Patricia A. C.
Diligent Blue Shield Customer Service Representatives
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