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.
but couldn't find one. And I couldn't reply to Kathy's message, either.
