Dr. Sanchez

I’m sharing an actual recent peer-to-peer call that shows what physicians and patients face when trying to get a surgery approved. This call felt as absurd as it sounds. The peer-to-peer call was to advocate for surgery to prevent and treat lymphedema for a patient with breast cancer. Her risk is high and we can perform a surgery to lower it. The doctors from the insurance company on the call were an ophthalmologist with a subspecialty in oculoplastic surgery and a plastic surgeon who currently has a cosmetic practice. Neither doctor has ever performed lymph venous bypass…the surgery I was trying to get approved for my patient. Neither doctor would provide their name or license number. At the conclusion of the call, the doctors told me that they didn’t have the power to make a determination or decision to perform the surgery. They were just there to inform me of United’s decision to deny it. The Medical Decision was not up to the doctors on the call. It had already been made by United. So here I am, appealing again. Medical decisions should be made by doctors who are well informed and patient-centered. Patients deserve access to the care that they paid for with their premiums.