So I have a prolapsed pouch that needs surgery. I had a surgery scheduled for July 17 at Cleveland Clinic only for my insurance to call and a week, yes, a week before my surgery to tell me they won’t cover it because Cleveland Clinic is out of their network. They say they will cover anyone in Michigan, so I’m already upset but ok whatever. Finally get the nerve to start scheduling another surgery, so I call the best hospital in Michigan, U of M. They then proceed to tell me that my insurance is out of their network!!! I am just so aggravated with this insurance thing and now my prolapse is worse, I’m in pain and now I’m going to have to go back to my original doctor who referred me to Cleveland in the first place because she had never, yep you heard right, NEVER performed this surgery before. I just feel like nobody takes this seriously, I just want to go to a doctor who has experience so I don’t have any mistakes happen. I’m just feeling so defeated. 

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BMarie, can you ask your doctor to give you names of three surgeons she knows have experience in this surgery?  She must know who among her peers has an excellent reputation. Tell her you are relying on her professional knowledge of her colleagues, which you do not have. Call your insurance company and ask if they cover any of those doctors and the affiliated hospital where they perform the surgery. Ask your doctor to set an appointment with that surgeon, hopefully very soon, so you can have your first meeting, then work with that surgeon to have your surgery.

Try not to stress too much; stress and anxiety will make your health worse. I know you feel like you are doing all the legwork, and you probably are. Ask your doctor to help you deal with your prolapse pain while you work together to find a surgeon fast. Do what you can to move this along but try not to use up your energy on stress. Save your energy. You can do this.

Thanks! I really needed to read this,  I called today and she recommended a colleague of hers who works in the same building so I’m making an appointment tomorrow for the earliest he can see me. I’m trying not to stress too much and I am trying different techniques when using the bathroom to avoid pain when possible. 

That's great news!  You'll feel better when the situation is moving along. If you come to a road-bump, go around it or climb over it. That's when your conserved energy comes into use. Good luck!

If you are needing a good surgeon in Michigan I recommend any of the surgeons as part of Spectrum Health in Grand Rapids, Mi.  This group were originally call the Ferguson Group.  My surgeon was Nadav Dujovny, MD 

Address4100 Lake Dr SE #205, Grand Rapids, MI 49546.
He did my j-pouch surgery 12 years ago and he is extremely knowledgeable about j-pouches and also has a great 'bedside' manner.
There are other gastro surgeons in that group that I've also heard good things about if you can't see Dr. Dujovny.

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