The Blue Shield of California billing system for the Individual and Family Plans offered through Covered California has been a nightmare for their members. Some of the problems are related to Covered California. However, Blue Shield has been very good at creating their own billing headaches without the aid of Covered California.
Blue Shield Billing Nightmares for Covered California Consumers
Since the summer of 2023 and continuing through at least January 2024, I have seen a variety of billing problems at Blue Shield with clients enrolling through Covered California. As an agent, I work with every insurance company offering health plans to individuals and families in California. No health plan has been as consistent and persistent with creating the premium billing problems as Blue Shield.
The latest billing implosion encapsulates every billing issue I have seen Blue Shield create. I assisted an existing Covered California consumer with enrollment into a Blue Shield PPO Silver 94 health plan on January 17, 2024. Upon enrollment, we immediately paid the February premium binder payment through the Blue Shield online payment website. I captured a screenshot of the confirmation of payment details.
The consumer’s Covered California account went from Pending to Enrolled. Covered California will only show Enrolled when the health plan communicates with Covered California that the consumer has made their binder payment.
Bills for Full Premium – No Subsidy Applied
On February 1, 2024, Blue Shield debited the full amount of the consumer’s premium from their debit card. I checked my Blue Shield agent dashboard and saw that Blue Shield was not applying any of the Covered California subsidy to the health plan. This debit exploded the consumer’s finances as they are self-employed and had not budgeted for a $1,200 expense on the first of the month.
Blue Shield has severely limited the ability of agents to communicate with them about these sorts of problems. I can no longer talk to a Blue Shield representative. I must use a chat feature. The chat feature limits how much information I can provide to help resolve the issue or get information from representative on the other end of the chat window.
Regardless, the consumer who was debited for the full premium amount is not an isolated case. Even with my small number of clients in Blue Shield plans, I have 6 or more full premium payment billings. From my small sampling of consumers affected by the Blue Shield bumbling billing system, there must be hundreds or thousands of others.
For another client, we split the couple into separate health plans through Covered California. One household member remained with Blue Shield. The other household member enrolled in a Health Net plan. Health Net properly invoiced for the second member’s health plan with the appropriate subsidy. Blue Shield billed the first member for the full amount of the health insurance.
Had you been near this family’s home, it would have sounded like an explosion as the Blue Shield member vented to me about the incompetent billing system of Blue Shield. The client was able to get a supervisor at Blue Shield who gave her grace period to pay the premium while they resolved the issue. On my side, I was able to push through a payment for the consumer’s Blue Shield plan for the amount stated in the Covered California account after the subsidy. The partial payment – even though it is the correct amount – will register as no payment at Blue Shield because the full balance was not paid, eventually leading to termination if the billing problem is not fixed.
Creating Multiple Accounts, Applying Payments to Wrong Accounts
In addition to the no subsidy/full premium billing pothole, I have had clients where Blue Shield has created multiple accounts for the same household members. I had one family with 3 different Blue Shield subscriber identification numbers. Another family had a second subscriber ID number generated by Blue Shield but kept accepting payments to the first ID number. The second ID was active and showed terminated for lack of payment.
Some of the billing issues at Blue Shield are created by Covered California. Unfortunately, the other health plans have figured out how NOT to create duplicate billing enrollments just because the family switches metal tier health plans. Another nightmare for the consumer ensues when they must fight to get a refund for the overpayment, especially when the overpayment went to a defunct subscriber number. (Insert sound of our heads collectively banging on walls and desks.)
Blue Shield, like other health plans, is a large company. All the health plans have dedicated units for the different activities such as paying claims, enrollment, prior authorizations, and billing to name a few. Most of the different units at Blue Shield function properly in an efficient manner. I have members in their individual and family plans, Medicare Advantage, and Medicare Supplement plans.
It is the individual and family plan insurance products that seem to have these persistent billing problems. Blue Shield has been hit with fines from the Department of Managed Health Care for denying and delaying claims or paying only a portion of the legitimately filed claim. At least for the individual and family plans, Blue Shield seems to have some systemic billing and provider payment issues it needs to address.
Other Health Plans have Figured Out the Billing Challenges of Covered California
There are many parts of the Blue Shield health plans that have no problems. Blue Shield has the largest network of providers for its individual and family plans of any health insurance offered. They regularly pay millions of dollars every month for health and drug claims. They offer their PPO plans in every county in California. No other health plan can make that claim.
When so much works correctly with Blue Shield of California, why are they blind to their billing issues. These billing issues are not new. They have had billing problems for years. However, in the last six months, the billing problems have gotten worse and more intractable to fix. If anyone is listening – or reading this post – at Blue Shield, please fix your billing system, it is driving your members to need mental health services.