The following is my appeal letter to BlueShield for denying payment on a doctor visit I recently had. I visit the doctor based on a recommendation from my primary Dr. as well as following the steps described below to confirm it was in network. Blue Shield is refusing to cover a short doctor visit with a Gastroenterologist PA who sent me to Quest for a test. I am now being told I owe $475 for this brief visit because they claim the physician assistant, not even a doctor, is out of network. This American health care system is absolute insanity.
"I was using www.blueshieldca.com to find an in network provider. As you can see from my screenshots attached it has my plan listed as EPO Shared Advantage+ on my profile's dashboard. Each time I go to select "Find a doctor" it preselects EPO Shared Advantage+. I've now been told that my plan is not EPO Shared Advantage+ but is instead Blue High Performance Network EPO. When I am at blueshieldca.com/fad/home and I change the plan to Blue High Performance Network EPO then click Doctors & Specialists it reverts the plan BACK to EPO Shared Advantage+. The site tells me to "Revert to my plan" EPO Shared Advantage+ at the top and I have to (for a second time) select Blue High Performance Network EPO.
None of this is intuitive to me. None of this is user friendly. It is in fact very hard to understand and incredibly frustrating. I have requested a new health insurance card from https://hnas.healthspace.net/MemberPortal/feature/Enrollment#!/home since I have not had a new one shipped out to me this year. I have moved often over the past few years which may have had the card lost in the mail.
Please help me resolve this bill as I feel misled and unsupported by your customer service experience provided by your website. As far as using Hnas to find a provider, I have included a screenshot of their portal as well and it is even less helpful. Please feel free to reach me for any questions or concerns. I look forward to hearing your reply."
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