Ms, Sharon E. Moore - by fax 410-468-2260
Insurance Investigator
Maryland Insurance Administration
525 St. Paul Place
Baltimore, Maryland 21202-2272
Re: MIA File Number 61022-L-2003-SEM-C
Company: CareFirst Blue Cross Blue Shield
Request for Hearing
Dear Ms. Moore:
Pursuant to Insurance Article Section 2-210 and COMAR 31.02.02.03, this is a request to challenge MIA's decision and request a hearing on the following grounds:
o My application received on October 7 at no time requested a September 1 effective date UNLESS those terms were hidden somewhere in the fine print. I did not knowingly accede to a backdated policy to the prior month.
o The billing system you say is designed to bill ahead. In the interests of fairness and equitability, the billing system should be redesigned to bill the 1st of the next immediate subsequent month.
o To my knowledge, natural "quarters" are from January through March, April through June, July through September, and October through December. CareFirst has utilized artificial means to redefine the normal calendar and has gone so far as to bill for partial unnatural quarters PLUS complete quarters non-customary to any other enterprise, State or Federal.
o There was no application for EasyPay billing in the application package. In fact, there was wording "send no money now" in bold print.
o As of my telephone call of October 17, I faxed back immediately and a copy of that document has been transmitted to your office.
o As for the November 1 start date, I was assuming on October 17 that I would be receiving materials in advance of that date. As bureaucracies happen, I did not receive materials until December 3. The upshot was that I was still going to have to pay at least a month of no coverage to CareFirst's pecuniary advantage.
o Any payment whatsoever to CareFirst is contingent on my father agreeing to submit payment. This will take time in and of itself in that my father is currently residing in a nursing home. I retain the right not to enroll in any CareFirst program no matter the bill, the billing cycle or the "quarter".
My Medicare coverage predates any contact with CareFirst by several months. CareFirst denied any rebate or compensation for the gap. My previous CareFirst policy was not cancelled for non-payment, but the fact of Medicare Parts A and B coverage in existence for some months before. This was explained to a CareFirst representative by phone well before the July premium was due. CareFirst maintains mistakenly that they provided coverage in the interim although several outpatient claims were rejected outright. CareFirst never provided coverage during the period of my Medicare eligibility.
As for Carole Walters' communications: They were never sent to me and I received them only through MIA. There is no EasyPay application enclosed. Further, it is clear that the output of CareFirst's fax machine is not forwarded to the proper party in a timely or accurate manner.
The remainder of Ms. Walters' letter of November 26 has been addressed above.
A few more not minor points: The enabling legislation for CareFirst specifies affordable and accessible. An initial bill for $998.60 when monthly billing has been requested does not fulfill CareFirst's legislative mandate. A computer system designed to bill ahead does not fulfill CareFirst's legislative mandate. Quarters of the year asynchronous with any other business entity do not fulfill CareFirst's legislative mandate. [citing 2003 Chapters 356 and 357]
I trust you will send a copy of this Request for a Hearing to Ms. Walters, Senior Executive Inquiry Specialist, by snail mail and not by fax.
Preamble 2003 Ch. 356: Health Insurance - Nonprofit Health Service Plans - Reform