Contacts :

Myrna Frank      264-6503
Karen Ploof      264-6504 (Case Manager)
Debbie Repice    1-800-777-4793 x-2395 (covering for Karen while she is out)
Member Services  1-888-687-6277

Benifit Coverage

Note from Myrna Saying XDQ code will be taken care of for the 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.

Per Myrna :

• 3 Initial Visits by VNA have been pre-approved.
• Concerning James Hospital stay 4/27 - 5/1
  • Since we did not request a private room (private rooms are not covered) it should be taken care of due to Medical Nessisity or Hosiptal Convience. If intial billing does not cover, have them "investigate".

Per Karen :

• Out of network consultation (2nd opinion) - Free
• Diagnostic and Pathology - No prior approval required, (out of network rates)

Wed May 5th, 2:50ish, called for prior approval for Ureter Stint and PET Scan. Karen was away and left the 1-888-777-4793 x2587 number. I talked to sue at that number and she said prior approval for Ureter Sint did not require prior approval. She refered me to Debbie Repice for PET Scan. Debbie did say the PET scan needed prior approval and that it was the responsibility of the Dr.s office to get it. She said she would call them and then call me back.

Dana Farber

Debbie also mentioned that as of 5/1/04 the PPO plans have contrated a Cancer Network that Dana Farber is a member of. This means that if we decide to use DF that we contact MVP and they set it up so DF will be treated as "In Network" with the same In Network Benefits. She also said the 2nd opinion stuff did not require any approval.

Thursday morning, May 6th, phone message from Debbie saying Pre approval of PET scan not required. Called and left her a message to get back to me concerning Dana Farber situation (May 6th 11:00ish)

Called Debbie Repice, MVP case Mgr, (May 11th 4:30pm) and left message to notify all upcomming procedures and asking for confirmation concerning pre-approval.

Called Debbie Repice, MVP case Mgr, (May 12th 8:30am) and left message to notify all upcomming procedures and asking for confirmation concerning pre-approval.

Debbie called to say every thing would be covered but if an overnight is required, the Hospital must notify MVP.