Health Plan of San Mateo - South San Francisco, California

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Health Plan of San Mateo (HPSM) does not cover expenses by an out-of-network provider. This is kind of unusual from my experiences with other health insurance providers. My denture broke as a result of bad materials from a former dentist and I had a hard time to chew food. So I got services from another dentist who recommended getting a new denture as fixing the old one already having a few teeth added on it would not last long and ended up with higher costs. I was not able to find extra help from Medicare and Medi-Cal, and had to pay for the denture out of my own pocket.
Then I submitted a claim to HPSM trying to get a reimbursement. Claim denied, reasons: 1) Issue not an emergency nor urgent. 2) Out-of-network provider services not covered.
They referred me to send a grievance to HPSM, Civil Right Coordinator, 801 Gateway Blvd, Ste 100, So San Francisco, CA 94080. I did. Denied.
Then they referred me to send an appeal to California Dept of Social Services, State Hearing Division, P.O.Box 944243, Mail Station 9-17-37, Sacramento, CA 94244-2430. I did. I received a schedule for a call from a judge for the hearing. On that day, I waited more than 1 hour for the judge to call. No call.
Later on, my case was dismissed, reason: No appearance. WHAT?
Judge Name: Margaret A. Boyd.
I would have rated HPSM a ZERO star if the system lets me post.

Julie

1) I would love to understand why your office feels it is allowed to place my health on hold while piles of overdue referrals are inhumanely and unethically neglected?!
2) You rarely respond, if at all!! What an insult to humanity. I have been nothing but patient and objective. Please rectify immediately.
3) I now, have no choice but to seek in person assessment while injured. Please be more considerate.

Brett K.

after 15 minutes of being on the phone and hearing robots talk and pressing random buttons in an attempt to talk to a human, they finally "connect" me And then instantly hang up on me.

the public health system in California is absolutely shambles, 3rd world quality, inhumane, and I'm shocked that any of this behavior is legal.

Jodi M.

This is awful medical insurance if you have to deal with mental health. I need a psychiatrist for dealing with medication management for trauma & anxiety. They have only one psychiatrist for their clients so you are stuck having to see a psychiatry nurse practitioner instead. The one I seen only tries to push medication onto you that you do not need. Also in regards to therapy, my 10 year old needs to start therapy. We found a awesome therapist who specializes in Childred and who accepts medi-cal. We cannot see her because she isnt Health Plan of San Mateo. Then the mental health number gives me referrals for places like community centers and bottom bucket therapy. But none that specialize in only children which is what my daughter needs. I am trying to break the cycle of Trauma for my daughter. If I send her to a terrible therapist then she will never want to go back to therapy. Lastly, I have been searching for a dentist for my daughter most of the referrals I have gotten are not even taking new patients. My daughter needs to see a specialist for a infected tooth. I ran into problems because she was a child with a adult tooth. the pediatric dentists would not help us and the adult dentists won't take children under 12. It took me almost 2 years to finally find someone, and this is after calling HPSM numerous times about it. Because it took so long to find a dentist the right molar along with another back molar on the left side needs to be extracted. Because of this and the fact that my 10 year olds teeth are already shifting she needs braces immediately. I spoke to HPSM earlier today and was informed that I will have to pay out of pocket for her braces. Just because most of us on here are poor doesnt mean that our children sqhould have to suffer by receiving awful care 95% of the time. I would love to not have to depend on HPSM at all at this point but unfortuantely I have no other choice. No human should ever be treated this way, its disgusting...

Andy O.

My son was given this Health Plan of San Mateo when he started with Medi-Cal after my health insurance no longer covered him at 26 years old. He was having stomach pain and could not keep from losing whatever he ate , and was rapidly losing weight. We were assigned to the North East Medical Services , 211 Eastmoor Ave, Daly City, under Dr Lauren Quan.They required blood and stool tests, and after they were done, they said they ordered the wrong tests and needed to be redone.( This was the Quest Center , that we were sent to.) After another week my son was diagnosed as possible Ulcerative Colitis. Then needed a Colonoscopy to verify, but they did not have any available until more than 60 days, and therefore could not treat him. My son lost 50 lbs and was barely able to walk. He was not able to retain any food, and under my wife's insistence, went to emergency where he was given 3 units of IV to restore his blood level. Again my wife NEEDED to INSIST, otherwise they would have sent him home. This center would not give him a sooner date for the Colonoscopy, in spite of this being a possibly fatal condition. I had called this center to speak to Dr Quan and was told 3x that i would receive a call back, that never happened. This health center is the worst I have ever seen in my entire life. Even trying to get his stool results from the untrained staff took 2 hrs because the employee could not "bring up the screen". If my son had to wait 60+ days for the Colonoscopy, he would not be alive today. I was able to switch his Medi-Cal coverage to be with Kaiser, which my son was with, with my coverage for 20+ years. They were able to get his colonoscopy done in 2 days and gave him the steroid to reduce his inflammation and probably saved his life. I needed to write this review as an alert to anyone that is considering this health coverage. In my option this center is run by untrained, non professional employees and doctors and should be avoided at all costs. In this day and age, this is completely unacceptable.

Sam A.

they have messed me up really bad now. I was looking for a physical therapy for a month with pain in neck , shoulder and lower back. My Stanford primary doctor could not help to find physical therapist because they were booked for months. I found burlingame therapeutic which was on HPSM.org website as a network PT. I also called the office and they said they are accepting careadvantage. now after three weeks that I started physicl therpay HPSM is sending a denial letter saying this practice is not in network..why it is in your website and why when I personally called you said they are in network. I dont know if I can win an appeal with them or have to pay $1000 out of my pocket now. their website to find provider is full of mistake and numerous errors and when you call they are not willing to help more than few minutes to find providers . Be very careful and double triple check before you see a doctor or practice. this was a nightmare physical therapy so far.

jamie L.

I have a tumor in my neck. They can't get me a doctor to take it out. But they want me to se a psychiatrist. She called and said I didn't have a tumor!!!!!!!!! I have never met this woman in my life. She said she was a Dr. Cooper. I was told she is the head of health plan of San Mateo, I can't believe that!! She said stress brought it on. How does this woman who didn't know who my primary care Dr was, decide I didn't have a tumor? And she is the head director of Health Plan of San Mateo. Omg. The care coordinator Veronica set the call up. I guess giving me psychological drugs and doping me up is cheaper than the surgery I need. I need an ENT. A surgeon. I have had a CT scan. It shows the growth. I am scared out of my mind......but I am strong.

Cecil P.

For the safety all HPSM members and employees, and to comply with public health guidelines, HPSM will no longer host in-person meetings at our offices during the COVID-19 pandemic. However, HPSM is committed to serving your needs during this crisis.