@grandmary It is employer funded FWIW. A LARGE employer.
HR and the head of the organization have been made aware of how awful this has been.
HR and the head of the organization have been made aware of how awful this has been.
Worst insurance experience of my life with Anthem BCBS / Accolade
- Thread starter warpur
- Start date
stratton609
New member
@christroy If you have accolade and you contact your insurance directly, they will force you to contact accolade instead. this is what happened to me when I need an MRI, they denied it, I asked why and they redirected me to accolade instead of providing an answer. It's criminal.
calvary4me
New member
@calvary4me Same. 
The provider has advised me that if I move forward out of pocket, insurance may choose not to retroactively cover the first treatment. They quoted me $46k for a single infusion.
The provider has advised me that if I move forward out of pocket, insurance may choose not to retroactively cover the first treatment. They quoted me $46k for a single infusion.
quirkymango
New member
@quirkymango I’m so sorry to hear. Best of luck getting through the process too!
@warpur Thank you for this. I have been dealing with Anthem/BCBS noncoverage notice for my mother’s stroke care (also has cancer) and it’s one of the biggest nightmares of my life. Being put on hold and incorrectly transferred to people who claim not to know how to transfer me to the correct department has become my full time job. Will be using the advice here.
abuniversity1
New member
@warpur My experience with Anthem Blue Cross has also been horrific. I have had many HMO plans throughout the years, some good and some not so good, but Anthem Blue Cross is the absolute worst! This year has been an absolute nightmare health wise and the incompetence, bureaucratic red tape, hours upon hours of being on hold to talk to a human being only to be cut off, and the overall "left hand not knowing what the right hand is doing" from Anthem Blue Cross has been the cause. I literally have pages of typewritten notes documenting their failure to provide adequate healthcare, despite working with my husband's company, our insurance broker, multiple Anthem Blue Cross reps, and Anthem's case management. The situation became so dire that I found it necessary to ditch my insurance and pay out of pocket to see a physician who could actually help me.
@abuniversity1 Yep, they suck.
I’m currently fighting them as they won’t pay the last chemo session (that they preauthorized) or the pathology from my surgery.
I’m currently fighting them as they won’t pay the last chemo session (that they preauthorized) or the pathology from my surgery.
abuniversity1
New member
@faroshee7 I did get my chemo approved, and went through twelve rounds of it, as well as surgery. They didn’t find any residual cancer at the time of surgery, which is the best possible outcome. Currently receiving radiation and it’s a bit rough but getting through it.
Insurance denied my last chemo session, even though it was preauthorized, as well as the pathology done looking for cancer in the lymph nodes my surgeon removed. Currently fighting both of those. I get antibody infusions every three weeks and we’ve had to fight them several times for that.
Thanks for asking.
Insurance denied my last chemo session, even though it was preauthorized, as well as the pathology done looking for cancer in the lymph nodes my surgeon removed. Currently fighting both of those. I get antibody infusions every three weeks and we’ve had to fight them several times for that.
Thanks for asking.
hungphatads123
New member
@warpur I work as an Insurance Billing Specialist for a medical provider on the Eastern Seaboard. In October, the Practice Manager asked me to compile a list of the best/worst insurance companies based on how fast claims are processed, how often they are denied, etc. The purpose was to determine which insurances we would continue to take/stop taking for next year. I created a rubric and assigned grades for 3 categories- Ease of Authorization, Amount of time it takes to pay on a claim, and the likelihood of "false denials" (denied claims which should not have been denied- ex. denying a claim for no prior authorization when we did have authorization and the authorization number was in the correct box on the claim form). Out of all insurances we accept, Anthem was the only company get a grade of less than 20/100 for all three categories. Some highlights of the report were:
Anthem denied a claim for no prior authorization when their website specifically states that no prior authorization is required for that specific procedure.
Athem Claims Supervisor who openly admitted they do not read the medical documentation which we submit to support medical necessity of procedures.
Multiple Anthem reps (including several supervisors) insisting April has 31 days.
Unfortunately, I also found out that this is not unique to my State, Many Insurancde Billers in other States have reported their own Anthem horror stories. Needless to say, our practice will not be accepting Anthem in 2024. We sent out a notice to our patients with a list of which insurances we are taking/dropping- every single one of our patients who had Anthem in 2023 (not an insignificant percentage) let us know that they want to remain with our practice and therefore have obtained insurance from another company. Our employee health plan has also stopped using Anthem and has gone with a different company.
Anthem denied a claim for no prior authorization when their website specifically states that no prior authorization is required for that specific procedure.
Athem Claims Supervisor who openly admitted they do not read the medical documentation which we submit to support medical necessity of procedures.
Multiple Anthem reps (including several supervisors) insisting April has 31 days.
Unfortunately, I also found out that this is not unique to my State, Many Insurancde Billers in other States have reported their own Anthem horror stories. Needless to say, our practice will not be accepting Anthem in 2024. We sent out a notice to our patients with a list of which insurances we are taking/dropping- every single one of our patients who had Anthem in 2023 (not an insignificant percentage) let us know that they want to remain with our practice and therefore have obtained insurance from another company. Our employee health plan has also stopped using Anthem and has gone with a different company.
@hungphatads123 Wow. Thanks for sharing.
heavenmindset
New member
@hungphatads123 Can you share what were the top rated insurances through your findings?
sister_in_christ
New member
@warpur Anthem Blue Cross in California are complete corporate scumbags. Was involed in a horrific car accident that left me with a crushed sternum and several brokemn ribs. My trauma surgeon prescribed Lidocaine patches for sleeping at night, but Blue Cross keeps rejecting the prescription at my local CVS. They keep forcing doctors to file prior authorization and asking for alternative medicine in a vain attempt to save themselves less than $100 in Lidocaine patches. They waste hundreds of dollars worth of doctors time and hospital overhead in a greedy attempt to save themselves pennies while patients suffer. Its been two weeks of sleepless nights because Anthem Blue Cross STILL wont approve what my doctors are sending to the pharmacy because Anthem BC are such evil, greedy corporate trash. No wonder hospitals like UC Davis Medical Center are deciding to not renew annual contracts with them in 2024. This is what happens when Americans allow greedy corporate pigs in between doctors and patients. Because of Anthem BC's inefficiency, the doctors time are unnecessary wasted dealing with pharmaceutical issues and patients suffer while we wait. Anthem Blue Cross is a trash corporation.
mdjuelrana
New member
@warpur Currently trying to figure out if I need a pre-auth for something, because my provider can't get through to anyone on the provider line. I talked with someone at member services, and their answer was basically "we can't find any information on if you need a pre-auth so... no? We're not sure." My experiences with Anthem have not been great.
@mdjuelrana Ugh. That’s pretty bad. Do you have Accolade as well? One magic trick I’ve finally discovered is to tell them you’d like them to escalate to Anthem to get an official answer back. I’ve also found that the quality of service you get greatly depends on which rep you’re talking to.
@erin136 Hmm… I’ve never heard it referred to as ERISA. How can I find out?
Unfortunately, it’s more a matter of time. They’ll probably have to approve it next week, but my tumor is growing extremely rapidly into my chest wall, and the delay of another three days may make a difference in my longterm outcome, which is why this is so incredibly urgent.
Unfortunately, it’s more a matter of time. They’ll probably have to approve it next week, but my tumor is growing extremely rapidly into my chest wall, and the delay of another three days may make a difference in my longterm outcome, which is why this is so incredibly urgent.