Re: Endoscopy--Preventive vs. Diagnostic Care

[Guest guest]

Hi All,

I went to the doctors last week and didn’t

even realize that my insurance had changed until I asked for a referral and

didn’t need one. I have always had an HMO which I liked as it covered everything

and my PCP is wonderful about giving me referrals to whomever I need to see,

but now it turns out I have some kind of hybrid PPO/HMO combo plan which is

good and bad. It’s nice because I still have co-pays for doctor visits with

no deductibles and I can choose my own doctors within the network with no

referral, but now I have out of pocket expenses and deductibles with labs,

xrays, procedures and hospital stays. Certain procedures that are considered

preventative are covered at 100% but endoscopies have always been considered

diagnostic procedures, so while it seems in our case that it should be considered

preventative care for us, there

is no such code to distinguish it as such.

I know that many of our more experienced surgeons/GI

doctors are now telling us that routine endoscopies are recommended post

myotomy, so I was just wondering if anyone knows if this is being considered a

preventative procedure for us or if it is still considered diagnostic and maybe

my local GI doctor isn’t aware of it? I have a list of procedure codes

and need to call the insurance company today to find out what my out-of-pocket

expense is going to be. My new plan covers 90% but that 10% can be costly

depending on how much the procedure costs!

I really did like my HMO that paid

for my procedures but it isn’t offered anymore.

If anyone has any info on this it would be

appreciated. It just seems to me that there should be a loophole around this as

it has really become a preventative procedure for us, don’t you think?

Sandi in No CA

[Guest guest]

Hi Sandi,

I've been told it's preventative and that's common sense as well, in my opinion, as we've already been diagnosed, know what we have and know what might go wrong without preventative checks.

Good luck.

Isabella

RE: Endoscopy--Preventive vs. Diagnostic Care

Hi All,

I went to the doctors last week and didn¢t even realize that my insurance had changed until I asked for a referral and didn¢t need one. I have always had an HMO which I liked as it covered everything and my PCP is wonderful about giving me referrals to whomever I need to see, but now it turns out I have some kind of hybrid PPO/HMO combo plan which is good and bad. It¢s nice because I still have co-pays for doctor visits with no deductibles and I can choose my own doctors within the network with no referral, but now I have out of pocket expenses and deductibles with labs, xrays, procedures and hospital stays. Certain procedures that are considered preventative are covered at 100% but endoscopies have always been considered diagnostic procedures, so while it seems in our case that it should be considered preventative care for us, there is no such code to distinguish it as such.

I know that many of our more experienced surgeons/GI doctors are now telling us that routine endoscopies are recommended post myotomy, so I was just wondering if anyone knows if this is being considered a preventative procedure for us or if it is still considered diagnostic and maybe my local GI doctor isn¢t aware of it? I have a list of procedure codes and need to call the insurance company today to find out what my out-of-pocket expense is going to be. My new plan covers 90% but that 10% can be costly depending on how much the procedure costs!

I really did like my HMO that paid for my procedures but it isn¢t offered anymore.

If anyone has any info on this it would be appreciated. It just seems to me that there should be a loophole around this as it has really become a preventative procedure for us, don¢t you think?

Sandi in No CA

[Guest guest]

HELLO I HAVE A. SINCE 2005 I HAVE A MYOTOMY BUT DIDN'T WORK I WAS BACK WITH THE SAME PROBLEMS IN 8 MONTH BUT THIS A RARE CASE MOST OF THE MYOTOMY SURGERY LIKE 98% HELP AND WORK FOR LONG LONG TIME AFTER THAT MY E START GETTING BIG AND RIGHT NOW 13 YRS LATER IS LIKE AN SOCK BUT IS STILL WORKING I HAVE SOME PROBLEMS BUT I LEARN HOW TO LIVE WITH THEM MY DOCTOR RECOMMEND FOR ME TO TAKE OUT BUT I'M NOT READY TO GO TO SURGERY YET I'M EATING EVRYTHING AND BELIVE IT OR NOT I'M OVERWEIGHT LIKE 80LBS MY DOCTOR IS SURPRISE HE TOLD ME WHAT HE SEE INSIDE NO MATCH WITH MY WEIGHT BUT SOMETHING HAVE TO BE WORKING

I JUST WANT TO SAID I HAVE ENDOSCOPY DONE ONCE A YEAR AS PREVENTION I JJUST HAVE MINE AND IT LOOK GOOD LIKE A SOCK AND VERY BIG AND RETAIN LIQUIDS A LITTLE BUT OK

SO I HOPE EVERYONE TAKE PREVENTION REALLY SERIUSLY

TAKE CARE

FRANCES FT LEWIS (wa) WE ARE A MILITARY FAMILY

From: Isabella Arnold <arnoldisabella@...>Subject: Re: Endoscopy--Preventive vs. Diagnostic Careachalasia Date: Thursday, June 19, 2008, 10:39 AM

Hi Sandi,

I've been told it's preventative and that's common sense as well, in my opinion, as we've already been diagnosed, know what we have and know what might go wrong without preventative checks.

Good luck.

Isabella

RE: Endoscopy--Preventi ve vs. Diagnostic Care

Hi All,

I went to the doctors last week and didn¢t even realize that my insurance had changed until I asked for a referral and didn¢t need one. I have always had an HMO which I liked as it covered everything and my PCP is wonderful about giving me referrals to whomever I need to see, but now it turns out I have some kind of hybrid PPO/HMO combo plan which is good and bad. It¢s nice because I still have co-pays for doctor visits with no deductibles and I can choose my own doctors within the network with no referral, but now I have out of pocket expenses and deductibles with labs, xrays, procedures and hospital stays. Certain procedures that are considered preventative are covered at 100% but endoscopies have always been considered diagnostic procedures, so while it seems in our case that it should be considered preventative care for us, there is no such code to distinguish it as such.

I know that many of our more experienced surgeons/GI doctors are now telling us that routine endoscopies are recommended post myotomy, so I was just wondering if anyone knows if this is being considered a preventative procedure for us or if it is still considered diagnostic and maybe my local GI doctor isn¢t aware of it? I have a list of procedure codes and need to call the insurance company today to find out what my out-of-pocket expense is going to be. My new plan covers 90% but that 10% can be costly depending on how much the procedure costs!

I really did like my HMO that paid for my procedures but it isn¢t offered anymore.

If anyone has any info on this it would be appreciated. It just seems to me that there should be a loophole around this as it has really become a preventative procedure for us, don¢t you think?

Sandi in No CA

[Guest guest]

Sandi wrote:

... I was just

wondering if anyone knows if this is being considered a

preventative procedure for us ...

I don't have any official information on how it is considered. On one

hand X-rays and endoscopies don't prevent anything, they just detect

them. On the other hand they help prevent small problems from becoming

bigger problems. These procedures will not stop or prevent the

progression of achalasia. They will give you and your doctor a chance

to change your treatment plan to maximize the reduction of symptoms.

These procedures will not prevent acid reflux, esophagitis or cancer.

They will give you and your doctor needed information for treating them.

notan

[Guest guest]

Noton, are you a doctor as well? How do you know all of this? I'm in

awe

[Guest guest]

christim1969 wrote:

> Noton, are you a doctor as well?

No, I am just some nut on the internet. I enjoy learning and I think of

searching the net as a sport. I fish for answers and new ideas. Like

fishing you have to have good bate and know where to fish.

notan

[Guest guest]

Hi notan,

Thank you for your response. I understand

your point of view and what you say is very factual, but these things you

mention are worthy of debate when you look at other procedures that are

considered preventative. Mammograms are considered preventative depending upon

your age but they don’t stop breast cancer. Colonoscopies are

preventative (also age specific) and they do not stop cancer, polyps or diverticulitis….these

procedures and others only catch the problems in time if there are any and give

the doctors the information needed for proper treatment, however they are still

considered preventative as they can prevent more serious complications, and

costs, which is what the insurance is concerned about.

Sandi in No CA

From: achalasia [mailto:achalasia ] On Behalf Of notan ostrich

Sent: Thursday, June 19, 2008 9:24

AM

achalasia

Subject: Re:

Endoscopy--Preventive vs. Diagnostic Care

Sandi

wrote:

... I was just wondering if anyone knows if this is being

considered a preventative procedure for us ...

I don't have any official information on how it is considered. On one hand

X-rays and endoscopies don't prevent anything, they just detect them. On the

other hand they help prevent small problems from becoming bigger problems.

These procedures will not stop or prevent the progression of achalasia. They

will give you and your doctor a chance to change your treatment plan to

maximize the reduction of symptoms. These procedures will not prevent acid

reflux, esophagitis or cancer. They will give you and your doctor needed

information for treating them.

notan

[Guest guest]

haha..... Well, I'm thankful for such fine " fishermen " as you.

> > Noton, are you a doctor as well?

>

> No, I am just some nut on the internet. I enjoy learning and I think

of

> searching the net as a sport. I fish for answers and new ideas. Like

> fishing you have to have good bate and know where to fish.

>

> notan

>

[Guest guest]

Hi Frances,

Thank you for your response. I am very

happy that you are managing so well even though your myotomy has failed you. I

also believe it is important to have routine endoscopies, not just post

myotomy, but even for anyone who has not had surgery, just to find out if the

esophagus has become dilated or not. It would make a big difference as whether

or not to proceed with surgery or treatment.

Wishing you continued success…

Sandi in No CA

From: achalasia [mailto:achalasia ] On Behalf Of frances colon

Sent: Thursday, June 19, 2008 8:58

AM

achalasia

Subject: Re:

Endoscopy--Preventive vs. Diagnostic Care

HELLO I

HAVE A. SINCE 2005 I HAVE A MYOTOMY BUT DIDN'T WORK I WAS BACK WITH THE SAME

PROBLEMS IN 8 MONTH BUT THIS A RARE CASE MOST OF THE MYOTOMY SURGERY LIKE 98%

HELP AND WORK FOR LONG LONG TIME AFTER THAT MY E START GETTING BIG AND RIGHT

NOW 13 YRS LATER IS LIKE AN SOCK BUT IS STILL WORKING I HAVE SOME PROBLEMS

BUT I LEARN HOW TO LIVE WITH THEM MY DOCTOR RECOMMEND FOR ME TO TAKE OUT BUT

I'M NOT READY TO GO TO SURGERY YET I'M EATING EVRYTHING AND BELIVE IT OR NOT

I'M OVERWEIGHT LIKE 80LBS MY DOCTOR IS SURPRISE HE TOLD ME WHAT HE SEE INSIDE

NO MATCH WITH MY WEIGHT BUT SOMETHING HAVE TO BE WORKING

I JUST

WANT TO SAID I HAVE ENDOSCOPY DONE ONCE A YEAR AS PREVENTION I JJUST HAVE

MINE AND IT LOOK GOOD LIKE A SOCK AND VERY BIG AND RETAIN LIQUIDS A LITTLE

BUT OK

SO I

HOPE EVERYONE TAKE PREVENTION REALLY SERIUSLY

TAKE

CARE

FRANCES

FT LEWIS (wa) WE ARE A MILITARY FAMILY

From: Isabella Arnold

<arnoldisabella >

Subject: Re: Endoscopy--Preventive vs. Diagnostic Care

achalasia

Date: Thursday, June 19, 2008, 10:39 AM

Hi Sandi,

I've been told it's preventative and that's common sense

as well, in my opinion, as we've already been diagnosed, know what we have

and know what might go wrong without preventative checks.

Good luck.

Isabella

RE: Endoscopy--Preventi ve vs. Diagnostic Care

Hi All,

I went to the doctors last week and didn¢t even realize that my

insurance had changed until I asked for a referral and didn¢t need one. I

have always had an HMO which I liked as it covered everything and my

PCP is wonderful about giving me referrals to whomever I need to see, but now

it turns out I have some kind of hybrid PPO/HMO combo plan which is good and

bad. It¢s nice because I still have co-pays for doctor visits with no

deductibles and I can choose my own doctors within the network with no

referral, but now I have out of pocket expenses and deductibles with labs,

xrays, procedures and hospital stays. Certain procedures that are considered

preventative are covered at 100% but endoscopies have always been considered

diagnostic procedures, so while it seems in our case that it should be

considered preventative care for us,

there is no such code to distinguish it as such.

I know that many of our more experienced surgeons/GI doctors are

now telling us that routine endoscopies are recommended post myotomy, so I

was just wondering if anyone knows if this is being considered a preventative

procedure for us or if it is still considered diagnostic and maybe my local

GI doctor isn¢t aware of it? I have a list of procedure codes and need to

call the insurance company today to find out what my out-of-pocket expense is

going to be. My new plan covers 90% but that 10% can be costly depending on

how much the procedure costs!

I really did like my HMO that paid for my procedures but it

isn¢t offered anymore.

If anyone has any info on this it would be appreciated. It just

seems to me that there should be a loophole around this as it has really

become a preventative procedure for us, don¢t you think?

Sandi in No CA

[Guest guest]

Thank you Isabella,

I agree with this. I am thinking about

calling UCSF or Cleveland Clinic to see if they have a special code for billing

the procedure as preventative.

Take care,

Sandi

From: achalasia [mailto:achalasia ] On Behalf Of Isabella Arnold

Sent: Thursday, June 19, 2008 8:40

AM

achalasia

Subject: Re:

Endoscopy--Preventive vs. Diagnostic Care

Hi Sandi,

I've been told it's preventative and that's common sense

as well, in my opinion, as we've already been diagnosed, know what we have and

know what might go wrong without preventative checks.

Good luck.

Isabella

RE: Endoscopy--Preventive vs. Diagnostic Care

Hi All,

I went to the doctors last week and didn¢t even realize that my

insurance had changed until I asked for a referral and didn¢t need one. I have

always had an HMO which I liked as it covered everything and my PCP is

wonderful about giving me referrals to whomever I need to see, but now it turns

out I have some kind of hybrid PPO/HMO combo plan which is good and bad. It¢s

nice because I still have co-pays for doctor visits with no deductibles and I

can choose my own doctors within the network with no referral, but now I have

out of pocket expenses and deductibles with labs, xrays, procedures and

hospital stays. Certain procedures that are considered preventative are covered

at 100% but endoscopies have always been considered diagnostic procedures, so

while it seems in our case that it should be considered preventative care for us, there is no such code to

distinguish it as such.

I know that many of our more experienced surgeons/GI doctors are

now telling us that routine endoscopies are recommended post myotomy, so I was

just wondering if anyone knows if this is being considered a preventative

procedure for us or if it is still considered diagnostic and maybe my local GI

doctor isn¢t aware of it? I have a list of procedure codes and need to call the

insurance company today to find out what my out-of-pocket expense is going to

be. My new plan covers 90% but that 10% can be costly depending on how much the

procedure costs!

I really did like my HMO that paid for my procedures but it

isn¢t offered anymore.

If anyone has any info on this it would be appreciated. It just

seems to me that there should be a loophole around this as it has really become

a preventative procedure for us, don¢t you think?

Sandi in No CA

[Guest guest]

Sandri wrote:

.... these things

you

mention are worthy of debate ...

I don't disagree with the idea that it needs to be answered, and I

don't claim to have the answer. I just wanted to clarify the issue. As

I stated before, these procedures do prevent small problems from

becoming big problems, as in your example of the polyps. Again, I have

no official information on how something is determined to be

preventative. I would guess that it is a statistical problem. If one in

a million people will be prevented from having a big problem the

procedure will probably not be considered preventative for everyone. At

some point a procedure prevents major problems in enough people so,

like mammograms, they become preventative for everyone in a certain

group. As you noted cost is also a factor. Are the costs, also risks,

of the procedures justified by what they prevent in the few patients

they do.

As has been discussed here before, doctors do not agree about the need

for surveillance in achalasia. Most doctors agree about the need for

mammograms, though there can be debate about the facts.

notan

[Guest guest]

Hi notan,

Thank you for your input….it’s

getting me stirred up inside to give me the motivation I need to deal with

insurance companies! LOL. I appreciate your input and realize that you are just

guessing and your information isn’t official. I hope that it is not a

statistical issue…that had not crossed my mind, but it could be as simple

as coming up with a new code for insurance billing purposes! I spoke to one

person who said it depends on if it is coded as a routine procedure or not, so

I guess I need to find out if it can be coded as routine, like colonoscopies….she

said I would need to discuss it with the doctor.

There is a special code to use for “routine”

colonoscopies, so I am trying to find out if there is a specific code for a “routine”

endoscopy.

I’ll let you know if I find out. I

have an appointment next week.

Sandri…kind of like that…. : )

From: achalasia [mailto:achalasia ] On Behalf Of notan ostrich

Sent: Thursday, June 19, 2008

10:38 AM

achalasia

Subject: Re:

Endoscopy--Preventive vs. Diagnostic Care

Sandri

wrote:

.... these things you mention are worthy of

debate ...

I don't disagree with the idea that it needs to be answered, and I don't claim

to have the answer. I just wanted to clarify the issue. As I stated before,

these procedures do prevent small problems from becoming big problems, as in

your example of the polyps. Again, I have no official information on how

something is determined to be preventative. I would guess that it is a

statistical problem. If one in a million people will be prevented from having a

big problem the procedure will probably not be considered preventative for

everyone. At some point a procedure prevents major problems in enough people

so, like mammograms, they become preventative for everyone in a certain group.

As you noted cost is also a factor. Are the costs, also risks, of the

procedures justified by what they prevent in the few patients they do.

As has been discussed here before, doctors do not agree about the need for surveillance

in achalasia. Most doctors agree about the need for mammograms, though there

can be debate about the facts.

notan

[Guest guest]

Welcome to the world of PPO. In my experience the doctors' insurance staff deals with this problem and will keep resubmitting it for you. You should just have to call them and they will fight the battle for you. They have just as much, if not more to gain in getting the insurance company to pay.

I missed calling you last weekend, so sorry. I feel guilty. Father's Day, and kids made that small a distance seem like a long ways away. No excuse. We lounged and cooked and just didn't ever seem like a time opened up. How was 's birthday party? That is a fun age, you can spoil them and they aren't greedy yet.

Sandy > > ... these things you mention are worthy of debate ...> > > I don't disagree with the idea that it needs to be answered, and I don't> claim to have the answer. I just wanted to clarify the issue. As I stated> before, these procedures do prevent small problems from becoming big> problems, as in your example of the polyps. Again, I have no official> information on how something is determined to be preventative. I would guess> that it is a statistical problem. If one in a million people will be> prevented from having a big problem the procedure will probably not be> considered preventative for everyone. At some point a procedure prevents> major problems in enough people so, like mammograms, they become> preventative for everyone in a certain group. As you noted cost is also a> factor. Are the costs, also risks, of the procedures justified by what they> prevent in the few patients they do. > > As has been discussed here before, doctors do not agree about the need for> surveillance in achalasia. Most doctors agree about the need for mammograms,> though there can be debate about the facts. > > notan>

[Guest guest]

That’s ok Sandy, I completely understand, it was Father’s

Day! M & L ended up taking to emergency on Father’s Day anyway

and we left earlier than planned and went to visit family in Redlands on the way home. Sadly, it’s

become routine to spend holidays at the hospital. Mother’s Day, Easter,

and last Father’s Day were all at the hospital so maybe they think of it

as a tradition? Anyway he was fine. They had just felt some bumps on ’s

head and were afraid his shunt might be malfunctioning after the surgery from

the reduced pressures, but everything was fine….it’s just not good

to have so many CT scans though.

He had a blast on his B-day. He could care

less about his presents but LOVES everyone to sing Happy Birthday to him….I

think he might be a conductor when he grows up! He was so excited to hear

everyone sing in unison and he kept raising his hands and saying 1-2-3, AGAIN….

so we (30 + adults and kids) kept singing it over and over….we are like

his puppets and he enjoys having this control he has learned he has over everyone

but he’s so special that you can’t help but to embrace it…he was

soooo happy to have everyone there celebrating and he absolutely loves being

the center of attention!

About the insurance-- I don’t like

PPO’s and I want my HMO back... I will take advantage of the insurance

staff to fight for me though because I really don’t have the energy to deal

with it.

Don’t know when I’m coming

down next….maybe we’ll do a Disneyland

trip because wants to go again. He was telling “Disneyland

NOW’ the other day…LOL…he’s very demanding and learning

to be his own best advocate early on!

Sandri

From: achalasia [mailto:achalasia ] On Behalf Of toomuchclutter

Sent: Thursday, June 19, 2008

11:38 AM

achalasia

Subject: Re:

Endoscopy--Preventive vs. Diagnostic Care

Welcome to the world of

PPO. In my experience the doctors' insurance staff deals with this

problem and will keep resubmitting it for you. You should just have to

call them and they will fight the battle for you. They have just as much,

if not more to gain in getting the insurance company to pay.

I missed calling you last

weekend, so sorry. I feel guilty. Father's Day, and kids made that

small a distance seem like a long ways away. No excuse. We lounged

and cooked and just didn't ever seem like a time opened up. How was

's birthday party? That is a fun age, you can spoil them and they

aren't greedy yet.

Sandy

>

> ... these things you mention are worthy of debate ...

>

>

> I don't disagree with the idea that it needs to be answered, and I don't

> claim to have the answer. I just wanted to clarify the issue. As I stated

> before, these procedures do prevent small problems from becoming big

> problems, as in your example of the polyps. Again, I have no official

> information on how something is determined to be preventative. I would

guess

> that it is a statistical problem. If one in a million people will be

> prevented from having a big problem the procedure will probably not be

> considered preventative for everyone. At some point a procedure prevents

> major problems in enough people so, like mammograms, they become

> preventative for everyone in a certain group. As you noted cost is also a

> factor. Are the costs, also risks, of the procedures justified by what

they

> prevent in the few patients they do.

>

> As has been discussed here before, doctors do not agree about the need for

> surveillance in achalasia. Most doctors agree about the need for

mammograms,

> though there can be debate about the facts.

>

> notan

>

[Guest guest]

Take my kids when you go to Disneyland, please, I'll pay.

How special is Notan constantly to suprise us... if you are like me you probably didn't ever really like . Sandy or Sandi... old news, but Sandri that is special. I like it, you take it up north and I'll start it here.

You are very understanding. It seems like achalasia can turn people into semi-hermits sometimes, maybe a touch of old habit of mild depression, but sometimes it is just easier to stay home. It is so enjoyable to see others and well worth the trip and the mascara layers, but sometimes hard to make that initial effort.

Maybe a conductor, how fun would that be, wonder what kind of music will be popular by the time he is ready for it. Glad you had fun and that he enjoyed it.

Sandy > > > > ... these things you mention are worthy of debate ...> > > > > > I don't disagree with the idea that it needs to be answered, and I don't> > claim to have the answer. I just wanted to clarify the issue. As I stated> > before, these procedures do prevent small problems from becoming big> > problems, as in your example of the polyps. Again, I have no official> > information on how something is determined to be preventative. I would> guess> > that it is a statistical problem. If one in a million people will be> > prevented from having a big problem the procedure will probably not be> > considered preventative for everyone. At some point a procedure prevents> > major problems in enough people so, like mammograms, they become> > preventative for everyone in a certain group. As you noted cost is also a> > factor. Are the costs, also risks, of the procedures justified by what> they> > prevent in the few patients they do. > > > > As has been discussed here before, doctors do not agree about the need for> > surveillance in achalasia. Most doctors agree about the need for> mammograms,> > though there can be debate about the facts. > > > > notan> >>

[Guest guest]

I like Sandri too….something new and

spicy…maybe a little sultry and exotic, but for the most part other than

here and with my family at home, most people call me . I think it’s

because I’m around a lot of Europeans and I love the way they pronounce

it…they say it so beautifully that I have actually come to love my name

now and like you, I never did before...

PS…you have to come to Disneyland too! : )

Sandri in No

CA

From: achalasia [mailto:achalasia ] On Behalf Of toomuchclutter

Sent: Thursday, June 19, 2008 1:02

PM

achalasia

Subject: Re:

Endoscopy--Preventive vs. Diagnostic Care

Take my kids when you go to Disneyland, please, I'll pay.

How special is Notan

constantly to suprise us... if you are like me you probably didn't ever really

like . Sandy or Sandi... old news, but Sandri that is

special. I like it, you take it up north and I'll start it here.

You are very

understanding. It seems like achalasia can turn people into semi-hermits

sometimes, maybe a touch of old habit of mild depression, but sometimes it is

just easier to stay home. It is so enjoyable to see others and well worth

the trip and the mascara layers, but sometimes hard to make that initial

effort.

Maybe a conductor, how fun

would that be, wonder what kind of music will be popular by the time he is

ready for it. Glad you had fun and that he enjoyed it.

Sandy

> >

> > ... these things you mention are worthy of debate ...

> >

> >

> > I don't disagree with the idea that it needs to be answered, and I

don't

> > claim to have the answer. I just wanted to clarify the issue. As I

stated

> > before, these procedures do prevent small problems from becoming big

> > problems, as in your example of the polyps. Again, I have no official

> > information on how something is determined to be preventative. I

would

> guess

> > that it is a statistical problem. If one in a million people will be

> > prevented from having a big problem the procedure will probably not

be

> > considered preventative for everyone. At some point a procedure

prevents

> > major problems in enough people so, like mammograms, they become

> > preventative for everyone in a certain group. As you noted cost is

also a

> > factor. Are the costs, also risks, of the procedures justified by

what

> they

> > prevent in the few patients they do.

> >

> > As has been discussed here before, doctors do not agree about the

need for

> > surveillance in achalasia. Most doctors agree about the need for

> mammograms,

> > though there can be debate about the facts.

> >

> > notan

> >

>