ANTHEM SUCKS !!! What can the healthcare providee do ?

Question

I'm so fortunate to be paying through the nose for ANTHEM healthcare coverage -- here's why...

In late November, I was rear ended by an insurance agent from PIAA in Henrico, Virginia -- at 45 mph. As a direct result my right knee swelled up to the size of a softball and I had to finally go to Patient First to get a knee imobilizer because of the pain and because an extreme amount of fluid had built up in my knee...it was a lot of fun, especially driving with it off which caused unbelievable pain...

Anyway, the fine folks at ANTHEM healthcare now are denying coverage because "the symptoms don't match the care provided, therefore they're not going to pay for the coverage" meaning I get a double whammy from the GEICO ripoff agency and ANTHEM healthcare ripoff "businesses"...

I guess it's all about the money when it comes right down to it -- Why should healthcare companies pay money out to anyone ??? "ANTHEM -- We're rich, you're not, so go suffer..."

...Yes, I'm gonna fix it...the insurance company won't like it either...

...Because, my knee is still clicking :-D

...1-800-WIN-WIN1

Answer 1

Contact the Bureau of Insurance for Virgina. The link is below.

The best guideline was this:

How to File a Health Insurance Complaint

If you feel your health insurance company or agent has acted illegally or improperly there is a simple process to resolve the issue:

1. First and foremost, keep detailed records of all relevant documents. Write down all conversations you have had with your agent / company. Keep all written correspondences in one folder. Save copies of canceled checks, bank statements, or paystubs with payments to the insurance company. Find and read through your policy agreement.


2. Contact your insurance company’s customer service department. Explain your complaint and give them a reasonable amount of time to address the issue.

If you still don’t feel that the issue has been resolved, you can elevate the dispute.
3. Consider your legal options. If the dollar amount in dispute is large, consider contacting an attorney to explain your problem and get their advice. Usually getting a referral from a friend is the best way to find an attorney. If this doesn’t work, you can try using an online lawyer database. For smaller dollar amounts, you may want to file a small claims suit. The dollar limit for small claims are set on a state by state basis.


4. Contact your state insurance commissioner. Almost all state commissioners have complaint forms on their websites (see State Insurance Sites for a list of state insurance departments). After filling out the form and submitting it, someone from your state will likely contact you to ask a few follow-up questions and may ask for supporting documents. Next, the state insurance department will contact your insurance company to discuss the issue. Afterwards, they will either contact you to tell you that they are closing their investigation, or they will transfer you to a specialist in the insurance department to continue working on resolving the issue.


5. Contact the Better Business Bureau and file a complaint with them as well. Health insurance companies work hard to resolve complaints because they hurt sales. Many people check with the BBB before buying insurance.

If all fails, you still can warn others about the practices of your company/agent.

6. Share your experience on consumer opinion websites such as epinions.com or consumeraffairs.com
http://www.ebuyingguides.com/how/Health_Insurance_c.htm

Answer 2

Is it possible that your doctor's office made a mistake in coding the symptoms or the treatment? They use numbers for the codes for diagnosis and treatment. My doctor's office once put the code for jaundice when I had neck pain.

If you have not already done so, I suggest you call or write the insurance co. that denied coverage and ask them for all the details, in case it was a mistake by the doctor's office. You could also call the doctor and ask them if they can explain the discrepancy.

I hope you get some satisfaction soon. I know the insurance co. tries to get out of paying anything if they can. I was rear-ended at a red light by a guy who admitted he was going at least 40 mph. He totaled my car and I injured my neck so that I had to have surgery. He only had $15,000 worth of coverage. My auto carrier would not pay for the balance of the medical because they said it was a "minor" collision. Fortunately I had medical coverage through my employer.

Also, if you have not already done so, talk to a lawyer. If you get a decent lawyer, they will get everything they can out of the insurance and charge you probably 1/3 of whatever they recover.

Answer 3

They call it a "health care crisis" I call it a health care scam. That's why it's not going to be fixed any time soon. If ever. I dropped my health care coverage. It's a lot cheaper to just pay the bill than the premiums, co-payments, etc. And yea if something really bad does happen I probably will be screwed. But it's not like Anthem would be a big help anyways.

Answer 4

get a job with insurance.

Answer 5

TURKEY importaated from england towels importated from spain. eveyrhting is in the dam room. so please do not complain.