TL;DR:

- Repeated lies from Blue Shield to weasel out of covering health expenses
- Also a huge lack of transparency in their claim process
- Discrimination towards mental health conditions



Would encourage everyone not to remain silent about the abuse they receive.
In front of headquarters of too much evil


Longer version

Since that's where the focus of my complain activities outside this page lies, I am going to focus here on my disappointing healthcare system stories involving Blue Shield. There are sadly older ones as well, involving for example pretty nasty immigration-based discrimination from Healthy SF, or the incompetence conspiracy of the social security administration and an employer which resulted in a lack of healthcare coverage during the first two months in the country.

When the Blue Shield coverage started, I was going to a pharmacy walk-in clinic that had reasonable rates - from the description of the coverage it seemed like still going to that place should be fine. However, there was a nasty surprise after I first made a claim for some doctor visits and blood tests - Blue Shield sent a letter saying the claim could not be processed. After several calls, I got to talk to a person from Blue Shield that claimed that the billing format from the clinic was not compatible with theirs, and I should visit the doctor again, requesting them to add some treatment codes in the right format. I found the time to do this, go and copy all the bills again, and send the corresponding letter to Blue Shield, along with a note containing the phone number of the walk-in clinic in case more information was required. Months afterwards, Blue Shield just replies with another non-descriptive letter stating that they still could not process the claim. At that point my health was worse and I was in the process of moving, so just gave up. This was a deeply unpleasant experience, and would have been quite terrible for many other patients who could not economically afford to just let it go.

At that point, I found the One Medical service, of which I have overwhelmingly good things to say (except when they lost a check), and which makes going to the primary care doctor a fine experience for a reasonable monthly fee. Note that by then I am paying taxes to a government that spends on healthcare as much as other Western countries where no further payment or very limited one is required for doctor visits, then my job is paying money for my insurance of which at least some would go into my pay otherwise, and I'm paying a third fee to One Medical. But hey, at least I can go to a primary care doctor and only pay the $15 co-pay (oops, I guess there is a fourth time!).

However, there remained multiple opportunities to experience negative interactions with Blue Shield regarding visits to the specialists.

The first that comes to mind is when after taking omeprazole and weaker stomach medication for months with little effect, I was finally upgraded to a stronger prescription that should stop the pain - then, Blue Shield initially refused to cover the prescription until they could contact the doctor (which didn't happen for three days because of a weekend).

Next came when after finally finding a psychotherapist that could work, Blue Shield declined to cover any of the fees - even if it is supposed to be a relatively fancy PPO plan from a relatively prestigious insurance company, apparently they deem mental health issues must not comparable to other ones, so the covered providers are a lot more restricted than in other cases.

And a final surprise (well, not really) came when a letter from Blue Shield after going to a travel doctor and submitting my claim. The letter said the claim could not be processed, and said they had failed to receive more information from the doctor after calling them. I was told by the workers at the doctor's office that no call or letter from Blue Shield requesting more information was received. I was also told after contacting a Blue Shield worker that this was due to an older code system in the doctor's office, but I shouldn't bother claiming with a more recent diagnostic/treatment code - they would not cover anything related to travel medicine. This is manifestly false, since they had actually covered a small fraction for a visit to the same doctor the year before - incidentally, they sent the refund check to the doctor's office, causing an extra trip to a neighborhood quite out of the way.

Note that in these two cases again, the specific reason for lack of coverage wasn't clear at all from the letters I got from Blue Shield, and it took almost one hour with a Blue Shield worker on the phone after navigating an annoying automatic system to get to the bottom of it.

There was also an ongoing clusterfuck of IDs that saw 3 member card replacements in a few months, and most likely other more "menial" inconveniences I could recall - they reflect the arrogance and lack of care toward the people they are supposed to serve, but at least they have less severe consequences for the health and pockets of those people.