Re: BC/BS NJ Copy of Denial Letter

[Guest guest]

Barbara, I have lots of questions for you but lets start with this one: you

didn't

receive the denial letter yet but did you recieve an explanation of benefits

(EOB)?

The EOB tells you if the claim is paid or denied. You would usually recieve this

first before a denial letter so don't lose faith yet. I'm familiar with Horizon

BCBSNJ's

procedures. The denial letter usually comes after an appeal, not on the initial

submission of the claim, so there may not be any letter to send to you, which is

why you are not receiveing anything. . I know, they should be more attentive

but

unfortunately, not all reps are attentive.

Before you start the appeal, make sure this is truely denied so that you don't

do

alot of work for nothing. Call 1-800-355-blue, put in your ID number and ask

the customer service rep if your claim has been finalized. If it has, ask for a

copy of the explanation of benefits. If it is denied, ask for the address to

where appeals

are sent. It is a different address from where you send claims. Also, if you

are unhappy with their service, you can agree via voice prompts, when you call

the

1-800 number, to take a 2 minute survey on how you were serviced. Horizon is

always looking to improve customer service, but they need to know when a

customer is unhappy. If this isn't enough to get your point across, when you

call,

ask to speak with a team leader or manager.

Hang in there. Please keep me posted so I can help you though the corporate

paperwork.

I live in NJ - Flemington area. Do you live in NJ? Are you doing the DOC

band at CT in Paramus?

ann/

NJ

> Message: 17

> Date: Mon, 24 Jun 2002 17:15:21 -0000

> From: " catasofia2002 " <catasofia2002@...>

> Subject: BC/BS NJ Copy of Denial Letter

>

> Hi,

>

> Blue Cross/Blue Shield of New Jersey told me over the phone that they

> have denied treatment for my daughter Sofia. Reason was it was not

> a " medical necessity " . Both her Pediatrician and plastic surgeon

> sent in letters saying it was a medical necessity. Why would they

> use this as an excuse? I have not received the denial letter in the

> mail so I asked them to please fax it over but they haven't. Every

> time I call and ask for it they take my number down but do not return

> my calls.

>

> What else can I do to get a copy of this denial letter? Also, what

> is my fist step in appealing their decision?

>

> I'm in tears every time I hang up the phone with them. I cannot

> understand how cold they can be especially when it comes to treatment

> for a baby.

>

> Barbara (Sofia's mommy)

>