Blue Shield of California

Review: I cancelled my Insurance plan Nov. 30 2014. I was automatically charged $249.98 Dec. 1st 2014 for this plan. I have called FIVE times re: a refund.

Insurance plan was cancelled Nov. 30, 2014, but the didn't stop the automatic billing and I was charged for December on December 1 2014. I have called and talked to FIVE people in varying countries not the United States who didn't seem to have full access to my account, or any refund information. I was give the run-around now for over a MONTH. I am due a refund of $249.98 and after everyone said it will be no more than 10 business days after the processed it - that would have been december 16th. I just want the refund I am due, and I have gotten nowhere with this company. Let's stop insurance companies from improper practice please.Desired Settlement: I am seeking the refund promised to me of $249.98 for the plan I cancelled Nov. 30 2014. It should be (as per the information given to me in one of the five calls I made to them about it) refunded directly back to the card used to make the automatic payments ending in -[redacted] Thank you.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 16, 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 Mr. [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are 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 any additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], CoordinatorGrievance Department ###-###-####

Review: Six months after my wife passed my 14 year old son started having seizures. Took him to the E.R. The specialist took an M.R.I.which was determined to be inconclusive due to the fact that my son was wearing braces at the time.FIRST ISSUE. Even though the doctor had an office only minutes away from our home, the insurance refused to allow us to seethe doctor there; she even tried to drill some sense into the insurance representative; they just said NO and that was it. We had to drive over an hour thru downtown San Francisco for the appointments; I just wanted my son to get proper care.My son has been taking medications for about three years now; his braces came off so his doctor decided it was a perfect time to take a second M.R.I. so that she could see the whole picture without any obstructions.SECOND ISUUE. I am appalled to receive a letter from some insurance paper pusher who decided my son does not need an M.R.I. so they are not approving it.My question is what Godly power does someone who does not know my sons' medical needs, family history etc. to say what my son needs are; overriding the specialist recommendation who has been treating, seeing him, following his health and has a first hand knowledge of his needs.It seems to me the insurance only motivation is to collect fees, with no regards for the real needs of its members.Desired Settlement: All I want as a father is for my son to get the care he deserves and needs. Any decisions about care to be made by his doctors not a paper pusher administrator.

Business

Response:

Company states: This complaint was with the son [redacted]. November 10th the letter to the consumer was sent. Company is standing the original denial based on the information received.

Review: Blue Shield grossly overcharged me (for 2 months of premium payments) by $ 1720 and promised to refund it by a specified date, but failed to do this.

On January 2, 2014, my bank account was charged $ 2656 by Blue Shield of California. This charge resulted in my bank account being temporarily overdrawn. I had to make a quick deposit to bring my balance up.

On January 5, 2014, I called Blue Shield of California to ask why my account was charged $ 2656 for two months of premiums (December and January), when my monthly premium was only about $ 468. The representative stated that I was erroneously overcharged, and stated that it would take 24-48 hours to "adjust the system" and then another 7-10 business days to complete the refund to my bank account. The reference numbers they gave me for this phone call were [redacted] (customer service) and [redacted] (billing dept).

The next day (January 6, 2014), I called Blue Shield of California to confirm what they had told me the previous day, and to get written confirmation. The reference number they gave me for this call was 150060007550. I received a written statement by email that same day, confirming the 24-48 hour "adjustment" period and the 7-10 day period to receive the refund. (I received the same statement by normal mail some days later.)

As of 1:15 AM Pacific Time on January 22, 2014, my bank account still does not show a refund.

This refund-related complaint is one of a series of complaints I filed with Blue Shield of California for poor customer service and billing issues I encountered during my 3 months of coverage with them (complaint reference # [redacted]). It is my belief that Blue Shield grossly overcharged my account (and then failed to issue the refund) in retaliation for my filing of those complaints against them. Going forward, I have terminated my coverage with Blue Shield of California (effective Feb 1, 2014) because I do not trust them and I believe that they may find other ways to retaliate against me.Desired Settlement: I want them to refund my bank account $ 1720 as they had stated in writing they would do.

Consumer

Response:

Thank you for your help with this complaint. Yesterday, a VP from Blue Shield of California contacted me by email stating that they had just sent me a refund check by overnight mail, and today I received the check. Since not receiving this refund was the original reason I filed the complaint with Revdex.com, there is no reason for me to further pursue the complaint (nor will there be need to edit the complaint, nor will I be completing the HIPAA form).

Review: July 31th 2014: I called Blue Shield of CA to cancel my dental policy as I did not want to be billed for August. I spoke with a "[redacted]" (call id# [redacted]) who confirmed 1) the account was canceled and 2) that he had gone into the billing system and confirmed the payment for August would not be attempted. July 31st 2014: Blue Shield hit my checking account with a debit for $20.80. I did not have the funds available given I was not expecting this charge to come through after being told it would not. My bank charged my a $28 NSF fee due to Blue Shields error. July 31st 2014: I called Blue Shield again and spoke to a "[redacted]" (call reference ID: [redacted]) and explained what had happened. He advised that he could refund the $28 to my checking account but that it would take approx. 7 days. I was not happy but agreed. He also confirmed that the payment system had been updated and no more payments would be deducted from my account. August 7th 2014: I received a credit to my checking account for $20.80, not the $28.00 I was told would be credited. Because I'd spent over 5 hours (not an exaggeration) on the phone with Blue Shield support people (most of it on hold) dealing with the refund, I decided to let it go and just accept the $20.80 and move on. August 11th 2014: Blue Shield hit my checking account AGAIN for $20.80. This is long after the account and EFT payment authorizations were in affect. Meaning, they illegal took funds from my checking account, not once, but twice. The fist time I could understand the error. The second time is incomprehensible. Here's my issue. Blue Shield is claiming that they will submit a refund for $20.80 but that it will take 7 days to process. Blue Shield illegally obtained funds from my account without authorization and have done everything in their power to make it very difficult for me to get my money back, making ME jump through hoops and not refunding the entire amount I was charged. I do not want this brushed under the rug. They should be held accountableDesired Settlement: I would like the $28 refunded to me, as well as additional compensation for my time and effort to resolve THEIR error. I am very likely going to take them to court to make a point but I am willing to use the Revdex.com to mediate a solution if BS is willing to discuss the issue and how their support teams handled it and are willing to re-train staff and realign policies to ensure that if BS makes an error, they are in a position to correct the error immediately and with no further pain to the customer

Review: 2014 denied medical surgery. 2014 out network outstaning reimbursements. 2015 denied 13 physical therapy visits.

In end 2014 Blue Shield denied my medical surgery needed. I was informed it is common for this insurance company to deny at end of year, to push into next calendar year and deductible.

In addition, 2014 outstanding reimbursements for out of network claims were not resolved.

I am given different medical benefit information over the phone depending on customer service reps at that time. I was informed a supervisor would contact me on numerous occasions, which has not happened.

Recently given different benefit information than my counseling provider regarding out of network provider coverage when inquiring about the same coverage.

Finally, 05-28-15 my medical office informed me my Blue Shield of Ca denied 13 physical therapy visits, which has haulted my post operation care and is setting me back physically and emotionally. Both my medical office and myself were informed by my insurance the physical theraphy benefit is 12 visits per year "unless medically necessary". Both my surgeoun and urgent care physicans have indicated it is medically necessary. Blue Shield of Ca is now stating my policy only includes 12 per year maximum and has no additional post operation care. Mis benefit information should never have been given prior and after surgery regarding my recovery care.Desired Settlement: A resolution from the business would to be contacted by a competent representative that is fully aware of my benefits. First to discuss outstanding reimbursements for out of network benefits from 2014. Next to resolve why Blue Shield denied the 2014 surgery. Finally, resolution on denied PT visits and post op care.

Business

Response:

Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on July 16, 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: I am still owed $297.02 from 2 months of health insurance that was canceled months ago.$841.62 was refunded to my account on 1/29/15. I want the money that has been owed to me since I cancelled in November of 2014, please send refund immediately.Here are records of all the calls I've made regarding this: Called 12/4/15, said check was mailed 12/4, allow 5-7 days for processing. -Called [redacted] 12/15/14, call #[redacted]. Backup dept was confused, refund processed.-Called 1/5/15, said refund was submitted but refund not processed yet because they couldn't refund to my bank account. Check will be sent soon.- Called [redacted] Feb 2015, call # [redacted]. Refunded $841.62 of the $1135.44 owed to bank account as a deposit; not sure why it wasn't refunded in full. Still owe me $297.02.Refund: 1/29/2015 DIRECT DEPOSIT- BLUE SHIELD OF C BS OF CA [redacted] $841.62. I also submitted a "grievance' letter, and received a letter dated 2/27/15 stating that you had delays and you needed additional information in order to process it, but no one has contacted me regarding it. I will leave messages for [redacted] in the Grievance Dept every day until I get my refund. --Called [redacted] 4/3/15, no results.

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

Please send my $297.02 refund immediately, with interest since November. I can't afford to pay my own income taxes die to this and another health insurance refund I am still waiting for.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 27, 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.

Consumer

Response:

I am rejecting this response because: I was told in writing and on the phone, many times, that I would be receiving the full refund amount of $1119.12-1138.64 back in November of 2014, and consistently since then. Please see all letters and records of calls, confirmation numbers, names, and dates for this information. I received $841.62 (for no apparent reason was this amount sent to me) in January of 2015. I then recevied a letter on 1/27/15, after I filed a greivance, that said 'We have confirmed that the delay... is due to needng additional information regarding your premium." Nowhere do they ask for the actual information, nowhere do they tell me who I can call to provide said information. Along with the check for $164.90 I received on April 16, 2015, (again, for no apparent reason was this amount sent to me) they don't even mention needing information in order to send me the full refund! I demand the full refund of the additional $132.12 that I was promised, or at least the $112.60 that would also fulfill their promise of a fully refunded amount.

Business

Response:

This is in response to the grievance by Blue Shield of California (Blue Shield) on April 14, 2015, regarding your health plan premium payment. You have requested Blue Shield refund and dues on file remaining after termination of your health plan.Your request has been approved. We have verified a refund of all health plan premium dues have been refunded to you. Upon review of your health plan, we found that a refund was processed to your bank account in the amount of $841.62. We also found that a refund of $164.90 was sent to you in the form of a check. In total, Blue Shield has refunded $1,006.52. We have included a table to explain how Blue Shield found the correct amount was refunded to you: 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 in this or any other claim. The appeal preview 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.Sincerely,[redacted]Grievance Coordinator

Consumer

Response:

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

Review: Dear Sir or Madam,I received Blue Shield of California coverage starting Feb 2014 through Covered California while I was a law student. After graduation, my employer provided me health coverage starting Sep 2014. As a result, I called Blue Shield to cancel my plan on Sep 29, but I was advised that my plan could only be canceled effective Oct 11 at the earliest. Thereafter, I was charged a full premium for the month of October by an auto-debit from my bank. After my plan was canceled on Oct 11th, I called to request a refund of the prorated premium for the month of October. After spending more than an hour with a billing agent, I was advised that a refund would be issued shortly. However, I have not yet received a refund, and when I call the insurance company I have been either been put on long holds, or the line disconnects automatically. I am not sure how to reach out to the company to get a refund. Thank you very much.Sincerely,[redacted]Desired Settlement: Provide $305.80 in refund for the premium charged for the canceled period (10/12/2014 to 10/31/2014).

Consumer

Response:

I just wanted to update you on the status of my claim against Blue Shield of California. I had asked the company to refund excess premium payment, and the company has refunded the amount to my satisfaction.Thank you so much for helping facilitate a communication. I am grateful for your help.

Review: Anthem owes me over $6000. It failed to reimburse me for a pre-authorized service in 2014 that I paid for out of pocket. Also failed to pay ambulance bill that was paid out of pocket after out of pocket maximum was reached. On top of that I keep getting billed for services that keep getting "readjusted" as an out of network, covered-CA plan, even though I was informed by both Anthem and the provider at the time that the provider was in network. I had made numerous calls regarding these matters, as well as my broker sending you letters, but nothing happens.Desired Settlement: I would like to get paid a reimbursement of all my out of pocket expenses that are due to me by Anthem.

Review: After having paid my bill every month (and have given proof of this) Blue Shield illegally cancelled my insurance. After trying to contact the person assigned to my case ([redacted] for over 3 weeks I have not received a call, email, or any type of communication. I have left messages and am at a loss, since I am in dire need of my medication. Blue Shield has basically stolen my money since they will not provide the service I have paid for.Desired Settlement: My resolution is simple. Give me the coverage I have been paying for!!! There is no valid reason why my insurance was cancelled. I want immediate reinstatement, as well as an apology. Because of Blue Shield's lack of professionalism and incompetence I also believe some compensation is in order. November and/or December should indeed be free of charge. This is the least this company can do after what I have wrongly been put through. (again, for NO reason.) Thank you.

Business

Response:

We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has completed our grievance process regarding this specific issue. A response letter was mailed directly to the member on December 16, 2015. 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 the member is dissatisfied with our grievance resolution, she may contact the Department of Managed Health Care for additional assistance. The department has a toll-free telephone number ([redacted]) and a TDD line ([redacted]) for the hearing and speech impaired. The department’s Internet Web site [redacted] has complaint forms, IMR application forms and instructions online.

Review: I was issued a refund for 704.03 back in February 18, 2015. I was away for about 6 months. When I returned my fiancé and I started going through my unopened mail. We came across three checks two from my retirement fund [redacted] and 1 from Blue Shield. My fiancé [redacted] contacted Great Western first and they immediately reissued two checks. [redacted] has been contacting Blue Shield for the last five months regarding reissuing the check and we still have not received anything. The last phone call was made on May 3,2016 and [redacted] spoke to [redacted] in customer service. [redacted] informed [redacted] that the matter was given to the supervisor and sent up to the accounting department so a new check could be issued. [redacted] informed [redacted] she would call her back within 48 hours regarding the status and that was never done.Desired Settlement: We would like to receive the refund that was originally sent to us back in February of 2015. We still have the original check we need them to reissue a valid check.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 17, 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.

Review: I cancelled my policy on December 26th effective December 31st and. However I was still billed for January and have not received a refund

I cancelled my policy on December 26th effective December 31st and received confirmation. However I was still billed for January and have not received a refund. I have called in 3 times and have still not yet to receive my funds.Desired Settlement: I would like a full refund of my premium plus additional settlement for the time spent on hold 3 times in a row trying to get my refund back.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 11, 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] 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.Sincerely,[redacted], Regulatory CoordinatorGrievance Department[redacted]

Review: refuse to give medication on per policy. for 6 months takes 7 - 10 after I run out . with many phone calls by me , sales agent , and pharmacy. no one calls back and puts us on hold for 30 - 40 minutes . some times never comes back .I am dietebic and a heart cond.Desired Settlement: I would like to pay for my time, agents time , pharmacy's , and honor the policy. for I can get by medication when needed.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 11, 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 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 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: Paided monthly, but still can not use the insurance for no new cards supplied. Waiting 3 weeks, still nothing. Can not get through to agents and the website is down most of the time. They did send old card- does no good. Paid but no services.Desired Settlement: Have the correct cards sent via next day and some type of credit for the use of not being able to use the insurance WE PAID FOR.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 5, 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

Consumer

Response:

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

Review: I am attempting to get a refund from Blue Shield for the one month of health insurance I paid for and never used in January 2015.(I already had and continue to have a health insurance plan with Anthem Blue Cross Covered California).I ordered Blue Shield insurance because my cancer surgeons office staff mistakenly told me that they did not take Anthem Blue Cross, when, in fact, they did.When I found out the surgeons office mistake, I cancelled the Blue Shield insurance. I did not receive any benefits. I called to terminate this insurance on January 20, 2015 and this is shown in Blue Shields records.I had telephone conversations with Blue Shield, each time being promised that the refund would be issued in a timely manner on 2/19/15, 3/14/15, 3/17/15, 4/29/15 and 5/28/15. My $1493.83 one-month policy premium has not been returned.Desired Settlement: I would like a check in the full amount of $1493.83 issued to me as soon as possible.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 11, 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 completed our grievance process regarding this specific issue. A response letter was mailed directly to the mamber on June 12, 2015. If the member is dissatisfied with the grievance resolution, she may contact the Department of Managed Health Care for additional assistance. The department has a toll-free telephone number ([redacted]) and a TDD line ( [redacted]) for the hearing and speech impaired. The department's Internet Web site [redacted] has complaint forms, IMR application forms and instructions online.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below. Chasytie White, Executive Inquiries CoordinatorGrievance Department(916) 350-7168

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory, on the condition that Blue Shield actually sends the promised refund check to me. Having been repeatedly verbally promised resolution before (including one statement that it would be resolved in my favor "in 48 to 72 hours" (BS ref. #[redacted])), I would prefer to keep this complaint open until it is actually satisfied as stated in BS's letter of June 12, 2015.They have given themselves 30 days to send me the check for $1,493.83. I should receive this check by July 11, 2015.Sincerely,[redacted]

Review: I have been trying to sort out our family insurance plan with Blue Shield and [redacted] California for over a month. Blue Shield sent out a letter informing us they needed a binder payment 1 day before it was due and cancelled the account because it was not paid. I called in to make the payment 1 day past the due date and was initially told she couldn't do anything until she spoke to [redacted] CA. I mentioned that I had already been through that in the past and when I call [redacted] CA they tell me to call BS. She then told me I was correct and calling [redacted] CA was actually not the answer. At this point she said she filed an accelerated claim with the issue resolution team and the account would be reinstated within 10 days. I have now made 3 phone calls trying to make the payment and am still being told the claim is pending. Most recently I was told it always take at least 30 days and the previous employees I spoke with were not correct in their 10 day estimate. Now we are without insurance and no one at BS can help. I have asked to speak with a supervisor and the first person I spoke to told me "They are all on a phone call" so she couldn't connect me. Next, I was told they are not allowed to pass the call to a supervisor. I am deeply disturbed that an industry of such importance would not have supervisors available or even employees who have answers. I am being passed around with no clear resolution all while hoping one of my kids doesn't get sick. I would hope Blue Shield would have better policies in place for issue resolution.Desired Settlement: Please have an actual supervisor or someone with a resolution call to reinstate the plan which was revoked due to an error on your end. Also, future correspondence should be handled by reps with a more clear understanding of policies. Additionally, when working with [redacted] CA the Blue Shield reps should be able to contact each other on the spot so the customer doesn't have to wait days and weeks for the two to communicate.

Review: I have previously started a new job and I switched over from Kaiser to an EPO through my employer with Blue Shield as my insurance servicer. I am very low on medication and I am mentally ill. I have been trying to get ahold of a psychiatrist to see and I have called twenty different listed doctors who claim they are taking new patients. I have been able to get an appointment but it is more than four months in advance and I need a refill of my mood stabilizing medication because if I go off my medication it could be life threatening. I spoke with two representatives today on the phone and they were not helpful. Moreover, the two customer service representatives were very short and made me feel stupid. I explained my situation the best I could and asked for advice and they were very unprofessional and were annoyed that I was asking for assistance and told me there was nothing they could do and to call back another time. I was homeless and I was unable to take care of myself before I got medical help and I feel I am not getting help. This has effected my job performance, my personal life, and my ability to concentrate and be productive.Desired Settlement: All I need is the next indicated step. I need to speak with a doctor or nurse at least and I need to address my medical issue with regards to my medication. I have one week left of my mood stabilizing drug and I would like to know what I need to do set an appointment to see a psychiatrist. I just would like someone who will explain to me what I need to do.

Review: Blue Cross Blue shield has failed and continues to render payment for medical supplies. This has been an ongoing battle since September of 2015. When I call customer service [redacted] I get the same answers...Were sorry we will have to issue a stop payment and re-issue checks (which are never sent) oh and when you ask for a senior manager they do not allow this.Desired Settlement: I would like Blue Cross Blue Shield to call [redacted] directly and resolve the issue...render payment and then have senior manager call me and let me know that this issue has be handled.

Business

Response:

Re Case #: [redacted]Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) pn July 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. Our records indicate that Mr. [redacted]'s is enrolled under the Federal Employee Program. As indicated in the member service benefit plan brochure, member complaints and claim processing disputes must be submitted directly to U.S. Office of Personnel Management (OPM) for review and resolution. While we understand Mr. [redacted]'s concerns, based on the benefits and provisions of his plan we are unable to initiate a formal review of his grievance at this time.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted] Executive Inquiry CoordinatorGrievance Department([redacted]

Review: Cancellation of Health Plan Coverage

Blue Shield cancelled my health care coverage although I have proof that they received my premium amount and cashed the check with it. I had received no warning of cancellation and only found out when I went to pick up a medication at the pharmacy for my illness I must take nightly and the withdrawl symptoms are severe without it. I had to end up paying out of pocket for it and could only afford two weeks of the medication. Blue Shield will not correct their mistake and instead has pocketed my money and cancelled my policy.Desired Settlement: I want my policy reinstated since the premium was paid on time and a refund of the out of pocket cost of my medication.

Business

Response:

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 completed our grievance process regarding this specific issue. A response letter was mailed directly to the member on July 14, 2015. If the member is dissatisfied with the grievance resolution, she may contact the Department of Managed Health Care for additional assistance. The department has a toll-free telephone number ([redacted]) for the hearing and speech impaired. the department's Internet Web site [redacted] has complaint forms, IMR application forms and instructions online.If you have ant additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted] Executive Inquiries Department

Review: Blue Shield cancelled my policy even though I have proof they received and cashed my money order.

1) I enclosed the document of Blue Shield's last statement saying all I had to pay by 9/30/14 was $850.30.

2) I sent a money order from [redacted] to Blue Shield on 9/30/14 certified return receipt request. I have attached documents showing from USPS that it was postmarked 9/30/14 and signed for on 10/2/14 by Blue Shield representative

3) According to [redacted] they have in their system that the check for $856.00 was cashed on 10/6/14 by Blue Shield. I have sent a notorized request to get a copy of the signed and cashed check to [redacted] and they said it will take 4-6 weeks to send me that copy.

4) I called Blue Shield to dispute the cancellation of my policy as of 8/30/14. The representative said on her screen I was paid through Oct. 2014. But she said according to the billing department they had not received payment and my policy was cancelled as of 8/30/14. I asked to speak to a supervisor and was on hold for almost an hour. The supervisor, [redacted], argued with me despite asking about the descrepancy her rep told me and the hard copies of proof they got and cashed the check and when I asked for the appeal info and address she hung up the phone on me.

5) Blue Shield basically cancelled my policy, still cashed my check, and stole my money.

6) The are now denying MD/therapist/Med claims from Sept and Oct AND won't let me pay for my Oct premium.

7) I am on Short Term Disability for Generalized Anxiety DIsorder and Depression and have GERD and hypothyroidism and need to take required medications for these. I can't afford out of pocket costs of meds and they are putting my mental and physical health at risk.

8) Their treatment of me caused me to have a panic attack and severe headache and nausea this afternoon 10/17/14.Desired Settlement: I want my coverage and policy reinstated and my claims and meds paid for since they cashed my check and I am paid through October. I want to be able to pay my premium for October.

Business

Response:

Company states: Member has been re-instated on 10/24 and a notice has been sent to the member.

Business

Response:

Company states: Member has been re-instated on 10/24 and a notice has been sent to the member.

Review: Have not been able to complete my medical application ( Covered California) even though I have paid my premium for the last three months.

I selected Blue Shield as my medical service provider in January through Covered California. 3 1/2 months later and my application is still not complete. I have spoken with more then a dozen agents and four supervisors who all work for Blue Shield ((average hold time 30 to 60 plus minutes) Also, I have send an e-mail to the Company and have written a certified letter to Mr. Markovich the President of Blue Shield, to no avail. The response is the same every time.. I am sorry we will forward your problem to the Escalation Department. Yet, to-date the problems are still not resolved. Even though I have paid the FULL premium every month since February. I mentioned to the Blue Shield agent that I need to see a doctor for my son. The response was... you just have to wait or pay for it yourself. I tried again today to get the problem fixed without success. I hope you understand how stressful this is especially given the fact that I need to see a doctor for my son.

Thank youDesired Settlement: I want Blue Shield to complete my application process. Send me the ID cards and information package and fix the wrong mailing address in their system.

Also, I should get a refund/credit for the previous months since the application process was never completed

Business

Response:

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