I have paid large premiums and have not been surprised by the large annual premium increases believing that I would get great care and coverage for my family holding a policy with Anthem BC/BS. It appears I have made a mistake in thinking the big name and big premiums would offer me the best coverage.
Recently, I took my 11 year old son in to get immunizations so he can attend middle school in the fall. His elementary school notified us that these immunizations are required by law to ensure the safety of our children and society and proof of the immunizations would be required for their entry into 6th grade. They were offering a free clinic at the school, but after reviewing my Schedule of Benefits I called and made an appointment with his pediatrician.
This was no elective service and I assumed it would fall under the Wellness Services - Preventative care and immunizations for children category under my Schedule of Benefits. Immunizations and Screening tests show that the deductible does not apply in-network or out-of-network. I pay $438.00 a month for coverage, so I felt I would take my son to his pediatrician for what I assumed where covered immunizations for children.
You can only imagine my horror when I received my Explanations of Benefits and saw where I would owe $357.63 for my sons office visit. I have made two attempts to appeal this coverage decision over the phone with Anthem Member Services Representatives, Ivey and Virginia. The first insulted me and made me irate! The second was sweet as she could be, but not helpful. She could not answer my questions and told me she realized that the Schedule of Benefits was unclear to me, but that she looked at it everyday and it was very clear to her. She kept directing me to the header Wellness Services, under Routine office visits, where the 20% deductible applies.
I felt that this clearly did not apply, since I consider my 9 and 11 year olds children and that Wellness services - preventative care and immunizations for children clearly would apply in this situation. I asked, that if it didnt, what was the cut off age for what they consider a child. She said it was an unfair question for me to ask her what Anthem BC/BS considers a child and that she could not answer the question. I told her I wanted to appeal the coverage decision and she instructed me to write this letter.
Your Schedule of Benefits is not clear. Are you ashamed to acknowledge that you only consider a kid to be a child if they are 6 and under? Is that why your reps could not answer my questions, because it falls underneath age discrimination? If that be the case, you need to clarify and put on the header, Wellness services - Preventative care & immunizations for children under 6. I feel like I have been deceived and am really disappointed in Anthem Blue Cross/Blue Shield!
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