Doctors: Does United Concordia Make You See RED?

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June 1, 2000

United Concordia Companies, Inc.
PO Box 898268
Camp Hill, PA 17089-8268
(1 800 322-0366)

Re: 
Subscriber ID:     Group:
( ) Pre D     ( ) Actual Submission  ( ) Date of Service _________
Relation to subscriber: ( ) self ( ) spouse ( ) child
Claim #: 

Dear Dental Advisor:

 As you are aware, I am insured by your company under the policy numbers provided above.  Dr. Markus has requested authorization to perform, or has performed, treatment and the claim has not been settled. The below is a list of outstanding treatment:

 It is my understanding that this request has been denied at least one time, and thus denied Dr. Markus permission to proceed with, or to be paid for the care for my teeth.  I would like to understand how, if Dr. Markus and his staff actually showed me the decay, on a camera, how your staff could deny it based on an x-ray?  Who is setting the standard of care here?  Dr. Markus has also explained to me that certain types of decay, breaks in fillings, open margins, etc. will not show up on an x-ray.  

In order that I may make an educated decision as to how I need to proceed, I would ask that the complete file as to the work product which resulted in the pre-determination or request for payment being rejected be sent to me within the next ten (10) days.  Thank you in advance.

Respectfully, 

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