Anthem

First, Blue Cross made it rather easy to have telephone consultations ("Visits") with the doctor without having to go through a lot of rigamarole to have that service reimbursed. Several months ago I needed some expensive diagnostic testing and apparently the doctor's office and hospital were able to handle the pre-cert smoothly enough that I didn't even have to get involved in contacting the insurer!

I encountered an issue with our pharmacy benefits program (not managed by Blue Cross) and a Blue Cross telephone representative was kind enough to initiate a 3-way call to the PBM. Given some of the stories I've heard about how long and how difficult it can be to contact that one particular PBM, my guess is that the Blue Cross agent probably saved me at least a couple of hours of work by initiating that call on my behalf. I was also pleasantly surprised that I didn't have to wait too very long (less than 15 minutes!) on hold to speak to the Blue Cross agent. Every health plan member deserves to receive that kind of prompt, courteous service!

The reason I have rated Blue Cross only 4 stars rather than 5 has to do with a corporate policy and how their telephone queue operates. Whereas many health care sector businesses are open on Saturdays, their call center (for members) is not. Furthermore, questions must be answered/data must be input into their telephone system before you even get the 'courtesy' of receiving a recorded message that tells you they are not open and says 'call back later.' If it's a weekend, wouldn't just make more sense to play that recording upfront? So many businesses operate their phone messaging system that way! Perhaps they don't want to do that because they are data mining and monitoring all the calls that come in, whether or not anyone is there to actually pick up the phone.

So as many of you know for the last two months I have been dealing with debilitating back pain. It has been just the most difficult journey to try to seek recovery but also the constant up hill battle with anthem Blue Cross Blue Shield. I can honestly say they have tried my patience and have beat me down to the point that I’m ready to just pay everything out of pocket. When I first went to my primary doctor I was referred to a spine specialist. In network. He was being conservative with initial treatment and wanted us to try alternative treatments before we did anything major. So I went to chiropractors, physical therapist, I had needling done, I had tins, Massage, heat, ice, Hot baths, 12 to 16 Tylenol or Tylenol per day, and anti-inflammatory such as Celebrex. With little to no relief.

They are nights that I cannot sleep and during the days, it’s difficult for me to even sit for more than a couple hours to do my job. A big part of my job is meetings so I have to be in virtual meetings and I’m self-employed so if I don’t work I don’t get paid. When I first went to the spine doctor I looked him up on the Blue Cross Blue Shield network and clear as, day in network. I print Screened it just for my back up. Thank the day before my Appointment, the doctors office called and said they were not in network and anthem would deny the claim for the doctors visit. This is a specialist so his fee is not cheap.

I spent 5 to 6 hours debating with Blue Cross Blue Shield/anthem and I got a preapproval letter for a year’s worth a visit to this particular doctor to this particular location. Everything’s OK right? I go to see the doctor thinks everything is all right and we begin the treatment plan and the first thing they do is deny the claim for out of network. That was another two days of fighting only to find out that they are going to pay the claim but they’re not going to honor the rest of the preapproval they only pay for one visit.

Now let me remind you how much pain I’m in and I have lost the battle to fight. So after all the pre-work that we did the last most logical procedure next was a Cortizone shot in my back. It was scheduled and the day before the procedure I got a call saying Blue Cross Blue Shield anthem does not cover that treatment because they think it’s not medically necessary. I’m someone who is in pain and at night, often in tears and they say it’s not medically necessary!!!! The doctor says it’s medically necessary. The MRI clearly shows an issue with the disk in between the vertebrae so it says it’s medically necessary. I had an appeal and it was denied once again .

Let me State that I am self-employed. But I played by the rules. I pay my taxes. I 100% fund My retirement.. I pay 100% of my medical insurance. I pay all of my business insurance. I play by the rules to be a business. I get no assistance from anyone, yet I’m know that premium Has to be paid that is one thing my mother taught me at a very young age about insurance. And I have never had a major medical claim for the years that I’ve been paying to them and the first time I do they decide to deny it now let me ask the state that I have met my deductible of $7000 for this year plus paying $700 a month for premium. So they wait to you meet your deductible and then they deny claims.

What’s worse, their management team does not even take phone calls. Numerous messages left for CEO and President of GA. They get emails because I do return receipt so I know they receive my messages, but they simply ignore me and all I get is a form letter back. All these years I’ve been paying into this policy just to be treated this way. It is absolutely heartbreaking and I believe their goal is to break you down so you won’t pursue the claim and that’s exactly what will happen I will wind up paying $1000 out of pocket because I can’t fight with them anymore and I can’t be in pain anymore. This is their agenda.

If you’re under the same situation that I I am in where you’re self-employed or by an individual policy from the exchange yet you don’t get any discounts or compensation I would find another company. The reviews on the Better Business Bureau complaints are terrible. Unfortunately I’m in the middle of the year and I cannot change right now. The CEO does not care about these complaints. It is obvious to that.

My family member had been slowly making progress in the mental hospital, with electro-convulsive treatment (ECT), recovering from both catatonia and severe depression, as measured in part by ongoing PHQ scores. Anthem's medical director had been denying payments for some of her treatments, but Langley Porter had appealed these denials and obtained payment, as they are, after all, the experts. My family member was ultimately discharged with a PHQ score of 14, abnormal, suggesting moderate to moderate-to-severe depression. She was sleeping constantly, eating little, suffering significant memory lapses, and unable to correctly self-administer her medications. Still, she was much better.

Discharge was difficult since it was unsafe to be home alone. To avoid a stepdown facility (and all associated costs to Anthem), I took over her cares. I came from Europe to stay with her. It is a two day trip to get to California and I was in constant contact with her Langley Porter team, planning exactly when to pick her up. I did my due diligence, arrived, and took over. I was in her home for over a month and a half, as this is how long it took to recover and be safe on her own (just barely). Even so, Anthem denied payment of her last two days of (mental) hospitalization, leaving her with a $33,000 bill which is now in collections. How can this be OK?

FINALLY, we see on their message site that they've reduced my wife's amount to less than what we'd been told. Rolling my eyes, I paid it. Five days later, I go online and it says we both still owe for the next month (although I can see it's gone through my bank) AND there is yet a new amount listed for my wife! No idea how they can stay in business: are they really that incompetent? All of this is in addition to the numerous ignored messages and/or messages where the agent hadn't either read the entire message or didn't look into it thoroughly. INCOMPETENT AND UNPROFESSIONAL.

During COVID-19, they promised to cover all client copays while using the telehealth option but this was a lie. Many of the therapists in CT are still waiting to be paid for the past month because Anthem can't seem to get it together. I want to leave the panel but more than half of my clients have Anthem so I feel stuck as a provider. They need to revamp their entire program with how they work with providers. I am appalled by their system and more disgusted that they are a billion dollar company and refusing to give rate increases, especially when the standard of living increases every year. Every year, they increase monthly insurance premiums between $100-150 but claim that they cannot provide a rate increase? This doesn't make sense to me as a provider or as a previous consumer.