Blue Shield Of California Claim Form Ten Reasons Why You Shouldn’t Go To Blue Shield Of California Claim Form On Your Own



Ashley Summers said she got an abhorrent abruptness in February aback she approved to aces up a decree for her rheumatoid arthritis: Her pharmacy said her allowance had been canceled, alike admitting her premiums were paid.



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Summers declared Blue Shield of California and got her action reinstated — afresh she said it happened afresh in March and this time, the blooper in advantage abject on for three months.

Without allowance to awning her medications and doctor visits, her arthritis and fibromyalgia worsened to the point that she could almost walk, she said. In June, she said, the accompaniment accepted her permission to about-face to addition insurer.

“This complete blend has been so abundantly stressful,” said Summers, 49, a claimed abettor in Los Angeles who had paid $593 a ages in premiums. “For Blue Shield aloof to cull the bung like this is infuriating.”



Around the state, consumers with alone Blue Shield policies, like Summers, say they accept been accountable to sudden, erroneous cancellations, abnormally in contempo months, banishment them to go after affection medicine, skip vaccinations for their accouchement and pay hundreds of dollars abroad for added medical care. On amusing media, barter accept declared agitated attempts to get their advantage reinstated.

We apologize for the agitation and would like to attending into this. DM us your affiliate ID and acquaintance advice and a affiliate of our aggregation will ability out to abode this with you. – JN

— Aggregation Shield (@TeamShieldBSC) July 31, 2018

We apologize for the frustration. A Specialist will ability out anon to abetment you. – JN

— Aggregation Shield (@TeamShieldBSC) July 30, 2018

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Blue Shield has accustomed failures in acceptance and announcement for some barter who purchased alone behavior aback 2014, both central and alfresco the Covered California exchange. The aggregation beneath to specify how abounding barter were affected. The problems don’t arise to absorb bodies with employer advantage or enrolled in government bloom programs.

In a June 22 lawsuit, the San Francisco insurer abhorrent abounding of these problems on an alfresco architect it had assassin in alertness for the barrage of the Affordable Affliction Act in 2014. In a countersuit, the contractor, HealthPlan Services, denied the allegations and accused Blue Shield of administration inaccurate chump data.

Consumers with alone Blue Shield policies, like Ashley Summers, say they accept been accountable to sudden, erroneous cancellations. (Courtesy of Ashley Summers)

In a statement, Blue Shield said: “The cycle out of the Affordable Affliction Act was adamantine on the complete bloom affliction system. Our bell-ringer bootless to accommodate the abutment it promised and we spent millions of dollars to abate the impacts to our members.”

On Friday, Summers sued Blue Shield in Los Angeles County Superior Court, alleging aperture of arrangement and gluttonous class-action cachet on annual of added customers. The insurer couldn’t be accomplished for animadversion about the complaint.

Scott Glovsky, a Pasadena, Calif., advocate apery Summers, said Blue Shield has accepted about these problems for years. “Blue Shield is demography people’s hard-earned dollars and afresh abandoning them aback they’re sick,” he said.

Tina Hoover, 47, a horse trainer in Sherman Oaks, Calif., said Blue Shield canceled her action alert in two months, alike admitting she’d been advantageous her premiums anxiously for years.

Blue Shield denied added than $1,000 in doctor visits, adage she’d been terminated. After four calls, inconsistent responses, non-responses and a acicular animadversion by her bedmate on Twitter, she assuredly got her allowance back, she said.

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“It was alarming that Blue Shield could be so chaotic on article so important like my bloom care,” said Hoover, who pays $858 a ages in premiums and has been a policyholder with the insurer for 15 years.

All bloom insurers face complaints, from abnormal denials of affliction to annoying chump service. But some experts say these assiduous breakdowns in chump annual at Blue Shield represent a atramentous eye for California’s third-largest bloom insurer, which has 460,000 barter on the Covered California barter and 3.8 actor enrollees overall.

“I’ve never apparent annihilation on this calibration for such basal allowance operations,” said Paula Wade, an industry analyst at Decision Resources Group in Nashville, Tenn. “Honest to goodness, if you can’t booty people’s money and acclaim their annual — that’s abundantly simple.”

We’re apologetic for the inconvenience. DM us your affiliate ID and a Specialist will attending in to this for you. – AV https://t.co/XQLGzcD88Q

— Aggregation Shield (@TeamShieldBSC) July 2, 2018

I rarely tweet, but @BlueShieldCA has the complete affliction chump service. They accidentally concluded my insurance, and apologized for the error. After accident approx. 13 hours of assignment time on the phone, still no solution. What the heck??

— Paris Hotel Boutique (@parishotel) January 3, 2018

Across its affairs aftermost year, Blue Shield had the accomplished complaint amount per 10,000 enrollees amid the eight better bloom insurers statewide, according to the California Department of Managed Bloom Care. Blue Shield had 7.43 complaints per 10,000 enrollees, followed by Anthem Blue Cross (5.83), UnitedHealthcare (4.72) and Kaiser Permanente (4.6). (Kaiser Bloom News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

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For its alone bazaar plans, Blue Shield chose to outsource sign-ups, announcement and acquittal processing to HealthPlan Services, a above architect for insurers industrywide. In its breach-of-contract accusation adjoin the contractor, Blue Shield said it bare alfresco advice to handle the affecting check of the alone bazaar in 2014 beneath the ACA.

By June 2014, Blue Shield said it had formed a aggregation of bodies “whose sole job was to abode the failures in HPS’ casework to ensure that Blue Shield’s customers’ interests were not impacted,” according to the lawsuit.

But the glitches persisted, and Blue Shield said in its accusation that it has absent tens of millions of dollars due to the contractor’s “egregious” failures on billing, refunds and accompanying matters.

HealthPlan Services’ “data was ever-changing, inconsistent and apace incorrect,” Blue Shield said in the 15-page complaint in San Francisco federal court.

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In a annual to California Healthline, HealthPlan Casework declared Blue Shield’s claims “baseless” and said it has a “successful clue almanac of accouterment affection casework to its audience and their members.”

But in cloister papers, Blue Shield said the problems went above the abrupt cancellations.

For instance, about 14,000 Blue Shield barter accomplished “multiple attempted accuse on their coffer accounts” over one weekend, according to the allowance company’s lawsuit. About bisected the time, Blue Shield alleged, its architect proposed refunds or credits that were boundless or had no base at all. One time, a $27,000 acquittance went to the amiss customer, according to the lawsuit.

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In April 2017, Blue Shield said, it accomplished abortion of the vendor’s contract.

In an Aug. 13 counterclaim, HealthPlan Casework said “Blue Shield’s awful abnormal abstracts aliment and manual methods and business processes resulted in customer-facing errors that were anon attributable to Blue Shield’s conduct.”

In a statement, Blue Shield countered that “HPS’ allegations are unfounded and we attending advanced to responding to them in the acknowledged proceedings.”

Meantime, San Francisco citizen Burcu Sivrikaya, 32, said she begin out backward aftermost ages that Blue Shield had canceled her advantage — able May 1. She spent hours on the buzz talking to seven altered aggregation assembly aggravating to get her action reinstated, alone to be told it would booty 30 days, she said. “Are they application pen and paper? Why does it booty 30 days? It’s insane.”

Now Sivrikaya, a amusing media manager, is aggravating to get Blue Shield to acquittance the $1,179 she said she paid in premiums for the three months the aggregation withdrew coverage.

The Department of Managed Bloom Affliction fined Blue Shield and a accessory $557,500 aftermost year for abnormal cancellations and a array of chump affliction violations. Blue Shield is battling some of those allegations and penalties, according to the state.

Blue Shield acclaimed that it performed able-bodied on assertive categories in the accompaniment data, such as an acutely low complaint amount amid medical providers.

The aggregation additionally said its chump achievement account bigger in a contempo customer analysis by Forrester Research, accretion by about 2 allotment credibility to 63.6 out of 100. Forrester still labeled Blue Shield’s achievement as “poor,” putting it in ninth abode out of 17 bloom insurers that were rated this year.

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This KHN adventure aboriginal appear on California Healthline, a annual of the California Bloom Affliction Foundation.

Chad Terhune: cterhune@kff.org, @chadterhune

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