Complaints

This profile includes complaints for Blue Shield Of California's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Blue Shield Of California

  601 12th Street Oakland, CA 94607

• 

  Blue Shield Of California

  PO Box 7168 San Francisco, CA 94120-7168

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:04/25/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Since my injury in 2022, I have been repeatedly denied necessary, doctor-recommended medical care by Blue Shield, especially chiropractic and acupuncture treatments that are essential for managing my pain and *****************. Ive submitted multiple grievances and appeals with proper medical documentation from licensed physicians including Dr. ******* and Dr. **** yet theyve continued to deny or delay care. Ive experienced discrimination based on my disability and financial hardship. Their repeated denials have caused immense physical suffering, emotional distress, and prolonged recovery. Ive paid out of pocketover $30,000to keep myself alive, while Blue Shield refused coverage for treatments that were clearly medically necessary.I filed formal complaints with multiple government agencies and sent copies to Blue Shield, yet I continue to face the same neglect and dismissiveness. Ive received only one chiropractic session, despite being approved for more, and have yet to access the 12 sessions my doctor recommended. Im underweight, unable to sleep properly due to pain, and still recovering from severe injuries that were never treated. Their behavior has been cruel and dismissive, causing further damage to my health and stability. I am asking for urgent intervention to stop this mistreatment and ensure I receive the ongoing care I need and deserve.

  Business Response

  Date: 04/25/2025

  We thank you for forwarding these concerns to Blue Shield of California Promise Health Plan. We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to Emek Echo within 72 hours. We will mail a resolution letter to Emek Echo's mailing address with information regarding the grievance resolution, as well as the phone number for our Grievance Department. Thank you.

  Customer Answer

  Date: 04/28/2025

   
  Complaint: 23248898
  
  I am rejecting this response because:
  Blue Shield continues their abuse. This time on their Call the Car ride service. Please add to my complaint. 
  **Subject: Emek Echo - Formal Complaint Against Call the *********** Representative Blueshield of California** 
  **Blueshield** and their **Call the ************* abuse: 4/28/2025
  
  To Whom It May Concern,
  
  I am submitting this formal complaint regarding an extremely distressing and unacceptable experience I had today with the Call the *********** representative named ********.
  
  On **April 28, 2025**, at **4:01 PM**, I was forced due to routine failure on their app for call their Call the Car ride service for patients, at their************** number, to schedule transportation services, as authorized by my health plan. 
  
  Rather than assisting me promptly, ******** subjected me to approximately **7 minutes of unnecessary, abusive, and unprofessional behavior**, adding significant emotional distress to my already fragile and severely disabled condition.
  
  Despite clearly informing her (calmly and respectfully) that I am disabled, medically documented, and that speaking on the phone causes me **severe anxiety and exacerbates my health conditions** information that has been repeatedly reported to Blueshield since 2023. **** was indifferent, dismissive, and combative.  
  
  Instead of efficiently providing the service within a few minutes as required, she repeatedly talked over me, refused to listen to my basic needs, and escalated the conversation unnecessarily.  
  
  I specifically told her that my complaints were not directed at her personally, but toward Blue Shields policies and services. 
  
  Despite this clear explanation, she continued to take it personally, which is highly unprofessional and inappropriate, especially for someone working in a health-related customer service role assisting patients. 
  
  Her behavior was irrational, emotionally unstable, and entirely unacceptable in a healthcare setting where compassion, professionalism, and calm communication are critical.
  
  Her conduct was unprofessional, uncompassionate, and hostile toward a disabled patient simply trying to schedule medical transportation.
  
  I am deeply concerned that Blueshield continues to employ representatives who clearly **lack the training, sensitivity, and professionalism** required to work with patients with disabilities, despite being informed of the harm this causes.  
  
  It is not acceptable to require a disabled person to repeatedly explain their disability and beg for basic accommodations. Once disability is declared, respect and understanding are legally required under the Americans with Disabilities Act (***).
  
  Additionally, I have repeatedly informed Blueshield that the Call the Car app malfunctions regularly, and that being forced to call and endure this mistreatment over and over is detrimental to my health and safety. Yet no effective changes have been made.
  
  I am demanding once again that Blueshield take immediate corrective action:
  - **Properly train** all Call the Car representatives on disability sensitivity and *** compliance.
  - **Discipline** **** for her unprofessional and harmful behavior during todays call.
  - **Improve** the Call the Car app functionality to allow disabled users to schedule transportation independently without abusive human interaction.
  - **Create a special accommodations process** for patients like myself to avoid these repeated traumatic interactions.
  
  Please be advised that since Blue Shield abuse continues, I will escalate my complaints to state and federal agencies responsible for healthcare discrimination and patient rights protections.
  
  I am documenting every incident carefully.
  
  Sincerely,  
  Emek Echo
  ***************************
  
  

  Business Response

  Date: 04/30/2025

  The member has requested multiple specialists be approved; our investigation shows all referrals have been approved within the access to care guidelines provided by the ****. We have attempted to reach this member to discuss her concerns,however, the member has alleged that our calls may trigger her to have a medical emergency; therefore,she refuses to speak with us. The **** requires we contact the member to provide her with her rights; however, the member refuses to speak with us. We have addressed all concerns via US postal Mail and have educated the member on the guidelines that are enforced by our regulators. We regret that the member is not satisfied with the services provided, however, we have found no delay in care and no denials of service have been provided. We will address the members most recent concerns directly with the member.

  
  We thank you for forwarding these concerns to Blue Shield of California Promise Health Plan. We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the new correspondence submitted. We will mail a resolution letter to the members mailing address with information regarding the grievance resolution, Thank you.

  Customer Answer

  Date: 04/30/2025

   
  
  I am rejecting this response because:
  Complaint: 23248898

  
  **Public Response from Emek Echo:**
  
  **Subject:** Emek Echo - Ongoing Abusive Conduct by Blue Shield - Disability Rights Violations, Medical Neglect, and Retaliatory Misrepresentation 4/30/2025
  
  Blue Shield of California's response is not only dismissive, it is dangerous, dishonest, and reflective of the very systemic abuse I outlined in my original complaint dated April 24, 2025.
  
  To suggest I "refuse" to speak with them when I have *filed a police report* to stop harassing calls, due to the trauma and emotional distress they have caused by consistently violating my disability rights, is a gross misrepresentation. 
  
  I have repeatedly informed Blue Shield in writing that phone calls are medically and psychologically harmful due to my disability, and Ive asked for **reasonable accommodations** in accordance with **state and federal disability laws**. 
  
  These include written communication and accessible, consistent coordination of care. They refuse.
  
  Further, the claim that no denials of service have been provided is outright false. I have *over 45 documented grievance denials* from Blue Shield in my possession, with more pending. This has been going on since July, 2023 when I first became their member. 
  
  I was severely injured by a violent and well-documented tackle in 2022, publicly available video evidence proves the seriousness of my condition, and exposes the ongoing negligence by both ***************** and Blue Shield. 
  
  After Anthem failed to provide necessary care, I switched to Blue Shield in 2023, hoping for better treatment. 
  
  Instead, they denied me access to proper medical care entirely. 
  
  Ive had to pay out-of-pocket for life-saving acupuncture, and my doctor had to send me to the **** ER, which saved my life. 
  
  Blue Shield has not only failed to help, theyve actively contributed to the deterioration of my health. 
  
  I was a healthy, active, and productive individual before this injury. Their actions have devastated my life, and now they have the audacity to lie publicly about it.
  
  Their gaslighting tactic to pretend there have been no delays in care is not only infuriating, it is legally and ethically indefensible. 
  
  These delays have caused me immense suffering, made worse by the bureaucratic obstacles they intentionally erect.
  
  Blue Shield has continuously failed to act in good faith, obstructed medically necessary treatment, and knowingly violated the rights of a disabled person in crisis. 
  
  I have legal counsel reviewing this matter, and all relevant documentation, including this outrageous public response, will be added to a formal complaint to the ***** the Department of ******************** and additional regulatory bodies.
  
  I also call on the leadership of Blue Shield to be held accountable. This is not just negligence, it is cruelty. 
  
  Its time for those responsible for this harm to resign and for competent, *human* professionals to take their place.
  
  This abuse must end now!
  
  Sincerely,
  
  Emek Echo

• Initial Complaint

  Date:04/21/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Im formally requesting help from the Better Business Bureau for help regarding a check that has been incorrectly issued to the provider.I submitted my own CMS1500 claim form through my BS of California member portal for direct reimbursement-As my Midwife does not accept insurance and has been paid in full. BS of California has processed my claim and issued the payment to the provider incorrectly.I am formally asking help from the Better Business Bureau in questioning BS of California as to why they incorrectly processed my claim and issuing the payment incorrectly.

  Business Response

  Date: 04/22/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). In order to research and properly respond to the members concerns, we ask that you provide the subscriber identification number of the account in question. 

• Initial Complaint

  Date:04/19/2025

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Blue Shield sent me a letter on 12/19/2024 stating there was a decrease in my premium starting 1/01/2025. My new monthly payment was ******. On 1/16/25 I received an invoice for *******. I had paid four different payments. On 12/4/24 $232.15. 2/3/25 $280.00 2/18/25 $250.00 and 2/28/25 $216.44. I tried to get my blood pressure medication and they said my policy was expired due to non payment. I contacted Bliue Shield and Covered California. They both tried to blame each other for the error. I overpayed Blue Shield cause they were threatening to terminate my insurance coverage. I called and a nice lady said she would issue a refund and I will see it in my mailbox. I never did. When I contacted Blue Shield again they said, the refund was an error. I am so upset with the incompetence of my health insurance provider. I have always had insurance. I am receiving less benefits and it is costing me triple. I contacted Covered CA and they said Blue Shield terminated my policy for non payment on March 4th. When you read the bill for April its shows none of my payments and me owing $****** for the month. I refuse to send another payment until I get my refund for the amount I overpaid. Once again they are threatening my coverage cause my account is past due. I am at a loss and really hope you can help with this debacle. I paid 4 payments totaling $978.59 minus three months at ****** is $514.39. I expect a refund check for the difference which is $464.30. Thanks

  Business Response

  Date: 04/22/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to **** ****** within 30 calendar days. We have mailed an acknowledgment letter to ********************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you
  
  

  Customer Answer

  Date: 04/29/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  **** ******

• Initial Complaint

  Date:04/14/2025

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am formally requesting the Better Business Bureau to please assist in helping me convey to my insurance company that a claim payment MUST be issued to my new address after the terrible California fires destroyed my home in *****************. My complaint is regarding claim number ************ is regarding a payment that has been issues to my old home address that was burned down during the terrible fires. Please assist my making BS of California accountable to sending my address to my current address: ********************************. I have conveyed the need to reissue the check to the correct mailing address multiple times to no avail. Please help!

  Business Response

  Date: 04/14/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to **** ******** within 30 calendar days. We have mailed an acknowledgment letter to ***************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you. 
  

• Initial Complaint

  Date:04/04/2025

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am formally issuing a complaint against BlueShield of California as I have submitted a maternity claim through member services for reimbursement on a claim that was paid in full for a non-network provider. After multiple attempts to have the $802.27 check reissued to my address, I am formally requesting the Better Business Bureau to become involved as BS of California is continuing to send my reimbursement check to the provider who has been paid in full and does not accept insurance.Please find the following notes attached: Fri, Mar 28, 2025 at 6:30AM I requested a supervisor. After a lot of holding and waiting, I was told your check would be reissued to the member (as the previous requests were not completed as promised). Name: Angel ********* to call: ************ Supervisor Request:Supervisor name: Larc ********* to call: ************ Feb 11, 2025 at 9:48AM The check received by Aleks dated 12/10 has been successfully voided. The new check was reissued, but there are no details on the provider's side-***************** can only confirm the check is still outstanding.Claim number for re-issue is ************ Name: *** ********* to call: ************ Dec 26, 2024 at 8:25PM: I just finished a call with *** in the claims department, *** was able to request the check be reissued to you under reference number ************.

  Business Response

  Date: 04/07/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to Crystal ******************* 30 calendar days. We have mailed an acknowledgment letter to ****************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you. 

• Initial Complaint

  Date:03/28/2025

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  This appeal is in regard to a facility claim that was submitted January 2024. As of today, the claim still remains unpaid with the home plan trying to process my UB04 itemized facility receipt as a facility submission. I am kindly asking the Better Business Bureau to please step in as multiple attempts have been made to notify member services at ************************ that the out of network facility has been paid in full-This member submission is my attempt to receive reimbursement for a facility fee that is covered by ****************. Any help to press the commercial insurance company to do their part and process my submission would be greatly **************** Notes:Mar 28, 2025 at 9:22AM Must contact member services to request the claim be adjusted as a member submitted claim-As of right now, the claim is requesting a provider on boarding pass as if the claim is to be paid to the contracted provider/*************: Mikayla Reference to call: ********* Feb 25, 2025I just called and spoke to ****** *. under reference to call *********.The **** additional information form and medical records were received on 02/18/202 Jan 13, 2025 at 8:00AM I spoke with ****** under reference number 17454338.According to ******, the claim is denying requesting the facility submit a provider onboarding from through ************************. It's as if *** ************ submitted the claim vs a member submission.Jan 17, 2025 at 9:49AM Spoke to member services to request claim be processed as a member ******************: ****** Reference number:175623714

  Business Response

  Date: 03/31/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to ****** Bostick within 30 calendar days. We have mailed an acknowledgment letter to ********************************************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you. 

  Customer Answer

  Date: 04/01/2025

   
  Complaint: 23129880
  
  I am rejecting this response because: I am filing a complaint with ********** and Blue Shield of Oklahoma not California. I want to make sure it is going to the right place. 
  
  Sincerely,
  
  ****** *******

• Initial Complaint

  Date:03/25/2025

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  In May 2022, Blue Shield of California sent us a check for $151.13 as a reimbursement for healthcare-related services. We called them about the check because it did not seem right that we should be receiving it, but they told us that the payment was ********** 2023, we received a letter from them stating that we owed them $151.13 for the overpayment they made to us, so we sent them a check for this amount. However, we continued to receive notices from them stating that we still owed them money. When we called them about this, they told us that they were behind on processing checks and we shouldnt worry about it.After we called, we continued to receive notices about owing them money. We tried calling again, but received no resolution. To put an end to this, we sent them a second check for $151.13. At this point, we assumed that the first check must have been lost in the ******* July 2023, shortly after sending the second check, ********** cashed the first check. Then, in October 2023, they cashed the second check, which means that they now owed us a balance of $151.13. Since then, we have tried on multiple occasions to get our money back. We also sent them copies of the check images from the bank, which confirmed that they had indeed been paid twice. Despite their promises, however, we have received no refund nor has anyone from Blue Shield reached out to us or responded to our last two letters. The last letter we sent to them was in January 2025.

  Business Response

  Date: 04/07/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to ******* ******* within 30 calendar days. We have mailed an acknowledgment letter to ***************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you

  Customer Answer

  Date: 04/09/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ******* *******

• Initial Complaint

  Date:02/24/2025

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  i hace been trying to contact in the last month to blue shield of california for very simple but urgent and sensitive information for my taxes. i have called and being on the-phone for 2 daily hours for the last 2 weeks i have records of the calls where they keep transferi g me and dont eant to provide me the total premiums i have paid each year to blue shields of california. this is shady an illegal and is goint to cause prejuice to me. i need thai resolved asap. the health care us shady and corrupt. what amazes me the most is what would people have to deal for health insurance claims. i am giving 2 business days to get thsi resolved if not will file a claim with the irs and the state regulator for not providing me my own information. i have contacted the headquarters and they dont of nothing at all. we are not going to allow these ilegal practices from insurances

  Business Response

  Date: 02/25/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to ******* ******* within 30 calendar days. We have mailed an acknowledgment letter to ************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you.

  Customer Answer

  Date: 02/27/2025

   
  Complaint: 22984464
  
  I am rejecting this response because:

  they have not contacted me and i need this information

  for tax purposes so what they are doing its illegal. i just need the premius paid for my insurance from 2016
  
  
  ** *******

• Initial Complaint

  Date:02/14/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  We had met our ************************ the year. We found **** ****** on the BLUE SHIELD website and it shows her as an in-network provider, so I started to see Dr. ******* After several sessions, I received EOB showing that Blue Shield was REFUSING TO PAY. We filed a complaint in August of 2024 and *******, ***** ************************************************ replied with documentation that Dr. ****** is in fact IN NETWORK and they apologized for the mistake and planned to update our account to cover her fees. They did end up paying Dr. ****** for her services but then shortly after they STOPPED PAYING HER AGAIN, making up some make believe story that she is out of network, even though the *** SHOWS THAT SHE IS IN NETWORK PROVIDER. This is a scam and needs to be stopped. We found Dr. ****** on the BLUE SHIELD WEBSITE under IN NETWORK PROVIDERS!! The *** says IN NETWORK. Dr. ****** showed us her IN NETWORK status herself. ***** ******* EVEN SENT A LETTER CONFIRMING THAT SHE IS IN NETWORK!!! PLEASE PAY HER FOR HER SERVICES AND STOP THE *******

  Business Response

  Date: 02/14/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to ******* ******** within 30 calendar days. We have mailed an acknowledgment letter to ********************************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you

  Customer Answer

  Date: 02/14/2025

   
  Complaint: 22940450
  
  I am rejecting this response because:
  

  IT HAS BEEN ALMOST A YEAR SINCE BLUE SHIELD ADMITTED THEMSELVES THAT THE SERVICES WERE ALL IN-NETWORK YET THEY ARE STILL REFUSING TO PAY!!! I HAVE IT WELL DOCUMENTED!!

  
  Sincerely,
  
  ******* ********

• Initial Complaint

  Date:02/04/2025

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been a member of ********** for multiple years, and it is the most expensive medical insurance, PPO/PERS Platinum. As of 1/1//2025 Blue Shield took over the administrative part of the insurance and I was not notified of it. My wife is a brittle Type 1 diabetic who requires insulin with insulin pump and a CGM (This device regulates blood sugar) from going too high or too low which is essential to live saving since my wife no longer senses when her blood sugars fluctuate which may lead to coma/complications. As of 1/1/25, all my wife's essential medications have been denied or not yet processed. We have contacted ********, Blue Shield and all companies that send the medication and still have not received any medication as of today. Very soon, my wife will not be able to regulate her sugars and may end up in the hospital due to lack of supplies. We have taken every opportunity to try to mediate these issues and have been given multiple run arounds. We are seeking resolution, or may end up having to contact an attorney, and possible media attention and other legal actions. We need your assistance in resolving this issue today as this is a life-threatening issue. The *** PERS agent was surprised of the lack of communication and my HR personnel as also identified many issues with this merger with other employees. Note: We have contacted all the doctors (approved under the plan), and they have sent multiple referrals to the insurance, and they don't know what more they can do since the insurance company is not communicating.

  Business Response

  Date: 02/04/2025

  We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). We would like to inform you that we have initiated a grievance analysis to review and respond to the concerns raised in the correspondence submitted. We will provide a written response to ******** *****] within 30 calendar days. We have mailed an acknowledgment letter to ****************** mailing address with additional information regarding the grievance process, as well as the phone number for our ********************* Thank you. 

  Customer Answer

  Date: 02/07/2025

   
  Complaint: 22895701
  
  I am rejecting this response because:
  My wife had type 1 diabetes and needs her insulin and pump supplies urgently since she can not live without it. We followed all protocols to get doctor authorizations and been dealing with this for over a month. Wifes supplies run out in less than 8 days. Cant wait another 30 days for review.  You f no resolution, will contact attorney and reach out to the media. 
  Sincerely,
  
  ******** *****