About a month after sending this letter, I was starting to wonder why I hadn't heard anything back yet (I figured government is slow, but maybe not that slow). I called NYS Department of Financial Services, and they informed me they had received my external appeal form, and had been trying to contact me unsuccessfully because there was in issue with the submission. In fact, I was told I had a day or two left to respond before they were going to close my case due to lack of a response. I found this odd as I had received no mail or calls that I knew of. I was put in touch with the manager of my case, who informed me that, indeed, no mail was sent, and no calls were made. They had however sent me two emails. They were emails whose subjects were just my name followed by a sequence of random letters and numbers, and whose entire content were the phrases "See attached external appeal assignment." and "See attached letters." respecively, in addition to a single PDF attachment each. Both emails had went to my spam folder. The NYS representative who worked my case was kind, and helped me get my materials resolved in time, but I find it baffling that after receiving a letter that clearly involved a lot of work from numerous people, and having all my contact info, NYS was just going to bury the appeal without once trying to call me, send me a piece of mail, or send me an email with more than a single English sentence in it.

In addition to being surprised to find I had missed correspondence from NYS, what the correspondence was about was pretty baffling as well. Part of the Physician Attestation Form that was filed by my doctor on my behalf required two references to peer reviewed literature supporting my case for an appeal of the coverage denial. The NYS representative in charge of my case had put my appeal on hold because they needed me to send them copies of the actual peer reviewed papers, in addition to the references. This was mind-boggling to me. First of all, the appeal instructions provided by this same department specifically asked for references to peer reviewed literature, not copies of that literature. If the copies are a requirement, obviously that should be stated up front, to avoid unnecessary correspondence such as this. Second, the medical field comes up severely short on the front of free access to research literature. You can't expect to find a preprint of every medical paper on arxiv or other free (and legal) servers; instead, the publicly accessible (legal) copies are frequently hidden behind paywalls for non-open-access journals. In my case, both papers referenced by my doctor were not freely available (to the best of my knowledge). When I reported this fact to the NYS represenative, they told me that was too bad, and I'd have to find a way to get copies. This is another ridiculous barrier to successfully appealing an insurance denial; after going to great lengths to submit an appeal, you still find you have to both send a check to Aetna for $25, and pay some journal additional fees for access to two articles, just for the right to possibly get coverage you already pay for each month (assuming the denial was inappropriate). It seems reasonable to me that if the external review agencies are in the literal business of reviewing appeals for a living, maybe they could themselves pay for one collection of subscriptions to medical journals, rather than requiring each person in New York State to get access to their own subscription just to be able to exercise a consumer right. But maybe I'm the insane person, I really don't know anymore.