Blue Shield of California

Review: I had been trying to cancel my coverage for about two weeks in January, 2014, but no one ever answers their phones. They did not even put me on hold, the automated voice would always say their agents were too busy and to call back another time and hang up on me. I tried E-Mailing them, but when that did not result in a response anywhere near quoted amount of time, when I received my bill, I wrote cancel policy on it and sent it back, along with additional written correspondence to cancel my policy. When I finally received an E-Mail response back three weeks later, it confirmed that this was an acceptable way to cancel my policy. Now I have received a piece of mail saying my policy will be cancelled for non-payment on March 17th, 2014 and that I will owe payment for the grace period, unless I call them. Calling them has been futile as it was back in January.Desired Settlement: I would like my policy to be cancelled as of January, the end of my previous billing period, when I originally requested it be cancelled.

Business

Response:

We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has not completed the grievance process with the plan. We are currently reviewing the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to Brandon Edwards, and a copy of the release of information with the correspondence submitted by the Revdex.com.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Policy has finally been cancelled.

Review: My coverage was dropped because of Blue Shields(BS) error. Apparently BS had a lack of communication with Covered Ca. I had paid all my bills. I have been trying 6 months now to try get this resolved. BS said they had no knowledge of cancellation notices being sent out. I have spoken with 5 BS agents over the last 6 months. Each time they say the issue is being resolved. Two weeks prior to cancellation I spoke with "Henry" of BS (Ref#[redacted]) assuring me that main computer showed I was fine on payment, and it was a website error that would be fixed, and that I would NOT be dropped. Sure enough I was dropped. BS says they will reinstate me once they hear from Covered CA. I have spent over 14 hrs on hold over the last 6 months trying to resolve this. They have done more damage to my health (stress) than good.Please Help: I expect my coverage to be activated IMMEDIATELY. It should also be prorated based on the reactivation date. They told me to pay out of pocket for any expense I occur.Desired Settlement: I expect for my July's payment to be prorated based on the when the plan is reinstated. Why should I pay the entire month of July's coverage if I was canceled because of Blues Shields error. I expect Blue Shield to pay for any bills occurred during this lapse. Failing to do so will result in immediate legal action.

Review: I am complaining about Blue Shield of California (Obama Care)in regards to my many requests both in person and in writing for them to correct my billing address and for them to send me a billing statement every month, for my premiums, in the mail. Covered California has even been contacted regarding this. This is a simple task.Desired Settlement: FIX IT AND SEND ME A MONTHLY STATEMENT FOR MY PREMIUMS IN THE MAIL.

Review: Payment issued well before active service date despite services being processed and ready. When speaking to a customer service rep, I was told I would not be charged until close to or on the service active date. During a second call, I was informed I could not benefit from service until their automated date a month and a half later. When filing an appeal, I was told to wait 30 days for a response regardless via standard mail.Customer service was unwilling to investigate or assist.Desired Settlement: Request the business provide me with the services I have paid for on a fixed income, ask customer service representatives to stop lying about when payment is due. Compensation for the misinformation either in the form of waived payment or adjusted payments would also be preferable.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dated April 25, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.

Review: Since changing to Blue Shield, I have made every payment as to the agreed upon rate. Even as the new rate came Jan. 1, 2015. Along the way, the accounting made mistakes until I would call them and have it adjust correctly. Then without my knowledge they increase the bill in September because they said my daughter needed dental insurance since she was under 18. She was almost 20 at that time so I filed a greivance and won.On January 1, 2015 I gave the okay to bill my credit card in the amount of $1368.46. They billed me $1515.46.So of course I called them and they said it would be straightened out. It was not, every month I have to go online and see what they are doing. Last month, the lady I spoke to said to pay my regular payment of $1368.46 and the result was that I did not pay enough. Every month I spend hours talking to a rep on the phone who calls the billing who in turn tells me what billing is doing. They never have worked this out and today I found that I was cancelled.As I type this, I have been on hold for about 15 minutes wiating for a supervisor. Many times I get hung up on after waiting long periods of time like this. Recently I found out I have cancer and time is of the essence. How will I see the doctors needed in time to save my life?Desired Settlement: Let me talk directly with the billing department and someone higher up that has the common sense and ability to straighten this out imediately. Legal action is possible if it is not taken care of imediately.

Business

Response:

Re Case: [redacted] Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 22, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submitted. A response will be sent directly to [redacted]. Our records do not reflect that a signed release of information was submitted with the correspondence signed by the Revdex.com. Unfortunately, without a signed release of information from [redacted], we are unable to provide a copy of the resolution to the Revdex.com. If [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at [redacted] or mail at:P.O. Box 5588El Dorado Hills, CA, 95762 If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below. Sincerely,[redacted], Executive Inquiry Coordinator

Review: Blue Shield did not notify me that 2 of my checks were returned, thereby threatening to cancel my health insurance. There were no warnings by "[redacted]", "[redacted]" or [redacted]. When I called there was laughing in the background. Finally the supervisor [redacted], found out the checks "bouncing" were not my fault but the credit union [redacted] Federal. I finally was able to pay [redacted] over the phone, but after I did that, I was told by [redacted] that I should be proactive, which I already know and the checks returned were not my fault. He also warned, chided me that the doctor's office may not honor my insurance which scared me since I am elderly, and even though I was paid, that did not have to be said. That evening at 5:50, someone on behalf of Blue Shield called to ask me to take part in a survey, which I agreed to. He asked the first question which I started to answer, and he apparently skipped over the part where he neglected to tell me that he was to give me some choices to choose from. When I asked him if I was being given choices, he said, "Well, if you'd stop talking, you would know that." I told him I was hanging up because of this rude obnoxious behavior. No consumer manners for any and all Blue Shield customer service employees.Desired Settlement: I would like a letter of apology, because of the rude behavior.

Business

Response:

This letter is in reference to the correspondence received by Blue shield of California (Blue Shield) on April 14, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.

Review: My complaint is with availability of representatives on the phone. I require the medication Symbicort to manage my asthma. To manage prescription costs, I purchased insurance. Before I had insurance, I could get Symbicort for roughly $250 at a "discounted" rate from CVS. After I purchased the insurance, my prescription cost $267.00. I called to get answers and options. My call was dropped after 30 minutes 2X. I am currently on the phone for 20+ minutes with no sign of being able to reach anybody soon. This is in an unethical and irresponsible way to run a business. I pay in a timely manner, why can't my needs be addressed in a timely manner?Desired Settlement: I would like some sort of action taken about Blue Shield's inability to handle their call volume. I would also like a written apology from them.

Review: I have put in a claim for costs incurred to me for doing hyperbaric oxygen which was needed after breast cancer surgery in October 2015. It has been 6 months since I put in this claim for $1975 from me personally. I need that money back as I have no income. The claim date is from 10/24/2015.I have called many times only to be told that I do not have the correct diagnosis code and that this is pending. I know they have the correct codes because their own employee told me so. I just want to be reimbursed.Desired Settlement: Have my claim processed and paid.

Review: In an attempt to make my April 2016 payment on my Dental Policy # [redacted] today in the amount of $207.40, I was informed by a customer representative [redacted] at Blue Shield that my policy had been terminated on 3/31/2016 due to an underpayment of $8.00 from a prior month. I explained to [redacted] that I usually pay whatever the automated system informed me to pay monthly and never have I underpaid any bill and furthermore I was willing to pay the current month's bill of $207.40 plus then deficit of $8 that was levied on the account to bring the account current since I am still within the 30 day period to pay my current month's bill but I was told that l can not make any payment to maintain my dental insurance coverage.

I further explained to [redacted] at Blue Shield that my monthly payments had fluctuated based on amounts dictated by the automated system, and I am still within the 30 day period of the current month to make good account, yet all my appeals fell on deaf ears. My policy can be paid anytime within the current month without the threat of termination but this obviously is not the case here.

I am therefore appealing to Revdex.com to look into this case as a matter of urgency in order to maintain my dental coverage for myself and my family.

I believe this decision to terminate my policy is because health insurance companies are reluctant to cover individuals on the Obama Care which is what my policy is under, especially In view of larger insurance companies like [redacted] care dropping people under the Obama care program.

My husband had a stroke in 2014 and we desperately need coverage so I urge you to intervene on our behalf for our policy to be reinstated and I am willing to pay bill of $215.40 for the month of April which includes the $8 shortage on this account. I would like to add that I wasn't aware of this $8 deficit until this afternoonDesired Settlement: I would like my dental insurance account to be reinstated. I have also filed an appeal with Blue Shield on 4/26/2016

Review: I had subscribed for Medical Insurance for myself and family through year 2015. The Insurance was through my employer [redacted].

I have two issues with company which has not been resolved in spite of number of call and followups. In my last call on Jan 11 th 2015. I was told someone will call in next 2-3 business days, so far there is no response.

Issue # 1. I had submitted claims for reimbursement for services dated 10/27/2015, 12/01/2015. When I called in January 2015, Representative told me that she does not see those claims in record, so resent it via email sent to representative. Still awaiting response and /or payment for same.

Issue # 2. I had submitted for services on 8/31/2015, 9/02/2015, 9/03/2015 and 9/29/2015. I had paid all charges to the provider. Company sent check for 621.94 to the Provider which they promptly sent back to them explaining that the charges were already paid. The check was dated 10/17/2015 and was returned by provider around 11/4/2015. I am still waiting for the check to be reissued to me. I was told during my last call that representative will look into it , contact relevant people and give call back within next 2-3 days. I am still waiting for the call and check.Desired Settlement: 1. Need the check which was issued to provider and was returned back , to be reissued to me as I had already paid those charges. Amount 621.94.

2. Send me reimbursement checks for my claims for services on 10/27/2015 and second one for 12/01/2015 for amount of 200.00USD each.Total = 400 USD.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 2, 2016, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submitted. A response will be sent directly to [redacted]. Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.com. Unfortunately, without a signed release of information from [redacted], we are unable to provide a copy of the resolution to the Revdex.com. If [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at [redacted] or by mail at: [redacted] If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiry Coordinator

Review: I have filed a change in my plan. I have been paying for one plan, but getting the benefits and fees of the lesser plan.

For several months, I have been dealing with rude, unhelpful customer service representatives. They have claimed they resolved my issue, claiming it will take 7-10 business days for the changes to be seen. It has been months now where results are not apparent, in fact nothing has been done to file this grievance.Desired Settlement: I'm seeking them to correct the mistake. I have spent several hours needlessly on telephone.

Business

Response:

Company states: Plan is correct. Customer is enrolled in the plan called Silver and also Enhanced 150.

Review: Constant customer services issues for years. Grievances filed with no resolve. Service canceled for non-payment after money was taken.

I have had nothing but problems with this group since I started their service in 2014. I have literally spent hours on the phone trying to get these issues rectified. The following issues have occurred:

Service canceled for non-payment. However all funds were submitted and accepted.

Inability to get an agent on the phone who can resolve my problems. I am constantly forced t speak with foreign call center agents who cannot fix the issues Blue Shield has created.

I canceled one section of my service and the company cancelled all of my service. They did not believe me and had to do an investigation only to see I was right and reinstate it. Their phone agent was the one who made the mistakes.

Following this I logged in to my account and noticed I am still be being billed

I constantly cannot access my member benefits. When I call in it takes far too long to get an agent on the phone who can understand my issues, understand what I am saying and they do not have any tools to fix the problems. They just say lets see if we can rectify it, put me on hold and come back with with a solution for a completely different matter.

In my most recent call, which I am currently on hold for, I was instructed to view the letter Blue Shield sent. The agent said this as if the letter explained a solution. However the letter states to problem was fixed. Considering I am on the phone trying to get it fixed this letter is a misrepresentation.

This has been going on since I started service. I am sure my records, if kept properly, can display the matters I am having issue with.

Now, with the insurance laws I am forced to either keep this insurance or not be covered and pay a fine so I am going to bring the issues I am having to light.Desired Settlement: I would like to have access to an english speaking representative who has the authority and access to fix these account issues as they constantly occur.

Business

Response:

March 8, 2016

Review: I was told by my Doctor that I have to receive the Shingle's vaccine due to my age. I was given a prescription, and told to go to any drug store because my doctor's clinic didn't have the vaccine available. I was told by Blue Shield to pay for it at CVS or Walgreens and then file a claim in order to be reimbursed. I did go to Walgreens and I was vaccinated in July, 2015. I submitted my claim to Blue Shield in July accompanied with the original receipt of $234.99, which I paid.It has been a nightmare to get reimbursed, every time I call to ask about my check, I receive the answer "Your check is in the mail and you will receive it in two weeks" or "The check was issued to the provider and we sent you another one."! Now its almost five months and the check still hasn't arrived.Desired Settlement: I would like to receive my the following:Cost of the vaccine...........................................................$234.99Plus 3 hours of my time @ $38.00.............................................. 114.00Plus 5% penalty .............................................................. 11.75 -----------Total reimbursement ...........................................................$360.74

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on December 21, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted]

Review: Gentlemen:On December 28, 2014, I sent a complaint to Blue Shield 65 Plus Member Services, Blue Shield of California with the following content:To Whom It May Concern:In July 2014, I submitted a Patient Agreement of T. Hearing Center for which I had to pay in full by [redacted] card as this Center did not accept partial payment from insurance for a hearing aid. And in September 2014, I received Monthly Report of Medical and Hospital Claims processed in July 2014 (partial enclosed) from Blue Shield 65 Plus Member Services indicated that the service was denied and T.Hearing Center, an Out-of-network provider.Perhaps the Patient Agreement which showed the full payment was not good enough for a claim, I quickly asked T. Hearing Center to provide me an invoice for which they did and right after receiving it, immediately I sent it along with a copy of my insurance card to Blue Shield office. Three months were overlapped now and I did not receive anything in reply. I would also like to keep you informed that I did not come to T. Hearing Center voluntarily but through the official reference of Dr [redacted] whose service was requested by my primary physician, Dr. H. N .and was approved by Affiliated Doctors of Orange County Agency. As I had followed all requisite instructions, I would expect a partial reimbursement but the complete denial made me confused.Your attention to this complaint and additional explanation is greatly appreciated.After mailing the letter I received a reply dated January 17, 2015, from a gentleman, Mr. Sam ** of Medicare Appeals & Grievances Department.He wrote "I will be responsible for researching this issue on behalf of Blue Shield 65 Plus (HMO). Within 60 days of receipt of your request, Blue Shield will issue a written notification for the outcome of your appeal. Should you have additional questions, please feel free to contact me at ###-###-#### or ###-###-####".Then in one another letter dated February 5, 2015, Mr. ** wrote "This letter is to advise you that your concern have been addressed". The claim was initially processed incorrectly and the claim to be reprocessed correctly and payment has been recently issued according to plan benefits. Check number 12564201 in the amount of $1009.76 has been issued to you. Please allow 5 to 7 business days to receive your payment". After waiting not 7 but 15 allowed business days with no check coming, again I wrote to Mr. ** on March 2, 2015:Could you please tell me how many more business days I have to wait in order to receive the check number [redacted] which you said has been issued to me in your letter of February 5, 2015 (copy enclosed).In the letter, you also wrote "Please allow 5 to 7 business days to receive your payment". Now 15 business days had been gone, I did receive neither check nor explanation. It is quite a frustration and distress at the time I have to keep track of blood pressure on a daily basis ordered by my primary doctor (you might well know the stress will increase the blood pressure). Your attention to this matter is appreciated.I wished I could receive at least, some types of explanation, any reason of delay, and whether or not the check had been forfeited but I had waited in vain. No word from Mr. ** ever since.On 3/17/2015, I received from Blue Shield 65 Plus, no check but Monthly Report of Medical and Hospital Claims, two in a row for the month of January 2015. Of these two, one relating to my hearing service in December 2013 made me so surprised when this report stipulated "Amount the provider billed the plan for $2,490.00, Total cost (amount the plan approved) $1000.00, Plan's share $1000.00 and You share $0.00". I do not think T. Hearing Center billed the plan when I had paid the full amount of $2490.00 right at the time the service rendered. And how about Plan's share of $1000.00? With whom the plan shares this amount? And even my share was not recognized? These details made me so confused.All of correspondence andDesired Settlement: Refund

pay the amount that was promised in the correspondence

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 24, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com.If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiries CoordinatorGrievance Department###-###-####

Consumer

Response:

I aFirst, I would like to thankthe Revdex.com for a quick forwarding of Blue Shield correspondence. And the correspondence again makes meconfused. I do not understand when BlueShield of California said that I have not completed the grievance process. If there will be more steps to comply, why Mr.S. G. of Medicare Appeals & Grievances, on behalf of Blue Shield 65 Plus, acknowledged that "theclaim was initially processed incorrectly and the claim to bereprocessed correctly and payment has been recently issued according to planbenefits". I do not think BlueShield would issue the refund check unlessit had all required papers. Moreover, the Section 2.1 concerning Hearingservices of the 2013 Blue Shield 65 Plus handbook wrote "Simply submityour bill to Claim Department". Asmentioned in my December 28, 2014, I had followed all requisiteinstructions. Please review allcorrespondence between me and Mr. S. G. of Medicare Appeals & GrievancesDepartment of Woodland Hills, CA. Ibelieve I had completely fulfilled mypart.Then yesterday, April 27,2015, I received a letter dated 4/20/2015 from Blue Shield of California, P.O.Box 272640, Chico, CA95927-2640. The letter wrote: "A stop payment hasbeen placed on the payment below as of 4/21/2015 and if you receive thispayment after that date, please do not try to cash it. Our records reflect thefollowing information about payment of this claim: Claim Number: [redacted] Amount: $1,000.00 Payment Number: [redacted] Payment Date: January27, 2015 Paid To: To[redacted] Summary Payment: $1,009.76The reason for a stop paymentwas because you have not received this check to date".Although I have not receivethe payment, the letter above is a proofindicating that all required papers had been obtained. It is hard, however, to beconvinced for me that the check had been either lost or misplaced during thedelivery as I never miss correspondence from Blue Shield for nearly 30 yearsboth at work and at retirementm rejecting this response because:

Consumer

Response:

Gentlemen:

Review: Company did not keep promise of sending refund., Blue Shield of California owes me $416.00 refund for health plan paid for in advance but cancelled before any part of it was used. Plan was cancelled end of December, 2013 but the money was already in Blue Shield�¢TMs hands as they received it by ECH from our Bank, Wells Fargo. We were promised at time of cancellation that refunds take 7-10 days. This was during our first call either December 30th . We phoned again January 21st and was essentially told us that it was just approved, in contradiction to the first call, and was told 7-10 days. We phoned again on February 5, 2014 and was again told 7-10 days. It is now February 24th and we cannot even reach them by phone because their lines are too busy. Proof of Cancellation prior to receiving any service based opon their letter of 12/31/2013 received by us on January 6,2014 Reference Data: ID Number: [redacted] Group Number [redacted] Subscriber number [redacted] Individual coverage, PPO with Rx Blue Shield of California P.O. Box d3008 Lodi, CA 95241 Customer Service phone###-###-####

Reference Data:

ID Number: [redacted]

Group Number [redacted]

Subscriber number [redacted]

Individual coverage, PPO with RxDesired Settlement: refund

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 4, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.

Review: Hi, I'm unable to reach Blue Shield of California. I've tried the published phone numbers and provided emails with no success? Once the phone is connected it will than disconnect. My issue is I'm being charged for 2 insurance plans, and only need / want 1 insurance plan.Desired Settlement: I would like to speak with blue shield personally to resolve.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dated February 4, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.

We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submitted. A response to the review will be sent directly to [redacted] and the Revdex.com.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Sincerely,

Consumer

Response:

I am unable to reach Blue Shield of California regarding having 2 insurance policy's and only need 1 policy. Currently I'm paying on the wrong policy.I've tried reaching Blue Shield by mail, phone, and email with no success. In addition, I've complained last Month with the Revdex.com. And the response back from Blue Shield is that they would contact me. I have not received any correspondence, nor phone or email from Blue Shield. I need to speak with someone direct, or correspond via direct person email.

Business

Response:

This letter is in response to a letter submitted by you to the Revdex.com dated January 31, 2014. Based on the information you provided, I understand your concerns to be: you have tried to reach Blue Shield by telephone and emails with no success. Also, you indicate you are being charged for two insurance plans. We understand some members and new enrollees are experiencing difficulties and delays in reaching Blue Shield of California (Blue Shield).

While we anticipated and planned for increased customer service needs due to Healthcare Reform, the numerous last-minute changes to the enrollment, eligibility and payment timeliness guidelines amplified the volume of year-end enrollments, which has impacted all major health plans. We are taking this matter very seriously and have put several measures in place to reduce these delays and ensure that members have access to care. In order to better take care of the high volume of customers contacting us and facilitate online payments, we have taken the following steps:

* Tripled our customer service phone capacity to handle increased call volumes

* Extended customer service hours to 8 am to 8 pm, Monday through Saturday to meet higher demand

* More than doubled our current bandwidth on our website to ensure new enrollees can make online payments and current subscribes can access their member portal

* Doubled voice response system automated self service

We would like to take this opportunity to advise you that the service expectations of our members are very important to us and apologize for any inconvenience this has caused. We thank you in advance for your patience, membership, and understanding. We appreciate you taking the time to share your experience with us. We value our members' feedback and use it to continually improve the services we provide.

We regret that your experience did not meet your service expectations. Your satisfaction is very important to us, and we have notified the appropriate department(s) about your concerns.

Also, please note, our records indicate the only plan you are currently enrolled in with Blue Shield, is the Basic PPO for HSA plan, effective January 1, 2014.

We appreciate you taking the time to share your experience with us. We value our members' feedback and use it to continually improve the services we provide.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Sincerely,

This is a complaint for customer Id [redacted]

I cancelled my membership health and life from blushiel back in September 2013 they still charge my bank account for life insurance since then

this is day light robbery

they did not allow me to cancel my life insurance via phone only health so I faxed them the cancelation notice in September 2013

what the hell is going on with blue shield

"Non profit " my [redacted]

Review: We have been billed for healthcare services since 11/1/14 for my daughter Alice Sperling, yet we have not received proof of coverage so we are unable to use the insurance.Desired Settlement: I would like one month of premiums refunded ($180.89) as we have been paying for a month of coverage we could not use due to lack of proof of coverage.

Business

Response:

This letter is in reference lo the correspondence received by Blue Shield of California (Blue Shield) on December 15, 2014, concerning a Blue Shield enrollee by the name of Mr. [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Mr. [redacted] has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances ore resolved within 30 days of the receipt date. A response to the review will be sent directly to Mr. [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com, If you have additional questions regarding this matter. please contact me directly at the telephone number listed below.

Review: Failure to activate Dental Benefits even though premiums were paid in full.

Failure to assign an existing, participating Dentist.

We have been paying for Dental Benefits from Blue Shield of California since last June 2014. During this time we have been unable to use any Dental Benefits because we were not assigned a participating Dentist. We did find a Dentist using the Blue Shield Website and were sent subscriber cards for that Dentist but that Dentist chose not to accept the Dental HMO plan. We were unwilling to bear the added cost of a PPO plan so Blue Shield assigned us to another Dentist we did not choose. After several failed attempts to contact this Dentist to make an appointment I discovered that the Dentist we were assigned is not a participating Dentist in the Blue Shield Dental Benefits.

When I attempted to login to the Blue Shield Website to find a participating Dentist I was unable to login so I called their technical assistance helpline. I was assigned a new username and password but was told it would be at least a day and possibly a week before their technical issues would be resolved.

I was also told that a request would need to be made to activate our account because for some unknown reason the account had never been officially activated, even though all premiums to date were completely paid up. (The account is on auto-pay.)

In lieu of of having the account activated I requested a reimbursement of everything paid while the account was not active. The total amount paid to date is $201.60.

This is request is now in the Blue Shield appeal system. The reference # for the appeal is [redacted]. I was told it could take up to 30 days before I was given a response. Meanwhile I am still paying for Dental Benefits on an inactive account.

I would like the Revdex.com's assistance in resolving this matter as quickly as possible so that I can make an urgent Dentist appointment.

If Blue Shield is willing to refund the premiums paid for the inactive account I would like to cancel the current account and start fresh. If Blue Shield is unwilling to that I do not want to lose anymore time either canceling the account or locating a participating Dentist.Desired Settlement: A refund of all premiums paid to an account that Blue Shield of California has never activated for us and has never assigned us an active participating Dentist.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on December 03, 2014. Concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Ms. [redacted] has submitted a grievance on November 17, 2014. Please be advised that grievances are resolved within 30 calendar days from the date of receipt. A response to the review will be sent directly to Ms. [redacted] and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information attached with the correspondence submitted.If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiry Coordinator###-###-####

Business

Response:

Dear Mrs. [redacted]:This is in response to the grievance received by Blue Shield of California (Blue Shield) on November 17, 2014, regarding Enhanced Dental HMO $0 plan. You have requested Blue Shield to cancel your dental plan to your original effective date and refund of your premium payments.Your request has been approved. Blue Shield has terminated your dental plan effective June 01, 2014. We have also issued you a refund check in the amount of $201.60.It is important to understand that this decision has been made on an exception basis and, in making this decision; Blue Shield does not waive any of its rights to enforce the provisions of your health plan on this or any other matter.The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievances.If you have any questions regarding this letter, please contact me directly.Sincerely,[redacted], CoordinatorGrievance Department(916) 350-9960Enclosures:Information regarding the DMHCInformation regarding ERISAInformation regarding Language Assistance Service

Consumer

Response:

I am rejecting this response because:

Review: Every month, I send a policy payment to check to BlueShield. Every month, they cash the check and withdraw the funds from my account. Then they send me a notice that says in effect "you haven't paid us yet" and so the amount outstanding grows each month.I have faxed them copies of the cancelled checks. Hearing no response, I sent them physical copies via certified mail. Still nothing, I then sent scans of all the payments to the special email response line. Nothing. Now I am told that they are going to cancel me for non-payment and I they won't cover medical expenses incurred. Having spoken with them on four separate occasions, I have no idea how to solve this problemDesired Settlement: I would like Blue Shield to credit my payments to my account to show that it is fully paid and therefore they will cover me as directed by the policy.

Business

Response:

June 21, 2014 Revdex.com 3075 Beacon Blvd. West Sacramento, CA 95691 Re Case #: [redacted] Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 16, 2014, concerning a Blue Shield enrollee by the name [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Ms. [redacted] has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to Ms. [redacted]. Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.com. Unfortunately, without a signed release of information from Ms. [redacted], we are unable to provide a copy of the resolution to the Revdex.com. If Ms. [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at ###-###-#### or by mail at: [redacted] If you have additional questions regarding this matter, please contact me directly at the telephone number listed below. Sincerely, [redacted], Executive Inquiry Coordinator ###-###-####

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is almost, but not quite correct. I did indeed check the box that they could release my information although as this is billing inquiry unrelated to any particular medical treatment - at the time of the complaint I hadn't used the policy at all for any reason - there should be no reason for them to release medical information. The complaint is that they bill me for the policy, deposit the check and then claim they never received the payment, despite the fact that I have sent them copies of the canceled checks three times now.

As for filing a grievance with Blue Shield, I have faxed, spoken to rep and sent information via overnight letter in an attempt to bring this to their attention. In none of my now 5 calls with them, did anyone direct me to a specific grievance form.