ComplaintsforAnthem Blue Cross and Blue Shield of Virginia

• Initial Complaint

  02/25/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Member ********, 3 12 21 visit to ****** ******* A MD On 3 12 2021 I had a doctors visit in Virginia. Claims were sent to Medicare, which paid their portion, and to BlueCross of North Carolina (BCBS of NC), my default secondary insurance. BCBS of NC forwarded the claim to BCBS of VA for payment. I have received 4 EOBs and one letter from BCBS, have called BCBS of VA numerous times, but STILL BCBS has not paid what they owe on this claim. My latest call to BCBS of VA (Stacy from Maine), I was told they received a denial of benefits from Medicare, but I have a Medicare claim which paid their portion in April 2021. I have tried submitting information thru BCBS website, but they won't accept it. There is NO electronic crossover between the BCBS divisions, instead they rely on 19th century technology to process crossover claims, which clearly is NOT working. EVERY time my wife and I go to VA for Drs appointments we have this issue. We are now getting bills and late fees from the providers because BCBS can't process their claims in a timely manner.

  

  Business response

  03/07/2022

  
  
  

  Good afternoon,

   

  Attached is Anthem’s response to *********

   

  Thanks,

   

  *****

   

  Anthem, Inc.

  ***** *******,RiskAnalyst I, Grievances & Appeals Risk Unit Regulatory Services **** ********** ******* Midland, Georgia 31820 O: ***************** ************** ************************

• Initial Complaint

  02/11/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have health insurance through my employee with Anthem and my member id is ************. On October 21, 2021 (claim *************) and January 28, 2022 (claim *************) I went to see my PCP regarding a lower back pain I have been dealing with for years. The PCP decided during both office visits to give me an injection called Ketorolac (Toreadol) for the pain to go away. All of the sudden I do receive a bill for $** from my doctor's office and there is another coming on the way for the same amount even though the office visits under my plan are covered 100%. For months I have been going back and forth calling Anthem and CHA (care provider) trying to explain that I am not supposed to pay anything. Initially Anthem told me to contact the care provider's office. I called the care provider multiple time and they say that Anthem should contact them directly and not the patient. Also they stated that Anthem is the one that decided not to pay them. Than multiple times I called Anthem to solve this issue again but no one seems to want to help. They have been coming up with excuses that the claim was not processed right from the care provider, or the injection was given into an hospital (which is not true) etc etc. I have been paying the premium for this health insurance for years and you guys are supposed to pay the bills for the services I am covered under the benefits. I also included a copy of the benefits where you can see that under the benefits. Escalating this through BBB is only the first step I am taking. I also escalated this with the Attorney General's Health Care Division.

  

  Business response

  03/17/2022

  Ms. Atkisson,

   

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

   

  Thanks

   

   

   

   

  Anthem, Inc.
  Nancy J. *******, Risk Analyst, Grievances & Appeals Risk Unit Regulatory Services O: (314)-923-5406|H: **************|F: (877) 333-8932 ************************

  
  

• Initial Complaint

  01/18/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Anthem (in Virginia) operates a program called Healthy Rewards. People who have certain healthcare plans through Anthem can get gift cards for completing certain health services. I received a $** gift card from them in 2021 for getting an annual physical with my new physician. On September 27, 2021 I got my flu shot, which is supposed to be rewarded with a $** gift card. I have called them multiple times to get this reward, but they always tell me they are still working on it. On 1-18-2022 I called and spoke to Sabrina (employee at Benefit Reward Hub; the administrator of the Healthy Reward Program at Anthem Virginia). She told me that they can't find that CVS filed a claim for this flu shot, therefore they haven't issued the gift card. I am in no position to call CVS and demand that they file a claim, nor is it my responsibility to do so. The deal was that I would receive a gift card for getting a flu shot. Nothing about billing issues. Below I have entered all the information I can find about my flu shot from the CVS web site, including the date and the Rx number. Surely, someone at Anthem can make a call to their counterpart at CVS and verify that this is true and correct. The other issue here is that I changed to United Healthcare on January 1, 2022. Anthem rules state that I must inform them of disenrolling within 30 days of doing so, in order to collect any healthy reward that was completed before the deadline. Are they trying to let the clock run out? Let it be known that I *have* informed them of this fact. Here is the information of my flu shot (cut and pasted from my profile page at CVS): Flu (Inactivated) Dose given on September 27, 2021 Vaccine administration information Vaccine name FLUZONE QUAD 2021-2022 SYRINGE September 27, 2021 Store Information (CVS Minute Clinic) 902 Garrisonville Rd. Stafford, VA 22556 540-659-1313 Store #3396 COST $0.00 RX # 1457682 QTY 0.5 SUPPLY 1 Days ISSUED 09/27/2021 EXPIRES 09/27/2022 NDC 49281042150

  

  Business response

  01/28/2022

  Good morning,

   

  Attached is Anthem’s response to VA BBB Complaint ID # 16481320.

   

  Thanks,

   

  Sarah

   

  Anthem, Inc.

  Sarah ********RiskAnalyst I, Grievances & Appeals Risk Unit Regulatory Services 6087 Technology Parkway Midland, Georgia 31820 O: (706)-985-8114|F: (866)-241-6586 ************************

  
  

  Customer response

  02/03/2022

  Better Business Bureau:
  
  I have reviewed the offer and/or response made by the business in reference to complaint ID 16481320, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  They have sent their response as an attachment in PDF format. When I try to open the PDF file I get an error message that says can't open file. I am able to open other PDF files but this one isn't working. Can this company please just respond in regular text instead of sending their response in PDF format? It seems to be overcomplicating the situation.  Thank you..
  
  Regards,
  
  Maynard ******
  
  
  
  
  

• Initial Complaint

  10/29/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  In June 2019, my OB/GYN scheduled me to receive genetic testing for my pregnancy. I called Anthem to discuss my coverage. They told me that because it is pre-natal, it is 100% covered under my health insurance. I called again to ensure that I received the same answer twice to rule out any error or lack of due diligence. Once again, an agent told me it is 100% covered, and further inquired who would be completing the testing (Natera). They said that Natera is covered and I was covered. Anthem is now saying Natera is out of network and is placing the burden of $****** on me. I want the calls listened to and the claims paid as two different agents representing Anthem gave me the pre-authorization. Had I been told otherwise, I cannot say with certainty that I would have gotten these tests completed as I cannot afford $****** in medical bills.

  

  Business response

  01/19/2022

  Good morning,

   

  Attached is Anthem's response to ********.

   

  Thanks,

   

  Sarah

   

• Initial Complaint

  10/22/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Anthem denied payment for multiple medical expenses from March 2021 through June 30, 2021. I was covered under my employer's Anthem insurance plan and Anthem denied payment as they had a secondary insurance listed, which is incorrect. They had me listed as covered by ******** Part B and this is not correct. I spent many hours since April 2021 contacting Anthem to clear this up. At the end of June, I had an Anthem representative contact ******** and the ******** representative confirmed that I did not have ******** Part B coverage during the time frame of March 2021 through June 30,2021. The Anthem rep promised that this would be resolved within 30-45 days. At the end of July, I contacted Anthem again and they said that the approval for these charges was pending. On September 4,2021, I mailed a detailed letter to Anthem, again proving that I did not have secondary medical coverage and I requested that they resolve this ASAP, as these medical providers were threatening to send the bills to collection for payment. To date, I have NOT had any response from Anthem and to preserve my credit rating, I have started making minimal payments to these medical providers. This has been very distressing and caused an unnecessary burden on me. I have yet to have any response from Anthem.

  

  Business response

  01/24/2022

  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.

   

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

  Medicare Complaints, Appeals & Grievances (MCAG)

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

  Fax: (************

   

  
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  Business response

  02/14/2022

  Good morning,

   

  Attached is Anthem's response to Rebuttal VA BBB Complaint ID # *********

   

  Thanks,

   

  *****

   

  Anthem, Inc.

  ***** ******************* ** ********** * ******* **** **** Regulatory Services 6087 Technology Parkway Midland, Georgia 31820 ** ***************** ************** ************************

  
  

  Customer response

  02/24/2022

  
  

  I was out of the country on a cruise last week and did not see the previous email sent to me from your office on February 14th until February 21st.  

  
  

  This matter has not been resolved, as I had to submit a Member Authorization form to Anthem Blue Cross for them to communicate with your office. This form was mailed yesterday to the Anthem BC& BS office address on the Virginia form and I also sent a copy to the Healthkeepers Grievances and Appeals office in Richmond.

  
  

  Please re-open my complaint, as I was not aware of the seven day deadline to respond existed until February 21.

  
  

  I have come this far with getting this resolved and I hoped that the Better Business Bureau will support me in resolving this costly oversight that has been forced upon me from Anthem Healthkeepers. I have been fighting to get this straightened out for months and I need the Better Business Bureau on my side.

  
  

  I look forward to your positive response and support.

  
  

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

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

  Norfolk VA 23518

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

  
  

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