I was an RN for Anthem for 2.5 years. Prior to being layed off 12/31 I was told that my spouse would be on medicare. He has terminal CA. On 1/5 I received a letter from Medicare stating that Daniel would not be covered until July 1st. I called Anthem to let them know. Also, Daniel has skin cancer and was treated 12/5 and his MD called to tell him that he needs to have a rather large squamous cell cancer next to his eye removed. Growth could cause vision loss. Dan is 57. So, I appealed to Anthem on 1/7. Anthem sent me an e mail that I could not open around 10 days ago. Even while working their secure system locks you out of it. I could not access the email after trying twice and then later when they wrote me back. I asked them to just mail it but never heard from them again. <br /><br /><br /><br />
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My main concern here is that I also dropped my daughter because she was no longer a student. Anthem has sent Kathryn numerous letters telling her she can apply for COBRA. Anthem did not send Daniel any such letter and on the COBRA sheet Daniel was excluded from having any insurance because I took him off prior to 12/31.<br /><br /><br /><br />
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I believe Daniel is being purposely ignored by Anthem because of his lymphoma cancer diagnosis 6/07. And, Anthem also purposely makes it impossible to communicate with them as their security system always locks out everyone. I had to deal with this for years. Seldom does it work right and so they are able to send you an e mail that you will never get but they have proof they sent it and they hold you accountable for it. <br /><br /><br /><br />
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That's what DEEP POCKETS can do. I'm so sick of this country and the way MONEY is only for the WEALTHY and WE THE PEOPLE GET SCREWED, ARE TAXED AND FORCED TO BE HELD RESPONSIBLE FOR GOLDMAN SACS AND CITIBANK YET WE CANNOT EVEN AFFORD TO SEEK MEDICAL CARE WHEN IT IS NECESSARY YET THE WEALTHY NOT ONLY GET THE MEDICAL CARE THEY NEED BUT THEY NOT ONLY HAVE RETIREMENTS FROM OUR TAX BUT ALSO AUTOMATIC PAY INCREASES WITH THEIR RETIREMENTS AND CADILLAC HEALTH PLANS, <br /><br /><br /><br />
WE NEED TO HAVE A SOCIAL REVOLUTION AND OVERTHROW THIS EXCESS TAXATION WITHOUT ANY REPRESENTATION.

On April 28, 2009, my neurologist prescribed a medication to replace one that I had been on since 2004. I have developed some side effects and find it is no longer effective. We submitted the request per instrucions to request an urgent processing of this claim. I was denied coverage on May 4, 2009. We again were given instructions about how to appeal a denial of claim and again faxed the required forms with the information we were told to provide. I was assured that I would have approval within 72hours as I had already complied with one of the "step therapy" requirements.
As of today, 5/28/09, I have spoken with 19 Senior Services Representatives, been told by one that I would never receive authorization, told by another that I should not have any problems being approved and that my policy will cover the medication, told by another that there is no record of the necessary paperwork reaching the prior authorization department and today I have been hung up on twice.

I would like to know what recourse I have and what options I have left. I cannot affort to pay for the medication out of pocket - this one is over $350 per month and I am on 9 other medications for my MS, Gout and now Neuropathy.

Folks, if you think you're covered in case of an emergency by your health insurance plan, THINK AGAIN. I suggest you read the fine print in your policy terms -- that is, if you can find the fine print. I thought I was covered until about 6 weeks ago when I suffered a pulp amputation in my right thumb. I spent a day at the emergency center having surgery performed on my thumb to re-attach the pad. Although badly disabled after the surgery, I was relieved that at least I had insurance. WRONG. They denied almost every single claim submitted to them by the various providers that worked on me. Even when treated by their so called "Participating Providers, " they only pay what they consider a "usual and customary" amount for that service. I ended up having to pay for the entire bill minus $135. The bill runs into the thousands. What's my complaint. Buried in their website, which of course is full of beautiful smiling people and is oh so user friendly, this "usual and customary" amount information is almost impossible to find. Nobody at their own customer service center could find it!!! Don't waste your precious dollars with this immoral company. Their health insurance is a fraud and a scam. I can only imagine the pain and desperation caused by this company to people who have a much more serious illness.