Anthem Blue Cross and Blue Shield

While this member's complaint did not contain an identification number, I was able to locate the member's ID number and determined his home plan is Anthem Blue Cross and Blue Shield of [redacted] The contact information for the member's home plan is as follows: [redacted] *** [redacted] [redacted]

Initial Business Response / [redacted] (1000, 5, 2015/11/25) */ Dear Mr***, thank you for bringing your concerns to our attentionPlease accept our apologies for the frustration and inconvenience you experienced with our Customer Service departmentYour issues have been forwarded to the attention of the appropriate parties for reviewWhen Anthem receives notice from a member that they would like to terminate their health insurance policy, it could be for various reasons, they can no longer afford the premiums, the policy does not suit their specific needs, etcIn an effort to assist our member's in keeping their health insurance coverage, Anthem's Health Plan Advisors are engaged to help the member find a policy that better fits their specific circumstancesFor example, there may be a different policy available that has a lower premium or different benefits that are more suitable for the member Your Benefit Certificate, states "Effective Dates of Termination: Except as otherwise provided, Your coverage may terminate in the following situationsThis information provided below is general, and the actual Effective Date of termination may vary based on Your specific circumstances; for example, in no event will coverage be provided beyond the date Premium has been paid in full: If You terminate Your coverage, termination will be effective on the last day of the billing period in which We receive Your notice of termination." In researching your concerns, our records indicate that Anthem cancelled your health insurance policy on November 17, 2015, with a policy cancellation date of December 1, However, based on your request, we have updated your account to show the cancellation date of your policy as November 11, 2015, and have issued you a refund in premiums in the amount of $You will receive your refund within daysI trust this addresses the concerns you have raised Sincerely, [redacted] SrGrievance & Appeal Analyst Anthem Blue Cross and Blue Shield of Colorado

Dear Ms [redacted] , Our records indicate that you are enrolled in the Anthem gold Pathway X HMO plan Page's and of your Benefit Certificate states:" “Where You Can Obtain Prescription Drugs Your Booklet includes benefits for Prescription Drugs You get at a Retail or Mail Order PharmacyWe use a Pharmacy Benefits Manager (PBM) to manage these benefitsThe PBM has a network of Retail Pharmacies, a Mail Service Pharmacy, and a Specialty PharmacyThe PBM works to make sure Drugs are used properlyThis includes checking that Prescriptions are based on recognized and appropriate doses and checking for Drug interactions or pregnancy concerns.” "Pharmacies, a Mail Service Pharmacy, and a Specialty PharmacyThe PBM works to make sure Drugs.are used properlyThis includes checking that Prescriptions are based on recognized and appropriate doses and checking for Drug interactions or pregnancy concerns retail ---- You can visit one of the local Retail Pharmacies in Our networkGive the Pharmacy the prescription from Your Doctor and Your Identification Card and they will file Your claim for YouRefer to Your Summary of Benefits for any Copayment, Co-insurance, and/or Deductible that applies when You obtain Prescription DrugsIf You do not have Your Identification Card, the Pharmacy may charge You the full retail price of the Prescription and may not be able to file the claim for YouYou will need to ask the Pharmacy for a detailed receipt and send it to Us with a written request for paymentIf We determine that You may be using a Prescription Drug in a harmful or abusive manner, or with harmful frequency, Your selection of Participating Pharmacies may be limitedIf this happens, We may require You to select a single Participating Pharmacy that will provide and coordinate all future pharmacy servicesBenefits will be paid only if You use the selected single Participating PharmacyIf You do not make a selection within days of the date We notify You, We will select a single Participating Pharmacy for YouHelpful tip : Benefits for Prescription Drugs, including Specialty Drugs, which must be administered to You in a medical setting (e.g., Doctor’s office, home care visit, or outpatient Facility) are covered under the ADMINISTERED BY A MEDICAL PROVIDER benefitPlease read that section for important detailsMaintenance Medication - Home Delivery Complete the PBM also has a Mail Service Pharmacy that You will use to obtain Drugs You take on a regular basisIf You are taking a Maintenance Medication, You may get the first day supply plus one additional day refill of the same Maintenance Medication at Your local Retail PharmacyYou must then use the Mail Service PharmacyYou will need to contact the PBM to sign up when You first use the serviceThe first mail order Prescription You submit must include a completed patient profile formThis form will be sent to You upon becoming eligible for this programAny subsequent mail order Prescriptions for that Insured need only the Prescription and payment enclosed" As using the mail order process for certain prescriptions is a requirement of your health insurance policy There is no opt out of this process However, if you disagree with this decision, you may file a written appeal to be reviewed by our Appeal Panel You can send your written appeal to: Anthem Blue Cross and Blue Shield of Colorado Attention: Grievance and Appeals Broadway Denver CO Sincerely, Julie Frisk SrGrievance and Appeals Analyst Anthem Blue Cross and Blue Shield of Colorado

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted]

Dear [redacted] , Thank you for bringing your concerns to our attention Please be advised that your health insurance policy is a self-funded account through Anthem Blue Cross of CaliforniaTherefore, Anthem Blue Cross and Blue Shield of Colorado does not administer your benefits Please contact your employer plan administrator for further assistance regarding your claims issues, or you may consider filing a complaint with the Revdex.com in California We have completed our research and have determined there is no further action to be taken by Anthem Blue Cross and Blue Shield of Colorado regarding this issue Sincerely, [redacted] SrGrievances and Appeals Analyst Anthem Blue Cross and Blue Shield of Colorado

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me provided the refund is received by me in the business day window Sincerely, [redacted]

Dear [redacted] ***,This is in regard to your disagreement with Anthem's previous response to your policy cancellation In researching your concerns, our records indicate that Anthem received your formal appeal request regarding this issue on August 7, Your appeal will be reviewed by Anthem's Appeal Committee within the regulated time frame Once the Appeal Committee has made a determination on your request for reinstatement of your policy, you will be sent an appeal determination letter informing you of the committee's decision For status on your appeal, please contact the Customer Service number on the back of your health insurance ID cardSincerely, [redacted] ***

Thank you for your December 18, 2014, letter on behalf of [redacted] * [redacted] I appreciate theopportunity to look into this matter and have the following information to offer.We regret that this issue became a source of concern to Ms [redacted] In reviewing the details of hercomplaint, it was determined that the claim in question was processed under a non-participating providernumberOn January 7, 2015, I called Ms [redacted] to let her know that her claim has been forwarded tothe claims team to reprocess using the in-network provider numberI have confirmed that the processingis complete and payment will be sent to the provider in the next weekThere is no patient liability on the claimin question.Please let us know whenever we can beof further assistance.Sincerely, [redacted] ***SrGrievances & Appeals AnalystExecutive Services

I do not recall working on this particular case However, I have responded to a couple of Revdex.com complaints filed in Colorado in which the member's policy is handled through another states plan For Example, the member may live in Colorado, but they have a national account through their employer located in another state (i.eAnthem Blue Cross CA) Since Anthem BCBS of Colorado is not the administrator of that member's plan, we are not accountable for issues with the member's home plan in CA and thus cannot respond to the members concerns The member would need to contact the entities within the state of CA for that plan to answer to the issues the member is experiencing with their particular planThis member may not have a policy through BCBS of Colorado, I don't see a name and address to assist us in looking to see if we can pull any information with the name and address, that does not always work, especially if the member is covered through an Anthem BCBS plan outside of Colorado If the member is covered through their employer, they can work with their HR department on their policy and insurance plan to get the information they need If it is an individual plan that they applied for through the Connect for Health Colorado Exchange, the Exchange can also assist them with their insurance informationIf it is an individual plan the member applied directly through Anthem BCBS of Colorado they can contact Anthem BCBS of Colorado's main number (303)831-and explain their situation to receive additional assistanceHope this helps to clarify [redacted] SrGrievance and Appeals Analyst Anthem Blue Cross and Blue Shield of Colorado

Dear [redacted] ***, Your complaint to the [redacted] Revdex.com has been forwarded to me for research and response Specifically, your complaint is in regard to the cancellation of your health insurance policyOur records indicate that the effective date of your health insurance policy was January 1, Anthem received your initial premium payment for the month of January on December 19, This payment paid your policy through February 1, Anthem received your premium payment for the month of February on January 11, 2017, this paid your policy through March 1, Anthem received your premium payment for the month of March on February 9, 2017, this paid your policy through April 1, Anthem received your premium payment for the month of April on April 19, 2017, this paid your policy through May 1, Anthem received your premium payment for the Month of May on May 19, 2017, this paid your policy through June 1, Anthem did not receive your premium payment for the Month of June and your day grace period to make this payment expired on July 2, Therefore, your policy was cancelled effective July 2, If you disagree with the cancellation of your health insurance policy, and would like further consideration for reinstatement of your policy, you can file a written appeal for further review You can send your written appeal to: [redacted] Thank you for bringing your concerns to our attention If you have any further questions, please contact the Customer Service number listed on the back of your health insurance card Sincerely, [redacted] Tell us why here

Dear Ms***, Our records indicate that you have your Health Insurance Policy through Blue Cross Blue Shield of Wisconsin Since Blue Cross and Blue Shield of Colorado does not service your membership, unfortunately, we are not able to address or resolve your concerns You will need to contact the State Agencies available to you in Wisconsin for further assistance with your concerns Sincerely, Julie Frisk SrGrievance and Appeals Analyst Anthem Blue Cross and Blue Shield of Colorado

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted] ***

Dear Ms [redacted] , Thank you for the prompt response to my email requesting additional information regarding your Anthem Blue Cross and Blue Shield membership Based on the information that you provided, you have indicated that you did not have your health insurance policy through Anthem Blue Cross and Blue Shield of Colorado, and that your health insurance policy was actually through Anthem Blue Cross and Blue Shield of Virginia Unfortunately, Anthem of Virginia is a separate health insurance carrier that Anthem of Colorado We do not have access to your membership, benefits, or claim information in our Colorado membership systemI regret to inform you that while I would like to assist you with your issues, you will need to go through Anthem in Virginia or Virginia's state agency for assistance with your concerns Thank you [redacted] Senior Grievance and Appeals Analyst Anthem Blue Cross and Blue Shield Colorado

Dear Mr***, I attempted to research your concern but I was not able to locate your Anthem Blue Cross and Blue Shield membership with the information you provided in your complaint I tried to call you but there was no answer Therefore, I sent you an email requesting you to provide me with the letter alpha prefix followed by the member number (front of your health insurance ID card), and Customer service number listed on the back of your health insurance ID card Once I receive this information I can continue my research into your concerns Sincerely, [redacted] SrGrievance and Appeals Analyst Anthem Blue Cross and Blue Shield of Colorado

Complaint: [redacted] I am rejecting this response because: Sincerely, [redacted] ,The first time Anthem received the application was May 19,I did not receive any communication until I phoned on May 21st when I called customer serviceAfter being transferred SIX times and hours and minutes (yes I have documentation), I was told by your customer service rep that she would call me back in minutes after looking into the applicationNever received a call nor ANY communicationMay I called customer service AGAIN, transferred times minutes and was told by your customer service rep ( [redacted] ) to resend the applicationI resent it May The first communication I received was an email from Maria was May saying that the application was being reviewedOn June 7th she emailed me to say there was no a qualifying event, and I will receive a letter in the mail, I still have never received a letter On Page # it was indicated there was a qualifying event and I never received a letterJune resent the application the 3rd time, on June I received an email saying it was being reviewed,on June 7th I was told there wasn't a qualifying eventAt no point did anyone ask for a letter from a former employerJune 9th sent the application in again, NOOOO response until I called my CongressmanWhat is up with not giving your customer service employees no power to service customers? It wasn't until I reached out to a Congressman that anyone had the capability to call me on June 27th to tell me that I needed to provide proof from the former employerI spoke with [redacted] I got the information to hime in business daysI have emailed him times just to get confirmation of receipt of the qualifying event letters still no responseAs of July my husband and I have paid $13,in premiumsThe least your company can provide is a person to answer the customer service line and provide some adequate serviceI do hope that this resolves soon as now both of my kids qualify for a fine from the ACAI really don't think having a representative that actually has the authority to help a customer is not too much to askI really wish we had a different option for a provider but we don't and it seems as if Anthem really takes advantage of that situation.So NO I still don't have insurance for my two kids and the problem is not yet resolvedI am far from satisfied

Initial Business Response /* (1000, 6, 2015/12/16) */
Dear Mr***,
Please accept our sincere apologies for the frustration and inconvenience you have experienced in getting this issue resolvedAnthem's Subrogation Specialist tried to reach out to you regarding this issue on December 9,
2015, at the phone number we have on fileUnfortunately, she was not able to get ahold of you and there was no voice mail set up to leave you a messageAs a result, Anthem's Subrogation Specialist sent you a letter on December 9, 2015, with a list of claims for the settlementMs*** will be glad to assist you in the resolution of this matterYou can contact Ms*** directly to resolve this issue at X-XXX-XXX-XXXX Ext4771, her fax number is X-XXX-XXX-XXXX
I trust the above will address the issues you have raisedThank you for bringing your concerns to our attention
Sincerely,
*** ***
SrGrievance and Appeals Analyst
Anthem Blue Cross and Blue Shield Colorado

Dear Mr***,Your complaint has been forwarded to me for research and response. In researching your concerns, your policy is administered through Anthem Blue Cross and Blue Shield of Nevada. Therefore, the Colorado Revdex.com does not have jurisdiction over your
concerns. If you would like to pursue this issue, you can send your complaint to the Nevada Revdex.com. If you have further questions regarding this issue, please call the Customer Service number listed on the back of your health insurance identification card. Sincerely, *** F.Risk Analyst Grievance & Appeals Regulatory Unit

Dear Ms***,Your recent complaint to the Colorado Revdex.com has been forwarded to me for research and a response. In your complaint, you mentioned that your son lives in South Carolina, you live in Tennessee, and his father lives in Georgia. It is unclear as to why this
complaint was filed in Colorado. However, with the information you provided, we are not able to locate a health insurance policy for your son through Anthem Blue Cross and Blue Shield of Colorado. Therefore, unfortunately, we are not able to address your concerns. I regret we could not be of further assistance to you. Sincerely, *** *.Risk Analyst Regulatory Unit Anthem Blue Cross and Blue Shield of Colorado

Dear *** ***,Your recent complaint filed with the Colorado Revdex.com has been forwarded to me for research and a response. Specifically, your complaint is in regard to the delay in the cancellation of your health insurance policy.Please be advised that your health insurance
policy is through Anthem Blue Cross of California. Therefore, Anthem Blue Cross and Blue Shield of Colorado is not the correct health insurance plan to respond to your complaintPlease contact the Revdex.com agency in California for assistance with your concerns. We have completed our research and have determined there is no further action to be taken by Anthem Blue Cross and Blue Shield of Colorado.If you have any questions or concerns, please contact the Customer Service number on the back of your health insurance identification card. Sincerely, *** **
*** ***
*** * *** *** ***

Thank you for your January 12, 2015, letter on behalf of *** and *** *** I have thefollowing information to offer in response to Ms***'s concerns regarding premiumpayments for her husband's HealthKeepers Bronze plan.We regret that this issue became a source of concern to Ms***
While mistakes do occur, itis always our intention to resolve problems promptly and efficiently when they arise We regretMs***'s recent experience and hope that it does not leave a lasting impression.Our records indicate that Ms***'s concerns have been resolved and the appropriate refundswere issued to her on January 16, With respect to her request to waive her premium forone month, we are not able to honor this request We do not offer free coverage for any length oftimeTo do so in this instance would be inconsistent, and, ultimately, unfair to other customerswho pay their premium.Ms***, thank you for your efforts on Ms***'s behalf I trust the information I haveprovided is helpful When we can be of further assistance to you, please let us know.Sincerely,*** ***SrGrievances & Appeals AnalystExecutive Services