Blue Shield Of California
Reviews and Complaints

Prior to temporarily leaving the state of California, I called Blue Shield of California and spoke with three different agents on three different occasions during the months of December and January inquiring of coverage in the state of Illinois (there are recordings of these conversations as provided to ***, the Grievance Coordinator). Each time I was told that there is a Blue Card that would cover my family during the time that we would be out of state and that there is not an application, but simply go to a provider who accepts Blue Shield insurance for that state. On January 27th, I took my six month old daughter in for her vaccinations, at the time of the visit the office stated that the insurance was approved on their end. However, in March I received notice that Blue Shield of California denied my claim for my daughters vaccinations. It was this notice that prompted my call to Blue Shield, which also means I have overpaid a premium insurance for three months ($8337.12, $2779.04) and have not been able to use as a result of Blue Shield and its agents have misleading me. I've had Blue Shield Platinum PPO for over four years and continuously made payments on time for myself and my family. There has never been a discrepancy in my commitment to pay. I am requesting that Blue Shield act in good faith and uphold their fiduciary duty and hold their agents accountable for the message that is being delivered.Full reimbursement of paid *** amount for January 27, 2022 $1116.00 to Central *** and $5558.08 for the total amount of $6674.08 (monthly premium for February 2022 and March 2022).

In 2014, I set up insurance solely for my minor daughter who was 10 at the time. She has pediatric medical, dental and vision that Blue Shield calls Silver 70 Off Exchange PPO. We recently moved and in late June, early July , I reached out to Blue Shield to advise them of our new mailing address. I was told by one of their reps, that they would need to speak with my daughter and proceeded to ask if she was near by. I told them that she was not and wanted to know why they were asking. They simply saidthat they would need my daughters "authorization " in order to make the address change. I advised them that I would ABSOLUTELY NOT ask my minor daughters permission for anything as long as I pay the bills. Fast forward to Oct. 2021, I recvd a medical *** from a doctor my daughter had been seeing. I was trying to dispute charges from their billing company that I have receipts for. They again, asked me the same question, is your daughter available to speak with. Told them she is not. They then asked if they could call her. I asked them for what reason They advised that since I as her mother was not listed on her account, that they could not speak with me. That they would need to speak with my daughter to get authorization or that I would need to provide a court document, or birth certificate stating that I am her mother. This is an account for a MINOR! Where were these questions when I was setting up the account? Why do you not need my daughters authorization to accept my $285.94 premium each month? This is absolutely ridiculous and will not ask my daughters authorization for anything that I am paying and have been paying on time, for the last 7 years!

I am a federal employee with medical coverage for both myself and my wife with the BlueCross BlueShield Federal Employee Program. I live and work on the East Coast. In February we traveled to California. In order to fly back to the East Coast, we obtained three rapid covid tests at an outdoor covid facility. My wife obtained the third after she decided to remain an extra week to assist my elderly parents. We were told the tests would be $50 each. We were asked if we had medical insurance and provided our BC/BS insurance cards. We signed some online "documentation" on our phones (i.e. no paperwork).We have so far received over thirteen hundred dollars in checks (and counting...) from Blue Shield of California over the past 7 months followed by requests from seemingly separate healthcare entities/providers for reimbursement in the exact amounts of the checks from Blue Shield. In calls to the original facility (i.e. where the rapid covid test was performed) I requested paperwork and explanations of what we signed and what the insurance would be billed for. These requests were never answered.I believe that our insurance may have been charged fraudulently. For example, I believe that the "office visits" (in a parking lot) were not necessary and the criteria for these office visits may not have been met .I have called my local BC/BS (Empire BC/BS) and was told that I must take this up with Blue Shield of California. I then called BS of CA and was provided a number for reporting suspected insurance fraud. I left a message. After many weeks of no response, I provided a written (online) complaint of suspected fraud. It has been over two weeks and I have had no response. Additionally, in my several calls to the polite service representatives for BS of CA I have gotten the feeling that there is no corporate interest in pursuing insurance fraud with the covid testing claims.

Blue Shield is the worst insurance company in America and does not deliver what they are contractually obligated to do under their policies. They count on the fact that they are so frustrating to deal with that their sick and tired policy holders will just give up rather than fight the long uphill battle to get the coverage that they are paying for. Well, not this time scammers! I filled an appeal with Blue Shield against my HMO "health" plan, Scripps. Under California law health insurers (Blue Shield) have 30 days to respond to an appeal. Not doing so is ILLEGAL. I sent my appeal via verified mail and have a signed receipt as evidence that Blue Shield received my appeal on July 15th. It is now November 6th and I have never heard from Blue Shield about my appeal for health care I desperately need. Besides being complete garbage insurance (I will spare you a long rambling rant of their terrible health care, constant mistakes, denials and overcharging) Blue Shield has broken the law by ignoring an appeal. I called their "grievance coordinator" Brandi O 4 times and left 4 voicemails and never heard back. During this time I have waited for health care I need my debilitating chronic health conditions have further declined. Ironically, Blue Shield will now spend tons more money on my care by denying what I needed 6 months ago. The good news is I can now file an official complaint with the government agency that regulates health insurance in California. In light of this combined with many other instances of gross negligence, my lawyer is recommending I pursue legal action against Blue Shield. I'm the HR manager for a company of over 100 employees and due to this will be changing our company coverage over to Aetna. I'm a somewhat influential chronic illness warrior with contacts in high places in the media and will be contacting everyone I know about the corrupt and illegal care I've received here. I will not stop until this is resolved and my medical care I need is approved. Blue Shield is the most horrific health insurance company I've ever had and I would NEVER recommend signing up with them. RUN FAR AWAY FROM THEM! GIVE YOUR HARD EARNED MONEY TO LITERALLY ANYONE ELSE BUT THEM! BLUE SHIELD: Approve my medical care outlined in my appeal to resolve this matter. No other course of action will resolve this. Generic comments in response to this complaint that you "initiated a grievance analysis to review and respond to the concerns raised" is laughable. You will open a grievance in response to my grievance? No. Get working on my appeal.

I was enrolled in automatic payments using my credit card (approximately $123.90/month) with Blue Shield where payments were taken out of my account January through August . For what I believe to be a glitch in their billing department, my plan got cancelled in April which I was never alerted about, and they kept extracting the automatic payments from my account. I found this out in August (4 months later) when I called to simply update my mailing address. They then told me I didn't have an active plan to bother updating. After looking into my credit card statements, I called back stating the payments had been coming out of my account all along and I wished to have my coverage back. It was clear this was not my mistake. The Blue Shield representative (Jay, reference #1926-***) assured me that if I paid $247.80, I would get my coverage reinstated. He strongly insisted on me paying that moment because it was a time sensitive issue. Confused and desperate, I paid him. After we hung up, I was under the impression the payment I just made with him would reinstate my plan, and I was good to go! Not the case. He called me back less than a week later (mid September). He apologized because in fact he could not reinstate my plan as promised He did assure me that while he couldn't reinstate my plan, he would be able to transfer me to Kim and get me a new plan. Jay guaranteed me that the payment of $247.80 would transfer over into my new coverage plan and could be applied accordingly. I was then connected with Kim (a Blushield supervisor, reference #[protected]) to set me up with a new plan (new subscriber ID 90***). She assured me I had to start from scratch which normally they wouldn't allow beginning a new plan mid year but she admitted the mistake was theirs. This new plan wouldn't be effective until the 1st of November (The entire month of October I went without coverage because of all the back and forth with Blue Shield and unanswered questions). Come November 1, I spoke with Anna (reference # 93***). I wanted to make my payment for my coverage to begin as promised. She looked into my previous coverage plan details and confirmed that I had $247.80 sitting in it. I requested to move it over. She assured she could send the request through. Since my new plan would cost $252.59, all I owed that day was $4.79 because that was the difference. I paid it. It's dated 11/2 on my credit card statement. We concluded the conversation by her providing my new subscriber ID and let me know she would update me on the transfer of funds request. Anna called back on November 15th (reference # 19***). She relayed to me that the transfer of funds did not get accepted. She assured me she would send the request through again and let her supervisor know. She seemed confused as to why it didn't go through because she herself said the funds were still in my old account. She then told me, that the time was here to pay for the month of December or my plan would be at risk. At this point i was very frustrated making yet another payment when I hadn't been properly reimbursed for the last. So yet again, I paid them. $252.59 for the month of December. This payment went through on my credit card on 11/16. She gave me the confirmation code for this payment as well (12***). On December 6th, I called Blue Shield because I was receiving bills stating I still owe money...not only for the month of November , but ALSO the month in June for my previous coverage (Old Subscriber ID 90***)(Invoice number: 19***). To rewind and recap...In June, according to BlueShield, I didn't even have coverage even though my monthly payment was still taken out via auto payments on my credit card. My credit card statement shows i was charged $123.90 on June 29th. I was charged the same amount on May 30th and July 31st so make no mistake, they are still claiming I owe for a month my health care was non existent. The last several of months (Sep, Oct, Nov & Dec) I have been trying to get this money reimbursed and they claim it's not in my account. I have been battling with them for 8 months now. I filed a grievance that got denied. In the letter they stated, "there is no provision in your EOC, to refund dues when coverage has been provided." However, the coverage was never provided. To clarify they cancelled my coverage in April due to non payment while my credit card (used for autopay) shows I was still being charged all along. I have reference numbers for every single conversation I've had with them over the last 8 months, including the one where Jay (Blue Shield employee) guaranteed me that when he wasn't able to reinstate my plan that i would get my payment of $247.80 back. I have not received it in any fashion. I would like to be paid what I am owed and what was guaranteed to me. I am beginning another coverage year with BlueShield for 2020. In the latest bill i was mailed on 12/30 (invoice number 19***) I see they are STILL saying I owe them the $247.80 which i already paid. I am now forced to pay this amount (again) or they will cancel my coverage.