About Blue Cross of California
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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.
My employer changed our company insurance plan to Anthem Blue Cross from AETNA, effective 8/1/2016. I provided all the necessary information so that deductibles would carry over from AETNA. In mid-September, I went to an in-network lab for lab work that my doctor had scheduled. The billed total was a little over $1400. In October, I received a bill from the lab stating that the claim had been denied. I went online to look at the EOB and found that the claim was denied pending my answers to a questionnaire about Medicare coverage that Anthem claimed to have sent me. When I still hadn't received that questionnaire 2 weeks later, I called Anthem, waited through the interminable delays, and explained my problem. The rep said they'd send another copy.
A week later, no questionnaire, I called again. I explained that I do have Medicare pt A, but I haven't signed up for the rest since I am employed full time and I have insurance through my employer. This second rep was polite and helpful. She took the time to call Medicare, got the proper information, and said she would submit it to Anthem. She assured me this would take care of things. A week later, no progress, the website said the claim was still denied, and now there was a second denied claim for the doctor's appointment that followed the lab work. Same explanation, they were awaiting the answers to the questionnaire. The one I still have never received.
The rep I spoke to on the third call somewhat rudely advised me that I needed to be patient because it would take 30 days to make the change (30 days to make a simple change as to whether I was covered under Medicare? What the heck?) Since then, I have been monitoring the EOB online. Until this past weekend, there was no change. Then, suddenly, the lab EOB disappeared and only the doctor visit EOB was visible.
A few minutes ago, I checked again, and I found an "adjusted EOB" which now states that they have denied the entire $1400 charge and that I am responsible for that charge. There is no reason given for the denial. I am flabbergasted. I have no other insurance that will cover this claim. I have paid my Anthem insurance premiums through my employer on each paycheck. I went to an in network provider. What is their problem? Can't wait for them to deny the doctor visit as well. I used to have good credit scores. Wonder what they'll be when Anthem is through with me. And my employer made this change because the Anthem premiums were a better deal for the employees. I was never thrilled with AETNA, but I never had problems like this with them. No wonder Anthem is cheaper. They keep premiums low by denying legitimate claims. I've emailed them this evening. I'm lodging a complaint with my HR department tomorrow.
Blue Shield of California increased my monthly from $815 to $1200 as of 2017. I called them and increased my yearly deductible from 6000 to 10,000. My monthly went up to $950 per month, an increase of $135 per month and worse coverage. I called to complain and got nowhere. They called me today on a robo call to tell me how good they are. That's it!!! All I can stand. I called them and told them that they are as bad as the government. They lie!!! They are complicit. Why did other company's opt out. I'll tell you why --- because they are honest. This company prefers to deceive their customers instead of standing up and telling the truth. NEVER BUY FROM THEM!!!
We lost our insurance last year and it was 2 months before I figured out what happened. I think it is deceptive practices how many notices Anthem sends out. After a while it's like the boy calling wolf. We always paid our premium on the 5th or 6th of the month. If you didn't pay by the 1st, notices about losing your plan start going out... and they keep going out. After a while we were kind of numb to them. We always paid... until something happened with our card and we didn't... problem is we didn't know it.
We eventually got other coverage (I was 9 months pregnant), but we just had to pay the penalty for not having insurance for 2 months. $1,100 people... If it was my fault then I would have no problem paying the penalty. But the fact that we had no idea we had even lost our insurance should be an exemption. Also I think Anthem needs to revisit how the issue notices and let you know about the status of your account. I think their current practices are intentionally confusing and it is wrong.
My husband carries me and our children on his Blue Cross/Blue Shield Federal Employee insurance through his job. On September 20, 2016, my husband, whom I am legally married to and have been for 17 years, called and told the representative that we were divorced and I was then terminated from the insurance plan as of September 30, 2016. We are not divorced. I was not notified and found out about the cancellation by accident. I am scheduled to have major surgery on October 31, 2016. On October 7, 2016, I called the hospital to verify my co-pay and register for surgery. At that time the assistant attempted to access my insurance information and it said I was inactive. I was informed to call BCBS to inquire about the issue. When I called BCBS, I was told that I had been removed from the policy because my husband called and said we were divorced. Again, we are NOT divorced.
I asked if he needed to show some type of legal documentation like a divorce decree and was told that "Your policy does not require that and that no notification goes out to the cancelled party." However, I was told that I had a 30 grace period. Today, I called BCBS back because the pharmacy said I have no insurance. BCBS now says that there is no 30 day grace period because the cancellation is due to a divorce that never happened. The representative told me that if I can prove that I'm still married then maybe you can fix this. So now I have to prove that I'm married, but he does not have to prove that we are divorced. This is just wrong!
So here I sit with no insurance, no asthma medication, no blood pressure medication and no very necessary major surgery that has been planned for 6 weeks. All of this because my husband is angry that his child support increased and BCBS does not care enough about its clients to at the very least verify the information that is being told to them, especially when benefits are being terminated. That's not just a minor thing. And why isn't the terminated party notified? If I had gone to my pre-op appointment tomorrow I would have unnecessarily been billed hundreds of dollars because I wasn't informed. I'm fortunate that I have a job that offers medical insurance. However, it won't be effective until November 1, 2016 because I was originally told that I had a 30 day grace period. Thanks for treating me like the number and cash cow that I and all of your subscribers obviously are to you. Shame on you Blue Cross Blue Shield!
I transferred my medicare plan over to Blue Shield 65 plus HMO plan several years ago. I just received a letter from them on September 29, 2016 in the mail but the letter was dated October 2, 2016. It stated that Blue Shield 65 Plus HMO won't offer our Medicare plan in 2017. It also stated that this means our coverage through Blue Shield 65 plus will end December 31, 2016 and that we should make a decision to take action about Medicare coverage by before December 31, 2016 or prescription drug plans will not be covered. In addition we should look into choosing a plan before February 28th 2017. There was no other explanation for why this was happening. I called the customer service line and they told me I should be receiving another letter stated that if I want to continue Blue Shield 65 plus I must fill out another application and pay a $29 premium monthly.
So I asked the customer service rep "I thought they were no longer handling medicare or taking over medicare". The representative told me they would still be an HMO with medicare but I have to pay a $29 a month premium in addition to what I pay each month for Part B Medicare out of my social security check. I said this is extortion of senior citizens who are on HMO because they can't afford supplemental medical insurance on fixed or low incomes. There was no explanation for the increase or what it would improve.
Blue Cross 65 plus has hoodwinked seniors into this plan knowing that they would be increasing. Also I am under Hills medical group which takes Blue Shield 65 plus but does not take straight medicare. I may have to find a new doctor which I am very upset about. Something needs to be done about Medicare, and these HMO plans that they sell out to. The newly elected Vice President Margaret Anderson of Senior Marketing is obviously stupid and not very good at her job, otherwise she would not have to send out two letters confusing people.
My husband and I have been paying for our Blue Cross policy for over four years now and the first time we are in dire need of it, we are denied. My husband is a severe alcoholic. We checked him into a rehabilitation facility after he ended up in the hospital on a breathing machine unable to breathe on his own. My husband is near close to death and this insurance company is only willing to pay for 5 days of treatment with complete disregard for all recommendations that he needs to be in house rehab for at least a month and then on to a sober living house.
Through group therapy I have learned he is not the only one with this problem and in fact it is common for Blue Cross to do this. They know his drinking has landed him on life support, many other hospital stays and that his addiction has been with him for the past 10 years. Going into the facility they ask many questions to submit to the insurance company to determine how dire a need the treatment is. It is clear to all doctors, myself, counselors and my husband himself that if he does not get help he will most certainly die. We have submitted all documentation that is required.
By law all insurance companies are now required to treat chemical dependency as they would any other disease. Blue Cross is blatantly ignoring the dire life-threatening situation and has made it clear they will only consider this medically necessary once he is no longer around to need it. Like I said, they're required by law to treat him as any other life threatening patient. They are ignoring that law and my husband may pay the price with his life. Another couple went through this with them and they lost their son to a drug overdose. It's up to my husband to do the work but it is up to Blue Cross to provide the service we pay for.
Their accounting is screwed up and they take too much money, then not enough... I was notified by Blue Shield that they were going to terminate my account for non-payment. However, I had overpaid last year and they were supposed to start taking automatic payments which I signed up for when they had it figured out. Long story short, they never sent me any bills or took any automatic payments from my account. I tried to pay online and it said that I had no payment due. I called and the automated system said no payment is due. Then I called one day after the date they were threatening to terminate me (only communication I received in over 6 months) and I was no longer in their system and when I got a hold of a Rep to make my payment, I was told I was terminated and there was nothing they could do.
That was my first case and grievance and I have spent countless hours on the phone getting a different person with a different story each and every time. "Yes, you are correct, it was our fault and you are being re-instated. I have escalated your case and you will get a call in 24 hours." It has been 8 weeks now and still they can't seem to get it corrected, even though they say someone is working on it. I call every day now, hoping that the squeaky wheel approach works, but it hasn't. I have filed grievances online and still nothing happens. I am getting threatening letters from medical billers that are not getting paid. This is not fair!!
Don't do it!!! BUY ANYTHING ELSE but coverage from this company!! We have the most expensive Platinum coverage available but it's next to worthless!!! Wife has been trying to find a in-home PT, prescribed and authorized, for two weeks. NO ONE WILL TAKE THIS INSURANCE!!! I don't write reviews, check, but this has been a nightmare of no responsibly, no availability, and no accountability, never mind just no help. Our lives are forever changed as a result of her injury. This company added insult to our misfortune at the most stressful time of our lives. Buy their horrible coverage and you too can learn this lesson.
I am an ILWU-Marine Clerk. It all started in 2013, after my employer (Pacific Maritime Association), dropped a notice that we would be using Blue Shield of Ca. It was all done by the Trustees. Anyway, my daughter had knee surgery and because most of the people at my job are out of network, I guess Blue Shield decided they would not be responsible for our bills, one the most horrific incidents in history. It was all in the newspaper, destroyed our credit. I did everything to fix it and to no avail. Here it is again 2016 and I guess I have to try again to fix my credit. I refuse to pay because it was their responsibility. Most of us were out of network, so why would they take us on and then not pay our bills. Pathetic! If I could afford my own insurance I would DEFINITELY stop using Blue Shield. That way I can go to whoever I want. I find this to be the best rather than be stuck in a network whose job is to not pay claims and destroy lives. Very upsetting!
I had gone to the provider and at that time they said they were paying it slowly, then all of a sudden, I started getting collection notices and then I found out they stopped paying altogether. I had sent every document following every instruction. It has been over 3 years and I have not received another collection notice in over a year, but my credit is destroyed. I refuse to pay them. I heard Blue Shield was one of the worst and unfortunately, my job as stupid as those persons who decided to take them put us all in jeopardy.
Let me tell you, if the other people from the surgery center had not known what to do, I would have a bill exceeding over $100,000. What they stopped paying was the therapy which comes along with the doctor's orders. Everyone's experiences are different, but this happened with my job. They were told to clear it and fix it, and if they didn't my job would drop them, but I guess I got lost in the mix so I need to find out what to do! I have everything documented, I never got help even with all of that! Weird! I understand they don't pay out of network, but why would you take 3-5000 employees on knowing all of our medical expenses are out of network if you knew you would not pay?
Went to Blue Cross, Dr refused one refill, changed another. First time there, spoke 5 minutes, forgot insulin. Also called Blue Cross, told a supervisor would call in 24 hours, didn't happen. I called twice today, waited to be put at beginning of phone waiting process, never got called or got through. Need my meds taking 4 years now. Customer service non existent. I need help before I lose it. Didn't sleep last night, leg cramps, back pain, sweating, greetings, holding. Dr. have specific reason for withholding meds, blood test, medical records. Before denying meds shouldn't Blue Cross be concerned and call me back? Not happy Blue Cross UG.
I signed up for paperless billing and made my first payment. Anthem never sent me a bill in mail or email. It is of course very easy to verify this with a quick mail search. I DID get emails about confirmation of my first payment and other wellness living emails. However no bill and they then terminated me. It is rather amazing to me. I'm still trying to get reinstated and then plan to hit small claims court.
I have been trying to get my refund from Blue Shield since last May 2015. Here is just my 2016 contact with them. I call, I get references, I get the whole 7-10 days processing and just excuses. I asked if they were going to refund the interest. 1-888-319-5999. Previously called in Jan. 4, 2016. At that time I was to receive a check back for $638.16. Called today 03-09-2016. Called Blue Shield regarding refund still due from May 1, 2015 - $659.54 Minus 1 Day ($21.38) = $638.16. Covered California plan ** Jan 1, 2015-April 30, 2015. Current Plan **. Effective May 1, 2015-April 30, 2016.
Blue Shield rep got Covered California on the line to get them to check on status. Blue Shield says they only show payment through Jan 31, 2015. Katnis asked me to call back in 7-10 days to check to see if they received notice from Covered California, so they can issue a refund to me. Called on May 2, 2016 to find out where my refund is. Spoke with Mark and he reviewed the ref# **. Prior agent (Katnis) worked on the incorrect member number which is why I haven't received the refund. Mark spoke with Tina in the back office and she is putting in for my refund. Mark said I would receive the refund the same way that I paid for it (i.e. my savings account). He also said it would take 7-10 days again to receive the refund.
Called on May 18, 2016 @ 4:16 pm to find out where my refund is. Spoke with Riza and she reviewed the ref# **. Riza is checked all the notes. Connected me to another department and I spoke with Christine. (Their direct number is 1-855-836-9705.) Christine was checking the status on the refund. She came back on the line and said they were still processing it. I argued that it has been over the 10 business days (today is the 12th day). I asked her to go find out WHY and that I needed the refund NOW.
She put me on hold to go check after trying to tell me it had not be 10 business days which I counted for her (from May 4th to today May 12th 12 days). She came back and said there were delays. I told her I needed my $638.16 now and there was no reason for this to be delayed. It is a simple refund not a claim or anything difficult. The rep keeps telling me she is calling the "back office" and they have "so many" claims that they need another 4 days. I told her that this is unacceptable and I wanted the refund tomorrow May 19, 2016. I let her know that I really need the money desperately. I will post again when I find out the results. They are a horrible company.
I was on a Blue Shield plan with Covered California until I began Medicare when I turned 65 and enrolled in another Blue Shield plan to supplement Medicare. Blue Shield refuses to acknowledge that I should not be covered by overlapping policies even though its overlapping coverage is impossible with Medicare regulations. Blue Shield is billing me for the overlap and is refusing to correct the situation. I will take the company and all the employees I have spoken so many, many times with about this to SMALL CLAIMS COURT if they cannot resolve this. They knew my date of birth and when I would enroll in Medicare but refuse to resolve this issue. They want me to pay hundreds of dollars for coverage that was invalid once Medicare and the supplemental plan began.
Their excuse so far is that Covered California has an incorrect date entered somewhere but it is Blue Shield that keep trying to make me pay! I have also called Covered California several times but all I get is promises that someone will look into it and get back to me. Both Covered California and Blue Shield were VERY AWARE OF MY DATE OF BIRTH AND WHEN I WOULD BEGIN MEDICARE! Each call to Blue Shield about this has resulted in explaining the whole situation to each individual even though they had the reference number from the previous call. Their complaint system seems to be structured so that a person will just give up and pay even though no product was provided! I will NOT GIVE UP!
I am a new insurer and have been trying to get a prescription authorization for over a month that is medically necessary. I keep getting the runaround and they denied the medication. I never had a problem with Kaiser or Anthem Blue Cross.
I signed up for dental insurance last year, and after checking with my dentist to make sure everything is covered, my dentist claims that Blue Shield suddenly changed their policies and only covered a minimal portion. At the end of the year, I decided to go with another insurance that actually covers SOMETHING. I kept getting charged after I'm pretty sure I called to cancel. After 4 months of charges, I called in to request cancellation, and they said I need to FAX in proof of insurance with the other company for me to be issued a refund.
Basically, the customer service representative I originally spoke to sounded like a high school girl on her first day of work. She just sounded like an idiot, which added to the frustration of having to go through all these horrible automated systems. She provided me two FAX numbers. I asked her if there's anything specific I need to include because I want to make sure I have the correct instructions before I get off the phone with her. She said "Nope, just fax the proof in..." I asked if there was a direct line I can call to skip the automated systems and she said no.
I drove out to a UPS and faxed my proof to both FAX numbers. I waited a few hours, and called back in. Waited through the HORRIBLE automated systems and the representative this time said they did not have access to the fax and she does not know that they've received it yet and to call back in a few days. I called back in a week and the gentlemen that helped me said he received nothing, no note, and from the notes that the previous rep left, I was given the wrong FAX numbers... He proceeded to give me the CORRECT FAX number and again, I had to go out and fax because they don't have a direct e-mail for customer service issues such as this.
2 weeks later, I noticed my account has been billed AGAIN. I called in and they said they have received the note, and they had only just proceeded with terminating my membership because I called in, but billing is completely separate? BASICALLY, just avoid Blue Shield. I don't understand how a company this big can be so disorganized and have such unprofessional, idiots on their front lines of customer service. They need to do something about their ways of communication and update their technology, etc. They also need to have a direct customer service line for those who have already opened a claim and need immediate assistance.
Also, it's one of my biggest pet peeves when it sounds like foreigners are in charge of customer service. I am a minority as well and have nothing against foreigners, but it only makes the situation worse when the person who is suppose to be helping you on the phone has an extremely THICK accent that's very difficult to decipher in an already frustrating ordeal. Either offer online chat support, or don't allow those that can't speak clear enough English to be on the phone. It's not only for my sake, but for their sake as well.
They show absolutely no understanding when I ask them to repeat what they had just said. They give attitude as if I'M the idiot that can't understand perfect English. They then proceed to just speak slower and louder, and add "okay" after every sentence. What would be OKAY is if they didn't speak like a foreign robot. My blood pressure spikes every time I have to be on the phone with them. Just avoid it. Life is too short to be this unhappy in unnecessary situations.
This insurance company has made me hate anything medical. Has caused so much stress, more than Ive ever had. My fiancee has Crohns Disease and its more of a nightmare because we have an insurance that sucks. They mess up all the time, we're on hold for 30+ plus every time, our prescriptions are always never approved for no reason, and to top it off we pay 500$$+ each month. WTF?!
What made me write this complaint was because my fiancée has been on HUMIRA for about 2 months now. IF you don't know, HUMIRA is a medicine for Crohn's disease that helps him stay in remission. If he doesn't take it on time he is screwed. SO...the insurance company said it will be at the pharmacy for pick up. He goes...and they're saying they couldn't approve it being picked up. OF course we call and get bounced back and forth from person to person with NO ANSWER. Oh by the way, this is not the first time. They compromise his health and I'm 100% more people than just this forum will agree.
I hate that I even have to give a star. This is by far the worst insurance I have ever had. Thank god my husband and I switched over to Oscar (which is AMAZING) - as we are now trying to conceive and I couldn't imagine having Anthem Blue Cross in our current situation. My story- I FRACTURED my ankle about 8 months ago. I went to the clinic that ANTHEM instructed me to go to. When I got there they said we were not up to date on payments (which we were as our payments were automatically deducted every month and we always checked to make sure it was operating correctly). So they said they couldn't see me. We called Blue Cross and since it was a Saturday there was NOBODY there to help us.
Long story short (some yelling ensued at the clinic - which was out of character for us), we ended up leaving WITHOUT BEING SEEN. At this point I didn't know my ankle was fractured since I didn't have x-rays. I stayed off of it until Monday. Monday morning I called Blue Cross (since there was NOT ONE PERSON there to help me over the weekend - because people don't get sick on weekends, right?). Again, they instructed me to go to the same clinic that had turned me away on Saturday. We told them what happened. They said they would make sure it wouldn't happen again - as we were up to date on payments. SO, we go back to the clinic. Not kidding... They said the same thing. They couldn't see me because we were not up to date on payments. SO we bring up our payment log and show them. We also have Blue Cross talk to them. They say "sorry - we can't see you, go to a hospital." We leave.
We don't go to a hospital because we can't afford it and because we PAY $680/month FOR INSURANCE. Back on the phone w/ Blue Cross. They tell us we can go to a clinic that is 33 miles from our house and they're sure there will be no problem (no joke). For anyone who lives in LA, you know that 33 miles is about 2 hours or more of a drive. We tell them that doesn't work. So they make some calls and send us to a closer clinic assuring us that we will be covered.
We hobble over to that clinic and guess what? THEY WON'T SEE US BECAUSE THEY DON'T TAKE OUR INSURANCE. I wish I was kidding. My husband said ** it and we ended up paying OUT OF POCKET for my x-rays. The staff was so accommodating and they felt so bad that they ended up only charging us half of what we had to pay (which is unusual and we were SO grateful). I found out that I had a fractured ankle and with no thanks to this AWFUL insurance company. EVERY SINGLE PERSON we spoke to had NO idea of what they are doing. It was honestly scary. What if we had a real emergency?? What if I was pregnant?? Thank god we got new insurance at the beginning of this year. This was a scary experience and I don't know how this company intends to stay afloat and keep customers. Dangerous, scary, uninformed and irresponsible - how I would describe Anthem Blue Cross.
This medical insurance company is the antithesis of "health". They have screwed up my billing so many times I have lost count and wasted at least 40 hours trying to straighten things out on the phone, only to have them bill me incorrectly again and again. It baffles my mind how these crooks are allowed to do business. My wife has hot flashes and they denied the doctors order for hormone therapy saying it was "medically not necessary". How does the insurance company get to tell the doctors what is medically necessary? I am diabetic and whenever my doctor prescribes the most effective drug they deny coverage. It like they want us to be sick. The stress of trying to follow up with the incorrect billing is bad enough, but to be constantly contradicting the doctors recommendations and denying coverage left and right after we pay over $1400 a month in premiums is just plain evil.
They are more than happy to keep cashing my checks and screwing me on the back end. I will be cancelling my insurance with them ASAP. Another scam that ALL of these companies get to use is called open enrollment. Why should healthcare be locked in for an entire year? People should be able to choose who they like, so when horrible evil companies like Blue Shield of California take your money and then don't provide service, you can cancel. Let the open market decide who is best. I bet the rates would drop then too. We will be cancelling and telling as many people as possible to never use Blue Shield of California PPO. The absolute worst of the worst. I had Kaiser before... HMO... wishing I still had it. They never screwed up the billing.
They bill me, I pay the premiums, they accept the payments. (Note that in several cases they have sent bills only after the due date. I complained about this and got a form letter in response). Then they claim I'm not covered and refuse to pay claims. When I call, I spend hours on the phone with employees who admit that I am covered and can't figure out why the claims are denied. This company seems to exist solely to take money and not to actually provide any health coverage.
Anthem Blue Cross is the worst company ever. I was on hold for 25 minutes and they never came back on the phone. I called back and now have been on hold for another 15 minutes. Who can do this? I have to work. Terrible, terrible terrible. I cannot even cancel my insurance because they won't pick up the line or stay on the line and to think I have paid my premium every month for 6 years. Shameful.
I am usually very patient when companies flub here and there, and errors/lack of communication are to be expected now and again when dealing with large companies. But I have to say that (BS) Blue Shield of California has serious issues and dis-function with their operations. I had the Blue Shield Bronze Plan in 2015, and I went through the usual eligibility process through (CC) Covered California, and all was good. However I had a life changing event at the end of 2015, and had to reapply through (CC) for the 2016 year.
Due to the life changing event and having less income, I qualified for premium assistance with (CC), so I was actually able to afford an upgrade to (BS) Silver Plan, which should be a simple change in plan coverage right??? (Wrong!) I will put in everything in chronological order regarding the chain of events: 11/12/15 - Received confirmation letter from (BS)/(CC) confirming my eligibility for premium assistance and coverage under the Silver Plan for 2016. 1/20/16 - Called (BS), because I was locked out of the member portal since January 1, and wanted to make my premium payment for January. (BS) accepted my premium payment, and had to conference in (CC) on the call because (BS) claimed they never received my eligibility information from (CC). Paid my premium for January on the phone with (BS). 1/26/16 - (CC) verified that they sent (BS) my eligibility information, and (BS) confirmed my eligibility.
2/2/16 - Went to pharmacy to get prescription with new membership id card from (BS) with new Silver Plan Policy # ending in **. Pharmacy said (BS) activated and cancelled this policy# on the same day (January 1), so I had no coverage. Called (BS) and they claimed that there was an internal glitch on their end, and they don't know why policy was cancelled, they advised that they needed to escalate to their Issue Resolution Team (IRT), and someone would call me back within 5-7 business days to resolve. 2/17/16 - (IRT) called me back and said that the problem was that they issued me a new Silver Plan Policy number ending in **, and this was the correct policy #, that I needed to use, and I should discard my original Silver Plan membership card ending in **. So I did. Problem was resolved.
2/18/16 - Member portal still showing old Bronze Plan information and unable to make premium payment on new Silver Plan in portal, called (BS), and made both February and March premium payment over the phone with (BS). 3/13/16 - Went to pharmacy using my new Silver Plan Policy # ending in ** as instructed, and the pharmacy said, "Sorry, (BS) activated and cancelled this policy on the same day (January 1) too."
3/14/16 - Called (BS) and they said that they never received my eligibility from (CC), therefore they cancelled my policy. (CC) was on this call with (BS) and myself, and they verified that my eligibility was sent to them on 1/26/16, and (BS) operator acknowledged the receipt of eligibility. Per (BS) operator, the original case that was sent to their (IRT) was closed out as resolved. Therefore, (BS) would have to open another case # in order to resolve. Was promised a call back from their IRT within 3-5 days. Never received a callback. 3/18/16 - Since I received no callback, I called (BS) and was promised a call back from IRT by the end of the day. Received no callback.
3/21/16 - Called (BS), operator placed me on hold so they could escalate issue to their supervisor per my request. I got disconnected when they did this and had to call back. Called back, and gave them all the reference numbers and case numbers, history of the issue etc... Placed on hold again. They advised that IRT should call me back by the end of the next day, and if they didn't then I should send their (IRT) an e-mail, and the case number. Which I did. 3/23/16 - No callback or e-mail response received. Called (BS) back and requested to be connected with a Supervisor or Manager. Operator forwarded me to team leader. Team leader placed me on hold and called IRT. Team Leader said that IRT promised to call me back by the end of the day. Of course, never received a callback. 3/28/16 - Received an e-mail from (IRT), stating that my account was reinstated.
4/1/16 - Received another set of membership cards in the mail. However, these membership cards have the original Silver Plan Policy number ending in **, the very same policy number they originally told me not to use at the beginning of this fiasco back in February. Therefore, since I am unsure what my policy number is, I called (BS), explained the situation, and now they show that both Silver Plan Policies #'s are now showing as active, but I do not know which one I am suppose to use. Therefore, (BS) has now had to open another case number (this will be the third one) and now have their Eligibility Team review this new case and verify which is the correct policy number I should be using. I am suppose to call (BS) back in 7-10 business days to follow up.
I cannot believe the incompetence. It is not a difficult one, as I simply upgraded my coverage, but this has resulted in 4 months of total nonsense and chaos, and endless hours on the phone with (BS). I am not complaining about their call center operators, as they have been as helpful as they can be as I know that they are limited in what they can resolve for you, but the special teams that they have to escalate these issues to are the ones who really stink. Ironically, I feel like dealing with (BS) is causing me health problems that I am trying to insure myself against. Maybe that's their goal. Beyond frustrated!!!
I used to pay my premiums online. Then they removed the payment option and refused to accept payments. Told me there was a problem on the Covered CA end. But Covered CA kept saying there wasn't a problem. My account was active on Covered CA, but Blue Shield still wouldn't accept my payments. So my family had no insurance for 2 months while Blue Shield kept telling me to call back in 10 days. So I kept calling back every 10 days so they could keep telling me the same thing. Finally, they told me they were cancelling my policy for nonpayment. When I had been trying to make payments for months! This is just their roundabout way of denying coverage for someone with a condition.
Do not sign up your parents for BCBS of IL. My parents had to leave the country for a vacation and used up their once a lifetime for vacation override in December 2015. They had to leave again for a funeral in March so the insurance refused to pay for the medication until March 2016. Come March, the insurance decided to change the policy themselves in February because it is within their own right once a new calendar year starts. So now, a medication that use to be covered is now $450 because they changed their mind on how much they want to cover.
Because my parents are out of the country and they don't speak any English, I have not been able to figure out how my mother can tell the insurance agent to allow me access to talk to one of their agents. Every time I call, I either get sent to the wrong department or they say it's above their knowledge on how they can help me. I finally got fed up 3 hours and 12 minutes later when a gentleman by the name of Shawn flat out say "I can't help you. I need your mom to talk to me." What got me really mad was that he refused to call out of country to gather this information. He asked to talk to my mom and it doesn't help matters that she doesn't speak any English and she doesn't know how to use the computer. So now, I asked him for the number to the pharmacy service desk and he also flat out refused to give me that number.
When I requested to speak to the supervisor, all she can say is "Calm down or I will hang up on you." This is what you will have to deal with. No one is empathetic and everyone refuses to help you. Now I'm frantically worried about my mom's uncontrolled diabetes when she's in another country and the fact that she's grieving a loss of a very close friend and all I can do is say, "I'm sorry mom, but $450 for 30 days' worth of pills is more than I can afford to pay this month." I'm still battling with this issue and no one on corporate can tell me why they decided to change her insurance and they won't tell me any definite information on when her medication will be covered again. I really can't wait to re-enroll her in something different once she comes back!
My wife, a long time Blue Shield customer, died on 27 of November, 2015. I called BS to inform them that she does not need any coverage, and to stop charging my account. B.S. took 850 for December. After four more calls and apologies, BS charged me again, this time 910 dollars, for January. Then, after I complained, representative asked for a death certificate of my wife, to be sent by fax. I did it, and two weeks later they still didn't got it. I been told that process of getting a fax is 4 weeks long. Finally, I asked for somebody from US, and I got B.S. representative Megan, who took my e-mailed documents, and promised quick resolve... On 5th of February message arrived saying that my money will be on my account in five to seven days. Today is March 10th, no money, and Megan stopped answering my messages... What I'm going to do next? Any ideas?
I have called twice in the past two weeks. Each time I have been on hold for over 50 minutes. At the 50 minute mark they have someone come on the phone and ask if you would like to be put on the call back list and be called back... get this... two weeks later! If I could wait two weeks to get my question answered or problem dealt with, I would call the company in two weeks! They also reminded me that I could access my information online. I told him if I had that information I would have done that and not called to talk to someone. Being on hold for over 50 minutes and listening to the same 2 minute track of music is enough to cause insanity. This company treats customers like numbers and not people. They need to get their act together.
Blue Cross cancelled my policy after I called to renew for 2016. I have been working with them for 3 months and they keep coming up with excuses as to why it's my problem. I have run out of critical medications and they have no interest. Health care has become a horrible American business. I hate this company.
First of all the Health Care Industry is pretty much a joke in the US. It is expensive, time-consuming, and inefficient. I have been with Blue Shield/Blue Cross since 2009 until now because the Grievance Department won't return my calls. I have been without Health Insurance for all of 2016 thus far and have been trying to get my policy reinstated.
Starting in October of 2015 I stopped receiving my monthly bills for my health coverage. I called them more than 3 times to update my mailing address, each time they read it back to me and said it was changed. When I finally did get something in the mail from them it was a notice that my policy was terminated for non-payment and that I had to get "permission" to have it reinstated.
I followed the protocol and reached out to them only to get a rude woman on the phone who told me that they wouldn't guarantee my policy be reinstated if I paid Oct through Dec 2015 dues. Why would I pay them money if they are not going to continue to cover me? I have called them 4 times again and they are ignoring me. Great health care system we have in America. They only want your dirty money and could care less if you are not covered even though you and your entire family have been with them since 2009. What a joke.
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