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The e-mail game


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 sent
e-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 =================================================================

Date: 11/30/98 09:17am
From: KJRose@compuserve.com
To: LINDA FARINA <LFARINA@metrogroup.com>
Subject: First Health Followup

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 =================================================================

Date: Tue, 01 Dec 1998 17:11:08 -0600
From: LINDA FARINA <LFARINA@metrogroup.com>
To: KJRose@compuserve.com
Subject: First Health Followup -Reply

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 =================================================================

Date: Sun, 06 Dec 1998 11:12:46
To: LINDA FARINA <LFARINA@metrogroup.com>
From: JAMES MARTIN <JMARTIN@metrogroup.com>
Subject: First Health Followup - Reply - Reply

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 Martin

e-mail 4 =================================================================

Date: Tue, 08 Dec 1998 18:38:13 -0600
From: LINDA FARINA

To: JMARTIN@metrogroup.com
Subject: First Health Followup - Reply - Reply -Reply

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.