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.
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 diagnosis—it 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 September—3 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] representatives—all 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 that…the patient's condition does not meet the criteria…for 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.