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.
Blue Shield of California
Posts related to Blue Shield of California, primarily individual and family plans, billing issues, enrollment, health plans, small groups, Medicare.
In March of 2021, Blue Shield approved the plan member to receive gender dysphoria health care services from an out-of-network provider. Unfortunately, Blue Shield, according to the press release, inappropriately adjusted several of claims submitted by the health care professional. The payment dispute led to the health care professional suspending continued treatment until the claims dispute was resolved.
Blue Shield PPO members can schedule a visit by calling the Blue Shield Nurse Hotline or contacting Dispatchealth directly via website or telephone. Blue Shield HMO members must call their Primary Care Physician for a referral for an in-home visit to treat a medical condition. In-home visits are grouped into 5-hour windows corresponding to morning, afternoon or evening. Appointments can be as early as 7 AM or as late as 10 PM, sometimes on the same day as the request. Care is available in English and Spanish.
Where households realize a dramatic increase in Blue Shield PPO Covered California premiums is when the SLCSP has a small increase or negative rate change. Consumers in regions 2, 3, 4, 6, 7, 15, 16 and 18, where the SLCSP rate increases were in the low single digits will see a smaller subsidy. In other words, the Blue Shield PPO plan rate increases in those areas was greater than the SLCSP that the subsidy is based upon. The subsidy did not keep pace with the Blue Shield PPO rate increase like they did in regions 1 and 10.
The BlueCard program allows members to receive some health care services outside of California. This is an important feature for individuals who routinely spend weeks or months outside of California on business. With the exception of emergency services, if an individual needed small health care service in another state, they were almost forced to buy two health plans; one for California and one for the other state.
Many people want predictable copayments for routine services and are willing to accept a large deductible and maximum out-of-pocket amount for the rare and unexpected hospitalization. Blue Shield of California has come pretty close to designing such a plan with their 2022 Bronze 7500 HMO individual and family plan. Services with a set copayment and not subject to the medical deductible are:
Not all Blue Shield health plans will be receiving the premium credit. The credits will be applied to fully-insured employer groups (except flex-funded), dental and/or vision plans, Medicare Supplements, and individual and family dental and/or vision plan subscribers. Blue Shield states they are issuing premium credits as permitted by state regulators and Covered California.
LifeSpring, a free meal delivery service, is also available to Trio HMO members experiencing a serious illness. In addition to meals, Trio HMO members can also use the Call the Car benefit. Call the Car is free non-emergency medical transportation for medical appointments, dialysis or other healthcare service appointments. Blue Shield Case Managers will determine eligibility for the Call the Car program.
For eligible plan members only, Blue Shield will offer an option to defer up to 75% of April’s premium to remain a paid current Member / Small Group customer (i.e. must pay a minimum of 25%). For example, April premium is $1,000. Member can defer $750. April payment due is $250. So long as the Member or Small Group enrolls in the program or pays the Total Amount Past Due before the end of the grace period, the Member or Small Group will not be cancelled after the applicable grace period ends.
Blue Shield of California is taking additional steps to remove barriers and help its members receive the health care they need during the coronavirus (COVID-19) pandemic, announcing today it will cover members’ coinsurance, copayments and deductibles for COVID-19 medical treatments through May 31, 2020.