Gail Chord Schuler
Melbourne, FL xxxxx
July 22, 2004
P.O. Box 55270
Phoenix, AZ 85078-4150
I received an Explanation of Benefits from you in which you give Codes A and B as your reasons for denying me reimbursement for my prescription medication.
Code A is not applicable in this case, because I am currently employed at Wal-Mart and my Starbridge insurance payments have been (and are being) deducted from my paychecks. So, to say that my coverage has been terminated due to non payment IS NOT CORRECT.
Code B is confusing. I sent you all the information you requested: original receipts and a letter explaining what the receipts were for. Very simply–the $10.46 was for an amoxicillin prescription which I paid for up front. It was prescribed for me by my doctor.
Let me give you a history of my interactions with Starbridge. When I worked for Burdines in 2001 and up to the spring of 2002, I was under Starbridge coverage for about two months. I then had to quit my job at Burdines in Tallahassee, FL and was allowed to continue my Starbridge coverage under COBRA. I made monthly COBRA payments until September 2003. My COBRA coverate terminated about October 7, 2004 because I was not allowed to extend it any further after this date–that is the way COBRA works. With COBRA, you can only extend your coverage for 18 months after your regular employer sponsored health insurance stops: April 2002 + 18 months = October 2003. Participants in group medical expense plans are protected by a federal law that guarantees a continuation of their group coverage (up to 18 months) if their employment is terminated for reasons other than gross misconduct. I did not make my last COBRA payment (in Sept. 2003) because I knew my 18 months were up, and I could not afford to make the last payment at the time.
From Oct. 2003 until March 20, 2004 I had no health insurance and was unemployed.
March 20, 2004 I got a NEW job at Wal-Mart and discovered (by coincidence???) that Wal-Mart also used Starbridge coverage for the 1st 6 months of a new full-time associate’s employment. I am currently employed at Wal-Mart and the Starbridge health insurance deductions are being taken from my paycheck. So your Code A reason for denying me payment is INACCURATE.
I NO LONGER WORK AT BURDINES or FEDERATED DEPT. STORES. It seems you have it stuck in your mind that I STILL WORK AT BURDINES or that I am still under the FEDERATED STARBRIDGE PLAN. I work for WAL-MART now and am no longer associated with BURDINES or the FEDERATED STORES.
Of course, judging by the way you have been handling my records, maybe you would prefer to call my new Starbridge plan the BURDINES-FEDERATED-WAL-MART PLAN. Perhaps you think Wal-Mart and Burdines and the Federated Stores are in some sort of conspiracy together?? PLEASE GET IT STRAIGHT THAT I DON’T WORK FOR THE BURDINES-WAL-MART CORPORATION, unless you’d like to create the new company!