- 1,737
Who in corporate made this decision about medical review procedures? Anthem has sent a letter to each of these employees, with separate ER/hospital admissions--to different hospitals-- stating that by their review of necessity, their hospitalization and ER visit were considered not medically necessary, and the claim would be refused. 
Do we now have to tell everyone to call the 24/7 nurse line from the ambulance? (imagined call: call back 911 and tell them you are going to use telemedicine line, stay at home)
Way to do customer loyalty, Anthem. With the first EE, I did a 3 way call to claims and was told that the ER doc needs to explain the reasoning to a review board at an 800 # that my client says has about a 20 min. hold time. Like this will happen easily.
After several email jail calls, I directed the first one to go to the hospital admin/billing, because they will care about getting paid. They are helping the first one. Just now got off the phone with the second one, who is calling the dept for that EE's admission.
How to help as an agent, my first full year in modern managed claims environment as a full time agent. This is an important client for me. Not like all of them aren't but they are also friends.
If this is the type of thing they are going to do, hospitals/staff should be warned to handle cases with the kind of documentation needed, and be instructed on standards. Or something. Not just traumatize folks who are ill and feeling fragile with threats of non-payment.
Do we now have to tell everyone to call the 24/7 nurse line from the ambulance? (imagined call: call back 911 and tell them you are going to use telemedicine line, stay at home)Way to do customer loyalty, Anthem. With the first EE, I did a 3 way call to claims and was told that the ER doc needs to explain the reasoning to a review board at an 800 # that my client says has about a 20 min. hold time. Like this will happen easily.
After several email jail calls, I directed the first one to go to the hospital admin/billing, because they will care about getting paid. They are helping the first one. Just now got off the phone with the second one, who is calling the dept for that EE's admission.
How to help as an agent, my first full year in modern managed claims environment as a full time agent. This is an important client for me. Not like all of them aren't but they are also friends.
If this is the type of thing they are going to do, hospitals/staff should be warned to handle cases with the kind of documentation needed, and be instructed on standards. Or something. Not just traumatize folks who are ill and feeling fragile with threats of non-payment.
Last edited:
