North Carolina State Health Plan 3200 Atlantic Avenue, Raleigh, NC 27609

"Just awful.. Just to start off, I have never in my life left a review, but one needed to be shared for this insurance company. Had a coordination of benefits error, understandable, since I am covered by 2 insurances, this one (being my own) and by my fathers. I called in June of 2023, and was told that the other insurance was primary, but when a supervisor from SHP and representative from my fathers insurance joined, things changed. I was apologized to and told that I had been given wrong information, and it was corrected (or so I thought). I was told State Health Plan was my primary and to contact my providers in order for them to refile all claims. August 2023, I am still receiving denied claims from my medical providers (16 to be exact). I call again, and am put on hold while “information is gathered”. Whenever I was back on with a (rude) representative I was talked over and dismissed. They told me they were not primary and it was an issue with the other insurance. Basically told, “not my issue sorry”. September 2023, the issue is still not resolved. SHP insurance will not accept me as primary, and my claims are still being denied, even though I am a subscriber on SHP."

"Another dissatisfied customer. My wife’s doctor prescribed a Nerivio device (a whopping $49 for the device and $89 per month for medication). After spending over 2 hours on the phone with several people in several countries I ended up batting 0 for my efforts. I have paid for it out of pocket for my wife's comfort. We only use the state plan for meds, we have Medicare Advantage for all other needs. It’s too bad you can not leave negative stars. I now understand why this program is rated at 1.4 stars."

"Giving this plan one star is generous. They have kept me waiting for a procedure for a painful condition since the beginning of May for no apparent reason other than they can. They have been provided with the information they need to approve the procedure but have kept me in limbo with their "appeals process." With the first appeal, they have thirty days. When they denied that over a technicality that could have easily been remedied, they put me in a phase 2 appeal, for which they have 45 days to resolve. Both matters could have been handled with a five-minute fax. Instead, they made me wait in pain for over two and a half months so they could conveniently go through their "process." Basically, they just wanted me to go away so that they wouldn't have to pay for a procedure that they are contractually obligated to pay for. The two ladies in charge of my case in the appeals department NEVER return phone calls--from me or my doctor's office. They don't even respond to BCBS customer service representatives who call them and attempt to get answers on my behalf. Basically there is no recourse for State employees when these people yank their chain and put them in limbo. The Department of Insurance won't even help resolve complaints for State Employee Health Plan holders. We're talking about people's health here. There is no room for unprofessional appeals office workers taking two weeks to return a simple phone call (and that's after multiple messages left by me, my doctor's office, and their own company's customer service reps)."

"I have been trying to get a medication approve for 2 days they lied to me 2 times saying they would send $25 coupon to drug store so I want pay $212 both times they didn't call I stayed on hold long wait time.don't like the fact they didn't care about my needs for med's when I clearing explain I'm sick and need med's bad don't think I will keep them sign up time have been with them for years. NO caring did not send coupon.will be calling commission on monday how this was handle.If they don't want to fill medication give it to Duke or somebody else."

"I have been on the phone all morning with customer service. I have had to sit on hold or even have someone call me back because I could not wait for 6 minutes or more. All I needed was to update my provider and I waited on hold for 20 minutes, meanwhile a co worker updated her primary doctor online quicker than customer service could. To be honest, I was still on hold and I managed to update my information in less then 5 minutes. I ended up hanging up. Prior to this call, I called customer service to find out why my co payment increased when I went to see a doctor at the same practice I did for years. Customer service told me it was because that doctors office address is not the same as my primary. Huh? It was a referral from my primary, of course it’s not at the same location. It’s about stupid. I guess I won’t be going to the doctor anymore because I feel I being ripped off. I would rather pay out of pocket."