Anthem Blue Cross and Blue Shield

Thank you for your December 18, 2014, letter on behalf of [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 providernumber. On 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 number. I have confirmed that the processingis complete and payment will be sent to the provider in the next week. There is no patient liability on the claimin question.Please let us know whenever we can beof further assistance.Sincerely,[redacted]Sr. Grievances & Appeals AnalystExecutive Services

Thank you for your inquiry dated December 30, 2014, regarding Mr. [redacted]'sconcerns about his HealthKeepers Bronze health care plan. I have the following information toshare with you.We have received notification from the Marketplace to cancel Mr. [redacted]'s health care plan.In turn, we have...

cancelled Mr. [redacted]'s plan and he should disregard any billing statementshe has received for that plan.We regret the concern this matter caused Mr. [redacted] and appreciate your efforts on hisbehalf.Sincerely,[redacted]Senior Grievances and Appeals AnalystExecutive Services

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.   Sent a statement that this has been paid.
Regards,
[redacted]

Review: I signed up for Anthem HealthKeepers in January online and I paid a premium. Two weeks later I received an email that stated that my application was incomplete. This time I had an insurance agent file for me online and once again I paid another premium. I got my prescriptions filled in March. I made a premium payment on March 25, 2014. Then on April 11th, I went back to the Pharmacy to get my medications and I was told I could not get them "due to lack of payment". I needed my medicines so I made a double payment to them. Between April 11th and April 16th, I made eight phone calls to Anthem and [redacted] (who authorizes my prescriptions) and every agent gave me a different story. First I was told my double payment made on April 11th would take 24 hours. Then I was told on April 14th, that it would take [redacted] 3 business days to clear my payment. On April 16th, I was told that Anthem still had me on hold! When I spoke to a supervisor, she said she was going to electronically send approval to [redacted] and give [redacted] 2 hours to take the hold off. When I called this supervisor back 2 hours ;later, she had left for the day and left a note that I needed to wait until the 17th!!!

I have been without my medications for 6 days and I have been shoved around and given a different story with every agent and supervisor from [redacted] as well as Anthem. Its 23 miles one way to the pharmacy It has been 7 days since they received my Debit Card payment and still no results.Desired Settlement: I have travelled a total of 184 miles going back and forth to the pharmacy because agents were telling me my account was cleared. I am seeking a credit for my premium for their negligence in processing my payment. I also think I should be given a month of free prescriptions for the aggravation of being incorrectly informed of my status.

Business

Response:

Sorry for the confusion! As we discussed the complaint for [redacted] was closed here on 050514. The issue the member was having with her premiums was resolved in late April. We immediately notified [redacted] and all of the prescriptions that had been previously affected were reprocessed on April 17, 2014. This case had been presented to our office from the Virginia Bureau of Insurance just prior to receiving your letter.

Hope that helps. Have a great afternoon!

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: I enrolled in health coverage with Anthem Healthkeepers Insurance through the Affordable Healthcare Act and paid my first premium on Dec. 24, 2013. I was told I would receive coverage starting Jan 1. 2014 or after it was processed which could take up to 14 days from first payment. I was not given a account number, but instead told it would be in the welcome packet, and that any providers could simply be given their phone number and coverage would be confirmed. On Jan. 2, 2014, I had an appointment with radiology at [redacted] in Ohio. I was refused the operation because I could not provided proof of insurance, nor was the phone number working. To this date, I still have not received anything from Anthem except an email confirming my first month's premium was paid. I have effectively not had the insurance I was paying for during this last month. I was additionally just charged a second month's premium for February. Furthermore, every phone call sent to Anthem has been dissconnected by their automated system after multiple hold times exceed 90 minutes.Desired Settlement: The premium for the month of January should be credited to my account as I did not receive the services I was paying for.

The cost of travel to [redacted], Ohio from my home in [redacted], VA and back due to operations rejected because lack of services from Anthem.

Business

Response:

Thank you for your letter received on January 30, 2014, written on behalf of [redacted].

The correspondence related to his recent enrollment in a HealthKeepers Exchange product and

a lack of response from Anthem resulting from that action. We have the following information to

share.

ln order to protect our member's privacy related to this request, our office has forwarded Mr.

[redacted] an Anthem lndividual Authorization form to be completed and returned to our office

regarding this matter. Once we have received permission from him, we will respond to the

dispute. A copy of the letter mailed to Mr. [redacted] is enclosed for your records.

lf you have further questions or need additional assistance you may call me direct at ([redacted].

Sincerely,

Senior Grievances and Appeals Analyst

Executive Services

Enclosure

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be a first step. I will wait for the business to perform this action and, if it does, will move on to correcting the fault with them. Once this has be done, I will consider this complaint resolved.

Regards,

Review: On September 19, 2013 our check # [redacted] paying Policy # [redacted] for [redacted], was miss-applied to another account.

I have faxed and e-mailed this information and all check numbers to Anthem several times. It is impossible to get anyone on the phone that is willing or able to help.

Our representative [redacted] spent time trying to resolve this issue without satisfactory results!

Thursday will be the 9th month without a return call from Anthem. Yet the late notices continue to arrive.

[redacted]Desired Settlement: Correct the issue

Business

Response:

Thank you for your recent inquiry on behalf of Mr. [redacted], regarding premium payments for

his employee, [redacted]. I understand there is concern about a premium payment that Mr.

[redacted] sent to us for Mr. [redacted] which has not yet been resolved.

We are in the process of gathering the information necessary to conduct a careful and thorough

review of the concerns of the concerns expressed in your inquiry. As soon as our review is

complete, we will respond directly to Mr. [redacted] as we do not have an authorization on file to

share information with the Revdex.com or Mr. [redacted]

ln the meantime, should you have additional information to provide or questions in this regard,

you can send an email to [redacted] or call me directly at [redacted] and I will be glad to assist you.

Thank you for your patience while these concerns are being reviewed.

Sincerely,

Business

Response:

Thank you for your recent inquiry on behalf of Ms. [redacted], regarding premium payments for

her employee, [redacted].

We have completed our review and have located the payment in question. I have responded

directly to Ms. West with the details and specifics of that payment. ln addition, I provided her

with my direct contact information should she have further questions in this regard.

Thank you for your efforts on behalf of Ms. [redacted].

Sincerely,

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Regards,

We were always aware that the money was applied to the wrong account. Our only request is that it be applied correctly so that we can close out our general ledger and let [redacted] take over paying his own account.

Anthem BCBS has been an absolute nightmare to work with. Prior to enrolling with them I spoke to a representative in depth about my coverage. At the time I was just placed on bed rest due to a high risk pregnancy and wanted to confirm my prenatal care including my frequent ultrasounds would be covered. (I had BCBS of Georgia prior to my company making the switch and had absolutely no problems with them and they covered everything at 100%) Being in the medical field I confirmed that this would be covered with the representative and signed up due to them having what appeared to be phenomenal coverage of paper. Since the plan went into effect I have been denied having the ultrasounds covered under prenatal care with an average of 206$ weekly despite what the representative had promised me. They refused to accept a letter from the MD stating that this was medically necessary prenatal care in my case. I have literally had to contact them on a weekly basis for one problem after another, while I am supposed to be stress free and on bed rest. Yesterday I spoke with them to get an approval for a breast pump, was stated that it would be 100% covered and the representative provided me with the DME company to call. I called immediately to get the process completed and was provided only 2 options that Anthem allows, both being pumps that have extreme substandard ratings. After agreeing to accept what they would cover, I received a phone call today stating that Anthem was now denying payment for the pump! One day after they stated I was 100% covered and directed my in the process. So I am now having to clean up their mess once again because they obviously want to take the cheapest way out and give their clients substandard care. Another 2 hours later of being placed on hold I am still waiting for yet another solution when I have never even been provided one for the initial problem.

Review: My wife ([redacted]) and I both had separate Anthem policies that were on autopayment from our bank checking account. We called Anthem Member Services the last week of Dec. 2013 and told them to cancel our policies on Dec. 31,2013 as we were switching to [redacted] Health Insurance. We were assured this would be done.

Jan. 7, 2014 Anthem withdrew from our [redacted] checking account $1025.98 for my canceled policy and another $304.00 for my wife's canceled policy. We called Anthem Member Services again and talked to a '[redacted]' who said he could see that our policies had been canceled but somehow it hadn't gone through. He said he was sending the information through and taking care of it as we spoke and a refund check would be mailed to us. When questioned 'how did we know this really had been done this time', he said that he was the only '[redacted]' in the Roanoke office and it had been done.

We just received a letter from Anthem saying 'Thanks for being a customer' so we called our bank to see if Anthem was still withdrawing money from our account. We were informed that they indeed had withdrawn another $1025.98 for my canceled policy and another $304.00 for my wife's canceled policy around Feb. 5, 2014. I immediately called Anthem Member Services and after 45 minutes of being placed on hold (and we have been placed on hold for 30-45 min. for each call we've ever made to Anthem.....they do not make it easy to contact them) talked with [redacted] (Ext. [redacted]) who said she would take care of making sure our policies were canceled and checks would be mailed to us.

We do not trust Anthem. We do not believe they have canceled our polices. I do not believe that they will send me a check for $1978.16 or my wife a check for $608.00 (totaling $2586.16). I believe that they are doing this to many other people with no intention of returning money.

We have lost many hours of work trying to straighten out this problem. I now will be contacting our bank to close out our account to make sure Anthem can no longer get any more of our money. Once our current account is closed I will have to spend several more hours redoing forms so our autopayments with other companies can go through our new account.

We are out $2586.16. How are we supposed to pay our bills?

If we ran our business the way Anthem is running theirs, we'd be in jail.Desired Settlement: We want our $2586.16 back in a check.

We have not had access to our money and we would like monetary compensation for them using our money.

We would like to be reimbursed for the hours we have had to take off work to take care of this matter.

I would like to see a news article written that shows the public how Anthem is ripping people off. I'm positive this is being done to other people.

Business

Response:

Thank you for your recent inquiry regarding Mr. [redacted]'s concerns about the cancellation

of his individual health care policy. I appreciate the opportunity to be of assistance to you.

While we do not have an authorization on file allowing us to share Mr. [redacted]'s information

with you, I can inform you that we have resolved his issues and he has received a refund of the

premium amounts in question. I will be responding directly to Mr. [redacted] with the details

surrounding this matter.

Ms. [redacted], thank you for sharing Mr. [redacted]'s concerns with us.

Sincerely,

Senior Grievances and Appeals Analyst

Executive Services

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

We're never sure what the 'link that was provided in the original email' is. Hopefully, it'll do to give our response by replying to this email.

Anthem did refund our premium amounts only after we spent hours over multiple days being put on hold and talking to numerous people. Anthem did not make it easy for us to get our money back. In fact they tried to give us only a partial refund. We had to tell them to put it in writing that they indeed had canceled our policies. We could not trust their word as we had been lied to two different times over the phone that our polices were canceled. When Anthem said they would mail us refund checks, we had to request they overnight the checks so we would receive them quicker (being out $2600.00 was making it hard for us to pay our bills). You would have thought they would had volunteered to overnight the checks as it was their mistake.

Although we would have liked to be reimbursed for all the time and inconvenience Anthem has caused us by their incompetence and mistakes, we accept the firm's response. Our advice to other people who have to deal with Anthem is to realize that they don't take care of their customers. Anthem only wants your money.

[redacted].

Review: Anthem has not issued a refund for a cancelled policy as I was told I would receive. I had a policy effective for July 01'st, 2014 and cancelled the policy a few days later, because I found out it was not what I had wanted. The rep. [redacted] said if I cancelled by the end of July I would receive a full refund. I cancelled the policy a few days after it started well before the end of July 2014. I have called SEVERAL times and been told the check is in the mail, it is over 6 weeks later and no check. I have spoke to [redacted], and [redacted]. This is a complaint is being filed against the health care reform division of Anthem Blue Cross in Roanoke, VA.Desired Settlement: I want my check for $184.25 as has been promised mailed to me as soon as possible.

Business

Response:

Thank you for your letter on behalf of [redacted]. Our review of Ms. [redacted]'s concerns is

complete and we have the following information to offer.

At Anthem, we believe every customer is entitled to prompt, efficient service and we are sorry to hear of

the difficulties Ms. [redacted] experienced while trying to obtain a premium refund. Our records indicate

that the refunds in question were issued to Ms. [redacted] and the checks have been received and cashed.

I hope this information is helpful. Thank you for your efforts on Ms. [redacted]'s behalf and please let us

know when we can be of further assistance to you.

Sincerely,

Sr. Grievances & Appeals Analyst

Executive Services

cc: [redacted]

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: I currently have Federal Anthem for my healthcare coverage. On April 6 2014 I was seen in the Emergency Room at [redacted] Hospital in [redacted]. This hospital is in Anthem's network.

I paid my emergency bill promptly. On Nov 15 2014 I received a bill from [redacted] Physicians LLC, claiming that I owe them $1143.00 for services rendered while in the ER. I do not feel this is fair practice on Anthem's behalf. If I am at an in-side network approved facility, then they should have in-side network approved physicians. I had no way of knowing that I was being seen by an out-of-network physician for services rendered that day. Please look into this matter and respond to my complaint promptly.Desired Settlement: Anthem needs to pay the $1143.00 for the physician bill. I am a customer of 20 years and have never had this problem. Thank you.

Business

Response:

Thank you for your December 18, 2014, letter on behalf of [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 providernumber. On 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 number. I have confirmed that the processingis complete and payment will be sent to the provider in the next week. There is no patient liability on the claimin question.Please let us know whenever we can beof further assistance.Sincerely,[redacted]Sr. Grievances & Appeals AnalystExecutive Services

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. Sent a statement that this has been paid.

Regards,

Review: I moved from Virginia to Kansas the first week of August. This was not a planned move. I was at risk of being harmed or worse if I stayed in Virginia. I had signed up for health insurance thru [redacted] back in May and I had been making my premium payment of $353.24 on their website. The payments were due on the first of each month. As I was in the middle of the move, I was not able to contact Anthem Blue Cross until 8/6. I called and asked to cancel this policy, as I have moved from Virginia to Kansas and I was not employed and could not afford the premium. I was referred to the Exchanges to cxl the policy since I had signed up thru them. I called the Exchanges and was told the policy would be cancelled, effective immediately, and I should contact Anthem in a couple of days to verify they had received the cancellation request. On 8/7 I found my bank account had been charged by Anthem for $353.24, without my authorization. I never gave them permission to charge my account electronically. I contacted Anthem and they said they had not received the cancellation request from the Exchanges. I then called them and they said the policy would not be cancelled until the 21st of August. They said the person I spoke to previous must have been new. I called the Exchanges today to verify they are indeed cancelling the policy and they said yes, effective tomorrow. I contacted Anthem and they said the policy would not be cancelled until September 1st, therefore no refund would be given. I can't even use that insurance here as it would be out of network, not that I could afford to go to a doctor in the first place. I have contacted Anthem repeatedly asking for a full refund due to the unauthorized charge and they continue to refuse to honor the request. The unauthorized charge also caused a $33 overdraft, which was covered by my almost ex's savings, an additional $50 was put into the account to avoid any further overdrafts. He is demanding that money be reimbursed from me as well. That equals $436.24 total.Desired Settlement: I have kept the checking account in Virginia open because I was waiting for the refund. That account has a fee of $5.00 per month. There is currently less than $15 in the account. I am requesting a full refund of the $353.24 plus the additional $83 to cover overdrafts caused by that withdrawal. I have not used the medical insurance, in fact the last medical bills were incurred in early July and I have not used the insurance for any prescriptions either. I know that isn't a lot of money to some, but to someone who is unemployed, it would mean a lot to get that back, and honestly, it would be the right thing for Anthem to do.

Business

Response:

Thank you for your August 21, 2014,letter on behalf of [redacted]. I appreciate the

opportunity to respond.

We regret the difficulties Ms. [redacted] experienced when trying to cancel her coverage. Members that

purchase a plan through the Federal Marketplace must go back to the Marketplace in order to cancel their

coverage. Anthem Blue Cross Blue Shield cannot cancel a member's plan until the Markeplace sends the

company the appropriate notification.

Our records indicate that Ms. [redacted]'s coverage was cancelled as of the effective date provided by the

Marketplace. The appropriate refund was issued to Ms. [redacted] on August 28,2014. Because there

was no error on the part of Anthem Blue Cross and Blue Shield we are not able to honor her request for a

refund for the overdraft fee or any additional funds that were placed into her account in order to avoid

additional overdrafts.

With respect to Ms. [redacted]'s concern about the automatic premium deductions from her bank

account, she authorized these deductions when she completed and returned her application to enroll in this

option.

Sincerely,

Sr. Grievances & Appeals Analyst

Executive Services

Consumer

Response:

Please note, I received only a partial refund as Anthem stated the cancellation date was August 21st, when I had originally contacted both Anthem and the Marketplace on the 6th of August. The general public should be made aware, in more clear terms, BEFORE they sign up with the Marketplace and Anthem, that it will take weeks to cancel your policy but only a few minutes for them to charge your account.

I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution is satisfactory, but not satisfying. I will not be using the Marketplace or Anthem for further health insurance needs. At this time, I really have no choice but to consider this issue resolved.

Regards,

Review: I applied on Dec. 7, 2013 online for health insurance covering rest days of 2013. But I did not get any reply or update until directly receiving a package on Friday evening of Dec 20 and ID cards on evening of Dec. 27. Both dates were too late so that I have not been able to use any health insurance service. I instantly called the given phone 1[redacted] for cancellation after receiving the late welcome package on 12/20/2013, the representative on the phone asked me to call another number of [redacted], which I then called but could not get through after waiting for a long time. I also emailed previous online service contact on 12/20 and got the reply on Monday, Dec 23, 2013, suggesting me to call [redacted]. I called the given number of [redacted] on Dec. 23,24, but I either couldn't get through or was transferred from one rep. to another one and then again couldn't get through after waiting for a long time. I saw the ID cards in the mailbox last Friday evening, 12/27/2013, especially, I noticed that my credit card was directly charged more than 3K bucks already this morning. It totally makes no sense in this case!Desired Settlement: I request for a cancellation of service that I haven't been able to use and a full refund for the charge.

Business

Response:

Dear Mr. **:

We are in receipt of an inquiry from the Virginia Revdex.com (Revdex.com) regarding a complaint

(Revdex.com Case# [redacted]) that you recently filed with them. Your concerns relate to online enrollment

problems and your current desire for full refund of premiums and termination of coverage.

This letter is to inform you and is in follow-up to a notification that you should have already received that

we have honored your request. Your coverage was terminated on January 4, 2014, effective December

8, 2013 and a full refund issued. However, if you desire to pursue this matter further, you must complete

the form that is attached to this letter and return it to us. This document will give our office permission to

discuss any information necessary to complete the Revdex.com's investigation of your complaint.

You may return the completed form to my attention by mail or fax:

By mail

Grievances and Appeals

By fax: ###-###-####

Mr. **, while we regret that this experience prompted you to end your association with Anthem, we

respect your decision and reasons for doing so. Please do not hesitate to contact us if we can be of any

assistance to you in the future.

Sincerely,

Grievances and Appeals Analyst ll

Executive Services

Enclosure

c: The Revdex.com

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: I have been with Anthem For more than 6 years. I get paied minimum wage and I have cancer. I pay 324.75 per month. I field 2 claims with Anthem regarding a splint that I bought and The company is with network with Anthem. I called their claims department every other day since 11/01/2013, Just want to let you know that Customer service is HORRIBLE and they treat me HORRIBLE. They promissed they will call me 1 month ago and I never got a phone call back. When I called 3 weeks ago an agent told me to not to call them anymore and I am bothering them. Also claims department manager hung up the phone on me. I have no money to pay them for this month and I dont know what to doDesired Settlement: They need to pay me back $100

Business

Response:

Thank you for your letter received on January 24,2014, written on behalf of [redacted]. The

correspondence relates to coverage of durable medical equipment (PlP Splint) purchased on

November 1, 2013.

In order to protect our member's privacy related to these requested medical services, our office

has forwarded Ms. [redacted] an Anthem Designation of Representative/Authorization form to be

completed and returned to our office regarding this matter. Once we have received permission

from her, we will respond to the dispute. A copy of the letter mailed to Ms. [redacted] is enclosed

for your records.

If you have further questions or need additional assistance you may call me direct at ([redacted]

Sincerely,

Grievances and Appeals Analyst ll

Executive Services, Grievances & Appeals

Enclosure

Business

Response:

Dear Ms. [redacted]:

This is a follow-up to an inquiry from the Virginia Revdex.com(Revdex.com)and our letter

dated January 27, 2014, regarding a complaint (Revdex.com ID# [redacted]) that you filed with them. It

has been brought to our attention that you did not receive that correspondence. We apologize

for any inconvenience and are providing it once again.

You are concerned about the processing and payment of a claim for durable medical equipment

(DME). The DME, a PIP splint was purchased on November 1, 2013. This letter is to inform

you that we will thoroughly review your concerns and will provide you with a response in the

near future. In the interim, fill out and sign the form that is enclosed with this letter and return it

to us. This document will give our office permission to discuss any information necessary to

complete the Revdex.com's investigation of your complaint.

Please return the completed form to my attention by mail or fax:

By mail:

Grievances and Appeals VA [redacted]

By fax: ###-###-####

We thank you in advance for your patience in this matter.

Sincerely,

Grievances and Appeals Analyst ll

Executive Services

Enclosure

Review: My coverage was dropped without my knowledge despite my consistent payment through my employer and automatic deduction from my paycheck. I suddenly received a charge from [redacted] for a visit almost an entire year ago due to a retracted claim by my insurance company for expiration of coverage/policy. I am now being told it can take 72 hours for my policy to be updated, and an additional 30 days from the update for the outstanding claim to be resolved. I have been given no explanation of why this occurred and especially do not appreciate the timing as this is Christmas and cannot afford to sacrifice extra money for other's mistakes. If the tables were turned is be charged penalties and negligence. This is the most unethical, and disappointing business practice coming from a business that should guarantee dependability - this is a matter of health and finances, two major elements of concern in every household. Especially during Christmas.Desired Settlement: Immediate refund, and although I doubt it will happen, additional funds for the trouble of coming up with funds to cover bills that ordinarily would not have been a problem.

Business

Response:

Thank you for your December 18, 2015, letter on behalf of [redacted] and her concerns about herhealth care coverage and an outstanding claim. I have the following information to offer.We have confirmed that Ms. [redacted] issues are resolved. We have corrected the information with regardto her claim and she should not experience any more difficulties related to this issue. Additionally, wehave responded directly to Ms. [redacted] to address her concerns and advise her of the outcome of ourreview.Ms. [redacted] thank you for bringing this matter to our attention and your efforts on behalf of Ms. [redacted].When we can be of further assistance, please let us know. Sincerely,[redacted]Sr. Grievances & Appeals AnalystExecutive Services

Review: Cancelled my insurance plan on September 16, 2014 at 11am. Was told everything was paid, my balance was at $0.00. Continue to receive bills culminating with one mailed on Christmas Day saying I owe money on an open account. Unable to contact Customer Support and have not received a response from Anthem in a timely manner. Every bit of customer support both online and on the phone is designed to specifically make it difficult for customers to reach members of the organization. As such I have not been able to contact Anthem in any way shape or form.Desired Settlement: I expect the insurance to be closed out and my balance set to $0.00 as I was told happened on the 16th of September 2014.

Business

Response:

Thank you for your inquiry dated December 30, 2014, regarding Mr. [redacted]'sconcerns about his HealthKeepers Bronze health care plan. I have the following information toshare with you.We have received notification from the Marketplace to cancel Mr. [redacted]'s health care plan.In turn, we have cancelled Mr. [redacted]'s plan and he should disregard any billing statementshe has received for that plan.We regret the concern this matter caused Mr. [redacted] and appreciate your efforts on hisbehalf.Sincerely,[redacted]Senior Grievances and Appeals AnalystExecutive Services

Review: My employer switched my health insurance plan inside the Anthem Blue Cross Blue Shield in the middle of the 2014 year. I fully paid my deductible and OOP before the switch and I was under impression my deductible and OOP will roll over my new plan starting October 1st, 2014. Not even sure if it did. I had a surgery on 10/09/2014 and I was expected max amount that I'd be responsible for the service would be the difference between my old and my new OOP (or deductible), which is $500. But I got almost $2700 fell on my responsibility instead. EOB for this service says 066 and 038 codes. It does not make any sense for me because even if the OOP did not roll over from my previous plan, only this particular claim exceeds my OOP by $700.

As the result of this, there is also something strange going on with the deductible and OOP for the Oct 1st, 2014 - Dec 31st, 2014 period:

my OOP limit is $2000, Accumulated is $4414.38 and Remaining Balance is negative - ($2221.95).

I tried to figure out what's going on with the different costumer representatives of Anthem a couple times since I got the EOB dated 11/07/2014, but I've never seen, heard or read any reasonable explanation. They usually ask me to wait for up to 45 business days but never resolve the issue.

On May, 14 2015 I sent the appeal to the Anthem Blue Cross and Blue Shield Corporate Appeals Department [redacted]. Customer Representative confirmed they received the appeal on May 20th. I was expecting a response within a 60 days upon receipt, but I did not receive anything.

I've heard a couple different stories what exactly going on. One of the stories is that my deductible was calculated the way as I have a family coverage, which is incorrect since I don’t have any co-insuread people in my plan (I have group insurance, but not family). Customer representative were saying she going to take those claims to the escalation department to recalculate them in two weeks. However, in two weeks I was receiving a call from the same costumer representative saying that they are still working on it.

I've also been told they have some internal system issue that calculates claims based on policy and they need to fix the system. Months later I keep getting calls that they still are working on the issue.

On my request to send me any kind of written explanation why it takes so long to resolve the issue - they are saying they are not able to send something like this.

In a bottomline, I have:

- $2700 amount due on my responsibility, which I believe my insurance should pay;

- 10 months trying to fix the issue with different costumer representatives - [redacted] (don't know her last name) and [redacted] supervisor);

- unresponded claim I sent on 05/14/2015 (Anthem recieved it on 05/20/2015);

- my personal notes on this case starting January 7th;

Please help.Desired Settlement: Billing Adjustment in a timely manner so I would not be responsible for the amount due on service dated 10/09/2015. Explanation of Charges in a timely manner.

Business

Response:

Thank you for your inquiry dated August 14, 2015, regarding Ms. [redacted]'s concerns about theprocessing of her claims. I have the following information to share with you.We have worked diligently on the issues that Ms. [redacted] has been experiencing on the claims inquestion. One of our managers has been in contact with Ms. [redacted] to inform her that her claims arenow resolved. In addition, Ms. [redacted] has confirmed that she has received the check that was sentto her regarding this matter. We will be responding to Ms. [redacted] in more detail regarding herconcerns.We regret the concern this matter caused Ms. [redacted] and hope that her future dealings with Anthemwill be more positive. Should she have further questions or concerns, she can call the number on hermember ID card for assistance.Ms. [redacted], thank you for your efforts on behalf of Ms. [redacted].Sincerely,[redacted]Senior Grievances and Appeals AnalystExecutive Services

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: I am a customer of the business at issue in this complaint. As required by law, prior to November 15, 2013, all customers must have notified this business that they either choose a new, private insurance plan and the offered premium, or choose to fall under the new Federal Healthcare law and its associated premium. On November, 13, 2013, a Member Services Specialist with [redacted] of VA, the agent for Anthem Blue Cross & Blue Shield that I initially contracted with many years back, emailed a "New Policy Offer" contract and an "Acceptance of Healthcare Form" to me whereas I was directed to sign the contract and fax it to my insurer. On November 14, 2013, I faxed the signed "New Policy Offer" contract and signed "Acceptance of Healthcare Form." Thereafter, in early January 2014, I attempted to utilize my insurance by filling a prescription whereas the pharmacy notified me that my insurance coverage was not active. On Janurary 6, 2014, I contacted the toll free customer service number for Anthem Blue Cross & Blue Shield whereas I was on the telephone continuously for 4.5 hours in which a customer service representative eventually informed me that my signed "New Policy Offer" contract was faxed to the wrong number. In fact, I was informed that it was faxed to the number for acceptance of new plans under the new Federal Healthcare Law. Consequently, I was informed that even though I signed a contract accepting a new policy not falling under Obamacare, I now fall under Obamacare because I faxed the contract(agreeing to something entirely different) to the "Obamacare fax number." He further stated to me that he would look into the issue and follow-up with me. I have never heard back from him nor any other customer service representative. Thereafter, between January 7-9, 2014, I called the agent mentioned above four (4) times and eventually was able to discuss this issue whereas she informed me that she would have to contact Anthem Blue Cross & Blue Shield in Roanoke, VA and then follow-up with me. She never followed-up with me and on April 9, 2014, I contacted the agent again regarding my disgruntled acceptance of these ridiculous issues as a matter of necessity and thus offered to pay the new Federal Healthcare Law premium, provided that I could have coverage immediately upon payment of the increased premium because I have been without insurance coverage for approximately three months in reliance upon the above developments in hopes of reaching a resolution. The agent informed me that she would have to contact Anthem Blue Cross & Blue Shield in Roanoke, VA and then follow-up with me. On April 10, 2014, the agent contacted me whereas she informed me that since I did not pay the premium in January 2014, that I never agreed to pay, then I could not be provided insurance coverage until October 2014, which is the company's next open-enrollment period for new customers.Desired Settlement: I would thoroughly appreciate this company honoring the premium associated with the "New Policy Offer" contract that I signed and timely faxed, as required. In the alternative, this company should provide coverage under Obamacare immediately because, but for their negligence, and but for my reliance on their fixing this issue due to their negligence, I would have timely paid my premium as I have for many years. That being said, at a minimum the public should be made aware of such poor customer service and such corporate-like conduct toward one of their long-time, paying customers, especially their conduct after being notified by me of this issue and my dissatisfaction thereof.

Business

Response:

Thank you for your letter received on April 24,2014, written on behalf of [redacted].

The correspondence related to his recent experiences while trying to enroll in an ACA-compliant

policy.

Unfortunately, after reviewing our membership systems, we were unable to locate any policy

matching the information Mr. [redacted] provided. In order to research this complaint further, he will

need to provide his prior Anthem Blue Cross Blue Shield of Virginia identification number and

date of birth or, the application identification number the Marketplace assigned to his application

submitted by [redacted] of Virginia. We will be happy to review the complaint again with this

information.

If you have further questions or need additional assistance you may call me direct at [redacted]

Sincerely,

Senior Grievances and Appeals Analyst

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I’m sending this email pursuant to our conversation on this past Friday, May 30, 2014. Since the filing of my Revdex.com Complaint on April 24, 2014, I was able to speak with Ms. [redacted] with Virginia [redacted] on April 30, 2014, whereas she informed me that, in addition to the issues expressed in my complaint, another issue exists. She informed me that Anthem’s records are indicating that my policy became classified as “Cancellation Status” due to an alleged non-payment by me for 45 consecutive days in fall of 2013. She stated that she would continue to seek that specific information from Anthem but that my efforts in obtaining such would be beneficial in order to properly dispute said allegation. That being said, I was able to reach a customer service representative for Anthem by the name of [redacted] on May 13, 2014, whereas my request for said payment history was processed by her. As of today’s date, I have not received the payment history from Anthem, nor have I heard back from Ms. [redacted], Senior Grievances & Appeals Analyst for Anthem, since my last contact with her on May 14, 2014. During our last conversation on that date, she indicated to me that she would like for me to send her the contract at issue and fax confirmation of its transmission as discussed in my Complaint, as well as any/all receipts of prescriptions filled out-of-pocket by me without insurance coverage since these issues arose & since I have been without coverage. She further stated that it may be possible for my policy to be reinstated if I am willing to pay the back premiums, less the overage paid by me for said prescriptions. Moreover, in the least, she stated that it may be possible to obtain a new policy in North Carolina (since NC is my state of permanent residence) as of June 2014. On May 16, 2014, I emailed Ms. [redacted] the contract at issue, fax confirmation of transmission, & receipts for prescriptions filled out-of-pocket by me without coverage since these issues arose.

For the record, Ms. [redacted] & Ms. [redacted] have been very helpful. I look forward to a resolution in the near future & I am sincerely grateful for your time & consideration of my Complaint, as well. Please have a great day!

Best regards,

Business

Response:

Thank you for your patience as we reviewed the complaint submitted on behalf of Mr. [redacted]

([redacted] regarding the termination of his Anthem Premier policy. We have the following

information to offer.

After reviewing the circumstances of his case and obtaining information from the insured and his

broker, [redacted] of Virginia, management has issued an approval to reinstate his Premier

policy retroactively to January 1, 2014. As long as premiums are paid, the policy will remain in

effect until August 31, 2014, to allow Mr. [redacted] time to seek coverage in his state of residence,

North Carolina. A letter advising of this approval is being sent to Mr. [redacted] today.

Ms. [redacted], we appreciate your efforts on behalf of Mr. [redacted]. Should you have any questions,

please contact our office toll-free at [redacted]

Best regards,

Senior Grievances and Appeals Analyst

Executive Services

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I do not accept this response from Anthem because it requires me to pay $1,438.00 by June 30, 2014, for coverage dating back to December 1, 2013. This potential resolution involves a lump sum payment by me for coverage that did not exist. But for negligence on behalf of Anthem & its agents, I would have continued to pay for my coverage monthly and on time pursuant to my Premier Policy. That being said, I was unable to do so because I was not recognized as a customer, and therefore was not provided coverage. On the other hand, had coverage been provided yet not paid for by me, then I would accept this potential resolution. However, requesting that I pay one lump sum payment for something that never existed due to no fault of my own is unconscionable.

If Anthem is willing to reinstate my policy effective moving forward as opposed to retroactively until August 31, 2014, then I will gladly and logically pay for the coverage that I am provided.

Regards,

Review: On January 8, 2015 Anthem took out a payment of $458.18 that I did not authorize. I therefore called them and talk to a representative about the situation. She looked at the notes that were made and notice I called on December 29 a made a payment of $391. I could only make one payment so had to call the next day to make another payment for new policy of $458. Called the next day December 30 and talk to a representative and she said it was only $334. I knew this was not right, but she said she could only take that payment. Then the next day December 31 I received a letter in the mail that stated I owed $462. This was not what was quoted to me by my agent. I then had to wait until January 2 to call and I talked to another representative and she said the representative on December 30 was wrong and I owed $124.18 for my new policy to start. I gave her that payment. Then on January 8th Anthem pulled a payment of $124.18 and $458.18. This then made my bank account negative. The representative that I talked to stated she did not see authorizing of the $458.18, but could not do anything about it because billing was closed, but would make sure that they got in touch with me the next day to resolve the matter. On January 9th I called at 8:30 am and talk to another representative. He stated to me all supervisors were in a meeting and would put in a request for a supervisor to call me. He also said that anthem has done this before of taking to much money out of peoples accounts. Then around 8:40 another rep called and stated her first name only ([redacted]) and said she was calling on behalf of her supervisor. She said we needed to call bank doing a three way to get matter resolved. I called back around 11:15 am and talk to rep and she said I was not authorized to talk I said yes I was and then stated to me rep was at lunch, but she would call me back and designated times. I called back at 3:05 pm and talk to another rep and she said that she did not know who [redacted] was and could do nothing about the situation but someone would get in touch with me 24-48 hours. I was not happen with this response. I let her know that I could not pay bills and it was my sons birthday and I had no money. I told her I would have to go [redacted] jewelry in order to pay for birthday and bills. She was upset about my sons birthday. I still have not heard anything back from Anthem and now it is Monday January 12. I also did not like how the reps did not tell you when they were reading notes. The phone sounded like it went dead. I do have authorization to talk on my husband behalf and was told that I was not.Desired Settlement: I would like anthem to credit my bank account and wave one month payment of my health insurance bill. I have taken time out of my schedule as a teacher to call them and try to solve the matter. My planning time has been taken away because I am the one that is calling them back and no one has had the curtsey besides one rep to call back. I would like the CEO of anthem to call me not a supervisor because their supervisors do not call. As an educator I am disgusted in how anthem handles themselves.

Business

Response:

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

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Regards,

[redacted] And [redacted]

I do not agree with your response. I had to contact Anthem several times to get my matter fixed. Each time that I called I had to tell my story over again. I never once got a call back from anyone until the last young lady that I spoke to. I also contacted my Anthem agent and let her know what was going on. I know for a fact that this is not the first time that this has been done to someone. I have dealt with a lot of companies over the years and never dealt with a company who would not have followed up with a problem. I never once got a apology from the billing department. I feel that if someone makes a mistake they need to fix it immediately and send a letter stating that your apologizing and will fix the problem. I believe if I did not stay on this it would never be resolved. You are a big company and deal with a lot of peoples health insurance, but I believe your way of dealing with a mistake on your part is no concern of yours. You were dealing with my money and could care less if I got the money. It took you almost three weeks to give me my money and I you then did not want to pay for any fees that were charged to my account for overdraft. I dealt with another young man from Anthem [redacted] who told me my refund for my fees would be sent to me. I have never received that and have called him numerous times. I am very disappointed that I am still dealing with this. It has taken your company two months to acknowledge my request and I feel that you are only doing this because of my complaint to the Revdex.com and Consumer Affairs. I am a working individual and don't need the stress of when someone makes a mistake as big as you guys did do not feel that you need to fix it. I have to continue making my payments to you guys for insurance, but feel that you do not care about your client. I understand that you do not think that waving a premium is fair because others would not think it is fair, but you think it is fair to take somebodies money and argue with that individual on the phone time after time and then promise them several times that you are going to fix the problem and never do. I took time away from my planning periods (I am a teacher) to call everyday more than three times. I only got a call back from you guys once to solve the matter. I think you need to reconsider what I asked because as far as I am concerned you only responded because I sent a complaint to Revdex.com. I would like a call from a CEO about my situation. I asked several times when I called with my situation to talk to a supervisor and never was able to talk to someone because either they were not available or had to call me back. Which never happened. I have never dealt with a company that would not honor a clients request to talk to a supervisor as far as my concern you only care about getting our money and not about the individual. I would like a call ###-###-#### and also a letter in writing [redacted]. You never fail to write your clients on when they have missed a payment, but you cannot acknowledge a wrong. Please respond to my request.

Review: When I first got health insurance from Anthem, I had to fill complaints with the Revdex.com and the Federal Governement before Anthem admitted that they received the three payments I made to them for health insurance.

I p[redacted] my August 2015 payment and went to [redacted] to get my prescriptions filled. I was told the insurance company refused to pay claiming that I have not paid my premium.

I paid my September 2015 payment and went to [redacted] to get my prescriptions filled and I was told the same thing.Desired Settlement: I want Anthem to contact [redacted] so I can get my prescriptions filled.

I want Anthem to know I am going to complain to the Federal Government about how Anthem treats me again.

Business

Response:

Thank you for your October 5, 2015, letter on behalf of [redacted] and his concerns regardingprescription drug coverage under his HealthKeepers Silver X plan. I appreciate the opportunity to be ofassistance.Regrettably, we do not have a signed authorization form from Mr. [redacted] allowing the release of specificdetails regarding his complaint. This is necessary to protect our members' personal health informationand to be compliant with federal and state rules and regulations. However, a separate letter has been sentto Mr. [redacted] to address his concerns.Ms. [redacted], thank you for your efforts on Mr. [redacted]' behalf. When we can be of further assistance,please let us know.Sincerely,[redacted]Sr. Grievances & Appeals AnalystExecutive Services

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

I will send the paperwork requested. But I want to know if I send payments for Oct and Nov before Dec can I get coverage until Dec 1 so I can get my prescriptions?

Regards,