Blue Shield of California

Review: Switched health plans between January and February (both with Blue Shield of California). Was told by agent that plan 1 would end and plan 2 would pick up at the beginning of February. The former plan was set to auto-pay on my credit card.Blue Shield did not cancel plan 1 and instead charged me the full amount (double-covering me for the month).To remedy the issue:1. January 25, 2014I attempted to call using the "Contact Us" number listed on the website https://www.blueshieldca.com/bsca/my-health-plan/resources/contact-us/home.sp)wh...⇄ is ###-###-#### - it would seem to be a real estate advertisement that then hangs up on me. "With mortgage rates at record lows, refinance now! Call ###-###-####".2. January 25, 2014I attempted to send a message via their online contact form - it would not submit regardless despite trying multiple internet browsers (always having an error upon submission).3. January 25, 2014I sent a message to their technical department regarding the two contact issues listed above, and also included the text of my issue asking them to submit it for me since the system was not working. (I received automated replies to the submission that it had been received I would be contacted within 2 business days.4.March 3, 2014After not having heard back, I called Blue Shield Shield at ###-###-#### (the number provided on the back of my current/second plan card): it was an automated system stating that call volume was very high and to try back later. It then hung up on me.4. March 3, 2014I called an alternate contact number (from my prior/first policy) and was on hold ~90 minutes before getting an agent.I spoke with [redacted] who looked into the issue: said it was an error, that they would refund the full amount to my credit card within a couple business days. (Call ref: [redacted]).It is now March 18, 2014 and I have not been refunded the wrongly charged money.Desired Settlement: I shouldn't have to wade through their terribly understaffed call center to get a charge reversed that was their fault. I want the money returned immediately ideally with an apology and some assurance that my account is in good standing and they will continue to charge the new correct monthly premium to my credit card.

Business

Response:

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

Review: BLUE SHIELD HAS THE WRONG EFFECTIVE DATE (1/1/2014) FOR INSURANCE AND THE WRONG CANCELLATION DATE (3/31/14) FOR INSURANCE.

MY COMPLETE APPLICATION FOR MEDICAL COVERAGE WAS SUBMITTED ON 3/13/14 VIA COVERED CALIFORNIA FOR THE EFFECTIVE DATE FOR COVERAGE TO START 4/1/14 WITH A PAYMENT OF $126.58 PROCESS ON 3/13/14. BLUE SHIELD HAS INDICATED THE START DATE AS 1/1/14 CHARGING MY BANK ACCOUNT OF $506.32 ON 5/2/14 FOR COVERAGE PAYMENT THAT DID NOT EXIST. ON 6/3/14 ANOTHER PAYMENT OF $126.58 WAS DEDUCTED FROM MY BANK ACCOUNT. AFTER SEVERAL DISCUSSION WITH BLUE SHIELD THEY CREDIT BACK MY ACCOUNT OF $379.74, STILL OWEING $126.58. AFTER BECOMING PERMANENT ON MY JOB AND OBTAINING MEDICAL BENEFITS I CALL COVERED CA TO CANCEL MY MEDICAL COVERAGE WITH BLUE SHIELD EFFECTIVE 5/31/14. BLUE SHIELD HAS MY CANCEL DATE AS 3/31/14 AND HAS STATE THAT THEY PAID FOR SERVICE IN ERROR IN THE AMOUNT OF $255.39 FOR SERVICES RENDERED ON OR AFTER MY COVERAGE WAS CANCEL. BLUE SHIELD RECORDS ARE INCORRECT I DID HAVE MEDICAL COVERAGE AT THIS TIME PERIOD AND THEY HAD PAID FOR LAB SERVICE ON THE SAME DATE THEY PAID FOR MY DOCTOR VISIT. BLUE SHIELD DID NOT NOTIFY OF THIS ISSUE UNTIL AFTER A YEAR AND THEY HAVE NOW SENT THIS BILL TO COLLECTIONS ALL FOR THE SIMPLE MISTAKE THEY MADE BY ENTERING THE INCORRECT START AND END DATES OF MY MEDICAL COVERAGE WITH THEM OF ONLY TWO MONTHS. I KEEP GETTING CALLS AND COLLECTION NOTICES BECAUSE OF THIER ERROR.Desired Settlement: BLUE SHIELD NEEDS TO CORRECT THEI5R ERROR AND REMOVE ME FROM COLLECTIONS, BECAUSE I DO NOT OWE THEM THEY STILL OWE A PAYMENT OF $126.58.

Business

Response:

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

Review: These dates may not be exact, but it’s the best that I can remember. My main issue is with Covered CA, but when I searched for them the company did not come up. Blue Shield of CA is also an issue though because I don't know where the problem resides. Maybe it is both.

FEBRUARY 12 - FEBRUARY 24

I applied for the Blue Shield Gold around February 12 (or whenever 2 days before the cut off for March 1st effective date was) through Sound Benefits - Northern California health care agent. A couple of weeks later I realized I never received any assistance despite only making around $25,000 in the past year. So I called my agent at Sound Benefits, and he told me he would cancel the Blue Shield Gold. He said I should then reapply through the Covered CA website. I reapplied for the Blue Shield Silver plan - case# 5[redacted]. My agent then confirmed after I completed my application that everything looked great, and I was good to go.

MARCH 5 - MARCH 12

I then received a call about a week later from my dad saying that my agent's assistant had told him they had accidentally inputted the effective date as January 1st instead of April 1st. She tried to remedy the issue by calling Covered CA, but they said that I had to call them directly. So I tried every day for a week to get a hold of Covered CA, but every time I called the automated message would say, “We are experiencing a high volume of calls. Please try again later. Good bye.”

MARCH 12

Finally after a week of this I decided to call Blue Shield instead - Ref #[redacted](Covered CA). 4 1/2 hours later we had supposedly handled everything. At the beginning of the call the only application they had record of was the Blue Shield Gold which had supposedly been cancelled by my agent. According to Blue Shield, the Blue Shield Gold had not yet been cancelled. So blue shield cancelled that - Ref #[redacted]. They then transferred me to Covered CA, and I spoke to a Covered CA rep and Blue Shield rep at the same time. Covered CA finally found my Blue Shield Silver app. It had supposedly been sent to Blue Shield, but Blue Shield had never received it. He said that because Blue Shield never received it then when he resent the application the new effective date would have to be May 1st. At this point they started arguing with each other about how this was not my fault, and I shouldn’t be penalized.

Eventually we got an effective date of April 1st approved. He then supposedly re-sent the application to Blue Shield who should have received it within 3-5 business days. They said once I paid then I my health insurance would activate. "GREAT! I would love to pay now." No, it doesn't work that way. That would be too easy. I have to be billed first. At this point, the Covered CA rep interrupts and tells me, “No, Blue Shield is notorious for not sending out their bills. I would advise you to call back in a week.” I then explain to the both of them that it is rare for me to have 4+ spare hours to try and get a hold of them just to pay a bill. The Blue Shield rep then assures me that she will call me within 5 business days as soon as my application comes in. 1 1/2 weeks later I have still not received a call.

MARCH 23

I call Blue Shield back. 3+ hours later we come to the conclusion that, in fact, nothing has been received - Ref #56487121. And on top of that my effective date STILL says January 1st. BAFFLING. They supposedly change the effective date again. They also tell me to call back in 2 weeks in order to make a payment.

APRIL 7

Around 2 weeks later I give them a call. I don’t have time to waste hours of my life again, so I attempt the automated system where I find out that my application is STILL set for January 1st.

I have been attempting to call back ever since, but I simply do not have the time in-between THEIR business hours to get a hold of them and “fix” the issue that is apparently too difficult to fix.Desired Settlement: My desired outcome would be:

1. Confirm that the initial application - Blue Shield Gold - has been cancelled.

2. Covered CA SUCCESSFULLY send my application for the Blue Shield Silver to Blue Shield.

2. Make my payment for Blue Shield Silver with the effective date as April 1, 2014 - NOT January 1. (MOST IMPORTANT)

3. My coverage was supposed to start April 1st; however, due to these insane issues on Covered CA and Blue Shield's side that they can't seem to work out I still do not have insurance. Therefore, I don't feel right about not only owing for the month of April but also owing for the month of May when I've spent most of March and almost the entire month of April dealing with their incompetence. I think I'm more than justified in not having to pay for April; and, yet, still having an effective date of April 1, 2014.

Thank you in advance for anything you guys can do. I am at a complete loss at this point.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 24, 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 failed to update my plan preference and thus overcharged me for my January 2016 monthly premium.

I have made several attempts to rectify this issue with Blue Shield directly, however, it seems that they are either unable or unwilling to make my refund available in a timely manner. The first supervisor I spoke with in January said I'd receive my reimbursement check in 15 business days. I did not receive anything. I spoke with another rep. mid-February and he said the payment was scheduled on Feb 10th to auto-deposit back into my bank account so give it about another week. In early March I spoke with yet another representative who stated that the refund had already been made. I have no evidence of the reimbursement into my bank account and my bank account could not confirm any forthcoming deposits from Blue Shield. I've been told by Blue Shield that I now have to wait another 30 days for them to figure out what happened. This is unacceptable to me unless they plan to compensate me for the reimbursement, plus interest on the monies due. I am still currently in limbo without my reimbursement or interest for Blue Shield overcharging my account almost 3 months ago. This is unacceptable and highly unethical business practice.Desired Settlement: I am seeking a reimbursement of the funds that they withdrew from my bank account erroneously. Plus interest on those funds for not correcting this matter expeditiously.

Business

Response:

Dear This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 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 [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com. If you have additional questions regarding this matter, please contact me directly at the telephone number listed below. Sincerely,[redacted]

Consumer

Response:

I am rejecting this response because: Per my conversation with Michela L. in grievances, grievances has found on 4/7/2016 that my complaint from January 2016 is still accurate and that I am still due a reimbursement. Also, I was informed that my reimbursement was requested to be expedited since Blue Shield erroneously deducted the wrong amount from my checking account. Since this current form of the letter sent from Blue Shield doesn't in any way reflect that conversation I cannot accept it as a reply to my issue and I do not agree that I should have to go through a further grievances process of 30 additional days. Thank you.

Business

Response:

Dear Ms. [redacted],

Review: Our family enrolled to Blue Shield of CA through Covered California program. We took our daughter to Sacramento Pediatric Association for doctor visit on 1/31/2014. Before we go there, we checked Blueshield's provider directory online to make sure that our doctor was contracted. Their website listed our doctor in their online directory. The doctor's office staff also confirmed that they are contracted. So we took our daughter for visit. After few days we received a bill for $245 from the office and contacted Blue shield of CA. We were told that the provider was not contracted and therefore the patient is responsible for all cost. When my wife argued that we saw it in the director and we took a screen shot of the website, we were then told that Doctor was contracted with blue shield for other plans but not Covered California plans. We mentioned that when we logged in as a member, with our member information, and clicked on the provider directory it showed us the doctors name in our directory and we confirmed it with the doctor's office too. We were told they can only re-process the claim if we send them the screen shot that has a date on it because the doctor's contract wasn't effective until after February xx. When we looked back at the screen shot that we had, there is no indication of date anywhere. It is absolutely unlogical that even though we did all our best to ensure our dr is contracted to avoid the excess cost, but all sources were unreliable and now we are responsible for $245 which is not our fault. It is Blue Shield's system defects and their lack of communication with their providers and lack of the provider's knowledge of their contract.Desired Settlement: reprocess the claim as in-network. claim number: 140xxx-xx-xxxx

Review: I have been attempting to get health insurance since 11/1/2015 with no success. Numerous phone calls to Blue Shield have been unproductive.Desired Settlement: Health insurance coverage.

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

Review: Blue Shield has been unable to manage a computer glitch properly which has continued to allow them to disallow companies from offering us care. This is due to an increase in premium in January. We use an automated bill-pay service and did not allocate enough funds ($91 short on a bill or over $1,000) in January when the bill was due. As soon as we realized the mistake we sent the balance immediately. They have NEVER been able to place us in a "current" status. Instead, everytime we want to use a doctor or medical service - we are DENIED coverage even though we are current. I have spoken 3 times to them and they promise every time to remedy the situation and then call me....they never have!! Please help us. This is embarrassing and we cannot get coverage without going through hoops every time to prove we have insurance!!! I would like this to change...for an update in the system to state we are and have been current. I would like a letter of apology sent to each of the providers they denied when we were covered.I would like a refund of at least 2 months of premium for this hassle.Thank You!!!Desired Settlement: I would like this to change...for an update in the system to state we are and have been current. I would like a letter of apology sent to each of the providers they denied when we were covered.I would like a refund of at least 2 months of premium for this hassle.Or, I would like to be able to switch to another insurance company penalty free.

Business

Response:

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

Business

Response:

Dear Ms. [redacted],This is in response to the grievance we received on June 4, 2015, regarding billing discrepancies on your account. You are requesting Blue Shield of California (Blue Shield) update your billing account to correct any errors, and to provide you with two months of coverage credit on your account. Your request has been partially approved for the following reasons:During the course of our review it was noted that you are enrolled in the Blue Shield Silver 70 PPO plan, with an original effective date of March 1, 2014. An Evidence of Coverage (EOC), containing the terms and conditions of your plan is sent to you once after enrollment, and again upon each renewal.We have approved your request to correct any billing errors associated with your account, which may have caused your providers to be incorrectly advised of your eligibility status at the time of their inquiry to Blue Shield.Your request for two months of coverage credit to be applied to your account has been denied because although you have experienced issues on your account, there are several claims in various months that have been processed and paid.While we understand the reason for your request for two months of coverage credited to your account, we have denied this request because you have claims paid throughout 2015. Your account has been corrected, and you are currently showing a credit on your account in the amount of $93.86.Blue Shield would like to apologize to you and your providers for any inconvenience you may have experienced while covered through our company. We are making many changes within the company to adapt to the frequent changes occurring in the industry. We will take your experience into account when we are making decisions which will affect our members now, and in the future to ensure that our service to you is the best it can be.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. In addition, we have 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 you 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], CoordinatorGrievance Department###-###-####