Shayna R Fja

Insurance id number {{Redacted}}

I have been trying to get special circumstance insurance for almost a month. the department who reviews my information keeps on loosing it or can't find it. I was suppose to get a call back yesterday from Blue Shield but no call! This is very upsetting and unfair. I was suppose to have coverage starting December 1st!!!!!!!! I am sick of calling over and over and it not being resolved. I need this resolved.
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Reason of review:
Poor customer service
Gregory C Ump
map-marker San Francisco, California

Blue Shield of California Lied to Me and Gave me the Run-Around for Weeks

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I left my job and lost my insurance coverage, and lost my coverage. It's a qualifying event, so I applied for PPO coverage to Blue Shield. As many of you know, there aren't other options in California currently. I called two weeks after I sent in my application to see the status, and the rep who spoke with me told me that I had indeed been approved, but it appeared there was an issue with processing the payment from the information that I had provided. She took down my number and indicated she would call me back shortly. A week passed, so I called back and spoke to another representative who said she couldn't locate me nor the application, and she said she would call me back, but another week passed with no return call. I called again, and after much time on the phone, they said that they had not processed my application because I had not turned in proof of my qualifying event (termination notice from employer). I indicated that it had been turned in as part of the application package, and I downloaded the submitted package from the Blue Shield website and sent it back in again. Anbother week passed, and I called a 4th time and was told that I needed to send in another document that would clarify that my coveraghe had indeed terminated with my employment. I then sent in that document and was told two weeks later that this final document came too late and their decision was to deny coverage as a result. I called to straighten this out, and they said that information spoke by their representatives could not be relied upon, and their decision was final.
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Loss:
$5000
Pros:
  • Plans they listed were just what we were looking for
Cons:
  • And frankly
  • Very incorrect information disseminated
  • Consistent lack of follow-up when promised
Reason of review:
Lied to and wrongly denied
Melania Dbz

Rude and very disrespectful to health insurance applicant for 2019

I am inquiring for 2019 medical insurance and a heavy accent man on 12/04//2018 at 135 pm , instead of helping me hung up on me and very rude talking over the phone because I am hard of hearing. I am a Registered nurse and I will tell the whole world not to enroll to you. Very poor customer service.
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Reason of review:
Poor customer service

Preferred solution: To give disciplinary action against that rude heavy accent man

1 comment
Machele Imf

What you should do is go to their website and email a complaint to them, telling them what happened, etc., and asking just how they think you are supposed to enroll with their customer service so rude, etc. You should receive an answer in a day or so.

Don't rule out Blue Cross, tho as it is still one of the better plans out there.

As a nurse, you may already know this. There are jerks in every business and you just happened to get one----altho, given that you are in California the chances are much higher in getting one.

jean t Xcu
map-marker Culver City, California

1 TIME HELP - REALLY

My medical provider had a issue and used the Doctors ID number and not the office ID number. So my claim was rejected and i was holding a check for a partial payment. I called sw Kim in claims and she said this was a 1 time adjustment she would do. One time i asked and she said yes we will not help you if this happens again. OH heck no - if i have medical insurance and there is a billing issue and i call Blue shield you will help me. What a *** thing to say one time - not true and Kim do your job - help your customers and not one time - you will help me UNTIL ....Until its corrected !
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Reason of review:
Poor customer service
Cassandra B Vgc
map-marker Los Angeles, California

AWFUL! No change in policy results in my daughter not getting her surgery in time.

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Blue Shield Of California - AWFUL! No change in policy results in my daughter not getting her...

My policy did not change in terms of any care needed by my daughter. So I renewed it.

Blue Shield without notice to me changed their policy with the doctors and pharmaceutical companies. They require the doctor to "buy in" which means the dr buys the drug needed for the procedure. Well only after 5 weeks of complete confusion and over 9 hours on the phone with Blue Shield my daughter is not sure she will get the implant needed in time. There is a small window for her to received it.

She had this exact procedure last year and they are fighting me and won\t find the solution. Due to there lack of communication and terrible customer service, i have had to explain my story 10 times from the beginning and have had no results, with only 1 week left for this needed procedure. I am currently sitting on the phone living this nightmare over again. I think this completely incompetent individual has given up.

I asked for a supervisor at the beginning of this call. Apparently no one has been available.

I have asked several times to speak to manager. NO ONE ever took my call.

It's unreal!!

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Loss:
$100000
Reason of review:
Poor customer service

Preferred solution: Get my daughter her insurance covered surgery complete within the window, which is next week!!

BRANDI R Tsj
map-marker Anaheim, California

Trying to force me to take a medication I don't need

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I have a prescription; Blue Shield feels that what I REALLY need is a laxative. Obviously, because it is cheaper. Going round and round with the pre-authorizations and appeals. Go with ANY other insurance company than this one. I am going to file a complaint with the Medical Board of California - practicing medicine without a license is a crime in California. So unless they have a doctor reviewing my medical history (and they do NOT have my medical history, as I am a new client, and my doctor has not sent my medical records yet), there is a physician making decisions based upon the "bottom line". This is an awful company, with poor customer service, and apparently, they would far rather see me in the hospital, than pay for my prescription. Go with someone else folks - they may be cheap, but there's a reason for that. They don't cover anything (my asthma inhaler was $55), AND if they don't like your prescription (read: costs too much), they will find another one for you - whether it is for your condition or not.
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Loss:
$3888
Cons:
  • That they tried to force me to take a laxative
Reason of review:
I want my prescription

Preferred solution: Deliver product or service ordered

Anonymous
map-marker Lodi, California

Horrible Insurance Company

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If I could give negative stars for this health insurance company, I would. DON'T EVER apply for insurance with them. Their customer service is horrible and I've had nothing but problems with them. At the beginning of the year, they withdrew funds from my checking account, without my authorization, and when I called to dispute it, I had to talk to 3 different people, all of whom had NO IDEA what they were doing. In the end, nothing was resolved and they had taken my money. Most recently, they suspended my coverage for non-payment and when I finally made my payment to catch up, they told me before they could reinstate me, I needed to make the current month's payment when I should have had the current month as a grace period. They told me it was their "new policy" not to reinstate until the account is made current. How kind of them to change their payment policy without letting any of their subscribers know! All they are is a bunch of greedy crooks who care nothing for their patients. I elected to have them through the Covered California and I'm paying close to $600 a month, and for what? I still have to pay $25-$55 copays and several services are not even fully covered. This is a joke! Fair warning to you all, STAY AWAY FROM BLUE SHIELD OF CALIFORNIA.
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Reason of review:
Poor customer service
Anonymous
map-marker Rancho Santa Margarita, California

Reimbursement nightmare

It has taken numerous hours on the phone to get one reimbursement. Each time it is the same story. Multiple claims filed incorrectly, i cant read them or we dont have it..etc etc. It is absolutely disgusting, especially the monthly premium . Disgusted.
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Reason of review:
Poor customer service
Hugo C Nit
map-marker Los Angeles, California

Camarillo, CA Dignity Healthcare System

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New to the Ventura County, Ca area. Dignity Healthcare provides medical services through St John's medical facilities. My primary physician is Dr M. Stokols who is excellent, but his office has been trying to get my medical records from the Office of Dr. Schmidt, Cardiologist (also in the Dignity Network and only 5 miles away), for weeks. It has now been four weeks, since I first requested a new Cardiologist. Four weeks and all I'm told is the new physician request is IN PROCESS. Poor medical services delivery. This is overseen by Blue Shield HMO - Calif. All approvals have to go through Blue Shield, which operates quite differently from my past experience with them. I moved here after 18 years with Hoag Medical System in Orange County with a similar Blue Shield HMO plan. But medical delivery was light years ahead of the Dignity system and Blue Shield oversight in the Ventura County area from my experience doesn't compare.
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Cons:
  • Customer service
Reason of review:
Poor customer service

Preferred solution: Let the company propose a solution

Anonymous
map-marker Chico, California

Fraudulent. NO doctors take my plan

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Even my ASSIGNED doctor--the doctor Covered California Blue Shield PPO assigned to me, doesn't take my plan! I've called 32 family practice doctors that are listed on my Blue Shield website as in-network for my plan, and NOT ONE actually takes my plan. So I've been paying $1600 per month for my family, and when we actually need to see a doctor, we can't. Not only is this outright fraud, but it's taken me all day to call all these doctors, only to be told they don't actually take my insurance. I'm looking into if there is a government agency that I can report Blue Shield to, because collecting my premium every month when they actually are not contracted with any doctors, is extremely fraudulent, and I deserve a refund.
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1 comment
Guest

I also am trying to find the government agency to report Blue Shield to.

Likeiwould G

No coverage

I accidently dropped something extremely heavy on my toes, injuring them. My doctor was out of town for over two weeks, and there was no other doctor covering in lieu. I needed an off work order due to the serious nature of my injury. Urgent Care could only give me 3 days off. Blue Shield did not have any solutions when I called them. There were no other doctors in my health group that could see me. I ended up returning to work, still injured and in pain because the human resource at my employment could do nothing more than refer me to Blue Shield and Blue Shield could not find a doctor to see me outside of Urgent Care. My accident happened on my own time and was not at work. Blue Shield lied by saying they contacted a local doctor that could see me, upon arriving at that doctor's office, they had no knowledge or had no contact with any Blue Shield representative. Blue Shield representatives refused to give their full names, instead they provided me with the reference number for the phone call 182290****00. It has been a dismaying, depressing, experience. Why doesn't my doctor have someone covering? Why can't Blue Shield authorize me to see another doctor? Why can't my employer contact Blue Shield and advocate for me? No attorney will take my case unless my toes become infected and I ultimately become disabled permanently...
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Elizabeth L Ljp

Just disguisting awful

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Signed up for june 1st qualifying event since husband lost ins with blue cross omnia as of may 31 lost job. This has been an utter nightmare with california blu shield. Money already taken from paycheck. I have never seen such stalling tactics. All parties involved should be in jail. No card no id no. Being shuffled back and forth from my hr to blue shield. Contacted our companies ins broker. Ive nevet seen such double talk. One side blaming other. This is unconscionable. A disgrace. Blue shield of california shame on you!
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1 comment
Cassandra B Vgc

I agree. Their expertise is shuffling.

The service is awful. I pay fortune for such terrible service, only to insure my kid gets her procedure.

As I sit hear and have no adequate solution from them. They are a disgrace

Kamil R Xka

Horrible

I did not have a problem with blue cross blue shield unless i relocated to CA. My plan is HMO. Every month i pay 600$ for the health insurance. In case of i have any pain even little, there is no way of finding a doctor who is not booked up. Yesterday i abdominal pain is increased and i went to the Urgent care. Doctor checked my body and said sorry, we do not have enough equipment in here. Consequently you have to go to emergency. Ok i can go to the emergency but i have to pay 250$-300$. WTH. Who do i pay 600$ every month if i cant go to the doctor cause they all booked up?
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Reason of review:
Problem with delivery
stanley B Ypj
map-marker Nashik, Maharashtra

Rude behavior of Representative

On a call @ 800-677-****, spoke with Sheen, under the reference Ref#201904****714. In My carrier of 8 years in Medical Billing i have never come across such a rude and arrogant representative. Wish if someone could retrieve our call recording and give a good feedback to that representative.
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Reason of review:
Poor customer service
Sarahann Jjl
map-marker Lake Forest, California

THE WORST INSURANCE CO

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Put the fact that their premiums rose by more than 100% in california. Mine went from $195 to $380. Most medical insurance companies are horrible to deal with on an administrative level, but Blue Shield (herein referred to as BS) is by far the worst of them all! They have the most clueless reps and claim processors. If you select BS as your provider be prepared to take hours or days off work just to be able to file a single claim. Their policy is to first deny the claim, then make you refile it, then pretend they didnt get it, then make you refile it, then tell you you failed to record a code right, then make you refile it, , then admit is was them who made the mistake, then make you refile it, then deny it again, then make your doctor resend the info, them make you refile it. Ad infinitum. Their outsourced customer service department is USELESS, they are clueless about proceedure. They tell you they will call you back, they NEVER do. They put you oin hold for minimum 40 mins, its worse than trying to reach the US Postal Service. Oh, and when you finally cancel, they will continue to take money from your credit card regardless of how many times you call to remind them the policy is cancelled. And to get reimbursed (when they charge you for 2 months past cancellation date) their reps will tell you it takes 45 BUSINESS days to get reimbursed. Thats more than 3 months. They make hundreds of thousands on holding everyone's money for 45 days. Is that even legal? I hope this horrible company goes out of business! They could care less about people. RUN LIKE ***
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Loss:
$9000
Reason of review:
Poor customer service