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Anthem Blue Cross: Stop Avoiding Financial Responsibility by Hiding Behind Policies which Hurt Patients

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In late May I was referred by my Primary Care Physician to a Surgeon,  whose office is in Sutter Health and that Surgeon is an in-network surgeon for my healthcare plan with Anthem Blue Cross.  

After my meeting with the surgeon, a surgery was scheduled at Sutter Health Hospital and I provided my insurance information to Sutter Health Hospital.  The admissions team checked with my insurance provider and found out that the procedure was covered and did not need pre-authorization.  The problem, it turns out, is that the Hospital where the procedure was performed was not in network.  Apparently the hospital called Anthem Blue Cross asking if the procedure was covered (which it was) but they didn't ask, "is the hospital in network", which it isn't, and Anthem Blue Cross didn't volunteer the information.  As a result, going into the surgery, I was given an estimate of what my copay would be but I was not advised that the hospital was out of my insurer's network and that only $380 of the $20,935 bill would be covered.    

After the surgery Anthem Blue Cross informs me and the Sutter Health Hospital that it will not cover the surgery because the hospital is not in network.  The surgeon, yes, the procedure, yes, but not the hospital it was performed at.  

I appealed that decision with Blue Shield explaining that the hospital had my insurance information ahead of time and did not inform me and that my surgeon, who is in network, has a consultation office in the very hospital where the surgery was performed, so I had no idea that the hospital would or could be out of network.  The grievance was denied stating that the responsibility was solely mine as the patient to verify that all aspects of the procedure would be covered including where it was physically done.  

Sutter Health, the hospital is also saying the same thing.  That it wasn't their responsibility to tell me that and I should have found it out on my own, even though they told me the procedure did not need authorization according to my health insurance provider.

It is unjust and without reason that, as a patient, it can be so easy to end up owing twenty thousand dollars when I had insurance.  

This petition helps bring light to unfair business practices where the hospital and insurance companies can avoid financial responsibility by not doing their job.  This matter of the hospital being out of network should have surfaced in their conversation.  I'd like to have my bill (less my copay) covered and in addiiton to my own finanical burdens covered, I'd like to see policies and procedures put into effect which prevent future victims (patients) from the same thing happening.  

Yours truly,

Jeremy Weintraub



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