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Blue Shield did not cover their portion of a bill from an IN NETWORK provider that I was referred to and received prior authorization. I submitted an appeal/grievance, Crystal H was the coordinator, and she denied the grievance, stating the doctor was out of network. I was asked to re-appeal with my "new information." However it is not new information, all this information is readily available on their own Blue Shield website and within their own system. They apologize for being "so busy" but if they just do their job correctly the first time, they wouldn't be so busy. Ridiculous, and the cause of expensive health insurance fees - administrators who cannot do their job correctly the first time and get "so busy."
My experience with Blue Shield has been the worst. I will recommend or renew with this insurance provider. In July of 2018, I was taken to the ER in Nevada to Sunrise Hospital for immediate treatment. I had given all the proper documentation with correct Blue Shield insurance information - to the Sunrise Hospital. I ensured I paid the ambulance bill, which blue shield covered.
As for the hospital bill, it was not covered by Blue Shield. Sunrise Hospital did not submit the bill to my insurance provider within the year time frame. Instead, Sunrise sent me to collections in January of 2019. I called the hospital to inform them I had insurance on 7/7/2018 and re-given my Blue Shield insurance information and advised Sunrise of the date the day of service was covered by Blue Shield. However, Sunrise Hospital once again failed to submit within the required time. Sunrise billed too late, and in August 2019 Blue Shield denied my claim and refused to cover the medical bill. While in this process I was also advising Blue Shield of Sunrise’s unfair practices of not billing in proper time frame.
I have been proactive in following up on my case, but it is unprofessional from both parties that they are putting this sum of $4,000 on me the patient, when I was fully covered. It is gross negligence of Blue Shield’s behalf, since I was fully covered when taken to the emergency room. Sunrise is also committing fraud with sending me to collections and not billing promptly. I’ve disputed this multiple times in the past 3 years. I will be reporting this matter further to all media and medical platforms & making sure another patient is not stuck with outrageous medical bill when they have medical insurance. Very dissatisfied with Blue Shield for denying my claim and highly suggest consumers not choose Blue Shield based on my poor experience.
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I changed policy type for myself and 2 daughters in January to save money. They told my broker to start new applications for each of my daughters and they would keep me on the same policy number. That was the start of my problem. I paid my premiums on time for each policy separately. Come January I log on to my account and it says I owe over $1900! Their system has all 3 of us on the policy still and for the old higher premium from 2019. I call to get it fixed. I was patient and was told it was fixed.
5 days later I log on and the high balance is still there. I call again and was told it was fixed and then the same thing happened again. Third time I sit on the phone for over an hour and it’s finally fixed. I decide to put all 3 policies on Auto pay starting for March 1st because it’s hard to remember to pay when you have 2 small kids. It takes 1-2 billing cycles to take effect. With February having an odd number of days for leap year I call to confirm there is no issue with payment for March. The associate says it’s a good idea to pay March manually and he will change his system to reflect auto pay to start in April.
I check my credit card statement today and I have been charged twice for both daughters policy premiums. Over $1k! I call to get it credited back and they tell me they will have to cut a check for both overpayments. I ask why they can’t credit back the credit card. I am told that this is the way it’s done. So a screw up on their end will cost me interest on my credit card as it takes 7-10 business days to receive the checks! Bullshit! I wouldn’t stay with Blue Shield but given you can’t change health insurance midterm I am held captive.
I work in the UR department for Mental Health for adolescents. This company puts children's lives at risk by providing them with the less than minimal service. I have watched them for years get away with denying VERY sick children the mental health services they need. For perspective, other mainstream insurance companies provide up to 20 days of service for the children to get treatment. They give 6-8 days. If you have children, STAY AWAY FROM THIS INSURANCE COMPANY!
My husband and I are going through infertility treatments. We have Blue Cross Blue Shield of CA. First they told the fertility clinic that my procedure was covered. Now all of a sudden they are saying it isn't covered. My explanation of benefits show it is covered. The clinic has been fighting with them to cover it. While going through fertility treatment, it's best to minimize stress. This whole situation has been nothing but stressful. They are awful. I filed an appeal and the lady at my husband's district office is going to try to get it sorted out. If they stick with the denial, we are switching ASAP. Shame on them.
This is a widely accepted supplement in the area I live. I can use the best hospital for surgery and cancer radiation treatment. I can also use their local clinic that accepts very few supplemental insurances. The customer service has helped me with out-of-town providers having problems getting paid.
It got too expensive, so I switched plans to United Healthcare. Blue Shield did pay the bills in a timely manner. None of the supplemental policies are inexpensive, though. I have only had the new policy for less than a month.
I am 69 years old and have had insurance my entire life. When I became eligible for Medicare having a supplemental policy was a given. In the last four years of coverage, my out of pocket expenses for medical care have been zero. My single largest expense is the gap in medication purchases, which is covered somewhat by SilverScript. Most people don't realize that Medicare monthly payments from my SS is expensive, this added to my supplemental policy and RX policy is a burden.
Blue Shield of California has got to be the worst insurance company I have ever encountered. I am new to Blue Shield this year and I have had nothing but problems. It all started with billing issues where I was being billed for visiting an "Out-of-Network" doctor, even though the doctor I I am seeing is "In-Network". I called Blue Shield and waited an excessive amount of time before getting to speak to an agent. Finally, they corrected the problem but it took me two months to get my money back from the provider. I have also had nothing but problems trying to get my necessary medication, because the drug is expensive and Blue Shield doesn't want to cover it.
I am a cancer survivor and have many medical issues resulting from my treatment, the most severe of which is Peripheral Neuropathy of the legs. The drug I take is expensive but I have tried everything else and it's the only one that works! After much effort, they finally approved the drug but imposed a $75 co-pay! What the heck.... Never seen that before but I need the drug and will pay whatever I have to. Fortunately I was able to get a manufacturer's coupon that brought the co-pay down to $4. Thank goodness! Now I'm trying to refill that prescription but, apparently, a generic version of the drug has recently been released and I must now use the generic drug. Problem is, my pharmacy doesn't have it.
I called around to a couple pharmacies in my area and they didn't have it either. AND even if they did, the coupon was for the name brand drug, so I will now be paying the full $75 for an inferior drug, when previously I was able to get the name brand for $4. And, after spending an hour an hour on the phone with customer service, they finally got a pharmacy to fill the prescription... for $75! Ridiculous! Way to go Blue Shield. You exemplify what is wrong with both our healthcare system and our prescription drug system. Capitalism at its finest! You are basically telling patients that profit is more important than providing quality healthcare. I will be switching insurance at open enrollment! You are unworthy of my business!
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?
Blue Cross of California Company Information
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- Blue Cross of California
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