January 1, 2012 Dr. Thomas Zorc Chevy Chase Surgical Associates, P.C. P.O. Box 70626 Chevy Chase, MD 20813-0626 Dr.

Zorc: I think you are aware of the long saga of the past four months, in which I have made four personal visits to Foreign Service Benefit Plan/Coventry¶s office on N Street NW, as well as prepared and submitted an appeal to OPM for denial of full PPO benefits to your PA Mindy Hong for services you both rendered during the successful removal of my appendix at Sibley Hospital on 11/29/2010. Numerous telephone calls and subject research added considerably to the time spent on this unwelcome project. Administratively, this has been a nightmare experience, but I would like to express my gratitude for the timely assistance of Lisa McManus on your staff, who promptly answered my many questions and offered helpful guidance throughout this lengthy process. During a December 2, 2011 office visit, I was told by a FSBP representative that Coventry had changed course and finally agreed to reimburse both you and Mindy Hong for the previously denied code procedure 44180 (removal of adhesions). Hopefully by now you have received an additional payment of $2,258.90 and Hong an extra $516.32. It is, at least, some reward for collective efforts expended. At that meeting, however, the FSBP rep informed me that we ³will not win´ on the issue of appealing for full PPO benefit levels across the board. Reason: according to Coventry¶s game plan, full PPO payments can only be made to non-preferred providers while the patient is being treated in the emergency room. Once a patient is admitted to the hospital and/or surgery begins, the ground shifts and the scenario reverts to non-PPO rates if appropriate. Needless to say, I find this interpretation to be deceptive and outrageous - - NOBODY would come to that conclusion by reading the language addressing medical emergencies in the Foreign Service Benefit Plan brochure. Furthermore, I received the week before Christmas a letter dated December 16, 2011 from OPM (copy attached), denying my November 7, 2011 appeal for full PPO benefit level reimbursement for Mindy Hong. OPM also declined to support payment for 44180-59-82 - apparently the operative report must now be worded (tailored?) to meet more exacting standards in order to extract insurance payment these days. All of this leads me to the conclusion it would be futile to submit a second appeal requesting full PPO benefit reimbursement for you, since OPM would likely fall back on the same arguments to concur with Foreign Service Benefit Plan/Coventry¶s original decision. (Note: Hong¶s appeal was filed first, both by your staff and me, due to the chronological order of Coventry¶s payments.) The only recourse at this point would be to hire an attorney and pay for litigation against OPM in Federal Court, which is financially and realistically a non-starter. I am a retired government employee currently supporting a live-at-home son attending community college, and do not have deep pockets. Ergo, I think it is time to make an arrangement acceptable to both of us.

00 for procedure codes 44970.08. VA 22101 .10.562. made out to Chevy Chase Surgical Associates P.357.919.. Sincerely. For simplicity¶s sake.00 for a consultation which occurred in the emergency room. which would lift her total reimbursement to $3. I propose to pay you the coinsurance amount of $2. in the amount of $3.857.00. and appreciated patience in resolving this matter. and 49322. Thank you again for your professionalism.If you agree.08. Hart 1117 Randolph Road McLean.00 for all charges. skill. Please let me know if you concur. I would request that I be allowed to pay one check.500. Shirley M. 44180. reaching the approved amount of $7.000. I propose to pay an additional $1. your total payment from FSBP/Coventry and me would reach $8. I believe this offer to be equitable and fair. For Mindy Hong. Together with Coventry¶s previous payment of $643.C.

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