ComplaintsforAnthem Blue Cross and Blue Shield of Virginia

• 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,
  
  *****************************
  
  
  
  
  

• Initial Complaint

  10/13/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In 2021, when I thought my divorce would be filial, I signed up for insurance, during open enrollment, through my employer. Things got postponed & I filed an appeal for enrollment, which was denied. I was told I had to pay the premium anyway. I never even opened the envelope with my cards. Anthem paid ALL claims in 2022. Now, Oct 2023, they are resending all money paid in 2023. My new insurance, which was not used in 2022, will not allow the claims to be filed. Anthem expects me to pay thousands of dollars in back payments when I was still covered, with a healthy family plan premium. I have tried to get someone to discuss this with. No one is willing to help in anyway.

  

  Business response

  10/16/2023

  Please be advised that in order to address the members concerns we would need the member's identification number complete with the three letter prefix. We also need written member consent from the member giving the BBB permission to act on their behalf.

   

  Thanks,

  *****

• Initial Complaint

  07/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  We have been trying for 3 years to get into the Antehm Network. My complaint is that ********************************* is a new African American female owned agency. We have been through a lot for a long period of time to get to this point and now we have hit another road block to find that Anthem HealthKeepers has closed their network and will not allow us to provide any Community Mental Health services is appalling. We have continually gotten the run a round with this insurance company and it just seems so unfair because we have worked so hard with the part of the families that we are able to provide services to. Theses services go hand in hand to provide support to the entire family that is at-risk. ********************************* has highly trained and qualified staff that have been able to build a positive rapport, community partners, and network with the ****************** of the Kings Daughters, The Juvenile District Courts, ********** ********** of ****** Services, and many others. These departments have been referring their clients to us because we offer quality services with Outpatient Therapy and Intensive ******* Services (H2012). And we are only able to provide part of the services that the families require in our community. We have lots of referrals for at-risk clients who are suffering from behavioral issues to severe mental health problems who have Anthem HealthKeepers and we are not able to provide any services to them because Anthem HealthKeepers will not allow us to be a part of their network as a participating provider for Community Mental Health services. We are not able to provide any Intensive ******* (H2012) services to a population who is at-risk. We are asking that you please allow us to join the Anthem network as a provider of Community Mental Health services (H2012) along with the outpatient services that we already provide.

  

  Business response

  07/24/2023

  Plese be advised the provider can go to either Anthem.com or www.availity.com to enroll in Anthem's network.

   

  Thanks,

  *****

  Customer response

  07/24/2023

  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.
  
  ********************************* have already completed the necessary paperwork on Anthem.com and in Availity.com to enroll in the Network.  We have been truned down several times since 2020 with Anthem saying that the network is closed and we have been in communication with *******************************, MSW, LCSW, LPN, Provider Network Support Consultant Sr. for Virginia ******** O: **************, ****************************************** who continues to tell us that the network is closed to us. 

  We are asking that you please allow us to join the Anthem network as a provider of Community Mental Health services (H2012) along with the outpatient services that we already provide.
  
  Regards,
  
  *********************
  
  
  
  

  
  

• Initial Complaint

  07/06/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  We have filed claims on a member numerous times since January in an effort to have the claims paid. First when the claims were electronically transmitted Anthem was capturing additional letters so they would deny the claim stating that the subscriber ID was wrong. Then they denied for medical records which have been sent numerous times. As of today 7/6/2023, this member claims have still not been processed and paid, every time I do a chat with Anthem or call, I get the same run around and told they are sending them back for review only to do the same thing all over again in 30 days. You cannot talk with a manager in claims you only get told no one is available and they are engaging in an important matter at this time. It is horrible and we cannot get paid for services we provided to a member. The same claims have been sent electronically, faxed, sent through a portal called Availity which Anthem encourages you to use, but we keep getting the same response and no results. They want your contact information but never call even after pleading for a manager to call no one responds and we are left with no resolution only to continue to have the same repeated conversation and steps started all over again.

  

  Business response

  07/07/2023

  Please be advised member authorization as well as the member ID with the three letter prefix is needed in order to review this complaint. Refer to attached letter. 

• Initial Complaint

  05/19/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I had an Anthem Healthkeepers Silver Plan through my employer for many years until they switched plans to another provider in Dec 2022. While I had the plan I had earned cash reward dollars for completing such activities as getting a physical, reading articles, getting a flu shot, and participating in online wellness activities thru the Anthem website as an incentive to live a healthy lifestyle. The flyer describing the program is attached. I was sent a debit card in the mail with money on it which I have also attached a pic of. It was a reloadable card and when I earned money it was put on the card. I earned a total of $350.00 which I could see thru my anthem login. I tried to use the card several times and it never worked. When I tried to get resolution by calling Anthem it never got resolved. I have tried again the last few days and the card still doesn't work. It didn't work when I had the Anthem plan and won't' work now. After two days, 7 phone numbers and probably 13 reps (I've lost count) no one can help me. No one understands the reward program or can get me someone that can. The last representative I had thought I had a prepaid OFC card which I don't. Another rep told me they give gift cards for the program now and can't assist me with my card. Everyone says something different or transfer me. It was not a benefit of the plan, it was cash dollars for completing activities that I have not been able to access. I am very disgusted that Anthem offered a program that I spent my time on and no one there has a clue about this. My last phone call was an hour and a half. The card expires in January ****. All I want at this point is a way to access the $350.00 on the card that I earned or to send me the funds via check or a gift card since they no longer issue debit cards.

  

  Business response

  05/22/2023

  Please be advised we need an authorization form from the member before we can proceed with the complaint. 

• Initial Complaint

  02/24/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I provide services to patients that purchase Anthem-provided health insurance plans. In fall 2021, there was a time period of several weeks where all claims submitted to Anthem were processed incorrectly, as if I was an out-of-network provider. I was informed by Anthem staff that Anthem had been in the process of changing computer systems and that all issues should be resolved quickly. While the processing issue appears to have resolved, I still have not been reimbursed for several claims from that time, amounting to several thousand dollars. I have attempted to resubmit the claims, have the decision reconsidered, and appeal the decision. I can find no reason on my part why the claims would have been processed differently over the course of a few weeks. (My business' tax ID is ************

  

  Business response

  03/14/2023

  See Attached

• Initial Complaint

  03/15/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  In 2014, I went overseas, obtained new health insurance and was no longer covered under Anthem ****. I had medical appointments during my tour that were covered, but only realized months after my Anthem coverage ended that the ***** Hospital did NOT bill insurance for the medical appointments. I paid for the medical bills out of pocket, and filed claims to be personally reimbursed. Since the claims were outside of acceptable time frame to file, I worked with customer service to have them processed. It was a long process due to erroneous forms, poor quality document scans, and the representative I was working with out on emergency leave. I've called and emailed customer service many times, and have explained my situation to multiple people. I've received updates that the claims were re-processed, but "denied" because payments can ONLY be paid to the ***** Hospital, instead of reimbursing me. The claims otherwise state that they are eligible for reimbursement. However, I cannot get any updates from customer service on whether or not the claims are actually being re-processed. This is the painful part- it's been 8 years since I've initially contacted Anthem. It seems like we are so close to wrapping the claims up and finishing, but no one wants to help me any longer. The emails I send get ignored and no updates are ever provided.

  

  Business response

  03/17/2022

  Ms. ********,

   

  Please see the attached response to VA BBB Case ********.

   

  Thanks

   

   

   

   

  Anthem, Inc.
  ***** ** *******, Risk Analyst, Grievances & Appeals Risk Unit Regulatory Services ** ***************** ***************** ***** ******** ************************

  
  

• Initial Complaint

  03/02/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  This company offers a "healthy benefits" grocery card for seniors and neglects to send the card with the benefits. I was supposed to receive a 50 allotment for groceries as a benefit to my insurance and have called several times about the card...I got the card in the mail yesterday(March 1st) and called today to find out my benefits I was entitled to for the last 2 months. Was told there is no roll over? BUT was not issued the card or any card until yesterday. What happened to the other 2 months? That's stealing.I spent 2 hours on the phone with customer service and could not get a manager to get to the bottom of the problem "due to high call volume". Seems like a scam..I would like some help with this please.

  

  Business response

  03/08/2022

  Good Morning,

   

  Attached is our response to your file number* ********

  If you have any questions or require any additional information please do not hesitate to contact me directly.

   

  Anthem, Inc.

   

  ****** ***** Grievance Analyst II

  Medicare Complaints, Appeals & Grievances (MCAG)

  Phone: *************

  Fax: *************

   

  *************** ******* **** ****** ******** ********* *** ************ ** *** *** **** *** ** *** ******** ************ *** *** ******* ************ *** ********** *********** ** *** ********* ** ********* ** **** *** ************ ******* **** ********** ** ************ ** *********** ** *** *** *** *** ******** ********** ****** ******* *** ****** ** ***** ****** *** ******* *** ****** ** *** ******** ******* *** *** ********** *******.

*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. ↩