Florida Bluealignment health of florida

K Aug 08, 2018

My complaint is in regard to unethical behavior on the part of Alignment Health, a provider of Florida Blue Cross Blue Shield.
Date of incident is 7/30/18 tp present day.
The issue is unresolved as of today August 8, 2018.

I am a BlueMedicare Preffered HMO SNP Member ID#XJCH26718031
I am status post Bome Marrow Transplant and i have chronic Graft Versus Host Disease (GVHD) and i am immune suppressed. I am also a cardiac and diabetic patient.

On July 30, 2018, I found that there was no appropriate referral for a scheduled visit to Dr Edgar Espana MD Opthalmologist University of South Florida( USF) .Diagnosis Severe Infection of Left Eye Rule out GVHD.
Alignment Health ( AH) previously approved a referral to return to Moffitt Cancer Center for Evaluation of Possible GVHD .
It seems that Moffitt set up the telephone referral to USF and I was told that a new referral should have been generated by AH prior to the visit.
I requested that AH approve referral for 7/30 /18 visit urgently and gave the update of the visit which was Left eye surgery by Dr Bajric MD USF Opthalmology on Friday August 3, 2018.
I spoke to the financial coordinator at USF Opthalmology Darrius.
Darrius contacted me that he had faxed the referral requests to AH after speaking with AH supervisor Norma.

Waited all week and no response from AH. Requested an escalation to a supervisor
spoke to Norma but no response back regarding eye care/surgery review.
To date no response from AH I have called day after day and still no response from AH regarding urgent eye surgery request

Filing a FORMAL COMPLAINT regarding UNETHICAL BEHAVIOR ON THE PART OF ALIGMNMENT HEALTH. Alignment Healthcare is holding back on authorization for care due to no financial arrangement with USF . Alignment Health claims they have not spoken to anyone at USF regarding this. Ih ave repeatedly demanded that AH prioritize my urgent medical need in regard to my eye to date no response
Contacted local eye doctor urgently as eye condition has deteriorated. I will visit on 8/9/18.
Please contact AH and call me back immediately at [protected]
Kathleen McEntee
2600 B Hidden Lake Drive North
Sarasota Florida 34237
Cell [protected]

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