An "Adverse Determination" is a determination that a service is not a covered service either because it is not medically necessary or because it is experimental or investigational in nature.

1,006 is the total number of Appeals of Adverse Determinations, in the aggregate*, sent to external review in the 2007 calendar year.

58.71 % of Appeals of Adverse Determinations, in the aggregate*, sent to external review in 2007, were upheld.

41.29 % of Appeals of Adverse Determinations, in the aggregate*, sent to external review in 2007, were overturned.

* Figures are cumulative and are based on information collected from National Capital PPO, Inc. and certain subsidiaries of National Capital PPO’s ultimate parent company, WellPoint, Inc.

National Capital Preferred Provider Organization, Inc. (“NCPPO”) is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation. Both are organizers of independently contracted provider networks, which makes available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. Neither has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers. Both are not insurance companies and neither have liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.