Blue Shield of California

Review: As part of my health insurance plan, I have a co-payment maximum. In the year 2014 I exceeded this maximum. I have contacted Blue Shield of CA multiple times regarding a refund, but they are 1)unable to produce documentation of the correct total amount of co-payments that I've paid and 2)seem unable to keep any notes or records of documentations that I send to them proving that I exceeded the co-payment maximum. I have been told multiple times (and I have recorded phone conversations) that it would be investigated, but have received no response.Desired Settlement: I would like to have a refund of the difference between my co-payment maximum stated in my plan and the amount of co-payments I made throughout the year 2014.

Business

Response:

Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on July 20, 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 resolves 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 Inquiry Coordinator

Review: This business shouldn't have to be allowed to do business...I just enrolled in with this healthcare insurance 1.5 months ago...I have been trying to contact them by phone...every day during the last month...to make a payment of my first month...their online payment system is not working...when you try all their numbers...nobody answers ever!!!...I have stayed on the phone waiting for more than 1.5 hrs...just to see if they will answer...and nothing...they ask me to wait in the line...I am desperate..I just need to make my payment...but wanted to bring this to the Revdex.com attention since there are thousands of customers with the same problem, if you go online to review ratings...everybody complains about no communication at all...this is causing me lots of frustration...I just want to pay my first monthly payment...I got these numbers -[redacted]...please try these numbers to see what I am talking about...THIS BUSINESS SHOULDN;T EXIST OR BE ALLOWED TO DO BUSINESS WITH THIS KIND OF CUSTOMER SERVICE.Desired Settlement: I ONLY NEED A GOOD PHONE NUMBER TO CONTACT THEM TO PAY MY BILL...I EXPECT A LITTLE RESPECT TO ME AND THOUSANDS OF OTHER UPSET AND FRUSTRATED CLIENTS TRYING TO CONTACT THEM.SOMEONE HES TO DO SOMETHING ABOUT THIS SITUATION THAT AFFECT ME...I ENROLLED, BUT I CAN;T USE MY INSURANCE BECAUSE I HAVE NOT PAID MY BILL.THANKS[redacted]

Business

Response:

This is in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dated May 7, 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 the member and the Revdex.com will be CC'd.

Review: To Whom Has the power to Help me....I am 33 weeks pregnant, due in April. Since January, 2014 I have been trying to get a hold of ANYONE in customer service at Blue Shield of California to answer a billing question that needs immediate attention. I have called every week since January, sometimes multiple times during the day- 8 am, 10 am , 1 pm, 3, pm only to sit on hold for over an hour or more at a time. I have spent well over 40 hours on hold. Sometime I just can't get through past the recording that tells me they have no one available to take my call and then hangs up on me. I have sent 7 emails to Blue Shield through the online "Contact Us" form regarding this billing issue and still have not gotten any response from anyone.In a nutshell, I am being billed multiple times from the California Public Health Department for a service that according to their records has not been paid by Blue Shield. However, when I go online to check the records on Blue Shield, it shows it has been paid, however according to the Genetics department they have not received payment. I have 8 questions that I need answered immediately from Blue Shield to resolve this issue, but I can't get the information I need and therefore I keep getting billed by the CPHD - the information I need it's not online and since NO ONE picks up the phone at Blue Shield and no one is answering my emails I don't know what to do?Can you please help me?Frantic, Frazzled and Frustrated, [redacted]Desired Settlement: I need someone from Blue Shield to call me immediately (before my baby enters the world in April) to give me the information I need so that I can clear this billing issue up. I don't want to go into collections or get penalized and all I need is to speak to a human being!

Consumer

Response:

Thank you for your help and your follow through.

Please send this along to Blue Shield- it has all the information on it.....

To Whom It Concerns.

I am 33 weeks pregnant, due in

April. Since January, 2014 I have been trying to get a hold of ANYONE in

customer service at Blue Shield of California to answer a billing

question that needs immediate attention. I have called every week since

January, sometimes multiple times during the day- at 8 am, 10 am, 1 pm, 3pm

only to sit on hold for over an hour (or more) or only to be

hung up on afterthis automated

message from Blue Shield tells me that "due to an overwhelming number of calls we are unable to take your call at this time" . I have spent well over 40/50 hours on-hold.

Sometime I can't even get through past the automated recording that

tells me they have no available representatives to take my call and again only to be hung up on. I have sent 7 emails to Blue Shield through the

online "Contact Us" form regarding this one billing issue and still have

not gotten any response from anyone.

In a nutshell, here is billing

issue and I need answers ...

I am being billed multiple times

(now with a PAST DUE notice) from the California Public Health

Department Genetics Disease Screening Program in the amount of $162.00

(Invoice # [redacted] bill dates 10/2/13). According to their records

they have not been paid by Blue Shield. However, when I go online to

check the EOB records on Blue Shield's website, it shows in the Explanation of

Benefits that indeed this bill has been paid, however according to the

California Public Health Department, Genetics Disease Screening Program

they have not received payment.

On 3/7/2014 I spoke with the Genetics Disease

Screening Program department again explaining that Blue

Shield shows that they HAVE paid the bill. But they informed me AGAIN

that they have not received payment. Now it is up to me ( according to them) to investigate on

their behalf with Blue Shield what happened to the payment? But I can't get any answers or get through to

ANYONE to get this resolved.

I have 8 questions for Blue Shield that I

need answered immediately to resolve this issue. I don't know what else to

do since can't get the information I need online, NO ONE picks up the

phone at Blue Shield Customer Service and no one is answering my emails.

Here

are the questions I have and the information that I need to collect from Blue Shield

to give to the Genetics Disease Screening Program so they can

investigate this payment on their end:

If Blue Shield DID pay this bill in the amount of $162.00 from 10/2/13, then...

What was the:

1. check amount

2. payment amount

3. check #

4. date on the check

5. was the check cashed?

6. If so, when was it cashed?

7. company name that sent the check out?

8. what address was the check sent to?

Please Help.

Frantic, Frazzled and Frustrated,

Review: Services not available when requested.

I signed up for Blue Shield through CoveredCA. I paid my premium on 12/30/14. I was then contacted on 1/6/15 and told if I didn't pay my premium, I wouldn't be covered. I paid my premium for a second time and my coverage was confirmed on start 1/1/15. I never received any cards, just a 1 page thank you for joining letter. I went to pick up an rx on 1/19/15 and was told my insurance rejected it because I wasn't covered and I had no cards, so no proof I had insurance. I had to pay $45 for my prescription, instead of the $15 copay.

I then had to call and deal with customer support for over an hour, trying to explain I had no cards and I was rejected. They attempted to give me my customer ID so I could log in and print cards, but that did not work either. Finally they told me it was confirmed I had coverage (again) and they called my pharmacy while I was on hold to let them know I was covered. They said to wait at least 24 hours, so I gave it an extra day and went back 1/21/15. I still had no coverage. I then had to call and be on the phone for an extended period of time only to be told they had confirmed my coverage again. I did not believe them, given they had already told me that twice.

I went back to the pharmacy on 1/22/15 and STILL could not get them to process my prescription as it was being returned for not having insurance. I still did not have cards, so I had no way of proving my member number for them to try. Finally, after over 30 minutes of waiting, my pharmacist was able to get them to process it and I was refunded my $30.

A week later, 1/29/15, I finally received my cards in the mail. I was still unable to log in online to use my member portal to find a doctor, check on my insurance status, or get the details of my plan. It was not until the first week of February that I was able to use the online portal.Desired Settlement: I request that the company refund me my premium paid for the month of January, given that I was not able to get any of the benefits until 22 days later, and even then, it took hours of phone calls and multiple trips to my pharamcy. Additionally, I did not receive cards until 1/29/15, so I couldn't go to a doctor, and was not able to log in online until after the end of the month.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 20, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included o 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 ore resolved within 30 days of the receipt dote. 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 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.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 20, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included o 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 ore resolved within 30 days of the receipt dote. 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 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.

Business

Response:

Thank you for taking the time on February 25, 2015, to let us know about your experience with your enrollment. From the information provided, I understand your concerns to be that you were unable to access care due to not receiving your cards. We appreciate you taking the time to share your experience with us and we regret that it was less than satisfactory. We would like to take this opportunity to advise you that the service expectations of our members are very important to us. Please be assured that all member concerns are tracked through our grievance process as Blue Shield of California uses the information received to continually improve the services we provide.Your satisfaction is our primary concern; therefore, we have notified Covered California regarding your concerns.We do apologize for any inconvenience this may have caused you. Blue Shield does not handle your eligibility. You will need to contact Covered California to request any changes to your account including changing your effective date of coverage. Covered California phone number is 1-800-300-1506.If you have any questions or additional concerns regarding this matter, please contact me directly.Sincerely,[redacted]Grievance Department[redacted]

Business

Response:

Thank you for taking the time on February 25, 2015, to let us know about your experience with your enrollment. From the information provided, I understand your concerns to be that you were unable to access care due to not receiving your cards. We appreciate you taking the time to share your experience with us and we regret that it was less than satisfactory. We would like to take this opportunity to advise you that the service expectations of our members are very important to us. Please be assured that all member concerns are tracked through our grievance process as Blue Shield of California uses the information received to continually improve the services we provide.Your satisfaction is our primary concern; therefore, we have notified Covered California regarding your concerns.We do apologize for any inconvenience this may have caused you. Blue Shield does not handle your eligibility. You will need to contact Covered California to request any changes to your account including changing your effective date of coverage. Covered California phone number is 1-800-300-1506.If you have any questions or additional concerns regarding this matter, please contact me directly.Sincerely,[redacted]Grievance Department[redacted]

Consumer

Response:

I am rejecting this response because:I received my letter from Blue Shield stating they are not responsibility for my eligibility, so I should go talk to Covered California to request changing my effective date of coverage. They clearly have not read the issue as it is not my eligibility date! The issue is that I was eligible AND covered as of 1/1/15, as indicated on both the Blue Shield and Covered California website - see attached - yet t I wasn't provided coverage for my prescriptions until 1/22 and did not receive my cards to be able to receive care from providers until 1/29/15. Once again, the issue IS NOT that I am contesting my eligibility or my coverage effective date. I am contesting the fact that my coverage WAS NOT effective as of 1/1/15, despite being indicated on both websites.

Consumer

Response:

I am rejecting this response because:I received my letter from Blue Shield stating they are not responsibility for my eligibility, so I should go talk to Covered California to request changing my effective date of coverage. They clearly have not read the issue as it is not my eligibility date! The issue is that I was eligible AND covered as of 1/1/15, as indicated on both the Blue Shield and Covered California website - see attached - yet t I wasn't provided coverage for my prescriptions until 1/22 and did not receive my cards to be able to receive care from providers until 1/29/15. Once again, the issue IS NOT that I am contesting my eligibility or my coverage effective date. I am contesting the fact that my coverage WAS NOT effective as of 1/1/15, despite being indicated on both websites.

Consumer

Response:

I am rejecting this response because:Clearly no one at Blue Shield is taking the time to READ and COMPREHEND what is going on here. Look at my last response. I will repeat it again:The issue IS NOT that I am contesting my eligibility or my coverage effective date. I am contesting the fact that my coverage WAS NOT effective as of 1/1/15, despite being indicated on both websites.I received my letter from Blue Shield stating they are not responsibility for my eligibility, so I should go talk to Covered California to request changing my effective date of coverage. They clearly have not read the issue as it is not my eligibility date! The issue is that I was eligible AND covered as of 1/1/15, as indicated on both the Blue Shield and Covered California website - see attached to last response - yet t I wasn't provided coverage for my prescriptions until 1/22 and did not receive my cards to be able to receive care from providers until 1/29/15. Once again, the issue IS NOT that I am contesting my eligibility or my coverage effective date. I am contesting the fact that my coverage WAS NOT effective as of 1/1/15, despite being indicated on both websites. MY COVERAGE WAS SUPPOSED TO START 1/1/15 ACCORDING TO BLUE SHIELD AND COVERED CALIFORNIA. I COULD NOT GET PRESCRIPTIONS UNTIL 1/22. I DID NOT GET MY CARD UNTIL 1/29. I WAS ELIGIBLE ON 1/1/15. I WAS PAID UP TO START 1/1/15. I DID NOT RECEIVE SERVICE UNTIL 1/22. I DID NOT RECEIVE MY CARDS UNTIL 1/29. I SHOULD HAVE BEEN ELIGIBLE FOR SERVICE ON 1/1/15. THIS IS INFORMATION FROM BLUE SHIELD, NOT INFORMATION I HAVE MADE UP. COVERED CALIFORNIA HAS NOTHING TO DO WITH THIS. COVERED CALIFORNIA SHOWS MY COVERAGE STARTED ON 1/1/15. BLUE SHIELD'S WEBSITE SHOWS MY COVERAGE STARTED 1/1/15. I WAS NOT ABLE TO RECEIVE SERVICES UNTIL 1/22. I COULD NOT RECEIVE PROVIDER SERVICES UNTIL 1/29 DUE TO MY CARDS NOT BEING RECEIVED AND NOT BEING ABLE TO REGISTER ONLINE BECAUSE DESPITE BEING ELIGIBLE AND HAVING A COVERAGE START DATE OF 1/1, MY MEMBER NUMBER GIVEN TO ME WAS NOT SHOWING AS VALID.HOPEFULLY IT IS CLEAR NOW THAT MY ISSUE IS NOT WITH MY COVERAGE EFFECTIVE DATE. MY ISSUE IS THAT DID NOT HAVE COVERAGE EFFECTIVE UNTIL LONG AFTER THE DATE THAT WAS STATED.

Consumer

Response:

I am rejecting this response because:Clearly no one at Blue Shield is taking the time to READ and COMPREHEND what is going on here. Look at my last response. I will repeat it again:The issue IS NOT that I am contesting my eligibility or my coverage effective date. I am contesting the fact that my coverage WAS NOT effective as of 1/1/15, despite being indicated on both websites.I received my letter from Blue Shield stating they are not responsibility for my eligibility, so I should go talk to Covered California to request changing my effective date of coverage. They clearly have not read the issue as it is not my eligibility date! The issue is that I was eligible AND covered as of 1/1/15, as indicated on both the Blue Shield and Covered California website - see attached to last response - yet t I wasn't provided coverage for my prescriptions until 1/22 and did not receive my cards to be able to receive care from providers until 1/29/15. Once again, the issue IS NOT that I am contesting my eligibility or my coverage effective date. I am contesting the fact that my coverage WAS NOT effective as of 1/1/15, despite being indicated on both websites. MY COVERAGE WAS SUPPOSED TO START 1/1/15 ACCORDING TO BLUE SHIELD AND COVERED CALIFORNIA. I COULD NOT GET PRESCRIPTIONS UNTIL 1/22. I DID NOT GET MY CARD UNTIL 1/29. I WAS ELIGIBLE ON 1/1/15. I WAS PAID UP TO START 1/1/15. I DID NOT RECEIVE SERVICE UNTIL 1/22. I DID NOT RECEIVE MY CARDS UNTIL 1/29. I SHOULD HAVE BEEN ELIGIBLE FOR SERVICE ON 1/1/15. THIS IS INFORMATION FROM BLUE SHIELD, NOT INFORMATION I HAVE MADE UP. COVERED CALIFORNIA HAS NOTHING TO DO WITH THIS. COVERED CALIFORNIA SHOWS MY COVERAGE STARTED ON 1/1/15. BLUE SHIELD'S WEBSITE SHOWS MY COVERAGE STARTED 1/1/15. I WAS NOT ABLE TO RECEIVE SERVICES UNTIL 1/22. I COULD NOT RECEIVE PROVIDER SERVICES UNTIL 1/29 DUE TO MY CARDS NOT BEING RECEIVED AND NOT BEING ABLE TO REGISTER ONLINE BECAUSE DESPITE BEING ELIGIBLE AND HAVING A COVERAGE START DATE OF 1/1, MY MEMBER NUMBER GIVEN TO ME WAS NOT SHOWING AS VALID.HOPEFULLY IT IS CLEAR NOW THAT MY ISSUE IS NOT WITH MY COVERAGE EFFECTIVE DATE. MY ISSUE IS THAT DID NOT HAVE COVERAGE EFFECTIVE UNTIL LONG AFTER THE DATE THAT WAS STATED.

Review: For 2014 and 2015, Covered CA enrolled me in Silver 73 PPO plan; however, Blue Shield has me enrolled in 2 plans. Silver 87 PPO needs to be voided.

For 2014 and 2015, Covered CA enrolled me in Silver 73 PPO only; however, Blue Shield has me enrolled in two plans: Silver 73 PPO and Silver 87 PPO. I called Covered CA who told me that I was only enrolled in Silver 73 PPO, and that they have sent this information to Blue Shield. I called Blue Shield multiple times to correct and confirm this information. Yet, Blue Shield still has me enrolled in two plans two months later, which is not correct. I should only be enrolled in Silver 73 PPO and not in Silver 87 PPO. Furthermore, Blue Shield has billed me for both plans. Because I was afraid of losing my coverage, I sent in payments for both plans (knowing it was incorrect) until I could get the issue resolved. But despite calling several times, the issue has yet to be resolved on the part of Blue Shield. They sent me an email last week saying that I have a premium due when, in fact, I do not. I should actually have a credit for overpaying. The Blue Shield website only indicates my enrollment in Silver 73 PPO, but I keep getting correspondence in the mail about Silver 73 PPO and Silver 87 PPO. Furthermore, I have asked Blue Shield at least 4 times to be enrolled in auto pay to avoid any payment problems, yet they still do not debit my account for monthly premiums. I have done my part regarding this issue and have made an earnest effort to resolve it. Covered CA has done their part; yet Blue Shield still fails to update their records and correct this problem despite my many attempts to rectify the situation. It is essential that my health insurance remain in tact and not get disrupted for any reason. Clearly, I have been unable to fix this problem on my own and need the support of a higher authority.Desired Settlement: I am seeking the following:

1) Blue Shield to correct their records to indicate that I am enrolled in Silver 73 PPO only and not Silver 87 PPO

2) Credit the $156 I paid towards Silver 87 PPO to my Silver 73 PPO since I only paid the $156 (knowing it was incorrect) to avoid having my coverage disrupted

3) Update their payment schedule to actually reflect the credit due to me, taking out any current payments due for Silver 73 PPO if need be

4) Enroll me in auto pay as requested and start debi

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on March 25, 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 Steve Ms. Mah, 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. Mah, 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 have reviewed the response made by the business in reference to my concern and am wondering if I have to file a grievance directly with Blue Shield or whether that process was started for me on my behalf by Blue Shield. Are there any other steps I need to take, or do I simply wait for Blue Shield to resolve this issue within 30 days, which would be no later than the end of April. Please let me know how I should proceed.Thank you,[redacted]

Review: After CoveredCA required my plan change starting July 1st, Blue Shield neglected to update my account in time, despite my calling Blue Shield prior to July 1 to check the status. Thereafter, CoveredCA had to resend the request to Blue Shield more than 3 additional times . However, by July 31st and a half a dozen phone calls to both CoveredCA and Blue Shield, my account was not only not updated but it had been terminated by Blue Shield for their own error. I had a 3-way call with both businesses that day and Blue Shield assured me that it would finally be adjusted; they even 'escalated' my account to the Resolution Center for expedited service. Unfortunately, that didn't work either. Instead, as I would later find out from a very helpful Resolution team member, my account actually went completely untouched for 5 weeks in the Resolution Center. What's worse is, regular customer service reps were no longer able to help once it had been escalated. By September 20, 3 months, over 15 calls and 4 hours of time spent on the phone with Blue Shield I was hit with a bill of nearly $900. They told me this was because I technically 'could have' gone to the doctor during this time and submitted a claim 'once my account was reinstated' although this assumes I can afford that cost in the meantime. I appealed my case and this is actually the worst part of the issue. From Sept 22 to Oct 22, the 30 day appeal period, the officer assigned never contacted me as they were supposed to. I got her number from the last rep assigned to my case but my voicemails went unanswered. On Oct 23 I received a letter from that officer *instructing me to call her directly* to resolve my case and pay the new balance. Between Oct 23-Nov 13, I left nearly a dozen voicemails and every one went unanswered. My account was canceled on 11/13 and the next business day she miraculously called me with no explanation and requesting payment to reinstate.Desired Settlement: I did everything in my power to resolve the 2nd half of my issue (Appeal period, once the account was corrected) and Blue Shield literally made it impossible for me to pay my balance and have my account in good standing -- and therefore have complete access to my health insurance sooner - because the Appeal officer who could process my payment would not call me back. Therefore, I would like my premium waved for the period that she failed to do so - between 1-2 months.

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 already been through our grievance process regarding these concerns. Her grievance was reviewed and responded via written correspondence. Additionally, our records indicate she has exercised her right to a second level of grievance to be reviewed by our regulating agency the Department of Managed Health Care (DMHC). Therefore, we will not initiate an additional review of this member’s concerns at this time.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted]

Consumer

Response:

I am rejecting this response because: As the letter from Blue Shield indicates, I have indeed gone through the entire second level grievance process with Blue Shield and I have STILL yet to have my issue resolved. I have left additional voicemails and emails with my initial grievance officer and I have also left 2 voicemails with the officer that was in contact with the rep from the Dept of Managed Health care. In all cases, I have requested a call back so that I can know the remaining balance I need to pay to resolve this issue and to pay it, and yet I have still not been able to speak to anyone in order to do this. In my second level grievance, I had requested that the months in which the grievance officer failed to return any of my dozens of calls have the premium for those months paid waived, but they declined my request. Therefore, since I received a written letter from Blue Shield grievances asking me to call them directly (which I did, twice a week for 6 weeks +) I have been without health care since at least October through the end of the year.It's beyond unacceptable that I can't resolve this issue even if I wanted to because they've made it impossible for me to reach a grievance officer with the correct information regarding my case and to resolve it. Instead, I have to accept no health coverage during all these months and then I have to pay the full premium for those same months that they refused to call me back.

Review: I have a dental insurance policy with BS of California. Every month, my account is automatically debited around the first of the month. The first week of May, I called the customer service number on the back of my insurance card and requested that my policy be cancelled. The representative assured me that I would NOT be billed for June. This morning, 5/30/15, I checked my bank account and I was debited again (for June). I have a confirmation number from the representative when I spoke to them early May. The confirmation for my request is [redacted]. To reiterate what I told the representative, I'm cancelling this policy because I have (free) dental insurance through my (new) employer - the State of CA. I want the money that was debited from my account today (for the month of June) to be returned to my account.Desired Settlement: I want the money debited from my account this morning (5/30/15) to be returned to my account. The amount is $21.80.

Business

Response:

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 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[redacted]

Review: Have not reimbursed me for $248 charged to my bank account after planned closed over a year ago.

Jan. 2014 my sons dental insurance plan was no longer a good plan so I cancelled his dental insurance through Blue Shield of California via telephone. I've been charged $19 a month ever since, and now this last month $20. I've called to complain and get a refund and they have not refunded me or called me back regarding the issue as promised and I've now spoke to 4 different people who said they cancelled my plan and it is STILL TO THIS DAY ACTIVE!Desired Settlement: I want to be refunded the $248.00 that they took out of my checking account without my authorization after I cancelled the policy.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 26, 2015, concerning a Blue Shield enrollee’s mother 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 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 the subscriber, 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,

Consumer

Response:

I am rejecting this response because: I spoke with [redacted] after making several attempts to contact her. She did not want to listen to what I had to say. I tried to explain to her that Blue Shield had charged me monthly, for a full year, after the original plan that I had for my son expired. It was no longer a good plan due to the new healthcare reform,with no benefits/coverage. If I were to take my son to the dentist, I would have had to pay for all costs out of my own pocket. I had made several calls to cancel this policy. The first time was in January 2014. I trusted that Blue Shield cancelled my plan, but they did not. I spoke with numerous representatives who ALL stated, that my plan would be cancelled from the conversations I had with them. One woman, [redacted], said she would send the confirmation letter via email and never did. After another phone call, I stayed on the phone with the rep and demanded I recorge a confirmation via email while still connected on the phone with her. [redacted] did not care that I was being charge for a service that I could not use. She dismissed my grievance claim. They made no attemp to help me.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 06. 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 have previously reviewed the concerns raised in the correspondence submitted. A response was 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

Consumer

Response:

I am rejecting this response because: [redacted] is my son who is only 6. The business has not tried to resolve the issue that money was taken out of my bank account without my consent.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 15, 2015, concerning a Blue Shield enrollee named [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield, submitted by [redacted]’s mother Katherine [redacted] on his behalf. Thank you or forwarding these concerns to Blue Shield for review. With respect to Ms. [redacted] concerns, we reviewed our records and determined the member’s complaint has previously been reviewed under our grievance process and o determination has been made. If Ms. [redacted] is dissatisfied with our response and/or determination, she has the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If the appeal meets the criteria as determined by the DMHC, an independent review organization as selected by the DMHC will review the pertinent issue(s) and/or medical documentation. A copy of the IMR Application Form and addressed envelope was enclosed with the determination letter for the member’s convenience. If she chooses to pursue on IMR, she would need to forward her request to the DMHC directly.

Review: Blue Shield of California called my husband at work to collect money. I was advised to file a complaint with Revdex.com regarding this by a Blue Shield representative.We have paid on time every month for 2 years and Blue Shield has threatened to cancel our policy every month for 4 months based on non-payment.I provided them with proof of payment three months in a row. They rejected each submission and requested to see all the activities on my bank statement, not just the payments to Blue Shield or else they would cancel my policy.This seems like abuse of power to me. We pay in full on time every time. This isn't right.Desired Settlement: What ever the consequences are for placing collection calls at one's place of business. I can't imagine what you can do to improve Blue Sheilds customer service but I do consider what I've gone through to be harassment.We pay on time and provide all the information asked for...Blue Sheild of California's left hand doesn't know what the right hand is doing by design for some reason. I was always told that the department that would have received my correspondence was barred from speaking to me.

Consumer

Response:

Blue Shield of California has decided to reinstate our coverage.

Review: my problem with this company is im getting survey calls from them on my home phone and I told them a year ago to stop but now they are start it up again I want it to stop!Desired Settlement: im asking Revdex.com help to have this company stop calling me for surveys with there company im not a member of this company and if they continue to harass me on the phone I might have to file a criminal complaint against blue shields I just want them to stop we had this problem a year ago they stop but now they started it up again and I want it to stop!

Review: On June 26, 2014 I called Blue Shield of California Customer Service in order to remove a family member from my plan. At this point, we had insurance that costs $473.00 monthly and with removing one family member, the plan would have been changed to ~$220 for an individual plan. This was supposed to take effect on the next billing cycle, which was July 1st, 2014. 2-3 months later Blue Shield of California has kept charging me the same amount for $473.00 and keeps creating a disaster in my bank account with overdraft fees. I have called several times, every month and I have spoken to several different customer service representatives. All of them had a different answer and all of them seemed to resolve my problem, but none of them have. 8/29/14 The last person I spoke to was [redacted], who among many others said she would research the issue and give me a call back within an hour. I never received a call back. Two hours later I called Blue Shield of California again, and they said that their system is down. This is the second time already within a month where I have called and their system is down. Several other customer service representatives promised me that they resolved the issue and I will see a refund in my bank within 7-10 business days. That also never occurred, instead they just charged me another month in advance. Meanwhile the company owes me about about $979 dollars (despite all the overdraft fees that happened with my bank) I have been wanting to cancel my plan with them but I am worried I will never see a penny. And every time I am wanting to cancel my plan, their system is down.Desired Settlement: I would like to receive a refund for the last 3 months that Blue Shield of California has been charging the the double of what my individual plan costs (after I called to make these changes) that comes out to about $979 USD further I had every time an overdraft fee from my bank that occurred for $35 each three months. My expenses due to their error has been already $1084

Business

Response:

Company states: Customer service department has contacted the customer and also trying to resolve system issues. There is a $792.33 they are trying to refund.

Consumer

Response:

I am rejecting this response because:

Review: Blue Shield was willfully negligent in responding to claims in a timely manner or at all which resulted in 11 dates of service that were not covered. After repeated attempts of talking with agents and led to believe I was covered, they flat out denied the claims after resubmitting multiple times. Their unresponsiveness has left me with bills totaling $1760. Upon submitting the claims I was told (relatively) quickly more information was needed to process the claim. I called immediately and gave the information (which was actually already provided at the top of each bill). The agent to whom I spoke indicated that it should not have been missed and would be taken care of immediately. There was no mention of out of network issue, no coverage of mental health, no issues whatsoever after submitting the information they needed (twice- once on the initial claim submission and then live on the phone). Then I waited. And waited. No EOB, no communication, nothing. I called on two occasions for an update and no agent could provide me with additional information. I continued care. I proceeded to check my blueshieldca.com account regularly and it still said it was under review. Additionally I emailed a few times with no response. In late June I submitted 8 additional claims for new dates of service. A couple weeks passed and nothing on my account showed up as being received nor rejected. I also never received an EOB. Again I called Blue Shield and got nowhere. They indicated it could take up to 30 days for a claim to show as received and recommended I fax them in. I took the same dates of service and faxed them in. Weeks later still no record. In August all were denied. Why was I not told this in April when the initial three claims of service were submitted? How can you ignore additional claim submissions and leave earlier claim submissions unresolved from April to August? That is completely unacceptable.I expect full repayment of all 11 dates of service.Desired Settlement: I expect full repayment of all 11 dates of service totaling $1760.00

Review: Called Blue Shield dental February 26 to cancel my dental plan and asked for reimbursement. May 5, 2015, the insurance is still active and no refund.

Blue Shield of California

Claims

Re: Claims and Reimbursement for Member ID# [redacted]

Subscriber: [redacted]

February 26, 2015, I called [redacted]1, the number on my Blue Shield dental card to ask them to cancel my insurance coverage starting immediately and asked for a reimbursement for the previous months that I have not used my insurance and not to stop the automatic transaction immediately.

March 1, 2015 there was an automatic transaction on my personal checking account from Blue Shield for $43,50. I called Blue Shield to find out why there was an automatic transaction on my account when I have already called to cancel my insurance plan. I was by the customer representative that my plan still shows active and that the insurance was cancelled with the policy department but billing department was not informed of my request to cancel my plan. I asked why billing was not informed and the customer service representative did not answer and said that she will follow-up and make sure that billing is notified of my request.

April 20, 2015, still no response or refund from Blue Shield. I called the [redacted] and this time I was told to call [redacted], which I did and talked to [redacted]. Same issue, no action from Blue Shield. [redacted] promised me to contact billing and request for a cancellation and get back to me in a day or two with the status of my request. A day or two passed and still no response from [redacted].

May 5. 2015, I got an insufficient funds notice from [redacted] bank, when I logged in to my account, I noticed that there was another automatic transaction of $43.50 from BLUE SHIELD OF C BS OF CA PPD ID and a $34.00 insufficient service fee from [redacted] because the transaction caused my account to be overdrawn.

May 5, 2015 aroud 5:16 pm, I called the [redacted] number on my insurance card and was told by [redacted] (customer service representative) to call the customer service billing department at [redacted]. I called the [redacted] and spoke to [redacted] from the Redding Office, CA about the issue, she then puts me on hold and gets [redacted] who said he was the supervisor on the phone.

I was on the phone with [redacted] for almost 30 minutes while he was investigating the issue. [redacted] said that the policy still shows active and billing was never contacted to process the cancellation. [redacted] puts me on hold to find out where in the cancellation process my request is at, he comes back and tells me the same thing that I have been hearing over and over for the last 3 months, my policy has been cancelled with the policy process department but nobody informed billing to cancel my insurance plan and issue a refund.Desired Settlement: Per my initial request to Blue Shield dated February 26, 2015 to cancel my dental insurance and process a refund, I would like Blue Shield to honor their promise to refund me back the money paid for the insurance that I have not used since December 2015. The amount owed by Blue Shield Dental is outlined below:

December 1, 2015 - $43.50

January 1, 2015 - $43.50

February 1, 2015 - 43.50

March 1, 2015 - $43.50

April 1, 2015 - $43.50

May 1, 2015 - $43.50

Insufficient fee of $34.00 charged

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on May 12, 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:[redacted]

If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.

Review: Blue Shield of California has cancelled us for non payment of premiums three times now when our money is clearly in their bank. They opened more than one account for us. Refuse to apply funds for 2015 premiums and continue to suspend us for lack of premium payment when we pay every month and they misplace the money. We have called 18 times and talked to 7 supervisors and 18 customer service reps who promise to fix the mistake and then never do. They are negligent, unorganized and the company lacks continuity and consistency in their billing and customer service departments. Members are not allowed to talk to their billing department and customer service never knows what billing is doing. The system is lame. Add Covered California to this mess and you get at 1095 Tax Form that is all screwed up because of Blue Shields inconsistencies and negligence. I am going to start a class action this Monday.Desired Settlement: I simply want my premiums applied to my account just like they are supposed to be each month. I want access to the CEO of this company to make him aware of what goes on day to day at Blue Shield. I have been dealing with this since May 2014.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on May 1,2015, 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.

Review: I was issued a refund check by Blue Shield that bounced. I was also charged a bank fee for trying to cash a bounced check. After a tons of e-mails and phone calls to their customer service. Their final conclusion is that the check had been deposited prior to the data I declared I deposited it. I asked them providing me the transition documents proving what they stated. The only scanned document they process does not contain any transition information stated the money deposited into the bank account that belongs to me. There is no any depositing bank information overlapping on top of my endorsement shown on the document either. The only bank account shown on the transition note of payee is Blue Shields checking account number of Bank of America witch is the same as the number printed on the check. Whit these contradictory evidences have been pointed out, blue shield still ignore and refuse to clarify them and just ask me to take to my bank about the transition with a document that showed nothing about my account. Blue shield still refuse to reimburse my refund and the penalty fee from my bank.

Product_Or_Service: Blue Shield Health Insurance

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

Reimburse my refund $120.65 plus $15.00 fee due to the returned check.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 06, 2015 concerning a Blue Shield enrollee by the name of Wanjen **. 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. ** 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. ** 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], CoordinatorGrievance Department [redacted]

Review: Blue shield has the worst customer service. I have tried for over a month now to reach them, have left emailed messages to no avail.I have held several times for up to two hours only to be hung up on once someone live answered the line. They continue to send bills & want their money, yet you can never reach anyone & are given no exlpanation as to why your monthly bill increases for no reason. This is the worst customer service I have even encountered. It is impossible to get through & it is amazing how their lines are always bust considering no one ever gets through.Desired Settlement: I would like an explanation from Blue Shield as to why they have no customer service & do not reply or respond to member messages.

Business

Response:

June 9, 2014 Revdex.com 3075 Beacon Blvd. West Sacramento, CA 95691 Re Case #: [redacted] Dear This letter is in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dated May 9, 2014, May 20, 2014, and May 30, 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 [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 Rachel Leigh Carrington (Mother of the enrollee), 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, LaShonda Hernandez, Regulatory Coordinator Grievance Department ###-###-####

Consumer

Response:

I am rejecting this response because:

This has not answered any of my original complaint. If Blue Shield requires a Grievance Form I have attached one for their review

My complaint is their customer service & in no way was their reply satisfactory nor did it answer the question of why I can never reach anyone by phone or email there to explain my policy

Business

Response:

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 of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield with additional information.

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 Ms. [redacted].

Review: I over paid $4200.00 and blue cross of california has gave me the run around for the last seven months.

In March of 2012, I had a major stroke. After 30 plus days of hospitalization, I came home. With in a short period of time I receive a collection notice from three different medical agencies. I paid out of pocket $4200.00. By me being admitted to the hospital, Blue Cross was suppose to pay 100%. Some where through all this we were in contact with blue cross. Blue Cross told us to fax them copies of everything that I paid. In the past 15 months I have sent them copies 4 times because they have kept telling me that they have never received any copies of what I have paid. August 23, 2013 I received a letter from Mrs. [redacted] M stating. The claims you are asking for reimbursement have been processed by Blue Shields of California. The payments for the claims have been sent to the providers. If you have over paid on the claims please contact the providers and ask them for the reimbursement. When we call the providers they tell me that there is a zero balance. This is not a provider issue, this a insurance issue and I am just getting the run around from Blue Cross of California.Desired Settlement: Reimbursement for out of pocket money given to the providers to keep from going into collections.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of

California Life & Health Insurance Company (Blue Shield Life) dafed December 2,

2013, concerning a Blue Shield Life enrollee by the name of [redacted]. The

information provided by the Befter Business Bureau included a consumer

complaint against Blue Shield Life.

We thank you for forwarding these concerns to Blue Shield Life and would like to

inform you fhat the concerns raised in the correspondence submitted have

been reviewed. We have enclosed a copy of our resolution letter issued to the

enrollee.

Please see attachment.

Review: I have been trying to pay for my 2nd month of health insurance since January 20th. I had not received a bill so I called on the phone. They said the bill is in the mail, and payment due by Feb 1st. I did not receive the bill by the due date. I tried to pay by credit card at their website on Jan 31st but it would not accept my payment and had the wrong information about my address. It showed an address in Connecticut, when I live in San Francisco, and it would not accept a correction. When I called again, they said I can only pay by check. I said How can I pay by check if I do not get a bill? Where do I mail the check? They gave me an address. I sent two checks via certified mail. They have not been processed. I called again on the phone, they took my checking account information and said the check would be paid electronically. They said verify with your bank that it was paid. My bank said it was not processed. I sent email to Blue Shield saying there is a problem getting my checks processed. I got email saying I would be contacted by a representative within 2 days. It has been over 2 weeks and no one has contacted me. When I called again, they said the payment center is not functioning but would be functioning in 48 hours. It is still not functioning. I am very worried that they will say I never paid for my coverage and cancel my policy when I have been trying to pay every day since January 20th. It is now February 15th. Many days when I call, I cannot get through to any human representative on the phone. I have been on hold for 45 minutes at a time and never get through. I do not understand how a major company like Blue Shield can have a non-functioning Internet payment site, refuse credit card payments, fail to send out bills, and fail to process checks.I am paying in full out of pocket $931 a month for coverage and it is allegedly the best plan they have, Platinum "Ultimate PPO" but they have the worst customer service I've ever had.Desired Settlement: I want the payments I have already made processed. I want verification that my coverage is active, and showing no delinquency in my account. I want monthly bills mailed to me.

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 [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.

Review: Multiple medically-necessary health claims have been denied by provider.

I have had several claims submitted that should be paid under our health insurance plan been denied. Claim [redacted] has been in process for over one year. I have spent hours of my life on the phone, been promised multiple callbacks, and sent plenty of emails... with little results. Finally after 14 months, the claim was denied with NO explanation. I refuse to spend more time on the phones, with customer service representatives who aren't able help me.

Just today, claim [redacted] was mailed to me as being denied. They paid nothing, even though this procedure was authorized by Blue Shield via my doctor's office. Not only was this procedure denied coverage, but any payments I make on it is not subject to deductible. I am tired of Blue Shield of California not paying for my medically necessary health procedures. I expect a health insurance company to pay for medical procedures.Desired Settlement: I would like to be refunded the one year of payments I made to Blue Shield of California.

Consumer

Response:

I have been contacted by Blue Shield. They are looking into my complaint. I have been assigned a case manager who has made contact once.

Best regards,

Business

Response:

We thank you for forwarding these concerns to Blue Shield Life and would like to inform you that we forwarded the enrollee's concerns to our appeals and grievance department for further review.

Business

Response:

This letter is in reference to the correspondence submitted Blue Shield Life of California Life & Health Insurance Company (Blue Shield Life) date November 27, 2013, concerning a Blue Shield Life enrollee by the name of Ari Cook. The information provided by the Revdex.com included a consumer complaint against Blue Shield Life.

We thank you for forwarding these concerns to Blue Shield Life and would like to inform you that we have reviewed the concerns raise in the correspondence submitted. We have enclose a copy of our resolution letter issued to the enrollee.

--------------------------------------------------

This is in response to the grievance received by Blue Shield of California Life & Health Insurance Company (Blue Shield Life) on November 15, 2013, regarding services provided on August 6, 2012, by Deborah Van Buren for the total billed amount of $682.00. You are requesting to reprocess and pay for the claim mentioned above according to your benefits.

Your request has been approved. The claim has been sent for processing. You and the provider for the service will receive an Explanation of Benefits shortly.

The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing grievances.

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.

Review: Date of Service: 9/23/2013 [redacted] from [redacted] - charges for out of network physician.Claim #[redacted] (Process date 12/20/2013)Background: I had an my 2nd ultrasound during my 3rd trimester at an in-network provider. That day they happen to have an out of network physician. So I received an additional bill for $95.00. I should not be liable for this. This is something between the provider and the insurance. It is not my responsibility which physicians they schedule on which day and I had no issues during the 1st ultrasound. After a few phone calls, BSCA agreed to reimburse me. First check came for $46.80. After more phone calls, I got another check for $24.10. But the 3rd check never came even after many calls. There is always an excuse - they sent it out and it was returned but after confirming address, there is still no check. The agents tell me they will process and send out a check but nothing arrives. And it doesn't make sense since the 1st check arrived and my address never changed.This is quite overdue and BSCA still owes me a check for $24.10!!!!Desired Settlement: BSCA should fulfill the entitled reimbursement to me -- a 3rd check for 24.10 to reimburse the total of $95.00. I wish I could ask for reimbursement of my wasted time on phone calls.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on November 24, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included o consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review arid would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating o 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 [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.