Reply to "Recommendations for surgeons."

Scott FMember

BMarie, it may be worth appealing this insurance company decision, based on medical necessity. Repairing J-pouches isn’t routine surgery, and it’s important to get it done by someone with appropriate experience. The insurance company will have an appeals process, and perhaps you could get a letter of support from the surgeon who referred you to the Cleveland Clinic. If you exhaust the insurance company’s appeals process then your state regulator (the Michigan Department of Insurance and Financial Services) accepts complaints https://www.michigan.gov/difs/...902_12907---,00.html

This takes some patience, but I have gone through the process successfully in my state. The insurer is obliged, for the most part, to enable you to get necessary, *qualified* medical care, but it can require some persuasion.

Good luck!

1/7/1910:32 PM

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