These benefit changes will reduce member cost share for Mental Health, Behavioral Health and Substance Use Disorder (MH/SUD) and emergency medical transportation benefits. Previously filed claims will be retroactively adjusted back to dates of service on or after January 1, 2016. Members who paid the incorrect cost sharing amount will receive a separate letter and refund, as appropriate.
California Department of Insurance detectives, assisted by multiple law enforcement agencies, arrested Chris Bathum and Kirsten Wallace on multiple felony counts of grand theft, and identity theft for allegedly conspiring to defraud patients and insurers out of more than $176 million through an elaborate conspiracy. Simultaneously, search warrants were also executed at 15 locations throughout Los Angeles and Orange County.
The letter will explain that Anthem Blue Cross has noticed a potentially risky pattern in the way they’re getting prescriptions filled. They will have 60 days to change this risky behavior. If Anthem Blue Cross doesn’t see a change in their drug claims within 60 days, they’ll follow up with another letter.