InsuranceComplaintCheck

Highmark Health — Insurance Complaint Report

Highmark Health Complaint Profile Analysis

Key Metrics

  • Total Complaints: 798
  • NAIC Complaint Ratio: 0.95
  • Market Share: 1.2%
  • AI Risk Score: 50/100
  • Most Recent Complaint: 2025-05-20

AI Insurer Analysis

Highmark Health has accumulated 798 insurance complaints on record. Their NAIC complaint ratio of 0.95 is near the industry average, meaning they receive fewer complaints than expected for an insurer of their market size. With approximately 1.2% market share, Highmark Health is a smaller player in the insurance market. The most common complaint categories are: health (20). Highmark Health has a near-industry average complaint ratio with a slight increase in recent months. The majority of complaints are related to network disputes and billing errors. Complaints are distributed across multiple states, indicating a widespread issue rather than a localized problem. The insurer has not faced any regulatory actions in the recent period. Trend analysis shows a slight increase in complaints, particularly in network disputes and billing errors. Areas of concern include: Recent increase in complaint count; High complaint ratio. On the positive side: No regulatory actions taken.

Risk Breakdown

  • regulatoryActions: none
  • complaintRatio: moderate
  • claimDenialRate: moderate
  • responseTime: poor

Red Flags

  • Recent increase in complaint count
  • High complaint ratio

Green Flags

  • No regulatory actions taken

Consumer Tips

When dealing with Highmark Health, keep these practical tips in mind: 1. Check your network coverage to avoid unexpected out-of-network charges. 2. Review your billing statements for accuracy and discrepancies. 3. Be aware of premium increases and ensure they are justified by the insurer. 4. Understand your coverage gaps and ensure you have the necessary protections. Before purchasing a policy, compare Highmark Health's complaint ratio (0.95, near the industry average) with competitors offering similar coverage. Always read the full policy document, paying attention to exclusions and limitations. Document all communications with the insurer in writing. If you experience a dispute, file a complaint with your state Department of Insurance — it is free and often results in faster resolution.

Trend Analysis

Trend analysis shows a slight increase in complaints, particularly in network disputes and billing errors.

Frequently Asked Questions about Highmark Health

Is Highmark Health a good insurance company?

Highmark Health has 798 complaints on record. Their NAIC complaint ratio is 0.95, which is near the industry average. They hold approximately 1.2% market share. A complaint ratio below 1.00 indicates fewer complaints than expected for a company of this size; above 1.00 indicates more.

What are the most common complaints about Highmark Health?

The most common complaint categories for Highmark Health are: health (20). The leading specific issues are: Network dispute (6), Billing error (5), Premium increase (3).

How does Highmark Health compare to competitors?

Highmark Health's NAIC complaint ratio of 0.95 is near the industry average. Companies with ratios below 1.00 receive fewer complaints relative to their size. When comparing insurers, also consider financial strength ratings, coverage options, and premium pricing alongside complaint data.

Should I file a DOI complaint against Highmark Health?

If you have an unresolved dispute with Highmark Health, filing a complaint with your state Department of Insurance (DOI) is a free and effective option. Steps: (1) Gather all documentation including your policy, correspondence, and claim records. (2) Contact your state DOI — most Highmark Health complaints come from Ohio. (3) File online or by mail. (4) The DOI typically responds within 30-45 days.

Are Highmark Health complaints getting better or worse?

Highmark Health has 798 total complaints. In the most recent data, 20 complaints were recorded across 1 coverage categories. Check the NAIC Consumer Information Source for the most current complaint ratio trends.

What insurance companies have the lowest complaint ratios?

Insurance companies with the lowest complaint ratios typically include mutual insurers and member-owned companies. To find alternatives to Highmark Health, compare NAIC complaint ratios for companies offering the same coverage types (health, etc.). Your state DOI website provides complaint data specific to companies licensed in your state.

Has Highmark Health been fined or sanctioned by insurance regulators?

Regulatory action information is available through your state Department of Insurance and the NAIC. Highmark Health has 798 consumer complaints on record with a complaint ratio of 0.95. For specific regulatory actions, check the NAIC Regulatory Actions database and your state DOI enforcement records.

Which states have the most complaints against Highmark Health?

The states with the most complaints against Highmark Health are: Ohio (3), North Dakota (3), California (1), Missouri (1), Alabama (1). This distribution may reflect the company's market presence in those states rather than indicating worse service in specific locations.

What patterns emerge from Highmark Health's complaint data?

Complaints are spread across multiple states, suggesting a systemic issue.

How does Highmark Health handle claims compared to peers?

The majority of complaints are related to network disputes and billing errors, indicating potential issues with network management and billing processes.

What is the complaint trend for Highmark Health?

Trend analysis shows a slight increase in complaints, particularly in network disputes and billing errors.

What should prospective policyholders know about Highmark Health?

No regulatory actions have been taken, which may suggest that the issues are being addressed internally.

Are there systemic issues in Highmark Health's complaint history?

The complaint ratio is near the industry average, but the recent increase is concerning.

Recent Complaints Against Highmark Health

Highmark Health Complaints by State

Highmark Health Complaints by Coverage Type

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This analysis is based on NAIC complaint data and AI interpretation. Not legal, financial, or insurance advice.