Medicare, BCBS of Ga., Maximus = NIGHTMARE!

kathrynusa
on 3/22/08 12:17 am - Ellerslie, GA
3/20/2008 I called BCBS again and was told to call Medicare.( I FINALLY GOT SOMEONE WHO KNEW WHAT WAS GOING ON!  Medicare told me my appeal was at Maximus. A contract with Medicare to handle appeals..I called there and left a message. I will ask for my file to get it to Georgia's Insurance Commissioner..My understanding after reading their web site at www.medicareappeal.com that there are at least 5 levels to jump through to get an answer..The appeal can go all the way to a court. 3/21/2008 Called Maximus 2 times and BCBS 3 times..BCBS telling me they sent my appeal to Maximus and there was nothing they could do about it....Even if Maximus told me thay don't have the appeal. I said maybe it got lost in the mail? ..BCBS said no , it did not...Maximus has it !!..By this time, I'm going nuts...So I called Maximus and left voice mail about what BCBS said...In the meantime I'm calling Georgia Commissioners Insurance Department to see if they could help me..I did get a live person...She told me to calm down about 3 times..LOL..She did say before I hung up She was sure I would hear something just give it time...So I started looking on the net who could I call to get help....It was close to 5:00 PM and Maximus is calling.?...On Good Friday???. ..I was shocked.!..It was Carla whom I talked to around 9:30 AM ..She must have gotten my voice mail telling her BCBS did send my appeal to her. She was upset, but very nice...She said Maximus DOES NOT have my appeal. She asked who was I getting at BCBS that told me that..I said Customer Service..Carla said ,you need to talk to Appeals dept. Not CS..I said I have asked CS to put me through and they refuse..They just tell me BCBS sent my appeal 2/26/2008 to Maximus..Carla said well try to get appeals if they don't do it report them to CMS..She said if Maximus has my appeal BCBS should have a paper from the mail saying it was delivered..Carla also said my appeal would have to be denied 2 times BEFORE it comes to Maximus...I told Carla to my knowledge I only had one denial...So I called BCBS and they told me Appeals was gone for the day..I will be sure to call them Monday..BCBS is playing with my life. Kathryn and Handsome Rascal
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