Re: (unknown)

January 23, 2003

Congratulations every VICTORY over an insurance company is a real

VICTORY!!!! Way to go!!!

(unknown)

Hey Folks!

I have BC/BS of Empire State (New York) through my husband's

employer, IBM. We have the self-managed plan. I started my process by

asking for a predetermination letter. In my letter to the insurance

company, I disclosed that the billing would be done by means of a

" global fee " and what that meant. The 12-page letter that Penny

prepared for the predetermination process also included extensive

dialog regarding the global fee and why this is the process by which

the insurance company would be billed.

A short time after receiving the predetermination letter from me, the

insurance company issued a letter stating that I had satisfied their

requirements for proof that the surgery was a medical necessity.

Their letter had a one-line disclaimer stating that this letter did

not necessarily mean that they would pay the claim. (Which begs the

question: What the heck is a predetermination letter for then?)

Anyway, I went forward with step number two, which was to get a

precertification letter from them. Once again, I disclosed the global

billing fee policy to them and, once again, they failed to address

this issue one way or another.

I borrowed the $17 K from Cosmetic Fee Plan and figured I might have

to pay one payment while awaiting the reimbursement from the

insurance company. When the payment came, it was only for a little

over $3,000. This was what the insurance company determined that the

prevailing rate in North Carolina was for the surgeon. They informed

me that they had no intention of paying for anything else. However,

because I kept great records of who I had spoken with and had the two

letters of predetermination and precertification, IBM's human

resources department went to bat for me -- insisting that the

insurance company had been given ample opportunity to deny service

during the preop stage and had left me with the impression that the

entire amount would be covered. In the meantime, we have made two,

$400 payments (most of which was interest).

Today is day 50 from the date of first submitting my appeal. In the

BIBLE this is the number for the year of Jubilee when all of your

debts are forgiven and you get back the land you may have had to

mortgage to get through the tough times. It is a year to be set free

from bondage! Today I received a call from IBM's Human Resources

department telling me that a check for the balance that the insurance

company owed would be mailed out on Friday or Monday! Praise the

LORD! I feel like I am recovering from the bondage of slavery to

obesity and now I am recovering from the debt associated with the

slavery! This is my year of JUBILEE!!!

January 23, 2003

Jansong:

Congratulations! Way to go! Never give up...

Vicki

> Hey Folks!

>

> I have BC/BS of Empire State (New York) through my husband's

> employer, IBM. We have the self-managed plan. I started my process by

> asking for a predetermination letter. In my letter to the insurance

> company, I disclosed that the billing would be done by means of a

> " global fee " and what that meant. The 12-page letter that Penny

> prepared for the predetermination process also included extensive

> dialog regarding the global fee and why this is the process by which

> the insurance company would be billed.

>

> A short time after receiving the predetermination letter from me, the

> insurance company issued a letter stating that I had satisfied their

> requirements for proof that the surgery was a medical necessity.

> Their letter had a one-line disclaimer stating that this letter did

> not necessarily mean that they would pay the claim. (Which begs the

> question: What the heck is a predetermination letter for then?)

> Anyway, I went forward with step number two, which was to get a

> precertification letter from them. Once again, I disclosed the global

> billing fee policy to them and, once again, they failed to address

> this issue one way or another.

>

> I borrowed the $17 K from Cosmetic Fee Plan and figured I might have

> to pay one payment while awaiting the reimbursement from the

> insurance company. When the payment came, it was only for a little

> over $3,000. This was what the insurance company determined that the

> prevailing rate in North Carolina was for the surgeon. They informed

> me that they had no intention of paying for anything else. However,

> because I kept great records of who I had spoken with and had the two

> letters of predetermination and precertification, IBM's human

> resources department went to bat for me -- insisting that the

> insurance company had been given ample opportunity to deny service

> during the preop stage and had left me with the impression that the

> entire amount would be covered. In the meantime, we have made two,

> $400 payments (most of which was interest).

>

> Today is day 50 from the date of first submitting my appeal. In the

> BIBLE this is the number for the year of Jubilee when all of your

> debts are forgiven and you get back the land you may have had to

> mortgage to get through the tough times. It is a year to be set free

> from bondage! Today I received a call from IBM's Human Resources

> department telling me that a check for the balance that the insurance

> company owed would be mailed out on Friday or Monday! Praise the

> LORD! I feel like I am recovering from the bondage of slavery to

> obesity and now I am recovering from the debt associated with the

> slavery! This is my year of JUBILEE!!!

>

January 23, 2003

Jan I think that is great. I am very happy for anyone who can have their

surgery paid for by the insurance company. God bless and rejoice!!

Sheffield

Concord, NC

11/26/02

261/212