Complaints

• Initial Complaint

  01/17/2025

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I enrolled in an Anthem Silver PPO plan online throught CoverME 11/13/2024 and paid for Jan 2025 1st months premium.Anthem automaticlly enrolled me into a MEB / *** plan 1/1/2025.I have contacted them through chat, email, phone several times form 1/1-1/15/2025 letting them know that I am NOT enrolled in the *** plan, I do not have an outstanding premium due and my account ID cards should not have the incorrect plan information.They continue to report that with in 3-5 days this will be resolved, they will call me back with an update and not to worry. I have not received any call back. Their team is very busy, it will get done. As of today 1/15/2025 it still has not been corrected. They have "put in an urgent request"I have spent over an hour on the phone each call, message exct. requesting the incorrect plan to be cancelled and the one I have already paid for to be on my account. This has yet to be fixed. I have had 2 members with doctors visits, with more up coming. I do not have correct ID cards to provide to the ********* as "they cannot issue new cards until IT department has corrected this" Will this "past due" amount on a plan I don't have effect my credit?

  Business response

  01/21/2025

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

  Thanks,

  *****

  Customer response

  01/27/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me and the matter has been resolved.
  
  Sincerely,
  
  ***** *****
  
  
  
   
  
  

• Initial Complaint

  01/09/2025

  Complaint Type:

  Product Issues

  Status:

  Unresolved

  More info

  In collaboration with the member, and with a signed form assigning us to be the authorized representative, we helped the member request an independent medical review- in response, the payer processed the request in a completely unintelligible manner- please see the attached despite following instructions on the 2nd level appeal letter. Payer may get in touch by email, phone, or through this portal. at the moment they've ignored a legal request for independent external review.we have re- sent the Independent external review regarding out of network services by certified mail- ********************** please get in touch by call or email

  Business response

  01/24/2025

  Member authorization giving the BBB permission to act on the members behalf is needed prior to us addressing the member's concerns. Refer to attached letter.

  Thanks,

  *****

  Customer response

  01/27/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  Here is the attached AOR form- we helped the patient with the request for External Medical review, That what everyone is asking for,  Patient should not have to administrate their own healthcare in the first place. 

   Please send the External Medical Review request to your vendor for processing.. 

   

   

   

  
  Sincerely,
  
  ********* ******
  
  
  
  
   
  

  Business response

  01/30/2025

  The authorization needs to be giving the BBB permission to act on the members behalf not the provider.

  Thanks,

  ***** *. 

  Customer response

  02/04/2025

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  *****,
  
  this has nothing to do with the member- this is in regards to the processing of our insurance claim.
  
  please review the most recent response and explain. 

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  ********* ******
  
  
  
  
   
  

• Initial Complaint

  01/07/2025

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  On 1/3/2025, I called the ******************** center because I noticed a charge on my *********** Benefits plan for long-term disability insurance. I had opted out of this coverage when making my selection through my employer for their health plans in collaboration with **********************. My health plan rolled over for the New Year, however, the ************* had been added on (while having no coverage from August 8 2024 - December 31 2024). When I called, the benefits center agreed that I had not made any changed to my health care plan by phone or email and therefore the plan should have simply rolled over. I have not made any changes nor would opt in for *************. Having acknowledged the mistake, they stated that they could try to take the charge away and that they would raise an incident. This is clear proof that the charge had been added on in hopes that it would not be discovered and as an attempt to scam. The process to remove the charge is long and could not be done on the spot. I am worried that if such a charge appeared out of nowhere for me, the same is being done to other customers. My account being rolled over and yet having a new charge is proof of an attempt to defraud instead of a potential mistake in inputting different selections (had I made changes).

  Business response

  01/08/2025

  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

  12/26/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Anthem is requesting $105.20 for an error they made in March 2023 which I dont have and did nothing wrong I am following up on your inquiry on December 20, 2024, pertaining to a debt letter you received from Anthem. I was able to review the claims further and was able to confirm there are two claims on file for date of service 3/1/2023 under claim numbers ************* and *************, both claims processed paying in error.

  Business response

  01/08/2025

  Good afternoon,

  Please be advised that the BBB site is preventing me from uploading the Plan response to the member's complaint. Consequently, I am sending the response in this message box. 

  Dear BBB Complaint Services:
  The Better Business Bureau (BBB) has notified Anthem Blue Cross Life & ************************ (Anthem) that you have contacted them recently requesting their assistance regarding the above-referenced file number. Your case has been assigned to me for special handling.
  Your request states the following:

  
  After reviewing the members appeal our records indicate that member is enrolled a Self-Funded Plan, and the Better Business Bureau BBB does not have jurisdiction over *** accounts. Therefore, the Plan (Anthem) respectively requests that the BBB remove this complaint from your file.
  

  The member is advised and redirected to submit their Appeal to the following:

  ****** **** ***** **** *** ************************ ***** ******* **** ********************************
  Or
  ********* ***************** ********************* ****** **** *** ********************* ** *************** ****************************************
  

  I hope you find this information helpful. If you have any questions or need more information, please call me directly at ************.
  

  Best regards,

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

  Grievances and Appeals Risk Analyst

  Grievances and Appeals Risk Management

• Initial Complaint

  12/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have two charges that I have disputed with anthem due to being approved for medical services but ultimately that means they pay nothing because it was somehow out of network. Which I was not told. They said it was out of network after the fact. My deductible has been met which is frustrating and I feel fraudulent to get the customer to pay out of pocket instead of going to a ** that is in network so they pay and not me. It shouldnt say approved if means they wont pay any money. If it said we wont pay anything not approved I would have went elsewhere and they would have had to pay. This is deceptive. In addition they wont even use my out of network deductible for the entire sum of the charges Im required to pay. That is very unfair. This is fraud to customers and not right. I am asking for significant reductions for two bills that had excessive fees on 7/1 lab corp and ********************** due to out of network while I was told it was approved. Nothing paid. The worst is that bills are in excess of $3k yet they only want to give less than $500 to my out of network deductible? How is that ok? These are significant grievances that I was not aware insurance wouldnt cover. They shouldnt say approved if its not going to pay anything. It should say not approved out of network we wont pay anything. These are extensive costs beyond even a self pay customer now and they say they cant reduce that because of having insurancewhich doesnt pay or give me full credit for out of network deductible. I am asking for these two bills to be paid as if they are in network due to not being properly noticed and the excessive charges well above the applicable out of network deductible that they are allowing themselves. They have tried to get out of paying claims by deceiving customers.

  Business response

  12/24/2024

  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

  12/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I am writing to formally file a complaint against Anthem Blue Cross Blue Shield (Anthem) due to their repeated wrongful denial of a valid medical claim and their fraudulent and unethical behavior toward both myself as a patient and my healthcare provider.On 10/10/2023, I received medical treatment from Silicon Medical Provider De (in my network for a service included in my plan). The provider promptly filed a claim amount $425 with Anthem for reimbursement. However, Anthem has continuously denied the claim, citing various invalid and contradictory reasons. The most recent denial reason is that the claim was submitted outside of the time limit, which is entirely false. The claim was filed immediately after the medical service was provided, well within the allowable time frame for ************* addition to the unjust claim denial, Anthem further exacerbated the situation by subtracting a portion of the amount due from my provider's account. This action has caused significant disruptions in the provider's billing system and has created undue complications for their office, which now must spend additional time and resources to correct Anthem's errors.I believe that Anthems actions are not only unjust but also potentially fraudulent. By continuously denying a legitimate claim based on incorrect information and making unauthorized deductions from the providers account, ********************** is engaging in egregious behavior that ***** both patients and medical service providers. This conduct reflects poorly on Anthem's business practices and undermines trust in the healthcare system.I am requesting that the Better Business Bureau investigate Anthems actions and take appropriate steps:Immediate processing and reimbursement of the valid claim submitted by my medical provider.Full restoration of any amounts deducted from the providers account.A thorough review of Anthem's claim processing practices to prevent similar wrongful denials and errors from occurring in the future.

  Business response

  12/19/2024

  Please be advised that member authorization is needed prior to us being able to address the members concerns. Refer to attached letter.
  
  Thanks 
  
  

• Initial Complaint

  10/30/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am requesting a refund for a dependent fee I was charged for 9 months. It's a fee that is charged when the spouse is offered insurance at their job. My husband is not working, he is a stay at home dad. I was wrongfully charged this fee for 9 months and now I am looking for a refund. I have attached my W2's as proof that he was not employed. Please advise.

  Business response

  11/05/2024

  Please be advised that authorization is needed before we can address the members concerns. Please review attach letter.

  Thanks 

• Initial Complaint

  10/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had a colonoscopy back in 2022 and listed my insurance as Anthem Blue Cross, the card is in the attachment I sent. Initially the benefit was paid, several months later I noticed on ******* that there was an outstanding balance of $2523. I called Cleveland Clinic and asked them what this was for they said it was for the colonoscopy I received, I said colonoscopies are fully covered under ********* they said they would have to get back to me. They later told me that Anthem denied the claim, they claimed I was insured by my wife's company. I was insured by my wife's company at the time however I removed her insurance card and replaced it with my Anthem card since it should have not cost me anything. I told Cleveland Clinic this and they informed that they had run my Anthem card and everything was ok. They don't offer preventive treatment without prior approval from the insurance company. I just want Anthem to pay the claim to ****************, I do not want any compensation for myself.

  Business response

  10/28/2024

  ******* *** **** ****** ******** ****** ***** ********** *** ******************* ********* ******* ******************* **** ***** ****************** **** *** ****** ******* ****** ***** *** ******* ***** *** **** **** ********
  
  Dear BBB:
  
  This is in response to your correspondence dated October 25, 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.
  
  ******* ********* **************** ******* *** ******** *********** ******* * **********
  

  Customer response

  10/29/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  [Your Answer Here]

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  ****** *****
  
  
  
  
   
  

• Initial Complaint

  10/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This is an ongoing matter. My son has been seeing an out of network provider. We have met the deductible. At first we were told the provider was in network. In August we were finally told out of network. We should send all claim information to Anthem. We were given multiple addresses. Claims were sent August 23rd. As of today there is no resolution. It is next to impossible to get in touch with anyone. No guidance, just misinformation.

  Business response

  10/30/2024

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

   

  Thanks 

  Customer response

  10/31/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  [Your Answer Here]

   

  Good afternoon. My member Id number is ************. The claims are for my son ******* ********. First date of service is 1/2/24. They are ongoing claims from *************.
  Thank you,

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

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  Good afternoon. My member Id number is ************. The claims are for my son ******* ********. First date of service is 1/2/24. They are ongoing claims from Qwest Therapy. 
  Thank you,
  Sincerely,
  
  **** ********
  
  
  
  
   
  

  Customer response

  11/09/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  [Your Answer Here]

   I will send the proper paperwork.

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  **** ********
  
  
  
  
   
  

  Business response

  11/12/2024

  The authorization submitted doesn't meet criteria, also, since ******* is over 18 he would need to sign the authorization. In order for the authorization to be valid the following is required:

   

            The members name, ID number, date of birth, and full address (must have 3 of these components)
            The full name of the person the member chose to act on their behalf
            A statement from the member giving us permission to share protected health information (PHI) with this person
            A statement from the member that lets us know the purpose for disclosing PHI to this person
            A description of the specific information we can share
            The date the authorization expires (not to exceed one year). Simply stating at the conclusion of the appeal process is sufficient.
            A statement that the member understands that they have the right to withdraw the authorization at any time in writing
            A statement that the member understands we arent responsible if their authorized representative shares their PHI with others
            A statement that the member understands they are not required to provide authorization in order to receive treatment or payment, or for enrollment or being eligible for benefits
            Member signature
  
  

• Initial Complaint

  10/16/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  September 4th notice of premium renewal issued but was not authorized. Refusal to credit back my bank account which was drafted.

  Business response

  10/17/2024

  Please be advised that member authorization is needed in order to review the members concerns. 

  Customer response

  10/21/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  Due to further information required, I will continue to pursue this until complaint resolved. The complaint is with Connecticut Blue Cross and Blue shield and will thus be filed through the proper channels. 

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  ******* *********
  
  
  
  
   
  

*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. ↩