This is a letter I wrote to the practice administrator for Dr. Cywes and Dr. Pinnar outlining the many reasons I decided to go with another surgeon even though it will cost me more money and time. I wasn't going to post it publicly, but since they seem inclined to ignore my repeated requests for my medical records, I feel justified in doing so. For what it's worth I do like Dr. Pinnar, but the accumulation of all the issues below finally motivated me to make the change.
I am contacting you as the practice administrator to request that all claims submitted to my insurance provider be withdrawn and to outline the reasons for my decision to go with another practice for my surgery. I will apologize in advance as this may be rather lengthy but this has been a difficult decision and one that I have weighed for the past month.
On February 7, 2008 I had lap band surgery which was performed by Dr. Cywes. I had considerable success until approximately two years ago when I began to be able to eat more and began to put on more weight. I then went to Dr. Baptista for maintenance fills primarily due to my past experiences of having to wait hours to get in for a fill with Dr. Cywes. It was faster and easier for me to get them done by Dr. Baptista. Last November, Dr. Baptista order an upper GI to check my band and discovered that my band had eroded. This was confirmed by an upper endoscopy in December. It was at this time that I decided I wanted the gastric sleeve but I was not comfortable with Dr. Baptista’s level of experience in this area so I made a call to Dr. Cywes as I felt more comfortable with him with a more complicated surgery. When I called and explained my situation to the person who answered the phone, she placed me on hold and then came back and informed me that Dr. Cywes felt I should have Dr. Baptista perform the surgery. In other words, he was not interested in seeing me since I went to his former partner. At this point, I decided to go to Dr. Webb’s practice to explore this option. When Dr. Webb’s office requested my records from your practice, I subsequently received a call from the office inquiring as to my reasons for pursuing another surgeon. I explained my experience to her and she assured me that Dr. Cywes did not mean that he was not interested in seeing me and that there were options out there that Dr. Cywes would like to speak with me about. She suggested that I come in with no obligation other than to hear what options were available to me and I agreed.
After meeting with Dr. Cywes, I agreed to have him do the surgery to remove the band and subsequent repeat surgery. This was on 2/1/2012. It took a month to submit the initial pre-determination request and the subsequent appeal letter as a result of the initial denial by my insurance provider. We received the approval to proceed on 3/1/2012. Due to an issue at Shand’s with Dr. Cywes, I had to schedule the surgery for 3/29/2012 with Dr. Pinnar at Memorial. Everything went smoothly. I liked Dr. Pinnar immediately and felt comfortable with him.
On April 6th, I had my post-op follow up appointment with Dr. Cywes in order to remove the abdominal drain that Dr. Pinnar had placed during my surgery. On April 27th (3 weeks later) I had another post-op appointment. In those three weeks I had put on weight due to my lack of restriction and not following the low-carb plan. As is typical for Dr. Cywes, he saw that I had gained weight and he gave me his usual talk about our relationship with food for 15 minutes and when he was done he said that he would need to tighten my band. I then had to inform him that I didn’t have a band. It appears that he hadn’t even looked at my chart prior to coming in. He just assumed that I had been not following the program. When I got back to my office, I wrote ***** and asked that my gastric sleeve surgery be performed by Dr. Pinnar. I am not comfortable having such an invasive and complicated surgery performed by a surgeon who doesn’t bother to read my chart in his office.
On May 15th, after repeated attempts to contact ***** to inquire as to the status of filing a claim for surgery with my insurance company, I finally wrote a lengthy email expressing my frustration with the practice, lack of communication and lack of action in filing my claim. I copied you on this email and it is attached.
At this point I finally received a response from ***** saying that she was having computer issues and had not been receiving emails. I responded to her expressing that I understood about computer issues and asked when she would file my claim. She wrote me back on May 17th and said she would be filing it that day. The next day (May 18th) **** wrote to me explaining that she had faxed clinical information to my insurance company. She stated that my current BMI was 35.8 and that if I had a BMI under 40 I would require a serious co-morbid condition to get approved for the sleeve. I wrote back to her explaining that since this surgery was a result of an eroded band that I didn’t believe my insurance would require me to have a co-morbidity. I didn’t hear back from ***** until May 25th stating that she had finally filed my claim.
On June 1st, I had a follow-up appointment with Dr. Pinnar. Once again, I had gained more weight, but I wasn’t concerned about it as I knew the reasons why. While I was waiting for Dr. Pinnar, the nutritionist came in looking very concerned and asking me what was up? She also asked me if I felt I had sufficient restriction. I explained to her that I didn’t have a band. She then asked if I was a conventional weight loss patient. This was not the first time she had seen me but once again, it was a case of not reviewing a patient’s information before coming into speak with them. I also had a chance to speak with **** and express some of my frustrations and concerns about the filing of my claim. She assured me that she understood and that she would make sure my claim was filed properly (i.e. for a repeat surgery as opposed to a first time surgery).
After **** left, I proceeded to wait approximately 45 minutes to see Dr. Pinnar. He knew I was there as I spoke to him when I first came in. I could hear him out in the hallway talking on the phone and waited patiently for him to finish his conversation. I justified that it must be an emergency since he knew I was there and was keeping me waiting. When he finally came in, he apologized and explained that he was on the phone with his attorney. I was aware of the issues he was having with the physician who bought his practice in Virginia and we discussed that matter for a few minutes. Thankfully, he was aware that I had had my band removed due to erosion. Still, I am a very busy woman. I manage the cash for ********** in their Treasury department. My boss depends on me a great deal. I understand that Dr. Pinnar has some serious issues going on, but he needs to address them on his time, not mine.
On June 7th, I wrote to ***** to advise her that my insurance company had submitted a reply to their correspondence department stating that in order to approve the surgery for the sleeve I would have to complete a six month weight loss program with my PCP, which is standard for someone having their first bariatric surgery. Since this is a repeat surgery resulting from erosion, I feel that this requirement should be waived. In my email, I reminded her of this and asked her what the next steps would be for my appeal. I wrote again on June 12th and again on June 14th asking what the next steps in the process would be. To date, I have not had a response from her.
****, I hope you can understand my frustration with this process. I am frankly tired of being ignored and having to constantly remind my health care provider of my medical status and hand feed insurance policy language to support my claims. I have registered with another practice and have an initial consult this Friday with them. I would appreciate my records being sent to them as promptly as possible once they submit the request for them. Even though this is going to cost me a considerable sum of money and probably a little more time since I am basically starting over again, I feel I will be more comfortable with a practice who respects my time and communicates with me. I am a very patient person, but my patience has been pushed to the limit.