Re: aetna help and crying tonight

[Guest guest]

> My own particular situation bites right now. Aetna,

> even with new codes, says investigational.

try adding this 21 yr follow up report:

http://www.duodenalswitch.com/Procedure/procedure.html

" The BPD procedure (without the duodenal switch), on which the BPD/DS

is based, was first performed in 1976 by Dr. Nicola Scopinaro of

Italy. In 1998, Dr. Scopinaro published a 21-year follow-up report on

a series of 2241 BPD patients (Scopinaro N, et al.: Biliopancreatic

Diversion, World J Surg. 1998 Sep;22(9):936-46. PMID: 9717419; UI:

98383147.). This report concludes that the BPD is the most effective

procedure for the surgical treatment of obesity. "

Scopinaro Report:

http://www.duodenalswitch.com/Procedure/1998BPD/1998bpd.html

Try to contact Walter by phone or any other means before filing your

appeal... once you get a ruling on an appeal you may not be able to

file another... each co has its policy about denails and appeals and

how many times you can try.

best of luck, hang in there!

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

Becki;

Try challenging them to prove to you it's experimental.

What I'm thinking is that they just expect you to accept what they

say. Take the position that you not only do not accept it, it is

patently aburd for them to try to even pull a fast one like that!

Tell them that you MUST have a copy of their info that is telling

them it is experimental. You'll want to figure out how best to

phrase it but go back to them, they say, " it;s experimental " ; you

say, " Prove it! " You get the idea?

Didn't you and I discuss a list that had VERY outdated studies for

the DS? Look up on some medical search engines, or, you

might have to go to a real library. What you want to do, is find

more current studies by the same organizations/universities that

were responsible for the ancient reports. If you cannot do that, try

to get studies by other places that address themselves to the

exact same subject. Finally, get whatever you can (as long as it

helps make your case).

If might seem even more official if the reports are from a library.

There's a prejudice AGAINST stuff from the internet. The theory is

that you can find anything you want to on the internet. There's a

greater tendency to accept it if it was copied from a magazine.

I would also contact Mt Sinai for studies. A lot of firsts were done

there, so they should have study info going back further than

anyone else. You may have to be persistant and creative to get

what you need from them. Have you actually contacted Dr. Hess

or did you just get what you could off the internet? Again,

personal contact should be impressive.

Based on what you said, I think it's do-able. Call the Insurance

Comissioner of your state. Just tell them that simply put, your

insurance company is declaring something as being

experimental that is not experimental. Cigna is doing this just to

avoid spending the money. It's a familiar ploy to Insurance

Regulators. See what they say.

Best of luck.

gobo

>

> My own particular situation bites right now. Aetna,

> even with new codes, says investigational. I haven't

> heard from Walter on my email request form to his

> website. I have gathered the HESS report, an

> impassioned personal letter, and the Regence BC/BS

> statement on acceptable WLS including the DS from

> their website. I will send all that to Aetna as a

> first appeal. I would still like at least the full

> names of anyone approved by them in the last 6 months

> so they can check their records. Specifically, Diane

> in Tennessee; Jodie of and Jodie, and

> someone. I have Betty Carley, Vickie Hewitt,

> Murdock, Judie Hensel, Randy Peck, and Spagner.

> Right now I feel totally like giving up. It is so

> unfair. My insurance premiums are well over 450 a

> month and I am also paying out of pocket deductibles,

> etc, on my initial appointments. I am not having a

> good time here.

>

> becki

>

> =====

> Becki, near Portland, OR

> BMI 50-ish, age 42

> pre-op DS. hoping to get approval

> through Aetna Traditional Choice

> (fighting 'investigational' denial)

> Consulted with Dr. on 3-13-01

> psych ok, nutrition ok, beckeye_58@y...

>

>

__________________________________________________

>

[Guest guest]

Hi Becki,

I have been fighting Aetna USHC for about 7 months. After they turned my

first appeal letter down I decided to contact Walter at ObesityLaw.com. His

wife , (very nice lady) called me back and then I sent all of the

required information. said part of the problem is there isn't a set CPT

code for this procedure. Some doctors use different codes than others so

Aetna uses this excuse and says its investigational. It will be sooooo nice

to have someone help me fight them. This whole ordeal with Aetna has been so

frustrating. Hopefully I will have the surgery in the not so distant future

with Dr. Rabkin in SF I will keep you posted................

Michele

Ventura, CA

[Guest guest]

In a message dated 5/13/01 12:30:26 PM Eastern Daylight Time,

Shellbell8177@... writes:

<<

Hi Becki,

I have been fighting Aetna USHC for about 7 months. After they turned my

first appeal letter down I decided to contact Walter at ObesityLaw.com. His

wife , (very nice lady) called me back and then I sent all of the

required information. said part of the problem is there isn't a set

CPT

code for this procedure. Some doctors use different codes than others so

Aetna uses this excuse and says its investigational. It will be sooooo nice

to have someone help me fight them. This whole ordeal with Aetna has been so

frustrating. Hopefully I will have the surgery in the not so distant future

with Dr. Rabkin in SF I will keep you posted................

Michele

Ventura, CA >>

Dear Michele,

I feel I will have to go through this myself. I am planning on seeing if

Aetna's will cover this in SF with USHC but I am also continuing to plan on

self pay too. I am asking everyone on this list if they can come forward and

give to us the amounts that they paid for this op with the SELF PAY. I really

need to know which DR. s WILL do this for self payers and which will not and

who will do it for what amount.

We need to get together on this a little bit more so that it can be

accessible for ALL of us to do. Would somebody please give the self pay cost

that they paid for the DS. I hope we can get a list of prices going so that

we all have that to fall back on if the insurance companies refuse to help

us. While on the other hand we can continue to also fight the insurance

companies too.

It's just as we fight them, if we have in the back of our minds the amounts

it will cost for different DR.s then while fighting this we can also save if

the inevitable happens.

So, can we get a list of different DR.s prices started and which ones will

even consider this for self payers?

I think this will serve us well and give our hearts and minds a break. We

need it.

Thanks for all those who will help us once again.

Lee H.

[Guest guest]

Becki,

Ask them if it was experimental for me. I had it done

only a week ago. They are covering it no problem.

__________________________________________________