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Initial Complaint
09/30/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I have had no luck appealing a denied claim for a lab service that was conducted on 12/11/23. We were informed that the claim was denied on the grounds that the service location and business were out-of-network. This was a yearly physical blood lab, nothing exotic. However, I am contesting this decision as the service location is clearly listed as "In-Network" on their website. It takes months to hear back from anybody and when I do, they just deny everything. If a provider is "in-network" on their website, a claim should not be denied stating the provider is "out-of-network." It's impossible to reach anybody in corporate escalations and nobody that answers the phone is helpful with my escalation. I need a corporate escalations manager to contact me, not a standard ***** representative. 9 months later, I'm still dealing with this.
Business response
10/09/2024
Good afternoon,
Member authorization is required to address the member's concerns. Please refer to the attached letter.
Thank you,
******** *.
Customer response
10/15/2024
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]
This will be the 3rd time I've had my wife sign this Designation of Representation letter for this same appeal. This should already be on record twice - now a third time. Attached is the requested signed document giving me permission to act as her representative during this appeal.

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

Sincerely,

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

Business response
10/16/2024
Good afternoon,
The authorization form submitted lists the member's spouse as her representative. We are unable to respond to the complaint until we receive an authorization form, signed by **** ****** listing the Better Business Bureau as her representative. The Better Business Bureau must be listed under "Other" in Parts B and D. Should the member need assistance completing the form, she may contact *************** at the phone number on her health plan identification card.
Thank you,
******** *.
Initial Complaint
09/06/2024
Complaint Type:
Product Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
This complaint is against Anthem Blue Cross Blue Shield in an attempt to receive a refund of $2,148.48 for $238.72 auto charged to my credit card on the first of each month from 01.01.24 to 09.01.24. I am currently a member of Aetna ID ********** and have been insured through my company ******************* since December of 2023 which to my knowledge was the only insurance I had as I NEVER signed an agreement with Anthem Blue Cross for the year of 2024. Prior to 2024 my insurance was under $35.00 and my insurance through the Market Place was going to change by over $200 even with the cheapest option if I signed up for a new plan. I NEVER signed up for a new plan as I had done the past several years because of the drastic increase and I went on my companys (*******************) insurance to help afford to have some healthcare coverage I could afford. Anthem has then been Auto charging my credit card unbeknownst to me for $238.72 this whole year. When I saw an email about it in my business email spam I became concerned and in August I called Anthem who should have a record of my phone call to which the *** claimed I did not have an account based on Name, SS# and Address and assured me I wasnt being charged and didnt have an account. I called them yesterday in receipt of another email on 9.1.24 in which I became worried and went through my cc statements. They have refused to refund the monies charged and said it would only charge back 4 days of credit since 9.1.24 based on their termination policy which I had to get on the phone with the market place who claimed I had an auto renewal policy which I was unaware of and have ALWAYS had to sign a new plan each year. When I saw the drastic increase of over $200 I did NOT sign up for coverage though the market place in 2024 and signed up with my company and Aetna. I cannot afford this and feel completely scammed by ANTHEM. Note - I dont even have an Anthem Insurance Card. Please help me recover my money due. Thanks!
Business response
09/06/2024
Good morning,
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. We understand that the member does not have a current identification card. We respectfully request that the identification number from the previous policy be provided.
Thank you,
********************
Initial Complaint
08/30/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
For years I purchased ******** supplemental insurance through Blue Cross and never had a problem. But for prescriptions I used ********* ******** Rx plan via *****************. However, for the period beginning in January, 2023, I found that United Healthcare ******** Advantage offered much lower prices on an expensive medicine I must take, so I switched from ********* to United for the prescription service. With this and Blue Cross I figured I was covered for any emergency. Little did I know what lay ahead. in 2024 I noticed that Anthem Blue Cross was not paying anything at all. Looking back I saw that they hadnt in 2023 either! I called Blue Cross and was told that I had to inform ******** that BC/BS was my secondary payer. That should solve the problem. I called ******** and wound up in shock. They told me that the Anthem BC/BC coverage I was paying for was not valid with the United Healthcare ******** Advantage Plan. I was paying hundreds of dollars every quarter for coverage that did not exist. There had been no indication anywhere that such a policy existed. I called Anthem again and after a long, conversation with plenty of time on hold, the Anthem *** confirmed that it was true. I was paying for nothing. I told the lady I wanted my money back. This was pure theft, nothing less. She agreed and said she would put in a request for same and Id receive a letter of some kind within 30 days. Update: I mysteriously received $309.69 in my checking account on July 8. Then I received a written ***ly from Anthem dated July 5. All it talked about was the terms of cancellation. I DID NOT call to cancel even though that would be the end result. I was calling as I explained above. I wanted the money I had paid for services they could not legally provide. If this happened to me it is probably to others. Bottom line, I either want my $2772 returned, or applied as premiums for new coverage next year, as if I paid for it in advance.
Business response
08/30/2024
Please be advised we need the member's identification number with the three-letter prefix to be able to locate their policy.
Customer response
08/30/2024
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:

I forgot to add the account numbers. They are shown on the attached .jpg and also here. My member ID is *********.

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

Sincerely,

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

Customer response
09/16/2024
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: They said they would deal with me directly yet I have heard nothing from anyone other than the letter attached.

[Your Answer Here]

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

Sincerely,

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

Business response
10/08/2024
******* ******* ****** *** ******* ****** *** **** **** ********
Dear BBB:

This is in response to your correspondence dated October 5, 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.

******** ********
********* ******* *
Medicare Complaints, Appeals & Grievances
Initial Complaint
08/28/2024
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I receive ***************** from Anthem through my employer. For the past several months, I have been submitting out of network claims for healthcare received from a provider of my choosing. Anthem has repeatedly shown a pattern of missing processing SLAs and mismanaging my claims (per several calls with customer service ***** I have learned there is often no record of my claims after they have been submitted). I am extremely disappointed in the lack of care, as well as the time I have had to invest in convincing Anthem to please process my claims in a timely fashion. Anthem simply refuses to make any necessary corrections or identify the root cause of the issue, which requires me to continue fighting to receive the benefits that are otherwise covered by my healthcare plan. I want Anthem to investigate this matter properly, implement any necessary technical and process solutions, and apologize for the unsatisfactory service I have received. It is simply unacceptable for a healthcare provider to be so complacent about issues preventing their customers from receiving healthcare they can afford.
Business response
08/28/2024
Good morning,
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,
********************
Customer response
09/10/2024
I accepted this response from the business in order to provide the requested information, but I do not view this matter as resolved. My member ID is ************.
Thank you,
**************
Initial Complaint
08/27/2024
Complaint Type:
Product Issues
Status:
Unanswered
The business failed to respond to the dispute.
I have been in contact with **** for the last 9 months. I've spoken with a number of supervisors (******* **** L, ******* G, and others). The request was simple; an in-network exemption for midwifery services that were not offered by their providers. I was granted the exemption relatively quick and thought this process would be simple, yet here we are nine months later and I'm no closer to getting reimbursed for my out of pocket expenses than I was last year. Initially, they entered the wrong date for the exemption, which then required additional approval to further backdate the request. Then, they had issues with the ****** asking them for information that they had already been sitting on for months. Then they didn't catch that my claims were to be processed as in-network and declined them as out-of-network. Then they only approved some claims and not all the claims, and had to resubmit for consideration. I've been waiting for checks to be issued for weeks now and every update I receive is the same one, "We escalating the issue to our finance department." WEEKS, and I've heard the same story. Yet, they're quick to send me bills that I have to make payment on, but to reimburse me for expenses already incurred, this is their process. It's a shame that this is our medical insurance world. An absolute crime they make patients go through this just to get some relief in the form of a check. I would highly advise anyone who has a choice to steer clear of ****.
Customer response
09/20/2024
Better Business Bureau:

At this time, I have not been contacted by Anthem Blue Cross and Blue Shield regarding complaint ID ********.

Sincerely,

******* *****
Initial Complaint
08/27/2024
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I cannot get accurate billing or payment information need for tax purposes from Anthem. They will no send a monthly bill electronically or via the **** and instead refer you to a terrible 3rd party web portal or their own erroneous website. I a missing transaction details for an entire quarter, and cannot resolve thru call center/ chat or portal. I have numerouse complaints about their coverage as I'm sure most have about every insurance *** but the clerical incompetence is astounding. AVOID AT ALL COSTS
Business response
08/27/2024
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,
********************
Initial Complaint
08/16/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I called my insurance company, Anthem to ask about benefits regarding regular routine counseling. They told me in April of 2024 that routine counseling was covered 100% before my deductible. My member id is ************. I called my therapist to ask if the counseling I requested was considered routine, she said yes. I then had 6 sessions of counseling. Between April-June 2024. Anthem denied all claims. My counselor called but was on hold too long. I called and was on hold an hour. They agreed again that routine counseling is covered 100% and would need to get my therapist on the phone to give correct billing code. We called again together, a three way call. Again the call took almost an hour. They again agreed that routine counseling is covered 100% before deductible. They gave her a code. It was denied again. *** called again on hold for an hour, asked to speak to a supervisor and was told they would call me back. They never did. I called again, same day hours later 8/15/24. Asked again for supervisor and was told someone would call me immediately. No call back. I need help resolving this issue because Anthem refuses to call me back so I can resolve the claim. They continue to refuse payment for the claim and no supervisor calls me back.
Business response
08/19/2024
Please be advised that authorization is needed before we can address the members concerns. Refer to attached letter.
Initial Complaint
08/08/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
On June 18, 2024, I filed claim for Medical bill on cruise, based on information from anthem, it was filed as international claim, 2 weeks later when I checked, was told needed to be filed differently.representative of anthem filed internal grievance for me. I checked today , was told they resolved it by telling me they were wrong.and threw it out, sent in new claim per their instructions to proper address, then received letter they needed itinerary. I mail in a week ago, checked today , now saying I needed to to resubmit everything again, which starts their 60 cycle all over again, and was hung up on by anthem rep. **** getting the runaround, all I want is for anthem to start their 60 clock on original date filed.in June. Ofcourse they say no!
Business response
08/08/2024
Good afternoon,
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
08/09/2024
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]
The claim number is************
My member number is *********

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

Sincerely,

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

Business response
08/19/2024
****** *** **** ****** ******** ****** ******* ********************* ********** ******************************************* ******* ******************* **** ***** ****************** *** ****** ****** ***** ******************************* *** ****** *** **** **** ********

Dear BBB:

This is in response to your correspondence dated August 16, 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 by email at *******************************

Thank you for your concern.
********************* ********* ******* *
Medicare Complaints, Appeals & Grievances
Initial Complaint
07/12/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Writer has been kept held for an extended period of time with the company obstructing writer's ability to provide care for patients. Writer has called multiple times, attempting to arrange a peer to peer to be able to provide care for a patient and has been obstructed at every corner with the call being "dropped" several times and writer being transferred numerous times before ultimately being told that writer could not speak to a supervisor. This has occurred multiple times over the last couple weeks and now after missing 1 phone call (writer was informed that 2 occurred but there is no evidence of this in writer's phone nor way for writer to call anyone back after missing the call), writer now has to file extensive paperwork to have someone review the case again as it has been formally rejected.
Business response
07/29/2024
Good afternoon,
So that we may route the request to the appropriate area for handling, please provide the *** and Tax ID belonging to the provider.
Thank you,
********************
Initial Complaint
07/10/2024
Complaint Type:
Billing Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I have traded messages, chats, and phone calls on JUST trying to update my debit card (i.e. replace my expiring debit card by the new one) JUST to pay my insurance premium.Simple, but suddenly complicated with the *** in their website.I attach a PDF of a message I am sending them this morning; below parts of it:please, the website is bugged for my dental and vision billing 1- I HAD AUTOPAY, UPDATED MY DEBIT CARD INFO BUT AM UNABLE TO LINK THE DENTAL AND VISION ACCOUNT TO NEW DEBIT CARD due to*** 2- I AM TOLD THIS ACCOUNT DOES NOT TAKE AUTOPAY but a- it took autopay so far b- it displays that it is on autopay c- you are telling me that autopay is cancelled for my dental/vision account on August 01, 2024. Why? When trying to EDIT autopay for dental and vision, it gives me an error message - dental/vision account cannot be used for autopay - is it because it is linked to the medical?It REFUSES to delete the autopay setting for dental and vision - it si LOCKED Also, and suddenly, the next billed amount stopped displaying for dental and vision though I got an email for the dental/vision bill of august 2024 (but not yet the medical)the website does not offer an option for electronic payment outside of autopay the instructions you give yesterday do NOT match what I have on the screen. I CANNOT find an option to Add Autopay under Pay Plan Premium - this may be because I already have autopay for medical! I do not want to mail and fax things to avoid errors. I am traveling out of the country till august 2024 and it is a huge inconvenience to mail and fax these forms, especially that no one can tell me they were received.This is the third time I am going in circles with your chat, your customer service and your IT - once for my old billing address being put back as contact, once for bills not displaying properly on the website, and now. AT THE FIRST OF EVERY MONTH I HAVE TO CHECK YOUR WEBSITE TO MAKE SURE MY BILL WAS PAID, HOLDING MY BREATH.
Business response
07/24/2024
Good afternoon,
We were unable to locate this member in our system. Please provide the member's identification number, including the three-character prefix. It may be found on the member's health plan identification card.
Thank you,
********************

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