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Anthem Senior Advantage


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Complaint
Posted by Ham090164 on 03/12/2008
CLEVELAND, OHIO -- We also have had a terrible time with Anthem Senior Advantage failing to cover my husband's doctor visits and labs dating back to 09/07/07. After multiple phone conversations and being told of different requirements, we finally phoned the broker through which we signed up for the coverage. He has contacted Anthem but as of 03/12/08, the claims have not yet been paid. My husband had health coverage with a different company through my employer for a short time, but that coverage was canceled on 06/30/07 when I became eligible for Medicare.

Anthem's Coordination of Benefits Department has not responded to its Customer Service Department's requests to eradicate duplicate coverage and until it does so, our claims will be refused. My husband also is paying for his Anthem Medicare premiums through deductions from his social security for Part B, so Anthem is receiving its payment, plus my husband has paid all his co-pays, but we are still struggling with the company to get the claims paid. I understand that providers need to be paid timely, but the fact is that the providers all agreed to accept Anthem's payments, so I feel we are being harassed by providers phoning and sending bills requesting that we deal with Anthem and clear up this matter.

Dealing with this situation has taken literally HOURS of phone calls, all of which are documented in Anthem's computer system, but which so far have yielded zero results. Today we went to pick up prescriptions, and one that my husband paid $30 for last month jumped to $221.00, so now I must phone Anthem yet again and ask what is the reason for the sudden increase; in essence, Anthem is not covering any part of the cost of that particular prescription. The prescription coverage limit has not been met, but we believe Anthem is unhappy with our complaints and is refusing to cover the aforementioned medication.

Thank you for letting me vent!

     
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Posted by Anonymous on 2008-08-01:
I work for a doctor, and we routinely run into problems like this.

I am surprised that your husband's physicians are not appealing the denials themselves. Appealing is an arduous task, but it gets results, especially when the patient submits an appeal along with the provider.

I strongly suggest that you write out an appeal and send it Attn: Appeals to the claims address on the back of your Anthem ID card. Your appeal should include the following:

Patient's name
Patient's DOB
Anthem subscriber ID#
Anthem group #
Subscriber's name, relationship to patient
Date of service
Provider's name
Claim number
Dollar amount of procedure charge
Description of procedure
Description of diagnosis

[include a copy of the eob]

"I am writing to appeal the denial for the above claim. This policy was active and effective at the time of service. An error on behalf of Anthem Blue Cross Blue Shield resulted in the denial. [Summarize the error here.] Several phone calls to Customer Service as well as Coordination of Benefits have resulted in zero action. [It would be ideal if you had the dates you contacted Anthem as well as the names of the representatives that you spoke to. Insert that information here.] If I am not satisfied with the course of action taken, I will escalate the issue by contacting an attorney. Please contact me at the above address and inform me of the action you intend to take to resolve this operational issue.

Sincerely,
Your husband's name"

Anthem is tricky. I strongly advise you to contact Customer Service again and make sure that you have the proper address for submitting an appeal.

If Anthem tells you that you need a procedure code and diagnosis code, you must contact the physician's office and obtain the codes from the billing department.

DO NOT make the mistake of lumping two or three appeals together. Write out an appeal for each denied claim and send them in separate envelopes WITH delivery confirmation [50 cents extra]. If you send an appeal without some sort of confirmation, Anthem will plead insanity and claim they never received your appeal.

Senior citizens were not put through these ordeals when Medicare plans were the property of the US taxpayer. Privatization of insurance was a horrible idea.

Best of luck to you.
Posted by Xylie on 2010-11-14:
Great advise,I wish this was posted on every complaint!
Posted by Mary on 2011-08-07:
I find it interesting that you state that Anthem will deny receiving the above appeal. They denied receiving the last installment for my prescription premiums and cancelled me with no notice. I have cancer and will die if I need the chemo and do not get it. They know I have cancer and conveniently claim that they do not have to send a notice that they will be cancelling coverage. I received NO notice. I paid every penny due and now my family has to eat, have a house to live in and I will be forced to not take life saving treatments and pain meds. They know this, also. I find it was a deliberate attempt to get rid of a sick patient, because my meds are costly. So, when I die it will be on them. I wish this were not true, but it all is.
Posted by JC on 2014-04-15:
Confusion about which code to use has caused my obgyn Bill to get payed. After three months it's still not payed. Service is covered but code is wrong according to Anthem. Dr. office says they can't change code. I'm in middle, Bill needs paid,not getting service from either.
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Pharmacy charges
Posted by Long Sam on 09/11/2009
In going to the pharmacy today I was shocked to see that Librax cost has jumped to $200.00. I take it because I was diagnosed with Lymphocytic Colitis. This is what the doctor has prescribed for me and it does work. How do you expect seniors to pay for their meds if they are going to charge that amount for a prescription. It is absolutely absurd. I have always been very happy with my coverage but this is really a terrible blow. Can't even get the meds you require. It is a sad day.
     
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Posted by Anonymous on 2009-09-11:
Yes it is. I would ask the Republican representatives in your area not to fight the health care bill that President Obama is trying to pass.
Posted by jktshff1 on 2009-09-11:
Not until "resident aliens" and illegal aliens are specifically removed from coverage.
Posted by Skye on 2009-09-11:
Can't your doctor write you an RX for the generic?? I'm sure he/she wouldn't have a problem doing that.

Posted by Eloise on 2009-09-11:
Librax works wonders! Librax's name is same in generic. You might want to check that you are receiving the generic. Another idea is to check the price at independent pharmacey their prices can be much less. I hope it works out for you!
Posted by Anonymous on 2009-09-11:
name the details of this great health care plan o is trying to pass. I've yet to see any.

Posted by Principissa on 2009-09-11:
Pardon my stupidity but what is a resident alien?
Posted by Anonymous on 2009-09-11:
A legal resident of the united states.
Posted by Skye on 2009-09-11:
Believe you me, you do not want the government involved in your healthcare. The government is already up in people's business with Prescription Monitoring.

NOT COOL
Posted by Nohandle on 2009-09-11:
Probably the same Princi as an Undocumented American. I heard that expression a couple of years ago on the radio on my drive to work. We must all learn to be polite to all and not hurt anyone's feelings.
Posted by Anonymous on 2009-09-11:
That what you are wally?
Posted by Anonymous on 2009-09-11:
JKT, if your a legal resident I disagree with you, You should be covered under the plan. Since your on your way to becoming a citizen.
Posted by Anonymous on 2009-09-11:
No I became a citizen two years ago. but I found out I was already a citizen because my mom was one, so I filed all those papers for nothing. Those dip shyts at INS didn’t tell me that.
Posted by Anonymous on 2009-09-11:
Ah. Ok
Posted by Eloise on 2009-09-11:
Couldn't agree with you more Skye. Prescription Monitoring creates more problems than it solves.
Posted by Nohandle on 2009-09-11:
Wally, tell the truth dear. You became a citizen three years ago, not two and obviously have mastered the art of the English language.
Posted by Anonymous on 2009-09-11:
My English is terrible, I have one of those really bad Russian accents.
Posted by Anonymous on 2009-09-11:
Wally, you've lived here for awhile. Is your accent still that strong?
Posted by Anonymous on 2009-09-11:
Why yes it is little, I sound like Borat
Posted by Anonymous on 2009-09-11:
Those ESL classes taught me nothing.
Posted by Anonymous on 2009-09-11:
Very nice
Posted by Skye on 2009-09-11:
Pardon my ignorance, but what are ESL classes?? Or is this a some kind of joke??...
Posted by Anonymous on 2009-09-11:
Eglish as a second language Skye. All the schools in San Diego had them for the students who didn't speak english fluently. It's not a joke. My mom taught ESL for a few years
Posted by madconsumer on 2009-09-11:
wally is sounding nicer and nicer!!

esl = elderly social league
Posted by Skye on 2009-09-11:
Thanks Wally! I love learning new things. My grandmother was from Poland. She has been gone for a few years, and I can still hear her Polish accent.

She used to call pizza, Beetza.
Posted by Anonymous on 2009-09-11:
sounds like a naughty word in Russian
Posted by Skye on 2009-09-11:
If you knew my grandmother, it may have been. She was fiesty.

I miss her.
Posted by Anonymous on 2009-09-11:
Skye, what you thanking wally for?
Posted by Anonymous on 2009-09-11:
Yeah my Grandma was born in the Ukraine. She passed away 6 years ago. She was awesome
Posted by Skye on 2009-09-11:
I'm thanking him for telling me what ESL stood for.
Posted by Anonymous on 2009-09-11:
I told you that!
Posted by Principissa on 2009-09-11:
My stepfather is from Holland. He has his green card, pays his taxes, gets health benefits from his job (he's a physical therapist) and he owns his own home. If I am not mistaken does that mean that people like him should not be allowed to have benefits under this "plan"? Would that mean that he has to give up his health benefits through his job?
Posted by Anonymous on 2009-09-11:
I agree Princi, That's BS to leave those folks out. This country was founded and built by immigrants.
Posted by Skye on 2009-09-11:
Oh little, I'm so sorry. My head is not clear today. Stupid cold.
Posted by Principissa on 2009-09-11:
It's terrible. People like my stepfather work very hard and do everything they are supposed to do to stay a citizen and the get punished for it. Meanwhile the illegal aliens in this country prosper. This breaks my heart. Most of the legal immigrants in this country are business owners, hard working people that came here for a better life. This is a slap in the face to my entire family who came to this country! I used to be proud of the fact that their names were in that book on Ellis Island and now I'm ashamed, I feel like I am insulting their honor and memory.
Posted by Skye on 2009-09-11:
I hear ya Princi. My grandmother, when she came from Poland, was in quarantine on Ellis Island for a month. She did everything she was supposed to, so she could become a citizen of the United States. Nobody gave anything. Her and my grandfather worked very hard and had to learn English.

Posted by Principissa on 2009-09-11:
My great-grandparents came here with nothing. They owned a market on Staten Island, they all lived on top of it. They learned English and were forbidden from speaking Italian outside of the house. There was no ESL program or anything like that, you either learned to speak English or you went nowhere back then.
Posted by Skye on 2009-09-11:
Same thing in my grandparents house. Polish was only spoken in the home, never outside. They were ashamed that they couldn't speak English when they first got here. They were considered Green horns.
Posted by Nohandle on 2009-09-11:
Now Skye, no shame. Just drag your child to school and demand their native tongue be spoken. As far as your grandparents the same. Signs everywhere for their benefit now. Sorry folks that's just my sarcastic way of putting it. People were once encouraged to learn the English language. No more, it seems.

Long Sam your complaint has been ignored and sorry. I went to pick up a script Wednesday that I take once weekly. The price I paid was $75.00 in the past. When I was told the charge was $150.00 absolutely knew there was an error somewhere even though the regular price was I think $254.00 for the medication. I told them to hold it until I could get home and check on the error. Well, I made a phone call and discoved my script did not fall under the preferred list as of 8-31-09 so rather than paying $25.00 co-pay each month I now had to pay a $50.00 co-pay each month for three months. I paid for the medication and certainly hope my doctor can change my script to a less expensive one that still serves the purpose.
Posted by jktshff1 on 2009-09-11:
Negative wally, unless you are a legal Citizen of this country, why should the government give you squat?
Posted by Anonymous on 2009-09-11:
JKT, you are legal if your a resident alien. I deeply disagree with you on this issue. And so do other members here. Why should folks who waited in line to get a green card and came here legally be treated like dog shyt. while they working for their citizenship. They pay taxes, they work.
Posted by Ben There on 2009-09-11:
I had to use a walk-in clinic in Australia last year as I got an ear infection and had to clear it up before the 14 hour flight back to LAX. My friends were worried about the expense because I had to pay full price as I am not a resident, but I knew my own insurance + travel insurance would cover it. The total bill for the doctors visit, plus antibiotic, plus nose spray was about $50 USD. Didn't even file it.

A few months later I got the same infection in the USA, went to a Primacare and got the same drugs and with my insurance I paid almost $500. Why does it cost 10 times more in the USA even though I am insured?
Posted by Anonymous on 2009-09-11:
principissa, If someone has a green card then they are resident aliens. These people would be covered by the health care reform.
Posted by The Medic on 2009-09-12:
Long Sam, a suggestion would be to look on-line at Anthem's program and see what tier this medication falls into. I have Anthem as well, and if the medication is a 3rd tier, they give the 1st-2nd tier equalavent that they will pay for first. If the first 2 don't work, then your physician can appeal to Anthem for payment of the medication. Another suggestion is that many drug manufacturers have assistance programs so you can get the medication.

Good luck!
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