August 02, 2007
Dear Ms Jones * (*not my real name)
Thank you for selecting ________ Health Insurance. We appreciate the confidence you have expressed in our organization and consider every interaction an opportunity to exceed expectations and invite your ongoing critique of that objective.

Your new cards will be arriving shortly, and if you have any questions concerning your coverage, call our Customer Service Department at our toll free number ###-###-####. You may also visit us at ____________.com where you will find a variety of helpful information under the Member section.

Again, thanks for choosing __________ where Innovative Health Care is Designed Around You.

Sincerely,
Paula Dixon
Individual Membership Administrator

************

From: Chris Cook
To: Velveeta Jones
Subject: Re: Why is my rate so damn high
08/26/07
Hey girl! I have spoken with Phil, my rep at ___________ to inquire about the rate. There may be some red flag from the medical survey, that's all I can figure out right now. Phil says he will be contacting you (or someone will be) to speak with you about the issue.

See you Saturday?

xxooxx (and to ________ as well)
Chris

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August 30, 2007
Dear Ms Jones:
We are responding to a recent inquiry requesting the specific reason for our underwriting decision. Due to the confidential nature of health information, we are sending this response directly to you.

Our rating and underwriting decision communicated to you previously for your __________ policy was based on the following condition(s):

Gall bladder disease and epilepsy/seizure disorder

If you disagree with our decision or would like your file re-reviewed, you may appeal within 90 days of the receipt of your original decision notice from _______. Upon receipt of this additional information, we will review your appeal and provide you with a written response within 21 business days.

Thank you for this opportunity to be of service to you.

Sincerely,
Lynda McMichaels
Vice President, Insured Customer Assistance, Retention and Enrollment

************

September 5, 2007
Dear Ms McMichaels:
Thank you for giving me an opportunity to appeal your decision for my health insurance. According to your letter, I was denied for 2 reasons. Perhaps I was not clear enough in the notes on my medical survey. So, I would like to re-address them:

1. Gall Bladder disease. I do not have a diseased gall bladder. My gall bladder was removed years ago, and since its removal, I have suffered no ill affects whatsoever. If you look back to the survey, you¹ll see where I wrote in "gall bladder removed". Unless you know of a reason for a removed organ to still be diseased, then I think we've solved that problem.

2. Epilepsy/seizure disorder. I have never been diagnosed with either epilepsy or a seizure disorder. I have had some "petite mal" episodes, however numerous doctors could find no cause for them, nor did they ever witness an episode. The best explanation given was that they occurred due to scar tissue (from successful brain surgery in to remove a blood clot). Since my last one in or around March of 2005, I have not had an occurrence as I began a program of taking Omega-3 on a regular basis. There is research by Dr. Edward Bromfield, Associate Professor of Neurology at Harvard Medical School and chief of the Division of Epilepsy and EEG Dept at Brigham and Woman¹s Hospital that strongly links an increase of these fatty acids with brain activity. He, along with other researchers, suggest that an important
way to control these seizures may be as simple as consuming more foods rich in DHA. Having changed my diet to include more of these foods, along with adding my supplement of Omega-3, seems to have succeeded in preventing further episodes.

Please consider also, that I was a member of __________ under a group plan and had no major medical conditions during for the past 3 years. Please also consider, that in 2003 I applied for a plan with you ­ and was accepted at a very reasonable rate, even with the same conditions! In fact, I would characterize my health as improving since that time.

I am enclosing some copies of my medical records regarding the seizures. And I hope that you will reconsider your decision.

Regards,
Velveeta Jones

PS: Please note that I am in the process of moving, and any further communication should be sent to:
9 Hydrangea Drive
Marshal, NC 27715

************

October 5, 2007
Dear Ms Jones
CASE: ##-###############
Your request for a re-evaluation of our rating and underwriting decision has been opened and assigned a case number. Please refer to this number in all communications.

To help us further, we are requesting that you provide to us, at your own expense your entire medical history for the past 5 years. Please forward these records to the following address:

Upon receipt of this additional information, we will review your appeal and provide you with a written response within 21 business days.

Sincerely,
Lynda McMichaels
Vice President, Insured Customer Assistance, Retention and Enrollment

************

October 25, 2007
Ms McMichaels:
Re: Case ##-#############
Enclosed are 5 years worth of medical records. They are in no particular order, since you told me to send these to you at my expense, I assume you are saving lots of money and can certainly afford to have some office peon sort through these.
Also, please note, that your last letter had to be forwarded to me, which only continues to delay our communications. My new address, again, is:

9 Hydrangea Drive
Marshal, NC 27715

Regards,
Velveeta Jones

************

December 17, 2007
Dear Valued ______________ Member:
Thank you for using ______________ for your health insurance needs. Enclosed are your new ID cards and Summary of Benefits. You may begin using your cards as of January 1, 2008.

We appreciate you as a customer and welcome the opportunity to serve you and your health insurance needs. If you have any questions, please visit us at __________.com or contact our Customer Service Dept. toll-free at ###-###-####.

Sincerely,
Lynda McMichaels
Vice President

************

January 4, 2008
Dear Ms McMichaels:
Thank you very much for reviewing my case and resolving this issue. Just a couple of items I¹d like to point out to you. First, you are still sending mail to my old address and so I am only getting my ID cards today, Jan. 4, when the postal stamp claims they were sent out on Dec. 19, 2007. Please update my address (see below).

Secondly, I have not received any further communications from you regarding my rate. Maybe another letter is lost in the mail forwarding, and I¹ll keep my eye out for it. However, to insure that you are promptly paid, perhaps now would be an excellent time to jot down my correct (new) address and keep it on file!!

Best,
Velveeta Jones

************

FIRST AND FINAL NOTICE OF FEES DUE
Account Number ########
Amount Billed: $1796.80
Balance Forward: $0.00
Total amount covers (from) 09/15/07 (Thru) 02/14/08

To avoid termination, payment is due within 31 days of this date: 09/15/07
__________ offers you an easy way to pay your premiums! EasyPay____ is our convenient monthly payment service ­ your premium is automatically withdrawn from your checking or savings account. To enroll, go to _________.com or call toll-free ###-###-#### 24 hours/day.

************

Sandra: Thank you for calling __________Customer service, this is Sandra, how may I help you?
Me: (after explaining situation and going back and forth on my few options) so, basically, I have no choice but to pay this bill ­ a bill that I received in mid-January, and starts my insurance in January - but goes back to September 2007?
Sandra: Yes.
Me: But, can I just re-apply?
Sandra: Oh yes, you can re-apply.
Me: Will I have to go through that 1 year waiting period ­ because now its been over 6 months since I lost my group plan?
Sandra: Yes.
Me: (after long sigh) so, let me see if I have this straight. In order to have your health insurance, you want me to pay you $1800 for a "product" that you sell, but you're not going to give me the actual "product" I'm paying for?
Sandra: Well.....
Me: Isn't that what you're saying? I mean, I can't use the insurance for Sept, Oct, Nov and Dec. 2007, right?
Sandra: Right........
Me: So, you are telling me that in order to be able to receive any health care I must pay you this money, even though I get NOTHING. How is this different from a mafia payoff?
Sandra: uh........
Me: How is it different? You just want the money isn't it? You think I'm some sort of risk, so the only way you'll take me is if I pay you off, right? Be honest.
Sandra: Well..............yes
Me: Man you guys are killing America. Just take your insurance and stick it where the sun don't shine. Goodbye.

************

January 16, 2008
Dear Velveeta Jones,
Recently we received information from the United State (sic) Postal Service (USPS) that indicates your address has changed. For your convenience, we have updated your information in our system to reflect the new address.

Your new billing address is:
Your old billing address was:

Please take a moment to review the new address listed above. If the new information is not correct, please call our Customer Service Department at the toll-free number listed on your ________ ID card.
We appreciate this opportunity to better serve you.

Sincerely
Dan Prather
Senior Director
Individual Membership Administration & Application Processing.

Fin