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Getting medical records and the digital records act is a joke. All they do is sell data and patients are on their on to get their own medical records when they need them. There is no consolidation of records at all. Hills Physician is one example. They ate a contractor of BlueShield.
Blue Cross is threatening to drop us as a provider based on a patient’s fraudulent accusation. They gave the patient inaccurate information and she has run amok with it. They keep asking me for corrected claims which I have submitted 27 times. Every time they call on the patient's behalf they can’t even pull up claims that I have submitted both electronically and mailed in. I worked an hour and a half with a Blue Cross representative to change this person's diagnosis to suit her, not the doctor or the provider who evaluated her. The patient herself is being permitted to choose her out diagnosis.
A person in grievances named Michelle called us yesterday and told us that they were dropping us as a provider based solely on the patient's grievance which keeps changing every time something gets changed. Michelle states that she has no record of that and has no access to those records. Boom, we are non-compliant in a grievance that the patient refuses to drop. She calls Blue Cross 20 times a day. She has called our office over 50 times, sent threatening letters and routinely sits in our parking lot just watching the office.
Blue Cross never even commented or reacted to our complaints of being harassed. Blue Cross is a very low end payer who puts the patient in the controlling seat as far as billing and medical records are concerned. That might be okay if the person is balanced and mentally stable. But we need protection and accountability from this insurance company when they goof and give the patient inaccurate and unauthorized information and they are allowed to run with it. I just want to say "Thank you Blue Cross for dumping a provider of 13 years based on a fraudulent and ever changing complaint."
I have to assume because I am a cynic that my issue is not unique to BS of CA. Health insurance is already practically unaffordable for most people and these insurance companies, like BS are doubling down ripping off consumers with their high deductible, convoluted, overly complicated plans. I know BS doesn't care about me writing this review... they haven't seemed to make any changes after 570 1-star Yelp reviews either. They just send out an auto-comm:
"We apologize for your experience and would like to have a Specialist reach out to address your concerns. Please email your info to email@example.com and a member of our team will be in touch. Sincerely, The Blue Shield Web Inquiry Team". Thanks but no thanks for the pretend to follow through and concern... But me telling you that BS is ** makes me feel better.
Unfortunately, there is nothing I can do at this point in time to fix my situation, but I hope this helps guide others away from BS. And, if you're stuck with them, please be advised they do not and will not offer a prorated deductible no matter when you start your plan, even if its less than 60 days away from the new calendar year. And they most definitely will not inform you that you don't have a full 12 months to hit your deductible... You have a single calendar year. Oh, and on top of that, you can't enroll at the beginning of the calendar year... you have to wait a month and a half. Just to ensure BS can screw you a little more on your way in/out. You have been warned.
Paid my deductible. Keep getting claims from provider that say pay or go to collections. Took 30 calls to Blue Shield member services providers and IPA, plus letters. Over 6 months has passed. They say problem is resolved. I don’t know yet. Nothing member services has ever told me has been right yet. Numerous times promised they would work on it and call back tomorrow. Never happened. They said they sent a letter that would take care of it. Others at member services say no record of letter. They say it takes time or give them 45 days. They just said they sent a letter that would take care of it and this one they have a record of.
Maybe this time.
Have had Blue Shield PPO SILVER for 3 years and although finding doctors can be challenging the low co payment for office visits 5.00, speciality 8.00, But calling today to renew to find out my 87.00 a month plan is now 193.00 a month with no added benefits from Blue Shield, everything the same except... the premium. I expected a increase not 105.00 a month more!!! I'm really shocked and now being forced to make other choices. Shame on you Blue Shield. Now you're just being greedy! Whoever negotiated for Covered California on The Blue Shield Deal Should Be Fired...
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This company should be put out of business and it amazes me they're still in business. Back in July, I was trying to make a payment over the phone with a representative, against my better judgment mind you. My internet was running slow, so I figured I would just go that route, despite knowing it would likely take at least half an hour, considering the phone reps are so poorly trained and inept at doing anything right or in a timely manner. To make a long story short, the rep tried to double charge me and I corrected the amount. Well, she must have already processed the payment because when I checked my account the next day, over $788 was missing instead of $394. I was livid!
I called them right away, they began any investigation and said that rep would probably lose her job for not disclosing she had overcharged me and getting a supervisor on the phone. 3 wks goes by... they stop following up with me, no refund check in the mail. I call and find out a check hadn't even been issued yet! They actually told me I needed to file an appeal to get the money back that they stole from me! They told me they wouldn't suspend my account unless 90 days behind. Now that they haven't applied that money, haven't returned it, yet they've suspended my insurance as I've been told to go to urgent care by the cardiologist to get an EKG, my blood pressure cuff has thrown 2 arrhythmias, and I called to see what happened to my ins.
Needless to say, I read them the riot act, I'm canceling, getting an attorney, calling the police, The FTC, etc. I'll also going to the ER. These crooks aren't getting another penny of my disability money!!! I only needed to find the surgeon I wanted. I hope he takes Medi-Cal! Then he can fix me and I can go back to work, if my heart is ok. So long Blue Shield. You are incompetent beyond belief! You cause grief, you're immoral and you'll see your day!
As a provider, I have needed to connect with Anthem Blue Cross to resolve and complete patient claims. I have spent hours being re-directed, disconnected, unanswered, and ignored. The email and phone systems are completely dysfunctional and I am frequently met with responses that state, for example, "I'm sorry, I didn't hear that, please repeat your information." I repeat, I type it in, I repeat again (I speak clearly, and I have a good phone connection) and the system consistently drops my calls.
This has been going on for over two months, and has occurred with 5 patients now who are awaiting care. The stalling/stonewalling I have faced from Blue Cross is inexcusable, especially given that people's health and well-being is involved. I am concerned that this avoidance is a deliberate attempt on Blue Cross' part to deny assistance to providers and patients who have legitimate claims and have done their due diligence to follow the rules, only to be met with a gridlock of ineptitude and inertia.
We have been an in network provider for the past 3+ years with Blue Shield of California. We had originally signed up under our group name. However our group only includes one provider so all of the information is the same. We were informed that in order to change our contract we needed to re-credential with our individual provider's information. We were informed that the process would take 120 days at most. Lo and behold 180 days have gone by with no new credential. We are now being told that Blue Shield says the process is MINIMUM 120 days.
We have many patients who have been waiting for us to be in network. The majority of other insurance companies are able to credential quickly by using CAQH, however Blue Shield insists on a committee meeting once a month. This is highly impractical. We are considering simply telling our patients to drop Blue Shield as it seems to be extremely unreliable in terms of contracting providers. I would not recommend this insurance to anyone and would recommend telling patients to consider alternative insurance companies.
I accidentally signed up for coverage through Covered California. I realized it right away and went through a long phone process with Covered California and Blue Shield to get a refund. I was promised my $600 back in 30 days via check even though I paid with a credit card. This was May 1, 2018. (They wouldn't just credit me back.) On July 18, 2018 they are saying they never did anything to refund me yet I have no coverage with them. The person on the phone got nasty with me when I asked them to credit my card back. This is fraud.
I’ve been with A-Blue Shields for over 29 years never had an issue until 2006, I am a cancer survivor, but I’m not sure I can survive the health care cost, my story: I had a wonderful policy at approx $425.00/475.00 per month Before my battle with cancer after the police kept going up in price until it reached $1695.00/$1800.00 and it was going to take another increase and was no longer affordable by any means but due to a pre-existing condition I could not change, when I called they explained that my policy no longer existed and the price was going to continue to increase no matter what until everyone was switched to a different policy. Well not being able to afford it I had to downgrade my policy to a Bronze that may as well be a plastic garbage bag, my rate went down 500.00 per month but my deductible increase immensely 7000/4000?
After the downgrade they started to increase my monthly from $500.00 up to $996.00 now with still a 7000/4000 deductible. It’s just not affordable, yes I own a home but I don’t own it making payments. My health insurance issues have been going on for over 12 years but come on $996.00 for 1-one-☝️ person is insane, and the coverage is less and less, and the deductible same. It’s just not right, work hard follow the rules and no relief in sight, at age 60 may have to sell my 1st and only home just to pay health insurance, you can see how people develop bad credit and there life's starts to spiral downhill, lose your homes and live in the streets, Last; after all this try and get a decent Drs app with a new Dr with Blue Shield's coverage and not have to wait 30 to 45 days for an appointment. It’s just not right.
Affordable family plan health insurance that is easy to obtain with FAQ answered online. The prices are quoted on a general basis so that you are aware prices may be slightly different according to your needs.
I have only had the occasion to contact My health insurance provider a couple of times. Both time I believe I was treated very respectfully. I had pointed questions which were answered very completely. I think this company does a good job of using its website that explain many of the little things that come up.
My physicians at Saint Mary's Spine Center have requested authorization for a spinal fusion procedure I desperately need to repair my lumbar spine. They deny claims that are medically necessary, resulting in prolonged severe pain and suffering to their insureds. Their greed for dollars over patient care is deplorable.
I call Blue Shield customer service from time to time and a simple request or single question can take up to 45 minutes or longer due to language issues and a complete lack of knowledge by the agent. They need to put you on hold every time you ask a question so they can look it up in their book and try to figure out what it is you are asking about. They literally know nothing and have zero training. Blue Shield outsources these jobs to save money, but if they hired people who spoke more than just a few words of barely discernible English in a heavy accent, the phone conversation would be all of about 5 minutes. Wouldn't that also save money? They would have to pay higher wages but it would not take an hour to answer a single and very basic question. There is only one explanation. Blue Shield is paying its outsourced workers three cents an hour. Blue Shield should be ashamed of themselves. Single payer now! End for profit heath care!
There is no way the government could be any worse than corporations at providing health care because health care corporations have hit rock bottom and can't possibly get any worse than they already are. Or can they? Either way, we need to try something else because this system is entirely dysfunctional and Americans are paying outrageous amount of money for some of the worst health care on the planet while executive sit on their yachts off Monaco counting their money and laughing at us.
This is by far the worst insurance I have ever had. I am diabetic trying to get my supplies for 3 weeks now and the authorization is still pending while I am running out of supplies. The customer service people don't care. Of course what health insurance company does care about its members? This one is by far the worst of any. Do not buy this insurance. It's a waste of money and nothing but trouble.
Had Blue Cross through my employer. Since I am retired living on social security have to be real careful about insurance cost. I paid for healthcare for 40 year. Rarely use it.
Very difficult for claims that are not routine. Correcting a typo they make is almost impossible as well. Rates for 2018 increased to the point of unaffordability.
I pay $1100.00 month for my insurance and Blue Shield has denied everything from X-rays to MRIs, my surgeries even my medication I've been in for years. Every one of my doctors and surgeons have to do a Peer to Peer just to get it paid for. Last year I waited 8 months for a medication to be ok. And it was something I had been on for 3 years. Just this last 3 weeks after being home from yet another surgery I was in the phone with Blue Shield. Not only is customer service there so rude this last lady had myself and my doctor's office on a 3 way call. This lady was rude. Had us on hold for over 40 mins before we realized she had hung up on us.
I don't think it's right we have to fight for medication that we need. And have been in for years. I'd like to know what they do when they need go to the doctor and need surgery and meds???? If a specialist is telling you you need surgery after looking at CT scans and MRIs and we are paying all this money to have health insurance but yet we are still being denied... Something needs to be done about this...
I don't know how many times I have called this company, and my enrollment issues are STILL unresolved! They have enrolled me with the wrong Drs., clinics and coverage, and when I requested that they send me another card with the corrected information, they sent me a card with an arbitrarily assigned doctor and clinic instead of the one I chose and had already seen! I really like my Dr., and I DON'T want another one.
I've worked in customer service in the past; companies rate their employees by how many calls they take each hour. If they can't get call queue down within a reasonable number, their performance ratings goes down and they can be fired. So there's no real incentive for providing quality service for the customers. There's only enough time to give people affirmative responses, promise to take care of the issue, get them OFF the line within 2 -3 minutes (sometimes more), and move to the next call. How much quality service can a representative give within that short time span, especially if there are complicated issues that involve inputting information on multiple screens?
Based on my own experiences doing that kind of work, it isn't easy trying balance speed with quality, especially when the employers' focus is on speed. One of my supervisors once said, "I feel it IS a service to take the customers' call quickly so they don't have to long wait times in the queue." That's true, but not at the expense of resolving that customers' issues!
I suspect that's what is going on with Anthem Blue Cross customer service. I hope I'm wrong, but I doubt it. I'm a former Kaiser Permanente member, and I switched to Anthem Blue Cross because I was very dissatisfied with their fast food industry approach to medical care. However, I never had any problems with their customer service. Now, I'm dealing with the exact opposite situation: great care from my medical providers, and ROTTEN customer service from my health insurance plan!
Due to lay-off from work in 2017 I obtained insurance with Blue Shield through Covered CA. So far nothing but problems and unfortunately when calling in to customer service I reach non-US based help desk who are very difficult to understand especially with loud environment they apparently work in. I've asked multiple times for US-based rep to call me back. Each time they indicate call-back within 24 hours but is now a week later and I'm still waiting. Called again and was told call-back within 24 hours but I'm not holding my breath. Such a disappointment after 5 years at United Healthcare where all their support is US-based. Shame on you Blue Shield.
I switched from Covered California with Blue Shield to a regular policy with Blue Shield in March of this year. It's been one nightmare after another with them and it just keeps getting worse. Blue Shield deposits my premium checks every month but stopped crediting them to my account three months ago. I have spent an inordinate amount of time on the phone with them about this issue. The last supervisor I spoke with told me that they had recently changed their billing system and that's why my payments weren't showing up. He told me that everything was alright and I should just put a different code on my next check rather than using my account number. Well, tonight I get a message saying that my insurance was CANCELLED and that I had 48 hours to pay them $1700 or my account would never be reinstated! This includes a $548.17 "reinstatement fee".
I have a complete paper trail of every premium check I've sent which they have deposited (I send them 10 days early too just to make sure). I have lost sleep and time from work as a result of Blue Shield's negligence and ineptitude. They outsource their calls to a call center overseas and the people are not trained. I very much look forward to finding a different healthcare provider once this is resolved. Shame on Blue Shield! I have filed a complaint with the Insurance Commissioner as this has gone much too far.
I have been trying to get a response from Blue Cross as far as my payments are concerned. I hit my deductible in January 2017, and to date Blue Cross has not rectified my account. I've spoken to numerous people at Blue Cross in regards to this, and have been trying to get in touch with Holly to no avail. To date, October 5, 2017, has not returned my calls. The bills keep coming and of course, the doctors and hospitals want payment. I don't know what to do at this point. I have EOB's that indicate I have hit my deductible, but no one will call me back to get this taken care of.
They terminated insurance with no cause, reinstated after a month with apology, reimbursed for the missing month of coverage for the family. 1 year later, (not near an open enrollment period), extortioned me for their missing month of coverage. I had to pay, as no way to change providers due to the Obama-Care requirements. Dropped them at my first opportunity. I would love to see this company go out of business for how I was treated. Never again with these crooks!
I was out of the country and ran into financial troubles and did not pay my premium for two months. They sent me my new card and a statement which I was prepared to pay upon my return. I called them and they told me they would return my call in 7-10 days. After 12 days I called and they said I received the wrong information and would receive a call in 30 days. After 33 days I called again and they told me it would be after 40-45 days. I asked if this is because of the new legislation and they confirmed that it was. I own multiple properties and need to be covered in case of a catastrophic accident. Out of the country it doesn't matter because there I can easily afford health care. I told this company they were lying to me and they had another term for it. I'm seeking a new provider.
The government should either stay out of health care or simply provide a universal plan to all its citizens. I've come to find out that I can get an excellent plan in Asia for $60 a month that includes almost everything. You get excellent care beyond what you get here. I'm moving probably at the end of this year. ** this place and ** Blue Shield. Their coverage is garbage along with their customer service.
My bank sent me a new credit card. I'm enrolled in Blue Shield's auto payment option. I logged into my account on the Blue Shield website and tried to add a new credit card for my payment. The website said all my info was already on file, which it was NOT because it was a brand new credit card. Called. Had to waste time wading through the phone tree only to be told the office was closed. Then they hung up on me. They make everything so difficult and waste so much of my time they should be paying ME.
Blue Shield of CA arbitrarily denies you a vital medication/treatment which has been proven and documented to shield (excuse the pun) you from pain and improve your overall quality of life by improving your mobility - this has to do with gel injections into your knee which is, for all practical purposes, bone on bone. I believe this to be inhumane and cruel, especially considering that I pay $733 a month to Blue Shield each and every month which they have no problem with taking. Also, claims processing is at a snail's pace (took about one month to process my claim - still waiting for the money!). The only thing that Blue Shield of CA is great at is taking your money monthly!
Blue Cross/Blue Shield business is appalling and if it was not such a large conglomerate it surely would have gone bankrupt because of their business practice. My story... For the past 2 years my prescription cost was $0 out of pocket. Come January 2017 my out of pocket rose to $535. Called BC/BS and waited on the phone for 35 mins on two occasions. Ok, I understand everyone is busy but really 35 mins!!! Third time was a charm as I got thru within 5 mins.
Went thru the menu and spoke with someone that deals with prescriptions. Told him since my conversation is being recorded I first I need to complain and it's nothing personal against him but rather for the company he works for. I said, "please let me know what kind of company is BC/BS that changes the conditions (I see it as a contract because a premium is being paid for service rendered) without notifying the customer first? I was paying nothing and now all of a sudden I'm paying over $500 a month. This is terrible customer service and because it is cost prohibitive, when I become ill (or die) for not taking my meds, I'll see BC/BS in court."
Enough said and as protocol dictates I started asking him what are the alternative meds I can take. I started with the 3 that cost the most; $394, $89 and $27. He gave me some alternative meds I could take and then I stopped him to ask a few more question. "How do you know what alternative meds to recommend? There is a chart that cross references to similar medications. So, for one of my pills the only alternative medication you are recommending is 10 mg; 20 mg is not available. Since I am taking 20 mg does that mean I double up on the medication or is it formulated to meet the 20 mg strength?" He could not answer and said he could transfer me to a pharmacist. I said "OK but I have one more question for you. Are you a Dr?" No. "If you are not a doctor how can you safely recommend an alternative medication?"
I am allergic to sulfur and how does he know any of these alternative medications do not contain sulfur. He said I should speak to their pharmacist and will transfer my call. As the call was being transferred it was dropped. I think they tried to call back within a minute but I was so pissed off with the answers I was getting I really did not want to speak with anyone.
So, I spoke with one of my doctors and he gave me enough samples of the $394 meds until there is a fix; whatever that may be. For the $89 meds, I am still waiting to hear from my other doctor and according to BC/BS there is no alternative medication. This experience is almost as bad as the EpiPen and my heart goes out to everyone that is experiencing similar medical cost problems.
Since I enrolled with Blue Shield CA in 2016, I have had ongoing repeated problems with the billing system. I am told that there is a 2 month delay in updates to the premiums due. This resulted in me being overcharged for my January coverage - the system continued to bill me for the 2016 plan, rather than the 2017 plan that I changed to effective Jan 1. I cannot believe that this level of service is considered acceptable by the California insurance bureau. Blue Shield CA should be required to upgrade their systems so that consumers are not routinely overcharged. I spent another hour on the phone with a rep who basically told me that I just needed to be patient and wait the 2 months for the system to catch up. I have taken the initiative to calculate and update my payments, so I am fine for moment... until the next Blue Shield SNAFU.
Blue Shield of California deceived me as to the terms of my dental plan. As a matter of fact, they did not disclose to me the complete terms of my plan either upon the enrollment or renewal. My plan had one year waiting period and when I wanted to use my insurance for the first time (after paying them for a year and half) they denied me practically everything.
It took me additional several months to get from them at least some explanation for their denial. Only then they sent me the evidence of coverage with some weird restrictions that had never been sent/disclosed to me before. When I complained to them that they failed to make proper disclosures, they prepared a false account of my complaint and just canceled my insurance, falsely alleging that the cancellation was requested by me. In such way, they managed to pocket all my premiums without having any expense. Since I had a deductible, I even had to pay for the full mouth X-rays they requested from my dentist without any legitimate reason (they did not need the full mouth X-rays to invoke the restrictions they had been concealing from me).
I am both a provider and a patient with Blue Cross PPO coverage, like many people, I also received a notice from this company indicating a 30% increase in my premiums, they also increased my deductible. I would like to share that as a healthcare provider, Blue Cross has slashed their reimbursement to providers by a whopping 60%. I will no longer will be accepting Anthem Blue Cross of CA. I understand this company wants to turn a profit; but increasing premiums by 30%, raising deductibles and co-insurances, and cutting back provider payments by such a huge percentage, one wonders how much profit is enough for this company. Unethical practice by this company.
Blue Cross of California Company Information
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- Blue Cross of California