In 23% of the investigated claims, Anthem has done something wrong? I’m surprised it’s not higher!
I bought my Anthem PPO policy after reading their marketing materials and understanding that we would have the ability to go out of network. (this is the most expensive plan offered through my employer) The coverage was 70% rather than the 90% within network.
So, I had my child treated by the (non-network) specialist in the area and submitted the bill for $175. Anthem applied $4.80 to my deductible. That is 2.7% of the charge. OK, their marketing material talks about getting less when you go out of network because you don’t get the negotiated rates. They show an example of getting about 26% of the billed cost.
2.7%????? You gotta be kidding me. If that is actually correct, I should have chosen one of the cheaper plans which would have allowed me to pay out of pocket with the premium difference.
We are currently in the appeal process. We’ll see. If it stands, we will be changing plans next open enrollment!
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In 23% of the investigated claims, Anthem has done something wrong? I’m surprised it’s not higher!
I bought my Anthem PPO policy after reading their marketing materials and understanding that we would have the ability to go out of network. (this is the most expensive plan offered through my employer) The coverage was 70% rather than the 90% within network.
So, I had my child treated by the (non-network) specialist in the area and submitted the bill for $175. Anthem applied $4.80 to my deductible. That is 2.7% of the charge. OK, their marketing material talks about getting less when you go out of network because you don’t get the negotiated rates. They show an example of getting about 26% of the billed cost.
2.7%????? You gotta be kidding me. If that is actually correct, I should have chosen one of the cheaper plans which would have allowed me to pay out of pocket with the premium difference.
We are currently in the appeal process. We’ll see. If it stands, we will be changing plans next open enrollment!
No wonder they asked for a 39% rate increase. All those fines have to be paid somehwo. It can’t come out of profits and bonuses.
Kaiser is looking pretty good right now.