Here is an overly-generous one star for the Santa Clara County IPA, which Blue Shield referred to as "my medical group", but it's really a network for physicians who want to get HMO referrals. In addition, they're supposed generate the authorizations for the PCP's referrals, and they process (pay) the claims for most of the HMO's covered services.
In the nine months that I put up with this health insurance arrangement, they erroneously "redirected" two claims to Blue Shield - one never got paid so the provider's office wrote it off, and the other took three months to process correctly.
It took them six months to generate an authorization for aquatic therapy, and they used these months to authorize treatment at physical therapy facilities that didn't have a pool. Another authorization took five months because they didn't have any doctors for that specialty in their network, so they wanted Blue Shield to take over, and apparently their lawyers had to haggle while I waited. Another time, they took 8 months to correct a copay that was misprogrammed into their database, but miraculously fixed the error overnight (literally!) when I notified them that I had filed a grievance with a government regulatory agency.
Significantly, there was not a single claim or referral that they processed correctly! Somebody needs to give this company a complete makeover! read more