Me? Id write to the BCBS CEO.
Dear CEO;
On (date), my daughter (name) required medically necessary medical care. Pursuant to Page (number) of my benefit manual, I was required to obtain authorization. I contacted your company's employees on (date) and I was given an authorization nmber (number). The claim was denied stating I did not obtain authorization. On (date), I called your company and spoke with your representative, named (name). During the conversation, your employee yawned and moped at havig to take my phone call. I consider his actions to be completelty unprofessional and his refusal to asisst me to be a possible breach of the contract your company has with me.
Rather than assist me, once given the authorization number, your employee stated the provider has to appeal the denial of the claim. This was NOT the doctor's claim to have my health benefit paid. This was MY health benefit that is being denied payment and I attempted to appeal the denial of the benefit payment only to meet complete resentment and malaise on the part of your employe to help a member.
As you can see, from page (number) of my contract with your company (benefit manual). the service you are denying is a benefit I am paying to receive and frankly, I am not getting what you agreed to provide. I do not wish to pursue this through the legal system or to file a complaint with the State Insurance Commisioner, the Federal Trade Commision and the Internal Revenue Service at this time. I will allow you fourteen (14) business days from the date of receipt of this letter, to correct the wrong that has taken place and I hope that incidents of this nature do not happen again. if this is not resolved to my satisfaction, I will make the appropriate grievances and consider speaking with an attorney. You may also force me to terminate my contract with your company.
Sincerely,
Your name
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Again, this is what I would do, but that is how I get things done. I can find the CEOs name by googling (State BCBS CEO), going to my State Division of Corporations or if they file with the SEC, I go to the SEC website (
www.sec.gov) and look for their def-14 form. BCBS doesnt file with the SEC.
