Providers complain ALL the time about Insurance but what does that get you? NO WHERE! Carriers don’t care what you have to say, but they DO CARE, and they HAVE TO CARE, when patients complain.
Anthem Blue Cross of California is taking it one step further – in 2021 they mandated that their network providers offer patients Anthem’s Grievance form and help them fill it out. Here is what they said:
“Anthem Blue Cross participating providers are REQUIRED to acknowledge (annually) that Member Grievance and Appeals forms, a description of grievance procedures, and assistance in filing grievances are readily available at each contracted provider location(s).”
In CA Anthem is handled by American Specialty Health. CA providers BOTH IN and OUT of network should be using this Grievance form and using it frequently. Patient’s can complain about their provider getting denied, getting lowered reimbursement, having to request care after 5 visits. When the patients SPEAK, the carriers HAVE to listen.
Link to Anthem of CA Grievance Form (Search for Grievance Complaint Form Instructions – English
All Major Carriers have Grievance Forms
In researching this I found that ALL major carriers have them. Some start with a phone call, but I’d want them all to be IN WRITING whenever possible. If the plan is a fully-funded plan, then a copy should also be sent to your state’s Dept of Insurance. If the plan is a self-funded plan, (one sponsored or funded by the patient’s employer) then a copy of that greivance should also be sent TO the HR department of the company.
Encourage Pro-Active Patients
A Pro-Active patient can make all the difference. ESPECIALLY if their benefits come from their employer. However, even if the insurance is purchased directly from the carrier, your state’s department of Insurance take EVERY greivance seriously. (They may be slow to respond, but they WILL respond.)
At the end of the day remember – Don’t let your patient off the hook, they can get things done and help make changes.