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Op/Ed: Medical insurance policy of denying policyholders claims 'routine' and 'unjust'

Lane S. Fulton
Anthem Blue Cross Blue Shield headquarters are located on Virginia Avenue in Downtown Indianapolis.

Seventy people came to Indianapolis from across the country and risked arrest at Elevance Health headquarters recently. I was one of them. We were there for a simple reason: Everyone needs health care, and private insurers like Elevance make a killing by denying us care when we need it most.

Elevance rebranded itself from Anthem Blue Cross Blue Shield in June. This new name reflects their desire, they say, to “elevate” and “advance” our health. Though Elevance has a dirty secret. Their record profits ― $6.1 billion last year ― are fueled by millions of denials of care to their own policyholders, like me.

I underwent six surgeries over three years at the IU Health, Bloomington Hospital, and three of these were while I had Anthem coverage. During COVID-19, I got insurance through the Healthy Indiana Plan (HIP), part of Medicaid. I am now one of the 2 million Hoosiers who rely on this public program.

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Medicaid covered my later surgeries. Then in the fall of 2020, I received a surprise letter from IU Health saying I owed $2,500 for old medical bills Anthem refused to pay. I was confused: I knew my Anthem policy had a deductible, and I paid every bill I received. I could not afford this surprise bill.

So I immediately applied for financial aid. A few months later, I received a letter from IU Health saying my medical debt would be canceled. I was relieved and happy to the point of tears.

Yet a few weeks later, I got a letter from a debt collection agency, Harris & Harris, demanding I pay even more ― $5,000 ― for bills Anthem still refused to pay, bills I never received.

I was scared. I was stressed. And I was angry. It seemed IU Health and Anthem were working together to force me to pay even more.

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Private insurers like Elevance/Anthem want to suck our bones dry, because denying care is easy money for them. Some private health insurers deny as many as four out of five claims. They know our health care system is way too complex, so most people don’t fight their denials — in fact, only 0.2% of denied claims are ever appealed. But we’re going to change that.

Those of us who showed up at Elevance’s headquarters are part of an effort called Care Over Cost. We help people who have had care denied by their insurance appeal these denials and raise the issue that this practice by private insurers is unjust. Claim denials shouldn’t be a routine part of our lives that we just have to accept, or face alone — instead we show up for each other and take them on together, so we can all get the care we deserve. 

Recently, we sent a letter to Elevance CEO, Gail Boudreaux, asking her to meet with us, and for Elevance to end their harmful practice of denying claims. We haven’t yet heard from Gail, but that’s OK ― we will be back. People like me are tired of being told by companies like Elevance we don’t deserve quality health care. Because wherever we are, and whatever we look like ― we all deserve better. We need health care that’s there for us, every day, and not just when it’s convenient to a billion dollar insurance company’s bottom line. 

So Elevance, if you really want to “elevate” and “advance” our health, it’s easy: Stop denying our care.

Bloomington resident Lane S. Fulton, holds a Master of Public Administration, is a member of People’s Action and works as an agency and safety net navigator, helping people get access to benefits such as SNAP, TANF, unemployment and health care.