/More questions-Unique Code for DS?

[Guest guest]

Hi ,

Thanks for all the info. You are a terrific resource! Can you tell

me a little more about the HCFA? What does that stand for? Who

comprises it? Doctors? Ins Cos? Drug Cos? Government agencies?

Can it be lobbied? By whom?

Who is the " watchdog " to prevent poor procedures from being approved

or used? Once I found the DS, I stopped looking at the purely

restrictive procedures, like the Lap Band, so I am not familiar with

the claims as to it's success/complication rate. Why would this be

any more effective than the proven-flawed VBG? Is it really true

that money alone can push through an ineffective procedure/product?

Who wooed doctors for the RNY? How did that get approved without the

backing of drug cos? Is the ASBS conference in June very critical in

terms of the future acceptance of the DS procedure?

Sorry for the barrage of questions! It's just that now that we seem

to have the problem fairly well-defined, there has got to be

SOMETHING we can do, individually and as a group, to support this

process. It needs to be easier to bring this life-saving procedure

to people who need it. I want to try and understand what I can do to

help.

Terri Hassiak

BMI 60

5/9/01 surgery date CANCELLED due to insurance denial

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

email(no spaces): bunsofluff @ hotmail.com

> > I posted something along this line a week or two ago, but got no

> > response. Gobo, this may not help your case right now, but I

think

> > it would go a long way to helping the BPD/DS become more accepted

> as

> > a 'gold standard'. The problem is that there is NOT a specific

> code

> > for the BPD/DS (the sleeve gastrectomy component with retention

of

> > the pyloric valve and section of the duodenum).

> >

> > This is actually part of the problem in my situation. My

insurance

> > is telling me I cannot go out-of-network to have this surgery

> because

> > there are in-plan surgeons who can provide it. They see it as

" all

> > gastric bypasses are created equally " because there is no unique

> CPT

> > code for the BilioPancreatic Diversion with Duodenal Switch.

> >

> > So here is my question to the list... How does a new CPT code

get

> > created and accepted by the insurance industry. Does there have

to

> > be an act of Congress? FDA approval? AMA endorsement? Surely

all

> > these studies about the long-term success rates of the DS and the

> > highly reputed opinions of the ASBS must be worth SOMETHING to

this

> > end? It seems to me that there currently exist unique codes for

> less

> > well-proven or successful procedures. How did they get there?

> >

> > Terri Hassiak

> > BMI 60

http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

> > 5/19/01 surgery date CANCELLED due to " Out-of-Network " Ins. Denial

> > email(no spaces): bunsofluff @ hotmail.com

[Guest guest]

> HCFA is a government agency. I don't know what it stands for. > >

Health Care Financing Administration

http://hcfa.hhs.gov/

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

> HCFA is a government agency. I don't know what it stands for. > >

Health Care Financing Administration

http://hcfa.hhs.gov/

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo