting that it is too absurd that during 911 call you will have to ask if the ambulance that is coming is In or Out of network. Another reason that they gave me when I made a call was, it is useless if they will contribute a payment because the Ambulance service is Out of Network. They have no control of the fee that the Ambulance Company will be charging on me but at least they must do their part based on the policy agreement I am aware that I haven’t met my deductible so I will be responsible to pay that service however they would have share a payment first then the rest is my responsibility.

4 years ago

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Maria White Plains, NY

Highmark has promised a download for a benefit booklet since they took over for Blue Cross/Blue Shield last year. It's still pending. I have no idea what's covered. I just got a call from my GP's office warning me that standard bloodwork may not be covered any longer due to the changes that Highmark made last year. This is unacceptable.

9 months ago

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Joe Russo Rensselaer, NY

Terrible service and basically they don’t want to pay for claims. Waiting a year now after multiple calls to no avail. All insurance companies just want to make maximum profits and could care less about providing service and Highmark is no different. Researching making a change now but not very many good options in the US.; Greed, Greed and more Greed by all of them!

1 year ago

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Brad Mary Anne Northrup

I had good service and responsiveness until this year. Would you know why their service has deteriorated this year? I've had coverage show as inactive at the hospital, Drs office and pharmacy. I call Highmark, coverage is active. But the call center is very hard to communicate with. Highmark has gone from 5 star to 1 star service over night. What happened?

1 year ago

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Chuckles Jamestown, NY

Impossible to contact! I have called 4 times 4 different days during business hours. After going though the minutes long covid testing spiel and placed on hold for over 20 minutes each time I gave up. I then tried contacting them 3 times via email after logging into my account online no response. I added there email mail address to my contacts as instructed and checked my junk mail several times each day nothing! I will not renew with Highmark!

1 year ago

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My Email Dallas, TX

Medical decisions regarding treatment and prescriptions made by company accountants and not your healthcare provider. In need of specialized or expensive treatment or prescriptions ? You better pray their balance sheet for the quarter will allow them to authorize spending the $ cash- if they are have a crummy financial quarter- you are 'S' out of luck, as the companies accountants will decline the treatment or prescription.

1 year ago

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Marcy Warning East Aurora, NY

Since Highmark took over BCBS of WNY, I have had nothing but problems!! They are forcing me to submit an appeal letter for anesthesia payment that was incurred during my PREVENTATIVE Colonoscopy! Their customer service is difficult to get through to, difficult to hear, and difficult to understand as this is a service they use a vendor in India for!! Awful insurance and customer service-would not recommend this health insurance to anyone!!

2 years ago

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Unhappy Willard, OH

This is the worst insurance on the planet. My company recently switched to them to save a buck on there end and now all the employees have to suffer. They deny everything. I have been on a CGM DEVICE FOR YEARS and when the company switched to Highmark from Anthem they denied all my claims for my supplies and I was stuck with a bill of over $3900 . Not to mention my A1C went up 4 points without my CGM. HEARTLESS company worst I've ever seen

5 years ago

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Hannah Greensburg, PA

We paid LESS for our medical bills WITHOUT ANY INSURANCE from the hospitals and doctors offices running our bills through their assistance programs for people without insurance than we pay now that they send our bills out to Highmark now! Switching insurances asap! No help at all!

2 years ago

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Robert Adkins Parkersburg, WV

Lousiest member service I have ever experienced. Agents and service reps are not trained properly. Down right lie to you to buy a policy from them and no service after the sale. Seems to me their motto should be “ If we ever talk to you again it will be too soon”. Oh and good luck getting in money back if you over pay them,

3 years ago

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Roger N Gilbert, AZ

Worst service ever. Chat is never available. They don't cover brand name Rx, no matter what the doc says or how much proof that the generic isn't the right choice.

1 year ago

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Atha Beveridge Morgantown, WV

Just found out i have cancer. Highmark is denying my chemo treatments. I pay high premiums for this coverage! They suck!! Who are they to decide my fate?!

5 years ago

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Travis Mckenzie Martinsburg, WV

Doesn't even pay for a quarter of my surgery. Go to hell Highmark...

8 years ago

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nwhitten Lincoln, NE

provider on hold for 5.5 hours for auth.

1 year ago

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