Lone Star Siding Solutions

Member appeals and complaints are reviewed under the Blue Shield (Blue Shield of California) grievance process. The grievance process is designed to give Blue Shield an opportunity to fully review and provide a written response to the submitted member concerns and make a determination of any request if necessary. If we are unable to comply with the member's request at the end of our review, we will provide information regarding an Independent Medical Review which may be available through the Department of Managed Health Care. If the member wishes to discontinue our review, they may request that the grievance be withdrawn by contacting the assigned grievance coordinator as indicated on the Blue Shield acknowledgement letter.

Member appeals and complaints are reviewed under the Blue Shield (Blue Shield of California) grievance process. The grievance process is designed to give Blue Shield an opportunity to fully review and provide a written response to the submitted member concerns and make a determination of any request if necessary. If we are unable to comply with the member's request at the end of our review, we will provide information regarding an Independent Medical Review which may be available through the Department of Managed Health Care. If the member wishes to discontinue our grievance review and withdraw the complaint, please advise.

I am rejecting this response because: blue shield told me that my case was expedited to get resolved within 5 days and it has been longer than that and I still don't have insurance.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me IF I receive the mentioned grievance documents and I am able to resolve my complaint.If the grievance process does not resolve my complaint I will file another complaint with the Revdex.com.Since filing this complaint with the Revdex.com I have met with my doctor who showed me the correspondence from the BCOC.  Seems they were not honest with me as to the holdup  with my authorization.  Apparently the insurance company is playing with my health in telling the doctor how to treat me with no regards to his expertise or my health history.   Cost is running the show with no regard to actual health care.I will play their game to resolve this issue but will not be quiet about the fact that this bureaucracy is at the cost of my health.[redacted]

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to [redacted]...

[redacted] within 30 calendar days. We have mailed an acknowledgement letter to Ms. [redacted]'s mailing address with additional information regarding the grievance process as well as direct contact information for her assigned grievance coordinator. Thank you.

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on May 12, 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] or mail at:[redacted]
 If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for review and would like to inform you that Ms. [redacted], has completed our appeal process regarding this specific issue. It is important to understand that Blue Shield strives to meet the needs of all of its...

members. However, at the same time, we must follow a consistent administration of the benefit coverage as outlined in the member materials and Evidence of Coverage (EOC), so that we are fair and equitable to all members in terms of benefit coverage issues. While we understand the member’s concerns in view of the terms, conditions and limitations of her health plan, we are unable to comply with her request to overturn the denial of her appeal.

I am rejecting this response because: The issue here is when Blue Shield of CA, if ever, intends to apply my $200.00 payment made via Navy Federal to my account. The payment was made on April 14, 2017. I was told by several BS customer service representatives and a supervisor that it would take 7-10 business days to move the $200.00 from the Eligibility Department to the Billing Department. This action simply involves transfering the money to JO8HO9 (the account in question.). This response goes against eveything I have been told, along with Navy Federal regarding resolution of this matter. It should not take 2+ months to apply a good faith premium payment to my account.  I need written confirmation that the $200.00 payment will be applied, and if not why. Otherwise, I will have to request that the monies be returned to me as this is the equivalent of conversion. Regards,[redacted]Attorney at Law

I am rejecting this response because: I was told in writing and on the phone, many times, that I would be receiving the full refund amount of $1119.12-1138.64 back in November of 2014, and consistently since then. Please see all letters and records of calls, confirmation numbers, names, and dates for this information. I received $841.62 (for no apparent reason was this amount sent to me) in January of 2015. I then recevied a letter on 1/27/15, after I filed a greivance, that said 'We have confirmed that the delay... is due to needng additional information regarding your premium." Nowhere do they ask for the actual information, nowhere do they tell me who I can call to provide said information. Along with the check for $164.90 I received on April 16, 2015, (again, for no apparent reason was this amount sent to me) they don't even mention needing information in order to send me the full refund! I demand the full refund of the additional $132.12 that I was promised, or at least the $112.60 that would also fulfill their promise of a fully refunded amount.

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to [redacted] and the Revdex.com...

within 30 calendar days. We have mailed an acknowledgement letter to Ms. [redacted] mailing address with additional information regarding the grievance process as well as direct contact information for her assigned grievance coordinator. Thank you.

I hereby am allowing all information of mine to be shared with the Revdex.com for purposes of this complaint.

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield) for review and would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted....

Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com via US Postal Mail.

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]
[redacted]
[redacted]

this is wrong information I solved it on my own calling for the 39th time. Your policy forced my son to wait 30 days for physical therapy. Shame on you.

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to [redacted] within...

30 calendar days. We have mailed an acknowledgement letter Ms. [redacted] mailing address with additional information regarding the grievance process as well as direct contact information for her assigned grievance coordinator. Thank you.

Dear Mr. **:This is in response to the grievance received by Blue Shield of California (Blue Shield) on August 17, 2016, regarding the eligibility of your dental plan. You are requesting Blue Shield to retroactively cancel your dental plan as never effective May 1, 2015.Your request has been approved. We will cancel your dental plan effective May 1, 2015. Please allow 30 business to receive the refund for the premium dues. If you have questions regarding your refund you may contact Customer Service at the phone number listed below.The appeal review was conducted by a Blue Shield Grievance Coordinator with training and experience in processing member grievances.If you have questions regarding this letter, please contact me directly.Sincerely,[redacted]., CoordinatorGrievance Department[redacted]

I am rejecting this response because: I want blueshield to refund our overpaid premiums as I had called Blue shield repesentatives many times they explained they will refund within 4 to 5 weeks. But it never happened since February. Please do the right thing. If Blueshield said they would review the case more, how long more? Please do the right thing. [redacted] and [redacted]

Member appeals and complaints are reviewed under the Blue Shield (Blue Shield of California) grievance process. The grievance process is designed to give Blue Shield an opportunity to fully review and provide a written response to the submitted member concerns and make a determination of any request if necessary. If we are unable to comply with the member's request at the end of our review, we will provide information regarding an Independent Medical Review which may be available through the Department of Managed Health Care. If the member does not wish to have their concerns reviewed within our grievance process, they may request that the grievance be withdrawn by contacting the assigned grievance coordinator as indicated on the Blue Shield acknowledgement letter.

We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to Ms. [redacted] within 30...

calendar days. We have mailed an acknowledgement letter to Ms. [redacted] mailing address with additional information regarding the grievance process as well as direct contact information for her assigned grievance coordinator. Thank you.

Following the completion of our grievance review, the member has the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC) if she is dissatisfied with the grievance resolution. 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. The department’s Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.