Anthem Inc

All Anthem Prior Authorization requests are handled by Carelon, whom Anthem presents as an independent, outside team of medical experts. Nothing could be further from the truth!

They are owned by Anthem, biased toward Anthem in denying almost every first request for medical services requiring their permission. Carelon makes mistakes repeatedly, resulting in unnecessary phone calls. It is then that a member (yes, remember us? The ones paying you for the service) find out that Carelon doesn't speak to members.

What?! (That's my logical brain exploding.) Carelon is controlling my medical care, my very health and I cannot even talk to them? I am told to have my provider call; they did, got only an answering machine and left a message for a return call. This did not happen.

Even Anthem Customer Service can't get an open line to them. What could and would have been straightened out had I been able to speak to these shadow people, with their shadow doctors making anonymous decisions they assume no responsibility for, nor will you ever be told their name, credentials, specialty, education, or practice experience. They make life destroying decisions callously every minute of every day. They don't care because they don't speak to you; you are just a case number, a series of codes to them, so they can easily deny based on code technicalities alone.

Matters not if it's surgery we are talking about or not. Please warn all consumers, particularly Medicare recipients, to run, not walk, from Anthem plans or risk dealing with Carelon. Do not let anyone tell you differently; Carelon counts on us seniors just laying down like a doormat and letting them walk right over us without consideration for our right to medical care. I, ladies and gentlemen, am not a doormat.

The process has begun, with the help of the Ohio Department of Insurance filing a formal complaint on my behalf to Medicare itself. Please stop letting the Anthem/Carelon companies, or for that matter all health insurers, get away with infringing on our rights, denying claims that should be covered and using divisions like Carelon to do their dirty work. Appeal, appeal, appeal, and file grievances. If your state has a Department of Insurance, file a complaint there and with Medicare.

Contact and file with the BBB. To summarize, keep fighting, and don’t give up until you have exhausted all options and resources. I assure you that if you do, and even if they attempt to dismiss you, let them know beyond a shadow of doubt that you will not be pushed around.

It would take more than Carelon and Anthem’s shady use of this division, (and a bulldozer, perhaps?) to repress me. Carelon is a snake that needs its head cut off, and Anthem needs to stop lying to people about their pet snake.