Anthem Insurance Rant!

[Wabbitdad12]

:rant:

I am absolutely furious with Anthem. We have a high deductible policy and have had to completely bear $4,000 of medical expenses since June, with NO benefits ($0, NADA). This is in addition to the thousands we have continued to pay for our premium, AND the thousands my husband's employer has paid in. We finally fulfilled the $4,000 deductible earlier this month, and thought, now we can let the stinkin insurance company pay for a few of our expenses. IF ONLY!! We have been attempting to fill our 90-day prescriptions through their mail order service, Net Rx, only to be told that it's too late in the year for them to process the order. I have talked myself blue for 2 dayswith both Net Rx's and Anthem'scustomer service departments, asking if we can squeeze this in before the deductible resets on January 1st. Net Rx insists that they cannot process the order that quickly. On the 29th I even offered to send it overnight express, or fax them in. No, they are only going to process the orders as they come in, and they take a couple of days to "get in the system", then prepare the order. "Couldn't you get it on the computer and charge it to Anthem before December 31st? Then take your time to ship it?", I asked. "No, we can't do that." I explained over and over again that I didn't care how long it took for the order to arrive, I just wanted to have it count for 2008. They would not budge.



My attemptsto get help from Anthem have been even more frustrating. After explaining that I just wanted to fill my 90 day prescriptions before December 31, I was basically told that I should have started the process sooner. Excuse me?? I had no control over how long the doctor's offices took to get the scrips ready (24-48 hours), or that there are holidays that have backed up Net Rx's shipping department, or that Anthem's computer system was down most of the day yesterday and I kept getting a message telling me to call back again later. Besides, it still IS 2008, isn't it? Am I not entitled to get 90 days' worth of prescriptions, according to my health care plan contract, before 1/1/2009? Why does it matter that today is 12/29? I asked if I could file an appeal. "Yes you can, but no one will be able to consider it before the 31[suP]st[/suP].” The service rep came up with a brilliant plan of her own: “You could always send the order in to Net Rx, pay for it, then appeal later.” RIGHT. Like I am going to fork out another five grand, just to be given the run-around again later. I even asked if we could get the prescriptions filled at the local pharmacy, and they refused to allow me to do that. “You can only get the 90 day prescriptions through the mail.” Even though they keep telling me that they can’t fill it by the 31[suP]st[/suP]? “Sorry, but we only pay for a 30 day supply if you fill your prescriptions at a local drug store.”



So basically we are screwed. Anthem has collected thousands of dollars for our health insurance since June 1st, and have paid almost nothing out, yet they conveniently cannot find a way to pay for our 90 day prescriptions - even though it is still 2008. I wish I had a company that collected money from people without having to provide any services in return – it sounds very profitable to me.



Thank You for the opportunity to let me rant. :banghead

 

[JadeIcing]

Umm my husband used to work for them... Yea they can be pricks. One small group was told just before xmas (few years ago) not to come back once they went home. Hubby only found out about his sections lay off by accident. I may have him post the whole thing later.

 

[Amy27]

I do medical billing and coding and one thing I have learned in difficult situations is to always ask for a supervisor. I would call and ask to speak with a supervisor. They can process the order faster if you were able to fax it. Hopefully they will. It is sad that it depends on their mood, because they certainly can get it through.

Another thing I would ask about is usually your company that you have your insurance through has a rep through Anthem that gives them the yearly rates and deals with any problems for your company, it is basically the person they deal with to buy the insurance and update the plans every year. I have had a lot of success contacting them. They want the business and want you to be happy so they tend to go out of their way more then a customer service rep who could really careless when you are unhappy.

It sounds like you have talked to several people. Sometimes just calling back and getting someone who is willing to help you. But if you have spoken to several different people already I would try the supervisor and your company's Anthem rep. Also if your company doesn't know who there Anthem rep is you can call Anthem and they should be able to tell you. At least in Ohio they assign reps by location so if you give your employers location they should be able to tell you the rep that handles that area. Though that again seems to depend on who you talk to and if they care.

I just thought of another idea. The physician's I worked for would do this as long as the patient was a long time patient and they knew they wouldn't take advantage of the situation. The physician would write the prescription for more then you would actually take a day. For example if you took one pill a day he would write the rx for two pills a day. That way a one month rx would actually last two months. Then you could take that rx to a local pharmacy before the end of the year and atleast have two months of rx. Or up the milligrams of the rx and you break them in half it that is possible.

I hope that helps. I know how frustrating insurance companies are. They really don't care about people and rarely go out of your way. I know you only have a few days left. I hope you can get something figured out.

 

[Wabbitdad12]

I kept going up the chain until there was no one else to talk to. I even called the VP for customer service and had a very nice person take my name and number, very nice way to blow me off.

Oh well I gave it a shot. Now, I just have to pay for all the prescriptions, premiums etc until I meet my $4000 deductible again.:censored2:

 

[TinysMom]

I know I'm going to sound really stupid here...but I thought you were retired Air Force....am I wrong? We get our medical stuff from the USAF - we have to pay a monthly premium (not free like it was SUPPOSED to be when Art joined in 1982)....but still yet - its cheaper than civilian insurance.

I don't know if you get Anthem through your work or something - but I think I'd try shopping around for better insurance. Fortunately - its something I know NOTHING about as we don't need it....but when I hear tales like this - it makes me so grateful once again that Art put in his 20 and got out with the healthcare we do have...

 

[Wabbitdad12]

No your not stupid, I retired from the Air Force Reserve. I applied for VA benifits but I make too much money according to the VA, so I have to wait until age 62, unless congress changes the rules. That will happen when I am elected pope and I'm not even catholic.

 

[TinysMom]

Wabbitdad12 wrote:

No your not stupid, I retired from the Air Force Reserve.

Ah...I think that one last word...."reserve" makes all the difference. I had no idea that they didn't get the medical benefits we did.

:shock:

 

[wabbitmom12]

TinysMom wrote:

Wabbitdad12 wrote:

No your not stupid, I retired from the Air Force Reserve.

Ah...I think that one last word...."reserve" makes all the difference. I had no idea that they didn't get the medical benefits we did.

:shock:

Yeah, that's a dirty little secret. I suppose people would say that since they don't have the same "committment" as Active Duty, Reserves shouldn't get the same bennies. But look at the Gulf Wars...Reserve units have made all the difference.

Reservists train monthly (or more often), "get" to disrupt their civilian jobs to go on depolyments, and get called up to go to exciting places like Iraq. They have a very large commitment, especially those that have stuck with it long enough to have retired.

Peg, I know you are probably saying "AMEN!" to all of that - other service members understand it - but, many people just don't get it. You'd think that Dave's retirement benefits could at least include CHEAP healthcare, if nothing else. Right now, he's got at least $3, 000 of dental work that needs to be done (NONE of it purely cosmetic), and there's just no way we can swing it....mostly because we don't have the monthly Reserve check coming in anymore. All in all, his retirement from the Reserves has virtually ruined us financially. (Taking a $700/month knock to your income will do that, not to mention some other things that have happened to us.) His "retirement" benefits will help when we're old, but right now we're basically rooked.

 

[Bassetluv]

Wow...all I can say is that system (or the people running it) is seriously flawed. I don't know how well private insurance works here in Canada (makes me wonder if it's the same as what you've described with your insurance provider), but with insurance through an employer, it usually works by paying a deductible at the beginning of the year (in my case, the deductible for both health and dental is $100.00 each) and then after that I submit my prescription certificates to the health care provider and get back 80%. Deductible isn't anywhere near $4000 :shock:! And in the case of dental, I only have to pay the balance of what the insurance company doesn't cover (which is usually 20%). The bill is submitted from the dentist at the end of the appointment; it's faxed through to the insurance company and the balance I owe is sent back by them within moments. So for a cleaning I might wind up paying $10-$12 up front; I don't have to pay the entire thing, and don't have to wait for the insurance company to send money back to me.

I wonder if there's some way of going after your insurance company with the charge that they aren't honoring their own rules....what they're doing is ridiculous, and sounds like it borders on illegal.

 

[wabbitmom12]

Bassetluv wrote:

Deductible isn't anywhere near $4000 :shock:! And in the case of dental, I only have to pay the balance of what the insurance company doesn't cover (which is usually 20%). The bill is submitted from the dentist at the end of the appointment; it's faxed through to the insurance company and the balance I owe is sent back by them within moments. So for a cleaning I might wind up paying $10-$12 up front; I don't have to pay the entire thing, and don't have to wait for the insurance company to send money back to me.

Well, we also had the option of a smaller deductible, with much higher premiums to pay. Of course, Dave's employer didn't want people to go with that, so they offered an incentive to go with the high deductible. So the premiums aren't bad, and if you don't have many health problems, you come out ahead.

Where we really got tripped up was in signing up in June. Usually our plan year would run June to May. This year, it ran June to December, then resets to a traditional Jan - December. Only problem is, the company's HR person didn't bother to make that clear when we were signing up. (She's since left, which is probably a good thing, given how mad we've been with her!!)

 

[wabbitmom12]

We have some health problems in the house that cause large medical expenses, month to month. Prescriptions are our biggest headache. 99% of Americans don't take nearly as many prescriptions - I guarantee it!!

I almost hate to disclose it here... you'll all think we're hypochondriacs!...but, for 3 people, we are filling 15 prescriptions a month!! I've mentioned before, our 17-year old is bi-polar. He takes several meds for that and the related insomnia he has. Not surprisingly, Dave and I then have a number of stress-induced illnesses. He and the boy also have asthma, and I have big-time allergy/sinus issues. The only one not taking prescribed meds is our daughter, who takes Melatonin (over the counter) for insomnia.

I have our little pill bottles lined up on the counter...It's all so pathetic! LOL

We just call it, Better Living Through Chemistry!

 

[Bassetluv]

wabbitmom12 wrote:

We have some health problems in the house that cause large medical expenses, month to month. Prescriptions are our biggest headache. 99% of Americans don't take nearly as many prescriptions - I guarantee it!!

I almost hate to disclose it here... you'll all think we're hypochondriacs!...but, for 3 people, we are filling 15 prescriptions a month!! I've mentioned before, our 17-year old is bi-polar. He takes several meds for that and the related insomnia he has. Not surprisingly, Dave and I then have a number of stress-induced illnesses. He and the boy also have asthma, and I have big-time allergy/sinus issues. The only one not taking prescribed meds is our daughter, who takes Melatonin (over the counter) for insomnia.

I have our little pill bottles lined up on the counter...It's all so pathetic! LOL

We just call it, Better Living Through Chemistry!

wabbitmom, I suspect a great many families deal with enormous prescriptions at various times; your family is probably more the norm than you think. I went through a time when I was undergoing radiation/chemo and had prescription after prescription to help deal mainly with side effects of the treatments - and some of those meds were very costly. (hehe...I could tell you about the time I ran out of two major painkillers at once - on a Sunday, of course - and had to go to a clinic to get them refilled. Was at the height of side effects when this happened, in major pain, and the doctor refused to fill them on the grounds that 'you might get addicted to them because they're narcotics'. I came this close to wrapping that stethoscope of his tightly around his neck...severe pain will do that to a person. )

My brother's wife and son both suffer from various maladies and need constant meds. His wife was diagnosed with MS - though they now think she has lupus - and she has been on and off meds for the past several years. His son was diagnosed with 5 different things...danged if I could name them all though. I recall that one was ADHD, another was Asperger's syndrome. Anyway, he's been on a cocktail of drugs for at least the past 8-9 years. And while this isn't a person, it is still a member of the family: their cat has asthma and has to take daily meds for that. My brother doesn't have any health insurance other than OHIP (Ontario Health Insurance Plan), so while some of the things are covered, not all are, and he's been struggling to live paycheck to paycheck for many years. This is basically the same story for my best friend as well...her daughter was on heavy meds from the time she was little for a couple of different illnesses, and just when my friend and her husband thought they were seeing a light at the end of the tunnel financially, he was diagnosed with colon cancer, and had to take an entire year off work to go through treatments. In order to not lose their house they had to use up their daughter's university fund, and she is so angry with her parents that she no longer speaks to them.

Better Living Through Chemistry...I think a great many households would join in with you on that one. :?

 

[JadeIcing]

Ha I bet my family coud beat you!

 

[wabbitmom12]

JadeIcing wrote:

Ha I bet my family coud beat you!

That's not an honor you want!

Seriously, though, we are lucky in that we are Mr and Mrs Middle America. No drug use going on, no physical abuse, etc. We're dysfunctional in our own way (I think all families are), but we don't have nearly the complications that so many people do, with alcoholism, or multiple divorces and half-siblings and step parents, or people in and out of jail, whatever, etc, etc.. Our mental illness is enough to keep us busy,thank you very much. (I'm not judging anyone else...I'm just saying that I am thankful that we don't have as many side issues to deal with. My life is already a roller coaster; I'm not sure how I would handle other complicated issues on top of it.)

 

[JadeIcing]

We take pride in our insanity.:biggrin2:

 

[xeblic]

JadeIcing wrote:

We take pride in our insanity.:biggrin2:

Good one!

Hey, we might as well laugh, right?!

If we don't, we'll cry.


POSTED BY WABBITMOM12, NOT XEBLIC...SORRY. Note to self: Check to see who's logged in before making posts.... Edited by me, because I'm a ding dong.