Univera Senior Choice Secure Cleveland CLinic denial .. Appeal begins ~

I was denied by Univera Senior Choice Secure plan to see a surgeon at the Cleveland CLinic for a second opinion on a RNY procedure I had done in 2007. My letter stated that the reason for the dnnial was that this could be provided for by an "in network MD".... well I called to see who the customer service representative wanted me to go to... Dr. Joseph Carauana... Director of Bariatrics in Western NY. Well guess what... he's the one in the same that denied my request... as his practice is called Synergy Bariatrics and they do not give second opinions on surgeries done outside of their clinic.   So I was soon back to square one... Now:

1) I have to write a letter to Univera to ask for an appeal... complete with notifications that I have been denied appointments with the group at Synergy due to office policy of not seeing patients other than their own

2) I have called Medicare HMO Patient Rights advocate and the Medicare Denial units... and they will be helping me with appeals directly from their office... as they said I cannot be denied coverage as it is my primary care physician that is requesting specialist care for me and if it cannot be provided for "in network" then they have to grant me an "out of network " approval.

More insurace hoops to jump through...but any of us that have dealt with bariatrics knows how fun insurance companies can be. Wish me luck... I'll post more as things progress....

I'm constantly hungry... my weight is on the rise and I continue to excercise and journal my food intake to keep track of things until I can get seen by another bariatric surgeon to see what's going on with my RNY pouch.  Post more as things progress...

Kathy