Pacificare HMO............this is confusing!

Ok, here is the gest of my last denial letter for VSG, and this is why I decided to go thru with the RNY. I haven't received the one for RNY, but I know it was denied per Managed Heatlh referral status line. The request for referral was denied not the RNY surgery because I have not seen a RNY specialist yet! I am starting to think that Managed Health are told to automatically deny anything they receive because Jill has a monkey on her back and she is starting to get on my nerves......

"The participating  Medical Groups pre-service denial for authorization and coverage of your request for authorization and coverage of your request for a Gastric Sleeve Laparoscopic procedure for treatment of your Morbid Obesity is upheld as no t medically necessary. Based on clinical records submitted for review, you meet the Plans Evidence of Coverage criteria for surgical treatment of morbid obesity (Bariatric Surgery). The Plan covers Medically Necessary bariatric surgical procedures with specific restrictions/limitations as detailed in the EOC through an in-network (Tier-1/HMO provider. However, the specific procedure you are requesting, Gastric Sleeve Laparoscopic Surgery does not meet the Plans Medical Necessity criteria and the denial for this specific bariatric procedure will be UPHELD as not medically necessary.........."

Gives me all kind of statistically background on why VSG is not yet approved as a stand alone procedure. I did submit the IMR and just got a letter from them but I don't think it is looking that good because they make me feel like I don't have enough co-morbidities yet!!

"......As such, the PMGs pre-service denial of your request for Gastric Sleeve Laparoscopic bariatric surgery is upheld as not medically necessary. As an alternative, you may discuss receiving alternative, medically necessary bariatric surgical procedures with your surgeon."

After getting this the surgeon doesn't do RNY and I definitely don't want the Lap Band. If I would have said yes give me the Lap Band, I probably would have been over this hurdle already! The problem now is getting the approval to go outside of my managed care but still in the network, or hospital group to meet with a surgeon (ex....from UCSD group to Pacific Bariatrics). Please Help!!!