Guest guest Posted June 4, 2012 Report Share Posted June 4, 2012 Carolyn, I was diagnosed in 1996 and achalasia was listed with NORD back then. This isn't something that's all that " recent " . Also, it seems that current research is showing similar success rates for dilation vs myotomy, so balloon dilation as the recommended course of treatment isn't really all that out-of-date, particularly given the cost savings and reduced nosocomial infections related to dilation vs surgery. Insurance companies are in the business of staying in business... they're not going to back a more expensive procedure when it's not significantly more beneficial than the less expensive alternative. My insurance company requires a referral from my primary care provider if I want to see a specialist -- this keeps their cost down, as I will only be able to see a higher-cost specialist if my PCP deems it medically necessary. My insurance company does not, however, require a referral to see a chiropractor, even though he's a " specialist " . That's because the insurance company has learned that MDs are less inclined to refer to a chiro (many see them as pseudo-doctors, even though they are licensed healthcare providers who completed medical school), and because patients who get chiro-adjustments for back/neck pain cost them less money than patients who see PCPs, orthopedic specialists, and neurology specialists for back/neck pain (all of those MDs are inclined to want prescription drugs, physical therapy, surgery, etc. -- all of which cost way more than a couple of chiro appts.). The insurance company SAVES MONEY while still giving decent treatment by allowing chiropractic care, just like it saves money by doing dilations rather than surgery. Dilation doesn't work for everyone, but neither does myotomy. Keep an open mind, folks. Debbi in Michigan formerly known as Pepto-Deb > > Just to let you know, in medical terms.. > > > The medical field and insurance company has a coding system. Each disease or disorder or etc has a code and there is also a dictionary description and recommended course of treatment of each disease. > > Many and I really mean most had a description that state ... " balloon dilation is the recommend course of action for treatment " > > > They were so out of date... from the early 1980's that it is scary. Most often if your insurance company says it will NOT cover surgery... myotomy and fundoplication, it means they are not current to today's standards of usual and customary. > > > Additionally, Achalasia only very recent, became prominent enough to make the National Organization of Rare Disorders Database. http://www.rarediseases.org/ > > At this site you can see the various diseases that occur more often than achalasia... It is still rare enough that there is not current funding or studies for it... > > > Carolyn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2012 Report Share Posted June 4, 2012 Deb -- You are right: insurance companies are in business to make money. NOT to make sure you get the best care. If they can make you " settle " for a procedure with a five year life, at one fifth the cost = Bingo. In five years, you are likely not to BE their client any more, and someone else will have to pay for the next one, and the one after that. And almost for certain sure they won't be around when you need the esophagectomy. . . . As late as ten years ago they were denying heart transplants as " experimental " -- of course, if you're willing to get a lawyer, and sue, they give in. But with luck, you'll be dead before that. My SIL died while waiting for an Insurance Company to reverse on a bone marrow transplant decision. Good business practice. Lousy medicine. And five little boys lost their mother. Whether or not the two procedures are even roughly equal is up for debate: http://www.sages.org/publication/id/ACHALASIA/ /WV > > > > Just to let you know, in medical terms.. > > > > > > The medical field and insurance company has a coding system. Each disease or disorder or etc has a code and there is also a dictionary description and recommended course of treatment of each disease. > > > > Many and I really mean most had a description that state ... " balloon dilation is the recommend course of action for treatment " > > > > > > They were so out of date... from the early 1980's that it is scary. Most often if your insurance company says it will NOT cover surgery... myotomy and fundoplication, it means they are not current to today's standards of usual and customary. > > > > > > Additionally, Achalasia only very recent, became prominent enough to make the National Organization of Rare Disorders Database. http://www.rarediseases.org/ > > > > At this site you can see the various diseases that occur more often than achalasia... It is still rare enough that there is not current funding or studies for it... > > > > > > Carolyn > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2012 Report Share Posted June 4, 2012 I was sick with A since 1988, was not treated until 2010 with surgery. That being said, when I did get them to do the right tests and surgery, it was ME that informed them of what I wanted and why....I gave them all the medical terms and success rates etc....This helped my case for surgery and with an experienced doctor....otherwise I would have been SOL.   When you get to the point that you can no longer keep food down, you learn to be persistent and use terms that doctors understand....like this is an emergency or I will starve to death....usually works  Good luck to all.  Julee ( from Oregon) ________________________________ From: bigbrillohead <imahockeymom@...> achalasia Sent: Monday, June 4, 2012 11:04 AM Subject: Re: rarity of achalasia..  Carolyn, I was diagnosed in 1996 and achalasia was listed with NORD back then. This isn't something that's all that " recent " . Also, it seems that current research is showing similar success rates for dilation vs myotomy, so balloon dilation as the recommended course of treatment isn't really all that out-of-date, particularly given the cost savings and reduced nosocomial infections related to dilation vs surgery. Insurance companies are in the business of staying in business... they're not going to back a more expensive procedure when it's not significantly more beneficial than the less expensive alternative. My insurance company requires a referral from my primary care provider if I want to see a specialist -- this keeps their cost down, as I will only be able to see a higher-cost specialist if my PCP deems it medically necessary. My insurance company does not, however, require a referral to see a chiropractor, even though he's a " specialist " . That's because the insurance company has learned that MDs are less inclined to refer to a chiro (many see them as pseudo-doctors, even though they are licensed healthcare providers who completed medical school), and because patients who get chiro-adjustments for back/neck pain cost them less money than patients who see PCPs, orthopedic specialists, and neurology specialists for back/neck pain (all of those MDs are inclined to want prescription drugs, physical therapy, surgery, etc. -- all of which cost way more than a couple of chiro appts.). The insurance company SAVES MONEY while still giving decent treatment by allowing chiropractic care, just like it saves money by doing dilations rather than surgery. Dilation doesn't work for everyone, but neither does myotomy. Keep an open mind, folks. Debbi in Michigan formerly known as Pepto-Deb > > Just to let you know, in medical terms.. > > > The medical field and insurance company has a coding system. Each disease or disorder or etc has a code and there is also a dictionary description and recommended course of treatment of each disease. > > Many and I really mean most had a description that state ... " balloon dilation is the recommend course of action for treatment " > > > They were so out of date... from the early 1980's that it is scary. Most often if your insurance company says it will NOT cover surgery... myotomy and fundoplication, it means they are not current to today's standards of usual and customary. > > > Additionally, Achalasia only very recent, became prominent enough to make the National Organization of Rare Disorders Database. http://www.rarediseases.org/ > > At this site you can see the various diseases that occur more often than achalasia... It is still rare enough that there is not current funding or studies for it... > > > Carolyn Quote Link to comment Share on other sites More sharing options...
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