Complaint information
  • Author: Valkyrie
  • Date: 07.2.2012
  • 0
 (Votes #: 0)

Wellpoint/Anthem Blue Cross - Complaints / Reviews / Scam Reports
ATTN: Toni Schiavo, Staff VP Wellpoint/Anthem Blue Cross wrongfully and without notice RETRACTED all health care claims paid spanning a two-year period.

This is a Complaint / Review about Wellpoint/Anthem Blue Cross.

Hell hath no fury like an insurers erroneous war path pursuit might best describe my unending nightmare with Anthem Blue Cross [ABC].

My ORDEAL began fifteen [15] months after my cancer surgery. A letter came in July 2010 from the hospital requesting payment for the five-figure treatment because ABC, without any notice to us, had retracted all benefits paid on my behalf retroactive to before the surgery. I was covered under a group policy [we first joined ABC in 2000] as spousal beneficiary and all premiums were duly paid [$2,720.20/mo for us both in 2010, the second premium increase in 12 months].

We were mystified. Inquiries met with Miss Peggy responses and an official Grievance Procedure lodged with ABC proved equally futile with the director of that department leading the charge. They had dug in their heels behind their fortress walls. And to add insult to injury, for the next three months ABC continued to invoice us and all premiums were paid. Yet, ABC refused to pay ANY covered claims during that period which, by any other name, is FRAUD. Provider bills and dun letters followed.

Months later ABC finally alleged that it had based the refusal to pay covered claims on my ineligibility under the group policy. Problem with that theory is that in 2007 ABC had dropped me from the policy averring ineligibility but reinstated me unconditionally after investigating the facts.

Turns out ABC had proceeded on erroneous information it had obtained through the backdoor in 2009 by means of a document called End Stage Renal Disease [ESRD] Request. I have NO renal disease, but ABC contends that it routinely uses this document for the purpose of obtaining otherwise inaccessible and protected government agency patient information. I have no idea why this is acceptable.

I filed a complaint with the Department of Managed Health Care [DMHC], the State Agency in charge. At first a low-rung analyst declined to investigate ABCs various statutory violations in this case. I persisted and the DMHC Legal department took over. Ultimately, ABC reached an agreement with the DMHC in which ABC was ordered to reinstate all retracted claims payments, pay all covered claims until the policy expiration, and to reimburse and to make me whole. In return, ABC would not be cited for its statutory and regulatory violations.

That should have settled the matter. But not long after the ABC-DMHC agreement, I was [repeatedly] contacted by a COLLECTION Agency from PA stating it had been contracted by ABC to collect from me previously paid Rx claims. So now I had to battle that entity.
As the months passed, providers also continued to send dun letters and threatened collection proceedings. Some of those demands we paid under duress. It took over a year to clear up most provider claims but because of this, I am now persona non grata with some of them. ABC, in the meantime, sent us one conflicting statement after another regarding the issues and resolution of this case. The latest incredulous act is the issuance of an IRS Form 1099-MISC for 2011 for $5,000.00 where as I/we have not received a single penny from ABC.

And while ABC has acknowledged it issued the1099-MISC in error, it refused to issue a Corrected 1099-MISC citing system problems. Instead, ABC averred it had notified the IRS of the erroneous issuance. Now ABC has changed their story again claiming it had never submitted the form to the IRS and therefore all is well. Maybe for ABC, but my experience in these years has been that every time ABC opens its mouth, a new lie is born. I now continue to loose sleep over it fretting the receipt of a failure to declare letter from the IRS.

And so the Ordeal continues as ABC gave lip-service to, but has not yet fulfilled the DMHCs mandate to reimburse and to make me whole. Instead, it has been stonewalling and continues to create issues thereby causing me more stress, loss of sleep and financial detriment. .

Thank You for reading of this Complaint / Review. For viewing of other complaints, reviews or scam reports about Wellpoint/Anthem Blue Cross, press here.
Complaint author: Valkyrie

Offender: Wellpoint/Anthem Blue Cross

Country: USA
State: California
City: Woodland Hills
Address: 21555 Oxnard St

Category: Health & Medicine

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