The Department of Managed Health Care (DMHC) announced a settlement with Blue Shield regarding its provider directories for 2014 Individual and Family Plans.
Some Blue Shield members feel that they were led to believe that their provider was in their plans network. As part of the settlement, Blue Shield will notify certain members that they are eligible to resubmit 2014 out-of-network claims for review. If your claims qualify under the settlement, Blue Shield will reprocess and pay the claims as if they were from an in-network provider.
If you qualify, Blue Shield will mail you a letter by December 31, 2015, with the necessary forms to resubmit those disputed 2014 claims The deadline to submit disputed claims for reprocessing is February 12, 2016.
If you need assistance on this matter, you can call Member Services at: (888) 256-3650, or for Covered California members, please call: (855) 836-9705.