Received: May 3, 2004  04:23:28 EDT EDT
Expires: Jul 2, 2004  04:23:28 EDT EDT
From: mfrank@mvphealthcare.com
To: jpettine@us.ibm.com; mfrank@mvphealthcare.com
Cc:
Priority:
Subject: RE: James Pettine

*********************This Email Was Encrypted*******************

Jim,
You are welcome.

Thank you so much for the info you shared. It was most helpful.

I contacted Claims, and was assured that it was not a problem, would request
that non-notification penalty be removed, that your wife was educated on
specifics of PPO policy, so it shouldn't happen in the future.
If you do receive any similar letters in the future, please call MVP Member
Services.  You can tell them that there should already be a case on file in
which the nurse called to advocate, so the process should be much smoother.

Reminder-Have your son James sign a release of info form and get it FAXED or
sent to MVP Member Services ASAP.  Otherwise, when you or your wife call
MVP, they are not allowed to share any info, not even his health coverage,
benefits, or anything. Once this signed form is on file @ MVP, you should be
able to access info you need.

I hope you don't mind that I took the liberty of sharing the info you sent
on James, with Karen Ploof, who will be his Case Manager RN,out of the
hospital. The same info being shared with those involved in his case, should
only serve to improve the quality of his care. It looks like it has been a
circuitous route to diagnosis.  Hopefully, you will have some clarity soon.


Good luck,
Myrna

-----Original Message-----
From: Jim Pettine [mailto:jpettine@us.ibm.com]
Sent: Monday, May 03, 2004 2:50 PM
To: Frank, Myrna BUR
Subject: James Pettine






Myrna,

Hi, thanks for the help. The benefits that are currently being challenged
with a XDQ code
(Non Notification Penalty applied) are from the  Radio Frequency Ablation
(RFA) James received on
his Facet Joints on 3/2/04, two CAT / CT  scans on 3/2/04,  and for Blood
tests done on 3/3/04.

First the blood test. James has had 19 blood tests from 11/02 thru 5/1/04,
these have always
been covered (5 under the current MVP PPO plan in 2004).  I don't
understand why the
blood test done on this date are in question.

James has also had multiple X-rays, MRI's and CT scans, again all of which
were covered
in 2004, except these two on 3/2/04  (Service #'s 76375 350  and  73700
352).

From mid Jan. thru to the RFA on 3/2/04 James was in often unbearable back
pain, there was a period of
weeks were he only got an hr or so of sleep each night. He couldn't attend
school or be tutored
as the non-stop pain prevented him from concentrating.
He was referred to the Pain Management Clinic at FAHC. On 2/10/04 they
performed an
Epidural Steroid injection which unfortunately did not help. On 2/19/04
they performed a Medial Branch Block,
this was a diagnostic procedure to see if it was reasonable to perform the
RFA.
It was successful in relieving the pain. James was scheduled for the RFA
sometime in May.
This seemed highly unreasonable due to the pain he was in but we were told
the RFA was the
"most popular procedure" the clinic provides. The RFA was done on 3/2/04 as
James' doctors
used their "pull" and we got in via an emergency wait list.

A more comprehensive sequence of events that cover James entire situation
(but still broad in details)
can be found at http://www.pettines.com/james_medical/
This page was just recently started to help us keep some sense of sanity to
all that's going on. As such, I hope
to updated it frequently to provide information in greater detail.

Please let me know if there is anything else I can provide.

Jim

=========================================
 James (Jim) E. Pettine          IBM Microelectronics
 VLSI Test, S390 TAE            Dept B32, Bldg 963-1
 (Tie) 8-446-7337                      (802)769-7337
 Email : jpettine@us.ibm.com


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