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Saw a provider several times in August. They were in network but did not process claims. Not a problem - I will pay out of pocket then submit claims myself. First submission failure regarded the claim receipts. They did not provide adequate info. It appeared to me they were complete so providers office contacted Anthem. The receipts were handwritten. Got the computerized receipt and submitted claim. After 3-4 weeks Anthem processed the claim and sent reimbursement. After several inquiries Anthem indicated they had sent payment reimbursement to the provider. The receipts clearly show I paid cash and credit card for the appointments and there was zero due to provider. I think my dog would do a better job at processing the claim. So here I am in November without reimbursement for provider charges I paid out of pocket. Maybe by the time 2018 gets here I will see the refund!
Anthem decided to mark me as "uninsured" for no reason so I had to pay several prescriptions out of pocket while they fixed it. They fixed it, but now I have submitted the claims 5 times and each time they request a new piece of information they didn't request the first time, and some of them have requested the SAME information, yet keep denying the claim.
It's as if they aren't reading their own form. They asked for the Express Scripts Group number... I called Anthem Member services to get that number and I put it on my claim form. Then I get a letter in the mail that says they need the Group Number and they included a copy of my claim with the form THAT HAS THE GROUP NUMBER ON IT. This is just one example of the multiple issues. Their business processes are in dire need of review. I'm being asked for a document that THEY SENT BACK TO ME. I mailed it, they claimed they didn't get it (or 2 other claims mailed on different dates - come on! Not getting one is probable, but not getting ANY of them mailed over a 2 week period?? Liar liar pants on fire!).
So I faxed it to the number they gave me. They sent it back denying the claim and said the person receiving the prescription was not authorized under my plan. IT WAS ME!!! I've been getting the same RX's for 3 years. But on various months this year they have a major hiccup and say "who are you, we don't know you." It's insane and I swear they're trying to drive me crazy.
I have everything documented and I'm sending it to the Bureau of Insurance because I feel harassed. They actually partially reimbursed me (only 4 days of pills but owed all 30 days). Anthem rep said "wow, don't know why they only paid 4, so resubmit and ask them to review again." So I did, and in response I got a letter saying they needed the RX date (ON THE FORM AND RECEIPT) then I got another letter using the same RX # saying that I didn't have insurance on that date so they denied it.
WHAT??? They already partially reimbursed so how is it that I don't qualify at all now? INSANE!!! This has been going on for months and I'm so distraught. My major depression and anxiety are being tested. I'm a chronic pain patient who can't work and is disabled so this run-around doesn't help. It's as if they're throwing up roadblocks hoping I'll give up and go away. Well I won't! And now I'm taking this up the food chain so someone can be exposed to the stupid processes they have. This form says the "receipt" is confidential so I hope it is because I'm attaching the letter I received where they ask for my Group Number but it's on the form (first piece of data) on page 2.
As long as you are completely healthy with no injuries, etc. you are fine with this insurance. If you need a specialist, you are screwed. I needed surgery to remove screws that were protruding from a metal plate in my wrist. I had the surgery almost 10 years ago, when I had private insurance. I went to my 'primary care' who after one week of extreme pain, referred to me to a doctor who refused to see me. I had to go back to my primary care who, after several days passed, referred me to another doctor who refused to see me. In desperation I went to the emergency room (I made sure hospital was covered by my insurance). They x-rayed me and sent me off to find a doctor - they also refused to help me.
One month went by while I was in agonizing pain, I had made calls to my primary care physician at least every other day and no help. I was not even able to get an x-ray (it had to be approved) until I walked into the emergency room. After one month I walked into my primary care's office and was set up with the physician on call (my doctor could not see me). He was horrified by my experience and promised me I would not leave that day without a appointment set up with a surgeon. I did leave without an appointment (after waiting 3 hours in waiting room), but I did get an appointment scheduled the next day. At this point I called Medicare and relayed my story, they gave me a one-time exception to cancel my Anthem Blue Cross advantage plan and I went with traditional Medicare (which I love by the way). Horrible, horrible plan if you are in need of a specialist!
This is the third or fourth time Anthem has refused to cover labs for medical items, including biopsies and treatments. Anthem suggested that I could avoid denied coverage if I went to one of their specific labs: What good is Anthem if they cannot cover the services provided by an IN-NETWORK doctor, and what good is a doctor being in-network if their labs are out of network? I'm frankly fed up with their refusal to cover me when my company is deducting immense amounts from my paycheck to cover them.
Have had minimal contact with Anthem because all our claims and requirements are managed by Anthem with very minor issues. Only issues we have had are with our specific providers not accepting Medicare. We're going away from Anthem, though, because they are increasing their cost to their clients.
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If you go online and try find a therapists that accepts them you will get so frustrated. I am trying to find a therapist within 10 miles of my home and work. They actually have a dead person on their list!! Even if you click accepting new patients and literally go down the list they either aren't accepting new patients or they are from all the company and want a credit card on file so they can charge you if you miss an appointment. Also they have a 72-hour cancellation policy not including weekends. Riddle me this. If you are going for therapy how are you supposed to know how you are going to feel 72 hours Monday-Friday. Completely frustrated. Getting metal shouldn't be this difficult!!!
I have had Blue Cross ever since I was young. I am now 61 and have yet to have a complaint about Blue Cross. Easy to figure out benefits, accepted everywhere, affordable payments. My four children were all delivered using Blue.
Anthem covers nothing 100%. Co insurances crippling. No way to know ahead of any procedure electively what consumer has to pay and no appeal is ever in favor of the insured member. Can't understand customer service, always outsourced and they give wrong info 85% of the time. No regulation to stop the greed.
All I need is an insurance card but customer service just runs me around in an endless grid. It's like I don't have insurance at all without that card. They make you go to a website and an app that don't work.
These folks are terrible when it comes to customer service, particularly online. Any time I've ever written them with a question they've not answered it, closed the request before I was satisfied, made me feel like nothing more than a number. Next election, they will be out of my life. My coverage is decent, but my employer pays upwards of 600 (individual) just for me. No dependents. Only half of my doctors are willing to deal with them, thus dropped them. Now I have to scramble for new doctors and leave the ones that know my history. It's terrible, and I'm done with them.
First, this company denied an out-of-network procedure that I need to have done for a serious illness I have. I have out-of-network benefits too, but the surgery was denied. I appealed the decision and it was denied again because they feel the surgery isn't "medically necessary." What insurance company has the right to tell someone their health isn't "medically necessary?!"
Now, I am out on a leave of absence because of this illness because it is spreading and I can't have surgery because my insurance company that I pay for every week won't pay for it. I have also been dealing with Anthem Life for 2 months now, trying to get my leave of absence approved so I can get paid, and they have done nothing but drag their feet and give me the runaround every time I call them. They have lost my doctor's documents numerous times, and now I am facing termination because these people don't know how to do their jobs. If you have the option to choose a different insurance company, do it.
If you have cancer this is not the insurance you want! I was denied a PET scan on Friday 9 am. I tried all day to get a denial letter so I can file an appeal. Theresa ** LPN dodged me. I had to get to other people to transfer me multiple times. She NEVER returned calls. She gave me a runaround about getting me the letter. I was promised by the end of the day Friday. I never received it. I truly believe this was done to prevent me from appealing the decision. My pet scan is scheduled for 7 am Tuesday. I want the name of the person who denied the coverage. I want the copy of the denial. I want to know how to file an appeal, it is not anywhere in your website that I can find and member services would not tell me how.
I want to know if the fact I have endometriosis was factored in to this decision. Was my family history taken into account? Grandfather brain and colon, mother lung, ovarian, uterine, aunt ovarian, breast, aunt throat and uterine. There's more but you get the idea. I have previously had a mass removed from my colon (benign). My DR at Northwell gyn oncology prescribed a pet scan as the best procedure for me. How does your dr if it is even a dr know what's better for me? Since my surgery is now delayed I am going for a second opinion at Sloan Kettering. I want the letter for my appointment there.
When my husband started his own small business, we were forced into the individual insurance market. We purchased a PPO through Anthem that was actually an ok plan - for three months. Then we got a letter saying the plan was discontinued and we could only purchase an HMO and things fell apart. They sold us an HMO plan that DID NOT PROVIDE COVERAGE FOR MY DAUGHTER who is out of state in college. Yes - we told them about her! They said no problem - she can see the Anthem doctors at school or she can sign up for our "away from home" program. Come to learn that we are considered "out of area" by all the doctors in my daughter's area (and therefore denied coverage) and the "away from home" program is not offered in the state where she lives. Oh and now the enrollment period is over so we can't switch. Thank you anthem!
That was just the beginning. They do everything they can to avoid paying you! I think their business plan states "wear people down until they stop asking for money!" DO NOT BUY ANTHEM. They will not fulfill their basic obligations to you. I have spent countless hours on the phone with these people just trying to get what we pay for. Anyone else has got to be better.
It is my understanding that the current healthcare was put in place by Nixon. I was under the impression that all rules made by an impeached president are suppose to go out the door with him. Our healthcare system feels to be run by the "American Mafia". We pay $400 a month on a BCBS plan that has an outrageous deductible. Okay- we knew that when we were forced to sign up. But they do not cover routine visits, and have to be reminded of state mandated coverages (depending on the state you live in). The medical offices are no better because they offer a discount on self pay and charge more if you are covered. But that money is still coming out of our pocket so we might as well be self pay!
The reason for my review is that I have noticed something that I want to share. It seems to me that most primary care and hospitals offer a discounted self pay option. If you open an HSA (health savings account) you can put pre-taxed money into the account for medical uses. I am not sure what the tax penalty is for not carrying health care, but it is likely less than the $5,000 you will dump into your health insurance, and you can take the money you would be paying BCBS and put it into your HSA account. There is gap coverage or accident insurance for a lot less premium- in the event something happens to you... something to consider.
Coverage is set up already and you have to accept it or not get coverage. They only sell certain plans that are overpriced. They have this super huge deductible or this other plan that you have to use some sort of bank account type of usage. Insurance prices are always going up to ridiculous amounts. The average person has hard time affording policy. Even with insurance they only cover a portion of bill which is a very small amount leaving policy holder with a huge amount still to be paid. Ripoff but forced to get. Unfair!!
Anthem Blue Cross is the worst health insurance company. They have way old systems and their systems are never up to date. Been a member for more than 5 years now and I deeply regret for this now. My wife had a baby boy last year and her obstetrician was in-network during the delivery but it was showing OUT-OF-network while processing the claim. They have rejected the claim now and I got to pay huge bill due to this. This has happened only due to one reason, not keeping their systems up to date. I will never ever go with Anthem in my life time. So, Folks, if you want a fair health insurance, do not go with them. Otherwise you will end up paying huge bills like me. I wouldn't give even a single star if I can.
Updated on 10/9/2017: In response to my previous dissatisfied experience on handling my claim I submitted on Consumer Affairs previously, one of the Anthem associate's gave me a call after a month and took all the details of my claim and said she would resolve. She wouldn't want me to call Anthem to follow up on it and she would contact me in a week and provide an update. She also supposed to send an email with all her details. I never received a call back or details to my email.
Now, I do not have that associate's contact info to follow up. This was not resolved yet. It's been a month now. I don't understand why they always do this. Am so vexed with them and am completely dissatisfied with their service again. If I have a chance I would move from them completely. I do not want the customer service now as they would take forever to get me an associate and I have to tell my year long story. Their systems are too old and never ever get updated with statuses accurately. I would never renew with Anthem again. They do not deserve a single star.
I just found out that I will need a CAT scan to rule out ovarian cancer. I also need a colonoscopy. Anthem will not cover a single penny of this, until I satisfy a $7000 deductible. Thank you BCBS, for making me choose between my life and keeping a roof over my children's heads, as well as having food on the table. I am a 42 year old, married woman, with 3 children. I work full time and pay RIDICULOUS money to your company for this horrible insurance, that's useless when it's truly needed. You're handing down a death sentence, making people choose between their health or making sure their families have a place to sleep and food to eat. I wouldn't wish this nightmare on anyone.
Federal BCBS is good. But, the dental benefits are horrible. They pay very little for important dental care. I must carry a second dental insurance because I pay so much out of pocket.
I never received my insurance card or any so called packet they said they would send. Impossible to get into contact with during enrollment period. Paid months for insurance I couldn't use. In fact their sign up process was so confusing I didn't think I even had insurance at all... until I checked my bank account. At least canceling was easy.
I am an attorney. I come from a professional athlete family. Many of my immediate family members are physicians. Being healthy is the number one goal in my family. I am the same weight as high school - 105 pounds. I am 59 years old. I do not smoke and never took drugs. I will have a Kahlua and cream if someone begs me at a host dinner. My family has been located in the United States since Jamestown. When I moved to Virginia I reached out to Anthem during open season. I had no idea nor did the rep state to me that I was speaking with a broker. I enrolled in an individual plan and promptly paid the monthly charges.
Subsequent to my enrollment I began to receive through the mail, requests for personal information. The documents did not contain any insignia that they were related to my Anthem insurance. I made several calls and wrote Anthem asking for clarity. I was told to "throw the documents away, they have nothing to do with us." In March, while traveling in Colorado, I reached out the Anthem for the billing address to mail my April payment. I was told that I was being dropped on April 1, 2017 for lack of verification of my citizenship. (Ridiculous - I am a very rooted American.) After discussion, the Anthem rep informed me that the documentation that I was told to "throw away" was, in actuality, information required from the Marketplace, a broker. I informed Anthem that I did not utilize a broker. Anthem responded that during open season they utilize brokers because they are "bombarded with thousands of phone calls during the open season."
I asked why there was no disclosure to me during my call and the Anthem rep said: "Would you prefer to be on hold for hours or speak to a broker?" How rude!!!! So... I wrote Anthem a letter demanding coverage. By the time I received a response I was nervous about exposing myself without insurance so I reached out to another insurance carrier - a type of temporary insurance which ends in October. Not sure what happens in October - I think I will have no insurance until open season??? Awful.
Additionally, while in Colorado prior to being dropped on April 1st, I got sick and was seen by a physician. I filed a claim on or around April 6th, 2016. It is August 10, 2017 and I have not heard a thing about the outcome except one representative who thought it would not go through (phone conversation). Repeatedly, Anthem made up nonsense concerning the claim in order to not address it - e.g. the date of service was too illegible. FALSE STATEMENT! Run from Anthem. There has got to be a better way. If I am an attorney having trouble with Anthem I pity the person who is not as educated.
They have no way to contact them directly, if say you do not have a card. Their website lists ONLY technical support. No way at all to contact them directly. When you call tech, and they manage to transfer you to a human. They will not know what to do, throw you into a phone directory or a switchboard operator who will then hang up on you. Do not know what to say other than if it is not too late, find another company.
Ok to start I have never had to speak to Anthem's Appeals Dept., when a letter was sent with the wrong name and erroneous info in it I started to as they say reach out, to no less than 15 people, over 30 days later still no corrected letter and no info to carry on an appeal with PERS, which sent me a letter that I have 15 calendar days to send any info to affect my appeal, well I do not even have the Anthem info to address and get back up for. It feels like what a black hole I imagine in space would feel like. All I get from the customer service dept. is the company line, I finally said did you hear me you are not responding like you have heard me. To think this insurance is something I have paid for and this is the service.
Anthem BCBS is a Very TERRIBLE health insurance provider! Lousy benefits resulting in high(er) intrinsic costs and BS coverage, regardless of which state you live in. Chose ONLY because it was the Better choice amongst very Limited choices (NH is Terrible with health insurance coverage). For a nationwide health insurance provider, it provides one of the least benefits to subscribers and makes you jump through hoops to get even the most basic benefits allowed on your plan.
Good example. CPAP supplies are subject to annual deductible but you "NEED" doctor's authorization. WHY?! People pay for it themselves. CPAP users already HAD medical authorization to get sleep study which resulted in purchase of CPAP. Why the heck do you need MORE authorization to buy needed supplies (sanitation health issues) if you pay for it privately? The subscriber needs to submit a Claims Report to have the amount Credited towards the annual deductible amount but BCBS REFUSES to do that UNLESS you get doctor's approval! WTHeck?!
Other insurance companies actually COVER (even partially limited) CPAP supplies (i.e. buy hoses/masks every 6 months) or get amounts paid personally credited towards annual deductible since you're ALREADY approved hence reason above that you already received a medical authority to buy a Cpap machine! The BCBS workers have to put up with grievances from subscribers for the BS guideline benefits that BCBS offers or does NOT offer. BCBS has a STRICT policy of getting Doctor referrals BEFORE ANY treatment so you better get it or else you pay the referral related expenses directly!
The company was bad BEFORE ObamaCare and has become WORSE AFTER ACA! Monthly premiums have gone up, annual deductibles/out of pocket costs have INCREASED SIGNIFICANTLY while benefits have dropped!! Some medical expenses that WERE ONCE covered may NOT be covered anymore esp. by BCBS! AVOID at all costs if possible! Stay healthy at all costs! Had better health insurance coverage at same price in MA with another insurance provider. NH has one of the most limited and lousiest health insurance providers!
My bill is never EVER right. We literally have to call Anthem every other month. Literally!!! The SOP at Anthem is to have the customer service rep take down every bit of information she can and "send" it to the billing department. I ask, "Can I please speak directly with the billing department" and her scripted response is that she does not have a number for the billing department. I ask for an email and she comes back with, "I do not have any information on how to reach the billing department." The only thing that I am ever told is that billing will look into it and send out a new bill. So they are glad to take my money but won't let me talk to the people that keep screwing it up. You cannot name a single other business that would pull that kind of crap. When I ask to speak to a supervisor I get the same run around until I am told, "there is no one above me that can take calls from customers." I cannot believe this is even legal!
The company in which I am employed required me to have this insurance plan. I thought I would never need it, and enjoyed paying them for this. Haha. As it turned out I needed to file a claim because of a fractured arm. I spoke with them on the phone, and submitted the proper paperwork. They were, suspiciously, indicating to me that they didn't like dealing with my insurance company because they indicated they were slow in responding. They suggested that I reach out to my doctor's office in an attempt to speed up the process so I did. I was able to get a fax line, contact #, and the insurance liaison's name all which were directly related to my doctor's office. I gave all this information to them on the phone for which they assured me that this would be added to my file. They did in this conversation indicate to me again that they still thought my insurance would drag their feet, and indicated that I should check on them regularly.
After two weeks of checking with my insurance they indicated that they had not received anything from Anthem Life. I called Anthem. At this time they said that they had not received any information from insurance company, and that because of that they were mailing me a letter indicating that they were closing my claim. They told me that I could file an appeal if I wish. I intend on it. My insurance has no reason to not reply to any insurance paperwork. It's not a fly-by clinic. I do believe, however, that they never had any intention of paying or sending the paperwork even after I sent them the proper point of contact information. I can imagine that the they are laughing at the idea of me appealing their judgement on my claim. Beware. Sneaky crooks whom I still have to pay for in my paycheck.
I called to get a letter verifying coverage for my auto insurance required in Michigan. I called and then said they would email it to me which they didn't, so I had to call back the next day and then the department I needed wasn't available because they were doing training. I called back the next day to find out that department didn't handle what I wanted. I called back and talked to someone who transferred me and told me to talk to someone else which in turn attempted to have me call my employer who doesn't handle this issue.
I was told by another department to ask for a supervision and the lady on the phone refused to give me one and hung up on me. I called back and talked to multiple different departments who gave me the same answer. I asked if they had someone who worked in the state of Michigan and they denied that and told me to call another number in which was of no help. I seriously called them probably 10 times, my auto insurance company 3 times to finally get someone that was willing to investigate how to get my problem solved. They seriously need some more training. It was a horrible experience.
I have my entire family covered under Anthem BCBS HDHP. I would just like to say this insurance is GARBAGE. I pay over $2,600 a year in premiums, just to have a HDHP of $4,500. I have to meet before they start paying anything. Even after the $4,500 is met, they only cover 80% for certain stuff. That's $7,100 I'd have to pay, out of pocket in a year, before Anthem starts to pay 80%. That is absurd considering that's 25% of my yearly take home income. But my current situation, my wife had our second born child recently. I called a customer service rep to see why, after the entire labor delivery, my deductible only had $600 applied to it.
After 30 minutes with a customer service rep, I come to find out that the newborn services for our newborn is not applied to my deductible (even though I'm paying $4,000 out of pocket for it). I asked the rep why this wasn't applied to my deductible and all she could tell me is that my benefit does not entail newborn care. This made me furious and I ended up hanging up on the customer service rep. I could go on and on about Anthem. But I'll keep this review somewhat short. DO NOT PURCHASE ANTHEM BCBS FOR YOUR HEALTH/MEDICAL INSURANCE!!
In December 2016, I called and asked about upgrading our dental plan to include orthodontics. I was given plan information, pricing and details on doing so. I told the customer service person at Anthem that I would check with our orthodontist and call back to get the plan. When I called back in 2 weeks to get the plan I was told that I could not upgrade to the plan that had orthodontics because we had missed open enrollment. After speaking with a manager, they approved retroactively upgrading us to the Family Plan C if we paid the November and December premiums. We paid the November, December and January premiums for the Family Plan C.
I gave my orthodontist the new plan information and was informed that our plan did not cover orthodontics at all. I enrolled in the Dental Family Enhanced Plan in January (which hopefully included orthodontics this time). I made appointments at the orthodontist for my children and received a letter on June 15, 2017 that even though our plan includes orthodontics, neither child will be covered for the cost of braces. I finally cancelled the plan on June 18 after spending $545 in premiums.
I've been a business owner for 20+ years and understand the importance of customer service. I honestly don't believe I've dealt with worse service. First, they deny a prescription that should have been quickly approved. They require my doctor to submit additional paperwork which was done immediately. After hearing nothing for several days, I called. That's where the fun began. First, HORRIBLE automated system that seems designed to annoy you into hanging up. If you can last, you get a person that literally knows nothing. I wasted almost 3 hours trying to get a simple answer. I was transferred 10 times (literally) and ended up back where I started.
Finally, someone told me they would get my prescription reviewed and it should be approved the next day. They were supposed to call. Instead, I waited until the afternoon, and I called back. After only 3 transfers and 1 hang up, I was told - "We made the decision at 10 this morning. It can't be approved until we get more paperwork from your doctor!" If people had options, they would have exactly zero customer/members. Terrible experience.
My company has an ongoing issue with Anthem retracting claims payments. After five months of weekly calls to Anthem along with email and phone complaints to higher ups, I was connected with a person who listened and help with our problematic claims. During that time, I was asked to provide the same information multiple times, and then representatives would advise they needed to review the information with supervisors. This turned into a five month fiasco because the reps weren't collecting information or calling back. The woman that finally assisted explained that this was a dropped ball by customer service, and the company was going to use this scenario as a training tool to improve claims service.
About a month and a half later, I have another similar problem. I've attempted to get help for the past three weeks. My contact doesn't call back as promised until I've called her (after patiently waiting five business days on two separate occasions) or I've called to ask for a supervisor. I've had to begin taking my issues to the same higher ups again.
It is extremely difficult to get help from this company. I deal with UHC and Medicare on a regular basis, and I've yet to experience the level of rudeness and apathy with them as I've experienced with Anthem. My contact returned a call to me today after I requested to speak with a supervisor. She said to me, "Here you are asking for a supervisor when I thought we had a working relationship." My response was, "I thought we did too, but you aren't returning my calls or providing me any information after three weeks." She didn't have a response to that. I worked in a customer service call center for over ten years, and I know it's a tough job, but this level of non-service is unacceptable and clearly a pattern with Anthem.
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
Health Insurance Contributing Editor
An independent journalist, Joseph Burns is the health insurance topic leader for the Association of Health Care Journalists and contributes to AHCJ’s Covering Health blog. He has also written about health policy and the business of health care for a wide variety of publications, including Healthcare Finance News, Hospitals & Health Networks, Managed Care magazine, Ophthalmology Management, TaxACT.com, and The Dark Report.
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