After I sent my response to Linda Farina concerning the two letters from First Health, I entered the spreadsheet from the Manager, Support Services into my computer.
I did a different sort, and my eyeballs detected some strange things.
I sente-mail 1 to Linda Farina pointing out what I saw.
She sent e-mail 2, telling me to call First Health.
I sent e-mail 3, asking for the decisions I asked for in the reply letter.
She sent e-mail 4, still begging the question.
I'll update this with any further e-mail shuffles.
e-mail 1 =================================================================
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I finally got the spreadsheet that the Manager, Support Services sent
transferred into my computer.
I then sorted it on description, CPT code, and date.
Some very interesting patterns show up that way, such as arbitrary PPO
discounts, non-uniform denials, etc.
No wonder we have had headaches with them.
e-mail 2 =================================================================
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James, I see in Mary Jo Thompson's letter that she asked that you
contact her if you have further questions. I would recommend listing in
writing your questions on PPO discounts, etc. and direct them to her.
I got your response to First Health's letters. I will send them a copy of
this letter tomorrow and ask them for a response to the concerns you
have expressed.
e-mail 3 =================================================================
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Linda,
I'm confused, but probably so are you.
My mistake in addressing so many issues in one letter.
At this time, it boils down to two issues:
1. First Health has declared that I've exhausted my appeal rights under The Plan, unless you direct them otherwise. Are you directing them to re-examine?
2. If you are not directing First Health to re-examine, when will you be making your final discretionary determination?
James Martine-mail 4 =================================================================
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James, when I sent them a copy of your recent letter to me, I pointed out your concern on the appeal issue. I will discuss their consideration of your September letter as an appeal with them and get back to you as soon as I can.
