Blue Cross California

Review: This complaint is in regards to the fraudulent billing acts by this company, after purchasing a health plan for medical coverage, with this company I have been steadily making payments and have not missed a single one, when I then received a bill stating that I owed for 5 months of payments that had already been made, not sure why this was happening I contacted the company, when the service representative informed me that in there system it was shown that they received the payments but that they had not been put towards my account ,and that it would be investigated, but that my other health plan for dental was payed up. I was told I would be contacted by an administrator the next day, it has been several days and I have heard nothing from them, aside from a new billing notice stating they will terminate my account for lack of payment on my dental coverage, that I had just confirmed was paid in full . I am extremely aggrieved with company. and can not afford to lose my health coverage.Desired Settlement: I require that this company and there acts be investigated thoroughly and that my account be fixed as I do not owe them this money ,I want to make sure that my account becomes secured that the person messing with it is fired and that this company makes amends for my grievances, regarding the possible loss of my insurance and that any do money is wiped , so that I may start a new account, If this is not rectified I will take my case to court since I have proof of payment and fraudulent acts.

Business

Response:

The member contacted the health plan on 10/29/14. Her complaint is being researched and she should have a resolution within 30 calendar days.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10289456, and find that this resolution is satisfactory to me. On the condition that the company must contact me with a satisfactory agreement with in the time frame provided .

Regards,

Review: I have tried to called Anthem multiple times but they are not reachable due to them blaming Obamacare. It is not reasonable to not be able to reach your insurance agency and they still are able to bill you and take your money. I noticed that they have charged me for Pediatric/Dental on my insurance for about $6 a month when I never wanted or requested this. I just want my money returned on this and for them to have much improved customer service.Desired Settlement: I want my money refunded, $50, and for you to stop billing me for the dental/pediatric dental part of my insurance which I never signed up for.

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.

Review: Anthem Blue Cross pre-approved a medical procedure and has not paid out despite multiple contact points and providing all requested documentation.Desired Settlement: Anthem Blue Shield needs to pay out the claim (as pre-approved and as processed).

Business

Response:

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

Review: I have recently begun to use the services of Anthem Blue Cross. This past Saturday I called the phone number on my membership card to ask questions regarding benefits and claims. The recorded message stated that the wait time was 18 minutes but after 45 minutes on the phone I had to end my attempt. Today, I am still trying to reach the claims department and benefits department. I waited for 55 minutes before someone at Anthem picked up the phone and hung it up immediately, without a word spoken by either of us. I called back and have been on hold now for over 45 minutes. I rate this customer service as the worst possible service and will consider any and all ways to communicate this complaint to others. I am saddened to find that on several rating sites this company rates at the lowest possible rate.Desired Settlement: I want a proper contact phone number that I can call in order to reach the claims department and the benefits department. The Revdex.com has a specific choice in their options menu titled "Customer Service Issues". This is clearly a customer service issue, and as such I seek some contact explaining why they can't be reached.

Business

Response:

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

Review: I apply for dental insurance with anthem blue cross.... I canceled my service the same month I applied for it.... They keep charging me monthly for it ... Total of 3 months they charged me for ($300 total ) They give me the run around .. They hang up on me numerous times and transferred me to departments I don't even need to be transferred to.... All I want it my money back for something I tried canceling from the get go ....Desired Settlement: I want my refund credited to the account they withdrew the money from that's a total of 300Please note I received no service at all period zero zip nada

Business

Response:

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

Consumer

Response:

Review: 10047796

I am rejecting this response because: the company is not stating that they will refund the remaining $208

Regards,

Review: Anthem Blue Cross has stalled processing my twin sons application for now over 3 months, despite receiving all the appropriate information. We had to pay for their immunizations which are over $1,300.00 each. We have been contacting Anthem since January and despite our numerous phone calls, nothing has been done. Most recently, after waiting for 1.5-2 hours on "hold" the phone calls get dropped and we still have no insurance for our twin boys. This is exceptionally irresponsible on the part of the company considering that had we known that we would encounter such incompetence, we would have chosen a different company. Additionally to deal with their exceptionally poor member services, both I and my husband had to take time away from seeing our own patients only to have our phone call be "dropped."Desired Settlement: My sons' visits have been "well baby" and I would like to have those visits and their immunizations covered as is required by the Law.

Business

Response:

This member contacted the health plan customer service on 3/12/14. They are researching her issues and she was advised memberhsip will be contacting her within a few days to resolve her issues.

Review: I initially called to get covered through Anthem Blue Cross and the agent signed me up with coveredca and said I did not qualify for a subsidy but I could cancel the plan before March 31st if I changed my mind. I later found out that I did indeed qualify for a subsidy and had to call coveredca to cancel the plan that the agent signed me up for per anthem blue cross. I then received numerous automated phone calls and paper bills in the mail saying I owed my first bill. I tried calling anthem and I was transferred from agent to agent and then hung up on while on hold. No one seems to know what they are doing so they transfer me and I have to listen to automation and then someone comes on and says they have to transfer me again. I have not been able to get help.Desired Settlement: I would like to hear from someone who can tell me what is going on with my account.

Business

Response:

This member's issue is unclear. Is she complaining about bills and calls from Covered California or Anthem Blue Cross. If it is about Covered California, the health plan can not help. If it is regarding ANthem Blue Cross bills and calls, please advise.

Thank you

Review: I am paying Anthem Blue Cross/Covered CA. None of my doctors accept this "coverage". Anthem refuses to give me an accurate list of doctors that accept

So, I signed up for Anthem Blue Cross to meet the May deadline. My previous employer also was Anthem Blue Cross, with prescription drug benefits. As I am starting a new business, I chose to go with Covered CA, thru Anthem Blue Cross. The same company, without the drug coverage--or so I thought. Here's what I got:

1. Cost $845.00/mo $5000.00 deductible.

2. Family Physician-- Dr Kiran Reddy- doesn't take Anthem Blue Cross/Covered CA

3. Wife's gynecologist- Dr R. [redacted]e-doesn't take Anthem Blue Cross/CoveredCA

4. Dermatologist- Dr. [redacted] doesn't take Anthem Blue Cross/Covered CA

5. Dentist- Dr [redacted]- Doesn't take the Covered CA dental plan

So for $10,140 annual premiums and $5000.00 deductible, I am now searching for all new doctors for my family. I had been with my family physician for about 14 years. Anthem Blue Cross sent me a list of doctors who supposedly take this "plan". I called 2 doctors from the "list". Both phone numbers were incorrect. One doctor was not accepting new patients, and the other was not in family practice- despite the fact that the "list" said he was a family physician.

So I pay the unsubsidized, full amount of health care for my family, and for that privilege, I am subsidizing those who don't pay, and so far, I cannot find physicians who accept "Anthem Blue Cross/Covered CA".Desired Settlement: An accurate list of doctors in Fresno that accept their coverage and are accepting new patients. The list they gave me has wrong phone numbers, doctors that don't accept any patients, and doctors that are listed as family physicians, and are not.

Business

Response:

This member cannot be located. Please have him provide his health plan member ID number.

Review: On 10/06/2014, I went to get the Flu Vaccination at the Palo Alto Medical Foundation (PAMF), which is one of the major In-network Hospital's for Anthem Blue Cross PPO insurance, and where I have my Primary Care Physician. And starting from that day's night onwards I had a severe cough which continued for almost 2 months from that date. Hence within the dates of 10/10/2014 and 12/24/19/2014, I had no other option than to keep making 6 visits to my Primary Care doctors' at PAMF, since none of the different medications they kept prescribing at each visit seemed to give me much relief, up until about the 5'th visit where I was prescribed an Asthma medication which finally seemed to make my condition improve quite rapidly. And during one of those visits, my Primary Care Physician ordered me to take 2 X-rays on 11/03/2014 and then a CT SCAN and a TB Blood test on 11/06/2014, none of for which I wasn't told beforehand in any way that I would have to pay anything else extra from my pocket, apart from the co-payment of $25, in regards to which I was well aware of since the co-payment was clearly listed in the insurance contract. But after a couple of days after taking those tests, I get completely blindsided by letters stating that I have been billed out of insurance a total of $730.48 by PAMF for only those 6 visits to my Primary Care physician, which is unbelievable, because all those visits were for the same reason of the persistent Cough, and for which my In-network Primary Care provider "PAMF" did not or were not able to prescribe the correct medicine for me up until the 5'th visit. And while out of this massive $730.48 that I have been demanded to pay out of my pocket, a total of $150.00 have been billed as Co-pays for just those 6 consultation visits, while the remaining of $580.48 have been billed for the CT scan, Blood Test and the 2 X-rays. This has come as an utter shock to me since I wasn't the one who requested to take the CT scan or Blood test or the X-rays, but that decision was completely made for me by my Primary care physician, without asking me or making me aware that it won't be covered by my insurance. For if I indeed was made aware of this, then I would have had the choice to at least consider the necessity of taking those tests, and I would then also have had the option of going to a different health care provider, since as I have mentioned earlier the doctors' at PAMF were not even able to diagnose a cough without having to make me visit them more than 5 times, the result of which is that now I'm burdened with a huge bill even when I'm subscribed with one of the largest health insurance companies there is available.Desired Settlement: Being billed a total of 730.48 for a cough when I already have a good insurance is absolutely unacceptable and nothing short of a rip-off, since if I have had no insurance to start with or had gone to a different health care provider I could have still ended up paying lesser than this amount. But since I wasn't even given the option of making those decisions for myself, I want my insurance to cover those payments for all the tests that I was ordered to take by my Doctors' without informing me about the charges prior.

Business

Response:

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

Review: I purchased a Health Insurance Plan (CoreGuard Plus 3500) on August 04, 2012 for myself and wife. At the time we decided which plan we will go with the insurance broker who represented Anthem Blue Cross assured us that we would each have a $3500 deductible after which our insurance plan would "Kick In" and we would be responsible for 20% of the bill. We where also told that our annual physical would be covered under the Preventative benefits, which would be no cost to us. This was false information, we have been billed for these preventative care visits. On April 7th, 2013 I had to go to the emergency at St Joseph's Hospital in Stockton with a Kidney Stone attack. A couple of weeks late I got a bill (my share) for $5,775,28. I assumed this was a mistake, as I was led to believe that I was responsible for $3,500 deductible. I was later informed by the insurance broker that he got bad information from Anthem when he sold me the policy and there is nothing he can do for me, I have this in writing from him. I cannot afford to pay this amount of money, it is more than my months pension. Had I been properly informed at the time of purchasing the policy, I would have picked a different plan. I feel the plan was misrepresented to me at the time of purchase.Desired Settlement: I feel the insurance company should pick up the tab for me for the amount over my $3,500 deductible and give me the option to purchase a plan that I can afford. I need to be given all the facts up front before making an informed decision. I made a decision on the information provided to me at the time of purchasing this medical plan, which I find out after the fact that the information provided to me was not accurate.

Business

Response:

We can not locate this member with the information given. Please have this member provide his health plan identification number so we may locate his membershp.

Consumer

Response:

Review: 9590040

I am rejecting this response because: My member ID is; JQD[redacted]608. I have also attached a copy of my card.

Regards

Business

Response:

This member has been located. The health plan is initiating a 30 day appeal to address his grievance. He will receive a response from the health plan within 30 calendar days.

Review: Anthem trying to collect $88.74 on a co-payment error made in 2012. Please see attached letter from Anthem. I made contact with Anthem & Walmart pharmacy in Port Clinton, OH. The pharmacy tells me that co-pay is charged per the insurance agent. They “Anthem” tells them what to charge. They “Anthem” had trouble telling me the name of the medicine taken in 2012. I stayed on line with customer service at least 45 minutes.Desired Settlement: Anthem should pay the $88.74. This is not the pharmacy’s fault no is it mine.

Business

Response:

We are unable to locate this person as an Anthem Blue Cross member. Please have him provider his Anthem Blue Cross health plan identificaton number.

Business

Response:

The member will be receiving a letter from the member stating a signed statement of representation is required to proceed with this grievance review.

Review: I have tried several times to cancel my health insurance with Anthem Blue Cross in the last 40 or so days.I called 10 or more times and was put on hold for several hours at a time and then passed around to different departments until someone finally said they would help me cancel my plan. However, the rep was refusing to cancel my policy stating that it is against law to do so because of new health care laws. I do not believe this is correct. Upon his insistence I gave him information about my Covered CA application sothat he would cancel my insurance. Upon finding me in the system and my information from Covered CA (he told me the date my application was submitted without me stating it) he said that he could not confirm my new health plan as their system was down and said that Anthem Blue Cross would confirm my new plan and then cancel my old plan and give me a refund for my premium payment for the month of January 2014. I have called 8 more times after this to try to figure out what happened but it is impossible to reach anyone on any day or at any hour that their customer service center is open. I have waited 2 or more hours without speaking to anyone. Thier call system does not even say how long the wait time would be: if something else comes up and you have to hang up you lose all the time you waited on hold and there is no option for them to call you back.Please help me get my the money I have paid so that I can afford to pay for my new plan. Thank you.Desired Settlement: I would like my health insurance cancelled and I want a refund of my policy payment for the month of January 2014.

Business

Response:

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

Review: I have been a member of PRUDENT BUYER DENTAL PLUS (PPO dental plan) with Anthem Blue Cross California for over 5 years, and the reason I pay higher premium for my PPO dental insurance is so that I can see an out-of-network dentist that I really like. However, effective 1/1/14, Anthem changed the insurance reimbursement amounts for dental services without properly notifying me of the changes in advance. In 2013, routine cleaning and x-rays cost me $25 ($259 billed by dentist - $234 paid by Anthem). This year in Feb 2014, I received the same treatment, and I had to pay $168 ($259 billed by dentist - $91 paid by Anthem). That is 672% increase in patient responsibility! When I called Anthem to inquire the reason for such drastic change, I was told that it was because Anthem wanted to "encourage" members to use in-network dentists. This is unacceptable since the primary reason I choose PPO coverage is for the freedom of choice in the doctors I want to see. If I am "forced" financially to see only in-network dentists, then I would be better off with a HMO dental insurance.Desired Settlement: I request that Anthem send me a check for $143 ($168 cost of routine check-up in 2014 - $25 cost of routine check-up in 2013). I also request that Anthem provide me details of how their insurance reimbursement changed from 2013 to 2014 for out-of-network services, so I can plan my future treatments.

Business

Response:

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

Review: I have been dealing with Anthem Blue Cross calling my phone at least once every three months to let the parents of a child or children know that their child or children have appointments. I have tried to have my number removed from the children's contact list however the calls continue to come, and no one can help me. It is frustrating and aggravating to deal with, especially since I have to call Anthem and then spend an hour or more at a time on the phone with them to try to have this resolved, only to be told they are sorry but they can not help me, that maybe I should call the number back and try to get passed the automated message giver.Desired Settlement: I would like my phone number removed from the information list for the children. It should not be a hard task and should easily be done if like every other company in America, Anthem had a global system in which information could be looked up through.

Business

Response:

This person's issue is unclear. Is she currently a member w/Anthem Blue CRoss. If so, please have her provider her ID number. If she is not, and is being called in error, please have her advise what telephone number she is being called on.

Review: I cancelled my policy plan for health insurance on 1/2/2014 (so I thought)to join a group plan at my company. The representative assured me my policy had been cancelled and I wouldnt be charged for Janurary. On 1/7/14 Anthem auto debit my account. When I called back, they had no record of me cancelling. I then told the new representative to make sure I was actually cancelled and auto payment was cancelled. Once again they assured me it was cancelled and I would receive a refund. One month passes and I notice my checking account was again charged by Anthem on 2/7/14. I repeated the same process in calling, being reassured my policy was cancelled, auto payment was cancelled and I would received a refund. March 7th, 2014 my checking account was again charged by Anthem. Rinse, Repeat, This actually happens again on April 7th 2014. 4 months in a row! At this point I have to call wasting even more of my time and I refuse hang up the phone until I receive an email from the person I was speaking with. He sent me a grievance and appeal form to fax in for a refund. This is the 1st representative that offered this to me! After 4 months he tells me all the other representatives should have given me this form. He said just provide a copy of your new insurance dated for 1/1/14 and I would be refunded.I sent in the grievance form and they contact me 30 days later stating they need something better to show my proof of new coverage date. On 5/20/14 I fax the grievance report back with an employee detail report and verification I was covered on 1/1/14. Yesterday I received a check from Anthem for $353.33. Exactly $721.47 less than what they pulled from my checking account with auto pay. On 1/7/14 they charged me $265.00, 2/7/14 they charged $265.00, 4/7/14 they charged $272.40, 4/7/14 they charged $272.40. That is $1,074.80 not $353.33. I'm not even sure how they came to $353.33, it's more than one month but definatley not 4 months. The whole situation has been a nightmare. I would never use them again!Desired Settlement: I want them to just send me the difference they withdrew from my checking account $1,074.80 minus the check they sent $353.33, which equals $721.47. I can also provide bank statements to show proof of auto payment withdraws. I honestly don't trust them enough to cancel the check I have and send me another check for the full amount, so I'm keeping this one. I'm sure I will get a response that it will take another 30 days to get it processed, etc., etc. just like the last 6 months.

Business

Response:

This member's complaint was addressed in writing to the member on 5/14/14. His name level of appeal is to the California Department of Insurance.

Consumer

Response:

Review: 10088686

I am rejecting this response because: They are not even acknowledging my complaint. They are stating I received a written response on 5/14/14 which I already knew. I responded to the letter right away and faxed my proof of coverage immediately. I attached all the information I submitted to them in my previous complaint. I want them to acknowledge why the only refunded $353.33 of the $1,074.80 they withdrew from my checking account. As I mentioned before, if you would like me to provide bank statements showing the charges and my Verizon call logs I can upload them immediately. The response I received from [redacted] from the grievances and appeals department was they would make an administrative exception to cancel you plan effective January 1, 2014 if I could provide evidence that my previous policy was effective January 1, 2014. As you can see in my previous attachment, this documentation was provided. Please note the document sent to me on April 14, 2014 also stated: Once I receive this information, I will have the plan retroactively cancelled and a refund of premiums. This did not happen.

What makes me question their process is the fact that my calls to cancel in January and February were to the same person and she told me to give her the contact information (phone number) for my new insurance carrier so they could verify. I gave her the number and she gave me a confirmation number so I know the policy was cancelled. In March when I noticed I was charged for my premium again, I called in and gave them the confirmation number. The person on the phone said there was no such confirmation number in the system. It wasn't until April 11th that I found out I was getting the run around and needed to fill out a grievance form and fax it in. Please see the email below:

Business

Response:

The member's request for reimbursment is being worked on. The should have the reimbursement within 30 calendar days.

Review: When I was attempting to sign up my daughter in law and grandchildren for new doctors, the pediatricians stated on the website to be on my plan which have been listed on line for over two weeks are not available to my grandkids. If fact there are no pediatricians available in the whole City of Santa Clarita which has a population of 125,000 people. The closest is in the San Fernando Valley(10 miles away) at a Medi-CAl office. I had a representative assist me this morning for over 2 hours and she even had her supervisor try to see why the doctors advertised as available in our plan, we were not able to access. I believe that if I had a choice when I was looking at the different plans offered to me and the showed more choices of doctors in my area than is truth, I may have been falsely swayed by their website.Desired Settlement: I would like to have one of the pediatricians advertised on the website that is within my plan in my area to be made available to my grandkids until open enrollment offered again.

Business

Response:

Anthem Blue Cross can not respond to this complaint without a Designation of Representation from the daugher-in-law due to HIPPA.

Review: I had an individual health insurance policy with Anthem since 1997. When Covered CA started in fall 2013, I looked at their policies, and the price seemed high. When a January 2014 premium increase notice arrived, I decided to revisit the Covered CA Anthem PPO policies, and had an assiged agent help me select one, in late January, to be effective March 1, replacing the old policy. I paid the March premium by phone with Anthem on 2/6. Then I started receiving notices that I hadn't paid my premium and would be cancelled unless I did. On the Anthem site, and on the insurance card I received, they showed that I had 2 policies in force, in February. What they had apparently done was say that I started my new policy 1/1/14, not 3/1/14 as was my INITIAL request. Covered California shows that I wanted to start 3/1, but they didn't successfully communicate that to Anthem. My agent and I tried to straighten this out, but we couldn't get anyone to help. On 2/28 I paid another month just to be sure I wasn't dropped, but then received a Grace Period notice that if I didn't pay I would be cancelled. On 3/13 we were finally able to reach a Supervisor at Covered CA, explained this to her, and she was supposed to communicate this to Anthem. But it is now 3/19, and I still see that the policy start date is 1/1/14, which means that this is not cleared up. We have spent dozens of hours trying to get Covered CA and Anthem to fix this to no avail. This needs to be corrected before the end of March.Their lack of attention to this is appalling. I have never been late with a payment in my life, and here this bureaucratic nightmare may interfere with my ongoing skin cancer treatment.Desired Settlement: Anthem should fix my start date on the new policy to March 1, and apply my two premium payments to March and April. And communicate this to me in writing or email.

Business

Response:

The health plan has initiated a grievance for this member. They will receive a written 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 9975300, and find that this resolution is satisfactory to me.

I am still awaiting the refund of the two payments of the monthly premium (2/6 and 2/28), now that I have made another payment that pays for March on a new policy that was created starting 3/1. Or, Anthem can apply those payments to the new policy, paying April and May.

Regards,

Review: It's very frustrating, I have faxed and mailed over a cancel request only to find out Anthem still deducts the monthly premium from my bank. I called and was left on hold for an hour, giving me the run around. Lousy service of a company. I will never recommend your company to my clients.Desired Settlement: I want refund for two months of premium.

Business

Response:

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

Review: I made my premium to Anthem/Cover California, Went to doctor & I had to payThe whole visit/service by myself. The plan was not activated.I call,call & call They hang up after the phone rings 10 timesI am sure I am not the only one[redacted]Desired Settlement: I want some service/Reimburesment for the services I paid for

Business

Response:

We can not identify this member. Please have him provide his health Plan member ID number. Thank you.

Consumer

Response:

Review: We live in California where the new Obamadoesntcareatall is called "Covered California". So far, all they have been able to "cover" is how to get screwed by Anthem Blue Cross. We signed up for an exchange plan with Anthem Blue Cross and sent in our payment for January. We still haven't gotten any insurance information. It takes hours to wait on hold with Anthem to get through to someone who has NO CLUE what is going on and they can't even find our payment. But they cashed it! They don't know what policy to apply it to because Covered California sent in multiple applications for us. Best part? We can't cancel the payment because it was a cashier's check.We've called Anthem many times only to be told to call Covered California because it's their fault. Covered CA says there's nothing they can do because it's all on Anthem.About 90% of the time when we call Anthem, their computer system hangs up on us a few minutes into the process of trying to talk to a person.I'm told by an insurance rep that Anthem basically gets to pocket our money for January's premium by making our coverage retroactive to the start date we applied for coverage. The problem there is that we could not go to the doctor, get prescriptions or anything since we applied so making it retroactive is pointless and ONLY benefits them.Anthem Blue Cross of California is STEALING our money. We get NO SERVICE for funds paid. This is a CRIME.Desired Settlement: Ideally, we'd like a refund of our premium payment and we will go find a company that is willing to actually provide the services paid for. If a refund is not possible, then make the payment we made take effect when they actually get this mess figured out and actually start our policy.

Business

Response:

The health plan has iniated a 30 day grievance regarding this member complaint. The member will receive a response within 30 calendar days.