Blue Shield of California Opiniões 60

Blue shield is impossible for providers offices to work with. They legitimately told me to call the customer only support line about a claim knowing nothing about their own company when i spoke to them. Cheapest and most poorly trained call center i have ever spoken with. They truly don't have the first clue about anything and a half way understanding of their own terribly grating script.

I used an out of network provider for my hearing aids and boy, was this a mistake! Blue Shield only paid one half of my hearing aids and claims a computer program problem caused only one half payment. They would have to manually input the other amount. This has been going on for almost 6 months! Every time I call, same old run around. I am getting very frustrated with their service and wished our organization never switched from United Health!

When I signed up for the plan under my Medicare coverage I was told all my current medications were covered. They were clearly not. The agent had lied. The only communications I received after becoming a member was denial letters. I switched plans 3 months later.

Submitted claim for reimbursement of durable medical equipment from In-Network provider in early July. Over course of 6 weeks spoke to three different representatives all telling me "...everything looked fine and the claim was in process." Spoke to a fourth representative a week later who told me there is no record of the claim being filed. So he had me refile online and told me "...he would watch this one personally and call me back in a couple of days to verify the claim was received and is being reviewed." No mention of expedited handling, of course. No call back, naturally so tomorrow I will start the whole follow-up process again. By the way, Blue Shield of CA has contracted with Included Health to handle customer (complaints) so that is who I have been dealing with. The claims were filed directly with Blue Shield of CA.

Can't get simple tasks done like updating ID cards. Awful customer service

Blue Shield of California Under Fire: High Prices, Poor Leadership, and Broken Promises

Blue Shield of California, once seen as a trusted name in health insurance, is rapidly gaining a reputation for being one of the worst providers in the state. Thousands of Californians are speaking out against the company’s outrageous pricing, poor service, and questionable partnership with Covered California — and many are placing the blame squarely on its leadership, particularly CEO Lois Quam.

Under Quam’s leadership, Blue Shield has taken a sharp turn for the worse. What should be a non-profit health insurer focused on helping people has become a bloated corporation acting more like a government bureaucracy than a customer-first healthcare provider. Premiums have skyrocketed, deductibles have soared, and access to affordable care is becoming harder to secure.

Many policyholders report being priced out of their own health plans, even as they remain under Blue Shield’s supposedly affordable umbrella. Customers trying to navigate care options or get answers from the company often face long hold times, unhelpful representatives, and a system that seems designed to frustrate rather than assist.

Adding insult to injury, Blue Shield’s tight relationship with Covered California — the state’s health insurance marketplace — has sparked widespread criticism. Rather than giving consumers options and lowering costs, this partnership appears to function as a pricing trap. Blue Shield premiums on Covered California are often higher than competitors, yet the system encourages users to choose them by highlighting coverage tiers or offering deceptive comparisons. It feels less like a health plan and more like a racket.

Critics argue that Lois Quam has failed in her duty to lead a fair, responsible healthcare company. Instead, under her watch, Blue Shield has continued to push higher rates while delivering substandard service and squeezing families who are already struggling with medical costs.

With California residents desperate for affordable, reliable care, many are asking: how much longer will this continue? Blue Shield of California needs a serious overhaul — in pricing, service, and leadership — before it loses whatever credibility it has left.

If you’re currently covered by Blue Shield and feeling the pressure, you’re not alone. Thousands are calling for accountability, transparency, and real competition. It’s time for California to demand better.

Better communication , but how do you go about the Rapid rehousing program? How do you go about case management to give you the proper referrals for these programs for a CES . Vs1collections zoom call every Monday weekly. Who would I let know about this to have more better communication

They deny everything they can with zero communication and try to run out the clock to see what they can get away with not treating.

I urgently need to get treatment for my condition approved, and they've made me wait for months. The communication between them and my doctor has been nonexistent, with the doctor telling me they can't get through to talk to anyone, and them saying my doctor sent what they needed but it was still denied with no rationale.

I just want to get a case manager on the phone with my doctor's office to explain why I need to get this treatment approved ASAP, but they're making it impossible. I've already had to pay out of pocket for the majority of my treatment for this well-recognized condition and been shopped off to various different customer reps while I tried to solve this problem by myself. It's abject cruelty.

Blue Shield, people are suffering enough. Stop adding to the suffering.

I've been assigned doctors that no longer practice in the area I am in, multiple times. The HMO service doesn't work and finding help is difficult.

Some of the medical groups they contract with, like Regal/Lakeside are absolutely awful and have no comprehension about the importance of member service or professional conduct.

However, this complaint is about BlueShield's Nursing Line. Why this alleged service even exists is incomprehensible to me. Today was the 3rd time in many years that I have called the line for advice. The first thing to note is, they are not a Triage Department.

In each call made to the Nursing Line, the calls each went as follows:

1. What are your symptoms?
2. How long have you experienced these?
3. You need to go to an Urgent Care facility or ER.
4. Promise me you will get there "within the hour."

They must be scripted because they always respond with the samr standard replies while offeringing no help.

BlueShields benefits have decreased annually for the last 3 years but the premium I pay has increased.

Called your Customer Service number (855) 836-9705 to inquire about in-network providers in northern California as I wasn't able to confirm that information on the website, and I live in SoCal. Unfortunately, your representative, Shemilia, was extremely incompetent and even sarcastic when after 45 minutes into the call, she still couldn't help me. She kept forgetting the zip code I had given her and instead kept looking around my home zip code. I explained to her several times, in different ways, what I really needed but she still was clueless (??). I've been on the phone with her for now over 1 hour and 30 minutes. She sent me 6 emails of the same exact thing and it wasn't even what I had requested. It actually looks like she is just doing it on purpose at this point. She kept using my zip instead of the one I had given her. She had no idea about what she was doing and instead of asking somebody else to help her, which I suggested her to do, she just had an attitude(!) and has kept me on hold for about 40 minutes waiting for a 'supervisor'. She seems to be enjoying the fact that she's making me wait as she tells me to wait with a slight tone of 'happiness' and while she makes me wait, she keeps sending email. SHE SHOULD NOT BE DEALING WITH CUSTOMERS. It is for this reason, that I will definitely consider going with another insurance. It is because of people like her that companies lose business. It would be so much better to have customer service individuals who are competent, trained, and who could have at least some level of intelligence to retain customers and be profitable as a business, but instead you have mediocre, unintelligent, rude and clueless people working for you. I guess you don't care about your customers or your business. I don't need this kind of experience nor treatment, especially when I pay $$$$ a month. Our entire family is insured, so I guess you'll be losing here.

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.