Marathon Life

Sunday, August 09, 2009

Grievance Victory!

I knew the day had come. On my way to pick up the mail at my PO box I was extremely nervous to receive a letter from Anthem Blue Cross. It had been 30 days since I filed a grievance with Anthem concerning my emergency larparscopic appendectomy I had in NYC on June 9. Apparently the surgeon they used for the surgery was "out of network" so I would have to pay for anything they deemed above "Usual, reasonable and customary". So I was slapped with an overage of $1200 and filed the grievance since it was so unfair. See my post here to read the entire background.

The letter I received on Friday stated, "Upon review of the above-mentioned claims we have found that services have been processed according to your in-network benefits. The provider of service, Dr. *****, is a participating provider. The claims were originally processed under your HMO group number and this provider does not participate in the HMO network. We have adjusted the claims to be processed under your PPO plan group number. We apologize for any inconvenience this may have caused."

This entire ordeal is so strange since I was told directly from an Anthem service rep that the surgeon was NOT in the PPO network and I would have to pay the overages. That is why I filed the grievance in the first place. Why was I told one thing and now this letter is reflecting the opposite? I guess I am not going to question this further. Frankly, I would like to keep the $1200 I would have had to pay. It's just a clear example of a severely screwed up health care system.

The ENTIRE TIME no one at Anthem Blue Cross could have simply looked up the surgeon's name in a fucking database and found out he was "IN NETWORK" according to my PPO plan??? This is the US health care system at its worst. Unproductive. Wasteful. Inefficient. Unsatisfactory. Note to President Obama, please fix this! I really hope a heath care bill can get passed in 2009. I already know that not everyone is going to be happy with this reform but this country needs something. There are too many people who have no insurance and then end up in the ER with a $28,000 bill and no way to pay it.

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posted by Anthony at 8:36 PM


Blogger Denis said...

Anthony, the healtinsurance companies do this all the time. few people bitch about their claims like you do. they count on this as part of doing business

12:19 PM  
Blogger Anthony said...

I can't believe that people would just sit back and pay something they don't have it. Ridiculous!

11:27 AM  

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