August 2, 1999 .... (retyped by Nancy Lee for posting, names/IDs edited, on 9/1/99)
Intergroup of Arizona
Attn: Intergroup Inquiry Supervisor
930 N. Finance Center Dr.
Tucson, AZ 85710
FAX: (520) 290-5176
Re: Patient: Nancy R. Lee
Policy: Member ID#: (xxxxxxxxxxx)
Dear Sir or Madam:
I am writing to appeal Intergroups denial of my request for a referral to Scottsdale Healthcare/Scottsdale Medical Imaging, dated July 27, 1999 and received via fax on August 2, 1999, for Uterine Artery Embolization to treat uterine fibroids. According to the letter of denial, Uterine Artery Embolization/Uterine Fibroid Embolization (UAE/UFE) is regarded by Intergroup - or rather, its parent company in California, Foundation Health Systems - to be an experimental/investigational procedure.
In accordance with Arizona state law, I request that my appeal and supporting materials now in the Member Inquiry area be submitted to the Arizona Department of Insurance for an External Independent Review. I request that the external reviewer assigned to this appeal be a board-certified interventional radiologist and therefore a medical specialist trained in arterial embolization. I appreciate your giving this matter immediate attention since I am experiencing considerable pain and discomfort, greatly impacting my work, family life and general well-being.
It is with much disappointment that I acknowledge that Intergroup, a company in which I have placed both my trust and medical care since 1992, has disregarded UAEs promise to provide women and their employers with a less costly, less risky, less invasive and far less debilitating treatment for uterine fibroids than hysterectomy. Some insurance companies who cover the procedure include Blue Cross/Blue Shield, Aetna, CNA, United Healthcare, PacifiCare, and ironically, Med-Cal in California and AHCCS in Arizona. It is sad to say that, in this matter at least, I would be better off indigent than working for the State of Arizona.