ComplaintsforAnthem Blue Cross And Blue Shield
HMOs
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Complaint Details
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Initial Complaint
03/20/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
I went for a routine mammogram on 9/30/2023 and Anthem keeps denying the claim. I have been on the phone for hours and hours with these people. One person says the claim needs to be processed by ******** and the other person says it should be sent to Anthem directly since I had the ******** Advantage Plan. In the meantime I keep getting bills from ******************* Medical Imaging in ****** threatening collection. This has become very stressful and is affecting my health.I feel that Anthem has no consideration for their members.Initial Complaint
02/05/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
One November 2nd I purchased an "upgraded" health care plan from Anthem Blue Cross Blue Shield. I had been a member with them for a few years already. They advised me that I could "upgrade" my plan and get better coverage including the hospital that I live next to for a higher premium. I agreed to the much higher premium as the salesman told my it was better insurance. Now that I am trying to use the insurance I find out it is a much worse plan that very few doctors accept and it is the only one my hospital DOES NOT accept. I have called and called and they just keep transferring me or telling me they can't fix the issue. Each call is about ***** in hold time and transfers.Initial Complaint
01/26/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Unresolved
Blue Cross and Blue Shield have given me absolute problems since I was hospitalized in 2023 for a ruptured appendix. I was in and out of the hospital on September 29, 2023, and about to lose my life. Blue Cross Blue Shield has been consistently denying a claim from September 29, 2023, because they needed more information from the doctor. I contacted ******* and the hospital,l. The hospital provided the authorization form to Carelon three times. Blue Cross Blue Shield keeps saying that they have not received the authorization form. So, they keep denying the claim. After several months of calling them, calling the hospital, calling Carelon, the only thing I was able to get was an approval in the mail from Blue Cross Blue Shield saying that they finally approved the *** code attached to that claim. Now, they are refusing to pay for the claim, stating again that they never received the pre-authorization form. They sent me an approval of the *** code with the claim, and yet they are still saying that they are not approving this claim because of the pre-auth form not being submitted. I had Intermountain Health send the pre-authorization again, and now Blue Cross Blue Shield is saying it takes up to 30 to 60 days to process the claim. Intermountain health is now threatening me to pay the 16k if blue cross blue shield wont help. I have never in my life dealt with a company like this. I have called several times to speak to many different people, and no one can give me any answers. These were for emergency services that I needed to keep my life. And now, I am being slapped with a $16,000 bill because Blue Cross Blue Shield is refusing to do anything about this issue.Business response
03/12/2024
Dear ****************:
We have reviewed your complaint, dated February 27, 2024, filed on behalf of member ***************************.The complaint regards delays in the processing of charges for date of service September 29, 2023.
A review of the claims on file with Anthem confirmed a claim for services provided on September 29, 2023 was initially received on October 6, 2023. An Explanation of Benefits was issued on October 17, 2023 advising additional information was required to complete the processing of the claim. Specifically, the provider coded the claim with an ICD-10-CM diagnosis code that became effective on October 1, 2023. Because this diagnosis code was not effective for the date of service billed (September 29, 2023), corrected information was needed from the provider.
Anthem received a second submission of the claim from the provider on November 10, 2023, but the second submission of the claim included the same diagnosis code that was not yet effective for the date of service. The member submitted an online Medical Claim Form, which was received by Anthem on November 22, 2023, but this claim submission did not include a corrected diagnosis code.
Following contact with Anthem customer **********************, the member was given instructions on filing a member appeal,but an appeal has not yet been received regarding this specific claim. The provider can also submit a corrected claim along with medical records to correct the diagnosis code.
Thank you for bringing your concerns to our attention. Please contact me directly if you have any additional questions or concerns.Customer response
03/21/2024
Complaint: 21203197
I am rejecting this response because:
This makes no sense. The over all denial of the claim you all are giving was that it didn't have a pre auth done. This does not mention that at all. I'm also not sure what you mean by "not yet effective". I had that imaging service on that date. I also recieved a response that it was approved. Yet; it is still not approved and Intermountain health has received no response on paying for my surgery.
Sincerely,
***************************Initial Complaint
01/19/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
I logged into my portal and ************************* was incorrectly listed as out of network. I verified with Anthem that he is in-network, but they stated they still had his old address in the system and needed to fix it. After several phone calls and emails trying to fix the issue to no avail, Anthem took it upon themselves to DELETE this provider from my care team! They now REFUSE to re-add him! I have tried, but it will not pull him up in the "Find a Provider" section. This is not the first issue I've had with Anthem listing doctors incorrectly- it took over 7 MONTH for them to finally update and correct my PCP!The rewards section of their website is also not working and I cannot access the benefits offered there. They have yet to address this issue too.I have called Anthem yet again and filed a complaint with them. I was on hold for over 2 HOURS! RIDICULOUS!Initial Complaint
01/05/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
The policy I bought included 2 doctor ***** paid by Anthem and they have not paid the UCHealth bill of ******.Initial Complaint
01/05/2024
- Complaint Type:
- Order Issues
- Status:
- Unanswered
Billing adjustment for the contract that ***************************** is approved with under Anthem's contracted rates.Initial Complaint
12/27/2023
- Complaint Type:
- Customer Service Issues
- Status:
- Unanswered
December 11th is the date of the letter received. Letter was received near the end of December 2023. I have signed up for automatic payment via a credit card. This payment option was offered and accepted. Now Anthem is saying they are going to change the payment option through my bank. Calling Anthem to discuss wastes a lot of time. The automated system takes a very long time to try and speak to a real person instead of the automated assumptions.Initial Complaint
11/07/2023
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
I have contacted anthem for over a month. I have received incorrect and conflicting information from all of their reps. All they have to do is offset my account. For thr expense I have uploaded. However, they are refusing to do so.Initial Complaint
11/06/2023
- Complaint Type:
- Product Issues
- Status:
- Unanswered
This company did not do the industry standard of verifying their client owned the email the client provided. Because of this I'm getting emails relating to "*******" because she used my email to sign up with them.This is a health insurance company so letting me see sensitive healthcare information is a violation of HIPPA and it's clogging my Inbox. They have no mechanism to contact them without being signed into their website.I want my email address removed from *******'s account with ************************ attempted to call them but I just get a 'call can not be completed' error.Initial Complaint
11/01/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
I am concerned that the individuals working for this business are unfit. This is the business my health insurance policy is through, and I have had nothing but issues. I have anaphylactic allergies, and if you're familiar, this is a life threatening allergic reaction that requires immediate medical attention. I recently had an episode where I had to be admitted to the hospital. I am being told by my insurance (the business who is the subject of this complaint) that I will owe $32,000 due to my claim being denied for the reason "Not Medically Necessary". I am a pharmacist myself, and I have 10 years of medical billing experience. I know for a fact anaphylaxis treatment is medically necessary and have the documentation to prove my claim. I have tried to contact my insurance regarding this matter multiple times using several different methods to rectify the situation to no avail. I am concerned about the level of negligence and incompetence from the employees of this company. I am concerned that insurance representatives with this company are not properly reviewing claims and assigning them declined statuses without doing any proper research. The representatives I speak with from this company have grammar skills of an elementary student, but they are somehow qualified to review medical claims? They are unable to answer even the simplest questions I have regarding my insurance coverage. Luckily, I have a doctorate degree and I am a health care provider myself so I can usually resolve insurance issues on my own. However, I am concerned that I know more about doing their job than Anthem employees do. I am concerned about the qualifications (or lack of) for these employees. I am concerned for others in my community with these issues who do not have the healthcare background I do and do not have the tools to resolve issues like these on their own. I believe the company is operating fraudulently and deceptively to obtain higher payment amounts from their patients.
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Customer Complaints Summary
45 total complaints in the last 3 years.
20 complaints closed in the last 12 months.