Recommendations for surgeons.

So I was diagnosed with a j-pouch prolapse and a weakened anal sphincter causing fecal leakage. I seen one surgeon who told me she wouldn’t do the surgery because she never performed one before and didn’t  feel comfortable doing it, which I respected, and she referred me to Cleveland Clinic. I seen Dr. Tracy Hull at Cleveland Clinic and had a surgery date set, however, a week before my surgery my insurance denied the pre-authorization because it’s out of state and they won’t cover anything out of state, (I live in Michigan). So then I decided to see another colorectal surgeon who I was referred to by the first surgeon who had performed 2 other procedures to fix the prolapse of a j-pouch. However, when I seen this surgeon he decided to not take on my case because he didn’t feel confident in his experience with j-pouch procedures. Especially mine, because of me being a younger patient, only having my pouch for 7 years and already having a prolapse that has probably been there for about 4 years based on past symptoms and just not being diagnosed due to all my doctors unfamiliarity of j-pouch and complications that can arise. So my question is, can anyone give me recommendations for REALLY, REALLY great colorectal surgeons in Michigan who have experience with j-pouch. I’m especially nervous because I’ve been told with the use of biologic mesh that most likely will be used it only takes a simple slip-up to cause me to have a permanent ileostomy, which I’m trying to avoid if I can. I really appreciate the help since I’ve been dealing with this for so long and I can feel that my symptoms are worse than before.

 

 

 

 

Original Post

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!

Add Reply

Likes (0)
Copyright © 2018 The J-Pouch Group. All rights reserved.
×
×
×
×