Heath insurance plan is American.
I am an 86 year old US citizen living in Italy, retired after 40 years of service asa Department of the Army Civilian at a US Army base (Camp Darby) located in Pisa. Asa government employee and retiree I have been continuously enrolled for more than 30years in the Mail Handlers Benefit Plan (MHBP) ID number XXXXXXXXXXX an approvedhealth insurance plan sponsored and partially paid for, by the US Office of PersonnelManagement (OPM). The monthly payment to MHBp currently deducted from my retirement payis some $450 a month. I have been an invalid since 1996 when my right leg was amputated above the knee andhave had to wear an artificial limb with an electronic knee to be able to walk. Theseexpensive ($32,800) electronic knees are guaranteed for 3 years with an additional 2 yearextension. After the maximum guarantee period the manufacturer recommends replacement ofthe knee if it is not satisfactorily functional. The MHBP has reimbursed the acquisitionof two of these legs. In December 2012 I submitted a claim to MHBP for replacement of my 13 year old leg. This claim included the same supporting documents as the two previously approved claims, a bill with English translation for the cost of the kneeand the cost of construction and fitting of the stump socket, prepared and signed bythe provider,as well as required information specified on the claims form.The first reply I received was a letter with date 01/02/2013,entitled "EXPLANATION OF BENEFITS" which specified, that the billed Amount, $37,254.85 (actually the amount I claimed 29,952 EURO) was ineligible for reimbursement. A remarks paragraph stated"RESUBMIT WITH CURRENCY USED, ITEMIZED BILL, DIAGNOSIS OR REASON FOR SERVICES AND TRANSLATION". Although my original claim contained all required information, includingtranslation I resubmitted the claim. I also sent a letter specifying that MHBP had already reimbursed for two knees in the past and that my condition was rapidly becoming urgentand required expeditious processing.I did not receive a reply until 23 May 2013. The letter had a date of 04/25/2013 andagain declared the billed amount ineligible with the remarks paragraph: (SERVICELACKS INFORMATION FOR PROCESSING. SEND ADDITIONAL DETAIL/ITEMIZATION WITH DOS & REVCODES). I immediately replied by FAX with step by step instructions on constructing limb prosthesis sockets which I found via internet. I also told them my conditiondeteriorated to the point that I can no longer leave the house without the use a wheelchair and an accompanying person. As for the DOS and REV codes I called MHBP with thetelephone number the letter indicated for clarification and the clerk told me that they were codes used for determining charges for hospital services and were notapplicable for oversea services.
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