Worst insurance experience of my life with Anthem BCBS / Accolade

[warpur]

@erin136 Also, the employer and the employee both pay into the plan. I don’t know if that narrows it down.

 

[erin136]

@warpur ERISA is a federal law that applies to employer group health plans. Check with HR to see if you can get the ERISA summary plan description - which is a legally mandated document. Do NOT delay treatment!! You can get reimbursed for treatment you pay for out of pocket under the law if the plan should have covered it.

 

[warpur]

@erin136 I don’t want to argue, and I desperately hope you’re right, but I’m afraid to do that since the provider told me the insurance can deny it based on lack of pre-auth.

They requested authorization for treatment starting today, but advised me that Anthem can decide to only authorize it forward from rubber stamp date, and not cover any treatments prior to the authorization. I have to make a choice between risking $46k or potentially risking my life.

I will ask about the ERISA summary plan description though.

 

[rosaryson]

@warpur Have you contacted your state's insurance commissioner? It's free and their job is to make sure insurance companies behave. Might be worth a shot, I worked with them on an appeal once.

 

[warpur]

@rosaryson Is that different from the Department of Insurance?

Edit: My employer and insurance are based out of California, and I’m out of a different state. Which state should I contact?

 

[slipg]

@warpur California would be the regulator your insurance company would pay attention to, but at this point, why not do both? Can’t hurt.

 

[warpur]

@slipg I did file in both states with the DOI. Doubt it’ll make a difference in time for my care, sadly, but maybe it’ll help someone else down the line.

 

[rosaryson]

@warpur I think you'd start with your local commissioner. My husbands employer and his insurance are also based in another state, and that's what I did.

I'm sorry, but I'm not certain if it's different from insurance department.

 

[bedford]

@warpur hey so i’ve been dealing with a very similar issue with accolade. i’m being denied treatment for mental health care after a suicide attempt due to “not enough clinical information.” we’ve spent dozens of hours on the phones. my doctors have called and faxed numerous times. i’ve talked to a million different people, none of whom seem to have any power. if you would be willing to send the email addresses to me and/or give any advice on how you’ve navigated accolade since this post, i would hugely appreciate it

 

[smoothy]

@warpur Anthem BCBS is the worst. You’re better off having no insurance since at least then your expectations can be realistic. Anthem denies almost every claim , has high deductibles and no customer service.

 

[goldenball]

@warpur Similar event as well. Who exactly is accolade? You actually can not speak to anyone with anthem, they tell you that you have to speak to accolade, I wanted over 20 min on hold for a representative with no response

 

[warpur]

@goldenball They’re a third party that Anthem BCBS has hired to handle all customer interfacing. It sucks and they suck. I’ve had similar wait times but also sometimes gotten lucky, especially early in the morning. Also, if you use the app, they seem to have some sort of SLA that they do have to respond, usually within 24 hours. Sorry you’re going through this. Good luck.

 

[warpur]

@goldenball Also, not sure if your segment and mine of Accolade draw from the same pool of people, but I’ve found that the support you receive varies widely depending on who you get as a rep. The only two really good ones I’ve encountered in my pool of people are named Lisa and Sarah. Also, the woman named Jackie is a total a-hole and will straight up lie.