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Anthem Blue Cross: Will the New Management be Consumer Friendly?

Home / Joan Borsten / Anthem Blue Cross: Will the New Management be Consumer Friendly?

Anthem Blue Cross: Will the New Management be Consumer Friendly?

Duke Helfand reported in the July 20, 2010 edition of the LA Times that the President of Anthem Blue Cross of California,  Leslie Margolin, is stepping down after  California’s largest for-profit insurer came  under fire over planned rate hikes of up to 39%.

I am hoping the Times asks Helfland, Scott Glover, Lisa Giron or one of the other dedicated reporters who write on health to investigate the Anthem Blue Cross system for their processing of chemical dependency claims during the two years Margolin was in charge.

From time to time, we have private-pay clients who are insured through Anthem and want to be reimbursed for what they have paid out for treatment.

Remember John Grisham’s 1995 novel “The Rainmaker?” Someone at Anthem must have read it for inspiration before designing their claims processing manual.  Unlike Grisham’s fictitious Great Benefit Life Insurance Company, Anthem does not deny each and every benefit, but it is not for lack of trying.  Claimants routinely face an impossible bureaucracy of unhelpful, unfriendly processers whose goal is to delay reimbursement for months or even years.   The goal of the claims representative seems to be wearing the claimant down in hopes he/she will go away.

At least two of our alumni finally gave up trying to get reimbursed for a benefit they pay for month after month, and allowed Anthem to pocket the money.   Another client had insurance through Blue Cross of Texas.  Because treatment was in California, Blue Cross of Texas was supposed to go through Anthem.  After months of delay, Blue Cross of Texas finally gave up on California and processed the claim themselves.

The successor to Ms. Margolin needs to reform the claims payment system.

Case in point:

We accept for treatment the wife of a Hollywood Studio Executive.  Let’s all her Jane.  The Studio’s chemical dependency benefits are administered by Anthem.  Every moment of Jane’s stay was authorized.  After treatment was completed, Niki, our insurance processor was told to send the claim to a specific address in California.  She did and then was told she had the wrong address.  Turned out she had the right address.  Then the claim was rejected because it needed to be processed by Anthem National.   She sent it to Anthem National which rejected the claim because Malibu Beach Recovery Center is “out of network.” Jane has “out of network” benefits.

90 days after Jane completed treatment, with no payment in sight, I called the Studio to complain.  A few moments later the phone rang and it was a representative of the Anthem National Desk Employer Service who said it was her division that was responsible for paying Jane’s claim and would do so right away.

“Your check will be mailed out this week,” she emailed.  “The claim was finalized today.  The check should be issued by Wednesday if not tomorrow.  I will keep you posted.”

The check finally arrived by snail mail many weeks later.  The total amount of time it took to get paid for authorized treatment:  6 months.

Here’s the punch line.  Later we received a letter from Anthem stating we owed them money.  Apparently because we “rushed” Anthem into processing the claim in “just” 6 months, the frazzled workers made a mathematical error in our favor.

Showing 2 comments
  • dave

    As an agent for Anthem Blue Cross I hate hearing stories like this. I try to assist all of my clients if they ever had a problem with billing or a certain claim that has not been paid on time.

  • Jeff Schwartz LCSW

    I am CEO a behavioral health utilization management company that deals with behavioral health insurance companies and managed care companies and 3rd party payers on a daily basis. Three of my clients who are licensed drug and alcohol treatment facilities have lost money in exactly the same manner that Joan Borsten speaks of in this article. One patient took the check from Anthem, cashed it and purchased heroin. The following day he was found dead with a needle in his arm. There should be a class action suit against Anthem, as they have ruined many patients and families by their ridiculous policy of sending large sums of money to recovering addicts. They become part of the problem instead of part of the solution. Anthem of California is by far the worst managed care company that I have ever encountered in my 24 years as a licensed therapist and advocate for patient rights and insurance injustices. Anthem has proved to be incompetent in every area that I have ever dealt with them on. It never ceases to amaze me with their total uncaring, arrogant and unwilling attitude towards their members and their contracted and non- contracted treatment facilities. I often wonder why anyone would buy one of their insurance policies and suspect that if they really knew the truth about the company and how it is operated in California, they would run as far away from them as humanly possible. Great big kudos to Joan Borsten for standing up for her patients and speaking out about a company like Anthem who are interested in nothing more than the bottom line and impressing their directors and stock holders at the dire expense of their members who pay dearly every month to hold one of their insurance cards.

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