Blue Shield of California Anmeldelser 

The STATE OF CALIFORNIA HAS CONTRACTS with Blue Shield and every medical Insurance in California and across the country with a dept of social workers that are supposed to help people receive housing. Blue Shield REFUSED TO PAY ME FOR HOUSING COSTS it's their responsibility. A big red flag is Blue Shield will use 3rd sh*** companies such as MEDZED who are grossly negligent and gross incompetence they are supposed to pay all costs and are later reimbursed with a cherry on top. Instead Andy and his sleazy supervisor Fernando Alvardo 6193307157
lied to BLUE SHIELD indicating it was my fault and the manager at G&K so they wouldn't have to pay. It's blackballing and a setup. This is one reason why many people are not getting help!! It's the responsibility of DMHC to hear my complaint that is supposed to assist me and Mary Wantabe refused to do so, she was the one stealing money from LA CARE in a lawsuit when all this was going on and took 55 million dollars. At that time I was under LA CARE and was caring for someone until he died. None of the patients received compensation. However, I reported Blue Shield to DMHC and they too refused to reimburse me for those costs. The Housing situation is all lies the MAIN STREAM MEDIA FUNNELS. The State and all GROSS NEGLIGENT 3rd party companies HELP NO ONE BUT THEY TAKE THE MONEY THEY ARE GIVEN!! I am fed up with all the corruption! It will get worse I guarantee it.

I just joined Blue Shield of California Dental HMO having been laid off but too early to take Medicare. I called to ask about benefits not understanding why after a visit to the dentist they didn’t pay anything, and she kept saying it’s a copay. I didn’t understand what that meant and asked when BSofC would pay something, and they hung up on me. I’ve never had that happen to me before, and just wanted someone to explain how the insurance works.

I would take the time to leave a negative review but seeing as how they don't respond to their reviews, I see no point in wasting my time, energy or words.

TLDR: They tell you to do an annual wellness exam and in exchange, they will send you a $50 gift card. But they never will. And then you'll waste your time talking to 13 different departments to try to get it resolved and nothing will happen.

I’ve had BlueShield/Optum for 8 years and loved them (before Optum it was something else, but Optum bought them out). I have to say I still love my PCP and have had mostly good luck. Over the past few months it has been hell. BlueShield pretty much told me that if I really wanted help I had to be talking to Optum since they are the ones who approve or deny all referrals. Which is who I started talking to after that. Things have been great till my last health crisis that involved me having to be hospitalized and stented. I was supposed to see a Neurosurgeon after two week from leaving the hospital, which supposedly optum took care of. 4 months out I have yet to see the specialist. This has included a lot of calls from my doctors office and me. Got a referral to a doctor who said they wouldn’t see me and it had to be who ever saw me at the hospital which Optum keeps denying with “out of network.” Eventually find me another doctor who is an hour away and has extra charges for everything. I called because I do not want to see a doctor where I’m already going to be out of pocket, this is why we have insurance. Became an issue and called BlueShield to file a grievance, on Optum. Pretty much gave me a “Sorry, too bad you have HMO, if that means paying extra.” I asked to speak to supervisor. I got a call back later that they had to request a case manager (which I had asked for over a month ago) but the supervisor wouldn’t speak to me. I called back to complain about this situation, there is no reason a supervisor should not talk to me directly and the persons answer was “Well you already have like 5 complaints today.” I called to make a grievance about Optum how ever their complain system works I can’t see. Now apparently there are 5 complaints… in the mean time my blood pressure is going up and my doctors are worried because of my health history.

They cancelled my policy without telling me. I contacted them and they told me it was their mistake but now may take 10 days to reinstate my policy. So I’m now walking around uninsured and have upcoming doctors appointments this week that took me months to get!

Greetings,
My experience with Blue Shield has been challenging but there are professional and diligent representatives namely Aneeka and Jacob (6/12/2024 and 6/18-19/2024 respectively). They researched the discrepancy that I was experiencing and Jacob found the exact amount $137.00 and reached out to Optum. The discrepancy is with Optum which handles the approval/denial process of claims. The representatives could see that on the Blueshield inquiry side that the claim had been paid. However, the invoice still got to a collection agency in Orange, CA even though it had been paid. I am thankful for Aneeka and Jacob being on the Blue Shield Insurance team. The date of this current experience was from (June 12, 2024 through June 19, 2024). I received a notice on my phone in the form of a text message regarding an invoice dating back from (4/22/2022) With in a few days after receiving the notice I spoke with the Blue Shield representatives. The representative put me in contact with an Optum representative in the form of a conference call.
We (Jacob and myself) were able to speak with the Optum representative. She also saw that the invoice had been paid.
On June 26, 2024 I was able to speak with a representative from Optum and she contacted the collection agency and verbally verified that the invoice had been paid. The representative from Optum emailed the proof of payment to the collection agency. I followed up with the agency and Optum and the agency had not received it. The representative emailed them again and sent a hard copy to me as well.
June 27, 2024 I spoke with more representatives from Optum and I was told that the original claim was submitted without the authorization information included. I was told this by a representative from Optum's Torrance office, that the invoice was paid late because of the missing documentation.
The invoice was eventually paid when it was submitted with the correct billing/remittance information.
This is one of three challenging scenarios with Blue Shield/Optum. Blue Shield
and Optum representatives were diligent in this scenario. However, they are not the decision makers as to which claims are reviewed per payment. The Clinical Utilization Review group at Optum are responsible for reviewing authorizations for payments per my conversation with the representative. This has been my experience.
Respectfully,
Patricia

I am unfortunately leaving a good doctor’s practice that I very much value because blue shield is too much of a risk. A complete shell game. My experience with Blue Shield has been horrible. I've been misquoted, then bullied and their billing practice is horrific - you’ll get bills much later - I’m moving to Kaiser. They misquoted me, had record of the misquote, would not send it to me, said they reprimanded the person that misquoted me - I just wanted them to pay the bill. So I sent the entire matter to the state of california insurance board - they reviewed it and I won. It’s disgusting what they tried to do. Do not trust them - go elsewhere- you can find better.

Had a life threatening emergency requiring a direct visit to the emergency room at the hospital at night. $12K Bill of which Blue Shield ponied up $0. Worthless insurance and company.

They won’t accept the diagnosis codes from my child’s therapist so they haven’t paid her. Took me a year to find someone in network for my son, For years Ive been hearing that therapists won’t work with Blue-shield because of how hard it is to get paid by them and now our therapist is putting in her notice with them. My kid is suffering from lack of continuity. This cycle keeps continuing. It feels like having this insurance and trying to use them is just keeping my family sick. The alternative is to go into debt to get mental health care.

Their customer service is very unprofessional and rude, if they feel you are challenging them and not agreeing with what they offer, either they hang up on you or ignore you!
I was trying to change our health coverage for 2024 but the customer service was insisting that I should do it online and seemed to be “sleepy/hangover “when I indicated I am having a hard time, she transferred me to mental health department:/) blueshield of ca seems to hire bunch of illiterate looser who can not fulfill even a simple conversations, apparently third class education is enough to be a Blueshield customer service representative. Hate this company.

I signed up for Blue Shield HMO and Blue Shield selected 3 doctors without my knowledge and approval. And after the first website login, I was locked access. After contacted Blue Shield several times, I was still locked. I then had to go back to direct Medicare. But then Blue Shield claimed that they were the best. I learned different. That's why I'm giving Blue Shield 2 stars and for misrepresenting them. Now I'll be still without medical coverage until next February 2024.

Poor customer service in claims dept and they are rude & no one seems to know what they are doing !!!

Negative 100 stars! BlueShield is TERRIBLE! Scroll to the bottom for the takeaway. If you want to read my detailed rant, read on.

Literally paid over $1,000 for a policy for myself and my husband. Today is 11/7/23. Whenever I tried to log in to my account, I always got a notice that said “content temporarily unavailable.” Which led me to cal customer support. Customer support found my application but couldn’t see a status. They said Sales processes applications and transferred me to sales. Sales said “customer service processes applications” and transferred me to CS. I spoke to 5 ppl yesterday in this game of ping pong. Finally with the last sales person I spoke to, I was fed up and when she said “I’ll transfer you to customer service” I said “customer service said you guys process applications.” She said “we don’t.” I asked “which department do I need to speak to to process my application? She said “I don’t know.” I asked “how are you going to transfer me to the department that processes applications if you don’t know who processes applications?”

Fast forward to later in the day and I went to my local Winnetka office. The doors looked closed and I’m assuming they weren’t supposed to let customers in. But I called the vendor number in the door and spoke to the person who answered the phone with authority like I was supposed to be there and he let me in. Once I was inside and he realized what was going on, he looked scared like he wasn’t supposed to do that and I didn’t want to get him in trouble so I waited by the door while he went to grab a customer service person for me to talk to. She informed me that everyone in the office only services Medical plans people and not commercial plans. She said all of the commercial plan people work remotely. So I left with nothing accomplished.

Next day (today) I check the website (still not able to login) and called CS. I spoke to Nora who assured me that I’d have coverage beginning November 1st and that all I needed to do for upcoming doctors appointments is pay out of pocket and then submit to be reimbursed. I asked her if she could send me a document or point me in the direction of a document that has this policy outlined. She said there was none. I explained to her my concern that if I do that in good faith, I could easily be told by someone else at that time that that’s not how things work. And that any company who has policies like this in place would have a legal disclaimer that clearly outlines the policy and the specific conditions that must be met in order for the company to be obligated to fulfill certain duties. She said “I’m not an insurance agent.” [Mind you, I’m talking to a customer SERVICE person. Customer service at any company should understand the basic legal obligations of the company to its customers and should know where to access that information.] I asked if I could speak to an insurance agent. She said no but I could speak to sales. I explained to her the back and forth I went through yesterday and that sales wouldn’t help me unless I was intending to purchase a policy which was not the case seeing as how I had already purchased a policy. She then said that my application is processing and that by Friday I should have my account up and running. I asked her if she could guarantee that. She said “no” and explained that all she sees is application in progress and that there was no date. So I asked her if there is no date, then how could she tell me it would be done by Friday? She said “so who do you want to talk to because this is ridiculous?” I said “excuse me? What did you just say?” Silence. “Did you just say this is ridiculous?” More silence. “Yeah I want to speak to a supervisor.” Call ends.

TLDR: BlueShield doesn’t give a rats behind about their customers. No one will help you and you’ll be given whatever false info the customer service team decides to make up on the spot.

Will find ways to drag out essential coverage. Waiting on months to get medication with what are basically fake authorizations. Then won’t cover basic administration of said medication… I’ll spare you the story, they will only pay their own “special” pharmacy who won’t do s*** and will delay everything as much as they can with flat out lies

Since being a member in 2019, my monthly has gone from 650$ to $820 roughly. This company should be sued

Should have 0 stars. #helpderekfsongs

I have a Blue Shield California HMO plan (my company only offers Blue Shield, no other providers) and the coverage is terrible. I live in Chico, CA - a major city with a population of over 100,000 people and a regional medical center + college - and there is 0 network coverage for providers in my area. My closest in network urgent care center is over 70 miles away in Roseville - when I called to point out driving over 140 miles roundtrip for urgent care was ridiculous the only solution I was offered was that twice a year they will pay for out of network providers as if they were in network providers. That did nothing to address my issue. In addition finding a primary care physician has been impossible, since doctors accepting new patients have waitlists out for a year and that's just the places within my horrible network. It's as if I have no insurance coverage at all. I'm so frustrated with them - the only solution I've been told is to try upgrading my plan for better coverage, but why should I pay more when the coverage is already this poor? This company is terrible and they offer no solutions/recourse for customers who point out their network flaws. Their teledoc was also completely unhelpful, since he just referred me back to my primary care physician (a year out waitlist) or an urgent care center (a 70 mile drive). I wish my company offered another alternative to these guys.

Blueshield has no shield and they don't even deserve ZERO Star. Worst experience ever. I added my daughter to the insurance when she was born, and everything was fine. I had an autopayment. 5 months later I received bills from the doctors for my daughter telling me my insurance refused to pay. I called blueshield multiple times, and they keep telling me I didn't add her. Her name is there online, but she shows inactive. They transferred me to the grievance department which they answer after 31 days. May 26th, Email me I didn't add her and there is no record of a call even her name is added . Nothing make sense. No answering calls. You can't talk to someone who is responsible for the grievance. MOST NEGATIVE CUSTOMER SERVICE. I DON'T THINK THEY EVEN DESERVE ZERO.

I am an RCM Manager. I am on hold as per the usual with Blue Sheild. This post is for Blue Sheild, Blue Card program and Anthem Blue Cross. EVERY time I call I get a rep with zero knowledge of anything. I am left on hold for 30 minutes at a time. The rep just now came back and said "He is still waiting for the account to come up" which is complete BS. These reps keep people on hold as long as possible to meet the required time and do zero work. If I am lucky enough to get someone that doesn't leave me on hold, I get incorrect answers or get transferred all over the world. I am so angry. ZERO ACCOUNTABILITY FROM THIS CARRIER. Z.E.R.O.

Blue Sheild Pharmacy issue !! All Customer service reps being told different info. Nothing resolved. Drug manufacturer, Drug distribution, Cvs Pharmacy , Physician assistance, nothing is getting resolved. I have tried since February to get a refill on a brand prescription that have an authorization approval from my physician and on file with Blue Sheild .
It’s now a NDC issue With drug manufacturer and Blue Sheild. Blue Sheild states not FDA approved. Virtus drug manufacturer disputes this accusation.!!
This is not acceptable , lack of information , lack of communication lack of follow up and lack of qualified experience. There was no issue last year but this February 2023 now has changed. No one responds back with any factual information or resolve . Thank God this
is not heart medication.. No one cares just wants your money. Also cannot speak with anyone in Blue Sheild Managment or qualified authority . On going since 2-14-23 See my health records

They lied about canceling our plan ,they wouldn't cancel it we have recordings we did ourselves and they want to now charge us for insurance we DIDN'T WANT ,we will be contacting a lawyer and also finding other people like ourselves that they've done thus to .This is by far the worst insurance company we've ever dealt with,total scams.