Blue Shield of California

I am rejecting this response because: it is not a responseIt is a we will get to it later I've been dealing with these same delay tactics for monthsI also have signed certified letter receipts from February in which our grievance was ignored

blue d of California July 3, [redacted] ** Santa Clara, CA 95051-Subscriber Number: [redacted] Group Number: WDear Ms***, Blue Shield of California has received your grievance inquiry, which was submitted on June 29, Please note that we work each grievance in the order received and we will respond to your grievance, via the U.SPostal Service, within calendar days from the receipt date noted abovePlease be assured that we will contact you directly if additional information is needed to process your grievanceIf we are unable to comply with your request at the end of this review, we will provide you with information regarding Independent Medical Review which may be available to you through the Department of Managed Health CareSincerely, [redacted] ###-###-#### Grievance Department Inquiry Number: [redacted] Enclosure(s): Information Regarding the DMHC & Regarding ERISA Notice of Language Assistance CC: Revdex.com **

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 we are currently reviewing the concerns raised in the correspondence submittedA 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.comUnfortunately, without a signed release of information from [redacted] , we are unable to provide a copy of the resolution to the Revdex.comIf [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at 916-350-or by mail at: [redacted] ***If you have additional questions regarding this matter, please contact me directly at the telephone number listed below

This letter is in reference lo the correspondence received by Blue Shield of California (Blue Shield) on December 15, 2014, concerning a Blue Shield enrollee by the name of Mr [redacted] The information provided by the Revdex.com included a consumer complaint against Blue ShieldWe 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 planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances ore resolved within days of the receipt dateA 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 matterplease contact me directly at the telephone number listed below

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 15, 2015, concerning a Blue Shield enrollee by the name of [redacted] The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Ms [redacted] , has not completed the grievance process with the planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances are resolved within days of the receipt dateA response to the review will be sent directly to Ms [redacted] , and a copy of the resolution letter 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 any additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely, [redacted] ***, CoordinatorGrievance Department ###-###-####

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

Company states: Per covered Covered CaliforniaCustomer must have coverage through March 1st to May 23rdMarch, April and May are due a partial refund of May which is $The other plan made a binder plan, after that break they did make initial payment of $and so those two amounts total $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 CaliforniaCovered California will then notify us that they did not need to have that coverage and we would reimburse them that full amount

Initial Business Response / [redacted] (1000, 5, 2015/06/29) */ This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 24, 2015, concerning a Blue Shield enrollee by the name of [redacted] The information provided by the Revdex.com included a consumer complaint against Blue Shield We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submittedA 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.comUnfortunately, without a signed release of information from [redacted] , we are unable to provide a copy of the resolution to the Revdex.comIf [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at XXX-XXX-XXXX or by mail at: [redacted] Box [redacted] El [redacted] Hills, CA XXXXX If you have additional questions regarding this matter, please contact me directly at the telephone number listed below

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

Final Consumer Response / [redacted] (4200, 6, 2015/06/03) */ May CCA incident #XXXXXX-XXXXXX June BS Back-end department ref #XXXXXXXX June BS Call ref #XXXXXXXXXX

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on November 24, 2014, concerning a Blue Shield enrollee by the name of [redacted] ***The information provided by the Revdex.com included o consumer complaint against Blue ShieldWe thank you for forwarding these concerns to Blue Shield for review arid would like to inform you that [redacted] ***, has not completed the grievance process with the planWe are initiating o grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances ore resolved within days of the receipt dateA 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.comIf you have additional questions regarding this matter, please contact me directly at the telephone number listed below

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

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 planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances are resolved within days of receipt dateA 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 belowSincerely, [redacted] **, Executive Inquiries CoordinatorGrievance Department###-###-####

RevDex.com: I have reviewed the response made by the business in reference to my concern, and find that this response is acceptable as it is being addressed by the California Department of Managed Healthcare (DMHC). While Blue Shield continues to have the false advertising on their website and will not honor the advertised price that lead to me choosing them vs Anthem, I have informed the DMHC and will continue the complaint with them. Blue shield informed DMHC that there was an asterisk after the $70 that referred to "after deductible" which is not true (see attached). I have several charts provided by Blue shield that have absolutely no asterisk. At this time there is no additional action that the BBB can assist with. As you can see with the enclosed documents, when doing a plan comparison Blue Shield says $70 to see a specialist, while Anthem says $70 "after deductible". Anthem is being honest about their prices while Blue shield is not. Considering Anthem has a lower monthly premium I would have chosen them instead of Blue shield if the plan comparison had stated accurate information. I now have to wait for open enrollment which isn't until the end of the year. I am stuck and there is no accountability on Blue shield's part.Thank you, [redacted]

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 20, 2015, concerning a Blue Shield enrollee by the name of [redacted] The information provided by the Revdex.com included o consumer complaint against Blue ShieldWe 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 planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances ore resolved within days of the receipt doteA 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.comIf you have additional questions regarding this matter, please contact me directly at the telephone number listed below

This has been resolvedThey pro-rated the amount as requestedYou can close as resolved

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on March 25, 2015, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you
for forwarding these concerns to Blue Shield for review and would like to inform you that Steve MsMah, has not completed the grievance process with the planWe are initiating a grievance to address the concerns raised in the correspondence submittedPlease be advised that, grievances are resolved within days of the receipt dateA response to the review will be sent directly to MsMah, 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,*** ***, Executive Inquiries CoordinatorGrievance Department###-###-####

Thank you so much for what you do! In today's mail I received my long-lost refund check for $522.01. The check is dated 8/12/and it appears Blue Shield mailed it out with no address (just with my name & "Ashland, OR" even though I had taken the trouble to give their rep my exact
address)I received this check today with the address hand-written: It was posted on 9/24/and arrived today with no apology nor explanation
This is the second time I have contacted the Revdex.com over problems with this company over the past couple of yearsI am confident I would still be without my refund had I not contacted the Revdex.com. I don't understand how a company such as Blue Shield (with such outrageously highly-paid CEOs) can give their subscribers such poor Customer ServiceIt is hard to know whether these kinds of problems result from this company's chaos and disorganization, or from their passive-aggressive style of wearing people down to the point where they give up and Blue Shield ends up keeping the moneyThank you for helping me to get some justice
I greatly appreciate your help and service!

blue of California November 4, 2017 Revdex.com WShaw Lane Fresno, CA 93711 Re Case #: Dear Revdex.com: This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on November 2, 2017, concerning a Blue
Shield enrollee by the name of *** ***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 *** ***, has completed our grievance process regarding this specific issueA response letter was mailed directly to the member on September 28, If the member is dissatisfied with the grievance resolution, she may contact the Department of Managed Health Care for additional assistanceThe department has a toll-free telephone number (***) and a TDD line (###-###-####) for the hearing and speech impairedThe department's Internet Web site hitp://www.hmohelp,ca.gov 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. Sincerely, *** ***, Executive Inquiries Coordinator Grievance Department ###-###-####

Dear Ms***:This is in response to the grievance received by Blue Shield of California (Blue Shield) on January 15, 2015, regarding PPO health planYou have requested Blue Shield to cancel your spouse policy to his original effective date and refund on the overpayment of your monthly premium dues.Your request has been approvedOur records show your spouse termination date as of April 2, 2014, in our systemIn regards to the reimbursement of your premium dates, we have issued a refund in the amount of $to your credit cardPlease allow 7-business days for the refund to be credited back to your credit card.Please note your Preferred PPO health plan for you and your dependents have been terminated, effective December 31, 2014, per your request.We apologize for any inconvenience this has causedWe thank you in advance for your patience, membership, and understandingWe value our members' feedback and use it to continually improve the services we provide.The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievances.Sincerely,*** *** ***Grievance Department###-###-####