Thank you all for your support, encouragement, and helpful suggestions (as well as your good humor) - I really appreciate ALL of you!
Thank you for all of the "lawyer" suggestions, but I should explain first that I AM a lawyer myself, employed by the federal government and very much used to dealing with insane bureaucracies on behalf of individuals. I've spent a lot of time in the courtroom and have no fear of taking on a righteous fight. But, as my supervisor and I discussed after I got the denial letter, our jobs take a lot of emotional energy out of us and leave little left for fighting our own battles, especially when the battles really take up a lot of time, attention, and focus. One of the things that has really frustrated me is that I am someone who will NOT give up this fight, but I know that there are many, many consumers who are being held at bay by the tactics of insurance companies and who do not get what they need as a result.
Before I got the denial letter, I had already considered a "lawyer letter" to speed the never-ending reapproval process. It would be better to have someone act as my attorney rather than representing myself, but that's not a problem - I have several friends who are lawyers who are EAGER to turn Doberman on PacifiCare for me if I just give the word. Now, since the denial, they want to talk to congressmen on my behalf (one of my good friends is a good friend of one of them), for crying out loud! We'll see if it comes to that...
Shortly before the denial, I also talked to the consumer advocate for the Arizona Department of Insurance (a lovely woman who was self-pay for her RNY four years ago because of her insurance hassles, and now LOVES to advocate for patients as a result) who was one of the few people in any bureaucracy I've dealt with who offered any help or even an iota of interest. Unfortunately, her help could only be to use her contacts with PacifiCare to find out what the hold-up was with my reapproval, because the State of Arizona has no jurisdiction over my insurance because I am a federal employee. I cannot get help from HR because that's not how the Governemnt works.
I CAN turn to the United States Office of Personnel Management ("OPM"), but only after I have exhausted the appeals process with PacifiCare. I can then file a lawsuit if OPM also doesn't get my denial reversed, but that process would be very lengthy.
I talked to a bunch of Burpee and Chiasson patients at the WLS support group on Tuesday night, and they were really in favor of my checking out those two doctors before deciding whether to appeal the denial. The Juarez patients all said to that their experience with Dr. Juarez was great, but aftercare has been a hassle. They recommended that I think about staying in Tucson if PacifiCare will cover Burpee and Chiasson. And, unlike Dr. Monash, who just finished a fellowship, Drs. Burpee and Chiasson have done about 450 lap RNYs each, from what I've been told, so they ARE pretty experienced, and staying in Tucson would be great. I most likely would have chosen them over Juarez had I known that I could have them, so they're looking interesting at this point. I'm still weighing my options and will decide what I want to do after the seminar a week from today...
Gobble-Gobble!
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- 24 September 2007 - Lap RNY
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