This is an appeal based on misrepresentation of a Blue Shield Covered California
plan (I will call it BSCC). Discrepancies between the proposed plan, disguised under
a “Blue Shield” plan and the actual plan (BSCC) are numerous. Therefore, I request a
hearing to expose Blue Shield and Covered California as falsely offering health plans
online (BSCC) that turn out to be completely different in reality. In other words:
what I signed up for is not what I got.
I worked diligently with a very dedicated agent in Alameda (David Reidenbach) in
order to sign up for a BSCC plan. We looked at directories to make sure that the
doctors, with whom I have developed a relationship for over 20 years, would be
enlisted in this plan. They were. I gave up a very good individual COBRA plan in
order to sign my husband and I up for a more affordable plan. It was challenging
and arduous, but I was happy to have spent the time necessary to have a solid health
insurance in place. I have a Gold 80 EPO BSCC.
Rumors mounted about the validity of this plan. People who had signed up like
myself were finding out that their doctors listed in the Blue Shield directory were
not contracted with BSCC, which it turns out is a subdivision of Blue Shield (not
made clear at the time). My fears were confirmed when a colleague and myself
verified these rumors and they were true. I called my doctors and none of them is
contracted with BSCC, although they were listed with Blue Shield upon signing up.
Not only are these doctors not contracted with BSCC, they are not even “out of
network”. If I were going to them, I would not be covered at all. None of this was
spelled out at sign in. On the contrary, it was really clear that my Blue Shield
contracted doctors would be available to me under BSCC. Both my agent and myself
saw this very clearly. I believe that it was purposely not revealed to those who
bought these plans. We all thought we would be part of the large Blue Shied family
when signing up. We are not.
I also made sure, when I signed up that my osteopath fee would be covered at 50%
per session with the new plan. I am healthy but I need her for my scoliosis often. It
was very clear to me that this service was covered at 50% upon signing up (she is
out of network). It was surely clear on the website page that both my agent and I
saw upon enrolling. Well, I just put my first claim in and the claim was rejected.
Again, a lie and a misrepresentation of the plan.
Hearing this, I decided to try to build new relationships with new doctors who
would be “in my plan”. I called around again, based on the official directories
provided by BSCC connected to my plan, and none of the doctors I called take BSCC.
When I mention that I find their names on the BSCC directory, they brush it off with
an “oh well, I know”. I have not so far even found a GP based in Alameda who takes
BSCC. I can’t turn back to Cobra, this opportunity is now gone.
I tried to call Blue Shield several times but I am always on hold for a long time and
work can’t wait. My colleague who is dealing with the same situation managed to
call Blue Shield and got through. The assistant told her “all the doctors listed on the
Blue Shield directory are contracted with BSCC”. This is another lie, or maybe
ignorance…The BS telephone assistant does not even know what really is going
on!….how can this be????? She issued a ticket and promised a response to my
colleague within two days. By now, it has been two weeks and still no answer.
I find this completely wrong, unethical and totally inacceptable. I am terrified at
being sick and nowhere to go. I have health insurance, but really, I don’t. And I am
not the only one. This is an excellent class action lawsuit waiting to happen and the
problem needs to be fixed. And I will be delighted to recruit legal counsel if this is
not fixed very soon.
I demand that Blue Shield revise their policies and cover those of us who are part of
the BSCC subdivision equally. This means going to the same doctors we used to go to
and pay what we used to pay, without raising the premiums that we contracted.
Your way of doing business is deceitful, fraudulent and of really bad taste. This is a
breach of contract and unacceptable as such. Any other entity, system or business
would be sued for such a breach.
I request a fair hearing to speak about this case. It is a blatant cover up.
Frederique Georges