Blue Shield of California

By far and away the worst medical insruance provider I have ever come across. The fact that they have a monopoly as the only offering for PPO insurance through Covered CA should be a crime. The only thing they are good at is taking the money out of my account for the monthly billing. They constantly deny claims in error which results in me having to spend hours with their incompetent customer support teams to try to resolve something. There should be a class action started against this company immediately for falsely impersonating a medical insurance company.

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.

We pay our premiums, outrageous co-pays, and now there's Co- Insurance. There's no way of knowing in advance what this arbitrary cost will be, but it will break you if you have any health problem. They have no in network doctors in Los Angeles- no reputable doctor will work with them.

I don't know how to spelling her name it sound like Hiry, she was very helpful, professional compasive, if I can give her a 10 stars I would.

If you wish to have headaches, go for them!
Blueshield is really and literally awful. The only thing they can do is get their money. They do not even try to help, do not follow up, and do not care about the customers. At all!
The supervisors are always busy, and one of them even told me he did not have time to talk. Seriously?
Do not recommend their service. If you have problems connected with them, you will have to deal on your own. They are not willing to help, nor do they want to understand what is going on. They are either not listening, or not taking care at all!
Also, the agents do not even know enough to help you! Do not be surprised if they say one thing, then it turns out another agent says a completely different thing!

I have been trying to cancel my policy for well over a month and they STILL HAVE NOT CANCELLED. DO NOT SIGNUP WITH THIS COMPANY BECAUSE THEY WILL TAKE ALL YOUR MONEY AND REFUSE TO CANCEL YOUR POLICY EVEN THOUGH THEY CLAIM THEY CANCELLED IT EVERY TIME YOU CALL. I JUST SPENT ANOTHER 30 MINUTES ON THE PHONE WITH THEM JUST TO GET THE RUN AROUND. THIS IS CRAZY!

Do not sign up for Blue Shield Medicare Supplement. Just don't. Their system is arcane and outdated. My pet insurance company works a thousand times better. The website and app are useless and if you try to talk to someone on the phone their entire phone system sounds as if you are talking to someone at the bottom of the Pacific Ocean during a heavy storm. (And I have no hearing deficit.) State your claim as clearly as you can to the first person you talk to, and they will shunt you to a series of different agents, each of whom has no idea what to do. I am currently on the phone with the fourth agent this morning, (fifth if you count the first one who hung up on me.) This is the fifth time I've called about this claim. They verify the details each time, then send me to another agent so I can explain it all again. I'm expecting the next agent in line to be the one who tells me there's no one there who can help me, and hang up on me again. (Edit: I was wrong. This is the agent who told me to resubmit the whole claim to a new address.) Oh, and just be forewarned, they will change the details of your policy with no notice to you. Please learn by my sad tale and go with another option, this is really bad.

Since the website doesn't allow me to make any real changes to the account, I'm forced to call the 800 number. I needed to change my HMO to a PPO. Of course, that option is not available under "self-service", so I have to waste my time at work talking to a person for over an hour instead of spending 2 seconds to check a box. After spending a combined total time of just under 2 hours, I want nothing to do with this company ever again. I had to provide my birthrate to the useless automated system (Avery?) about 12 times, sit on hold for over 10 minutes repeatedly, request a transfer to another department/call back/"wait 2 minutes while I pull up your account" an unacceptable number of times. I'm not sure if their hiring requirements are "Do you know how to use a cell phone? You do?!? You're hired!". Seems like they received about 3 minutes of online training for their job. This is the FIRST TIME EVER I actually support removing humans from the equation and replacing them with disgusting robots. Absolute INCOMPETENCE! And since noone seems to know where people work at BlueShield, I am NOT wasting another second on the phone to cancel my account. I'm simply stopping the "Autopay". Hope they take the hint. So disappointing...just unbelievable!

I am so tired of Blue Shield, I need to getaway from them. My doctor has prescribed different weight loss medications but this crooked company continues to find ways to shut it down (den). Then they want to send a manuscript that explains why...I'm not reading all of that fluff. If I were back with Kaiser I would have these prescriptions by now. Maybe I will tell my husband let's do that...makes more sense. My BMI is dangerously high, I am paying out of pocket for stuff that is working however, what's the point of the insurance if most of the prescriptions don't get approved. Thank God I have the VA, I will soon be able to get something through their program. Just waiting for my orientation. It's sad and disgusting that we pay money for medical services that are limited and these crooks play around with your health. I'm not surprised, just frustrated and this is not the only issue I have with Blue Shield. I mean my goodness...people on Medicare/Medi-Cal whatever it is get approved like there's no tomorrow. People incarcerated get better medical here in California, they go to most of what's considered top notch hospitals...I know, I've taken them there. PPO is another option, wayyyyyy better than dealing with this budget HMO stuff. I like my doctor and the fact that they communicate with the VA is a plus...I'll have to find another way to keep that going unless I go to Kaiser.

Their agent puts you on hold for hours and hours, since they work from home, they obviously do their own stuff and don't give a $#*! to the person on the line.

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.

I have made several appts with mental health care providers whom either cancel night before or consider me to be too damaged to take on. Thanks guys! Way to be great therapists. Hope you aren't treated half as dismissed and rejected as i have felt trying to secure an appt. Rude. I feel for any one else who has experienced this, know it has nothing to do with you! These ppl are goofy to call themselves therapists. Found some info online. Apparently the company is called Magellan. An article written in 2015 " Blue Shield of California and Magellan: A Deceptive Arrangement " https://theinsurancemaze.com/articles/magellan/

LAST FRIDAY SEPTEMBER 29 I CALL MANY TIMES! TO BLUESHIELDS. I WAS IN SANTA ANA LOOKING THE OFFICE OF THE COMPANY BUT HAPPEND THAT IT DOES NOT EXIST! AND DAYS AGO I WENT TO GARDEN GROVE CALIFORNIA AND THERE IS A OFFICE OF ANOTHER COMPANY! SO I CALL TO BLUESHIELDS AND I SAID WHAT HAPPEND? CAN YOU TELL ME WHERE IS THE OFFICE OF THE COMPANY BECAUSE I CANT FIND IT AND THE MAN THAT ANSWER TELL ME I DONT SPEAK SPANISH SORRY SO I WAS EXPLAINED IN ENGLISH AND HE CUT THE PHONE! I CALLED MANY TIMES AND THIS MAN FINISHED THE CALL! THIS IS TERRIBLE AND THEN LAST MONDAY ( OCTOBER) I CALL AGAIN AND HE ANSWER AGAIN AND I ASK SOMETHING AND HE GAVE ME ANOTHER ANSWER AND I SAID HEY PLEASE CAN YOU TELL ME WHAT I AM ASKING? AND HE CONTINUID REPEAT ANOTHER THING OMG THIS IS THE WORST COMPANY THAT I HAD SPOKEN! THE SERVICE IS HORRIBLEEEEEEEEEE

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# **************. Also my cancellation number #*******635.

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.

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.