Alert: Blue Shield California Individual & Family Health Plans – Problems with Billing and Payments

(This concerns Individual and Family Health Plans either through Covered CA or Off Exchange direct from Insurance Carriers. This does not concern you if you are on Medicare or on an Employer group plan.)
We have been alerted to the fact that a good number of our clients have been experiencing payment issues with their Blue Shield individual health plans. This problem has affected members’ plans enrolled through Covered California, as well as plans enrolled outside of Covered CA (Off Exchange plans). In some cases, this has resulted in the cancellation of plans, even where clients have made timely payments.

We have discussed these payment issues with Blue Shield’s management. They are ongoing, known issues to Blue Shield. The payments issues stem from multiple factors such as:
1. Blue Shield is the only carrier that uses an outside billing vendor (one called HPS). Problems in their interface with this vendor is what caused many of their billing issues.
2. Blue Shield has been having problems in their interchange of information with Covered CA. These problems stem from an electronic file called Form 834 that is sent to Blue Shield by Covered CA containing enrollment details.
3. In cases where a member’s income or subsidy amounts have changed, there have been problems with incorrect transmittals from Covered CA. Some of these subsidy issues have to be corrected at the Covered CA level before being transmitted to Blue Shield.

We are told that Blue Shield is working on correcting these issues. In the meantime, please let us know at 925-284-2000, if we can help.

Lee Health Insurance Services 935 Moraga Road, Suite 240, Lafayette, CA 94549
Ph: 925-284-2000 Fx: 925-284-5484 [email protected] www.Health-Insurance.com
Employee Benefits and Health Insurance

About Phil Lee
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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445