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Customer Complaints Summary
20 complaints closed with BBB in last 3 years | 8 closed in last 12 months
Total Closed Complaints
Advertising / Sales Issues
Billing / Collection Issues
Problems with Product / Service
Guarantee / Warranty Issues
Total Closed Complaints
Additional Complaint Information
Anthem is committed to addressing any customer issues and/or complaints. The company asks that you contact Josie Morales, grievance & appeals manager, (303) 831-2131 or firstname.lastname@example.org prior to submitting a complaint. Further, Anthem would like to inform consumers that due to HIPAA regulations they may not be able to fully address a complaint through the BBB without first receiving a signed HIPAA authorization form.
Complaint Category: Failure to provide promised assistance or support for products or services
Complaint: I was signed up for an insurance plan beginning in 2014 without my knowledge or consent. I attempted to cancel and was unable to speak to anyone. I previously (2013 and a couple years prior) had an individual plan with Anthem Colorado, at about $100/month premium. In the last few months of 2013 I received multiple letters in the mail from Anthem notifying me that my plan would be canceled and I would not be covered by them as of January 1, 2014, but they had other plans I could look at and purchase if I desired. This was fine with me. (My insurance from them was completely paid off for last year. I did not, and do not not owe them anything for my plan that I had through them up until Jan. 1, 2014.) Yesterday in the mail I received two bills from Anthem, both dated December 28 of 2013. One was for $1.50 and one was for $207.94. They both stated payment was due by February 1, 2014. The ID number on both bills was 686AXXXXX. As I was told that my plan would be canceled, and as I did not agree to any new plan or to continue coverage, I was surprised by these bills and attempted to call Anthem. I found the number on their website and called it (X-XXX-XXX-XXXX). I was on hold for over 20 minutes and had to leave before I had a chance to talk to anyone. Later on in the day (around 3:00pm) I called again and an agent picked up after I was on hold for a few minutes. I said I was charged for something I did not want, and I would like to cancel my plan. She said she would have to transfer me and I said okay. I was then on hold for over two hours. After that time, an agent answered and said I had been transferred to California's Anthem call center, not Colorado's. She said she would transfer me to the correct line. About a minute later a recording said "goodbye" and I was hung up on. I then located my old Anthem insurance card and called the number on the back. A recording asked for my information (date of birth, social security or plan number), and at first when I provided my information, the recording said it didn't recognize it and that I would be transferred to an agent. I was then hung up on (by the recording, on accident, on purpose, I don't know). I called back several more times and again provided the required information. One of those times the recording told me I would not be able to be helped, before I even had a chance to say what I needed help with. The last few times I called I was simply disconnected after providing my information. A couple times the recording told me I was enrolled in both a PPO and an HMO. I have no idea if that is true, and if so, why I am in two programs. I do not want to be in either. I spent several hours on the phone trying to speak to a human being, and I was completely unsuccessful in even speaking for more than a couple seconds to something other than a recording, let alone canceling my plan. I searched for and found the local Anthem office here in Denver, and there is no possibility to speak to a person without know the direct line number of the person you want to speak to. Pressing "0" just starts the recording over again. I eventually emailed Anthem telling them I wanted to cancel my plan. I have not yet heard back from them, and it is now January 8 and I do not know if I will be charged for the first 8 days (or more, depending on what day it will be, if and when they get back to me) of the month. After repeated attempts, totaling many hours, Anthem did not allow me to speak to the proper person in order to cancel my plan. I do not know if this was on purpose, or on accident; I just know I have never once before had to call a company so many times, and I have never been hung up on repeatedly (or even once, actually) while calling a line for customer assistance. I have never spent so many frustrating hours on the phone and accomplished so little.
Initial Business Response Dear Ms. ****,
Thank you for your patience in this matter. I would like to offer my apologies, on behalf of Anthem, for your service delays. We are experiencing a temporary large call volume at this time.
In researching your concerns, I show that Anthem received your request to cancel both the PPO policy and the HMO policy on January 17, 2014. As of January 20, 2014, both policies have been cancelled with the cancellation effective date of February 1, 2014. Since the HMO policy effective date was scheduled for February 1, 2014, you would not owe a premium on this account.
I trust the above addresses the concerns you have raised. Thank you.
***** ***** Senior Grievance & Appeals Analyst Anthem Blue Cross and Blue Shield of Colorado
Complaint Category: Failure to honor a contract or agreement
Complaint: They are denying my claim for my yearly doctors appt because I asked him about losing weight. I have been with Anthem since 2012 when I signed up I had high blood pressure and non working thyroid. Aug 29th 2013 I for the first time used my insurance for my yearly doctors appt. because I have a non working thyroid I have but on some weight and I asked my doctor what can I do about this. Anthem is denying my claim cause they say I'm not covered for obesity this is my family doctor this was a yearly check up if I can't talk to my doctor then who ? They said I have to appeal it I am in that process but I'm angry. This is the first time I used this insurance for anything other than my meds I pay 250.00 a month and my one and only visit in a whole year isn't covered what am I paying for? He is on they're plan.
Initial Business Response Dear Ms. *****,
In researching your complaint the claim submitted by your provider for the visit you are referencing is not coded by the provider's office as an annual, preventive, yearly visit. The claim submitted is coded as a medical office visit for services that are specific exclusions of your policy. These exclusions are listed on page's 39 and 53 of your benefit certificate.
Anthem did receive your letter of appeal regarding the denial of this claim. Your letter was received by Anthem on January 9, 2014. This is a benefit appeal which allows 60 calendar days for review. The Appeal Analyst assigned to your case is ********* ******* she can be reached directly at (XXX) XXX-XXXX. Your appeal determination will be made on, or before, March 10, 2014.
***** ***** Senior Grievance and Appeals Analyst Anthem Blue Cross and Blue Shield
Complaint Category: None of the Above - Contract Complaint Issue
Complaint: See scanned complaint.
Initial Business Response Dear Mr. ********,
In response to your concerns, a determination has been made to adjust the claims in question, date of service 02/10/11 from ****************, for benefits. The Explanation of Benefits notices for these adjustment will be sent to the member at the address on file with Anthem.
I trust this addresses the issues you have raised.
Complaint Category: Failure to correct billing errors
Complaint: Cancelled our policy without informing us. Will not reinstate until next month. I am the office manager for our group policy, I have always made payments on time, however I missed a payment in August because there was confusion with our policy being renewed properly. I tried logging into our account to pay online on September 9th, 2013, but the login was not working. I then called numerous times but did not get through to a customer service rep after waiting for longer than 30 minutes at a time. The reason I thought everything was ok was I received a bill (invoice # XXXXXXXXXXXXX) in the mail, dated September 5th, 3013 stating that we were being billed for 10/1-11/1. Obviously, if you are billing for a month ahead the policy is active.
Once I was able to get in contact with the billing department, they said to send an ACH form and the policy will remain active. I immediately sent in what was asked from me, and spoke with a representative named **** *********** I then spoke to another representative on the 13th when one of our members tried to get a RX filled, again they did not tell me the policy was cancelled. I have not received a letter either, if my policy was cancelled on September 9th I should have the letter in hand by now.
My point is, I was treated unfairly and lied to; I was in contact with Anthem since beginning of September. I spoke with another rep today to (finally) make the August payment and was rudely reminded that our account will not be reinstated before she hung up the phone on me. My broker with Sage Benefits was able to get in contact with Anthem regarding this issue, and they said we will be without health insurance for the rest of September and we will be able to activate our exact policy on October 1st. How does that make sense? Anthem punishes their loyal members for missing a payment by a week after the grace period. Again, the payment was missed due to Anthem's lack of communication that our policy was being renewed. We have had no major claims, and are all young, healthy individuals that have no preexisting health conditions-- acquiring a new health insurance provider is not a problem for us. This current policy is for our owners and spouses, but, we will be adding 200+ employees onto our policy as a benefit in our company, and we would like to use Anthem.
Initial Business Response This small group was sent a letter on 8/16/13 advising that their 8/1 - 9/1 premium had not been received, and then a letter dated 9/5/13 advising that the group had been terminated for non-payment. Even when a group is going through renewal, their premiums must still be paid. They could not log on to make a payment on 9/9 because access to the online payment tool is terminated when the group is terminated.
It's unclear what department they called with wait times over 30 minutes, since that is not typical of wait times to reach Anthem's small group membership unit. The October invoice they received was generated on 9/1, before the group was terminated for non-payment. Any payment sent in after that would be cashed by Anthem, since the August premium was still outstanding.
An administrative decision was made to reinstate the group on 9/20/13, with no gaps in eligiblity. The group remains currently effective.
Groups are responsible for continuing to make their premium payments when they are up for renewal, and it is unclear why they state they did not receive the 8/16 and 9/5 communications from Anthem, because the invoice referenced in tht complaint was sent to the same mailing address.
Complaint Category: Failure to respond to phone calls or written requests for assistance or support
Complaint: They have made two errors which have caused delays and are not processing the appeal I have filed on behalf of my mom, a disabled senior citizen. My mom lives in Colorado. An appeal was first sent by me on or around *************. About two weeks later, I received a letter back from a *********. (******) which showed that she had not thoroughly read the correspondence. (She wasn't going to act on it.) I then re-sent everything back and again requested their action, but instead I received a letter dated ******************, back from a ************, Grievance and Appeals Analyst, saying that we needed to fill out a Designation of Representative/Authorization Form in order for me to be able to file the appeal for my mom. Again, it seems someone has not been thorough and completed due diligence. I signed my mom up for this Anthem Medigap plan years ago. Any bills and EOB's come to me at my address in ****** as I handle all her affairs. I ensure the premiums are paid. I am the person who calls their 1-800 number when I have a question about a claim or benefits or EOB's. Those reps. verify I am authorized to be making those calls and assist me. Why, then, am I being asked to fill out another form or have my mom do so? Anthem has on file the Attorney in Fact documents. I am her daughter and her Rep. Payee for Social Security and Medicare. Medicare doesn't give me such hassles. I am disappointed in Anthem's poor service in this issue and the employees at this office who have not been detailed or conscientious.
Initial Business Response Dear Ms. Brackett,
I want to thank you for providing us with this feedback. It is through this kind of customer input that we can take a better look at ourselves and look for ways to continuously improve our business processes and sharpen our customer focus in our interactions and transactions.
In reviewing your concerns, on **************, Anthem did receive your appeal request, on behalf of your mother. Anthem values the privacy of its customers. HIPAA privacy regulations have placed a number of complex restrictions on when and to whom Anthem may disclose/take action on a healthcare issue or private health information.
Anthem's appeal representative overlooked your Power of Attorney authorization that we do have on file and sent a letter asking your mother to complete a Designation of Representation form in order for you to initiate the appeal for her. However, since we had the Power of Attorney already on file for you, this form should not have been sent to you and the appeal should have gone forward without it.
Your second request for an appeal was received by Anthem on ******************. In reviewing this second request, a determination was made that the claim was originally denied by Medicare and that Anthem was your mother's secondary insurer. On****************, Anthem sent your mother a letter indicating that her Medicare Pre 65 Plan follows Medicare Guidelines. We will be able to process the ambulance claim if Medicare approves your appeal and approves the services she received. If Medicare does change their claim determination we will reprocess the claim when we receive the corrected Explanation of Benefits.
I would like to apologize on behalf of Anthem, for overlooking the Power of Attorney authorization on file when the first appeal request was received. I hope this information has been helpful.
Sincerely, ************ ********************************* Anthem Blue Cross and Blue Shield
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*Anthem Blue Cross And Blue Shield is in this range.
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