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]

> 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]

Hi Becki:

> Right now I feel totally like giving up.

DON'T LET THE BASTARDS WIN!

Crawl over broken glass if you have to to get the surgery

you NEED IN ORDER TO LIVE A LONGER, HAPPY LIFE! You will

never regret it.

On the other hand, if you let them beat you, just so they

can save a few bucks, you'll regret it forever!

> 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.

Here's what I don't understand. Where is your surgeon

in all this? Why isn't he on the phone to these nitwits

at your insurance company? After all, he is the best

person to explain to them that this is NOT " investigational "

surgery.

Tom

[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]

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.