Blue Shield of CaliforniaReviews of blueshieldca.com

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.