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Anthem refuses to pay for MRI reading

carolp99
Posts: 70
Joined: Aug 2012

Have stage 4 cancer and had a MRI in July, just received a bill for $407.00 because Anthem denied claim 2 times. They will not pay for the reading of the MRI. Have another one this Friday, and now afraid that this will not be paid either. Has anyone else encountered this problem.

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

This has not happened to me as of yet. Hate to be a broken record,but this is only the beginning with this EVIL Obama Care Plan.Insurance companies are getting a jump on the plan before it comes into full effect.There is also a long list of medications that are no longer going to be paid as well. Most are life and death drugs. Then a special democratic committee will decide if you even need medical attention.If this Bozo gets back into office then and only then will you see what this horrible plan has done to the medical field.No one wants to touch this on here,but our future health depends on this,including my own. John

yesyes2
Posts: 462
Joined: Jul 2009

Hi Carol,

I'm so sorry that you are faced with this charge for reading an MRI. I also have Anthem, but fortunitly have not been faced with this situation. Have you called Anthem to find out why it is not being covered? It could be as simple as the provider used the wrong diagnosis code and once that is fixed your claim will be paid. That has happened to me in the past. Anthem has even called the provider to help speed up payment. Did they pay the MRI charge? If they did than this really doesn't make any sense at all. If the MRI hasn't been paid for did your doctor's office get the pre-approvals? With out that the insurance companies will not pay.
And sorry John, this has been a practice of Anthem Blue Cross since Bush was in office.

Good luck Carol,
Leslie

cathyp's picture
cathyp
Posts: 366
Joined: Dec 2009

Carol,

Please call Anthem as Leslie has stated. What was the reason code on your EOB? I have had to call Anthem a number of times to get a charge straightened out or paid for. They were all resolved. If it is a matter where there has been no mistake, they provide you with the instructions on how to appeal a claim. Hang in there.
And John, sorry, Anthem is not government insurance. It is a private insurance company and I echo what Leslie said, I was calling them in the Bush days too!!!

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

No problem people. You can lead a horse to water ,but can not make it drink. BTW: The job market and gas prices are not federal either,but guess what.....God help us.If I would have been diagnosed with Lymphoma 6 months from now and not 2 1/2 years ago I do not think the good medical care I got would be there for me or any of us. I really feel for the future people being diagnosed. Its bad enough having to fight this disease and then having to fight for medical help as well. I have not added up my medical cost to the dollar,but I can tell you it is close to a million dollars and I have not paid out one dime out of pocket as of yet. If you think Obama Care is gonna allow that well so be it. Don't forget the Socialistic governments' goal is to control everything, private or otherwise. You will not hear another word out of me about this. Good Luck. John

cathyp's picture
cathyp
Posts: 366
Joined: Dec 2009

Yes John you are fortunate to have not paid a dime for your medical care. As for my self, I have had to pay well over $100,000 all these years for my medical care, this does not include the premiums I've paid. One year was very bad as we paid for Cobra coverage. If we lapsed coverage, I would have been denied insurance for my pre existing conditions. I'm having a better year as I have yet to reach my catastrophic limit. Whatever the answer is, it's been hard for me to wrap my head around fellow Americans having such a huge disparity in their cost of care.
So Carol, keep on your insurance company, hope it works out so you can minimize your expenses.

carolp99
Posts: 70
Joined: Aug 2012

Thanks guys for all your suggestions. Yes, I will call Anthem tomorrow. I hope that it's just a clerical error. Again thanks!

onlytoday's picture
onlytoday
Posts: 596
Joined: Jun 2010

Carol,

Hopefully this was a clerical error! It happens. If not... raise the roof!! I haven't had any big mix-ups post NHL diagnosis but years ago had a big one with a claim for my husband's surgery. NJBCBS denied 1/2 of his neck fusion surgery (it was two part- removal of bone from his hip which was fused into his neck). The rep said that they NEVER pay for two surgeries in one day! I went nuts- got a supervisor on the phone and then got HER supervisor on the phone and stayed on the phone for 3!!!! hours to get it fixed! It was ridiculous but eventually they got it right.

Makes me very mad when claims aren't payed correctly in the first place. A friend of mine who used to work in the healthcare industry said that he was trained to decline first and then see what happened. Meaning if we don't complain- it's over.

I have no idea if this is a widespread practice or if it is still in effect.
So please call! :)

Hugs,
Donna

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

Cathy,
Yes,by all means keep your insurance. They are looking for anyway they can to not have to pay. They will cut any corner they can to avoid any payment. I have to get on the phone every other month because of something they will not pay. So far I have won the arguements. I have Medicare and BC & BS. No problems out of Medicare yet,but the blue cross part is a pain in the ass. They do not want to pay their part. I have to argue with them everytime. This is where I heard it said from one of the reps that Obama care will give them some relief. They are not federal either. If it wasn't for the "federal" Medicare I would be in trouble. This is going to happen to all of us after the first of the year if the Socialist fixes the election again. Colorado has already caught 5,000 ILLEGALS that voted early for him.They are not sure if they are going to disallow the votes or not. WTF is that? ( they have been gauranteed FREE health care).Nothing is free,you and I will be paying for it with HIGHER premiums.That is not democracy. Sorry you had to pay so much out of pocket. I know Cobra is offered if we can afford it. John
BTW: I am not Democrate or Republican. Just a an American trying to live out whats left of the American Dream

GKH
Posts: 325
Joined: Jul 2012

My sister spent $1.4 M to treat her son for Ewings sarcoma. He lasted four years and insurance was capped at $1 M lifetime. They sold their house and car then made payments for the rest over the next 10 years. Yes some people do pay under the current system.

carolp99
Posts: 70
Joined: Aug 2012

Yes, thank goodness they did pay for the MRI. On Friday I have another MRI and I'm hoping I don't have any issues with that payment. Thanks for your help.

carolp99
Posts: 70
Joined: Aug 2012

Called Anthem this morning and talked to one of the reps. Looked over my records and said that it was just a miscommunication and that they would pay the bill. Also, told me that she would call the hospital herself. Such a relief! Again thanks for all your help.

hiccup (not verified)

Hey Carol,

Like the others said, just call 'em. You have stage 4 cancer, and that MRI has a purpose!

I have not had this type of problem... usually I spend a few days waiting for my insurance to pre-approve it. I thought it was how all insurance worked?

Anyway.. Hope you're feeling good :) - Nathan

carolp99
Posts: 70
Joined: Aug 2012

All is good! Talked to an Anthem rep this morning and she said that the bill will be paid and she will call the hospital herself. So relieved. Again thanks to everyone for all your help.

tall floridian's picture
tall floridian
Posts: 87
Joined: Dec 2011

Carol I've been very fortunate- I have 4th stage lymphoma too and all my hundreds of thousands of dollars of bills have been paid by Medicare and AARP coverage. Without those two I would be homeless and living in a cardboard box. I'm in remission now thank God - praying that I stay healthy and wondering what the future holds if my lymphoma returns. I also am concerned as John stated in his post for others that may get lymphoma-how they will be affected by Obamacare - it's something to talk over with the payment office at your doctors office. May god bless you and keep you healthy- Hugs- Steve

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