Re: Terri/HCFA

[Guest guest]

Terri,

Thanks you're very sweet. I think it's just from being in that

" industry " for so long. It's all about the money. Sad but true.

> > > > > 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