General Category > General Questions

Medicare

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ste:
2 important additions

1. The home plan has made it clear that the letter must come directly from Medicare. A letter from me with attachment of Medicare rules from the Medicare web site is not acceptable.
2. Blue Card, the middle men in all this, have made it clear that I have exhausted all opportunities to communicate with the home plan and get this issue resolved. Hence my ending statement in the second post, Where can I turn next?

I have filed a complaint with the Oregon Insurance Commissioner's office but have yet to hear back from them

   

PMRNC:

--- Quote ---I have filed a complaint with the Oregon Insurance Commissioner's office but have yet to hear back from them
--- End quote ---

Unless this is govt/church plan OR an individual plan with BCBS the State dept of insurance is not going to be able to do anything. Group health plans that are not govt/church are ERISA plans and therefore subject to Dept of Labor. IF this is an ERISA plan than you can file an appeal with them showing them that Medicare does not enroll nor accept claims from your provider. (use the links Michele posted earlier). Meanwhile you can make SURE it's a covered service under the patient's plan by asking for a copy of their summary plan benefit and make a copy of it. YOU might STILL be out of luck if the secondary does not cover the services or the provider, that's why you really need to make sure you have the SPB in your hands, again, IF this is an ERISA policy.

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