Blue Cross California

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.

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: I am writing this as my hold time is continuing past the two hour and mark for the 3rd time in a month. I just spoke with Alex (2-20-14) from the cr on my card. I called to find out why I was being billed nearly $1000 more than my ‘max out of pocket’ from last year. Then she focused on the fact that Anthem cancelled my individual policy in January. The fact that I had a ‘Summary Bill’ for months must not have registered with someone there and they decided to cancel my policy and add extra months to my daughters policy. I explained to Alex that the reason I called was to get answer s to my issue with being charged $1000 more than my ‘total out of pocket’ of $5,590 in 2013. Alex focused on trying to get me to pay $518 to back pay my policy for this year. I’m sure she gets a pat on the back from you guys for only trying to get more money from me but I really need answers to why my ‘total out of pocket’ actually meant nothing. I went to my Insurance Agent, Steve Flinders in Burbank, CA before I had my hernia surgery last year. He checked and assured me my total out of pocket would not exceed $5,590. Then Anthem sends me a bill for $6,890. Before surgery I met with a representative from St. Joseph’s Hospital in Burbank and I was specific that I didn’t want anyone from out of network, such as anesthesiologist, lab work, or anything. She said she understood and we proceeded with the surgery. I don’t feel it is right, or legal, to then try to get more money from me than the stated ‘out of pocket’. My phone reads, 2:05 at this time. This represents my time on hold today. Alex actually talked to me in this time period before she transferred me to get more information on a new policy. Alex didn’t even address my main reason for calling, even though I reminded her more than once why I called. Alex said she didn’t see where my policy was a Summary Account with my daughter even though she acknowledged my past payments of $354 for months. Which she conceded were a total of my daughters $95 monthly payment and my $254 monthly premium. Still Anthem cancelled my policy?? Maybe Anthem cancelled me because of the $25,000 hernia surgery I had in December 2013. Which you continue to try to get more than the ‘total out of pocket’ my agent assured me was a true maxium. I tried to use your website, www.anthem.com to file this grievance but it would NOT let me proceed past the sign in page. Terribly convienant for you to not have to hear a grievance but I still need answers to why Anthem is trying to get more money from me than the ‘total out of pocket’ that’s stated on my policy. Also your website would not let me send an email, hence this snail mail letter. In triplicate. Now about you cancelling my policy even though my payment hadn’t changed in months. Now you won’t answer the phone. Maybe hours on end are required to get through or days on end to reach a person and honestly I have to work to make money. I’ve been with Anthem for years and to get cancelled with no reason is unacceptable. It’s not my fault if you returned a portion of my payment to let me go. Please, someone there have a heart and communicate with me. I’m afraid that I will have to hang up again after hours on hold and not being covered. I am sending a copy of this letter to the Revdex.com. Along with the State Department since your record of customer service is so one sided. I need a paper trail if disaster happens before you reinstate my policy. Thank you.Desired Settlement: Now about you cancelling my policy even though my payment hadn’t changed in months. Now you won’t answer the phone. Maybe hours on end are required to get through or days on end to reach a person and honestly I have to work to make money. I’ve been with Anthem for years and to get cancelled with no reason is unacceptable. It’s not my fault if you returned a portion of my payment to let me go. Please, someone there have a heart and communicate with me.

Business

Response:

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

Review: My billing statement (generated in February 2014) for March was $305.The amount charged was $362.16 plus a second charge $5.87Apparently I have been force-fed a dental policy I never signed up for, plus a pediatric dental policy for children I don't have. This is just a guess.My attempts to contact Blue Cross were futile: a phone call to one number produced a recorded response that my phone number was not on file, and I need to call a different number. The second number (after following an exhaustive procedure of menu selection after menu selection) eventually arrived at the sound of a phone ringing. And ringing. After several minutes of this and a total of about 20 minutes for this call, I hung up.My next attempt on March 7 was the online message center. My message is still on file: without a response.Desired Settlement: Refund of the $63.03 total balance and an apology

Business

Response:

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

Business

Response:

The member will receive a response in a maximum timeframe of 30 calendar days but may be sooner.

Consumer

Response:

Review: 9973334

I am rejecting this response because: I was clear before: a 30 day time frame is unacceptable in light of the first inquiry on March 7. "up to 30 days, maybe sooner" is equally unacceptable. I will disputed the charge and cancel my health plan if not resolved by March 28.

Regards,

Review: I held an individual Blue cross policy, but cancelled when I purchased the same policy through a group policy at my girlfriends work.I waited to receive confirmation of the new policy with my card then cancelled the old policy therafter.Anthem pulled another payment from my account and now says they cannot refund the amount that they owe me after my effective cancelation date saying I waited to long since they bill in advance.Even though there were no services or coverage during the 40 days past my effective cancelation date according to them, even though it took most of that time to receive my new police that was effective 4-23-13Bottom line they are keeping an extra $230 for double coverage because I couldn't cancel one policy until I had my card and confirmation of a new one.They still owe me $444.00 that they agreed to refund ,all for just changing from one of their policies to another.Just like stealing.Desired Settlement: $674 ,may june and july payments taken from my acct

Business

Response:

ANthem Blue Cross can not locate an invidual plan for this member. Please have the member provider the health plan ID # for the account he is disputing

Review: I payed my bill on the 31st of December, 2013. However, my credit card was canceled and ABC did not attempt to charge the card until the 21st of January. At that time they retroactively canceled my insurance and denied all claims. After spending 6 hours on the phone with them, they refuse to reinstate my policy.Desired Settlement: I would like my outstanding medical bills covered and my time reimbursed.

Business

Response:

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

Business

Response:

We are not sure who "Lucinda" is or who she is with. Please clarify. Thank you.

Consumer

Response:

Review: 9929819

I am rejecting this response because:

How is the identity of any employee of anthem relevant to the issue at hand?

Regards,

Review: I am a single mother of one child. I cannot afford to insure both myself and my child, so I choose to insure my child only, who is 12 years old. His policy is with Anthem. This not through the "exchange" or my employer. I am frustrated that I cannot create an online account with Anthem, as you either have to 1. Be a policy holder or 2. Be over 18 AND a policy holder to create a online "member" account.I've spoken with tech services and explained that I would like to create an online account for my child's policy, but have been told this is not an option, I must be a member as well or my child needs to be 18 years of age. Since my child is 12 and cannot have an account created with his policy due to this, I am not allowed the convenience to pay his premium online, I am not allowed access to other "member" services, such as viewing claims,finding providers or other benefits that I am not even aware of due to the fact I cannot take part in this part of Anthem's service.I'm sure that the monthly premium not only is for health care, but also for for these online tools that I am not privy to. This is the 21st century- Anthem cannot reconfigure their programming to allow parents to create a member account for their "member"? Because I am not a policy holder, my son's "membership" is less than others? Shame on Anthem for not having a system in place for child-only policies. Do not discriminate against parents who choose insure their child over themselves and then treat them different than other policy holders.Desired Settlement: I want the ability to be able to create an account for my child. I want to have the same options and benefits of any other policy holder and right now, I don't. If I can only have the same option as the other policy holders, I would not have had any issues.

Business

Response:

The health plan needs the child's (member) name and full health plan ID number to locate this specific member.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 9899357:

MESSAGE FROM BUSINESS:

The health plan needs the child's (member) name and full health plan ID number to locate this specific member.

My child's name is [redacted] and his member ID is JQ[redacted]63

Regards,

Review: I have called Anthem Blue Cross 3 times in the last 10 days and each time, I have called during normal business hours and they have told me they are unable to help me at this time. Please call back at a later date. I have also tried to reach them online but there is no way to do that. I need to cancel my California insurance because I have moved to North Carolina. there is no way to do this on the phone or online. You have to talk to a representative but there is no way to do this. I am left with the only thing I can do: Take all my money out of my checking account and my savings account so that they cannot withdraw my premium for Feb 1, 2014 AND THEN will have to cancel me. This is not the way to do business. I am so frustrated that I have to do this. I will never use Anthem Blue Cross in the future. Sincerely, [redacted]Desired Settlement: I want to make sure that if I don't pay my bill (which is the only option they leave me with) that it will not affect my credit. Thank you!

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.

Consumer

Response:

Review: 9902174

Review: I was getting double billed. I have been dealing with double billing and getting a refund since March 2015. While paying on two bills until they corrected their mistake. I went to get my medication and was told they could not fill because I had not paid my insurance account. I was so embarrassed. They finally started billing me for one account. They issued me a refund and sent to my old address. As of today June 12, 2015 I still do not have a refund. When I called its another 40 to 60 days before they send me my refund. Will I ever get my refund. Bad businessDesired Settlement: they need better customer service

Business

Response:

This member contacted the health plan and was advised refund being processed.

Business

Response:

The member was advised on 6/25/15 that her check was mailed.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10667676, and find that this resolution is satisfactory to me.

Regards,

R[redacted]

Review: For two months I have been trying to get my policy canceled. I have new insurance, and because they are not helping, I can't cancel and so I was charged at the beginning of March for $400 , which is two months worth because they forgot to charge me one month. I have been trying to get my policy cancelled since feb 24th, a few days ago I got to talk to someone, and she refused to help me cancell, or refund my money. On top of that, she then told me that the $17 charge on my monthly bill was not for my dental policy ( which is why I paid it) but just some fees. I am fed up, I want my premiums for the last two Months returned to me, and I would also like the dental premium I was paying since April returned to me, since I was not covered with dental and still was billed for it.Desired Settlement: Refunded to me. The $420.78 ($210.39 x two months)dollars for the last two months I have been trying to cancel my plan.Also refund the 12 charges for dental that your service agent informed me wasn't paying for the dental as originally agreed upon. That's $17.40x12 months, equalling $208.80 Total refund wanted: $629.58

Business

Response:

This member contacted the health plan on 3/31/14. The health plan is currently researching her issue. She will have a response within 30 calendar days, if not sooner.

Review: I cancelled my insurance policy from this company back in December. They refused to provide a refund.Again, in January, they billed me even though I had called and cancelled my policy.Desired Settlement: Refund my December and January billed payment.

Business

Response:

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

Review: We enrolled for health insurance for my wife (I have VA health benefits)with Covered California and because of our location in Needles,Ca, we were told that Anthem/Blue Cross rider would give access to medical care in both Nevada and Arizona because of the lengthy travel (4 hours) to receive medical care in California. We were given a "multi state access" policy. This was critical since my wife had to have a breast biopsy for cancer (fortunately it was negative). All the billings were submitted and month after month she was on the phone asking why they were being rejected. All they would say that they would resubmit for payment. After time passed and no action on their part we have been sent to collections for non-payment. We finally got mad and demanded an explanation why our Multi State Access (as it is written on her insurance card) isn't picking them up. We were then told that Covered California is only for medical within it (understandable)but the Anthem/Blue Cross rider only meant that only emergency room access and not regular medical care. THAT IS A BALD FACE LIE! Why on earth would we buy a medical policy as such. After much discussion with them, the only thing they could do is resubmit as a grievance since we were not given the correct information. BS! Bottom line is they were deceptive and not truthfully. Like many the premiums are another burden on our already stressed finances and to find out we've paid $277.31/month since March 2014 for absolutely NOTHING. I'm considering legal council for those premiums and a written complaint to the insurance commission on this matter. What can we do? We stopped paying any further premiums. Please advise and appreciate your input. Thank you.Desired Settlement: Want refund to use on our mounting medical bills.

Business

Response:

The health plan needs the health plan ID number or, at least, the wife's name who the complaint is referencing.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID 10273886, and find that this resolution is satisfactory to me.

Regards,

Athem/Blue Cross customer: [redacted]

Policy ID : 9[redacted]98

Review: I am a new customer with Blue Cross and was taking Cymbalta. Anthem Blue Cross will not approve my Cymbalta medication (60 mg), for my depression, to be picked up at a local pharmacy. My doctor sent in the request in November 2014. It is now January 2015, I am now without the medication, and am experiencing signs of depression. They seem to be playing games with me when I call in and am transferred to various people in different departments. There is no sense of urgency nor concern that I am not feeling well and am experiencing signs of depression.Desired Settlement: Expedited approval to pick up my medication at nearby Rite Aid.

Business

Response:

The health plan has initiated an expedited appeal for this member. He will receive a response from the health plan within 72 hours advsing if his appeal meets expedited criteria.

Review: I have individual health insurance with Anthem Blue Cross. On 1/10/14 I went to my health care provider (High Desert Medical Group of Lancaster) and when my provided checked the information they received was that my membership with Anthem Blue Cross was inactive. My premium payments (at the original contract rate) are current with the most recent payment covering through the end of January 2014. A premium increase notice was sent to me after I paid my January 2014 premium. The due date for payment of this increase is stated as January 1, 2014. It states in my contract that there is a 30 day grace period to make payment. Anthem Blue effectively cannot be reached either by phone or by email to resolve this matter. If I call the call is terminated. If I try to email I get a message that the message center is not available. If I call customer support the call is terminated. This makes it impossible to resolve this issue with Anthem Blue Cross and I believe it is unethical under any circumstances.Desired Settlement: 1. I want the insurance benefits I paid for. 2. I applied for replacement benefits and do not intend to pay the increased premium Anthem Blue Cross has demanded (which makes my total monthly premium (518.70/month). 3. If they have terminated my individual policy because of my application for affordable healthcare (I chose Anthem Blue Cross as my insurance provider) I want my January premium back as I was denied benefits. 4. communication with Anthem Blue Cross without excuses

Business

Response:

A 30-day appeal has been initiated for this member. The member will receive a response from the health plan within 30 calenar days.

Review: I have a complaint that was reviewed by Revdex.com of Southern Nevada. It is Revdex.com Claim: 90088434. They thought it should be handled by Revdex.com of Ca. Some additional info I submitted is currently under review. Please investigate.Thanks.Desired Settlement: I want Anthem Blue Cross to pay claims as they should.

Business

Response:

This member can not be located. Please have him provider his health plan ID number. Thank you.

Business

Response:

This member has had 2 appeals with the health plan and has now exhausted his appeal options with the health plan. This member must now contact his employer group for further assistance per his summary plan description with his employer group.

Consumer

Response:

Review: 9662589

I am rejecting this response because: Totally unacceptable.

Regards,

Review: I went for a routine, preventive check with my Doctor (10 minute visit, discuss issues related with stress, verify that they don't develop into a worse condition), thinking that it would be covered by my insurance's "Routine Preventive Services", which covers 100% of the cost of a doctor visit for preventive care, once a year. One week later, I get a bill for $116.00. I called my insurance to see why they didn't consider this visit preventive and they blamed my doctor and their billing service for it. I called my Doctor and they blame my insurance for not considering their description of the visit as preventive. None of the two is interested in helping me sort out this issue. Last year I made a couple of visits to this same Doctor having the same insurance and I never had to pay such a large amount for the visit.Desired Settlement: Have my insurance cover this one visit (the only one I made this year to my Doctor), under the "100% coverage for preventive care doctor visits, 1 exam each year for covered adults age 19 and older" as stated under my plan.

Business

Response:

This letter is written in response to your correspondence regarding Mr. [redacted] recent complaint filed with the Revdex.com.Our records indicate Mr. [redacted] is not enrolled with Empire. Based on the identification number prefix, enrollment is with Blue inquiry should be referred to Blue Cross of California. Therefore, this inquiry should be referred to Blue Cross of California.We trust that this information proves helpful. If you have further questions regarding this matter, please submit them via facsimile to [redacted] at ###-###-####.

[redacted] Grievances and Appeals Analyst

Grievances and Appeals Department

Review: I canceled my Wife's policy on Dec 4th, 2013 but as of now I didn't get my refund. I called 100 times to find what is happening.I even contacted supervisor [redacted] at ext: 3[redacted]9. She is useless and no point of working. Please give job to some other jobless person who will do better job and follow-upDesired Settlement: I wish I can send you to collection like you guys do to customers. Shame on you guys.I want $1000.00 as refund for wasting my time and putting me under stress.

Business

Response:

This member's new address was updated and a check went out on 1/24/14

Business

Response:

If your refund is not received within 10 days, please contact the health plan.

Consumer

Response:

Review: 9905417

I am rejecting this response because: I contacted more than ten times. Details are in complaint description.

Regards,

Review: I wish to file a complaint due to the fact that I had called earlier this year in March 2013 to cancel an health insurance plan for my Grandson [redacted] #XDL 527A70152 due to the fact that (1) the premium was too high for a nine year old and(2) he already had medical coverage. The agent then talked me into trying a lower plan for several months and I did. Due to overwhilming problems with my job and financial hardship I called today earlier on Oct 3 before noon to cancel my policy again because my grandson [redacted] continues to have medical insurance and it didn't make sense for me to pay out of pocket for medical coverage that he already has and the premium was already authorized to come out of my business account and the representative stated that he could not cancel my plan until November 2,2013. My question is why can't I have an immediate refund for October since I telephoned earlier to cancel the plan and the agent practically coerced me into trying the lower plan. We are still in the beginning of the month and I would like my 126.00 to be credited back into my Bank of America account since my Grandson already has medical insurance.Why do I have to wait until November to cancel a health insurance plan that I never used and I don't wantDesired Settlement: I would like the money to be credited to my account and cancelation of medical coverage for the month of October and not November 2013.

Business

Response:

A 30 day appea/grievance has been initated for this member. They will receive a response within 30 calendar days from the health plan.

Review: I have been insured through Anthem Blue Cross for several years. I went to the emergency room on June 27, 2014. I paid my $100 co-pay while in the emergency room. I was discharged that day and never used Anthem again. I had paid my insurance in full through the month of June 2014. I changed my insurance on July 1, 2014. I have no been sent a collection letter from CPLM Integrated Pathology Services Inc because they claim Anthem Blue Cross said I was no longer under their insurance at the time. That is a lie. My insurance was for the entire month of June. my emergency room service was June 27, 2014 and the labs were drawn, ran, and results returned that same day. I am being billed for 179.85, Anthem needs to cover this as I was insured. I do not have my insurance card and do not know my member ID. Look up my information through my name or contact me for my social security number immediately.Desired Settlement: 179.85 as of today but it may increased if not paid asap.

Business

Response:

We are unable to ideintufy this member. Please have her provide her health plan ID number that was in effect in June 2014.

Consumer

Response:

Review: 10191729

I am rejecting this response because:

My member ID to add to the complaint xdm413a21839 and my birthday so they can sop making excuses 01/17/1984. thank you

Regards,

Business

Response:

Please provider your DOB as it was not provided with the complaint.

Review: I enrolled "Blue Cross Silver 94 EPO" plan (a Covered California plan) starting 3/1/2014. However, Blue Cross made a big mistake, the new ID card I received shows my new plan has $1500/$3000 deductible, but it should be $0/$0 deductible. I called many times, each call had more than 90 min wait time, and sent many online messages asking for correction. Every time, I was told this will be corrected in a few days, but after many weeks,it's still not corrected. I need my plan content be corrected and receive the correct ID showing $0/$0 deductible because I need to schedule a major procedure. My ID is VX[redacted]45.Desired Settlement: I need my plan content be corrected and receive the correct ID showing $0/$0 deductible because I need to schedule a major procedure.

Business

Response:

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

Business

Response:

The health plan is required to respond to all member grievances within 30 calendar days but it could be sooner.

Consumer

Response:

Review: 9969076

I am rejecting this response because:

This response does not resolve my problem at all !! It's just like the responses from the numerous phone calls and online messages I have made, they just keep delaying the issue !