ANTHEM BC/BS RIP OFF An 11year old NOT A CHILD?

 BEWARE - 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. Don’t make my mistake and think the big name and big premiums will offer you 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, because I pay $438.00 a month to provide Anthem BC/BS for myself and two sons. (NOTE: we are healthy, have no pre-existing conditions and rarely go to the doctor).

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 a deductible does not apply in-network or out-of-network. 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.

For the record, prior to this posting, I made two attempts to appeal this coverage decision over the phone with Anthem Member Services Representatives. 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 was clearly did not apply, since I consider my 9 and 11 year old children and that “Wellness services - preventative care and immunizations for children” clearly would apply in this situation.

I asked, that if it didn’t, 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 gave me the steps I need to take to write a letter.

So, I decided that if I had to put it in writing and go through all this that the world should know about it! Beware people, Anthem is deceptive and not worth it and apparently doesn’t care about our children’s health!