Blue Shield of California

Review: Anthem has recently stated that they have had a breach in their security and millions of it's customers information was hacked. Their responce to this was to create a website www.Anthemfacts.com and a toll free number.

I needed to know if my information was among the millions that have been hacked and this is the results of me attempting to find out.

The toll free number that they gave connected us to Anthem call center. The only information they had was to inform us that their system was hacked, that if I had any other questions to go to the website above. Another words the 800 number was created just to tell us to go to the website.,

I went to the website site and it stated that this was from the presidents desk. He went on to say the facts. One of the facts was that he knew he had his information stolen. but really their was very little other facts or information to be gained at the website. I called back the 800 number again and they repeated what they told me before, that I needed to go to the website for the answers I seek.

They also informed me that Anthem hired a 3rd party [redacted] id who would have the answers I needed. This is suppose to be a security company but not really.

I called them the next day as instructed and discovered that they aren't eve [redacted] ID but another 3rd party company hiored by [redacted] ID to answer the phones.

When I contacted them they just told me the exact samething as the original 800 number I called the day before. They said I would have to go the the website WWW.Anthemfacts.com for the answer to my one question "was my information stolen"?

Anthem changed the information "from the desk of the president" to now stating we had to call the 800# or go to the website for [redacted] ID for any answers.

I contacted [redacted]ID or rather the 3rd party they hired to answer the telephones. They still insisted that I had to go to the website Anthemfacts.com in order to get my questions answered. But this time they stated that if I'm a victim that Anthem would send me a letter in a few weeks.

Even if that was true and I'm doubting it is because of all the other false and misleading information Anthem has so far provided us, a lot of damage can happen to me if I'm indeed a victim, as I would now describe from the inability of Anthem properly securing all our information as required by law.

Anthem setting up a toll free number, a website and then hiring a 3rd party "security company" who then hired a 3rd party call center to answer our calls (but seemed to have no answers other then to refer us to a website that had no answers) seems to be a sham setup to make it look like they are doing something but in fact they are doing nothing but stalling in an attempt to persuade the government and the news agencies that they are doing everything to help their cherished customer (insured) but in fact are preventing us from finding out if we have indeed been subject to their inept security by allowing our information to be hacked from their system.

May I point out if the president of the company states it is a fact that he knows his information was hacked why won't he allow us the insured (victims) the same knowledge that he himself was able to obtain. In doing so I and the rest of us can take immediate action to protect ourselves as best as possible like he did when he found out his information was hacked.

Anthems attempt as resolution is to hire a 3rd rate (I Googled this company ) supposedly "SECURITY" company to give all of us 2 years of what they call assistance, but if our identity, medical history, SS# and who knows what else was taken so easily from Anthems data bases, 2 years of some sort of assistance is not going to be even close to being helpful.

AGAIN I PROFFER THAT ANTHEM HAS TAKEN HALF STEPS NOT TO INFORM OR HELP BUT TO DO DAMAGE CONTROL BY MAKING IT SEEM ON THE SURFACE THAT ANTHEM IS BEING HELPFUL. IN REALITY THEY ARE BEING ANYTHING BUT AND ATTEMPTING TO DO IT ON THE CHEAP LIKE I HAVE TO ASSUME THEY DID IN PROTECTING EVERY ONES INFORMATION IN THE FIRST PLACE.Desired Settlement: Anthem stop withholding information from its customers and insureds about their information being stolen and what information exactly was stolen. Their web site is very ambiguous about that.

Allowing us to be able to contact them and be able to answer our questions, HONESTLY and in an informative manner.

Have someone with this information contact me via email with a yes or no to my question, HAS MY INFORMATION BEEN STOLEN OR AM I ONE OF THEIR VICTIMS?

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on May 14, 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 signed 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]r mail at:[redacted] If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.

Consumer

Response:

I am rejecting this response because:Blue Shields response is vague at best. They didn't provide any contact information of anyone that might be taking responsibility for the issue. They provided nothing except a very vague and inconclusive response to a issue that does not seem important to Blue Shield.They have not at this time bothered to contact me nor do I expect them to. I would be glad to sign an authorization form so that they would release the information to you so I can obtain it because they certainly won't be contacting me. This is why I had to contact your office for assistance.

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 Bruce Schwartz, has completed our grievance process regarding this specific issue. A response letter was mailed directly to the member on June 1, 2015. 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 phone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department's Internet Web site [redacted] has complaint forms, IMR application forms and instructions online.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

Consumer

Response:

I am rejecting this response because:At the end of this message this person invited me to call them but did not provide their name or telephone number to do so.

Review: I have been calling for over two weeks now and can never get in contact with anyone. I've been waiting 2hrs on hold no one ever picks up.

I have been contacting Blue Shield of California for over two weeks now with no response. All I want to do cancel my coverage but cant get in contact with anyone. There is no way to cancel it online, I contact them via the website got a response 3 days later saying I have to call in. I attempted again and again most times the system hangs up on me saying there is too long of a wait time.

This is the 3rd time I finally got through and waited on a real person to pick up its now been over 2 hours and no one had picked up. I don't have all day to be placed on hold to resolve something so small that I could do online.Desired Settlement: Cancel my coverage ID# [redacted]. I've already stopped automatic payment weeks ago since no one seems to be able to get in contact with you.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California Life & Health Insurance Company (Blue Shield Life) dated January 27, 2014, concerning a Blue Shield Life enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield Life.

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. The enrollee's concerns was resolved on January 24, 2014, his plan was cancelled effective December 31, 2013.

Review: We have logged over 35 phone calls trying to get some policy errors corrected. No one has been able to assist us.

I don't know where else to turn after 107 days of being pushed from one person to the next and getting no resolution. We have logged over 35 phone calls to Blue Shield and Covered CA. Can you please see if anyone is willing to take 5 minutes to resolve my concerns? I don't think this will take much time.

The below issues were prompted by mixed up information between my partner's application and my application with Covered CA. Without going into too much detail, I will give you what I believe you will need.

On 5/31, my coverage (policy [redacted]) was cancelled by CoveredCA direction to Blue Shield. I was not informed of any issue or the cancellation, but was later told that this was resulting from an incomplete change of address that was submitted in March. In an effort to resolve this issue, we uncovered the crossed information on my application and [redacted] application with CoveredCA, which led to issue number 2 below. Through many phone calls and emails (some with [redacted] in your resolution team), we did get me a different policy started for me, which retroactively began on 6/1. That policy is in force and you are accepting monthly payments. My new policy number is: [redacted].

Here are the remaining issues:

1. My new policy (ending [redacted]) shows no deductible paid and I've spoken to several people who said that my deductible will be transferred from my old policy to my new policy, but this has not taken effect.

2. MOST IMPORTANT ISSUES: My partner, [redacted], has policy number [redacted]. In an effort to resolve my issue, CoveredCA first changed her CoveredCA application information to my information and submitted that to Blue Shield (a mistake made on June 24th). As a result, [redacted] coverage went into a pending termination status. This was corrected by CoveredCA on July 17th and [redacted] details were re-submitted to Blue Shield on that date.

[redacted] policy still has two issues:

A. [redacted] policy had a claim for $3,000 on June 17th for provider Gita Zarnegar. This claim showed that it was processing, but in July, it disappeared from the online system and has never returned. We have not had any further details on this claim, but we know it was received and in-process.

B. No payment has been taken for [redacted] policy for July, August, or September. Auto pay is set up on this account, but there is an error with her payments and according to the Blue Shield team, this is because CoveredCA active policy info has not been received yet. We reported this to your escalation team and CoveredCA team on August 6, yet it is still not resolved.

Here are details that you may need to reference:

1. [redacted]: CoveredCA case ID: [redacted], Blue Shield Policy: OLD: [redacted], NEW: [redacted] LAST 4 SS: [redacted]

2. [redacted]: CoveredCA case ID: [redacted]. Blue Shield Policy: [redacted]: LAST 4 SS: [redacted]

3. Blue Shield Ref # regarding [redacted]'s policy: [redacted] (representative was [redacted])

4. Blue Shield Ref # regarding [redacted] policy: [redacted] (representative was [redacted])

5. CoveredCA incident number that corrected [redacted] policy info on July 17th: [redacted] (representative was [redacted]).

We realize that you may not be able to respond with detailed information via email. You may call our numbers on file and we can verify our identities to discuss any questions you may have.

[redacted]

Our Address:

[redacted] Ave

#[redacted], CA [redacted]Desired Settlement: Two resolutions are requested:

1. [redacted] paid deductible is transferred to new policy so that any new claims don't incur a new deductible.

2. [redacted] policy is corrected to accept payment and provide consistent coverage. Her claim is processed or we are told to re-submit the claim.

Consumer

Response:

Thank you [redacted]. The business has resolved the issues when I told them I was contacting your group. They took care of everything within 2 hours.

Review: On 01/01/15 I changed insurance and I had already paid my previous insurer( Blue Shield of CA for the month of Jan. I submitted the appropriate and requested documentation to them and they sent me a statement on 01/27/15 that I had a credit of $1102. I never received a check and called them 02/20/15 and was told it was in process. I called them again on 03/23/15 and was initially told to wait 3days and if I didn't receive a check to call them and they would resubmit. I questioned them about whether a check had been issued and they admitted a check had not been sent but said it was sent to process on 03/06/15 and to call them again in 3days. This is a bizarre business practice. Refunds should be timely.Desired Settlement: I would like my legal refund of $1102 immediately.

Business

Response:

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]

Consumer

Response:

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

They sent me a check dated 4/2/15 so the issue is belatedly resolved.

Review: Blue Shield of California has held over $1100 of mine hostage and offers no one via Customer service, billing, or even dispute departments who will help or can help. This has been going on for 6 months now and I need help. I have been lied to several times by Blue Shield about when I will receive my refund and by what means (mail or direct deposit). I have been told that the refund check was cashed but say they do not have access to a copy of said cashed check. Further they asked me to please provide them with a faxed copy of my bank statements proving I never received anything or deposited to the account they claim received the money and they don't even keep that info in their records.

I have spoken with the Customer Service department more then ten times for longer than 1 hour, left over 20 voicemails with the grievance person assigned to my case at one point who will not even call me back anymore and has told me there is nothing they can do. I am now in my third or fourth appeal process being told that I need to wait another 30 days for anything to get solved. I have payment history statements from THIER website showing whats happened but they still won't help. I have been behind on rent numerous times because of this and other important bills related to necessity.

Like every other working American in the middle class I do not have the luxury of a buffer when it comes to monthly bills. Because of their negligence and disrespect not to mention condescending nature that has only lead to a dead end within their own system I have experienced nothing has been done to resolve my issue. I have however had additional sums of money taken out of my account by them without my permission which has created massive confusion on their end as they only acknowledge this later instance when going through appeal processes. They do not contact me when they say they will. They do not give me consistent reliable honest information when I request it and they have made my life a living hell.Desired Settlement: I would like this resolved by giving me my full refund plus interest earned. As this is not court and I am not showing how this has negatively impacted my life on a day to day basis I would like it to be known publicly the failure Blue Shield of California has shown me through their existing channels of dispute resolution

There should be ways to help those who need it when a companies own systems fail NOT a dead end.

Review: Last February 21, 2015, received a letter from Blue Shield of California stating that they will debit my account for the amount of $826.86 on March 2, 2015 (enrolled in EFT). Called up customer service and was told that I will not be debited for the amount of $826.86 but rather what is due only which is $265.98. On March 2, 2015, was debited for the amount of $826.86. Called up customer service and demanded crediting back my excess payment as soon as possible amounting to $560.88. I was told that I have to wait first for the fund transfer to be processed before they can credit back the excess payment to my account. Contacted customer service again to follow up my request on March 5, 2015, the only answer I got was they cannot do anything about this as the system processes refund for 7-10 days. I tried to talk to his supervisor but told this matter was elevated to higher management already. I called up customer service again for the 3rd time on March 10, 2015 insisting them to give back my money as soon as possible. Felt useless arguing anymore, just requested to remove the automatic debit from my account. Last March 18, 2015, got a mail from Blue Shield about the termination of my coverage effective March 1, 2015. Got surprised so I contacted again the customer service for the the 4th time on March 19, 2015. He explained to me that it was terminated because as per their record, my husband got dropped from the plan on February 28, 2015. I told him that information was incorrect. My husband and I enrolled for health plan though Covered CA effective January 1, 2014 with subsidy. But when his employer offered an insurance already, I just dropped him off from the plan under Covered CA effective July 1, 2014. They said to call Covered CA instead. Even it was the 10th day from my refund request, just told to wait till the day ends. To date, no refund yet.Desired Settlement: Give back my money as soon as possible. Also, reconcile and update records with Covered CA in order to avoid confusions with the customers by providing them wrong information.

Review: On 11/27/2013, I was walking on a beach in Venice, CA where I stepped on a hypodermic needle. I immediately went to the doctor so that I could be given post-exposure prophylaxis (PEP) so that I would not contract diseases such as HIV. Because my first doctor was not knowledgable about PEP, he told me to go to the emergency room, which was nearby. I immediately did so and was given a prescription for two medications: Sustiva (i.e. efavirenz) and Lamivudine. I was shocked to find out that the bill for these two prescriptions was $720.29, because my healthcare insurance plan refused to pay for them even though I have prescription coverage. Blue Shield's refusal to help me out in this situation is particularly mind-boggling because I was doing my best to avoid contracting a chronic, debilitating, and astronomically expensive disease. It seems only logical that they would want to assist me in PREVENTING this disease rather than force me to take a terrible chance and risk contracting this deadly disease. Perhaps Blue Shield would argue that the doctor should have prescribed something different, but after the pharmacist called him, this is exactly what he intended to prescribe. In short, this was deemed the most appropriate medication to prevent the disease. It is simply unacceptable that Blue Shield is refusing to help out with the one-time cost of this medication (which only needed to be taken for 30 days). I saved myself and Blue Shield untold thousands of dollars by preventing this disease, yet Blue Shield seems neither interested in that prevention nor encouraging of such prevention efforts in the future. Blue Shield should know and recognize that the world is changing. In this case a few "pennies" of prevention are worth many, many pounds of chronic disease maintenance. I sincerely want to believe that somebody at Blue Shield will recognize how obvious this is and will make some substantive effort to pay me back or the $720.29 that I spent doing the responsible thing!Desired Settlement: As I mentioned, I paid Ralphs Pharmacy in Marina Del Rey, CA a total of $720.29 using my American Express card, because Blue Shield refused to pay for the Sustiva drug, even though it was deemed absolutely necessary by my physician and even though it ultimately prevented my acquiring of any disease. I certainly do not expect Blue Shield to pay every last penny, but I ask them to look carefully at this situation and pay the one-time/one-month benefit for Sustiva as a covered drug.

Review: Blue Shield charged me for premiums after I had already cancelled my account.

I cancelled my account as of Dec. 2015, but was billed $983.86 in February. I've contacted Blue Shield nearly every other week since the fraudulent charge, and every time I was told that the charge was in fact an accident and that I should receive a refund within 7-10 business days. I've been told this at LEAST 4 times since February, and I still have not received a refund. On April 11th after telling them I would like to file a grievance, I was told that the issue was being raised to a their customer complaint support team (that may not be the correct name of the team, but something like that) and that I would be contacted within the week. I never was.

I have multiple reference numbers for many of the calls, and the customer support team (including supervisors) has tried to be helpful. Each call has ended with me being told that I should expect my refund within 10 days. I've also been told that the issue has been raised to their Issue Resolution Team, but I never received a call, a refund, or any indication that this issue will be fixed or I'll get my money back.Desired Settlement: Entire promised refund of $983.86 delivered ASAP.

Review: We sent an automatic payment (as we always do) from our [redacted] account dated March 28 to pay our monthly Blue Shield bill, due April 1 for $959.00. We received a notice of cancellation of our account later, stating that it would be canceled for non-payment. We called [redacted] immediately, who confirmed that the check was sent. We then called Blue Shield who informed us that we would need to provide the cancelled check as proof. We had [redacted] do that in mid April. We never heard anything back from Blue Shield.I called again on April 30 and spoke with [redacted] who asked me to send the canceled check as they still had no record of our payment.I emailed a copy of the check to her personal work email on May 1. I followed up with an email. She responded and said to allow 5-7 business days for it to post to our account. Today, May 19 I emailed her again as we still have not had the $959.00 posted to our account. She said she would check into it again, but I have not received a reply in the intervening 8 hours.Desired Settlement: I want the $959.00 credited to our account and a confirmatory letter documenting that our account is paid in full through June 1st.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California Life & Health insurance Company (Blue Shield Life) dated May 23, 2014, concerning a Blue Shield Life enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield Life.

Review: I have been attempting to process an out of network claim for over two months. I've made five phone calls to their customer service line, and with each call, they say that there's a new issue with my documentation (that was conveniently never mentioned before) or that it's "being worked on." At this point I've lost all confidence in their services and am convinced that I'll never get paid for the claim. I can absolutely see why people just give up and lose money! It's been a colossal waste of time and source of major frustration. They're at best wildly incompetent and at worst outright thieves.Desired Settlement: I need to have the claim processed immediately so that I can receive my funds! It's been 60 days since I first sent in my paperwork.

Business

Response:

We thank you for forwarding these concerns to Blue Shield of California (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] within 30 calendar days. 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.

Review: Service was cancelled effective February 28th, 2015. I received cancellation # [redacted], from an individual with badge # [redacted].This occurred because after many issues with Blue Shield, I was charged $20 (the monthly fee) on Feb 18th for March's dues, two weeks early. I cancelled my monthly, no subscription plan and was told I would receive my refund at the beginning of March.On March 23rd I received, instead of my refund, a bill for April's payment, for a service I no longer have. I called Blue shield's payment department and spoke to a woman named Mary (case # [redacted]) who said it was a mistake, and that I would NOW receive my $20 refund, and to ignore the bill that came for April's payment.I never even cared if I got my refund back. Blue Shield has just been so horrible to deal with that I just want no further contact with the company. But instead, on April 18th, I received ANOTHER bill demanding $40 now for April AND May. I also did not receive the refund that three separate individuals from Blue Shield have told me is coming, despite me telling them of the previous problems I've had each time I contact someone.Desired Settlement: I want my $20 back, I want you to stop sending me bills for absolutely nothing, and I want you to leave me alone. This is the same thing I've asked every single time I've called.

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 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.

Review: I am writing to file a formal complaint against Blue Shield of California, Installation and Billing, P.O. Box 3008, Lodi, CA 95241-1912. I have been a member since 04/01/14 when I initially purchased health insurance for my family of 4. I requested my husband be removed from the policy as of 06/30/14 due to his already existing health insurance he maintained due to health issues prior to April 2014. The original plan was for him to switch but with his health issues at the time, he was unable to make the switch. I called to remove my husband and was informed it was done. I was told a new premium would be calculated and would be auto deducted as previously instructed. As time went on I began to notice that the premium had not been revised and they were continuing to deduct the full amount from my account. When I called I was given the new premium amount of $760.54, which would allow for a credit for July, August, September, and October for the months that the incorrect premium of $1,098.70 was removed from my account. I also inquired about crediting back to April since my husband had other insurance and never used Blue Shield. They stated that as long as I provided them with a copy of the insurance card they would be able to. I later found out from another phone call into Blue Shield that the copy of the card would not work despite what the representative instructed. I then fax in the welcome letter for my husbands insurance 3 different times which I was continually told that it was not received despite my three receipts of fax number verification and success receipts. I called in numerous times to be told that the credit would be complete and to call back in 48 hours. Each time that I did this every representative didnt have any clue as to the issue that I was talking about and they would tell me the same thing. I eventually spoke to a manager named Phil after approximately 10 calls into the company without any success. Phil kept me on hold for one hour and 5 minutes, which was completely unacceptable. He finally called me back to tell me that the credit should be $371, which is completely unreasonable after going through the charges. He said I would be called back 72 hours later, which again no representative ever called. I have attached an excel sheet of the charges and my view of the credits. I am feeling completely helpless as each phone call into Blue Shield has placed me back to the beginning without any resolution. On December 18th Blue Shield did credit my account for a total of $883.52, which is at least something but there is still a need for further credit to be resolved. The company is not taking this matter seriously as it has been 2 months since the original complaint was made. I am asking for your help in getting such a matter resolved, as they are not responding to me as a consumer. I sincerely appreciate your time and concern with addressing such a matter.Desired Settlement: Credit the remaining amount that I am due.

Business

Response:

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

Business

Response:

Dear Ms. [redacted]:This is in response to the grievance received by Blue Shield of California (Blue Shield) on January 15, 2015, regarding PPO health plan. You 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 approved. Our records show your spouse termination date as of April 2, 2014, in our system. In regards to the reimbursement of your premium dates, we have issued a refund in the amount of $723.06 to your credit card. Please allow 7-10 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 caused. We thank you in advance for your patience, membership, and understanding. We 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,[redacted]Grievance Department###-###-####

Consumer

Response:

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

Consumer

Response:

I previously submitted a complaint regarding a premium refund and was sent a letter from Blue Shield of California dated 1/30/15 that my refund of $723.06 would be credited back to my credit card 7-10 business days from [redacted], Coordinator from the Grievance Department ###-###-####. I have left Tracey numerous messages because the refund has not been credited back. Upon calling the service line for Blue Shield they informed me once that the credit was in suspension and the rep would check why. Our call was disconnected after 25 minutes on hold then I never received a call back despite the fact that they assure the caller if a disconnect happens they will call back. Upon calling back 2 hours later another rep told me that my credit due would only be $300 some dollars. At this point I am at a loss at what to do because the first time I contacted Revdex.com Blue Shield then responded with the letter therefore I informed Revdex.com that the issue was taken care of because of the letter and phone call I had received. I am asking that a check be sent to me directly from Blue Shield or immediate credit to the bank account. Thank you for your time in resolving this matter.

Review: Around the time Obamacare was being implemented (December 2013), I used CoveredCA to choose a different health care provider and was billed for the month of January, thereby effectively starting my new healthcare. During that time, I tried calling every day for 4 months (until a few days ago) and each time I called Blue Shield of CA, I was given an answering machine message saying that I could not be helped at this time due to call volumes, and then it would hang up, so I NEVER got a chance to cancel my Blue Shield. Now they say that it's my fault, and they're charging me for the month of January, and threatening to go to a collection agency. This is inexcusable.Furthermore, when I finally was able to contact them, they asked me to fax my starting kit information, which I never received from my current provider (Kaiser). I then called Kaiser to request one or proof that I never needed Blue Shield for the month of January (because I already had Kaiser), but Kaiser's message center now says the same thing as Blue Shield's did the whole time (that they cannot help me over the phone due to call volumes, and then hangs up).Blue Shield's website never gave me the chance to cancel, nor does Kaiser's website give me the chance to request the billing information I need.Desired Settlement: I would like Blue Shield to stop harassing me for the bill, and stop threatening to go to a collections agency. I would like the matter closed with no further action on my part.

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: Non-existent customer service for customers. Cannot make changes to current plan or get information regarding past services.

In mid January 2014, I Called Blue Shield of California to upgrade one family member and add another to a medical plan. After nearly 45 minutes on hold, I spoke to an agent,[redacted], from a call center in the Philippines. I was told that the coverage I requested would begin on Feb 1, 2014. To date, I have not received any communication documenting the assurances made by [redacted], or her supervisor, [redacted]. Since then, have called on at over 10 separate occasions. Most of the time the customer service line hangs up on me ''due to call volume'' after I enter my insurance information. On the two occasions I did not get hung up on right away, I was placed on hold for nearly an hour. I could not wait any longer, so once again did not speak to anyone. I have also sent two e-mails with my queries but am yet to receive a response. The Blue Shield of Cali websites promises a turnaround time of 24 hours for e-mail questions. It's been a week and NOTHING. I don't know if my request to upgrade coverage and add coverage for another person has been processed, thus, I don't know if the newly added family member has insurance.Desired Settlement: I am requesting to speak to a competent Blue Shield of California agent who can confirm coverage changes & provide documentation and explain a claim anomaly. A discount based on the lack of service is also appropriate.

Business

Response:

This letter is in reference to the correspondence submitted to Blue Shield of California (Blue Shield) dated May 10, 2013, 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 and would like to inform you that we have reviewed the concerns raised in the correspondence submitted. We have enclosed a copy of our resolution letter issued to the enrollee.

If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

Sincerely,,

[redacted], Executive & Regulatory Coordinator

Review: I have twice contacted Blue Shield through their website inquiry form. Twice I received emails saying I would have a response to my inquiry within two business days. It has been more than 5 business days for my first inquiry and over 3 business days for my second. These are inquiries regarding claims and getting reimbursed for services. Wait times for phone are incredibly long, so I used their online inquiry service and it seems the inquiry has been lost into the ether.Desired Settlement: I would like my inquiries answered in detail in a timely manner.

Business

Response:

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 9, 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 a grievance to address the concerns raised in the correspondence submitted. Please be advised that grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to Mr. [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com.

If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

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

Consumer

Response:

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

Review: When signing up for a Blue Shield of California Enhanced Dental HMO plan the website states that for a resin-based composite filling costs $20 per tooth. When I went to the dentist they told me that it would be $90 out of pocket per tooth. No $20 option was available. This was a provider whom was on a list of choices given to me by Blue Shield, so I know my insurance was valid there. There was no $20 filling through my insurance. I thought that I would be able to file a claim to be reimbursed for the difference between the prices. But was informed by the company that I could not file a claim. Their website is very misleading. I would have never bought that insurance plan had I known that the out-of-pocket cost would be $90. No where does it state that different fillings have different prices. Under the benefits page they list the cost as being $20 per tooth. Stand behind what is clearly stated, not what is hidden from consumers.Desired Settlement: I paid $360 for four fillings. I should have had to pay $80 for all four fillings. They were resin based composites, which according to the blue shield website should have been $20 per tooth. I want the $280 difference refunded to me.

Review: My cobra administrator, Tri Ad, managed my health insurance payments and policies between myself and your organization. In November 2013, I called them and told them to cancel my health insurance policy. I asked them to keep my dental and vision care, till the end of my term which was another 2-3 more months. But to cancel the medical insurance. My bank made a mistake continuing to send payments that weren't supposed to go out. I contacted Tri-Ad, alerted them of the mistake, and asked them to refund the money. They have refused, and I lost my remaining savings. $3,000 was gutted from my account, and it financially destroyed me. I ask please to refund this money. I did not use the insurance at all. I told them to cancel it, so I did not use it at all. I had become approved for state medicaid, and didn't need it anyway. They say I had insurance and paid for it, but I never used it, and had asked them to cancel it. Please refund the money. I am not disabled and this money that was lost, is a significant amount of money for me, and would be very helpful for me to have again.Desired Settlement: Please return the money that was lost, nearly $3000.

Review: I was on vacation for the month on July of 2013 in Mexico, and had an emergency procedure done on my breast due to pain & inflammation; I got very scared due to my current condition of mammary fibrocystic disease & consulted a doctor. I had the procedure done and when I came back I made a foreign claim to get reimbursed by my health insurance Blue shield; since august last year, and they had requested many records of the procedure, receipts, laboratory results, etc. and was told many different reasons every time I called to obtain status. Now they are asking for everything to get translated to English after I was told that the foreign claims dept. would take care of it. Now I am at position that after 10 months of calling I think that they are falsely informing me of the process of my claim, since all the customer service representatives just tell you their own assumption of the status of my claim.Desired Settlement: Total of $4041.29 spent on my surgery.

Business

Response:

In regards to the out Country Claims it is a blue shield policy to have the claim translated into English and the Currency needs to be converted. The member has filed a formal appeal and the response will be sent out shortly after the formal review.

Review: I received a letter in the mail on June 30th, 2015 stating that 2 prescriptions were filled passed my insurance termination date. After I was terminated from my previous employer on October 28th, 2014 I knew that I would be losing my insurance therefore I ordered my medications prior to the end of my insurance. Being that was a Wednesday I guarantee the order wasn't processed immediately and it was filled after my insurance was terminated. I called Anthem on the evening I received the letter and was transferred to [redacted] where I spoke to a woman by the name of [redacted] whom I was extremely distraught about this situation to. Being that I owe $492.24 when I would have never ordered this medications she explained to me, that at the time they were finally filled the insurance showed still active in their system, and they processed it. It was not until 2/2015 that [redacted] received notification that the insurance was terminated. [redacted] stated that I need to have Anthem place a three way call to them and they can explain the situation to me, and the policy and/or medications can be backdated to correct this error for me. I explained to her just as I explained to [redacted] this morning when I called (6/30/15) that I would have never ordered the [redacted] medication had I know that the insurance wouldn't be active. The Topirimate if my insurance wouldn't have covered that being that they are saying I only owe $1.06 obviously I could have gladly paid cash for that. [redacted] my doctor always had samples of and I could have called her to leave me samples behind the front desk until my new insurance [redacted] with the State of California became effective.

I filed a Grievance with [redacted] this morning I felt the need to write this letter in hopes that it can be resolved quickly as I am [redacted]ply upset over receiving this. Being that my new insurance won't even pay for this medication I have had to switch to a cheaper medication for the time being. I would have gladly told [redacted] PLEASE DO NOT fill the order then, let me call my doctor and get some assistance, or as well I am very much aware these pharmaceutical companies offer assistance programs to get the medication to the consumer free of cost in certain situations. All of this could have been avoided.Desired Settlement: I am asking Anthem Blue Cross to assist me in this matter and please back date this to cover the cost so that I do not have to pay this absorbent amount of $492.24. I was told by Express Scripts that it is indeed possible and they have seen it happen times before in situations such as this. If I could have my new insurance step in and refile the claim I would but as stated prior I am no longer on this medication as it was not approved and I have since switched to an entirely different drug.

Consumer

Response:

You may withdraw this now, they have settled this with me and closed my account with a 0 balance.

Review: After many attempts, I have been unsuccessful in getting Blue Shield of CA to refund my August premium for $522.01 which has been owed to me for over six weeks. I moved out-of-state and obtained coverage under a new plan. I called Blue Shield on 7/30/14 and spoke with Rep, [redacted]. I let her know I was cancelling my policy, ID# [redacted], as of 7/31/14. I also let her know Blue Shield had already charged my credit card for the August premium in the amount of $522.01 through Auto-pay on 7/29/14. I requested she make sure I would be reimbursed immediately. She gave me lots of excuses as to how she could not verify this would take place, but would submit to the accounting department. I asked her to follow up, she agreed to, though I never heard from her nor received reimbursement. Additionally, I gave her my new address and had her change it on my account (though don't know if it was done correctly).I called to follow-up on 8/1 and spoke with a trainee, [redacted] who refused to get me to a manager and kept me on hold only to give me incorrect & unclear information. I called againon 8/21 and spoke with Blue Shield Supervisor, [redacted]. He was unable to give me info as to the status of my refund but said he would look into it. I let him know I had not been successful in getting Blue Shield reps to follow up on past issues. He promised he would follow-up and call me back the following day. I received a message from him on my voicemail on 8/27 saying my refund check had been issued on August 12th (#[redacted]) and I should receive it within twelve business days. However, this did not happen.I called again on 9/8/14 four separate times to attempt to get through to someone who could help. I instead spent a great deal of time entering their complex security information required to access their automated telephone system. Each time this resulted in hearing a ring followed by a busy signal, at which point the call then became disconnected. This happened four times consecutively.Desired Settlement: Blue Shield of California needs to refund my August premium of $522.01 immediately. I prefer it be deposited directly into my account. Assuming they insist on their chaotic check process, they need to get me this check to my correct address: I have my doubts as to whether this check ever actually got sent out from their offices.

Consumer

Response:

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 8/12/14 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 9/24/14 and arrived today with no apology nor explanation.