ANTHEM BLUE: Sued Over Alleged Failure to Send Insurance Card

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Cristin Severance, writing for ABC10News, reports that a woman called Team 10 after fighting for months to get repaid thousands of dollars by her insurance company.

Laura Schove of Carlsbad said she paid out-of-pocket for a procedure to help her continue to walk and function because she was never given an insurance card.  Ms. Schove has had multiple sclerosis for 20 years.  She just started to need a cane to walk after what she called an episode nine months ago.  She said her neurologist recommended getting a five-day infusion treatment.
Ms. Schove had signed up for Anthem Blue Cross in December.  They had not sent her an ID card.

"I had the entire neurology office, staff, MS assistant . . .everyone was working to call the insurance company to get answers," said Mr. Schove.

She said Anthem Blue Cross could not tell her what was covered or who was in-network.

"The patient is left with a difficult choice: Do I pay out of pocket or do I wait?" said Jerry Flanagan, an attorney at Consumer Watchdog.

The consumer advocacy group just filed a class-action lawsuit against Anthem Blue Cross claiming the company did not send ID cards and gave incorrect information about coverage.

Ms. Schove paid the biofusion company $2,000 for the procedure.
She said she tried for seven months to get reimbursed.

"I never got to anybody that knew anything," said Ms. Schove.

She finally got a letter that said they would pay $350 out of $2,000.

"I mean, it got the Irish up in me," Ms. Schove said.  "I was angry.  How could they do this?"

Mr. Flanagan is hoping to get Ms. Schove and others reimbursed through the class-action lawsuit.

Anthem Blue Cross gave Team 10 this statement:

"This member purchased an EPO plan, which has no out-of-network benefits.  While the member saw an out-of-network provider, and as a courtesy, Anthem agreed to pay the claim as in network at the maximum allowed rate.  As you know, there is great variability in what providers charge for the same treatment to different people. Unfortunately, it appears that the provider may have charged the member an amount exceeding what insurers usually pay for the same procedure."

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