I’ve just been on the phone for an hour with Anthem. Six months ago, I applied for a policy with a request for HIPAA coverage if they denied my application (I knew they would, and they did). I waited for the notice that I’d been accepted under HIPAA. I knew it would take a few months. This has happened before.
Backstory: twice now, the company that carried my COBRA went out of business, taking my coverage with it. Instantaneously stripped of health insurance coverage.
Single mom of three, sole support.
I checked in periodically until last week when I finally got someone to admit that they had made a mistake. You see, they insisted that I had not checked the box for HIPAA, but I had. They finally admitted the mistake, awarded me coverage backdated six months to the last date of COBRA, and then promptly demanded that I pay all six months of premiums in 30 days or risk cancellation of the policy that had been awarded not ten minutes earlier.
“We’re sorry, we made a mistake, we’re correcting it, and you owe us $3,014.00 in thirty days. Or we’ll cancel the policy we should have awarded you months ago.”
Irony: my monthly medical expenses have averaged roughly the same as my monthly premium. I would MUCH rather have been paying Anthem directly.
So I went on a campaign. For the first twenty minutes they insisted that I pay all six months or suffer consequences.
So I went over heads. One supervisor later, they’d agreed to allow a partial payment of two months, about $1,000.00.
Two supervisors later, I’d gotten them down to one month, or $504.00. BUT! I must pay the remaining five months in the next billing cycle, which I assume will have one more premium accrued, so—wait for it— I’ll be facing that 6-month bill again for $3.014.00.
Christ in a breakfast nook holding a bagel in one hand and a newspaper in the other.
I had to get aggressive to get them to admit they were at fault, and then was shut out. I tried to go to legal, they would not allow it. A supervisor said, “This is not for Legal, this is our fault.” That is why they made an exception and allowed me to pay just one month within 30 days.
And they will not provide a way to expedite reimbursements for pharmacy and medical office charges. She’s sending me an email with a claims form.
God Bless America.
UPDATE: As of today, Tuesday, February 9, 2010, I have still not received the emailed forms. Looks like I will have to call in again for another go-round.
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02.03.10 at 08:29 PM |
Seriously, how do these “people” sleep at night?
Can you bill them for mental duress and/or anguish? Carp!
02.03.10 at 09:17 PM |
Have you considered going to your legislators? They love stuff like this, because they get to be the hero. Your situation is so clearly unfair, and your request is so reasonable. I hope Anthem gets its head out of its butt soon.
02.04.10 at 12:09 AM |
This is needful to accomplish a greatest range thesis writing while people are at study at the high school. Therefore, your superior idea about this good topic could be a a really good issue for the thesis project performers.
02.04.10 at 07:14 AM |
Do you have any sort of Legal Aid where you live? I don’t know if they could help, but they may be able to point you in the right direction. It is so wrong that insurance companies can get away with crap like this when we have to depend on them. Our country’s health care is seriously messed up and unfortunately I don’t see any fix in the near future. Good luck sweetie!
02.04.10 at 07:42 AM |
Is it worth it to back date it if the premiums are the same as your out of pockets?Can’t you just get coverage moving forward?
02.04.10 at 08:04 AM |
@Rose They always back date it. The golden rule in insurance is Thou Shalt Not Have a Gap in Coverage. Each time you apply for a policy, you need a certificate of continuous coverage from the previous company. It’s like your passport. It may be worthwhile in my case because I had a few office visits and paid cash for everything.
@Jayme I’m going to look into it. I can’t have that conversation every month, and no one anywhere near a public phone number is authorized to make common sense calls on bad policy.
@Gemma, if you don’t stop spamming me with thesis paper comments I am going to ban ever permutation of your email and IP addresses. And for all of your friends.
02.04.10 at 10:28 AM |
Ugh, I’ve had similar problems with Anthem. And with just something as simple as getting them to admit I had no pre-existing conditions. It’s beyond ridiculous. I’m glad it worked out for you!
02.04.10 at 03:30 PM |
I am canadian. I have friends and family in the US who have had similar struggles. I have tried, over & over again, to wrap my head around the health care system & I cannot. While I can’t relate, I sympathize. :(
02.05.10 at 12:48 PM |
4 years makes me suffer from severe back pain in the lower part, and so far not found anything, why turn to drugs such as Tramadol, Oxycodone and who are the only calming the terrible pain I feel, a few weeks ago asking for I found this Web browser findyourdrug gave me good information and alternatives, I do not think I made a mistake and asked to prove their safety and so far I seriously hope this is for you. a good indicator.
02.05.10 at 01:37 PM |
Insurance Company (noun): 1. Name for a bloated, greedy corporation that takes your money in exchange for insurance coverage.
2. A corporation that denies you insurance coverage once they’ve taken your money .
Ugh. My heart really goes out to you and all Americans living with this type of shoddy system . I’m Canadian and, while our health care isn’t perfect, it doesn’t force you to go into debt just to get medical coverage.
Best of luck! I hope it works out for you.
02.05.10 at 04:49 PM |
Ugh - this is so wrong. How can they ask you to pay it all in 30 days… I don’t see them reimbursing all your payments from the past 6 months in 30 days. Can you try talking to a supe one more time and see if you can double up on payments until you’re caught up and use the “waiting for reimbursement” reason? You are a strong lady to put up with so much. Maybe you can ask the Merc to run an article on this. Healthcare is all the rage right now. If they’re willing, I have a feeling the supe will be more willing in working out a payment plan for THEIR mistake! Hang in there.
02.06.10 at 12:27 AM |
Ugh! What a horror story! I hope you can get it sorted out soon! Good luck to you!
02.06.10 at 01:16 AM |
While all of this sucks (you knew that already) and while insurance in America sucks (which we ALL know) I have to say it’s good to see people pushing until they get what is deserved of them. I don’t have a quick fix (or even a solid plan for how to fix) healthcare. But I think in the interim, strong willed people standing up for themselves with insurance companies has got to lead us somewhere good.
02.09.10 at 04:01 AM |
What a great post. What an inspiration for everyone who is asking ‘Where is all this stuff I’ve asked for?’
auto insurance directory
02.09.10 at 07:49 AM |
I feel your pain. I was denied coverage by Anthem because of a pre-existing condition: asthma. When I explained that I have always had insurance and the only reason I was switching was because my husband’s company changed providers, I had to prove that I was covered before WITH A HAND WRITTEN LETTER from our old carrier. Huh? Does anyone actually hand write ANYTHING anymore?
I was told by an agent that I “would be surprised by how many people try to get insurance just because they’re sick”. Yeah? Go figure.
02.09.10 at 07:55 AM |
Mindy, I apologize for how confusing and complicated this has become, as well as for how long it has taken to get it fixed/addressed. No excuse on our part.
I have asked one of my team leaders to find your contact information in our system, place an outreach call to you and to get this resolved. We will also be sure to get you the documents you have requested.
I will follow up w/ my team to be certain that this occurs in a timely manner. You can contact me through customerservice@anthem.com
David-
02.09.10 at 08:54 AM |
I’m a former Anthem employee who lost my job in a wave of massive layoffs in the fall and winter of this year. I stay in contact with some people there.
The people who are left say they are so overworked that they can’t get everything done. Others say they have been put into jobs with no training to replace people who have been laid off and are still trying to do their old jobs, too.
So to the people who wonder how this can happen - the people who are trying to help you might be struggling really hard and are nice people who just want to keep their jobs and get through endless piles of paperwork each day.
It doesn’t excuse Anthem’s actions, but I just wanted to give you a different perspective.
02.09.10 at 09:50 AM |
Another horror story from the insurance world. I agree with going to an elected official so they are aware that things happen because of insurance and they happen to real people. Then, analyze where your medical costs lie. If they are with the ER or hospital, get hospital only coverage and find a cash only practice - they will make a deal with you for office visits and don’t report your families conditions to the insurance companies. If they are with the doctors office, you are stuck with HMO.
02.09.10 at 12:06 PM |
@ Anon - I know they are overworked, have been there myself, and I went out of my way to say that I wasn’t upset with them, I was upset with the policy. I was able to hang onto that attitude until the final supervisor would not let me appeal to Legal or go over her head for a common sense override to bad policy. Also? It’s bad business to cancel me. They’ll get much more $ if they let me keep my coverage.
@ Lizzy - I had to get one of those letters once. From a company that had gone out of business, and it had to be from the CEO on company letterhead. That was fun. And not at all awkward. O_o