/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]

Hi Terri,

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

they can be lobbied (?) possibly by people like Walter and activist

surgeons like Dr Welker. I guess the AMA is the watchdog that

prevents bad surgical procedures. For example Dr Rutledge is being

investgated for his " mini-gastric bypass " etc. The FDA is the

watchdog for drugs and devices and if the stats are not as good as

the VGB (hard not to be) or the RNY it will not be approved. Money

alone can not push a bad product through the FDA. Their rules are

very stringent.

As far as the RNY being so widely accepted. (These are my OPINIONS

only.) Prior to the RNY they had gastric stapling and the intestinal

bypass; both had varying degrees of success but lots of problems. So

along came the RNY and the BPD. Rny had great success, still does in

most areas. Remember they are not looking at " quality of life " issues

for us. They are looking at getting us below MO levels thus reducing

our comorbidities. So the RNY got so popular because it got good

results and it was a relatively easy operation for the surgeons to

perform. The BPD had good weight loss but still had a lot of

malabsorptive problems. (In most cases.) So up until Dr Hess started

doing the hybrid surgery the RNY was the best there was. Now the

sheer numbers of RNY speak for themselves. A lot of Dr's and surgeons

still get nervous when you start talking about any malabsorptive

procedure because they start thinking of the old intestinal bypass

and the Scopinaro BPD.

Now we know that the LG/DS is the best surgery because of the

excellent long-term weight loss and the quality of life it affords

us. There are still A LOT of misconceptions about our surgery. Just

take a look at the AMOS site!!!

I think the June ASBS meeting is going to be important. The more

surgeons that talk about the benefits of our surgery the more popular

it will be and more bariatric surgeons will start to perform it. This

in turn will create more good data and studies to drive all the

insurance companies to take it off their E&I list.

Hope this has made sense.

-- In duodenalswitch@y..., " Terri Hassiak " wrote:

> 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]

Hi Terri,

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

they can be lobbied (?) possibly by people like Walter and activist

surgeons like Dr Welker. I guess the AMA is the watchdog that

prevents bad surgical procedures. For example Dr Rutledge is being

investgated for his " mini-gastric bypass " etc. The FDA is the

watchdog for drugs and devices and if the stats are not as good as

the VGB (hard not to be) or the RNY it will not be approved. Money

alone can not push a bad product through the FDA. Their rules are

very stringent.

As far as the RNY being so widely accepted. (These are my OPINIONS

only.) Prior to the RNY they had gastric stapling and the intestinal

bypass; both had varying degrees of success but lots of problems. So

along came the RNY and the BPD. Rny had great success, still does in

most areas. Remember they are not looking at " quality of life " issues

for us. They are looking at getting us below MO levels thus reducing

our comorbidities. So the RNY got so popular because it got good

results and it was a relatively easy operation for the surgeons to

perform. The BPD had good weight loss but still had a lot of

malabsorptive problems. (In most cases.) So up until Dr Hess started

doing the hybrid surgery the RNY was the best there was. Now the

sheer numbers of RNY speak for themselves. A lot of Dr's and surgeons

still get nervous when you start talking about any malabsorptive

procedure because they start thinking of the old intestinal bypass

and the Scopinaro BPD.

Now we know that the LG/DS is the best surgery because of the

excellent long-term weight loss and the quality of life it affords

us. There are still A LOT of misconceptions about our surgery. Just

take a look at the AMOS site!!!

I think the June ASBS meeting is going to be important. The more

surgeons that talk about the benefits of our surgery the more popular

it will be and more bariatric surgeons will start to perform it. This

in turn will create more good data and studies to drive all the

insurance companies to take it off their E&I list.

Hope this has made sense.

-- In duodenalswitch@y..., " Terri Hassiak " wrote:

> 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]

Hi Terri,

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

they can be lobbied (?) possibly by people like Walter and activist

surgeons like Dr Welker. I guess the AMA is the watchdog that

prevents bad surgical procedures. For example Dr Rutledge is being

investgated for his " mini-gastric bypass " etc. The FDA is the

watchdog for drugs and devices and if the stats are not as good as

the VGB (hard not to be) or the RNY it will not be approved. Money

alone can not push a bad product through the FDA. Their rules are

very stringent.

As far as the RNY being so widely accepted. (These are my OPINIONS

only.) Prior to the RNY they had gastric stapling and the intestinal

bypass; both had varying degrees of success but lots of problems. So

along came the RNY and the BPD. Rny had great success, still does in

most areas. Remember they are not looking at " quality of life " issues

for us. They are looking at getting us below MO levels thus reducing

our comorbidities. So the RNY got so popular because it got good

results and it was a relatively easy operation for the surgeons to

perform. The BPD had good weight loss but still had a lot of

malabsorptive problems. (In most cases.) So up until Dr Hess started

doing the hybrid surgery the RNY was the best there was. Now the

sheer numbers of RNY speak for themselves. A lot of Dr's and surgeons

still get nervous when you start talking about any malabsorptive

procedure because they start thinking of the old intestinal bypass

and the Scopinaro BPD.

Now we know that the LG/DS is the best surgery because of the

excellent long-term weight loss and the quality of life it affords

us. There are still A LOT of misconceptions about our surgery. Just

take a look at the AMOS site!!!

I think the June ASBS meeting is going to be important. The more

surgeons that talk about the benefits of our surgery the more popular

it will be and more bariatric surgeons will start to perform it. This

in turn will create more good data and studies to drive all the

insurance companies to take it off their E&I list.

Hope this has made sense.

-- In duodenalswitch@y..., " Terri Hassiak " wrote:

> 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