After receiving hundreds of complaints from retirees on the new Blue Shield CA healthcare plan, POB requested monthly meetings to discuss the problems and try to find a holistic solution to the issue. “We weren’t interested in solving these issues on a case by case basis,” said POB President Fred Sanchez. “We wanted to find a way to get ahead of the problems, and find some overarching solutions.”

BSC and their client, SFHSS agreed to meet with a POB leadership committee each month to resolve any outstanding medical issues our SF city retirees were experiencing. The group has met twice so far, on  Mar. 4, and April 9, and agreed to meet on a regular basis moving forward to iron out any problems during the transition. “People were very unhappy with the number of denials they were getting,” said Sanchez. “We didn’t want to take to the streets, but we would have had to go public if we couldn’t resolve these issues our retirees were having.”

The automatic denials, refusal of service for ongoing illnesses, and prescription co-pays rising astronomically with no explanation was more than our retirees could take. Each day, the POB leaders had to address multiple emails from panicked retirees. Happily, we are able to report that our inbox has gone from 5-10 complaints a day to several each week.

Furthermore the group of SFHSS and BSC reported that their goal is to respond to any emails within 24 hours of receiving complaints.

In the process of researching solutions, we have discovered several good ideas for members to follow:

  • Appeals: 80% of seniors do not appeal a denial decision from their healthcare provider. But of those who do appeal, the vast majority are approved. Make sure to appeal your decision.
  • Results: If you don’t get results, contact us at POB and we will advocate for you.
  • Phantom Billing: Make sure you are regularly checking your amazon and Medicare accounts for any erroneous or “ghost prescription billings” for medications you did not order or receive. Mail order drugs are particularly vulnerable to this kind of fraud.
  • Co-pays: Retirees have complained about 90 day supply of drugs with one co-pay dropping to 30 days with multiple co-pays. BSC is looking into this and will try and rectify.
  • Webinars: BSC has pledged to begins some educational webinars so retirees understand their rights. Stay tuned for more information on these.

A few issues are still to be resolved, including gym membership and Dental insurance that we will be addressing in our upcoming meetings. If you continue to have issues, we are here to help resolve them. Reach out. Keep those emails coming.