What You Need to Know
Anthem integrates healthcare services in ways that benefit its customers and help them get more and better care at competitive prices.
Anthem owns Blue Cross–licensed or Blue Cross Blue Shield–licensed companies in 14 states.
It calls itself a “health benefit” company, not an insurer.
Who Is Anthem?
Anthem is the largest for-profit insurance and managed-care company in the giant Blue Cross Blue Shield Association (BCBSA), but it is more than just a franchisee.
It’s a healthcare and business force in its own right.
Anthem owns Blue Cross–licensed or Blue Cross Blue Shield–licensed companies in 14 states. It also owns some large healthcare subsidiaries that offer health insurance and other healthcare products under names not affiliated with Blue Cross Blue Shield. These include America’s 1st Choice, Amerigroup, Aspire Health, CareMore, Freedom Health, HealthLink, HealthSun, Optimum HealthCare, Simply Healthcare, and Unicare.
Formed in 2004 by a merger with WellPoint Health Networks, Anthem now serves 107 million people — more than one in eight Americans.1 It calls itself a “health benefits company,”not an insurance company, and prides itself on creating innovative programs,2 which in some ways distinguishes it from other BCBS affiliates.
Just two examples: Anthem is using IBM Watson artificial intelligence to give its physicians instant access to research. And it has adopted the team-based “Medical Home” concept of primary care, which makes it easier to integrate various aspects of healthcare under one, electronically connected, caregiving umbrella.3
In addition, Anthem Care Comparison gives its members online tools that allow them to estimate what their costs will be at hospitals and caregiver offices, so members can make intelligent decisions about care alternatives.4
What Insurance Does Anthem Sell?
Anthem provides insurance policies for individuals and families, including preferred provider organization (PPO) plans, health maintenance organization (HMO) plans, Medicare Advantage plans, Medicare Supplement insurance (Medigap plans) and Medicare Part D coverage of prescription drugs.
Anthem also offers employer-sponsored plans for both large and small employers. It has a national contract with the U.S. Office of Personnel Management through which it provides federal health insurance in markets where it does business.5
It manages Medicaid, the joint federal and state healthcare program for low-income people, in 23 states and the District of Columbia.
The company works with the states of California, Indiana, Kentucky, Nevada, Virginia and Wisconsin to directly provide low-cost Medicaid coverage for children, adults and families, and it offers combined Medicare and Medicaid — “dual eligible” — coverage in California.6
It runs a pharmacy benefits plan, IngenioRx, which serves most of its affiliates and brings the efficiency of size to managing prescription drug coverage and costs.
Through its affiliated companies, it sells dental and vision insurance, plus critical illness and cancer plans, behavioral health, life, and disability insurance.7
More Than Health Insurance
Anthem Inc. is a huge managed care and health insurance company that provides more than traditional health insurance.
What Benefits Does Anthem Offer?
Some pretty technologically sophisticated ones.
Anthem has an in-depth, online, database-driven analysis of which services will work best for every member, as well as what will help in locating resources.8 Users are asked to answer simple questions that lead them through a series of steps to decide what kind of care is most appropriate — telemedicine, a retail clinic at a drugstore or similar location, a doctor’s office, urgent care, or an emergency room. At each decision point, Anthem provides a list of available caregivers and an estimate of costs.
If users are still unsure of the best option and would like expert help, they can talk to a doctor online 24 hours a day, seven days a week.
Anthem asks its healthcare providers to handle the claims process using an online portal. During check-in, check-out and billing, it gives the provider handling the procedure information about available benefits and costs, and outlines the next steps. For members, that means fewer frustrations and surprises — for example, with out-of-pocket expenses and deductibles.
Toolbox for Customers
Customers have access to sophisticated online tools to help them manage their healthcare choices and costs.
How Do You Enroll in Coverage with Anthem?
If you’re seeking individual or family health insurance, Anthem has a website that is easier to use than Healthcare.gov, the government’s Affordable Care Act site. It walks you through your choices and provides cost estimates. If you decide to buy, you can log in, talk to an agent and make a purchase. If Anthem owns the BCBS affiliate in your area, you can also call 888-630-2582 and be connected to a BCBS representative at your local insurer. Anthem also works with licensed insurance brokers and agents if you’d prefer to turn to an outside expert for advice that doesn’t come directly from the company.
How Does Anthem Stack Up?
One of the most basic concerns when buying health insurance is the company’s financial strength and ability to pay for your healthcare, while providing good service and paying claims quickly. In December 2020, AM Best, the most respected financial rating service among insurance companies, gave Anthem Inc. an A rating and some of its affiliates an A+, the top rating. If you’d like to look up the AM Best rating of the Anthem company you are considering, you can do it here.
While you are talking to an Anthem agent, you might ask how long it takes to get a claim paid. Insurance companies maintain that data and are usually happy to tell you, especially if they can brag that they pay 90% (or more) of their claims within 10 days, although most state insurance overseers give companies 30 days to act on a claim.
The percentage of in-network claims denied is also an important issue. Research on the 2019 denial rate among ACA insurers shows that denial rates of in-network claims ranged from 1% to 57%. Ask your Anthem representative to find out the company’s ACA claim-denial rate, or if you are comfortable working with data, you can search Kaiser Family Foundation files.
Another concern: how customer-friendly the Anthem insurer is that you are considering. State insurance departments regulate insurance companies doing business within their borders, and most provide an annual report that offers the number and type of complaints they received about those insurers. It also may offer customer reviews. Use this website to find your state’s office. If the information available doesn’t address your concerns, call the office and ask for what you need. State insurance departments exist to educate and protect citizens.
Alternatively, you can search for the company on the National Association of Insurance Commissioners’ website, where complaint reports are recorded.
You also can ask the Better Business Bureau (BBB) in your area. Search for Anthem in your Zip code. The customer service ratings and complaints lodged in the last year will pop up.
Strengths and Weaknesses of Anthem, Inc.
Anthem is an innovative, financially solid company that is dedicated to efficiency. Last year, it was recognized as among the most profitable companies in the world.9 As a public company, Anthem reported its 2020 results, pointing out solid growth across its businesses. All of this is to say that customers of Anthem can rest assured that the company has the resources to provide for their healthcare and manage it smartly.
Being part of the giant BCBS network is also an advantage for customers. Most BCBS affiliates enjoy nationwide networks, which means you can receive care wherever you are.
Finally, it can be helpful if you are digitally savvy, given how much Anthem relies on online communications with its customers.
- Find the Anthem company that serves your area.
- Avail yourself of the company’s significant online resources.
- Read — and make sure you understand the company’s products. Health insurance is complex. If you have questions, ask and get the answers you need before you enroll.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.