Blue Shield of California

I am rejecting this response because:
Blue Shield of California is refusing to acknowledge my payments I will fax all of the supporting documentation to the fax number you provided I am hoping this will resolve the matter It is so frustrating

June 21, 2017 Blue Shield blue of California Revdex.com Beacon BlvdWest Sacramento, CA 95691 Re Case #: 12076546 Dear Revdex.com: This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield)
on May 22, 2017, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we have reviewed the concerns raised in the correspondence submittedA response will be sent directly to *** *** on May 12, Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.com_ Unfortunately, without a signed release of information from Ms*** ***, we are unable to provide a copy of the resolution to the Revdex.comIf you have additional questions regarding this matter, please contact me directly cat the telephone number listed below. Sincerely, *** ***, Executive Inquiries Coordinator ###-###-####

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on April 20, 2015, concerning a Blue Shield enrollee by the name of *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that *** ***, has completed our grievance process regarding this specific issueA response letter was mailed directly to the member on April 3, The member now has the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC)If the complaint meets the criteria as determined by the DMHC, an independent review organization as selected by the DMHC will review the pertinent issue(s) and/or medical documentationAn IMR Application Form and addressed envelope was enclosed with the Blue Shield determination letter for the member's convenienceIf the member chooses to pursue an IMR, the request must be submitted to the DMHC directly.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.Sincerely,*** ***, Executive Inquiries CoordinatorGrievance Deparmtnet###-###-####

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 15, 2015, concerning a Blue Shield enrollee named *** ***The information provided by the Revdex.com included a consumer complaint against Blue Shield, submitted by ***’s mother Katherine *** on his behalfThank you or forwarding these concerns to Blue Shield for reviewWith respect to Ms*** concerns, we reviewed our records and determined the member’s complaint has previously been reviewed under our grievance process and o determination has been madeIf Ms*** is dissatisfied with our response and/or determination, she has the right to request an Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC)If the appeal meets the criteria as determined by the DMHC, an independent review organization as selected by the DMHC will review the pertinent issue(s) and/or medical documentationA copy of the IMR Application Form and addressed envelope was enclosed with the determination letter for the member’s convenienceIf she chooses to pursue on IMR, she would need to forward her request to the DMHC directly

I have been having problems with Blue Shield since February of 2018. It began with me being charged monthly for much more than my monthly plan. It seemed to me I was being charged for my old plan and my new plan. I contacted Blue Shield and they confirmed that indeed I was being billed for 2 plans. They instructed me to contact Covered Calif. which I did. Covered CA on 2/26/18 said they would correct it and Blue Shield would take about 3 weeks to correct. After 4 weeks there was not correction by Blue Shield and it was not possible for me to obtain any payment information on my account. I make payments every month so I decided to send a letter to the main address on the website with a payment on 3/26/18. On 4/13/18 I spoke to a Blue Shield representative who said my coverage had been terminated as of 4/3/18 due to non payment. She began the reinstatement process and it was escalated to her supervisor. Spoke to another rep of Covered Ca on 4/17/18 who said it looked like my payments had been applied to the wrong account (my old plan). He said it would take Blue Shield 30 days to correct. He gave me another phone number to call for Blue Shield. This was unacceptable. It was 2 months already with a problem not of my doing and it kept being pushed off. Also, I still could not obtain any payment information on the website. I spoke to a Blue Shield representative who said it would take 20-30 days to be reinstated. In the meantime I had a prescription to pick up as I take both blood pressure medication and thyroid medication. I was able to get the representative to request reinstatement as soon as possible which was 5 -7 days. On 4/25/18 I received a letter with an amount of $644.55 due within 72 hours to complete the reinstatement process. After all this time with Blue Shield dragging its feet in correcting my account (again not my error). I still was not able to obtain my information on their website. I needed to know how Blue Shield came up with the amount due as the letter gave no breakdown whatsoever. The 72 hour deadline was ridiculous. I had been waiting all this time for a resolution and for Blue Shields mistake I am given a deadline. On 4/26/18 I spoke to a Blue Shield representative to voice my concerns and she finally gave me a breakdown of what was due. She looked me up and said I was a longtime customer and made my payments on time. She also mentioned that the website was having maintenance done and I would be able to get back on soon. Also, I should mention the check that I sent to the main office was never cashed. The representative informed me that it would be ripped up or sent back to me since I didn't send it to the correct office. I offered to pay most of what I owed that day and the balance the following day since I had to stop payment on my previous check and wanted to make sure it was not cashed. She did not want to accept a partial payment and because of the 72 deadline was insinuated that I may not have coverage. I had to speak to a supervisor to make my payment and she assured me I would be ok with the payment arrangement I made. The next day I made the payment for the balance I owed. I was told by automation that I owed $20 more than the original amount. After I questioned a representative, I was told they made a miscalculation on the first amount. I told her I would pay the balance based on the 1st amount. I didn't feel it was my fault that they made that error. I had a voicemail and letter with that same amount. Recently, I tried once again (we are almost in June) to obtain payment information from the Blue Shield website. Once again I was not able to review my information. I emailed Blue Shield and received a response. They said since I have the new plan I need to register again and I will be able to see my information. I have tried 4 different times. When I have tried to register I get the message about them doing maintenance to the website. How in the world could it take this long to perform maintenance on the website? It's been at least 3 months

Consumer states: I am now in contact with DMHC and will pursue this matter with them further and consider this matter closed with the Revdex.com. If I receive a resolution I will contact the Revdex.com.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me to some degree.
We have faxed our HIPPA Authorization form to Kika B of Blue Shield of California.We understand that Blue Shield is currently investigating our complaint through their system, however, if there is no action or resolution, we will seek legal services. We also have proof of banks statements and medical bills that prove our claims are true.We thank the Revdex.com for getting the attention of Blue Shield.We hope that there is a resolution to this matter.Thank you for your time.[redacted] [redacted] [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to my concern and am wondering if I have to file a grievance directly with Blue Shield or whether that process was started for me on my behalf by Blue Shield.  Are there any other steps I need to take, or do I simply wait for Blue Shield to resolve this issue within 30 days, which would be no later than the end of April.  Please let me know how I should proceed.Thank you,[redacted]

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 12, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield. We...

thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating o grievance to address the concerns raised in the correspondence submitted. Please be advised that grievances ore resolved within 30 days of the receipt date. A response to the review will be sent directly to Mr. [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com. If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

I am rejecting this response because: [redacted] is my son who is only 6. The business has not tried to resolve the issue that money was taken out of my bank account without my consent.

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on June 4, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Bruce Schwartz, has completed our grievance process regarding this specific issue. A response letter was mailed directly to the member on June 1, 2015. If the member is dissatisfied with the grievance resolution, he may contact the Department of Managed Health Care for additional assistance. The department has a toll-free phone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department's Internet Web site [redacted] has complaint forms, IMR application forms and instructions online.If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.

Initial Business Response /* (1000, 8, 2016/01/15) */
January 15, 2016
Revdex.com
4201 W. Shaw Avenue Suite 207
Fresno, CA XXXXX
Re Case #: XXXXXXXX
Dear Revdex.com:
This letter is in reference to the correspondence received by Blue Shield of California (Blue...

Shield) on January 14, 2016, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield.
We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submitted. A response will be sent directly to [redacted]. Our records do not reflect that a signed release of information was submitted with the correspondence sent by the Revdex.com. Unfortunately, without a signed release of information from [redacted], we are unable to provide a copy of the resolution to the Revdex.com. If [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at XXX-XXX-XXXX or by mail at:
[redacted] Box [redacted] CA XXXXX
If you have additional questions regarding this matter, please contact me directly at the telephone number listed below.
Sincerely,
Chasytie White, Executive Inquiry Coordinator
(XXX) XXX-XXXX
Initial Consumer Rebuttal /* (3000, 10, 2016/01/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have already faxed the singed release form to Revdex.com last week!
Final Business Response /* (4000, 17, 2016/03/09) */
Thank you for taking the time on January 15, 2016, to lef us know about your experience with Blue Shield of California (Blue Shield). From the information provided, lunderstand you have not received a reimbursement check for the purchase of medical supplies with footwear etc., back in October 2015, billed amount of $111.63.
Upon review of your complaint, we have confirmed our records do not reflect the above mentioned claims. In order to process the claim please submit all required documents including proof of payment directly to Blue Shield for further review.
We would like to take this opportunity to apologize for any inconvenience this may have caused. We understand that your time is valuable, and regret that you had to take time out of your busy schedule to get these issues resolved.
If you have further questions regarding this matter, please contact me directly at the telephone number listed below.
Sincerely,
[redacted]
Coordinator Grievance Department
(XXX)XXX-XXXX
Final Consumer Response /* (4200, 19, 2016/03/14) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I am talking to them about December 16th prescription reimbursement in yhe amount of $278.
They keep confusing me and Revdex.com!
They need yo keep their acts together!!! I still am waiting to hear from them on that! I sent all the required documents twice now as requested and explained, still nothing. Its mid March. Ive been fighting with them about this since mid December 2015. Help or Ill have to sue them! Thank you!!

Initial Business Response /* (1000, 8, 2015/11/11) */
Dear Revdex.com:
This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on November 10, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided...

by the Revdex.com included a consumer complaint against Blue Shield.
We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com.

Sincerely,
Executive Inquiries
Grievance Department
Initial Consumer Rebuttal /* (3000, 10, 2015/11/13) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Blue Shiled has violated law by not reimburseing me foor the 20% deductable, on nPart B, which I paid at Rite Aid, and RITE aid told me, the supplement insurance would auto pay me, once the medicare billing was complete! UNREAL

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on January 26, 2015, concerning a Blue Shield enrollee’s mother by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue...

Shield. We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Ms. [redacted], has not completed the grievance process with the plan. We are initiating a grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to the subscriber, and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com. If you have additional questions regarding this matter, please contact me directly at the telephone number listed below,

Thank you for your help with this complaint.  Yesterday, a VP from Blue Shield of California contacted me by email stating that they had just sent me a refund check by overnight mail, and today I received the check.  Since not receiving this refund was the original reason I filed the...

complaint with Revdex.com, there is no reason for me to further pursue the complaint (nor will there be need to edit the complaint, nor will I be completing the HIPAA form).It is my personal opinion that the complaint should remain in permanent record in some way.

I am rejecting this response because: I spoke with [redacted] after making several attempts to contact her. She did not want to listen to what I had to say. I tried to explain to her that Blue Shield had charged me monthly, for a full year, after the original plan that I had for my son expired. It was no longer a good plan due to the new healthcare reform,with no benefits/coverage. If I were to take my son to the dentist, I would have had to pay for all costs out of my own pocket. I had made several calls to cancel this policy. The first time was in January 2014. I trusted that Blue Shield cancelled my plan, but they did not. I spoke with numerous representatives who ALL stated, that my plan would be cancelled from the conversations I had with them. One woman, [redacted], said she would send the confirmation letter via email and never did. After another phone call, I stayed on the phone with the rep and demanded I recorge a confirmation via email while still connected on the phone with her. [redacted] did not care that I was being charge for a service that I could not use. She dismissed my grievance claim. They made no attemp to help me.

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on September 24, 2014, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue...

Shield.
We thank you for forwarding these concerns to Blue Shield for review and would like to inform you that Mr. [redacted] has not completed the grievance process with the plan. We are initiating o grievance to address the concerns raised in the correspondence submitted. Please be advised that, grievances are resolved within 30 days of the receipt date. A response to the review will be sent directly to Mr. [redacted], and a copy of the resolution letter will be sent to the Revdex.com as we received a signed release of information with the correspondence submitted by the Revdex.com.
If you have additional questions regarding this mailer, please contact me directly at the telephone number listed below.

July 3, 2017 [redacted] 1 1 1 2 Emerald Street San Diego, CA 92109 Subscriber Number: 9[redacted] Group Number: X[redacted] Dear [redacted], Blue Shield of California has received your grievance inquiry, which was submitted on June 29, 2017. Please note that...

we work each grievance in the order received and we will respond to your grievance, via the U.S. Postal Service, within 30 calendar days from the receipt date noted above. Please be assured that we will contact you directly if additional information is needed to process your grievance. If we are unable to comply with your request at the end of this review, we will provide you with information regarding Independent Medical Review which may be available to you through the Department of Managed Health Care. Sincerely, [redacted] ###-###-#### Grievance Department Inquiry Number: 1[redacted]03 CC: Revdex.com Enciosure(s): Information Regarding the DMHC & Regarding ERISA Notice of Language Assistance rc

This letter is in reference to the correspondence received by Blue Shield of California (Blue Shield) on May 14, 2015, concerning a Blue Shield enrollee by the name of [redacted]. The information provided by the Revdex.com included a consumer complaint against Blue Shield. We...

thank you for forwarding these concerns to Blue Shield for review and would like to inform you that we are currently reviewing the concerns raised in the correspondence submitted. A response will be sent directly to [redacted]. Our records do not reflect that a signed release of information was submitted with the correspondence signed by the Revdex.com. Unfortunately, without a signed release of information from [redacted], we are unable to provide a copy of the resolution to the Revdex.com. If [redacted] has signed a release of health information to the Revdex.com, you may send a copy to my attention via fax at [redacted] *r mail at:[redacted] If you have any additional questions regarding this matter, please contact me directly at the telephone number listed below.

Blue Shield of California has decided to reinstate our coverage.Thank you.