Finding the chain of command and utilizing it is the modus operandi of pinning down a decision in the corporation. You must remember who you are talking to and the purpose of your conversation. It would make no sense to argue with this employee about the details of the patient's condition, coverage or state law's requirements about covering the patient's condition. The purpose of this conversation was to find out who to write the letter detailing these facts to and putting the best case forward. It makes no sense to argue your case before a bailiff, you must find the judge.
Persistence is the key to effective information gathering and pinning.
Most people, however, are uncomfortable pushing the cusp of a conversation beyond what may be considered good manners. These are inhibitions which must be forgotten when an HMO jeopardizes a patient's health. The documentation, research and advocacy you contribute to this process can help change things for the better for others. When all else fails, or does not appear to be succeeding in time, enlist others who can help even the balance of power between the patient and the corporation, such as the media. The level of what is reasonable that you help to establish for yourself or loved one will help clear access to care for those in the future.