Anthem Anthology

June 6, 2023

I had an ankle biopsy for a nerve fiber density test with Dr. Brian Maurer with Rocky Mountain Foot and Ankle.

June 14, 2023

Got the results of the biopsy. They told me that within a 1mm specimen, you should have around 14 fibers. Low is around 7. Mine is 2.6 fibers per mmm. Dr. Maurer prescribed some supplements with folic acid…specialty compounding, with the possibility of being able to grow the nerves back. EB-N5 from EBM.

June 15, 2023

Information passed along to Dr. Jolley.

July 5, 2023

I asked for a referral request to a neurologist, saying I didn’t know if this was the right referral. I describe constant pain that is waking me up with a 1-10 scale of 8 or 9. I asked about any therapies that might help, and told Dr. Jolley that I had tried lidocaine patches and Icy Hot. Mentioned again that my mom had peripheral neuropathy. In previous appointments, I mentioned that my mom had Sjogren’s Syndrome. They responded that I should make an appointment.

July 7, 2023

I mention that we’ve already talked about this in an appointment, and that I was trying to get a referral. I mentioned the previous referral to a podiatrist for the same issue, and said I’m willing to come in, but I’m looking for a referral. She forwarded the message to Dr. Jolley, but says she’s out of town until 7/21, two weeks later.

July 11, 2023

I reply that I’ve got to get the pain under control because it’s interfering with my sleep.

July 21, 2023

Dr. Jolley placed a referral to Dr. Reynolds. Said he comes up to the specialty clinic in Frisco. He is NOT in the Anthem app. I called Dr. Reynolds’ office, and I’m told that he doesn’t have any appointments until December at the earliest, but that he’s in-network in Summit County, but not in Denver if I want to see him sooner. He still shows that he’s out of network in the Anthem app. His number goes to an allergy clinic. I give a list of the in-network doctors to the nurse…Braxton, Ross, Jensen, Esfandi, Spencer.

July 24, 2023

The first referral to Dr. Esfandi is placed. I respond that Dr. Esfandi is “not board certified,” according to the Anthem app.

July 26, 2023

They respond by saying that per his website, he IS board-certified, so the Anthem app is wrong.

July 27, 2023

I contacted Anthem’s UM group for a waiver or exception to see Dr. Esfandi in Lakewood. It is marked URGENT.

July 28, 2023

On July 28th, I learn from Dr. Esfandi’s office that the doctors in Summit County are ONLY COVERED IN-NETWORK IF I SEE THEM IN SUMMIT COUNTY. Dr. Esfandi’s page in the Anthem app shows him in Frisco, in Summit County. I learn that the doctors in Summit County are now scheduling out to January and February. Shea responds that they will keep an eye out for any documentation from Anthem.

August 4, 2023

I call into Anthem’s UM to follow up, and they told me that someone at Dr. Esfandi’s office told them that the patient didn’t need the appointment anymore, and the request was closed. This was the request on July 27th, which was addressed and closed the following day, on July 28th. Nobody contacted me to find out if this was correct. I’m told by Dr. Esfandi’s office (Ava) that someone named Heather cancelled it, and I learn that Heather is in Dr. Jolley’s office. It looks like she thought that the appointment was with a non-network doctor, so she canceled the referral and made a new one with Dr. Vargas in Steamboat Springs. I’m really upset, so I go into Dr. Jolley’s office to figure out what’s happened. Jen explains to me that ALL of the doctors listed in the Anthem app are either not practicing anymore or are only in Denver. One doctor retired, three more were part of a group called Blue Sky that disbanded, another is only a spinal surgeon, and one is a psychiatrist. Dr. Esfandi is listed, but only seeing patients in Lakewood. Dr. Jolley suggests we try Gabapentin, so I set up an appointment for August 8th. We cancel the referral to Vargas, and put in another referral to Esfandi.

August 8, 2023

Appointment with Dr. Jolley to talk about the pain and how to manage it. She prescribes Gabapentin. We talk about getting into a neurologist and how frustrating the situation has been with Anthem.

August 9, 2023

I write her to tell her that the Gabapentin was helpful, and that I got a full night’s sleep.

August 11, 2023

I called into Anthem’s UM to check on the status of covering my appointment with Dr. Esfandi, and I’m told it was denied AGAIN. The agent tells me that they want me to use an in-network neurologist in Basalt, and tell me that the doctor is 57 miles away. I don’t even know where Basalt is, so I plug it into Apple Maps, only to find out that the doctor’s office is NOT 57 miles away, it’s either 114 miles over Independence Pass (almost 3 hours each way), or through Glenwood Springs down to Basalt, which is 117 miles. I had a panic attack on the phone, as I’m trying to explain to them that this is not an acceptable solution. They then try to tell me I can go to Steamboat Springs, which is fewer miles but a little less than 2 hours each way. I tell them that in winter, I won’t be able to drive the roads to get to either of those. That Denver and 62 miles is about an hour’s drive. They won’t approve it, but I’m told that they will put in an urgent request to re-review the request. I told them that I have an appointment on August 17th, so I need the approval quickly.

August 4, 2023

I call intoI call into CHPG and request an appointment with Amanda Hart, my therapist, because I’m so stressed out and having panic attacks because of Anthem.

August 15

I got a call from Dr. Esfandi’s office, with the woman telling me that since I don’t have insurance coverage, they’re cancelling the appointment. I told her that I’m in contact with Anthem’s UM group, and she uncancels the appointment, and I tell her I’ll call Anthem’s UM again. I talked with UM, and they told me that my only option is to put in an appeal, since they can’t put in a request to re-review. The appeal can take up to a month, and it doesn’t matter that I have an appointment on Thursday…they tell me they don’t know if they’ll cover the appointment because it’s out of network. I tell them that this whole mess is because they don’t have any neurologists in-network in our area, even though there are SIX in-network options in the app. I’m upset again, although I don’t freak out like last time. I feel hopeless and frustrated. I decide to call in again to Anthem’s customer service and try to find an executive level customer service agent. I call the corporate number, then the lady says she’ll transfer me to a US-based agent. I get transferred to an agent in the Philippines AGAIN. I request a transfer to a US-based supervisor, and around 48 minutes into the call, I am connected to a supervisor. A long conversation with the supervisor, and he told me that he can override the out-of-network status for a one-time appointment, but that it would have to go through UM for future appointments. This call to 833-401-1577 lasted an hour and 47 minutes. He said he was in Las Vegas, and would call back on the 15th or early on the 16th.

An agent from Anthem called back in the afternoon to get any evidence that my doctors have referred me to a neurologist and for what. She also says that there are no notes from the supervisor, and nothing showing that he promised me that he would approve the one-time visit. She thinks his name is Glen Long, and she was going to review the call. She asked me to see if I could fax doctors’ notes from my visits, any test results. I reached out to Dr. Maurer’s office and the lady there said she would fax them to 303-764-7294, attention Cheryl. I also called Dr. Jolley’s office, and Shea faxed the information from their office.