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So, the only time I write reviews, positive or negative is when an organization excels in being truly amazing, or is shockingly inept. Words cannot describe the unethical behavior displayed by Blue Cross of CA, and if you have a choice of health insurers, do not pick this company. I get my health insurance through my wife's work, so changing insurers is not an option for us.
About a month ago my doctor ordered an MRI for me. After the appointment was made and a week or so went by I contacted Blue Cross to make sure the procedure was authorized, and I was told they had never received any information from my doctor for it. Confused, I contacted my doctor to check and they confirmed they had sent it and would again. A few days later I called back and a different representative again told me they never received the doctor's order. While on the phone with the representative, they called my doctor and had it resubmitted for a third time! The representative confirmed with me he had it!
Another week goes by and I gave them another call to confirm as I hadn't yet heard from them that the procedure was authorized, but guess what... they said they had no information about it! So now I go to a supervisor, who instead of doing anything spent the entire conversation speaking over me, explaining their internal policies of authorizing procedures and the nuance difference of procedure codes, not letting me speak until I became so frustrated I hung up. I now have the order from my doctor in my hand, along with my doctor's call log of exactly who they spoke to at Blue Cross, when and who the doctors order was submitted to. Proof! After two days now of speaking with Blue Cross supervisors, they are continuing to feign ignorance and saying they've never received anything.
So, what's apparent here is that the standard unethical practice at Blue Cross is to avoid paying claims by avoiding authorizing procedures. Their representatives and supervisors are trained to just say they never received any information. So, I have a procedure I must have for a life threatening condition, and Blue Cross's attitude is "well, we already have your money, so..." What does one do here? I can file a grievance with the Department of Managed Healthcare and write reviews on the internet, hoping some HR rep looks at these things and cares (probably not), but really, what does one do?
Since April 2019 my husband and his pain management MD have been trying to have his spinal ablation approved. We live in Ohio. They even told us it's because our MD isn't from California. Due to opioid crisis they are cutting back on pain meds, yet alternative options don't get approved. Just get the runaround. BCBS of California shame on you. No wonder people are overdosing on street drugs. Insurance companies need to care about people more than money.
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.
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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...
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.
Blue Cross of California Company Information
- Company Name:
- Blue Cross of California