St. Vincent IPA

I just recently switched over to Blue Shield and unfortunately I have St. Vincent’s IPA. They have been a nightmare to deal with, my son had an emergency where he had sliced his hand open and was bleeding all over the place and I had to drive him to the nearest emergency room and I gave my insurance information for the visit and my own medical insurance St. Vincent’s IPA denied the claim for payment. They didn’t give me a reason why they denied it no, one called me and instead I ended up getting slapped with the bill from Kaiser stating that my insurance company refused to pay for the emergency room visit. At this point I am disgusted with St. Vincent’s IPA. And I don’t know what they can do to rectify it but at this point I have no problem putting it out there in the Internet of just how incompetent they are. Next step is filing a formal complaint with the dept. of health insurance. You have Blue Shield and you have a choice of which IPA you get to choose, please stay away from that St. Vincent’s!!! I’m giving you pearls here.

You know the situation is bad when people who deal with insurance companies for a living are shocked by your story. When your own doctor, specialists and even advocate from your major insurance carrier are horrified at your treatment at the hands of your medical group.
Let’s start with the fact that as a patient you are not allowed to have any direct communication with them. No phone number, e-​mail or anything. If you have questions about your network, access to providers or your treatment you are quite literally on your own.
I developed a pretty bad infection, and even with a very specific diagnosis and treatment plan from two specialists and my PCP, St. Vincent IPA refused to send me to an appropriate specialist or authorize the treatment I needed.
I was strung along for four months, sent to several doctors who who were not qualified to help me, meanwhile struggling on antibiotics because all I needed was the procedure to resolve it. Eventually they started spreading rumors about me and avoiding phone calls (including those of my doctor and insurance company). They denied me, and then rescinded it in order make my appeal process more difficult. They never sent me any record of denials and authorizations, so I now have no written record of anything they have done to me. Pretty clever on their end, I have to say. Finally I saw a surgeon outside of my insurance and paid for the procedure out of pocket. A medical group isn’t of much use if they deny you access to healthcare you need. Stay away.