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Has anybody ever had a claim actually make it through Blue Cross Blue Shield Anthem?

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Has anybody ever had a claim actually make it through Blue Cross Blue Shield Anthem?

Old 08-23-2019, 08:50 AM
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Default Has anybody ever had a claim actually make it through Blue Cross Blue Shield Anthem?

I have been going back and forth with Blue Cross Blue Shield Anthem since late April attempting to get a out of network claim processed. Its in my plan up to a certain dollar amount. It always gets kicked back for one thing or another. They wont tell you until you ask and just sit on you until you do then throw some random oh your missing this or that or this is wrong. I hate to get lawyers involved but I think it maybe the next step at this point. Its not about the money but the fact they are not honoring their commitment or doing what I pay them to do monthly. Tired of the run around and the games they are playing. Just a vent I guess.
Old 08-23-2019, 08:52 AM
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I feel your pain.
Old 08-23-2019, 08:53 AM
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That’s how all healthcare works now. Its called preventative healthcare for a reason.
Old 08-23-2019, 08:54 AM
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Never had any issues with Blue Cross Texas, or North Carolina, either private insurance or employer. Something may be odd with the out of network provider. Have you tried escalating your contact?
Old 08-23-2019, 08:56 AM
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People that work in medical billing are single cell organisms.

It's not surprising to hear of your issues.
Old 08-23-2019, 08:57 AM
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Hmmm, Anthem doesn't operate under cross/shield brand in FL. Are you sure you are submitting to the correct payer? Maybe Anthem is the secondary plan? Those always get a little more complicated.
Old 08-23-2019, 09:34 AM
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Yeah we've had 'em for our work for years....not bad. Yeah can take a while sometimes..but eventually gets sorted. Never had a "good" experience with ANY healthcare insurance...but never had a "bad" one with BC/BS.
Old 08-23-2019, 09:39 AM
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They suck! Every claims submitted is rejected for some reason and are so impossible to communicate with, our company had to hire a third party company to help get things resolved and move claims along.
I have to admit, our company plan is pretty good with what they pay for though. Getting them to pay.......
Old 08-23-2019, 10:46 AM
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I married a Pit bull——- when she submits a claim she doesn’t let go till they pay.
Old 08-23-2019, 10:55 AM
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How anybody thinks that our current system works is beyond me. Nobody knows what is going on and when questions are asked you get 10 different answers from 10 different people. Blue cross told me that they didn't cover me being weighed at my physical, I disputed it and it came back the same, then I was told that I would have to write a letter to dispute it further. after going rounds with them I visited the office manager at my doctor and she told me it was coded wrong and she would take care of it, there is no common sense in this industry. Seems everytime I go in for something the billing is screwed up. From now on if I have a dispute, I'm going right back to the doctors office face to face and have them figure it out.
Old 08-23-2019, 10:58 AM
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File a complaint with the state insurance commissioners office. They will pay attention Once notified by the state. I've had to do it before and you get someone who is incentivized to make sure your problem gets fixed vs some low level phone person.
Old 08-23-2019, 11:11 AM
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If the Ins. Co. rejects a claim that they are responsible for, they should be forced to pay you the claim amount along with paying the doctor. If they reject a legit claim and you just pay the Dr. yourself instead, they just made profit along with your premiums. Rejecting legit claims is part of the business model. Most people are not like THTers, researching and following up on issues.
Old 08-23-2019, 12:44 PM
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As someone else referred to, a lot of the time it is due to miscoding by the care provider. When I have had employees complain, and had someone from HR follow up, that has been almost always the reason. Out of network providers need to be avoided at all costs if you can.
Old 08-23-2019, 01:23 PM
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Originally Posted by kurttruk View Post
I have been going back and forth with Blue Cross Blue Shield Anthem since late April attempting to get a out of network claim processed. Its in my plan up to a certain dollar amount. It always gets kicked back for one thing or another. They wont tell you until you ask and just sit on you until you do then throw some random oh your missing this or that or this is wrong. I hate to get lawyers involved but I think it maybe the next step at this point. Its not about the money but the fact they are not honoring their commitment or doing what I pay them to do monthly. Tired of the run around and the games they are playing. Just a vent I guess.
Don't take no from someone who can't say yes........make them connect someone who can say yes.

Old 08-25-2019, 10:32 AM
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My wife had about half a million dollars of brain surgery a few years ago while covered by BCBS and we were out of pocket maybe a couple thousand. As far as I'm concerned they are heroes.
Old 08-25-2019, 11:17 AM
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what is anthem?
Old 08-25-2019, 11:50 AM
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Originally Posted by edwardh1 View Post
what is anthem?
What is Google? Or Bing?
Old 08-25-2019, 03:49 PM
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Has the doctor contacted you for payment ? Usually they get denial notice they refile with correct coding and all is good.

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