Impatient | Helping make the health care system work for you

More voice frustration with Anthem and other insurers

Anthem says it stands ready to help members who need help with issues regarding their health insurance.
Anthem says it stands ready to help members who need help with issues regarding their health insurance. Creative Commons

Last week, KPCC reported that Consumer Watch had filed a class action lawsuit accusing Anthem Blue Cross of fraud and unfair business practices "allegedly intended to lure customers into buying its health insurance plans."

I asked Impatient readers if they’d ever felt misled by Anthem Blue Cross, or another insurance company. A number of people responded on this blog and on the KPCC Facebook page, telling us about their frustration, confusion, and annoyance regarding their insurance companies.

"I don't know if the word 'mistreated' is quite strong enough," Rachel Yonda wrote on Facebook.

Yonda said she switched to Anthem at the beginning of the year because of a "'bait and switch' situation" with Blue Shield. After moving to an Anthem EPO plan, "we are continually surprised by what isn't covered, and finding an unexpected amount of fairly routine care is subject to our deductible (so not being covered at all for the time being)," she wrote.

EPO headaches

The lawsuit alleges that Anthem misrepresented its Exclusive Provider Organization (EPO) health service plans, with no out-of-network coverage and benefits, as Preferred Provider Organization (PPO) health services plans, which do provide out-of-network coverage and benefits.

On this blog and Facebook, several people expressed frustration with their EPO plans. A spokesman for Anthem defended these plans, saying they were approved by Covered California.

"The whole EPO thing is definitely confusing," Maryam McMullin commented on Facebook. "How about the fact that it can sound exactly like PPO, especially over the phone."

"Yes! I knew this was coming!" Caress Johnson Brown wrote on Facebook in reaction to the lawsuit. "The EPO/PPO switch happened to me. I want in!"

More frustration

Kriss told her story in Impatient's comments section. Her weeks-old baby needed to see a specialist and, she says, Anthem took eight days to approve the doctor's urgent request for a referral to a children's hospital.

"It has been weeks since the pediatrician told me that my son needs to see the specialist, that it's urgent and we should not wait, but we don't even have an appointment yet, all because of Anthem Blue Cross HMO," wrote Kriss, who did not include her last name.

"You think you have decent insurance, until you try to access care and then you learn that all you have is a policy of: wait, stall, delay and denial."

On Facebook, Jason Schmidt shared that he's undergone a litany of prescription issues with Anthem: "Denied coverage on a medication I have been taking for 6 years," he wrote. "Misfiled claims, Rx delays/denials, horrible customer services, the list goes on."

Anthem responds

I shared several of these stories with Darrel Ng, a spokesman for Anthem. Here's his response:

"Over the last 12 months, healthcare in America and California has fundamentally been transformed. Because of that, we know that there will be a transition period. Anthem members who need help navigating the system should contact our customer support system so we can assist."

Have you felt misled by your insurance company? Tell us about it in the comments section, or e-mail us, We’re listening.