Business Profile

Insurance Companies

Blue Shield Of California

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Important information

Customer Complaint:
BBB’s profile for Blue Shield of California, was created June 1956. A review of the file was done in September 2024. Complaints on file concern billing and authorization issues.

BBB recommends patients and providers to review the Prior Authorization List and File A Grievance.

For additional support, please visit Blue Shield of California's Contact Us.

Complaints

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

Customer Complaints Summary

120 total complaints in the last 3 years.
43 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

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: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,

******** *****
Initial Complaint
Date:02/03/2025
Type:Product Issues
Status:
UnansweredMore 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 received a check from Blue Shield for my husband( *** *******) , he passed away in July of 2023, I notified them at the time and changed my health insurance in 2024, so last week they sent a check made out to my deceased husband, so of course my bank cant honor that, so I called today( 2/3/25), to request a new check, I called 5 times and each time I was put on hold , because the employee didnt know how to handle the situation and 5 times the phone was disconnected after holding for approx. 10 mins., I provided my call back #, but of course no one called back, is this their way of just not refunding monies, just disconnect the call and not follow-up ?
Customer Answer
Date: 02/28/2025
This is a follow- up to a complaint I filed earlier, Blue Shield did contact me about a refund I received in my husbands name, my husband pasted away in 2023, they sent the check in 2025, I notified them at the time of my husbands death, they couldnt locate that information , so I resent a copy of death certificate , its been almost a month, still no check, I guess they just keep the money, seems that this wouldnt be legal.
Initial Complaint
Date:01/25/2025
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.
On 9/11/24 I paid my monthly premium of $379.49. Blue ******* took two payments from my account instead of 1 Throughout the month of September, they returned fees and recharged me multiple times. The final payment was taken out on 9/18/24 Blue shield took $379.49 twice again. The final refund 1 payment on 9/20/24. Blue shield does not acknowledge keeping any money from my bank account in September.I contacted Blue shield over 15 times with regards to this matter. I provided them proof with my bank statement through multiple emails, faxing and speaking directly with managers, and theyve been unable to get the money credited to my account. Because Blue ********************** is unwilling to accept the proof of my payment in September the money I paid in October was put to September. The money I paid in November was put to October. I had to pay two times in December and both of those payments were put towards November and December, as opposed to them acknowledging my bank statements that showed that I paid September. Blue shield to this day does not acknowledge that they ever kept any form of payment from me for September even though Ive given them proof via bank statements and Ive had the bank speak directly to them. I contacted directly to my bank, which is ************** and they stated they were unable to take funds away from them from months prior. They stated I wanted to pay them and the bank said they only could provide the proof that they actually paid them which they did. Blue shields managers state that they believe that I paid September but Blue shield was unwilling to credit my money because they dont have any record at all in their was a payment and they have nothing to refund. At this moment, my payment is lost. Blue shield is unwilling to credit me for my payments through January. My account is currently delinquent and I received multiple overdraft fees Id also like refund for from when they charged me over 6 times in 9/24 and refunded only 5. 5 mos
Business Response
Date: 01/27/2025
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 ****** Cox 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: 02/25/2025
I like to reopen my complaint and I reject their response. Ive been waiting for them to fix this issue since September ******* and they havent fixed this situation.

Thank you,

****** ***
Business Response
Date: 02/26/2025
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: 02/26/2025

Complaint: 22857450

I am rejecting this response because: I been waiting since Sept 11 2024, I spoken to multiple managers/ supervisors this is not getting done, and i believe this is a blow off to make this go away, I want this escalated to an higher supervisor in Blue shield and understand I was double charged. I would like this case to remain open for an addiotnal 10- days for the business to effectively respond. [ Taken indication by BBB rep *** ]

Sincerely,

****** ***
Initial Complaint
Date:01/23/2025
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.
On April 11, 2024, I submitted a claim for a surgery performed on March 12, 2024 by Dr. ***** *** from ******************. I paid for the surgery out of pocket, which cost $18,567.87. After hearing nothing about the claim for months, I called at least twice. A customer service representative told me the claim had initially been processed incorrectly, but that the issue would be resolved. She told me someone would contact me. I was never contacted. It is now 9 months later. I have yet to receive reimbursement for this claim. I have moved since I filed it, but I have had all my mail forwarded to my new address and still have no reimbursement check. My plan did not have a deductible, and I expect to receive the out-of-network reimbursement percentage for the surgery.I would like the claim processed on an expedited timeline and would like the check, with a tracking number, sent to this residence:****************************************************************************
Business Response
Date: 01/23/2025
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: 01/23/2025

Complaint: 22848910

I am rejecting this response because: I have received no email from Blue Shield about the grievance process. I have had to contact them over and over again about several medical reimbursement claims. This claim happens to be the only one I'm filing a BBB report on. Blue Shield has a pattern of not properly processing claims or reimbursing them in a timely manner. I am not going to be stuck in an endless loop where after over a month passes, I then have to call their grievance department. It has been 9 months since I filed my claim. There is no reason for them to spend 30 business days investigating this. I need this resolved quickly.

Sincerely,

**** ******
Business Response
Date: 02/07/2025
Please see attached business response
Customer Answer
Date: 02/08/2025

Complaint: 22848910

I am rejecting this response because I will keep this case open until I receive my reimbursement for my surgery claim. It has been nearly 10 months now. Without this complaint remaining open, I do not trust BlueShield of California to follow through with its grievance investigation or to communicate with me after that process is complete. In my previous dealings with them on other claims, I was told numerous times, a representative would call me, and no one ever did.

Sincerely,

**** ******
Initial Complaint
Date:01/23/2025
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.
Canceled my policy twice with telephone assistance BEFORE the starting date of coverage. And once again on January 22 December 3 with *** ********* and my mother ************** December 27 with Destiny Blue shield ************* Reference # *** 620 035 771 January 22 ****** /Raven blue shield/coveted California ************* Ref # ******** January 22 phone call to blue shield Oakland ************** Call to confirm cancellation and to escalate this. At this time I was given the reference number for my phone call with destiny. I asked for the number
Business Response
Date: 01/23/2025
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 ******* Sutton 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: 01/24/2025

Complaint: 22847820

I am rejecting this response because:
I have not received an acknowledgment letter in my email this is false information

Sincerely,

******* ******
Initial Complaint
Date:01/13/2025
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.
On December ******* I ******* ******** personally applied for health insurance with blue Shield of California, that have successfully processed the initial enrollment plan ID: **************************, subscriber ID: ************, payment date.12-*******, Effective date. January *******. Confirmation N: ********* For the first 30 months the insurance blue Shield of California processed and paid the medical claims on a regular basis.Unfortunately, on September 2024, the cancer center City of ************* that is located in ************************************ informed me by mail that Blue Shield denied to pay.Blue Shield of California PPO has denied all the claims for the last 18 months from several providers. However, this insurance continuously collects auto payment processes every month for the amount due on the due dates, that also including the payment for January 2025 for the amount of $1383.70 payment date: 12-31-2024 account ending in *5412. Confirmation Number ********** THIS IS FRAUD AND DISCRIMINATION On October 2024, I personally called the ********************* to inform them that I had been in contact with the Blue Shield insurance to solve this problem regarding denied claims for the last ************************************************************************************************************************************** order to continue the necessary medical treatments.I am a cancer patient yet it is very frustrating and tedious because deny Blue Shield of California is responsible for any health complications that arise due their negligence and significant barriers that have prevented me from receiving needed medical care services. Because accurate and timely diagnosis are very critical to ensure adequate treatment and management of chronic diseases I request that Blue Shield of California reviews and processes all the denied claims from August 2023 forward and/or refunds the money for those auto payment for the last 18 months which total around $21,600.
Business Response
Date: 01/13/2025
We thank you for forwarding these concerns to Blue Shield of California (Blue Shield). Our records indicate this member currently has a grievance in review, received on 01/09/2025 regarding these specific concerns. Please note that grievances are reviewed and responded to via the ******************* within 30 calendar days. Therefore, we will not initiate a secondary review at this time.
Customer Answer
Date: 01/14/2025

Complaint: 22802774

I reject this response because although your records indicate the grievance in review that was received on 01/09/2025, I have personally been in contact with Blue Shield of California trying to seek resolution including the listed phone calls:
October 22-2024
November 14-2024
November 15-2024
January 09-2025
However, the problem unfortunately continues and it has far exceed the within 30 calendar days mentioned.
Blue Shield of California is creating obstacles that are forcing me to avoid any medical care by continuously denying all medical claims since August 2023.
Blue Shield of California has been very unprofessional because they continue collecting the auto payment on time every single month from my checking account yet deny coverage claims.
I personally believe this is fraud, dishonesty and discrimination.
Sincerely,

******* ********

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