Day 39. Letter to GHC

Members Appeals Department, May 13^th, 2010

PO Box 34593

Seattle WA 98124-1593

Attn: Appeal Coordinator

RE: Member Id 02197826

Please accept this letter as my appeal to Group Health Cooperative’s decision to deny coverage pertaining to my May 7^th 2010, doctor visit to Yusal Yazici MD at New York University’s Behçet's Syndrome Evaluation, Treatment and Research Center. I will outline below why I feel this appointment was necessary.

The doctors I have seen while being covered by GHC and also when I was not covered by GHC are unfamiliar with Behcet’s, a rare auto immune disease. My GHC primary care doctor and GHC pulmonary doctor have had no other patients with Behcet’s Disease, and I’m only the second patient that my Rheumatologist has seen with this disease. The Behcet’s disease is affecting my lungs, causing a rare pulmonary disorder. My GHC Pulmonologist Dr Russian rushed my last CT scan so that I would have the results in time for my appointment with Dr Yazici. My doctors were eager to have Dr Yazici review my medical records and to receive his opinions and recommendations.

I feel this appointment was extremely beneficial to my treatment. Dr Yazici explained things about my disease and answered questions that no other doctor has been able to. He also told me that additional genetic testing was necessary, and gave me the correct information to request. He did a pathogen skin test and had me email him pictures after 48 hours. He explained why it’s necessary to increase my current medication (Imuran) and how long I will need to be on it in order for it to work. He recommends I stop one of my other medications as it is not beneficial to my treatment. He recommends that I have another PFT in 6 months to review my lung disease. He is also faxing his recommendations to my GHC doctors. All of these services I listed above were included in the $350.00 that I paid out of pocket.

I’m not interested in receiving treatment or traveling to NYU on a regular basis but I would like my Group Health doctors to receive consultation when necessary. If I was to travel to see Dr Yazici again, the office visit cost would be $150 since I am now an established patient. I would like GHC to reimburse me for my initial appointment expense of $350.00 and agree to pay for any further consultation from Dr Yazici as recommended by my GHC doctors. I think this is a fair request considering I paid nearly $1200 in travel expenses and I’m not requesting reimbursement for my travel costs. I will no longer need my referral to the University of Washington Rheumatology Dept or to the University of Washington Pulmonary Dept. I have no doubt the cost of these appointments to the UW would have exceeded $350.00.

Thank you for your consideration in this matter. Please know we are very happy with the care our family has received through Group Health Cooperative.

Sincerely,

Annie Van De Grift