ComplaintsforAnthem Blue Cross And Blue Shield

• Initial Complaint

  09/29/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I filed a claim for services received on 2.1.22 on a cruise ship due to illness while on a cruise. I had to pay out of pocket to get off board to be flown home to my local hospital. The amount was $3,605.67. I have called Anthem 21 times and spoken to reps that do not have any clue about my claim. My claim was mailed in on **** and again on 3.23.22. When I call no one can help. Half of the time, they can't even find my claim. I spoke to "supervisors" and they say they are going to research it and call me back. I have left my name and number 4 times in the past 2 months and NO ONE has ever called me back. I don't care if you pay or deny my claim, I just need a claim letter to give to my ************************ (which I have 100% insurance with). They are not paying my claim ($12,386.00) until I have a letter from my insurance company saying they are going to pay it or deny it. PLEASE PLEASE pay or DENY this claim. Thank you

• Initial Complaint

  09/21/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Unanswered

  More info

  Below is the complaint sent to anthem and vita cobra benefits administrator:I am the member. See member information below. My employer was Heron Therapeutics.My cobra benefits continuation is being handled through Vita COBRA.I signed up for cobra on 8/29. These benefits have been PAID since 9/1. It is now 9/21 and you STILL do not show that I have coverage, which is incorrect. You (anthem member services) are saying that you havent received anything from Vita. **** says that theyve sent the information and havent received anything from you, so Im at a loss here. I have TWO appointments on Friday 9/23 that are more than an hour away from my house including a very Important breast cancer screening, and more than $2400 in cobra payments later, you and vita are blaming each other like poorly behaved children. Someone needs to learn how to follow up appropriately, like true professionals, in the year 2022.Since payment for coverage was made almost a month ago, and it is now TWENTY-ONE days later, I assumed everyone had done their job, but I was wrong.Of course, anthem member services will not talk to members directly, as that is their protocol.***** from vita had already attempted to call anthem member services TODAY and was unable to get through. Huge surprise. Im connecting everyone here, since Ive now wasted an entire half day one the phone with all of you. For $2400 in payments, I would expect some follow up from AT LEtone of the professional organizations involved in this transaction. Vita customer ********************** people Ive talked to today: ***** and ***** Anthem customer ********************** person from today:Padma Vita contact information:Email us at: ***************** Call us at: **************

• Initial Complaint

  09/02/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  Anthem has denied a claim in bad faith. On February 15, 2022 I received a letter from them in connection with prescription glasses I purchased. The letter confirms that of the $797 submitted for the claim $521.40 was allowed. When I went to pick up my glasses, the store told me they were out of stock, and to purchase them through a website (which the store provided). When I purchased the glasses through the website and submitted a new claim (as the original claim was retracted since the store couldn't perform), they denied my claim, paying only $85, asserting I "exhausted my benefits." I am merely asking for the difference between what they agreed to pay (i.e., $521.40) and what they paid ($85). While the organization it "strives for customer satisfaction," I tried resolving this with them and they refused to engage and denied the claim in bad faith.

• Initial Complaint

  08/17/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I am enrolled in a ******** advantage plan through Anthem Blue Cross. They have me enrolled in a provider group named Imperial Health which DOES NOT EXIST in the county where I live. I have tried repeatedly to contact them to correct the provider group affiliated with my primary care physician (PCP) in the county WHERE I LIVE but they negligently refuse to do so. As a result, I am unable to get approval for any needed medical care as Anthem, for some bizarre reason, will NOT fix it. I have the correct PCP in the correct county where I live on my medical card but not the correct medical group. Therefore, despite multiple referrals from the **** I am unable to get further urgently needed medical care for the reasons mentioned above.

• Initial Complaint

  07/26/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Unanswered

  More info

  Anthem has refused to compensate my health care provider for services that are 100 percent covered by my plan. I had an encounter on 3/1/22 for routine preventative care that Anthem's employees have told me was covered and that Anthem had covered in previous years. They did not cover the full cost. When I asked them to review the decision, they said they would do so and contact me with an update, which they did not do. Now, 5 months later on 7/26/22, the provider has sent a bill for costs that Anthem should have paid. Anthem always fails to process claims correctly in order to squeeze unearned revenue out of their customers and shift the burden of fixing errors with claims from their staff who they have to pay to their customers who they force to perform unpaid labor in order to get claims processed correctly. Anthem has incorrectly billed the vast majority of my claims by dollar amount. The claim at question here is 2022066CH3714.

• Initial Complaint

  06/10/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  Anthem is not paying out healthcare claims so all the providers in my state are dropping those of us who are covered by Anthem. Even the hospitals and emergency rooms wont accept it. My OBGYN just notified me that they were no longer accepting Anthem. We dont have very many options to begin with and have even less now. Not to mention a lot of practices arent accepting new patients so switching is that much more difficult.

• Initial Complaint

  04/07/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I keep being told by Anthem (last year and in 2022), that I did not complete all the ??action plans?? on their Sydney app. For example, I completed an action plan on January 29, 2022 (reduce stress) and another one on February 14, 2022 (sleep better). I only received the reward points for the Sleep Better plan. Anthem Support (chats and phone) keeps saying: 1) wait 60 days to see points - that didn't resolve it; 2) we don't give points for more than one action plan per quarter - false because you can do up to 5 per year (see attachment); and finally 3) telling me that I never completed the Reduce Stress plan in 2022.Because of similar issues in 2021, I've started to take screen shots with stamped dates of the completed action plans. Even with this proof, they are still telling me I didn't do it. Clearly, something is wrong with their app. I've spent hours on chats, on the phone and emails with them over these reward points (small: worth $5 each). I've also reached out to my company for a resolution with them to no avail. What am I supposed to do, take a screen shot everytime I finish a plan and argue with them incessantly?

  Business response

  04/13/2022

  This is not a CO Anthem BCBS member, this is a BCBS of ME member, we cannot resolve this complaint as we do not have access to BCBS of ME accounts. 

   

  Thanks

   

  Anthem, Inc.

  *********************, Risk Analyst, Grievances & Appeals Risk Unit Regulatory Services 700 Broadway, ******, Colorado 80273 O: ************** | F: ************** ************************************************

  
  

  Customer response

  04/13/2022

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  03/17/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  Anthem is not covering the costs/providing reimbursement for covid at-home tests. The receipt from ********* does not include UPC, which Anthem states is required. However, there is NO option to input this value manually either.Their instructions make no mention of this requirement, nor do their online web form allows for this inclusion.If You Are Submitting For A ******19 At-Home Test Reimbursement:1. Include the retailer's name (retail store or online retailer) where the ******19 at-home test was purchased.2. For doctor's or other healthcare professional's tax ID, enter (or copy) this code: ***********. Disregard the Additional Required Information section. It is not required for ******19 at-home test reimbursements.4. Where it says, Are all of these items on your ****?, please select Yes and then select Next.

  Business response

  04/13/2022

  This is not a CO Anthem BCBS member. This members plan is administered by BCBS of **.  We are unable to research this members concerns because we do not have access to BCBS CT accounts.

   

  Thanks

• Initial Complaint

  02/01/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On multiple occasions I have called Anthem to resolve billing issues regarding my care with ***********************. Several of the bills that have been submitted have been either coded wrong on the anthem side, not put towards by deductible, partial reimbursement, or denied. There is no rhyme or reason to how things are coded. At one point one the bills was entered in as an injection and denied. This was for a virtual visit. it took 5 phone calls to anthem to resolve this issue. Each time I call I get a different answer regarding what was covered and why. recently I received bills from Anthem where they had made a mistake and refunded me money and are now asking to recover that money. When I had asked in July about the refund I was told partial visits were being refunded because of an exception from Covid. A couple of months following this I was told they had wrongly reimbursed me and it was not the case of a Covid exemption. billing and reimbursement continues to be a mess with no rhyme or reason to how the claims are handled.

  Business response

  02/15/2022

  Dear Ms. ******************************** complaint you filed with the Colorado Better Business Bureau, has been forwarded to me for research and a response. 
  
   
  
  In researching your concerns, your health insurance policy benefit year goes from July 1 through June 30 of each year.  This plan also has a deductible for in-network services and a separate deductible for out-of-network services.  The member is responsible to meet the deductible in full prior to any benefits being paid or copay and coinsurance applies.  In your case, you had four claims that processed and paid before your deductible had been met.  As a result of a claim audit, these claims were re-adjusted to apply to your deductible correctly; therefore, a request for you to refund the previous amounts paid in error, was sent to you. 
  
   
  
  All claims are processed, and benefits determined, based on the procedure codes and diagnosis codes listed on the claim form identifying what services were performed.  Your claims for *********************** are being submitted by you, instead of the provider.  One of your claims was processed with the information you provided and benefits were applied based on the information submitted by you.  Anthem then received a corrected claim from you with different diagnosis and procedure codes.  Your claim was reprocessed with the updated information you provided and correct benefits were applied. 
  
   
  
  Please accept our sincere apologies for the inconvenience and frustration you have experienced.  It is never pleasant to learn of the frustration an individual may encounter in connection with their health insurance claims, it is important that we listen, understand and strive to prevent similar instances from occurring. We appreciate the important feedback you have provided to us about our customer ********************** and can assure you that Anthem will improve from this experience. 
  
   
  
  Sincerely,
  
   
  
  **************
  
  Risk Analyst, Grievances & Appeals
  
  Appeal Risk Unit
  
  Regulatory Services 

• Initial Complaint

  01/27/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I called anthem blue cross in June of 2021 and I spoke with an agent for a quote. I ask all the right question and she sounded confident response. She quoted me an yearly fee and put me on a monthly payment and said I would have to renew next June. I asked her clearly if it was from the month I started and a year from that date and she said yes. Later I found out I was quoted wrong and she was wrong about the renewal and everything else she said. So she out on month payment and I called back in 3 month and told her I wanted to make a payment of *****. My payments where 500 a month so I asked if they would keep biking me next month or stop for 3 months. She said they would stop for 3 month and charge automatically when the next payment was due because I was in auto payments anyway. That was wrong the next month they did not try and run a payment and canceled my policy without contacting me. I called a montager when my insurance went off and she promised the world that she would have it fix in 5 days and call me back. Nothing happen so I called again. Same thing but this guy said he would call me at noon every day until it was fix. He wasnt even listening it was a joke. Not sure if he just didnt care or what. I was asking him question and he kept saying yes to my question that where not yes or no question. So I said yes what? What did I just ask you and he just mumbled. He game me a reference number the didnt work the next time I called and never called again. I paid this company ***** and it cost me over ****** for not having medical coverage. We can start with a refund maybe.

  Business response

  02/08/2022

  Dear *******************,
  
   
  
  You recent complaint to the Colorado Better Business Bureau has been forwarded to me for research and response.  After extensive research, we are unable to locate any Colorado Blue Cross and Blue Shield membership for you with the information provided.  It is possible that your coverage is through a Blue Cross Blue Shield plan in another state that Colorado does not have access to.  I would be happy to further research your issues if you could provide to the Better Business Bureau, the three letter pre fix, member number, and Customer ********************** number listed on your identification card.  The three letter pre fix identifies which state handles your plan.  If you can provide that information, I can proceed. 
  
   
  
  Sincerely,
  
   
  
  **************
  
  Risk Analyst, Grievances & Appeals Risk Unit
  
  Regulatory Services

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩