Business Profile

Insurance Companies

Anthem, Inc.

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Complaints

This profile includes complaints for Anthem, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

360 total complaints in the last 3 years.
118 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:05/07/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
RE: Denied coverage for preventive care (annual screenings)Insurer: Anthem Blue Cross Member ID: ********* Case number: REQ-COMM-******* To Whom it May Concern: I would greatly appreciate assistance with the following matter.On March 5, 2025 I visited my primary care physician for an annual physical at which time she ordered laboratory studies, as she has done every time I've had an annual exam. Prior to getting my blood drawn, the laboratory admission clerk ran an estimate of the costs based on my insurance and coverage which she estimated to be $0. However, when I received the *** from Anthem, they said I owed $296.18 for a complete metabolic panel and **** 2 lab panels they didn't cover because they were not considered preventive care. This came as a surprise since all of my insurance carriers, for decades, have fully covered these labs annually. When I contacted a representative at Anthem, she said they weren't covered because they didn't have one of the following codes: 07V, 07X, or 07Z. When I contacted ****** Health, they confirmed that the information they submitted to Anthem was correctly coded as ************* an RN for ************************************** Nursing academia for 17 years, I am shocked that a complete metabolic panel and a *** would not be considered preventive care and denied coverage for the following reasons: A Complete Metabolic Panel includes: Glucose (screens for pre-diabetes and diabetes), Sodium (screens for endocrine, kidney, and adrenal gland disease), Potassium (screens for endocrine and kidney disease), Calcium (screens for kidney, parathyroid, and thyroid disease), Phosphorus (screens for kidney disease), Creatinine and BUN (screens for kidney disease); while a *** (complete blood count) screens for blood dyscrasias, infection, bleeding disorders, and anemia. After all, these labs are screened annually as the standard of care.I am seeking reimbursment of $296.18 for labs that should be covered as preventive care.
Business Response
Date: 05/14/2025
Please see attached response for the member's complaint.
Customer Answer
Date: 05/15/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Anthem is only asking for an authorization form to discuss my complaint. The authorization form has been sent to Anthem and has been uploaded here allowing representatives at the Better Business Bureau to discuss this matter. Nothing about the bill has been addressed nor resolved. It remains my position that the labs that Anthem has refused to cover are preventive in nature and should be covered under my Health plan. The appeal is still active and has not been resolved.

Regards,

****** ******-*******
Business Response
Date: 05/22/2025
Please see attached follow-up response.
Customer Answer
Date: 05/27/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[Provide details of why you are not satisfied with this resolution.]

Regards,

****** ******-*******
Customer Answer
Date: 05/27/2025
I reject Anthem's response as it is a blatant lie that my labs were ordered as diagnostic. You can see in the highlighted text in the attached document, that my PCP ordered these labs as routine health maintenance. Also attached is my correspondence with my PCP about being billed by Anthem for these labs and she clearly responded that she was surprised since she put them in ******** system as routine health maintenance, i.e. preventive care.
Business Response
Date: 06/04/2025
Please see attached Follow up response.
Customer Answer
Date: 06/05/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Anthem's response is unacceptable and just another example of an insurance carrier trying to get out of paying what they are responsible for. Once again, the patient (me) is not responsible for billing codes and should not be in the middle of a dispute between coding by the health care provider versus what codes the insurace carrier will accept for preventive services. I have provided multiple documents indicating that the visit was an annual physical with the intent of all services, including labs ordered, to be preventive. In fact, in my original statement I mentioned that the admin clerk in the lab ran an estimate against my insurance using the codes that my provider entered and I was told it would be $0 for ALL of the labs and venipucture performed. No one ever mentioned that the facility where I had my blood drawn was associated with a hospital which doesn't make any sense since there is not a ****** hospital within miles of this location. Trying to get the codes changed by ******************* to reflect the codes that Anthem will recognize should not be my responsibility as it is entirely out of my control as the patient. In my complaint and the subsequent rebuttals, I have provided correspondence from *** **** who said that she entered the codes as preventive and an insurance carrier has never denied covering these labs before. I have been seeing the same provider for years and having my labs drawn at the same facilty, which is an outpatient lab located in the same office complex as my health care provider as well as multiple others. In fact, my prior insurance carrier, *****************, ALWAYS 100% covered the annual exam and the same labs that Anthem is refusing to reimburse. This experience has been an abomination! If Anthem wanted to resolve this dispute, they would work with ****** Health to find codes to cover these labs! I am at the point that if this dispute cannot be resolved, I will be contacting 7 on Your Side, a local media outlet that helps consumers like me by investigating and broadcasting stories like mine. In addition, I am considering changing insurance carriers as my experience thus far has been an outrage considering that I have only used the carrier once since I signed up through Covered California in January 2025.

****** ******-*******
Business Response
Date: 06/16/2025
Please see attached Follow-up Response.
Customer Answer
Date: 06/16/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Once again, this response is unacceptable. Despite Anthem's claims that they are not responsible for what is submitted by the ***, they have the ability to recognize through all of the documents provided that this visit and its subsequent lab work was preventive in nature and intended as such. At this point, I will be contacting my attorney who is standing by to file a lawsuit in this matter.

Regards,

****** ******-*******
Initial Complaint
Date:05/06/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I need Anthem Blue Cross Blue Shield, Federal, GA ID Number:R60460564 Claim Number:24276F031701CA Claim Paid On:11/11/2024 Claim Received On: 10/02/2024 Claim Processed On:11/07/2024 Patient Acct No:H103118526600 In September 2024, I underwent a heart procedure (ablation for *******************) that was covered under my insurance benefits. However, after my insurance paid the hospital bill, I was left with a surprising balance of $5,484.05, with a charge of $5,334.05 that lacked a reasonable explanation.BCBS sent me an "Explanation of Benefits" along with a copy of the bill from **************. The insurer selected the highest charge in the bill for a "medical supply," amounting to $5,334.05. This charge shares the same codes (411 and #***) as all other insurance-related charges. I have attached the bill to support my ************* is hard to believe that these two institutions expect me to pay over $5,000 without providing details clarifying my charges. Only an artificial intelligence system could produce such a perplexing and non-transparent Explanation of Benefits (EOB), which fails to reference the procedure or include ICD-CM or CPT codes.Emory Hospital has never provided a good-faith estimate for this procedure. If I had known I would be responsible for such a significant amount, I would have reconsidered my decision to proceed with the surgery, as I do not have $5,000 to spare, or I would have selected a different health system that satisfied the allowed amount from the insurance company. The fact that ************** has never informed me about the possibility of out-of-pocket expenses of more than $1,000 is deceptive business practice. I request an itemized bill from **************** that includes all ICD-10-CM and CPT codes and the names of medications and supplies used during my procedure. I want **** to review my hospital bill and medical chart and send a revised bill to ***************,***** ******* 04/28/2025
Business Response
Date: 05/19/2025
Good afternoon,
Thank you for contacting the Federal Employee Program in reference to your inquiry of 24276F031701CA. The member has a Basic option policy that has a #0% of the plans allowance for agent's, drugs and supplies until the reach an individual out of pocket of $6500. it is not possible for our office to provider the member with an estimated cost for facility services prior to the service being rendered. We have no way to determine what drugs, or supplies will be needed or if the provider encounters a problem. Our recommendation would be for the member to contact the facility and request an itemized bill for her outpatient visit. We understand this may not be the answer the member is looking for, but the claim was handled per her benefit plan.
Initial Complaint
Date:05/05/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Anthem is aware that my health insurance through the ******** Marketplace was retroactively terminated as of March 1, 2025. However, after multiple calls and multiple hours on the phone with Anthem and the ******** Marketplace, Anthem refuses to give me a refund for March or April 2025. Even though they said the termination date was May 1, 2025 Anthem charged me for an additional month's premium. They also refuse to refund that amount. I am demanding a full refund of $586.48 (premiums for March $185.77, April $185.77, and May $214.94). A service request ticket was created with Anthem. The service request ID is ***********. I have spent over 5 hours trying to communicate with both parties involved and have had both of them on the same call and we were all in agreement that March 1, 2025 was the correct termination date. Even after that Anthem refuses to refund my premium charges and continues to charge me. I am there by seeking damages in the form of $500 to $1,000 or more to settle out of court depending on how long it takes Anthem to truly resolve this issue. I've spent enough time on the phone with them but I may take the matter to court if necessary. Their continued charges and refusal to refund are unacceptable and causing financial harm.
Business Response
Date: 05/06/2025
We are unable to locate the member in our system. Please provide the member identification number complete with the three-letter prefix. This can be located on the member's identification card.

Thanks,
Paige
Customer Answer
Date: 05/06/2025
My Anthem Health Keepers member ID is ************. They should have had no problem finding my information in their system as I have provided my name and address and currently have multiple service tickets open with them relating to this issue.
Customer Answer
Date: 05/07/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

My Anthem Health Keepers member ID is ************. They should have had no problem finding my information in their system as I have provided my name and address and currently have multiple service tickets open with them relating to this issue.

Regards,

***** ******
Business Response
Date: 05/08/2025
Please be advised that member authorization is needed prior to us being able to address the members concerns. Refer to attached letter.
Thanks,
***** *.
Customer Answer
Date: 05/08/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Anthem has permission to access my account and refund my money in accordance with my complaint to the BBB over the next 10 calendar days. They have shown an obvious ineptitude to refund funds charged to me even after they admitted that my policy was to end. If at the end of the time I am allowing the refund has not been fully processed I will contact my credit card issuer and process Anthem's charges as fraud, and if they wish to dispute that action they can contest it in a court of law. My patience is wearing thin.

Regards,

***** ******
Business Response
Date: 05/09/2025
I have attached a blank form but we need the form filled out before we can proceed.
Thanks,
Paige
Customer Answer
Date: 05/12/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

*****, you do not need any forms filled out. You need to either call and get confirmation directly from me or go ahead and do the job I authorized you to do. The clock's ticking. I gave you 10 days and your time will be up soon enough. Get on with it!

Regards,

***** ******
Customer Answer
Date: 05/14/2025
Anthem was using stall tactics and wasting my time both here on the BBB website and by contacting them. How is it that the case will be closed without any resolution?
Customer Answer
Date: 05/14/2025
Here's the form Anthem requested. They didn't need it because they already had authorization.

Please reopen the BBB complaint.
Business Response
Date: 05/20/2025
Please be advised the authorization form is not filled out correctly. the member is not giving the BBB permission to act on his behalf. He needs to fill out part B and part D giving the BBB permission to act on his behalf.
Thanks,
***** *.
Customer Answer
Date: 05/20/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Please accept the amended form granting temporary permission to ******* ***** of the BBB to act on my behalf to resolve this issue.

Regards,

***** ******
Customer Answer
Date: 05/23/2025
The only additional information I have about the case is that Anthem has had the requested form for no less than 3 days and have yet to reply to me in any way. What is the hold up? I will again reaffirm that they are using stall tactics and will likely now stop communicating with myself or the BBB.
Business Response
Date: 05/27/2025
Please refer to attached decision letter.
Thanks,
***** *.
Customer Answer
Date: 05/28/2025
What is the hold up? The holiday weekend is over and I've heard nothing from Anthem or the BBB. Either resolve this issue or I will take other actions to get a resolution.
Customer Answer
Date: 05/29/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Anthem has wasted many hours of my time over several months trying to keep from refunding my money. They can't keep their story straight. They don't even know how the refunds were sent. Why send them by refunding part of it to my card and part of it they sent by mail, but they never told me the check was on its way. At this point I am demanding the $1,000.00 as compensation for having to deal with them over all of these months! I've had Anthem, the ******************************** and myself on the phone and we were all in agreement that I should have been issued the refund before May 1. Here we are at May 29, 2025 and Anthem still doesn't know what's going on.

This is Anthem's last chance to settle out of court on this matter. If ***** doesn't have the authority to make that call she'd better get in contact with someone that can do it.

Regards,

***** ******
Customer Answer
Date: 05/30/2025
Did Anthem respond? Why was the case closed if they had not responded?
Initial Complaint
Date:05/05/2025
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Attention BBB, this follow up complaint is regarding my original complaint to request Anthem BCBS ****. My previous complaint with the BBB was closed as the complaint ended up with the wrong insurance company (*************).Please submit a complaint to Anthem BCBS of ****, whose address is : *************************************************************** complaint is regarding my current facility claim processing at the incorrect out of network level of benefits. Per my home plan, an in-network PPO waiver was approved under CPT code ***** for the facility's NPI and EIN. The *** waiver approval under UM63913255 allows my claims to process at the in-network level during the approved date span. As of today, my claims are still processed towards the out of network benefit level.Please review my current issue with BCBS of Texas:*****, **** $5,550.00 FF Claim Finalized on 02/11:50385011N830X00 Allowed $2,099.55-Deductible $2,099.55 Coinsurance $0.00 Paid $0.00 02/19-Sent claim for in-network processing due to previous PPO Waiver *************: ***** Reference to call: 03/10-Closed on the 6th of March. Anthem responded on 03/03 that the claim was processed **************: ******** Reference to call: ********* Claim was sent for in-network adjustment again under case number CL-******** through the Anthem *********: ***** *.Reference to call: i-32114699
Business Response
Date: 05/05/2025
Please be advised that member authorization is needed prior to us being able to address the members concerns. Refer to attached letter.

Thanks,
Paige
Customer Answer
Date: 05/08/2025
The requested DOR Form is attached.
Customer Answer
Date: 05/09/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[Provide details of why you are not satisfied with this resolution.]
The requested DOR Form is attached.

Regards,

**** *****

Business Response
Date: 06/02/2025
Please see attached decision letter. Sorry it is late. Got dates confused.
Business Response
Date: 06/02/2025
Please see attached decision letter. Sorry it is late. Got dates confused.
Customer Answer
Date: 06/02/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

The response claims that the claims were processed at the in-network level of benefits, however, that is patently FALSE. The *** and claim screenshots I have attached show that although there was an in-network exception granted and on file, the claims were processed as out-of-network.

The company continues to not address the issue of the dispute and is now communicating false information.
The company has not met the agreement that was outlined in their communication and is now communicating false information. This a breach of contractual obligations, and I have uploaded ample evidence to support my claims. The company continues to not address the documented claims and requests, and is now communicating inaccurate and patently false information. This should be rectified by the company immediately.

Regards,

**** *****

Customer Answer
Date: 06/02/2025
I have uploaded an additional claim which was included in the pre-authorized In-Network Processing exception agreement, but was processed as out of network. This should also be rectified with the other *** claim.
Business Response
Date: 06/04/2025
Please see attached letter and documents.
Thanks,
*****
Customer Answer
Date: 06/04/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Please address the Claim #: 2025041MC0891 which was incorrectly processed as Out-of-Network, when an In-Network Exception was authorized. (screenshots and documents attached)

Regards,

**** *****
Business Response
Date: 06/05/2025
As stated in the resolution letter, the claim did process as in-network but you have a $3000.00 deductible that had not been met prior to the services. So the claim applied the allowed amount to the deductible. Your policy will only cover to the maximum allowed amount. Refer to the claims payment section of your Certificate of Coverage where it states in part:
Unlike In-Network Providers, Out-of-Network Providers may send you a bill and collect for the amount of the Providers charge that exceeds our Maximum Allowed Amount unless your claim involves a Surprise Billing Claim. You are responsible for paying the difference between the Maximum Allowed Amount and the amount the Provider charges. This amount can be significant. Choosing an In-Network Provider will likely result in lower Out-of-Pocket costs to you. Please call *************** for help in finding an In-Network Provider or visit our website at ******************************.
Your cost share amount and Out-of-Pocket Limits may vary depending on whether you received services from an In-Network or Out-of-Network Provider. Specifically, you may be required to pay higher cost sharing amounts or may have limits on your benefits when using Out-of-Network Providers. Please see the Schedule of Benefits in this Booklet for your cost share responsibilities and limitations, or call *************** to learn how this Booklets benefits or cost share amounts may vary by the type of Provider you use.
Customer Answer
Date: 06/06/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

You are saying that the claim did process as in-network, and I have provided evidence that clearly shows it was processed as out-of-network.
You then say to refer to the claims payment section of my Certificate of Coverage where it states in part:

"Unlike In-Network Providers, Out-of-Network Providers may send you a bill and collect for the amount of the Providers charge that exceeds our Maximum Allowed Amount unless your claim involves a Surprise Billing Claim. You are responsible for paying the difference between the Maximum Allowed Amount and the amount the Provider charges. This amount can be significant. Choosing an In-Network Provider will likely result in lower Out-of-Pocket costs to you. Please call *************** for help in finding an In-Network Provider or visit our website at ******************************.
Your cost share amount and Out-of-Pocket Limits may vary depending on whether you received services from an In-Network or Out-of-Network Provider. Specifically, you may be required to pay higher cost sharing amounts or may have limits on your benefits when using Out-of-Network Providers. Please see the Schedule of Benefits in this Booklet for your cost share responsibilities and limitations, or call *************** to learn how this Booklets benefits or cost share amounts may vary by the type of Provider you use."
Why would you refer me to information on an out-of-network provider, while also saying the claim was processed in-network? The claim was processed Out-of-Network, and we had an authorized In-Network Exception for the provider used.

Please address this, as I have provided ample evidence that the claim was incorrectly processed out-of-network and should have been processed as in-network. Please see the attachment titled **** ***** - Out Of Network Processing Error, where it clearly shows in the top right that the claim was processed as out of network. I also have seen no evidence that any amount of this EOB charge was applied to any deductible.
Please address these claims and attach supporting evidence, as I have done.
Regards,

**** *****

Business Response
Date: 06/10/2025
Please see decision and attached documents.
Thanks,
*****
Customer Answer
Date: 06/16/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I was explicitly told by multiple people from Anthem that the claim was processed out-of-network citing that "the codes that were submitted were not approved." Feel free to pull those call logs to confirm this.

I also never saw that amount applied to my deductible. Please provide documentation showing that amount being applied to my deductible for 2024.

Regards,

**** *****
Initial Complaint
Date:05/01/2025
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Premiums have been paid monthly on auto debit. Company keeps telling me that they have not received them, but I have screenshots of the payments and company showing that they received them. Today they cancelled my policy.
Business Response
Date: 05/02/2025
We are unable to locate the member in our system. Please provide the member identification number complete with the three-letter prefix. This can be located on the member's identification card.

Thanks,
***** *.
Customer Answer
Date: 05/02/2025
Just to clarify complaint is for Anthem Dental. I am including my dental ID card for Anthem dental.
Member ID for ********************** dental is
091W19142 included a picture.
Customer Answer
Date: 05/02/2025
Just to clarify complaint is for Anthem Dental. I am including my dental ID card for Anthem dental.
Member ID for ********************** dental is
091W19142 included a picture.
Customer Answer
Date: 05/02/2025
Auto payment has been set up. And they deny the fact that these payments have been automatically deducted each month
Customer Answer
Date: 05/02/2025
Auto payment has been set up. And they deny the fact that these payments have been automatically deducted each month
Customer Answer
Date: 05/03/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[Provide details of why you are not satisfied with this resolution.
Anthem Dental has continued to take out auto payments monthly but does not show these payments were made towards my account.

Regards,

******* *******
Initial Complaint
Date:04/30/2025
Type:Delivery Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
MY SON WHO IS A MINOR IS INSURED THROUGH HIS DAD AS PRIMARY INS SON IS **** ****** 06/02/2012, MY SON HAD LABS DONE LAST YEAR AND A PROCEDURE DONE FROM JULY 2024 TO SEPTEMBER 2024, WE HAVE 3 KIDS ON THE SAME PLAN THROUGH DAD WHOS ALWAYS BEEN PRIMARY AND MY HUSBAND SECONDARY...THEY HAVE DENIED ALL ***** CLAIMS BECAUSE THEY WANT A DIVORCE ORDER AND THERES NO ORDER.
Business Response
Date: 05/02/2025
Good afternoon,
We were unable to locate the member in our system. Please provide the member's identification number, including the three-character prefix. This information may be found on the member's health plan identification card.
Thank you,
******** *.
Initial Complaint
Date:04/30/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was eligible for Covered California as of 01/01/25 and qualified for premium assistance. My enrollment status is still active. My premium with Anthem Blue Cross on the Covered California records are just under $150 a month. Coverage started 01/01/25. I received a letter today dated April 8, 2025 welcoming me as a new member to the plan and saying that as of February 1, 2025 my monthly premium is over $1000 and I owe them over $4000 in unpaid premiums. There has been no change to my income. The W2 income that my eligibility was based on began on or around 01/07/25. Therefore, I am eligible for the premium assistance and the rate of $147 per month since 01/01/25.
Business Response
Date: 05/08/2025
Please see attached response for the member's BBB complaint.
Initial Complaint
Date:04/29/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I do not trust Large businesses. So I MEVER give authorization for card/payment information to ever be stored in any system for future use. I always call and make payments, every month, so i can verify *** agree with thr funds before taken. Somebody within Blue Cross stored my card info ILLEGALLY without my permission. I have spent 2 months being told it would be removed. It still is not. So I attempt to cancel my Debtal/Health insurwnxe because I obviously can not trust anyone in that company to do what they say. Now, they won't cancel my service. Says "they will but takes a couple days". Obviously I can NOT trust anything to be done. I tried contacting my bank to put a block on this company. I need an answer/help to cancel this service and to know how/why they saved my card info; and WHY they won't allow me to cancel services immediately. Unbelievably Infuriating.
Business Response
Date: 04/30/2025
We are unable to locate the member in our system. Please provide the member identification number complete with the three-letter prefix. This can be located on the member's identification card.

Thanks,
***** *.
Initial Complaint
Date:04/16/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My complaint stems from the fact that I paid an April payment that was supposed to take care of my March payment cuz I got behind. And then when I go to make my April payment after I already paid my March payment on April 7th 2025, they have the audacity to try to say that I owe 2 months when I only owe April so I am not going to deal with them anymore this is my complaint and this is what I have to say
Business Response
Date: 04/17/2025
Good morning,
We were unable to locate the member in our system. Please provide the member's identification number, including the three-character prefix. This information may be found on the member's health plan identification card.
Thank you,
******** *.
Initial Complaint
Date:04/14/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am filing a formal complaint against Anthem Blue Cross Blue Shield of Georgia for wrongfully terminating my Marketplace health insurance plan despite receiving my first premium payment of $4.00 on February 19, 2025. I received ID cards and a welcome packet confirming active coverage. However, Anthem failed to provide the legally required notice of payment rejection and later claimed my policy was terminated, though it still appeared active in another internal system.Because of this error, I was denied access to my account and unable to make further payments or access benefits. At the time, I was recovering from major reconstructive knee surgery (ACL and meniscus repair) and missed over a month of medically necessary physical therapy. Anthem reinstated my plan only after I escalated my complaint and obtained a recorded admission from their representative (******) confirming Anthems internal error and lack of notice.Their plan also enforces a 20-visit per year cap on physical therapy, which is medically inappropriate for my long-term surgical recovery and contradicts ACA essential health benefit protections. I provided documentation from multiple physicians and still received no proactive resolution until I involved state agencies. Ive filed with the ******************************* (Complaint #*********) and now seek public accountability.I am requesting:A formal written apology and policy correction Full policy reinstatement retroactive to March 1, 2025 Override of the 20-visit therapy cap due to medical necessity Formal support for my damages claim of $30,000 based on: Physical and emotional harm Denial of care Administrative ****** ***-related interference with post-surgical rehab Full retroactive reinstatement to March 1, 2025, waiver of the 20-visit PT cap, $30,000 in damages for harm caused, and formal changes to internal notification and handling processes.
Business Response
Date: 04/16/2025
Please be advised that member authorization is needed before we can address the members concerns. Please see attached letter.
Thanks,
*****
Customer Answer
Date: 04/16/2025
I am rejecting Anthems response. This is not a third-party HIPAA violation I am the member who submitted the complaint. Anthem already received my name, date of birth, member ID (BYH **********, address, and documentation through BBB, including signed materials, proof of payment, call transcripts, and doctor letters.

Anthem is using HIPAA as a deflection to avoid addressing public accountability and regulatory violations Ive already raised: wrongful termination of my Marketplace policy, failure to provide a rejection notice, denial of medically necessary care, and violation of *** and ADA ************************ have also filed with the ******************************* (Case #*********) and am appealing through the Georgia Access/HHS system. This BBB complaint does not require the release of confidential medical records. It is about *********************** documented misconduct including recorded admissions by their **** and the damage caused to my recovery.
Heres your form now answer the complaint. please address each part of the complaint, including my demand for restitution.
Anthem is improperly citing HIPAA as a barrier to responding, but this is a public consumer complaint about administrative misconduct and denial of access to care not a request for confidential health records.
Their refusal to respond is a delay tactic to avoid addressing their own admitted failure, which caused missed medical care and emotional distress. I am preparing to escalate this further through CMS/HHS and the media if needed. In good faith, I will provide a completed Designation of Representative form (DOR) to eliminate this excuse. addressing each part of the complaint.

Customer Answer
Date: 04/16/2025
Subject: Continued Access Issues with Anthem's System - Hindering Progress
Dear ******* *****,

I am following up on my complaint (ID ********* regarding Anthem, Inc., and I need to update you on the ongoing technical issues I am facing, which are preventing me from moving forward with this matter.

For the past month, I have been unable to access Anthems system despite numerous attempts. This issue is preventing me from completing several critical steps, including submitting necessary forms, making payments, and uploading required documentation such as the Department of Insurance report (DoR).

To further emphasize the severity of the issue, I have recorded three calls with Anthem representatives during which I clearly explained that I cannot access my account. During these calls, it was confirmed that the system does not recognize any of my information, and I have been unable to proceed with any of the required actions.

I have full transcripts of these calls and the recordings, which I can provide for your review. These recordings show that the access issues are ongoing and have been raised multiple times with Anthem, yet they remain unresolved.

This situation is a major barrier to resolving the issue, and I believe it is important for the BBB to include this in my case. The inability to access my account and make the necessary payments or submit forms is significantly hindering the next steps in this process.
Please let me know if I can provide the recorded calls and transcripts, and thank you for your continued assistance in escalating this matter.

Sincerely,
Antaniah ******
************

Business Response
Date: 04/18/2025
Please be advised that the member has to fil out an actual authorization form. One is attached to this request.
Thanks,
Paige
Customer Answer
Date: 04/21/2025
Better Business Bureau:
I am rejecting and updating this complaint to state that as of today, I still have not received any written communication, email, or documents from ****** or Anthem, despite her recorded promise on our last call to send everything to me that same Wednesday. This includes the medcal reinstatement notice, therapy cap clarification, and policy resolution. This is not just negligence its a breach of duty, a violation of your ACA rehab protections, and evidence of bad faith conduct. ( see ATTACHED PHONE CALLS ) from the phone call - phone calls cant lie but people can )

****** openly acknowledged on our call that Anthem failed to send me a rejection notice and admitted this was their error. Yet even after this admission, I was left waiting again with no follow-up, no confirmation, and no accountability.

I have now gone over two full weeks without access to medically necessary physical therapy following state-approved ACL and meniscus surgery. My orthopedic surgeon has explicitly stated he will not be held liable for complications or damage due to Anthem's failure to maintain care continuity. The surgery was approved, but therapy which is standard, mandatory post-op care has been denied through Anthem's mishandling. You cannot approve a mandatory surgery and then block recovery care. has been denied through Anthem's mishandling. You cannot approve a mandatory surgery and then block recovery care.
This has severely impacted my ability to walk and to fully extend my leg. The damage caused by these delays may be permanent. I have every lie, contradiction, and broken promise recorded including Anthem **** acknowledging their system errors, misleading statements, and failed internal transfers. This has caused extreme physical,emotional, and legal harm, and I will not stop until there is full resolution and restitution.
_______________________________________________________________________________________________________
Anthems current 20-visit physical therapy cap is medically inappropriate and violates my right to adequate, continuous post-operative care. My orthopedic surgeon who performed my ACL reconstruction and meniscus repair surgery approved through the State of ******* specifically prescribed 2 to 3 physical therapy sessions per week as part of my standard recovery plan.
That means I would exhaust Anthems entire annual therapy limit in just 6 to 8 weeks when the medical standard for ACL rehab is 912 months of progressive physical therapy. You cannot approve mandatory surgery and then block the required rehabilitation that determines its success.
A total of 20 sessions is not sufficient for anyone recovering from major joint reconstruction, much less someone relearning how to walk, stabilize their knee, and restore range of motion. My leg cannot fully extend, and I am at risk for re-injury and long-term disability due to this interruption in care.
Anthems cap violates ACA essential health benefit protections related to habilitation and rehabilitation services, and their failure to make medically necessary exceptions especially after admitting fault in my case is a violation of federal standards and basic decency.
That 20-session cap Anthem is hiding behind is not just medically wrong its legally indefensible, especially when your doctor prescribed 23 sessions per week and you're recovering from a state-approved reconstructive surgery.

Customer Answer
Date: 04/25/2025

Subject: Update to BBB Complaint - Additional Violations and Requests for Resolution
Dear [BBB Representative's Name],

I am writing to provide an update to my ongoing complaint against Anthem Blue Cross Blue Shield (Complaint ID: *********, which highlights further violations and misconduct regarding my health insurance coverage. Despite repeated efforts to resolve these issues directly with Anthem, I continue to face substantial medical harm due to their failure to honor their obligations. This update serves to document Anthem's ongoing violations and to request the immediate resolution of these matters.

New Violations:
Failure to Authorize and **********************Surgery Physical Therapy: My ACL and meniscus surgery, approved by the state of Georgia, was contingent upon 9-12 months of physical therapy as part of my medical recovery plan. Anthem, however, has failed to authorize and has denied access to physical therapy services for over two weeks, which directly impedes my recovery and puts me at significant risk of further medical complications. Without physical therapy, I cannot regain proper mobility and walk again, which is essential for my recovery. This constitutes a failure to provide necessary care that was clearly indicated in my medical records and communicated to **********************.

Failure to Fulfill Promises and Provide Written Confirmation: On April 14th, 2025, during a recorded conversation with Anthem representative ****** *****, she acknowledged Anthem's error in terminating my policy and promised to send follow-up documentation by Wednesday, April 16th to resolve the issue. To date, I have received no written confirmation or follow-up from Anthem. This failure to meet their promise further complicates my ability to receive the care I need. This non-compliance is contrary to Anthem's obligation to resolve disputes promptly and in writing.

False Claims of Payment Rejection and Failure to Investigate: Anthem has repeatedly asserted that my payment was rejected by my bank. However, I have submitted proof of successful payment to Anthem, including bank records confirming the transaction. Anthem has failed to investigate this matter thoroughly and continues to claim a false payment rejection, which has delayed the processing of my benefits and violated my rights under the Patient Protection and *************** Act (PPACA).

Failure to Correct Errors in Member Information: Despite Anthems failure to correct errors related to my personal information, I have been forced to use a fraudulent address to access customer service, resulting in continued delays and denials. This issue was reported to Anthem repeatedly, and the company failed to correct it, violating their responsibility to maintain accurate records and process claims correctly.
Legal and Contractual Obligations:
Under both state and federal law, including provisions of the *************** Act (ACA) and ERISA, Anthem is obligated to provide necessary care as part of my health insurance plan. They have failed to meet these obligations by denying access to necessary post-surgical care, failing to honor their promises to follow up, and continuing to rely on false claims to justify their actions.

Requested Resolution:
Immediate reinstatement of all necessary benefits, including physical therapy for my recovery, retroactive to the date of my surgery on April 9th, 2025.

Immediate written confirmation from Anthem acknowledging their errors and outlining the steps they are taking to resolve these issues. This should include a clear plan for how they will address the ongoing failure to authorize treatment and correct personal information errors.

A full investigation into the systemic errors and failures outlined in this complaint, including an internal review of the actions taken by representatives such as ****** *****, and a comprehensive plan to avoid similar issues in the future.

Supporting Documentation:
For your reference and review, I have provided the following evidence:
Recorded phone calls and call transcripts from interactions with Anthem representatives, including the April 14th, 2025 conversation with ****** *****.

Medical records confirming the need for 9 months of physical therapy and detailing the necessity of timely recovery.
Email correspondence and written promises from Anthem representatives.
Phone records confirming the failure to follow up as promised and providing proof of denied access to physical therapy.
Bank records and proof of payment to Anthem.

Next Steps:
I request that Anthem provide a written response within 7 days confirming the reinstatement of benefits and providing a clear plan for resolving the ongoing issues. If this matter is not resolved within the specified timeframe, I will escalate this complaint to the *******************************, ******************************************** (***), and the ************************************ (****), and will pursue all legal avenues available.

Thank you for your continued attention to this urgent matter. I trust that BBB will ensure Anthem complies with its legal obligations and provides the necessary support to resolve this complaint.

Emploee names are as follows :
*********************************************** ( April 8th call )
************************************************************************** ( April 14th call )

Sincerely,
Antaniah ******
Member ID: BYH *********
Phone: ************ / ************
Email: ****************************************

Attachments:
BBB Complaint Documentation
Phone Records and Transcripts
Medical Records and Therapy Letters
Emails with Anthem Representatives
Proof of Payment

Business Response
Date: 04/25/2025
Refer to attached resolution letter.
Thanks,
Paige
Customer Answer
Date: 04/25/2025
BBB Rebuttal to Anthem Blue Cross Blue Shield
Complaint ID: ********
Member ID: BYH *********
Submitted by: Antaniah ******

I am rejecting Anthems response for the following reasons:
Their response ignores the facts, documentation, and timeline of this dispute.
I submitted payment on February 19, 2025, through the Georgia Access Marketplace. I received confirmation from both HealthSherpa and Anthem (Exhibits D and E), along with my insurance card and welcome materials yet I was locked out of their systems and unable to make any further payments.

Anthem already admitted this was their error.
On April 8, representative **** confirmed in writing that my case was escalated due to an Anthem system failure where one department marked my policy terminated and another showed it active. This was confirmed again in my April 14 call with ******, who stated my policy was reinstated due to Anthems error and I had 710 business days to make a payment yet I received no working contact number to complete the transaction.

The payment portal and system were never made accessible.
I attempted to pay via phone, app, and website all attempts failed due to system recognition errors. I have screenshots and call records to prove this. ****** herself confirmed in the call that **** cannot accept payments unless enrollment and billing clear the account which they failed to do.

I never received written instructions or follow-up.
****** promised an email by April 17, which never came. Mr. ******** (supervisor) did not call until April 18, left no voicemail, and never followed up via email. This contradicts their statement that outreach was attempted appropriately.

I am recovering from major ACL and meniscus surgery and being denied access to medically necessary physical therapy.
This denial of care due solely to Anthems system failure puts me at risk of permanent damage, violates ACA protections, and potentially violates ADA ********** I have submitted medical documentation, therapy letters, and call transcripts proving the urgency of care and Anthems negligence.

What I Am Requesting Now:
Immediate retroactive reinstatement of my policy to March 1, 2025
A full technical fix and working access to my member account and payment systems
A written apology and acknowledgment of the mishandling and system error
That no lapse or penalty be recorded on my policy due to Anthems failure
Confirmation that my physical therapy care is authorized immediately as part of state-approved post-surgical recovery
A full investigation by Anthem's Regulatory/Compliance division
Key Problems in Anthems Response (from ***** *.)
They ignored all evidence of system failures and wrongful termination.
? No mention of your initial payment confirmation, policy activation, or system lockouts.
? No reference to the April 8 email from ****, your April 14 call with ******, or the reinstatement already approved.
They falsely imply its my fault for not paying.

? But their own **** ******** *****) confirmed you were blocked from paying due to their internal error.
? You tried every channel online, ****** app, phone none worked.
They place the burden of proof on you to justify medical care.
? They also fail to acknowledge your post-op status, doctor's letters, and the urgency of care for recovery.
They completely skipped over all complaints of misconduct, broken promises, and emotional/physical harm.

? No mention of ****** promising an email by April 17.
? No mention of Mr. ******** failing to email.
? No apology for call hang-ups, system errors, or three-hour escalation calls.
I am submitting this rejection to the BBB and will also be forwarding this complaint to the *******************************, CMS/Marketplace, CFPB, and the ******************************. I am preserving all documentation, emails, call transcripts, and phone records for regulatory review and legal use.

Sincerely,
Antaniah ******
Email: ****************************************
Phone: ************ / ************
Member ID: BYH *********
( in case I decide to handle this legally I will be preserving all recorded calls, transcripts, emails and documented each unethical behavior)
_________________________________________________________________________________________________________
Today I spoke with ******** ***** regarding making a payment for my health insurance. She stated I could no longer make a payment because the timeline expired. I was told that nothing could be done and that I would need to restart the process entirely, which contradicts the earlier information I had received. This is preventing me from making a payment as I was led to believe that I still had time before the May 1st deadline.
I kindly request that Anthem ******************* address this situation promptly by either allowing me to make the payment over the phone as originally agreed upon or providing an explanation for the conflicting information Ive received.
Thank you for your attention to this matter. I know on the phone they said it was a 4.00 payment please confirm about as I am trying to make payment that ****************************************** she refused and would not allow me to make payment - I have the full recorded call and transcript for anthem review
Customer Answer
Date: 04/30/2025
Subject: Follow-Up Evidence Failed Resolution & Inability to Pay Due to Anthem Errors
This is additional documentation related to my ongoing complaint against Anthem (Case ID: *********.
On April 29, I engaged in direct email communication and a phone call with ***** ****** from Anthem's Grievance & ******************* During this call, ***** admitted she did not send me the original "resolution" email because she had mistyped my email address and "hadn't had her coffee" as stated on a recorded call. This is critical because she previously told the BBB that I was notified and simply needed to make payment. In fact, I attempted to make payment multiple times, including on a 3-way call on April 29, but Anthem failed to process it and offered no working solution before their stated May 1 deadline.
I emailed ***** at 1:07 p.m. and 1:18 p.m. on April 29 to request support making payment. She responded that she would try to get a better number from a manager who was unavailable until the next day. I was never provided any confirmed route to make a timely payment. This contradicts Anthems claim that reinstatement was dependent on prompt payment they blocked the ability to pay
I am requesting that this new information be added to my complaint record and that BBB hold Anthem accountable for the following:
Falsely claiming I received written reinstatement details
Blocking my ability to meet their deadline
Misleading and contradicting communications from multiple reps
Documented delays that disrupted medically necessary post-operative therapy
I have submitted this same information to the *******************************, the ****, and will be forwarding to CMS and HHS for formal civil rights and ADA ******* I expect Anthem to be held accountable for misrepresentation and obstruction of care.
I am happy to provide additional call transcripts and emails if requested.

Antaniah ******
Member ID: BYH *********
Phone: ************
Email: ****************************************
Business Response
Date: 05/01/2025
Please see attached decision letter.
Thanks,
Paige
Customer Answer
Date: 05/01/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

To Whom It May Concern:

I am formally rejecting Anthem Blue Cross Blue Shield's response to my BBB complaint for the following reasons, all of which are documented and supported by recorded calls, emails, and medical documentation:

Wrongful Termination and Delay of Coverage: Anthem improperly terminated my policy and later admitted it was a system error. Despite reinstating my policy after significant delay, they denied coverage for urgently needed post-surgical physical therapyeven though I was told by multiple representatives, including a supervisor named *** ******** (who promised a call back after April 25th), that I had full reinstated benefits and should not worry. No such callback occurred, and no help was provided.

Failure to Pay for Post-Surgical Therapy: I underwent a medically necessary surgery with pre-authorization, and my recovery required immediate physical therapy. Despite having insurance coverage at the time and being assured of eligibility, Anthem has refused to pay, stalled the approval process, and forced me to go without carecompromising my recovery and causing significant medical hardship.

Violations of Georgia State Law:

Anthems failure to provide timely coverage and payment violates the Georgia Prompt Pay Act (O.C.G.A. 33-24-59.5).

Their deceptive practices and failure to honor their contractual obligations violate the Georgia Fair Business Practices Act (O.C.G.A. 10-1-390).

Violations of Federal Law:

Under the Americans with Disabilities Act ***** 42 U.S.C. 12181-12189), Anthems delay and denial of care following my surgery and the failure to accommodate my post-operative needs constitute discriminatory actions.

Under the *************** Act (ACA), insurers are required to ensure timely access to medically necessary servicessomething Anthem failed to do.

Negligent Infliction of Harm: Because of Anthem's admitted system failure and refusal to approve essential care, I experienced physical regression, emotional distress, and financial damage. I was forced to delay essential rehabilitation, leading to further complications and long-term impact on my health.

Proof of Wrongdoing: I have documented:

Recorded phone calls with Anthem representatives confirming reinstatement and eligibility.

Written communication acknowledging Anthems internal system error.

Proof that I had surgery under the plan and attempted to access covered therapy services afterward.

Medical documentation showing that delay in care has negatively impacted my condition.

This is not just a customer service failureit is a legal and ethical violation.

I am preserving this record as evidence for ongoing complaints with the *******************************, the ******************************************************************** (***), and as part of future legal action for damages under both state and federal law.

I request the BBB to keep this complaint open as unresolved and on record to reflect the ongoing harm and failure by Anthem to resolve the issue or take accountability.

Sincerely,
************
Antaniah ******

Business Response
Date: 05/05/2025
She was given the correct information and a supervisor contacted her and left a message with a callback number. Ms. ****** called her back and was able to make payment and her policy has since been reinstated.
Thanks,
***** *.
Customer Answer
Date: 05/06/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint.

Rebuttal to Anthem's Response
BBB Case ID: ********
Member Name: Antaniah ******
Date: May 6th 2025

Dear Better Business Bureau,

I am formally rejecting Anthem Blue Cross and Blue Shields response to my complaint. The company has failed to address the core issues of my claim, and their actions continue to violate both state and federal laws regarding the provision of medically necessary care and insurance practices.
The delays have contributed to significant emotional and physical distress, as I am unable to recover from a surgery that was approved by the STATE OF GEORGIA. The lack of physical therapy has left me in a constant state of pain and jeopardized my ability to return to normal functioning.
Why the response is unacceptable:
Anthem caused the delay by failing to allow payment:
I attempted to pay multiple times and was denied access or given conflicting instructions by reps.
I was promised call-backs from Mr. ******** after April 25 and from ****** via rep ****** these never happened.
My surgery and post-operative care were approved, yet Anthems administrative failures prevented me from receiving medically necessary physical therapy crucial for me to walk again. This contradicts Georgia healthcare laws and potentially violates provisions of the *************** Act, the Rehabilitation Act, and state disability protections.
Their letter says I must submit medical records to appeal PT limits however, the issue is not about appeal rights but the fact that:
Anthem withheld coverage, then refused to accept payment until the last minute.
I was already under a GEORGIA STATE APPROVED surgical care plan.
I am now in worse physical condition due to these delays and denials.
Here are the key points of concern:

1. Failure to Provide Medically Necessary Physical Therapy
The minimum standard of care for my recovery after a major surgery, approved by the State of Georgia, is 9-12 months of physical therapy. However, I am currently only in the 4th month of recovery and have not received any physical therapy for over a month, which significantly hinders my recovery. I have already experienced a fall while trying to manage the pain and regain balance on my own. This delay in essential care is directly harming my health.

2. Anticipated Harm from Delay in Treatment
As my doctor has confirmed, my recovery cannot progress effectively without consistent physical therapy. Without therapy, I am at risk of prolonged pain, worsening mobility, and an increased chance of permanent disability. This is especially concerning given the nature of my surgery and its approval by the state as medically necessary.

3. Anthems Inaction and Delayed Response
I have provided all the necessary documentation to Anthem regarding the medical necessity of continued physical therapy. Despite this, Anthem has failed to extend my therapy coverage unless I provide additional proof of medical necessity, despite the fact that I have already submitted comprehensive medical records. *********************** actions are effectively denying me access to the care I need, causing severe financial, physical, and emotional harm.

4. Legal Violations
Anthems actions violate several state and federal laws:

Georgia's ******************* Statutes (O.C.G.A. 33-6-7): Anthem has delayed or denied my benefits without valid reason, which constitutes bad faith under Georgia law.

The *************** Act (ACA): The *** mandates timely access to medically necessary services, and Anthems delay in approving my continued physical therapy is in violation of this federal law.

By blocking my access to medically necessary physical therapy, Anthem is also engaging in unlawful discriminatory practices by impeding my recovery due to bureaucratic delays.

5. Request for Peer-to-Peer Review
I am requesting an immediate Peer-to-Peer review between my physician and Anthems medical reviewer to expedite the approval of my physical therapy. The current situation has gone on far too long, and further delays in addressing my health needs are unacceptable.

6. Next Steps
If Anthem continues to fail in fulfilling its obligations to provide necessary care, I will be filing formal complaints with the ***************************************. Additionally, I will pursue legal action, including seeking monetary damages for the harm caused by Anthems failures to act in good faith.
Summary of Violations:
Negligence: Anthem knew of my urgent post-surgical needs and failed to act.
Breach of contract: I was entitled to care and had coverage tied to an already approved surgery.
Bad faith conduct: Multiple promises were broken, and internal confusion caused prolonged harm.
Violations of Georgia law: Denial of access to care and mishandling of coverage for a disabled patient.
Federal violations: Potential ACA noncompliance and civil rights failures under disability law.
Final Note:
I have submitted formal complaints to:
The *******************************
HHS/Marketplace
Anthem has not taken accountability for the harm done and their response fails to address the core issue: they denied and delayed urgent care during a critical recovery window. I reject their response and reserve all legal rights.
Anthem has failed to adequately address my concerns, and as a result, I am proceeding with legal action for breach of contract, bad faith insurance practices, and violations under the *************** Act. I will also be seeking compensation for the damages incurred, including financial loss, physical harm, and emotional distress."
Please keep me informed of any updates regarding this complaint, as I continue to seek a prompt resolution to this matter.
Thank you for your assistance in this case.
Sincerely,
Antaniah ******

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