Anthem Blue Cross and Blue Shield of CT Reviews (18)
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Anthem Blue Cross and Blue Shield of CT Rating
Description: Insurance - Accident & Health, Insurance Companies
Address: 108 Leigus Rd, Wallingford, Connecticut, United States, 06492
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I have had ongoing problems with Anthem. Their website malfunctions, their claims processing is often flawed, incorrect and requires numerous calls to resolve. Filing appeals is fraught with Anthem Appeals personnel making incorrect decisions forcing you to file complaints with your state Insurance Commission. They misrepresent facts and search for a gray area in which they can escape statutory regulation. If you live in Connecticut, don't depend on any agency, particularly the Insurance Commission or Dept. of Public Health being proactive in your defense. They have traditionally backed insurers at the expense of the public best interest.
Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***
it shows they would respond but never didI contacted them and they informed me it was in appeals and would be payed out within 3O days and it has not
Hello
Please fax all complaint to the attenion of the Grievances and Appeals Department at ***
Please do not send your requests via email.
Thank you
*** ***
I am following up on our conversation on February 2, *** *** contacted the Revdex.com concerning her medical health insurance policy*** *** had specific question pertaining to her plan benefits for both medical and prescription services that were renderedAs stated
in our conversation, since *** *** did not provide a written release of information, I cannot address these issues with anyone other than *** ***. After numerous phone calls, I was able to speak with *** *** and she stated that the medical and prescription issues have been addressedPlease advise if you need additional information. With thanks and appreciation, *** *** *** ***Grievance and Appeals Risk Analyst IGrievance and Appeals
Anthem refused to pay my pharmacy benefit for z-pack antibiotic refill They first I could not refill the script until 3/1/(script was initially filled 2/22/with dosing days) Called Anthem again on 52/29/The it afraid I needed )"prior autgoriZation"from my doctorI said the script stated refillShe said I could not refill it for daysWhen I asked who, said this, she said "it was an FDA recommendation" I said it was AnthemI called my doctor's office on 2/29/16, explaining what Anthem rep had said My doctor would be in the office 3/2/and would fax a completed prior authorization form to Anthem On 3/2/16, I received a call from my doctor's office, stating they had faxed the form to AnthemA few hours later I called *** *** pharmacy to try to file the script againAnthem declined it a secondOn 3/8/I called *** *** pharmacy, asked them to put the script through for a third time, it was declinedAnthem is practicing medicine without a license, and not paying valid pharmacy claimsI reported them to the CT Insurance Department
Hello
I am writing in response to Complaint ID: [redacted].
Our records show that the member's application was received on November 3, 2014. The information received indicated the member was enrolling in a plan to become effective November 1, 2014. He provided his credit card information and the payment of $205.76 was processed on November 3, 2014. Anthem processed his enrollment on November 4, 2014.
The payment processed by Anthem on November 3, 2014 was returned on November 6, 2014. The payment was not honored.
On November 14, 2014, Anthem sent the member a letter informing him his November premium of $205.76 was due on November 1, 2014 and to avoid losing the policy, the premium payment would need to be received by December 15, 2014. A bill was generated for the November bill on November 16, 2014.
In reviewing the Customer Service documentation, our records show Anthem received a call from the member on November 24, 2014 to make a payment. The Customer Service representative incorrectly advised the member that the initial payment was paid and posted. On January 18, 2015, Anthem received an email from the member asking why his coverage was cancelled. On February 4, 2015, a response was sent informing him it was due to non-payment of the November premium payment since his original payment was returned. He was referred to the Health Plan Advisor (HPA) line to reinstate his coverage. On March 11, 2015, Anthem received an email from the member asking to have his policy reinstated. On March 12, 2015, an email response was sent to the member advising him he must file an appeal to have his request reviewed further.
While wait times to get a Customer Service representative were high due to open enrollment, the member waited too long between Anthem's email response on February 4, 2015 to request the reinstatement of his plan.
When a valid November premium payment had not been received, Anthem cancelled the member's plan on December 22, 2014 with a retroactive termination date of December 2, 2014.
His requset for a first level grievance (appeal) was received on February 13, 2015. The Grievances and Appeals Analyst reviewed the member's request, the policy provisions, and the Customer Service call documentation. On March 12, 2015, the analyst determined that the previous coverage decision could not be changed and sent the member a letter informing him his request for reinstate was denied.
Therefore, Anthem is unable to to honor the member's request for payment of $200 as a refund of the tax penalty he had to pay.
Sincerely,
[redacted]
Grievances and Appeals Analyst
Grievances and Appeals
Complaint: [redacted]
I am rejecting this response because:This is what they pulled last time, they need to submit this complaint to their own "Complaints" department, I can't imagine that is a major ordeal.
Sincerely,
[redacted]
Dear [redacted]
I am writing in...
regarding the above complaint [redacted]
I have sent the claim for [redacted] Cruise Ship on January 30, 2015 for processing, please allow 10-14 business days
Review: For 2014 Blue Cross Blue Sheild required its customers to change policies due to the afforadable health care act. I have been a member for almost 10 years and have had the same policy - Individual BlueCare Direct. I submitted a new application on 12/23/13 and paid my new premium price of $1068.00 in full as required. I have an ongoing issue with my back and was scheduled an [redacted] by my doctor for 1/05/2014. I was then notified that my new policy is not active therefore I could not receive my [redacted]. I have contacted BCBS multiple times since this issue has come to light - my wife and I have spent almost 10 hours on hold and have nothing resolved. Customer service says my account is active but refuses to fax me or email me anything to confirm the policy. I am supposed to receieve my new membership pack sometime but can not guarantee when I might receive.This issue is putting not only my health at risk but the health of my wife and 11 year old son.I have paid for an insurance plan in full for 1 month and do not have insurance...Desired Settlement: I would like the portion of my inactive policy refunded and would like compensation for my lost time and continued suffering while waiting for health care.
Review: In order to obtain better coverage as a full time doctoral student, I dropped my plan with [redacted] and purchased a plan through acccesscthealth. Blue Cross has mishandled the general public in the roll out of these plans in a way that I feel is premeditated to add to the bottom line. I was not billed for the plan. Instead I was sent a letter that came in the mail January 6th but dated December 13th that states if I do not pay by January 1st I could not complete my enrollment. I paid on January 6th through their website. However, they make it 100% impossible to obtain ID card information. Instead after 6 calls I've come to the realization it is an automated system designed to hang up on you. It gives you the option only to pay them, or other automated functions. The problem is I am paying for service that by their records is effective January 1st. I have no ability to use the insurance and can not get my plan number. I should not be charged for January. 4 emails and 6 calls to customer service, over 2 hours on hold, and no person on the other end. Ordered ID cards by the automated system but have no faith they will come in the 7 to 10 days the robot voice tells me to expect. They know we are paying for the month of January and can not use the service. Lets face it, 100% profit is the best margin you can get. Enrollment has been less then expected, and there is no reason for them being so overwhelmed they can not provide any service of any kind to paying customers. Now I need to fill a prescription I get every month and can't, or pay the inflated cash price.Desired Settlement: A refund for January premium for my Blue Cross GOld plan. If I don't have the ability to use my insurance in Febuary I would like to cancel with a full refund.
Review: Anthem sent me two letters on the same day. One said "we did not receive your payment, and your grace period has ended." The other said "This months premium is due." We had a confirmation number for the previous payment, so I called to clarify.It takes forever to get a human on the phone. After following many prompts and holding for 19 minutes and 32 seconds listening to noise, the operator said her name and 'how can I assist you' and there was a long beep. I was concerned she was not still on the line. I said are you still there? I heard nothing. I said 'if you are there i'm not hearing you, are you hearing me?" She said - I can hear you. If you can't hear me, call back..... and which time I started yelling "NO NO NO NO I can hear you." The operator hung up. I'm so angry with the flippant way they treat customers. I'm working and spend another 20 minutes getting a person on the phone. This is a company we pay over $10,000. yearly. They have a virtual monopoly through Obamacare. With all of that revenue they MUST improve their customer service. 19 minutes is a ridicuolous time to wait to speak to a person to discuss THEIR error.Desired Settlement: I would like them to call me. [redacted]
Review: I applied for health insurance back in September 2014. It took over a MONTH to finally get situated and get my plan started as their customer service is horrendous and website is constantly facing issues. It was finally put in place on November 1st and a few days later I called (and waited over an hour to get through to someone) to confirm the plan was enabled and my credit card was on file and successfully charged. A young lady who was very rude and clearly uninterested in her job confirmed that my card was all set and charged properly. That was NOT the case as it was never charged and someone from Anthem's end says that it was declined…which would’ve been impossible at that point in time. My coverage was then cancelled on December 4th, and I did not get a notification that it was ended until a letter came in the mail in January stating that it was cancelled...over a month later. I have been without health coverage ever since, had something happened to me I would’ve been completely screwed. On top of that I am paying a penalty on my tax return for lack of insurance coverage. It is now past the day to apply for insurance. I was screwed out of health insurance due to horrible customer service and site issues on their end. It is now March 9th, I still have NO health insurance just a huge string of emails I sent to them including ones simply saying "hello?" just to ensure they are even getting my messages or even reading them, when I finally did get a response (weeks ago) they just said my case is being reviewed. They haven't done anything to help, I NEVER get through to anyone over the phone and am always getting hung up on, and they take a month in between email responses. Now I am scrambling to find insurance through another agency so I am not facing another penalty next year, and obviously am covered if something were to happen. I am about ready to call a lawyer to sue Anthem for false information, cancelling my policy without my consent, taking well over a month to inform me of cancelling, and on top of that causing me to pay a $200 penalty on my return, unless they are willing to reimburse me for this.Desired Settlement: A check for $200 that I had to pay as a penalty on my tax return for no health insurance coverage due to their absurd customer service and ignoring my every call and email...on top of failure to notify me of declined card payment which could've been resolved with a 5-minute phone call.
Business
Response:
Hello
Please fax all complaint to the attenion of the Grievances and Appeals Department at [redacted]. Please do not send your requests via email.
Thank you
Consumer
Response:
Review: [redacted]
I am rejecting this response because:
This is what they pulled last time, they need to submit this complaint to their own "Complaints" department, I can't imagine that is a major ordeal.
Sincerely,
Business
Response:
Hello
I am writing in response to Complaint ID: [redacted].
Our records show that the member's application was received on November 3, 2014. The information received indicated the member was enrolling in a plan to become effective November 1, 2014. He provided his credit card information and the payment of $205.76 was processed on November 3, 2014. Anthem processed his enrollment on November 4, 2014.
The payment processed by Anthem on November 3, 2014 was returned on November 6, 2014. The payment was not honored.
On November 14, 2014, Anthem sent the member a letter informing him his November premium of $205.76 was due on November 1, 2014 and to avoid losing the policy, the premium payment would need to be received by December 15, 2014. A bill was generated for the November bill on November 16, 2014.
In reviewing the Customer Service documentation, our records show Anthem received a call from the member on November 24, 2014 to make a payment. The Customer Service representative incorrectly advised the member that the initial payment was paid and posted. On January 18, 2015, Anthem received an email from the member asking why his coverage was cancelled. On February 4, 2015, a response was sent informing him it was due to non-payment of the November premium payment since his original payment was returned. He was referred to the Health Plan Advisor (HPA) line to reinstate his coverage. On March 11, 2015, Anthem received an email from the member asking to have his policy reinstated. On March 12, 2015, an email response was sent to the member advising him he must file an appeal to have his request reviewed further.
While wait times to get a Customer Service representative were high due to open enrollment, the member waited too long between Anthem's email response on February 4, 2015 to request the reinstatement of his plan.
When a valid November premium payment had not been received, Anthem cancelled the member's plan on December 22, 2014 with a retroactive termination date of December 2, 2014.
His requset for a first level grievance (appeal) was received on February 13, 2015. The Grievances and Appeals Analyst reviewed the member's request, the policy provisions, and the Customer Service call documentation. On March 12, 2015, the analyst determined that the previous coverage decision could not be changed and sent the member a letter informing him his request for reinstate was denied.
Therefore, Anthem is unable to to honor the member's request for payment of $200 as a refund of the tax penalty he had to pay.
Sincerely,
Grievances and Appeals Analyst
Grievances and Appeals
Review: I am absolutely livid with the way that Anthem has handled my insurance plan since being forced to transition to what they deem to be a plan that is "comparable" to the one that I had through them for many years prior to the Obamacare fiasco. Nevertheless, toward the end of December, I made payment, as the letter I received explained that they would "make it easy" for me by just making the switch without me having to do anything other than may my payment. I was supposed to see a Dr. yesterday who is rather hard to get an appointment with. On my way to the office, they called me and informed me that Anthem said I am no longer active with them. This is a lie. I arrived at home and immediately called Anthem. I was on hold for about 2 hours when someone finally answered the phone and told me that they weren't the right people to help me with this - all they could do was take new applications - UNREAL! He then put me on hold, where I stayed for another hour. The person who finally answered asked me how I would like to process payment -WHAT??? I was trying to find out why they never applied the payment I made in December to the new plan. I understand that the ID number changed, but that was NEVER provided to me and how on earth am I supposed to make payment to the new ID # if they refuse to send me any information to do so? After another HOUR, the person I had been speaking with said he would contact the office that handled my prior policy (WHAT?), at which point he put me on hold AGAIN and then came back to tell me the office is now closed. UNACCEPTABLE! At this point, I made payment on the new plan (since they gave me the ID number over the phone) but am FURIOUS that they have about $500 of MY money which they refuse to transfer to the new account and have NEVER told me was not processed correctly. WAS I EVER GOING TO GET THIS MONEY BACK??? They've had it for almost 3 weeks now and never attempted to contact me about it. I am furious with Anthem!!!Desired Settlement: I expect a FULL REFUND of my overpayment and a formal apology from the company for holding on to my money, never notifying me about it, never sending me the information necessary to make payment the proper way, and giving me the runaround for HOURS on the phone and I STILL have yet to be given a resolution. The way they are doing business is completely unacceptable and they MUST be held accountable!
Review: I am unable to contact my insurance company for the past month spending hours on the telephone with no representative to assist me. They have increased my primary for an additional 200.00. I have paid for two months til the end of February. They changed my ID no. and have attempted to obtained my group no. and type of increase with no success. I have no new id card. I would like to cancel and get my money reimbursed; however I can not get through customer service.Desired Settlement: I would like my primary refunded of $815.88 for the month of Jan & Feb 2014 and cancel with BCBS.
Review: Several times, [redacted] has submitted claims to Anthem BlueCross BlueShield for date of service 1/6/14 and each time Anthem has denied the claims of which there are 2 stating that I could not be identified as a member. It behooves me why they can pay my primary care provider with no [redacted]ions asked, but when it comes to [redacted], they suddenly can't identify me. I have been billed approximately 4 times since I had blood work done at [redacted] and each time I call Anthem, they have a different answer each time I call about why these claims have not been processed. I called today and the gal that answered the phone today asked me where I went to [redacted]--out of State? To which I replied, "No, right here in [redacted]." I am being billed out of [redacted] from [redacted] and now they said that they are not billing right. The contract states that, If you use an independent lab whenever you have a blood test, urine test, Pap test or biopsy, your share of the cost will be zero ($0). You will not have to pay any deductible and/or coinsurance. [redacted] is an independent lab as stated by Anthem, yet they still deny my claims. [redacted] also has the right patient ID. I have spent a lot of time on the phone trying to make sure that these claims get processed and still no one has taken the time to get these done. I called [redacted] today to notify them of the fact that I have been in touch with Anthem on several occasions to get this straightened out and refuse to contact them any more on the issue and frankly, I am surprised that [redacted] hasn't put these claims into Collections which would affect my credit. Please help.Desired Settlement: Please contact them to see what can be done about this issue before it winds up in collections. They know these claims should have been processed a long time ago and I feel they are trying to ruin my good standing by waiting too long to process my claims.
Review: On 4/17/14, I applied for individual insurance plan from Anthem. I spoke with [redacted]s. I repeatedly informed [redacted] that I needed the plan to begin on June 1. She stated that any plan applied for after April 15th could not start prior to 6/1/14. After applying over the phone, I received an email stating that I had a desired start date of 5/1. I informed [redacted] of this error, and she said she would correct it on her end. She also stated that I would not have to pay my premium until the plan started in June. My card was charged the next day, and when I called I was told that this was incorrect and payment was due at the time of the application, and that my coverage would start 6/1.On 4/30, I received my membership packet in the mail stating that my plan started 4/1 and that I had a premium due on 5/1. I called Anthem and was told by [redacted] that this was an error that was fixed, my payment would be applied to the month of June, and no further action was required on my part.A few weeks later, I received a notice of late payment in the mail for the month of May. I called [redacted] twice and emailed her once when she did not call back. She replied to my email telling me that I needed to contact customer service. I called customer service and told [redacted] of my issue. She stated that it would be fixed within the next two days. When I did not hear back from her, I assumed the issue was resolved.On 6/12, I called to cancel my policy because I am moving out of the state. I spoke with [redacted], who told me that my plan had been canceled due to lack of payment. I never received any notice that my policy had been canceled and would not have known if I had not called in.[redacted] called me back and informed me that she was putting in my request and that they "might" be able to change my start date, apply my payment to the month of June, and take the late payment off of my file. She told me that she would call me by 8PM Eastern on 6/17. She did not contacted me prior to that time.Desired Settlement: I want my policy start date to be changed to 6/1/14 per my original request. I want the "balance due" note taken off of my policy and this confirmed in writing. I want my policy to last from 6/1/14-6/30/14. If the changes to the date of my policy cannot be made before 6/30, I want the policy cancelled and my initial premium uf $282 refunded to me because I paid for health insurance for June and am not receiving that. I want a written apology from Anthem for their error and the inconvenience.
Review: On 11/04/13 my Doctor's office requested authorization for a right eye procedure , I had an appointment for 11/07/13 and Anthem stated that it takes 24 to 48 hours for the authorization , on 11/05/13 I contacted Anthem to check on the authorization and was told by Julie that it was not cleared yet that by the time the appointment comes it should be authorized , I contacted the Doctor's office billing department to let then know , on 11/06/13 I was contacted by my Doctor's billing department and I was told that my appointment will be cancelled because Anthem stated that the authorization will take 15 days ,I once again contacted Anthem and all they said was that still pending ,first Anthem said 24 to 48 hours now they say 15 days , I have taken the day off from work for this and I lost the day , today 11/07/2013 I received a call from Anthem that the authorization still pending. This procedure is covered by my insurance but I have to pay for it because of my co-pay , what if I go blind because this waiting , why they have to lie to their clients , very irresponsible health insurance company.Desired Settlement: To have my procedure authorized and Anthem should pay for it because as of now my eye can get worse, thanks
Business
Response:
Dear Ms. Goodwin:
I am writing in response to your letter dated November 8, 2013, concerning the above-referenced case. [redacted] has contact your office referring a request for prior authorization for services with Dr. [redacted].
By way of background, [redacted] is enrolled the Lumenos HSA plan. This is a PPO plan with managed benefits. Certain procedures require prior authorization from Anthem BCBS. Anthem has up to 15 days to conduct an initial prior authorization review. However, we do make every effort to review these requests as quickly as possible.
A review of our records shows that on November 4, 2013, Anthem's Utilization Management Department received a request from Dr. [redacted]'s office for prior authorization for a procedure. Dr. [redacted]'s office was instructed to submit medical records for review of this request. This information was received on November 4, 2013 and forwarded for review. This review was completed on November 7, 2013. Noficiation was sent to the member and provider on November 7, 2013 advising of this approval. Additionally, on November 8, 2013 a Customer Service representative contact Mr. [redacted] by phone to advise him of this approval.
I trust this information is helpful to you. If you have any questions or wish to discuss this matter further you can contact me directly at ###-###-####.
Sincerely,
Grievance & Appeals Analyst, Senior
Consumer
Response:
Review: [redacted]
I am rejecting this response because: I was told on November 4 by Anthem that this authorization will take about 24 to 48 hours so I already have taken a day off from work because I won't be able to work after the procedure was done and lost that day of work , my appointment was for 11/07/2013 at 9:30am and that was more than enough time for the approval , never I was told that it could take up to 15 days , my Doctor's office advised me of that when I called them to see if it was approved , I kept calling the Doctor's office and Anthem but never got a straight answer from Anthem all they said was that still pending and don't know why it takes so long . this procedure was approved before with no problem , all of that and they don't even pay a penny on this claim because it goes towards my deductible , so is coming out of my pocket , thank you
Sincerely,