Also, Dr. Konety may have some ideas to help with the HMO problem.. These doctors see such things more times than you would want to imagine.
And CONGRATULATIONS on going ahead with the consult on your own. I know it is difficult for you, but it is very important that you get the best treatment available, and it surely doesn't sound as if that is what you were getting!
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Good for you Sonya...you're getting the ball rolling. These appeals have a tendency to last forever and i believe thats by plan so that you eventually give up. I would also write my senators about your situation and make as much noise as possible...maybe the Sacramento newsstaions would do a segment?? The insurance companies hate publicity.
And as Stephanie suggested talk to UCSF billing department to see what they might be able to do.
But don't hold off treatment until they decide to act on this. This is time you can't get back and its your life we're talking about not a scrapped knee.
Let us know what the advocacy group can do for you. Find a pro-bono lawyer.
Hope you have a great session with Konety.
Thank you all for responding. I talked to the insurance today and also the Dept. of Managed Care in Sacramento. I told the insurance I was appealing the decision regarding Dr. Konety and also simultaneously filing a complaint with Dept. of Managed Care. I learned about the Knox-Keane Act which states I am entitled to a 2nd opinion with a qualified Dr. within a certain distance. The Sutter (my plan) Docs are Urologists only, we don't have a Urologist/oncologist in the group. My argument is (1) none of the Sutter referrals are qualified to do what Konety will do which is a written review of path slides, written treatment protocol, office cysto, other lab tests, and discussion re: radiation vs surgery protocols. Even my own uro used a collaborative approach to get treatment protocols, he took my case to tumor board with several other specialists giving input. 2 of the docs they referred me to don't handle HMO patients, one specializes in post vasectomy and 4 cite conflict of interest. I think I have a good appeal. The only issue is that they have 30 days to turn it around and I am holding up treatment. I am paying for the WED. appointment which is about $2,000. I will contact a patient advocate group you guys refer to later today. RIght now I am going out to get one more medical record so I have everything ready for Weds. It remains to be seen if my uro will follow Konety's advice. I see him the day after (Thurs) Konety's apapointment, so I'll know then. He probably will not do the surgery, so if I need it, if the appeal goes through, it at least opens the door to use Konety as the surgeon. Again, I am so gratefull for advice I got here. Thank you. I'll check back when I get home.
11 years 4 days ago - 11 years 4 days ago#24312by Stephany
Sonya, I'm glad to see your post! I had been watching the list, hoping we'd hear from you. And I'm glad you're on your way to a second opinion. I think you'll end up with lots of answers, and probably lots more questions, too.
Just bring 'em on back, and we'll see what we can do. Let us know what your second opinion is, too, and we'll see what the others think.
While you are at the new doctor's office, ask to talk to their insurance person. They may be able to help you with the issues you are facing with your insurance company. They've been through this before, I would wager.