i canceled my plan at Feb 7 2018. and still waiting for the refund for Mar 2018. i been contacted the customer service server time and been told wait and wait and wait. who ever the customer service locate in Philippines. very disappoint.
here's latest Ref# 181060007154 . also my cancellation number #8180380042635.
I have a left knee which is almost bone on bone in certain areas of the knee. I tried cortisone injections - they did not work, I tried Ibuprofen and had two adverse reactions (one of my feet having severe swelling, the other of my blood pressure shooting up (I already have high blood pressure)). Then, miracle of miracles, I started using Euflexxa injections which are a gel injection administered directly into my left knee. It was truly like a miracle, took away all of my pain, kept my knee from "catching" which caused further severe pain, prevented my left knee from buckling right out from under me. While I was being given these injection, I did not even know that I had a knee problem. I was given two sets of injections - a set consists of three injections given every 6 months. When I went to get my third set after one year, without any warning, Blue Shield of CA denied me stating some bogus studies about their findings on Euflexxa. I say bogus, because I thoroughly researched Euflexxa (having been a retired Registered Nurse) and the FDA does not state what Blue Shield of CA is stating, nor does Ferring Pharmaceuticals (the actual manufacturer of Euflexxa). Also, Blue Shield's so-called studies contradict written evidence of actual documented patient experiences. To sum it up, Blue Shield of CA is stating one thing - absolutely everyone else is stating the opposite. This so-called health insurance provider is a SCAM. I really want to make as many people aware of this as I can so that, very hopefully, no one else goes through the pain and suffering (not being hardly able to walk) that Blue Shield of CA has inflicted upon me. Oh, and as a side note, I pay them $733 each and every month so that I can sit here like this.
I'm transgender and they've been covering my hormone and surgery costs with relative ease. Compared to other healthcare providers, I think they're very good.
For a second year in a row, I have paid thousands of dollars to Blue Shield of California for health coverage (as part of the Affordable Care Act). In return, I have been denied treatment for osteoarthritis in my right knee. It's an ongoing scam by Blue Shield to collect money and deny access to treatment in return.
In June 2014, I scheduled an appointment with my orthopedic surgeon to inject Synvisc-One into my right knee to provide lubrication in the joints, as he has done for the past seven years. But, Blue Shield would not approve of the treatment unless my physician first gained Blue Shield's authorization for the medication. After my physician requested authorization, several weeks went by without any response from Blue Shield.
Without any data to back up its allegations, Blue Shield denied authorization of Synvisc-One, stating that the requested treatment would not be covered because my "condition does not meet the criteria as established by Blue Shield of California Pharmacy and Therapeutics Committee for use of the requested viscosupplementation agent." In other words, someone at Blue Shield decided that the documentation my physician provided did not support the diagnosis of osteoarthritis of the knee, and therefore did not meet the criteria for Synvisc-One.
Outraged, my physician submitted more documentation and a current x-ray report which, again, exposed their obvious error. Several more weeks went by. I called Blue Shield and asked why there was a delay. The representative said it was declined because my policy did not cover injected medication, which was a lie. Blue Shield's original letter declining service specifically stated that documentation did not support the diagnosisit had nothing to do with coverage. Denial of treatment had now gone beyond two months, and I was in pain.
My physician submitted a grievance. Blue Shield then sent a letter stating that it would "respond to your grievance via the U.S. Postal Service within 30 calendar days." In September3 months after my first attempt to get treatment--Blue Shield finally conceded. History then repeated itself.
In April 2015, I called my physician for an appointment to get another injection. (Effectiveness lasts about 6-7 months.) His coordinator tried to put my insurance card through, but Blue Shield denied treatment, stating "I was not eligible for service, since I had not paid my insurance." This was a lie. I was paid in full. As a matter of fact, my premium had been raised $50 a month ($600 more a year more), and I was getting less service.
After three months of speaking with six different [oversees] representativesall of whom assured me that I was paid in full and that the misinformation "has been taken care of"--one representative finally discovered that the two systems Blue Shield uses for coverage were not in sync. The payment system showed that I was paid, but it was not "talking to" the eligibility system, which said I was ineligible because my monthly premium was NOT paid.
The rep then replied that it would take "5-7 days to correct the two systems." I told the rep that if the information was not corrected within one day, I was going to "cancel my policy and go on the internet to warn people to NEVER go with Blue Shield."
The rep then told me he would try to process the information "manually" within a day. Yet, once the two systems were finally in sync, it was a repeat of last year. I was denied treatment again!
My physician, again, requested authorization for Synvisc-One. Several weeks went by. I called Blue Shield. A representative told me that there was no record of the request for authorization on file, even though my physician's coordinator has record of the request being faxed 3-4 times.
I just received a response from Blue Shield. Even though my condition met the criteria for last year's Synvisc-One authorization, Blue Shield again denied authorization stating that, a "physician advisor has reviewed the information provided and determined thatthe patient's condition does not meet the criteriafor use of the requested [Synvisc-One] agent"the very agent that Blue Shield authorized last year.
Yet, Blue Shield will approve of treatment if my physician uses a different and less-effective agent that Blue Shield recommended in the letter. (Really? I thought I didn't meet the criteria for a viscosupplementation agent.) Either I don't meet the criteria, or I do. It can't be both. (We all know what's going on here.)
I have paid $1800.00 thus far this year for health insurance coverage, and I have yet to be able to see my physician for treatment! It is all a scam by Blue Shield to take money and deny access to treatment--whether it be through an appointment or medication--in return. I refuse to allow the abuse to remain hidden behind closed doors.
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