ComplaintsforAnthem Blue Cross and Blue Shield of CT
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Complaint Details
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Initial Complaint
05/22/2023
- Complaint Type:
- Billing Issues
- Status:
- Resolved
Anthem refused to pay a dental bill that was covered under my dental plan. I have Medicare Part C with this company. They insist on telling me that my dentist is out of network when he is listed as a provider on their website that I log into with my personal information. There is a discrepancy between Anthem and their dental provider, *******. ******* does not have this dentist listed as a provider. Anthem is refusing to log in with my account information to see that they list Dr. ******* ***** as a provider. They are refusing to acknowledge that there is a clerical error and that the providers for the two companies do not match. I have printed out the pages that show that Dr. ***** is listed on their website in my account login. They are refusing to look at the papers that I sent to them. I filed a grievance with Anthem twice. I paid the bill in the meantime.Business response
05/24/2023
*** *** **** ****** ******** ******* **** ********** ****** ********* ** ****** **** ********* ** ***** **** ****** ****** ****** ***** ***** *********** *** ****** ***** ****** *** **** **** ******** **** ****
This is in response to your correspondence dated May 22, 2023, regarding the above referenced member.
Due to federal laws pertaining to the Health Insurance Portability and Accountability Act (HIPAA) and the Protected Health Information (PHI) portion of it that went into effect April 14, 2003, we cannot relinquish information without proper authorization. Therefore, we will be addressing the concerns in question and responding directly to Mr. ***** ***********.
I trust that the information provided will aid in resolving your concerns and want to thank you for the opportunity to assist you. Should you have any additional inquiries, please do not hesitate to contact me by email at *******************************
Thank you for your concern.
Julie B****
Grievance Analyst I
Medicare Complaints, Appeals & GrievancesCustomer response
05/24/2023
Complaint: ********
I am rejecting this response because:This is an attempt by Anthem to dispose of the matter quickly. This is the only thing they are interested in doing. They are persistently refusing to accept responsibility for an error that they made with their publicly posted documentation.
Sincerely,
***** ***********Business response
06/05/2023
**** ** **** ****** ******** ******* **** ********** ****** ********** ******* ********** ********** ** ****** **** ********* ** ***** **** ****** ****** ****** ***** ***** *********** *** ****** ***** ****** *** **** **** ******** **** ****
This is in response to your correspondence dated May 22, 2023, regarding the above referenced member.
Due to federal laws pertaining to the Health Insurance Portability and Accountability Act (HIPAA) and the Protected Health Information (PHI) portion of it that went into effect April 14, 2003, we cannot relinquish information without proper authorization. Therefore, we will be addressing the concerns in question and responding directly to Mr. ***** ***********.I trust that the information provided will aid in resolving your concerns and want to thank you for the opportunity to assist you. Should you have any additional inquiries, please do not hesitate to contact me by email at *******************************
Thank you for your concern.Julie B****
Grievance Analyst I
Medicare Complaints, Appeals & GrievancesCustomer response
06/05/2023
Complaint: ********
I am rejecting this response because: Anthem keeps saying the same thing over and over again. They refuse to look at their own website to see that Dr. ***** is listed as a provider. I know that ******* does not show Dr. ***** as a provider. The two companies are giving different information. Anthem shows that Dr. ***** is a provider for *******. ******* does not have Dr. ***** listed. I don’t know how many times that I have to repeat this. It is as though I am dealing with a bunch of children. I have middle school students who aren’t as thick as these people are. It’s not about the money. I already paid the bill. I am trying to get through to a bunch of stubborn bureaucrats.
Sincerely,
***** ***********Customer response
06/22/2023
Dear Stu,
Anthem finally paid Dr. ******* ***** the amount that was owed to him by Anthem. Dr. ***** refunded the amount that I paid to him earlier.
I realize that I had made a couple crude remarks about Anthem's service in the process of making the complaint. I felt that this was necessary to get them to notice that there was a problem with the way that they had been responding to my several previous polite complaints.
Thank you for your help.
*** ***********
Initial Complaint
01/11/2023
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
I have been with this insurance provider since 1/1/23 and need to find a doctor who could see me and refill my medication. I keep getting a list of doctors from the in network that have all of the phone number not really of the doctor's office... some numbers are of hospitals that don't even know who the doctor i am calling about is. I have been trying to get this medication refill for 11 days now and am about to give up. The insurance keeps giving me useless doctor lists.... all the information is outdated or never have been corrected at any time in the past. this is a health issue.... and i am spending a lot of time on the phone calling numbers that are wrong.... instead of getting help this is making me feel terribly worse. this insurance company needs to be liable for this. i am sure all other patients are experiencing the same problem. No wonder suicide rates are high.... even for people who can afford health insurance without subsidies are still subject to his stupid system and sudo health insurance companies that just want profits and care very little for their clients. I will do everything in my power to make the pay for this.Business response
01/12/2023
Dear Dispute Resolution Team:
This letter is in response to your recent inquiry concerning the above case.
Based on the federal regulations of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to answer your inquiry without the specific authorization and release of the complainant. The Better Business Bureau is not considered a Regulatory Agency and is therefore, required to provide a copy of the HIPAA authorization with the inquiry to our office.
A copy of a BBB Authorization to Release Health Information form was submitted with this complaint; however, it does not meet Anthem’s Enterprise Guidelines.
A valid authorization must include the following components:
· Member name
· Member identification number
· Member date of birth
· Member address
· Full name of the party who is authorized to act on the member’s behalf
· Clear indication that the party is authorized to file an appeal/grievance on the member’s behalf
· Date(s) for which the authorization applies
· Legible member signature
The complainant may go to ***************************** and download a "Member Authorization Form" so that we may provide the BBB with information regarding his/her complaint.
We regret we are unable to provide any further assistance to your office. However, federal regulations, including those applicable to any of the new Health Care Reform regulations prevent us from releasing any further information to a non-authorized designee.
Thank you for allowing us the opportunity to address this concern.
Sincerely,
Paige M.Initial Complaint
09/24/2021
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
My daughter has a ******* ********* and two of her doctor’s have written notes stating that continued care with her out of network exception provider was medically necessary. Anthem has not resolved this issue despite many phone calls, doctor’s notes etc. we switch from ****** who understood the importance of my daughter receiving care from the provider she had been seeing since she was 14 weeks old. It has been nothing but frustrating continuously getting the run around. It is criminal to be denying services to a 4 year old child with a medical diagnosis.
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Customer Complaints Summary
20 total complaints in the last 3 years.
5 complaints closed in the last 12 months.