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My hip replacement surgery was denied as not medically necessary and my surgery was canceled, last minute. I have severe arthritis. My doctor appealed, but was denied. I also appealed, and was also denied. I made sure I answered every excuse to the letter, for example, I tried non-surgical treatments for at least three months. They say I didn’t state “for at least three months”, but I did. I was also denied in 2017, but for a different reason. It is inhumane to put someone through the pain, inconvenience and expense of preparing for surgery, and then have it cancelled. I believe discrimination is occurring, but I’m not sure why. My family has had this same insurance policy since 1992, through my husband’s union, Metal Trades Local 638. I believe BCBS has violated their contract.
My mom was complaining about pain in her abdomen since 2015. Every time the pain was excruciating she went to the hospital. The doctors did what they could for her but they needed to see deeper into her abdomen. So they filed for an MRI with Anthem and she was denied. This went on and on until May of 2018. The doctors say MRI and Anthem continues to deny her. When she was finally approved for MRI the doctors found a massive tumor on her pancreas that started to attach to her surrounding organs. The doctor that performed the surgery said that she was lucky. Any longer and her life would have ended. It's been a month since her surgery. Now they are denying her rehabilitation. The doctors and nurses at Toledo Hospital found out what the insurance company did and was furious about the whole ordeal. Anthem is terrible coverage when it comes to the seriousness of someone's life.
I'm writing a negative review on the pages of each of the companies: CVS Caremark, Walgreens, and Anthem for their mishandling of prescription claims. My Anthem insurance plan switched to CVS Caremark for handling prescriptions in January 2018. I went to Walgreens, my usual pharmacy, to refill my prescriptions during my coverage period. On several occasions, the prescriptions I had filled went through without a hitch at Walgreens, with my normal co-pay. Several months later, I received a $500 bill from Anthem saying I owed them for those prescriptions. They stated that since I went to Walgreens and not CVS to get my prescriptions filled, I owed them the full price of the prescriptions. However, there was never a flag at the Walgreens counter telling me I could not fill my prescriptions there. They went through and allowed them to be filled, not ever informing me they were not covered by my insurance.
Normally when a prescription is not covered, the pharmacy will not be able to process it through your insurance and you will have to pay full price. This did not happen - it went through as usual and with my usual co-pay. Anthem, CVS Caremark, and Walgreens are each passing the blame off to each other when I call them to try to get the issue resolved. I'm stuck with a $500 bill because none of them can own up to their error.
Anthem is the worst insurance I have ever had. Just got it a few months ago. They will not pay for prescription medicine I need because it’s not on their list? Even though we were told all medically necessary “preventative” RX’s will be covered with a small copay. Apparently, Depression, Anxiety and ADHD are not medically necessary, and medicine is not considered preventative. I am so upset I want to make a case about someone attempting to harm themselves due to being denied the proper medication for a mental illness that was completely under control with prescription medicine for 25 years.
Terrible. Every month have to fight and be declined for medication necessary for health. This is in a top tier plan. Never renewed Dental, Cancelled Dental, and they have continued to charge me, will not allow me into my online account and the member services advises that cancellation must be in writing but they provide no address. This is an obscene abuse of patient welfare and finances.
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Every time I submit a claim at the message center, it logs me out continuously. When I mail it in, the claim goes into the black hole, you can't even call them up to reference the claim you submitted and ultimately and no one can help. There is no one to email regarding technical support. Call them is virtually impossible with hours and hours of waiting.
I have re-submitted numerous claims over and over again by mail, to the point where I have completely run out time to submit my claims, and ultimately end up paying out of pocket, On top of that, nothing goes towards my deductible. The system, on so many levels is inept and some sort of scam. Everything goes into the circular bin it seems. Online system must be set up to log members out deliberately so that claims CANNOT be submitted and paid. Ultimately, the member runs out of time.
I have been working with my dental provider since March to get my complaint filed. Several times we have been told they have everything they need to review the claim, only to find out later that the claim cannot be processed until they get something else or something different. It has been resubmitted so many times it has gone to appeal. I was assured they had everything they needed. Guess what? Today I found out they don't. When I insisted that we had sent in everything that exists, the rep said maybe something just wasn't good enough. On top of that, they have my old mailing address on file. Both my HR department and I have attempted to change it. The rep told me it 'takes time' to get through to other departments, maybe a week--and he had no answer when I advised it has been about 3 weeks since our requests.
They will not pay for prescription medicine I need. They will not pay for dental treatment I need. I'm a childhood mass murder survivor, have a moderate to severe traumatic brain injury, other sequela, such as PTSD. ** in large amounts, 60 - 80 mgs per day, is capable of quelling the worst of my symptoms, which are terrible, indeed. Anthem tells my neurologist's nurse that my "plan" allows for only 30 mgs per day. This astonished and bewildered my pastor, who commented, "Plan?! How can anyone 'plan' for something like that?!"
Anthem makes appeals instructions as abstruse to understand as possible; you almost need a legal background to understand them. Oh yes, about my neurologist's nurse: she told me that she cannot get over her shock that Anthem turned down a request for coverage for generic **, the drug which slows Alzheimer's, for another patient. This is shocking, the inhumanity of it is shocking. I want very much to leave Anthem. My only regret will be losing my primary care physician, who is excellent.
I had a prostatectomy seven years ago. Subsequent PSA tests showed negligible levels for several years, but a few months ago rising PSA levels were noticed. My first doctor in Golden Gate Urology ordered a prostate cell specific PET scan to localize the metastasis, Anthem denied this diagnostic method. In the absence of diagnostic evidence, the doctor at Golden Gate Urology, told that 60% of recurrence happened in prostatic bed and recommended radiotherapy (RT) of prostate bed or systemic hormone therapy. After second opinion consultation in Stanford, we found out a clinical trial for a diagnostic technology (MPSA-PET). Through this diagnostic technology, the presence of a single focal metastasis outside of prostate bed was confirmed while the prostate bed itself was negative.
I was supposed to begin focal CT guided radiotherapy in Stanford. The treatment was supposed to last 5 days as opposed to 7 weeks of traditional RT; additionally, it focused to the metastasis rather than blindly applied RT to the prostate bed. 7 weeks RT (with much higher cumulative dose) directed to prostate bed will not do anything to the metastatic development, and will harm the healthy organs in the field. My condition is one of the conditions for which focal treatment can be particularly helpful. Knowing that metastasis is not in the prostate bed, I disagree with accepting RT to the prostate bed. Knowing the metastasis is focal, I also disagree with long term systemic treatment. But Anthem denied this treatment option. Appeal application is very difficult and will clearly take a long time.
I had a baby in 2016 and added my son to my insurance within the 30-day period required. The hospital billed Anthem and they denied my month-old son insurance and when the hospital sent me a bill I contacted them and they said I would need to have Anthem process the claim. I called Anthem, they informed that the hospital would have to re-submit the claim. Another month later it still wasn't taken care of and so I called Anthem who proceeded to do a 3-way call with me and the hospital on the line. How it didn't get taken care of then, I have no idea. Fast forward two years later, I receive a court summons from a debt collector. I immediately call Anthem and the representative on the phone immediately saw the problem when he pulled my account before I even told him this story.
He said he would get it processed right away which I was thankful for but I informed him I had been summoned to court and he said he'd send me a letter saying it was their fault. I waited almost two weeks for the letter and all it was, was the normal statement that they send out showing what they covered and what I owed. Anthem paid my hospital bill in full but I still had to go to "court" which was a card table outside the clerk's office in the hallway with the debt collectors trying to get my tax refund information and wanting to know how much money I make a year. I refused to pay the debt collector $900 they were requesting for court fees, attorney fees and interest so now I have to go to court again and defend my case.
I called Anthem asking them what happens if the judge decides I have to pay and they said I would have to write a formal appeal to Anthem and Anthem would have to reimburse me whatever I owed the debt collector. People have babies every day, yet Anthem couldn't seem to figure this one out. I am extremely disappointed that I am having to go through this and this stress as a single mother, full-time worker and part-time student.
When I was searching for medicare part C insurance I chose Anthem because the ad brochure said they cover 1 chiropractic visit per month. This is not true. After pre-authorize by doctor, they deny payment consistently. When the doctor at the medical center pre-authorized a minor procedure, the medical procedure was performed on me and billed to Anthem. After submitting their claim 3 times Anthem continues to deny payment. Because I chose Anthem, I am factually uninsured. Even though I pay every month, nothing is covered. Anthem is an insurer in name only. Next October I can get out of this trap.
Ok over almost 30 years I've had Blue Cross Blue Shield insurance. Well I started a new job 12/4/2017 and said yes. They have Blue Cross so it shouldn't be that difficult. I even signed up for the exact same coverage from previous job that had Blue Cross Blue Shield. Ok I had to verify my marriage and my dependents which I thought was normal cause I've done it before. Well they didn't like my marriage certificate so we had to send end our 1040 tax information and guess what? There was a problem with that too. So while we were going back and forth trying to verify my wife (who also works at same place) and middle daughter were dropped from insurance. So we finally talked to my HR rep and they said send them info, they could fix our problem and they did help. We got a confirmation that they were verified and back on my insurance.
Well today after fighting with this for nearly five months my daughter who was dropped and now added back went to the Dr and they said she was not insured. I have to pay $1035.26 a month for this insurance and I have never ever had this much trouble getting coverage. It's going on FIVE months now and still no coverage for my wife and daughter. With my wife working at the same exact place you'd think the marriage could be easily verified and that all my kids have always been on my insurance which has always been Blue Cross Blue Shield could have easily been verified too. With all this trouble it's not worth keeping Blue Cross Blue Shield and I've always had them as my insurance provider. I hope they do a better job verifying others and not put them in the same situations at us.
Insurance Dental Coverage - I just received a notification that Anthem Blue Cross Blue cancelled my coverage. The cancellation took effect on April 1, 2018 and the notice was not sent until April 9,2018 not even allowing me a change to correct the issue. They did not receive my payment due to the fact that I did not receive an invoice, I did not receive any warning notices, just a cancellation notice 9 days AFTER the fact. I am unable to enroll until the next enrollment period. This is unacceptable that I will have to wait that long and Anthem made absolutely no attempt to contact me until it was too late. This is unacceptable when there is such a consequence that they made no effort to notify my of the error. So now I will not have any insurance until Jan. 1, 2019.
My employer recently switched to Anthem. I was told to search the “find doctor“ as a guest to find out if my doctor was included. Doctor’s name was on the list. However when my insurance went into effect we were on a very specific limited plan of that did not include this doctor. My doctor happens to be a psychiatrist that knows my history. Now I’m in crisis, can’t get into a doctor and Anthem doesn’t cover an inpatient facility anywhere near me.
I have literally battled non-stop with this company for the last 5 months. Blood tests that are FEDERALLY required when you are pregnant (HIV test, other STD panels) they refuse to cover and don't consider it preventative care when in fact it is and is a part of prenatal care. I recently had a genetics test to prepare myself and fiancé in case we had to go through what my uncle did, my family is a deletions syndrome carrier as well as Down Syndrome, my fiancé is a Down Syndrome carrier as well. Because of the genetic mutations on both sides, my doctor wanted the Natera test done, I was told at most I'd end up paying 200 out of pocket. Ok no biggie.
Imagine my surprise in January when I got a bill for the first set of prenatal tests and panels only to see of 1200 dollars, this garbage insurance company only covered 300, so I had to pay 900 out of pocket for the STD panels and the glucose test. 2 tests that are usually covered by any other insurance company. So over the last week I noticed a denied insurance claim. The Natera test. For the deletion syndrome and the down syndrome. 8,000 dollar bill. Yes, 8 freaking grand! So yesterday I get an email stating they'll pay 3k of it, of the 3k I have to pay 529, and I'm responsible for the remaining 5k. Excuse me? Come to find out that 5 grand won't apply to my out of pocket which my out of pocket max is 4 grand, it also won't apply to my deductible because they consider it "experimental". Actually this test has been around for quite some time and most doctors prefer it over the quad test.
I am livid. I get a bill for my ultrasound yesterday as well, of the bill, they covered 20 dollars, 20 measly bucks, I have to pay the remaining 289 of that. I'm sorry. Why the hell do I even pay this company for coverage when clearly they cover nothing. Next thing they'll say is giving birth is "experimental". I do not recommend this health insurance company. Find someone better. You may as well have COBRA for what you pay with no coverage. No matter if it's in network.
They cancelled my enhanced premium for dental and vision by mistake and because it is not open enrollment I can't get it back. They won't admit their mistake. Awful customer service. Spent all day on the phone with Anthem. They kept switching me from person to person. Can't wait till open enrollment to switch plans.
My family has 5 family members on Anthem insurance. One child has had multiple claims denied because Anthem cannot click a button that will say the member does not have other insurance. Claims have been resubmitted after calling and supposedly having it fixed only to be denied for the same reasons.
I'm a senior, I've paid tens of thousands of dollars to Blue Cross and Blue Shield in the last 35 years. The last time I had coverage with them prior to 2016-1017 where I specifically CHOSE them based on past experience, they didn't seem that bad. THIS time however, wow, corporations are considered people now and this one, like most, is psychopathic. They are not in the health insurance business to help the consumer in any way, they are in it to make obscene profits off of your blood and sweat, and put tons of your money into their shareholder's and management's pockets.
I'd love to give them minus 10 stars and it wouldn't be close to enough. Please read all the reviews here and choose another company, but research them first. I had to go through Covered California to get covered, that is a separate horror story, but be aware that if you get coverage through a state exchange you will be in an even more horrendous circle of hell than if you buy coverage directly. They blame all their own lack of even minimal competency on the exchange, in fact they won't even speak with you, except to tell you you need to go through the exchange.
So I did, twice, in mid December 2017 to cancel my insurance. I replaced it with Kaiser which thankfully in hindsight, I bought directly from Kaiser. I got confirmations of termination of the policy both times, but was billed in January, so I called Blue Shield directly again to get another "cancellation"! Mind you my premium had gone up from $636 to $778 to $1068 in just 2 years, with very little in the way of usage, meaning they made a very large profit off of me. I continued to get bills through March 2018 for the first 4 months of the year. I really had a massive fit at the 4th bill asking for $4,271.56, threatening cancellation, when I'd already made three cancellations!
At the end of January I even filed a dispute with my credit card company to block the billing, because even the credit card company could see that IT WAS COMPLETELY FRAUDULENT!!! So then BS (** you know what) started sending me paper bills again. The bills say pay or be canceled, and I of course was expecting them to follow through and cancel, but this is what I learned: I had started looking for reviews, and found that they have a pattern of continuing billing and then sending the person who had canceled them to COLLECTIONS!
BS would claim the person had "been covered" all that time, even in spite of the fact they had gotten health insurance elsewhere, thus attempting to take money that wasn't theirs, and creating a horror show of bills people couldn't pay, time lost fighting a psychopathic behemoth they couldn't spare, psychological trauma and damaged credit! They are committing breach of faith, and FRAUD! There were people who had to pay thousands to this company when they were actually insured elsewhere, due to this shady abusive bullying practice!
I spent another 2 hours on the phone today, talking with another BS "supervisor" who was hoping I'd just hang up, and supposedly this time I am "truly canceled" and can ignore the bill, but I'm pretty sure they will just let it double and then hit me up with a $13,000 bill and I will have to get an attorney to sue them. I can't even come up with the words to say how much I DESPISE this kind of egregiously bullying behavior, especially on such a massive scale! These people are vermin!
BS has already had several class action suits against them due to their corrupt policies within the market, but they don't seem to be held accountable for the damage they do on an individual scale. Please sign my petition which will be sent to the head of the California Department of Insurance. And for the love of all that is good and kind, please do not give this company your money!
We have been told we can only get our prescriptions from two sources: Walmart... that is always out of meds. Or the 90 day supplier through the mail. Advising all who want to get their scripts from whichever supplier they want. I'm willing to pay a little more for great service and not having to wait for supplier to be supplied by their supplier. Not yelling. Just want all to see this: IF THIS IS HAPPENING TO YOU CALL YOUR CONGRESSPERSONS OFFICE. Make a complaint and have them call Anthem. You should have the right to buy wherever you want. Last I checked I live in the great USA!!!
They paid to the doctor for an appt. that never occurred. I called multiple times over period of three month asking them to fix that error, that charge is still on my account. I even got bill from the doctor asking to pay him $8 for the appt. I never had. In the meantime I was working on lowering my cholesterol and paid for the test myself to see if method I was using worked. My cholesterol is within normal range now, however it took me two month of faxing and e-mailing after finally they informed me that my claim was denied.
You fax them a claim. They tell you they got it, I call back month later they never seen my fax and they don't know what I am talking about. When I complained thru messaging center they responded that I am sending message from someone else's account, which clearly wasn't true. I will look into getting different insurance because I don't understand what I am paying so much money for every month. This company has no problem paying doctor for bogus appt., but to apply $29 to my deductible when I am trying to improve my health and save them money in the future is a big deal.
I have used Anthem for a number of years and would recommend avoiding them at all costs. The customer support will lie about what is covered and not have any culpability. They did to me and were not held responsible. After submitting several documents many times (after Anthem lost them or claimed they didn't receive them), I went through first and second level appeals, only to be turned down for claims that they simply lost or did not disclose phone records for. Of course they always say... "We can't be responsible for what our reps say!" Catherine ** handled all of them. She did report all the calls I made. How disgusting to be the criminal lackey for a company that purposefully leaves off information on appeals and shows no consideration for the time and effort the insured has gone through to even get the information in their hands. My experience has been that this company serves itself and no one else and does so at a high cost to the consumer.
Unfortunately, customer service is offshore and communication with persons who do not understand English can be quite challenging. Had a surgery and was constantly called by regarding alternate solutions for the purchase of medications, after-care if necessary and request to confer with insurance specialist regarding conditions that gave rise to surgery. Constantly calling me before a surgery to take advantage of discounted options was alarming and bothersome. Notwithstanding that I declined all offers, my medical bills were paid.
Unfortunately, in my area the top rated hospitals only take Anthem PPO plans and the premiums are expensive in relation to the deductible. Anthem is no longer offering insurance in my area commencing January 2018, and my only alternative is Blue Cross. The premium costs in relation to the deductible are the same as Anthem. For those who are lucky enough to be treated at top tier facilities with other insurance, please maintain your insurance as you are lucky.
I had Anthem for 16 years before retirement and they were excellent. I'm Medicare primary, with Anthem secondary through My retirement with State of California. Overall very happy.
It is awful, I paid like 300 for group ins and now I pay the same and the government pays about an additional 700 for a plan that is 7500 deductible and everything goes to deductible if it not a will visit, insurance companies cleaned up on this deal. They tripled their premiums so we pay the same and then the government pays 2x the old premium and now Anthem has dropped St Louis out of the coverage area.
They are our secondary Ins. and never had a problem of not making up the difference Medicare did not pay. We have a very good rate, and a PPO. So far the Doctors on our plan have been very good.
Anthem Blue Cross has become horrible. They are constantly raising their rates and never pay a claim. Their insurance is set up so that you end up paying and they pay nothing either by denying charges, deductible or out of network, even though a hospital is in their network. I was in and out of hospitals and doctors over a dozen times in 2017 and Anthem never paid a dime. I had to pay it all. I had to stop going to my asthma doc, my cardiologist visits. So, I changed to Cigna for 2018. Premiums are $5000 per year less than Anthem.
My worst problem is defeating weight reduction. I am not able to receive help needed for effective progress through Anthem...according to representatives.
This company is about one thing: money at any cost. I have had them question every prescription and visit. The latest is that I paid a doctor who doesn't deal with insurance (smart guy) $720 for 3 hour-long visits. Our contract stipulates that they are to pay 70% of this visit. They are sending me a check for $51. You read that correctly. Here's their fancy Trump math: They won't pay for the first visit, since it included a diagnosis and tests. That was the most expensive visit. It included an hour of therapy too, but because I had a diagnosis done too, they won't pay for it.
The other two visits were $185 each. I live in Seattle. According to Anthem, a "Fair and Regional" compensation for a Psychiatrist should be $36/hour. In Seattle. Of course, they don't even have a presence here, so they admit they don't know the market. But it follows some mysterious formula of pricing. My contract says nothing about testing, and certainly nothing about what they *think* it should cost vs. what it actually costs. They messed with the wrong woman. I'll see them in court. Avoid at ALL costs!
I have Anthem through my employer. The company has been very good about paying any billings, and they sent a payment made notice each billing. I recommend this company.
I would recommend Anthem with confidence to anyone researching coverage. In my experience, they have been a great service provider. Just be sure to research the medical groups, for that is where you will see differences of quality of care.
Anthem expert review by Joseph Burns
Anthem is one of the better-known national insurance companies. It operates under different names, depending on what state a patient is from, but covers patients throughout the United States.
It’s easy to add other types of insurance: Anthem customers can easily add dental, vision and life insurance to their policies.
Offers benefits to people who become incapacitated by illness: Unlike many health insurance providers, Anthem offers disability benefits.
Fairly low-price plans: Consumers can get insurance for less than $100/month, although they also may have to pay high deductibles.
Plan options: Heads of families have fewer health insurance options than other consumers.
Best for: Students, senior citizens
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