Blue Shield of California

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on November  24, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included o consumer complaint against Blue...

Shield. We thank you for forwarding  these concerns to Blue Shield for review arid would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating o grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances ore resolved within 30 days of the receipt date. A response to the review will be sent directly to [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com. If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

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 completed our grievance process regarding this specific issue. A response letter was mailed directly to the member on April 9, 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 (1-888-HMO-2219) and a TDD line (###-###-####) for the hearing and speech impaired. The department's Internet Web site http://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,[redacted], Executive Inquiries CoordinatorGrievance Department###-###-####

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 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 916-350-7405 or by mail at:[redacted]If 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 10/24 and a notice has been sent to the member.

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.

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

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 20, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included o consumer complaint against Blue Shield....

We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Ms. [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances ore resolved within 30 days of the receipt dote. A response to the review will be sent directly to Ms. [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com. If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on December 03, 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 Ms. [redacted] has submitted a grievance on November 17, 2014. Please be advised that grievances are resolved within 30 calendar days from the date of receipt. 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 attached with the correspondence submitted.If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiry Coordinator###-###-####

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on March 13, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com including 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 grievances 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], Executive Inquiries CoordinatorGrievance Department###-###-####

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 20, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included o consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Ms. [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances ore resolved within 30 days of the receipt dote. A response to the review will be sent directly to Ms. [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com. If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

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 Revdex.com 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 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 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 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 ###-###-####

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 6, 2015, concerning a Blue Shield enrollee by the name [redacted]. The information provided by the Revdex.com including 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 Ms. [redacted]. Our records to 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 a copy of the resolution to the Revdex.com. If Ms. [redacted] has signed to a release of health information to the Revdex.com, you may send a copy to my attention via fax at ###-###-#### or by mail at:[redacted]If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiry Coordinator[redacted]

Initial Business Response /* (1000, 5, 2015/12/29) */
Contact Name and Title: [redacted] Exec. Coord.
Contact Phone: (XXX) XXX-XXXX
Contact Email: [redacted]@BlueShieldCA.com
December 29, 2015
Revdex.com
3075 Beacon Blvd.
West Sacramento, CA XXXXX
Re Case #:...

XXXXXXXX
Dear Revdex.com:
This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on December 29, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.
We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submitted. A response will be sent directly to [redacted]. Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.com. Unfortunately, without a signed release of information from [redacted], we are unable to provide a copy of the resolution to the Revdex.com. If [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at XXX-XXX-XXXX or by mail at:
[redacted] Box [redacted]
El [redacted] CA XXXXX
If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.
Sincerely,
[redacted] Executive Inquiry Coordinator
(XXX) XXX-XXXX
Initial Consumer Rebuttal /* (3000, 14, 2016/01/04) */
(The consumer indicated he/she DID NOT accept the response from the business.)
There isn't a response? I don't want to have to call Blue Shields again and get the whole runaround again. That's the problem.
Final Business Response /* (4000, 18, 2016/01/28) */
This is in response to the grievance received by Blue Shield of California (Blue Shield) on December 29, 2015, regarding a stale-dated claim check in the amount of $138.36, for the dates of service of March 4, 2014, through March 20, 2014, provided by United California Surgical. You hove requested an explanation from Blue Shield of California (Blue Shield) for why we have not reissued this check to you.
During the research of your concerns, we found that the claim associated with this claim check was reprocessed by Blue Shield after receiving a corrected claim from your provider. This corrected claim included additional procedures. After processing the corrections on your claim, it was determined that payment for the original procedures were included in the payment of the additional procedures. The adjusted claim has been finalized, and a check in the amount of $527.16 was cashed by you on March 5, 20)5. Based on this information, we will consider this matter resolved and no further action is necessary. We are therefore closing your case.
We would like to take this opportunity to advise you That the service expectations of our members are very important to us. Please be assured that all member concerns are tracked through our grievance process as Blue Shield uses the information received to continually improve the services we provide.
If you have any questions or additional concerns regcrding this matter, please contact me directly.
Sincerely,
[redacted]
Final Consumer Response /* (2000, 20, 2016/01/29) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I do accept the response. It would have been if they would have told me this back in July 2015 when I first starting calling about the check. Thank you for your time and the explanation.

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 06, 2015 concerning a Blue Shield enrollee by the name of Wanjen **. The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you...

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

Company states they will give the consumer a call in regards to the member ID.

blue d of California July 3, 2017 [redacted] Santa Clara, CA 95051-5141 Subscriber Number: 9[redacted]0 Group Number: W0055698 Dear Ms. [redacted], Blue Shield of California has received your grievance inquiry, which was submitted on June 29,...

2017. Please note that we work each grievance in the order received and we will respond to your grievance, via the U.S. Postal Service, within 30 calendar days from the receipt date noted above. Please be assured that we will contact you directly if additional information is needed to process your grievance. If 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 Care. Sincerely, [redacted] ###-###-#### Grievance Department Inquiry Number: 1[redacted]63 Enclosure(s): Information Regarding the DMHC & Regarding ERISA Notice of Language Assistance CC: Revdex.com **

Final Consumer Response /* (4200, 6, 2015/06/03) */
May 6 CCA incident #XXXXXX-XXXXXX
June 3 BS Back-end department ref #XXXXXXXX
June 3 BS Call ref #XXXXXXXXXX

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

Initial Business Response /* (1000, 11, 2016/06/02) */
With respect to your concerns, we reviewed our records and were unable to identify [redacted] as a Blue Shield of California (Blue Shield) member. We have no record of [redacted] based on the information provided. In the documentation...

submitted, Anthem Blue Cross was mentioned as a possible insurance provider. Please note Blue Cross Anthem and Blue Shield of California are separate companies. Based on the submitted information, we are unable to initiate a review of this member's complaint at this time.
Initial Consumer Rebuttal /* (3000, 13, 2016/06/02) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This is absolutely false & I have the member cards for blue shield and the mailed agreements from a years worth of paid for by me membership and plan to prove it. This is the same kind of run around - no answers given I have received by Blue Shield every time I have tried to remedy this grostly Unjust treatment of a paying customer at the PPO level. This does not solve or address anything. I have the screen shots from the blue shield of California website showing the money they have not paid me back. I have aberyrhjg to prove this. Please how do I submit my entire case and all proof of the issue?
Final Consumer Response /* (4200, 18, 2016/06/04) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This is ludicrous! I have filed several appeals about this issue with Blue Shield this is the first time they have responded. The last 3 or four of them I have waited the said 30 days each time to be told either, there is nothing they can do or they addressed a completely different issue ignoring he real one. And I don't know what game they are playing but I have signed that release that the Revdex.com requested me to already so that's a lie on the part of the insurance company. Their entire tactic has been criminal. I hope it is documented the disgusting treatment they have given me, one of their paying customers at the PPO level. Please let me make clear this is the worst kind of treatment I have ever experienced from any company in my 29 years on this earth. It is a disgrace that this is a required service we must pay to endure or be taxed. They just take people's money and then don't give it back when their customers quit their unfair and dishonest service. This does by NO means address the problem. I repeat I would like my $1100 back and interest earned as I have been negatively affected by this amount being held hostage for over half a year by them. I am a middle class American who has TWO jobs to make ends meet. This kind of financial doscrepency has impacted my financial situation and my ability to get medical coverage time and time again.
Final Business Response /* (4000, 20, 2016/06/07) */
We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We will include the additional information submitted in our grievance review. Following the completion of our review, if the member is dissatisfied with the grievance resolution, he may contact the Department of Managed Health Care for additional assistance. The department has a toll-free telephone number (1-888-HMO-2219) and a TDD line (X-XXX-XXX-XXXX) for the hearing and speech impaired. The department's Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.