ComplaintsforAnthem Blue Cross And Blue Shield
HMOs
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Complaint Details
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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.Initial Complaint
08/31/2023
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
In October 2023, I received dental treatment. The procedure was to address pain, significant tooth degradation, and followed the professional recommendation of my dentist (*****************************). The claim was denied was denied by my insurer, Anthem **/BS. I asked my ************** to verify the claim was legitimate and resubmit, which they did. There was no communication from Anthem since, despite repeated attempts from the dentist office. I spoke with an Anthem rep in May 2023, and they said that criteria #2 was not met. I subsequently contacted my dentist office again, asked them specifically about this criteria, and they confirmed that the criteria was easily met and cannot understand why the claim is being denied. On May 31, I provided the supporting paperwork/documentation to Anthem using their online appeals process. I was told I would receive a written response, which never came. To date, no one from Anthem has contact me or my dentist even once and the claim remains denied and situation unresolved.Initial Complaint
08/29/2023
- Complaint Type:
- Billing Issues
- Status:
- Answered
The insurance company provided many false and inaccurate information. This has lead to financial difficulties due to cryptic and false messaging from the insurance company. It has take 11 months to finally get our claims denied, even though we were told multiple times that they would be approved and that we were following the proper instructions.Business response
09/25/2023
We were unable to locate Anthem enrollment with the limited information supplied. In order for us to review this inquiry further we would require the members identification and a completed DOR
Thanks
Business response
09/26/2023
Dear *******************:
We have reviewed your follow-up complaint, dated August 29, 2023, filed on behalf of *************************. The complaint regards delays in the processing of claims.
A review of this complaint indicates the members home plan is Anthem Blue Cross of **********. In an effort to have the complaint reviewed,please forward the complaint to the home plan at:
Anthem Blue Cross of **********
P.O. Box 60007
***********, ** 95670
Thank you for bringing your concerns to our attention. Please contact me directly if you have any additional questions or concerns.Initial Complaint
08/15/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
Anthem Blue Cross Blue Shield paid my 401k to someone other than me. They have refused to replace my funds or issue them to me. They have also refused to assist in retrieving my funds. Please see the attached documents.Initial Complaint
07/21/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
Anthem denied 3 of my claims, all of which were for expressly covered care. One had a referral and 2 were for urgent care, which is explicitly covered. However that is not my present complaint. In the course of contacting anthem, Ive contacted or been contacted 5 times since 7/12. Twice anthems live chat system (to which I was direct) dropped mid conversation and I had to start over with a new agent and then give up. Last night, 7/20 I was called by a rep outside of office hours who said my appealed claim had been redenied. She promised me a supervisor would speak with me and then placed me on hold for 17 minutes without a word, so long I worried shed dropped my call. She then said due to technical difficulties I should hang up and she would have the supervisor call me immediately. I did so and received no call. I called back and was sent to a message saying it was out of office hours. Again she called me. I have received no call as of noon 7/21. Today I used live chat to request the call happen. A rep spoke with me and claimed he was a supervisor but said he could not call because he was on an internal call. I expressed that I had been promised a phone call, which I wanted, and that he would not be able to help me while engaged in a second conversation. He said he would continue both conversations and I asked him if it was anthem policy to refuse to call in order to multi task conversations. He accused me of baiting him and stopped replying to the conversation, essentially hanging up on me. This is unacceptable.Initial Complaint
07/18/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
Filed for a medication ,much needed ,approval 4 weeks ago and never got a call from this insurance. Called 2 weeks ago, and insurance said that we got denied and all you need is a bmi. Apparently my doctor faxed all the info but they didnt receive page 2 and never bothered to call me. My doctor resent the document and not even 2 hours later, I got denied again because it needs more info. I dont know why we are paying high dollar a month and when we need the insurance, they give excuses not to approve you. This insurance is worse than ********Initial Complaint
07/05/2023
- Complaint Type:
- Customer Service Issues
- Status:
- Unanswered
I was denied medical care and I called Anthem today to speak to someone about it. I spoke to a person from member services, which the form you sent for my denial told me to call. After wasting a 1/2 with her she had to route me to someone else and promised me it would be taken care of. Despite her promises, she sent me to the wrong department who then rerouted me back to her department! I don't get paid to sit on hold an HOUR to have nothing done and then transferred right back to the same department who doesn't deal with account holders.I guess the people from out of country could care less about making us happy and Anthem also could care less whether their customers are taken care of or not! Thank you for wasting more of my time, especially since you denied my claim and I am in SEVERE Pain. Jerking me around really makes me feel better.Initial Complaint
06/27/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
2 years of work-up and diagnostics were disregarded by Anthem BCBS **************************** They sent a denial letter 20 days before a surgery that has been scheduled for 4 months to fix a debilitating issue regarding knees. Career job? Gone. Home life? Severe pain or medicated(and residually very painful). No 38 year old is begging for knee surgery and has documentation to support it. Come on, Anthem BCBS, be better than your bottom line.Initial Complaint
06/09/2023
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
Went to see my GENERAL Physician in December 2022 because I was sick and needed a strep test. Anthem/Blue Cross DENIED my claim because they claim I need PRIOR approval to see a general physician assistant. I cannot (and should not) get prior approval, to go to my General doctor. There is ONE medical care center in our town. I had to pay $222 to avoid having the claim go to insurance. I had another doctor *********** today either my SAME doctor. My doctors office said I was not approved. After 2 1/2 hrs TRYING to get some help on customer support, I had to eventually give up and cancel my general checkup *********** with my primary care physician. This is absolutely wrong and should be illegal.Initial Complaint
06/08/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
Dear Anthem Health Insurance,I hope this letter finds you well. I am writing to bring to your attention a discrepancy I have discovered while reviewing the claim records. It appears that my visits to ************************* P have been incorrectly counted as both Chiropractor and Physical Therapy visits. I would like to clarify that ************************* P is a Chiropractor, not a Physical Therapist, and therefore the visits to this healthcare provider should not be categorized as Physical Therapy visits.Please check the attached PDF file for details.
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Customer Complaints Summary
46 total complaints in the last 3 years.
21 complaints closed in the last 12 months.