The Anthem Blue Shield Letter That Upset Me

Here is an excerpt from the letter that started it all:

“Based on the medical documentation submitted, the peer clincial reviewer, Robert Karalian, MD, has determined that the following services are not medicall y necessary . . . your request for an assistant surgeon can not be authorized as there is no function for an assistant surgeon to perform for the denied service or services.  As a result, the service is not covered by the member’s health benefit plan.  The decision is based on the American College of Surgeons consensus for assistant surgeons.”

Anthem Blue Cross Gives You 455 Characters to Complain

I spent an hour on the phone talking with Anthem Blue Cross today.

They said I need to file an online grievance within their online form (because they don’t accept email).

After I finished typing in my grievance (about 400 words), I noticed the form deleted 3/4 of my content.

I thought it was a mistake until I looked at the code and realized there is a 455 character limit to online grievances.

Yep, you got 455 characters to work with.

And they want to see names of providers, info an any records pertinant to the case, and reasons why the surgery was medically necessary.

Try to squeeze all that into a little web form.

It bothers me that they don’t show you a character limit anywhere on the form.

You can just start passionately typing – and then tab over to the next area – only to realize that your content gets automatically deleted.

Here’s their web form:

Nothing resolved so far.

Anthem Blue Cross Denies Coverage of Assistant Surgeon

I never went to medical school, but apparently I should start approving every medical instrument, medicine and staff member in the surgery room.  At least that’s what Blue Cross wants me to do.

You see, I just received a letter in the mail stating that the assistant surgeon used in my wife’s surgery was not medically necessary, and therefore I’m responsible for payment.

This is obviously upsetting.

This blog will document my experience dealing with Blue Cross over this situation because I refuse to pay.