Evercare Health Plan QUEST Expanded Access P.O. Box 15923, Honolulu HI 96830 ‘Member Services 1-888-980-8728 TTY: 711, for hearing impaired Q® Evercare by UnitedHealthcar Date: November 5, 2010 To: Summer Harrison 3663 Papalina Road Kalaheo, Hi 96741 Re: — Request for Services for Hannah Harrison Dear Summer Harrison, | am writing this letter to you as we are concerned about the communications we receive from you and various providers. These communications are often times sent to Evercare QExA and many other recipients, including Hawaii DHS/MQD, CMS Regional/National office and possibly other agencies/persons. These communications are most often via email and sometimes forwarded to Evercare QEXA by others. Our concems are as follows: 1. Itis unclear who these communications are directed to. As an example, Dr. Koh's letter of October 7, 2010 "To: Whom it may concern’. It is a challenge to understand who, if any, should respond to such communications. 2. Generalized communications do NOT constitute a formal request for services as they do not utilize the request for services form (“Prior Notification Form’). We are willing to assist providers in filing out this form and have done so in the past. 3. These communications are often sent via email. As you know, email is an unsecure method of communication. The plan cannot respond to you or your providers via email with any specificity for confidentiality reasons. To formally request service(s), you and Hannah's providers should submit such request(s) to Evercare QExA using regular mail or via fax to our toll free local fax # 1-800-267-8328. We have previously sent the Prior Notification Form to Hannah's providers, including Dr. Koh in Denver. Hannah's Evercare QExA Service Coordinator (Carol Franklin, RN) can also assist you and Hannah's providers with this process. Upon receipt of a formal request for services directed specifically to Evercare QExA via mail or fax referenced above, the plan will process the request timely and in accordance with the terms of the benefits. This will also enable us to better coordinate service(s) that may be covered by other agencies, such as the Department of Education and Department of Health. “Col bt Haque David W. Heywood Executive Director — Hawaii Ce: State of Hawaii, DHS/Med-QUEST Division