2nd level conference

[Guest guest]

I'm so sorry to hear of your troubles. Most of my experience has been

with disability insurers, which is a different kind of problem.

One thing I have learned is that it makes a big difference how much they

can push you around depending on what state you live in and whether the

policy is part of the job benefits one might receive covered by ERISA.

If you happen to live in California, and you are NOT covered by ERISA (I

don't know the standard, just that I wasn't because I worked for

University of California, a quasi-state agency and was thus exempt) then

you have the option of suing, and juries right now don't like insurance

companies who capriciously and maliciously deny benefits. You probably

don't have time to find an attorney specializing in insurance issues in

your state before the conference, but it's worth a try. You might also

consider an attorney who specializes in malpractice to take the meeting

with you.

My advice:

1. Record the conference - advise all participants that you will be

recording it, and will prepare a written summary of the discussion and

will distribute it to all of them. (I was advised early on in my case

NOT to have any phone conversations with insurance company without

following it up with a letter that recaps the conversation: such as you

said " that you are now changing the day that you must have the records

from your previous request that they be available on X day. This is

causing me great personal difficulty, and my physician's staff is

frustrated as well. "

2. Remind them that stress aggravates any medical condition, some

more than others and this is one of them. Tell them that this is a

frustrating problem to have under the best of circumstances, and because

they are being so difficult to deal with, they are actually aggravating

your condition.

3. Do some research on whatever it is they are suggesting instead

of surgery. I've been following your difficulties, but must confess

I've forgotten exactly what they want to do (or not do). Maybe some of

us research-inclined can come up with published citations that you could

quote that would help you feel more confident of what you're saying

4. Try to sound reasonable, but not like you're a pushover or

stupid. Remember that the word hysteria and hysterectomy have the same

base word in latin. Be matter of fact about the frustration you're

feeling, but try to control it so you can participate in the discussion

as an equal. Practice what you want to say - have some key phrases that

you have on 3x5 cards, or some other convenient way of finding them

during the conversation.

5. If myomectomy is the only option that your MD believes to be

best for your health and also allows you to have children, ask them to

state the language in the policy (evidence of coverage) the allows them

to deny you the opportunity to have children, and send it to you. You

should insist, if you don't already have one, that they provide you with

a complete copy of the policy or " evidence of coverage " before the

hearing.

6. You should also request from them the Curriculae Vitae of the

physicians that are making up the advisory group in advance. They

should have those on file. You should also ask each physician during

the conference call what percentage of their income they receive by

sitting on such advisory groups. You should also ask each physician how

many patients they are currently treating for problems similar to yours.

Ask them what special training (sub specialties) they may have recently

obtained, or whether they have recently acquired CME credits in the

current treatment methods for uterine fibroids.

7. If you have the MD's names, see if the state in which they are

licensed has a public access data base, and check them out.

8. Ask your cooperative GYN for the name of the most aggressive

malpractice attorney in your town and see if that attorney can be with

you at the phone conference (go into the law office and have them call

you there). It may cost you up to $1000 just to have the attorney

review it with you and take the call with you and write a letter or two

afterward, but it may be the best $1000 you ever spend. Insurance

companies treat you differently if they know you have an attorney.

Within the company, your case often gets kicked to a higher level (and

perhaps smarter) person. They generally try to jerk you around less if

you have an attorney. While an attorney often is counterproductive in

the early stages of working with companies, in the later rounds like

you're in now they can be a help.

I am so sorry you have to go through this - we'll all be praying for

you.

Regards,

Gunden