Blue Cross California

Review: charged for a premium which they canceled and refuse to refund meDesired Settlement: I want my son's portion of my febuary health insurance premium refunded since you canceled his policy after I paid it and refuse to refund me my money

Business

Response:

Member's issue was resolved on 9/16/14 by customer service.

Business

Response:

This member spoke with a lead on 9/16/14 who advised his refund is being processed.

Consumer

Response:

Review: 10224074

I am rejecting this response because:It is a false statement. I spoke with a lead which agreed that I am owed a refund, however everytime I speak with someone I am told that they agree I am owed money but when it come down to getting it their accounting department says they will not issue me any more refunds.

Regards,

Review: I have repeately asked for a refund for a payment (electronically )did on January 7 to Anthem BX $653.00. I cancelled the policy later on because I chenged insurances to another company .I was with Anthem for over 15 year, and individual PPO policy.I got an email telling me that they could'n find a payment.That I wasn't owed any moniesHere is the email from 1/28/2013:Hello I don't show we owe you a refund ? The plan was canceled before we charged you . please see notes from 01/08/14HIPAA VER//MBR 20 CLLD TO CANCEL//REASON FOUND ANOTHER ACA PLAN//CANCELD 0RX1& 13VV WITH EFFECTIVE DT OF 01/01/14//MBR MADE PAYMENT ON 01/07/14$654.00//PDT 01/01/14 WE HAVE NOT PROCESSED PAYMENT//I cancelled my policy and I haven't received my refund yet.When should I expected it.It's over 15 days.Thank you.I have sent copies of the debit from my checking account. The transaccion record that can be checked in their website and the personal account that I have with Anthem BX.I responded to them to them: 1/28/14/. Wrote again on 2/3 and 2/14.Every email shows the following:"See attached receipt for proof of payment from January 2014. The money was withdrawn from my checking account January 7th. Thank you. [redacted]"Payment Information Account # Product Name Customer Name Nickname Bill Date Minimum Total Amount Amount Due Due Due Date LUMENOS HSA PLUS 3000 ADRIANA COSTA adriana001 01/ 27/2014 $0.00 $0.00 01/01/2014 Payment Details Date & Time: Sat Jan 04 2014 01:17 PM Payment Status: Completed Payment Account Nickname: wamu Account Type: Personal Checking Name on Account: ADRIANA M COSTA Address: 4905 AMADOR DR OCEANSIDE,CA 92056 Routing Number (ABA): [redacted] 1627 JPMORGAN CHASE BANK,NA Bank Account Number: [redacted]9877 Payment Date: 01/ 06/2014 Payment Amount: $654.00 Confirmation Number: 2[redacted]0225261 Return to Payment HistoryI don't even get a response.Calling them is a waste of time they will not even pick up the lines. The excuse is Obama Care.Thank you for your attention.A. CostaDesired Settlement: Send the refund ASAP.

Business

Response:

The complaint has been entered into our standard 30 day grievance and appeals process due to close on 3/21.

Review: We requested our current Blue Shield policy be cancelled because the existing policy was going to more than double in price on 1/1/14. We also purchased a new policy to begin on 1/1/2014 from Blue Shield. Payment was debited from our bank account for this new policy on 1/7/2014.In addition to the new policy Blue Shield debited our bank account on 1/7/2014 in the amount of $666.78 for a health insurance policy that was cancelled (and expired on 1/1/2014). We've tried unsuccessfully to remedy this situation through their web-site. We've also spend approximately 5 hours on the telephone (mostly on hold) and have been unable to solve this issue. As I write this complaint, I've been on hold for over an hour and forty minutes and haven't spoke to anyone. My wife also spent 3 hours on hold this morning only to be cut off twice. That's not to mention the countless times we've called and been on hold and had to hang up after hours of waiting with no answer.Desired Settlement: I would like the $666.78 that withdrawn from our account without authorization refunded immediately.

Business

Response:

Please have this member provide the health plan ID number that is in dispute so we may research his issue.

Consumer

Response:

Member ID JQ[redacted]358

Review: I currently have health care with Anthem Blue Cross. I changed banks and sent in my form request several weeks ago, via fax - to have my autopay switched to my new bank. The request was not completed in a timely manner, and I had to call in and pay by credit card. The customer service rep, stated that my request was never received. I have a fax confirmation receipt from Kinkos. Today the customer service rep said she would email me a new form, to be completed and faxed in again. I have not received the new form. It's been over a month since I have switched banks, I have completed what was requested of me to no avail... and I feel I am being treated poorly, like a number... not a person. I need to get my autopay set up ASAP.Desired Settlement: I would like to receive a call from a manager who has the authority to stream line this broken system of setting up Auto Pay for my health insurance.

Business

Response:

This member cannot be identfied. Please have the member provider his/her health plan member ID number.

Business

Response:

As we have many Jesse L Gros member's, the health plan ID number would be required to research further. Or, the member's social security number, if he chooses to provide it.

Consumer

Response:

Review: 10263544

I found my card:ID No: XDL[redacted]102Since: 06/01/2007

Regards,

Review: Anthem cancelled my health insurance. I contacted them when there was a policy change to find out why my insurance was changing. The rep had no answer for me and said they would contact a supervisor and call back. I missed their phone call. Also, apparently they sent mail - however, I live in 3 different places. Multiple phone calls should be necessary to contact me. Also, I tried calling them multiple times only to be kept on hold while an "agent is busy" for over 25 minutes each time. I don't have 25 minutes to sit on a call and wait for a rep. I tried to reinstate my insurance but they are saying that I cant until October. That is completely ridiculous. They cancelled my policy without verbally making every attempt to contact me.Desired Settlement: I want my health insurance reinstated.

Business

Response:

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

Consumer

Response:

Review: 10068740

I am rejecting this response because:

There is no guarantee that my insurance will be reinstated. I did what was necessary to contact my provider and they had no answer for me. The terms are clearly set up in the companies favor and not that of the insured. I am willing to pay what is necessary to reinstate my insurance and I do not understand why this is an issue.

Regards,

Business

Response:

The member's grievance will be thorougly reviewed and he will receive a written resolution from the health plan.

Review: Toward the end of last year, I signed up for Anthem Blue Cross through the Covered CA website (no subsidy), and paid my premiums in full and on time for January through April 2014. I then switched from Blue Cross to Blue Shield for the following reasons:1) Blue Cross sent me an incorrect health card multiple times.2) Blue Cross would not let me enroll in automatic payments or pay online.3) Blue Cross made it almost impossible to speak with a customer service representative.4) Prior to choosing Blue Cross, their online docs claimed that my current doctor and medication would be covered. Neither was covered.I went to the Covered CA site around the beginning of April and cancelled my Blue Cross coverage, effective at the end of that month. In May, I received a letter from Blue Cross informing me that Covered CA notified them I had cancelled retroactive back to Jan 1. They included a check for my four premiums and said that I would now be responsible for all services I'd received during those four months, unless I immediately re-enrolled with Blue Cross. I did not deposit the check and did not re-enroll.Instead I tried calling Blue Cross multiple times to file a complaint and correct their error. I only got through to a representative once, and after I explained the issue, he immediately transferred me to a line that immediately hung up on me. I then called Covered CA who had in their records the April 30 cancellation date and explained that it would be impossible for me to cancel retroactively on the website as Blue Cross had claimed. To do so would have required an intervention from the Covered CA staff and they had made no such intervention (They would have had a record of that). Covered CA filed my complaint and sent it to Blue Cross, but Blue Cross seems to have ignored it. Yesterday I received a notice from Blue Cross informing me that I am now responsible for paying a doctor for a March office visit. I assume this is the first of many notices that Blue Cross will be sending me.Desired Settlement: I paid all of my premiums in full and on time and then canceled my coverage during the insurance open enrollment period due to Blue Cross's horrible service. I would like them to stop withdrawing their payments to my medical providers. I would also like them to stop sending me mail. A quick search online shows that Blue Cross has repeatedly resorted to retroactive cancellations when they had no just cause to do so. Please help me get Blue Cross to stop harassing me.

Business

Response:

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

Business

Response:

The member complaint is regarding the Revdex.com response to the member allowing the person to accept or reject in 7 days as the health plan advised they would respond to the member in 30 calendar days.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10134116, and I do not have the time or energy for a prolonged fight against

Anthem Blue Cross so I am dropping my grievance.

Regards,

Review: I purchased an insurance policy for myself and my family on August 22, 2014 and asked to be billed monthly. The insurance policy was set to incept on September 1, 2014. I provided a credit card for automatic billing. In October, I received much of my 2nd trimester testing (rather expensive tests) from my obstetrician. Such tests are covered, for the most part, by my insurance. On November 12, 2014, I received in the mail WITH NO POST MARK, a letter dated October 1, 2014 stating that my policy would be cancelled for non-payment and that I had 31 days to pay the past due premium (until November 1). I believe this was intentional on the part of Anthem to cancel, retroactively, my insurance coverage. I cannot understand how they can send time-sensitive materials under an envelope with no post mark. I also do not understand how I received every other mailing from Anthem, with the exception of this letter, which I received 12 days after the time lapsed for me to act on its contents. I called Anthem asking to resolve this, offering to pay any premium amounts owed for October and November, and they advised that they could not reinstate the policy. Anthem also advised that they cannot bill a credit card monthly; I have to link this policy to my checking account. I was never advised that this was the case. Had I been, I would have asked for the information to link my account. In addition, Anthem advised that any treatments I received after the date of cancellation (October 1, 2014) are not covered. I believe this is bad faith on the part of Anthem to not cover my medical treatment.Desired Settlement: I would like Anthem to reinstate my insurance policy, with coverage retroactively for October and November 2014. I am happy and able to pay the premium for those months.

Business

Response:

An appeal has now been initiated for this member. She will receive a response from the health plan within 30 calendar days.

Review: Anthem Blue Cross has referred a bill collection to Genpact, LLC. After responding to their correspondance, They continue to threaten to send collection information to Credit Bureaus. I have repeatedly requested that they show written proof that coverage is owed and give an explaination of why the company paid this claim if it had been terminated prior to the claim. The amount of the billing is 411.62.Desired Settlement: I request that the collection information be withheld from the reporting credit bureaus and that the 411.62 billing dispute be dropped.

Business

Response:

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

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10623404, and find that this resolution is satisfactory to me.

Anthem Blue Cross responded by putting this complaint in the grievance 30 Day notification process. Since then the Company has graciously reversed the amount due by proclaiming that the billing was sent in error. Again, Thanks to the Revdex.com for mediating this and know that your sevice is vital in resolving disputes.

Regards,

R[redacted]

Review: They never refunded my $98.00. In Dec. 2013 when I cancelled the insurance over the phone, they did not tell me I had to write a letter to cancel the insurance.Desired Settlement: Refund $98.00

Business

Response:

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

Review: Confession: My complaint indirectly relates to a health issue.Im writing to recover my health insurance expenditures 9/23/13-1/2/14. UC SHIP informed me I could access coverage through Anthem in NY. In fact, strenuous efforts yielded no covered medical providers, and no meaningful help or support.The treatment window was 3 months from Oct sign up. Anthem delayed access. Snail-mailing initial info wasted a week. Later snail-mail took 3 weeks, indicating a 2-week delay in mailing letters to clients with time-sensitive coverage.To access Anthem providers, you must sign in online. Sign-in requires lengthy, redundant forms which work until you hit submit, then time out. I did this over 15 times. All redundant information must be reentered each time. I phoned & was eventually channeled to a person who said it would work if I were covered. I emailed to complain. A week later, they called back. I signed in. After 2-3 hours, I realized no search found any doctor in NYC. I called: If youre covered, you can access providers online. I am covered! I just gave you my info! I called UCSD: If you are covered, the easiest thing is to come to Student Health. But Im in NY! They had no more ideas.My health insurance expired. Now, treatment is denied me because NY Medicaid shows me as covered by Anthem! My dentist called for a termination date, but was told I never had coverage. After many calls of my own, I finally reached a man at Anthem who searched for me even after reporting that no account existed. Twice he said he could not find me, but I persisted, and eventually he was able to find me & provide a term date.Anthem did not make it possible for me to see a medical provider. Even after expiring, this useless insurance is preventing me from getting medical attention.(This complaint in no way reflects upon the staff in the UCSD insurance office, or the staff at Anthem. It does reflect upon Anthem's bureaucracy, corporate policy, website, and service.Desired Settlement: I would like a full refund of my expenditure, as no service was provided or accessible. In fact, the contract has only prevented me from accessing the supposedly provided service.

Business

Response:

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

Business

Response:

I cannot respond to how the Revdex.com responds to your complaint on whether they keep the complaint open or close. As stated previously, Anthem Blue Cross will respond to your grievance in writiing within 30 calendar days.

Consumer

Response:

Review: 9995281

I am rejecting this response because I am forced to by the insipid policy of the Revdex.com that matters are considered resolved even if they have not been addressed in any way. Yes, an Anthem representative emailed me. No, the email had no substance whatsoever. It merely said that they'd get around to giving me some sort of actual response within 30 days.

Review: MARIA HAS BEEN TRYING TO CANCEL THE HEALTHCARE BECAUSE THEY WERE CHARGING HER $273.00 PER MONTH AND THEN THEY RAISED THE MONTHLY BILL TO OVER $500.00 PER MONTH WITHOUT TELLING HER !NOW THEY HAVE SENT HER A BILL TO OVER $1100.00 PER MONTH ! SHE IS ON A FIXED INCOME WITH SSI AND IN NO WAY AFFORD THIS. SHE WANTED SUPLEMENTAL INSURANCE AND THEY ARE CHARGING THIS CRAZY RATE ! SEVERAL PEOPLE IN THIS FAMILY HAVE TRIED TO CALL ANTHEM BLUE CROSS WITH NO LUCK AT ALL ! NORMAL WAITING TIME IS OVER 1 HOUR . AND 2 1/2 HOURS ONE TIME AND ALWAYS GETS DISCONNECTED AFTER WAITING FOR SO LONG ! IT IS IMPOSSIBLE TO TALK TO SOMEONE THERE ! WE ARE SICK AND TIRED OF THIS STUPID COMPANY AND THERE IT EMPLOYEES ! THEY KEEP CHARGING HER THE MONTHLY BILL EVEN THOUGH MARIA HAS SENT THEM LETTERS TO CANCEL . SHE PUT A ( REFUSAL OF PAYMENT )AT HER BANK BECAUSE THE $500.00 WAS TAKEN OUT OF HER ACCOUNT WITHOUT HER KNOWING IT SO SHE FIXED HER ACCOUNT SO SHE COULD NOT BE CHARGED THIS RATE ANYMORE . MARIA IS LEGALLY BLIND AND CANNOT PAY THIS KIND OF PAYMENT. SHE CAN'T EVEN PAY HER BILLS . THE FAMILY HAS TRIED SO LONG TO GET THIS CORRECTED BUT WE CANT TALK TO OR GET ANY KIND OF RESPONSE FROM ANYBODY THERE ![redacted]'S INSURANCE ID NUMBER IS ( J[redacted]02 ) FOR ANTHEM BLUE CROSS !! AND SHE HAS ASKED FOR THAT INCREASE OF THE MONTHLY INCREASE REFUNDED TO HER !!Desired Settlement: SHE WANTS ANTHEM TO QUIT CHARGING HER THE MONTHLY PAYMENTS.. SHE HAS THE PROOF OF THE LETTER SENT REQUESTING THE CANCELLATION OF THE INSURANCE .IT IS IMPOSSIBLE TO TALK TO SOMEONE THERE ! SHE WANTS THIS INSURANCE CANCELLED !!

Business

Response:

A grievance has been initiated by the health plan for this member. She will receive a written response from the health plan within 30 calendar days.

Review: Anthem Blue Cross:Without notice, they tripled my health insurance, and did not get my authorization. Moreover, I have been trying since December 2013 to cancel my account. I informed them via phone after 100s of tries to cancel my account. The lady told me they typically are unreachable most days of the week except possibly Wednesday.I told her I want to cancel my account, and was given a fax number. She was polite but not empowered to do anything except hand out a nummber.I faxed 3 cancellation notices, and requests for refunds for 2014. Nonetheless I keep getting invoices/bills. I even faxed another number listed as the cancellation fax number. I have tried to call 100s more times and have been told snail mail is extremely slow for processeing and so fax is the BEST way to cancel. My latest fax to them was mid-February. I received another checking automatic deduction notice for about $400, despite me telling them this is unauthorized since December, and me giving them written notice to stop. They have caused me overdraft fees with my bank, and have charged me without authorization thousands of dollars of which I have received NO benefit. They intentionally have underbudgeted their cancellation customer service but are quick on the sales side. The company is unethical if not illegal, and I may end up taking them to small claims, if not seeking class action.Desired Settlement: I have documented communications with Anthem Blue Cross and just need them to STOP charging my bank account. I request a full refund for 2014 on the basis of me never authorizing charges, and me trying since December 2013 to try to cancel my account which I have logged.

Business

Response:

The health plan has iniated an appeal for this member. They will receive a written response from the health plan within 30 calendar days.

Review: Billing issues and Customer service issues. I have been trying to contact anthem since the beginning of January 2014 when I first noticed they overcharged my bank account to find out what this charge was. Then, this week (Monday, January 20, 2014) I finally received all of my forwarded mail from my last address which contained a letter showing what this charge was. Ok, now I understand. But I need to get a hold of somebody from anthem to clear everything up and change my coverage and also there is NO WAY online that I can get rid of my bank account info so they dont take my money again. So for the entire month of January I have spent hours upon hours trying to get through their automatic system. Finally today January 23, 2014, I at least got to the point where I could either wait on the phone for 11 minutes or have anthem call me back. So of course I chose to have a callback. Well I get my callback as promised only to take me back where I started with all of the automated options. No matter what I CANNOT get a person on the phone or get accomplished what I need to do. I will NEVER EVER EVER EVER for the life of me choose them again for health insurance. I just need somehow to get in touch with them to put an end to this madness and unnecessary stress! Which is why I am coming on here to report them because I don't know what else to do. Thank you.Desired Settlement: I want to be contaced by a PERSON from anthem to resolve everything. I want a refund on my account for the amount of $208 that was taken out of my bank account without my knowledge! And I want to cancel my policy, as I will be ready to join another from a different provider! And if this issue does not get resolved before February, which most likely it wont because I will be out of the country all of next week, I am not going to be responsible for any payments for the month of February.

Business

Response:

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

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 9897794, and find that this resolution is satisfactory to me.

Regards,

terrible customer service they try to screw you at every turn after a simple co payment they try to charge you an extra 158.00 just to meet with a doctor and this is supposed to be cover why have a co payment run from this provider before you have to make a claim you will be glad you did

Review: I have tried to get a hold of someone over at Anthem Blue Cross about getting my paperwork fixed, but I relentlessly keep getting transferred from one person to another for hours. My insurance has been cut off because of this companies negligence, all I need is a "Credible Insurance Letter" to provide to my real provider. I have paid premiums and have pregnant wife as well as a sick toddler walking around with a bad cold. Apart from having to pay premiums I'm also paying for medicines prescribed by doctors and having to come out of pocket.Thanks for reading this.Desired Settlement: I would like to receive my "credible insurance letter" and I would also like to be refunded for everything that I came out of pocket for, as well as my premium payment.

Business

Response:

Our records indicate this member's concerns were addressed by Anthem Blue Cross customer service on 12/29/14.

Review: Anthem originally processed my claim wrong for an ultrasound in February of this year, yes February and yes, the claim has still not been resubmitted properly despite numerous phone calls to their "cus[redacted]er service" reps. The first two times I called and spoke with two different people neither one could find my doctor on their list and basically just told me to go on their website and pick a new doctor from their list of in-network physicians (keep in mind I am almost in my third trimester by this point). I hang up and then go on the website and type in my doctor's information and immediately his name comes up. Frustrated, I call back again... finally the 3rd person I talk to finds my doctor and says yes he is in network (duh) and apologizes for the problem and supposedly resubmits the claim. A few weeks go by and I hear nothing, haven't received anything in the mail and the doctor's office hasn't either so I call back again and talk to [redacted]. He says the claim was never resubmitted and I'll go ahead and do that right now and I'll expedite it and I will follow up with you weekly until it's resolved. He did call the following Friday but only to tell me that nothing had been done and I'll call next week. He never calls back. I wait a week or two and still hear nothing so I call back AGAIN and talk to a woman who sees all my notes with [redacted] and tells me that the claim takes so and so business days and it will be resolved for sure next week. It has now been 2 weeks and STILL NOTHING. I call back today and talk to someone who acts like she doesn't know what I'm talking about and keeps telling me my doctor is out of network..I ask to be transferred to a supervisor and asks me to hold then transfers me to another claims assistant. She asks me for all the same information I just told the last person and just tells me that lots of claims are backed up and there's nothing she can do. I ask to be transferred to a supervisor and she hangs up on me. This is the absolute most disgraceful excuse for a health inDesired Settlement: I just want my claim fixed and properly! OR I want a refund of my premium. I want them to acknowledge how horrible they have been to their members. We pay A LOT of money each month and for what? For me to tell them how to process claims...for me to tell them what doctors are in their network? It's mind boggling to me that an insurance company can get away with stuff like this. I know I'm not the only one and IT"S NOT RIGHT. Anthem needs to be held accountable for their actions (or lack thereof).

Business

Response:

We are unable to identify this member. Please have him provide his health plan ID number. Thank you.

Business

Response:

This member's complaint was received by the health plan on 6/3/14. Her request is being processed and should be completed within 7-10 business days.

Consumer

Response:

Review: 10076867

I am rejecting this response because:

"should" is not good enough. Hence, my entire complaint to begin with. The claim was already expedited (after not being originally resubmitted like it should have) and I was told "for sure" it will be completed the week of memorial day...it is now June 5th and NOW today you are telling me it "should be completed within 7-10 business days"? That's the best you can do??? This is absolutely ludacris. This started MONTHS and many, many phone calls ago. The fact that you can't just get one single claim finished that you messed up to begin with is RIDICULOUS.

39 weeks pregnant and this is what I have to deal with? DEALING WITH MY HEALTH INSURANCE COMPANY'S MISTAKE SHOULD BE THE LAST THING ON MY MIND RIGHT NOW.

The way you conduct your business and treat your members is abslutely depolorable.

Not to mention, you also processed one of my dental claims wrong as well...but that's a whole other story. Get your act together.

Review: I have asked repeatedly via phone, email and fax to be REMOVED from ALL Anthem Blue Cross / Blue Shield mailing lists.I have received yet another mailing from you.Please REMOVE me from all mailing lists.[redacted]PO Box ### Ukiah, CA [redacted]Desired Settlement: REMOVE me from all mailing lists.

Business

Response:

This member cannot be located in our system. Please have her provider her Anthem Blue Cross health plan ID number.

Business

Response:

We need to know if she is getting literature from Anthem Blue Cross. And if she is, what specifically is she receiving.

Consumer

Response:

Review: 9992281

I am receiving envelope mailings and postcards from Anthem Blue Cross begging me to sign up for a Medicare policy. Numerous mailings.

Regards,

Shirley Kleim

Review: Claim:Unreasonable delay in repayment of claims, unwillingness or inability to clarify documentation needed for claims processing.Timeline:-11/27/13 I filed my initial claim-December 2013 (specific dates unknown) I called and emailed Anthem offices multiple times, customer service reps couldn't find my claim, get me in touch with anyone who could confirm that claims department had received my claim, confirm that claim would be processed as promised, or confirm that everything was in order on my claims form-Shortly after Christmas, spoke with supervisor Schameca Thresher-Baldwin for the first time as a supervisor. She confirmed partial payment of my claim, but told me that I would need to resubmit remainder of my claim using different procedure codes. She promised payment in 10-15 business days-1/8/14 I sent the revised claim using the instructions provided-1/10/14 I requested confirmation that everything was in order. Schameca replied to let me know that I needed to sign the form-1/14 I sent the signed form-1/15 I asked for confirmation that everything was in order-1/17 I asked for confirmation that everything was in order. Schameca told me the procedure codes were incorrect and promised to research them for me-1/22 Schameca let me know the correct procedure code. I asked if this was a change I could make myself, or if my provider needed to make the change to the form. I never heard back-2/4/14 I sent the revised form with corrected procedure codes-2/6/14 I asked for confirmation that they had everything they needed to process-2/10/14 I asked for confirmation that they had everything they needed to process. Schameca let me know my claim had been "submitted" but did not confirm that all paperwork was in order. I asked again for confirmation that they had everything they needed to process- 2/12, 2/13, and 2/18/14 asked for confirmation that everything was in order- 2/19/14 Schameca told me diagnosis code was incorrect- 2/20/14 resubmitted and demanded immediate resolutionDesired Settlement: I want my claim processed. I want clarity for future on how to get claims tracked and processed in timely manner. I want Anthem to expedite the claims I have not yet submitted while I waited for resolution of this issue and clarity on their filing requirements.

Business

Response:

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

Consumer

Response:

Review: 9943728

I am rejecting this response because:

My complaint is specifically regarding the lack of timely response from the business. Being in touch with me in 30 days is a) too long of a response time and b) does not give any guarantees that I will receive the repayment owed to me. I will be satisfied when I am repaid and when I receive clarity on how to avoid such delays in the future.

Regards,

Business

Response:

Health plan appeals/grievances take a maximum of 30 days to research and respond.

Review: Last year, I signed up for "Anthem Premier DirectAccess - ceab" insurance just for myself. The computer printout said that coverage starts "01/01/2014" and states the name of the new policy that I signed up for. However, my new insurance card says that the effective date is "04/01/2014" and that I have "Anthem Core DirectAccess cacs". It is both for me and Susan C Pastika. This policy is inferior to the one that I signed up for, with a $6000 deductible. In contrast, "Anthem Premier DirectAccess - ceab" insurance has no deductible. Anthem processed the payment by check that was the quoted premium for the new policy on January 2. The check was received about 10 AM on 12/31/13 and was signed for--it was mailed by USPS mail. The local CVS pharmacy said that the policy with the new policy number isn't effective until 04/01/2014, so Anthem's computer records are incorrect. I called Anthem multiple times today and yesterday but each time I received a recording that they could not take my call. I also wrote a message today and yesterday about the problem in Anthem's message system and I have not received a reply.Desired Settlement: I would like to promptly receive an insurance ID card that correctly states that I have "Anthem Premier DirectAccess - ceab" insurance with an effective date of 01/01/2014 that is just for myself. I would like Anthem's computer records to be changed to reflect this correct information. This should be a fair settlement because Anthem processed the payment by check that was the quoted premium for the new policy on January 2, 2014.

Business

Response:

The health plan has iniitated a 30 day appeal for this member. She will receive a response from the health plan within 30 calendar days.

Review: I had been with Blue cross for a few years, I recently moved out of state and decided to change my insurance. I canceled my policy since january, they had already withdrawn the monthly payment, however I was told they I would receive a refund for this amount and it would take 3-6 weeks. I have called many times and every time I call I get the same answer..."we apologize we will submit this request and you should receive sour check in 3-6 weeks" well it is now end of may and nothing. I just want to get my money back, why is this company so fast to withdraw from my account and so shady when all I want is my own money. This is my last resort I am so frustrated I don't know what else I can do. Please help.Desired Settlement: I want this money to be drawn back into my account!!

Business

Response:

The health plan has initiated an appeal for this member and she will receive a written response within 30 calendar days.[redacted]