Blue Shield of California

I am rejecting this response because: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 - 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.

Company states: This case has now been sent to the Department of Managed Healthcare. Please contact them at ###-###-####.

Review: Blue Shield misrepresented the terms in their new plan, raising our premiums without offering any usable services in return.

Our family had a usable health insurance plan with Blue Shield of California in January. Blue Shield misrepresented the terms of their new plan during a change in February, with fraudulent materials distributed to employees. They misrepresented coverages and actual deductibles were much higher. They also raised premiums. We did not discover the fraud had occurred until I attempted to see a doctor in May, when I also discovered Blue Shield was misrepresenting the doctors who would accept this new healthcare plan. I logged into my account on the Blue Shield website to search for a provider, and one by one each doctor's office informed me they used to accept Blue Shield's plan from January, but they no longer accept the new Blue Shield insurance plan at all. We could not find a doctor who accepted the new plan. Therefore, the entire time we were paying for this new plan it was useless. Since Blue Shield gained this business using fraudulent practices we are entitled to a full refund.

We immediately attempted to cancel coverage and needed to find other coverage, which we promptly did the very same month.

The employer's benefits representative has been unsuccessful in requesting a refund, but it is with the unanimous understanding that Blue Shield misrepresented their new plan.Desired Settlement: We are willing to accept a full refund for our two children and myself, medical portion only. Even though my wife's coverage was equally useless, her portion was paid by her employer who has since needed to upgrade her coverage to be anything of value. If Blue Shield issues our requested refund we will not pursue a refund for her coverage as well. The amount Blue Shield fraudulently took for the 3 of us was $921.64 between February and May of 2014, which is a total of $3,685.64.

Business

Response:

Company states: The customer was referred to their employer. Since this is a group policy no changes can be made from the individual and the group makes the decision and has to be notified.

Business

Response:

Company states: If customer is wanting to cancel then the customer must go to the employer. Blue Shield does not make any cancellation changes. Once the cancellation occurs the refund would happen. Keep in mind that this decision to cancel is up to the employers digression.

Consumer

Response:

I am rejecting this response because:

Review: Consistent delay in processing of an appeal. This delay is enabling Blue Shield to prevent paying on claims due.

We first submitted an appeal in December of 2012 regarding claims for my family.

We then resubmitted an appeal on the denial of claims in February 2013. Blue Shield never responded so the appeal was resubmitted in May 2013. Blue Shield requested 45 business days, finally responded with a denial in June. We then resubmitted an appeal on the incorrect denial in June 2013. Blue Shield then requested another 45 business days to process in JUly 2013.

Today (10/28/13), Blue Shield requested an additional 35 days to process our appeals.

These consistent delays are preventing us from receiving payment that is due to us from Blue Shield of California.Desired Settlement: Process our claims and appeals timely per CA state law on processing times.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California Life and Health Insurance Company's (Blue Shield Life) dated November 15, 2013, concerning a Blue Shield Life enrollee by the name of [redacted]. The information provided by the Revdex.com include a consumer complaint against Blue Shield.

We thank you for forwarding these concerns to Blue Shield Life and would like to inform you that we have reviewed the concerns raised in the correspondence submitted.

Upon review of your letter, it is my understanding that the enrollee is requesting status of their appeal with Blue Shield's Provider Dispute Resolution Team for services rendered to [redacted]. We have contacted our Provider Dispute Resolution Team and the enrollee will receive a response from them upon completion of their review to be concluded by December 27, 2013.

Review: This is a complaint against BLUE SHIELD OF CALIFORNIA - 65 PLUS DENTAL PLAN. On 11-20-15, I called the Blue Shield Office and spoke with [redacted] and her supervisor, [redacted], in the Membership Dept. I wanted to get a confirmation for me to go to a dentist to get two extractions done, because Blue Shield have a lot of dentists, with the same addresses, who utilize a call center and the Call Center employees do not know who the dentists are. I spoke to both [redacted] and to her supervisor, [redacted], who told me that I do not have any insurance; my insurance was cancelled for (non-payment). I asked [redacted] if they had received my premium payments; she stated yes; however, my payments were late. I told her that my payments were not late. I told her the payments were returned to me stating that I had mailed it to the incorrect address in Woodland Hills, CA. I called Blue Shield, they gave me the correct address. Blue Shield told me not to worry about it, just remail it to the correct address, which I did. From the beginning of the year, I have been requesting Blue Shield to please mail me a Blue Shield 65 Plus Dental Plan card; over and over I requested this card. Each time I call they have told me that they will mail the card; to date: November 20, 2015 they have never mailed me an ID Card. I asked the Membership Dept. if they have ever mailed me out any statements for payments due; they told me yes; they have a record that they have mailed me 10 statements. I told them to date I have never received any statements from them. [redacted] told me that they feel that maybe they may have a wrong address on file for me. I verified my address to her; they have my correct address. I would like to know why Blue Shield has terminated my insurance, when I have paid my premiums and why I cannot get insurance for another 3 or 4 months. I need my extractions badly, and it is extremely upsetting to me the way that BLUE SHIELD has treated me. They have received/cashed my checks; I should be insured; my payments were not late.

Product_Or_Service: Blue Shield 65 Plus Dental Insurance

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like the Membership to reflect their records to show the following:(1) My payments were received by Blue Shield 65 Plus Dental Program- my payments were not late.(2) My checks was sent to wrong address/returned back to me; Blue Shield said okay to remail no problem; I complied.(3) From the beginning of the year I have requested an ID Card - I need an ID Card.(4) I would like to be reinstated so that I can have my extractions -I am in pai

Review: I applied for a dental HMO through Blue Shield of California website on 2/9/2015. I used a credit card to make the initial payment. I never received anything in the mail after two weeks. I called several times, probably 5 in total to get the paperwork confirming my enrollment in the policy. Each time I was transferred around to billing, benefits, technical support, member services, etc. Finally after 3 unresolved calls I got someone in member services who deals with enrollment. They confirmed my enrollment and gave me my new member ID number to take to the dentist. My dentist used the ID provided but every time she called to verify the policy Blue Shield said it was terminated or inactive. I called Blue shield to see what was going on and they said everything was active, though today is 3/31/2015 and I still have yet to receive any piece of mail or email from Blue Shield. The only thing I do have are the BILLS they keep sending me. I have paid for 2 months of coverage at this point, and have been able to receive no treatment at all because Blue Shield keeps telling the dental providers that I am inactive. This is fraud. I eventually got so frustrated that I had Blue Shield call the dentist while I was on hold to verify my enrollment. Blue Shield faxed a letter to Dentist called evidence of coverage. Finally I could make an appointment. Then when the dentist tried to give me a treatment estimate, the benefits department at Blue Shield said my account was not active. The nightmare just never ends with this company. I advise anyone considering services from this company to consider other options if you actually want a policy.Desired Settlement: This company needs to be audited. They are not following the law. They are committing fraud.

Business

Response:

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

Review: Six months after suffering a freak jaw injury, which required being rushed to the ER and emergency oral surgery, I started having various medical issues as a result of my bite, which was beginning to misaligned - a common thing that happens after a jaw breakage & splint removal. These various medical issues included the onset of TMJ problems, problems eating & chewing, chronic headaches, and neck issues.

Finally, my general physician concluded that orthodontics was my only viable option. My dentist completely concurred. So, after consulting with an orthodontist, I was explicitly & clearly told by my insurance company, Blue Shield of California - on a few different occasions in fact, and by various representatives - that since the orthodontic treatment I was undergoing was a direct result of a medical issue, that the treatment would be covered under my Blue Shield of CA policy.

That was over 8 months ago. Since that time I have had to contend with every sort of excuse imaginable from Blue Shield... From them repeatedly "not receiving" my faxes (despite my repeatedly receiving fax confirmations),To them later telling me that they needed forms I was never told about previously (which I subsequently & immediately sent to them), To their ongoing inability to ever locate or find my Reference Number in their system,

To being told on three separate occasions that my info was sent to the Claims Department and to wait 45 days (only to find out AFTER 45 days that my information never actually went to Claims, and that it was sitting in limbo),

To finally being told by a supervisor that since my orthodontist uses dental codes and not medical codes, that there would be nothing they can do due to the absence of medical codes (DESPITE THE FACT that I was told 8 months ago that the aforementioned PHYSICIAN'S LETTER WAS TO TAKE THE PLACE OF any medical/dental codes).

Needless to say, I have completely been getting the run-around from Blue Shield of CA, and dealing with them has been a nightmare.Desired Settlement: A fair resolution would be for Blue Shield to simply honor what was originally explained to me: that since my treatment directly stems from a physical injury, thereby making it medically necessary - as attested by my general physician's letter which THEY REQUESTED - I expect them to cover my ongoing orthodontic treatment and to begin doing so immediately.}

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 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 April 20, 2015. The member now has the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC). If the complaint 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. An IMR Application Form and addressed envelope was enclosed with the Blue Shield determination letter for the member's convenience. If the member chooses to pursue an IMR, the request must be submitted to the DMHC directly.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiries CoordinatorGrievance Deparmtnet###-###-####

Consumer

Response:

Consumer states: I am now in contact with DMHC and will pursue this matter with them further and consider this matter closed with the Revdex.com. If I receive a resolution I will contact the Revdex.com.

Review: I wish there was an option to include multiple complaint types. After upgrading my plan to a preferred plan, there have been nothing but issues. Billing amounts have been different every month, I've been calling since January and cannot get anyone to help me. I get the standard "your case has been escalated and someone will contact you within 72 hours" response yet NO ONE ever calls back. After upgrading my plan in January, I have not received a new packet of information for my new benefits, I have not received new cards, etc.I was apparently upgraded to a plan by a sales rep that gave me false information. I just want someone to call me back that knows the plan, understands the plan, can straighten it out, etc. It takes 2-3 hours to get in touch with a real person and then they say they can't do anything but escalate the case and for me to wait. I am tired of waiting, tired of being lied to, and want to get this resolved. I am pregnant and am not getting the coverage I am paying for.Desired Settlement: I want a phone call from upper management. Someone who fully understands each plan and its benefits. Then if it is true that I was upgraded to a false plan, I want to be refunded for claims that I should not be responsible for.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield o California (Blue Shield) on May 2, 2014, concerning a Blue shield enrollee by the name of [redacted]. the information provided by the Revdex.com included a consumer complaint against Blue Shield.

Review: This complaint regards a claim submitted to Blue Shield of California to partially subsidize mental health office visits as agreed in the member's contract with Blue Shield.The member ([redacted]) submitted a claim for 12 mental health office visits from an out-of-network provider ([redacted] in Pasadena, CA) for reimbursement of the subsidies owed to the member as stated in the member's current contract. Blue Shield promises to cover 50% of mental health office visit costs after the $500 annual deductible was met by the member. Each office visit costs $50, therefore all visits after the tenth (as ten visits @ $50 each meets the $500 deductible criteria) should be subsidized 50%, or $25 per visit. Therefore, two visits from this claim should be subsidized, for a total of $50 for this claim. Also, all additional visits during this [redacted]e calendar year should be subsidized at 50%.To date (Aug 19, 2014), Blue Shield has neither credited the account nor reimbursed the member for these costs. Blue Shield's excuse for this is because the healthcare provider ([redacted]) did not provide the "tax-id" number of the business (which is a nonprofit). The member has attempted numerous times to resolve this issue and finalize the claim, including:Apr 11 2014 w/ "[redacted]";May 30 2014 w/ "[redacted]";June 6 2014 w/ "[redacted]" and "[redacted]";and July 11 2014 w/ "[redacted]."Blue Shield stated that they will not contact [redacted] to acquire the "necessary" info. Also, the member cannot intervene on this matter directly, as both parties are claiming that it is the other's responsibility to resolve the problem. [redacted]y has already meticulously drafted and sent the original claim to Blue Shield in order to meet all of the exact info required by the Blue Shield claims dept. Apparently, the format of this claim, as requested by Blue Shield, is very particular and apparently a single mistake can (and did in this case) delay and ultimately void the entire claim.Desired Settlement: The member requests that Blue Shield act professionally, ethically, and expeditiously to acquire the necessary "tax-id" number of [redacted] in order to finalize this claim and credit the member $50.Furthermore, the member requests that all additional forthcoming claims for mental health office visits by [redacted] be accepted and completed accordingly, so this issue will not arise every time the member seeks to receive benefits agreed upon in his contract with Blue Shield of CA.

Business

Response:

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

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 o 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 mailer, please contact me directly at the telephone number listed below.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and will follow the business' recommendation to proceed with the "in house" resolution process outlined by the business.

Review: Dear Revdex.com-I had an unfortunate bike accident several years ago and have been struggling to get Anthem to pay for a variety of claims related to my injuries. They have been making it extremely difficult, denying claims and forcing me to appeal and generally giving me the run around.In the most recent case, an Explanation of Benefit was posted to my account for the last stage in my facial reconstruction ; the date of service was September 22, 2014 which denied payment of the claim. This claim was initially filed on on February 18, 2015 so it took almost 3 months to get an answer despite Anthem telling its members it process claims within 30 days.In summary, I had a call with [redacted] of Anthem and my rep from from HealthAdvocate (a customer advocate firm who I engaged because of Anthem's horrible claim processing history for my previous claims) on on July 24, 2014 regarding submitting this claim to (1) confirm this was a covered benefit and (2) see if pre-approval was required. I was told yes this is a covered benefit and that a pre-approval was not required. During this call we specifically discussed me submitting claims associated with my crown (i.e. dental codes [redacted] and [redacted]); furthermore, I asked specifically if I had to get pre-approved; the answer was empathetically no; I asked specifically if these were covered by Anthem; the answer was yes.Furthermore, this is the 3rd step in a process to reconstruct my mouth following a bike crash. The first step involved a bone graft and the second step was an implant. Both of these were covered by Anthem. In both of the prior cases, I had to jump through hoops to get the claims paid instead of Anthem providing proper customer service. Why does Anthem make me waste my time to get my claims processed and paid? My accident caused significant physical trauma and having an insurance company that makes my life difficult, waste my time and provides misleading information makes it worse and causes mental trauma.Please help me.Desired Settlement: For Anthem to stop playing games, process and pay my claim and issue me an apology.

Review: I terminated my health insurance policy with Blue Shield of California in 2012, but they refuse to delete my personal information from their system.

I terminated my health insurance policy with Blue Shield of California in 2012. It has now been 3 years since I permanently terminated my policy with Blue Shield of California, but they refuse to permanently delete all my personal information from their system. Blue Shield of California told me that because of their internal retention policies they are unable to comply with my request to remove my personal information from their system. California Department of Insurance told me that the law does not require them to keep my personal information after the account closure. Recently Anthem Blue Cross Blue Shield had a data breach where social security numbers of some of former members were compromised. Although Anthem Blue Cross Blue Shield offered a 2-year complimentary membership at AllClearID, this credit monitoring service cannot guarantee 100% protection from the consequences of the data breach. It has now been 3 years since I permanently closed my account. I do not owe any money to Blue Shield of California, and my account was closed in good standing. I do not intend to use their service ever again in the future. The law does not require them to keep my personal information in their system after the account closure, and I do not want my information to remain at risk for possible future data breaches. Therefore, I request permanent and immediate removal of all my personal information from their system.Desired Settlement: Permanent removal of all my information, including social security number, from Blue Shield of California computer system and paper files.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on March 30, 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]. Our records do not reflect 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 a release of health information to the Revdex.com, you may send a copy to my attention via fax at ###-###-#### or by mail at:P.O. Box 5588El Dorado Hills, CA 95762If you have additional questions regarding this matter, please contact me dreictly at the telephone number listed below.Sincerely, [redacted], Executive Inquiry Coordinator###-###-####

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 21, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has 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###-###-####

Consumer

Response:

I am rejecting this response because: by law Blue Shield of California is NOT required to keep my social security number in their system after my policy has been closed (I called California Department of Insurance, and they confirmed that). Therefore, I request that Blue Shield permanently deletes my social security number from their system --- it is very sensitive information and I do not want it to be vulnerable to potential future data breaches. Again, by law Blue Shield is NOT required to retain my social security number, and I request that they permanently remove it from their system.

Review: I signed up with an insurance agent for Blue Shield PPO. I made it very clear to him that I did not want a Covered CA or Pathways plan. He said okay and contacted BCBS to sign myself and my husband for the Blue Shield Silver 70 PPO. I then go to my regular eye doctor and the front office immediately states my doctor does not take a covered CA plan. I was there telling them over and over that it was not a CCA plan. Then they pulled up my information on their billing site and it stated that the plan sponsor is "IFP OFF EXCHANGE" and it is a part of CCA which they do not accept. I contacted the insurance agent and have had no resolution, because he keeps insisting that BCBS stated this is a PPO plan that is not under CCA or Pathways. This is a complete bait and switch. I am appalled that I am going through this. I know there are many others that have been deceived and it is just disgusting to toy with people's lives like this. The doctor told me that my id begins with XEK and it is the first indication of CCA in disguise apparently.Desired Settlement: I would like to cancel the current policy or at least switch to a plan my doctors do accept through Blue Shield (of course that would be without the help of the insurance agent I had hired before to do this work for me). My doctor does accept Blue Shield PPO's just not those that are part of covered CA or pathways. I hope to have a resolution to this matter.

Review: I paid November and December 2015 premiums as a new customer of Blue Shield of CA, but have been unable to go to a doctor or get my prescriptions filled because Blue Shield of CA shows my eligibility date as 1/1/2016. I have documents that reflect my eligibility date as 11/01/2015. I spent over 2 hours on the phone with their customer service who repeatedly put me on hold and still could not resolve the issue. Nor could they give an explanation except to say their billing and eligibility systems needed time to synch. I requested this issue be elevated to Senior Management but they would not. There is no way I believe their computer system takes two months to update. I believe they take premiums but purposely don't reflect that you have coverage so you can't use the insurance and they are able to take your premiums and put towards profit. All the while advertising they are a not for profit company. This is despicable for a U.S. company to be allowed this behavior.Desired Settlement: I would like for their company to complete a root cause analysis for this and to provide written corrective action and give a credit for my November and December premium.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 2, 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 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.Sincerely,[redacted], Executive Inquiry Coordinator

Review: I have not received an accurate bill from Blue Shield since December of 2013. I called Blue Shield in March of 2014 because I had not been receiving any bills in 2014 and there were no bills listed in their online system. I was told that my premium had not changed and they couldn't explain the lack of bills. In June of 2014, I received notification that our monthly premium had increased from $363.00 to $655.84 per month. I began paying the higher premium effective July 1st, 2014. On December 21, 2014, I received a letter stating that my account was in default and my insurance would be cancelled effective January 1, 2015. I called Blue Shield and spoke to several representatives. No one could figure out what was wrong. I was told repeatedly that I would receive follow up calls and never did. I spoke to one rep who explained that the default was from months in 2014 previous to July when I received notification that the premium had increased. She stated that paying $878.52 would cover this period of default, which I immediately paid. On January 16th, I was informed by my doctors office my insurance was canceled. I called Blue Shield and was informed that they had cancelled my coverage effective December 1, 2014. They could not explain why. After many calls, Blue Shield realized the mistake and reinstated my insurance retroactively. On the final call on January 17th, I was told my new premium for 2015 was $678.41, which I began paying February 2015. Since January 2015, I have received bills outlining my old premium amount. I continued to pay the new premium even though it appeared I was overpaying. In May 2015, I received a bill outlining a new premium of $1415.01 and a billing detail that outlined additional plans I had never signed up for. I called and was told it was fixed. In June 2015, I received notification that I was in default and my insurance would be cancelled July 1. I called again and was told it was being escalated to the Issue Resolution Team. I am awaiting a return call.Desired Settlement: I need written confirmation of what our monthly premium is. I need a bill that consistently outlines that confirmed amount. I have spoken to numerous customer service representatives and have documented these calls. I receive different information every time I call. I have even been hung up on by a rep when I asked repeatedly to speak to a supervisor. I have been told numerous times that I would receive follow up or calls back and never have. For every resolution I receive, a new problem arises

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: Dear Revdex.com,

We signed up for Blue Shield of California and live in [redacted] zip code in May 2015. Prior to signing up we asked to see what the out of network limit would be on the providers our family were receiving care from. We were denied ability to find out this information until after we signed up for the plan.

After signing up we received care from out of network providers for reasonable rates for the area in which we reside. However, the “allowed amount” was significantly less than what any provider in the area would charge and reimbursed me at a much lower rate than claimed when I signed up based on this. The amount I should have been reimbursed for is $1245. Blue Shield only reimbursed $518.63.Desired Settlement: I would like the $726.37 owed to me from services provided from May-June 2015. Thank you.

Business

Response:

Dear Revdex.com, This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on February 2, 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, grievance are resolved within 30 days of the receipt date. A response to the review 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:Dear Revdex.com, I have in fact completed the grievance process with Blue Shield's plan and have letters from them if needed to verify. I waited the 30 days, and was not reimbursed for the out of network claims in full.I would like to reiterate that they hid the details of the out of network services from me prior to my signing up even though requested and then had unreasonable amounts allowed per provider and annually once I had a contract with their company. We have had 2 other insurance companies prior to and after blue shield with no issues at all with the amounts our providers are requesting. Further, there are no providers in our area that will charge the allowable fees that blue shield requires. I am continuing to request that blue shield reimburse us according to the full amount from each out of network provider. Thank you for your assistance.Sincerely,[redacted]

Business

Response:

Dear Ms. [redacted], This is in response to the grievance we received on February 2, 2016, regarding services provided for yourself and your family, by non-participating providers throughout your enrollment with Blue Shield of California (Blue Shield). You are requesting that Blue Shield reprocess your claims to allow a greater amount, rather than applying the allowable amounts to non-participating providers claims. Your request has been denied for the following reasons:1. During the course of our review it was noted that you were enrolled in the Silver 70 PPO plan, with an original effective date of May 1, 2015, and which coverage had ended on June 30, 2015. An Evidence of Coverage (EOC) containing the terms and conditions of your plan was sent to you once after enrollment, and is sent again upon each renewal. 2. It is your responsibility as a member to read all of the Blue Shield plan materials immediately after you are enrolled so you understand how to use your benefits and how to minimize your out of pocket costs. 3. Participating providers agree to accept Blue Shield’s payment, plus the member’s payment of any applicable deductibles, copayments, and coinsurance as a payment-in-full for covered services. This is not true of non-participating providers. Charges for services received by a non-participating provider in excess of Blue Shield’s allowance amount are the responsibility of the member. 4. If a member receives care from a non-participating provider, Blue Shield’s payment for that service may be substantially less than the amount billed. The subscriber is responsible for the difference between the amount Blue Shield pays and the amount billed by the non-participating provider. 5. We have reviewed your appeal, and examined your agreement with Blue Shield. Non-participating providers do not accept the same usual and customary rates that our preferred providers in your area do, and because we have processed your claims according to these rates for your area, your request to have your out-of-network claims reprocessed in a way that increases the allowable amount has been denied. 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 your appeal meets the criteria as determined by the DMHC, and independent review organization as selected by the DMHC will review the pertinent issues(s) and/or medical documentation. We have enclosed an IMR Application Form and addressed envelope for your convenience. If you choose to pursue an IMR, please forward your request to the DMHC directly. You are 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. Diagnosis and treatment codes related to your grievance, and their meanings, can be requested by contacting your grievance coordinator. If you have questions about this letter, please contact me directly. Sincerely,[redacted]

Consumer

Response:

I am rejecting this response because:When selecting Blue Shield as our insurance company, we specifically chose the Silver 70 PPO plan with out of

Review: From March 2014-September 2014, my wife and I paid double coverage to Blue Shield through Covered California. We over paid $1552.32 to Blue Shield of California. We realized this in August 2014 and we spoke to [redacted] from Covered CA. He confirmed we were paying double coverage and out policy would be under Enhanced Subsidized PPO at $129.06 per month, and the extra funds would be put towards the rest of the year, therefore we would be covered until the end of December 2014.In October 2014 we spoke with [redacted], who told us we needed to pay $66.97 to be covered for the rest of the year. We have a reference number and billing ID's for several conversation with Blue Shield and Covered CA. We called several times in November and December of 2014, and Blue Shield representatives told us we were covered. In March of 2015, we received medical bills which services took placed in 2014 of December. We spoke with [redacted] and she explained both policies ended on November 30, 2014. Both Covered CA and Blue Shield have placed the blame on each other but no one has resolved this issue. We have already placed a Revdex.com complaint against Covered CA on 3/23/2015.Desired Settlement: We ask for a full refund from on of our policies, medical coverages that ends in December 31, 2014 and the correct tax credit information.

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.

Review: I bought Blue Shield Gold Health Insurance directly on their web site via agent (I bought it from 3rd party web site, and they direct me to Blue Shield main web site). The coverage start on Feb 1st and I paid the fee for Feb when I applied. I received the approval letter on Feb 18. I was busy during Feb and didnt have time to get a clinic. So, I waited until Mar. I was thinking I pay the due on early mar, then get a clinic so I would have the continuous coverage. I tried to pay online on early Mar but their web site doesnt let me pay. It redirect me to coveredca web site and then kick me out, the message says you have been log out. I contact my agent and ask to clarify and she told me to pay by phone and that I should call early in the morning about 8am. She also told me Blue Shield didnt give her any reason why I got kicked out from their web site. I call a few days later, in the morning, but cant get through. So, I try to send them message from their web site contact us page, on Feb 3rd and Feb 26th. Below is the exact text of my message as I sent to them.Message sent on 2014 mar 3.I want to pay my Premium online but your web site doesnt let me pay. Please fix it and let me know when I can pay online. Thanks.Message sent on 2014 mar 26.I contact you on Mar 3 because your web site doesnt let me pay the due. But, nobody response. When I click pay my premium your web site directs me to covered ca. I didnt buy it from covered ca, so I should be able to pay on your web site. When I ask my agent, she told me to call to pay. But, phone call didnt go through. She also asked me to call at about 8am. I understand Obamacare and Coveredca have lousy web sites because they are Government agencies. But Blue Shield is a private company. We are in the 21st century now: all the web site I deal with let me pay online using credit card. Even the road side Pizza shop that has only one room let me pay online. Please fix your web site, so I can pay with credit card online. If you dont let me pay, I may have to buy from another provider, cancel Blue Shield and ask for refund of Feb due. Thanks.For both cases, I received the confirm email from them on Mar 6 and Mar 26 which says Thank you for contacting us. We have received your email. A service representative will contact you within two business days.But, I NEVER receive any follow up from anybody.Please help me to contact them so that I can pay my due online using my credit card. Please remember, I not trying to buy Insurance, its already been approved. I just trying to pay my due. By the way, I still waiting for the coverage packet. They didnt send to me by mail or by email. If I were to buy another Insurance because Blue Shield cant accept my payment online. They simply have to refund my payment for the Feb. Thank you for your help.Desired Settlement: They simply have to fix their web site so that I can pay online using my credit card OR refund my money for Feb.

Review: I have registered a complaint against Blue Shield before and was quickly contacted by Blue Shield in regards to the matter this occurred in October and they were prompt to ensure that my mom's clinical care needs were going to be addressed....it is now December and I am facing the same issues as before. The case management by Blue Shield is horrific...If you need a case manager you will probably want to switch insurance providers during open enrollment. Getting in touch with ANY supervisor is worse than pulling teeth. I wish they hadn't told me they would help my mom so I could have enrolled with another insurance when it was our open enrollment period. DO NOT GO TO BLUE SHIELD IF YOU NEED CASE MANAGEMENT!Desired Settlement: I want them to provide the care that they promised and help my mom

Review: To Whom It May Concern, I have been trying to cancel my coverage with Blue Shield of California for the last TWO MONTHS. It is incredibly easy to PAY them, that service is always available. But for the last two months I have not been able to actually speak to a human. I always get to a dead end and disconnected. Whenever you call the number it always says the same thing "due to high call volumes no one can take your call" HOW MANY PEOPLE WORK FOR THIS COMPANY? This is incredibly unprofessional and inconvenient and even perhaps illegal! My current bill which was only $20.00 is now at $62....and will continue to climb because I cannot speak to anyone or even find information online on how one should go about canceling. There are no high call volumes, this is simply how this company robs the poor. I'm sorry the day I signed up for this insurance. I WILL NOT be paying this bill and I NEED this to be resolved ASAP. Thank you.Desired Settlement: Please cancel my account. Thank you! Subscriber # [redacted]

Business

Response:

This letter is in reference to the correspondence received by Blue shield of California (Blue Shield) on April 14, 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: My family moved from Humboldt County on July 1st due to my husbands work. I previously had a Blue Shield policy with my work, Food for People which expired on June 30, 2014 when we moved. In addition to that policy, I was also on my husband's work insurance with Blue Shield which was active through December 30, 2014. When we moved, I went to Sutter Health Palo Alto Medical Foundation for two doctor appointments. When my insurance was processed (with my husbands policy which was current at the time), somehow it got bumped in the system back to my Food for People policy which was expired and hence, denied. Since then I have called numerous and spoke with very nice people who understand, agree that my health care was covered at the time and process the claim in the very same way and it get denied every time. My husband's insurance representative with the United Methodist Church has also followed up numerous times and has had the same experience. When we talk to people who check the system, they agree but when they process (probably the same way every time without changing anything), it gets denied. Recently I wrote to the Department of Insurance who referred me to Managed Health Care Help Center who contacted Blue Shield who sent my claim through the system and guess what - it was denied. When I speak with people they agree they are responsible but no one take the responsibility to fix whatever keeps their system in place (i.e. maybe they just have to change something on their system which puts my husband's insurance in first place and then it will be processed). But no one disagrees that I had coverage at the time and no one has addressed this issue successfully. I hope you can help. I do have all the documentation if necessary. I appreciate your assistance.Desired Settlement: I would like Blue Shield to pay the outstanding invoice from Sutter Health which is currently $366 (started out as $195 but was recently increased by Sutter Health) and to make any repairs to my credit since they sent my invoice to collection. I have consistently with help tried to correct this error without success.

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 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 [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:P.O. Box 5588El Dorado Hills, CA 95762If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,[redacted], Executive Inquiry Coordinator(916) 350-7168

Consumer

Response:

Consumer states: The company has contacted me and are working to resolve my issues.