My Anthem Insurance saga

I want to preface this blog post by saying I have had a wonderful week. I am almost afraid to put those words down in black and white. Our children visiting from Israel were here for the weekend and we celebrated Chanukah.

My three grandchildren from Israel are so full of life. Each has a strong personality. Atara "Ati", the oldest, almost nine, asked  questions about my treatment and seemed to understand quite a lot. She loves gymnastics and knows so much Torah that she floors me. Eliana, "Luli",six, tells me she prays for me every day. I was very overcome by her sincerity. She is a riot and keeps us entertained with her elaborate modern dances and funny faces. The little guy, Shmaya, age four, can't stop kissing me. Jeff made him pancakes on Sunday morning at 5AM.  He is on the move constantly and reminds me of his Abbah. It won't be long until he will be doing computer programming

One night they all came in to bed with me for cuddling. They are very sweet kids and it is nice that in Israel the emphasis is not on Chanukah gifts so they were not expecting piles of presents. Of course they ended up getting inundated with gifts from their grandparents and extended family anyway.


Last Saturday the whole family hung out. The son-in-laws shared beers and good food. The sisters caught up with each other.  The babies were entertained by the older kids. Ati and Luli  played Monopoly and cards. Jeff kept checking to see if I was OK. It was almost overwhelming for us with what we have been through to be able to enjoy this rare event and for me to  feel well through it all.

Sunday we all went to another Chanukah party given by my cousin's daughter Kimberly and her husband Vlad with even more adorable little ones there and their parents, my nieces and nephews and cousins. I was thrilled to enjoy the chaos of the kids, the yummy food and drink.

In one of my earlier posts I said I would share my Anthem Blue Cross saga. I'll start at the end of it. Once all my issues were straightened out and I  paid my deductible, they have paid everything without question. My bills are considerable. Just the special shot I take the day after chemo is $6,000!!  That is not a typo. This  shot is what boosts my white cell count, and I will have taken eight of them by next week.

This all began when somehow I signed up for Covered California through Anthem Blue Cross. I have been a Blue Cross member forever and ended up with Covered CA even though I was not eligible for subsidies.   However, I soon realized when I researched surgeons that the entire Sutter Health organization of doctors in the East Bay did not accept Covered CA and Anthem. This also meant that two of my long time Oakland doctors dropped me because they did not accept Anthem and Covered CA.When I figured out I could not find a top surgeon in Oakland, I thankfully discovered that the UC system did accept Covered CA and Anthem.

 In a way, I decided that the fact that I was thrust in the UCSF system was meant to be and right from the start I was not going to second guess myself nor seek second opinions. UCSF, as I have written  previously, has state of the art treatment and world class doctors who are researchers as well as teachers.

So I was in the UCSF system and thought everything was OK. Three days before my surgery in August I got a call saying the Covered CA had dropped me. I almost had a heart attack...no insurance and surgery in a few days which could be cancelled?!!  Then I got on the phone and found out that was some sort of screw up. It took me begging, pleading and practically crying to make sure I was re-instated with Covered CA and Blue Cross in time for my surgery.

Then I got another call saying that I had not paid my premiums to Anthem. One of the biggest issues I had with Anthem was never being able to reach the same person twice. I was angry because my premiums were automatically deducted from my checking account. I could see where they had been taken out. Again I was on the phone for marathon sessions being promised by this agent and that agent that I would be called back, but it never happened. There was no follow up. On top of dealing with the emotional whiplash of cancer, I had to contend with insurance issues. I had heard of people having nightmare insurance problems.  Was this happening to me now too? For sure I did not need this aggravation.

Then I got a letter stating that my policy was going to lapse. I was furious because my $629/month had been deducted, and I had the proof. This time I was bound and determined to stay on the phone until this was resolved. I got on the phone at 8AM and told myself I would hang on the phone all day if I had to. I demanded to speak to a supervisor and finally got someone who listened to the entire saga and it was a long one. What she determined after investigating was that my payments had been applied to PEDIATRIC DENTAL.

Great, I have no kids at home and I'm paying for someone to take their kids to the dentist using my entire premium which was supposed to be a minimal mandatory charge mandated by Obamacare. Obviously my premiums had been misapplied. Then she said that I would be sent a refund. Uh-oh...a refund?  I was very nervous that Anthem would say I have no coverage and my payments were overdue and my medical bills would be unpaid or that my treatment would be delayed.

She assured me that she would handle this properly. She took a three month payment over the phone using my credit card which would make my account current. Then she set me up on the correct automatic deduction program which would not go to pediatric dental. I almost didn't believe that this frustrating drama was finally going to be set right but it was.She said I was to cash the refund check though I was almost afraid to do so.

What I have since found out over these last months is that coverage changes all the time. Anthem Covered CA was accepted at my recent emergency visit to Summit in Oakland even though not all the doctors I saw there accepted my insurance. I was able to appeal to Anthem because if the hospital accepted me then I had a legitimate claim to have the doctors take my insurance as well which is what happened.  If you think this is a little crazy you are absolutely correct. I think the whole system is still in flux and changing rapidly.


Now with the renewal which had to be done in mid December, Jeff and I decided to leave everything exactly the way it is. We are afraid of making any changes. In 2015 I will be 65 (oy) and will go to Medicare when I will be making major changes.

One week from today is my last chemo. I am literally holding my breath to make it to that day and stay the way I am with no other side effects. I will keep you posted.. Happy Holidays.