Homecomplaint › Lisa - Walnut Creek, CA - Anthem Blue Cross denies claim on technicality

Consumer Complaint

Lisa - Walnut Creek, CA - Anthem Blue Cross denies claim on technicality

Companies Involved: 
Anthem Blue Cross
Issue Area: 
Heath Care

My daughter has Anthem Blue Cross through the University of California. She needed to see a doctor over Christmas break. She tried to get a referral through the student health center but it was closed for the vacation, so we just selected a doctor off the website. The $1,000 bill was denied because we didn't go to an ER or Urgent Care center. I had actually considered taking her to the ER but thought that was a costly alternative to just seeing a doctor. At no time did the website or doctor himself put up a roadblock or warning to go through an Urgent Care center. This information was NOT clearly communicated to her or to us. We appealed the decision and though they agree that her condition was urgent, since we didn't go the Urgent Care, they're denying it once and for all. Clearly they are looking for ways NOT to pay claims. As a long time Kaiser member, I have really been horrified by our brief experience with Anthem Blue Cross -- in every way possible they are less efficient and harder to work with than Kaiser. I have literally spent more time on this one claim than I have for our whole family over 25 years at Kaiser. I see first hand how poor administration contributes to our out-of-control healthcare spending. We will be leaving Anthem at the end of the quarter to go back to Kaiser -- less convenient but infinitely preferable to staying with this lousy provider.