Blue Shield of California Reviews

We're also getting repeated higher premium charges despite being confirmed of the correct, lower amount by Covered California (who're also not able to figure out why their multiple updates to Anthem Blue Cross, even though getting confirmed as received, is not getting processed). So, indeed, it appears that the system is designed to reject and delay almost all claims coming from the patient.

If you have the Blue Cross SISC plan (school plan) many common routine medicines (thyroid, blood pressure, cholesteral, etc) are NOT covered. Next year, I’ll enroll in Kaiser HMO and just pay cash for my neurologist and hepatologist and use Kaiser as a year infection, flu docs haha. Blue Cross SISC covers random things and doesn’t cover some of the most routine ailments in older folks. AVOID this plan. You would think a PPO would be the way to go, but Anthem Blue, specifically, acts as an HMO.

If you have zero health issues, it’s fine. You’ll never use it.

The only competent health care that I have received in a year took six months to get into the orthopedic specialist. Any other specialist that I saw or should have seen, dropped the ball at the clerical staff or the specialist did not provide competent care. So in a year that I paid monthly premiums, I received almost no healthcare. We should be refunded our money when they are negligent. We should be refunded our money when we are not able to get health care established in the contract. Whether on purpose or by mistake it is not right to take money while knowing that you are hindering patient care. And, since the review guidelines indicate that I cannot insult anyone, please feel free to read between the lines.

They approved a cheaper rehab with terrible ratings. We have been told if she just had Medicare there would have been no problem being admitted. A lot of these places don’t even want you if you have Blue Cross because they are difficult to deal with. The New York Times has had articles about Medicare v, Medicare Advantage. I will not be choosing them for my future Healthcare needs after what I’ve seen with approvals. It’s fine if you are generally healthy and on the younger end of retirement.

To make a long story short. Blue Shield apparently knows much better than my doctor and I should "try" two other antibiotics first before getting the one my doctor thinks will help my gut infections without causing more systemic harm. This is a petty petty company. I already pay over $30,000 in out of pocket medical costs every year because they don't cover those doctors and things. Okay. But they couldn't even pretend to want to be helpful and pay for one two-week prescription of antibiotic. Needless to say I will never do business with them again. I hope to save someone the heartache in the future. Also, talking to people, I learned from a friend that is older that the same thing happened to him 20 years ago. He also never went back to them. I guess things haven't changed at all.

I am trying to get a phone number and email for the Anthem CEO, Gail K. Boudreaux. Does she know what's really going on with her company? Are you really living up to your: Mission- Improving Lives and Communities. Simplifying Healthcare. Expecting More. Vision- To be the most innovative, valuable and inclusive partner. Our Values- Leadership, Community, Integrity, Agility, Diversity? I think not. Give me a call.

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.

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 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!

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?

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."

"We apologize for your experience and would like to have a Specialist reach out to address your concerns. Please email your info to help@blueshieldca.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.

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!

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 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.

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.

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.

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'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!

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.

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.

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.

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).

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.

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.

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!

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.

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.

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!!

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?

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.

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!

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.

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.

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.

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.

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!!!

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!

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.

Now that the registration period is over, both my sister and I are stuck without insurance plans for the new year. This is absolutely insane and unfair given that it is NOT OUR FAULT BCBS crashed during the enrollment period. And forget about trying to call BCBS, NO ONE will answer your phone call. I've talked to people who've been on hold for 3-4 hours at a time. I finally got a hold of an "agent" this past week who claimed he "does not know anything about a crash" and "sorry, but the registration period has ended." The whole Obama Care is a failure and has caused many to lose out on being covered by a proper insurance. I hope that out of the goodness of their hearts they extend the registration deadline. Will be seeing more about this issue on the news I'm sure.

They still have me switched to a lower coverage program that somehow manages to charge exactly the same monthly fee. Had I not caught it, I would have been paying for 30% less coverage. Oh yea, and they play that terrible music in your ear very loudly for the incredibly long time that you are on hold and often hang up on you once you have a person on the phone. Their headquarters is not located far from me. I am thinking about walking in there with a close friend who is a multi Emmy award winning new producer for a major network. I still want to post this here because I can see reading these other postings that they are doing this to a lot of people! BTW, I think they should be required by law to allow a person to disable the hold music because I do not deserve to be tortured by terrible music when I call in. On hold now for 25 minutes! Still holding.

Went to the Health Savings Account side of Blue Cross and with 30 minute plus hold time on calls, no billing consistency and a maze of paperwork. It's no wonder they make money each month! I have faithfully paid for insurance monthly for 25+ years and to have to haggle over each bill and speak to people that make no sense is pure disgusting. If this country ran its business the way Blue Cross does we'd be taken over and a third world.

Today I have been trying to track down a billing representative to get a bill and pay for January - 4 phone calls later and still no resolve! I'm on the phone with a "your wait time will be approximately 30 minutes" and a "I'm sorry but our website nationally is down. We apologize for the inconvenience." REALLY??? I can't pay because I don't have a bill and can't get a rep on the phone to make a payment and will be without care because??? Will try and shop around and see if I can somehow get in elsewhere. Advice: Stay clear of Blue Cross.

After calling and waiting for someone to speak to about this they never apologized for their faults. They continued to put me on hold and said it would work in a week. Two weeks went by and I never received a phone call and still could not create an online account. I contacted again and got someone who told me it was never fixed and that she'd try it again. Finally it was fixed. I then went in for a checkup and was told that my insurance card didn't work. I called Blue Shield again and it turns out they cancelled due to nonpayment. I originally gave them my current employers business card that was being used for my insurance and yet they never ran it as ongoing.

Instead they claimed they sent "Mail" to me regarding my Bills. I'm never home and when I am I never check my mail because all of my bills are automatic or paperless. I've never received a call on late payment etc. or else I would have notified my Employer. After 1 month of waiting for them to fix it they said they can reinstate my insurance with 1 payment of $966.00. I refuse to pay for their mistake and for ZERO service. I can't believe people can go to sleep at night doing this. I have been treated like a nonexistent human and they do no care for their customers. I am livid and should have listened to the reviews that I read in the beginning. Please learn from my mistake.

I spent hours in line at the post office mailing this paperwork back four times. Just now (mid-October) they told me that as of July 1 they will no longer pay for any compounded medications. I've spent hours on the phone with their customer service people, hours in line at the post office, time and money only to be told four months later that they will not cover any compounded medications. What a waste of time, money, people, and paperwork. Unbelievable.

Now let me rewind to the day before this happened (Friday, 10/9). I injured my ankle on Thursday night. I called my insurance company on Friday to find an Urgent Care near me. They gave me a list - not ONE place actually took my insurance. THESE WERE ALL PLACES THAT ANTHEM TOLD ME TO GO TO AND ASSURED ME I'D BE COVERED. I'm so happy I called beforehand. When I called Anthem back for the 5th time to see if there was any capable person whom could help me, a nice woman said, "Sorry everybody gave you the wrong information. The only Urgent Care you can go to is in Chino, CA" to which I replied "Um, I don't even know where Chino is." Then I asked, "What about Reliant Immediate?" She said, "Oh, yeah. You can go there too." Um, ok. Thanks.

SO - back to Saturday 10/10. Reliant Immediate's front desk attendant gave me "promissory note" and said we can basically agree to pay for everything and we can take it up w/ Anthem on Monday morning. If anyone knows what this means - it means that the insurance company WILL FIND A WAY to NOT reimburse you. They will say, "You agreed to pay and we're not reimbursing." I know, because it's happened to me before.

So I ADVISE ANYONE TO NOT SIGN THOSE FORMS. It's SUCH a hassle to get your insurance company to agree to cover your services (and knowing how awful Anthem is, I'm sure I would have ended up paying out of pocket for everything). SO, as advised by the miserable woman at the front desk at Reliant, we called Anthem to have them fax over proof of insurance activity. Only to find out that Anthem was closed for the day. CLOSED FOR THE WEEKEND. Closed. Nobody there to help. I was literally in shock.

SO, we told the front desk at Reliant and she (I swear) said, "Well, then we can't help you. Who's next in line?" I have NEVER had anyone treat me this way. I love people and I would never in a million years treat someone this way and I don't expect to be treated this way. SO I broke down in tears and my husband carried me back to our car and she yelled - "Go to the ER" as we were leaving and I yelled back "WE CAN'T AFFORD IT. WHICH IS WHY WE HAVE INSURANCE." and I may have added a few things that I'm not proud of... understandably so.

SO once in the car, my husband called ANTHEM PROVIDER SERVICES and interestingly enough, THEY were open. Of course, ANTHEM will take NEW patients on weekends, but will NOT help EXISTING patients in emergencies. We stayed on the phone w/ the poor provider for over an hour - BEGGING him to help us. All we needed was a FAX to RELIANT. We literally were asking this guy "What if your wife or kid or parent had a possible broken ankle and couldn't get help. And had ACTIVE INSURANCE?!?!?" Even the ANTHEM EMPLOYEE said, "This is messed up. I am SO sorry I can't help. I understand your frustration and this is not right."

Anthems own employee couldn't believe how poorly Anthem is run. That's sad. Luckily, a friend of mine is a nurse and she drove over 35 miles to me and diagnosed my ankle as a bad sprain and put me on crutches. I STILL HAVEN'T HAD x-rays and let me remind you I HAVE ACTIVE INSURANCE. When I called Anthem this morning and told them what happened they said,"Oh, sorry. Yeah - the problem is on Reliant's end." Which I replied "No. You're the company I pay. You get my money every month. The problem is on YOUR end." I cannot wait to get new insurance from an ethical, reliable company at the start of 2016. In the meanwhile, I am so happy I have friends who are doctors and lawyers. My doctor friends can take care of me and I will 100% be speaking to my lawyer friends regarding this matter.

This is USA. I pay hundreds HUNDREDS of dollars every month to have health care. I was refused to be seen by a facility that my OWN HEALTH CARE PROVIDER sent me to standing on a painful injured ankle and all ANTHEM BLUE CROSS could say for themselves is "Oh, must have been a glitch on their end. Not our fault." No apology. No humanity. Just terrible, sad, disgusting service. I am appalled and I will be posting this email everywhere. This company needs to be investigated and SHUT DOWN.

I feel they de facto decline coverage and wait to see who has the tenacity and patience to take on each thing. My doctors are too busy to write complicated explanations and/or challenge each of their decisions or write in advance for each rx. Since when to insurance companies and their mds who get paid to work at home decide what is in a patient's best interest? Anthem needs to be held accountable and cost management is fair and necessary but their tactics are dangerous and I believe not ethical.

I have called them at least three times and each time they say it has been escalated, they give me a resolution number, or tell me they don't know why billing hasn't submitted a credit to my Visa. I have filled out a form for Chase Bank to dispute the charge and have informed Chase to block Blue Shield from taking further monies from my card.

Fast forward to June 2015, I received a bill on a Saturday stating that I owed $862 that was due the following Monday??? I called again and spoke to a supervisor who stated there was an error on their part last year and this is what I owed. But I was not to worry as I had 3 months to pay this amount. 2 days later I filed a grievance with BS and then 2 days after that I received a letter stating I was cancel as of MARCH 2015??? Every time I speak to someone I get a different answer. Even if I get proof in writing I'm told that's too bad, this is what I owe because that's what the computer says??? Never once have they shown me how or why this error occurred. Or have they allowed me to even set up some sort of payment plan. Now I've been canceled due to non-payment and I'm not eligible to get insurance through other companies because of this. This has caused me sooooo much wasted time and stress in phone calls is just ridiculous...

It is extremely difficult to get any support. You will wait on hold for long periods of time and finally reach someone who cannot help you. They will tell you that they cannot reach other departments and you have to hang up and call again.You are not allowed to speak to a supervisor. I have asked many times after getting nowhere with support only to be told that there are no supervisors, or I get the same canned response. My payments and copays continuously rise. My prescription drug prices continuously rise and they suddenly stop fill prescriptions for certain medications causing my doctor to try and find a substitute. My doctor is the one who should decide which medication I use -- NOT Anthem.

Their website is the worst I have ever seen. It is difficult to find what you are looking for and you eventually have to give up and call them back, ask for a different department and wait for hours. Prepare to be constantly spammed too. You will be called at all hours of the day to take part in surveys and special plans. You have to call the support people, sit on hold for an hour, and tell them you do not want to receive offers and surveys. Then you have to call them and repeat that at least three times before they stop calling you.

Get this.. I know they received them because they sent back the forms with incorrect reimbursement amount and to the wrong address! Another excuse is they can't talk to me because my child is no longer a minor. When I explain that I'm his conservator they say "you need to send in form," which I've already done. Apparently they can't "see" that either. When I went through that process I had to talk to several customer service agents because no one could agree on what form I needed to fill out and what specific documentation was needed. They said just put him on phone.. Well that's impossible he is disabled and can't speak. Huh.. inept agent couldn't figure that one out..

So I filled out what looked like the appropriate form and sent in every piece of documentation imaginable. Called again to try to solve issue and they still can't "see" form or documentation. Called Argus (Blue Shield's Company that handles checks), they refused to talk to me because I'm a member and I was told that I should call Blue Shield instead. But get this.. a Blue Shield "customer service agent" gave their number and told me to call them. Perfect!

Today I've spent roughly and hour and a half on the phone trying to solve a reimbursement issue and that ended with the agent telling me that he couldn't get me to prescription claims department, because of the high volume of calls to that department. He was a supervisor and couldn't get anyone on the phone. Next year.. new company..a one star rating is too high.. Too bad, it used to be a decent company.

But yet every time I call (including this time) I'm told $4500 is my deductible. Saying I have a $4500 is a flat out lie. And if ** says "this is a common misunderstanding" then why isn't Blue Shield doing anything to help clear this up. I'm told to file a grievance complaint but we all know that this will not change a thing. They should be ashamed on their purposeful way of intentionally misleading me and the countless others. Shame on Blue Shield and I will be telling and posting my story everywhere! And I will file a complaint with them and update this posting just to prove my point that they won't do a thing but deny this.

In my opinion, insurance providers are greedy and corrupt beyond comprehension for most of us. If you have a problem with BSofCA, file a grievance first with BSofCA then with the Dept. of Managed Health, link below. If enough people take a stand and go through the process of filing complaints, we have a better chance of changing the system for the better. You can also write to your local state representatives.

I decide to test my son's insurance. We go to the same medical practitioner. She says that according to Blue Shield he is not insured - either wrong member ID or wrong birth date. I decide to communicate the problem in written. I try to find Customer Support email address on their website. No such thing. I fill in the form I find with the text I have prepared, and click the button. The information departs somewhere. I do not receive a copy. I do not receive even a confirmation that they have received anything from me. Totally cloak and dagger. Probably for a reason. No reply from Blue Shield.

A few days later I call and ask what is happening. Customer Support says everything is fine, always has been fine and I just needed some letter from them saying that I am insured to show it around. I thought that what the membership cards were for? I do not receive a letter. I call again to ask for it and finally it appears. My wife's name is misspelled. Those things seem to matter when you need your insurance to work. I decide to terminate and call Customer Support. We make sure the last day of my insurance is 2/28. I ask for a confirmation letter and they promise to send one. I do not receive it.

The termination date approaches. It is good to know what the worst that could happen is. I read a bit on the Internet. People say that if you leave a credit card on file with them - they will keep billing it and then never return the money. Hmm, perhaps I should remove my credit card from there. I try to do that on their website. It does not work. I call Customer Service and they come through - I go on the site and my credit card is not visible anymore. I ask for termination letter again and they send it immediately by email. This is a good day.

In the beginning of March I receive a letter from Billing, with - guess what? A paper bill! It seems there is a problem in the communication between Customer Support and Billing, or Billing does not like looking at the computers that say that I am not a member anymore. I call Customer Support and explain. They feel bad for me and promise to sort it out. I cross the fingers. In the beginning of April I receive another letter that because I have stopped paying my insurance is terminated on 3/31. Good news and bad news, right? At least Billing knows I am not insured anymore. Of course, I have the correct expectation that Billing will start bullying me for March payment.

Before I manage to pick up the phone - I receive another letter. That is a bill for April and May, saying that now I owe them over $2K. My curiosity spikes. That means not only Customer Support does not talk to Billing, but perhaps Billing has a bug in their software which never stops billing anyone who is in their database. I call again and get confirmation that I have not been insured with them since March 1st, and they will notify Billing. I truly hope they use a different channel this time. I am trying to get a loan, and those people can really break things if they touch my credit rating by (another) mistake. The more I deal with them the more I am starting to believe they owe me money back for an insurance that never worked, and perhaps some compensation for the time I keep losing dealing with them.

When I finally faxed in my enrollment form they couldn't tell me if I was enrolled or not. I called many times and even talked to supervisors who could not tell me or who never called back. Not knowing if I was enrolled I had to pay out of pocket to a dentist for a tooth extraction. However, half way through the 3 month billing cycle they sent me a bill and membership card. So I was enrolled but did not get to use it because of their incompetence.

On top of that they gave me the wrong dentist instead of the one I had requested. When I called to try to straighten it out I was shuffled back and forth between customer service and dental over and over again as no one seemed to know what their responsibilities were. I decided I had enough and called to cancel the policy and was told they would have to mail me a disenrollment form and then I would have to wait 7-10 days to receive it where I would have to fill it out and fax it in and hope that somebody there can verify that they received it. Where have I heard this story before? I can't wait to change providers at the end of the year.

Customer service rating: Frequently, the representatives hang up on you. If you'd be successful to talk to someone after a LLLOOONNNGGG wait, then set aside an hour and hope that your question would be answered. The representatives are useless. They constantly put you on 3-minute holds to get back and put you on more holds...until you get fed up and hang up!

Online: Only provides general answers to your questions. Otherwise it's useless. Next year I'm getting out of this insurance, but I just wanted to warn the public to never consider this insurance!

Turns out that the card I received from Blue Cross reads Gold 80 PPO, but it also has "Pathways" written on the front. This is considered a network and none of my doctors contract with the Pathway network. None of this is indicated on their website and after hours upon hours with their customer service reps, none of whom understand the details of their plans, I am stuck with this plan as Open Enrollment is over. This is fraud and nothing less! If I want to see my doctors, I will need to meet a $5000 out-of-pocket deductible, and only then, maybe, they will start paying 50% after I pay a high co-pay. They clearly misrepresented their plan/product. This is unethical and I question why as a consumer we are powerless to hold them accountable.

I was also given invalid phone numbers to call that aren't even anthem related. The last person I spoke to said they would mail me the information. I hope it does arrive but I have doubts since I have been diverted instead of helped by their customer service department in over a half a dozen phone calls. It is unacceptable to be billed for a policy and then not be able to confirm even basic information about it. There is no content on their website so I must call to get information. The number I have been given over and over is 1-800-333-0912. I have called that number only to be told by the person not the other end to call that number.

Finally, when I asked to speak to a third person in order to file a complaint, I was told that the first two people were in error, and that the medication was in fact covered. That call took 85 minutes. Today I called because Anthem Blue Cross won't pay for the prescription to be filled because the amount prescribed by my doctor is more than the plan covers - once again, even though I've been taking this medication for three years and Anthem Blue Cross has covered this medication for that amount of time.

Anthem finally reinstated my insurance and credited my account for two months for the months of account service suspension. After renewing my plan for 2015, I received notice on February 12th, which landed in my mailbox after the open enrollment deadline had passed (highly coincidental), that the credits from last year would no longer be honored, and had since been added back to my 2015 plan charges. I've protested this obviously, and have now wasted three full days trying to sort through this paperwork nightmare.

Beyond this issue, I now have credit inquiries for auto loans in Indiana while living in San Francisco, which were obviously not intentional on my part. I've never had credit issues in my life and have maintained a credit score in the 770 to 810 range since my early 20s. I pay around $500 a month for the health insurance plan I have as an individual with no dependents. I never wanted to use Blue Cross Blue Shield, but UnitedHealthcare was not an option for individuals in my state, and I didn't take extra steps to migrate away from Anthem. I will never make that mistake again, and will seek out the service of Humana or another strong health insurance company. Be warned and please share: DO NOT USE ANTHEM OR BLUE CROSS BLUE SHIELD.

On February 20, I received a claim form from Anthem stating that I was not covered for any of my $583 routine check/cleaning. It took me 2 weeks to reach someone in accounts receivable (they make you leave a message and "say" they will return call in 24 hours - never happened). I called claims and spoke with Sandra (who transferred me to Tressie because she did not take care of small groups). Tressie told me this: The entire policy was cancelled 1/1/15 even though they had cashed my check; They applied the check to December 2014. I had additionally noted on the remittance that I was sending the amount less the one employee; Although I had faxed the cancellation for an employee mid-October and could prove the fax receipt, she could only cancel 1/1/15 because it was received 1/20/15; I had to pay for December and January, then get reimbursed for January; If I wanted to cancel 2/1/15, I needed to reinstate policy and pay for January & February, then get reimbursed for February (she would cancel me as for 2/1/13).

Tressie transferred me to accts. rec. since she could not reinstate. I was forced to leave a message again (knowing they didn't return call the 1st time). I called the next day 2/27/15. Spoke to Nile to reinstate. He said that Tressie was wrong and the policy could not be reinstated even though we received no billing for January nor any cancellation notice! Nile further stated that he could not do anything and my employees would have to pay for their January visits, that it was too bad we didn't get any billing or notices. He offered no alternatives for anything and did not care that this would be reported.

In summary, Anthem dental has questionable policies and procedures in place to ensure that insureds are notified of coverage or issues of coverage; Anthem requires "up-front" money for insureds who have cancelled in a timely manner but have not been cancelled in their system; Anthem does not notify insured companies that there is an issue with eligibility; Anthem does not address "referrals" in a timely manner and many of the so-called contracted doctors state they do not take patients; Anthem does not address individual or small businesses in the same professional manner as larger corporations; and Anthem has verbally iterated that they do not care if negative comments are posted. I will pay a small increase in premiums and switch our company and family to Delta Premier.

I phoned tonight for a different matter. I received a cancellation notice on my policy, despite my premium being sent, and cashed each and every month via auto payment. I now had to provide proof that I paid, via fax with specific instructions. I spent over an hour on the phone talking to representatives in another country who are completely handcuffed by the organization they have the severe misfortune of working for. To be told that the onus was on ME to provide proof that I paid every month so they could submit to their IT department to reinstate my coverage is negligent to say the least. This is no mere oversight or one off error. I say again, this is the 4th time this has happened.

Do you know what happens when you have a routine mammogram thinking you are covered only to find out your insurance company has not applied payments? Yes, now I have to deal with my health care provider and send them a retroactive reinstatement letter so they can re-bill, but who knows how long that will take! I was told I would just have to "wait" for them to process. And the reason for the delay in refunding for my sons account? "They've had so many requests, I just have to wait for them to process.”

Just makes me wonder... with my experience and all of the other similar experiences I've read about, WHY is this happening? WHO is accountable? As a nation, a first world country, HOW is it we have become so beholden to a government placating lobbyists for a large FOR PROFIT organization. Aren't there any attorneys willing to delve into the real lives being impacted, the wrong doings and illegal practices and "incompetence by design" that these insurance companies are perpetuating? This is WRONG! If ever there were a cause worth fighting, you have my full support.

We re-started the insurance in September 2014 for October 1, 2014 start date. Paperwork never received from Blue Shield. Covered California re-sent application for a November 1, 2014 start date. I made a payment to Blue Shield over phone 10-21-2014 by credit card. No medical cards sent to me yet. November payment coupon came in and sent out by money order and was posted to my account December 2, 2014 and still no cards. Everytime I called customer service I got different answers, Cards sent out. Cards not sent because I.D. Number is a terminated account. I went through this up to the present day. I never received payment coupon for December so I called and was told to call covered california as they did not authorize for another year.

I spoke with covered california was told I did not have Insurance September 1, 2014 because Blue Shield called covered california and reported non payment of premiums on October 29, 2014 so insurance was cancelled so I had no Insurance for October, November or December. According to covered California the I.D. number will have to change as they can't use a terminated policy number. Then Blue Shield sends me medical cards December 29, 2014 but the cards are still using a terminated policy number per the doctor and covered california said the cards are no good as all policies end December 31 and start new January 1st and since Blue shield canceled the cards are dead. So where did the money I paid go to for November and December 2014?

I started back with blue shield on January 12, 2015 and have a start date of February 1, 2015. Still that problem of getting an invoice to pay my premium is there and no medical cards. Nobody can tell me why no invoice or medical cards have been sent, but tell me it's a problem they need to look at. I have spoken to managers and customer service agents and even called the corporate office in San Francisco and was told someone would call me back the next day. No one called. I got a response from a grievance I filed so I called the woman February 9, 2015 and left a message and still no call back. Spoke with customer service same day and was told they need 24 to 48 hours to fix my account so the billing will be sent along with medical cards. February 12, 2015 I called Blue Shield because if my payment is not received by the end of the month it will cancel but how do you pay something when you have no bill to pay.

The rep I spoke with said they need 24 to 48 to fix my account and that they should have it corrected no later than March 13, 2015. I requested that the money I paid for Nov and Dec 2014 be transferred to my new account as payment. The rep said she spoke to the finance dept and that will happen but they need time to correct which can be possibly March 2015. I'm still waiting for medical cards and the rep said to use the cards that they sent which have the same I.D. number of the terminated account because that will be the number they are going issue. This is really a long time for all this mess and still no resolution other than they need time. Every call I made to blue shield I kept notes and have a good stack of what was resolved and by who and ref. #'s. What does one do with a situation like this? Just wait it out and hope you don't get sick!

The story of how Anthem Blue Cross has mismanaged my money since November 2014 has become SO convoluted that I am going to write the whole thing down. I feel like a crazy person trying to explain my grievance to whomever I speak with over the phone, since the story is complicated and no longer easy to follow. This written grievance is my last effort to straighten out the multiple errors committed by Anthem Blue Cross employees, costing me over $200.00 and 30+ hours of telephone and email time. Update: I now just received a letter in the mail: Notice of Grace Period, Intent to Suspend Coverage and Prospective Cancellation. This letter is in error unless my premium covering me for the month of March is already way past due.

The story begins: On November 10, 2014 at 11:15 am Pacific time, I spoke to Edgar who took an initial payment of $209.16. This payment was for my Anthem Bronze 60 PPO plan (ID **) effective November 1, 2014. On December 1, 2014 I called Anthem to make a monthly payment and inquire as to why my new policy was not represented on the Anthem Blue Cross website (I initially intended to pay online, but couldn't because I didn't see my new policy listed). The woman I spoke to on the call was Claricce **.

Claricce told me that I did not have an active Covered California plan because no initial payment was ever received, and that receiving the initial payment is what activates the policy. She said that nowhere could she find proof that I had ever made a payment of $209.16. She suggested that I fax evidence of my initial payment to Anthem, so that is what I did. On December 1, 2014, per Claricee's instructions, I faxed proof of initial payment to the fax number she provided me # 866-931-1829. Nothing ever came of this fax.

On December 11, 2014 I spoke to Rikki, a specialist in the processing department. Rikki asked me to email her proof of payment - ** - so I emailed Rikki the Bank of America Transaction Details that showed the $209.16 debit from my account. Rikki confirmed that she received this email and after a while of trying to track down my payment in Anthem's system, she discovered that Edgar (who took my initial payment) did not process it through the initial payment portal, but rather, the regular payment system- this is why my policy was never activated (and therefore not covering me).

Rikki told me that I could apply that payment for the intended effective start date of November 1, 2014. However, since my policy was never activated and I had been told by multiple Blue Cross employees that my policy had been basically non-existent, I didn't want to apply my money toward uncovered time. Rikki said this was completely understandable and that Anthem would refund my $209.16 and cancel my Bronze policy. She then advised me to resubmit my Covered California application and attempt the initial payment again through the correct initial payment portal. Essentially I was starting over from scratch.

As advised by Rikki, on December 12, 2014 I spent several hours on the phone with Covered California, updated my income information, picked a plan, and made a payment. I selected a new health plan for 2015 (Anthem Blue Cross Silver 70 PPO multi-state plan). The total monthly premium after the monthly fed tax credit is $208.40. I paid the initial payment online by following the link from Covered California to the Anthem site. The payment confirmation ID # is **. The plan has an effective date of January 1, 2015.

On January 3, 2015 at 9:35 am Pacific time (still no reimbursement check in the mail) I spoke with Veronica ** in the new enrollment department. I called the sales department because I had no luck connecting with anybody in member services. I told Veronica that I had just received a billing statement in the amount of $419.08. The current charges to my account were $418.32 (monthly Bronze premium x2) plus a balance forward amount of $0.76. The first intent of my call was to understand my bill, and what the charges represented. The second intent was to check the status of my reimbursement check, which I still hadn't received.

Veronica was attentive; she took notes including my Bronze policy number, Rikki's email address, and payment confirmation numbers. Veronica assured me that she would email the senior manager of member services, but that that she does not know when they would be in contact with me. I told her that I did not feel comfortable giving Anthem Blue Cross any more of my money until I was certain that my Bronze policy was cancelled and I received reimbursement for the policy that was never activated.

On January 15, 2015 @ 11:45 Pacific time I spoke with Kenneth call tracking # ** and he sent an email to the billing/payment department asking if my BRONZE plan can be retroactively cancelled. He said that if so, a reimbursement check for the amount of $209.40 will automatically be generated. On January 23, 2015 I received a call from Kenneth- he said that a reimbursement check was mailed on Jan 20, 2015 and may take 2-3 weeks to arrive at my doorstep.

Kenneth also mentioned something interesting; he said that his system shows that my Bronze policy was active October 1, 2014 through December 31, 2014. I only made one initial payment on November 10th, so why did I have three months of coverage?! I explained to Kenneth that on October 28, 2014 I spoke with Eleanor from Covered California who had to withdraw and re-do my application because I accidentally put that I was a naturalized citizen. Since I hadn't made my initial payment yet (and it was now October 28) she would make the effective date November 1, 2014. This worked out well because my previous Anthem Cross Premier PPO plan was effective through November 1st.

On January 26, 2015 I made a second payment in the amount of $208.40 on my Silver plan via the online BillPay service. I have a confirmation email of the payment available on request (although I already emailed it to Juana). On February 3, 2015 I received a check in the mail for $208.40. This was NOT the amount of the initial payment I paid via Edgar on November 10th, 2014, which was $209.16 - the amount I was supposed to be reimbursed. My concern was that I was being reimbursed the price of my silver plan monthly premium.

Even after having made an initial payment for my silver plan on Dec 12, 2014 and a second payment on Jan 26, 2015 (to cover the month of February) I was still receiving a bill from anthem saying that I owed $208.40 for the month of February. So at 8:40 am Pacific time on February 3, 2015, I called the Anthem billing department to ask why I was being billed for February still. I spoke with AJ call tracking # ** and he told me that he saw my January 26th payment, BUT NOWHERE IN HIS SYSTEM DID HE SEE MY INITIAL PAYMENT FOR THE SILVER PLAN. It is VERY CURIOUS that my initial payments for both my Bronze and Silver plans could not be tracked in Anthems system. AJ said that because the system showed that my initial payment was never received, the payment I made on January 26th was applied for the month of January.

AJ said I would have to show proof of initial payment (made on Dec 12th) which I must email to his billing specialist at **. I did this immediately, attaching Transaction Details from my bank indicating that the amount of $208.40 posted on December 16th. AJ said that Juana will call me back tomorrow to let me know that proof of payment was received. I did receive a call from Juana, and she left a message saying that I cashed the check already.

In sum, I believe I was mailed a reimbursement check for the wrong policy. Why did I cash the check? Because after three months of trying to get reimbursed $209.14, I finally got my money back, albeit short by $0.76. I am losing faith that this will ever be properly resolved, and am prepared to cancel my Anthem silver policy and enroll with a different insurance carrier. Anthem Blue cross owes me the difference of the error in reimbursement ($0.76) and it should be noted that I have paid TWO premiums for my silver plan, covering me through the end of February. Since one of these has been refunded in error, I am happy to pay it again, but only with the understanding that Anthem then owes me for the Bronze initial payment.

I am willing to wait through the end of February for this problem to be resolved. I am also willing to work with Anthem and email any proof of payment, etc. that is requested of me. If this is not resolved by the end of February, I have full intention eating the cost of Anthem's multiple errors, canceling my policy, and sending this grievance to the California Department of Consumer Affairs.

So turns out the ER Doc was not in network and Blue Cross tries to shave 189.00 of the ER bill after I paid my 100.00 deductible for not being admitted and another 100.00 for my yearly deductible. I called Blue Cross and stated "this is not my fault, I did everything right as a patient and more." They said "you're right, will send you a form to fill out, then just send it back and will review it and most likely pay the rest of the bill." Did that and heard nothing 4 weeks after they received it.

Meanwhile Beach Med. is sending me bills for 189.00 telling me I have a week before they ruin my credit. So I had to pay that bill also. Then on the 5th week I got a short letter in the mail from Anthem Blue Cross stating it's not their responsibility to pay the 189.00. So then my employer fought with them for around 6 weeks before they took responsibility. This really took a lot out of me mentally and financially all though Beach Med Serv. finally sent me my 189.00 back 7 months later.

OK so now I blow your mind! After thinking this is over and 10 months has past I go to get the mail today (1-30-15) and there is a bill from ** MDS for 80.59 for my Cat Scan, yes back in March of 2014 that 1 and only day I went to the Hospital. They say they're out of network now and Anthem Blue Cross only paid 121.41 out of the 202.00 they were owed. This kind of irresponsibility must stop, I really think we have very bad incompetent people running this health care system. And yes I called Blue Cross and it got me nowhere, back to my employer to fight another one out! Needless to say Blue Cross is down the toilet when open enrollment gets here. For people who are thinking on getting Anthem Blue Cross : RUN AS FAST AS YOU CAN AWAY FROM THEM!

I have now contacted my Congressman as Anthem seems untouchable. One of our doctors feels that Anthem is calculating the savings they are getting by delaying and dropping people and not covering many millions of claims. I am writing to Consumer Affairs to see if they have any response to offer help and not necessarily to make a complaint.

Several phone calls later to reps who when asked if they were in North America responded with, "And what is North America?" and a final phone call to Lodi, CA. With a youngster in the "executive inquiry" department (and no employee number --- only the name of " Josh") and a promise to call by close of business day --- (a call that I have never received) I am left with a desk littered with letters vowing to take me to collections unless I pay -$1,536.94. Yep, you read that right ---negative 1,536.94. I guess now that they cancelled me they want to hunt me down to give me some money back. Mr. Kafka had it all right folks!

Last time it was a fax and after the first fax went through I called customer service for the third time to make sure they received my information, only to find that I needed to provide all my information in a certain way. Today, again, I receive a letter that they did not receive payment. Again, I had to get on the phone, calling several times because the first answer I got was "Oh everybody got this letter and to disregard it because it was a mistake." I can smell BS a mile away. Again I call and was told to email proof of payment.

I'm a busy person. My husband has advanced liver cancer. I don't have the time or the emotional strength to have to deal with this on a regular basis. We can't afford to lose our policy over their incompetence--a policy which is the second highest expense in our household budget--first being the mortgage.

I won't get any of my premium back for the 2 years that she has been there which equates to $135 per month times 24 month. The money was automatically deducted from my checking so I never had to worry about anything. Because I do business this way, I have never received a bill, a letter or any type of correspondence from them or the broker, I never worried about my daughter. I have been paying this premium for 2 years and now I find out my daughter was never covered.

I am warning anyone who deals with insurance brokers or Anthem Blue Cross, make sure you understand everything and ask as many questions as needed. Blue Cross to me has always been a shady company because of the way they manipulated pricing for years. My personal belief, which I never had before this is that Obamacare would be better than nothing, at least the insurance companies could not screw you like this. I have never hated anything or anyone to this date in my life like I hate Anthem Blue Cross. For the rest of my life, I am going to do everything I can to keep as many people as I can from anthem as well as I am going to put it out to any congressman who will listen to my issue. Truly a pathetic company that deserves to be out of business.

Since September of 2013, these claims have been submitted Anthem Blue Cross a total of 4 times, and to date they have "never been received". Two of the times I sent the claims, they had to sign for them - yet these claims were "never received" either. When I attempted to contact Anthem Blue Cross, they told me that due to the type of contract they have with our administrator, they will not talk to me. I have to talk my administrator’s claims department. So I did that, and was told by the administrator, that they cannot do anything about a claim until Anthem Blue Cross enters it into their system. Well isn't that clever, Anthem sets it up so they don't have to answer to me, and then refuses to acknowledge the claims it does receive by simply throwing them away, so I have no recourse.

I am very tenacious, this will get resolved. However what about those who have difficulty understanding and navigating bureaucracies, older people, younger people, people who have limited English, they would be totally lost and give up, and quite frankly I believe this is what Anthem Blue Cross is hoping for. Anthem Blue Cross epitomizes the corrupt corporate greed that is plaguing our country, by those corporations not content with reasonable profits so they resort to unscrupulous business practices for their illicit gain.

We have an option to appeal the bill, but they don't actually give you any information on how to contact the people that are making the decisions. It appears that they have a separate company (Anthem UM) that has to justify its existence by rejecting bills and foisting them back on their customer base. I followed their process to notify them that I was appealing the billing, and they sent me a letter notifying me that my appeal was rejected before I could even see my doctor to get information on why my wife was sent for this test. I can't wait to get rid of them. One star only because I can't go zero.

From December 1st to December 5th, I made several calls to Anthem and every single agent I spoke to, told me they had no record of me. On December 5th, I spoke to an agent named Rachel. Again, she told me they had no record of me. In frustration I mention to her I will contact my attorney in regard to this matter. She immediately found my application. "It was lost in limbo". After apologizing she guaranteed me coverage by the end of the day. The end of the day came: I still had no health coverage.

She called back on December 7th, apologizing, and guaranteed me coverage by the following day. The following day I still had no coverage. I called Anthem again on December 9th. Rachel was not in, spoke to Dean, to find out that Rachel never processed my application. Dean guaranteed me coverage by the end of the day. End of the day, still no coverage. Today I called again and asked to speak to a supervisor. Kiana answered my call. She personally guaranteed me coverage within 48 hours. I demanded to have it in writing in an email. I had never received that email. Today is December 10th. I have no insurance, Anthem is aware of my need for surgery and do not want to insure me, breaking the law in doing so. I had been in touch with the California Insurance Commission, which they urge me to file a claim. I will contact my local Congressman in regard to the matter and I have no other choice but to hire an attorney and file a lawsuit against Anthem Blue Cross. I will not recommend Anthem Blue Cross to anybody.

Even after deleting the profile the online system still thought I had a profile in the system. Basically I am stuck in log-in credential hell. "Register as a new user," they tell me, but then it says I am already in the system. Log-in as existing, I try, and the system doesn't recognize me. I call them every month to see if the problem has been fixed and all I am told is this is a known problem. Oh great. Known problem. Why is it taking over six months to simply fix my log-in information. I depend on on-line access to my health plan information. What a joke. It is so frustrating I am close to switching health plans next enrollment period (unfortunately that is 12 months away). Anyway.....What kind of major insurance company can't fix this in a timely manner. Totally unacceptable.

I ended up having to go my other in case travel insurance I bought from Allianz for reimbursement. And they are super competent, fast, understanding, and incredibly helpful. You can actually reach them quickly which is another great thing. I HIGHLY HIGHLY RECOMMEND ALLIANZ for any travel insurance related product.

BCBS assures us that since the claim was filed months ago in a timely manner and they are still reviewing, everything will be backdated and reimbursed to us directly. Not convinced until I see a check in our mailbox and communication has dwindled from 3 times a week to once a week. Still waiting.......thoughts? I feel like I need to step up and be more aggressive since I have maintained a strong paper trail, but I'm waiting for the loophole when it should be straightforward reimbursement. Do they have recording of the conversations they have had with me? They have admitted that since they received documentations to process claim, it has indeed been "unusually" long and they need to get it squared away. Still playing nice but starting to look through their average user rating score of 1 makes me feel like I need to move forward faster.

I was instructed by my primary physician Vijay **, MD, 6 months ago 5/05/14 to contact Sutter Pacific located in San Francisco office who I was told accepted my insurance. I met with with Tammy ** the Sutter health Nurse practitioner in their S.F. Office. Tammy, not only accepted the coverage I have, but scheduled a complete blood analysis and lab work to be completed. She was intelligent and very knowledgeable. Tammy, informed me that with the Hep C virus I have had for 35 years, I could expect a 300 to 400% increase in pain as in inflammation as I was past 50 years in age. She was correct on this assumption, I can barely walk or work unless I am on pain medication and sleeping a few hours is all I can have, without using the bed frames to help me turn in different positions to relieve some discomfort. After waiting and calling for the follow up I was told I was not covered by my plan.

At the advice of my Primary doctor, I then transferred to the Sutters Pacifics Oakland office. Explained my coverage and was told they would accept it. I met with specialists Edward ** Md., I had a helpful consultation in regards to Tammy ** requested and completed blood work. Doctor ** reviewed the blood work in great detail, he then assured me of a new Hep C treatment, Solvaldi. I had a personal promise from Dr. ** and his staff that they would indeed accept my coverage Blue Shield covered California plan, and not to worry.

I have spent much time worrying while trying to understand the denials of coverage. My conclusion is my Blue Shield Covered Californian plan is valid however most insurance companies refuse to honor the current laws, instead they seek legal loopholes. I am just an individual who signed up to the Blue Shield in good faith and now feel a pawn in a political showdown of denial and acceptance. Please help!

Time went by and even though we called time and time again, we'd get the, "Sorry, they'll be there any day now." A month goes by and I called ONCE MORE, asking, where the heck our cards were. Still no word. Oh, but they were SURE to tell me our payment for the first month was "overdue". I, (not knowing these guys were the slime balls they are) agreed to pay over the phone. They seemed nice enough and I had no reason to be suspicious. He gave me a "confirmation number" afterward and I thought all was fine and dandy.

My Husband, mind you, was in incredible back pain for a good 6 months and NEEDED to be seen and diagnosed STAT. An ENTIRE other MONTH goes by with call after call from us. Sure! We PAID our premium but no doctor would touch us without cards...2 months premium paid, NO SERVICE. We FINALLY got the cards late August. We joined July 1st. We start the long process of MRIs, XRays, etc., etc. We find he has a cyst on the lumbar region of his back. He needs a surgical procedure to "pop" the cyst and "hopefully" he'd get better.

One day we discovered they had cancelled our policy with NO WARNING. No letter, no call. After MORE run around being tossed around like hot potatoes between Covered CA (not much better themselves) and them, Confirmation #s that disappear into thin air, and HRS, I mean HRS wasted on the phone holding, we FINALLY got "reinstated"...not really. They said we were, but we still weren't coming up in the system. Paying out of pocket. A "Welcome to Blue Shield" letter arrives in the mail dated Sept. 29th. Ok? It turns out the Hubby needs spine fusion surgery. GREAT. But guess what??? Our friends send us another letter dated October 15th stating our coverage was discontinued due to nonpayment...WHAT?! 16 days after being "welcomed"??? 7 FRIEKIN DAYS BEFORE HE GOES IN FOR SURGERY! WHAT THE? We immediately give them a call, and apparently they refused our payment "during the lapse in our coverage." Well NO *BEEP*! That WAS THEIR "MISTAKE" IN THE FIRST PLACE! We really started to panic now!

Here's a little piece of advice: Should you find yourself so trapped as we are in this situation with these Swindlers: Record, record, record your phone calls and keep every piece of correspondence! You're definitely gonna need it! The only thing that saved us. They will literally LIE thru their teeth and tell you what you want to hear to placate you, "Sure you guys are fine! And fully covered!" by multiple people! I've been on the phone literally since Mon. and it's Thurs. They told me Mon. that we'd be reinstated AGAIN Fri. morning. His surgery is Mon!! But OF COURSE, in order for them to re-enroll us, they would NEED a sum of $2,000+ for back pay that THEY REFUSED. They knew they had us over a barrel because we were desperate to have my Husband's surgery covered! So I paid it.

The hospital called in a frenzy because when they tried to bill Blue Shield, it said we were INACTIVE. EVER AFTER MY PAYMENT AND PROMISE WE'D BE FOR SURE COVERED. RECORDED STATEMENT ASSURING US. And that ALL we had to do was have the hospital on the day of surgery, call this 800 # and everything's Peachy Keen and Good to Go. WRONG. None of our doctors could get ANY confirmation that we were covered. Hence they cannot hold a place for surgery without confirmation of coverage and they might have to cancel the surgery! My poor Husband, the one who's in so much pain, has to battle with these Bait and Switch Cons and was hung up on 5 separate times EVEN while the hospital coordinator was conferenced in...They lied and were caught in these lies with recorded false statements made by their fellow colleagues. With dogged, dogged persistence on both our parts, WE GOT 'EM. Too much diligence and evidence stacked against them and they CAVED. BINGO BANGO! ALL OF A SUDDEN WE GOT COVERAGE!!! OUT OF THE WILD BLUE YONDER!

They were planning on placating us until Mon. when we went into surgery and deny us coverage! Going to leave us HIGHLY AND DRY with a $40,000 at least surgery bill!! These people outright LIE, LIE, LIE, CHEAT and STEAL and should NOT be in business! We plan on running from these guys once open enrollment rolls around! Take it from us! RUN! DON'T WALK THE OTHER WAY!!! HIGHWAY ROBBERY! DON'T GET CAUGHT IN THIS WEB OF DECEPTION!

This is the worst insurance experience I have ever EVER had. I have spent countless hours on the phone with people who give no information, transfer me to numbers that eventually hang up on me, and who are always reluctant to give their name. This cannot be ethical or legal can it???

In May 2014 it came to my attention that I was being overcharged for one of my prescribed medicines. I called the customer service line on my card and was left on hold, then got disconnected while the matter was being investigated by the representative. I had to call back multiple times, be put on hold again, only to have to start over with another representative who could not give me a satisfactory answer. I was being charged $70 rather than the plan designated $50. After many hours, I finally spoke to a representative who confirmed that the medication is formulary and I was to be charged 50.00 for the next refill. On 8/28/2014 I was charged the $70 again!

I was due to have another medication refilled, one I had been taking for quite some time and under my new Blue Shield plan would have been charged $70 because I was told it was not formulary. I learned through my pharmacist that it went generic prior to the request; therefore, the price would be much less expensive. I called the Blue Shield Gold representative phone number once again, was on hold for long amounts of time, got disconnected, and when I finally did get an answer, was told that Blue Shield had not yet updated their computers to show the medication as generic. No one offered to help me to find a way to get the price lowered to the generic cost.

I have been diagnosed with Macular Degeneration and have been seeing Doctor Stephanie ** at the Gavin Herbert Eye Clinic at University of California in Irvine for over a year and a half. When I found out that Dr. ** was not on the Blue Shield Gold network, I asked her to review the eye doctors on the network and there was no retina specialist able to provide the treatment in our area that I need. I am losing my vision and am trying to avoid complete blindness. In May, 2014 I contacted the Blue Shield Gold Customer Service call center where I spent many hours on hold and spoke to various representatives who gave me varying answers regarding continued care for my condition. Each one had a different explanation on how to process a continuity of care request.

Initially, I was told I was to send in the form. I did that and then on follow up, they told me it was lost. Then I was told that my doctor would have to send in a Continuity of Care form, that she would have to call a special number to get a fax number to send in the form, a number I was not permitted to have. All of this was a very time consuming process and ate up hours of my time. When Blue Shield did write to Dr. ** to request my records, Blue Shield put my husband down as the patient, confusing Dr. ** and UCI, creating another delay. Latest communication I received from Blue Shield on Sept. 4 has denied continuity of care with Dr. **. I continue to lose my vision this issue drags on unresolved.

Due to another medical condition, I was referred to a Urogynecologist. This is a very specialized field and I called every urologist and gynecologist listed on the Blue Shield network, and no one provides the services of a Urogynecologist. I was referred to Dr. Patricia ** in Mission Viejo who is on the private PPO Blue Shield network and not on the Exchange. I had to pay hundreds of dollars out of pocket because this doctor is not on the network and because there is no other doctor with her specialty on the network. I will need surgery l and will not be able to pay for such a procedure out of pocket. This is another example of the lack of specialized doctor on the Blue Shield Gold network. I just received notification that the appeal for this doctors services was denied.

Feeling sick is stressful in itself. However, that stress pales in comparison to how I feel regarding my healthcare coverage. Blue Shield Gold does not have enough specialty providers on the PPO network causing me huge concerns and anxiety about how I am going to receive the treatments I so desperately need. Also Blue Shield’s inability to provide educated and professional representatives makes me question whether to continue to be a Blue Shield consumer. I am disappointed in Blue Shield’s lack of concern for my welfare and I need help in getting these issues resolved so I can get back to living a healthy productive life. I have read Blue Shield of California’s Mission Statement, “To ensure all Californians have access to high-quality health care at an affordable price.” Now ask yourselves, with all that I have experienced with Blue Shield’s inability to provide me with the health care I need, does it appear to you that Blue Shield is living the mission statement?

Customer service is non-existent. We are seeing the Covered Cal Exchange paying for almost nothing. The worst part of both Blue Cross/Shield and indeed all insurances is that there is no government agency to oversee and make them straighten up their act. The California Insurance Commissioner cannot MAKE the insurance companies do anything. They can recommend, they can say "Bad Insurance Company". There is NO Federal agency overseeing insurance companies, which should tell us all that the insurance companies have some of the most powerful lobbyists in Washington and the money they spend. SHAME.

In June 2014, my lower back went into complete and paralyzing spasms - after ten years of back issues, this was easily the worst episode. My wife called 9-1-1 and I was taken to Marin General, where I had to stay for 3 days to recover from this incident. After filing an insurance claim a month later with the ambulance provider (Southern Marin Emergency Medicine - who were amazing and friendly), I was notified by Anthem Blue Cross of California that I chose an out-of-network ambulance provider, and they were going to cover $0 of the $1,435 bill. I am relatively young and other than the back thing, pretty healthy. But I see the value in health insurance, so my wife and I pay our monthly sum to Anthem in the hopes that if needed, we won't face additional bills for care that should otherwise seem like a no brainer. I cannot wait until the open enrollment period so that I may finally leave Anthem Blue Cross of California. They are a joke. Their network is a joke. Their customer service is a joke. And every person I have interacted with, since the debacle of signing up through Covered California is a joke.

I received my August bill and it showed another increase. I complained again, this time to Blue Shield top executive. I also supplied a link to a Blue Shield document that stated that premium increases based on age goes into effect the January of the year following the odd birthday. I did not receive prior warning of either increase -- Blue Shield claimed that letters were mailed to me regarding these increases.

I was told by Blue Shield that link I referenced regarding age-based increases was for regular plans and because I had a Medigap plan, it did not apply to me. I said that, that appeared to be discriminatory. The response was that Medicare had approved the decision. I was told that the August increase was due to an across the board increase for all Medigap customers -- first increase since 2012.

I am upset with both Medicare and Blue Shield for these unfair practices. Customers spend hours deciding which plan to select and a part of that decision is based on the premium price. You expect that that price is based on a calendar year. It did say 2014 premium prices. These are unfair increases using the bait and switch practice. This should be illegal. And why would Medicare sign off on a practice that allows Blue Shield to unfairly bill senior citizens out of their fixed income. This is age discrimination.

The list of negatives with Anthem BC goes on and on, and now they report that they will also be raising rates. So, I ask normal people out there, should we just go without insurance since they pay for nothing and don't even cover the hospitals in our area? What if we are really sick and go to the hospital, we will not be covered because this is not in their network? I live in the San Fernando Valley, oddly where the ABC headquarters are and wonder why I am paying over $16k per year for no coverage.

Yesterday, June 10, I was contacted by the CSR I have been working with and told that they located all my payments except April. I provided her with the confirmation number from my bank and she said she would get back to me in a week or so. Last night I received a cancellation notice effective May 31 (They of course have already received my June payment.). This is after I have spent countless hours talking to their CSR, my bank, and faxing verification of my payments. RESULTS. No insurance after paying on time for 5 months. AND, Blue Shield has given themselves a tip of getting one extra month from me. This is the worst insurance company in California and this should not be happening.

One call took 1-1/2 hrs to complete (59 min 17 sec to get a live person) and today was 45 minutes with a 7 min wait. I then asked how often they update their list and was told they are working on February's list of doctors so the website is 3 months old. If it is true that 70% of the doctors are jumping ship it will get uglier. I can't change plans because the government has me locked into this plan (enrollment period closed). No wonder all the insurance companies' stock went up the day after the ACA passed! We have to buy insurance and get poor service and a sad list of providers and the insurance companies get their money and many of us won't use their doctors. So sad.

The search process defaults to your home address and forces you to enter an entirely new address (street #, name, type, city, state and zip) which is often necessary if you are searching for a DR close to where you work. What a waste of time to reenter completely new information. There are no pictures of the doctors. Some of us want older, more seasoned DRs; others patients may want younger, hipper, cooler ones. There are no ratings of the medical groups. For example, is Sutter Health's office in Albany easy to deal with or hard? That's an important factor in choosing a physician because finding a good physician with a bad front office is a recipe for unhappiness. Finally, I was searching for a PCP and guess what, there is no search term for a Primary Care Physician. There are search terms for DRs that have a Family Practice or practice Internal Medicine but there is no way to search for a PCP.

Someone needs to dramatically rethink BS' website and bring it out of the stone ages. Even BS' customer survey about its website, which I filled out, is atrocious. The user filling it out is only able to see about 12 words of text at a time making it incredibly hard to write constructive feedback. All in all, a highly disappointing experience. It doesn't seem as if BS has progressed at all in the five years our family has been away. I gave all this information to BS in their survey and told them I was going to post it on Yelp and other consumer ratings sites to socialize this problem with the others.

Initial attempts to pay online were impossible as there was no link for payment. This morning a link magically appeared but it demands an excessive payment more than 3x the correct amount and will not accept the correct amount. I sent a Premiums message via the web site but (of course) there has been no reply other than an acknowledgement that I sent a message. So BS provides no way for me to pay the correct amount! And given the general level of incompetence, I do not trust BS to correctly handle the massive overpayment, demanded by the web site.

THEN, after signing up and keeping a careful record of the log in and password, I was denied entry the first time I tried to use it, so I filed a "lost password" message. They said they would send 2 (why 2??) emails with information to redo the whole thing. I'm still waiting--with most sites like this the email comes almost immediately. This has been my experience with all insurance companies. I am convinced they are trained to delay, delay, delay....maybe the claimant will just give up and go away. I predict this situation won't last. With articulate baby boomers retiring in huge numbers the din will grow so loud that the insurance companies will be forced to change their attitudes - the "Blues" first among them? If I sound pissed, you are right!!

Anyway 7 weeks went by and I just could not take it anymore. I thought I was losing my mind, I came home from work one day and slept which I never do. I called my doctor and asked if she could fax a blood request for me to have done and within 2 days she called me back. My Estrogen was at 0 and the others were right in that area. This combi-patch that Blue Cross said they would pay for was doing NOTHING for me. I had completely depleted myself of everything I had in my system and now I have to pay CASH for the bio-identicals so I can get my life back together. This is not right. I think we are, after all these years, ready to try a new insurance company. It is not like this company does not charge an arm and a leg already.

I really feel that this company only cares about getting your money, then they answer and help, but when it comes to providing customer service.... ha! You can yell, cry, be patient, provide the same answers to their inane questions over and over and then.... THEY HANG UP ON YOU!

I dial the 800 number and am speaking with a Blue Shield employee within two-and-a-half minutes. Blue Shield is perfectly willing to take their clients' money, but when it comes to resolving even the most mundane issues, they make us walk atop miles of smoldering coal. Blue Shield has never called me back. They've never provided a legitimate response, save for boilerplate, to any of my e-mails. Never. I get the sense that this is business as usual. Don't make the same mistake I did. I wish I'd have just gone with Kaiser. Stay away from Blue Shield of CA.

I don't think that the Ames doctor should make a decision on what I need based on the cost difference for lower back and lower back and hips. My pain I am having is more in my hips than my lower back, I explained to my doctor. On May 1st, my doctor put in for a new referral for both lower back and hips. I am waiting to hear back if it has been approved. I feel that this insurance is just to take your money. I paid over two hundred dollars for myself and children. We hardly ever go to the doctors. Now that I need to use my insurance, I am being stonewalled by authorization doctors. I am upset. I am in pain. I need to return to work. I hope upon next year, my company (FedEx) will find a new provider.

The patients are frustrated and we are frustrated, and the only one who benefits from not training their employees is BC/BS because no one can ever figure out how to get services or supplies covered.

When they finally got the address correct, they increased my premium instead of decreasing it, which resulted in about 3 more calls and an appeal which is still in the process. Then they cancelled my policy without informing me which resulted in another phone call where it was reinstated yet never got reinstated. Three calls and a week later, they still didn't reinstate my plan although each person I spoke with assured me it would be reinstated within 5 days, 3 days, 2 days, within a day, 4 hrs or, "We'll call you when it has gone through the system." Are you serious?

This is complete BS. I pay $175 a month to these jokers and they can't get anything right. I have been waiting to pick up a prescription for 5 days that the pharmacy won't fill because their computers tell them my insurance is not reinstated. It's a joke and they are basically stealing my money. For five days of the month of February (the shortest month of the year), I've been without insurance. Yet, I have paid $175 for the month. No one in their customer service dept. has a clue as to what's going on or why. And I don't have any idea why I continue to pay this company for sub par service and terribly unethical business practices.