ComplaintsforAnthem Blue Cross And Blue Shield

• Initial Complaint

  09/28/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unresolved

  More info

  Unable to get care after hours of just trying to get an appointment for a physical. Physical is covered under my plan with no deductible, but after hours on the phone with nice people, was given an appointment only to get a quote for the cost which was $270. I cancelled the appointment and am back at **********. This company assigned me an out of network provider which I couldn't correct on the website. It necessitated quite a bit on time and energy only to get an appointment (and was told I was not guaranteed routine bloodwork with this doctor) with someone who per my plan will cost me almost $300 to see for something that is supposed to be covered. It is clear this company wants to make it difficult and time consuming to get even basic care. It seems clear that they don't want you to use the insurance you paid for with ease, but they would rather you give up. The WORST experience with insurance I've had in my life.

• Initial Complaint

  09/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  Claim for MRI was incorrectly denied. I appealed it, and that appeal was incorrectly filed so was denied. Filed a new appeal that was escalated, and they are now also saying denied as out of network. It is not out of network, as I verified with the facility and anthem before receiving **** Anthem also sent me a letter approving the **** Now they want to file another claim, and wait another ***** days. The most frustrating part of all this, is that THEY KEEP HANGING UP ON ME! Any time I relate that I am frustrated, or ask to speak to a supervisor, they just hang up. I find this unacceptable. I have called over 10 times, and spent hours on this.

• Initial Complaint

  07/16/2024

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  I have sent 3 requests to Anthem requesting a rate increase consideration for my business as I am a mental health provider for them. These requests were sent via email on November 14, 2023, August 24, 2023, September 29, 2023. I am an LCSW and have been serving clients through Carelon/Anthem BCBS since 10/1/2021 and have over 5 years of experience as a managed care provider. Since emailing them I have received no response not even recognition that they have received my request. The demand for services and referral rate is outpacing the availability I have. With that demand has also come increased overhead costs to match current inflation trends. I hope to be able to continue make the important services I offer available to your customers which is why I am requesting an adjustment in rates to match demand for services and the unique and specialized services I offer.I have pursued extensive additional training to offer unique and specialized psychotherapy services. These include trainings in: EMDR Basic and Advanced training to treat individuals with early childhood trauma Dialectical Behavior Therapy Cognitive Behavior Therapy *************** Systems Clinical Supervision Furthermore, I also serve the following specialized populations: Adolescence/teens and their families PTSD Borderline Personality ************************** care I also offer evening and weekend appointment hours to meet the academic and work needs of my clients in addition to offering telehealth services to broaden the geographical range of clients I can serve.Below are my current rates and my requested rates:PPO CPT Code Current Rates Requested Rates ***** $104 $134 ***** $93 $123 ***** $79 $109 ***** $51 $71 ***** $109 $129 ***** $81 $101 ***** $81 $101 ***** $44 $64 HMO CPT Code Current Rates Requested Rates ***** $83 $123 ***** $77 $113 ***** $66 $86 ***** $36 $66 ***** $95 $115 ***** $66 $96 ***** $66 $96 ***** $38 $58

• Initial Complaint

  07/15/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  On 1/20/24 I was taken by ambulance to a hospital for a medical emergency. They took me to a hospital that was out of network. My plan Anthem Silver Pathway HMO says that emergency room care that is out of network is covered as in network on my benefits statement. Anthem has denied ******* of charges for claim 2024030EV8742. These charges consist of pain medication, the IV bag of fluids, labs that were run including (lipase assay, HCG panel, and a metobolic panel, and costs for the doctors and nurses to care for me while I was there. That portion of the claim is being denied that I should pay for the entire amount due to being out of network but my plan specifically states this will be billed for in network care and covered. I have called twice to get this rectified. The first time more of all the bills were taken care of so that my portion would be less an Anthem is not required to pay this is just to be applied to my deductible and out of network costs. I have called again to no avail even though this is what my plan states in my portal. I was on the phone for over an hour and waiting for a manager for over thirty minutes. Please help. I cannot afford 7000 after already paying all the money I did as I was transferred after to an in network hospital and then had emergency surgery.

• Initial Complaint

  05/09/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I had surgery at ******************************************* Center on February 1, 2024. On January 26, 2024 the hospital billed me $9,373.29 up front which is essentially my entire deductible. The procedure was pre-approved by Anthem and presumably they told St. *******'s what they could collect from me up front. That payment has not been acknowleged by Anthem ostensibly because the initial claim was rejected for not being itemized. Meanwhile, additional claims have been processed and approved as if my deductible were $0. This has resulted in me being billed for nearly $5,000 beyond my out of pocket maximum. I have repeatedly contacted Anthem and wasted hours of phone and chat time trying to resolve this. I have attempted to have this escalated to a manager and have been denied. The bottom line is that I have already paid $9,551.80 for in-network healthcare, which is $101.80 more than my out of pocket maximum. Anthem is required to pay all of my remaining medical expenses for the year. I'm not sure how to unravel all of this, but the mess is not of my making. I need Anthem, St. ********************* Medical Center and Common Spirit to work this out so that all of my providers get paid without me being forced to front thousands of dollars that I don't owe or being taken to collections for non payment of money that I don't owe. I also want my $101.80 refunded by Anthem.I'm being incorrectly billed for amounts of $202.98, $113.55, $2587.34, $1643.40, and $406.18. Anthem needs to absolve me of responsibility since I'm max out of pocket and pay the portion of these claims which they have erroneously assigned to me.

  Customer response

  05/29/2024

  I was able to work with Common Spirt to get a refund on my initial payment to cover the patient portion of the claims that Anthem assigned to me because they failed to acknowledge the payment to St. *******'s Medical Center while they are fighting over the claim. So I was finally able to resolve this on my own and need no action from Anthem.

• Initial Complaint

  04/30/2024

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  I was not informed my tax credit would not be applied for my 2024 Anthem coverage. Instead of the $164 being auto paid, as the past 3 years, they auto drafted $705 January 1st out of my account. I had to switch to ******** and they back dated it for 1/1/24. Anthem WILL NOT REFUND my money! I have had 4 one hour - two hour phone calls were they have had me jumping thru hoops becuase they tell me on the phone I have no claims, the ******** was backdated, I should get my $700 refunded. When the issue is attached to an "escalation ticket" it comes back denied due to a claim made in January. I HAVE NOT BEEN TO THE DOCTOR SINCE OCTOBER 2023! I have NO reoccurring meds! So when I call Anthem states (now 5 times) they have no claim for ******** I should be able to get my $700 back, and they will put in a ticket to the "back room" escalation team. Who is constantly denying it for the PHANTOM claim AND even if I did have a claim I WAS BACK DATED by ******** and would be covered thru them. I hear one story after another, I'm constantly doing what they ask me to do, I NEVER hear back from Anthem with updates AS THEY SAY THEY WOULD EVERY TIME! I am being put through these delayment tactics thinking I will forget or stop pursuing my refund but I want my money back as they stated I am applicable for and due to receive!

  Customer response

  05/09/2024

  Just an update on my end...I was told by my broker to check my daughter's claims for ******* (even thonshe had a completely separate policy). And she did go to the Doctor in ******* for a cyst, got a simple antibiotic rx. I just called Anthem BCBS to get whatever claim refiled under her ******** (which was also backdated to 1/1/24).  They stated she was not active in ******* thus has no claims for ******* filed. So back to square one...they are saying no refund due to a claim and yet again for me AND my daughter, no claims filed in *******.   Thank you for your time.

  Sincerely, 

  *********

• Initial Complaint

  04/15/2024

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  I was unable to access my ACBS HSA account in order to make a contribution, and my attempts to resolve the issue through customer support were frustrating and unsuccessful. After spending approximately 3 hours on chat and phone support, I received incorrect information, was disconnected, and transferred multiple times. I communicated with ~6 different individuals. During my final call, which lasted an hour with overseas support, they needed to contact two additional departments. They told me that they had to put in a request to email me an HSA contribution form, which had to come from yet another department, and I never received it. The form was not available online. Despite providing my phone number for in case we were disconnected, I was informed that a supervisor could not call me back when requested. The level of support was atrocious. Why should anyone pay for an HSA plan if they are unable to access it?

• Initial Complaint

  03/20/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I went for a routine mammogram on 9/30/2023 and Anthem keeps denying the claim. I have been on the phone for hours and hours with these people. One person says the claim needs to be processed by ******** and the other person says it should be sent to Anthem directly since I had the ******** Advantage Plan. In the meantime I keep getting bills from ******************* Medical Imaging in ****** threatening collection. This has become very stressful and is affecting my health.I feel that Anthem has no consideration for their members.

• Initial Complaint

  02/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  One November 2nd I purchased an "upgraded" health care plan from Anthem Blue Cross Blue Shield. I had been a member with them for a few years already. They advised me that I could "upgrade" my plan and get better coverage including the hospital that I live next to for a higher premium. I agreed to the much higher premium as the salesman told my it was better insurance. Now that I am trying to use the insurance I find out it is a much worse plan that very few doctors accept and it is the only one my hospital DOES NOT accept. I have called and called and they just keep transferring me or telling me they can't fix the issue. Each call is about ***** in hold time and transfers.

• Initial Complaint

  01/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unresolved

  More info

  Blue Cross and Blue Shield have given me absolute problems since I was hospitalized in 2023 for a ruptured appendix. I was in and out of the hospital on September 29, 2023, and about to lose my life. Blue Cross Blue Shield has been consistently denying a claim from September 29, 2023, because they needed more information from the doctor. I contacted ******* and the hospital,l. The hospital provided the authorization form to Carelon three times. Blue Cross Blue Shield keeps saying that they have not received the authorization form. So, they keep denying the claim. After several months of calling them, calling the hospital, calling Carelon, the only thing I was able to get was an approval in the mail from Blue Cross Blue Shield saying that they finally approved the *** code attached to that claim. Now, they are refusing to pay for the claim, stating again that they never received the pre-authorization form. They sent me an approval of the *** code with the claim, and yet they are still saying that they are not approving this claim because of the pre-auth form not being submitted. I had Intermountain Health send the pre-authorization again, and now Blue Cross Blue Shield is saying it takes up to 30 to 60 days to process the claim. Intermountain health is now threatening me to pay the 16k if blue cross blue shield wont help. I have never in my life dealt with a company like this. I have called several times to speak to many different people, and no one can give me any answers. These were for emergency services that I needed to keep my life. And now, I am being slapped with a $16,000 bill because Blue Cross Blue Shield is refusing to do anything about this issue.

  Business response

  03/12/2024

  
  Dear ****************:    
  
  We have reviewed your complaint, dated February 27, 2024, filed on behalf of member ***************************.The complaint regards delays in the processing of charges for date of service September 29, 2023.     
  
  A review of the claims on file with Anthem confirmed a claim for services provided on September 29, 2023 was initially received on October 6, 2023. An Explanation of Benefits was issued on October 17, 2023 advising additional information was required to complete the processing of the claim.  Specifically, the provider coded the claim with an ICD-10-CM diagnosis code that became effective on October 1, 2023.  Because this diagnosis code was not effective for the date of service billed (September 29, 2023), corrected information was needed from the provider. 
  
  Anthem received a second submission of the claim from the provider on November 10, 2023, but the second submission of the claim included the same diagnosis code that was not yet effective for the date of service.  The member submitted an online Medical Claim Form, which was received by Anthem on November 22, 2023, but this claim submission did not include a corrected diagnosis code.   
  
  Following contact with Anthem customer **********************, the member was given instructions on filing a member appeal,but an appeal has not yet been received regarding this specific claim. The provider can also submit a corrected claim along with medical records to correct the diagnosis code.
  
  Thank you for bringing your concerns to our attention. Please contact me directly if you have any additional questions or concerns.

  Customer response

  03/21/2024

   
  Complaint: 21203197
  
  I am rejecting this response because:
  This makes no sense. The over all denial of the claim you all are giving was that it didn't have a pre auth done. This does not mention that at all. I'm also not sure what you mean by "not yet effective". I had that imaging service on that date. I also recieved a response that it was approved. Yet; it is still not approved and Intermountain health has received no response on paying for my surgery.
  Sincerely,
  
  ***************************

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