Complaints

• Initial Complaint

  12/17/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My address is a landscaping company not a residence, I keep receiving mail from anthem insurance and they refuse to put a stop to it, they are sending for three different people, none of them are affiliated with this address, it would be such an honor if the mail sent from anthem will cease

  Business response

  12/18/2024

  We are unable to locate the member in our system. Please provide the member identification number complete with the three-letter prefix. This can be located on the member's identification card. 

  Thanks 

• Initial Complaint

  12/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My ***** claims keeps being denied for different reasons causing my *** to not get reactivated. The same claims have been approved by the same provider. Im unsure why some claims are accepted and some not. Seems like different people are reviewing the claims or people are not being properly trained. Im needing to use my FSA card to pay for my childs school and unable to. Its normally takes a couple days and we are on day 3 . I tried to call and get my claims expedited and no luck.

  Business response

  12/09/2024

  We are unable to locate this member in our system. Please have the member supply their member identification number complete with the three-letter prefix. 

• Initial Complaint

  12/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My company switched to Anthem in July and the pharmacy provider switched from ******** to Carelon RX. Since switching to Anthem, I cannot access my pharmacy benefits on their web portal to order new prescriptions. When I try to access it through Carelon RX, I'm instructed to return to Anthem website, which continues to block me from accessing my pharmacy benefits. I've called several times and no one seems to be willing to fix this for me. Six months and I am still unable to order meds through the Anthem website. The bot cannot fix the problem.

  Business response

  12/05/2024

  Good afternoon, 

  We were unable to locate the member in our system. Please provide the members identification number, including the three-character prefix. This information may be found on the members health plan identification card.

  Thank you, 

  ******** *.

• Initial Complaint

  12/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I submitted out-of-network claims for reimbursement to my medical insurance (Anthem Blue Cross) many months ago, as my out-of-network therapy payments are eligible for 70% reimbursement by Anthem. After the ***** day review period, the claim was denied. Upon calling, multiple representatives said the reason for denial was that it a missing diagnosis code, but it was actually in fact included, noting that it was denied in error, and needed to be resubmitted and wait another ***** days despite it being their error. After this period, it was denied again, with the representatives again agreeing it is an error. I was told that it's an AI technology that reviews the claims, and often makes mistakes, so they would escalate and resubmit for human review, with a conclusion in 10 business days on case number IC20844188. It's been over a month. I called again, and the representatives agreed it's been a mistake, but that there's no direct person they can escalate it to, and will continue to circulate internally without a final conclusion of reimbursement. I'm owed over $1k. And I'm nearing the end of the year, when I plan to submit more recent claims, already anticipating I'll go through this again.

  Business response

  12/04/2024

  Good afternoon, 

  We were unable to locate the member in our system. Please provide the members identification number, including the three-character prefix. This information may be found on the members health plan identification card.

  Thank you, 

  Michelle 

  Customer response

  12/04/2024

  Hello,

  Anthem can find more information about me by checking my account details. My member ID is ************. Attached are two of the submissions I'm awaiting reimbursement for. Again, Anthem has noted that the denial of reimbursement is an error on the part of their AI review system, and that all information needed to reimburse my claims is included in the documents. Despite escalating this for manual review, there has not been any movement that I'm aware of, and it has been months. They're dragging out a process so I give up in order to scam me and not reimburse me. Please advise.

  Thank you.

  Customer response

  12/04/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  Anthem can easily find more information about me by checking my account details. My member ID is ************. Attached are two of the submissions I'm awaiting reimbursement for. Again, Anthem has noted that the denial of reimbursement is an error on the part of their AI review system, and that all information needed to reimburse my claims is included in the documents. Despite escalating this for manual review, there has not been any movement that I'm aware of, and it has been months. They're dragging out a process so I give up in order to scam me and not reimburse me. Please advise.
  
  Regards,
  
  ****** *********
  

  Business response

  12/12/2024

  Good afternoon,

  Please see attached Plan response. Thank you.

   

  Customer response

  12/16/2024

  Better Business Bureau:

  I have reviewed the response made by the business in reference to complaint ID ********, and find that this response/resolution is satisfactory to me. 
  
  I have been reimbursed (as a result of escalation).

  Regards,

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

• Initial Complaint

  12/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Since the beginning of 2024, Anthem BCBS has misled me about a contractual issue they are experiencing with one of my providers. The provider was billing both myself and Anthem at 100%. When I followed up with Anthem, I was made to file a grievance so that they can look into the issue. Although I provided all of the required details, Anthem applied the grievance to a different provider and abruptly closed my grievance even though it was their error. I've followed up multiple times and had the matter escalated however Anthem refuses to cooperate. Additionally, Anthem BCBS is attempting to not reimburse me for well over $600 in out of network claims that I've paid upfront. I have used this provider for years and never had an issue until now. Anthem is trying to dictate who clients see for care in order to keep their costs low while collecting extremely high premiums. Anthem is denying the claims for various reasons however there is nothing missing or incorrect on the invoices, all of which Anthem customer service has confirmed. I've attempted to resolve this matter and even communicated with a supervisor named, **** ******* however this company has since stopped responding.

  Business response

  12/04/2024

  Good afternoon, 

  We were unable to locate the member in our system. Please provide the members identification number, including the three-character prefix. This information may be found on the members health plan identification card.

  Thank you, 

  ******** *.

  Customer response

  12/05/2024

  Good Morning,

  Thank you for your assistance with trying to help facilitate the resolution of this matter. My Anthem BCBS member ID number is ************. I've never had to provide this in the past as customer service has always easily located my account using either my phone number or full name, all of which were provided with my complaint. 

  I really appreciate this. 

  Rebecca 

  Customer response

  12/10/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Anthem has all of my information including my membership details. Card details as follows: OTF025W09001; 270095MA1A ]
  
  Regards,
  
  ******* *****
  

  Business response

  12/12/2024

  Please be advised member authorization is needed before we can address the members concerns. refer to attached letter.

  Thanks,

  *****

  Customer response

  12/19/2024

  Hi,

  I am unable to proceed to the next screen after attaching the requested documentation. There is no error message or indication as to why nothing happens when I hit the 'proceed' button.

  Please advise?

  Thank you.

  Customer response

  12/19/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response 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.]

  [Attached are the completed release and supporting documentation that Anthem BCBS requested but did not require as this type of cost information/detail does not fall within the guidelines for HIPAA]

  
  
  Regards,
  
  ******* *****

  
  

  Business response

  12/26/2024

  Please refer to attached decision letter.

  Thanks

  Paige 

  Customer response

  01/03/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Anthem BCBS has confirmed on record to already have this information. Anthem BCBS knowingly lied and misled me around the contractual issues they caused with ****, which in turn caused for me to have to pay in full and out of pocket.  Anthem should refer to electronic communications instead of now attempting to include me in what is now a legal issue between them and their vendor.  Anthem is well aware of the provider's information -- ******* *****; ********************************************* 

  Also, as of this writing, Anthem BCBS has still not provided me with the reasoning for the fraudulent denials of my out of network mental health claims. Anthem BCBS knows that I am currently on a mental health employment leave and are attempting to hinder my treatment even though they have collected my and my employer's premiums] 

  
  Regards
  ******* *****

  
  

  Business response

  01/13/2025

  Please see attached resolution letter.

  Thanks,

  *****

  Customer response

  01/16/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. 
  
  [Anthem continues to provide the same automated response alleging they will escalate both matters yet their own escalations division has confirmed on record multiple times that this is not the case whatsoever. This has been quite a hardship for me. Anthem is fully aware of my circumstances. Should I not receive an update along with my refunds in full, I will seek to escalate this at Anthem's cost.]
  
  Regards,
  
  ******* *****
  

• Initial Complaint

  12/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Hello,My wife has been receiving Medicare related mail from Anthem on a regular basis for over a year now, although we never contacted Anthem or had any service with them. However, having opted out of any mail solicitation and finding a letter from Anthem in the mail almost every month annoyed us, and I tried to contact Anthem to have my wifes name and address removed from their distribution list. Anthem, however, told me that they cannot remove her name and address, unless I provide them with her phone number, that Anthem should not have in the first place!! I even asked why they CAN send letters to my wifes address but CANNOT remove her name and address without her phone number? We are very careful with our personal information, and I am just not willing to provide Anthem with even more information about us, especially since Anthem also solicitates over the phone solving one probable and creating a new one!I believe it is our right (of privacy) that Anthem removes our address from their distribution list! Since Anthem was not willing to help me with my request, I am seeking help from the BBB.Thank you!Dr. ***** *******

  Business response

  12/04/2024

  December 4, 2024
  
  Better Business Bureau (BBB)
  Attention: ******* *****,Accredited Business Dispute Resolution Specialist
  *******************
  12th Floor
  ******************
  VIA: BBB Portal
  
  
  Member: ***** *******
  Re: Marketing
  BBB File No.: 22628662
  
  Dear BBB:
  
  This is in response to your correspondence dated December 3, 2024, regarding the above referenced member.
  
  Due to federal laws pertaining to the **************** Portability and Accountability Act (HIPAA)and the Protected Health Information (PHI) portion of it that went into effect April 14, 2003, we cannot relinquish information without proper authorization.  Therefore, we will be addressing the concerns in question and responding directly to ***** *******.  
  
  I trust that the information provided will aid in resolving your concerns and want to thank you for the opportunity to assist you.  Should you have any additional inquiries, please do not hesitate to contact me at **********************************************************************.         
  
  Thank you for your concern.
  
  ******** ********
  Grievance Analyst I
  Medicare Complaints, Appeals & Grievances

• Initial Complaint

  11/21/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Anthem is refusing to honor my policy. I have more than half my physical therapy visits remaining and they won't approve them. I require 3 hour long visits each week and the only 2 times they approved the visit extensions they gave only 4 and then 6 visits. I have gone without therapy for 3 weeks and it is affecting my physical condition. The excuses are either no claim was filed, which I know fotlr a fact is a lie, or the doctor hasn't sent the documents which is also a blatant lie. Once they said it wasn't medically necessary but this condition won't go away on its own and requires consistent therapy. I'm still paying premiums but they won't pay for the therapy and have also left me with almost ****** dollars above my max out of pocket in medical bills they haven't paid. They need to pay the outstanding bills and approve my therapy.

  Business response

  11/22/2024

  Good morning, 

  We were unable to locate this member in our system. Please provide the member's identification number, including the three-character prefix. This information may be found on the member's health plan identification card.

  Thank you, 

  ******** *.

  Customer response

  11/24/2024

  For the third time the Physical Therapy request got denied. And one again we were not notified and had to call 5 times before getting an update. Once again they said the reason was the doctor didn't send in documents. I know this is a lie because the office sent then in 4 times because Carelon (the approval **** for Anthem) said they couldn't read the first fax received. If I hadn't called repeatedly we wouldn't have been told until the appeal window closed. Now the doctor has to call and do a peer to peer so I won't have to wait 90 days for an approval. They always claim they never received the documents which forces the doctor to call and  wait on hold forever before they get the peer to peer.  Now Anthem wants me to publish my member ID and personal information in this thread so the whole world can have it. How am I supposed to send this information privately?

  Customer response

  11/26/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response 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.]

  For the third time the Physical Therapy request got denied. And one again we were not notified and had to call 5 times before getting an update. Once again they said the reason was the doctor didn't send in documents. I know this is a lie because the office sent then in 4 times because Carelon (the approval **** for Anthem) said they couldn't read the first fax received. If I hadn't called repeatedly we wouldn't have been told until the appeal window closed. Now the doctor has to call and do a peer to peer so I won't have to wait 90 days for an approval. They always claim they never received the documents which forces the doctor to call and  wait on hold forever before they get the peer to peer.  Now Anthem wants me to publish my member ID and personal information in this thread so the whole world can have it. How am I supposed to send this information privately?
  
  Regards,
  
  ******** ********

  
  

  Business response

  11/26/2024

  Good afternoon, 

  Please provide the first three characters of the member's identification number.  That information will help us determine which state her policy is handled in, so that we may provide the appropriate mailing address or fax number.

  Thank you, 

  ******** *.

  Customer response

  12/01/2024

  The first three numbers of the ** are:  V5R

   

  Thank you,

  ********

  Customer response

  12/04/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ** ********, and have determined the response 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.]

  The first three numbers of the ** are:  V5R

   

  Thank you,

  ********

  
  
  

  
  

  Customer response

  12/11/2024

  Obviously this insurance company only wants to take you money but not pay out claims. The doctors office ended up sending everything by email to an Anthem customer service *** who was very helpful and she sent it to the approval **** (Carelon). They still have not approved my PT. The doctor even scheduled a peer to peer call with them to expedite the approval but Carelon left him on hold for 90 minutes and never got on the call with him, I am unable to get therapy and that is hurting my recovery progression. IIf BBB can't deal with these people my next step is a lawyer.

  Business response

  12/12/2024

  Dear ******* *****.:    
  
  We have reviewed your complaint, dated November 21, 2024, filed on behalf of member ******** ********. The complaint regards delays in the authorization of requested physical therapy visits.   
  
  The member is effective on a large group employer $3200 Deductible HSA Plan.  The members complaint states less than half of her plans annual physical therapy visits have been used, but authorization requests for physical therapy visits have been denied or delayed by Anthem.
  
  The members plan allows sixty (60) physical therapy visits per Benefit Period.  There are currently thirteen (13) claims on file for physical therapy services with A&***************  Physical therapy visits are authorized based upon medical necessity.  The members complaint notes some physical therapy visits have been authorized by Anthem
  
  An authorization request for additional physical therapy visits was most recently reviewed as Anthem Reference Number UM69907983.  The authorization request was initially denied because no clinical documentation was submitted for review.  As noted in the members complaint, a peer-to-peer conversation took place between Anthem and the providers office on November 25, 2024. During this conversation, it was stressed with the providers office that more recent documentation was needed to document the progress towards a functional goal since October 14, 2024. 
  
  Clinical documentation was faxed to Anthem on December 9, 2024 and the request for additional physical therapy visits was reviewed.   A determination letter for Anthem Reference Number UM69907983 was mailed to the member and provider on December 9, 2024 advising the request for additional physical therapy visits was denied as not medically necessary.  The determination letter included the following rationale:
  
  Physical therapy (PT)has been requested for you. PT is care that aims to help you function,
  move and live ********** recently had PT visits approved. To approve more PT for you, we
  must receive your records. Your records should show your current status. Your records
  should also show that you made progress during the last set of approved visits. We reviewed
  the records we have. The records do not show that you made progress during the last set of
  approved visits. As a result, more PT is not medically necessary. We used Carelon Medical
  Benefits Management Clinical Guideline titled Outpatient Rehabilitative and Habilitative
  Services, Physical Therapy to make this decision. You may view this guideline at
  ************************************************************.
  
  Now that the requested physical therapy visits have been denied authorization, the member has appeal rights available to her if she wants to request overturning this denial. 
  
  Thank you for bringing your concerns to our attention. Please contact me directly if you have any additional questions or concerns.

  Customer response

  12/16/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response 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.]

  Obviously this insurance company only wants to take you money but not pay out claims. The doctors office ended up sending everything by email to an Anthem customer service *** who was very helpful and she sent it to the approval **** (Carelon). They still have not approved my PT. The doctor even scheduled a peer to peer call with them to expedite the approval but Carelon left him on hold for 90 minutes and never got on the call with him, I am unable to get therapy and that is hurting my recovery progression. IIf BBB can't deal with these people my next step is a lawyer.
  
  Regards,
  
  ******** ********

  
  

• Initial Complaint

  11/15/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I had employer coverage through Anthem, which ended on Sept 1, 2024. I elected continued coverage with ***** on Sept 27. 2024. Today is Nov 15, 2024 and my insurance coverage has not been activated by Anthem despited repeated communications from the third-party COBRA vendor, ******, and myself. Details:-September 27, 2024: ****** sent the first letter to Anthem to reinstate my coverage. ****** also sent a letter to me confirming this infromation.-November 4, 2024: I realized Anthem did not reinstate my insurance after being denied service from a medical provider due to lack of insurance. I immediately called Medcom.-November 4, 2024: ****** sent a second letter to Anthem.-November 7, 2024: I contacted Anthem and spoke with **** who told me Anthem needed to activate my account.-November 8, 2024: I contacted ****** again. The representative ther contacted Anthem again. She called Anthem and was told they couldn't speak with her and she should email the information. She complied.-November 8, 2024: I called Anthem again. I spoke with **** for over an hour. He tried to contact Anthem's **************************** He received no response. He said he was putting my account on his bucket list to monitor for a response. He said he would contact me when there was a response. I also spoke with a Supervisor named ****. He said the same thing as ***** I asked how I could escalate this situtation. He had no answer.-November 15, 2024: I called Anthem again. I was told my account has not been activated. After waiting on hold for 15 minutes, the representative hung up.I have been paying for health insurance for 3 months without the ability to get medical services because Anthem has not activated my account. This is unacceptable.

  Business response

  11/18/2024

  Please be advised that member authorization is needed prior to us addressing the members concerns. Refer to attached letter. 

  Thanks

• Initial Complaint

  11/13/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On January 12, 2024 I got laid off from *************, a California company. I had Anthem BC BS health insurance for me, my wife and and my son from May 1, 2023-January 31, 2024. I chose COBRA to the continue the same insurance for February, March, and April OF '24. I paid the ~$4,000 premium for February '24 on 2/1/24. On 2/15/24, my wife had a routine colonoscopy. At the last minute, the doctor's office said No, we didn't have insurance. I called Living Carbon. They said Yes, you do have insurance, and to go ahead. We did. But I HAD TO PAY FOR IT WITH MY CREDIT CARD, $2,318.81. They told me to submit a claim for $2,318.81 afterward. I said ok.I have submitted the claim 3 times, once on paper that they rejected and caused me to gather more information, a 2nd one was on-line/electronic which got lost, and the 3rd time on paper on 6/28/24 by signed registered mail. Since then, I have called several times. Each time has been a long call (over an hour), asking me the same questions repeatedly and no result. It appears that they can see and read my claim, but it is in the "wrong tool box" and is "not in the system". Finally, on a 8/28 call, a nice employee named ***** seemed to understand! He said it needed to be Re-keyed, and gave me ReKey #******* and I-*********, plus reference numbers *********** and *************. On 10/2 there seemed to be good news: the claim had moved forward, and 30 days were needed. On 11/1, nothing had happened and it was less clear. I spoke to Eve who said ***** would call me 11/4. He did not. On November 6, I spoke to Lucel. I emailed her my claim. She saw it and understood. She communicated with *****. She mentioned "it was in the wrong tool". She said she would take over for *****, and would call me soon. She did not. Today, 11/13 I spoke to April who said "it is not in the system" yet. But, she appears to have set up another Re-key! WILL THIS EVER END? WILL SOMEONE PLEASE PROCESS MY CLAIM FOR $2,318.81?

  Business response

  11/21/2024

  Good afternoon,

  Please see attached Plan response.

  Thank you.

• Initial Complaint

  11/13/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  3/3/24 desert trauma surgeons er visit made me pay $179.68 although I was admitting to the hospital Pih urgent care 10/13/24 Always have to call to get the billing taking care of in network

  Business response

  11/14/2024

  Good afternoon, 

  We were unable to locate the member in our system. Please provide the member's identification number, including the three-character prefix. This information may be found on the member's health plan identification card.

  Thank you, 

  ******** *.

*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. ↩