ComplaintsforAnthem Blue Cross and Blue Shield of Virginia

• Initial Complaint

  06/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Ive been a member of Anthem (ID: ************* since January 2022. I experienced issues immediately with them denying all claims because they wouldnt accept that I no longer had *****. Now I am having a dispute with Bon Secours where theyre charging me for 2 separate CTA Scans from 01/18/24 even though it was 2 just anatomical sites scanned in the same encounter. Ive been told that Bon Secours billed and Anthem processed the claim correctly, however, this is clearly not the case because they originally charged me for 3 separate scans and when Bon Secours removed one my patient responsibility decreased. Anthems own estimates also show that the 2 are being added together, and for some reason, my estimate was higher than my husbands despite us being on the same plan, and having already met my deductibleAMA Ethical Guidelines state that I should only have to pay for 1 scan, and since Bon Secours is refusing to comply Anthem should be advocating for me but they couldnt care less:***********************************************************************

  

  Business response

  06/25/2024

  Good afternoon, 

  Please see the attached letter.

   

  Thank you,

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

  Customer response

  06/25/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have attached the requested Designation of Representative/Authorization Form.

  Please forward this document to Anthem.

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

  
  

  

  Business response

  06/28/2024

  Good afternoon,

  Please see the attached letter.

   

  Thank you,

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

   

  Customer response

  06/28/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  Anthem is claiming that I reached my maximum allowed after the first charge - meaning that I would be, in effect, only seeing final charges for the head. However, I spoke with an Anthem representative recently who stated that although EOBs are written that way for simplicity, all charges are considered in tandem when calculating the maximum allowed amount. I believe this is the case because:
  

  1. My patient responsibility changed when the brain scan was removed.
  2. Anthems pricing tool shows $309.25 as the allowed amount for a CTA of the head at ****************** and a range of $792-$1,018 for a CTA of the neck (it would not populate for this provider). Therefore, the $1,387.87 total is clearly the sum of 2 scans together.

  Again, the **************************** publishes ethical guidelines on CT Scan bundling which were developed by the Centers for ******** and ******** Services and state that patients should only be charged for 1 scan if multiple anatomical sites are scanned during a single encounter (they use the example of the abdomen & pelvis, see link below). It's my understanding that the majority of insurance providers use the *** standards as a baseline. It's Anthem's responsibility as my insurance provider to protect me from being overcharged for these services.

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

  P.S. - The advice about Imaging Centers is not relevant because the test has already been completed. My doctor also explained that they sent the order to ****************** because most Imaging Centers don't accept insurance and/or aren't able to do certain procedures. I need a practical solution for this instance, not just suggestions to prevent future issues.

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

  
  

  

  Business response

  07/09/2024

  Good afternoon, 

  Please see the attached response.

  Thank you,

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

  Risk Analyst

   

  Customer response

  07/09/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint. Anthem admitted that my patient responsibility changed when the scan for the brain was removed, however the previous EOB was showing the same as the new one - that I had reached my maximum allowed with the scan of the head. If that was the case, the total patient responsibility shouldn't have decreased. They also failed to explain why their pricing tool shows a maximum of about $309 for that procedure code at that same facility (which is comparable to Bon Secours's estimate of $485), yet I am being held responsible for $1,388 (not including the reading of the scan). I stand by my assertion that the only explanation I can find is the total is indeed being affected by the 2 separate scan charges, which also was confirmed by an Anthem representative named ******* on 06/14/24. $1000+ is not a reasonable margin of error; Anthem needs to continue their investigation until they come up with a legitimate resolution.

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

  
  

• Initial Complaint

  05/09/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  We have an active ********************** policy for our entire family. My daughter gets daily injections which are prescribed by her doctor. ********************** uses CarelonRx specialy. When we contact ********************** to get her prescriptions refilled they tell us to contact the pharmacy. ******* says that she is not active with them and to talk to **********************. They do this repeatedly and no one from ********************** speaks to ******* and vice versa.

  

  Business response

  05/09/2024

  Good afternoon, 

  We were unable to locate the member in our system.  Please provide the member's identification number, including the three-character prefix.

  Thank you,

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

  Customer response

  05/09/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  I have attached copies of my daughters active ID card and information from the Anthem website that she is active. 

  Whenever we call CarelonRX they say we need to call member services because on their system she is not active. CarelonRX and Anthem refuse to coordinate their information in order for my daughter to get her necessary medication. 
  
  Regards,
  
  ***************************
  
  
  
  

  
  

  Customer response

  05/09/2024

  Member ID number is ************

  Name is ***********************;

  Date of birth is 1/27/2012

  

  Business response

  05/15/2024

  Member authorization is required to address the member's concerns.  Please refer to the attached letter. 

• Initial Complaint

  03/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have medical insurance with **** through my employer. My family uses the **** coverage exclusively. Many times I receive my medical treatment through the VA. As a service disabled veteran I find it more comfortable to receive care this way. When I am treated by the VA or they refer me to the Community for care the VA has a billing process where they will bill my primary healthcare (****). **** will not actually be required to make payments but any amounts processed will offset my deductible. Since May 2023 **** has continually denied many of these bills. For example I had a CT Scan denied that was ordered by the ER physician. I also had a bone stimulator device that the VA provided for a bone broken that had not healed in nearly two years. I have called to speak to our **** "advocate" several times but each time our "advocate" was not available and I spoke to whomever was available. I have inquired why these claims are taking so long and how can we expedite the reviews and make it more visible. It seems to be that the default is to deny and see if the VA will resubmit. I have also spoken with the VA and they assure me that they are doing their best but **** is spring loaded to deny. The effect this has is my deductible is not met and I spend more and more money out of pocket. I am hoping that by filing this complaint that **** can be nudged to be more reasonable on processing times and more transparent on how I can help the process with **** being less evasive. As a 30 year veteran I am able to follow orders, but the current process is too "secret". I am also requesting that when the claims are finally applied to my deductible that I be refunded any overages based on date of treatment. **** is incentivized too much by dragging their feat and not making this process clearly defined.

  

  Business response

  03/25/2024

  Please be advised that member authorization is needed in order for us to review the members complaint. Refer to attached letter. 

  Customer response

  04/08/2024

  In further looking at the case on your portal I see that I missed a hyperlink when reviewing this matter.  I am hoping we can continue to look at this matter.  If I need to I can refile a complaint.  I filed the complaint in the first place because I could not get anywhere with BCBS so I solicited the help of the BBB.  In the past the BBB has been very helpful.  I did not expect to need to fill out a DOR form.  This continues the theme of BCBS being very difficult to work with.  In any event please find attached signed DOR form.  I am attaching the last note from your office to help you find the correct case.  Thank you in advance.

   

  

  Business response

  04/12/2024

  Refer to the attached letter.

• Initial Complaint

  03/11/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Inadequate dental provider information. Database needs to be edited because many providers no longer accept Liberty Dental Plan. Many alledge Anthem is a slow payor and denies most claims. In need of extraction and in pain and could not find a single doctor in network to provide services. Have to come up with cash to see a dentist. Truthfully, Anthem Healthkeepes are a major disappointment. If there was a way to get the government to dump this plan I would request it.I intend to file a formal complaint with the state of Virginia and with overseers on the Federal level. BBB is taking government money and provide poor quality healthcare.

  

  Business response

  03/12/2024

  In order to review this member issue, we need the member identification number to include the three-letter prefix. 

• Initial Complaint

  03/05/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I spoke to the Virginia Marketplace (**) & with Anthem regarding the cancellation of my insurance. The rep with the ** told me the cancellation date was 2/29. I called Anthem & talked to ***** ****** referred me back to the **. I'm appealing the date of 2/29 bc my husband was interviewed on 1/5 with ******* & was told there was a 90 waiting period on health ins. My husband was offered a job on January 16th, & started on January 29, my ** **** was paid on 1/16. Sometime between the job ************** husbands start date, *******" was bought out by "First Call Mechanical". HR contacted him on 2/5 that he was eligible for ins. as of 2/1. We told them that we were told there was a 90-day waiting period. HR explained that under First Call Mechanical, u r eligible on the first day of the next month of employment, which was 2/1. I pushed her for an ** card to have a verification of covg. HR sent him an email on 2/20 saying "They pushed you into the ********** ***** gave us our ** number. I called ********************** on 2/22 & verified coverage & emailed the ** card. On 2/23, I asked to cancel my cov through the **. The **** had already been paid (which is normal for us because we pay our bills early) before he was even offered the job. When we did learn of the waiting period change due to the company buyout, we pushed for conf of the new coverage so we would not cancel one health plan & then find ourselves in a position to have no coverage. That would make me double insured & to no fault of my own. I have tried to handle the situation in a timely manner. Please cancel my *********** eff. 2/1/2024. I understand I went thru the VA market place, but Anthem should be able to decide when to cancel and not get money from someone twice. I paid for my individual plan (******) and thru my employer (******) for the month of February.

  Customer response

  03/05/2024

   I have attached the authorization form.

  

  Business response

  03/06/2024

  Good afternoon, 

  We regret that we are unable to assist with this matter.  The member will need to contact the exchange directly. 

  Thank you.
  

  Customer response

  03/06/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  I have contacted the market place twice and then filed an appeal which they denied.  They suggested that I go back thru to  Anthem which is what I have attempted to do. They said that Anthem would need to make the final decision. That only Anthem could verify there were 2 policies and premiums had been collected on both and that they overlapped.  I find it hard to believe that the market place has control over what Anthem can and can not do. Its not right for premium to be kept for the same person on 2 different policies. There is no reason to be double insured.  I'm just simply asking for my premium back on the individual plan.
  
  Regards,
  
  *************************
  
  
  
  
  

  

  Business response

  03/14/2024

  Good morning,

  Please see attachment. 

   

  Thank you,

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

   

  Customer response

  03/14/2024

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

  I wish there was another option to respond to this complaint. I will accept the response, once I am informed of how I can receive my refund.  I look forward to hearing more on this issue.
  
  Regards,
  
  *************************
  
  
  
  

  
  

• Initial Complaint

  02/21/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Anthem Healthkeepers switched pharmacy providers in January of 2024. To date the pharmacy interface to Anthems website is not working. Almost 3 months into the plan year the information is inaccurate, you cannot find tracking information for medications, medication status is wrong...for example is still shows a medication that shipped on 1/29/24 is on its way, despite receiving on 1/30/24. You cannot pay o line for any prescription. Existing refills were never transferred to the new pharmacy. Obtaining a refill on a specialty drug takes multiple calls. NO ONE has returned calls, despite customer service saying a Tech or Pharmacist will call back. The wait times are unbelievable. I just hung up the phone after waiting 45 minutes. I have spoken with 2 of my doctors because I had to request new scripts because they were not transferred...they are soooo frustrated with the new pharmacy change. Can you imagine how many patients under Anthem are contacting doctors to duplicate work!! I have specific dates and facts on each call. I submitted a grievance with Anthem and nothing has changed. Their reply is everything is online...have they looked as it's not there. When you call they have something different on the Carelon screen. Since January I have logged in over 10 hours of just hold time for 2 prescriptions...just 2. I have one prescription through Specialty that has 3 open orders for the same drug and order. No one will take responsibility and do something. I pay my premium on time and expect them to handle their end. I received a letter in December from. CARELONRX stating the transition will be smooth and seamless! Two of the Carelon reps told me they are ready to quit because of the problems and grief they receive from patients who are frustrated.

  

  Business response

  02/22/2024

  Please be advised in order to assist the member we need the members identification number to include the three letter prefix.

  Thanks

  Customer response

  02/22/2024

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

   

  Anthem requested my ID number, which is as follows - YTR134W11968

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

  
  

  

  Business response

  02/23/2024

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

  Customer response

  02/29/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  Executed form is attached as requested. 
  
  Regards,
  
  *****************************
  
  
  
  
  

  Customer response

  03/04/2024

  Enclosed please find the executed form as requested.

   

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

  

  Business response

  03/12/2024

  Please refer to attached decision letter. 

  Customer response

  03/12/2024

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

  Anthem has only addressed one issue - namely, my concerns with *****************.   They have failed to address the issue with CarelonRx and their own ****** website/app that still does not show accurate information.   Someone at Anthem needs to take ownership.  I pulled all my prescriptions from Carelon as they informed me that they would take 10 to 14 days to input into their system due to backlogs and then an additional 10 to 14 days to fill plus shipping time.  That is an unacceptable fill time for a prescription.  I had to contact my doctors for a 3rd time to send new scripts to CVS.  The doctors office is fed up with CarelonRx due to the extra work this has caused. 
  
  Regards,
  
  *****************************
  
  
  
  

  
  

  

  Business response

  03/19/2024

  Please refer to attached decision letter. 

• Initial Complaint

  01/28/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Carelon is the mail-order prescription service that contracts with Anthem. For reference, my anthem ID # is *************. I have run out of a medication (Celexa), because Carelon failed to provide the auto renewal/refill service that I have set up multiple times. I spent 4+ hours yesterday on the phone with Carelon personnel (including transfers and hold time), and another hour and 45 minutes today, trying to get a resolution. The only option offered was an expedited delivery, which would take 3 days for delivery. The delay would have been at least 5 days, if I hadn't had refills available. I explained the problem with abruptly stopping the medication (which is info the pharmacist should be giving ME!). I was told that ******* will not overnight medications. I was told to contact my doctor for an new prescription and request an override from Anthem. This was a Saturday and refill requests are only honored during office hours. At one point, the Carelon tech suggested I go to the emergency room! The med was scheduled for expedited delivery. In the process, I learned that none of my meds (4 in total) were scheduled for refill. We went through each one and set up auto renewal (again) and I confirmed my mailing address 3 times (this has been a problem in the past, because I have a different billing address). My husband received a notification on his phone (he is the policy owner) that the med was on its way to the billing address! After another 1.75 hours on the phone today, I learned that personal contact information was not transferred into the new system and that ******* has been using the policy owners info for med delivery since the beginning of the year. This is not only a ***** violation, but other patients are not getting their needed medications. As of today, there has been no notification to the patients. I was told that "leadership" is aware and is dealing with the problem on a case-by-case basis, as patient's call in with concerns. So the ***** violations continue... I now have to call my MD tomorrow to request a new rx to be filled locally as an emergency override on my insurance. I have already been billed for the prescription that was sent to Virginia. Good thing it is generic or I could be hit with an unexpected large expense that is no fault of my own. I empatize with anyone else dealing with this.

  

  Business response

  01/31/2024

  Member authorization is needed to address the member's concerns.  Please refer to the attached letter.  Thank you.

  Customer response

  02/01/2024

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

    I have provided the documentation required by Anthem to allow the BBB to receive Anthem's response to complaint #********.  Please proceed with the investigation.
   
  Regards,
  
  *************************
  
  
  
  

  
  

  Customer response

  02/01/2024

  The total time spent on the phone with ******* regarding this issue has been over 4 hours: 2hrs 26 mins on 1/27/24 to ask why I had not received the scheduled delivery, and another 1hr 26 minutes on 1/28/24 (sunday) to ask why the prescription had gone to Virginia.  It was during the 1/28/24 call that I was told an override would be requested for re-delivery of the 90-day prescription to the ************ address and that it would be shipped as soon as Carelon could get a refill prescription from the provider.  I was told it should go out on Tuesday, 1/30/24. In the meantime, ******* told me that it would request a second override to have the prescription filled at my local pharmacy, so that I would not run out of pills before I received the mailed prescription.  I questioned whether Anthem would approve two overrides for the same medication and was told that it would not be a problem, because Carelon had informed Anthem that it was their mistake.  I called my provider on Monday 1/29/24 and had a new prescription sent to the local pharmacy in ************. As I feared, the override was not approved. I was forced to pay out of pocket to have that prescription filled. I called Carelon today to check the status of the 90-day prescription coming to ************, as I have not received notification of its delivery. The automated system stated that there were no orders in process, so I requested to speak with an associate.  I held for 9 minutes and then was disconnected.  I will be reporting the ***** violation to the ***** of ******** and am looking forward to the publishing of this complaint.

  

  Business response

  02/06/2024

  Anthem received two responses to our request for a Designation of Authorized Representative (DOR) form.  It appears that the form wasn't attached to this inquiry, but is attached to the second one, received on February 1, 2024.  We will respond to the second inquiry.  Thank you.  

  Customer response

  02/06/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  Anthem did not respond to the complaint. They only stated that they will respond, but gave no time frame for when I can expect them to do so. 
  
  Regards,
  
  *************************
  
  
  
  
  

  

  Business response

  02/07/2024

  Good afternoon,

  The authorization form submitted wasn't fully completed and isn't considered valid for this type of appeal.  I have attached the appropriate form.  The member will need to complete all sections, making sure to list the Better Business Bureau under "Other" in Parts B and D.  She will need to check the first or second box in Part C, one of the boxes in Part E and both boxes in Part F.  She will also need to sign and date in Part ** We apologize for any inconvenience.  
  

  Customer response

  02/08/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  The Company has requested more information in order to process my complaint.  I am attaching a revised authorization form per their instructions.
  
  Regards,
  
  *************************
  
  
  
  
  

  

  Business response

  02/09/2024

  Good afternoon, 

  We received the additional information you provided and will send a response within seven business days. 

   

  

  Business response

  02/21/2024

  Good morning,

   

  Please see the attached response 

   

   

  Thank you,

   

  ********   

   

  Anthem, Inc.

  ***********************,Risk Analyst 220 Virginia ******************** ******* 46204 O: **************|F: ************** **************************************************

  
  

• Initial Complaint

  01/19/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Member ID: ************ This is regarding claims at Integrative Physical Therapy for below mentioned 6 dates 12/05/23, 12/13/23, 12/26/23, 12/28/23, 01/02/23, 01/09/24 Before getting the service we called at Anthem customer service and spoke with ******, call reference number #I-C6515928 and she confirmed the charges would be 40$ for us out of pocket per visit. She not only spoke with us but with also ******* at Integrative *********************** and said the same to her.Now, once the claims are processing, Anthem is saying Integrative manual therapy is out of Network and denying claims.We did our due diligence before going to this provider. We spoke with Anthem representative and also had Anthem representative call them and confirm everything before we started the treatment. We would not have gone to this service provider if we were given the right information by Anthem when we called.After the 6 visits, we come to know through our web account that we have raked up bills of 1100-1200$ for 6 visits, instead of 240$ which would be 40$ per visit.I request Anthem to adjust all these claims and bill us 40$ for each visit which was discussed on the call, call reference number #I-C6515928.

  

  Business response

  01/22/2024

  Member authorization is needed to address the members concerns. Refer to the attached letter.
  Refer to attachment.

  Customer response

  01/24/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that what the business offerred was a request for additional documents and not a resolution.
  

  I have filled out and sent the Authorization form at Anthem *********** office and sent a copy at the *************** in ******** ** where the complaint was filed.

  I am attaching the **** reciept with tracking number. I hope once you recieve it, you can address my complaint.

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

  
  

  

  Business response

  01/26/2024

  Thank you for your additional response to the BBB.  In our previous response we did advise we required a completed Member Authorization Form in order to release information to the BBB.  We understand that you have sent this needed information to Anthem; however, at this time we do not have a copy.  Once this information is forwarded to our unit we will review and provide an additional response.

  Customer response

  01/26/2024

  Better Business Bureau:
  
  Please send a response when you have the required information. Please don't put me in a position to accept/reject the response when there is no response.
  
  Regards,
  
  ***********************
  
  
  
  
  

  Customer response

  01/30/2024

  Attached the signed Authorization form and also **** reciept of the physical copy sent to *************** of Anthem with tracking number.

  Also this attachment is sent to the BBB ******** email id.

  

  Business response

  02/01/2024

  Member authorization is needed to address the members concerns. Refer to the attachments..

  Customer response

  02/01/2024

  Better Business Bureau:
  
  I have already sent this form physical copy to Anthem

  USPS reciept is attached

   

  Sent to ******** PO BOX

  USPS Tracking number : 9589071052700223734741

   

  Sent to *********** PO BOX

  USPS Tracking number : 9589071052700223734796

   

  Please let me know if you did not recieved the hard copy, I have reciepts of the certified mail.

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

  
  

  

  Business response

  02/05/2024

  Thank you for your most recent correspondence.  Unfortunately, the document supplied labeled as "Authorization Letter" does not meet all of Anthem's requirements to release information to the Better Business Bureau. Therefore, at this time we kindly request you complete the attached Anthem Designation of Representative/Authorized form that you previously received. Without this completed form we are unable to release any information to the BBB. However, you may still contact our **************************** directly by calling the telephone number on the back of your identification card or by visiting Anthem.com.

  Customer response

  02/05/2024

  Better Business Bureau:
  
  Complaint ID ********.
  

  Can you please share the contents of the hard copies sent to you, attaching the **** tracking number for a 3rd time.

  That envelope has the form that you are asking for from Anthem's website.

  Anthem is now just stalling and not answering the questions. They first asked to send the filled forms on a PO Box number in the form filling instructions and now are asking for the same here. 

  I have sent the filled form from Anthem's website in a hard copy. Please let me know if you did not recieve it. 

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

  
  

  Customer response

  02/05/2024

  Attaching the filled form from Anthem's website.

  We authorize BBB and Anthem to look into the account of *********************** at Anthem Blue Cross Blue Shield to resolve this query.

  Customer response

  02/06/2024

  Please attach the attached Authorization form to the complaint 21168191.

   

  Anthem Blue Cross Blue Shield instructions on website ask for the form to be sent to a PO Box which I did. And yet they keep asking for the ssme form on the portal (Attaching the **** reciept). 

   

  ************************* is the co-ordinator on this.

   

  Thanks,

  *******

  

  Business response

  02/14/2024

  Please see the attached letter.

  Customer response

  02/14/2024

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********.
  
  The wording of the response does not put me at ease and makes me think I will be going in circles again until the claims have been processed.

  My discussion with the Anthem agent, call refrence mentioned in earlier communications, was that my co-pay will be a maximum of 40$ per visit with *************. We confirmed this before starting the therapy, it was the only reason we called and had them talk to the PT office.

  If Anthem can honor this and agree to this wording, we can close this issue. 

  Otherwise I want to keep this issue open until the claims have been reprocessed. 

  I need clarity on the dollar amount that we would be responsible for after claims have reprocessed. 

  Thanks,

   ***********************

  
  
  
  

  
  

• Initial Complaint

  11/15/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Anthem Insurance Fraud 2/14 I called Anthem since I was having a mental health crisis and I was given list of in-network Anthem providers *************************** was on the list of in-network providers provided to me by both Anthem EAP and Anthem number on the back of my insurance card *************************** also confirmed she accepted my insurance.I saw her regularly and started improving with medicine.May I first called Anthem and asked why claims with the provider were not being paid Anthem confirmed they were in-network and that the provider submitted the claim incorrectly This process repeated itself every few weeks until September Provider cut off services until I paid my balance since insurance was not paying my claims or providing any updates September 29th, I was told the provider was now in network and was not previously. I called Anthem and was able to secure a copy of list that was provided me and **************** was indeed on the list. Anthem had assumed I was lying.Early October, I had to make an appoint to refill my meds End of October after making no progress, I gave up and found a new provider 11/14/23 Anthem rep called and said I am responsible for the entire bill for the provider.11/15/23 I received the statement from the provider with an explanation of benefits. The total bill for services was **** and Ive paid 500 Ive spent about 20 hours of time on the phone in total trying to resolve this claim and I am at a **** end. I want them to figure this out and pay my medical bill. They didnt have any problems approving claims until I hit my deductible. Now they dont want to pay anything. Anthem claims they did not start recording interactions before May and the burden lies on me to produce evidence of what was provided to me. When I finally found the list, they still made excuses. This is causing emotional distress, *** been ghosted by reps and even hung up on. I don't feel there has been a good-faith effort to resolve this.

  

  Business response

  11/16/2023

  Please be advised that we need member authorization before we can address the members concerns. Refer to attached letter.

  Thanks

• Initial Complaint

  11/14/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been fighting with Anthem over my wife ***'s PT. They denied the first 2 visits of the year. Approved 11 visits in a row. Then they decided to deny the next 7 visits (when my deductible was met....hmmm). Approved the last 3.I have called multiple times and explained that MS is a chronic condition that requires maintenance treatment to keep range of motion and strength. I spent an hour and a half of PTO, talking to 3 different people with the last being a supervisor. I thought I had made some headway on getting the denied dates of service paid and future visits approved. I got word yesterday that they are planning on not authorizing tomorrow's visit.

  Customer response

  11/14/2023

  Here is a screenshot of the dates of service and HIPPA  release.

  

  Business response

  11/14/2023

  Please be advised we need the members authorization before we can address the member's complaint. 

  Customer response

  11/14/2023

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID ********, and have determined that this proposed action 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,
  
  *****************************
  
  
  
  
  

*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. ↩