ComplaintsforAnthem, Inc.

• Initial Complaint

  07/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My son was covered by Acentra Health and had a prior authorization that was Administratively Approved on ******** ***************** Services) before being moved, at no request of parents, to Anthem ******************************* Services that were being provided by Acentra are now being denied by Anthem although my son still has same conditions that he was previously approved for and the approval ran through 8/30/24. I have been arguing and trying to get services reinstated since June 26th, 2024 since he's approved through August 30th, 2024. I have filed a grievance and an appeal which were both ignored/denied. I have been seeking legal council and asked for mediation with no resolve.

  Business response

  07/24/2024

  Good afternoon, 

  We were unable to locate this member in our system.  Please provide the member's identification number, including the three-character prefix.  This information may be found on the member's health plan identification card.

  Thank you,

  ********************

   

• Initial Complaint

  07/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  ell Point is by far the worse insurance, unprofessional, unorganized insurance company Ive ever seen. How is this even possible that not once but twice at different dates they dont have the needed Authorization that were emailed to them with proof provided and they still dont right their wrong. Im definitely switching and will continue to tell people how horrible well point is. We are waiting on an urgent authorization to have a family go into a rehabilitation program for needed safety and physical therapy. Again they dont have the authorization that takes anywhere from ***** hrs for approval. Last time it took two weeks to straighten this out and now on this 24 hr period they dont have the needed pending authorization that was emailed to them from the facility. If this family falls being safety then what? Another hospital stay possibly another surgery. Trust it will definitely be an attorney involved because well point doesnt care about the clients

  Business response

  07/22/2024

  Good afternoon, 

  Please provide the name and identification number of the member, including the three-character prefix.  This information may be found on the member's health plan identification card.

  Thank you,

  ********************

   

• Initial Complaint

  07/17/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I keep getting letters from them addressed to my husband ********************* and he's been dead for nearly 8 years. I have repeatedly asked them not to send me this stuff, via ******** messenger, email and last month I even mailed the letter to them with my personal request that they stop sending me this stuff (in June). Now I get another sales letter addressed to my husband again this month to sign up for ********* I just want it to quit. Do I need to be reminded all the time that he's gone? Please have them remove my address from their system. He never had their insurance and I moved here after he died so he never lived here. I have tried everything. You are my last hope.

  Business response

  07/17/2024

  Please be advised member authorization is needed before we can address the member's concerns. Please refer to attached letter. 

  Customer response

  07/18/2024

  My dead husband is not a member. This is regarding their sales letters that they keep sending to my address. He passed away almost 8 years ago. My address is ***********************************************. His name is ********************* and he passed away. He did not have their insurance. He never lived at this address. This is my address. Their response appears to be like they never read my complaint. What do I need to provide? I don't have a member number for their company. I never had their insurance. My husband had united health for ********

  Customer response

  07/22/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Provide details of why you are not satisfied with this resolution.]

  My dead husband is not a member. This is regarding their sales letters that they keep sending to my address. He passed away almost 8 years ago. My address is ***********************************************. His name is ********************* and he passed away. He did not have their insurance. He never lived at this address. This is my address. Their response appears to be like they never read my complaint. What do I need to provide? I don't have a member number for their company. I never had their insurance. My husband had united health for medicare
  
  Regards,
  
  *******************

  
  

  Business response

  07/23/2024

  Without written member consent we cannot address the member's concerns. Refer to previously sent letter. 

  Customer response

  07/25/2024

  No they did not address my concerns. The address they are sending their sales letters is mine. I don't understand why they can not take my permission to remove my address from their system. My husband is dead. He is not going to need their insurance and I want my information removed from their system. If I receive another letter, I will proceed to further action.

  Customer response

  07/25/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Provide details of why you are not satisfied with this resolution.]

  No they did not address my concerns. The address they are sending their sales letters is mine. I don't understand why they can not take my permission to remove my address from their system. My husband is dead. He is not going to need their insurance and I want my information removed from their system. If I receive another letter, I will proceed to further action.
  
  Regards,
  
  *******************

  
  

• Initial Complaint

  07/16/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  WellPoint, formally Amerigroup, a private ************** contractor, is required to subsidize 100% of all co-pays due as a result of a ******** claim. Amerigroup/WellPoint failed to remit Cross ************** a $1590.00 copay for an impatient claim of mine. Texas requires prior dispute resolution on all contractor claims prior to taking administrative action. The BBB qualifies as a Texas Attorney General partner, and therefore qualifies as an acceptable dispute resolution process. Cross ************** indicates that since Amerigroup/WellPoint failed to remit the co-pay, I must now remit the co-pay, even though I had coverages with Amerigroup/WellPoint to satisfy that co-pay. I am requesting that Amerigroup/WellPoint remit $1590.00 to Cross ************** in my behalf to settle this compulsorily outstanding debt. I filed a BBB Complaint against Amerigroup, but no answer was returned by the trade. The BBB officer commented that I can file the Complaint in the name of the new parent company WellPoint, based on possible uncorrected contact information of Amerigroup.Original BBB Complaint #********. CMS guidelines state that all QMB ******** providers WILL pay ALL co-pays for dual eligible members. ******************************************************************************************************************************************************************************************************************************************************************************************************************************* ******************************* XXX-XX-7752 ************ ************************************************************************

  Business response

  07/18/2024

  Good afternoon,

  We were unable to locate this member in our system.  Please provide the member's identification number, including the three-character prefix.  This information may be found on the member's health plan identification card.

  Thank you,

  ********************

  Customer response

  07/18/2024

  Anthem is the parent company of WELLPOINT/Amerigroup. The date of service is 02/13/2023 Cross **************. ************************ paid the entire hospital stay bill, leaving a co-pay balance of $1590 for the dual ******** provider to pay (Amerigroup was the dual ******** provider on the date of service at date of service). ******** Acct# *********, ******** Acct# ********. I have attached a copy of the Texas rules for dual ******** providers regarding their co-pay obligations to their dual members. The hospital claims that they billed Amerigroup for the $1590, and unfortunately never received payment. Amerigroup in ***** has been sold to WELLPOINT/Anthem, but they are still responsible for all co-pays related to the date of service. I request that this trade pay in full the $1590 to Cross ************************, ******

  The 3 elements are present to warrant relief on this matter:

  1.  I was a dual member of Amerigroup ******** at the time of service

  2.  Amerigroup is liable for the co-pay balance, as the Texas ******** contractor (attachment links of Texas dual eligibility rules posted in original Complaint)

  3.  Amerigroup was billed timely by the hospital in good faith, and are eligible for payment under my insurance plan and Texas ******** guidelines

  BBB Please share this reply with the trade WELLPOINT/Amerigroup, it has all the information they will need to process a payment in my behalf. I have included as an attachment the hospital bill and balance due Amerigroup.

   

  Thank you,

   

  *******************************

  Customer response

  07/18/2024

  Here is evidence that Amerigroup accepted dual ******** status as early as 2021. This is a valid medical services contract, and full acceptance of all Texas ******** rules, and monetary liability from Amerigroup to pay all outstanding co-pays until 04/23, the date of termination of services.

  Customer response

  07/18/2024

  Hi: I am no longer a member of Amerigroup, and do not have a current ID card with that prefix number they desire. I did however submit my ******** and ******** numbers on the BBB Complaint, which is a cross reference to the trades account proprietary member number. CMS indicates that the providers host the ******** accounts based on the ******** number, and therefore have a lifetime cross reference to a proprietary member number of the company's choice. In plain words, my social security number or ******** number will be associated with their member number, and should be crossed referenceable. My SSAN is XXX-19-7752.

  If the trade is serious about concluding this Compliant, I would be very glad to reach out to them, or have them contact me concerning more information that is available to resolve the issue.

   

  Thank you BBB

   

  *******************************

  Business response

  07/25/2024

  Per review of Amerigroup / Wellpoint records, ******************************* was no longer eligible after 10/31/2022.  This means that she was not active on the date of service 2/13/2023.  The health plan cannot pay for charges if the member is not active.  Please note that we did not receive a claim from Cross Creek Hospital.  

  The patient will need to consult with ******** if she was on another health plan at the time of service, 2/13/2023.

  Thanks,

   

  Monica 

  Business response

  07/25/2024

  Good afternoon,

  The member's concerns have been forwarded to Wellpoint of Texas. They will reach out to the member directly.

  Thank you,

  ********************

  Customer response

  07/25/2024

  Better Business Bureau:
  
  I have received a response from the business. They indicated that they will be attending to the debt. We are waiting for them to make the payment to ******************** before we close out. There intentions are good though.

  Once the payment is made we will close out the Complaint. 

  Thank you BBB!!!

  
  [Provide details of why you are not satisfied with this resolution.]
  
  Regards,
  
  *******************************

  
  

  Customer response

  07/25/2024

  If this assumption is correct, ***************** would be responsible. I will have to check dates of coverage verses date of service. If they are correct, we received incorrect information from *****************. As such, I have no problem with taking a leap of faith and closing this complaint out and adding ***************** as the Respondent. Strange how ***************** directed us to Amerigroup for relief, clearly a unfair and unscrupulous business practice. BBB, please close this Complaint out without any further interactions. I will use the BBB system to add a Complaint of *****************.

  Thank you BBB

• Initial Complaint

  07/09/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The above company has a prigram with cigna to do a home health visit in exchange for a $100 gift card. I scheduled and lost time and money by making time for this appointment. Now BCBSA is sating only some of the plans are eleigible and the letter I recieved was old information. ***** the nurse that came and the letter from Blue Cross said I would receive this. This false adverting at minimum, insurance fraud at the most

  Business response

  07/10/2024

  Good morning, 

  So that we may direct your inquiry to the appropriate area, please provide the member's Identification number, including the three-character prefix.  This information may be found on the member's health plan identification card.

  Thank you,

  ********************

   

• Initial Complaint

  06/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Anthem refuses to pay for PT. Then they refuse to pay for MRI, because no PT. I had to pay 2 MRI for hip and cspine myself, cash price so can't file a claim, almost $1000. Hip was extremely bad and replaced. Cspine also very bad, 4 level fusion. After fusion Anthem still refuses to pay for PT, have to pay out of pocket cash price so again cannot file claim. Anthem still refusing to pay!! Nonsense gobbledegook on the statement of benefits - "PT to have tape placed on skin not medically necessary" when the referral is for bicep tendonitis and moderate lumbar stenosis - no human wrote this, it is that stupid and incomprehensible. ******** says no preauth needed, then when they refuse to pay it's because no preauth. Shame on Anthem for not helping, about to lose job because can't get PT to walk.Phone number for help goes to provider support, where theycannnot do a single thing, but ********** to a member for 5 min "as a courtesy". Phone tree options are for dental care, building healthy families, or pharmacy help ONLY. Reps will disco call after holding for half an hour - this happened numerous times while I was sitting with business manager trying to get sorted out. Insurance broker also could not help, got frustrated, and told me to use ****** and do my own PT. ANTHEM IS SHAMEFUL AT EVERY LEVEL. A NAME CHANGE WON'T HELP.

  Business response

  07/01/2024

  We are unable to locate the member in our system. We need the members identification number complete with the three letter prefix.

  Thanks,

  *****

  Customer response

  07/01/2024

  AZL097342823 is my member ID

  Business response

  07/11/2024

  Good afternoon, 

  Please see the attached letter.

  Thank you,

  ********************

• Initial Complaint

  06/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In 2023, I had medical insurance coverage from Anthem Blue Cross Blue Shield for my whole family as a family plan (me, my wife **** and my son ****). On 12/12/2023, my wife had a doctor visit and we were still covered by Anthem BCBS. The doctor's ****** filed the claim on 12/25/2023 (claim #*******BP9531) and it was approved. The insurance paid on 1/8/2024. On January 2024, we changed health insurance to BCBS of ********** through my wife's employer and again as a family plan. Then on 5/2/2024, Anthem BCBS denied payment of my wife's claim for her doctor visit on 12/12/2023 claiming that we had another insurance through my wife's employer. Our insurance through my wife's employer only started on January 1st, 2024. We also talked to her new insurance and they clearly said Anthem is responsible because the doctor visit date falls under their coverage time period.I've called Anthem and discussed with various person 3 times over the last 3 months and every time I'm getting the run around and vague explanations claiming we had another coverage. I offered to send them our new health coverage insurance so they see dates of coverage and Anthem representatives just ignore my suggestion. In my last call 5 weeks ago, they said they would re-evaluate the case and get back at me. I heard nothing from them.Anthem is liable for the doctor visit on 12/12/2024 but they refuse to fulfill their obligation. We are getting the runaround and vague excuses every time I call them. The doctor ****** is now sending us again a bill for Anthem's unpaid cost and Anthem just ignores the whole obligation, trying to wear us down.What good is a health insurance if they refuse to pay normal doctor visits? Anthem is very sleazy. They owe the doctor $251.21.

  Business response

  06/27/2024

  Good afternoon, 

  Please provide the identification number, including the three-character prefix, for the policy that was in effect on the date of service in question.  In addition, please provide the identification number for your new policy.     

  Thank you,

  ********************

  Business response

  06/27/2024

  Good afternoon, 

  Please provide the identification number, including the three-character prefix, for the policy that was in effect on the date of service in question.  In addition, please provide the identification number for your new policy.     

  Thank you,

  ********************

  Customer response

  07/01/2024

  As requested:

  Old policy: held by ******************************* as employee of ************ (Anthem BCBS, 1/1/2023-12/31/2023): Member ID: ************ 

  New policy: held by ************************* as employee of *********** (BCBS **********, 1/1/2024-12/31/2024): Member ID: ***************

   

  Customer response

  07/02/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Provide details of why you are not satisfied with this resolution.]

  As requested:

  Old policy: held by ******************************* as employee of ************ (Anthem BCBS, 1/1/2023-12/31/2023): Member ID: ************ 

  New policy: held by ************************* as employee of *********** (BCBS **********, 1/1/2024-12/31/2024): Member ID: ***************

  
  Regards,
  
  *******************************

  
  

  Business response

  07/05/2024

  Please be advised member authorization is needed before we can address the members concerns. Refer to attached letter. Thanks

• Initial Complaint

  06/21/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I get yearly physical which ******** does not cover, My former employer pays premiums so that I have coverage form Anthem.In 2022 and ********************************************************** advance. I submitted a paid bill to Anthem for the physical and chest xray , 1/11/2024 Anthe ID ************. All these months later, I cannot get paid even though all agents agree I have the required coverage.I allege fraud on the part of Anthem! I have tries to work with them six times , submitted anything they asked for. No one is willing to give me a straight answer. There is always a reason to resubmit, but it never gets resolved. They are stealing from me plain and simple. I want them to cut me a check for 270 and look into others that have the same problem(fraud)Yours truly ***************************

  Business response

  06/25/2024

  please be advised authorization is needed prior to us being able to address the members concerns. Refer to attached letter.

  Thanks

  Customer response

  06/25/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Provide details of why you are not satisfied with this resolution.]
  
  Regards,
  
  ***************************
  

• Initial Complaint

  06/21/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Anthem denied me coverage of the prescription drug wagovy last year, because they said i was not diabetic and needed the prescription for weight loss. So this year,i was prescribed zepbound for weight loss, and again they refused to cover my prescription, even though i filed a grievance and gave them access to my health needs. When i called to get information on my grievance case, they could give me none and suggested i file a new grievance, after being put on hold for 45 minutes. So i decided to cancel my insurance because it was not covering my needs. I was told that i could not cancel it, to call marketplace and the lady got very hateful and hung up on me! I called back and finally got someone to cancel my policy. I guess i will use my premium money to pay my out of pocket costs for the medication i need. If the *** approves a drug for use, then how can insurance deny coverage.....they are NOT the Doctor!

  Business response

  06/25/2024

  Please provide the member's identification number, including the three-character prefix.  It can be found on the member's health plan identification card.

   

  Thank you,

  ********************
  

• Initial Complaint

  06/17/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I obtained preauthorization for the purchase of a Durable Medical Goods Device, and was told it would be covered at 90% of the cost, after I submit a claim. I have provided all of the paperwork (multiple times) yet Anthem keeps making errors & changing their reasons for not sending my reimbursement to me. The original call was made on Nov. 28, 2022, interaction # I-839-*****. The original Date of service claim was for 12-01-2022. After numerous appeals w/ all of the Anthem reps. agreeing I am due reimbursement, Anthem finally sent a check to my Medical ****************** IN ERROR, as the dr.'s office did not provide the **** so they cannot accept the money due to me, the patient. After a total of over 20 calls to Anthem, 7 calls to my ************* & 5 calls to my employer's Insurance Benefits Specialist, all taking place over a year and 1/2, I still have not received my reimbursement, & just received a letter from Anthem, saying they are asking my doctor for more information re: my claim! Anthem has already agreed to pay the claim, yet they have not sent it to me for over 18 MONTHS! Their policy states that their appeals process is normally completed within 60 DAYS! My employer's Insurance rep said they've had a lot of trouble w/ Anthem not handling claims correctly.

  Business response

  06/18/2024

  Good morning, 

  Please provide the member's identification number, including the three-character prefix. This information may be found on the member's health plan identification card.

  Thank you,

  ********************

  Customer response

  06/20/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Provide details of why you are not satisfied with this resolution.]

  Member ID # ************
  
  Regards,
  
  *************************

  
  

  Business response

  06/27/2024

  please see attached Plan response

  Customer response

  07/16/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 

  ANTHEM HAS AN "F" RATING W/ the BBB! (The lowest possible.) Anthem preauthorized my purchase of a DME device at 90% coverage, so I purchased it.  Then Anthem said they approved it in error, yet at least 4 different Anthem representatives (w/ them involving supervisors) each said that they would try to get this resolved & covered, since it was preauthorized & ANTHEM'S ERROR.  Finally, after over 20 phone calls due to lack of promised follow-up on Anthem's part, they sent a pymt. to my dr.'s office in error. Then they had to retrieve the funds...& now they're trying again to say they're not reimbursing me, even though several of their employees have assured me that I would be reimbursed!!!  This is horrible customer service, & they have spent more $$ in staff hours than the cost of the original claim!  How can they keep promising to pay me, & then keep changing their mind...over a period of almost 2 years?!?  We pay them nearly 4 times the **** of the claim EVERY MONTH in premiums...yet they are trying to avoid paying for what they originally authorized!  I will be contacting the ******* Gov. ****** of Insurance to file a complaint as well, & will submit a write-up to ************************* to let all of their millions of readers know of Anthem's "F" rating w/ the Better Business Bureau. 
  
  [Provide details of why you are not satisfied with this resolution.]
  
  Regards,
  
  *************************

  
  

*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. ↩