Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Hi Everyone - I just wondered how difficult (or easy lol) it is to get this surgery approved compared to RNY? I have Blue Shield HMO and am wondering what type of battle to expect. thanxs, gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Hi Anita - Dr. Rabkin is in-network under my HMO. I will have to switch to his medical group however - but then again there is no other Dr within my medical that does the DS. gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Gail, In general, it's a lot harder to get the DS approved than the RNY, because the DS is a more complex and therefore more expensive surgery. Due to the complexity of it and the expense, there are also not that many doctors that perform it yet. Do you know if you have any DS doctors under your HMO policy ? There is a list by state on www.duodenalswitch.com, if you need to check. I will be switching from a HMO to PPO later this year, but then again, if I had Great West HMO or PPO last year, it would have actually been approved because Rabkin was in-network last year, although he's not this year. Good luck! Anita Pre-pre-op in Denver > Hi Everyone - > I just wondered how difficult (or easy lol) it is to get this surgery > approved compared to RNY? I have Blue Shield HMO and am wondering what type > of battle to expect. > thanxs, > gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Gail, You're lucky, you have one of the most experienced lap (and open) DS doctors in your HMO. Congratulations!! You may want to ask on DS- Pacific Laproscopy (Doctor Rabkin & Jossarts e-group) since I know some of the people on that list do have Brown & Toland. Anita Pre-pre-op in Denver > Hi Anita - > Dr. Rabkin is in-network under my HMO. I will have to switch to his > medical group however - but then again there is no other Dr within my medical > that does the DS. > gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 > Hi Everyone - > I just wondered how difficult (or easy lol) it is to get this surgery > approved compared to RNY? I have Blue Shield HMO and am wondering what type > of battle to expect. > thanxs, > gail I have Great West/General American PPO... everything I'd read on AMOS told me that after a fight, they would approve as long as it is medically neccessary & you get a psych eval. I applied with trembling hands.. & was approved in 10 days without a hitch! I would have been approved sooner, but the Dr's office told me not to call for a week after she mailed my LOMN. Which was a waste, because it was promptly lost, & I made her fax it to my case manager directly. Its worth fighting for, ok? Hugs, Liane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Anita, You are actually pre-op in Denver??? I'm in Denver and every time I mention DS, I get really strange looks. Especially from the medical crowd. Do you have a recommendation for a supportive PCP?? Any advice and thoughts would be helpful!! Al Stomach Stapling: 1981 Denver, CO ----Original Message Follows---- Reply-To: duodenalswitch To: duodenalswitch Subject: Re: insurance & DS ? Date: Thu, 24 May 2001 19:16:13 -0000 Gail, You're lucky, you have one of the most experienced lap (and open) DS doctors in your HMO. Congratulations!! You may want to ask on DS- Pacific Laproscopy (Doctor Rabkin & Jossarts e-group) since I know some of the people on that list do have Brown & Toland. Anita Pre-pre-op in Denver > Hi Anita - > Dr. Rabkin is in-network under my HMO. I will have to switch to his > medical group however - but then again there is no other Dr within my medical > that does the DS. > gail ---------------------------------------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Al, I have Kaiser right now, but I'm switching in September to Great West PPO. I will be switching probably to Dr. Autumn Stone at Aurora Womencare's or something along thoses lines, I can't remember the name of their group. I doubt she's heard of the DS either, but she's been supportive of WLS in general and ppl having the RNY, so I plan to take reams of paperwork to educate her on the benefits of BPD/DS. She was recommended to me by who had a medial RNY in Denver (Dr Tillquist). There was also a male doctor that Kenya in Denver used for her RNY and she said he was great, but he wasn't in network for me. I will try and look up his name again as well. Anita Pre-pre-op in Denver > > Hi Anita - > > Dr. Rabkin is in-network under my HMO. I will have to > switch to his > > medical group however - but then again there is no other Dr within > my medical > > that does the DS. > > gail > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2001 Report Share Posted May 24, 2001 Anita, Thanks for the info...I feel better already!! Ü ----Original Message Follows---- Reply-To: duodenalswitch To: duodenalswitch Subject: Re: insurance & DS ? Date: Fri, 25 May 2001 01:36:26 -0000 Al, I have Kaiser right now, but I'm switching in September to Great West PPO. I will be switching probably to Dr. Autumn Stone at Aurora Womencare's or something along thoses lines, I can't remember the name of their group. I doubt she's heard of the DS either, but she's been supportive of WLS in general and ppl having the RNY, so I plan to take reams of paperwork to educate her on the benefits of BPD/DS. She was recommended to me by who had a medial RNY in Denver (Dr Tillquist). There was also a male doctor that Kenya in Denver used for her RNY and she said he was great, but he wasn't in network for me. I will try and look up his name again as well. Anita Pre-pre-op in Denver > > Hi Anita - > > Dr. Rabkin is in-network under my HMO. I will have to > switch to his > > medical group however - but then again there is no other Dr within > my medical > > that does the DS. > > gail > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2001 Report Share Posted May 25, 2001 liane - thanxs for the info. I spoke with my insurance company and they said that the duodenal switch is an eligible procedure for me as long as it is medically necessary. Yeah!!! gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2001 Report Share Posted May 25, 2001 > liane - > thanxs for the info. I spoke with my insurance company and they said that > the duodenal switch is an eligible procedure for me as long as it is > medically necessary. Yeah!!! > gail Conga- rats for you!!!! Hugs, Liane J. French Preop, Dr. Warden Ocean Springs, MS May 30, 2001 Starting BMI 60 Quote Link to comment Share on other sites More sharing options...
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