Sample Medical Benefits Letter
NAME AND ADDRESS
Dear CLAIMANT NAME:
As a beneficiary under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), you are entitled to medical benefits for treatment of your MEDICAL CONDITION (ICD-9 codes: ICD-9 CODES), effective February 29, 2012.† Covered medical services are payable in accordance with the fee schedules and medical benefits policies established under the Energy Employees Occupational Illness Compensation Program (EEOICP).† Your medical benefits coverage includes payment to medical providers for services such as medical appointments, hospitalizations, home health care services (see attached Notice Regarding Home Health Services), medical appliances, supplies, and drugs that are prescribed by a qualified physician and approved by the EEOICP.
Within the next few weeks, you will be receiving additional information regarding your medical benefits coverage.† This will include a medical benefits identification card, which you will need to show to your physician or other enrolled medical provider you chose to treat your covered condition.† This card will be accompanied by instructions and a phone number to call to activate the card.† The card will instruct your physician, hospital, durable medical equipment supplier or other health care providers to bill the EEOICP directly, so that you will not have to pay for medical treatment covered under the program. There are no deductibles for services or equipment as long as the services are billed by an EEOICP enrolled medical provider.
To bill us directly, providers must be enrolled in the Program. For information about enrollment and billing, please have your provider contact us at the address and telephone number listed at the end of this letter, or give us your providerís phone number when you call to activate your medical benefits identification card.† We will call and explain the Program to your provider(s) and give them the necessary forms required for submitting bills for reimbursement.
To request reimbursement for out of pocket medical expenses associated with treatment of your accepted condition, you must submit the following forms: (OWCP-915 Form, Claim for Medical Reimbursement Under the Energy Employees Occupational Illness Compensation Program Act), and (OWCP-957 Form, Medical Travel Refund Request).† Both forms are enclosed for your convenience and include instructions for completing these forms and submitting any additional required documentation.
Please mail completed forms to:
U.S. Department of Labor
Energy Employees Occupational Illness Compensation Program
P.O. Box 8304
London, KY 40742-8304
If you or your provider(s) have questions regarding submission or payment of bills, or require any other medical bill program assistance, contact a representative toll free at†1-866-272-2682.
Notice Regarding Home Health Care Services
Note: if the EEOICP pays less than the billed amount (in accordance with the fee schedule), you are not responsible for payment of the difference to a provider.† Providers and claimants may submit requests for reconsideration of fee determinations in writing, with accompanying documentation to the address supplied in this letter.
Notice Regarding Home Health Services
As a beneficiary under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), you are eligible for those services, appliances, and supplies prescribed or recommended by a qualified physician, which are likely to cure, give relief to, or reduce the degree or the period of the accepted illness.†
Home health care is one of the many medical benefits you may receive for an accepted illness under the EEOICPA.† Home health care includes both in-home skilled nursing care, and the services of a home health aide to assist you with activities of daily living, related to your accepted condition(s).† Examples of these daily activities include assistance with mobility around the house, dressing, feeding and food preparation, and accompanying you to medical appointments.
It is important for you to be well informed about your EEOICPA benefits as they relate to home health care services.† This begins with an explanation of the benefits you are entitled to, and the information you and your doctor will be asked to provide before home health care can be approved.††
As with all forms of health care, you play an important role in determining the appropriate level of care and the types of services being provided to you.† If you have questions regarding home health care, direct your concerns to the District Office servicing your claim.†