Anthem BCBS playing games after exceeding my OOP maximum for 2022

Good evening everybody,

I was hoping somebody could advise on how to proceed, because I’ve about exhausted Anthem BCBS’s customer service options. Sorry for not disclosing exact numbers – using a throwaway here already so I don’t earn a big fat corporate bullseye on my back.

I first noticed they had exceeded my OOP max when I looked at the final EOB for 2022. Let’s call my OOP maximum X. They said a number, Y, had been applied to it. Y was substantially bigger than X.

So I filed a grievance with them explaining that they’d exceeded my OOP max, and I expected them to reimburse me for the balance. I received a letter by USPS a couple weeks later referencing number Y and saying that my grievance was accepted/approved.

I waited about 60 days and no check or deposit ever came. I started another chat with them asking them to review a charge from last year because I thought they should’ve covered it. My understanding of my policy was somewhat erroneous, but I mention that conversation because it will come up again later.

About 30 days after that, I still hadn’t received any reimbursement so I called my company’s insurance portal. A lady said she’d check on it and get back with me. She never did get back with me. So about a week later I started another chat with Anthem’s customer service. The conversation didn’t go anywhere – they first said they only owe me a minuscule amount, then that they told me they owed me nothing (they never told me that), when confronted with a chat log they ignored how I pointed out that they’d just lied to me, and finally told me they’d get back to me in 5 business days.

So now that I’ve downloaded all the data from my EOB’s from both their website and my pharmacy website, and added every-freaking thing up for 2022…I came up with a DIFFERENT number A, which is a bit over 1/3 of Y-X, that I overpaid by.

So how do I make them cough up at least A, and preferably more for my trouble? Frankly I don’t think any of their EOB numbers are accurate at all. I’d like a more thorough accounting, but I’m not digging up every single medical receipt for 2022.

Is this the kind of thing a lawyer would even be worth bothering? I would feel silly suing over amounts that are admittedly under $1000, but they owe me at least a few hundred bucks and I’m not going to let that go because I’m not exactly rich.

Would HR be likely to help? Of course their job is to protect the company’s interests, not to help me.

Maybe try the company insurance portal again?

Report them to the state?

What are your thoughts?

TL;DR: My insurance company made me overpay my OOP max for 2022 per my EOB, confessed, recanted, tried to say they only owe me a little money, then tried to say they owe me no money. So I did the math myself the hard way, and they owe me at least a few hundred bucks. Any advice?

submitted by /u/Mammoth-Trick9660
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