Thread regarding Elevance Health (Anthem) layoffs

3 OON member filed claims submitted twice. Both times claims were deleted and not processed by the system. Since when we do we delete member-filed claims?

Still haven’t had the energy to call back in to question

We're getting claims and pre auths confused on the thread so I'd like to offer a reference.

A claim is for a service rendered. The member has received the service already. If we deny, they blame us, but it's ultimately up to the provider to fix the errors or balance bill the member. Much of claims is automated, just not by AI.

Traditional pre auths do occur before or during service and do impact a members ability to get care. You also have retro auths that don't. We have auto approvals in specific cases but never denials. Those would always be reviewed by clinical.

In claims or auths, decisions can be appealed or disputed.

Not offering an opinion one way or the other, just making sure we're all on the same page.

Aren’t medical reviews offshored now

Had a ground ambulance ride denied due to lack of pre auth. Problem is my plan doesn’t require a pre-auth nor would that be realistic.

Appealed, denied. Appealed, denied. Stopped caring and forgot about it. Turns out it was the way the ER billed - once they fixed their bill, so was the ambulance ride even though the two were unrelated entities. Glad they let me waste hours of my time calling customer service in the Philippines who were useless though.

They would rather deny and wait and see if there is a lawsuit, those are big $$

It was NOT AI, it went through medical review…..to a physician. All air ambulance go through physician. .. it was not an error, it was intentional denial.

I saw that article. I doubt that was AI. Just people not paying attention. I could be wrong, but AI would be smarter than to deny ER for pre-auth. Looking forward to hearing from someone who can say for sure.