Catching the California Wave

Is Deliberate Confusion and Disinformation the New Tactic for Denying Health Insurance Claims?

By Jennifer Kady Stanton

For Christmas Eve this year, I traveled to Arizona to spend time with my family. As I wrapped last-minute gifts as guests streamed inside, I found it increasingly difficult to breathe and began to have sporadic coughing. As I’ve had asthma attacks in the past, I decided to make a quick trip to Dignity Health, a freestanding emergency room in Chandler, Arizona.

My care was fast and efficient. It appeared that I was the only one there, and I was in and out within an hour. Since I didn’t have my insurance card with me, I was advised that I needed to fill out a “48-hour” form to provide my insurance information. On Christmas, the next day, I filled out the form by hand, took a picture of it with my phone, converted it into a PDF, and then uploaded the PDF into an email that was provided to me. A few days later, I received confirmation that the form had been received.

Unfortunately, I cannot say it was to my surprise, I received a bill via email, stating that I owed $1,058. It did appear that my insurance was charged, because on the itemized bill, it listed “Insurance Payments and Adjustments” that decreased my bill from $2,658 to my final charge of $1,058. I believe that many people would mistakenly assume that insurance had been charged, especially since I had received a confirmation of receipt from the “48-hour email” that provided my insurance information. This confusion could especially be true if someone had new insurance or was not intimately familiar with their insurance plan.

However, although my plan was fairly new, I did remember that I had a $0 deductible. I called Anthem, my insurance carrier. Ms. M advised me that I would only owe the $50 ER co-pay, and the bill was incorrect. She also advised me that there had been no claim presented. She said that she would have a three-way call to Dignity Health to give them the insurance information.

Ms. G answered the phone and graciously asked for my insurance information. Ms. M of Anthem provided her with my ID and group numbers. Ms. G of Dignity then asked for the claim billing address.

It was then that all hell broke loose.

Ms. M of Anthem advised her that there was no claim billing address because it was an HMO, not a PPO. Ms. G of Dignity advised that without a claim billing address, she could not process the claim, and I’d be responsible for the bill.

The two reps continued to argue with each other. Ms. M of Anthem, insisting that there was no claim billing address, and Ms. G of Dignity Health, insisting that without the address, she could not process the claim, and I’d be responsible for the full bill. Ms. G also explained that the adjustment that I saw under “Insurance Billing and Adjustments” was merely an adjustment for cash-paying patients, not a partial insurance payment.

I let them argue, not quite knowing who to believe. Ms. M of Anthem asked for a Dignity supervisor. Mr. L came onto the line and explained, as did Ms. G, that without a claim billing address, they could not process the claim. He also stated that this is standard protocol.

Ms. M of Anthem then changed her position. She stated that there was, in fact, a claim billing address, but she could not provide it to him or to me. I stated again that there was no claim billing address on the back of my card, so I could not be of any help.

Ms. M of Anthem repeatedly told me, “Don’t worry, you won’t owe this bill, and I’ll take care of it.” She stated that she had to call another department to “verify” the claim billing address, but that they were closed for the holiday on January 2nd. She told me that she’d verify the claim billing address next week, and “take care of it”. (At the end of the call, I attempted to call the Optum Group to verify that they were, indeed, closed on Friday, January 2nd, and got only a fast busy signal.)

I’ve been down this road before and realized something was not right. Mr. L, the supervisor at Dignity, was also frustrated at this response and insisted he only needed the claim’s billing address to process the claim. Once he had this elusive information, we could all go on to celebrate our January 2nd holiday.

I asked for Ms. M at Anthem for a supervisor, thinking that two supervisors on the line could crack the code of providing the claim billing address. After some argument, Ms. A, a supervisor at Athem, came on the line. I now had two supervisors from each company, and myself, on the line.

Ms. A apologized and acknowledged that not only was there, in fact, a claim billing address, but a claim billing fax number and a claim billing email address. All were provided to Mr. L, the supervisor at Dignity Health. Mr. L assured me that he had everything that he needed to process the claim.

I was on the call for over an hour, not counting hold times, and not counting the first call that disconnected me when the prompt could not understand that I was asking for a representative. “REP-RE-SEN-TAT-TIVE”.

Some may argue that this is an isolated event. Maybe the Anthem rep was new, or still recovering from an eggnog-induced hangover. Maybe she was celebrating the fictional January 2nd holiday. However, in my experience, it seems that the majority of the time that I have a claim, even something as simple as my yearly physical, it takes countless hours and calls to resolve.

I did not have to work today, and was able to spend over an hour on the phone trying to resolve this mess. I have a fair amount of education and experience in billing, which worked in my favor.

What if I hadn’t been? What if I had taken Ms. M’s statement that “She would take care of it next week,” or if I had mistakenly believed that the “Insurance Billing and Adjustments” deduction was my insurance payment, especially since Dignity Health had acknowledged receipt of my insurance form? Fortunately, this was not the case, and as it appears as of the date of this writing, I was able to resolve the situation with much effort and two supervisors.

Not everyone is so lucky. Some may have to work long hours and may not have the time to make these long, frustrating calls. The elderly, disabled, or young patients who may not have experience dealing with these types of situations may assume that insurance has already paid, or may not have the capacity to deal with two feuding representatives.

Since this is far from an isolated event, it has left me wondering if this is a new tactic to avoid paying an insurance claim.

If I had not had the time or the capacity to handle the situation, and the bill had been left unpaid, it would have severely affected my credit, hampering my ability to rent an apartment, buy a car, or obtain other credit-based necessities. All of this is because Anthem would not provide a claim billing address without supervisor interaction, or at least provide it on the back of the card.

I can’t help but believe that this is intentional. Mr. M of Anthem had stated that “it was against policy” to provide the claim billing address.

Americans are facing rising healthcare premiums and deductibles, a loss of government subsidies to offset increasing expenses, and a lack of integrity and efficiency within the healthcare industry.

I believe that not only was this intentional, but it could have easily been avoided. It appears to be the latest tactic to reduce the number of paid claims, even from those of us who are still lucky enough to have insurance at all.

According to Elevated Health, Anthem Blue Cross and Blue Shield profited 1.2 billion in the first three quarters of 2025. After this experience, and many others like it, I can only imagine how much of this profit is a result of mismanaged claims and patients who are not able to navigate the ever-increasing maze of obstacles before them.

Congress and the current administration appear to be impotent to resolve these complex issues. Promises of a plan “better than Obamacare” have been suggested for years, yet none have ever materialized.

In the meantime, we are stuck on hold, both figuratively and literally, as we are left to navigate these created obstacles, on our lunch breaks and January 2nd holidays, hoping that we will hang up in frustration, or just simply go away.


References

Becker’s Payer Issues. (2025, October 21). Elevance Health Q3 income up more than 17%. https://www.beckerspayer.com/financial/elevance-q3-income-up-over-17/