Re: Re: Fed Blue Cross Prob DAWN

May 17, 2001

Yes, the BPd/DS is the same. Dr. Hess's letter to my insurance company

called my surgery a long limb roux en y (which it is--in addition to other

things). He then went on to list codes (but didn't name what they are) that

included the reduction of the stomach and other intestinal parts. I had no

problem getting approved (which I am thankful for every day). When my letter

of approval from the insurance company came it said " gastric bypass is a

covered benefit under this patient's plan. " Never did Dr. Hess or the

insurance company use the terms duodenal switch. I think this is partly

because there are no official " codes " for the DS. Doctors have to use other

codes which they feel best represent it. I was in no way going to call the

insurance company and start throwing the DS terminology around. By the way

Dr. Hess's office was amazed at how well my insurance paid on the surgeons'

fees.

Dawn

Dr. Hess, Bowling Green, OH

BPD/DS

www.duodenalswitch.com

267 to 165

size 22 to size 10

have made size goal, weight goal may need to be adjusted.

no more high blood pressure, sore feet, or dieting!

May 17, 2001

Gobo,

I'm not Dawn but in the old FYI category I have PacifiCare which covers

gastric bypass surgery like yours does. In the TAG review it states that

RNY gastric bypass (RGB) is covered. Later it says " Other variations of RGB

are BPD and distal gastric bypass/duodenal switch (DS)(Noya et al, 1998;

Rabkin et al, 1998) " . This was important for me and I hope important in

your case since if the RNY is covered then the DS would be as well based on

this association. So my position for insurance purposes is that the BPD/DS

or the DGB/DS is an improved form of RNY based on both having the Roux-en-y

limb, both able to have the malabsortive component, but the DGB/DS (DS for

short) has the improvement of maintaining the pyloric sphincter and part of

the duodenum and allowing for better nutrition with the slightly larger

stomach.

The NIH is made up of many branches and I found through researching the

WEB a couple of these main branches that have come to support the BPD and

DGB/DS since the 1991 Consensus Statement. I mentioned them in another

posting but if you want them I will be happy to repeat.

I am making a list of anyone who has had the DS covered by PacifiCare

to support my position as well which you could do. If possible try to get a

copy of your TAG requirements. I was searching all over the WEB for

documentation and research supporting the DS surgery when it was all done

for me in the TAG review.

I hope something in here helps Gobo. You can email me privately if you

wish at rfinch@...

Janice in Texas

Re: Fed Blue Cross Prob DAWN

> Hi Dawn;

> Thanks for your answer. That's a start.

> I hate to sound like a moron but do you know if

> the DS/Switch is the same as the BPD/DS?

>

> If not, how are they different?

>

> If they ARE different, is the DS/Switch considered 'gastric bypass'

> or not?

>

> Thanks a lot-

> gobo

> 309/307/123

> BMI 56

> DS pre-op

>

> > In a message dated 05/17/2001 5:29:09 PM Central Daylight

> Time,

> > yoemoe@y... writes:

> >

> > << exactly what 'gastric bypass'

> > means. I thought it was the generic term for ANY Bariatric

> > Surgery. Please educate me. ;-} >>

> >

> > The BPD/DS is a form of gastic bypass.

>

> ----------------------------------------------------------------------

>

May 17, 2001