Help - Ins. Doctors don't speak English?

September 23, 2002

Hi,

I need some advise please. Horizon BCBS of NJ received my appeals

package via Federal Express. After weeks of speaking to them they

have now finally acknowledged receiving it but don't know where it

is. Also, the 30 days they have to respond to me are up.

In speaking to one of their rep's I asked to speak to the medical

advisors office to find out how they could lose my appeals package.

She told me they did not take phone calls and if they did I probably

would not understand them because they did not speak English. I told

her I was told my appeal would be reviewed by a board of medical

doctors. She responded, " they are very knowledgeable and have some

type of medical degree, they just don't speak English " . I asked to

speak to her supervisor and I asked him that if these Doctors do not

speak English how could they read my appeals that was prepared in

English. He asked me who told me this, he did not deny it was true.

I told him who had said this to me. I also questioned what type of

medical degree these doctors have because some type of degree, as I

was told, doesn't necessarily qualify them to make a decision on our

daughter's condition. Who knows what degree they have.

A complaint investigator from the Dept. of Managed Care has opened a

case with previous complaints I had. I now have to send in another

complaint to be added to my previous one stating that they lost my

appeals package and that I was told their medical advisors did not

speak English.

BCBS wants me to send in another package (which I kept a copy of) and

that they will work on it right away and get back to me ASAP. Should

I send in another package? My contract says they will respond in 30

days to appeals. Since they haven't responded aren't they in

violation of our contract agreement? They have been very incompetent

and unprofessional in most of my dealings with them. Is there

anything else I can do?

Any advise please.

Thank you

Barbara (Sofia DOC Grad 9-17-02 & Catalina)

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