What is the purpose of Carelon?
I have Anthem Blue Cross in California. TL;DR – Carelon keeps calling me to try to get me to move procedures to different facilities. But they quote me the wrong costs for the facilities and can't give me a complete list. Why does Carelon continue to exist?
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I unfortunately have needed three MRIs in the last 18 months. Each time my provider sends in a request for authorization, Carelon calls me a few days later claiming that they want to help me find lower cost care.
They then give me a list of 10 facilities within 50 miles. They claim they can't send a longer list or use a smaller radius, and that nobody has ever been dissatisfied before. I ended up talking to the 'team lead' and she was belligerent and constantly interrupted me.
Even though they know what my plan is, how much remaining deductible I have, etc, they show projected costs that are 5-10x what I ended up paying. Probably many reasons why their data is bad, but the biggest one I saw is that they lump together 6-10 CPT codes that cover a huge variety of procedures.
The first MRI, I used their recommended facility. It cost me the same as using my provider's facility, but it took two months for them to get a *CD* of my scans to my doctor.
The second MRI, I ended up changing to a facility near my provider. This cost 1/5 what they said it would cost, and it significantly delayed me getting a scan. They also used the wrong email address (they just made it up) and sent my PII to someone else!
The third MRI was more time-sensitive. I already had it by the time they called me. I told them they keep wasting my time and to never contact me again.
I wrote to the CEO of Anthem and to various Carelon executives. I got some semblance of a response from Anthem but they didn't really seem to grasp how incompetent Carelon employees are.
I just filed a complaint with the state insurance commissioner, though it's unclear exactly what they would find Carelon did wrong.
submitted by /u/Typical-Car2782
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