Re: Jubilee

[Guest guest]

Wow, what a wonderful Jubilee for you! " In all ways acknowledge Him, and he

shall direct thy paths. " Provembs 3:6

In his hands,

Kathy in NM

>From: " jansong777a <janteel@...> " <janteel@...>

>Reply-

>

>Subject: (unknown)

>Date: Thu, 23 Jan 2003 20:23:06 -0000

>

>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!!!

>

>

>

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