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.