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Anthem Blue Cross PPO / Changed primary provider

1 Fresno, CA, United States

My husband has had a policy with Anthem Blue Cross for a PPO since 1997 which covers me and our children. In 2007 I went to work for an employer that provided a HMO policy without the option to opt out. I was not interested in changing insurance usage as I had established doctors, etc. that would not accept the HMO. I contacted both companies and was told that I simply needed to declare who the primary and who the secondary insurance was, so I declared the PPO as my primary and never used the HMO. Every year my husband's insurance would send a coordination of benefits questionairre that I would send back listing the other HMO information. This year I sent it back and suddenly all my claims are being denied by the PPO. Furthermore, they are now going back through prior years and adjusting claims to disallow payments. They state that my insurance through the HMO is primary and that they were not aware of it's existance until the recent questionarre that I returned, which is untrue. They deny having ever received prior questionaires from me. When one of the medical providers contacted them they were told that the policy of the company is to have the insured declare primary (which I did), but that I had changed primary with the last questionnaire, which is untrue. It didn't even ask anything like that on the questionnaire. When I called them back immediately after I spoke with the health care provider the insurance once again said that my HMO is primary and that I cannot declare primary. I am now in the middle of some sort of twisted game where I think my insurance company is trying to weisel out of payment. I know they have lied to me because they knew about the other insurance from the start. Anyone know if a situation like this? The best way to resolve it?

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