Insurance company updated group number, impacting OOP maximum

Hi all,

I am insured with Anthem BC under my husband's plan which he receives through his employer. We received our policy and group number which went into effect on 1/1 of this year but approximately halfway through March, we received an updated group number and plan number (with a new card) but we remain on the same plan with the same coverage and claim history.

Between Jan-March, I wound up in the ER for health issues and had subsequent follow-up appointments that were billed and processed through the original group number. The total amount of OOP expenses I owe that was billed to the previous group number was approximately $5000. The issue is, the EOBs and out of pocket expenses between Jan-March are not being reflected in my yearly OOP maximum ($8500) which has now been surpassed from other medical bills.

Anthem is giving us the run-around saying they need the Jan-March providers to resubmit the claims to the new group number. However, these providers are being slow and unresponsive and Anthem is doing nothing to stop our plan from continuing to accrue OOP expenses. I ended up having a surgery several weeks ago that was an OOP expense and the hospital billed me $3000 – but I should have only been billed for approximately $1800 because that procedure got us to my OOP maximum.

Does anyone have advice on how to deal with this? I am continually seeing specialists to address my ongoing health issues and receiving bills when all of this should be covered. Anthem has acknowledged they see I am past my OOP maximum but are dragging their feet on remedying the situation.

Thank you!

EDIT: Update to state that I am located in California.

submitted by /u/__scooter
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