METASTATIC  CANCER LETTER                                                 

           

                                                                        Date:                                                               

           


Employee Name:

                                                                        File Number:

 

 

Dear:

 

This is in further reference to your eligibility to receive medical benefits as a beneficiary of the Energy Employees Occupational Illness Compensation Program (EEOICP).  On [Date of FAB Final Decision] the Final Adjudication Branch advised you by letter that you were entitled to medical benefits for treatment of [Malignant Neoplasm of the Lung Middle Lobe:  ICD-9 code 162.4]. 

 

Subsequently, medical bills were submitted to the Division of Energy Employees Occupational Illness Compensation for the treatment of [metastatic cancer—ICD-9 code—i.e. Liver, specified as secondary:  ICD9 code 197.7].  Medical evidence has established that this cancer is a result of [Accepted/Primary Cancer --i.e. Malignant Neoplasm of the Lung], entitling you to medical benefits for this additional approved condition under EEOICPA.  Your entitlement to these benefits is retroactive to {the status effective date}.    Therefore, if you or your provider submitted bills for this condition on or after this date that have been denied, please resubmit them to DEEOIC for reimbursement.  Covered medical services are payable in accordance with fee schedules and medical policy of the Energy Employees Occupational Illness Compensation Program (EEOICP).  The policy includes coverage of medical appointments, hospitalizations, medical appliances, supplies and drugs that are prescribed by a qualified physician and approved by EEOICP.

 

Within the next few weeks you will be receiving an updated Medical Benefits Identification Card that includes the additional, approved ICD-9 code shown above.  You should present this card to your physician and any other authorized medical provider you choose to treat your approved covered conditions.   

 

If you or your provider(s) have questions regarding enrollment procedures, submission or payment of bills, or require any other medical bill program assistance, please contact a billing representative toll free at 1-866-272-2682.

 

Sincerely,

 

 

 

Claims Examiner