Blue Cross California

Review: I was assigned onto Anthem Blue Cross under Medi-Cal Managed Health Plan. I have moved since four years ago and I already informed both Medicare & Medi-Cal. All the correspondence from these two main health insurances have been properly sent to my current address, including the handbook from Anthem Blue Cross. As I have not received my member ID card to see my doctor (it's already late because I supposed to get it by 7/31/14). Upon calling Anthem Blue Cross, I talked to two different representatives (I called twice): the first time was [redacted], and the second time was Candy A. My calls were at 1:40 pm and 1:50 pm on 8/18/14. [redacted] told me that my membership ID card was sent to my previous address, and I told her that I have moved out of that place long time ago. She reasoned that because I did not report my change of address, so she could only changed temporarily my address until 9/1/14. Then I knew that something wrong here: I did report my change of address to Medicare and Medi-Cal and also the handbook from Anthem Blue Cross was sent to my correct address. I called back and talked to Candy A, she provided me the same explanation. I requested to speak to her supervisor, she put me on hold for almost 30 minutes and came back, telling me that I should call back after 2 weeks to see if their system would be updated yet. I asked her for her supervisor's name, because she never let me speak to that person, she told me that her supervisor was Ashley; and her station was in Georgia. Both of these representatives were very rude, and the system was messed up. How could the handbook be sent to the correct address and my address for the ID was different? [redacted]'s explanation was that because the handbook was sent from another department (?).Desired Settlement: I would like to receive a formal explanation about this incorrect address of mine in the system of Anthem Blue Cross, also an apology from the supervisor about these two representative (especially Candy A. who put me on hold for 30 minutes but still did not let me talk to her supervisor as I requested). I feel like we seniors are treated like dirt because everyone has to join health plan and our life is in their hand, we have no options; even the list of doctor and specialists are very limited.

Business

Response:

We are unable to locate this member. Please have them provider their health plan identification number.

Review: They have denied a claim to pay for CPAP therapy. I have had a clinical sleepmstudy clearly showing I have sleep apnea. I am a particularly high risk patient having had four way heart bypass surgery, a stent and 3 heart attacks. Theres no question by cardiologists, internists and other medical professionals that use of a cpap is a must. They have even paid for a past cpap machine in 2006 and 2007. I filed a formal appeal and the claim was again rejected. They have completely run the provider thru the grinder that has been trying to get paidDesired Settlement: Pay the claim and quit being so difficult to work with

Business

Response:

The health plan has a current open appeal for this member that was initiated on 10/15/14. The member should receive a response within 30 calendar days from the original receipt date.

Consumer

Response:

Review: 10299000

I am rejecting this response because:

They already responded to the appeal and denied the claim. I sent a response asking them to review the appeal and have not got a response.

Regards,

Business

Response:

This member's next level of appeal is to the Department of Managed Health Care.

This company demonstrates poor telephone etiquette and their associates and management are absolutely rude. The staff is poorly trained on dealing with customer complaints within the billing department. I would not recommend doing business with them if you value these attributes.

Review: This business does not answer its customer service telephone numbers within a reasonable amount of time at any hours of the day, effectively depriving the customer (i.e. the person paying for healthcare) of any sort of service. I have called several different customer support numbers, including those listed on the website for "members" and those on my healthcare plan card for "members" to no avail. On at least three occasions, I have waited over an hour on hold during normal business hours only to have the Anthem line ring through and then hang-up on me. Most recently, using the customer service number listed on my card, after nearly an hour of waiting, it simply came on with a recorded message stating that the "phone number was not in use." It is completely unreasonable and unacceptable to have no means of accessing and changing certain details regarding my healthcare plan when there are no online management options and the customer service numbers apparently aren't answered by anything other than robo-answerers.Desired Settlement: There is no particular settlement that will help my situation, other than Anthem actually hiring a human customer service staff and picking up their customer service phones.

Business

Response:

The health plan has initiated a grievance regarding this member's complaint. The member will receive a written response within 30 calendar days.

Review: Anthem changed my plan without so much as a letter. I had to find out through my doctors office when they informed me that I could not make an appointment because they were told that my insurance had been cancelled. Two days later I was able to pay my bill (which is now double the original price), but still have no information about my new plan. When I tried to pick up my prescription the next day I was told that I needed to get the new numbers in order to pick it up. When I failed to get a hold of anyone at Anthem I ended up having to pay out of pocket for the prescription. I have not been able to get a hold of anyone at Anthem either by phone or by email. I have made several calls only to hear an error message and be hung up on. I have also written emails and have not gotten a single response all month.I am currently in the middle of an auto claim in which I need physical therapy for. Due to the lack of response from Anthem, I have not been able to receive treatment for my injuries. I have not had health insurance this entire month. I am in pain and cannot get the treatment that I need. Effectively, I have paid double the price I paid per month last year and have not received any of the benefits I have paid for in the month of January.Desired Settlement: I would like a refund for the payment for the month of January as well of the prescription that I had to pay for out of pocket, totaling $332.40. I would also like my plan information and cards overnighted to me. As well as an apology for the lack of response and the pain that I have been in all month.

Business

Response:

We are unable to identify this specific member. Please have her provider her health plan ID number.

Consumer

Response:

Review: 9907705

I am rejecting this response because: I don't want to post my personal information.

Regards,

Business

Response:

If the member does not want to provide the requested information, she may send her complaint in writing directly to Anthem Blue Cross PO BOX [redacted], Woodland Hills, CA 91365

Review: To whom it may concern: On January 1, 2014, I called the Anthem Blue Cross California to cancel my health insurance because I had different health insurance starting January 1, 2014. However, the company continued to withdraw my bank account on January 08, 2014. Despite I have called the company many times since then that I wanted to cancel the insurance and refund the money back to my bank account, I have not received the money. I do not know what else I can do because the customer service department of the company just ignore my request even though I told he/she that I have called many times regarding this issue. Now I must file this complaint because I am afraid that the company will withdraw my bank account again on February 08, 2014.Desired Settlement: I want the Anthem Blue Cross California to cancel my health insurance, stop withdrawing my bank account in February and refund the amount of $527.93 for the month of January 2014 or any amount that the company has withdrawn or will withdraw after January 01, 2014.

Business

Response:

The health plan has initiated an appeal for this member's complaint. He will receive a written response from the health plan within 30 calendar days.

Business

Response:

The member's issue will be reviewed and responded to within 30 calendar days.

Consumer

Response:

Review: 9916887

I am rejecting this response because: there is no refund issued to my bank account. I want the dental plan to be canceled since I did not sign up for it. I want all the money that the company charged refunding to my bank account as early as possible.

Regards,

Review: Called to cancel insurance plan and auto bill pay Nov 21st. I got married and was going on my wife's insurance. I talked with a representative and he said it was done. I didn't have insurance and didn't get auto billed in Dec. Auto bill started up again jan 6th total $283.43, along with my insurance that was cancelled and I didn't sign up for. I called again on Jan 7th and representative said I must fax in a written request. I did on january 23rd from fedex long beach, I have a receipt saying the fax went through 1/23/14 11:24am. Got Billed again Feb 6th $283.43 and Mar 4th $283.43. Mar 11th I went to my bank Wells fargo and placed a 6month stop payment through the bank costing an additional $31 service fee. They recommended I file a complaint with Revdex.com.My Membership was clearly cancelled over the phone in Nov, shown by the no charge in Dec, and again in writing via Fax.Desired Settlement: I would like a full refund for Jan, Feb, and Mar and my service fee for the stop payment. Total (283.43X3) +31.00 = 881.29

Business

Response:

The health plan ID number that is listed is missing one number. Please return with complete member ID number so that the health plan can research.

Business

Response:

As we now have the member completed health plan ID number, we are initiating a grievance for this member. They will receive a written response within 30 calendar days.

Review: Anthem Blue Cross of CA is refusing to pay for my annual well-woman exam because my doctor is located in another state (Texas). I am on a Multi State Plan and my doctor is considered to be IN NETWORK.Desired Settlement: I expect Anthem Blue Cross to pay for my annual well woman exam fee and pap smear as they are required to by the Affordable Care Act, regardless of what state my doctor is in.

Business

Response:

The health plan initiated a grievance for this member on 3/3/14. She will receive a written response from the health plan in 30 calendar days.

This started when I started my new job and lost my old insurance. The employer I work for now told me that many employees found it more cost effective to get insurance through Covered California and so they did not offer in-house insurance. I called Covered California prior to starting my new job, on 6/23/14, to find out what I needed to do to get insurance. The person I spoke with said it can take some time to set up so I should do it in advance, if I can. I did that. I set everything up and selected an insurance. I was told Anthem would contact me to establish the account.

I received a bill from Anthem in July. It stated it was my first month's bill and would be due 7/23/2014. I paid that bill on 7/22/2014. The next bill I received in early August said I was overdue. I called the company and they agreed I had made the one payment, but said there was another due on the same day, 7/23. I explained this made no sense, as I had only received the one bill. I stated that there was no way for me to know I had two bills due the same day if they didn't notify me, and also that it made no sense, since I had insurance through the old company through 8/1. The company said my effective date was 6/23/14, so I needed to pay for June (a month I would have coverage for 7 days for) and July. I explained that that should not be my effective date, though I selected the insurance that day I was specifically told it would take time to process. I was then told to contact Covered California.

This took weeks. I waited on hold for more hours than I could count, at least 2-3 per sitting. I called while at work, to my boss' dismay, when I got home from work, on Saturdays. I could make no headway. I called Anthem back, distraught because I was running low on my medications. They did a conference call with Covered California, which went through much more quickly, I assume they have a different number or priority level. The two representatives from each company worked it out and changed my effective date to 8/1/14. I was told I needed to pay for September at that time, and I did so. This was at the end of August. I was told it would take 7-10 days for the information to be processed. When my insurance still wasn't active by 9/12/14, I contacted Anthem again and was told none of the paperwork had been processed, despite having a full month's payment from me. I have now paid for August and September, but had no coverage in either. The person I spoke with said he would handle it and call me back. He called back saying everything was fixed. He sent me a new insurance card via email to use until my new one came in the mail. I asked if I would be able to get my prescriptions right away and he said yes.

Today I went to fill my two prescriptions at the local CVS. I take birth control for hormone management and a medication for migraines. I was told by the pharmacist I would have to pay the full amount, which I cannot afford and shouldn't have to do, because the insurance company had frozen my account for nonpayment. This was using the new information. He tried to call the company and got the same information. I could not call, they are closed today. Despite the more frequent migraines I have experienced, I am trying very hard to make it to work every day and maintain my 4.0 at school. I'm becoming very scared. I can't pay for both my insurance and the full cost for my medications. First, I should not have to, as that is the point of having insurance. But even if I wanted to, just to deal with it, I couldn't afford to.

I have now written a letter to the President, my Assembly person, and my Congress woman trying to raise awareness about this issue. It is not appropriate to be jerked around this way. When I sign onto the Anthem website to see what payment they say I owe them, the billing portal says "Can't pay on a 0.00 balance". I don't know what to do or where to turn. It would appear I will need to cancel my insurance to afford my medications, that seems to be the only option left since they are unable to resolve the issue.

Review: On 1 January 2014, I became enrolled as a customer of Anthem BlueCross with an mailing address in Oxnard, CA. To date, I have made two (2) payments to this organization, and I have tried for 29 days (and countless hours on phone hold) trying to speak to someone directly about my medical coverage, about why the medical group and doctor assigned to me doesn't have me listed as a patient, about why I can't seem to change my primary doctor to someone closer to where I live, and about how I can go about seeing a medical specialist for a problem I'm experiencing, the result of a recent car accident. I finally contacted my local state Senator, who was able to convince someone from Anthem Blue Cross to call me back, yet even he has been unable to resolve my issues. And here I sit typing this complaint, in pain from the car accident, with not a word from Anthem BlueCross.Desired Settlement: Customer service that actually works. Answers to my questions. A call back from someone who can help me with my issues. And refund for the month of January, since I have been unable to use any of this organization's services.

Business

Response:

We can not identify this member. Please have this member provider his new health plan ID number.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 9905474, and here is the information requested: The Identification Number listed on the card sent to me by the business is JQO318A75972, effective date 1/01/2014.

Regards,

Review: I needed to get some vaccinations before my trip to India in December. I went to the Kaiser Permanente in Walnut Creek, CA to receive the necessary vaccinations. Kaiser let me know that my insurance from Anthem Blue Cross would cover a part of the total cost but not all of it. I understood that and so I paid all the money that Kaiser asked me to pay right on the day I received the vaccinations. However, a few months later, Kaiser sent me a bill for the blood testing that I had received before getting vaccinated. The doctor and the front desk staff very clearly told me that the blood testing would be covered by my insurance. I did not have to and was not going to do the blood testing if I had to pay for it. I decided to run the blood test only because I was told that it would be covered by my insurance. I do not understand why I was charged only later for the blood test and why Anthem Blue Cross does not cover the blood test.Desired Settlement: Please clear all my debts from Kaiser Permanente.

Business

Response:

We are unable to locate this person as an Anthem Blue CRoss membe. Please have him provide his health plan ID number.

Review: My health insurance policy was scheduled to expire at the end of 2013, as the policy itself is being discontinued due to requirements of the ACA. I appear to have been automatically enrolled in a new health insurance plan without notification, and my account charged for this plan without my consent. In addition I did receive notification I was being automatically enrolled in a dental plan without my approval, which I assumed must be a clerical error as I was notified explicitly that my insurance would be discontinued several times. I have attempted to contact Anthem Blue Cross customer service daily for the past week, being put on hold for hours at a time, and have been unable to reach a representative to resolve this issue.Desired Settlement: I want the $253.99, and $6.69 charges to my account returned to me, and the coverage to be canceled.

Business

Response:

We have initiated a 30-day appeal for this member. He will receive a response from the health plan within 30 calendar days.

Review: I have been unable to reach online customer service for Anthem Blue Cross and get an answer to my simple question about billing ("What is my current billing status and where can I find this info on your website?") since first trying with a message sent to them on December 23, 2013. I have since followed up with a second message and have received no reply to that follow-up either. Their online response performance was already very slow even before this latest experience; I had already been accustomed to having to wait at least a week or two to get a reply to online inquiries, but this time I am getting the sense that there is nobody working there any more, that the office is empty.I cannot get this simple basic info that any customer should be entitled to access. I cannot find it on their website, and I cannot call the company by phone because I am in Ecuador. I considered trying to email one of the executive officers directly as a way around the unresponsive customer service department, but alas I could find no email addresses listed. So I am left with no choice but to appeal to the Revdex.com.Desired Settlement: I would like someone in a position of some importance at this company to reply to me and explain to me why this has happened, and to please give me the information I am requesting before my policy is cancelled due to non-payment of premiums as a result of being unable to access the basic customer info I should be entitled to knowing at any time with ease. And I would like someone in the company to apologize to me and offer some sort of consolation for forcing me to waste my personal time on this

Business

Response:

The health plan has initated a 30-day grievance regarding this member's complaint.The member will receive a response from the health plan in 30 calendar days.

Review: To whom this May concern,I have tried for 2 weeks everyday to receive customer service on a charge to my account in the amount of $262.54 plus an additional charge of $6.69 both extracted from my checking account on 01/08/14, I canceled my service with Blue Cross in December 2013 as I have insurance thru another provider. Blue Cross has failed to recognize the cancelation of my coverage at my request and decided to charge my account, Blue Cross has provided no explanation for the additional charge and have placed me on hold for at least an hour during each attempt, I am not sure I will ever receive the lost sum and feel the only way to be reimbursed is thru a small claims suit. I have used most of the minutes on my phone and wasted time on trying to receive customer support. What can the Revdex.com do to help me in this matter? -[redacted]Desired Settlement: My desired settlement for this matter would be a monetary sum for lost time, phone minutes and corporate failure to provide necessary customer service to a paying customer.

Business

Response:

The health plan has initiated a 30-day appeal for this member. He will receive a response from the healt plan within 30 calendar days.

Consumer

Response:

Review: 9890109

I am rejecting this response because: The message does not make any sense or provide any documented details of the matter.

Regards,

Business

Response:

The health plan initiate and resolves all member grievances and appeals within 30 calendar days.

Review: I have been trying to get a hold of Anthem Blue Cross of Califonria to no avail. The date is 2/19/14. I have tried to get a hold in customer service as well as a sales rep to answer questions about enrolling in Covered California. I am currently covered by Anthem Blue cross. When I tried to ask questions last year about enrolling in Covered California, Gus Michas, License # 0E77749 just seemed to want to get me off the phone and seemed to blame me when I asked questions. Also, I tried calling Gus today and along with other members of Anthem to enroll in Covered California by the due date and they are not answering their phones.Desired Settlement: I would like a return phone call by an Anthem sales rep so I can enroll in Covered California. I would like the rep. to be polite, and answer my questions truthfully.

Business

Response:

The health plan has initiated a grievance for this member. The member will receive a response from the health plan within 30 calendar days.

Review: Feb 2014 I E-mailed Athem to alert them that I was receiving benefits through my employer and would not require their Insurance so they could cancel the policy effectively immediately, I did not receive a returned e-mail. In march 2014 I received another bill this time it was for 393.39 again I sent another E-mail and sat on hold for over 2 hours before hanging up. I then called again on 5/21/2014 and got the run around telling me I needed to contact the exchange to cancel. I told them you cannot reach Covered Ca which is well noted by everyone including Mr Obama himself. I am not responsible for the roll out of Obama care and I'm not paying for duel Insurance, I tried everything to get this resolved but my efforts have been in vain. I have not used the coverage did not want the coverage and I Can not help it if Anthem can not deal with the abundance of people they were enrolling.and couldn't handle the phones and E-mailthey were getting. I do however expect them to not break the law by forcing a policy on me that I told them to cancel as I am covered by my employer.Desired Settlement: I want all back premiums discharged from my name and a letter stating this has been done.

Business

Response:

The health plan has initiated a grievance for this member. She will received a written response from the health plan in 30 calendar days.

Business

Response:

A formal grievance takes 30 calendr days (or less) to resolve. The member will receive a written response with your resolution to her complaint

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10135179, and find that this resolution is satisfactory to me.

Regards,

Review: First, I spent 15 hours on hold in January, with no resolution to any query EVER by phone. This alone warrants a complaint, in my opinion. However, my real problem is with the providers now listed with my Covered CA Anthem plan. Let me be more clear. They have no providers in them. And I live in a major medical hub of Northern California. Two examples:- In a 20-mile radius, the only OB in-network in my plan works solely with Native Americans. There are 123 OBs in their overall provider network in the same area. In a 100-mile radius the ratio of in-network to overall OBs grows to almost 10% (still insufficient), however the list itself is severely inaccurate and is comprised almost entirely of low-cost community health centers that serve the uninsured.- In a 20-mile radius, there are 0 chiropractors in my plan, while 53 are part of Anthem's overall network. In the entire 100-mile radius (that includes San Fran, Sacramento, and Stockton), Anthem has exactly 4 in-network chiropractors in my plan vs. 1193 listed for Anthem overall.I was told by Anthem's customer service that this was the choice of the providers, I find it implausible that this many doctors opted out of joining a specific plan in the network. In discussions with providers, many were not extended to the Covered CA plans without their knowledge or communication. Some that I spoke with are trying to establish these contracts and they are getting nowhere. I suspect something far more systemic than individual providers opting out of Covered CA. Perhaps the most egregious part, Anthem did not publish their in-network doctors for specific plans until the second week of January, and they falsely suggested doctors would be in-network prior to the release of this information.Covered CA/Anthem are now collecting premiums, subsidies, and exchange fees for plans that have no chance of providing healthcare to its customers. I know everyone is focused on enrollment, but enrollment in phantom plans like mine needs to be addressed.Desired Settlement: I would like Covered CA and its associated plans to address and remediate the systemic issues in their provider network.

Business

Response:

The health plan has initiated an appeal for this member. The member will receive a response within 30 calendar days.

Review: I had to switch medical providers due to distance in 2012, and my new medical provider (UCLA Health) required me to submit to $911.41 worth of preventative-care biometric-screening labs that Anthem BCBS had assured me is covered as preventive. When the provider misbilled the charges as non-preventive/"medical diagnosis," thereby reducing my Healthcare Reimbursement Account, Anthem assured me that if the provider resubmitted the claim as preventive, the funds would be restored, as all preventive care is covered by traditional coverage. After almost a year of requesting, pleading, and reminding the provider to resubmit the charges, they finally agreed to do so after I finally filed a Revdex.com complaint with them. When they did resubmit, Anthem denied coverage and gave the reason that the preventive tests were tied to an annual exam, and only one such exam is covered per year. (My prior provider had run some tests earlier in the year.)At no point did Anthem warn me of such a restriction, nor is such a restriction to be found anywhere in the plan materials. In fact, because the laboratory (Quest Diagnostics) my prior provider worked with earlier in 2012 also miscoded most of these annual exam labs ($165.77) as medical instead of preventive, those ALSO reduced my account, and Anthem's repeated promises to follow up with the laboratory - several Anthem representatives have promised to follow up to resolve this, and none have - went unfulfilled even with full cooperation of the physician.In short, Anthem used every reason, from supposedly miscoded billing to novel restrictions not found in plan materials, to deny my preventive claim. Anthem has acted in bad faith repeatedly as I have attempted to resolve the issue.Desired Settlement: I would like Anthem to refund the amount of the preventive care, including the $929.52 that was wrongly deducted from my Healthcare Reimbusement Account as well as the $141.57 that I had to pay out of pocket to the provider after my account was depleted, for a total of $1,071.09. I can provide a full accounting of all charges if helpful.

Business

Response:

We can not locate Cory Fryling as an Anthem Blue Cross member. The number he referenced is not an Anthem health plan ID number. Please have him provide his Anthem Blue Cross ID number so we may locate and research his issue.

Consumer

Response:

Review: 9748137

I am providing additional information for this complaint as requested by Anthem in their initial response.

Review: I received a "notice of grace period" from Anthem Blue Cross regarding my Life Insurance Policy back in September. There was no payment slip, or address included with this letter mind you. I have been trying to class their Customer Service team to make a payment for weeks. When I would call, even during business hours, I would hear "not open" or their self-serve menu would not allow me to make a payment. I called today, and finally got through only to learn my account has been CANCELED! I have been with this company for over 8 years, and they didn't even try to rectify the situation. All I got was a "we're sorry, but you had until.... to pay." I tried to pay! Their system is never working correctly. I always pay two months, or more at a time via check. I have YEARS of proof, and because of their faulty "self-serve" my policy has been canceled. I demand that they either reinstate my policy, or issue me a refund of all funds paid over the years.Desired Settlement: At this point, I would like them to either reinstate my policy as it was, no changes, increases, and caring same balance. Or a complete refund of all monies paid over the years.

Consumer

Response:

Review: 9795236

I am rejecting this response because:

Review: We received a letter saying we have not paid our Health insurance Bill. We sent the check on 12-27-13 to PO box 9041 in Oxnard CA.We have attempted to call the 3 phone numbers we have for them to resolve the issue. Beginning at 7 AM throughout the day and ending at 7 PM per the phone mail message referring to hours of operation.The message is always the same (with a small exception) " Due our high call volume we can not take your call at this time." and then the phone hangs up.How does someone resolve issues if no contact can be made with this organization??Tuyen and Roger WaldowDesired Settlement: I WOULD LIKE TO BE CONTACTED BY SOMEONE WHO CAN RESOLVE THIS ISSUETuyen Waldow916-799-0156

Business

Response:

The health plan has initiated a grievance regarding this member's complaint. The member will receive a response from the health plan within 30 calendard days.