Worst insurance experience of my life with Anthem BCBS / Accolade

[warpur]

I missed my desperately needed first chemotherapy session today because Anthem BCBS outsourced my authorization to Accolade, who outsourced it to American Health Holdings, who entered it incorrectly somehow and first denied under lack of medical necessity and then left it in “clinical review”. My provider (one of the top three cancer centers in the US) called repeatedly and these guys could not get their shit together. They kept claiming the provider hadn’t sent the right information, and had my provider fax it to three (!!!) different numbers.

The prior claims specialist at my provider finally got an Accolade rep this morning who dug into the issue and figured out that they’d processed it incorrectly. They had to close the case and open a new one, but they pinky promised they’d copy the clinical notes over. I’m not holding my breath. Since my case is now marked as “urgent,” they’ll respond within 72 hours, meaning my rapidly growing tumor will get to keep spreading into my chest wall until Monday if I wait for them.

Oh, and I can only talk to the Accolade patient reps, who don’t actually interface with American Health Holdings, and have no real power to see what’s going on or to advance my case.

Update: I have an authorization! My friend who’s an absolute legend found the email addresses of a bunch of executives and contacted them. My employer also pushed from their side. Thanks all for your help.

Update #2: Accolade formally apologized to me and said they’re opening an internal investigation on what happened with my authorization case. I don’t know if I believe them, but I hope it’s true.

 

[yjyj]

@warpur Let me share what I did when my late husband's insurance was pulling some nonsense like this with his chemo. I first called at 8am and I started getting the runaround. I finally got the direct number to who it had been outsourced to and I promised the person I was going to call every hour on the hour until it was approved and guess what....it was approved by 2pm. Be assertive, not aggressive. Good luck with your chemo!!! Best wishes!!

 

[gwenyth]

@yjyj Also, if they ever say they’ll call you back after doing something (speaking to a manager, calling a doctor, etc.), tell them you’ll stay on hold while they do it (and put it on speaker phone or something while you do other things if it takes a while).

 

[christroy]

@warpur I’m sorry you’re dealing with this runaround. I know it does not help you in this moment but
1. Blast them on social media and tag as many of the groups you can find on twitter, facebook, etc. social media complaints tend to get traction
2. BCBS is state specific so try googling BCBS + state and find emails/ contact for their corporate office contacts - most email addresses have a standard format of Firstname.Lastname@BCBS.com
3. Open a complaint with your state’s department of insurance which will hopefully put a bug up their ass about handholding your casework going forward. Mention the DOI in your messages to their corporate office and social media posts

 

[warpur]

@christroy Thank you so much for the advice. What is DOI?

 

[christroy]

@warpur Department Of Insurance

 

[warpur]

@christroy Oh derp. Thank you!

 

[mikail]

@warpur Email help@anthem.com, this is their complaints department. They will call you within a day, trust me. I’ve had similar issues with little incorrect problems and their complaints department don’t mess around.

 

[warpur]

@mikail Thanks, I did this morning and got into their Proofpoint secure email system. I did receive a call promising I’d receive another call, from authorizations, later today. No call

I emailed them again tonight.

 

[mikail]

@warpur Call 212-563-5570 extension 66578. This is empires direct grievance line.

 

[warpur]

@mikail Thank you. I will try that first thing tomorrow.

 

[warpur]

@mikail Oh, that’s Empire. I need Anthem. Will search for it tomorrow; too tired at this point.

 

[mikail]

@warpur I believe empire is a part of anthem. I have BCBS, that’s what they sent me in the mail for my insurance plan

 

[warpur]

@mikail Ok thanks, will try then.

 

[dutifulsunshine]

@warpur Which state are you in? Most departments of insurance have an “immediate medical review” phone number for these kind of situations.

 

[warpur]

@dutifulsunshine The insurance company is out of California. I’m in Illinois.

 

[jeanes22]

@warpur You may have actually a department of managed health care that you have to contact. All depends if you have a H.M.O. ( health maintenance organization) or not. It kind of sounds like you do

 

[kalisha78]

@christroy Also check the state laws on authorizations, you might be able to ding them on a technicality. In some states, they must be handled within x number of days and then screwing up the auth might apply.

 

[nagomirov]

@christroy Second the DOI complaint. State regulators are the only way to get their attention these days.

 

[grandmary]

@nagomirov Not necessarily. Complaints for self-insured plans will not be heard and acted upon by state regulators, who only have the power to regulate fully insured and Medicaid plans. So it all depends on whether it is an employer funded plan or not.