Blue Shield of California

Review: I'm requesting that Covered California cancel my application for my daughter [redacted] and my write [redacted]. Due to the fact, that I never receive nany ID cards or any proof of coverage for them. I called Covered California Blue Shield of California to cancel the coverage but I was told that only Covered California can give them permission to do so. On April 11, 21014 reference # 14040102511 I talked to Paul regarding this issue and he said that he was going to get in touch with Blue Shield of California to solve this problem, but nothing was solved. I made four payments since February 2014 for the amount of $184.03 totaling $736.12 for coverage that my wife or daughter never received. Covered California BLue Shield of California continues sending me billing statements totalling $728.28 for June, July, August and September. I will not be responsible to pay this premium because my daughter and my wife never received any ID cards showing proof of coverage. I'm also demanding that Covered California Blue Shield of California to reiumbursed me the amount of $736.12. I have tried several times to solve this problem over the phone, but not one is able to help me.Desired Settlement: I'm requesting that Covered California cancel my application for my daughter [redacted] and my wife [redacted], and to request Covered California Blue Shield of California to refund me the amount of $736.12

Business

Response:

Company states: Per covered Covered California. Customer must have coverage through March 1st to May 23rd. March, April and May are due a partial refund of May which is $82.72. The other plan made a binder plan, after that break they did make initial payment of $184.03 and so those two amounts total $266.75. We can get those funds processed and refunded but as per Covered California if they wanted the full amount returned they would have to cancel with Covered California. Covered California will then notify us that they did not need to have that coverage and we would reimburse them that full amount.

Consumer

Response:

Customer states: We accept the refund amount.

Review: Blue Shield of California enrolled me in an ACA-compliant health plan without my consent. I purchased a heath plan from another provider through Covered California, and do not need the Blue Shield policy. I have been trying to cancel my policy since January 2014. The Blue Shield phone system is unresponsive. Most of the time it simply hangs up on me. Once or twice I have been put on hold indefinitely. This is after dozens of calls. I have sent 4 email messages via the Blue Shield webpage, and have sent two letters via the mail, one to a Chico, CA address, and another to an El Dorado Hills CA address. I have received no response to any of my communications. Blue Shield continues to send me bills, and today has threatened to send my case to collection. Blue Shield claims that I owe them over $1200, yet I never agreed or consented to the purchase of the policy, and have been completely unable to cancel it.Desired Settlement: I would like my policy canceled immedately and for Blue Shield to cease its attempts to bill me for services that I never purchased.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dat** March 19, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provid** by the Revdex.com included a consumer complaint against Blue shield.

Review: I have contacted Blue Shield 6 times in 2015 to correct billing errors on their part. I also received cancelation letters due to their incompetence

in 2014 blue shield accepted all of my monthly payments via BofA bill pay. In 2015 they started rejecting them and I received a cancelation notice. When I called blue shield they stated it was their back end issue and the only way to resolve it was for them to have my back account information to withdraw money on a monthly basis. I believe this to be a ploy on their part.

Then I received notice that they were going to start the with monthly withdraw at TWICE my contracted premium! I had to call multiple times to correct this. I am concerned about their access to my bank account and their ability to withdraw bogus amounts.

by the 6th call I have spent over 3 hours trying to solve their problems. I feel like my time should be compensated. I further wish that I could change providers but I am told I cant at this point or I will not be insured. I believe blue shield feels they can entrap customers and they have no boundaries on their ethics.Desired Settlement: Above all else I want the service I pay for. If I performed my job at their standards I would be fired. Unfortunately I can not fire them. I also believe I should receive compensation for my time and aggravation

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 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 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 mater, please contact me directly at the telephone number listed below. Sincerely,[redacted], Executive Inquiries CoordinatorGrievance Department###-###-####

Business

Response:

Dear Mr. [redacted]:This is in response to the grievance received by Blue Shield of California (Blue Shield) from the Revdex.com on April 21, 2015, regarding billing and compensation. You are requesting that you are able to use the service that you pay for and Blue Shield compensate you for your time spent fixing the billing problems.Your request has been approved. Our records indicate that your health plan is active and you currently have access to health care. We have placed a onetime credit on your account for your April 2015 premium in the amount of $299.92. Please allow three to five business days for the credit to reflect on your account.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 otherclaim.The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievances.If you have questions regarding this letter, please contact me directly. If you have questions regarding your health plan benefits, please contact your Customer Service Department at ###-###-####.Sincerely,[redacted]., CoordinatorGrievance Department###-###-####

Review: In March of 2014, Blue Shield was contacted to inquire about insurance coverage for physical therapy. Blue Shield did not provide any documentation(letter, card, etc.) to confirm membership status yet according to Medicare they were being paid. So, when I decided to go to Capitol Physical Therapy for their services, I thought Medicare would cover the charges, which was not the case. Capitol Physical Therapy did not get paid for the therapy sessions and decided to discontinue their services to me. Medicare was not willing to cover these charges as they believe Blue Shield is the insurance carrier responsible to cover these charges. I feel like I have been taken advantage of by Blue Shield as they have been been getting paid without my knowledge.Desired Settlement: I would like Blue Shield to resolve this billing issue as soon as possible so I may continue receiving services from Capitol Physical Therapy. I would also like an explanation on why there was never any written verification on my membership status.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 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 [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 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: I've been buying a health medical plan for my son (currently 14-year-old) from Blue Shield for at least the last 5 years. With the recent reform in health care, Blue Shield discontinued my health plan and offered me another one which I agreed to. However, along with the medical plan, BS obligated me to purchase a dental plan from them for an additional $19.95/month. I have a separate dental plan with Guardian DentalGuard (Dental Member ID [redacted]) for my son and I'm very happy with it. The plan that BS offers (Pediatric DPPO id#[redacted]) barely covers any services. When I disputed the charges with BS, they refused to help me relying on the new law that obligates them to make sure that every individual has a dental coverage. No reasonable offers (existing dental plan proof) could change BS' position on my request. May, 2014 was the second months when I had to pay for the dental plan that I do not use in addition to the Guardian Dental plan that I am very happy with and also pay for on monthly basis. I think I should be the person who decides which plan benefits my child the most. I cannot afford to continue paying for both plans.Insurance Information:Blue Shield of CA (MEDICAL POLICY)Subscriber: [redacted] (minor)ID# [redacted] ENHANCED PPOBlue Shield of CA (DENTAL POLICY)Subscriber: [redacted] (minor)ID#[redacted]Desired Settlement: I would like Blue Shield of CA to allow me to buy medical plan from them only and be able to continue to purchase dental coverage for my son from Guardian Dental Guard. I also would like them to refund the dental policy premium to me for every month I paid for it until this issue is resolved.

Business

Response:

This is in response to the grievance Blue Shield of California (Blue Shield) received on March 24, 2014, regarding your pediatric dental benefits. You are requesting to remove your child's embedded pediatric dental and vision coverage.

Your request has been denied for the following reasons:

The federal Patient Protection and Affordable Care Act (ACA) now

requires that all health plans offered in the individual and small-group

markets must provide a comprehensive package of items and services,

known as essential health benefits. These items and service categories

include ambulatory patient services, emergency services, hospitalization,

maternity and newborn care, mental health and substance abuse

disorder services, behavioral health treatment, prescription drugs,

rehabilitative and habilitation services and devices, laboratory services,

preventive and wellness services, chronic disease management, and

pediatric services including dental and vision care. These are the

minimum categories of health insurance coverage that every qualified

health plan must have starting January 1, 2014.

* While we understand not all essential benefits will apply to every member,

as mandated by the ACA we are unable to offer Health Plans that do not

include all of the essential benefits. Therefore, we are unable to comply

with your request as the pediatric dental and vision benefits cannot be

removed.

* Please note the most up-to-date information on the ACA is available at

blueshieldca.com/healthreform. Information is also available from the U.S.

Department of Health and Human Services at www.healthcare.gov.

Your request was reviewed by a grievance coordinator who is knowledgeable about your plan's benefits and coverage. We have enclosed copies of the appropriate pages of the Evidence of Coverage (EOC) for your health plan.and underlined the language that supports our decision.

You have the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If your 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. We have enclosed an IMR Application Form and addressed envelope for your

convenience. If you choose to pursue an IMR, please forward your request to the DMHC directly.

You are entitled to, upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim for benefits.

If you would like more information about the diagnosis and treatment codes and their meanings, used in making this decision, please contact your provider.

If you have questions about this letter, please contact me directly.

Consumer

Response:

I am rejecting this response because:

This is a complete violation of my right to make my personal choice of which medical (in this case dental) coverage I would like to participate in for my child's benefit. As already said before, I'm not refusing to have a dental coverage for my child. I already have one through a provider that I believe I can benefit the most. I refuse to accept the fact that I have to pay $20.00/month for a policy that doesn't provide an adequate dental service coverage for my son. I already pay $50.82/month to Guardian for a dental coverage that I'm very happy with (I offered to provide a proof for this policy). I feel that I being robbed on the monthly basis. Why the Insurance company (Blue Shield of California) assumes that they know better what is best for my child? I would like receive a further recommendation on where to complain and get this issue solved. Every law, even the law as ridicules as ACA, must have room for exemptions and negotiations if the reason is valid which in my case it.

Thank you,

###-###-####

Business

Response:

Attached to this response are the documents corresponding with the rejection received by the member of Blue Shield of California. Thank you.

Business

Response:

Parent(s) of [redacted] Subscriber Name: [redacted] Patient Name: [redacted] Dear Parent(s) of [redacted]: This is in response to the grievance Blue Shield of California (Blue Shield) received on March 24, 2014, regarding your pediatric dental benefits. You are requesting to remove your child’s embedded pediatric dental and vision coverage. Your request has been denied for the following reasons: • The federal Patient Protection and Affordable Care Act (ACA) now requires that all health plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits. These items and service categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitation services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services including dental and vision care. These are the minimum categories of health insurance coverage that every qualified health plan must have starting January 1, 2014. • While we understand not all essential benefits will apply to every member, as mandated by the ACA, we are unable to offer Health Plans that do not include all of the essential benefits. Therefore, we are unable to comply with your request as the pediatric dental and vision benefits cannot be removed. • Please note the most up-to-date information on the ACA is available at blueshieldca.com/healthreform. Information is also available from the U.S. Department of Health and Human Services at www.healthcare.gov. . Your request was reviewed by a grievance coordinator who is knowledgeable about your plan’s benefits and coverage. You have the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If your 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. We have enclosed an IMR Application Form and addressed envelope for your convenience. If you choose to pursue an IMR, please forward your request to the DMHC directly. You are entitled to, upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim for benefits. If you would like more information about the diagnosis and treatment codes and their meanings, used in making this decision, please contact your provider. If you have questions about this letter, please contact me directly. Sincerely, [redacted]., Coordinator Grievance Department ###-###-#### Enclosures: Information about the DMHC Information about ERISA Information about Language Assistance Services The Department of Managed Health Care Notification The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at ###-###-#### and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number ([redacted]) and a TDD line (###-###-####) for the hearing and speech impaired. The department’s Internet Web sitehttp://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online. Employee Retirement Income Security Act (ERISA) Notification If your employer’s health plan is governed by the Employee Retirement Income Security Act (“ERISA”), you may have the right to bring a civil action under Section 502(a) of ERISA if all required reviews of your claim have been completed and your claim has not been approved. Additionally, you and your plan may have other voluntary alternative dispute resolution options, such as mediation.

Review: Yes I tried cancelling my Blue Shield of California Dental plan for two months without avail I would call numerous times and wait over 30 minutes

Yes I tried cancelling my Blue Shield of California Dental plan for two months without avail I would call numerous times and wait over 30 minutes without any assistance. I finally wrote them a letter with cancellation and they still charged me but now its cancelled but I still have yet to see a refund post to my account. My Dental Plan ID#[redacted]Desired Settlement: I am seeking a refund for the past two months since they were unsuccessful in assisting me all they would do is transfer me and then no one would pick up for over 30 minutes over 30 minutes no excuses for such a long wait absolutely none. I am seeking a refund in total for $41.60. Back to my credit card.

Review: My girlfriend and I tried to take advantage of Blue Shield's CDI-mandated extension of our current healthcare plan to March 31, 2014. We went online in November to complete the signup, but apparently there was a problem with the form, internet- who knows- and that process didn't complete. Assuming it worked, come January 1, 2014 we were instead moved automatically to a more expensive plan. We both filed appeals with Blue Shield to extend our current plan to March 31, as Blue Shield had already offered to do. As Blue Shield has agreed, both our appeals were IDENTICAL (same health plan, same circumstances, submitted days apart). My girlfriend's appeal was approved. Mine was denied. I have spoken with 3 levels of people at Blue Shield all who admit that the appeals, circumstances, and health plans were identical. Yet, they are clearly not treating me equally under the law, or within their decision parameters. They also have the audacity to say they they "did nothing wrong". The contact person I spoke with was [redacted], ###-###-#### at Blue Shield. The only reason that two identical petitions could be given opposite rulings is unfair treatment, or worse, discrimination -since the only difference is one petitioner was a male, and one a female. It is also remarkable that they can't endorse the extension of the current plan, which they already offered to do- I'm not asking for anything extra, costly, or beyond what was already promised. It is completely unreasonable.Desired Settlement: I simply asking for the same treatment as my girl friend ([redacted], Blue SHield subscriber #[redacted]) My subscriber # is [redacted]. My current plan extended to March 31, 2014- as Blue Shield has already offered to do. If not extension can not be granted, then I request a refund in the difference between the two plans over those three months, which is roughly $450. My phone number is ###-###-####. Thank you for your help.Best, [redacted]

Review: I am an active health insurance member of Blue Shield of California, my wife as spouse is also covered under my plan.

In November 2015 we had made a choice to switch from the Platinum PPO plan with a monthly fee of $1267.98 a month to a Silver Seven PPO plan with a cost of $956.37.

In November 2015 the Blue Shield of California received our application for a switch of plan from Platinum PPO to Silver Seven PPO.

I contacted customer service at the Blue Shield various times before the start of the year and ensured that they have NEW billing information. I switched my automatic payments to be withdrawn from a business credit card.

I called various times (about three times to verify the application standing) and to ensure that Blue Shield will not charge my [redacted] Business checking account but instead the automatic payments will be drawn from my [redacted] business credit card. The customer service representatives assured me that no charges will be made towards my checking, and confirmed on the phone to me that they have the correct card information.

January 2 2016 I contacted Blue Shield and asked why I still have not been charged to my business card for my new Silver Seven plan, and they informed me that they will be processing payments on the January 4th 2016. I again asked them to make sure and NOT charge my business checking but instead charge business credit.

On January 4th 2016 Blue Shield withdrew a payment of $956.37 from my business credit as agreed for my Silver Seven PPO plan, AND additional $1600 dollars from my business checking account!!!

I contacted customer service that this had lead my checking account into a problem because that was money I had been saving for bills/groceries.

Blue Shield of California is refusing to refund the amount of $1600 of unauthorized charges to my business checking account. I called various times and got told that "we will deposit this money in half an hour". Blue Shield is refusing to refund in a timely matter.Desired Settlement: I would like the $1600 dollars to be refunded back to my [redacted] bank account that had been made by an unauthorized charge.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 1, 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: To whom it may concern: On July 9th, I terminated my policy with Blue Shield as of July 31, 2015 via letter. I followed up with a confirming phone call to your customer service on July 21st and spoke [redacted] (your phone conversation no. [redacted]). At that time, I directed [redacted] to discontinue automatic withdrawal from my account as of July 31st. He assured me the deduction would be stopped and the policy would be "extinct" on 8/1/2015. Imagine my surprise and alarm when I received my bank statement and found that you has automatically deducted $11, 0163. from my account on August 3rd. This amount is approximately 17 times the $651 you were authorized to deduct from the previous months premium. Why? I find it unconscionable that you took this large sum of money from my account without notifying me in any way.On September 16th I called and spoke to Blue Shield customer service; [redacted] (your phone conversation no. [redacted]). She said that she could not see the debit from my account but would have to look into it further. She promised to call back that , but did not.The next day, September 17th I called again and spoke with [redacted] (your phone no [redacted]). He assured me the debit was a mistake and I would receive the $11,016. back within 5 business days. He apologized for the mistake.Now it is 2 weeks later (10 working days) and still no money or communication from Blue Shield. Yesterday, October 5th, I called again. This time I spoke to [redacted] (your phone conversation no [redacted]). He said the refund had been requested, but no refund has been sent as yet. Also, that your "resolution team" would respond to this issue in an expedited' and highest' manner within 30 days. [redacted] assured me that someone from your resolution team would call me to confirm response. 24 hours later, I have, once again, heard nothing from you. I can evoke no confidence in Blue Shield's ability to rectify this, so I must register my outrage: if I didn't pay my premiums from the beginning of August until November, you surely would have cancelled my insurance. It seems a lot easier for you to take my money erroneously than to return it as you should in a timely manner. As you might expect, the functionality of my checking account has been negatively impacted now for over two months. Please return my money immediately. The next phone call I will make will be the fraud division of the Revdex.com. Yours truly,[redacted] Desired Settlement: As you might expect, the functionality of my checking account has been negatively impacted now for over two months. Please return my money immediately.

Business

Response:

Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on September 9, 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]

Business

Response:

Dear Mr. [redacted] This is in response to the grievance Blue Shield of California Life & Health Insurance Company (Blue Shield Life) on November 2, 2015, regarding an erroneous debit on your financial account ending in “0050”. You have requested that Blue Shield Life return the payment to you as soon as possible. Your request has been approved. After reviewing your account with the Billing Department, it was determined that an incorrect debit was deducted from your account. An overdraft for the amount of $11,016.00 was returned to your account on November 23, 2015. The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievance. If you have questions regarding this letter, please contact me directly. Sincerely,

Consumer

Response:

I received all my money back. Thank you.

Review: I work for state of California in year 2014 I got health benefits from BLUE SHIELD NET [redacted] ID#[redacted]. I was paying $277.00 every month on 3/28/2014 I visit my previews Dr. [redacted]. when I visited my Dr. [redacted] they told me Blue shield will pay my bill since I was paying $277.00 of $1644.16 of monthly payment but after one year I receive bill from Dr. [redacted] that BLUE SHIELD NET [redacted] didn't pay my bill I have to pay $148.00 and my wife pay $133.00 so I called BLUE SHIELD NET [redacted] they promise to pay it but receive final notice form my Dr. [redacted], if you guys please advise BLUE SHIELD NET [redacted] to pay my bill since I paid them every month for year .

thank you so much

sincerely Mirwis ZadranDesired Settlement: please advise BLUE SHIELD NET [redacted] to pay my bill $148.00 any my wife bill $133.00 since I paid them every month for year .

thank you so much

sincerely,

[redacted]

Review: On 01/14/2014 I canceled my coverage with Blue Shield. On 01/15/2014 they still took the payment out even after I had canceled. I called back to ask for a refund, and find out why I was still charged. They advise the person forgot to cancel the automatic monthly billing system. I was told my refund would be 13-15 business days. After these days passed I called to inquire about the whereabouts. I was told my refund has not been processed. I called again a few days later and was told it still had not been processed. I asked for a supervisor and they informed me that for some reason they did not process mine and that supervisor will email the refunds department. I learned that my check was mailed out on 02/14/2014. Here it is 02/26/2014 and still no refund. This is over 25 business days.Desired Settlement: Due to Blue Shield charging me after I canceled it has forced me to be late on other bills that I would have not been had blue shield canceled my coverage correctly. I have also been out 281 dollars that could have been used on other things. This is a health insurance company and if I would have been late paying my bill they would have canceled my coverage yet they are allowed to take almost one month to refund a customer. This isn't right and should be illegal.

Review: I called and cancelled my policy more than a month before the termination date and I am still being billed. They will not help resolve the issue until the next payment is processed even though it is their error. I have been on the phone with them for over an hour and a half (mostly on hold) with no resolution. I feel they should correct their error without me having to spend another hour on the phone with them in January. This is the worst customer service I have ever experienced.Desired Settlement: Refund the amount they billed in error without me having to spend more time on the phone with them.

Review: Inability to communicate with company. I want to cancel my coverage, but have called their listed phone number numerous times, only to be put on hold for upwards of 20 minutes and then the call is disconnected. I cannot find any way to communicate with the company on their website blueshieldca.com. The only way I can find to get the coverage cancelled is to stop paying my bill, but I am concerned about the affect on my credit rating.Desired Settlement: I want a public record in case my credit is affected.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 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.

Review: This is my first time with blue shield insurance. I went with the silver coverage thinking it would offer me better coverage. Today, I have a medical issue I need addressed so I called my physician of 10 years. They informed me that blue shield dropped them. I called blue shield (BS) to find another physician and was given only 3 within the network. I called all three, and an unable to see any (one is out 2 months, one cannot help with my issue, and the third cannot accept me as a new patient). I called BS back and explained the situation, asking what my options are. The customer service person ([redacted]) have me all the same names & numbers to call again. Frustrated, I explained, again, that I cannot go to those three and asked what could I do. He said he could email me the names of the physicians, confirming it would be the same ones AGAIN. I asked if they would cover a visit to another physician but was told if out of network I'd pay out of pocket and they would cover none of it.My only other option is to go 2 hours away to someone out of the area. They also would not update my mailing information or billing address, since I moved. I asked for a supervisor and was placed on hold for over 15min only for him to pick up and tell me no one is available. After an hour I received no help and feel I'm being ripped offDesired Settlement: I want to be able to see a physician, in this area, and have my insurance cover it. If they don't have anyone available for me to see regarding an immediate medical need then I should be able to see someone outside the network and have my insurance cover it. My medical needs should not be ignored due to this, not should I have to pay out of pocket when I have insurance to cover my medical costs.

Review: I purchased Blue Shield of CA health insurance on 01/02/2015 in the amount of $451.05 the Silver 70 PPO Single plan. I made my second payment and have called them four times to request my ID cards, ID health number, and pamphlet. I have not received anything and feel I should get my first payment refunded since I cannot use health insurance that I paid for without ID cards or ID numbers. Desired Settlement: The first month payment of $ 451.05 should be refunded because I payed for a service that I cannot use because the company will not send ID cards, ID numbers, or pamphlets that allow me to use the coverage that I purchased.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 1 1. 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 are resolved within 30 days of the receipt date. 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.

Review: I began dealing with insurance broker [redacted] in December of 2013 to obtain medical insurance once my Cobra coverage from [redacted] ended. Mr. [redacted] indicated I would be able to use the Blue Shield Insurance without an ID card or the group number, but this was not the case. No one was willing to see me without proof of insurance. Also, my [redacted] coverage did not end until January 2014. He indicated it would be no problem to do so and said he'd take care of it.

Each month when the new premium statement came I contacted him to find out where he was on clearing up the January premium issue and he assured me it was taken care of.

Well, imagine my surprise when I'm in [redacted] getting a RX filled this past July. The pharmacist advised my medical insurance had been cancelled. I was not notified of this and had no alternative. Since this time, I've been paying for my prescriptions at full retail price.

to make matters worse, they refunded my premiums for Julyh & August(I'm guessing because there was nothing to reference or explain the reason for the refund). So, I fear further colossal debt once the entire group of Doctor's begins billing me for visits to their office.

Please help, I am not sure what else to do.Desired Settlement: Please help, I am not sure what else to do.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on September 22. 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 Mrs. [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 Mrs. [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.

Consumer

Response:

One of my kids picked up the Revdex.com reply dated 10/1/14 and I have some concerns. I had been working with two individuals from Congressman [redacted] office regarding the handling of this issue. There was a change of staff in her office, this issue was put on the back burner and not addressed for some time. I was unaware I had to go through a grievance process until receipt of your letter dated 10/1/14, but not received until today.

I had notified Blue Shield of this Issue back in March of this year, yet did not receive ANY reply from Blue Shield. I have proof of submission if needed. Never once did I hear any mention of a grievance process or it’s necessity to do so.

Now I’m receiving payment requests from providers I saw in the spring of this year and they state Blue Shield cancelled my coverage in the spring. Yet, I have not received a refund of any premiums from this far back.

I was in regular contact with the congressman’s office and never once did they indicate I had to go through the grievance process. All that was said was someone from Blue Shield would be In contact with me to obtain more information on my Issue. To date, I have not been contacted by anyone from Blue Shield ever!!!

I hope you can help me with this; I don’t feel I should be penalized for late receipt of mail and miscommunication from the congressman’s office. I brought my issue in everyone’s attention in good fait this past spring, as I am not working, have extensive medical ailments, and no monies to pay the providers I saw earlier this year.

Please help, I am not sure what else to do.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on November 24, 2014, concerning o Blue Shield enrollee by the name Shirley [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 o copy of the resolution to the Revdex.com. If Ms. [redacted] has signed o release of health information to the Revdex.com, you may send a copy to my attention via fax at ###-###-#### or by mail at: P.O. Box 5588 El Dorado Hills, CA 95762

Review: I signed up and paid for both medical & dental PPO in January, 2014. I received a letter from Blue Shield saying coverage would start in March, and that I had signed up for medical ppo and pediatric dental hmo.I had a dental appt the following week, so began calling to clarify start date and dental ppo. I couldn't get through. Wait times were always more than an hour, and I don't have that time before going to work. And my cell phone minutes were getting used by waiting for hours!I went to the dental appt, since it was scheduled 6 months before and appts are hard to come by. I explained to the dentist, they said they would wait to submit the claim until I verified coverage with Blue Shield.Again I kept calling Blue Shield. I got through and explained my situation. Blue Shield corrected my coverage to start 2/1. I was told someone would call me back soon regarding the dental ppo, it would take 2 wks to receive verification that my coverage started 2/1.No one called, I never received verification of the correct start date. I kept calling. I finally got through after waiting more than an hour, got transferred around, no one could help me. The last person I spoke with told me I needed to contact the agent who helped me. I explained that no one helped me, I signed up and paid on line. She cut me off and transferred my back the queue I had been in for more than an hour!This was on March 5. I went to the site and submitted an email regarding the phone wait times. Their operating hours, by the way, have been reduced. I submitted a second email asking for resolution assistance,since it's so hard to get through, calls aren't returned, I keep getting transferred. I received an automated email for each inquiry saying I would be contacted in 2 business days. I wasn't.I keep trying to get through. I emailed on 3/14, was emailed I'd hear back in 2 days. Nothing. I just called dental, got a message no one is available and was disconnected.I want resolution, but there's no help!Desired Settlement: I went online to again sign up for a dental ppo. I would like that retroactive to my medical coverage start date.I want to receive verification, as promised, that my coverage start date is 2/1 and not 3/1.I want my phone call returned, as promised.I want my emails responded to, as promised.

Business

Response:

This is in response to the grievance we received on April 4, 2014, regarding your Enhanced Dental PPO plan. You are requesting that Blue Shield of California (Blue Shield) change your effective date of this plan from May 1, 2014 to February 1, 2014.

Your request has been denied for the following reasons.

During the course of our review ti was noted that you are enrolled in the Basic PPO plan effective February 1, 2014, and the Enhanced Dental PPO plan effective May 1, 2014. The benefits and provisions of these plans are outlined in the Evidence of coverage (EOC) provided upon enrollment. It is important to become familiar with the benefits and provisions of you plan.

Please be advised, at the time of your enrollment on January 26, 2014, you did not enroll in dental coverage. You enrolled in the Basic PPO plan for medical coverage. Unfortunately, the only dental coverage available on this policy is pediatric dental, which is embedded into the plan to be compliant with the Affordable Care Act (ACA). In order to have dental coverage, you would have had to specify the request for a dental policy at the time you applied for medical coverage.

Our records indicate that you applied for dental coverage on March 19, 2014, for the Enhanced Dental PPO plan with an effective date of May 1, 2014.

As stated in you EOC, enrollment of subscribers or dependents is not effective until Blue Shield approves an application and accepts the applicable dues. An applicant, upon completion and approval of the application by Blue Shield, is entitled to the benefits of the plan upon the effective date.

Based on the above noted information, we are unable to comply with your request to retroactively change your effective date for the Dental PPO plan from May 1,2014 to February 1, 2014.

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, we have taken the following steps:

Tripled our customer service phone capacity to handle increased call volumes

Extended customer service hours to 8 a.m. to 8 p.m. , Monday through Saturday to meet higher demand

More than doubled our current bandwidth on our website to ensure new enrollees and current subscribers can access their member portal

Doubled voice response system automated self service

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

Your request was reviewed by a grievance coordinator who is knowledgeable about your plan's benefits and coverage. We have enclosed copies of the appropriate pages of the Evidence of Coverage (EOC) for your health plan and underlined the language that supports our decision.

You have the right to request an independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If your appeal meets the criteria as determined by the DMHC, and independent review organization as selected by the DMHC will review the pertinent issues(s) and/or medical documentation. We have enclosed an IMR application Form and addressed envelope for your convenience. If you choose to pursue an IMR, please forward your request to the DMHC directly.

You are the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If your 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. We have enclosed and IMR Application Form and addressed envelope for your convenience. If you choose to pursue an IMR, please forward your request to the DMHC directly.

You are entitled to upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim for benefits.

If you would like more information about the diagnosis and treatment codes and their meaning, used in making this decision, please contact your provider.

If you have questions about this letter, please contact me directly.

Review: I had Blue Shield Medical Health Insurance coverage [subscriber ID [redacted]] that cost $470/month. In January,2014, I applied for new coverage under [redacted]]. In February I received a letter from Blue Shield notifying me my application was being processed. [Application ID [redacted]] I then received a bill for the new BS policy and sent in a $133 payment for the new insurance policy. The check was cashed on March 14. I sent in letter and e mail requests to BS several times asking them to cancel my old policy [xxxxxxx[redacted]] and send me medical ID cards for my newly approved policy.For the last two weeks I continue to get BS notices requesting payments for the old policy [xxxxxx[redacted]] while I still have not received the ID cards for the newly enrolled policy even though my premium payment check was cashed. There is a BS number that can be called but it is next to impossible to talk to someone about the failure to cancel the old BS account and send ID cards for the new account. I am having some serious medical issues and am concerned I will not get my new ID cards before March 31st so I get medical treatment on April 1. My premium check was cashed on March 14 so there is no reason BS should not have sent new ID cards to me.Desired Settlement: I want BS to cancel my old insurance policy xxxxxx[redacted] and stop sending me billing notices for a policy I cancelled weeks ago.I want BS to send me ID cards for the new BS insurance policy [app ID [redacted]] for which I have paid for but have not jreceived

Business

Response:

This letter in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dated May 12, 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: Blue Shield has failed to process the majority of my 2015 claims. I filed an internal grievance in May. Opened a dispute case with member services in June. Filed another grievance in July. Filed a complain with the [redacted] in August.It is now November 23rd. I received ANOTHER invoice from a provider stating Blue Shield did not pay on my claim because I have not yet met my deductible. I have never failed to pay my monthly premium. I have never failed to pay toward my contracted deductible or out of pocket responsibility amounts. Yet, Blue Shield sees fit to fail to provide the ONE service they are contracted to provide. I do not know what to do. I keep paying into a health plan that never provides a benefit. I have exhausted every possible recourse available to me as a consumer to no end. I have disputed this issue with Blue Shield for OVER SIX MONTHS. I am not asking them to move heaven and earth. I am asking that they do their one, single job.Desired Settlement: FIX IT. Blue Shield did not pay on my claim because I have not yet met my deductible. I have never failed to pay my monthly premium. I have never failed to pay toward my contracted deductible or out of pocket responsibility amounts

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on December 4, 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 to the review 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 to provide a copy of the resolution to the Revdex.com, you may send a copy to my attention via fax at [redacted] If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below. Sincerely, [redacted]

Review: Make payments for 2014 totally 4,300 and could not use my approve plan.Desired Settlement: Refund my funds or apply to 2015 coverage

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 [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 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]., Executive Inquiries CoordinatorGrievance Department[redacted]

Consumer

Response:

I am rejecting this response because: I file an grievance back in March...I was assign to [redacted]...to help sort this out. On our first call she lead to believe that she understood what was going on, she said she read the file and would work this out. She advise me to contact CA coverage and [redacted] for Families Services, which is what I have been going through since January, 2014.(see attached letter).I inform [redacted] that I almost lost my job due to many, many hours on the phone with [redacted] & CA coverage and that I could not do that again. I stated her that Blue Shield was the one taking my money and not providing the Services that I qualify for. (2) days later I called her with an update and was told she had to close the file!!!! The result of my finding those (2) days: [redacted] did not show any coverage for my son it was me that showed the problem. CA coverage sent my application (without my permission) to [redacted] to see if I qualify, while CA Coverage had already approved for coverage. I was told by the Supervisor ([redacted]) that she had done everything she could do at her level and that I needed to contact MMCD by phone then email to release me from [redacted] even though I did not qualify for [redacted] but in there system it was showing something different. This process took about (2-3) months. During this time I still not do have coverage but when you call CA Coverage it shows that as of February I was approve for the Silver 70PPO at $157 per month, but when you call Blue Shield they show something totally different. I have tried to still make payments to Blue Shield but the amount they have in there system shows a different amount and will not accept my payments unless I pay the monthly of $472.24 of which I cannot afford. As of today MMCD has released me from there systemBlue Shield did not honor the coverage I was approved for by CA Coverage in 2014 but took my payments every month. Again I have spent hours on the phone with these people and they all say the thing, just continue to make the payment to keep the coverage, my question to them is what coverage? I did that in 2014 for a whole year and Blue Shield could not verify my coverage according to them for past due payments. I had coverage prior to CA coverage but now due to my age and pre-condition of High Blood Pressure I cannot get coverage at a price I can afford. I am asking for your help because Blue Shield took my money knowing that they would not honor coverage.

Business

Response:

Dear Ms. [redacted]:This is in response to the grievance we received on June 22, 2015, regarding premium dues. You are requesting we refund $4,300.00, in premium dues for the year 2014, or we apply the funds to your health coverage for 2015, as you feel you were unable to access care.Your request has been denied for the following reasons: * During the course of our review it was noted that you are enrolled in the Ultimate PPO plan through Covered California (CCA) effective March 1, 2014. The benefits of your health plan are outlined in the Evidence of Coverage (EOC). * According to your EOC your monthly premiums are as stated in your appendix and are set for a rating period that runs for the calendar year. There are no provisions in your health plan that allows for Blue Shield to waive your premium dues. * Our records show we received ten premium payments totaling $3,756.40, for medical and nine premium payments totaling $506.70, for dental. With a combined total of $4623.10, from March 2014, thorough December 2014. All premium payments were applied to the account correctly. * Based on research our records show you were fully eligible with access to care benefits. We were unable to find any errors on your account supporting your request. Therefore we are unable to refund or credit your premium dues at this time. * If you would like to further pursue a refund or have questions regarding eligibility please contact CCA directly at [redacted], for additional assistance.Although we understand your reasons for your request, we are unable to comply with your request due to provisions of your EOC. Therefore we must be consistent with the agreement terms of your plan so that we are fair and equitable to all subscribers.Your request was reviewed by a grievance coordinator who is knowledgeable about your plan's benefits and coverage. We have enclosed copies of the appropriate pages of the EOC for your health plan and underlined the language that supports our decision.You have the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If your 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. We have enclosed an IMR Application Form and addressed envelope for your convenience. If you choose to pursue an IMR, please forward your request to the DMHC directly.You are entitled to, upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to your claim for benefits.If you have questions about this letter, please contact me directly. Sincerely,[redacted]. Coordinator