• How do I choose a doctor?

    Review the guide on how to choose a doctor near you in the Blue Shield of California Promise Health Plan Provider Directory.

    If you do not choose a doctor within 30 days of enrollment, one will be chosen for you. You have the right to change your doctor, if you wish, at any time. If you have any questions or need help contact our Member Services at (800) 544-0088 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from October 1 through March 31, and Monday through Friday, from April 1 through September 30.

  • How do I get more information about my doctor?

    You may have questions that our Provider Directory does not answer. You can call our Member Services and get information such as:

    • Doctors office hours
    • Languages the doctor or staff speak
    • Is the doctor a man or a woman
    • How long have they been practicing
    • Medical training history

     

    Blue Shield of California Promise Health Plan Member Services: (800) 544-0088 (TTY: 711), 8 a.m. - 8 p.m., seven days a week, October 1 to March 31, and Monday through Friday, April 1 to September 30.

  • What do I do if I lose my ID card?

    If you lose your ID card call our Member Services to request a new card or submit a request online. If you are having trouble getting care because you lost your card, call Member Services and someone will be able to help you.

    Blue Shield of California Promise Health Plan Member Services: (800) 544-0088 (TTY: 711), 8 a.m. – 8 p.m., seven days a week, October 1 to March 31, and Monday through Friday, April 1 to September 30.

  • How do I get care after hours?

    It is important you always carry your Blue Shield of California Promise Health Plan ID card with you. If you think you have an emergency, call 911 or go to the nearest hospital emergency room. Call your doctor if you need medical care and he or she can help you to arrange care. If your doctor is not available, contact Member Services, and we will help you.

    Blue Shield of California Promise Health Plan Member Services: (800) 544-0088 (TTY: 711), 8 a.m. – 8 p.m., seven days a week, October 1 to March 31, and Monday through Friday, April 1 to September 30.

  • How do I file a complaint?

    Blue Shield of California Promise Health Plan wants to give you the best care and services. Sometimes you may not be satisfied with services you have received. Blue Shield of California Promise Health Plan wants to help you when you are unhappy or are having problems.

    You can contact Member Services with questions, or to file a verbal complaint. Blue Shield of California Promise Health Plan also has complaint forms available if you wish to file a formal complaint in writing. Blue Shield of California Promise Health Plan will send you a written acknowledgement within five (5) days of your filing a complaint. Blue Shield of California Promise Health Plan will also send you a written decision within 30 days. You can also get a formal complaint form at your doctor's office or file a complaint online.

    Blue Shield of California Promise Health Plan Member Services: (800) 544-0088 (TTY: 711), 8 a.m. – 8 p.m., seven days a week, October 1 to March 31, and Monday through Friday, April 1 to September 30.

  • How can I get transportation to my appointments?

    Blue Shield of California Promise Health Plan offers free transportation* to plan approved health-related locations, such as your doctor's appointments. This benefit is only for members in the following plans:

    • Blue Shield Promise AdvantageOptimum Plan (HMO)**
    • Blue Shield Promise AdvantageOptimum Plan 1 (HMO)
    • Blue Shield Promise Coordinated Choice Plan (HMO)
    • Blue Shield Promise TotalDual Plan (HMO D-SNP)

    For transportation, please call the Blue Shield of California Promise Health Plan Member Services at (877) 433-2178 (TTY: 711), 8 a.m. - 6 p.m.

    *The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.

    ** Routine transportation services are not available for Blue Shield Promise AdvantageOptimum Plan 2 (HMO) in San Diego County and Blue Shield Promise AdvantageOptimum Plan (HMO) in Merced County.

  • How can I get interpreter services?

    Blue Shield of California Promise Health Plan Member Services has staff that speak several different languages. They will be able to help you in your language when you call. If you need interpreter services for appointments, you can call Member Services and arrange for these services. We also offer face-to-face interpreter services and sign language services upon request. Learn more about our language assistance services

    Blue Shield of California Promise Health Plan Member Services: (800) 544-0088 (TTY: 711), 8 a.m. – 8 p.m., seven days a week, October 1 to March 31, and Monday through Friday, April 1 to September 30.

  • What if I have Medical Services denied?

    It is very rare that Blue Shield of California Promise Health Plan denies requested care or services. You or your doctor can appeal the denial and Blue Shield of California Promise Health Plan will review the appeal. If Blue Shield of California Promise Health Plan does not change the initial decision, your case will be forwarded to the Independent Review Entity (IRE) to review your case.

    For medical coverage:

    We are required to send your appeal to the Independent Review Organization. When we do this, it means that your appeal is going on to the next level of the appeals process, which is Level 2.

    For drug coverage:

    If we deny your Level 1 appeal, the written notice we send you will include instructions on how to make a Level 2 appeal with the Independent Review Organization. These instructions will tell who can make this Level 2 appeal, what deadlines you must follow, and how to reach the review organization.

  • What if I have a complaint about the quality of care I receive, or think my coverage for a hospital, home health agency, skilled nursing or comprehensive outpatient rehabilitation facility is ending too soon?

    If you have a complaint about quality of care and think that your coverage for your hospital, skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation stay is ending too soon, you can file a complaint with the Quality Improvement Organization. Blue Shield of California Promise Health Plan members can file a complaint with Livanta (California's Quality Improvement Organization):

    Livanta contact information:

    Phone:(877) 588-1123 (TTY: (855) 887-6668)

    Fax: (833) 868-4063

    Website: www.bfccqioarea5.com

      Livanta BFCC-QIO Program
    10820 Guilford Road, Suite 202
    Annapolis Junction, MD 20701

    For more information, please visit the Appeals page. Details are also included in Chapter 9 of your Evidence of Coverage.