ComplaintsforAnthem Blue Cross Blue Shield in Missouri

• Initial Complaint

  04/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am in receipt of your Audit Notice dated March 27, 2024 and I am appalled by the entirety of your demand. You accuse me of fraudulently seeking payment for prescription medications after expiration of my Anthem policy. In reality, however, I updated the pharmacy with my new insurance information. If they failed to bill the proper insurance company, that is both unknow to me and outside of my control.Further, and more significantly, your company apparently approved payment for prescription medications after my policy expired. That decision is wholly on Anthem, a voluntary choice to pay when there existed no duty to do so. I was completely unaware that Anthem was billed, and similarly unaware that Anthem chose to pay the pharmacy. For your to now suggest that I have done something fraudulent is slanderous, and the fact that you retained a collections agency before notifying me of a perceived problem is clearly bad faith. You have demanded that I reimburse Anthem more than $700, yet you fail to provide any proof that you paid anything to the pharmacy, much less the amount paid. As my medication can be purchased for far less than $700 without insurance, I again question the efficacy of your demand.Please have someone phone me to discuss this. My business card is attached.I am simultaneously sending a copy of this letter to the Better Business Bureau and may later copy the Attorney General for the State of Missouri. If payment of some form is owed, I am happy to discuss it, but I will not be harassed when the error is clearly on Anthem.

• Initial Complaint

  12/31/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  (I have a Speech Disability, I prefer email instead of talking on the phone)Complaint is not a health concern, it has to do with "Health Blue" that is part of ** Medicaid.About 1 to 2 months ago, I was supposed to receive a $10 reward (within the ***** minutes) for receiving a **19 vaccine (self-report). Couple days later, I have not receive the reward.I wanted to contact the **************** about it, I saw on the website that it gave 3 options. Option 1 was phone, option 2 was online chat, and option 3 was secure email.I chosen options 2 and 3 because of my speech disability.I did online chat and told them the issue, they refuse to look into it.I did the secure email and told them the same thing, they refuse to look into it.I then started the online grievance procedure.I explained whats going on and made sure to let them know about my speech disability.Do you know what happened next?After a while, they closed my complaint. For some reason that they thought my complaint was about the Flu Vaccine instead of the **19 Vaccine reward.Not once that they reach out to me via email about the **19 Vaccine that I never received.I just now in real time check the status of the reward, it is still missing.

  Customer response

  01/02/2024

  BBB Hipi form

  Business response

  01/04/2024

  This is not our member. This appears to be a MO ******** member which we do not handle. 

  Thanks 

  Customer response

  01/04/2024

  A year or 2 ago, I signed up for ** *************************** assigned me to "Health Blue" in which is a private company who has a contract with MO to provide ******** Coverage.

  Health Blue is run and own my the "BlueCross BlueShield Insurance ********** **** as indicated my the website.

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

   

   

  Customer response

  01/04/2024

  I was not done with the last part. I was scanning my card to submite proof that I am a member of them.

   

   

  Customer response

  01/04/2024

  I just tried to log into my account, they closed my account.

  They did not closed my account until I submitted a complaint against them with the BBB.

  They retaliated against me.

  Customer response

  01/04/2024

  UPDATE:

  I know have access to my account.

• Initial Complaint

  12/20/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Horrible/no customer service!!!! Customer service reps do not speak english. Customer service reps are incompetent and lack knowledge. I signed up with MO Blue RX Plus(PDP) member id:********* I need an ENGLISH speaking supervisor to call me!!!!! I need to set up direct debit for premiums. I need to find out why my bank account is mislabled as ‘business account.’ It is a personal account. I need to find out why I keep getting error messages and rejections when I try to add a bank account. DO NOT refer me to a customer service phone number. They are INCOMPETENT. I need an ENGLISH speaking supervisor to CALL me!!

  Business response

  12/27/2023

  December 27, 2023
  
  
  Better Business Bureau
  Serving Eastern & Southwest Missouri & Southern Illinois 
  Attention: Dispute Resolution Department
  *** ** ********* ***** ****
  St. Louis, MO 63102
  VIA Portal
  
  Member Name: ******** ********
  
  Re: Customer Service
  BBB File No.: ********
  
  
  Dear BBB:
  
  This is in response to your correspondence dated December 26, 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 ******** ********.
  
  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.
  
  ***** *****
  Grievance Analyst
  Medicare Complaints, Appeals & Grievances

  Customer response

  12/27/2023

  Complaint: ********
  
  I am rejecting this response because:
  
  Nobody from Blue Cross has contacted me!!!

  Nobody has called!!
  They need to call me.
  Sincerely,
  
  ******** ********

• Initial Complaint

  10/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  See attached

  To: ****** Life Insurance Company ATT: **** K *******
  
  From: C. ********
  
  Group Number: *********
  
  Date: October 5, 2023
  
  RE: Threat of cancellation of life Insurance Policy
  
  • • 1_. D 2023' ·-
  
  _,
  
  r -:- J 202f
  
  On September 23, 2023 I received a letter from ****** Life informing me that my life insurance payment of $13.20 was late. The letter stated that payment was due on July 1. I NEVER RECEIVED A BILL FOR MY LIFE INSURANCE PRIOR TO RECEIVING MY NOTICE TWO
  
  AND A HALF MONTHS LATER. At least four other retirees from ********* High School experienced this same problem with billing from ****** Life. While I am no expert on business and billing matters, it seems to me that ****** Life would send out a bill PRIOR to the payment date. In addition, there was no "due by" date on the letter for my "late" payment to be received.
  
  I quickly called the telephone number on the front of the letterhead only to find out that the number was no longer in service. On the letterhead! An incorrect telephone number! I finally found another telephone number for the company and called. They could not help me, but gave me another number. After a considerable time on hold, I was connected to a representative that took my payment information over the phone. I have enclosed a copy of my phone log AND a letter from your company thanking me for my payment. As I am confident that most telephone conversations are recorded, please refer to that recording on September 26 at 11:17 a.m. for 24 minutes.
  
  Imagine my surprise when I received a letter from ****** Life yesterday threatening to cancel my life insurance for non-payment. I have enclosed yet another payment, this time in the form of a check, to continue my life insurance policy. I will need confirmation that my life insurance is reinstated within a week of receiving this letter.
  
  If you have any further questions, don't hesitate to c
  
  / I
  
  ******* ********
  
  ***** **** ******* ****** *********, MO ***** *************************** ************
  
  CC: ***** ****** ********: Attorney at Law
  
  Gail Koziara Boudreaux - President and CEO of ****** Better Business Bureau of Central Ohio
  
  *******************ALL FOR AA

• Initial Complaint

  05/05/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Member ID *********. I should have dental coverage I put it on autopay in the amount of 34.00 a month. Something got messed up and they canceled my coverage for dental. I can go into my account on the website but I am unable to get any information. I was informed that I could not get reinstated for Dental coverage and that I would have to wait the following year in order to get the coverage. I have been with this insurance for four or five years and somehow the autopay did not stick and now I am without dental coverage. I would like my dental coverage reinstated as soon as possible.

• Initial Complaint

  04/13/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Received a mischarge that I would like to appeal. Attached is the EOB and my Summary of Benefits. On page 3 of Summary of Benefits, it states that In-Network visit is a $75 charge. We received a bill for almost $300. I would also like to point out that I visited the same Urgent Care a month prior and paid cash without insurance for the exact same type of visit. The Urgent Care confirmed the visit cost out of pocket is only $125, yet on your statement I see that is says its a $327 for the exact same visit. While I understand that Health insurance providers and hospitals have negotiated rates, I would not think that it would cost 3X for the exact same treatment. I find this to be an error or very immoral and unethical. If I am paying over $800 to protect my family with your insurance, how do you get to turn around and charge me 3X for the same service? Finally, if you are not willing to modify the balance due, I would like to request that this NOT be submitted through insurance so I can pay them directly. In addition if this is not found an error, I will be opening up a Better Business Bureau claim as I find this to be unethical and immoral for working families that pay high amounts for good medical coverage to be price gouged and charged 3X more than what the Urgent Care would charge for a cash payer. I would like the resolution to be that I pay the $75 that me Summary of Benefits states for In Network Urgent Care.

  Business response

  04/28/2023

  Better Business Bureau
  ** ******** *** ******** ** *****
  
  RE:     Member Name:       **** *********     
              BBB Case ID #:       ********
              Anthem Case #:      **************
  
  
  Dear Dispute Resolution Team:
  
  This letter is in response to your recent inquiry concerning the above case.
  
  Thank you for submitting a completed Member Authorization Form.  According to the complaint filed by Mr. **** ********* on behalf of Ms. **** *********, the member stated they received a mischarge that they would like to appeal regarding urgent care services provided on January 16, 2023.  The member stated that on page three (3) of the Summary of Benefits, it states that an In-Network visit is a $75.00 charge, and the member received a bill for almost $300.00.  The claim number is ************* and the total billed charges are $327.00.
  
  In response to the member’s concerns, we first reviewed Anthem Case Number APP-COMM-1569873.  On March 28, 2023, Anthem received an online appeal from Ms. **** ********* regarding the benefit coverage for the urgent care services provided on January 16, 2023.  On April 26, 2023, an appeal response letter was mailed to Ms. ********* stating in part that:
  
  “We've finished reviewing the first-level appeal for your claim *************. You requested that we review the cost share for your urgent care provided on January 16, 2023, by Mercy-GoHealth Urgent Care.
  
  We have sent the claim to be adjusted on April 26, 2023, to be processed with a $75.00 copay per your benefits. Please allow 30 business days for adjustment. Once adjusted you will receive a new explanation of benefits showing the adjustments.”
  
  I hope this additional information is helpful.  Thank you for allowing us the opportunity to address this concern.
  
  Sincerely,
  
  ******* ****** **** ******* ********** *** ******* ********** ****

• Initial Complaint

  02/04/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  February 4, 2023 Re: ******** ***** (DOB **********) ID: ************ Claim : *************  On December 18th, 2022, My son ******** ***** went to the *** ****** Urgent Care located at *** ****** ******** ******* ******** *****. This urgent care was located in the Anthem Blue Cross Blue Shield ****** app under the “Care” tab and then “Urgent Care Settings”. I have been receiving bills from Anthem stating it was an Emergency Room visit, and letter’s from *** ****** stating they are working with Anthem to bill it correctly as an Urgent Care visit. Please see the documentation attached to this letter with a copy of ********** Urgent Care Discharge instructions, the screenshot of the *** ****** Urgent Care location listed in the Anthem ****** App, and letters received in the mail from *** ******. Thanks You, ******** ***** **** ***** Forest ** ********* ** ***** *********************** *** *** **** 

  Business response

  02/07/2023

  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,
  
  ******* ****** ********** *** ******** **** ******* ********** ****

  Customer response

  02/13/2023

  See attached

  Business response

  02/15/2023

  Dear Dispute Resolution Team:

   

  This letter is in response to your recent follow-up 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 Anthem’s Member Authorization Form was submitted with this complaint; however, it was blank and does not meet Anthem’s Enterprise Guidelines.   The complainant will need to complete the 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,

   

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

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

• Initial Complaint

  11/03/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have ******* for my medical insurance coverage, I just used it at the doctor and everything went through as it should, however I continue to get Welcome letters from Blue Cross Blue Shield thanking me for using them for my insurance needs. I called the number on the new card they sent and got a runaround, they tried then to sell me auto insurance. I did not sign up with this company nor did I give authorization to be switched. They will not assist me in getting the issues resolved and to stop changing my plan without my knowledge.

  Business response

  11/09/2022

  Please find the HIPAA response: Medicare Complaints Appeals and Grievances (MCAG)
  Mailstop: ***********
  4361 Irwin Simpson Rd.
  Mason, OH 45040
  Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New
  Hampshire, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM
  is a registered trademark of Anthem Insurance Companies, Inc.
  **************** ********** *************
  November 8, 2022
  Better Business Bureau
  Serving Eastern & Southwest Missouri &Southern Illinois
  211 N. Broadway, Suite 2060
  St. Louis, MO 63102
  Email: [email protected]
  Member Name: ******* ******
  BBB File No*********
  Dear BBB,
  This letter is in response to your correspondence dated November 3, 2022, regarding the above
  referenced member.
  Due to federal laws pertaining to the Healthy Insurance Portability and Accountability Act
  (HIPAA) and the Protected Healthy 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 ***** *******
  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 at ************************************
  Sincerely,
  ******* ******** Grievance Analyst II
  Medicare Complaints, Appeals and Grievance

• Initial Complaint

  04/18/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I put in for a reimbursement 10 days ago and only got back what was on my eob when I had to pay out of pocket for my frames making the total amount ******. The agent on the phone tried to say I was lying and kept saying she was getting a manager and really just keep stringing me along. I need my hra reimbursement. I have submitted all my receipts and eob proving the amount I paid

• Initial Complaint

  12/12/2021

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I had inpatient ankle surgery at *** ****** **** hospital on 25 March and was released on 26 March. Anthem preapproved the surgery as in network and agreed to pay costs over multiple days. Now they say it is out of network and outpatient. I have spoken to numerous people on the phone. All gave contradictory wrong information. I have a debt in collection to the hospital that they need to pay but are refusing. I sent them all the attached information a month ago, and two weeks later they said they needed it again. They have had 9 months to make this right and gave refused. My next step if this doesn't work will be to take them to small claims court.

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